Bernese髋臼周围截骨术早期手术效果的影响因素分析

Analysis of influencing factors of early surgical results of Bernese periacetabular osteotomy

目的探讨Bernese髋臼周围截骨术(PAO)术后功能恢复及疼痛的影响因素。方法对2017年1月至2019年11月接受改良Smith-Peterson入路Bernese髋臼周围截骨术治疗的发育性髋关节发育不良患者进行回顾性研究。纳入标准为在此期间接受PAO治疗的所有DDH患者。排除标准:髋关节外伤史,现有神经肌肉或结缔组织疾病,既往有髋关节手术史,影像资料不全者,髋臼后倾(交叉征阳性),采用髂腹股沟入路的PAO和失访者。测量术前和术后的影像学指标,观察了髋臼顶倾斜角,外侧中心边缘角,髋臼外展角,股骨头超出指数,股骨头球度指数,Shenton线,骨关节炎Tonnis分级,头臼匹配度,p/a比值,髋臼前倾角,西安大略和麦克马斯特大学骨关节炎指数(WOMAC)疼痛评分和改良Harris髋关节评分(MHHS)等因素,使用logistic回归分析确定术后功能及疼痛的影响因素。结果在此期间共有75名患者接受Bernese髋臼周围截骨术,排除髂腹股沟入路16例,失访5例,影像资料不全者8例,术前髋臼后倾2例,最终有44名患者纳入此次研究,术后随访时间平均(2.1±1.4)年。患者MHHS从术前70(55,84)分提高到术后91(88,91)分(Z=-7.067,P<0.01),WOMAC疼痛评分从术前4(1,8)分降至术后0分(Z=-4.920,P<0.01)。根据logistic回归分析,术前外侧中心边缘角每增加一个单位,术后MHHS被归类为优秀的几率是原来的1.2倍[比值比(OR)=1.183,95%置信区间(CI)(1.077,1.299),P<0.01]。年龄每增加一个单位,术前疼痛程度增加一级的可能性是原来的1.1倍[OR=1.090,95%CI(1.018,1.157),P=0.012]。身体质量指数每增加一个单位,术前疼痛程度增加一级的可能性是原来的1.2倍[OR=1.244,95%CI(1.050,1.474),P=0.011]。其它因素与术前疼痛及术后功能评分之间不存在有统计学意义的相关性。结论Bernese髋臼周围截骨术后患者功能评分显著提高,疼痛症状显著减轻。术前外侧中心边缘角较大的患者术后将获得更佳的关节功能,年龄及身体质量指数较大的患者疼痛程度更重。

Objective To explore the influencing factors of postoperative functional recovery of Bernese periacetabular osteotomy(PAO)and influencing factors of pain degree.Methods A retrospective study was conducted on the patients with developmental dysplasia of the hip(DDH)who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019.The inclusion criteria was all the DDH patients who received PAO during this period.Exclusion criteria:history of hip joint trauma,existing diseases of nerve,muscle or connective tissue,history of hip surgery,incomplete image data,acetabular retroversion(positive cross sign),the iliac-inguinal approach patients,and the patients who were lost during the follow-up.The preoperative and postoperative imaging indicators were measured.The acetabular top tilt angle,lateral central edge angle,acetabular abduction angle,femoral head extrusion index,sphericity index of femoral head,Shenton line,Tonnis grade of osteoarthritis,joint congruency,p/a ratio,acetabular anteversion angle,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)pain score and modified Harris hip score(MHHS)were measured and recorded.Multiple regression analysis was applied to determine the preoperative pain degree and postoperative function influencing factors.Results A total of 75 patients underwent Bernese PAO.Among them,16 cases using the iliac-inguinal approach were excluded,five cases were lost during follow-up,eight cases had incomplete imaging data,and there were two cases of acetabular retroversion.Eventually the study was conducted on 44 patients.The follow-up time was(2.1±1.4)years on average.The MHHS increased from 70(55,84)points before the surgery to 91(88,91)points after the surgery(Z=-7.067,P<0.01),WOMAC pain score decreased from 4(1,8)points before surgery to zero after the surgery(Z=-4.920,P<0.01).According to the logistic regression analysis,for every unit increased in the lateral center-edge angle,the postoperative modified Harris score was 1.2 times more likely to be classified as excellent[odds ratio(OR)=1.183,95%confidence interval(CI)(1.077,1.299),P<0.01].For each increase of age by one unit,the probability of preoperative pain level increasing by one level was 1.1 times higher[OR=1.090,95%CI(1.018,1.157),P=0.012].For each increase in body mass index by one unit,the probability of preoperative pain level increasing by one level was 1.2 times higher[OR=1.244,95%CI(1.050,1.474),P=0.011].Regression analysis of other factors showed no significant correlation with preoperative pain and postoperative functional score.Conclusions The overall function score of patients after Bernese periacetabular osteotomy is significantly improved,and the pain symptoms are significantly reduced.The patients with larger lateral center-edge angle may have better joint function after surgery,while the patients with elder age and lager body mass index may suffer more severe pain.