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KMID : 0359620090210040205
대한슬관절학회지
2009년 21권 4호 p.205 ~ p.211

슬관절 인공관절 치환술 후 감염 발생에 대한 진단적 접근


Diagnosis of Infected Total Knee Arthroplasty

전철홍 ( Chun Churl-Hong ) - 원광대학교 의과대학 정형외과학교실

Abstract

슬관절 인공관절 치환술 시행 후 발생한 감염은 정확하고 빠른 진단이 적절한 치료를 위한 첫걸음이며, 가장 중요한 단계이다. 관절액 천자 검사가 가장 간단하고 정확한 검사 방법이지만 그 외에 임상적 증상과 징후, 혈청학적 검사(적혈구 침강 속도, C-반응성 단백질 시험), 방사선학적 검사, 방사선 동위원소 검사, 동결 절편 생검 및 배양 검사, 분자생물학적 방법을 종합적으로 해석하여 진단이 이루어져야 한다.
Infection of a knee prosthesis leads to specific problems in relation to the function of the knee joint. Making an accurate and early diagnosis is the first step in effectively managing patients with periprosthetic joint infection. At the present time, the diagnosis remains dependant on clinical judgment and reliance on standard clinical tests, including serologic tests, analysis of the aspirated joint fluid and interpretation of the intra-operative tissue and fluid test results. The screening test results that may suggest the possibility of infection include elevation of the erythrocyte sedimentation rate and/or the serum C-reactive protein level at more than three months after an arthroplasty. Cultures of the aspirated joint fluid can be especially helpful for patients who have symptoms suggestive of infection. The joint fluid cell counts may also be helpful, but Gram staining of the joint fluid has poor sensitivity and specificity. Intra-operative culture should not be used as a gold standard for periprosthetic infection owing to the high percentages of false-negative and false-positive cases. The criteria for diagnosing infection on the basis of frozen sections of implant membranes have not yet been standardized, but in many laboratories, more than five neutrophils per high-power field in five or more fields have been found to be suggestive of infection. Combined with clinical judgment, the total white cell count and percentage of neutrophils in the synovial fluid more accurately reflects periprosthetic joint infection. When this is combined with hematologic exams, infection can be safely excluded or confirmed.
KeyWords
인공관절치환술, 감염, 술전진단
Arthroplsty, Infection, Pre-operative diagnosis
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학술진흥재단(KCI) KoreaMed 대한의학회 회원