假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素

郑美亮; 李克鹏; 帖小佳; 薛宏伟

doi:10.11659/jjssx.12E022045

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假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素

临床研究 | 更新时间：2023-12-13

- 假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素
- Effect and influencing factors of prosthesis placement angle on hip replacement for bone fusion of hip joint
- 局解手术学杂志 2023年32卷第12期页码：1063-1067
- 作者机构：
  
  保定市第二中心医院骨科，河北涿州 072750
- 作者简介：
  
  郑美亮，E-mail：adlcpw@126net.com.cn
- 基金信息：
  
  河北省重点研发计划项目(21377762D)
- DOI：10.11659/jjssx.12E022045
  中图分类号： R687.4
- 纸质出版日期：2023-12-25，
  
  收稿日期：2022-12-07，
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郑美亮,李克鹏,帖小佳等.假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素[J].局解手术学杂志,2023,32(12):1063-1067.

ZHENG Mei-liang,LI Ke-peng,TIE Xiao-jia,et al.Effect and influencing factors of prosthesis placement angle on hip replacement for bone fusion of hip joint[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(12):1063-1067.
郑美亮,李克鹏,帖小佳等.假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素[J].局解手术学杂志,2023,32(12):1063-1067. DOI： 10.11659/jjssx.12E022045.

ZHENG Mei-liang,LI Ke-peng,TIE Xiao-jia,et al.Effect and influencing factors of prosthesis placement angle on hip replacement for bone fusion of hip joint[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(12):1063-1067. DOI： 10.11659/jjssx.12E022045.

摘要

目的

探究假体放置角度对髋关节置换术治疗髋关节骨性融合的疗效及影响因素。

方法

选取2019年5月至2022年1月我院收治的100例髋关节骨性融合患者为研究对象，将其随机分为观察组（

=50）和对照组（

=50）。观察组假体放置角度为30°~40°，对照组假体放置角度为41°~50°。比较2组患者的临床资料、手术前后VAS评分及Harris评分、术后并发症发生情况。随机行走模型比较2组患者髋关节功能改善情况。根据患者预后情况将其分为预后不良组（

=32）和预后良好组（

=68），通过单因素和多因素

Logistic

回归分析髋关节置换术治疗髋关节骨性融合预后的独立影响因素，构建预测模型并验证。

结果

观察组患者术后6个月的Harris评分显著高于对照组（

0.05），2组患者手术前后VAS评分及术后并发症发生率无明显差异（

0.05）。随机行走模型结果显示，观察组患者髋关节功能改善情况优于对照组。预后良好组和预后不良组患者年龄、高血脂、骨质疏松、假体放置角度、术中出血量、情绪障碍、术后并发症、康复训练及术后室外活动时间比较差异具有统计学意义（

0.05）。多因素

Logistic

回归分析结果显示，骨质疏松、假体放置角度41°~50°为髋关节置换术治疗髋关节骨性融合预后的独立危险因素（

0.05），康复训练为保护因素（

0.05）。构建髋关节置换术治疗髋关节骨性融合预后情况的预测模型，模型的校正曲线与理想曲线拟合良好，受试者工作特征曲线下面积（

AUC

）为0.854（95%

: 0.830~0.871），提示该预测模型具有良好的准确度。模型的一致性指数（

C-index

）为0.849（95%

：0.817~0.868），提示该预测模型具有较高的区分度。

结论

假体放置角度为30°~40°可显著改善患者术后髋关节功能，疗效显著。骨质疏松、假体放置角度、康复训练为髋关节置换术治疗髋关节骨性融合预后的独立影响因素。

Abstract

Objective

To explore the effect and influencing factors of prosthesis placement angle on hip replacement for bone fusion of hip joint.

Methods

A total of 100 patients with bone fusion of hip joint who were admitted to our hospital from May 2019 to January 2022 were selected as the research objects and randomly divided into the observation group （

=50） and the control group （

=50）. The prosthesis placement angle was 30° to 40° in the observation group and 41° to 50° in the control group. The clinical data， VAS score and Harris score before and after operation， and postoperative complications of the two groups were compared. The improvement of hip joint function of the two groups was compared by random walking model. According to the prognosis of patients， patients were divided into the poor prognosis group （

=32） and the good prognosis group （

=68）. Univariate and multivariate

Logistic

regression analysis were used to analyze the independent influencing factors of the prognosis of hip replacement for bone fusion of hip joint， and a prediction model was constructed and verified.

Results

The Harris score 6 months after operation in the observation group was significantly higher than that in the control group （

0.05）， and there was no significant difference in VAS score before and after operation and incidence of complications after operation between the two groups （

0.05）. The results of random walking model showed that the improvement of hip joint function in the observation group was better than that in the control group. There were significant differences in age， hyperlipidemia， osteoporosis， prosthesis placement angle， intraoperative blood loss， emotional disorder， postoperative complications， rehabilitation training and postoperative outdoor activity time of patients between the good prognosis group and the poor prognosis group （

0.05）. Multivariate

Logistic

regression analysis showed that osteoporosis and prosthesis placement angle of 41° to 50° were the independent risk factors of the prognosis of hip replacement for bone fusion of hip joint （

0.05）， and rehabilitation training was the protective factor （

0.05）. A prediction model of the prognosis of hip replacement for bone fusion of hip joint was constructed. The calibration curve of the model fit well with the ideal curve， and the

area under the receiver operating characteristic curve

（

AUC

） was 0.854 （95%

： 0.830 to 0.871）， which indicates that the prediction model had good accuracy. The

concordance index

（

index

） of the model was 0.849 （95%

： 0.817 to 0.868）， which indicates that the model had high discrimination.

Conclusion

The prosthesis placement angle of 30° to 40° can significantly improve the postoperative hip joint function of patients， and the therapeutic effect is significant. Osteoporosis， prosthesis placement angle， and rehabilitation training are the independent influencing factors of the prognosis of hip replacement for bone fusion of hip joint.

关键词

髋关节置换术髋关节骨性融合假体放置角度预后因素

Keywords

hip replacementbone fusion of hip jointprosthesis placement angleprognostic factors

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