初次全髋关节置换术后髋关节疼痛发生影响因素分析

目的探讨初次人工全髋关节置换术后中重度髋关节疼痛发生影响因素分析。 方法选择2015年1月至2017年9月在四川省巴中骨科医院初次接受全髋关节置换术的完整成年患者的病历资料进行回顾性分析。翻修手术、长期慢性疼痛、合并恶性肿瘤、精神疾病等情况的病例排除在外。记录患者的性别、年龄、身体质量指数、合并症、置换类型、术前评估、术中指标和术后并发症发生情况等资料。采用单因素和多因素Logistic分析观察患者术后中重髋关节疼痛的发生率及上述资料与髋关节中重度疼痛发生的相关性。 结果共有476例(476例髋)患者纳入研究，中重度疼痛发生率为9.66%。单因素分析显示，置换部位、疾病类型、高血压、吸烟、饮酒不是影响初次髋关节置换术后中重度疼痛发生的危险因素(P>0.05)；性别(χ²＝6.145)、年龄(χ²＝7.847)、身体质量指数(χ²＝14.704)、髋关节活动时间(χ²＝8.043)、糖尿病(χ²＝10.356)、美国麻醉师协会(ASA)分级(χ²＝10.654)、入路方式(χ²＝6.746)、假体类型(χ²＝5.917)、手术时间(χ²＝5.024)、下肢深静脉血栓(χ²＝11.145)、术后C反应蛋白(CRP)值(χ²＝7.494)是影响初次髋关节置换术后中重度疼痛的危险因素(P<0.05)。多因素Logistic分析结果显示，身体质量指数≥28 kg/m²OR＝3.224，95%CI (2.059，8.159)]、下肢深静脉血栓OR ＝6.902，95%CI (4.574，13.589)]是影响全髋关节置换术后中重度疼痛的独立危险因素(P<0.05)，年龄≥60岁OR ＝0.718，95%CI (0.611，0.829)]、关节活动时间>2 d OR ＝0.624，95%CI(0.417，0.852)]是全髋关节置换术后中重度疼痛的保护性因素(P<0.05)。 结论初次人工全髋关节置换术后中重度髋关节发生是多因素综合作用的结果，临床应综合考虑这些因素，以降低全髋关节置换术后中重度疼痛的发生。

Influencing factors of hip pain after primary total hip arthroplasty

ObjectiveTo study the influencing factors of hip pain after primary total hip arthroplasty. MethodsAdult patients with complete clinical data who underwent total hip arthroplasty in Sichuan Bazhong Orthopedic Hospital from January 2015 to September 2017 were retrospective analyzed. The cases of evision, long-term chronic pain, malignant tumors, and mental disorders were excluded. Gender, age, body mass index (BMI), complications, replacement types, preoperative assessment, intraoperative index and postoperative complications were recorded. Univariate and multivariate Logistic analyses were used to observe the incidence of postoperative moderate-weight hip pain and the correlation between the above data and the occurrence of severe pain in the hip joint. ResultsA total of 476 patients (476 hips) were enrolled. The incidence of moderate and severe pain in 476 patients was 9.66%. The single factor analysis showed that replacement site, disease type, hypertension, smoking, and drinking were not the risk factors of moderate and severe pain after primary hip replacement (P>0.05), and the gender χ²=6.145), age(χ²=7.847), BMI(χ²=14.704), hip motion time(χ²=8.043), diabetes(χ²=10.356), American Society of Anesthesiologists classification(χ²=10.654), entry mode(χ²=6.746), type of prosthesis(χ²=5.917), operation time(χ²=5.024), lower extremity deep venous thrombosis (DVT) (χ²=11.145)and postoperative C reactive protein (CRP) (χ²=7.494)were the risk factors for moderate and severe pain after primary hip arthroplasty (P <0.05). The results of multifactor Logistic analysis showed that BMI≥28 kg/m²OR =3.224, 95%CI (2.059, 8.159)]and lower extremity DVTOR =6.902, 95%CI (4.574, 13.589)]were the independent risk factors (P <0.05) for severe pain after total hip replacement (P <0.05). Age≥60 years OR =0.718, 95%CI (0.611, 0.829)] and time for joint motion over two daysOR =0.624, 95%CI (0.417, 0.852)]were the protective factors of moderate and severe pain after total hip replacement (P <0.05). ConclusionThe occurrence of moderate and severe hip joint after primary total hip replacement is the result of multiple factors, which should be considered to reduce the incidence of moderate and severe pain following total hip replacement.