股骨头缺血性坏死患者髋关节置换术后股内收肌挛缩的影响因素分析

Analysis of the influencing factors of contracture of adductor femoris after hip arthroplasty in patients with avascular necrosis of femoral head

目的:探讨股骨头缺血性坏死患者髋关节置换术后发生股内收肌挛缩的影响因素。方法:回顾性分析2017年1—12月在广西医科大学第一附属医院、广西壮族自治区江滨医院、广西骨伤医院住院的179例行髋关节置换的股骨头坏死患者的一般资料,根据术后股内收肌挛缩发生情况分为挛缩组和未挛缩组。采用单因素及多因素Logistic回归分析方法分析患者髋关节置换术后股内收肌挛缩的影响因素。结果:179例患者中,64例(35.75%)发生股内收肌挛缩。两组肢体短缩程度、手术史、是否有效牵引、手术入路、手术方式、术后是否系统功能煅练比较,差异均有统计学意义(均P<0.05),多因素Logistic回归分析显示:病因、肢体短缩程度、手术史为髋关节置换术后发生股内收肌挛缩的危险因素,术前进行有效牵引、前外侧手术入路、术后进行系统功能煅练是保护因素(均P<0.05)。结论:股骨头缺血性坏死患者行髋关节置换术后可能发生股内收肌挛缩,应在术前进行有效的术前牵引、选择前外侧手术刀路、术后系统功能煅练,可预防髋关节置换术后发生股内收肌挛缩。

Objective: To investigate the risk factors of femoral head contracture after hip arthroplasty (HA) in patients with avascular necrosis of femoral head. Methods: Retrospective analysis was performed in 361 cases of femoral head necrosis patients taking HA from January 2017 to December 2017.A total of 179 patients with no significant preoperative adductor muscle contraction were finally enrolled in this study.These 179 patients were further divided into two groups: contracture group and noncompaction group.Risk factors were identified by univariate and multivariatelogistic regression analysis. Results: Of the patients included,64 patients (35.75%) developed into end adductor muscle contracture.The degree of limb shortness,the history of surgery,whether it was effective traction,the approach to surgery,the operation method,and whether or not the system function exercise performed after surgery were statistically significant between the two groups( P <0.05).Multivariate logistic regression analysis showed that the etiology,degree of limb shortening and surgical history were risk factors for contracture of adductor femoris after HA,and preoperative effective traction,anterolateral approach and postoperative systemic exercise were protective factors ( P <0.05). Conclusion: Effective preoperative traction,anterolateral surgical approach and systematic functional exercise should be performed to prevent the contracture of adductor femoris after HA.