全髋关节置换术后异位骨化X线表现及其相关因素研究

Study on X-ray manifestations of heterotopic ossification after total hip arthroplasty and related factors

目的探讨全髋关节置换术(THA)后异位骨化(HO)X线表现及其发生的危险因素,为预防及减轻其程度提供依据。方法回顾性分析356例(385髋)患者全髋关节置换术后异位骨化的发生情况,以双髋关节正位X线片为诊断依据,通过影像学表现,有异位骨化的180髋作为研究组,按Brooker分级记录;无异位骨化的205髋作为对照组。对两组患者的年龄、性别、人工关节材料、手术时长、术中出血量、切口长度及术后应用非甾体类抗炎药(NSAIDs)时间进行单因素分析,并对有统计学意义的因素行多因素Logistics回归分析,得出与异位骨化发生及分级的相关性。结果单因素分析显示,患者的性别、年龄、术中出血量及术后应用NSAIDs时间均为全髋关节置换术后异位骨化的影响因素(P<0.05)。多因素Logistic回归分析结果显示,患者的性别、年龄及术后应用NSAIDs时间均为全髋关节置换术后异位骨化的独立危险因素(P<0.01)。异位骨化在46.8%(180/385)的患者中形成。其中, BrookerⅠ级为119髋(66.1%),Ⅱ级为48髋(26.7%),Ⅲ级为12髋(6.7%),Ⅳ级为1髋(0.6%)。引入brooker分级,将性别、年龄、术后应用NSAIDs时间与异位骨化的等级进行Spearman相关分析,结果显示,异位骨化的发生与患者性别(r=0.178, P<0.01)、年龄(r=0.152, P<0.01)呈正相关,与术后应用NSAIDs时间呈负相关(r=-0.153, P<0.01)。结论异位骨化是全髋关节置换术后的常见并发症。年龄大、男性会增加异位骨化的发生,术后应用NSAIDs可预防和减少异位骨化的发生。

Objective To discuss the X-ray manifestations of heterotopic ossification(HO)after total hip arthroplasty(THA)and related factors,and provide a basis for prevention and mitigation.Methods The occurrence of heterotopic ossification after total hip replacement in 356 patients(385 hips)was retrospectively analyzed.Based on the diagnosis of double hip joint orthotopic X-ray film,180 hips with heterotopic ossification were taken as the research group,recorded by Brooker classification.205 hips without heterotopic ossification were taken as the control group.The age,gender,artificial joint material,operation time,intraoperative bleeding volume,incision length and post-operative application time of non-steroidal anti-inflammatory drugs(NSAIDs)time were analyzed by univariate analysis.Multivariate logistic regression analysis was used to analyze the statistically significant factors,and the correlation with the occurrence and classification of heterotopic ossification was observed.Results Univariate analysis showed that gender,age,intraoperative bleeding volume and application time of NSAIDs after operation were all influencing factors of heterotopic ossification after total hip arthroplasty(P<0.05).Multivariate logistic regression analysis showed that gender,age and application time of NSAIDs were independent risk factors for heterotopic ossification after total hip arthroplasty(P<0.01).Heterotopic ossification was found in 46.8%(180/385)of the patients.Among them,there were 119 hips(66.1%)of Brooker gradeⅠ,48 hips(26.7%)of gradeⅡ,12 hips(6.7%)of gradeⅢ,and 1 hip(0.6%)of gradeⅣ.Introducing Brooker classification,Spearman correlation analysis was made between gender,age,time of application of NSAIDs after operation and grade of heterotopic ossification.The results showed that the occurrence of heterotopic ossification was positively correlated with gender(r=0.178,P<0.01),age(r=0.152,P<0.01),and negatively correlated with application time of NSAIDs after operation(r=-0.153,P<0.01).Conclusion Heterotopic ossification is a common complication after total hip replacement.Older age and male increase the occurrence of heterotopic ossification.Application of NSAIDs after operation can prevent and reduce the occurrence of heterotopic ossification.