背景:即使是最有经验的骨科医生,诊断假体周围感染(PJI)也是一项艰巨的任务,因为目前没有可用的测试可以提供绝对的准确性。利用已建立的滑膜指标来检测PJI而不产生额外的成本或资源将是预测感染存在的最佳解决方案。因此,我们假设滑膜中性粒细胞绝对计数(ANC)可以提高慢性膝和髋部PJI的诊断准确性.
方法:纳入所有有慢性症状并入住我们机构的患者进行审查。这包括260名患者(134名男性和126名女性,平均年龄70岁(范围,26至89),在术前检查中进行了抽吸。其中,109例(41.9%)被诊断为慢性PJI(50膝,59臀部),151例患者(58.1%)被诊断为无菌(94膝,57臀部)。从所有患者获得的数据包括年龄,性别,手术类型(全髋关节或全膝关节置换术),操作侧,滑膜白细胞(WBC)计数(细胞/μL),滑膜多形核细胞百分比(PMN%),从电子病历中检索入院时的滑膜α-防御素(AD)免疫测定值。
结果:滑膜ANC的最佳阈值为1,415.5细胞/μL,与慢性膝关节PJI诊断的曲线下面积(AUC)为0.930相关。敏感性和特异性分别为90%和93%,分别。2,247细胞/μL的滑膜ANC的计算最佳阈值与用于慢性髋关节PJI诊断的0.905的AUC相关。敏感性和特异性分别为86.4和89.4%,分别。
结论:本研究已得出结论,滑膜ANC在PJI的复杂诊断中具有重要的价值。应利用这种高效的方法通过标准测试获得更多信息,从而排除了PJI的可能性。
BACKGROUND: Diagnosing periprosthetic joint infection (PJI) is a daunting task for even the most experienced orthopedic surgeons, as there is currently no test available that can provide absolute accuracy. Utilizing an established synovial indicator for detecting PJI without incurring additional costs or resources would be the optimal solution for predicting the presence of infection. Therefore, we hypothesized that synovial absolute neutrophil count (ANC) would improve the diagnostic accuracy of chronic knee and hip PJI.
METHODS: The study included 260 patients (134 men and 126 women, mean age of 70 years [range, 26 to 89]) who underwent aspiration during preoperative workup. Of these, 109 patients (41.9%) were diagnosed with chronic PJI (50 knees, 59 hips), and 151 patients (58.1%) were diagnosed as aseptic (94 knees, 57 hips). Data obtained from all patients included age, sex, procedure type (total hip or total knee arthroplasty), operation side, synovial white blood cell count (cells/μL), synovial polymorphonuclear cells percentage, and synovial α-defensin immunoassay value at the admission were retrieved from the electronic medical record.
RESULTS: The calculated optimal threshold for synovial ANC of 1,415.5 cells/μL was associated with an area under the receiver operating characteristic curve (AUC) of 0.930 for chronic knee PJI diagnosis. The calculated optimal threshold for synovial ANC of 2,247 cells/μL was associated with an AUC of 0.905 for chronic hip PJI diagnosis.
CONCLUSIONS: This study has conclusively shown that the synovial ANC serves as a valuable marker in the complicated diagnosis of PJI. This highly effective and efficient approach should be utilized for obtaining further information through standard tests, thereby ruling out the possibility of PJI.
METHODS: III.