弗兰克·斯廷奇菲尔德奖：社会经济因素对全髋关节置换术后结局的影响：一项前瞻性、随机研究。
The Frank Stinchfield Award: the impact of socioeconomic factors on outcome after THA: a prospective, randomized study.
机构信息
Starkville Orthopedic Clinic, Starkville, MS, USA.
出版信息
Clin Orthop Relat Res. 2011 Feb;469(2):339-47. doi: 10.1007/s11999-010-1519-x.
BACKGROUND
Most studies of total hip arthroplasty (THA) focus on the effect of the type of implant on the clinical result. Relatively little data are available on the impact of the patient's preoperative status and socioeconomic factors on the clinical results following THA.
QUESTIONS/PURPOSES: We determined the relative importance of patient preoperative and socioeconomic status compared to implant and technique factors in predicting patient outcome as reflected by scores on commonly utilized rating scales (eg, Harris Hip Score, WOMAC, SF-12, degree of patient satisfaction, or presence or severity of thigh pain) following cementless THA.
METHODS
All patients during the study period were offered enrollment in a prospective, randomized study to receive either a titanium, tapered, proximally coated stem; or a Co-Cr, cylindrical, extensively coated stem; 102 patients were enrolled. We collected detailed patient data preoperatively including diagnosis, age, gender, insurance status, medical comorbidities, tobacco and alcohol use, household income, educational level, and history of treatment for lumbar spine pathology. Clinical evaluation included Harris Hip Score, SF-12, WOMAC, pain drawing, and UCLA activity rating and satisfaction questionnaire. Implant factors included stem type, stem size, fit in the canal, and stem-bone stiffness ratios. Minimum 2 year followup was obtained in 95% of the enrolled patients (102 patients).
RESULTS
Patient demographics and preoperative status were more important than implant factors in predicting the presence of thigh pain, dissatisfaction, and a low hip score. The most predictive factors were ethnicity, educational level, poverty level, income, and a low preoperative WOMAC score or preoperative SF-12 mental component score. No implant parameter correlated with outcome or satisfaction.
CONCLUSION
Socioeconomic factors and preoperative status have more impact on the clinical outcome of cementless THA than implant related factors.
LEVEL OF EVIDENCE
Level I, prospective, randomized clinical trial. See the guidelines online for a complete description of level of evidence.
背景
大多数全髋关节置换术 (THA) 的研究都集中在植入物类型对临床结果的影响上。关于患者术前状态和社会经济因素对 THA 后临床结果的影响，相对较少的数据。
问题/目的：我们确定了患者术前和社会经济状况与植入物和技术因素在预测接受非骨水泥 THA 后患者结局（如 Harris 髋关节评分、WOMAC、SF-12、患者满意度程度或大腿疼痛的存在或严重程度）方面的相对重要性，这些结局通过常用评分量表来反映。
方法
在研究期间，所有患者均被邀请参加一项前瞻性、随机研究，以接受钛制、锥形、近端涂层的股骨柄；或钴铬制、圆柱形、广泛涂层的股骨柄；有 102 名患者入组。我们在术前收集了详细的患者数据，包括诊断、年龄、性别、保险状况、合并症、吸烟和饮酒史、家庭收入、教育程度以及腰椎病理治疗史。临床评估包括 Harris 髋关节评分、SF-12、WOMAC、疼痛图和 UCLA 活动评分和满意度问卷。植入物因素包括股骨柄类型、股骨柄尺寸、在管内的匹配度以及股骨柄-骨的刚性比。95%的入组患者（102 名）获得了至少 2 年的随访。
结果
患者的人口统计学和术前状态比植入物因素更能预测大腿疼痛、不满意和髋关节评分低的情况。最具预测性的因素是种族、教育程度、贫困程度、收入以及术前 WOMAC 评分或术前 SF-12 心理成分评分低。没有任何植入物参数与结果或满意度相关。
结论
社会经济因素和术前状态对非骨水泥 THA 的临床结果的影响大于植入物相关因素。
证据水平
I 级，前瞻性、随机临床试验。有关证据水平的完整描述，请参见在线指南。
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