双髋与单髋置换术后患者健康相关生存质量对照研究

Control study of health-related quality of total hip arthroplasty patients between bilateral and unilateral

目的评价双侧与单侧全髋关节置换术后病人的健康相关生存质量差异以及两种评价体系的特点。方法对2004年1月～2008年1月26例双髋(双髋组)和26例单髋(单髋组)接受全髋关节置换术的病人,进行6个月的前瞻性研究。术前、术后6个月对两组病人进行Harris髋关节评分和SF-36简明健康状况调查量表评分,并分析Harris髋关节评分和SF-36各项评分之间的相关性和两组病人间的差异。结果两组病人术后6个月的Harris髋关节评分和SF-36各项评分均较术前有统计学意义上的差异(P<0.001),但两组病人SF-36各项评分的改善程度并不一致,且单髋组改善较双髋组明显。Harris髋关节评分和SF-36生理功能(PF)和躯体疼痛(BP)项评分有相关性(r>0.4,P<0.001),但与SF-36其他方面评分无明显相关性(r<0.4),或无相关性(P>0.05)。结论单髋组术后健康相关生存质量较双髋组改善好;Harris髋关节评分更注重于评估全髋关节置换术病人的生理功能和缓解疼痛的改善,而SF-36评分较能全面的评价全髋关节置换术对病人健康相关生存质量和其它方面的改善。因此,两种评分体系结合更能全面评价双侧与单侧全髋关节置换术后病人的健康相关生存质量的差异。

【Objective】 To evaluate difference of health-related quality of life in total hip arthroplasty（THA） patients between bilateral and unilateral and both characteristic of Harris hip Score（HHS） and MOS 36-item Short Form Health Survey,SF-36.【Methods】 Based on a prospective study design,from Jan 2004 to Jan 2008,26 eligible patients who had bilateral total hip arthroplasty and unilateral total hip arthroplasty were interviewed and measured by the Harris Hip Score（HHS） and Chinese-version Short-form 36-item Health Survey（SF-36） before and six months after operations.The differences between the scores before and after operations were tested with T test and the correlation between HHS and the SF-36 domains were tested with Pearson correlation,and the differences between two group patients.【Results】 Both the HHS and eight domains of SF-36 were significantly improved 6 months after operations compared with the scores before operations.However,except for the correlations between HHS and Physical Function（PF） and Bodily Pain（BP） domains of SF-36 were significant（r 0.4,P〈0.001）,other domains of SF-36 had poor（r 0.4） or no correlations（P〉0.05） with HHS.【Conclusions】 The patients of health-related quality of life of unilateral total hip arthroplasty is better improved than bilateral total hip arthroplasties;the result of this study suggested that HHS could not capture additional important quality of life domains except for physical function and pain relief that are influenced by THA.So it was necessary to combine HHS and a quality of life survey such as SF-36 to allow a more global assessment of THA.