全髋表面置换术后发生股骨颈狭窄非手术相关危险因素分析  

Non-operation related risk factors for femoral neck narrowing after resurfacing arthroplasty of the hip

作　　者：蒋志勇[1] 茹江英[1] 胡玉华[1] 仓海斌[1] 胡传亮[1] 

机构地区：[1]武警江苏省总队医院骨科,扬州225003

出　　处：《中国矫形外科杂志》2013年第17期1702-1707,共6页Orthopedic Journal of China

摘　　要：[目的]探讨全髋表面置换术(resurfacing arthroplasty of the hip,RSAH)术后发生股骨颈狭窄的非手术相关危险因素。[方法]回顾性分析行全髋表面置换术的患者53例(61髋),男31例,女22例;年龄26～54岁,平均45.3岁;体重指数(RMI)为20.4～37.8,平均为27.4。按病因学分类:股骨头坏死22例(26髋),先天性髋关节发育不良13例(15髋),骨性关节炎10例(12髋)和创伤性关节炎8例(8髋)。观察术后股骨颈狭窄发生情况并分组,股骨颈狭窄率≥5%纳入研究组,<5%列入对照组。对可能导致股骨颈狭窄的17个变量进行单因素分析,对差异有统计学意义的变量进行多因素非条件logistic回归分析。[结果]将37例(43髋)狭窄率>0%且<5%和未狭窄的病例纳入对照组;将16例(18髋)狭窄率≥5%的病例,纳入研究组。在研究组中,2例在术后1年于股骨头杯柄周围1、3区出现透光线;1例于术后2年出现假体松动、移位。单因素分析显示,体重指数、患髋疾病、颈干角、头颈比、股骨头囊肿大小及股骨假体柄固定方式6个变量差异有统计学意义(P值均<0.05);多因素分析显示,患髋疾病、颈干角、头颈比为独立危险因素(P值均<0.05)。[结论]髋关节原发病的诊断、头颈比、颈干角是全髋表面置换术术后股骨颈狭窄发生的非手术独立危险因素。[Objective]To analyze the non-operation related risk factors for femoral neck narrowing after resurfacing arthroplasty of the hip（RSAH）.[Methods]Fifty-three cases（61 hips）treated with RSAH were retrospectively analyzed.The study included 31 men and 22 women with a mean age of 45.3 years（range,26~54 years） and body mass index of 27.4 kg/m2（range,20.4~37.8 kg/m2）.Twenty-two cases（26 hips）were diagnosed as osteonecrosis of the femoral head,13（15 hips） as developmental dysplasia of the hip,10（12 hips）as osteoarthritis,and 8（8 hips）as traumatic arthritis.Post-operative femoral neck narrowing was observed and classified.According to the rate of femoral neck narrowing,the 53 cases were divided into a study group（≥5%） and control group（＆lt;5%）.Univariate analysis was used to analyze 17 factors that may lead to the occurrence of femoral neck narrowing,and multi-factor unconditional logistic regression analysis was performed on the factors showing a significant difference.[Results]According to the rate of femoral neck narrowing,37 cases（43 hips） were included in the control group and 16 cases（18 hips） in the study group.Two patients from the study group presented 1 year after surgery with lucency lines on zones 1 and 3 surrounding the femoral cup.One patient from the study group presented 2 years post-operatively with prosthesis loosening and displacement.Univariate analysis showed significant differences in BMI,hip disease diagnosis,neck-shaft angle,head/neck ratio,diameter of a femoral head cyst,and fixed femoral short-stem between the 2 groups（P＆lt;0.05）.Logistic regression analysis revealed that hip disease diagnosis,neck-shaft angle,and head/neck ratio were independent risk factors for femoral neck narrowing（P＆lt;0.05）.[Conclusion]Hip disease diagnosis,neck-shaft angle,and head/neck ratio are independent risk factors for femoral neck narrowing after RSAH.

关 键 词：关节成形术 表面置换 髋 股骨颈狭窄 并发症 危险因素 

分 类 号：R687.4[医药卫生—骨科学]