ECT与实验室检查在假体周围感染诊断中的应用价值

发布时间：2018-05-03 03:05

本文选题：假体周围感染 + 人工关节置换术　；参考：《吉林大学》2016年硕士论文

【摘要】：背景:人工关节置换术已成为当今世界治疗髋、膝等关节终末期疾病,改善其功能的首选手术方法,可以明显缓解患者的症状,改善关节的活动度,大大提高患者的生活质量。但随着人工关节置换手术的开展,它的并发症也越来越凸显出来,如感染、松动、脱位等。其中假体周围感染(prosthetic joint infection,PJI)是毁灭性并发症,不仅给患者的身体、精神以及经济上带来沉重的压力,甚至最终导致死亡;并且对医生的信心也是打击,破坏医患之间关系,影响医患之间的和谐。有关研究表明,感染在髋膝关节初次置换中的发生率约为1%-2%,在关节翻修术中增长到7%。但假体周围感染的诊断在临床上存在一定的难度,甚至一些症状及体征不明显的感染往往存在漏诊误诊,耽误了感染患者的及时有效的治疗。实验室检查,包括血细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)及白细胞(white blood cell,WBC),被广泛的应用于临床,但其敏感性及特异性均不高,不能直接诊断感染。发射单光子计算机断层扫描(Emission Computed Tomography,ECT)全身骨扫描技术是通过放射性核素检测骨组织的代谢异常,在临床已被广泛应用于骨肿瘤、骨折以及骨髓炎中诊断中,近几年渐渐被用于假体周围感染的诊断中,但对假体周围感染的诊断价值目前并没有特别多的报道,尤其是与实验室检查的比较,其优点和缺点需要进一步的研究。目的:本研究通过对全身骨扫描、实验室检查、联合诊断与感染金标准之间的相互比较,探讨全身骨扫描和实验室检查在假体周围感染诊断中的应用价值,为其在临床中的应用提供相应依据及相关建议。方法:收集于2013年12月-2015年12月就诊于我院怀疑假体周围感染的患者,并均进行全身骨显像及实验室检查(血沉,c-反应蛋白,白细胞及中性粒细胞比值),联合诊断即为单纯的全身骨显像、血沉及c-反应蛋白组合在一起进行诊断,其中任意有两项阳性者即可诊断联合诊断的结果为阳性;联合诊断、全身骨显像、血沉及c-反应蛋白的灵敏性和特异性进行统计学分析,并分别与“金标准”进行内部一致性统计学分析,分析它们在假体周围感染诊断中的特点,进而判断它们在假体周围感染诊断中的应用价值,以获得假体周围感染诊断的最佳方法。结果:ect与血沉、c-反应蛋白之间在灵敏性及特异性无统计学差异(p0.05);联合诊断与血沉、c-反应蛋白在灵敏性及特异性上的差异有统计学意义(p0.05);ect及联合诊断与金标准之间的一致性检查kappa0.4、p0.05,一致性较好;血沉及c-反应蛋白与金标准之间的一致性检查kappa04、p0.05,一致性差。结论:ect的阴性检出率较高,具有很高的排除价值;ect的敏感性及特异性与实验室检查相比无明显的差别;联合诊断可以明显提高假体周围感染的敏感性及特异性;全身骨显像及联合诊断与金标准的一致性较高,具有较高的准确性。
[Abstract]:Background: artificial arthroplasty has become the first choice for the treatment of hip knee and other end-stage diseases in the world. The first choice to improve its function can significantly alleviate the symptoms of patients improve the motion of joints and greatly improve the quality of life of patients. But with the development of artificial joint replacement, its complications are more and more prominent, such as infection, loosening, dislocation and so on. Among them, the infection of prosthetic joint around the prosthesis is a devastating complication, which not only puts heavy pressure on the patient's body, mind and economy, but also results in death. Moreover, his confidence in doctors is also a blow to the relationship between doctors and patients. Affect the harmony between doctors and patients. The incidence of infection in primary hip and knee arthroplasty was about 1-2 and increased to 7 during revision. However, the diagnosis of periprosthetic infection is difficult in clinic, even some of the symptoms and signs of infection are often misdiagnosed and misdiagnosed, which delays the timely and effective treatment of infected patients. Laboratory tests, including erythrocyte sedimentation ratec, C-reactive protein (CRP) and white blood cell (WBC), have been widely used in clinical practice, but their sensitivity and specificity are not high, so they can not be directly diagnosed for infection. Emission single photon computed tomography (Computed) bone scanning is a radionuclide technique for the detection of metabolic abnormalities in bone tissue, which has been widely used in the diagnosis of bone tumors, fractures and osteomyelitis. In recent years, it has been gradually used in the diagnosis of periprosthetic infection, but the diagnostic value of periprosthetic infection is not much reported, especially compared with laboratory examination, its advantages and disadvantages need to be further studied. Objective: to explore the value of bone scanning and laboratory examination in the diagnosis of periprosthetic infection by comparing the bone scanning, laboratory examination, combined diagnosis and the standard of infection gold, in order to explore the value of systemic bone scan and laboratory examination in the diagnosis of periprosthetic infection. To provide the corresponding basis and relevant suggestions for its clinical application. Methods: from December 2013 to December 2015, patients suspected of periprosthetic infection were collected, and all patients underwent bone imaging and laboratory examination (erythrocyte sedimentation rate (ESR) -reactive protein). The combined diagnosis of leukocyte to neutrophil ratio is a simple whole body bone imaging. ESR and c-reactive protein are combined to diagnose. The sensitivity and specificity of bone scintigraphy, erythrocyte sedimentation rate and c-reactive protein were analyzed statistically, and the internal consistency with "gold standard" were analyzed respectively to analyze their characteristics in the diagnosis of periprosthetic infection. In order to obtain the best method for diagnosis of periprosthetic infection, the value of their application in the diagnosis of periprosthetic infection was determined. Results there was no significant difference in sensitivity and specificity between the specific and sensitivity of the c-reactive protein between the fraction and erythrocyte sedimentation rate (ESR), and the difference between the sensitivity and specificity of the combined diagnosis and ESR protein was statistically significant, and the difference between the combined diagnosis and the gold standard was significant. The consistency of kappa 0.4 p0.05 was good. Erythrocyte sedimentation rate (ESR) and consistency between c-reactive protein and gold standard were examined by kappa 04 p0. 05, and the consistency was poor. Conclusion there is no significant difference in sensitivity and specificity between the positive rate and the laboratory examination of the negative detection rate of the fraction, and the sensitivity and specificity of the combined diagnosis can obviously improve the sensitivity and specificity of periprosthetic infection, and the sensitivity and specificity of the diagnosis are not significantly different from those of the laboratory examination. The whole body bone imaging and combined diagnosis are consistent with gold standard and have high accuracy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.4

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