摘要
[目的]研究术前合并ESR和/或CRP升高的拟行人工关节置换手术患者的诊治流程。[方法] 2017年于本科拟行人工关节置换术合并ESR和/或CRP升高的患者93例,男25例,女68例,膝关节75例,髋关节18例。入院常规查ESR和CRP,伴有升高患者,除外内科疾病和其他器官感染后,需检查血降钙素原,并行关节穿刺,同时进行MRI检查。根据关节液细胞计数和分类、关节液培养和术中病理结果,选择人工关节置换或者清创术。[结果] 93例患者ESR平均值为(32.21±18.52) mm/h,CRP平均值为(15.63±25.72) mg/L。复查仍升高患者26例,其中诊断为内科疾病和其他器官感染8例,进行关节腔穿刺16例,拒绝关节腔穿刺2例。关节腔穿刺的患者中,关节液培养阳性8例,其中4例行关节清创术,4例行药物保守治疗。关节液培养阴性8例,其中根据术中冰冻病理行关节清创术2例,行人工关节置换术6例。术中软组织培养阳性4例,阴性8例,其中2例软组织研磨后培养瓶培养阳性。[结论]术前合并ESR和/或CRP升高的拟行人工关节置换手术患者不能除外感染性关节炎的可能性,需按照诊疗流程进行诊治,避免关节内感染的漏诊。
[Objective] To summarize the diagnosis and treatment algorithm of candidates for major joint arthroplasty with elevated erythrocyte sedimentation rate(ESR) and/or C-reactive protein(CRP).[Methods] In 2017, 93 patients who were candidates for major joint arthroplasty with elevated ESR and/or CRP were included into this study in our department. The patients included 25 males and 68 females, involving 75 knees and 18 hips. The ESR and CRP were routine tested inhospital. For the patients with elevated ESR and/or CRP, the serum procalcitonin(PCT), MRI, joint aspiration and bacterial culture, even intraoperative biopsy were conducted. The treatments, including arthroplasty and debridement, were chosen according to the results of cell count and differentiation of synovial fluid, bacterial culture and frozen biopsy in operation.[Results] The 93 patients proved ESR of(32.21±18.52) mm/h and CRP of(15.63±25.72) mg/L. Of them, 26 patients remained elevated ESR and CPR in the reexamination. Eight patients were diagnosed of internal medical disease and infection of other organs, and16 patients received the joint aspiration whereas 2 patients refused. Among the 16 patients received joint aspiration, 8 patients were of positive results and 8 were of negative bacterial culture. In 8 patients with positive results, 4 had debridement and the other 4 had conservative treatment, by contrast, in the 8 patients with negative bacterial culture of joint aspiration, 6 underwent arthroplasty, 2 had debridement performed according to intraoperative frozen biopsy. Among the 12 patients who had intraarticular tissue samples for bacterial culture during operation, 4 patients were positive including 2 with positive results after the tissue sample grounded,whereas 8 patients were of negative results.[Conclusion] The patients who are candidates for major joint arthroplasty with elevated ESR and/or CRP should follow the diagnosis and treatment algorithm rigidly, to rule out the infectious arthritis.
作者
杨昕
曹永平
文立成
朱天岳
柴卫兵
卢宏章
刘震宁
李军
叶一林
张道俭
YANG Xin;CAO Yong-ping;WEN Li-cheng;ZHU Tian-yue;CHAI Wei-bing;LU Hong-zhang;LIU Zhen-ning;LI Jun;YE Yi-lin;ZHANG Dao-jian(Orthopedic Department, The First Hospital of Peking University, Beijing 100034, China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第9期789-793,共5页
Orthopedic Journal of China
