Ramanujam Crystal L, Han David, Zgonis Thomas
Division of Podiatric Medicine and Surgery, Department of Orthopaedics (CLR, TZ), The University of Texas Health San Antonio.
Department of Management Science & Statistics, College of Business (DH), The University of Texas at San Antonio, Texas.
Foot Ankle Spec. 2018 Oct;11(5):433-443. doi: 10.1177/1938640017750255. Epub 2017 Dec 31.
The primary aim of our study was to compare the preoperative diagnostic accuracy of plain radiographic findings with the accuracy of magnetic resonance imaging (MRI) findings for diabetic foot osteomyelitis in hospitalized patients who underwent first-time partial foot amputations with confirmed histopathological specimens positive for osteomyelitis. Second, it was desired to determine whether certain variables within the initial clinical presentation and preoperative laboratory findings were associated with more accurate diagnosis of diabetic foot osteomyelitis in this study population. Finally, it was desired to determine the most common bacterial organisms found in bone and soft-tissue cultures taken intraoperatively and to determine how often the same organism was found in both. After applying the inclusion and exclusion criteria to the initial 329 patients identified through chart review, the final sample size for further analysis was n =107. In this study, after adjusting for the effects of covariates such as age, erythrocyte sedimentation rate (ESR) and C-reactive protein, plain radiographs seemed to have statistically more significant power than MRI in predicting and diagnosing diabetic foot osteomyelitis. In addition, higher ESR values were confirmed to predict a higher chance of positive diagnosis for diabetic foot osteomyelitis. Furthermore, the presence of positive bacterial identification from intraoperative bone cultures did not always indicate true osteomyelitis on histopathological examination.
Level II: Diagnostic study.
我们研究的主要目的是比较普通X线平片检查结果与磁共振成像（MRI）检查结果对糖尿病足骨髓炎的术前诊断准确性，这些患者为首次接受部分足部截肢手术的住院患者，其组织病理学标本确诊为骨髓炎阳性。其次，本研究旨在确定初始临床表现和术前实验室检查结果中的某些变量是否与该研究人群中糖尿病足骨髓炎的更准确诊断相关。最后，本研究旨在确定术中获取的骨和软组织培养物中最常见的细菌种类，并确定在两者中发现相同细菌种类的频率。在对通过病历审查确定的最初329例患者应用纳入和排除标准后，进一步分析的最终样本量为n = 107。在本研究中，在调整年龄、红细胞沉降率（ESR）和C反应蛋白等协变量的影响后，普通X线平片在预测和诊断糖尿病足骨髓炎方面似乎比MRI具有统计学上更显著的效力。此外，较高的ESR值被证实可预测糖尿病足骨髓炎阳性诊断的可能性更高。此外，术中骨培养物细菌鉴定呈阳性并不总是意味着组织病理学检查确诊为骨髓炎。
二级：诊断性研究。
