合并症对股骨颈骨折人工全髋关节置换术后髋关节功能的影响  

Effect of Comorbidities on Hip Function after Total Hip Arthroplasty in Femoral Neck Fracture

作　　者：顾颀 朱柯雨 盛晓磊 田守进[1] 徐又佳[2] 葛建飞[1] Gu Qi;Zhu Keyu;Sheng Xiaolei;Tian Shoujin;Xu Youjia;Ge Jianfei(Department of Orthopaedic Surgery,Zhangjiagang Hospital Affiliated to Soochow University,Suzhou 215600,China;Clinical Center of Osteoporosis,Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属张家港医院骨科,江苏苏州215600 [2]苏州大学附属第二医院骨质疏松临床中心,江苏苏州215004

出　　处：《骨科》2024年第3期218-223,共6页ORTHOPAEDICS

摘　　要：目的探讨何种合并症对股骨颈骨折人工全髋关节置换术(total hip arthroplasty,THA)术后髋关节功能及死亡率有影响;美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级和Charlson合并症指数(Charlson Comorbidity Index,CCI)是否是术后髋关节功能水平降低及死亡率升高的危险因素。方法纳入2020年1月至2022年1月于苏州大学附属张家港医院就诊并接受THA的175例老年股骨颈骨折病人,年龄为65~86岁,其中男42例,女133例,收集包括合并症在内的临床资料,术后12个月随访使用Harris髋关节评分(Harris Hip Score,HHS)评价髋关节功能并进行回顾性分析。采用Logistic回归分析术后12个月髋关节功能不良和死亡事件发生的危险因素。结果脑血管疾病[OR=6.917,95%CI(2.983,16.023),P<0.001]、痴呆[OR=11.531,95%CI(1.774,74.963),P=0.010]、中重度肾功能不全[OR=12.629,95%CI(2.998,53.197),P=0.001]、肿瘤(不伴转移)[OR=63.118,95%CI(5.419,734.360),P=0.001]、ASA分级[OR=25.305,95%CI(3.337,191.905),P=0.002]和CCI[OR=12.367,95%CI(1.876,81.451),P=0.009]为术后12个月髋关节功能不良的危险因素;心肌梗死[OR=52.985,95%CI(3.575,785.248),P=0.004]、帕金森病[OR=58.850,95%CI(5.618,616.464),P=0.001]以及ASA分级[OR=16.643,95%CI(2.264,122.486),P=0.006]是术后12个月死亡的危险因素。结论在股骨颈骨折THA术后髋关节功能恢复方面,脑血管疾病、痴呆、中重度肾功能不全和肿瘤是需要被特别关注的合并症;为降低术后12个月死亡率,应对合并心肌梗死和帕金森病的病人加强护理、支持和合并症治疗。此外,CCI和ASA分级在THA术后髋关节功能评估方面有一定的临床意义,ASA分级同样可以用于术后死亡率的评估。Objective To explore which comorbidities have influence on postoperative hip function and mortality after total hip arthroplasty(THA),and whether American Society of Anesthesiologists(ASA)classification and Charlson Comorbidity Index(CCI)can predict postoperative hip function and mortality.Methods A total of 175 elderly patients with femoral neck fracture who underwent THA in Zhangjiagang Hospital Affiliated to Soochow University from January 2020 to January 2022 were enrolled.The age range was 65-86 years old,with 42 males and 133 females.The clinical data including comorbidities were collected and followed up 12 months after operation with Harris Hip Score(HHS).Logistic regression analysis was used to analyze the independent risk factors of hip dysfunction and death 12 months after operation.Results Cerebrovascular disease[OR=6.917,95%CI(2.983,16.023),P<0.001],dementia[OR=11.531,95%CI(1.774,74.963),P=0.010],moderate and severe renal insufficiency[OR=12.629,95%CI(2.998,53.197),P=0.001],tumor(without metastasis)[OR=63.118,95%CI(5.419,734.360),P=0.001],ASA classification[OR=25.305,95%CI(3.337,191.905),P=0.002]and CCI[OR=12.367,95%CI(1.876,81.451),P=0.009]were independent risk factors of hip dysfunction 12 months after operation.Myocardial infarction[OR=52.985,95%CI(3.575,785.248),P=0.004],Parkinson's disease[OR=58.850,95%CI(5.618,616.464),P=0.001]and ASA classification[OR=16.643,95%CI(2.264,122.486),P=0.006]were independent risk factors for death 12 months after operation.Conclusion For the recovery of hip function after THA,cerebrovascular disease,dementia,moderate and severe renal insufficiency and tumor are comorbidities that need special attention.In order to reduce the mortality of 12 months after operation,nursing and support should be strengthened for patients with myocardial infarction and Parkinson's disease.In addition,CCI and ASA classification have certain clinical significance in the evaluation of postoperative hip function after THA,and ASA classification can also be used to evaluate postoperative mo

关 键 词：股骨颈骨折 人工全髋关节置换 合并症 髋关节功能 死亡率 

分 类 号：R687.4[医药卫生—骨科学]