甲状腺功能减退患者人工全髋关节置换术的安全性及有效性分析

Safety and effectiveness of total hip arthroplasty in patients with hypothyroidism

目的评价甲状腺功能减退(以下简称甲减)患者行人工全髋关节置换术(total hip arthroplasty,THA)的安全性与有效性。方法回顾分析2009年11月—2018年11月收治并接受初次单侧THA的63例甲减患者(甲减组)临床资料,并以同期收治的63例甲状腺功能正常且无甲状腺疾病史的THA患者(对照组)进行对照研究。两组患者性别、年龄、体质量指数、患髋侧别、关节置换原因、美国麻醉医师协会(ASA)分级以及术前血红蛋白(hemoglobin,Hb)、Harris评分比较,差异均无统计学意义(P>0.05)。记录甲减组手术前后血清促甲状腺激素(thyroid stimulating hormone,TSH)及甲状腺素(thyroxine,T4),以及围术期甲减相关症状发生情况。比较两组患者术后并发症发生率、Hb下降程度、围术期总出血量、输血率、住院时间、出院后90 d内再入院率以及随访期间假体周围感染、假体无菌性松动发生情况,髋关节Harris评分。结果甲减组患者术后第3天血清TSH、T4与术前比较,差异均无统计学意义(P>0.05);术后均未出现甲减相关症状。甲减组术后Hb下降程度、围术期总出血量明显高于对照组(P<0.05);但输血率、住院时间、出院后90 d内再入院率组间差异无统计学意义(P>0.05)。甲减组术后贫血发生率明显高于对照组、肌间静脉血栓形成发生率明显低于对照组,差异均有统计学意义(P<0.05);肝功能下降、心力衰竭、肺部及泌尿系统感染以及切口并发症发生率差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间1.0~9.9年,平均6.5年。末次随访时,两组髋关节Harris评分均明显高于术前(P<0.05);甲减组Harris评分较术前增加(39.5±12.3)分、对照组增加(41.3±9.3)分,组间比较差异无统计学意义(t=0.958,P=0.340)。X线片复查示随访期间对照组无假体松动或感染发生,甲减组1例术后4年发生假体周围感染伴窦道形成。结论对于甲减患者,通过术前控制血清TSH达0.5~3.0 mU/L、T4达正常水平,以及多模式血液管理措施,可安全地度过THA围术期,有效改善关节功能,并获得良好中期疗效。

Objective To evaluate the safety and effectiveness of total hip arthroplasty(THA)in patients with hypothyroidism.Methods Sixty-three patients with hypothyroidism(hypothyroidism group)and 63 euthyroid patients without history of thyroid disease(control group)who underwent primary unilateral THA between November 2009 and November 2018 were enrolled in this retrospective case control study.There was no significant difference between the two groups in gender,age,body mass index,hip side,reason for THA,American Society of Anesthesiology(ASA)classification,preoperative hemoglobin(Hb)level,and preoperative Harris score(P>0.05).The perioperative thyroid stimulating hormone(TSH)and thyroxine(T4)levels,the hypothyroidism-related and other complications during hospitalization,the decrease in Hb,perioperative total blood loss,blood transfusion rate,length of hospital stays,and 90 days readmissions rate in the two groups were recorded and evaluated.The periprosthetic joint infection,aseptic loosening of the prosthesis,and hip Harris score during follow-up were recorded.Results The differences in the TSH and T4 of hypothyroidism group between pre-and 3 days post-operation were significant(P>0.05)and no hypothyroidism-related complications occurred after THA.The decrease in Hb and perioperative total blood loss in the hypothyroidism group were significantly higher than those in the control group(P<0.05),but there was no significant difference between the two groups in terms of transfusion rate,length of hospital stays,and 90 days readmission rates(P>0.05).No significant difference in the rate of complications(liver dysfunction,heart failure,pulmonary infection,urinary infection,and wound complication)between the two groups was found(P>0.05)except for the rate of intramuscular vein thrombosis which was significantly lower in the hypothyroidism group,and the rate of postoperative anemia which was significantly higher in the hypothyroidism group(P<0.05).The two groups were followed up 1.0-9.9 years(mean,6.5 years).At last follow-up,Harris score in both groups were significantly higher than those before operation(P<0.05).An increase of 39.5±12.3 in hypothyroidism group and 41.3±9.3 in control group were recorded,but no significant difference was found between the two groups(t=0.958,P=0.340).During the follow-up,1 case of periprosthetic joint infection occurred in the hypothyroidism group,no loosening or revision was found in the control group.Conclusion With the serum TSH controlled within 0.5-3.0 mU/L and T4 at normal level preoperatively,as well as the application of multiple blood management,hypothyroid patients can safely go through THA perioperative period and effectively improve joint function,quality of life,and obtain good mid-term effectiveness.