影响髋关节表面置换术后关节功能恢复的多因素分析

目的探讨影响股骨头缺血性坏死患者行髋关节表面置换术后关节功能恢复的因素。方法1997年6月至2008年7月对股骨头缺血性坏死患者45例47髋行半髋关节表面置换，男25例，女20例；年龄29—49岁，平均36．6岁。应用Harris髋关节评分对疗效进行评定。研究患者的年龄、性别、体重指数、职业、病因、Ficat分期、髋部手术史、股骨假体柄干角、术后开始锻炼时间等相关因素，在单因素分析基础上应用Logistic回归模型作多因素分析。应用SPSS13．0进行统计学分析，其中Harris髋关节评分作为因变量，分为优、较好、良、差4类，其中前2类视为功能恢复满意。结果45例患者随访1—11年，平均8．6年。Harris髋关节评分：优15例，较好20例，良8例，差2例，满意率为77．8％。单因素分析结果发现患者的体重指数、Ficat分期、股骨假体柄干角、术后开始锻炼时间4个因素与髋关节功能恢复显著相关（P〈0．05）。Logistic回归发现此4个因素是影响髋关节功能恢复的主要因素。结论体重指数、Ficat分期、股骨假体柄干角、术后锻炼时间可明显影响髋关节表面置换术后功能恢复。

Analysis of factors related to prognosis in necrosis of femoral head treated with hip resurfacing arthroplasty

Objective To study the factors affecting the functional restoration of the hip joint with necrosis of femoral head treated with hip resurfacing arthroplasty. Methods 45 patients with necrosis of femoral head were treated with hip resurfacing arthroplasty from June 1997 to July 2008. The function of the hip joint was evaluated with the Harris hip score. Nine factors including age, gender, body mass index （ BMI）, occupation, etiology, Ficat classification, hip operation history, stem shaft angle of radiography （SSA） and time of functional exercise were analyzed statistically withx2 test and Logistic multiple regression with a significant difference （P 〈 0. 05）, SPSS 13.0 was used to analyze data. The hip-joint function was classified by excellent, better, good and poor. The former two were thought of excellent recovery of function. Results All cases were followed up from 1 to 11 years. According to Harris hip joint score, 20 cases were excellent, 15 better, 8 good and 2 poor. The excellent and better rates reached 77. 8%. Univariance revealed that BMI, Ficat classification, SSA and time of functional exercise were closely correlated with the prognosis of necrosis of femoral head treated with hip resurfacing arthroplasty with a significant difference （P 〈 0. 05）. Logistic multiple regression revealed that 4 factors as said before were key factors influencing function of hip joint after hip resurfacing arthroplasty. Conclusion BMI, Ficat classification, SSA and time of functional exercise chiefly affect the functional resoration after hip resurfacing arthroplasty. Control operative indication strictly, weight reduction, appropriate SSA placement and early rehabilitation will greatly improve the function of hip joint postoperative.