肥胖对经皮穿刺辅助的微创髋关节置换术临床疗效的影响

Effect of obesity on the treatment of femoral neck fracture with SuperPATH hip arthroplasty

目的 探讨肥胖对经皮穿刺辅助的微创(SuperPATH)髋关节置换术治疗股骨颈骨折治疗效果的影响.方法 选择无锡市第二人民医院2014年1月至2017年1月收治的行SuperPATH髋关节置换术的患者70例为观察对象,根据患者体质量指数(BMI)的不同分为肥胖组(BMI> 30 kg/m2) 23例、超重组(BMI为> 25~30 kg/m2)22例、正常组(BMI为>18.5~ 25 kg/m2)25例,比较三组切口长度、手术时间、手术出血量、输血率、疼痛评分、髋关节功能评分、影像学测量结果及术后并发症.结果 70例患者均顺利完成手术.肥胖组切口长度为(7.4±0.2)cm,超重组为(7.2 ±0.1)cm,正常组为(7.1 ±0.8)cm,三组切口长度差异有统计学意义(F =24.671,P<0.001).患者均获得9~13个月的随访,肥胖组髋臼前倾角、髋臼外展角、疼痛评分、髋关节活动度、行走能力评分分别为(17.8±1.2)°、(40.9±3.4)°、(1.26 ±0.61)分、(95.43±7.89)°、(8.10±0.27)分,超重组分别为(16.7±3.3)°、(42.9±2.9)°、(1.23 ±0.58)分、(96.78±3.22)°、(8.20±0.92)分,正常组分别为(15.8±2.7)°、(43.9±5.1)°、(1.24 ±0.78)分、(97.12±6.44)°、(8.20±0.48)分,三组髋臼外展角差异有统计学意义(F=9.803,P=0.002).肥胖组发生切口感染2例、深静脉血栓2例、肺部并发症1例,并发症发生率为5%;超重组发生切口浅表感染1例,深静脉血栓1例,并发症发生率为2%;正常组发生深静脉血栓1例,并发症发生率为1%.三组并发症发生率差异有统计学意义(X2=15.31,P<0.01).结论 肥胖增加SuperPATH全髋关节置换的手术风险,对于这类患者更应注意围手术期和术后相关处理.

Objective To explore the effect of obesity on the treatment for femoral neck fracture in patients with SuperPATH hip replacement.Methods Seventy patients who were treated with SuperPATH hip replacement in the Second People's Hospital of Wuxi from January 2014 to January 2017 were selected in the study.Based on their body mass index(BMI),the patients were divided into obesity group(BMI ≥30kg/m2) (23 cases),overweight group (BMI:25-30kg/m2) (22 cases),and normal group(BMI:18.5-25kg/m2) (25 cases).The incision length,operation time,blood loss,blood transfusion rate,pain score,hip joint function score,imaging measurement results and postoperative complications were compared among the three groups.Results All 70 patients received the operation successfully.The incision length of the obesity group was (7.4 ± 0.2) cm,which of the overweight group was (7.2 ±0.1) cm,which of the normal group was (7.1 ± 0.8) cm,the difference among the three groups was statistically significant (F =24.671,P < 0.001).The patients were followed up for 9-13 months.The acetabular anteversion angle,acetabular abduction angle,pain score,mobility of hip joint,walking ability score in the obesity group were (17.8 ± 1.2) °,(40.9 ± 3.4) °,(1.26 ± 0.61) points,(95.43 ± 7.89) °,(8.10 ± 0.27) points,respectively,which in the overweight group were (16.7 ± 3.3) °,(42.9 ± 2.9) °,(1.23 ± 0.58) points,(96.78 ± 3.22) °,(8.20 ±0.92) points,respectively,which in the normal group were (15.8 ± 2.7) °,(43.9 ± 5.1) °,(1.24 ± 0.78) points,(97.12 ± 6.44)°,(8.20 ± 0.48)points,respectively.The difference of acetabular abduction angle among the three groups was statistically significant (F =9.803,P =0.002).In the obesity group,there were two cases of incision infection,two cases of deep venous thrombosis and one case of pulmonary complication,the incidence rate of complications was 5%.In the overweight group,there was one case of superficial incision infection,and one case of deep vein thrombosis,the incidence rate of complications was 2%.In the normal group,there was one case of deep venous thrombosis,the incidence rate of complications was 1%.The difference of incidence rate of complications among the three groups was statistically significant (x2 =15.31,P < 0.01).Conclusion Obesity increases the surgical risk of SuperPATH total hip replacement,and more attention should be attached to perioperative and post-operative treatment for such patients.