全髋关节置换术后早期并发脱位的多种危险因素回归分析

Logistic Regression Analysis for Early Dislocation after Total Hip Replacement

目的：探讨人工全髋关节置换术早期并发脱位的多个相关因素的危险度及相应的预防和处理对策。方法：分析1 208例首次全髋关节置换术病例。选择患髋既往手术史、手术入路、髋臼前倾角、髋臼外展角、股骨头旋转中心垂直距离进行多因素Logistic回归分析。结果：1 208例中发生脱位44例（3.6%）。患髋既往有手术史的患者发生脱位是无手术史的10.255倍;后外侧入路发生脱位的风险是前路的16.573倍;髋臼前倾角〈10°的患者发生脱位是前倾角10°～20°的3.770倍,前倾角〉20°发生脱位是10°～20°的8.011倍;髋臼外展角〉50°的患者脱位是40°～50°的7.8倍;股骨头旋转中心垂直距离≥30 mm的患者脱位是〈30 mm的2.908倍。结论：患髋既往手术史、手术入路、髋臼前倾角、髋臼外展角、股骨头旋转中心垂直距离是影响全髋关节置换术早期并发脱位的重要因素,术前做好髋关节周围软组织和骨质的评估;在术中保持髋臼前倾角10°～20°、髋臼外展角40°～50°、股骨头旋转中心垂直距离〈30 mm,尽力修复关节囊、调整好关节周围软组织的张力和平衡,是防止术后脱位的关键。

Objective： To explore the criticality of multi - factors for the early dislocation of total hip replacement and summafise some measures to prevent and treat the early dislocation. Methods： 1208 cases of primary total hip replacement were analyzed including 620 men and 588 women. The statistical indexes included previous hip joint operation, operative approach, acetahulum of anteverted angle and abducens angle, the height of the femoral head center. Logistic Regression analysis was made for those tlve factors and summarization was made for the criticality of each factor for the early dislocation. Results： 44 cases had dislocation of hip joint, there were statistical significances of those five related factors. There were 10. 255 times that the patient with previous hip joint operation occurred dislocation than that without previous hip joint operation. There were 16. 573 times that the operative-approach from back- outside occurred dislocation than that from ahead. There were 3.770 times that acetabulum of anteverted angle 〈 10° occurred dislocation than acetabulum of anteverted angle 10° - 20°. And also had a 8.011 times that anteverted angle 〉 20° occurred dislocation than acetabulum of anteverted angle 10° - 20°. The abducens angle 〉 50° had a 7. 807 times dislocation likelihood than abducens angle 40° - 50°. The height of the femoral head center ≥ 30mm had a 2.908 times dislocation likelihood than the height of the femoral head center 〈30 mm. Conclusion： Previous hip joint operation, operative approach, acetahulum of anteverted angle and abducens angle, the height of the femoral head center are the effective factors of the early dislocation of total hip replacement. Keeping acetabulum of anteverted angle（ 10° - 20°）, abducens angle（40° - 50°） and the height of the femoral head center（ 〈 30mm）, restoring the joint capsule and keeping tension and balance of parenchyma around the joint are the hinges to prevent the dislocation after the total hip replacement.