人工全髋关节置换术后患者关节功能评估及影响因素研究

The evaluation and study on the influence factors of joint function after THA

目的：探讨人工全髋关节置换术（THA）后患者关节功能变化情况及影响关节功能恢复的相关因素。方法：采用回顾性分析方法,根据纳入标准选择73例股骨颈骨折、26例股骨头缺血性坏死（Ⅳ期）、21例原发性髋关节骨性关节炎3组研究对象接受THA,采用Harris评分评估髋关节功能恢复情况,分析髋关节功能恢复的影响因素。结果：经THA治疗,股骨颈骨折、股骨头缺血性坏死、原发性髋关节炎总有效率分别为84.9%、80.7%、80.9%,3组患者Harris评分组间差异无统计学意义（P〉0.05）;单因素分析发现患者体重指数、术后下地时间、股骨假体柄干角、髋臼外展角与前倾角、偏心距、隐性出血量等因素与髋关节功能恢复有显著相关性（P〈0.05）,Logistic回归分析发现这7个因素与THA术后髋关节功能恢复独立相关。结论：（1）THA术后关节功能恢复情况与体重指数、术后下地时间、股骨假体柄干角、髋臼外展角及前倾角、偏心距、隐性出血量等因素密切相关。（2）当THA术中髋臼外展角位于40°~50°、前倾角位于10°~20°,颈干角〉135°,偏心距得到重建,股骨假体柄干角尽量位于解剖位置的情况下术后髋关节功能预后最好。

Objective： To investigate the changes and influence factors of joint functions after the artificial total hip arthroplasty（ THA）. Methods： A retrospective analysis was done in this study. According to the inclusion criteria,73 cases of fracture of neck of femur,26 cases of femoral head ischemic necrosis and 21 cases of primary hip osteoarthritis after THA were accepted as research objects. Harris score was used to assess the hip joints function recovery and the influence factors of the hip joints function recovery were analysed. Results： The total effective rate of fracture of neck of femur was 84. 9%,the total effective rate of femoral head ischemic necrosis was80. 7%,and the total effective rate of primary hip osteoarthritis was 80. 9% after THA. Harris scores had no differences among three groups（ P 〉 0. 05）. By analyzing the single factor,BMI,lying in bed time after operation,the femoral prosthesis shaft angle,acetabular abduction and anteversion angle,eccentricity and the amount of recessive bleeding were significantly correlated with the recovery of hip joint function（ P 〈 0. 05）. Logistic regression analysis showed that these seven factors had independent correlation with the recovery of hip joint function after THA. Conclusion：（ 1） The joint function recovery after artificial THA is closely related to the BMI,lying in bed time after operation,the femoral prosthesis shaft angle,acetabular abduction and anteversion angle,eccentricity and the amount of recessive bleeding.（ 2） When acetabular abduction angle is 40° to 50°,anteversion angle is 10° to 20°,collodiaphyseal angle is above 135°,and the femoral prosthesis shaft angle is in the anatomical position,hip joint function can recover at best after operation.