肱骨近端骨折的钢板内固定与半关节置换术——常规筛查全身炎症生物标志物有意义吗？
Plate osteosynthesis versus hemiarthroplasty in proximal humerus fractures--does routine screening of systemic inflammatory biomarkers makes sense?
作者信息
Horst Klemens, Hildebrand Frank, Pfeifer Roman, Köppen Karin, Lichte Philipp, Pape Hans-Christoph, Dienstknecht Thomas
机构信息
Department of Orthopaedics and Trauma Surgery, Aachen University Medical Centre, Pauwelsstrasse 30, 52074, Aachen, Germany.
出版信息
Eur J Med Res. 2015 Jan 14;20(1):5. doi: 10.1186/s40001-014-0079-z.
BACKGROUND
Increases in C-reactive protein (CRP) and white blood cell (WBC) counts after orthopedic surgical procedures can give evidence of postoperative infection. However, there is a lack of knowledge about the kinetics of these biomarkers in cases with an uneventful clinical course after osteosynthesis of upper limb fractures. This study investigated CRP and WBC serum levels after osteosynthesis or hemiarthroplasty of humeral head fractures.
METHODS
A retrospective study on patients with humeral head fractures who had open reduction and internal fixation via plate osteosynthesis (PO) (n = 64) or hemiarthroplasty (HA) (n = 28) without any complications in the postoperative clinical course. C-reactive protein serum levels (mg/l) and leukocyte counts (g/l) were assayed at several time points. Multiple regression analysis was performed to evaluate the influence of several confounding variables (the surgical procedure, duration of surgery, patient's health status, and comorbidities) on the kinetics of CRP and WBC.
RESULTS
Our data showed that CRP levels were statistically significantly higher in the HA cohort when compared to the PO cohort (p = 0.003). Moreover, daily measurement of CRP levels during the postoperative course showed that CRP peaked on the 2nd and 3rd days postoperatively in both cohorts and started to decrease afterward, reaching normal values on day 8 to 10. However, WBCs did not show any significant differences between the HA and PO cohorts. Finally, the choice of surgical procedure and the patient's health status were associated with higher peak levels of CRP.
CONCLUSIONS
After osteosynthesis or hemiarthroplasty of humeral head fractures, CRP is a responsive serum parameter in the postoperative course of an uneventful inflammatory response. Abnormalities from these values should be interpreted carefully as they may give a hint as to postoperative complications such as infection.
背景
骨科手术后C反应蛋白（CRP）和白细胞（WBC）计数升高可能提示术后感染。然而，对于上肢骨折内固定术后临床过程平稳的病例，这些生物标志物的动力学情况尚缺乏了解。本研究调查了肱骨头骨折内固定或半关节置换术后的CRP和WBC血清水平。
方法
对肱骨头骨折患者进行回顾性研究，这些患者通过钢板内固定术（PO）（n = 64）或半关节置换术（HA）（n = 28）进行切开复位内固定，术后临床过程无任何并发症。在多个时间点测定C反应蛋白血清水平（mg/l）和白细胞计数（g/l）。进行多元回归分析以评估几个混杂变量（手术方式、手术持续时间、患者健康状况和合并症）对CRP和WBC动力学的影响。
结果
我们的数据显示，与PO组相比，HA组的CRP水平在统计学上显著更高（p = 0.003）。此外，术后过程中每日测量CRP水平显示，两组CRP均在术后第2天和第3天达到峰值，随后开始下降，在第8至10天恢复正常。然而，HA组和PO组的WBC没有显示出任何显著差异。最后，手术方式的选择和患者的健康状况与CRP的更高峰值水平相关。
结论
肱骨头骨折内固定或半关节置换术后，CRP是炎症反应平稳的术后过程中的一个反应性血清参数。这些值的异常应谨慎解读，因为它们可能提示术后并发症，如感染。
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