终末期肾病患者行人工全髋关节置换术的安全性与有效性分析

发布时间：2018-06-14 08:16

本文选题：终末期肾病 + 人工全髋关节置换术　；参考：《中国修复重建外科杂志》2017年12期

【摘要】：目的评价终末期肾病(end stage renal disease,ESRD)患者行人工全髋关节置换术(total hip arthroplasty,THA)的安全性与有效性。方法选择2009年12月—2016年5月收治并行THA的28例(30髋)ESRD患者(ESRD组)以及28例(30髋)肾功能正常患者(对照组)进行对照研究。两组患者性别、年龄、髋关节侧别、美国麻醉医师协会(ASA)分级以及术前Harris评分、血红蛋白(hemoglobin,Hb)比较,差异均无统计学意义(P0.05)。比较两组患者住院期间并发症、Hb变化值、围手术期输血率、住院时间、住院费用、出院后90 d内再入院患者例数,ESRD组透析患者肌酐水平变化情况;以及假体周围感染、假体无菌性松动发生情况,髋关节Harris评分及随访期间死亡事件。结果术后两组患者均获随访;ESRD组随访时间1.0~7.4年,平均3.4年;对照组随访时间1.0~7.4年,平均3.5年。两组住院时间、出院时Hb以及出院时与术前Hb差值比较,差异均无统计学意义(P0.05)。ESRD组住院费用、围手术期输血率较对照组明显增高(P0.05)。ESRD组透析患者术前及出院时肌酐值比较,差异无统计学意义(t=1.804,P=0.089)。末次随访,两组Harris评分均明显高于术前(P0.05);两组末次随访与术前Harris评分差值比较,差异无统计学意义(t=1.278,P=0.207)。ESRD组:住院期间5例发生并发症,出院后90 d内再入院1例;随访期间死亡2例。对照组:住院期间1例发生并发症,无出院后90 d内再入院患者,随访期间无死亡患者。随访期间两组均未出现假体松动及假体周围感染,假体位置良好。结论 ESRD患者行THA可以改善关节功能,提高生活质量,但手术风险、围手术期并发症发生率、输血率及费用较高。经正确术前评估和个体化围手术期处理,患者可安全度过围手术期。
[Abstract]:Objective to evaluate the safety and efficacy of total hip arthroplasty (tha) in patients with end stage renal disease (ESRD). Methods from December 2009 to May 2016, 28 patients with ESRD and 28 patients with normal renal function (control group) treated with tha were studied. There was no significant difference in sex, age, hip side, ASA-grade, Harris score and hemoglobin (HB) between the two groups (P 0.05). The changes of HB, blood transfusion rate, hospitalization time, hospitalization cost during hospitalization, creatinine level of dialysis patients in ESRD group and periprosthetic infection were compared between the two groups. Prosthesis aseptic loosening, hip Harris score and death events during follow-up. Results the follow-up time of ESRD group was 1.0 ~ 7.4 years (mean 3.4 years) and that of control group was 1.0 ~ 7.4 years (mean 3.5 years). There was no significant difference between the two groups in hospitalization time, HB at discharge and the difference between preoperative HB and preoperative HB. There was no significant difference in hospitalization cost between the two groups. The perioperative blood transfusion rate was significantly higher than that in the control group. The creatinine levels of the dialysis patients before and after discharge were significantly higher in the ESRD group than in the control group. The difference was not statistically significant. At the last follow-up, the Harris scores in the two groups were significantly higher than those in the preoperative group (P 0.05), and there was no significant difference between the two groups in the difference between the last follow-up and the preoperative Harris score. In the ESRD group, 5 cases had complications during hospitalization and 1 case was re-admitted within 90 days after discharge. 2 cases died during follow-up. In the control group, one patient had complications during hospitalization, no patients were hospitalized within 90 days after discharge, and no patients died during follow-up. During the follow-up period, there was no loosening of prosthesis and infection around prosthesis in both groups, and the position of prosthesis was good. Conclusion tha can improve joint function and quality of life in ESRD patients, but the risk of operation, the incidence of perioperative complications, the rate of blood transfusion and the cost are higher. After correct preoperative evaluation and individualized perioperative management, the patient can survive the perioperative period safely.
【作者单位】：四川大学华西医院骨科;
【分类号】：R687.4

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