骨科金属内固定物置入后患者血清C-反应蛋白和红细胞沉降率的变化

Changes in serum C-reactive protein level and erythrocyte sedimentation rate in patients after use of orthopedic metal implants

背景:骨科修复手术大部分会使用内置物,这种方法虽然会为患者带来好的治疗效果,但同时会使患者发生感染。而血清C-反应蛋白和红细胞沉降率是临床上便于检测炎症的相关指标。目的:观察骨科内置物置入后患者血清C-反应蛋白和红细胞沉降率的变化。方法:回顾性分析山东省临朐县人民医院骨科2012年10月至2014年10月收治的100例安置金属内置物患者的临床资料,其中36例置入髓内钉,34例置入人工关节,30例置入固定钢板。根据置入后是否感染分为两组,无感染组52例,感染组48例。内置物置入后第1,3,7,14,21天检测两组患者血清C-反应蛋白水平及红细胞沉降率,同时结合其他化验结果、切口情况以及患者体温来判断是否发生感染,总结并分析疾病进展情况,为抗生素合理应用提供可靠依据。结果与结论:两组患者置入后第1天血清C-反应蛋白、红细胞沉降率相比差异有显著性意义(t=3.43,P<0.05;t=3.78,P<0.05);两组患者置入后第3天血清C-反应蛋白、红细胞沉降率相比差异有显著性意义(t=3.35,P<0.05;t=3.68,P<0.05);两组患者置入后第7天血清C-反应蛋白、红细胞沉降率相比差异有显著性意义(t=3.28,P<0.05;t=3.54,P<0.05);两组患者置入后第14天血清C-反应蛋白、红细胞沉降率相比差异有显著性意义(t=2.56,P<0.05;t=3.02,P<0.05);两组患者置入后第21天血清C-反应蛋白、红细胞沉降率相比差异无显著性意义(t=1.76,P>0.05;t=1.98,P>0.05)。提示骨科内置物置入后应密切观察患者血清C-反应蛋白及红细胞沉降率变化,同时需结合切口情况、临床体温等资料综合分析判断是否出现了内置物置入后感染,从而制定有效的修复对策,为临床合理治疗及预防提供可靠依据。

BACKGROUND： Most orthopedic surgeries use metal implants. Although this approach will benefit for patients, it simultaneously makes patients infected by some bacteria. Serum C-reactive protein level and erythrocyte sedimentation rate are two indices for clinically determining the inflammation. OBJECTIVE： To investigate the changes in serum C-reactive protein level and erythrocyte sedimentation rate in patients after use of orthopedic metal implants. METHODS： The clinical data of 100 patients who used metal implants between October 2012 and October 2014 at the Department of Orthopedics, Linqu People＇s Hospital of Shandong Province of China were retrospectively analyzed. Among these patients, 36 patients received implantation of intramedullary nails, 34 patients artificial joint, and 30 patients steel plates. At 1, 3, 7, 14, and 21 days after implantation, infection was determined according to serum C-reactive protein level and erythrocyte sedimentation rate, as well as other laboratory indices, wound healing, and body temperature. According to these indices, the patients were assigned to two groups： no infection（n=52） and infection（n=48）. Disease progression was analyzed for providing reliableevidence for rational use of antibiotics. RESULTS AND CONCLUSION： There were significant differences in serum C-reactive protein level and erythrocyte sedimentation rate in patients between infection and non-infection groups at 1（t=3.43, P〈0.05; t=3.78, P〈0.05）, 3（t= 3.35, P〈0.05; t=3.68, P〈0.05）, 7（t=3.28, P〈0.05; t=3.54, P〈0.05）, and 14 days after use of orthopedic metal implants（t=2.56, P〈0.05; t=3.02, P〈0.05）. No significant differences in these two indices were observed between infection and non-infection groups at 21 days after use of orthopedic metal implants（t=1.76, P〉0.05; t=1.98, P〉0.05）. These findings suggest that after use of orthopedic metal implants, serum C-reactive protein level and erythrocyte sedimentation rate in patients should be closely monitored and simultaneously other indices like wound healing and body temperature should be determined to determine whether infection occurs after use of orthopedic metal implants so as to develop effective repair strategies. This will provide reliable clinical evidence for rational treatment and prevention of orthopedics-related diseases.