ĐẶC ĐIỂM XÉT NGHIỆM BILAN VIÊM, HÌNH ẢNH VÀ KẾT QUẢ SINH THIẾT MÀNG HOẠT DỊCH DƯỚI HƯỚNG DẪN SIÊU ÂM TRONG CHẨN ĐOÁN VIÊM NHIỄM KHUẨN MỘT KHỚP

Abstract

Purposes: To describe the characteristics of inflammatory bilan tests, imaging, and results of synovial membrane biopsy (MHD) under ultrasound guidance (SA) in the diagnosis of bacterial infection (NK) of a joint. Material and methods: A descriptive study of inflammatory bilan tests, ultrasound (US), magnetic resonance imaging (MRI) and ultrasound guided synovial biopsy results of 36 patients with mono-arthritis with negative fluid synovial culture at Hanoi Medical University Hospital from 09/2020 to 10/2022. Biopsy sample analysis included histopathology, bacterial culture, and TB PCR testing. Results: The median age of patients was 60, female accounted for 2/3. There was no significant difference (p>0.05) between infection and non-NK arthritis groups in terms of inflammatory biban test, joint MHD thickness and associated markers. Biopsy samples of 36 patients were examined, 9 patients had positive bacterial cultures, 4 patients had a positive TB PCR test, 2 patients had TB-specific granulomatous inflammation and 2 patients had a positive reaction of infectious inflammation (purulent, polymorphonuclear leukocytes..) on histopathological analysis. These 17 patients were diagnosed with septic arthritis (including pyogenic infections and tuberculosis). There were no neurological or vascular complications during the biopsy. There was 01 case of infection at the puncture site, accounting for 2.7% and one case of hemorrhagic fusion, accounting for 2.7% after biopsy. Conclusion: MHD biopsy under SA guidance is a safe and easy method to perform. Examination of biopsies provides valuable diagnostic hints for septic arthritis. An US-guided synovial biopsy should indicate for patients with negative fluid synovial cultures, inflammatory bilan tests, and imaging that cannot differentiate septic or aseptic arthritis.