强直性脊柱炎全髋关节置换术后髋关节满意度评价及影响因素分析

Evaluation of hip satisfaction and influencing factors following total hip arthroplasty in patients with ankylosing spondylitis

目的:评估强直性脊柱炎(AS)合并髋关节终末期受累患者接受全髋关节置换术(THA)后髋关节满意度,并分析其影响因素。方法:回顾性分析2006年1月至2021年12月行THA的AS合并髋关节终末期受累患者462例(658髋)的临床资料。根据末次随访患者对髋关节满意度的评价结果分为满意组(492髋)和不满意组(166髋),收集并比较患者的基线资料、人口学数据、疾病相关数据、髋关节及手术相关参数,及实验室检查结果。将单因素分析结果中差异有统计学意义(P<0.05)的因素纳入多因素logistic回归分析,分析髋关节满意度的影响因素。结果:随访时间为17~208个月,平均(108.3±50.2)个月。末次随访患者对髋关节满意度的评价结果显示,48.0%(316髋)为非常满意、26.7%(176髋)为比较满意、19.1%(126髋)为较不满意、6.1%(40髋)为非常不满意,患者髋关节总满意度为74.8%。髋关节评价不满意的主要原因包括关节活动度受限、跛行、双下肢不等长、疼痛及并发症。多因素logistic回归分析结果提示,吸烟史[风险比(OR)=0.634,P=0.047]、风湿性疾病合并症指数(OR=1.610,P<0.001)、使用大直径球头(OR=0.550,P=0.007)和使用陶瓷对陶瓷关节面(OR=0.584,P=0.008)是导致髋关节评价不满意的独立危险因素。结论:AS合并髋关节终末期受累患者接受THA术后的髋关节满意度较高。其中,关节活动受限是导致髋关节评价不满意的首要原因。围手术期管理需要密切关注与髋关节满意度相关的影响因素,包括吸烟史、内科合并症及假体选择。

Objective:To evaluate total hip satisfaction in ankylosing spondylitis(AS)with end-stage hip involvement after total hip replacement(THA)and analyze the influencing factors.Methods:A retrospective analysis was conducted on clinical data from 464 AS patients(658 hips)with end-stage hip involvement who underwent THA between January 2006 and December 2021.Based on satisfaction at the last follow-up,patients were divided into the satisfactory group(350 cases,492 hips)and the dissatisfactory group(114 cases,166 hips).Baseline characteristics,demographic data,disease-related data,hip and surgery-related parameters,and laboratory results were collected and compared between the two groups.Factors with statistical significance(P<0.05)in the univariate analysis were included in a multivariate logistic regression analysis to assess the factors influencing patient satisfaction with the hip joint.Results:The follow-up period ranged from 17 to 208 months,with an average of(108.3±50.2)months.Evaluation of the hip satisfaction at the last follow-up showed that48.0%(316 hips)were very satisfactory,26.7%(176 hips)were relatively satisfactory,19.1%(126 hips)were less satisfied,6.1%(40 hips)were very unsatisfactory,and the total hip satisfaction was 74.8%.The main reasons for unsatisfactory hip evaluation include limited joint mobility,claudication,unequal length of both lower limbs,pain and complications.The multivariate logistic regression model revealed that smoking history(OR=0.634,P=0.047),rheumatic disease comorbidity index(odds ratio[OR]=1.610,P<0.001),use of a large-diameter femoral head(OR=0.550,P=0.007),and use of a ceramicon-ceramic bearing surface(OR=0.584,P=0.008)were independent risk factors for patient dissatisfaction.Conclusions:AS patients with end-stage hip involvement have high satisfaction after THA.Limited mobility is the primary reason for postoperative dissatisfaction.Therefore,perioperative management should focus on factors related to postoperative dissatisfaction,including smoking history,medical complications,and prosthesis selection.