中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (33): 5324-5328.doi: 10.12307/2021.321

• 人工假体 artificial prosthesis • 上一篇    下一篇

D-二聚体、红细胞沉降率和C-反应蛋白在髋、膝关节置换后下肢深静脉血栓形成中的诊断价值

范鑫超1，鲍文娟2，张  凯2，孙喜龙2，黄  腾2，高  博2，翟金帅2，周逸彬3，邱长茂2，李文毅2，李西成2
  

  1. 1河北北方学院骨科，河北省张家口市   075000；2河北省人民医院骨科，河北省石家庄市   050000；3河北大学附属医院骨科，河北省保定市   071000
  • 收稿日期:2021-01-20 修回日期:2021-02-04 接受日期:2021-03-10 出版日期:2021-11-28 发布日期:2021-08-05
  • 通讯作者: 李西成，博士，主任医师。河北省人民医院骨科，河北省石家庄市 050000
  • 作者简介:范鑫超，男，1992年生，河北省邢台市人，汉族，河北北方学院在读硕士。

Diagnostic value of D-dimer, erythrocyte sedimentation rate and C-reactive protein in deep vein thrombosis of lower extremity after hip and knee arthroplasty

Fan Xinchao1, Bao Wenjuan2, Zhang Kai2, Sun Xilong2, Huang Teng2, Gao Bo2, Zhai Jinshuai2, Zhou Yibin3, Qiu Changmao2, Li Wenyi2, Li Xicheng2   

  1. 1Department of Orthopedics, Hebei North University, Zhangjiakou 075000, Hebei Province, China; 2Department of Orthopedics, Hebei Provincial People’s Hospital, Shijiazhuang 050000, Hebei Province, China; 3Department of Orthopedics, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
  • Received:2021-01-20 Revised:2021-02-04 Accepted:2021-03-10 Online:2021-11-28 Published:2021-08-05
  • Contact: Li Xicheng, MD, Chief physician, Department of Orthopedics, Hebei Provincial People’s Hospital, Shijiazhuang 050000, Hebei Province, China
  • About author:Fan Xinchao, Master candidate, Department of Orthopedics, Hebei North University, Zhangjiakou 075000, Hebei Province, China

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摘要：

文题释义：
单髁置换：指仅对膝关节病变一侧关节间室进行表面置换，用人工假体代替膝关节破损的软骨表面，一般多为内侧间室。
下肢深静脉血栓：是由于下肢深静脉的血液凝固形成血栓，阻塞血液回流，从而引起的一系列临床症状。
背景：下肢深静脉血栓形成是髋膝关节置换的后常见并发症，关于其影响因素介绍较多，但有关影响因素的阈值介绍较少。
目的：探讨D-二聚体、红细胞沉降率、C-反应蛋白对髋、膝关节置换后下肢深静脉血栓形成的诊断价值。
方法：回顾性分析2018年1月至2020年11月在河北省人民医院行髋、膝关节置换的216例患者的临床资料，包括全膝关节置换77例，单髁置换31例，全髋关节置换35例，半髋关节置换73例。术后第1天行双下肢深静脉彩超，并由2名以上主治医师确诊为下肢深静脉血栓形成。其中术后下肢深静脉血栓形成患者86例，术后无下肢深静脉血栓者130例，比较不同置换下肢深静脉血栓形成率差异。以年龄、性别及置换类型为标准利用PSM倾向评分配对方法从130例术后无下肢深静脉血栓患者中选取86例患者作为对照组，比较172例患者(血栓形成组和对照组各86例)血浆D-二聚体、白蛋白及血红蛋白水平，利用ROC曲线分析各指标诊断髋、膝关节置换后下肢深静脉血栓形成的诊断效力。
结果与结论：①患者172例中，与对照组相比，血栓组患者D-二聚体水平升高(P < 0.05)；②诊断髋关节置换后下肢深静脉血栓形成的D-二聚体灵敏度为71.8%、特异度为74.1%；凝血酶原时间灵敏度为66.7%、特异度为66.7%；红细胞沉降率灵敏度为61.5%、特异度为70.4%；C-反应蛋白水平灵敏度为94.9%、特异度为33.3%；年龄灵敏度为71.8%、特异度为100%；③诊断膝关节置换后下肢深静脉血栓形成的D-二聚体灵敏度为78.7%、特异度为44.1%；④上述数据证实，对髋、膝关节置换后下肢深静脉血栓形成患者而言，D-二聚体水平均具有较好的诊断敏感度，相比之下D-二聚体水在诊断膝关节置换后下肢深静脉血栓形成时敏感度更高；而凝血酶原时间、红细胞沉降率、C-反应蛋白水平及年龄仅在诊断髋关节置换后下肢深静脉血栓形成时具有一定的灵敏度和特异度。
https://orcid.org/0000-0002-8795-1444 (范鑫超) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髋关节置换, 膝关节置换, 下肢深静脉血栓, D-二聚体, 红细胞沉降率, C-反应蛋白, 灵敏度, 特异性, 诊断

Abstract: BACKGROUND: Lower extremity deep vein thrombosis is a common complication after hip and knee arthroplasty. There are many introductions about its influencing factors, but there are few introductions about the thresholds of influencing factors.  
OBJECTIVE: To investigate the diagnostic value of D-dimer, erythrocyte sedimentation rate and C-reactive protein in deep vein thrombosis of lower limbs after hip and knee arthroplasty.
METHODS:  The clinical data of 216 patients who underwent hip and knee arthroplasty in Hebei Provincial People’s Hospital from January 2018 to November 2020 were retrospectively analyzed, including 77 cases of total knee arthroplasty, 31 cases of unicondylar arthroplasty, 35 cases of total hip arthroplasty, and 73 cases of hemiarthroplasty of the hip. Color Doppler ultrasonography of deep veins in both lower extremities was performed on the first day after surgery, and the diagnosis of deep vein thrombosis in lower extremities was confirmed by more than two attending physicians. Among them, there were 86 patients with lower extremity deep vein thrombosis and 130 patients without deep vein thrombosis. The rates of deep vein thrombosis in lower limbs were compared. According to the criteria of age, gender and replacement type, 86 patients without lower extremity deep vein thrombosis after surgery were selected as the control group using PSM propensity score matching method. The levels of plasma D-dimer, albumin and hemoglobin in 172 patients (86 patients in the thrombosis group and 86 patients in the control group) were compared, and the diagnostic efficacy of each index in the diagnosis of lower extremity deep vein thrombosis after hip and knee arthroplasty was analyzed by ROC curve.  
RESULTS AND CONCLUSION: (1) Compared with the control group, the D-dimer level of 172 patients in thrombus group was increased (P < 0.05). (2) The sensitivity and specificity of D-dimer for the diagnosis of deep vein thrombosis of lower extremity after hip arthroplasty were 71.8% and 74.1%. The time sensitivity and specificity of prothrombin were 66.7% and 66.7% respectively. The sensitivity and specificity of erythrocyte sedimentation rate were 61.5% and 70.4%. The sensitivity and specificity of C-reactive protein level were 94.9% and 33.3% respectively. The age sensitivity was 71.8% and the specificity was 100%. (3) The sensitivity and specificity of D-dimer for the diagnosis of deep venous thrombosis of lower extremity after knee arthroplasty were 78.7% and 44.1%, respectively. (4) The above data confirmed that the sensitivity of D-dimer level indicators in the diagnosis of deep vein thrombosis of lower extremities after knee replacement was higher, while the sensitivity and specificity of prothrombin time, erythrocyte sedimentation rate, C-reactive protein level and age in the diagnosis of deep vein thrombosis of lower extremities after hip arthroplasty were higher.

Key words: hip arthroplasty, knee arthroplasty, deep vein thrombosis of lower limbs, D-dimer, erythrocyte sedimentation rate, C-reactive protein, sensitivity, specificity, diagnosis

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