髋关节置换术后发生早期脱位的危险因素分析

摘要

Objective To explore the risk factors on impact of early dislocation after hip arthroplasty,and provide patients with individ-ualized treatment programs. Methods We retrospectively analyzed the clinical data of displaced femoral neck fractures in 247 patients who accepted hip arthroplasty from January 2006 to December 2011,and a total of 8 potential factors associated with occurrence of early dislocation were evaluated by univariate analysis and multivariate logistic regression analysis. Results The univariate analysis showed that sex,surgical approach and femoral head size were correlated with early dislocation (P<0. 05). Multivariate logistic regression analysis showed that female (OR=1. 862),posterolateral surgical approach (OR=3. 478),the use of 22 mm femoral heads (OR=2. 558)were independent risk factors (P<0. 05). And use of≥30 mm femoral heads(OR=0. 635) was a protective factor(P<0. 05). Conclusion Occurrence of early dislo-cation after hip arthroplasty is mainly correlated with many factors,various risk factors should be taken into account in preoperative and intrao-perative and choose the optimal individualized treatment plan.%目的：探讨影响老年患者髋关节置换术后发生早期脱位的危险因素，为患者采用个性化治疗方案提供思路。方法收集2006年1月1日至2011年12月31日获得明确诊断并接受髋关节置换术治疗且有术后随访资料的老年股骨颈移位骨折患者共247例为研究对象，对8个可能与置换术后早期脱位发生有关的因素进行单因素和多因素Logistic回归分析。结果通过比较发现，性别、手术方式、人工股骨头直径大小等因素在有脱位组与无脱位组的差异具有统计学意义(P<0.05)。进一步多因素Lo-gistic回归分析显示，女性(OR=1.862)、手术方式为后外侧入路(OR=3.478)、人工股骨头直径为22 mm(OR=2.558)可作为预测置换术后早期脱位发生的独立危险因素(P <0.05)，而当股骨头直径大于或等于30 mm(OR =0.635)时则是保护性因素(P<0.05)。结论置换术后早期脱位的发生与多个因素有关，建议术前、术中应将各危险因素纳入考虑并选择个体化最优治疗方案。