摘要
背景:系统性红斑狼疮(SLE)患者行全髋关节置换术(THA)的安全性和有效性的报道较多,但SLE患者以青年女性为主,既往的对照研究难以匹配与SLE组患者生物学特征一致且样本量足够大的对照组。目的:进行匹配度较好的大样本研究,尽可能控制混杂因素,为SLE患者行THA手术治疗提供依据。方法:回顾性纳入2004年1月至2017年6月行THA治疗的100例SLE患者为SLE组,同期因创伤、饮酒等其他原因导致股骨头缺血性坏死(AVNFH)的100例患者为对照组,其性别、年龄、术侧、身高、体重、Ficat分期、随访时间皆匹配SLE组。结果:SLE组患者术后随访24~98个月,平均(57.5±31.5)个月;对照组患者术后随访31~128个月,平均(64.2±29.5)个月。SLE组患者与对照组比较,术前白蛋白、血红蛋白、红细胞压积、淋巴细胞计数较低,而红细胞沉降率(ESR)、C反应蛋白(CRP)水平较高。SLE组患者术后出现浅表伤口感染、深静脉血栓(DVT)和血肿形成的比率高于对照组(P=0.01),使用糖皮质激素是以上并发症的危险因素。两组患者均未出现感染、松动、脱位等其他并发症。对照组仅1例出现假体周围骨折。术前SLE组的Harris髋关节评分(HHS)和SF-12均低于对照组。末次随访时两组患者仅SF-12生理得分(PCS)差异有统计学意义(P=0.02)。结论:疾病活动控制良好的SLE患者的THA术后功能良好,未发生感染、松动、脱位等严重并发症,仅短期并发症较多。短期并发症的危险因素包括罹患SLE和使用糖皮质激素。疾病活动控制良好的SLE患者行THA治疗AVNFH安全而有效。
Background:Although previous studies provided evidence about the effectiveness and safety of total hip arthro?plasty(THA)on systemic lupus erythematosus(SLE)patients with avascular necrosis of the femoral head(AVNFH),they gen?erally lacked a well matched control group due to the young average age of SLE patients.Objective:To provide evidence for to?tal hip arthroplasty of SLE patients with AVNFH by a better matched large sample cohort with confounding factors best con?trolled.Methods:From January 2004 to June 2017,100 SLE patients with AVNFH undergoing THA were included as SLE group and meanwhile 100 patients with AVNFH caused by trauma and alcohol consumption were included as control group with age,sex,side of surgery,weight,height,follow-up time and Ficat staging matched with SLE group.Results:Patients in SLE group were followed for 24-98 months with the average of(57.5±31.5)months,while patients in the control group were fol?lowed for 31-128 months with the average of(64.2±29.5)months.Compared with control group,the SLE group had significant?ly lower albumin,hemoglobin levels,as well as lower hematocrit and lymphocyte counts,and higher erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)levels before the operation.The SLE group had higher incidence of complications as superficial wound infection,deep venous thrombosis and hematoma formation(P=0.01)compared with the control group,and corticosteroids usage was the risk factor of these complications.No complications such as infection,loosening or dislocation were found.There was one case of periprosthetic fracture in the control group.The preoperative Harris Hip Score and only PCS of SF-12 score remained slightly lower in the SLE group than in the control group(P=0.02).Conclusions:Well controlled SLE patients have good function after THA,with no serious complications such as infection,loosening or dislocation and only a little more short term complications.The risk factors of short term postoperative complications include SLE attack and corti?costeroids usage.THA is safe and effective for well-controlled SLE patients with AVNFH.
作者
陈朗
冯辉雄
李宏超
顾建明
CHEN Lang;FENG Huixiong;LI Hongchao;GU Jianming(Department of Orthopaedic Surgery,2.Department of Rheumatology,Beijing Jishuitan Hospital,Beijing 100044,China)
出处
《中华骨与关节外科杂志》
2020年第2期143-147,共5页
Chinese Journal of Bone and Joint Surgery
关键词
系统性红斑狼疮
全髋关节置换术
股骨头缺血性坏死
并发症
Systemic Lupus Erythematosus
Total Hip Arthroplasty
Avascular Necrosis of Femoral Head
Complication
