全膝关节置换术后皮温变化联合检验指标在预测和早期发现膝关节感染中的应用

Application of Combined Test Index of Skin Temperature Changes after Total Knee Arthroplasty in Prediction and Early Detection of Knee Infection

摘要: 目的：探究全膝关节置换术后皮温变化联合检验指标在预测和早期发现膝关节感染中的应用。方法：收集自2017年1月至2020年1月收治我院关节外科的378例TKA患者，其中32例术后发生感染，收集患者术后1天，术后7天，术后1月，术后半年和末次随访的皮温变化和血清学指标，比如白细胞量(WBC)，血沉(ESR)和C反应蛋白(CRP)，利用单因素分析和Logistic多因素分析TKA术后感染的相关因素。结果：单因素分析结果显示，WBC，ESR，CRP和患肢皮温是影响TKA术后感染的相关因素(P < 0.05)。并且相关因素赋值如下：WBC < 2.0 × 10⁹/L为1，WBC ≥ 2.0 × 10⁹/L为2；ESR < 20 mm/h为1，ESR > 20 mm/h为2；CRP ≥ 10 mg/L为1，CRP < 10 mg/L为2；患肢皮温 ≥ 38˚C为1，患肢皮温 < 38˚C为2。TKA术后感染的多因素分析结果显示，WBC ≥ 2.0 × 10⁹/L，ESR < 20 mm/h，CRP ≥ 10 mg/L和患肢皮温 ≥ 38˚C是人工全膝关节置换术后感染的危险因素。结论：WBC ≥ 2.0 × 109/L，ESR < 20 mm/h，CRP ≥ 10 mg/L和患肢皮温 ≥ 38˚C是人工全膝关节置换术后感染的危险因素，临床上需要加以重视。

Abstract: Objective: To explore the application of combined test indexes of skin temperature changes after total knee arthroplasty in predicting and early detecting knee infection. Methods: From January 2017 to January 2020, 378 patients with TKA in the Department of Joint Surgery of our hospital were collected, including 32 patients with postoperative infection. The changes of skin temperature and serological indexes, such as white blood cell count (WBC), ESR and C-reactive protein (CRP), were collected 1 day, 7 days, 1 month, half a year and the last follow-up, Univariate analysis and Logistic multivariate analysis were used to analyze the related factors of infection after TKA. Results: The univariate analysis showed that WBC, ESR, CRP and affected limb skin temperature were related factors affecting postoperative infection after TKA (P < 0.05). And the relevant factors are assigned as follows: WBC < 2.0 × 10⁹/L is 1, WBC ≥ 2.0 × 10⁹/L is 2; ESR < 20 mm/h is 1, ESR > 20 mm/h is 2; CRP ≥ 10 mg/L is 1, CRP < 10 mg/L is 2; the affected limb skin temperature ≥ 38˚C is 1, and the affected limb skin temperature < 38˚C is 2. Multivariate analysis of infection after TKA showed that WBC ≥ 2.0 × 10⁹/L, ESR < 20 mm/h, CRP ≥ 10 mg/L and affected limb skin temperature ≥ 38˚C are the risk factors of infection after total knee arthroplasty. Conclusion: WBC ≥ 2.0 × 10⁹/L, ESR < 20 mm/h, CRP ≥ 10 mg/L and affected limb skin temperature ≥ 38˚C are the risk factors of infection after total knee arthroplasty, which should be carefully paid attention on.