發(fā)布時間：2018-03-03 19:51

  本文選題：血沉　切入點：C-反應蛋白　出處：《吉林大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的： 關節(jié)置換術后感染被稱為人工關節(jié)置換災難性并發(fā)癥,是導致人工關節(jié)置換術后翻修的常見原因。本文通過收集大量關節(jié)置換手術患者的術前血沉（erythrocyte sendimentation rate,ESR）和C-反應蛋白（C-reactive protein,CRP）以及術后出現(xiàn)早期感染的情況，，探討術前不同升高水平ESR和CRP與人工關節(jié)置換術后早期安全性的關系。 方法： 收集我科2012年~2014年行關節(jié)置換病例811例（898髖和膝），記錄每一個患者術前ESR和CRP以及術后出現(xiàn)早期感染的情況。其中股骨頭缺血性壞死患者362例（402髖），膝關節(jié)骨性關節(jié)炎患者339例（376膝），成人髖關節(jié)發(fā)育不良繼發(fā)骨性關節(jié)炎或髖關節(jié)脫位患者110例（120髖）。根據(jù)術前ESR和CRP值的高低進行分組，分別分為正常組，1-2倍組，2-3倍組，大于3倍組等四組。采用適當?shù)慕y(tǒng)計學方法進行統(tǒng)計學分析，比較術前ESR和CRP不同水平組術后出現(xiàn)早期感染情況的差異。 結果： 股骨頭缺血性壞死患者的術前ESR和CRP升高的幾率和程度均較膝關節(jié)骨性關節(jié)炎和成人髖關節(jié)發(fā)育不良高。所有898例關節(jié)中共出現(xiàn)了6例關節(jié)置換術后早期感染，并且6例均為人工全膝關節(jié)置換術（total knee arthroplasty,TKA）術后患者，因股骨頭缺血性壞死或成人髖關節(jié)發(fā)育不良繼發(fā)骨性關節(jié)炎行人工全髖關節(jié)置換（total hiparthroplasty,THA）手術患者均未出現(xiàn)術后早期感染。6例感染患者中包括淺表感染4例，深部感染2例。術前ESR和CRP不同程度升高的三組之間感染率無明顯差異。術前ESR和CRP不同程度升高的三組的感染率均高于正常組，差異具有統(tǒng)計學意義。（P㩳0.05） 結論： 術前ESR和CRP與疾病種類有明顯的關系，對于不同種類的疾病，在術前初步評估手術安全性時ESR和CRP應當有不同的參考值基線。術前ESR和CRP的升高會增加關節(jié)置換術后早期感染的風險，但是早期感染風險與術前ESR和CRP的升高的程度無明顯相關性。由于ESR和CRP的影響因素較多，不能單獨應用術前ESR和CRP值的高低來評估手術的安全性。對于術前ESR和CRP升高的患者，應結合其他各方面的因素，包括疾病的種類，年齡，性別，肥胖程度，是否有其他內(nèi)科合并癥，病人臨床表現(xiàn)及局部體征，術前關節(jié)穿刺，以及術中冰凍切片等進行綜合評估，最后確定能否進行關節(jié)置換以及手術的安全性。
[Abstract]:Objective:. Infection after arthroplasty is known as a catastrophic complication of arthroplasty. In this paper, we collected a large number of preoperative erythrocyte erythrocyte sedimentation rate (ESR) and C-reactive protein (C-reactive protein), and the incidence of early infection after arthroplasty. To investigate the relationship between ESR, CRP and early safety after arthroplasty. Methods:. From 2012 to 2014, we collected 811 cases of arthroplasty from 2012 to 2014, and recorded ESR and CRP before operation and early infection after operation in each patient. Among them, 362 patients with avascular necrosis of femoral head were treated with hip and knee bone. There were 339 cases of osteoarthritis with osteoarthritis or dislocation of hip joint, and 110 cases of adult hip dysplasia with osteoarthritis or dislocation of hip. The patients were divided into two groups according to the preoperative ESR and CRP values. The patients were divided into four groups: normal group (1-2 times) and group (> 3 times). The difference of early infection between ESR and CRP before and after operation was compared by using appropriate statistical method. Results:. The increase of ESR and CRP in patients with avascular necrosis of femoral head before operation was higher than that of osteoarthritis of knee joint and adult hip dysplasia. 6 cases of early infection after arthroplasty were found in all 898 cases of avascular necrosis of femoral head. All the 6 patients were treated with total knee arthroplasty. Total total hip replacement (total hip arthroplasty) was performed on patients with osteoarthritis secondary to avascular necrosis of femoral head or adult hip dysplasia. There were no early postoperative infections in 6 cases, including superficial infection in 4 cases. There was no significant difference in the infection rate between the three groups with different degrees of ESR and CRP before operation, but the infection rate of the three groups with different degrees of ESR and CRP was higher than that of the normal group, and the difference was statistically significant. 0.05). Conclusion:. Preoperative ESR and CRP were significantly related to the types of diseases. ESR and CRP should have different reference baselines for preoperative preliminary evaluation of surgical safety. Increased preoperative ESR and CRP may increase the risk of early infection after arthroplasty. However, there was no significant correlation between the risk of early infection and the increase of ESR and CRP before operation, because there were many factors affecting ESR and CRP. The preoperative ESR and CRP values should not be used alone to evaluate the safety of surgery. For patients with elevated ESR and CRP, other factors, including disease type, age, sex, and obesity, should be taken into account. Whether there are other internal complications, clinical manifestations and local signs of the patients, preoperative joint puncture and intraoperative frozen section were comprehensively evaluated, and the safety of joint replacement and operation was finally determined.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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本文編號：1562450