术前不同水平ESR和CRP与关节置换术后早期安全性的相关性研究

发布时间：2018-03-03 19:51

本文选题：血沉　切入点：C-反应蛋白　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：关节置换术后感染被称为人工关节置换灾难性并发症,是导致人工关节置换术后翻修的常见原因。本文通过收集大量关节置换手术患者的术前血沉（erythrocyte sendimentation rate,ESR）和C-反应蛋白（C-reactive protein,CRP）以及术后出现早期感染的情况，，探讨术前不同升高水平ESR和CRP与人工关节置换术后早期安全性的关系。方法：收集我科2012年~2014年行关节置换病例811例（898髋和膝），记录每一个患者术前ESR和CRP以及术后出现早期感染的情况。其中股骨头缺血性坏死患者362例（402髋），膝关节骨性关节炎患者339例（376膝），成人髋关节发育不良继发骨性关节炎或髋关节脱位患者110例（120髋）。根据术前ESR和CRP值的高低进行分组，分别分为正常组，1-2倍组，2-3倍组，大于3倍组等四组。采用适当的统计学方法进行统计学分析，比较术前ESR和CRP不同水平组术后出现早期感染情况的差异。结果：股骨头缺血性坏死患者的术前ESR和CRP升高的几率和程度均较膝关节骨性关节炎和成人髋关节发育不良高。所有898例关节中共出现了6例关节置换术后早期感染，并且6例均为人工全膝关节置换术（total knee arthroplasty,TKA）术后患者，因股骨头缺血性坏死或成人髋关节发育不良继发骨性关节炎行人工全髋关节置换（total hiparthroplasty,THA）手术患者均未出现术后早期感染。6例感染患者中包括浅表感染4例，深部感染2例。术前ESR和CRP不同程度升高的三组之间感染率无明显差异。术前ESR和CRP不同程度升高的三组的感染率均高于正常组，差异具有统计学意义。（P㩳0.05）结论：术前ESR和CRP与疾病种类有明显的关系，对于不同种类的疾病，在术前初步评估手术安全性时ESR和CRP应当有不同的参考值基线。术前ESR和CRP的升高会增加关节置换术后早期感染的风险，但是早期感染风险与术前ESR和CRP的升高的程度无明显相关性。由于ESR和CRP的影响因素较多，不能单独应用术前ESR和CRP值的高低来评估手术的安全性。对于术前ESR和CRP升高的患者，应结合其他各方面的因素，包括疾病的种类，年龄，性别，肥胖程度，是否有其他内科合并症，病人临床表现及局部体征，术前关节穿刺，以及术中冰冻切片等进行综合评估，最后确定能否进行关节置换以及手术的安全性。
[Abstract]:Objective:. Infection after arthroplasty is known as a catastrophic complication of arthroplasty. In this paper, we collected a large number of preoperative erythrocyte erythrocyte sedimentation rate (ESR) and C-reactive protein (C-reactive protein), and the incidence of early infection after arthroplasty. To investigate the relationship between ESR, CRP and early safety after arthroplasty. Methods:. From 2012 to 2014, we collected 811 cases of arthroplasty from 2012 to 2014, and recorded ESR and CRP before operation and early infection after operation in each patient. Among them, 362 patients with avascular necrosis of femoral head were treated with hip and knee bone. There were 339 cases of osteoarthritis with osteoarthritis or dislocation of hip joint, and 110 cases of adult hip dysplasia with osteoarthritis or dislocation of hip. The patients were divided into two groups according to the preoperative ESR and CRP values. The patients were divided into four groups: normal group (1-2 times) and group (> 3 times). The difference of early infection between ESR and CRP before and after operation was compared by using appropriate statistical method. Results:. The increase of ESR and CRP in patients with avascular necrosis of femoral head before operation was higher than that of osteoarthritis of knee joint and adult hip dysplasia. 6 cases of early infection after arthroplasty were found in all 898 cases of avascular necrosis of femoral head. All the 6 patients were treated with total knee arthroplasty. Total total hip replacement (total hip arthroplasty) was performed on patients with osteoarthritis secondary to avascular necrosis of femoral head or adult hip dysplasia. There were no early postoperative infections in 6 cases, including superficial infection in 4 cases. There was no significant difference in the infection rate between the three groups with different degrees of ESR and CRP before operation, but the infection rate of the three groups with different degrees of ESR and CRP was higher than that of the normal group, and the difference was statistically significant. 0.05). Conclusion:. Preoperative ESR and CRP were significantly related to the types of diseases. ESR and CRP should have different reference baselines for preoperative preliminary evaluation of surgical safety. Increased preoperative ESR and CRP may increase the risk of early infection after arthroplasty. However, there was no significant correlation between the risk of early infection and the increase of ESR and CRP before operation, because there were many factors affecting ESR and CRP. The preoperative ESR and CRP values should not be used alone to evaluate the safety of surgery. For patients with elevated ESR and CRP, other factors, including disease type, age, sex, and obesity, should be taken into account. Whether there are other internal complications, clinical manifestations and local signs of the patients, preoperative joint puncture and intraoperative frozen section were comprehensively evaluated, and the safety of joint replacement and operation was finally determined.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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