Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Arthroplasty. 2012 Sep;27(8):1526-9. doi: 10.1016/j.arth.2011.12.003. Epub 2012 Feb 8.
From the joint registry of 2831 primary total hip arthroplasties (2351 patients) performed between 1998 and 2003, we identified 15 patients (16 hips) who had a documented history of substance abuse disorders at the time of the index surgery. The patients included 13 men (14 hips) and 2 women (2 hips), with the mean age of 49 years (range, 29-65 years). On the basis of the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 13 patients had alcohol abuse disorders, 1 had amphetamine abuse disorder, and 1 had heroin abuse disorder. We found high rates of postoperative substance withdrawal delirium and psychosis (46%), late complication (25%), and lost to follow-up (27%) in these patients. Because patients with substance abuse disorders have unexpected perioperative psychotic episodes, poor compliance, and a tendency to not follow medical advice after surgery and show early discontinuation of follow-up, we suggest that surgeons should work with other medical professionals and carefully perform total hip arthroplasty in such patients.
从 1998 年至 2003 年进行的 2831 例初次全髋关节置换术（2351 例患者）的联合注册中心中，我们确定了 15 例（16 髋）在指数手术时存在药物滥用障碍病史的患者。这些患者包括 13 名男性（14 髋）和 2 名女性（2 髋），平均年龄为 49 岁（范围为 29-65 岁）。根据《精神障碍诊断与统计手册》第四版的规定，13 名患者患有酒精滥用障碍，1 名患者患有安非他命滥用障碍，1 名患者患有海洛因滥用障碍。我们发现这些患者术后物质戒断谵妄和精神病的发生率很高（46%），晚期并发症（25%）和失访（27%）。由于患有药物滥用障碍的患者在围手术期会出现意外的精神病发作、不遵守医嘱和术后不遵循医疗建议的倾向，并且早期停止随访，因此我们建议外科医生应与其他医疗专业人员合作，在这些患者中仔细进行全髋关节置换术。
