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中华诊断学电子杂志 ›› 2018, Vol. 06 ›› Issue (02) : 139 -143. doi: 10.3877/cma.j.issn.2095-655X.2018.02.018

所属专题: 文献

综述

关节置换术后假体周围感染诊断的研究进展
杨飞1, 王国栋2, 赵晓伟2,()   
  1. 1. 272067 济宁医学院
    2. 272029 济宁医学院附属医院骨关节科
  • 收稿日期:2018-02-07 出版日期:2018-05-26
  • 通信作者: 赵晓伟
  • 基金资助:
    山东省自然科学基金(ZR2017MH119); 山东省医药卫生科技发展计划(2014WS0513)

Progress in diagnosis of periprosthetic joint infection after arthroplasty

Fei Yang1, Guodong Wang2, Xiaowei Zhao2,()   

  1. 1. Jining Medical University, Jining 272067, China; Department of Orthopedics, the Affiliated Hospital of Jining Medical University, Jining 272029, China
    2. Department of Orthopedics, the Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2018-02-07 Published:2018-05-26
  • Corresponding author: Xiaowei Zhao
  • About author:
    Corresponding author: Zhao Xiaowei, Email:
引用本文:

杨飞, 王国栋, 赵晓伟. 关节置换术后假体周围感染诊断的研究进展[J/OL]. 中华诊断学电子杂志, 2018, 06(02): 139-143.

Fei Yang, Guodong Wang, Xiaowei Zhao. Progress in diagnosis of periprosthetic joint infection after arthroplasty[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2018, 06(02): 139-143.

假体周围感染(PJI)是人工关节置换术后患者的灾难性并发症之一,已经成为关节置换术后翻修的首要原因,目前的实验室和影像学诊断方法各有优缺点,PJI的诊断仍缺乏金标准。红细胞沉降率、C反应蛋白等传统诊断学方法敏感度和特异度不高;白细胞酯酶测定、α-防御素等关节液标记物具有极高的诊断价值,引起越来越多的重视;与血清中相比,关节液中的降钙素原和白细胞介素-6对诊断PJI更具价值;白细胞闪烁扫描、抗粒细胞闪烁扫描和18氟-氟脱氧葡萄糖等影像学技术具有较高的敏感度和特异度,但目前尚无法大规模应用;而二代测序等分子生物学技术能检测到常规细菌培养阴性的病原菌DNA,且不受抗生素使用与否的影响,已成为目前研究的热点。本综述旨在提供更具敏感度和特异度的诊断方法,使人工关节置换术后假体周围感染的患者能够早诊断、早治疗,从而减轻病人的痛苦和降低医疗费用。

Periprosthetic joint infection (PJI) is one of the catastrophic complications of patients undergoing joint replacement and has become the primary cause of joint replacement revision surgery. At present, diagnosis of PJI still lacks golden standard because of the limited sensitivity and specificity of laboratory and imaging diagnostic methods, such as erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP). Synovial fluid biomarkers such as leukocyte esterase and alpha-defensins have extremely high diagnostic utility and have attracted increasing attention. The concentration of procalcition and IL-6 in joint fluid has higher diagnostic value than that in serum. Leukocyte scintigraphy, anti-granulocyte scintigraphy and 18fluoro-fluorodeoxyglucose imaging techniques perform well but they are still not widely applied. Molecular biology techniques such as second-generation sequencing have become the focus of current research due to the ability to detect DNA in culture-negative pathogens and being unaffected by previous antibiotics administration. This article aims to provide more sensitive and specific diagnostic methods to get early diagnosis and early treatment for patients with PJI, so as to reduce patients′ pain and costs.

[19]
Shahi A, Kheir MM, Tarabichi M,et al.Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation[J].J Bone Joint Surg Am,2017,99(17):1419-1427.
[20]
Lee YS,Lee YK,Han SB,et al.Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection[J].J Orthop Surg Res,2018,13(1):36.
[21]
Rodelo JR,De la Rosa G,Valencia ML,et al.D-dimer is a significant prognostic factor in patients with suspected infection and sepsis[J].Am J Emerg Medi,2012,30(9):1991-1999.
[22]
Saleh A,George J,Faour M,et al.Serum biomarkers in periprosthetic joint infections[J].Bone Joint Res,2018,7(1):85-93.
[23]
Xie K,Dai K,Qu X,et al.Serum and synovial fluid interleukin-6 for the diagnosis of periprosthetic joint infection[J].Sci Rep,2017,7(1):1496.
[24]
李睿,李想,倪明,等.对降钙素原诊断关节假体周围感染的评价[J].解放军医学院学报,2016,37(4):339-342.
[25]
Yoon JR,Yang SH,Shin YS.Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection: a systematic review and meta-analysis[J].Intl Orthop,2018(Suppl 2):1-14.
[26]
Xie K,Qu X,Yan M.Procalcitonin and alpha-defensin for diagnosis of periprosthetic joint infections[J].J Arthroplasty,2017,32(4):1387-1394.
[27]
Kim TW,Kim DH,Oh WS,et al.Analysis of the causes of elevated c-reactive protein level in the early postoperative period after primary total knee arthroplasty[J].J Arthroplasty,2016,31(9):1990-1996.
[28]
Saleh A,George J,Faour M,et al.Serum biomarkers in periprosthetic joint infections[J].Bone Joint Res,2018,7(1):85-93.
[29]
Ali F,Wilkinson JM,Cooper JR,et al.Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty[J].J Arthroplasty,2006,21(2):221-226.
[30]
Shahi A,Tan TL,Kheir MM,et al.Diagnosing periprosthetic joint infection:and the winner is?[J].J Arthroplasty,2017,32(9S):S232-S235.
[31]
Drago L,Toscano M,Tacchini L,et al.alpha-Defensin point-of-care test for diagnosis of prosthetic joint infections:neglected role of laboratory and clinical pathologists[J].Clin Chem Lab Med,2017,56(1):19-24.
[32]
Shahi A,Parvizi J,Kazarian GS,et al.The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration[J].Clin Orthop Relat Res,2016,474(7):1610-1615.
[33]
蔡东峰,刘毅.α-防御素在关节假体周围感染诊断中的作用及应用前景[J].中国矫形外科杂志,2017,25(11):1005-1008.
[34]
Li R,Li X,Yu B,et al.Comparison of leukocyte esterase testing of synovial fluid with synovial histology for the diagnosis of periprosthetic joint infection[J].Med Sci Monit,2017(23):4440-4446.
[35]
Koh IJ,Han SB,In Y,et al.The leukocyte esterase strip test has practical value for diagnosing periprosthetic joint infection after total knee arthroplasty:a multicenter study[J].J Arthroplasty,2017,32(11):3519-3523.
[36]
Parvizi J,Gehrke T,International consensus group on periprosthetic joint infection.Definition of periprosthetic joint infection[J].J Arthroplasty,2014,29(7):1331.
[37]
Corvec S,Portillo ME,Pasticci BM,et al.Epidemiology and new developments in the diagnosis of prosthetic joint infection[J].Int J Artif Organs,2012,35(10):923-934.
[38]
Saleh A,Ramanathan D,Siqueira MBP,et al.The diagnostic utility of synovial fluid markers in periprosthetic joint infection:a systematic review and meta-analysis[J].J Am Acad Orthop Surg,2017,25(11):763-772.
[39]
Lee YS,Koo KH,Kim HJ,et al.Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection:a systematic review and meta-analysis[J].J Bone Joint Surg Am,2017,99(24):2077-2084.
[40]
Verberne SJ, Raijmakers PG, Temmerman OP. The accuracy of imaging techniques in the assessment of periprosthetic hip infection:a systematic review and meta-analysis[J].J Bone Joint Surg Am,2016,98(19):1638-1645.
[41]
Verberne SJ,Sonnega RJA,Temmerman OPP,et al.Erratum to: what is the accuracy of nuclear imaging in the assessment of periprosthetic knee infection?a meta-analysis[J].Clin Orthop Relat Res,2017,475(6):1395-1410.
[42]
朱林波,王淑侠,徐卫平,等.18F-氟代脱氧葡萄糖正电子成像术/计算机断层扫描对甲状腺结节鉴别诊断的价值[J/CD].中华诊断学电子杂志,2014,2(4):249-251.
[43]
Aksoy SY,Asa S,Ozhan M,et al.FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection[J].Eur J Nucl Med Mol Imaging,2014,41(3):556-564.
[44]
Basu S,Kwee TC,Saboury B,et al.FDG PET for diagnosing infection in hip and knee prostheses:prospective study in 221 prostheses and subgroup comparison with combined(111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses[J].Clin Nucl Med,2014,39(7):609-615.
[45]
Kwee RM,Broos WA,Brans B,et al.Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis[J].Acta Radiol,2018,59(5):569-576.
[46]
Gomez E,Cazanave C,Cunningham SA,et al.Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication[J].J Clin Microbiol,2012,50(11):3501-3508.
[47]
Morgenstern C,Cabric S,Perka C,et al.Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection[J].Diagn Microbiol Infect Dis,2018,90(2):115-119.
[48]
Bémer P,Plouzeau C,Tande D,et al.Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection:a prospective multicenter cross-sectional study[J].J Clin Microbiol,2014,52(10):3583-3589.
[1]
Gausden EB,Parhar H,Popper J,et al.Risk factors for early dislocation following primary elective total hip arthroplasty[J].J Arthroplasty,2018(17):31140-31143.
[2]
Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J].J Bone Joint Surg Am,2007,89(4):780-785.
[3]
Kurtz SM,Lau E,Watson H,et al.Economic burden of periprosthetic joint infection in the United States[J].J Arthroplasty,2012,27(8 Suppl):61-65.
[49]
Thoendel M,Jeraldo P,Greenwoodquaintance KE,et al.A novel prosthetic joint infection pathogen,mycoplasma salivarium,identified by metagenomic shotgun sequencing[J].Clin Infect Dis,2017,65(2):332-335.
[50]
Behjati S,Tarpey PS.What is next generation sequencing?[J].Arch Dis Child Educ Prac Ed,2013,98(6):236-238.
[51]
Tarabichi M,Shohat N,Goswami K,et al.Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing[J].J Bone Joint Surg Am,2018,100(2):147-154.
[4]
Namba RS,Inacio MC,Paxton EW.Risk factors associated with deep surgical site infections after primary total knee arthroplasty:an analysis of 56 216 knees[J].J Bone Joint Surg Am,2013,95(9):775-782.
[5]
Samara E,Moriarty TF,Decosterd LA,et al.Antibiotic stability over six weeks in aqueous solution at body temperature with and without heat treatment that mimics the curing of bone cement[J].Bone Joint Res,2017,6(5):296-306.
[6]
Otto-Lambertz C,Yagdiran A,Wallscheid F, et al. Periprosthetic infection in joint replacement[J].Dtsch Arztebl Int,2017,114(20):347-353.
[52]
Jacovides CL,Kreft R,Adeli B,et al.Successful identification of pathogens by polymerase chain reaction (PCR)-based electron spray ionization time-of-flight mass spectrometry (ESI-TOF-MS) in culture-negative periprosthetic joint infection[J].J Bone Joint Surg Am,2012,94(24):2247-2254.
[53]
Tarabichi M,Shohat N,Goswami K,et al. Can next generation sequencing play a role in detecting pathogens in synovial fluid?[J].Bone Joint J,2018,100-B(2):127-133.
[54]
杨志寅.医学不是神[J/CD].中华诊断学电子杂志,2016,4(4):217-221.
[7]
Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection:from the Workgroup of the Musculoskeletal Infection Society[J].Clin Orthop Relat Res,2011,469(11):2992-2994.
[8]
Huerfano E,Bautista M,Huerfano M,et al.Screening for infection before revision hip arthroplasty:a meta-analysis of likelihood ratios of erythrocyte sedimentation rate and serum C-reactive protein levels[J].J Am Acad Orthop Surg,2017,25(12):809-817.
[9]
Chen A,Fei J,Deirmegian C.Diagnosis of periprosthetic infection:novel developments[J].J Knee Surg,2014,27(4):259-265.
[10]
Alijanipour P,Bakhshi H,Parvizi J.Diagnosis of periprosthetic joint infection:the threshold for serological markers[J].Clin Orthop Relat Res,2013,471(10):3186-3195.
[11]
Osmon DR,Berbari EF,Berendt AR,et al.Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the Infectious Diseases Society of America[J].Clin Infect Dis,2013,56(1):e1-e25.
[12]
Park KK,Kim TK,Chang CB,et al.Normative temporal values of CRP and ESR in unilateral and staged bilateral TKA[J].Clinl Orthop Relat Res,2008,466(1):179-188.
[13]
Siljander MP,Sobh AH,Baker KC,et al.Multidrug-resistant organisms in the setting of periprosthetic joint infection-diagnosis,prevention,and treatment[J].J Arthroplasty,2017,33(1):185-194.
[14]
Alvand A,Rezapoor M, Parvizi J. The role of biomarkers for the diagnosis of implant-related infections in orthopaedics and trauma.[J].Adv Exp Med Biol,2017(971):69-79.
[15]
Cipriano CA,Brown NM,Michael AM,et al.Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis[J].J Bone Joint Surg Am,2012,94(7):594-600.
[16]
Parvizi J,Mckenzie JC,Cashman JP.Diagnosis of periprosthetic joint infection using synovial C-reactive protein[J].J Arthroplasty,2012,27(8):12-16.
[17]
Deirmengian CA,Citrano PA,Gulati S,et al.The C-reactive protein may not detect infections caused by less-virulent organisms[J].J Arthroplasty,2016,31(9):152-155.
[18]
Piper KE,Fernandez-Sampedro M,Steckelberg KE,et al.C-reactive protein,erythrocyte sedimentation rate and orthopedic implant infection[J].PLoS One,2010,5(2):e9358.
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