强直性脊柱炎患者全髋术后异位骨化的危险因素分析

发布时间：2018-01-24 10:26

  本文关键词： 强直性脊柱炎 全髋关节置换术 异位骨化 危险因素 中医证型　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨强直性脊柱炎Ankylosing spondylitis(AS)患者行初次人工全髋关节置换术 total hiparthroplasty(THA)后发生异位骨化 heterotopic ossification(HO)的危险因素。方法:回顾性分析2011年6月—2015年12月因AS行初次人工THA且随访达6个月以上的87例(132髋)患者,男76例(115髋),女11例(17髋);平均年龄34.8岁(18～80岁);平均随访时间28.2月(6～65月)。对患者的手术前后临床资料和影像学资料进行收集整理。临床资料包括患者的年龄、性别、病程、中医辨证分型、术前髋关节是否强直、术前CRP、术前ESR、术中出血量、手术时间、假体类型、麻醉方式。影像学资料包括患者术前及术后的髋关节正侧位X光片。观察末次随访X线片假体周围异位骨化的范围,并按Brooker分型分为Ⅰ～Ⅳ型。术前和末次随访的髋关节功能评估采用Harris评分。用SPSS20.0软件建立数据库并进行统计学分析,组间差异采用独立样本t检验,计数资料采用X2检验。t检验和X2检验中有统计学意义(即P0.05)的资料继续采用二分类logistic回归进行相关分析,PK0.05为有统计学意义,即有相关性。结果:AS 术后 HO 的发生率为 32.6%。Brooker Ⅰ 型 17 髋(12.9%),Ⅱ 型 17 髋(12.9%),Ⅲ型8髋(6.1%),Ⅳ型1髋(0.7%)。其中男性42髋,女性1髋。平均Harris评分从术前的36.7分(0～62)上升到了术后最后一次随访的82.9分(49～99)。危险因素分为可变因素和不可变因素。男性(P = 0.045)、术前髋关节强直(P0.001)是HO发生的不可变因素,增加了异位骨化的发生率。在众多的可变因素中,手术时间过长(P = 0.044)、术中使用全麻(P = 0.009)中医证型为实证(p=0.049)也会增加HO的发生率。患者的年龄、病程、术前ESR及CRP、术中出血量和假体类型与术后HO的发生无明显相关性。结论:AS全髋关节置换术后HO的发生率与手术时间长短,术中软组织损伤程度,以及是否全麻等可变因素密切相关。可以通过改善患者体质,缩短手术时间,减少术中软组织损伤以及术中尽量避免使用全麻,来降低HO的发生率。
[Abstract]:Objective: to study the Ankylosing spondylitis (ASA) of ankylosing spondylitis. Primary total hip arthroplasty (total hithroplasty). Heterotopic ossification of heterotopic. Methods: a retrospective analysis was made on 87 patients with primary artificial THA who were followed up for more than 6 months from June 2011 to December 2015. There were 76 males (115 hips) and 11 females (17 hips). The average age was 34.8 years old and 1880 years old. The average follow-up time was 28.2 months from 6 to 65 months. The clinical data and imaging data before and after operation were collected and sorted. The clinical data included age, sex, course of disease, TCM syndrome differentiation and classification. Preoperative hip ankylosis, preoperative CRP, preoperative ESRs, intraoperative bleeding, operative time, type of prosthesis. Methods of anesthesia. The imaging data included the positive and lateral radiographs of hip joint before and after operation. The range of heterotopic ossification around the prosthesis was observed during the last follow-up. According to the Brooker classification, the hip function was divided into 鈪，

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