[1]黄丽槐,黄钢勇,吴建国,等.股骨颈骨折行髋关节置换术患者血沉、C反应蛋白和D-二聚体的变化及临床意义[J].中华老年骨科与康复电子杂志,2019,(02):62-67.[doi:10.3877/cma.j.issn.2096-0263.2019.02.001]
 Huang Lihuai,Huang Gangyong,Wu Jianguo,et al.Changes and clinical significance of erythrocyte sedimentation rate, CRP and D-dimer in femoral neck fracture patients undergoing hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(02):62-67.[doi:10.3877/cma.j.issn.2096-0263.2019.02.001]
点击复制

股骨颈骨折行髋关节置换术患者血沉、C反应蛋白和D-二聚体的变化及临床意义()
分享到:

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年02期
页码:
62-67
栏目:
基础研究
出版日期:
2019-04-05

文章信息/Info

Title:
Changes and clinical significance of erythrocyte sedimentation rate, CRP and D-dimer in femoral neck fracture patients undergoing hip arthroplasty
作者:
黄丽槐1黄钢勇2吴建国2魏亦兵2王思群2夏军2
674400 迪庆藏族自治州人民医院骨科1;200040 上海,复旦大学附属华山医院骨科2
Author(s):
Huang Lihuai1 Huang Gangyong2 Wu Jianguo2 Wei Yibing2 Wang Siqun2 Xia Jun2
1Department of Orthopedic, People’s Hospital of Diqing Tibetan Autonomous Prefecture, Diqing 674400, China; 2Department of Orthopedic, Huashan Hospital, Fudan University, Shanghai 200040, China
关键词:
血沉 C反应蛋白 D-二聚体 关节成形术置换 静脉血栓栓塞症
Keywords:
Blood Sedimentation CRP protein D-dimer Arthroplasty replacement hip Venous thromboembolism
DOI:
10.3877/cma.j.issn.2096-0263.2019.02.001
文献标志码:
A
摘要:
目的 分析股骨颈骨折行髋关节置换术患者血沉、C反应蛋白和D-二聚体的围手术期水平及其对髋关节置换手术预后判断的临床意义。方法 前瞻性收集髋关节置换术病例共152例,分为骨折组(股骨颈骨折,72例)及骨病组(股骨头坏死、髋关节骨性关节炎、成人髋关节发育不良,80例)。测量两组术前及术后血沉、C反应蛋白及D-二聚体水平,并随访术后两年以上,分析股骨颈骨折行髋关节置换患者术前血沉、C反应蛋白和D-二聚体的水平、围手术期变化特点及其对术后感染、血栓等并发症的预测价值。结果 术后随访6~49个月,平均(29±5)个月。术后随访24个月及以上患者138例,随访率90.8%。骨折组术前血沉为(26.575±6.292)mm/H,骨病组为(16.743±4.235)mm/H,差异有统计学意义(t=11.353,P<0.01)。骨折组术后血沉为(40.424±17.566)mm/H,骨病组为(36.643±11.836)mm/H,差异无统计学意义。骨折组术前C反应蛋白为(28.402±4.103)mg/L,骨病组为(5.666±1.692)mg/L,差异有统计学意义(t=44.133,P<0.001)。骨折组术后C反应蛋白为(75.405±18.345)mg/L,骨病组为(48.062±12.453)mg/L,差异有统计学意义(t=10.812,P<0.05)。骨折组术前D-二聚体为(1.613±0.833)mg/L,骨病组为(0.784±0.175)mg/L,差异有统计学意义(t=8.346,P<0.01),骨折组术后D-二聚体为(3.200±1.106)mg/L,骨病组为(2.852±1.415)mg/L,差异无统计学意义。术后两年随访显示两组均无假体周围感染病例,骨折组2例下肢症状性深静脉血栓形成,骨病组为1例,两组均无肺栓塞病例。骨折组术后两年髋关节Harris评分为(89±6)分,骨病组为(86±14)分,差异无统计学意义。结论 股骨颈骨折行髋关节置换患者的术前血沉、C反应蛋白和D-二聚体存在不同程度升高。经术前仔细筛查排除合并感染性疾病或下肢深静脉血栓后,术前血沉、C反应蛋白和D二聚体的增高并不增加术后假体周围感染率和血栓性并发症。
Abstract:
Objective To investigate the perioperative level of erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and D-dimer in femoral neck fracture patients undergoing hip arthroplasty and their clinical significance for the prognosis. Methods A total of 152 cases of hip arthroplasty were prospectively enrolled and divided into fracture group (femoral neck fracture) and non-fracture group (osteonecrosis of femoral head, hip osteoarthritis and developmental dysplasia of the hip). The ESR, CRP and D-dimer were measured before and after the surgery. Then their relation to postoperative infection, venous thrombosis and other complications were analyzed in more than 2 years follow-up. Results There were 72 cases in fracture group and 80 cases in non-fracture group. The mean follow-up period was 29±5 months ranging from 6 to 49 months, among which 138 cases(90.8%)were followed up more than 24 months. The preoperative ESR was (26.575±6.292) mm/h in fracture group and (16.743±4.235) mm/h in non-fracture group (t=11.353, P<0.01),with postoperative ESR (40.424±17.566) mm/h and (36.643±11.836) mm/h respectively. The preoperative CRP was (28.402±4.103) mg/L in fracture group, (5.666±1.692) mg/L (t=44.133, P<0.01) in non-fracture group with postoperative CRP (75.405±18.345) mg/L and (48.062±12.453) mg/L (t=10.812, P<0.05) respectively. The preoperative D-dimer was 1.61±0.83 mg/L in fracture group and (0.784±0.175) mg/L (t=8.346, P<0.01) in non-fracture group, with postoperative D-dimer (3.200±1.106) mg/L and (2.852±1.415) mg/L respectively. There was no case of periprosthetic joint infection (PJI) in either groups within two-years follow-up. There were 2 cases of deep venous thrombosis in the fracture group and 1 case in the non-fracture group, without pulmonary embolism in either group. The postoperative Harris score was (89±6) in fracture group and (86±14) in non-fracture group. Conclusion The preoperative ESR, CRP and D-dimer in femoral neck fracture patients often increase significantly. These abnormalities do not increase the risk of VTE or PJI postoperatively in those without proved preoperative infection or VTE.

参考文献/References:

1 曾德华, 何小进. 髋关节置换治疗老年人股骨颈骨折和股骨头坏死的临床分析 [J]. 临床和实验医学杂志, 2011, 10(15): 1163-1164.
2 张君伟, 齐磊, 李宝堂. 超敏C反应蛋白及D-二聚体在老年股骨颈骨折中的应用 [J]. 当代医学, 2012 (26): 76-77.
3 杜非. 老年股骨颈骨折关节置换术后血清白细胞介素-6和C反应蛋白的变化及临床意义 [J]. 中国老年学杂志, 2014 (12): 3343-3344.
4 黄瑞良, 林伟文, 阮艺, 等. 红细胞沉降率、C反应蛋白及血清淀粉样蛋白在不同类型人工髋关节置换术前后的变化及临床意义研究 [J]. 华西医学, 2014 (7): 1234-1237.
5 刘鹏. 股骨颈骨折人工股骨头置换围术期红细胞沉降率和血清炎症因子含量的变化及其临床意义分析[J]. 中国实用医药, 2018(31):85-86.5 .
6 王创明,郑洵,陈海波,等. 股骨颈骨折人工股骨头置换围术期红细胞沉降率和血清炎症因子含量的变化及其临床意义[J]. 中国医药导报,2017(18):98-101.
7 Dhupar S, Iorio R, Healy WL , et al. A comparison of discharge and two-week duplex ultrasound screening protocols for deep venousous thrombosis detection following primary total joint arthroplasty.J Bone Joint Surg (Am), 2006 ,88(11):2380-2385.
8 Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an Evidence-Based and validated criteria [J]. Journal of Arthroplasty, 2018, 33(5): 1309-1314
9 王德华. 骨伤科患者的血沉变化及临床意义 [J]. 中国医药指南, 2011, 9(12): 255-255.
10 代艳杰, 包学英, 吴玉华. CRP检测的临床意义 [J]. 北华大学学报:自然科学版, 2003 (3): 233-234.
11 夏璇, 黄清春. D-二聚体的检测及临床应用 [J]. 现代中西医结合杂志, 2011, 20(7): 908-910.
12 Kuzyk PR, Dhotar HS, Sternheim A, et al. Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes [J]. J Am Acad Orthop Surg, 2014, 22(3): 153-164.
13 陈捷, 邱赛琴, 崔志丹. 人工全髋关节置换术的术前准备及术中医护配合 [J]. 中国实用医药, 2013, 8(13): 222-224.
14 徐昭乐. 人工髋关节置换术后感染原因及防治措施 [J]. 中外医疗, 2012, 31(2): 71-71.
15 王岩, 郝立波, 周勇刚, 等. 人工髋关节置换术后感染的临床经验分析 [J]. 中华外科杂志, 2005 (20): 21-24.
16 梅仁富, 谌洪亮. 人工全髋关节置换术后感染的诊断和防治探讨 [J]. 新疆医学, 2015, 45(4): 501-502.
17 李铁军. 关节置换术围手术期感染的控制 [J]. 中华医院感染学杂志, 2011, 21(16): 3482-3428.

相似文献/References:

[1]赵立力,王魁向,张小冲,等.血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J].中华老年骨科与康复电子杂志,2023,(06):351.[doi:10.3877/cma.j.issn.2096-0263.2023.06.004]
 Zhao Lili,Wang Kuixiang,Zhang Xiaochong,et al.Diagnostic value of ESR to C-Reactive protein ratio in diagnosis of periprosthetic joint Infection[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(02):351.[doi:10.3877/cma.j.issn.2096-0263.2023.06.004]

备注/Memo

备注/Memo:
基金项目:上海市宝山区科技创新专项基金(18-E-24)
更新日期/Last Update: 2019-04-12