髋发育不良全髋置换术后跛行相关因素与预测△

Related factors and prediction of claudication after total hip arthroplasty for hip dysplasia

摘要:

[目的] 探讨发育性髋关节发育不良（developmental dysplasia of the hip, DDH） 患者全髋置换术（total hip arthroplasty,THA） 后跛行步态的影响因素。[方法] 选取青海大学附属医院2019 年1 月—2023 年1 月收治的接受THA 治疗的DDH 患者106 例。根据术后6 个月髋关节Harris 评分分为跛行组和步态正常组。采用单因素比较和多元逻辑回归分析探索DDH 患者THA 后跛行步态的影响因素，构建风险预测模型。[结果] 106 例DDH 患者中跛行的发生率为34.0%（36/106）。跛行组患者的股骨假体置入深度[(134.7±21.1) mm vs (156.7±23.9) mm, P＜0.001]、髋关节旋转中心高度[(9.6±5.8) mm vs (31.0±4.2) mm, P＜0.001] 均显著小于正常组，股骨距长度[(18.7±3.3) mm vs (15.1±2.1) mm, P＜0.001] 及股骨偏心距[(36.9±2.5) mm vs (34.8±2.8) mm, P＜0.001] 均显著大于正常组。逻辑回归表明，术后股骨假体置入深度大（OR=0.259, 95%CI 0.089~0.759） 是DDH 患者THA 后发生跛行步态的保护因素；而股骨偏心距大（OR=4.084, 95%CI 1.395~11.947）、术后保留股骨距长度（OR=3.050, 95%CI 1.042~8.922）、髋关节旋转中心高度（OR=2.998, 95%CI 1.025~8.772） 是DDH 患者THA 后发生跛行步态的危险因素。列线图模型预测DDH 患者THA后发生跛行步态的灵敏度为0.791（95%CI 0.653~0.872），特异度为0.847（95%CI 0.752~0.936），AUC 为0.839（95%CI 0.791~0.927）。[结论] 术后股骨假体置入深度、术后保留股骨距长度、髋关节旋转中心高度及股骨偏心距是DDH 患者THA 后发生跛行步态的影响因素，构建风险模型有助于预测术后跛行。

Abstract:

[Objective] To search the related factors and prediction of claudication after total hip arthroplasty (THA) for developmentaldysplasia of the hip (DDH). [Methods] A total 106 patients who received THA for DDH were enrolled into this study in Affiliated Hospital ofQinghai University from January 2019 to January 2023. According to whether or not lameness happened after THA and Harris score 6months after operation, the patients were divided into lameness group and normal gait group. Univariate comparison and multiple logistic re-gression analysis were used to explore the influencing factors of claudication after THA for DDH, furthermore a prediction model based onthe related factors was created and verified. [Results] Of the 106 patients with DDH, lameness happened in 36 patients, accounting for34.0%. Regarding univariate comparison, the limp group proved significantly less than the normal gait group in terms of depth of femoralcomponent placed [(134.7±21.1) mm vs (156.7±23.9) mm, P＜0.001], hip rotation center height [(9.6±5.8) mm vs (31.0±4.2) mm, P＜0.001],while the former was significantly greater than the latter in terms of femoral calar length [(18.7±3.3) mm vs (15.1±2.1) mm, P＜0.001] and thefemoral eccentricity [(36.9±2.5) mm vs (34.8±2.8) mm, P＜0.001]. As results of logistic regression, the greater depth of femoral componentplaced (OR=0.259, 95%CI 0.089~0.759) was the protective factor for lameness after THA in DDH, while the larger femoral eccentricity (OR=4.084, 95%CI 1.395~11.947), the more length of femoral calaris retained (OR=3.050, 95%CI 1.042~8.922), and the higher the center of rota-tion of the hip (OR=2.998, 95%CI 1.025~8.772) were the risk factors for claudication after THA in DDH. Based on the factors abovemen-tioned, a nomogram predicting model was created, and verified by ROC analysis, which had sensitivity of 0.791 (95%CI 0.653~0.872), speci-ficity of 0.847 (95%CI 0.752~0.936) and AUC of 0.839 (95%CI 0.791~0.927) for predicting claudication after THA in DDH. [Conclusion]The depth of femoral prosthetic placement, length of preserved femoral calar after surgery, height of hip rotation center and femoral eccentric-ity are the influencing factors for claudication after THA in DDH, while the prediction model based the factors might be helpful to predictclaudication after THA.