强直性脊柱炎患者全髋关节置换后异位骨化的危险因素

发布时间：2018-03-26 10:44

本文选题：关节成形术　切入点：置换　出处：《中国组织工程研究》2017年11期

【摘要】：背景:强直性脊柱炎患者初次人工全髋关节置换后发生异位骨化较常见,会对术后功能造成一定影响。目的:探讨强直性脊柱炎患者行初次全髋关节置换后发生异位骨化的危险因素。方法:纳入2011年6月至2015年12月因强直性脊柱炎行初次全髋关节置换且随访达6个月以上的87例(132髋)患者,对患者的手术前后临床资料和影像学资料进行收集整理,影像学资料包括患者术前及术后的髋关节正侧位X射线片。观察末次随访X射线片假体周围异位骨化的范围,并按Brooker分型分为Ⅰ-Ⅳ型。将与异位骨化相关的危险因素分为两大类,不可变因素包括年龄、性别、病程及术前髋关节是否强直;可变因素包括术前C-反应蛋白、术前红细胞沉降率、术中出血量、手术时间、假体类型及麻醉方式,从中找出与异位骨化发生相关的危险因素。结果与结论:(1)有43髋在术后发生了异位骨化,发生率为32.6%;(2)男性(P=0.029)、术前髋关节强直(P0.001)、病程(P=0.029)是异位骨化发生的不可变因素,增加了异位骨化的发生率;手术时间过长(P=0.031)和术中使用全麻(P=0.003)是异位骨化发生的可变因素,也会增加其发生率;患者的年龄、术前红细胞沉降率及C-反应蛋白、术中出血量和假体类型与术后异位骨化的发生无明显相关性;(3)综上,异位骨化的发生率与手术时间长短以及是否全麻等可变因素密切相关,可以通过缩短手术时间以及术中尽量避免使用全麻来降低异位骨化的发生率。
[Abstract]:Background: heterotopic ossification is common in patients with ankylosing spondylitis after primary total hip replacement. Objective: to investigate the risk factors of heterotopic ossification in patients with ankylosing spondylitis after initial total hip replacement. Methods: from June 2011 to December 2015, the risk factors of heterotopic ossification were studied. The first total hip replacement and follow-up of more than 6 months in 87 patients with 132 hips), The clinical and imaging data of the patients before and after operation were collected and sorted. The imaging data included the anteroposterior and lateral radiographs of the hip joint before and after the operation. The range of heterotopic ossification around the prosthesis was observed during the last follow-up. According to Brooker classification, the risk factors associated with ectopic ossification were divided into two categories: immutable factors including age, sex, course of disease and ankylosis of hip joint before operation, and variable factors including preoperative C-reactive protein. The risk factors related to ectopic ossification were found out from the RBC sedimentation rate, intraoperative bleeding volume, operative time, prosthesis type and anaesthesia mode. Results and conclusion 43 hips had ectopic ossification after operation. The incidence of ectopic ossification was 32. 6% (P 0. 029), preoperative hip ankylosis (P 0. 001), course of disease (P 0. 029) were the immutable factors of ectopic ossification, the incidence of ectopic ossification was increased, the operative time was too long (P 0. 031) and the intraoperative use of general anesthesia (P0. 003) was the variable factor of ectopic ossification. Age, preoperative erythrocyte sedimentation rate and C-reactive protein, intraoperative blood loss and type of prosthesis were not significantly correlated with postoperative ectopic ossification. The incidence of ectopic ossification is closely related to the duration of operation and variable factors such as general anesthesia. The incidence of ectopic ossification can be reduced by shortening the operative time and avoiding the use of general anesthesia.
【作者单位】：广州中医药大学第一临床医学院;广州中医药大学第三临床医学院;广州中医药大学第一附属医院骨科中心;
【基金】：国家自然科学基金(KBC110134K11)“组蛋白去甲基化酶JMJD2蛋白家族在补肾法防治骨质疏松症中的作用机制” 广东省自然科学基金(2015A030310203)“股骨头坏死症候异质性与其分子分型及临床MRI表现的相关性研究”~~
【分类号】：R593.23;R687.4

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