经改良Hardinge入路全髋关节置换术及翻修术后发生完全性腓总神经损伤的危险因素与预后分析  

Prognostic analysis and risk factors for complete common peroneal nerve injury after total hip replacement and revision via the modified Hardinge approach

作　　者：苏春阳 魏纪童 郭璀璀 张一帆 王英振[1] 项帅 徐浩[1] Su Chunyang;Wei Jitong;Guo Cuicui;Zhang Yifan;Wang Yingzhen;Xiang Shuai;Xu Hao(Department of Joint Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院关节外科,青岛266000 [2]青岛大学附属医院运动医学科,青岛266000

出　　处：《中华创伤骨科杂志》2024年第12期1034-1040,共7页Chinese Journal of Orthopaedic Trauma

基　　金：中国博士后科学基金面上资助项目(2022M721751)。

摘　　要：目的探讨经改良Hardinge入路全髋关节置换术(THA)及翻修术后发生完全性腓总神经损伤的危险因素及患者预后。方法回顾性分析2016年4月至2022年4月期间青岛大学附属医院关节外科经改良Hardinge入路行THA及翻修术后发生完全性腓总神经损伤的11例患者资料(神经损伤组)。男7例,女4例;手术时年龄(59.5±10.1)岁;体重指数为(26.1±3.5)kg/m^(2)。以1∶5纳入手术年份、手术类型、手术入路、假体固定模式和主刀医生相匹配的55例THA或翻修术后未发生腓总神经损伤患者(无神经损伤组)。比较两组患者的临床资料,将P<0.05的变量纳入多因素logistic回归模型,分析THA及翻修术后发生完全性腓总神经损伤的危险因素。记录神经损伤组患者神经功能恢复时间及末次随访时腓总神经功能恢复情况。结果神经损伤组与无神经损伤组患者是否放置引流管、体重指数、手术时间、术后肢体延长长度比较差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示:未放置引流管(OR=0.047,95%CI:0.003~0.680,P=0.025)和手术时间长(OR=1.063,95%CI:1.002~1.128,P=0.044)是经改良Hardinge入路THA及翻修术后发生完全性腓总神经损伤的危险因素。神经损伤组11例患者术后获(48.0±22.0)个月随访。其中3例患者腓总神经功能分别于术后3、21、24个月完全恢复;4例患者腓总神经功能分别于术后2、3、10、48个月开始恢复,末次随访时分别恢复至3、2、2、1级肌力;4例患者神经功能未恢复,行走时足下垂明显,严重影响患者日常生活。结论未放置引流管、手术时间长是经改良Hardinge入路THA及翻修术后发生完全性腓总神经损伤的危险因素。一旦发生完全性腓总神经损伤,患者的预后一般较差。Objective To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty(THA)and revision via the modified Hardinge approach.Methods A retrospective study was conducted to analyze the clinical data of 11 patients(nerve injury group)who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery,The Affiliated Hospital of Qingdao University from April 2016 to April 2022.There were 7 males and 4 females,with an age at the time of surgery of(59.5±10.1)years and a body mass index of(26.1±3.5)kg/m^(2).In a 1∶5 ratio,another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year,surgical type,surgical approach,prosthesis fixation mode,and chief surgeon.The clinical data were compared between the 2 groups.Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach.The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group.ResultsThe differences were statistically significant between the 2 groups in the comparisons of drainage tube placement,body mass index,operative time,and postoperative limb lengthening(P<0.05).The multifactorial logistic regression analysis showed that absence of drainage tube placement(OR=0.047,95%CI:0.003 to 0.680,P=0.025)and long operative time(OR=1.063,95%CI:1.002 to 1.128,P=0.044)were the risk factors for complete common peroneal nerve injury after THA and revision.The 11 patients were followed up for(48.0±22.0)months after operation.The function of the common peroneal nerve recovered fully at postoperative 3,21,and 24 months respectively in 3 patients,and began to recover at postoperative 2,3,10,and 48 months

关 键 词：关节成形术 置换 髋 手术后并发症 髋关节翻修 改良HARDINGE入路 腓总神经损伤 

分 类 号：R687.3[医药卫生—骨科学]