医学毕业论文Ⅱ期翻修治疗全膝置换术后感染化验指标动态观察研究.docVIP

Ⅱ期翻修治疗全膝置换术后感染化验指标动态观察研究 作者：孙振辉，刘军，张宇，田孟强，孙云波，曹建刚，王磊，王沛 【摘要】 [目的]分析Ⅱ期翻修治疗全膝置换(total knee arthroplasty,TKA)术后感染化验指标动态变化，探讨感染有效控制的敏感指标。[方法]自2004年6月～2008年4月本院共收治TKA术后延迟感染患者20例，均采用抗生素骨水泥间隔假体植入Ⅱ期关节翻修治疗，每周检查血常规、红血球沉降率(ESR)、C反应蛋白，观察上述指标的动态变化，分析最为敏感的监测指标。[结果]C反应蛋白对感染控制最为敏感，其最大值出现在抗生素骨水泥隔体植入术后第1周，之后迅速减低，术后第2周和术前相比具有统计学差异(t=105.84，Plt;0.05)。ESR的最大平均值出现在隔体植入术前，平均为52.14 mm/1 h，之后缓慢下降，术后6周时基本接近正常范围。C反应蛋白和ESR在Ⅱ期翻修假体植入术后均升高，术后第2周C反应蛋白恢复正常，而ESR仍高于正常范围。白细胞计数治疗期间呈总体下降趋势，隔体植入术后6周时平均为4.1×109/L，但存在较多的波动。中性粒细胞各个时期比较无统计学差异(t检验，Pgt;0.05)。[结论]Ⅱ期翻修治疗全膝置换术后感染控制指标中C反应蛋白最为敏感，治疗过程中一过性的升高无明显临床意义，ESR、白细胞计数相对不敏感，中性粒细胞百分比的动态变化无明显临床意义。 【关键词】 全膝关节置换; 迟发感染; Ⅱ期翻修; C反应蛋白 　　Abstract: [Objective]To analyze the dynamic changing of inflammatory markers　in second stage revision for infected TKA and to explore the sensitive indicators. [Methods]From June 2004 to April 2008，20 cases of infected TKA were admitted and treated by the two stages knee revision. The inflammatory markers included full blood count, erythrocyte sedimentation rate (ESR).C-reactive protein (CRP) were examined weekly, and to evaluate the dynamic changes and the most sensitive indicators.[Results]CRP was the most sensitive index for infection control, and its maximum presented in the first week post antibiotic bone cement implantation, followed by rapid reduction in the second week and there was statistical difference compared to the CRP level before surgery(t=105.84, Plt;0.05). the largest ESR appeared before the spacer implantation, with an average of 52.14 mm/1h, after slow decline it returned to the normal range 6 weeks later. CRP and ESR post the prosthesis implant operation rose again and CRP returned to normal after the second week while ESR was still higher. White blood cell count during treatment showed an overall downward trend, 6 weeks after implantation it amounted to an average of 4.1×109/L, but there was more volatility. Neutrophil cell different during the periods showed no significant difference.[Conclusion]CRP is the mos