目的探讨强直性脊柱炎（ankylosing spondylitis，AS）行人工全髋关节置换术（total hip arthroplasty，THA）围手术期炎症指标的变化规律，并与非炎性髋关节疾病比较，评价炎性活动是否影响术后炎症指标的变化及增加并发症发生。 方法回顾分析2013年1月-2014年12月明确诊断为AS并行初次THA的153例患者，根据髋关节活动度（range of motion，ROM）将患者分为强直组（ROM 0°；A组，92例）和僵直组（ROM 3～46°；B组，61例）；随机选取120例同期行THA且术前炎症指标C反应蛋白（C-reactive protein，CRP）、IL-6、红细胞沉降率（erythrocyte sedimentation rate，ESR）处于正常范围、住院期间未发生感染的非炎性髋关节疾病患者作为非炎性疾病组（C组）。分别于术前及术后1、3、5、7 d检测血清CRP、IL-6、ESR变化情况，并观察并发症发生情况。 结果组内比较：3组患者血清CRP、IL-6及ESR均呈先升高后下降的趋势。术后各时间点CRP、ESR与术前比较差异均有统计学意义（P＜0.05）；术后1、3、5 d IL-6高于术前（P＜0.05），但术后7 d与术前比较差异无统计学意义（P＞0.05）。组间比较：除术前B组CRP、IL-6、ESR高于A组，术前及术后1 d A、B组CRP、IL-6高于C组，以及术前及术后1、3 d A、B组ESR高于C组（P＜0.05）外，其余各时间点各组间CRP、IL-6、ESR比较差异均无统计学意义（P＞0.05）。所有AS患者术后均未出现炎性活动或并发症增加的情况。 结论AS与非炎性疾病的炎症指标手术前后变化趋势相似；AS的炎性活动对术后炎症指标的变化无明显影响，也未增加术后并发症的发生
References
[1]
10. J？msen E, Varonen M, Huhtala H, et al. Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty, 2010, 25(1):87-92.
[2]
11. Moll JM, Wright V. New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis, 1973, 32(4): 354-363.
[3]
12. Ozmen M, Oktay E, Tarhan EF, et al. Serum procalcitonin levels in patients with ankylosing spondylitis. Int J Rheum Dis, 2014.[Epub ahead of print].
[4]
17. Claushuis TA, de Vries MK, van der Weijden MA, et al. C-reactive protein polymorphisms influence serum CRP-levels independent of disease activity in ankylosing spondylitis. Clin Exp Rheumatol, 2015, 33(2):159-165.
[5]
18. Laiho K, M？enp？？ H, Kautiainen H, et al. Rise in serum C reactive protein after hip and knee arthroplasties in patients with rheumatoid arthritis. Ann Rheum Dis, 2001, 60(3):275-277.
[6]
6. Shen H, Zhang N, Zhang X, et al. C-reactive protein levels after 4 types of arthroplasty. Acta Orthop, 2009, 80(3):330-333.
[7]
13. Neumaier M, Metak G, Scherer MA. C-reactive protein as a parameter of surgical trauma. Acta Orthopaedica, 2006, 77(5):788-790.
[8]
14. Minetto MA, Oprandi G, Saba L, et al. Serum interleukin-6 response to elective total hip replacement surgery. Int Orthop, 2006, 30(3): 172-176.
[9]
15. Glehr M, Friesenbichler J, Hofmann G, et al. Novel biomarkers to detect infection in revision hip and knee arthroplasties. Clin Orthop Relat Res, 2013, 471(8):2621-2628.
[10]
16. Reveille JD. Biomarkers for diagnosis, monitoring of progression, and treatment responses in ankylosing spondylitis and axial spondyloarthritis. Clin Rheumatol, 2015, 34(6):1009-1018.
[11]
1. Ye C, Liu R, Sun C, et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop, 2014, 38(12):2473-2476.
[12]
2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet, 2007, 370(9597):1508-1519.
[13]
3. Wang W, Huang G, Huang T, et al. Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis. BMC Musculoskelet Disord, 2014, 15:344.
[14]
4. Leonard HA, Liddle AD, Burke O, et al. Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res, 2014, 472(3):1036-1042.
[15]
5. Camurcu Y, Sofu H, Buyuk AF, et al. Two-stage cementless revision total hip arthroplasty for infected primary hip arthroplasties. J Arthroplasty, 2015.[Epub ahead of print].
[16]
7. Wirtz DC, Heller KD, Miltner O, et al. Interleukin-6:a potential inflammatory marker after total joint replacement. Int Orthop, 2000, 24(4):194-196.
[17]
8. Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythroeyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A Prospective evaluation. J Bone Joint Surg (Am), 2007, 89(7):1409-1416.
[18]
9. Battistelli S, Fortina M, Carta S, et al. Serum C-reactive protein and procalcitonin kinetics in patients undergoing elective total hip arthroplasty. Biomed Res Int, 2014, 2014:565080.
[19]
19. Niskanen RO, Korkala O, Pammo H. Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(3):431-433.
[20]
20. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection. J Arthroplasty, 2011, 26(8):1136-1138.
[21]
21. Schmidt AH. Inflammatory markers in patients with inflammatory arthritis:perhaps they can be helpful in diagnosing chronic periprosthetic infection. J Bone Joint Surg (Am), 2012, 94(7):e47.
24. Sweeney S, Gupta R, Taylor G, et al. Total hip arthroplasty in ankylosing spondylitis:outcome in 340 patients. J Rheumatol, 2001, 28(8):1862-1866.
[25]
25. Shi D, Xu X, Song K, et al. Comparison of venous thromboembolism after total hip arthroplasty between ankylosing spondylitis and osteoarthritis. Biomed Res Int, 2014, 2014:712895.
