摘要
目的探讨肥胖对股骨头坏死患者行人工全髋关节置换术(total hip arthroplasty,THA)治疗效果的影响。方法股骨头坏死患者140例,分为正常组(体质量指数≤24kg/m2)53例、超重组(体质量指数>24~27kg/m2)48例、肥胖组(体质量指数>27kg/m2)39例,3组均行THA,术后3d行骨盆正位X线片观察假体位置。比较3组住院时间、手术时间、术中出血量、术后引流量、术后3d感染发生率;记录术前及术后1、6、12个月髋关节Harris评分;随访观察假体位置、切口愈合及静脉血栓发生情况。结果术后3d骨盆正位X线片示无假体周围骨折,无假体位置不良。肥胖组手术时间[(147.8±42.5)min]、住院时间[(11.7±3.3)d]较超重组[(127.9±39.5)min、(9.4±2.5)d]和正常组[(126.8±37.7)min、(10.2±2.6)d]长(P<0.05),术中出血量[(302.0±150.0)mL]、术后引流量[(352.8±176.0)mL]较超重组[(233.2±212.5)、(263.1±164.5)mL]和正常组[(204.7±161.4)、(247.5±220.1)mL]多(P<0.05),超重组与正常组比较差异无统计学意义(P>0.05)。肥胖组术后3d感染发生率(10.2%)高于超重组(0)、正常组(1.9%)(P<0.05),超重组与正常组比较差异无统计学意义(P>0.05)。肥胖组术后1、6、12个月髋关节Harris评分[(71.5±5.6)、(79.0±5.3)、(84.9±4.9)分]均低于超重组[(74.1±6.3)、(81.4±5.4)、(86.9±4.2)分]和正常组[(75.2±6.2)、(82.2±5.2)、(87.5±4.1)分](P<0.05),超重组与正常组比较差异无统计学意义(P>0.05)。随访12~24个月,超重组、正常组均无假体松动、位置不良发生,肥胖组1例发生假体松动;肥胖组切口愈合不良发生率(15.3%)高于超重组(4.2%)、正常组(1.9%)(P<0.05),超重组与正常组比较差异无统计学意义(P>0.05);肥胖组(5.1%)、超重组(2.1%)、正常组(0)静脉血栓发生率比较差异无统计学意义(P>0.05)。结论肥胖可增加THA术中出血量,延长手术时间,增加感染发生率,影响围术期恢复、近中期切口愈合及髋关节功能。
Objective To investigate the influence of obesity on the effect of total hip arthroplasty(THA)in patients with osteonecrosis of the femoral head.Methods Totally 140patients with osteonecrosis of the femoral head were divided into 53patients with body mass index(BMI)≤24kg/m2(normal group),48patients with BMI 24to≤27kg/m2(overweight group),and 39patients with BMI>27kg/m2(obese group).All three groups were performed THA.The pelvic orthotopic X-ray film was performed on the 3rd postoperative day to observe the position of the prosthesis.The length of hospital stay,operation lasting time,intraoperative blood loss,postoperative drainage volume,and infection rate on the 3rd postoperative day were compared between three groups.The hip joint Harris scores were recorded before as well as 1,6and 12months after operation.The position of the prosthesis,incision healing and venous thrombosis were followed up.Results On the 3rd postoperative day,the pelvic orthotopic X-ray film showed no periprosthetic fracture or malposition of the prosthesis.The operation lasting time and length of hospital stay were longer in obese group((147.8±42.5)min,(11.7±3.3)d)than those in overweight group((127.9±39.5)min,(9.4±2.5)d)and normal group((126.8±37.7)min,(10.2±2.6)d)(P<0.05),the intraoperative blood loss and postoperative drainage volume were larger in obese group((302.0±150.0),(352.8±176.0)mL)than those in overweight group((233.2±212.5),(263.1±164.5)mL)and normal group((204.7±161.4),(247.5±220.1)mL)(P<0.05),and all the above showed no significant differences between overweight group and normal group(P>0.05).The infection rate on the 3rd postoperative day was higher in obese group(10.2%)than that in overweight group(0)and normal group(1.9%)(P<0.05),and showed no significant difference between overweight group and normal group(P>0.05).The hip joint Harris scores in 1,6and 12months after operation were lower in obese group(71.5±5.6,79.0±5.3,84.9±4.9)than those in overweight group(74.1±6.3,81.4±5.4,86.9±4.2)and normal group(75.2±6.2,82.2±5.2,87.5±4.1)(P<0.05),and showed no significant differences between overweight group and normal group(P>0.05).The 12-to 24-month follow-up showed no loosening or malposition of the prosthesis in normal group and overweight group,and 1 case of loosening of the prosthesis in obese group.The rate of poor incision healing was higher in obese group(15.3%)than that in overweight group(4.2%)and normal group(1.9%)(P<0.05),and showed no significant difference between overweight group and normal group(P>0.05).The incidence of venous thrombosis showed no significant difference among obese group(5.1%),overweight group(2.1%)and normal group(0)(P>0.05).Conclusion Obesity would increase the blood loss during THA,prolong the operation time,increase the infection rate,affect the perioperative recovery,and worsen the short-and mid-term healing of incision and hip function.
作者
王晨光
丁贺辉
李真
姚征
郑稼
WANG Chenguang;DING Hehui;LI Zhen;YAO Zheng;ZHENG Jia(Department of Orthopaedics,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第5期456-459,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
科技部国家重点研发计划(122300411149)
河南省基础与前沿技术研究计划项目(141PPTGG295)。
关键词
股骨头坏死
肥胖
人工全髋关节置换术
切口愈合不良
髋关节功能
osteonecrosis of the femoral head
obesity
total hip arthroplasty
poor incision healing
hip joint function
