人工股骨头置换治疗帕金森病患者股骨颈骨折术后功能恢复的影响因素

目的 探讨人工股骨头置换术治疗帕金森病患者股骨颈骨折后对功能恢复的影响因素.方法 2002年9月至2007年7月对18例发生股骨颈骨折的帕金森病患者行人工股骨头置换术治疗.术前根据Hoehn-Yahr方法 对帕金森病病情进行分级:Ⅱ期5例,Ⅲ期9例,Ⅳ期4例.手术入路:前方入路5例,外侧入路7例,后外侧入路6例.手术时机:1周内手术13例,1周后手术5例.术后1周内开始功能锻炼11例,1周后开始7例.采用多因素Logistic回归模型对帕金森病分级、手术时机、手术入路及术后开始功能锻炼的时间等因素与功能恢复的相关性进行分析. 结果 18例患者术后获8～42个月(平均22个月)随访.根据Harris髋天节功能评分标准评定疗效:优5例,良7例,可4例,差2例,优良率为66.7%.对影响髋关节Harris功能评价结果 的各因素进行多因素Logistic回归分析结果 显示:帕金森病分级、受伤至手术时间、手术入路及术后开始功能锻炼的时间筹异均有统计学意义(P值分别为0.0324、0.0416、0.0292、0.0257).结论 帕金森病分级、手术时机、手术入路和术后开始功能锻炼的时间均与术后关节功能恢复相关.帕金森病病情较轻者,早期行人工股骨头置换术,选用前侧或外侧手术入路,术后1周内开始患肢功能锻炼,能够明显提高手术疗效.

Postoperative functional restoration of the hip following femoral neck fracture in patients with Parkin-son's disease

Objective To investigate factors which may affect functional restoration of the hip after hemiarthroplasty for femoral neck fracture in patients with Parkinson's Disease(PD) . Methods From September 2002 to July 2007, 18 PD patients were treated with hemiarthroplasty for femoral neck fracture. They were followed up for an average of 22 (8 to 42) months and their complete clinical data were documented. Assessed by Hoehn & Yahr system, their PD was rated as stage Ⅱ in 5 cases, stage Ⅲ in 9 and stage Ⅳ in 4.The operation was done through anterior approach in 5 eases, lateral approach in 7 and posterior approach in 6. The function of the hip was evaluated by Harris scoring. The relationships between the results and the factors-Hoehn & Yahr stage, interval from injury to operation, operative approach and initial time of postoperative rehabilitation-were analyzed with cumulative Logistic regression model of SAS software V8.2. Results Of the 18 cases, 5 were excellent, 7 good, 4 fair and 2 poor in hip functional restoration. The excellent and good rate was 66.7%. And the odds ratio estimates of the 4 factors were 2.554, 2.019, 0.496, and 0.676 re-spectively, indicating that Hoehn & Yabr stage, interval from injury to operation, operative approach and initial time of postoperative rehabilitation were statistically significant factors. Conclusion Since Hoehn & Yahr stage, interval from injury to operation, operative approach and initial time of postoperative rehabilitation affect the functional restoration of the hip, early stage PD, early operation, lateral approach and early rehabilitation can help improve the functional restoration in PD patients after hemiarthroplasty for femoral neck fracture.