可溶性细胞间黏附分子-1及皮肤温度对全膝关节置换术后假体周围感染的诊断价值

摘要

目的 探讨血清可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)及膝关节皮肤温度测定在全膝关节置换术后假体周围感染诊断中的作用.方法 收集2012年11月至2015年10月收治的初次单侧全膝关节置换患者30例(全膝关节初次置换组),男11例、女19例,平均年龄(59.3±9.5)岁;因全膝关节置换术后感染而行二期旷置翻修的患者10例(全膝关节感染翻修组),男3例、女7例,平均年龄(60.9±8.2)岁.分别于术前(全膝关节感染翻修组为诊断时)、术后(全膝关节感染翻修组为二期翻修术后)第1天、第7天、1个月、3个月、6个月及12个月检测血清C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、sI-CAM-1,并用红外热像仪评估双膝关节平均皮肤温度差值.结果 所有患者均获得随访.全膝关节初次置换组患者术前血清CRP、IL-6、ESR水平正常,术后明显升高并于术后第1～7天达到峰值,之后缓慢下降,1～3个月内恢复正常;血清sI-CAM-1水平在观察期间无明显波动.全膝关节感染翻修组患者一期手术前血清CRP、IL-6、ESR明显高于全膝关节初次置换组(P均＜0.05),二期翻修术后3个月内逐渐降至正常.sICAM-1一期手术前明显高于全膝关节初次置换组,旷置3个月后恢复正常,二期翻修手术及以后随访期间无明显升高.全膝关节初次置换组患者术前双膝关节平均温度差为(0.73±0.62)℃,术后第1天开始升高,第7天达到峰值(4.37±1.06)℃,之后开始下降,术后6个月基本恢复正常.全膝关节感染翻修组患者一期旷置术前双膝关节平均温度差为(5.03±0.81)℃,明显高于全膝关节初次置换组(P＜0.05),二期翻修术后6个月基本恢复正常.结论 全膝关节置换术后,双膝关节平均皮肤温度差与血清CRP、IL-6、ESR水平变化趋势一致,联合应用有提示感染的作用.血清sICAM-1可用于预测全膝关节置换术后假体周围感染.%Objective To investigate the diagnostic value of knee skin temperature and serum soluble intercellular adhesion molecule-1 (sICAM-1) level in peri-prosthetic infection after total knee arthroplasty (TKA).Methods Thirty patients (11 males and 19 females,aged 59.3±9.5 years old) underwent primary TKA during November 2012 and October 2015.Ten patients with peri-prosthetic infection (3 males and 7 females,aged 60.9±8.2 years old) underwent two-stage revision TKA from November 2012 to October 2015.The interleukin-6 (IL-6),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),sICAM-1 in serum and the skin temperature in knee joint were recorded preoperatively (revision patients on diagnosis),at days 1,7 and at 1,3,6,12 months post-operatively.Results All of the 40 patients were followed up for 12 months.The serum CRP,IL-6 and ESR levels in the primary TKA group were normal preoperatively and increased after operation,reaching their peaks at 1-7 days postoperatively.These indexes then returned slowly to the normal levels within 3 months.The serum sICAM-1 level in the primary TKA group did not change significantly during the follow up.The serum levels of CRP,IL-6,ESR,and sICAM-1 in the revision group were significantly higher than that in the primary TKA group preoperatively (P＜0.05),IL-6,CRP,ESR returned slowly to the normal levels within 3 months after the second-stage revision,while the level of sICAM-1 returned to normal within 3 months after the first-stage revision.During whole follow-up after the second-stage revision,the level of sICAM-1 didn't change significantly.The preoperative mean differential temperature (MDT) in the primary TKA group was 0.73±0.62 ℃ preoperatively and elevated to 4.37±1.06 ℃ at 7 days postoperatively,which returned to the baseline within 6 months after primary TKA.The preoperative MDT in the revision group was 5.03±0.81 ℃,which was significantly higher than that in the primary TKA group (P＜0.05).The MDT returned to the normal level within 6 months after the second-stage revision TKA.Conclusion The change of MDT is in accordance with serum CRP,IL-6,and ESR,which together may predict the occurrence of infection.Serum sICAM-1 level may also be valuable in the diagnosis of peri-prosthetic infection.