Kuhn Margaret G, Lenke Lawrence G, Bridwell Keith H, O'Donnell June C, Luhmann Scott J
Department of Orthopedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110 USA.
J Child Orthop. 2012 Mar;6(1):61-7. doi: 10.1007/s11832-012-0394-2. Epub 2012 Mar 9.
The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count are frequently obtained in the work-up of post-operative fever. However, their diagnostic utility depends upon comparison with normative peri-operative trends which have not yet been described. The purpose of this study is to define a range of erythrocyte sedimentation rates and white blood cell counts following spinal instrumentation and fusion in non-infected patients.
Seventy-five patients underwent spinal instrumentation and fusion. The erythrocyte sedimentation rate and white blood cell count were recorded pre-operatively, at 3 and 7 days post-operatively, and at 1 and 3 months post-operatively.
Both erythrocyte sedimentation rate and white blood cell count trends demonstrated an early peak, followed by a gradual return to normal. Peak erythrocyte sedimentation rates occurred within the first week post-operatively in 98% of patients. Peak white blood cell counts occurred with the first week in 85% of patients. In the absence of infection, the erythrocyte sedimentation rate was abnormally elevated in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively. The white blood cell count was abnormally elevated in only 6% of patients at 1 month post-operatively. Longer surgical time was associated with elevated white cell count at 1 week post-operatively. The fusion of more vertebral levels had a negative relationship with elevated erythrocyte sedimentation rate at 1 week post-operatively. The anterior surgical approach was associated with significantly lower erythrocyte sedimentation rate at 1 month post-operatively and with lower white cell count at 1 week post-operatively.
In non-infected spinal fusion surgeries, erythrocyte sedimentation rates are in the abnormal range in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively, suggesting that the erythrocyte sedimentation rate is of limited diagnostic value in the early post-operative period.
红细胞沉降率（ESR）和白细胞（WBC）计数常用于术后发热的检查。然而，它们的诊断效用取决于与尚未描述的围手术期正常趋势进行比较。本研究的目的是确定非感染患者脊柱内固定融合术后红细胞沉降率和白细胞计数的范围。
75例患者接受了脊柱内固定融合术。术前、术后3天和7天以及术后1个月和3个月记录红细胞沉降率和白细胞计数。
红细胞沉降率和白细胞计数趋势均显示早期峰值，随后逐渐恢复正常。98%的患者术后第一周内出现红细胞沉降率峰值。85%的患者术后第一周内出现白细胞计数峰值。在无感染的情况下，术后1个月时78%的患者红细胞沉降率异常升高，术后3个月时53%的患者红细胞沉降率异常升高。术后1个月时只有6%的患者白细胞计数异常升高。手术时间较长与术后1周白细胞计数升高有关。融合的椎体节段越多与术后1周红细胞沉降率升高呈负相关。前路手术与术后1个月时红细胞沉降率显著降低以及术后1周时白细胞计数降低有关。
在非感染性脊柱融合手术中，术后1个月时78%的患者红细胞沉降率处于异常范围，术后3个月时53%的患者红细胞沉降率处于异常范围，这表明红细胞沉降率在术后早期的诊断价值有限。
