Cai Pengde, Hu Yihe, Liu Hua, Li Mingqing, Song Xinglai
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 May;37(5):500-4. doi: 10.3969/j.issn.1672-7347.2012.05.013.
To explore the difference in level of pain experienced by patients with total hip arthroplasty between aseptic loosening and periprosthetic infection, and to examine the correlation between C-reactive protein (CRP) and pain.
Fifty-one patients (recruited from our hospital between March 2010 and November 2011) suffering aseptic loosening or periprosthetic infection after total hip arthroplasty were included in this study: 24 males and 27 females, with mean age 68.13 years. The patients were divided into an aseptic loosening group (n=31) and a periprosthetic infection group (n=20). Both the visual analog scale (VAS) and Harris pain score were used to estimate the level of pain experienced by the patients. CRP levels in serum were measured. The difference in assessment of pain by VAS and Harris pain score was compared between the two groups, and the correlation between pain and CRP was analyzed.
The mean VAS in the aseptic loosening group was 5.39 (2.10-8.13) compared with 5.48 (2.09-8.30) in the periprosthetic infection group; however, the difference was not statistically significant (P=0.85). The mean rank of Harris pain score was 26.23 in the aseptic loosening group and 25.65 in the periprosthetic infection group, but again there was no significant difference (P=0.88). The CRP level in the periprosthetic infection group (36.20-101.40 mg/L, mean 72.86 mg/L) was obvious higher than that in the aseptic loosening group (1.37-13.70 mg/L, mean 6.53 mg/L), and the difference was statistically significant (P<0.01). The VAS was related with the CRP level in the periprosthetic infection group (r=0.87, P<0.01), and the correlation between Harris pain score and CRP level was conspicuous (r=0.92, P<0.01) in this group. However, those correlations were not evident in the aseptic loosening group (r=0.25, P=0.17; r=0.19, P=0.65).
There is no difference in perception of pain in patients after total hip arthroplasty between those with aseptic loosening and those with periprosthetic infection. It is therefore unreliable to make a initial diagnosis only according to the level of pain. However, the level of CRP is a sensitive and effective way of differentiating the two conditions. The positive correlation between CRP and pian exists in patients with periprosthetic infection but not with aseptic loosening.
探讨全髋关节置换术后无菌性松动与假体周围感染患者疼痛程度的差异，并研究C反应蛋白（CRP）与疼痛之间的相关性。
本研究纳入了51例（于2010年3月至2011年11月在我院招募）全髋关节置换术后发生无菌性松动或假体周围感染的患者，其中男性24例，女性27例，平均年龄68.13岁。患者被分为无菌性松动组（n = 31）和假体周围感染组（n = 20）。采用视觉模拟评分法（VAS）和Harris疼痛评分来评估患者的疼痛程度。检测血清中CRP水平。比较两组患者VAS和Harris疼痛评分在疼痛评估上的差异，并分析疼痛与CRP之间的相关性。
无菌性松动组的平均VAS为5.39（2.10 - 8.13），假体周围感染组为5.48（2.09 - 8.30）；然而，差异无统计学意义（P = 0.85）。无菌性松动组Harris疼痛评分的平均秩次为26.23，假体周围感染组为25.65，但同样无显著差异（P = 0.88）。假体周围感染组的CRP水平（36.20 - 101.40 mg/L，平均72.86 mg/L）明显高于无菌性松动组（1.37 - 13.70 mg/L，平均6.53 mg/L），差异有统计学意义（P < 0.01）。在假体周围感染组中，VAS与CRP水平相关（r = 0.87，P < 0.01），且该组中Harris疼痛评分与CRP水平的相关性显著（r = 0.92，P < 0.01）。然而，在无菌性松动组中这些相关性不明显（r = 0.25，P = 0.17；r = 0.19，P = 0.65）。
全髋关节置换术后无菌性松动患者与假体周围感染患者在疼痛感受上无差异。因此，仅根据疼痛程度进行初步诊断是不可靠的。然而，CRP水平是区分这两种情况的敏感且有效的方法。CRP与假体周围感染患者的疼痛存在正相关，而与无菌性松动无关。
