Chen Lu, Zhang Jianguang, Zhang Wei, Deng Changgong
Department of Orthopedics, the Affiliated Hospital of North Sichuan Medical College Nanchong 637000, China.
Ann Palliat Med. 2020 May;9(3):1055-1061. doi: 10.21037/apm-20-855. Epub 2020 May 12.
There is still a risk of refracture of the contralateral hip after total hip replacement, to analyze the expression of C-reactive protein (CRP) and albumin (Alb) in elderly patients with contralateral hip refracture after total hip arthroplasty (THA), and to determine its correlation with the risk of post-surgery refracture and guide the prediction of the risk of contralateral hip fracture in the future.
The medical records of elderly patients who suffered hip fracture and underwent THA at our hospital between July 2016 and July 2019 were reviewed, and 224 eligible patients were finally enrolled. The patients were divided into the refracture group and the control group according to the incidence of contralateral hip refracture. The baseline data of the two groups were compared, and all relevant laboratory tests were performed before surgery. The serum levels of CRP and Alb were compared, along with the CRP/ Alb ratio, between the two groups to establish whether CRP/Alb is a predictor for post-surgery contralateral hip refracture in elderly patients.
Twenty (8.93%) of the 224 patients suffered post-surgery contralateral hip refracture. There were no significant differences in the baseline data of the refracture and control groups (P>0.05). However, the patients who experienced refracture had significantly higher CRP levels and lower Alb levels compared with the controls, resulting in an elevated CRP/Alb ratio in the patients with refracture (P<0.05). Serum CRP level was negatively correlated to that of Alb (r=-0.443, P<0.001). The linear regression equation was Y=2.718-0.598X, indicating that the CRP/Alb ratio is a risk factor for contralateral hip refracture in elderly hip fracture patients following THA (P<0.05). The area under the receiver operating characteristic (ROC) curve of the CRP/Alb ratio as a predictor for post-THA contralateral hip refracture was 0.841 (95% CI: 0.702-0.914). The optimal cutoff value was 1.12, which corresponded to high specificity and sensitivity of 0.782 and 0.945, respectively, and the Youden index was 0.727.
Serum CRP level is closely associated with Alb level in elderly hip fracture patients, and the CRP/Alb ratio is a risk factor for post-THA contralateral hip refracture. Therefore, preoperative measurement of serum CRP/Alb level can assist with predicting the risk of post-THA refracture in elderly hip fracture patients.
全髋关节置换术后对侧髋关节仍有再骨折风险，分析老年患者全髋关节置换术后对侧髋关节再骨折时C反应蛋白（CRP）及白蛋白（Alb）的表达情况，确定其与术后再骨折风险的相关性，为今后对侧髋关节骨折风险预测提供指导。
回顾性分析2016年7月至2019年7月在我院因髋部骨折行全髋关节置换术的老年患者病历资料，最终纳入224例符合条件的患者。根据对侧髋关节再骨折发生率将患者分为再骨折组和对照组。比较两组的基线资料，并在术前进行所有相关实验室检查。比较两组血清CRP、Alb水平及CRP/Alb比值，以确定CRP/Alb是否为老年患者术后对侧髋关节再骨折的预测指标。
224例患者中有20例（8.93%）术后发生对侧髋关节再骨折。再骨折组与对照组基线资料比较差异无统计学意义（P>0.05）。然而，再骨折患者的CRP水平显著高于对照组，Alb水平显著低于对照组，导致再骨折患者的CRP/Alb比值升高（P<0.05）。血清CRP水平与Alb水平呈负相关（r=-0.443，P<0.001）。线性回归方程为Y=2.718-0.598X，表明CRP/Alb比值是老年髋部骨折患者全髋关节置换术后对侧髋关节再骨折的危险因素（P<0.05）。CRP/Alb比值作为全髋关节置换术后对侧髋关节再骨折预测指标的受试者工作特征（ROC）曲线下面积为0.841（95%CI：0.702-0.914）。最佳截断值为1.12，对应高特异性和敏感性分别为0.782和0.945，约登指数为0.727。
老年髋部骨折患者血清CRP水平与Alb水平密切相关，CRP/Alb比值是全髋关节置换术后对侧髋关节再骨折的危险因素。因此，术前测定血清CRP/Alb水平有助于预测老年髋部骨折患者全髋关节置换术后再骨折风险。
