全髋关节置换术治疗强直性脊柱炎累及髋关节的疗效观察

发布时间：2018-03-24 15:32

  本文选题：强直性脊柱炎　切入点：全髋关节置换术　出处：《中国修复重建外科杂志》2017年01期

【摘要】：目的总结全髋关节置换术(total hip arthroplasty,THA)治疗强直性脊柱炎(ankylosing spondylitis,AS)累及髋关节的中远期疗效,并对影响疗效的因素进行探讨。方法 1999年3月—2011年5月采用THA治疗32例(42髋)AS累及髋关节患者。男26例,女6例;年龄20~78岁,平均39岁。病程2~41年,中位病程10年。假体摩擦界面采用金属-聚乙烯者19髋,陶瓷-陶瓷者23髋;股骨头假体采用36 mm直径者15髋,28 mm直径者27髋;假体均采用生物学固定。手术前后测量并记录患者髋关节总活动度(屈-伸、内收-外展、内旋-外旋活动度总和),髋关节功能采用Harris评分、疼痛程度采用疼痛视觉模拟评分(VAS)评价。根据X线片,髋臼侧和股骨侧假体分别采用De Lee分区和Gruen分区描述;异位骨化程度采用Brooker标准。结果术后患者切口均Ⅰ期愈合,无麻醉意外、感染及神经、血管损伤等并发症。术后29例(39髋)获随访,随访时间5~17年,平均9年。术后股骨头假体28 mm直径组24髋中发生髋关节前脱位2例(2髋),36 mm直径组15髋无脱位发生。末次随访时,所有患者VAS评分、Harris评分及髋关节总活动度均较术前显著改善(P0.05)。其中术前病程越短,术后Harris评分越高、髋关节总活动度越大(P0.05);股骨头假体直径越大,术后髋关节总活动度越大(P0.05)。末次随访时臼杯和股骨柄假体均固定良好。采用金属-聚乙烯假体的18髋中,臼杯周围显示有广泛性骨溶解者9髋(50%),但假体尚无松动;采用陶瓷-陶瓷假体的21髋中无任何骨溶解和假体松动征象。7髋发生异位骨化,其中BrookerⅠ级5髋,Ⅱ级2髋。结论 THA是治疗AS累及髋关节的有效手段;术前病程短,并采用大直径股骨头陶瓷-陶瓷假体行THA者,术后疗效更好。
[Abstract]:Objective to summarize the middle and long term effects of total hip arthroplasty for ankylosing spondylitis (ASA) in the treatment of ankylosing spondylitis. Methods from March 1999 to May 2011, 32 patients (26 males and 6 females) with hip involvement were treated with THA. The age was 2078 years (mean 39 years). The course of disease was 2 ~ 41 years. The median course of disease was 10 years. There were 19 hips with metal-polyethylene interface, 23 hips with ceramic and ceramic prosthesis, 15 hips with 36mm diameter and 27 hips with 28mm diameter of femoral head prosthesis. The total motion of hip joint (flexion-extension, adduction-outreaching, total rotation and external rotation) was measured and recorded before and after operation. The hip function was assessed with Harris score. The degree of pain was evaluated by visual analogue score of pain (vas). According to X-ray film, acetabular side and femur prosthesis were described by de Lee partition and Gruen partition, ectopic ossification degree was evaluated by Brooker standard. There were no complications such as anesthesia accident, infection, nerve and vascular injury and so on. 29 cases (39 hips) were followed up for 5 ~ 17 years. The average was 9 years. In 24 hips with 28 mm diameter of femoral head prosthesis, there were 2 cases of anterior dislocation of hip joint in the group of 36 mm diameter of femoral head prosthesis. No dislocation occurred in 15 hips in the group of 36 mm diameter of femoral head prosthesis. The VAS score and total motion of hip joint in all patients were significantly improved compared with those before operation (P 0.05). The shorter the course of disease before operation, the higher the Harris score after operation, the larger the total motion of hip joint and the larger the diameter of femoral head prosthesis. The total motion of hip joint increased after operation (P 0.05). At the last follow-up, the prosthesis of acetabular cup and femur handle were all well fixed. In 18 hips with metal-polyethylene prosthesis, 9 hips with extensive osteolysis around the cup showed extensive osteolysis, but the prosthesis was not loosened. There were no signs of osteolysis and loosening of prosthesis in 21 hips with ceramic ceramic prosthesis. 7 hips showed ectopic ossification, including 5 hips of Brooker 鈪，

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