2018-2020年陕西省大骨节病患者手术类型分析

Analysis of surgical types for patients with Kashin-Beck disease in Shaanxi Province from 2018 to 2020

目的分析陕西省大骨节病(Kashin-Beck disease,KBD)患者手术类型,为优化KBD手术提供参考。方法采用回顾性分析,以陕西省地方病防治信息系统中2018-2020年接受手术治疗的KBD患者作为调查对象,排除手术治疗信息不全病例,采用χ^(2)检验,分析不同性别、受教育水平、生活地区、疾病严重程度、社会环境等因素对KBD患者选择不同手术类型(游离体摘除术或关节置换术)所产生的影响;采用倾向评分法对不同手术类型患者进行1∶1匹配,通过多因素logistic回归分析KBD患者接受不同类型手术治疗的影响因素。结果2018-2020年,陕西省共有1084名KBD患者进行手术治疗,其中男性555人(51.20%)、女性529人(48.80%),年龄中位数为64岁。关中地区(铜川、西安、渭南、咸阳、宝鸡)患者917人(84.59%),陕北地区(榆林、延安)患者120人(11.07%),陕南地区(安康、汉中、商洛)患者47人(4.34%)。Ⅰ、Ⅱ、Ⅲ度KBD患者分别为401人(36.99%)、525人(48.43%)和158人(14.58%)。接受游离体摘除术患者548人(50.55%),接受关节置换术患者536人(49.45%)。单因素分析显示,不同性别、受教育水平、生活地区、疾病严重程度、经济状况、是否搬迁、饮用水类型、主食粮类型及主食粮来源均是KBD患者选择不同手术类型的影响因素(χ^(2)=81.82、22.38、93.68、22.38、5.17、15.68、13.82、39.37、49.63,均P<0.05)。在通过倾向评分法匹配游离体摘除术和关节置换术的374对患者中,经多因素logistic回归分析发现,高中及以上受教育水平[比值比(OR)=0.42,P=0.008]、关中地区(OR=0.12,P<0.001)、搬迁(OR=0.60,P=0.004)、饮用井水(OR=2.15,P=0.001)是KBD患者选择不同手术类型进行治疗的影响因素。结论对陕西省KBD患者进行手术治疗时,临床医生在考虑疾病严重程度的同时,还应参考KBD患者受教育水平、生活地区、搬迁状态和生活饮用水类型等因素,为KBD患者提供更加适合的手术类型。

Objective To analyze the surgical types of patients with Kashin-Beck disease(KBD)in Shaanxi Province,and to provide reference for optimizing KBD surgery.Methods Retrospective analysis was used to investigate KBD patients who underwent surgical treatment,and the patient's information was from the Shaanxi Provincial Endemic Disease Prevention and Control Information System.Patients with incomplete surgical treatment information were excluded,andχ^(2) test was used to analyze the impact of factors such as gender,education level,living area,disease severity,and social environment on the selection of different surgical types(free body enucleation or joint replacement)for KBD patients.Using propensity score method to perform a 1∶1 match on patients with different surgical types,and analyzing the influencing factors of KBD patients receiving different types of surgical treatment through multivariate logistic regression.Results From 2018 to 2020,a total of 1084 KBD patients in Shaanxi Province underwent surgical treatment,including 555 males(51.20%)and 529 females(48.80%),with a median age of 64 years old.There were 917 patients(84.59%)in the Guanzhong region(Tongchuan,Xi'an,Weinan,Xianyang,Baoji),120 patients(11.07%)in the northern Shaanxi region(Yulin,Yan'an),and 47 patients(4.34%)in the southern Shaanxi region(Ankang,Hanzhong,Shangluo).The number of patients with KBD gradeⅠ,Ⅱ,andⅢwas 401(36.99%),525(48.43%),and 158(14.58%),respectively.Five hundred and forty-eight patients(50.55%)underwent free body enucleation surgery,and 536 patients(49.45%)underwent joint replacement surgery.Univariate analysis showed that different genders,educational levels,living areas,disease severity,economic status,whether to relocate,type of drinking water,type of staple food,and source of staple food were the influencing factors for KBD patients to choose the type of surgery(χ^(2)=81.82,22.38,93.68,22.38,5.17,15.68,13.82,39.37,49.63,P<0.05).Among 374 pairs of patients who underwent free body enucleation and joint replacement through propensity score matching,multivariate logistic regression analysis found that high school and above education level[odds ratio(OR)=0.42,P=0.008],Guanzhong region(OR=0.12,P<0.001),relocation(OR=0.60,P=0.004),and drinking well water(OR=2.15,P=0.001)were the influencing factors for KBD patients to choose different surgical types for treatment.Conclusion When performing surgical treatment for KBD patients in Shaanxi Province,clinicians can consider the severity of the disease,as well as factors such as the education level,living area,relocation status,and type of drinking water of KBD patients,to provide more suitable surgical types for KBD patients.