| 阿卜杜萨拉木·玉苏音,李国庆,汪洋,等.术前不明原因C-反应蛋白和红细胞沉降率升高对初次全膝关节置换术后早期假体周围感染的影响.骨科,2022,13(4): 325-332. |
| 术前不明原因C-反应蛋白和红细胞沉降率升高对初次全膝关节置换术后早期假体周围感染的影响 |
| Effect of Preoperative Idiopathic CRP and ESR Elevation on Early Periprosthetic Joint Infection after Primary Total Knee Arthroplasty |
| 投稿时间：2022-01-05 |
| DOI：10.3969/j.issn.1674-8573.2022.04.008 |
| 中文关键词: C-反应蛋白 红细胞沉降率 骨关节炎 全膝关节置换术 假体周围感染 |
| 英文关键词: C-reactive protein Erythrocyte sedimentation rate Knee osteoarthritis Arthroplasty, replacement, knee Periprosthetic joint infection |
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| 目的 探讨术前不明原因的C-反应蛋白（CRP）和红细胞沉降率（ESR）升高对初次全膝关节置换术（total knee arthroplasty，TKA）术后早期假体周围感染（periprosthetic joint infection，PJI）的影响。方法 回顾性分析2016年11月至2021年10月在我院因膝骨关节炎行TKA治疗的病人，均排除CRP、ESR升高的明显诱因，经纳入和排除标准获得882例，男293例，女589例，年龄为（67.00±7.91）岁（43~98岁）。根据病人术前血CRP和ESR水平将病人分为四组：双阳组44例，CRP阳性组27例，ESR阳性组176例，双阴组635例。评估四组病人行TKA术后90 d内PJI的发生率，通过二元Logistic回归分析CRP和ESR升高的风险因素。结果 双阳组、CRP阳性组、ESR阳性组和双阴组术后90 d内的PJI发生率分别为6.82%（3/44）、0（0/27）、2.27%（4/176）、1.10%（7/635），四组的感染率比较，差异有统计学意义（P=0.022）。合并糖尿病（OR=2.629，95% CI：1.535~4.502，P＜0.001）和身体质量指数（BMI）高（OR=2.575，95% CI：1.867~3.552，P＜0.001）是术前CRP水平升高的风险因素；女性（OR=2.701，95% CI：1.810~4.031，P＜0.001）、高BMI（OR=1.207，95% CI：2.435~3.942，P＜0.001）和合并糖尿病（OR=1.827，95% CI：1.218~2.739，P=0.004）是术前ESR水平升高的风险因素。结论 术前不明原因CRP和ESR升高增加初次TKA术后90 d内PJI发生风险，应结合性别、BMI、是否合并糖尿病，最后确定能否进行手术，是否需要围术期的额外治疗来预防和降低PJI的发生。 |
| 英文摘要: |
| Objective To investigate the effect of preoperative idiopathic C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) elevation on early periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). Methods A retrospective analysis was performed on the patients who were treated with TKA for knee osteoarthritis in our hospital from November 2016 to October 2021. After excluding those with known diseases having elevated CRP and ESR, 882 KOA patients who met the initial screening criteria were enrolled, namely, 293 males and 589 females, aged (67.00±7.91) years (range, 43-98 years). They were divided into four groups based on the preoperative CRP level and ESR: 44 cases in both elevated group, 27 cases in CRP elevated group, 176 cases in ESR elevated group, and 635 cases in both normal group. The incidence of PJI within 90 days after TKA was evaluated in the four groups. The risk factors of CRP and ESR were analyzed by binary Logistic regression. Results The infection rate in the both elevated, CRP elevated, ESR elevated and both normal groups was 6.82% (3/44), 0 (0/27), 2.27% (4/176), and 1.10% (7/635), respectively. There was significant difference in the infection rate among the four groups (P=0.022). Diabetes mellitus (OR=2.629, 95% CI: 1.535-4.502, P＜0.001) and elevated body mass index (BMI) (OR=2.575, 95% CI: 1.867-3.552, P＜0.001) were risk factors for CRP elevation; female (OR=2.701, 95% CI: 1.810-4.031, P＜0.001), elevated BMI (OR=1.207, 95% CI: 2.435-3.942, P＜0.001) and diabetes mellitus (OR=1.827, 95% CI: 1.218-2.739, P=0.004) were risk factors for ESR elevation. Conclusion Preoperative idiopathic CRP and ESR elevation increase the risk of 90-day PJI after primary TKA. Gender, BMI and diabetes mellitus should be taken into consideration, then deciding whether surgery can be performed, or additional perioperative treatment is needed to reduce the occurrence of PJI. |
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