骨折术后早期感染使用VSD保留内固定治疗时炎症指标的动态变化及其意义

doi:10.3969/j.issn.10073205.2018.11.007

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨白细胞（white blood cell，WBC）、红细胞沉降率(erythrocyte sedimentation rate，ESR）、降钙素原（procalcitonin，PCT）、C反应蛋白（creactive protein，CRP）在保留内固定的同时使用真空负压引流技术(vacuum sealing drainage,VSD)治疗骨折术后早期感染时的动态变化规律及其预后价值。
〖HTH〗方法〖HTSS〗〖KG*2〗将收治的45例骨折内固定术后深部感染患者采用VSD治疗。记录患者切口封闭术前1 d及术后1，3，7，14，21 d时患者的炎症指标WBC、ESR、PCT、CRP。所得结果按患者最终治愈与否分为治愈组和未治愈组，进行组内自身对照研究和组间对照研究。
〖HTH〗结果〖HTSS〗〖KG*2〗治愈组和未愈组外周血WBC组间、时点间、组间·时点间交互作用方面差异均无统计学意义（P＞005）。2组ESR均术后轻度升高，第3天达到高峰后逐渐下降，其组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）。治愈组和未治愈组PCT于术后均有不同程度下降，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）。治愈组CRP术后第3天到达高峰，然后下降，未治愈组术后随着时间增加CRP水平显著增加，其组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗CRP于术后早期升高、持续上升，提示保留内固定的同时治愈骨折内固定术后感染的可能性较小，应及早考虑取出内固定，改用其他治疗。WBC在术后3周内变化不明显，不建议用于早期预后的判断。

关键词: 骨折, 负压引流技术, C反应蛋白质, 红细胞沉降率

Abstract: ［Abstract］ Objective〖HTSS〗〓 To investigate the dynamic change rule and prognostic significance of white blood cell（WBC）, erythrocyte sedimentation rate（ESR）, procalcitonin（PCT） and creactive protein（CRP） in the treatment of early infection after fracture surgery by retaining internal fixation while using vacuum sealing drainage（VSD）.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 45 patients with deep infection after internal fixation were treated by VSD. WBC, ESR, PCT and CRP were recorded before and 1, 3, 7, 14 and 21 days after operations. The results were divided into cured group and noncured group according to whether the patients were cured or not. The selfcontrol study within the group and the intergroup control study were carried out.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no significant difference in the interaction of WBC in group, time, group·time between the cured group and the noncured group(P ＞005). ESR in both groups was increased slightly after operation, and decreased gradually after the peak on the 3 rd day. There were significant differences in the interaction among group, time, group·time(P＜005). PCT was decreased both in the cured group and the noncured group, and there were significant differences in the interaction among group, time, and group·time(P＜005). CRP in the cured group reached the peak on 3rd day after operations, and then was decreased; The level of CRP was increased significantly in the noncured group as time increases, and there were significant differences in the interaction among group, time, and group·time(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓CRP were raised early after operation, and continued to rise, suggesting that preserving internal fixation and curing the infection after internal fixation was less possibility. Removal of internal fixation should be considered and other therapies should be used. WBC did not change significantly within 3 weeks after operation, and was not recommended for early prognosis.

Key words: fractures, bone, vacuum sealing drainage； Creactive protein, erythrocyte sedimentation rate

孙建涛，贾世孔，刘明辉，白志津，白彦东，田学忠*. 骨折术后早期感染使用VSD保留内固定治疗时炎症指标的动态变化及其意义[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.11.007.

SUN Jiantao, JIA Shikong, LIU Minghui,BAI Zhijin, BAI Yandong, TIAN Xuezhong*. Dynamic changes and significance of inflammatory markers in patients with early postoperative infection treated with VSD retaining internal fixation#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.11.007.

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骨折术后早期感染使用VSD保留内固定治疗时炎症指标的动态变化及其意义

Dynamic changes and significance of inflammatory markers in patients with early postoperative infection treated with VSD retaining internal fixation#br#

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