摘要
目的研究关节假体周围感染(prosthetic joint infection,PJI)患者中,细菌培养阴性与培养阳性患者临床特征及实验室检查指标差异。方法回顾分析2012年1月-2013年7月收治的104例关节翻修患者,其中66例符合PJI诊断标准纳入研究。根据术前关节穿刺与术中关节液或组织培养结果将66例患者分为培养阴性组(CN组,21例)和培养阳性组(CP组,45例)。两组患者性别、年龄、身高、体重及体重指数等一般资料比较,差异均无统计学意义(P>0.05)。分别比较两组患者术前红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)及假体生存时间,术中取炎性组织行石蜡切片,根据Morawietz等分型方法进行组织学分型;并将术前及术中关节穿刺液行细菌培养。结果 CN组患者术前CRP和ESR分别为(1.29±1.84)mg/dL和(22.86±28.42)mm/1 h,均显著低于CP组的(5.08±9.57)mg/dL和(36.74±31.26)mm/1 h(t=2.094,P=0.038;t=7.761,P=0.000)。CN组假体生存时间为8~504个月,中位时间72个月;CP组为15 d^300个月,中位时间25个月;两组比较差异有统计学意义(U=2.231,P=0.026)。组织学分型示CN组Ⅰ型2例,Ⅱ型7例,Ⅲ型12例;CP组Ⅰ型6例,Ⅱ型25例,Ⅲ型13例,Ⅳ型1例。细菌培养阳性患者占PJI患者的68.18%(45/66),其中葡萄球菌属为主要致病菌(68.89%)。结论细菌培养阴性的PJI患者发病较缓慢,炎性反应较弱,必须结合病理学、实验室检查及术中组织学情况综合诊断。
Objective To explore the clinical characters and histopathologic differences between patients with culture-positive and culture-negative prosthetic joint infection （PJI）. Methods Between January 2012 and July 2013, 66 PJI patients in accord with diagnostic criteria were enrolled. According to the results of preoperative aspiration and intraoperative cultures, the patients were divided into culture-negative group （CN group, n=21） and culture-positive group （CP group, n=45）. There was no significant difference in gender, age, height, weight, and body mass index between 2 groups （P 〉 0.05）. Preoperative C reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, and prosthesis survival time were compared between 2 groups. Intraoperative frozen sections and paraffin sections were both performed to identify infections, and histological typing was performed according to Morawietz’s methods. Results The preoperative CRP was （1.29 ± 1.84） mg/ dL in CN group and （5.08 ± 9.57） mg/dL in CP group, showing significant difference （t=2.094, P=0.038）. The preoperative ESR was （22.86 ± 28.42） mm/1 h in CN group and （36.74 ± 31.26） mm/1 h in CP group, showing significant difference （t=7.761, P=0.000）. The median survival time of prosthesis was 72 months （range, 8-504 months） in CN group and 25 months （range, 15 days-300 months） in CP group, showing significant difference （U=2.231, P=0.026）. Morawietz’s histological typing results showed that 2 cases were rated as type I, 7 cases as type II, and 12 cases as type III in CN group; 6 cases were rated as type I, 25 cases as type II, 13 cases as type III, and 1 case as type IV in CP group. The positive culture rate was 68.18% （45/66）, and pathogenic bacteria was dominated by Staphylococcus, accounting for 68.89%. Conclusion The patients with culture-negative PJI have slow onset and mild inflammatory response, so comprehensive diagnosis should be made based on pathological detection, laboratory examination, and intraoperative cultures.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第1期30-33,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
关节假体周围感染
细菌培养
C反应蛋白
红细胞沉降率
Prosthetic joint infection Bacterial culture C reaction protein Erythrocyte sedimentation rate
