致病菌在关节假体周围感染早期诊断中价值的研究进展

关节假体周围感染是关节置换术后最严重的并发症,早期确诊并确定具体致病菌能够帮助医生尽早采取针对性治疗措施,从而有效改善患者预后。目前国内外诊断关节假体周围感染的方法众多,各有优点和缺点。近年以致病菌或致病菌基因为检测目标实现关节假体周围感染早期诊断成为一种新思路。本文针对关节假体周围感染早期诊断技术以及以致病菌为目标的检测诊断方法作一综述,为致病菌检测应用于临床关节假体周围感染早期诊断提供理论基础。     

关节置换术后假体周围感染临床诊断与治疗的研究现状

目的:总结髋、膝关节置换术后假体周围感染(PJI)的临床诊断,以及保留假体清创术和翻修手术治疗PJI的研究现状。方法:在中国知网、万方数据、PubMed等中、英文数据库,以"假体周围感染""诊断""清创""再手术"以及"periprosthetic joint infection""diagnosi""debridem...     

关节假体周围感染早期诊断中的eno和sar A基因检测

目的 探讨eno和sar A基因检测应用于关节假体周围感染(PJI)早期诊断的效率和价值.方法 选择5种最常见PJI致病菌,通过37℃培养、单克隆TSB肉汤扩增;盖玻片置入并37℃恒温摇床48 h培养成膜,建立.体外PJI人体关节模型,并提取经过超声波裂解的RNA洗脱液样本41个进行eno和sar A基因的PCR检测,...     

血清学炎性指标作为早期诊断关节置换术后假体周围感染的研究现状

作为人工关节置换术后的灾难性并发症,关节假体周围感染目前尚无完美的敏感性和特异性血清学炎性指标。所以假体周围感染的早期诊断依然是骨科医师面对的挑战。本文筛选了目前临床用于人工关节假体周围感染的一些血清学炎性指标,予以综述。希望为临床骨科医师早期诊断人工关节假体周围感染提供参考。     

滑膜液α防御素和C-反应蛋白在关节假体周围感染诊断中的价值

背景:假体周围感染是膝/髋关节置换最常见最严重的并发症之一,占全膝关节置换失败原因的25％,全髋关节置换失败的16％.因此,及时准确地诊断关节假体周围感染具有重要临床意义.目的:评估α防御素和C-反应蛋白对假体周围感染的诊断效应.方法:选取2014年9月到2016年9月初次关节置换或关节翻修手术后疼痛的患者,并检测所选...     

髋膝关节置换后假体周围感染的治疗

背景：假体周围感染是关节置换后医生及患者最不愿意遇到的并发症之一,其顽固性和难治性一直是让关节科医生头痛的难题。目的：综述国内外近年临床最新治疗髋、膝关节置换后假体周围感染的常用临床治疗手段,包括抗生素治疗、手术治疗、生物治疗、中医药治疗等,以期促进国内治疗假体周围感染的研究进展。方法：第一作者检索中国知网(CNKI)、万方、维普、PubMed等数据库2000年1月至2022年10月的文献,通过阅读题目初筛获得762篇文献,然后通过阅读摘要,排除内容重复、数据可靠性低、观点过时的文献后获得194篇文献,再通过精读原文最终纳入88篇文献。结果与结论：(1)治疗假体周围感染过程中,组合型抗生素给药方案或有助于根除感染;(2)Ⅱ期翻修术仍是治疗假体周围感染的金指标;(3)Ⅰ期翻修术缺乏大样本的临床研究,需要更多的临床观察;(4)生物治疗中的噬菌体疗法、新式载药系统已少量应用于临床,在假体周围感染的预防和根除上表现出其优势特点;(5)中医药配合抗生素、手术治疗手段能提高预防、治疗假体周围感染的效果,但缺乏高等级的循证医学证据。     

全髋关节置换后假体周围感染的研究进展

背景：全髋关节置换后发生的假体周围感染常导致置换失败并需行翻修手术。 目的：综合近几年文献探讨全髋关节置换术后感染机制,以及其诊断与治疗的进展。 方法：应用计算机检索1990-01/ 2010-12 Pubmed数据库、1970-01-01/ 2010-12-31 SpringerLink数据库相关文章, 检索词为“total hip arthroplasty, infection”共检索到文献2 109篇, 并参阅其他相关的著作及高影响因子的相关文献, 最终纳入符合标准的文献29篇。 结果与结论：假体表面生物膜的形成是微生物难以消除的主要原因。耐药菌的出现及多微生物的感染比例正逐渐上升, 及时而正确的诊断对其预后影响很大, 但尚无统一诊断的金标准, 每种诊断手段都有其优缺点, 必须综合考虑,白细胞介素6因为其廉价无创及高敏感和特异性,正逐渐成为研究热点。治疗目前包括单独抗生素治疗、清创保留假体、一期翻修、二期翻修、关节融合及截肢等方法。抗生素的预防是非常重要的, 抗生素丙烯酸骨水泥假体技术(PROSTALAC), 正逐渐被越来越多的术者接受。但是每一种治疗方案的选择应根据每一患者其具体病情需要选择合适的治疗方案。     

血清C反应蛋白和红细胞沉降率在关节假体周围感染患者中表达及不符合MSIS诊断标准的相关因素

目的:分析关节假体周围感染患者血清C反应蛋白以及红细胞沉降率表达情况不符合美国肌肉骨骼感染协会(American Musculoskeletal Infection Association,MSIS)诊断标准的有关因素。方法:选取2017年3月至2020年3月在菏泽市立医院因关节假体周围感染而进行住院治疗的50例患者作...     

D-二聚体在诊断假体周围感染中的应用价值及准确性:系统评价与荟萃分析

目的:目前尚没有单一或联合应用的指标可以用来直接确诊或排除关节置换后假体周围感染.D-二聚体近年来作为一种新兴的检测指标被骨科医生用于辅助诊断假体周围感染,但它的可靠性仍然存在争议.文章运用Meta分析方法明确D-二聚体用于诊断假体周围感染时的实际应用价值及准确性.方法:在PubMed,EMbase,Web of Sc...     

放射性核素骨显像在人工关节置换后假体松动与感染鉴别诊断中的作用

背景：假体松动和感染是人工关节置换失败的常见原因,因此两者的鉴别非常重要。因大多患者无典型的临床表现,其他实验室检查的确诊方法也非常有限。目前,放射性核素骨显像与CT、磁共振成像及X射线检查已成为诊断假体松动和感染的常用方法,但何种方法能更有效地检查出病变,一直存在争论。 目的：分析人工关节置换后假体松动和感染的放射性核素骨显像与CT、磁共振成像及X射线诊断的相关文献,对这些检查方法进行优选,为临床治疗方案的选择和预后的判断提供根据。 方法：收集人工关节置换后假体松动和感染患者的放射性核素骨显像与CT、磁共振成像及X射线诊断的相关文献,对其影像学表现进行回顾性分析,比较几种影像学诊断方法的优缺点。 结果与结论：人工关节置换后假体松动和感染的临床表现不容易区分,而且假体松动的早期尚未形成假体周围骨骼结构异常或假体周围较细小的透亮带被遮挡等,常影响X射线或者CT诊断,所以诊断时常出现误诊、漏诊。另外关节假体多为金属材料,CT或磁共振成像会出现伪影,也影响对假体松动和感染的判断。放射性核素骨显像可更准确的对人工关节置换后假体松动和感染的患者定位、定性诊断,对预后有更重要的临床价值。     

Effects of intra-articular D-amino acids combined with systemic vancomycin on an experimental Staphylococcus aureus-induced periprosthetic joint infection

BackgroundThe D-isoforms of amino acids (D-AAs) exhibit anti-biofilm potential against a diverse range of bacterial species in vitro, while its role in vivo remains unclear. The aim of this study was to investigate the effects of a combination of D-AAs and vancomycin on a PJI rat model.MethodsEight-week-old male SD rats were randomized to the control group, sham group, vancomycin group, D-AAs–vancomycin group. After treatment for 6 weeks, we analysed the levels of inflammatory factors in serum, behavioural change, imaging manifestations. The anti-biofilm ability of D-AAs was detected by crystal violet staining and scanning electron microscope observation, and its ability to assist antibiotics in killing bacteria was assessed by culture of bacteria. Additionally, micro-CT and histological analysis were used to evaluate the impact of D-AAs combined with vancomycin on the bone remodelling around the prosthesis.ResultsThe group treated with a D-AAs–vancomycin combination sustained normal weight gain and exhibited reduced the serum levels of α2M, IL-1β, IL-6, IL-10, TNF-α and PGE2. Moreover, treated with D-AAs in combination with vancomycin improved the weight-bearing activity performance, increased the sizes and widths of distal femurs, and improved Rissing scale scoring. In particular, treatment using D-AAs enhanced the ability of vancomycin to eradicate Staphylococcus aureus, as demonstrated by the dispersion of existing biofilms and the inhibition of biofilm formation that occurred in a concentration-dependent manner. This treatment combination also resulted in a reduction in bacterial burden with in the soft tissues, bones, and implants. Furthermore, D-AAs–vancomycin combination treatment attenuated abnormal bone remodelling around the implant, as evidenced by an observed increase in BMD, BV/TV, and Tb.Th and the presence of reduced Trap⁺ osteoclasts and elevated osterix⁺ osteo-progenitors.ConclusionsCombining D-AAs with vancomycin provides an effective therapeutic strategy for the treatment of PJI by promoting biofilm dispersion to enhance antimicrobial activity.     

Origin and characteristics of haematogenous periprosthetic joint infection

ObjectivesRecognition of infectious origin of haematogenous periprosthetic joint infections (PJI) is crucial. We investigated the primary focus and characteristics of haematogenous PJI.MethodsConsecutive patients who presented with haematogenous PJI between 01/2010 and 01/2018 were retrospectively analysed. Haematogenous PJI was defined by diagnosis of infection ≥1 month after surgery, acute manifestation after a pain-free period and positive blood or prosthetic-site culture and/or evidence of distant infectious focus consistent with the pathogen. Fisher's exact, Student's t and Mann–Whitney U tests were used, as appropriate.ResultsA total of 106 episodes of PJI were included, involving 59 knee, 45 hip, one shoulder and one elbow prostheses. The median time from last surgery until haematogenous PJI was 47 months (range, 1–417 months). The pathogen was identified in 105 episodes (99%), including Staphylococcus aureus (n = 43), streptococci (n = 32), enterococci (n = 13), Gram-negative bacteria (n = 9) and coagulase-negative staphylococci (n = 8). Gram-negative bacteria were significantly more often found in hip joints than in knee joints. Blood cultures grew the pathogen in 43 of 70 episodes (61%). The primary infectious focus was identified in 72 episodes (68%) and included infections of intravascular devices or heart valves (22 episodes), skin and soft tissue (16 episodes), the oral cavity (12 episodes), urogenital (12 episodes) or gastrointestinal tract (seven episodes) and other sites (three episodes).ConclusionsIn acute PJI manifesting after a pain-free period, the haematogenous infection route should be considered and the primary infectious focus should be actively searched for. The cardiovascular system, skin and soft tissue, oral cavity, urogenital and gastrointestinal tracts were common origins of haematogenous PJI.     

Diagnosis of prosthetic joint infection by beadmill processing of a periprosthetic specimen

We report a microbiological process for the documentation of prosthetic joint infection (PJI). Intraoperative periprosthetic tissue samples from 92 consecutive patients undergoing revision surgery for PJI were submitted to mechanized beadmill processing: specimens were aseptically collected in polypropylene vials, filled with sterile water and glass beads and submitted to mechanized agitation with a beadmill. The documentation rate of PJI following culture on solid and liquid media was 83.7% and the contamination rate 8.7%. Final documentation was obtained after overnight culture for 51.9% of cases and with 7 days of broth culture for all documented cases.     

关节液中纳米颗粒的测量对关节疾病诊断的意义

 目的：探讨不同状态下关节液中纳米颗粒与关节疾病种类的相关性。方法：抽取正常人、膝关节骨性关节炎（KOA）和滑膜炎（KTS）患者的关节液，利用准弹性激光散射技术测定关节液中纳米颗粒的粒度大小及其分布，利用相分析电泳光散射技术测定关节液纳米颗粒的Zeta电位，并采用相关分析方法分析纳米颗粒的粒度、Zeta电位与疾病的相关性。结果：KOA和KTS关节液纳米颗粒的平均粒度和Zeta电位都分别显著大于正常对照（P<0.01），粒度和Zeta电位分布曲线比正常对照组的宽（P<0.01）。关节液中纳米颗粒的平均粒度（r_p=0.7972，P<0.01）、Zeta电位（r_p=0.6319，P<0.01）与关节的疾病种类存在很好的相关性。结论：关节液纳米颗粒的粒度和Zeta电位与关节疾病存在显著的相关关系, 可建立起一个关节疾病早期诊断的检测方法。     

Success rates,characteristics, and costs of articulating antibiotic spacers for total knee periprosthetic joint infection

Background

The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate.

Analysis of synovial fluid from clinically healthy Iranian fat-tailed sheep

In this study synovial fluid from the radiocarpal joints of 100 clinically healthy Iranian sheep (Lori-Bakhtiari) were analyzed. Total nucleated cell count (TNCC) of the synovial fluid was 178.9±75 cells/l (mean±SD). Lymphocytes were the predominant cell type composing 48.34±17.2% of the cells found in the synovial fluid, whereas monocytes, macrophages and neutrophils composed 36.52±3.5%, 12.75±5.9% and 2.28±1.18% of the cells found in the synovial fluid, respectively. The glucose concentration of synovial fluid was 44.9±9 mg/dl. The concentration of total protein, albumin and globulin of the synovial fluid were 2.31±0.55, 1.49±0.38, 0.81±0.28 g/dl, respectively. The albumin to globulin ratio (A/G) was 2.02±0.61. Age and sex had no significant effects on TNCC, percentage of lymphocytes, monocytes, macrophages and neutrophils, concentration of total protein, albumin, globulin, and A/G ratio of fluid from the radiocarpal joint. However, glucose concentration in radiocarpal fluid in sheep less than 1-year-old was significantly (P0.05) higher (48.27±1.4 mg/dl) than 1- to 2-years-old (42.1±1.4 mg/dl) and more than 2-years-old sheep (43.9±1.8 mg/dl). No significant differences were found between right and left limbs for any parameters evaluated in this study.     

Supravital staining of synovial fluid with Testsimplets.

We explored the use of Testsimplet (TS) in synovial fluid (SF) analysis. TS is a glass slide coated with a dry mixture of methylene blue and cresyl violet, which in contact with one drop of SF provides a stained fresh preparation. We applied the TS to the study of 159 SFs of patients with different rheumatic diseases. In those SFs of patients with crystal-associated diseases, the crystal search was performed both on unstained preparations and with TS. TS was as good as the Wright's and Papanicolaou stain in characterizing SF cells, lupus erythematosus cells, and detection of occasional bacteria. TS allowed a better visualization of Reiter's cells, cartilage fragments, synovial villi, fat droplets, and fibrin. Crystals were identified in every TS of those patients with crystal-associated diseases. TS is a rapid and reproducible method of SF supravital staining. Crystals are well preserved for simultaneous examination with compensated polarized light.