| Background and Purpose With the progress of population aging,more and more patients with knee osteoarthritis choose to receive total knee arthroplasty.Although joint surgeons take various measures to reduce the risk of infection,the number of patients suffering from periprosthetic joint infection after surgery is still increasing gradually,and has become the main reason for early revision knee surgery.Periprosthetic joint infection is the most serious and catastrophic complication after joint replacement.Patients diagnosed with PJI after total knee arthroplasty may present with symptoms of pain,swelling,limited function and even systemic inflammatory diseases,etc.Due to PJI,platelet function of these patients may undergo a series of changes,which may be related to the progress and outcome of the disease.Currently,the treatment options for PJI include non-surgical treatment,one-stage revision and two-stage revision.Two-stage revision are considered the gold standard for treating infections among many treatments.The two-stage revision includes two steps: the first stage is open surgery,including joint cavity cleaning,prosthesis removal and antibiotic cement spacer implantation;In the second stage,after the infection was cured,a new joint prosthesis was implanted with a special tool for knee revision.In general,anti-infective therapy should be prescribed at least 3 months after exclusive surgery.Most of the PJI are hematogenous infections,and the platelet function of these patients will be affected by the infectious factors,resulting in pathological and physiological changes.PJI patients tend to suffer more complications,with a higher probability of bleeding,thrombosis and thromboembolic events than normal patients,and platelets play an important role in these adverse events.In recent years,the inflammatory progress and metabolic regulation function of platelets in infectious diseases have become a hot issue.It has been found that in the progression of severe infectious diseases,platelets are involved in the regulation of inflammation through different mechanisms.For example,abnormal activation and aggregation of platelets are often found in the pathogenesis of sepsis to assist immune cells to control infection.Many studies have proved that platelet aggregation function is closely related to bacterial infection.Platelet count and mean volume are also affected in the course of infectious inflammatory disease.Platelet dysfunction often indicates a poor prognosis.The study population was defined as patients diagnosed with PJI and treated with two-stage revision.Objective: to explore the changes of platelet function in patients with PJI before open therapy,and to explore the changes of platelet function in patients with PJI after the treatment of infection;the regularity and characteristics of platelet changes in PJI patients before and after infection were summarized.Methods1.Grouping: A total of 21 patients(21 knees)admitted to the department of joint surgery of Henan Provincial People's Hospital from October,2017 to April,2018 and diagnosed as periprosthetic joint infection after knee joint replacement with the surgical treatment scheme of "exclusion surgery + revision surgery" were included,which were set as group A.At the same time,we have to select 21 individuals with osteoarthritis as a control,set to group B.2.Surgical methods: the surgical methods in group A were all "knee joint debridement + joint prosthesis removal + antibiotic bone cement spacer implantation".The surgical operations were completed by the same group of physicians.The surgical method of group B was standard "total knee arthroplasty",and the surgical operations were completed by the same group of physicians.The routine postoperative low-molecular-weight heparin anticoagulation was 4000 U.3.Perioperative blood collection points: peripheral venous blood was extracted from 42 patients during the perioperative period to check their platelet function.The blood collection points in group A were 1 day before the operation,1 day after the operation,3 days after the operation,7 days after the operation,14 days after the operation and 12 weeks after the operation,A total of 6 blood collection points were collected.The blood collection points in group B were 1 day before,1 day after,3days after,7 days after,and 14 days after knee replacement,with a total of 5 blood collection points.4.Platelet function testing method: take peripheral venous blood 2-3 ml more than 2 hours after meal or morning on an empty stomach,keep calm and soothe patients,and send samples as soon as possible.Detection in 24 ? ± 2 ? indoor temperature control,if the blood samples under the condition of low temperature should be put into 22? to 28? heat preservation box,in the process of transfer to avoid vibration.Various measures should be taken to reduce the activation of platelets:do not flap the blood collection site,do not use tourniquet as much as possible,select the second blood tube as far as possible for the test sample,and complete the test within 2 hours.Blood samples should be collected by 3.8% sodium citrate double-layer vacuum blood collection.5.The method for the use of a PL-12 platelet function analyzer is to inject the polyagent before the platelet analyzer,and then put the sample in the test position of the device,press "test" button,and wait for the test to be done until acquire automatic print results.Results1.MAR and AAR: the results measured 1 day before the operation,1 day after the operation,3 days after the operation,7 days after the operation,and 14 days after the operation,respectively,were higher in group A than group B,and the difference was statistically significant(P < 0.05).2.MAT: the results measured at 1 day before surgery,1 day after surgery,3 days after surgery,7 days after surgery and 14 days after surgery were different in group A compared with group B,and the difference was not statistically significant(P > 0.05).3.PLT: the results measured 1 day before surgery,1 day after surgery,3 days after surgery,7 days after surgery and 14 days after surgery in group A were different from those in group B,and the difference was statistically significant(P < 0.05).4.MPV: the results measured 1 day before surgery,1 day after surgery,3 days after surgery,7 days after surgery and 14 days after surgery in group A were different from those in group B,and the difference was statistically significant(P < 0.05).5.Group A: MAR,AAR,MPV and PLT were significantly different at 12 weeks after operation compared with 1 day before operation(P < 0.05).MAT at 12 weeks after surgery was different from that at 1 day before surgery,and the difference was not statistically significant(P > 0.05).Conclusion1.Patients with PJI suffered abnormal preoperative aggregation function,higher platelet aggregation rate,lower platelet count and higher average platelet volume than those of the general patients.2.In PJI patients,platelet function was highly activated within 14 days after surgery,and platelet aggregation rate first climbed and then declined.Both the platelet count and mean platelet volume showed a gradually decreasing trend within14 days after the operation,but the platelet count was lower than that of ordinary patients and the mean platelet volume was higher than that of ordinary patients.3.The platelet aggregation function and mean platelet volume of PJI patients were significantly decreased and the platelet count was increased 12 weeks after the operation. |
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