中国修复重建外科杂志

中国修复重建外科杂志

终末期肾病患者行人工全髋关节置换术的安全性与有效性分析

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目的 评价终末期肾病(end stage renal disease,ESRD)患者行人工全髋关节置换术(total hip arthroplasty,THA)的安全性与有效性。 方法 选择 2009 年 12 月—2016 年 5 月收治并行 THA 的 28 例(30 髋)ESRD 患者(ESRD 组)以及 28 例(30 髋)肾功能正常患者(对照组)进行对照研究。两组患者性别、年龄、髋关节侧别、美国麻醉医师协会(ASA)分级以及术前 Harris 评分、血红蛋白(hemoglobin,Hb)比较,差异均无统计学意义(P>0.05)。比较两组患者住院期间并发症、Hb 变化值、围手术期输血率、住院时间、住院费用、出院后 90 d 内再入院患者例数,ESRD组透析患者肌酐水平变化情况;以及假体周围感染、假体无菌性松动发生情况,髋关节 Harris 评分及随访期间死亡事件。 结果 术后两组患者均获随访;ESRD 组随访时间 1.0~7.4 年,平均 3.4 年;对照组随访时间 1.0~7.4 年,平均 3.5 年。两组住院时间、出院时 Hb 以及出院时与术前 Hb 差值比较,差异均无统计学意义(P>0.05)。ESRD 组住院费用、围手术期输血率较对照组明显增高(P<0.05)。ESRD 组透析患者术前及出院时肌酐值比较,差异无统计学意义(t=1.804,P=0.089)。末次随访,两组 Harris 评分均明显高于术前(P<0.05);两组末次随访与术前 Harris 评分差值比较,差异无统计学意义(t=1.278,P=0.207)。ESRD 组:住院期间 5 例发生并发症,出院后 90 d 内再入院 1 例;随访期间死亡 2 例。对照组:住院期间 1 例发生并发症,无出院后 90 d 内再入院患者,随访期间无死亡患者。随访期间两组均未出现假体松动及假体周围感染,假体位置良好。 结论 ESRD 患者行 THA 可以改善关节功能,提高生活质量,但手术风险、围手术期并发症发生率、输血率及费用较高。经正确术前评估和个体化围手术期处理,患者可安全度过围手术期。

Objective To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD). Methods Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups (P>0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded. Results There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups (P>0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group (P<0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation (t=1.804, P=0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups (P<0.05); however, there was no significant difference in Harris score between groups (t=1.278, P=0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position. Conclusion THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.

关键词: 终末期肾病; 人工全髋关节置换术; 安全性; 有效性

Key words: End stage renal disease; total hip arthroplasty; safety; efficacy

引用本文: 肖强, 李金龙, 周凯, 陵廷贤, 周宗科, 沈彬, 杨静, 康鹏德, 裴福兴. 终末期肾病患者行人工全髋关节置换术的安全性与有效性分析. 中国修复重建外科杂志, 2017, 31(12): 1418-1422. doi: 10.7507/1002-1892.201707106 复制

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1. 张路霞, 王海燕. 中国慢性肾脏病的现状及挑战——来自中国慢性肾脏病流行病学调查的启示. 中华内科杂志, 2012, 51(7): 497-498.
2. Tejwani NC, Schachter AK, Immerman I, et al. Renal osteodystrophy. J Am Acad Orthop Surg, 2006, 14(5): 303-311.
3. Abbott KC, Bucci JR, Agodoa LY. Total hip arthroplasty in chronic dialysis patients in the United States. J Nephrol, 2003, 16(1): 34-39.
4. Bucci JR, Oglesby RJ, Agodoa LY, et al. Hospitalizations for total hip arthroplasty after renal transplantation in the United States. Am J Transplant, 2002, 2(10): 999-1004.
5. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 2004, 351(13): 1296-1305.
6. Kildow BJ, Agaba P, Moore BF, et al. Postoperative Impact of Diabetes, Chronic Kidney Disease, Hemodialysis, and Renal Transplant After Total Hip Arthroplasty. J Arthroplasty, 2017, 32(9S): S135-S140.
7. Tan TL, Kheir MM, Tan DD, et al. Chronic Kidney Disease Linearly Predicts Outcomes After Elective Total Joint Arthroplasty. J Arthroplasty, 2016, 31(9 Suppl): 175-179.e2.
8. Cavanaugh PK, Chen AF, Rasouli MR, et al. Total joint arthroplasty in transplant recipients: in-hospital adverse outcomes. J Arthroplasty, 2015, 30(5): 840-845.
9. Klement MR, Penrose CT, Bala A, et al. Complications of total hip arthroplasty following solid organ transplantation. J Orthop Sci, 2017, 22(2): 295-299.
10. Ledford CK, Watters TS, Wellman SS, et al. Risk versus reward: total joint arthroplasty outcomes after various solid organ transplantations. J Arthroplasty, 2014, 29(8): 1548-1552.
11. Lizaur-Utrilla A, Martinez-Mendez D, Collados-Maestre I, et al. Elective Total Knee Arthroplasty in Patients With End-Stage Renal Disease: Is It a Safe Procedure? J Arthroplasty, 2016, 31(10): 2152-2155.
12. Warth LC, Pugely AJ, Martin CT, et al. Total Joint Arthroplasty in Patients with Chronic Renal Disease: Is It Worth the Risk? J Arthroplasty, 2015, 30(9 Suppl): 51-54.
13. Ackland GL, Moran N, Cone S, et al. Chronic Kidney Disease and Postoperative Morbidity After Elective Orthopedic Surgery. Anesthesia & Analgesia, 2011, 112(6): 1375-1381.
14. Cavanaugh PK, Chen AF, Rasouli MR, et al. Complications and Mortality in Chronic Renal Failure Patients Undergoing Total Joint Arthroplasty: A Comparison Between Dialysis and Renal Transplant Patients. J Arthroplasty, 2016, 31(2): 465-472.
15. Augustin ID, Yeoh TY, Sprung J, et al. Association between chronic kidney disease and blood transfusions for knee and hip arthroplasty surgery. J Arthroplasty, 2013, 28(6): 928-931.
16. Zhao Y, Jiang C, Peng H, et al. The effectiveness and safety of preoperative use of erythropoietin in patients scheduled for total hip or knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2016, 95(27): e4122.
17. Yi Z, Bin S, Jing Y, et al. Tranexamic Acid Administration in Primary Total Hip Arthroplasty: A Randomized Controlled Trial of Intravenous Combined with Topical Versus Single-Dose Intravenous Administration. J Bone Joint Surg (Am), 2016, 98(12): 983-991.
18. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复–围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
19. Siracuse BL, Chamberlain RS. A Preoperative Scale for Determining Surgical Readmission Risk After Total Hip Replacement. JAMA Surg, 2016, 151(8): 701-709.
20. Ponnusamy KE, Jain A, Thakkar SC, et al. Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty. J Bone Joint Surg (Am), 2015, 97(16): 1326-1332.
21. Erkocak OF, Yoo JY, Restrepo C, et al. Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty. J Arthroplasty, 2016, 31(11): 2437-2441.
22. Lieu D, Harris I A, Naylor JM, et al. Review Article: Total Hip Replacement in Haemodialysis or Renal Transplant Patients. J Orthop Surg, 2014, 22(3): 393-398.