[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]
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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()
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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; 髋;  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.

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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