【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。更多还原

【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 twoyears follow-up. There were 2 cases of deep venous thrombosis in the fracture group and 1 case in the nonfracture 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.更多还原