移位性髋臼骨折患者术后的生命质量及其影响因素分析

Analysis of Quality of Life and Its Influential Factors after Operative Treatment in Patients with Displaced Acetabular Fractures

目的：评价移位性髋臼骨折患者术后的生命质量及其影响因素,为治疗和康复方法的选择提供新的结局指标,从而指导临床。方法：应用SF-36量表中文版测定2000年6月～2006年6月本院骨科收治的124例（125髋）移位性髋臼骨折患者术后的生命质量,并与当地常模进行比较。对性别、年龄、合并伤、骨折类型、手术入路、并发症、功能结果等12个指标进行单因素分析,取其中有统计学意义的变量作多因素Logistic回归分析。结果：本组患者生命质量综合评分较当地一般人群下降,差异有显著性（P〈0.000）,但GH,VT、RE、MH四个维度与一般人群相当（P〈0.000）,仅PF、RP、BP、SF四个维度较一般人群下降（P〉0.05）。单因素分析显示年龄、骨折类型、手术方式、创伤性关节炎、股骨头缺血坏死以及功能结果等与髋臼骨折术后生命质量有关,其中骨折类型和功能结果在多因素分析时最终进入Logistic回归方程。结论：髋臼骨折患者术后总体生命质量较一般人群下降,但在心理、精神因素方面与一般人群无显著差异,在生理活动方面较一般人群下降并造成了职能限制。骨折类型和功能结果是影响髋臼骨折患者术后生命质量的独立危险因素,其中功能结果是最重要的可控性因素。年龄、手术入路、创伤性关节炎以及股骨头缺血坏死等是影响生命质量的间接因素。

Objective：To evaluate the quality of life of the patients treated by surgery,and analyze its influential factors.Methods：Self-management method was applied to fill in the Chinese version SF-36 to assess the quality of life of 124 patients（125 hips）with displaced acetabular fractures who were treated operatively.Firstly,univariate analysis was used in 12 clinical variables.Then,multivariate Logistic regression analysis was used in the selected variables.Results：To compare with general people in Sichuan province,levels of the PF,RP,BP and SF were below local population norms matched for age and sex,and levels of the GH,VT,RE and MH were comparable to the local population norms.The general quality of life was below the local population norm.The age of the patient,fracture type,approach of surgery,OA,AVN and functional outcome were selected through single factor analysis.By Logistic regression analysis,fracture type and functional outcome were in the Logistic regression equation.Conclusion：The quality of life of the patients with acetabular fractures treated operatively is poorer than general local people.Associated fracture type and sub-optimal outcome were risk factors independently associated with a poor quality of life.The age of the patient,the approach of surgery and the presence of OA or AVN were factors which were not directly associated with a poor quality of life.