强直性脊柱炎全髋关节置换术患者基线数据特征分析  

Analysis of baseline data of patients with ankylosing spondylitis before total hip arthroplasty

作　　者：马远[1] 张亮[2] 郭邵逸 满斯亮[3] 黄德勇[2] 周一新[2] MA Yuan;ZHANG Liang;GUO Shaoyi;MAN Siliang;HUANG Deyong;ZHOU Yixin(Department of Orthopaedic Surgery,Bayannaoer City Hospital,Bayannaoer 015000,Inner Mongolia;Department of Adult Joint Reconstructive Surgery,Beijing Jishuitan Hospital,Beijing 100035;Department of Rheumatology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]巴彦淖尔市医院骨科,内蒙古巴彦淖尔015000 [2]北京积水潭医院矫形骨科,北京100035 [3]北京积水潭医院风湿免疫科,北京100035

出　　处：《中华骨与关节外科杂志》2022年第12期939-944,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:分析全髋关节置换术(THA)治疗强直性脊柱炎(AS)合并髋关节终末期受累的基线数据分布特征。方法:回顾性分析2005年4月至2020年9月接受THA治疗的AS患者。术前人口学资料、临床参数和实验室检查数据通过查阅院内纸质病例和电子病例系统及网络问卷进行收集。结果:共纳入567例(805髋),其中男478例(680髋),女89例(125髋),男女比例为5.4∶1。体重指数平均(23.0±4.2)kg/m^(2),其中<18.5 kg/m2者115髋,占14.3%;≥30 kg/m^(2)者51髋,占6.3%。发病年龄22.0(16.5,26.0)岁,诊断年龄29.0(22.0,39.0)岁,手术年龄38.0(29.0,49.0)岁。诊断延迟6.0(2.0,14.0)年,治疗间隔16.0(10.0,23.5)年。术前中位巴氏强直性脊柱炎疾病活动度指数(BASDAI)和巴氏强直性脊柱炎功能指数(BASFI)分别为4.0(3.0,5.3)分和56(45,70)分。术前Harris髋关节评分(HHS)36(26,44)分。后8年(2013—2020年)病例在双侧置换比例、发病年龄、诊断年龄、手术年龄、髋关节活动度(ROM)(包括总ROM、髋关节屈曲和屈髋挛缩角度)、BASFI、血红蛋白(HGB)浓度、白蛋白(ALB)、C反应蛋白(CRP)浓度、基线HHS和生活质量评定12简表躯体健康因子(SF-12 PCS)及心理健康因子(SF-12 MCS)等方面与前8年(2005—2012年)病例差异存在统计学意义。与非融合患者比较,髋关节骨性融合患者身高、体重、体重指数、发病年龄更低,合并吸烟史患者比例更低,HGB和ALB水平更低,BASDAI和BASFI更高,SF-12 PCS更低。结论:近年来AS终末期髋关节受累患者在整体疾病活动度、功能水平、全身营养状态及髋关节受损程度和功能状态等方面改善显著。髋关节骨性融合在本研究病例中占有较高比例,骨性融合患者发病年龄较非融合患者更小,极易出现生长发育障碍,整体高炎症水平和低功能、低营养状态。因此,AS患者行THA术前务必完善术前评估和围手术期管理计划。Objective:To analyze the baseline data of patients with ankylosing spondylitis(AS)and end-stage hip joint involvement who received total hip arthroplasty(THA).Methods:A retrospective analysis of AS patients who received THA from April 2005 to September 2020 was conducted.Preoperative demographic data,clinical parameters,and laboratory examination data were collected by paper medical records and electronic case system in the hospital,as well as online questionnaires.Results:A total of 567 patients(805hips)were enrolled,including 478 males(680 hips)and 89 females(125 hips).The ratio of male to female was 5.4∶1.The average body mass index(BMI)was(23.0±4.2)kg/m2.115 hips with BMI<18.5 kg/m^(2)accounted for 14.3%;51 hips with BMI≥30 kg/m^(2)accounted for 6.3%.The median age of onset was 22.0(16.5,26.0)years,the median age at diagnosis was 29.0(22.0,39.0)years,and the median age at surgery was 38.0(29.0,49.0)years.The median diagnosis delay was 6.0(2.0,14.0)years,and the median treatment interval was 16.0(10.0,23.5)years.The preoperative median BASDAI and BASFI were 4.0(3.0,5.3)and 56(45,70)points respectively.The preoperative median HHS score was 36(26,44).In the latter eight years(2013-2020),the proportion of bilateral replacements,age of onset,age of diagnosis,age of surgery,ROM(including total ROM,hip flexion and flexion contracture angles),BASFI,hemoglobin(HGB),albumin(ALB),C-reactive protein,baseline HHS,SF-12 PCS and SF-12 MCS were statistically different with those in the previous eight years(2005-2012).Compared with the non-fusion group,the hip osseous fusion group had lower height,weight,BMI and age of onset,a higher proportion of patients with a history of smoking,lower HGB and ALB levels,higher BASDAI and BASFI,and lower SF-12PCS.Conclusions:In recent years,AS patients with end-stage hip joint involvement have been improved significantly in terms of overall disease activity and functional level,systemic nutritional status,and hip joint damage and functional status.Patients with bone fusion of the hip h

关 键 词：强直性脊柱炎 髋关节置换 基线数据 围手术期管理 

分 类 号：R681.8[医药卫生—骨科学]