长期血液透析患者行全髋关节置换术的围术期处理及预后  

Perioperative management and outcomes of total hip arthroplasty in patients with long-term hemodialysis

作　　者：陈浩[1] 谢宏明[1] 倪江东[1] 宋德业[1] 丁木亮[1] 刘刘[2] 

机构地区：[1]中南大学湘雅二医院骨科,湖南长沙410011 [2]厦门大学附属第一医院骨科,福建厦门361003

出　　处：《中国医药导报》2015年第1期44-47,66,共5页China Medical Herald

摘　　要：目的：评价长期血液透析患者行人工全髋关节置换术的有效性、并发症发生率和早期病死率。方法选择2010年1月～2013年6月于中南大学湘雅二医院行工全髋关节置换术的慢性肾功能衰竭患者19例（21髋）为研究对象，术前平均血透时间为（6.10〈2.88）年，术前诊断包括股骨头坏死8例（10髋），髋关节骨性关节炎5例，股骨颈骨折6例，94%的患者存在除肾衰以外的其他一种或多种并存病。术前积极治疗并存病，术前24 h予血透1次，选择合适的假体，在全麻下行全髋关节置换术。临床评估其关节功能、视觉模拟评分（VAS）疼痛评分及影像学复查。登记围术期并发症、远期并发症及死亡事件。结果随访8～43个月，平均（22.4±7.8）个月。术前及术后髋关节Harris评分分别为（32.3±22.8）分和（89.6±8.2）分，差异有统计学意义（P＜0.05）；术前及术后VAS疼痛评分分别为（5.7＜1.7）、（0.7±0.1）分，差异有统计学意义（P＜0.05）。早期并发症3例，远期并发症3例，无90 d内死亡病例。结论慢性肾衰合并髋关节病患者行全髋关节置换术可以减轻疼痛，改善关节功能，提高生活质量。但是较高的风险及早期并发症不容忽视。经正确的术前评估和围术期处理，手术相对安全可行。Objective To evaluate the effectiveness, complication rate and early mortality of total hip arthroplasty in patients with long-term hemodialysis. Methods 19 patients （21 hips） with hemodialysis who were preformed total hip arthroplasty in the Second Xiangya Hospital of Central South University from January 2010 to June 2013 were enrolled. The mean duration of hemodialysis before operation was （6.10±2.88） years;indications included osteonecrosis of femoral head （8 patients, 10 hips）, osteoarthritis （5 patients） and femoral neck fracture （6 patients）; 94% of the patients com-bined with one or more comorbidities. All comorbidities were treated actively and each patient received hemodialysis within 24 hours before operation. The surgery was carried out under general anesthesia using proper prosthesis. All pa-tients were proceeded hemodialysis without heparin for 1 day after surgery. The clinical outcome was assessed using the Harris hip score, VAS for pain and radiography. Early and long-term complications and mortality were record. Results All patients were followed up 8 to 43 months, average （22.4±7.8） months. The preoperative and postoperative Harris hip score were （32.3±22.8） points and （89.6±8.2） points respectively, the difference was statistically significant （P〈 0.05）;the preoperative and postoperative VAS for pain were （5.7±1.7） points and （0.7±0.1） points respectively, the difference was statistically significant （P 〈 0.05）. 3 cases of early complications and 3 cases of long-term complications were record; no patient died within 90 days. Conclusion For the dialysis population suffered from severe hip diseases, total hip arthroplasty may substantially release pain, improve the function of hip and the quality of life. However, high risks and complication rate should not be neglected. Proper preoperative evaluation and perioperative management are cru-cial elements to make the surgery relatively safer.

关 键 词：慢性肾功能衰竭 血液透析 围术期 全髋关节置换术 并发症 

分 类 号：R687.4[医药卫生—骨科学]