股骨头坏死患者全髋关节置换术后非计划再入院的发生率、原因和危险因素分析

作者	单位	邮编
李立勋	河北省优抚医院骨科，河北石家庄，050062	050062
刘珍	河北省优抚医院骨科，河北石家庄，050062	050062
李磊	河北省优抚医院骨科，河北石家庄，050062	050062
郑晓佐	河北医科大学第三医院关节科，河北石家庄，050051	050051
石楠楠	河北省优抚医院骨科，河北石家庄，050062	050062

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中文摘要:

目的研究分析因股骨头坏死（osteonecrosis of the femoral head, ONFH）初次接受全髋关节置换术（total hip arthroplasty, THA）的患者术后1年内非计划再入院情况，探究其发生率、原因和危险因素。方法回顾性收集2018年1月至2022年6月因ONFH于河北省优抚医院接受初次THA治疗的住院患者临床资料，并进行为期1年的随访。共纳入640例符合标准的患者临床资料，其中男377例（58.9%），女263例（41.1%），并根据再入院情况分为再入院组（n=32）和对照组（n=608）。通过医院电子病历系统收集患者住院期间临床资料，主要包括人口统计学资料、合并症、手术相关资料及术前实验室检查指标，主要以电话方式随访。采用多因素Logistics回归和向后逐步回归法确定非计划再入院的独立危险因素。结果术后1年内发生非计划再入院的患者32例（5.0%），其中发生在术后30 d内者11例（1.7%），术后90 d内者18例（2.8%）。再入院原因包括髋关节脱位、假体周围骨折、深静脉血栓形成、切口延迟愈合/不愈合、手术部位感染、疼痛、心梗、心绞痛、脑梗塞和急性膀胱炎，其中最主要原因为髋关节脱位（28.1%）。年龄＞60岁（OR=2.19，P=0.045）、ARCO Ⅳ期（OR=3.96，P=0.017）、CCI≥4（OR=4.87，P=0.007）、白蛋白＜35 g/L（OR=3.26，P=0.003）、住院时长（OR=1.06，P=0.034）等指标被证实为非计划再入院的独立危险因素。结论 ONFH患者THA术后1年内非计划再入院的发生率为5.0%，最主要原因为髋关节脱位，年龄＞60岁、ARCO Ⅳ期、CCI≥4、白蛋白＜35 g/L、住院时长等危险因素与非计划再入院独立相关。

英文摘要:

Objective To investigate the unplanned readmissions within one year after initial total hip arthroplasty (THA) for patients with osteonecrosis of the femoral head (ONFH), and to explore its incidence, causes and risk factors.Methods Clinical data of inpatients who received initial THA for ONFH in Hebei You Fu Hospital from January 2018 to June 2022 were retrospectively collected, and followed up for one year. A total of 640 patients' clinical data who met the criteria were included.There were 377 males (58.9%) and 263 females (41.1%). The patients were divided into a readmission group (n=32) and a control group (n=608) according to readmission. The patients' clinical data during hospitalisation were collected from the hospital's electronic medical record system, mainly including demographic data, comorbidities, surgery-related data, and preoperative laboratory test indicators. Follow-up was mainly conducted by telephone. Multivariate logistic regression and backward stepwise regression methods were used to identify independent risk factors for unplanned readmission.Results Thirty-two patients (5.0%) had an unplanned readmission within one year after THA, of which 11 cases (1.7%) within 30 days and 18 cases (2.8%) within 90 days. Reasons included hip dislocation, periprosthetic fracture, deep vein thrombosis, delayed incision healing, surgical site infection, pain, myocardial infarction, angina, cerebral infarction, and acute cystitis, with hip dislocation being the most common cause (28.1%). Age>60 years old (OR=2.19, P=0.045), ARCO stage Ⅳ (OR=3.96, P=0.017), CCI≥4 (OR=4.87, P=0.007), albumin <35 g/L (OR=3.26, P=0.003) and length of hospital stay (OR=1.06, P=0.034) were confirmed as independent risk factors for unplanned readmission.Conclusion The incidence of one-year unplanned readmission after THA in ONFH patients was 5.0%, and the leading reasons was hip dislocation. Age>60 years old, ARCO stage Ⅳ, CCI≥4, albumin <35 g/L and length of hospital stay were independently associated with unplanned readmission.

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