本文選題：假體周圍感染 + 人工關節(jié)置換術　； 參考：《吉林大學》2016年碩士論文

【摘要】：背景:人工關節(jié)置換術已成為當今世界治療髖、膝等關節(jié)終末期疾病,改善其功能的首選手術方法,可以明顯緩解患者的癥狀,改善關節(jié)的活動度,大大提高患者的生活質(zhì)量。但隨著人工關節(jié)置換手術的開展,它的并發(fā)癥也越來越凸顯出來,如感染、松動、脫位等。其中假體周圍感染(prosthetic joint infection,PJI)是毀滅性并發(fā)癥,不僅給患者的身體、精神以及經(jīng)濟上帶來沉重的壓力,甚至最終導致死亡;并且對醫(yī)生的信心也是打擊,破壞醫(yī)患之間關系,影響醫(yī)患之間的和諧。有關研究表明,感染在髖膝關節(jié)初次置換中的發(fā)生率約為1%-2%,在關節(jié)翻修術中增長到7%。但假體周圍感染的診斷在臨床上存在一定的難度,甚至一些癥狀及體征不明顯的感染往往存在漏診誤診,耽誤了感染患者的及時有效的治療。實驗室檢查,包括血細胞沉降率(erythrocyte sedimentation rate,ESR)、C-反應蛋白(C-reactive protein,CRP)及白細胞(white blood cell,WBC),被廣泛的應用于臨床,但其敏感性及特異性均不高,不能直接診斷感染。發(fā)射單光子計算機斷層掃描(Emission Computed Tomography,ECT)全身骨掃描技術是通過放射性核素檢測骨組織的代謝異常,在臨床已被廣泛應用于骨腫瘤、骨折以及骨髓炎中診斷中,近幾年漸漸被用于假體周圍感染的診斷中,但對假體周圍感染的診斷價值目前并沒有特別多的報道,尤其是與實驗室檢查的比較,其優(yōu)點和缺點需要進一步的研究。目的:本研究通過對全身骨掃描、實驗室檢查、聯(lián)合診斷與感染金標準之間的相互比較,探討全身骨掃描和實驗室檢查在假體周圍感染診斷中的應用價值,為其在臨床中的應用提供相應依據(jù)及相關建議。方法:收集于2013年12月-2015年12月就診于我院懷疑假體周圍感染的患者,并均進行全身骨顯像及實驗室檢查(血沉,c-反應蛋白,白細胞及中性粒細胞比值),聯(lián)合診斷即為單純的全身骨顯像、血沉及c-反應蛋白組合在一起進行診斷,其中任意有兩項陽性者即可診斷聯(lián)合診斷的結果為陽性;聯(lián)合診斷、全身骨顯像、血沉及c-反應蛋白的靈敏性和特異性進行統(tǒng)計學分析,并分別與“金標準”進行內(nèi)部一致性統(tǒng)計學分析,分析它們在假體周圍感染診斷中的特點,進而判斷它們在假體周圍感染診斷中的應用價值,以獲得假體周圍感染診斷的最佳方法。結果:ect與血沉、c-反應蛋白之間在靈敏性及特異性無統(tǒng)計學差異(p0.05);聯(lián)合診斷與血沉、c-反應蛋白在靈敏性及特異性上的差異有統(tǒng)計學意義(p0.05);ect及聯(lián)合診斷與金標準之間的一致性檢查kappa0.4、p0.05,一致性較好;血沉及c-反應蛋白與金標準之間的一致性檢查kappa04、p0.05,一致性差。結論:ect的陰性檢出率較高,具有很高的排除價值;ect的敏感性及特異性與實驗室檢查相比無明顯的差別;聯(lián)合診斷可以明顯提高假體周圍感染的敏感性及特異性;全身骨顯像及聯(lián)合診斷與金標準的一致性較高,具有較高的準確性。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R687.4

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