TNF-α拮抗剂与传统药物相比对全髋关节置换术后强直性脊柱炎患者关节功能影响的研究

发布时间：2018-03-19 09:47

  本文选题：内科治疗　切入点：强直性脊柱炎　出处：《中国人民解放军医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的：研究人工全髋关节置换术后(Total Hip Arthroplasty, THA)使用TNF拮抗剂、传统药物与不进行内科治疗的强直性脊柱炎患者术后髋关节功能的不同。方法：回顾分析2006年6月至2013年10月在解放军总医院骨科行THA的96例强直性脊柱炎患者。男89例(138髋),女7例(12髋);年龄16～60岁,平均31岁；强直性脊柱炎发病距关节置换间隔2-38年,平均12年。强直患者21例,僵直患者75例。根据术后是否进行内科治疗分为3组,TNF组纳入15例(18髋),传统组纳入27例(37髋),对照组纳入54例(95髋)。三组患者在基础资料如年龄、身高、体重、BMI等方面均无统计学差异(P0.05)。对三组组间进行临床疗效评估,实验室指标检测及影像学评估。结果：TNF组、传统组和对照组术前Harris评分分别为34.55±3.25分,32.51±3.21分,30.28±4.45分;术前疼痛评分分别为6.83±0.54分,7.13±0.63分,7.27±0.41分：术前总被动活动度分别为42.69±9.78°,40.41±7.98°,39.76±8.22°。对于随访时结果TNF组与对照组相比,髋关节Harris评分由术前34.55±3.25分、30.28±4.45分别提升至87.53±4.35分、81.52±6.72分,差异有统计学意义(P=0.03),疼痛评分6.83±0.54分,7.27±0.41分别降低至1.53±0.23分,2.24±0.71分,差异有统计学意义(p=0.05)。而活动度方面由术前42.69±9.78°39.76±8.22°分别提升至192.69±10.23°,191.54±10.41。(p=0.83),无明显的统计学意义。TNF组与传统治疗药物组相比,髋关节Harris评分由术前34.55±3.25分,32.51±3.21分分别提升至87.53±4.35分、82.17±5.97,差异有统计学意义(P=0.02)。疼痛评分由6.83±0.54分,7.13±0.63分分别降低至1.53±0.23分,1.44±0.77分,差异无统计学意义(p=0.10)。活动度方面由42.69±9.78°40.41±7.98°分别提升至192.69±10.23。,190.76±9.45°(p=0.66),差异无统计学意义。随访时间为15个月-97个月,平均49个月。随访三组患者均未发现假体周围感染。生物制剂组发生不良反应5例,上呼吸道感染2例,出现皮疹3例；传统药物组发生不良反应11例,均为胃肠道反应,恶心呕吐。随访x线片示,4髋于髋臼侧Ⅰ、Ⅰ区出现宽度2mm的透亮线。结论：从随访结果来看,THA术后继续使用药物进行内科治疗可以进一步改善髋关节功能,但活动度变化不明显。TNF拮抗剂的作用并没有明显强于传统药物组
[Abstract]:Objective: To study the total hip arthroplasty (Total Hip, Arthroplasty, THA) using TNF antagonists, traditional medicine and surgery in patients with ankylosing spondylitis medical treatment after different hip function. Methods: a retrospective analysis from June 2006 to October 2013 in 96 cases of ankylosing spondylitis patients Department of orthopedics of PLA General Hospital for THA. 89 male patients (138 hips) and 7 females (12 hips); the average age of 16~60 years, 31 years of age; the pathogenesis of ankylosing spondylitis from joint replacement interval of 2-38 years, an average of 12 years. 21 cases of tetanus patients, 75 cases of patients with postoperative stiffness. According to whether the medical treatment is divided into 3 groups, group TNF included 15 cases (18 hips), the traditional group included 27 patients (37 hips), the control group included 54 patients (95 hips). Three groups of patients with basic information such as age, height, weight, there was no significant difference (P0.05). BMI and other aspects of evaluation of clinical curative effect between the three groups, laboratory index detection and 褰卞儚瀛﹁瘎浼，

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