检测ESR、CRP在TKA术后感染及二期翻修手术中的临床意义  

Clinical significance of ESR and CRP in postoperative infection and second-stage revision after total knee arthroplasty

作　　者：赵丰年 黄志鹏 康俊杰 韩鹏[1] 邹志晨 宋科官[1] ZHAO Fengnian;HUANG Zhipeng;KANG Junjie;HAN Peng;ZOU Zhichen;SONG Keguan(Department of Three Orthopedics,The First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院骨三科,黑龙江哈尔滨150001

出　　处：《检验医学与临床》2021年第23期3395-3398,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨检测红细胞沉降率(ESR)、C-反应蛋白(CRP)在全膝关节置换术(TKA)术后感染诊断中的意义,及其对二期翻修手术时机选择的意义。方法将2013年1月至2019年11月该院收治的6例TKA术后感染患者纳入感染组,同期12例TKA术后非感染患者纳入对照组。收集患者一般临床资料及实验室检查结果,包括入院后、间隔假体置入术后、二期翻修手术前的ESR、CRP水平及间隔假体置入时间等。比较两组间临床资料及实验室检查指标,并通过受试者工作特征曲线(ROC曲线)分析各指标诊断TKA术后感染的效能。结果感染组患者ESR、CRP水平显著高于对照组(P<0.05);二期翻修手术前患者ESR、CRP水平显著低于感染后,差异有统计学意义(P<0.05)。ESR与CRP联合检测诊断TKA术后感染的特异度为83.3%,灵敏度为100.0%。TKA术后感染患者间隔假体置入术后(26.67±10.50)周进行二期翻修手术,与二期翻修手术前ESR及CRP水平无相关性(P>0.05)。结论ESR及CRP联合检测有助于诊断TKA术后感染,对二期翻修手术时机选择及抗菌药物应用有临床指导意义。Objective To investigate the significance of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in the diagnosis of infection after total knee arthroplasty(TKA)and their implications for the timing of second-stage revision surgery.Methods Six patients with postoperative infection(infection group)after TKA admitted from January 2013 to November 2019 were included in this study,and 12 non-infected patients after TKA during the same period served as the control group.The general clinical data and laboratory test results of the patients were collected,which included ESR,CRP levels and spacer placement time after admission,after spacer placement surgery,and before second-stage revision surgery.Statistical methods were applied to compare data such as clinical data and laboratory tests between the two groups,and the efficacy of indicators in diagnosing postoperative TKA infection was analyzed by the receiver operating characteristic curve(ROC curve).Results ESR and CRP levels were significantly higher in infection group than in the control group(P<0.05).ESR and CRP levels were significantly lower in patients before secondary revision surgery than those of after infection,and the differences were statistically significant(P<0.05).The combined diagnostic specificity of ESR and CRP was 83.3%,and the sensitivity was 100.0%.The mean time to second-stage revision surgery in patients with post-TKA infection was(26.67±10.50)weeks,and there was no correlation with ESR and CRP before second-stage revision surgery(P>0.05).Conclusion The combined detection of ESR and CRP is helpful in diagnosing post-TKA infection,and has clinical guidance significance for the second-stage revision surgery and the application of antibiotics.

关 键 词：全膝关节置换术 二期翻修手术 感染 红细胞沉降率 C-反应蛋白 

分 类 号：R684[医药卫生—骨科学]