髋关节置换术后中位生存时间及相关预后影响因素分析

The Median Survival Time and The Related Factors of Hip Replacement Prognosis

目的探讨髋关节置换术后3年内发生再次骨折、骨质溶解、各种原因引起的骨质代谢等疾病的发生影响因素。方法回顾性收集在本院骨科进行髋关节置换术的198例患者的基本资料,包括年龄、是否吸烟、BMI体重指数、是否饮酒、合并症情况、是否口服皮质醇类药物以及口服维生素D情况,以及相应的术后相关骨质疾病发生情况;收集118例在围手术期口服维生素D患者的具体口服时间,并对其进行随访,主要观察其相关并发症的发生情况、中位生存时间等,并在不同水平对比口服维生素D对于患者术后生存时间和相关并发症的影响。结果 198例患者基本资料分析结果提示能显著影响髋关节置换术后患者病情复发的影响因素包括吸烟、合并并发症情况以及是否口服维生素D,其中口服维生素D情况能极为显著影响患者预后相关并发症发生（P〈0.01）;对口服维生素D的患者依据其术后相关并发症的情况进行分组分析（持续大于6个月、持续大于12个月、持续大于24个月和累计超过90 d、超过180 d、超过360 d）（两组率的比较采用多组率比较的χ2检验）,χ2=16.005,P=0.001（持续时间组）,χ2=6.39,P=0.041（累计时间组）,提示口服维生素D超过一定时间后能显著降低髋关节患者术后相关并发症的发病率,但两组均无进一步的时间依赖性;对于口服维生素持续时间组生存时间进行分析,三组（持续大于6个月、持续大于12个月、持续大于24个月）患者中位生存时间及相应可信区间分别为（12个月、95%CI 10.76-13.24;20个月、95%CI 17.93-22.06;24个月、95%CI 19.36-28.63）,对于口服维生素累计时间组生存时间进行分析,三组（累计超过90 d、超过180 d、超过360 d）患者中位生存时间及相应可信区间分别为（13.5个月、95%CI10.76-15.24;18个月、95%CI16.65-20.10;20个月、95%CI 18.06-22.30）,持续时间组与累计时间组生存时间分析提示口服维生素D能提高术后生存时间（χ^2=10.742,P〈0.001、χ^2=8.252,P〈0.001）。结论吸烟、合并并发症情况以及是否口服维生素D能显著影响髋关节置换术后患者相关并发症发生,其中术后6个月后口服维生素D超过一定时间能显著提高患者术后生存时间,降低相关并发症的发生。

Objective To discuss the fracture,osteolysis,various causes of the occurrence of bone metabolic diseases after hip replacement. Methods We collected the basic statistics of the 198 patients who recieved the hip replacement,incluedind age,smoking,BMI（ body mass index）,drinking,oral cortisol drugs and oral vitamin D,and corresponding related bone disease following surgery. Results The influence factors of relapse of patients with complications including smoking,merge and whether oral vitamin D（ P〈 0. 01）,the analysis between patients with oral vitamin D groups（ lasting more than six months,lasts for more than 12 months,lasts for more than 24 months,and accumulated more than 90 days,more than 180 days,more than 360days） showed that,Oral vitamin D intaking could significantly reduce the incidence of related complications postoperatively in patients with hip joint at some term（ χ^2= 16. 005,P = 0. 001（ the consistent group）,χ2= 6. 39,P = 0. 041（ the accumulate group）. Three groups（ lasting more than six months,lasts for more than 12 months,for more than 24 months） patients＇ median survival time and the corresponding CI were1 2,9 5 % CI1 0. 7 6 - 1 3. 2 4,2 0,9 5 % CI1 7. 9 3 - 2 2. 0 6,2 4,9 5 % CI1 9. 3 6 -28. 63 respectively; Three groups（ accumulated more than 90 days,more than 180 days,more than 360 days） patients＇ median survival time and corresponding confidence intervals were 13. 5,95% CI 10. 76 - 15. 24,18,95% CI 16. 65 - 20. 10,20,95%CI 18. 06 - 22. 30 respectively. The survival analysis of oral vitamin D in two groups showed that the vitamin D intaking could improve the survival time. Conclusion Smoking,complications and oral vitamin D intaking can influent the complications after the hip replacement,and especially the intaking of vitamin D can improve the survival time and reduce the related complications after six months.