血沉、C反应蛋白升高与下肢骨不连感染相关性的系统评价

发布时间：2018-07-03 02:32

本文选题：骨不连 + 血沉　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究在下肢骨不连当中,血沉、c反应蛋白升高与感染的相关性。方法:回顾性选取2014年1月-2016年12月于我院创伤骨科进行治疗的37例下肢骨不连患者作为研究对象,依据感染与否,分为A(非感染组),B(感染组)两组。收集两组研究对象入院时的ESR、CRP、PCT、WBC,中性粒细胞数及骨不连局部压痛,活动度,局部流脓破溃情况,x线片髓腔变窄情况,并对两组研究对象进行随访,了解之前骨折手术的手术时间及住院天数。采用SPSS19.0软件进行统计分析。结果:两组研究对象在运用t检验的指标中,ESR(t=1.402,P=0.181)、CRP(t=0.753,P=0.457)、WBC(t=1.164,P=0.274)、中性粒细胞数(t=1.158,P=0.274)方面A组高于B组,但无统计学意义。两组研究对象都进行了随访,A组骨折手术的手术时间(t=0.157,P=0.877)较B组稍长,但无统计学意义,骨折手术住院天数(t=-1.658,P=0.119)上B组高于A组,但也无统计学意义。运用χ2检验的指标中,PCT(P=1.000)、WBC(P=1.000)、中性粒细胞数(P=1.000)及骨不连局部压痛(P=0.262),活动度(P=1.000),均无明显差异,在局部流脓破溃情况(P=0.000),x线片髓腔变窄(P=0.036)上,B组发生率明显高于A组,有统计学差异。该样本中ESR的灵敏度、特异度、阳性预测值分别为46.67%,50.00%,38.89%,CRP的灵敏度、特异度、阳性预测值分别为86.67%,4.55%,38.24%,WBC的灵敏度、特异度、阳性预测值分别为26.67%,68.18%,36.36%。结论:血沉、c反应蛋白升高,与下肢骨不连感染之间并无确切的相关性,在研究组中,40.5%(15/37)是确实存在感染的,有将近60%的患者无需进行抗感染治疗,可直接进行骨不连的相关手术。这不仅可以减少患者的住院时间,减轻患者的经济负担,对于医疗资源的合理利用也大有裨益。感染与否的判断,可以先行血沉、c反应蛋白(灵敏性高)的初筛,有利于感染的早期发现,早期治疗,必要时需要进一步的检查(血培养等)。但出现局部流脓破溃或x线片提示髓腔变窄,患者感染的风险大大提高,有必要先行抗感染治疗。
[Abstract]:Objective: to study the correlation between ESR c reactive protein and infection in nonunion of lower extremity. Methods: 37 cases of lower extremity nonunion treated in trauma orthopedics department of our hospital from January 2014 to December 2016 were selected retrospectively. According to infection or not, 37 patients were divided into two groups: group A (non-infection group) and group B (infection group). Two groups of patients were collected, including the number of neutrophils, the number of neutrophils and the local tenderness, mobility, local empyema rupture, and the narrowing of the medullary cavity of the two groups at admission, and the two groups were followed up. Understand the operation time and hospital stay before fracture operation. SPSS 19.0 software was used for statistical analysis. Results: compared with group B, ESR (t 1.402) and CRP (0.75 3) were significantly higher in group A than in group B in terms of t test, WBC and neutrophil count (t = 1.158 and P = 0.274), but there was no significant difference between group A and B, but there was no significant difference between group A and group B (P < 0.05). The results showed that the number of neutrophils in group A was significantly higher than that in group B, but there was no statistical significance between group A and group B in terms of neutrophil count. The operative time of fracture operation in group A (t = 0.157) was longer than that in group B (t = 0.157), but there was no significant difference between the two groups. The days of hospitalization for fracture surgery in group B were higher than those in group A, but there was no statistical significance. There were no significant differences in PCT (P0. 000), neutrophil count (P0. 000), nonunion local tenderness (P0. 262), and activity (P0. 000) in the patients with PCT (P0. 000) or WBC (P0. 000), but the incidence rate in group B (P 0. 036) was significantly higher than that in group A (P 0. 036). The sensitivity, specificity and positive predictive value of ESR in this sample were 46.67 and 50.00and 38.89, respectively. The positive predictive values were 86.67 and 4.55 respectively. The sensitivity, specificity and positive predictive value of ESR were 26.67 and 26.67, respectively. Conclusion: there is no definite correlation between ESR and bone nonunion infection in the lower extremity. In the study group, 40.5% (15 / 37) of the patients were infected, and nearly 60% of the patients did not need anti-infective therapy. Direct nonunion related surgery can be performed. This can not only reduce the hospitalization time of patients, reduce the economic burden of patients, but also benefit the rational utilization of medical resources. The first screening of ESR c reactive protein (high sensitivity) is helpful for the early detection of infection, early treatment and further examination (blood culture, etc.) if necessary. However, the occurrence of local purulent rupture or X-ray film suggests that the medullary cavity becomes narrower, and the risk of infection is greatly increased. It is necessary to first treat the infection with anti-infection therapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683

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