髋膝关节置换手术前后CRP、ESR的变化情况比较及其临床意义

Comparison of changes of C-reactive protein level and erythrocyte sedimentation rates before and after joint replacement and its clinical significance

目的研究行髋、膝关节置换治疗的患者血清c反应蛋白(CRP)和红细胞沉降率(ESR)在手术前后变化的比较及其临床意义。方法前瞻性设计要行关节置换的患者在术前和术后第1～3天、7 d、14 d、3个月血清CRP和ESR的变化情况。纳入2010年3～12月份非股骨颈骨折患者在该院行关节置换的202例患者,均获得完整随访。其中男90例,女112例;年龄18～89岁,平均53.5岁。87例行非骨水泥的全髋关节置换术(THR)、64例全骨水泥THR,51例行骨水泥型全膝关节置换术(TKR)。结果髋膝关节置换患者血清CRP浓度均在术后迅速增高,在术后第2～3天达到峰值[生物型THR(126.68±51.94)ms/L,骨水泥型THR(125.92±59.69)ms/L,TKR(147.42±36.32)mg/L],以后逐渐降低,到术后第3个月时均回落到正常水平。ESR在术后也逐渐升高,到第7天生物型THR患者ESR(70.62±30.13)mm/h,水泥型THR患者ESR(61.79±29.52)mm/h,TKR患者(66.22±35.75)mm/h都达到峰值。THR患者术后3个月基本回落到术前的水平,TKR患者在术后3个月时的ESR水平仍高于术前水平。结论人工关节置换术后CRP值呈曲线变化,于术后第2～3天达峰值,之后逐渐下降至正常水平。血清CRP值比ESR变化快而大,恢复到正常值的速度也快。骨水泥对CRP的变化无影响。

【Objective】 To study the difference of CRP and ESR levels between patients with hip and knee replacement and the clinical significance.【Methods】 A prospective study was designed to observe the changes of CRP levels and ESR in patients who need a surgery of joint replacement before and at 1～3,7,14 days,3 months after the operation.ALL cases received follow-up.There are 90 males and 112 females with average of 53 years,ranging from 18 to 89 years.87 had cementless total hip replacement（THR）,64 had hybrid THR,51 underwent cemented total knee replacement（TKR）.【Results】 In all groups serum CRP level increased rapidly after surgery,peaking at day 2～3（cementless THR（126.68±51.94） mg/L,cement THR（125.92±59.69） mg/L,TKR（147.42±36.32） mg/L,and dropping gradually to pre-operative values at the end of the third month in all the three groups.ESR peaked at day 7 respectively after operation in all groups（cementless THR（70.62±30.13） mm/h,cemented THR（61.79±29.52） mm/h,TKR（66.22±35.75） mm/h,dropping to pre-operative values at the end of the third month in THR patients.But the ESR level of TKR patients still higher than pre-operative values.【Conclusion】 The CRP values increased rapidly after surgery until the peak at day 2～3,then dropping gradually to normal values.Serum CRP levels changed more rapidly and greater than ESR.There is no correlation between cement and CRP response.