外科文献用户指南:如何使用一篇关于诊断测试的文章

M. Bhandari, V. Montori, M. Swiontkowski, G. Guyatt
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引用次数: 58

摘要

临床情景:你是一名骨科医生,因一周前开始新发的右髋关节疼痛,被要求对急诊部一位65岁的女性进行评估。7个月前,患者接受了右侧全髋关节置换术治疗骨关节炎。疼痛向大腿和臀部放射。病人报告说,她几天前在厨房地板上滑倒了,但没想到自己受了重伤。此外,她的鼻窦感染(一种病毒性疾病)已经恢复了十天。她除了服用口服双膦酸盐治疗骨质疏松症外,其他方面都很健康。经检查,她的体温为39℃。她以弯曲的姿势走路最舒服。右髋关节活动范围正常。右臀部及大腿未见红斑及引流窦。骨盆和右髋关节的正位x线片显示加压配合的髋臼组成部分和骨水泥固定的股骨干,无松动迹象。实验室检查显示白细胞计数12.1个/μL,其中85%为中性粒细胞。血培养呈阴性。你想知道新的髋关节疼痛是软组织损伤的结果,放射到髋关节的背部疼痛,假体松动在x光片上不明显,还是髋关节感染的结果。如果髋关节确实受到感染,患者将需要手术处理伤口并取出植入物。虽然你的一些同事会把所有这样的病人都带到手术室进行髋关节探查,但你对没有发现感染的病例数量印象深刻。出于这些考虑,你的做法是对怀疑感染的病人进行常规的髋关节抽吸。就在你考虑把病人的名字列在第二天的抽吸手术清单上时,c反应蛋白测试结果显示为8mg /dL(正常,≤10mg /dL)。这一发现提出了一些问题
本文章由计算机程序翻译,如有差异,请以英文原文为准。
User's Guide to the Surgical Literature: How to Use an Article About a Diagnostic Test
Clinical Scenario You are an orthopaedic surgeon who is asked to evaluate a sixty-five-year-old woman in the emergency department because of new-onset right hip pain that started one week ago. Seven months previously, the patient had had a right total hip arthroplasty for the treatment of osteoarthritis. The pain radiates to the thigh and buttocks. The patient reports that she slipped on a kitchen floor a few days ago but did not think that she had sustained a serious injury. In addition, she has been recovering from a sinus infection (a viral illness) for the past ten days. She is otherwise healthy except that she takes oral bisphosphonates for the treatment of osteoporosis. On examination, she has a temperature of 39°C. She walks most comfortably with a flexed posture. The range of motion of the right hip is normal. There is no erythema or draining sinus over the right hip and thigh. Anteroposterior radiographs of the pelvis and the right hip reveal a press-fit acetabular component and a cemented femoral stem with no evidence of loosening. Laboratory evaluations show a white blood-cell count of 12.1 cells/μL, of which 85% are neutrophils. Blood cultures are negative. You wonder whether the new onset of hip pain is the result of a soft-tissue injury, back pain radiating to the hip, prosthetic loosening that is not apparent on radiographs, or an infection of the hip joint. If the hip is truly infected, the patient will require an operative procedure for débridement of the wound and removal of the implants. While some of your colleagues would take all such patients to the operating room for exploration of the hip, you have been impressed by the number of cases in which you have found no infection. Because of such concerns, your practice is to routinely aspirate the hip in patients in whom an infection is suspected. Just as you are thinking about placing your patient’s name on the next day’s procedures list for an aspiration, the result of the C-reactive protein test comes back as 8 mg/dL (normal, ≤10 mg/dL). This finding raises some question as to
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