血液透析患者髋关节置换中远期疗效分析  

Analysis of middle and long term effect of hip arthroplasty in hemodialysis patient

作　　者：顾锋[1] 胡美丽[2] 唐小穗[1] 沈鹰[3] 赵京元[3] 

机构地区：[1]辽宁医学院航天中心医院研究生培养基地,北京100049 [2]航天中心医院神经外科,北京100049 [3]航天中心医院骨科,北京100049

出　　处：《现代预防医学》2015年第17期3250-3254,共5页Modern Preventive Medicine

摘　　要：目的研究终末期肾病血液透析患者施行髋关节置换手术的中远期疗效,总结此类患者的手术治疗经验,为临床治疗提供参考。方法选择2001年1月-2012年1月因肾功能不全血液透析治疗,并施行髋关节置换的18例患者,将随访3年以上的15例作为研究对象。将术前、最后1次随访HHS进行配对t检验,计算P值。采用Kaplan-Meier法计算生存率。通过对Harris髋关节评分、并发症、假体松动及留存率等因素进行总结分析,观察中远期疗效。结果平均随访(6.67±2.61)年。死亡8例。术后5年生存率为78.6%,中位生存时间为8.00年。术前及最后1次随访平均Harris评分分别为(22.33±20.42)、(81.60±14.01)分,评分差异有统计学意义(t=-15.741,P<0.05)。死亡病例为死亡前最后一次随访评分。所有病例无感染、假体脱位并发症。发生股骨柄假体无菌性松动2例,臼杯侧无松动病例,假体松动率13.3%。发生假体周围骨折1例。结论肾功能不全血液透析髋关节置换患者,手术并发症多,假体松动率及病死率高。但大多患者在生存期内髋关节疼痛明显减轻,髋关节功能改善,生活质量明显提高。所以髋关节置换手术是此类患者的较好选择。Objective To investigate the middle and long term clinical curative effect of hip arthroplasty in hemodialysis patients, to summarize the experience of surgical treatments, and to provide reference for clinical treatments of these hemodialysis patients. Methods Eighteen hemodialysis patients were treated with hip arthroplasty in our hospital between January 2001 and January 2012. Fifteen cases followed up for more than 3 years were chosen as the research objects. Paired t-test was used for comparison of the preoperative and final follow-up Harris Hip Score （HHS）. Kaplan-Meier analysis was performed to calculate the survival rate. We evaluated the middle and long term curative effect by HHS, complications, prosthesis loosening and retention rate. Results The mean follow-up period was （6.67± 2.61） years. Eight cases died. The postoperative 5-year survival rate was 78.6%. The median survival time was 8.00 years. The mean of preoperative and last follow-up HHS were （22.33± 20.42） and （81.60 ±14.01）, respectively. The score difference was statistically significant （t=-15.741, P〈0.001）. The HHS of the death cases was the last follow-up before death. No infection and hip prosthesis dislocation occurred in all cases. Femur periprosthesis aseptic loosening appeared in 2 cases. There was no case presented with acetabular periprosthesis aseptic loosening. The periprosthesis aseptic loosening rate was 13%. While one case presented with periprosthetic fracture. Conclusion Many surgical complications are appeared in renal insufficiency hemodialysis patients with hip arthroplasty. Meanwhile the mortality rate and prosthesis loosening rate are high among these patients. However, most of the patients with hip pain significantly decrease and have better hip function in the survival period, and the quality of life has improved significantly. So hip arthroplasty is the good choice for the hemodialysis patients.

关 键 词：髋关节 关节置换 慢性肾功能不全 透析 

分 类 号：R457[医药卫生—治疗学]