全身免疫炎症指数及血小板与白蛋白比值对全膝关节置换术后早期伤口并发症的预测价值

The Predictive Value of the Systemic Immune-Inflammation Index and Platelet-to-Albumin Ratio for Early Wound Complications after Total Knee Arthroplasty

摘要: 目的：全膝关节置换术(TKA)术后伤口并发症显著影响患者预后及医疗成本。可靠的术前生物标志物对于识别高风险患者至关重要，这有助于优化患者管理并降低并发症的发生率。本研究评估了全身免疫炎症指数(SII)及血小板与白蛋白比值(PAR)对全膝关节置换术后伤口并发症的预测价值。方法：回顾性分析2024年1月至2025年9月于沧州市人民医院关节骨科一区接受膝关节置换术治疗的患者，共纳入149例患者。术前采集血液样本检测血小板、白蛋白、中性粒细胞计数及淋巴细胞计数，用于计算全身免疫炎症指数(SII)及血小板与白蛋白比值(PAR)。监测患者预后，记录术后2周内伤口并发症(如持续性伤口引流、血肿、血清肿、皮肤糜烂及伤口裂开)。根据有无早期切口并发症分为两组。结果：对两组患者的基础资料进行比较分析，结果显示年龄、性别、高血压、糖尿病、吸烟史、饮酒史、ASA评分、术前血红蛋白、淋巴细胞计数方面两组无统计学差异(P > 0.05)。术前血小板、中性粒细胞计数、血清白蛋白、BMI、SII、PAR方面两组存在统计学差异(P < 0.05)。SII (OR: 1.004, 95% CI: 1.001~1.008, P = 0.024)和PAR (OR: 2.109, 95% CI: 1.055~4.216, P = 0.035)均被确定为全膝关节置换术(TKA)后发生切口并发症相关的独立危险因素。ROC分析显示，SII的最佳临界值为915.56 (曲线下面积[AUC]：0.899，灵敏性94.1%，特异度87.9%)，PAR的最佳临界值为6.975 (AUC：0.900，灵敏性88.2%，特异度86.4%)。结论：术前SII和PAR升高可有效预测TKA术后伤口并发症，支持其作为临床实践中简单、经济高效的生物标志物的实用性。将SII和PAR评估纳入术前评估可增强患者分层和预防策略，从而降低风险并改善手术结局。

Abstract: Objective: Postoperative wound complications following total knee arthroplasty (TKA) significantly impact patient prognosis and healthcare costs. Reliable preoperative biomarkers are crucial for identifying high-risk patients, which aids in optimizing patient management and reducing the incidence of complications. This study evaluates the predictive value of the systemic immune-inflammation index (SII) and platelet-to-albumin ratio (PAR) for wound complications after TKA. Methods: A retrospective analysis was conducted on 149 patients who underwent knee arthroplasty in the First Department of Joint Orthopedics at Cangzhou People’s Hospital between January 2024 and September 2025. Preoperative blood samples were collected to measure platelet count, albumin level, neutrophil count, and lymphocyte count for calculating SII and PAR. Patient outcomes were monitored, and wound complications (such as persistent wound drainage, hematoma, seroma, skin erosion, and wound dehiscence) within two weeks postoperatively were recorded. The patients were divided into two groups based on the presence or absence of early incision complications. Results: Comparative analysis of baseline characteristics revealed no statistically significant differences between the two groups in terms of age, sex, hypertension, diabetes, smoking history, alcohol consumption history, ASA score, preoperative hemoglobin, or lymphocyte count (P > 0.05). However, statistically significant differences were observed in preoperative platelet count, neutrophil count, serum albumin, BMI, SII, and PAR (P < 0.05). Both SII (OR: 1.004, 95% CI: 1.001~1.008, P = 0.024) and PAR (OR: 2.109, 95% CI: 1.055~4.216, P = 0.035) were identified as independent risk factors associated with incision complications after TKA. ROC analysis demonstrated that the optimal cutoff value for SII was 915.56 (AUC: 0.899, sensitivity 94.1%, specificity 87.9%), and for PAR was 6.975 (AUC: 0.900, sensitivity 88.2%, specificity 86.4%). Conclusion: Elevated preoperative SII and PAR levels effectively predict wound complications after TKA, supporting their utility as simple and cost-effective biomarkers in clinical practice. Integrating SII and PAR assessments into preoperative evaluations may enhance patient stratification and preventive strategies, thereby reducing risks and improving surgical outcomes.