Field R E, Cronin M D, Singh P J
Epson and St Helier Hospital NHS Trust, Carshalton, Surrey SM5 1AA, UK.
J Bone Joint Surg Br. 2005 May;87(5):618-22. doi: 10.1302/0301-620X.87B5.15390.
We have used the Oxford hip score to monitor the progress of 1908 primary and 279 revision hip replacements undertaken since the start of 1995. Our review programme began in early 1999 and has generated 3900 assessments. The mean pre-operative scores for primary and revision cases were 40.95 and 40.11, respectively. The mean annual score for primary replacement at between 12 and 84 months ranged between 20.60 and 22.57. A comparison of cross-sectional and longitudinal data showed no significant differences. All post-operative reviews showed a significant improvement (p < or = 0.0001). The 50- to 60-year-old group scored significantly better than the patients over 80 years of age up to 48 months (p < 0.01). A subgroup of 826 National Health Service (NHS) and 397 private patients, treated by the senior author (2292 Oxford assessments), had a higher (i.e. worse) mean pre-operative score for the NHS patients (p < or = 0.001). The private patients scored better than the NHS group up to 84 months (p < 0.05). Patients treated by a surgeon performing more than 100 replacements each year had a significantly better outcome up to five years than those operated on by surgeons performing fewer than 20 replacements each year. The age of the patients at the time of operation, and their pre-operative level of disability, have both been identified as affecting the long-term outcome. Awareness of the influence of these factors should assist surgeons to provide balanced advice.
自1995年初以来，我们使用牛津髋关节评分来监测1908例初次髋关节置换手术和279例髋关节翻修手术的进展情况。我们的评估项目始于1999年初，已产生3900份评估报告。初次手术和翻修手术病例的术前平均评分分别为40.95和40.11。初次置换术后12至84个月的平均年度评分在20.60至22.57之间。横断面数据和纵向数据的比较显示无显著差异。所有术后评估均显示有显著改善（p≤0.0001）。在48个月内，50至60岁年龄组的评分显著高于80岁以上患者（p<0.01）。由资深作者治疗的826例国民健康服务（NHS）患者和397例私人患者组成的亚组（2292次牛津评估）中，NHS患者的术前平均评分更高（即更差）（p≤0.001）。在84个月内，私人患者的评分高于NHS组（p<0.05）。每年进行超过100例置换手术的外科医生治疗的患者，在长达五年的时间里，其结果明显优于每年进行少于20例置换手术的外科医生治疗的患者。已确定患者手术时的年龄及其术前残疾程度均会影响长期结果。认识到这些因素的影响应有助于外科医生提供全面的建议。
