围手术期检查对翻修全肩关节置换术中感染诊断的意义
Significance of Perioperative Tests to Diagnose the Infection in Revision Total Shoulder Arthroplasty.
作者信息
Ahmadi Shahryar, Lawrence Thomas M, Sahota Shawn, Schleck Cathy D, Harmsen William S, Cofield Robert H, Sperling John W
机构信息
Research performed at Mayo Clinic, Rochester, USA.
The Department of Orthopedic Surgery, Rochester, USA.
出版信息
Arch Bone Jt Surg. 2018 Sep;6(5):359-364.
BACKGROUND
The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infection in revision shoulder arthroplasty.
METHODS
A retrospective analysis was performed on 537 shoulder arthroplasties (429 patients) that underwent revision shoulder arthroplasty at our institution. Periprosthetic tissue cultures were positive in 169/537 surgeries.
RESULTS
White-blood cell count (WBC) was elevated in 3.8% revision arthroplasties. Erythrocyte sedimentation rate (ESR) was elevated in 23.1% revision arthroplasties. The C-reactive protein (CRP) was elevated in 20.8% revision arthroplasties. Bone scans (technetium, indium) were performed on 9.9% patients and it was positive for osteomyelitis in just one revision arthroplasty. Intra-operative pathology was read as consistent with acute inflammation in 11.9% revision arthroplasties. The positive and negative predictive values for intra-operative pathology were 56.7% and 71.6% respectively.
CONCLUSION
All of the perioperative tests had a high specificity and negative predictive value, but low sensitivity and positive predictive value.
背景
本研究的目的是评估围手术期检查对翻修肩关节置换术中感染诊断的价值。
方法
对在我院接受翻修肩关节置换术的537例肩关节置换术（429例患者）进行回顾性分析。169/537例手术中假体周围组织培养呈阳性。
结果
3.8%的翻修置换术中白细胞计数（WBC）升高。23.1%的翻修置换术中红细胞沉降率（ESR）升高。20.8%的翻修置换术中C反应蛋白（CRP）升高。9.9%的患者进行了骨扫描（锝、铟），仅在一例翻修置换术中骨髓炎呈阳性。11.9%的翻修置换术中术中病理结果显示与急性炎症一致。术中病理的阳性和阴性预测值分别为56.7%和71.6%。
结论
所有围手术期检查均具有较高的特异性和阴性预测值，但敏感性和阳性预测值较低。
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