Total Eklem Artroplastisini Takiben D-Dimer'ın Progresyonu ile Erken Postoperative Yara ve Eklem Enfeksiyonu Arasındaki İlişki

Yıl 2021, Cilt: 8 Sayı: 2 , 91 - 96 , 31.08.2021

Emre Gültaç , Fatih Can , Cem Yalın Kılınç , Hıdır Tanyıldızı , Ahmet Acan , Nevres Aydoğan

https://izlik.org/JA38GC63GF

Öz

Eklem artroplastisi sonrası postoperative enfeksiyon, azımsanamayacak derecede insidansı olan kötü bir komplikasyondur ve erken tespiti önemlidir. Bu retrospektif çalışmanın amacı, eklem artroplastisi sonrası postoperatif D-Dimer düzeyindeki değişimi diğer proinflamatuar mediatörlerle birlikte değerlendirmek ve D-Dimer progresyonu ile erken postoperative yara enfeksiyonu arasındaki ilişkiyi belirlemektir. Ocak 2017'den Mart 2018'e kadar, elektif primer total kalça artroplastisi (49 hasta) veya total dizartroplastisi (72 hasta) ameliyatı yapılan 121 hastanın retrospektif bir değerlendirmesi yapıldı. CRP, INR, troponin ve D-Dimer düzeyleri preoperatif 1. gün, postoperatif 1., 3., 7., 14. Günlerde kaydedildi ve perioperative değişiklikler karşılaştırıldı. Tüm hastalar enfeksiyon açısından takip edildi. Çalışmaya toplam 121 hasta (% 76.9 kadın, % 23.1 erkek) dahil edildi. Postoperatif CRP ve INR değerlerinin değişkenliği benzerdi. D-Dimer erken postoperative dönemde CRP'den daha hızlı yükselme ve düşüş gösterdi. Postoperatif dönemde artan akut faz reaktanları olan CRP ve D-Dimer'ın eş zamanlı yükselmesinin ardından, enfeksiyondan bağımsız olarak süreç içinde CRP'nin normal değerlerine dönerken D-Dimer'ın tekrar pik yaptığı görüldü. Yirmi dört hastada (%19.8) erken yara enfeksiyonu tespit edildi ve yara enfeksiyonu olan hastaların %70'inde erken postoperatif D-Dimer artışı görüldü ve ayrıca erken dönemde yara enfeksiyonu olan hastalardaki CRP düzeyindeki artış ile D-Dimer yükselişi arasında anlamlı bir ilişki bulundu (p<0.05). Postoperatif takip döneminde D-Dimer değerlerinin dalgalanması ve dengesizliği, güçlü bir enfeksiyon göstergesi olarak kullanılmasının olası olmadığını düşündürmektedir. Sadece D-Dimer seviyeleri diğer enflamatuar aracılarla kombine edilerek değerlendirilirse, eklem artroplastisi sonrası enfeksiyonunun erken tespitinde etkili olabilir.

Anahtar Kelimeler

Artroplasti , CRP , D-Dimer , Periprostetik Yara nfeksiyonu

Proje Numarası

none

Correlation between Progress of D-Dimer Following Total Joint Arthroplasty and Early Postoperative Wound and Joint Infection

https://izlik.org/JA38GC63GF

Öz

Postoperative infection after joint arthroplasty is a bad complication with incontrovertible incidence and early detection is essential. The purpose of this retrospective study was to evaluate postoperative change of D-Dimer level after joint arthroplasty along with other proinflammatory mediators and to determine the correlation between progress of D-Dimer and early postoperative infection. From January 2017 until March 2018, a retrospective evaluation of 121 patients operated for elective primary total hip arthroplasty (49 patients) or total knee arthroplasty (72 patients) was conducted. CRP, INR, troponin and D-Dimer level were noted on the preoperative day 1, postoperative days 1, 3, 7, 14 and perioperative changes compared. All patients were followed up for infection. 121 patients included in the study. The variability of postoperative CRP and INR values was similar. D-Dimer showed a more rapid rise and fall than CRP in early postoperative period. Early wound infections were detected in 24 patients (19.8%) and 70% of the patients with wound infection had early postoperative D-Dimer increase and also a significant relationship was found between the patients with wound infection in the early period and the increase in CRP level (p<0.05). The fluctuation and instability of D-Dimer values during the postoperative follow-up period suggests that it may be unlikely to be used as a strong indicator of infection. If only the D-Dimer levels combined with other inflammatory mediators like CRP etc. then it might be effective in early detection of wound infection after joint arthroplasty.

Anahtar Kelimeler

Arthroplasty , CRP , D-Dimer , Periprosthetic Wound Infection

Destekleyen Kurum

none

Proje Numarası

none

Teşekkür

none

Kaynakça

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