【作者】 王旭；

【导师】 薛金伟；

【作者基本信息】 河北大学 ， 外科学， 2023， 硕士

【摘要】 目的:分析全膝关节置换术(Total Knee Arthroplasty,TKA)患者术后患膝皮温变化规律及其与术后白细胞(White Blood Cell,WBC)、C-反应蛋白(C Reactive Protein,CRP)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、患膝疼痛、患膝肿胀程度变化的相关性,并探讨其在术后感染和非感染炎症反应鉴别诊断中的意义。方法:选取2021年1月至2022年1月于河北大学附属医院行单侧TKA的36名患者为研究对象,分别于术前1天,术后第1天、第4天、第7天、第10天、第14天、第1个月、第2个月、第3个月、第6个月测量双膝皮温、WBC、CRP、ESR,并采用数字评定量表(Numerical Rating Scale,NRS)评估患膝疼痛程度,通过双侧大腿周径差评估患膝肿胀程度。采用配对t检验对双膝皮温变化进行比较。通过重复测量方差分析和非参数检验法比较术前、术后不同时间点各指标变化差异,分析术后双膝皮温差、WBC、CRP、ESR、患膝疼痛评分及双侧大腿周径差变化的规律。通过直线相关分析和秩相关分析法分析双膝皮温差变化与WBC、CRP、ESR、患膝疼痛评分及双侧大腿周径差变化的相关性。结果:配对t检验结果显示:术前、术后第6个月患膝和健膝皮温差异无统计学意义(P>0.05),术后第1天、第4天、第7天、第10天、第14天、第1个月、第2个月、第3个月患膝皮温高于健膝皮温(P<0.05)。重复测量方差分析结果显示:TKA术前、术后各时间点双膝皮温差(F=1106.515,P<0.001)、WBC(F=245.332,P<0.001)、CRP(F=506.445,P<0.001)、ESR(F=197.099,P<0.001)、双侧大腿周径差(F=2353.411,P<0.001)均存在显著差异,术后均表现为先升高后逐渐降低的变化趋势。其中双膝皮温差于术后第4天达到峰值,为2.29±0.17℃,术后第6个月恢复至术前水平(P>0.05);WBC于术后第1天达到峰值,为10.50±1.99×10~9/L,术后第10天恢复至术前水平(P>0.05);CRP于术后第4天达到峰值,为61.65±11.05 mg/L,术后第1个月恢复至术前水平(P>0.05);ESR于术后第7天达到峰值,为69.22±10.54 mm/h,术后第3个月恢复至术前水平(P>0.05);双侧大腿周径差于术后第4天达到峰值,为51.06±4.33 mm,术后第2个月基本恢复至术前水平(P>0.05)。非参数检验结果显示:TKA术前、术后不同时间点患膝疼痛评分存在显著差异(χ~2=308.865,P<0.001),术后也表现为先升高后逐渐降低的变化趋势,于术后第1天达到峰值,为7.36±0.83分,术后第6个月疼痛评分降至最低,为0.86±0.64分。直线相关分析和秩相关分析结果显示:WBC(ρ=0.936,P<0.001)、CRP(ρ=0.988,P<0.001)、ESR(r=0.773,P=0.009)、患膝疼痛评分(r=0.769,P=0.009)及双侧大腿周径差(r=0.934,P<0.001)变化与双膝皮温差变化均呈正相关。结论:TKA术后患膝皮温较健膝皮温升高。术后双膝皮温差、WBC、CRP、ESR、患膝疼痛评分及双侧大腿周径差均表现为先快速升高后逐渐降低的变化趋势。双膝皮温差的变化与WBC、CRP、ESR、患膝疼痛评分及双侧大腿周径差的变化均呈正相关,这可能是术后非感染性炎症反应的结果。更多还原

【Abstract】 Objective:To analyze the changes of skin temperature of affected knee after total knee arthroplasty(TKA)and its correlation with postoperative white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),knee pain and knee swelling,and to explore its significance in the differential diagnosis of postoperative infection and non-infectious inflammatory reaction.Methods:Thirty-six patients who underwent unilateral total knee arthroplasty(TKA)in the Affiliated Hospital of Hebei University from January 2021 to January 2022 were selected.The skin temperature of both knees,white blood cell(WBC),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were measured 1 day before operation and 1 day,4 days,7 days,10 days,14 days,1 month,2 months,3 months and 6 months after operation.The degree of knee pain was evaluated by numerical rating scale(NRS)and the degree of knee swelling was evaluated by the circumference difference of bilateral thighs.Paired t-test was used to compare the changes of skin temperature of both knees.The changes of knee skin temperature difference,white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),knee pain score and bilateral thigh circumference difference were analyzed by repeated measurement analysis of variance and nonparametric test.Linear correlation analysis and rank correlation analysis were used to analyze the correlation between the changes of knee skin temperature difference and white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),knee pain score and bilateral thigh circumference difference.Results:The results of paired t-test showed that there was no significant difference in skin temperature between affected knee and healthy knee before operation and 6 months after operation(P>0.05).The skin temperature of affected knee was higher than that of healthy knee on the 1 day,4 days,7 days,10 days,14 days,1 month,2 months and 3 months after operation(P<0.05).The results of repeated measurement analysis of variance showed that there were significant differences in skin temperature difference of both knees(F=1106.515,P<0.001),white blood cell(WBC)(F=245.332,P<0.001),C-reactive protein(CRP)(F=506.445,P<0.001),erythrocyte sedimentation rate(ESR)(F=197.099,P<0.001)and circumference difference of bilateral thighs(F=2353.411,P<0.001)at different time points after total knee arthroplasty(TKA).After operation,they all showed the trend of increasing at first and then decreasing gradually.The skin temperature difference of both knees reached the peak value of 2.29±0.17℃on the 4th day after operation and returned to the preoperative level at the 6th month after operation(P>0.05).The white blood cell(WBC)reached the peak value of 10.50±1.99×10~9/L on the first day after operation and returned to the preoperative level on the 10th day after operation(P>0.05).C-reactive protein(CRP)reached the peak value of 61.65±11.05 mg/L on the 4th day after operation and returned to the preoperative level in the first month after operation(P>0.05).The erythrocyte sedimentation rate(ESR)reached the peak value of 69.22±10.54 mm/h on the 7th day after operation and returned to the preoperative level on the 3rd month after operation(P>0.05),and the circumference difference of bilateral thighs reached the peak value of 51.06±4.33 mm on the 4th day after operation,and basically returned to the preoperative level at the second month after operation(P>0.05).The results of nonparametric test showed that there were significant differences in knee pain scores at different time points after total knee arthroplasty(TKA)(χ~2=308.865,P<0.001).The postoperative pain scores also increased at first and then decreased gradually,reaching the peak value of 7.36±0.83 points on the first day after operation and decreasing to the lowest score of 0.86±0.64 points on the 6th month after operation.The results of linear correlation analysis and rank correlation analysis showed that the changes of white blood cell(WBC)(ρ=0.936,P<0.001),C-reactive protein(CRP)(ρ=0.988,P<0.001),erythrocyte sedimentation rate(ESR)(r=0.773,P=0.009),knee pain score(r=0.769,P=0.009)and circumference difference of bilateral thighs(r=0.934,P<0.001)were positively correlated with the changes of skin temperature difference of both knees.Conclusion:The skin temperature of affected knee was higher than that of healthy knee after total knee arthroplasty(TKA).After operation,the knee skin temperature difference,white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),knee pain score and bilateral thigh circumference difference increased rapidly at first and then decreased slowly.The changes of knee skin temperature difference were positively correlated with white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),knee pain score and bilateral thigh circumference difference,which may be the result of non-infectious inflammatory reaction after operation.更多还原