Osmanski-Zenk K, Steinig N S, Glass Ä, Mittelmeier W, Bader R
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock.
Institut für Biostatistik und Informatik in Medizin und Alternsforschung, Universitätsmedizin Rostock.
Z Orthop Unfall. 2015 Dec;153(6):624-9. doi: 10.1055/s-0035-1557909. Epub 2015 Sep 14.
As the need for joint replacements will continue to rise, the outcome of primary total hip replacement (THR) must be improved and stabilised at a high level. In this study, we investigated whether pre-operative risk factors, such as gender, age and body weight at the time of the surgery or a restricted physical status (ASA-Status > 2 or Kellgren and Lawrence grade > 2) have a negative influence on the post-operative results or on patient satisfaction.
Retrospective data collection and a prospective interview were performed with 486 patients who underwent primary total hip replacement between January 2007 and December 2010 in our hospital. The patients' satisfaction and quality of life were surveyed with the WOMAC-Score, SF-36 and EuroQol-5. Differences between more than two independent spot tests were tested with the non-parametric Kruskal-Wallis test. Differences between two independent spot tests were tested with the non-parametric Mann-Whitney U test. The frequencies were reported and odds ratios calculated. The confidence interval was set at 95 %. The level of significance was p < 0.05.
The average WOMAC-Score was 77.1 and the total score of the SF-36 was 66.9 points. The patients declared an average EuroQol Index of 0.81. Our data show that the patients' gender did not influence the duration of surgery or the scores. However, female patients tended to exhibit more postoperative complications. However, increased patient age at the time of surgery was associated with an increased OR for duration of surgery, length of stay and risk of complications. Patients who had a normal body weight at time of the surgery showed better peri- and post-operative results. We showed that the preoperative estimated Kellgren and Lawrence grade had a significant influence on the duration of surgery. The ASA classification influenced the duration of surgery as well the length of stay and the rate of complications.
The quality of results after primary THR depends on preoperative factors. Existing comorbidities have a significant influence on the duration of surgery and therefore on the perioperative rate of complications and the postoperative outcome. Despite improvements in the functional and subjective outcome after primary THR, an adverse preoperative symptomatic status is associated with less favourable postoperative results.
随着关节置换需求持续上升，初次全髋关节置换术（THR）的效果必须在高水平上得到改善和稳定。在本研究中，我们调查了术前危险因素，如性别、手术时的年龄和体重或身体状况受限（美国麻醉医师协会身体状况分级>2或凯尔格伦和劳伦斯分级>2）是否会对术后结果或患者满意度产生负面影响。
对2007年1月至2010年12月在我院接受初次全髋关节置换术的486例患者进行回顾性数据收集和前瞻性访谈。采用WOMAC评分、SF - 36和欧洲五维健康量表（EuroQol - 5）对患者的满意度和生活质量进行调查。两个以上独立样本检验之间的差异采用非参数Kruskal - Wallis检验。两个独立样本检验之间的差异采用非参数Mann - Whitney U检验。报告频率并计算比值比。置信区间设定为95%。显著性水平为p < 0.05。
WOMAC评分平均为77.1分，SF - 36总分平均为66.9分。患者报告的欧洲五维健康量表指数平均为0.81。我们的数据表明，患者的性别不影响手术时长或评分。然而，女性患者术后并发症倾向更多。然而，手术时患者年龄增加与手术时长、住院时间和并发症风险的比值比增加相关。手术时体重正常的患者围手术期和术后结果更好。我们表明，术前估计的凯尔格伦和劳伦斯分级对手术时长有显著影响。美国麻醉医师协会分级影响手术时长以及住院时间和并发症发生率。
初次全髋关节置换术后的结果质量取决于术前因素。现有的合并症对手术时长有显著影响，因此对围手术期并发症发生率和术后结果有显著影响。尽管初次全髋关节置换术后功能和主观结果有所改善，但术前有症状的不良状态与较差的术后结果相关。
