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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
Changes and clinical significance of erythrocyte sedimentation rate, CRP and D-dimer in femoral neck fracture patients undergoing hip arthroplasty
【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 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.
【Key words】 Blood Sedimentation; CRP protein; D-dimer; Arthroplasty,replacement,hip; Venous thromboembolism;
- 【文献出处】 中华老年骨科与康复电子杂志 ,Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition) , 编辑部邮箱 ,2019年02期
- 【分类号】R687.4
- 【被引频次】13
- 【下载频次】257