Pruijn Nathalie, Schuncken Antonius Ch, Kosse Nienke M, Hofstad Cheriel J, Dorrestijn Oscar
Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Shoulder Elbow. 2021 Apr;13(2):131-148. doi: 10.1177/1758573220913243. Epub 2020 May 21.
is the most commonly detected pathogen during shoulder surgery. Lack of typical infection signs make infections difficult to diagnose. This systematic review aims to determine which pre- and peroperative diagnostic tools are most reliable to identify infections after shoulder surgery.
PubMed/Embase were searched for diagnostic studies. Methodological quality of included studies was assessed using QUADAS-2. Forest plots summarized results (sensitivity and specificity) for each pre- and peroperative diagnostic tool.
Twenty-two studies were included, of which 8 described preoperative, 10 peroperative, and 4 both pre- and peroperative diagnostic tools. Quality of the studies varied widely. For preoperative tools, synovial calprotectin, interleukin-6, and combined interleukin-6/interleukin-2/tumor necrosis factor-α had the best efficacy measures. Pre-revision biopsies and arthroscopic tissue cultures were the best peroperative tools.
Despite a lack of evidence and the use of different infection criteria and reference standards, the use of combined interleukin-6/interleukin-2/tumor necrosis factor-α as preoperative and arthroscopic tissue cultures as peroperative diagnostic tool is for now recommended based on results and validity. More research should be performed to provide valid evidence on these tools. In order to do so, an internationally accepted definition of infections is essential.
Systematic review.
是肩部手术期间最常检测到的病原体。缺乏典型的感染迹象使得感染难以诊断。本系统评价旨在确定哪些术前和术中诊断工具在识别肩部手术后的感染方面最为可靠。
在PubMed/Embase中检索诊断性研究。使用QUADAS-2评估纳入研究的方法学质量。森林图总结了每种术前和术中诊断工具的结果（敏感性和特异性）。
纳入22项研究，其中8项描述了术前诊断工具，10项描述了术中诊断工具，4项同时描述了术前和术中诊断工具。研究质量差异很大。对于术前工具，滑膜钙卫蛋白、白细胞介素-6以及白细胞介素-6/白细胞介素-2/肿瘤坏死因子-α联合检测具有最佳疗效指标。翻修术前活检和关节镜组织培养是最佳的术中工具。
尽管缺乏证据且使用了不同的感染标准和参考标准，但基于结果和有效性，目前建议将白细胞介素-6/白细胞介素-2/肿瘤坏死因子-α联合检测作为术前诊断工具，将关节镜组织培养作为术中诊断工具。应开展更多研究以提供关于这些工具的有效证据。为此，国际上对感染的公认定义至关重要。
系统评价。
