探討髖部缺血性壞死之全髖人工關節翻修的相關因子分析－使用臺灣地區健保資料庫追蹤分析

背景與目的在過去20年，髖部缺血性壞死患者接受全髖人工關節置換的中、長期堪用率被認為不理想。本研究的目的是調查髖部缺血性壞死族群且年齡小於70歲的世代，接受全髖人工關節置換後，以健康保險申報之資料，追蹤至少9年，探討影響其長期翻修風險的主要因子，並分析不同人工關節品牌之間的累積翻修率差異。病人及方法在1996至1998年間加入全民健康保險的保險對象，於健康保險資料庫中，所有登載有接受全髖人工關節紀錄者，經過國際疾病分類(ICD-9-CM，1992年版），以罹患髖關節缺血性壞死（ICD-9-CM 733.42）且年齡小於70歲的世代為研究對象（n＝4,643）。以研究對象接受全髖人工關節翻修或再置換手術的登載之時間紀錄或2007年12月31日為觀察終點。使用Kaplan – Meier方法分析累積翻修率，以及使用生命量表計算每年翻修密度。Cox回歸模型來計算可能影響因子之風險比。調整性別、年齡、接受手術的醫院層級與骨科醫師3年手術量的干擾，分析不同人工關節品牌之間的累積翻修率之風險比。結果罹患髖關節缺血性壞死的族群占全髖人工關節置換總人次的46.2%。年齡小於70歲的世代，其3年累積翻修率為0.3%、5年為0.7%、10年為2.9%。性別、接受手術的醫院層級與骨科醫師3年手術量對全髖人工關節的十年累積翻修率無顯著影響。Cox回歸分析證實，60－64歲者經調整後，有最高的翻修風險（RR為3.6，95％CI：1-12.8），而40－44歲者經調整後，翻修風險次高（RR為3.4，95％CI：1-11.6）。在台灣最常使用的6種全髖人工關節品牌至少含七種不同的設計類型，其中2種羥基磷灰石（Hydroxyapatite，HA）塗佈植體表面的全髖人工關節經調整其他風險因子後的翻修風險比較高（4120NH1，RR= 6.0，95％CI：1.4-25.8；1000NS2，RR= 4.6，95％CI：1.1-19.9）。另一品牌的全髖人工關節雖然無法區分設計類型，但總體調整後的十年累積翻修率相對較高（1000NC2，RR= 5.2，95％CI：1.3〜21.9）。所有6種全髖人工關節品牌經調整後的十年累積翻修率低於5%。結論現代第二代人工關節類型，不論是骨水泥固定或是骨柄近端塗佈多孔或HA塗層的非水泥固定類型，在台灣骨科醫師執行手術下，對於年齡小於70歲的髖部缺血性壞死的患者，似乎有令人滿意的低翻修率。

關鍵字

全髖人工關節置換術；全髖人工關節翻修術；全民健康保險研究資料庫；堪用率

並列摘要

Background and purposeSurvival rate of total hip prosthesis has been considered to be poor in the patients of avascular necrosis of hip in past two decades. The purpose of this study was to investigate the revision rate of a large total hip replacement cohort of avascular necrosis of hip in patient less than 70 years of age, specifically any differences between the prosthesis brands and to analyz the factors affecting revision. Patients and methods Between 1996 and1998,all national health insurance enrollees whose insurance claims records have total hip arthroplasties（ICD-9-CM procedure code 81.51）were analyzed. The study cohort was the diagnostic subgroup of avascular necrotic hip（ICD-9-CM disease code 733.42）with the age less than 70-year-old. Kaplan-Meier survival analysis with the date of revision of any component, orDec. 31,2007, as the endpoints was performed. Cox regression models were used to calculate risk ratios for revision of total hip replacement for various reasons, adjusted for sex, age, hospital level, orthopedic surgeon of 3-year surgery volume ResultsThe rate of avascular necrotic hip in the causes of total hip arthroplasty was 46.2%. The cumulative revision rate of the cohort was 0.3% in 3 years, 0.7% in 5 years and 2.9% in 10years. Nodifference in 10-year cumulative revision rate wasnoted in sex, hospital level or orthopedic surgeon of 3-year surgery volume groups. Cox regression analysis confirmed that 60-64 year-old group had a highest risk of revision for any reason (RR=3.6, 95% CI: 1.0-12.8) , whereas 40-44 year-old group had a higher risk of revision for any reason (RR=3.4, 95% CI: 1.0-11.6). In Taiwan, six most common used prosthesis brands included 7 types of prosthesis designs, at least. There were 2 types of hydroxylapatite coating designs with a higher risk of revision (4120NH1，RR= 6.0，95％CI：1.4-25.8；1000NS2，RR= 4.6，95％CI：1.1-19.9).Another brand of prosthesis, in general, also had a higher risk(1000NC2，RR= 5.2，95％CI：1.3〜21.9). However, all the prostheses had a 10-years revision rate less than 5%. InterpretationThe performance of modern second-generation cemented and cementlessprostheses with porous- or hydroxylapatite coating has satisfactorily low 10-year revision rate in the avascular necrotic hip groups of age less than 70-year-old.

並列關鍵字

total hip replacement ； revision of total hip replacement ； national health insurance research database ； survival rate

參考文獻

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Towheed T E, Hochberg M C. Health-related quality of life after total hip replacement.

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Archibeck M.J., Berger R.A.and Jacobs J.J.et al., Second-generation cementless total hip arthroplasty. Eight to eleven-year results, J Bone Joint Surg Am 2001 (83-A): p. 1666.

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探討髖部缺血性壞死之全髖人工關節翻修的相關因子分析－使用臺灣地區健保資料庫追蹤分析

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