Yang Daniel S, McDonald Christopher L, DiSilvestro Kevin J, Patel Shyam A, Li Neill Y, Cohen Eric M, Daniels Alan H
Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
J Arthroplasty. 2023 Apr;38(4):700-705.e1. doi: 10.1016/j.arth.2022.03.061. Epub 2022 Mar 22.
The effect of spinopelvic fixation in addition to lumbar spinal fusion (LSF) on dislocation/instability and revision in patients undergoing primary total hip arthroplasty (THA) has not been reported previously.
The PearlDiver Research Program was used to identify patients aged 30 and above undergoing primary THA who received (1) THA only, (2) THA with prior single-level LSF, (3) THA with prior 2-5 level LSF, or (4) THA with prior LSF with spinopelvic fixation. The incidence of THA revision and dislocation/instability was compared through logistic regression and Chi-squared analysis. All regressions were controlled for age, gender, and Elixhauser Comorbidity Index (ECI).
Between 2010 and 2018, 465,558 patients without history of LSF undergoing THA were examined and compared to 180 THA patients with prior spinopelvic fixation, 5,299 with prior single-level LSF, and 1,465 with prior 2-5 level LSF. At 2 years, 7.8% of THA patients with prior spinopelvic fixation, 4.7% of THA patients with prior 2-5 level LSF, 4.2% of THA patients with prior single-level LSF, and 2.2% of THA patients undergoing only THA had a dislocation event or instability (P < .0001). After controlling for length of fusion, pelvic fixation itself was associated with higher independent risk of revision (at 2 years: 2-5 level LSF + spinopelvic fixation: aHR = 3.15, 95% CI 1.77-5.61, P < .0001 vs 2-5 level LSF with no spinopelvic fixation: aOR = 1.39, 95% CI 1.10-1.76, P < .0001).
At 2 years, spinopelvic fixation in THA patients were associated with a greater than 3.5-fold increase in hip dislocation risk compared to those without LSF, and an over 2-fold increase in THA revision risk compared to those with LSF without spinopelvic fixation.
III.
先前尚未报道过在初次全髋关节置换术（THA）患者中，除腰椎融合术（LSF）外进行脊柱骨盆固定对脱位/不稳定及翻修的影响。
使用PearlDiver研究计划来识别年龄在30岁及以上接受初次THA的患者，这些患者接受了（1）仅THA，（2）先前有单节段LSF的THA，（3）先前有2 - 5节段LSF的THA，或（4）先前有带脊柱骨盆固定的LSF的THA。通过逻辑回归和卡方分析比较THA翻修和脱位/不稳定的发生率。所有回归均对年龄、性别和埃利克斯豪泽合并症指数（ECI）进行了控制。
在2010年至2018年期间，检查了465,558例无LSF病史的THA患者，并与180例先前有脊柱骨盆固定的THA患者、5299例先前有单节段LSF的患者和1465例先前有2 - 5节段LSF的患者进行了比较。在2年时，先前有脊柱骨盆固定的THA患者中有7.8%、先前有2 - 5节段LSF的THA患者中有4.7%、先前有单节段LSF的THA患者中有4.2%以及仅接受THA的患者中有2.2%发生了脱位事件或不稳定（P <.0001）。在控制融合长度后，骨盆固定本身与更高的独立翻修风险相关（在2年时：2 - 5节段LSF + 脊柱骨盆固定：调整后风险比（aHR）= 3.15，95%置信区间（CI）1.77 - 5.61，P <.0001，与无脊柱骨盆固定的2 - 5节段LSF相比：调整后比值比（aOR）= 1.39，95% CI 1.10 - 1.76，P <.0001）。
在2年时，与无LSF的患者相比，THA患者中进行脊柱骨盆固定与髋关节脱位风险增加超过3.5倍相关，与无脊柱骨盆固定的LSF患者相比，THA翻修风险增加超过2倍。
III级
