目的:组织学是诊断关节假体周围感染(PJIs)的既定工具。不同的门槛,使用各种感染定义和组织病理学标准,已被描述。这项研究确定了多形核中性粒细胞的不同阈值(≥5PMN/HPF,PMN/HPF≥10,≥23PMN/10HPF),当使用欧洲骨与关节感染协会(EBJIS)时,美国传染病学会(IDSA)以及PJI的国际共识会议(ICM)2018年标准。
方法:共119例接受全髋关节翻修术(rTHA)或膝关节置换术(rTKA)的患者。在高倍(400倍放大)下评估假体周围组织的永久性组织学切片,并根据HPF计数中性粒细胞。计算10个HPF中的平均嗜中性粒细胞计数(PMN/HPF)。基于接收机工作特性(ROC)曲线分析和z检验,阈值进行比较。
结果:使用EBJIS标准,≥5个PMN/HPF的截止值显示,敏感性为93%(95%置信区间(CI)81~98),特异性为84%(95%CI74~91).应用IDSA和ICM标准时的最佳阈值为≥10PMN/HPF,敏感性为94%(95%CI79至99)和90%(95%CI76至97),特异性为86%(95%CI77至92)和92%(95%CI84至97),分别。在RTKA,当使用IDSA标准时,与rTHA相比,观察到组织病理学分析的性能更好(p<0.001).
结论:具有较高的准确性,组织病理学分析可以作为诊断假体周围感染的确认标准。可推荐≥5个PMN/HPF的阈值来区分败血症和无菌性松动。检测更多由低毒力生物引起的感染的可能性增加。然而,中性粒细胞计数介于1至5之间,应考虑提示感染,并结合其他诊断测试方法进行仔细解读.引用这篇文章:骨关节试验2021;10(8):536-547。
OBJECTIVE: Histology is an established tool in diagnosing periprosthetic joint infections (PJIs). Different thresholds, using various infection definitions and histopathological criteria, have been described. This study determined the performance of different thresholds of polymorphonuclear neutrophils (≥ 5 PMN/HPF, ≥ 10 PMN/HPF, ≥ 23 PMN/10 HPF) , when using the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and the International Consensus Meeting (ICM) 2018 criteria for PJI.
METHODS: A total of 119 patients undergoing revision total hip (rTHA) or knee arthroplasty (
rTKA) were included. Permanent histology sections of periprosthetic tissue were evaluated under high power (400× magnification) and neutrophils were counted per HPF. The mean neutrophil count in ten HPFs was calculated (PMN/HPF). Based on receiver operating characteristic (ROC) curve analysis and the z-test, thresholds were compared.
RESULTS: Using the EBJIS criteria, a cut-off of ≥ five PMN/HPF showed a sensitivity of 93% (95% confidence interval (CI) 81 to 98) and specificity of 84% (95% CI 74 to 91). The optimal threshold when applying the IDSA and ICM criteria was ≥ ten PMN/HPF with sensitivities of 94% (95% CI 79 to 99) and 90% (95% CI 76 to 97), and specificities of 86% (95% CI 77 to 92) and 92% (95% CI 84 to 97), respectively. In
rTKA, a better performance of histopathological analysis was observed in comparison with rTHA when using the IDSA criteria (p < 0.001).
CONCLUSIONS: With high accuracy, histopathological analysis can be supported as a confirmatory criterion in diagnosing periprosthetic joint infections. A threshold of ≥ five PMN/HPF can be recommended to distinguish between septic and aseptic loosening, with an increased possibility of detecting more infections caused by low-virulence organisms. However, neutrophil counts between one and five should be considered suggestive of infection and interpreted carefully in conjunction with other diagnostic test methods. Cite this article: Bone Joint Res 2021;10(8):536-547.