白细胞酯酶：金属对金属关节假体失败与假体周围感染
Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection.
作者信息
Tischler Eric H, Plummer Darren R, Chen Antonia F, Della Valle Craig J, Parvizi Javad
机构信息
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Rush University Medical Center, Chicago, Illinois.
出版信息
J Arthroplasty. 2016 Oct;31(10):2260-3. doi: 10.1016/j.arth.2016.03.012. Epub 2016 Mar 15.
BACKGROUND
Adverse local tissue reactions (ALTRs) and periprosthetic joint infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out periprosthetic joint infection in ALTR revision THA.
METHODS
Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified -/trace, + (mildly positive), and ++ (strongly positive).
RESULTS
LE strip tests were ++, +, -/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively.
CONCLUSION
++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.
背景
金属对金属全髋关节置换术（THA）后可能发生局部组织不良反应（ALTRs）和假体周围关节感染，两者都可能产生脓性滑液（SF）并导致白细胞计数升高。这使得诊断难以区分；因此，我们评估了白细胞酯酶（LE）试纸条检测在排除ALTR翻修THA中假体周围关节感染方面的可靠性。
方法
对61例进行了LE试纸条检测的ALTR患者进行评估，排除15例滑液中有金属碎屑的病例。LE试纸条检测分为- /微量、+（轻度阳性）和++（强阳性）。
结果
LE试纸条检测结果为++、+、- /微量的患者分别有8例（占比13.1%）、14例（占比23.0%）和39例（占比63.9%）。滑液白细胞计数和多形核细胞百分比的均值及范围分别为1291.4（0 - 10,886个细胞/μL）和46.1%（0% - 94%）。
结论
++的LE试纸条检测结果，结合术前检查，能可靠地排除92.9%因ALTR接受THA翻修患者的感染。
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