Department of Orthopaedics, Tianjin Haihe Hospital, China Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin University, Tianjin, China.
Orthop Surg. 2021 Apr;13(2):501-505. doi: 10.1111/os.12896. Epub 2021 Feb 11.
To explore the trend of changes in the serum prealbumin (PA) level in patients with spinal tuberculosis during the perioperative period and its relationship with postoperative incision complications.
A retrospective study was performed by enrolling 162 patients (82 men and 80 women) with spinal tuberculosis who had been admitted to the Tianjin Haihe Hospital from June 2013 to June 2017. The included patients were then assigned to the elderly group (≥65 years of age, n = 35) and the non-elderly group (<65 years of age, n = 127). The chemotherapy regimen was 3HREZ/9HRE, in combination with nutritional support for 3-4 weeks, as well as one-stage debridement and (or) bone graft fusion and internal fixation. The serum PA levels of patients with spinal tuberculosis at admission, prior to surgery, and at 2 and 4 weeks after surgery were collected, and incision healing and sinus formation were observed for 3 months. Changes in serum PA levels of all patients at different time points were observed using one-way analysis of variance. Pairwise comparison at different time points was performed using the least significant difference method and comparison of serum PA levels between different groups at the same time points was subjected to t-test. The χ -test was used for comparison of the incidence of incision complications between different groups and between different subgroups based on different PA levels.
There was a gradual increased trend in the PA level from admission to 4 weeks after surgery in all patients [(0.14 ± 0.03) g/L < (0.16 ± 0.04)g/L < (0.22 ± 0.04) g/L < (0.25 ± 0.04) g/L]. The increase in the non-elderly group was higher than that in the elderly group (P < 0.01). Furthermore, the incidence of incision complications in the elderly group was higher than in the non-elderly group (14.29% > 1.78%, P < 0.01). The serum PA level was graded in accordance with NRS2002. There were 88 patients with preoperative grade 0-1 serum PA level (≥0.16g/L) who had no incision complications. The incidence of incision complications in patients with grade 3 serum PA level (<0.10 g/L, 9 patients) was higher than in patients with grade 2 (0.100-0.159 g/L, 66 patients) (44.44% > 6.06%, P < 0.01).
Changes in serum PA level in patients with spinal tuberculosis during the perioperative period are consistent with the trend of inflammation control and nutrition improvement, and are correlated with the incidence of incision complications after surgery. The relationship between the changes and the timing of surgery is worthy of future research.
探讨脊柱结核患者围手术期血清前白蛋白（PA）水平的变化趋势及其与术后切口并发症的关系。
回顾性分析 2013 年 6 月至 2017 年 6 月在天津市海河医院收治的 162 例脊柱结核患者（男 82 例，女 80 例）的临床资料。将患者分为老年组（≥65 岁，n=35）和非老年组（<65 岁，n=127）。化疗方案为 3HREZ/9HRE，联合营养支持治疗 3-4 周，一期清创及（或）植骨融合内固定。收集脊柱结核患者入院时、术前及术后 2、4 周的血清 PA 水平，并观察切口愈合及窦道形成情况，随访 3 个月。采用单因素方差分析观察不同时间点所有患者血清 PA 水平的变化，采用最小显著差法进行不同时间点的两两比较，采用 t 检验比较同一时间点不同组间血清 PA 水平的差异。采用 χ 2 检验比较不同组间及不同 PA 水平亚组间切口并发症的发生率。
所有患者的血清 PA 水平从入院时逐渐升高，术后 4 周时达到最高水平[(0.14±0.03) g/L<(0.16±0.04) g/L<(0.22±0.04) g/L<(0.25±0.04) g/L]。非老年组的升高幅度高于老年组（P<0.01）。此外，老年组切口并发症的发生率高于非老年组（14.29%>1.78%，P<0.01）。根据 NRS2002 对血清 PA 水平进行分级，术前血清 PA 水平为 0-1 级（≥0.16 g/L）的 88 例患者无切口并发症。血清 PA 水平为 3 级（<0.10 g/L）的 9 例患者切口并发症发生率高于 2 级（0.100-0.159 g/L）的 66 例患者（44.44%>6.06%，P<0.01）。
脊柱结核患者围手术期血清 PA 水平的变化与炎症控制和营养改善趋势一致，与术后切口并发症的发生相关。其变化与手术时机的关系值得进一步研究。
