發(fā)布時(shí)間：2018-07-03 02:32

  本文選題：骨不連 + 血沉��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究在下肢骨不連當(dāng)中,血沉、c反應(yīng)蛋白升高與感染的相關(guān)性。方法:回顧性選取2014年1月-2016年12月于我院創(chuàng)傷骨科進(jìn)行治療的37例下肢骨不連患者作為研究對(duì)象,依據(jù)感染與否,分為A(非感染組),B(感染組)兩組。收集兩組研究對(duì)象入院時(shí)的ESR、CRP、PCT、WBC,中性粒細(xì)胞數(shù)及骨不連局部壓痛,活動(dòng)度,局部流膿破潰情況,x線片髓腔變窄情況,并對(duì)兩組研究對(duì)象進(jìn)行隨訪,了解之前骨折手術(shù)的手術(shù)時(shí)間及住院天數(shù)。采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:兩組研究對(duì)象在運(yùn)用t檢驗(yàn)的指標(biāo)中,ESR(t=1.402,P=0.181)、CRP(t=0.753,P=0.457)、WBC(t=1.164,P=0.274)、中性粒細(xì)胞數(shù)(t=1.158,P=0.274)方面A組高于B組,但無(wú)統(tǒng)計(jì)學(xué)意義。兩組研究對(duì)象都進(jìn)行了隨訪,A組骨折手術(shù)的手術(shù)時(shí)間(t=0.157,P=0.877)較B組稍長(zhǎng),但無(wú)統(tǒng)計(jì)學(xué)意義,骨折手術(shù)住院天數(shù)(t=-1.658,P=0.119)上B組高于A組,但也無(wú)統(tǒng)計(jì)學(xué)意義。運(yùn)用χ2檢驗(yàn)的指標(biāo)中,PCT(P=1.000)、WBC(P=1.000)、中性粒細(xì)胞數(shù)(P=1.000)及骨不連局部壓痛(P=0.262),活動(dòng)度(P=1.000),均無(wú)明顯差異,在局部流膿破潰情況(P=0.000),x線片髓腔變窄(P=0.036)上,B組發(fā)生率明顯高于A組,有統(tǒng)計(jì)學(xué)差異。該樣本中ESR的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值分別為46.67%,50.00%,38.89%,CRP的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值分別為86.67%,4.55%,38.24%,WBC的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值分別為26.67%,68.18%,36.36%。結(jié)論:血沉、c反應(yīng)蛋白升高,與下肢骨不連感染之間并無(wú)確切的相關(guān)性,在研究組中,40.5%(15/37)是確實(shí)存在感染的,有將近60%的患者無(wú)需進(jìn)行抗感染治療,可直接進(jìn)行骨不連的相關(guān)手術(shù)。這不僅可以減少患者的住院時(shí)間,減輕患者的經(jīng)濟(jì)負(fù)擔(dān),對(duì)于醫(yī)療資源的合理利用也大有裨益。感染與否的判斷,可以先行血沉、c反應(yīng)蛋白(靈敏性高)的初篩,有利于感染的早期發(fā)現(xiàn),早期治療,必要時(shí)需要進(jìn)一步的檢查(血培養(yǎng)等)。但出現(xiàn)局部流膿破潰或x線片提示髓腔變窄,患者感染的風(fēng)險(xiǎn)大大提高,有必要先行抗感染治療。
[Abstract]:Objective: to study the correlation between ESR c reactive protein and infection in nonunion of lower extremity. Methods: 37 cases of lower extremity nonunion treated in trauma orthopedics department of our hospital from January 2014 to December 2016 were selected retrospectively. According to infection or not, 37 patients were divided into two groups: group A (non-infection group) and group B (infection group). Two groups of patients were collected, including the number of neutrophils, the number of neutrophils and the local tenderness, mobility, local empyema rupture, and the narrowing of the medullary cavity of the two groups at admission, and the two groups were followed up. Understand the operation time and hospital stay before fracture operation. SPSS 19.0 software was used for statistical analysis. Results: compared with group B, ESR (t 1.402) and CRP (0.75 3) were significantly higher in group A than in group B in terms of t test, WBC and neutrophil count (t = 1.158 and P = 0.274), but there was no significant difference between group A and B, but there was no significant difference between group A and group B (P < 0.05). The results showed that the number of neutrophils in group A was significantly higher than that in group B, but there was no statistical significance between group A and group B in terms of neutrophil count. The operative time of fracture operation in group A (t = 0.157) was longer than that in group B (t = 0.157), but there was no significant difference between the two groups. The days of hospitalization for fracture surgery in group B were higher than those in group A, but there was no statistical significance. There were no significant differences in PCT (P0. 000), neutrophil count (P0. 000), nonunion local tenderness (P0. 262), and activity (P0. 000) in the patients with PCT (P0. 000) or WBC (P0. 000), but the incidence rate in group B (P 0. 036) was significantly higher than that in group A (P 0. 036). The sensitivity, specificity and positive predictive value of ESR in this sample were 46.67 and 50.00and 38.89, respectively. The positive predictive values were 86.67 and 4.55 respectively. The sensitivity, specificity and positive predictive value of ESR were 26.67 and 26.67, respectively. Conclusion: there is no definite correlation between ESR and bone nonunion infection in the lower extremity. In the study group, 40.5% (15 / 37) of the patients were infected, and nearly 60% of the patients did not need anti-infective therapy. Direct nonunion related surgery can be performed. This can not only reduce the hospitalization time of patients, reduce the economic burden of patients, but also benefit the rational utilization of medical resources. The first screening of ESR c reactive protein (high sensitivity) is helpful for the early detection of infection, early treatment and further examination (blood culture, etc.) if necessary. However, the occurrence of local purulent rupture or X-ray film suggests that the medullary cavity becomes narrower, and the risk of infection is greatly increased. It is necessary to first treat the infection with anti-infection therapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R683

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