Which factors will affect the medium-term results of total hip arthroplasty?

doi:10.3969/j.issn.2095-4344.2013.13.023

Abstract

Abstract:

BACKGROUND: Life quality of patients after total hip arthroplasty will affected by various factors, and the factors that can affect the treatment effect after replacement should be analyzed in order to take the specific measures to intervene.
OBJECTIVE: To investigate the relative factors that affect the treatment effect of initial total hip arthroplasty.
METHODS: The clinical data of 352 patients treated with initial total hip arthroplasty were retrospectively analyzed, and the factors that affect the scoring were determined according to the Harris score. The relationship between various factors and the treatment of total hip arthroplasty was evaluated and analyzed through chi-square test and Spearman classification. Comparative analysis was performed to compare the results of relative articles and researches.
RESULTS AND CONCLUSION: Age, body mass index, hip rotation center, femoral eccentricity and post-operative rehabilitation training of the patients with initial total hip arthroplasty could affect the medium-term results after total hip arthroplasty. While the influence of preoperative diagnosis, surgical approach, patient gender and type of prosthesis on the treatment effect of total hip arthroplasty was not obvious. Adequate attention to these factors, correct prevention and scientific treatment of a variety of factors that may affect the recovery of joint function, all these effort are the prerequisites for the surgeons to improve satisfaction of the patients.

Key words: bone and joint implants, academic discussion of bone and joint implants, total hip arthroplasty, influential factor, therapeutic effect, hip function score, Mayo efficacy assessment, type of prosthesis, surgical approach, acetabular rotation center, bone cement, age, gender, body mass index, diagnosis, rehabilitation training, eccentricity

CLC Number:

R318

Chen Ming, Kan Wu-sheng, Fang Zhen-hua, Zheng Qiong, Xu Min-chao. Which factors will affect the medium-term results of total hip arthroplasty?[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2447-2454.

Figures/Tables 4

1 人工髋关节置换后中期疗效的影响因素分析 1.1 一般资料选取武汉市普爱医院骨科从1994年7月至2003年9月实施人工全髋关节置换治疗的患者共1 026例，对其中由同一医师完成的526例患者进行随访，随访时间5.7-14.9年，平均随访时间8.5年，得到回访病例352例，均为单侧髋关节置换。其中，男性191例，女性161例。平均年龄65岁，平均体质量65.3 kg。患者类型及治疗方法：352例患者中，股骨颈骨折78例，陈旧性股骨颈骨折28例，股骨头缺血性坏死50例，髋臼发育不良CroweⅠ-Ⅳ型共25例，髋关节骨性关节炎114例，类风湿性关节炎和强直性脊柱炎57例。采用骨水泥假体82例，非骨水泥假体270例；前侧手术入路41例，外侧手术入路62例，后外侧手术入路249例；置换后有条件的患者进入康复病房进行康复训练。 1.2 测量指标在人工髋关节置换前和置换后标准骨盆平片及双侧髋关节正侧位X射线片上，确定股骨头中心、股骨干轴心、泪滴等位置，以测量股骨偏心距和股骨头旋转中心，把置换后股骨偏心距与健侧的差别小于4 mm的患者视为股骨偏心距得到重建。测量股骨头旋转中心到泪滴线的垂直距离以及患侧泪滴底点到沿泪滴线至股骨头旋转中心与泪滴线垂线的水平距离。同关节置换前健侧测量值对比，规定髋关节旋转中心同健侧对比，其差值垂直距离在5 mm，水平距离在4 mm以内为达到恢复标准。 1.3 疗效评价通过复习患者的住院病案、影像资料、门诊、信件、电话以及追踪方式进行随访。随访内容包括人工髋关节置换后患者疼痛和关节活动功能，完全负重行走时间，置换后并发症，目前满意情况等。对患侧髋关节进行Harris关节功能评分及Mayo疗效评定。 Harris髋关节评分标准是目前国内外学者最常采用的人工全髋关节置换后关节功能的评分标准[1]。满分为100分，最低分为0分，常按得分范围将髋关节功能分为4级，90-100分为优，80-89分为良，70-79分为可，少于70分为差。此评分由疼痛、关节功能、关节运动和行走能力组成。疼痛在评分中比重最大，占总分的44%。关节功能在评分中所占权重为18%，其中包括自行穿袜子或鞋子，能否搭乘公共交通工具，能否坐在不同高度的椅子上，能否上下楼梯，腿部是否有畸形等。关节运动在评分中权重为5%，包括内收、外展、弯曲、内旋转和外旋转。行走能力在评分中的权重为33%，包括行走距离，行走时是否需要支撑等[2]。人工全髋关节置换的主要目的是缓解患者疼痛症状和改善髋关节的活动功能，而疼痛和下肢功能性活动在Harris髋关节评分中权重较大，可独立反应髋关节功能，由于髋关节畸形和活动范围在Harris髋关节评分中权重较少，通过疼痛和关节功能的评定可大致反应出髋关节功能的分数，并且有利于随访[3]。 1.4 统计学分析应用SPSS 12.0统计学分析软件，对患者人工全髋关节置换后髋关节Harris功能评分与患者年龄、性别、体质量指数、诊断、手术入路、髋臼旋转中心以及偏心距恢复，不同假体类型，置换后康复情况等因素行卡方检验，同时，采用Spearman等级相关分析上述影响因素与置换后髋关节功能的关系。P < 0.05认为差异有显著性意义。 1.5 不同影响因素对人工髋关节置换后中期关节功能卡方检验结果见表1。"

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