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Intraoperative frozen section histopathology for the diagnosis of periprosthetic joint infection in hip revision surgery: the influence of recent dislocation and/or periprosthetic fracture.

术中冰冻切片组织病理学诊断髋关节翻修手术中假体周围关节感染: 近期脱位和/或假体周围骨折的影响。

  • 影响因子:1.28
  • DOI:10.1177/1120700020933993
  • 作者列表:"Luyckx L","Somers JFA","Cokelaere K","Deloose S","Delrue G","Hermans L
  • 发表时间:2020-06-14
Abstract

AIMS:To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. PATIENTS AND METHODS:The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). RESULTS:The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. CONCLUSIONS:Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

摘要

目的: 评价术中冰冻切片组织病理学诊断髋关节翻修手术中假体周围关节感染 (PJI) 的准确性,无论是对髋关节有无近期创伤的患者。 患者和方法: 该研究包括所有翻修全髋关节置换手术,其中在 2008 年至 2015 年间,术中冰冻切片组织病理学已用于单个机构的感染评估。采用肌肉骨骼感染学会标准定义感染。纳入 210 髋进行评价。翻修手术前,36 髋有脱位或假体周围骨折 (a 组),174 髋无脱位或假体周围骨折 (B 组)。 结果: 感染率 14.3% (A 组 5.6%,B 组 16.1%)。使用 Feldman 标准,A 组组织病理学的敏感性为 50.0%,特异性为 47.1%,阳性预测值为 5.3%,阴性预测值为 94.1%。B 组冰冻切片组织病理学诊断的敏感性为 75.0%,特异性为 96.5%,阳性预测值为 85%,阴性预测值为 95.3%。 结论: 术中冰冻切片组织病理学对髋关节翻修术前未发生脱位或假体周围骨折的 PJI 诊断是可靠的。

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