D-二聚体在低毒性感染性骨不连术前诊断中的应用价值

目的:评估D-二聚体及常用血液学检查指标在术前诊断低毒性感染性骨不连中的应用价值。方法：回顾性分析2015年6月至2020年1月收治的骨不连病例116例，其中男91例，女25例；年龄18~65（45.3±11.2）岁。根据诊断标准分为低毒性感染性骨不连组31例和无菌性骨不连组85例。入院时测定D-二聚体、白细胞总数、C-反应蛋白和血沉，对比两组之间的差异，并通过受试者工作特征曲线和曲线下面积分析诊断的准确性及比较它们的敏感性和特异性。结果：所有患者获随访，时间12~24（11.5±4.3）个月。低毒性感染性骨不连组的D-二聚体、白细胞总数、C-反应蛋白和血沉均高于无菌性骨不连组（P<0.05）；相比于其他血液学指标，D-二聚体曲线下面积最高，为0.826，D-二聚体的最佳截断值为1.57 g/L。术前诊断低毒性感染性骨不连的敏感性78.3%和特异性84.2%也最高。结论：D-二聚体在低毒性感染性骨不连的术前诊断价值优于其他炎性指标，D-二聚体与其他炎性指标联用有利于早期诊断低毒性感染性骨不连及评估病情。

Application value of D-dimer in preoperative diagnosis of low toxic infectious nonunion

Objective: To evaluate the value of D-dimer and common hematological indexes in the preoperative diagnosis of low toxicity infectious bone nonunion.Methods: Total of 116 cases of bone nonunion from June 2015 to January 2020 were analyzed retrospectively, including 91 males and 25 females;the age ranged from 18 to 65 years old with an average of(45.3±11.2) years old. According to the diagnostic criteria, 116 cases were divided into low toxicity infectious bone nonunion group(31 cases) and aseptic bone nonunion group(85 cases). D-dimer, total leukocyte count, C-reactive protein and erythrocyte sedimentation rate(ESR) were measured at admission, and the differences between two groups were compared. The diagnostic accuracy, sensitivity and specificity were analyzed through the subject working characteristic curve and the area under the curve.Results: All patients were followed up for 12 to 24 months with an average of (11.5±4.3) months. D-dimer, total leukocyte count, C-reactive protein and ESR in low toxicity infectious bone nonunion group were higher than those in aseptic bone nonunion group(P<0.05);compared with other hematological indexes, the area under the curve of D-dimer was the highest, which is 0.826, and the best cut-off value of D-dimer was 1.57 g/L. The sensitivity and specificity of preoperative diagnosis of low toxicity infectious bone nonunion were 78.3% and 84.2%.Conclusion: The preoperative diagnostic value of D-dimer in low toxicity infectious bone nonunion is better than other inflammatory indexes. The combination of D-dimer and other inflammatory indexes is conducive to the early diagnosis of low toxicity infectious bone nonunion and the evaluation of the condition.