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Діагностика інфікованого перелому: чинні концепції та рекомендації
27 січня 2021
Джерело: Переклад українською та адаптація АО Травма Україна
http://europepmc.org/article/MED/31855973
Джерело: Переклад українською та адаптація АО Травма Україна
http://europepmc.org/article/MED/31855973
Geertje A. M. Govaert, MD, PhD (к.м.н., док.мед. Гертьє А.М. Говаерт), Richard Kuehl, MD (док.мед. Річард Куель), Bridget L. Atkins, MD (док.мед. Бріджет Л.Аткінс), Andrej Trampuz, MD (док.мед. Андрей Трампуш), Mario Morgenstern, MD (док.мед. Маріо Моргенштерн), William T. Obremskey, MD, MPH (док.мед., магістр охорони здоров’я Вільям Т.Обремскей), Michael H. J. Verhofstad, MD, PhD (к.м.н., док.мед. Мішель Х.Дж. Ферхофштад), Martin A. McNally, MD, FRCS(Orth) (док.мед, член Королівської колегії хірургів (орт.) Мартін А. Мак-Неллі), та Willem-Jan Metsemakers, MD, PhD (к.м.н., док.мед. Віллем-Жан Мецемейкерз) від робочої групи інфікованих переломів
Резюме.
Інфікування перелому є тяжким ускладненням після травми кістки та може становити серйозні проблеми для діагностики. Загалом, існує досить обмежена кількість науково обґрунтованих діагностичних критеріїв інфекції перелому. З огляду на це, «AO Foundation», спільно з Асоціацією суглобових та кісткових інфекцій запропонувала спільне визначення інфекцій переломів, щоб стандартизувати діагностичні критерії та підвищити якість лікування пацієнта і практичне застосування майбутніх досліджень цього стану. Мета даної статті – підсумувати усі доступні діагностичні ознаки та надати рекомендації щодо діагностування інфекції переломів. Для цього співавтори в ході дискусій прийшли до спільного визначення та запропонували удосконалення на підставі доступних доказів діагностичної цінності клінічних параметрів, маркерів запалення в плазмі крові, методів візуалізації, взяття зразків тканин та рідин після обробки ультразвуком, молекулярних біотехнологій та гістопатологічних досліджень. Крім того, буде надано рекомендації щодо взяття мікробіологічних зразків та оперативних лабораторних процедур у випадках інфікування переломів.
Ключові слова: інфікований перелом, діагноз, діагностичні критерії, визначення, клінічні критерії, медична візуалізація, гістопатологія, мікробіологія, маркери запалення в плазмі крові, перелом, інфекція.
Рівень доказовості: діагностичний рівень V. Повний опис рівнів доказовості наведено в інструкціях для авторів.
Докладніше з матеріалом можна ознайомитися за посиланням http://europepmc.org/article/MED/31855973 (Free full text)
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21. Scherer MA, Neumaier M, von Gumppenberg S. C-reactive protein in patients who had operative fracture treatment. Clin Orthop Relat Res. 2001:287–293. [Abstract] [Google Scholar]
22. van den Kieboom J, Bosch P, Plate JDJ, et al. Diagnostic accuracy of serum inflammatory markers in late fracture-related infection: a systematic review and meta-analysis. Bone Joint J. 2018;100B:1542–1550. [Abstract] [Google Scholar]
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24. Goebel M, Rosa F, Tatsch K, et al. Diagnosis of chronic osteitis of the bones in the extremities: relative value of F-18 FDG-PET [in German]. Unfallchirurg. 2007;110:859–866. [Abstract] [Google Scholar]
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26. Govaert GA, Glaudemans AW. Nuclear medicine imaging of posttraumatic osteomyelitis. Eur J Trauma Emerg Surg. 2016;42:397–410. [Europe PMC free article] [Abstract] [Google Scholar]
27. Glaudemans AW, Prandini N, DI Girolamo M, et al. Hybrid imaging of musculoskeletal infections. Q J Nucl Med Mol Imaging. 2018;62:3–13. [Abstract] [Google Scholar]
28. Ballani NS, Al-Huda FA, Khan HA, et al. The value of quantitative uptake of (99m)Tc-MDP and (99m)Tc-HMPAO white blood cells in detecting osteomyelitis in violated peripheral bones. J Nucl Med Technol. 2007;35:91–95. [Abstract] [Google Scholar]
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