摘要
目的内毒素的动态检测对关节置换术后假体松动的早期诊断和治疗意义重大。文中旨在探讨分析内毒素检测在关节置换术后假体松动中的临床意义及疗效评价。方法选取2015年1月至2016年6月南京军区南京总医院骨科58例接受关节置换术后的患者进行前瞻性研究。按照术后并发症结果分为感染松动组(关节置换术后感染性松动患者,n=15)、无菌松动组(关节置换术后假体无菌性松动患者,n=23)和正常组(关节置换术后患者正常,n=20)。采用MB-80微生物动态快速检测系统对内毒素进行检测,比较内毒素水平,并进行ROC曲线分析,获得不同内毒素切点值下的灵敏度及特异度指标,并找出最佳诊断界点。结果感染松动组、无菌松动组内毒素水平[(0.56±0.11、0.49±0.08)ng/mL]明显高于对照组[(0.24±0.06)ng/mL],差异有统计学意义(P<0.01);而感染松动组与无菌松动组比较差异无统计学意义(P>0.05)。当血清内毒素浓度为0.36 ng/mL时,Youden指数最大,可作为诊断的最佳临界点,其判断为假体松动的准确性最高,其灵敏度66.7%,特异性为88.2%。结论内毒素可作早期诊断假体松动的较好指标,其检测对提高关节置换术后假体松动诊断有着显著帮助。
Objective The dynamic detection of endotoxin is of great significance for the early diagnosis and treatment of prosthesis loosening after joint replacement.This study aimed to explore and analyze the clinical significance and efficacy of endotoxin detection in prosthetic joint loosening after joint replacement. Methods Fifty-eight patients who underwent arthroplasty in the department of orthopedics in Nanjing General Hospital from January 2015 to June 2016 were selected for prospective study.The patients were divided into the infection loosening group(patients with infectious loosening after arthroplasty,n=15),the aseptic loosening group(patients with aseptic loosening of after arthroplasty,n=23)and the control group(patients were normal after arthroplasty,n=20)according to the postoperative complications.Endotoxin was detected with MB-80 microbial dynamic rapid detection system.We compared the endotoxin level and the ROC curve was made to acquire the sensitivity and specificity under the different cut-off values.Eventually find the best diagnostic threshold. Results The levels of endotoxin in the infection loosening group and the aseptic loosening group[(0.56±0.11,0.49±0.08)ng/mL]were significantly higher than that in the control group[(0.24±0.06)ng/mL].The difference was statistically significant(P<0.01).The difference was not statistically significant between the infection loosening group and the sterile loosening group(P>0.05).ROC curve analysis showed that when the serum endotoxin concentration was 0.36 ng/mL,the Youden index was the highest,which could be the best cut-off value for diagnosis.It had the best accuracy to judge the prosthesis loosening with a sensitivity of 66.7%and specificity of 88.2%. Conclusion The endotoxin can be a good indicator for early diagnosis of prosthesis looseness.It is helpful to the diagnosis of the prosthesis loosening after arthroplasty.
作者
曹青刚
孟嘉
包倪荣
汪春风
赵建宁
CAO Qing-gang;MENG Jia;BAO Ni-rong;WANG Chun-feng;ZHAO Jian-ning(Department of Orthopaedic Surgery,Jingling Hospital,Nanjing University School of Medicine/Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,China;Department of Orthopaedics,Guangji Hospital of Wuhu,Wuhu 241000,Anhui,China)
出处
《医学研究生学报》
CAS
北大核心
2018年第8期828-830,共3页
Journal of Medical Postgraduates
基金
江苏省自然科学基金(BK20161385)
关键词
血清内毒素检测
假体周围感染
无菌性松动
感染性松动
serum endotoxin detection
periprosthetic joint infection
aseptic loosening
infectious loosening
