Service des maladies infectieuses et réanimation médicale, CHU de Rennes, 35033 Rennes, France; Centre de référence en infections ostéo-articulaires du Grand-Ouest (CRIOGO), 35033 Rennes, France.
Service d'orthopédie et traumatologie, CHU de Rennes, 35033 Rennes, France; Centre de référence en infections ostéo-articulaires du Grand-Ouest (CRIOGO), 35033 Rennes, France.
Orthop Traumatol Surg Res. 2019 Feb;105(1S):S23-S30. doi: 10.1016/j.otsr.2018.04.029. Epub 2018 Jul 26.
The diagnosis of peri-prosthetic bone and joint infections relies on converging information from clinical, laboratory and imaging assessments. Clinical findings alone may suffice: a sinus tract is a major criterion that establishes the diagnosis of infection. Identifying the causative organism is crucial and requires the early collection of high-quality samples from sites in contact with the prosthetic material. The bacteriological samples may be obtained by aspiration or open surgery. Imaging techniques have undergone remarkable improvements over the last two decades. Ultrasonography can be performed early and can be used to guide a needle biopsy if appropriate. Computed tomography or magnetic resonance imaging shows the extent of bone and/or soft-tissue involvement, provided effective artefact-suppression techniques are applied. Nuclear medicine methods have an undefined place in the diagnostic strategy and their possible role must be evaluated during a multidisciplinary discussion. The array of new laboratory methods introduced in recent years includes microbiological culture techniques, molecular biology tests, antigen and antibody assays and tests for immune markers in blood and/or joint fluid. When the first-line investigations fail to provide a definitive diagnosis, a multidisciplinary discussion at a referral centre for complex osteo-articular infections makes a major contribution to defining the subsequent diagnostic strategy. This lecture focusses on the following six questions: does the clinical assessment still have diagnostic relevance? What is the diagnostic contribution of imaging studies? Must the infection be documented pre-operatively and if so, how? Which microbiological techniques should be used? Which non-microbiological investigations help to diagnosis peri-prosthetic bone and joint infections? What role do referral centres for complex bone and joint infections play in the diagnostic strategy?
人工关节周围骨与关节感染的诊断依赖于临床、实验室和影像学评估的综合信息。单凭临床发现可能就足够了：窦道是确立感染诊断的主要标准。确定病原体至关重要，需要尽早从与假体材料接触的部位采集高质量样本。细菌学样本可通过抽吸或开放性手术获得。在过去的二十年中，影像学技术取得了显著的进步。超声检查可以早期进行，如果需要，可以使用超声引导进行针吸活检。计算机断层扫描或磁共振成像可以显示骨和/或软组织受累的程度，但需要应用有效的伪影抑制技术。核医学方法在诊断策略中的地位尚未确定，其可能的作用必须在多学科讨论中进行评估。近年来引入的一系列新的实验室方法包括微生物培养技术、分子生物学检测、抗原和抗体检测以及血液和/或关节液中的免疫标志物检测。如果一线检查未能提供明确的诊断，那么在复杂的骨与关节感染转诊中心进行多学科讨论对确定后续的诊断策略有重要贡献。本讲座重点讨论以下六个问题：临床评估是否仍具有诊断意义？影像学研究的诊断价值如何？术前必须进行感染的诊断吗？如果需要，应该怎么做？应该使用哪些微生物学技术？哪些非微生物学检查有助于诊断人工关节周围骨与关节感染？复杂骨与关节感染的转诊中心在诊断策略中扮演什么角色？
