非创伤性股骨头缺血性坏死患者病程对全髋关节置换术后疗效的影响  

Influence of the course of non-traumatic osteonecrosis of the femoral head on the outcome of total hip arthroplasty

作　　者：杨辉 黄易 鲍星安 陈有泉 刘锋[1] YANG Hui;HUANG Yi;BAO Xing'an;CHEN Youquan;LIU Feng(Department of Orthopedics Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029

出　　处：《南京医科大学学报(自然科学版)》2025年第3期396-403,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省人民医院临床能力提升工程(JSPH-NB-2022-8)。

摘　　要：目的:探究非创伤性股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)患者病程对人工全髋关节置换术(total hip arthroplasty,THA)后患者疼痛、功能恢复及生活质量的影响。方法:回顾性分析2022年9月—2024年3月诊断为国际骨循环研究会(Association Research Circulation Osseous,ARCO)Ⅲ、Ⅳ期的ONFH并于南京医科大学第一附属医院行THA治疗的患者。根据患者病程分为短病程组(病程≤3年)与长病程组(病程>3年)。对比两组患者手术时间、住院时间、总失血量、术前术后的视觉模拟疼痛评分(visual analogue scale,VAS)、髋关节Harris功能评分、双下肢不等长(leg length discrepancy,LLD)、臀中肌肌肉脂肪浸润程度(muscle fat infiltration,MFI)、骨盆倾斜角度(pelvic obliquity angle,POA)以及术后并发症发生率。结果:共纳入219例患者,短病程组149例,长病程组70例。与短病程组相比,长病程组患者手术时间长(P<0.001)、住院时间久(P=0.036)、总失血量多(P=0.016),术后3 d、5 d、1个月的VAS疼痛评分高(P=0.034、<0.001、<0.001),术后1个月髋关节Harris评分低(P<0.001),术前双下肢不等长明显(P<0.001),臀中肌脂肪浸润程度大(P<0.001),术前术后骨盆倾斜角大(P<0.001),而在术后3个月疼痛VAS评分、术后3、6个月髋关节Harris评分、双下肢不等长及术后并发症方面,两组差异无统计学意义(P>0.05)。结论:与病程长的患者相比,病程短的患者在接受THA治疗后短期内疗效较好。Objective:To explore the impact of the course of non-traumatic osteonecrosis of the femoral head(ONFH)on pain,functional recovery,and quality of life after total hip arthroplasty(THA).Methods:A retrospective analysis was conducted on patients diagnosed with Association Research Circulation Osseous(ARCO)stageⅢandⅣONFH who underwent THA at the First Affiliated Hospital of Nanjing Medical University between September 2022 and March 2024.Patients were divided into the short course group(course of disease≤3 years)and long course group(course of disease>3 years)according to the length of the course of disease.Comparisons were made between the two groups regarding the surgery time,length of hospital stay,total blood loss,preoperative and postoperative visual analogue scale(VAS)pain scores,Harris hip joint function scores,leg length discrepancy(LLD),muscle fat infiltration(MFI),pelvic obliquity angle(POA),and the incidence of postoperative complications.Results:A total of 219 patients were included,within 149 patients in the short course group and 70 in the long course group.Compared to the short course group,patients in the long course group exhibited longer surgery time(P<0.001)and hospital stays(P=0.036),greater total blood loss(P=0.016),higher VAS pain scores on postoperative days 3,5,and 1 month(P=0.034,P<0.001,P<0.001),while lower Harris hip function scores at 1 month postoperative(P<0.001).Additionally,there was a greater preoperative LLD,MFI,and larger preoperative and postoperative POA in the long course group(P<0.001).However,there was no significant difference between the two groups in VAS pain score at 3 months,hip Harris scores at 3 and 6 months,leg length discrepancy,or postoperative complications(P>0.05).Conclusion:Compared with patients with a long disease course,patients with a short disease course have better short-term outcome after THA treatment.

关 键 词：股骨头缺血性坏死 病程 人工全髋关节置换术 疼痛 预后 

分 类 号：R584[医药卫生—内分泌]