老年股骨颈骨折半髋关节置换术后髋关节脱位的危险因素分析

Risk factors for dislocation after hemiarthroplasty in elderly patients with femoral neck fractures

目的探讨老年股骨颈骨折病人行半髋关节置换术(HA)后髋关节脱位的危险因素。方法2015年1月~2022年10月行HA治疗的股骨颈骨折病人133例,根据病人术后是否发生髋关节脱位,将病人分为脱位组(35例)和非脱位组(98例)。记录两组病人年龄、性别、体重指数(BMI)等人口统计学变量;记录糖尿病、高血压、心脏病、慢性阻塞性肺病(COPD)等合并症情况;记录假体类型、手术入路、软组织修复类型、出血量等手术相关因素;在X线片上测量中心边缘角(CEA)、外展角(ABA)、偏心距、下肢长度差(LLD)、髋臼宽度、髋臼深度、股骨头覆盖率(FCR)等影像学参数。采用Wald法建立logistic回归模型,分析HA后发生脱位的危险因素。结果除脱位组COPD比例显著高于非脱位组(P<0.05)外,两组病人的基线特征比较,差异无统计学意义(P>0.05);两组病人的手术情况、CEA、ABA、LLD、髋臼宽度、偏心距、FCR比较,差异无统计学意义(P>0.05)。脱位组的髋臼深度和深宽比小于非脱位组,两组比较差异有统计学意义(P<0.05);性别、COPD、CEA、髋臼宽深比和LLD是影响HA术后髋关节脱位的独立危险因素(P<0.05)。结论合并COPD、男性、LLD以及过小的CEA和髋臼宽深比是HA术后髋关节不稳的独立风险因素。不推荐存在上述情况的老年病人采用HA治疗股骨颈骨折。

Objective To investigate the risk factors of hip instability in elderly patients with femoral neck fracture after hemiarthroplasty(HA).Methods The medical records of 133 patients with femoral neck fracture who received HA treatment in the Department of Orthopedics of our hospital from January 2015 to October 2022 were retrospectively collected.According to whether the patients suffered hip dislocation after surgery,the patients were divided into dislocation group(n=35)and non-dislocation group(n=98).Demographic variables such as age,sex and body mass index(BMI)were recorded in the two groups.Complications such as diabetes,hypertension,heart disease and chronic obstructive pulmonary disease(COPD)were recorded.Prosthetic type,surgical approach,soft tissue repair type,blood loss and other surgical phase variables were recorded.Central marginal Angle(CEA),extraneous Angle(ABA),eccentricity,lower limb length difference(LLD),acetabular width,acetabular depth,and femoral head coverage(FCR)were measured on radiographs.Wald method was used to establish Logistic regression model to elucidate the risk factors of dislocation after HA.Results The proportion of COPD in the dislocation group was significantly higher than that in the control group(P<0.05),and there was no significant difference in baseline characteristics between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).There were no significant differences in CEA,ABA,LLD,acetabular width,eccentricity and FCR between 2 groups(P>0.05),but the acetabular depth and depto-width ratio in luxation group were significantly lower than those in control group(P<0.05).Gender,COPD,CEA,acetabular width-to-depth ratio and LLD were independent risk factors for hip instability after HA(P<0.05).Conclusion In this study,COPD,male,LLD,and small CEA and acetabular broad-to-depth ratio are independent risk factors for hip instability after HA,and therefore HA is not recommended for the treatment of femoral neck fractures in elderly patients with these conditions.