CAJ | 학술논문

目的：探讨初次全髋关节置换术（ THA）后影响髋关节疼痛的因素及防治方法。方法对我院2006年1月-2012年1月初次行THA并具有完整资料的229例（238髋）患者进行随访，实际随访到155例（共164髋），随访率为67.7%；随访时间为1~6年，平均3.7年。初次筛选采用Charnley髋关节评分标准，髋关节出现疼痛患者进一步用Harris髋关节评分标准，对出现疼痛的17例（18髋）患者进一步分析疼痛的原因，并用视觉模拟评分法（VAS）评估疼痛程度。结果17例（18髋）患者出现术后髋关节疼痛，疼痛原因为：关节内因素8例（47.1%），包括假体脱位3例（3髋）（17.6%）、假体感染2例（2髋）（11.8%）、无菌性炎症2例（3髋）（11.8%）、假体松动1例（1髋）（5.9%）；关节外因素4例（23.5%），包括腰椎源性疾病3例（3髋）（17.6%），异位骨化1例（1髋）（5.9%）；其他原因5例（29.4%），包括心理及精神因素2例（2髋）（11.8%），不明原因3例（3髋）（17.6%）。结论引起THA后疼痛的关节内外源性因素很多，包括假体脱位、松动、不稳及感染等；心理及精神因素引起的疼痛易被临床医生忽视，不明原因疼痛是目前临床诊断和预防的难题。
목적：탐토초차전관관절치환술（ THA）후영향관관절동통적인소급방치방법。방법대아원2006년1월-2012년1월초차행THA병구유완정자료적229례（238관）환자진행수방，실제수방도155례（공164관），수방솔위67.7%；수방시간위1~6년，평균3.7년。초차사선채용Charnley관관절평분표준，관관절출현동통환자진일보용Harris관관절평분표준，대출현동통적17례（18관）환자진일보분석동통적원인，병용시각모의평분법（VAS）평고동통정도。결과17례（18관）환자출현술후관관절동통，동통원인위：관절내인소8례（47.1%），포괄가체탈위3례（3관）（17.6%）、가체감염2례（2관）（11.8%）、무균성염증2례（3관）（11.8%）、가체송동1례（1관）（5.9%）；관절외인소4례（23.5%），포괄요추원성질병3례（3관）（17.6%），이위골화1례（1관）（5.9%）；기타원인5례（29.4%），포괄심리급정신인소2례（2관）（11.8%），불명원인3례（3관）（17.6%）。결론인기THA후동통적관절내외원성인소흔다，포괄가체탈위、송동、불은급감염등；심리급정신인소인기적동통역피림상의생홀시，불명원인동통시목전림상진단화예방적난제。
Objective Toinvestigatetheinfluencefactorsforpostoperativehippainamongpatientswhohadprimary totalhiparthroplasty(THA),andthepreventionmeasuresandtreatmentmethods.Methods 229cases(238hips)whohad primary THA from January 2006 to January 2012 in our hospital were followed up,155 cases(164 hips)were available at last, the follow-up rate was 67. 7%(155/229),the average duration of follow-up were 3. 7 years(1~6 years). The Charnley hip scoring system was used for initial screening,then Harris score system was used for further screening,the reason for postoper-ative hip pain among 17 cases ( 18 hips ) was further analyzed, the degree of pain was evaluated by visual analogue scale (VAS).Results 17patients(18hips)hadpostoperativehippain,thecauseofpain:intra-articularfactors(8cases, 47. 1%),including 3 cases(17. 6%)of dislocation(3 hips),2 cases(11. 8%)of infection(2 hips),2 cases(11. 8%) of aseptic inflammation(3 hips),1 case(5. 9%)of prosthesis loosening(1 hip);Extra - articular factors(4 cases, 23. 5%),including 3 cases(17. 6%)of lumbar-originated diseases(3 hips),1 case(5. 9%)of heterotopic ossification (1 hip);Other reasons(5 cases,29. 4%),including 2 cases(11. 8%)caused by psychological and spiritual factors(2 hips),3cases(17.6%)withunknownreason(3hips).℅onclusion Manyintra-articularandextra-articularfactorscan cause pain after THA,dislocation,infection,prosthesis loosening,and instability are the main factors. The pain caused by psy-chological and spiritual factors is easily ignored by doctors,unexplained pain is a difficult problem in clinical diagnosis and pre-vention at present.