脊椎楔形截骨加全髋置换术矫治强直性脊柱炎后凸及髋关节强直  

Wedged vetrebral osteotomy and total hip arthroplasty for kyphosis and hip stiffness of ankylosing spondylitis

作　　者：陈立民[1] 赵承斌[1] 姚猛[1] 王长纯[1] 

机构地区：[1]哈尔滨医科大学附属第四医院骨科,哈尔滨市150001

出　　处：《中国脊柱脊髓杂志》2009年第4期264-267,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨脊椎楔形截骨及人工全髋关节置换术治疗强直性脊柱炎后凸畸形合并髋关节强直的临床疗效。方法:2002年6月～2007年6月共收治25例强直性脊柱炎后凸畸形合并髋关节强直患者,男24例,女1例。先行人工全髋关节置换手术(THA),单侧22例,双侧3例,共置换28个髋关节,应用骨水泥型假体13个,非骨水泥型假体15个。间隔1个月后采用脊椎楔形截骨矫正脊柱后凸畸形,截骨均在T10～L5进行,截骨后应用后路椎弓根钉棒系统固定。通过术前、术后Cobb角测量评价脊柱后凸畸形矫正效果,采用Harris评分对术前、术后髋关节功能进行评价。结果:本组22例单侧THA平均手术时间1.5h,3例双侧同期THA平均手术时间3.5h;单侧THA平均失血量200ml,双侧同期THA平均失血量450ml。行双侧同期THA后,发生应激性溃疡1例,经治疗后痊愈。脊柱后凸矫正平均手术时间3.0h,平均失血量400ml。随访10～60个月,平均32个月。脊柱后凸Cobb角术前平均76.84°±13.29°,术后3个月时平均10.20°±3.85°,平均矫正66.64°±13.26°(P<0.01)。髋关节Harris评分术前平均15.84±7.50分,术后3个月时平均73.36±7.35分(P<0.01)。末次随访时X线片示脊柱截骨部位已骨性融合,无矫正角度丢失。结论:脊椎楔形截骨加人工全髋关节置换术是治疗强直性脊柱炎后凸畸形并髋关节强直的安全、有效方法。Objective：To discuss the clinical effect of total hip arthroplasty and wedged vertebral osteotomy on the treatment of kyphosis and hip stiffness of ankylosing spondylitis.Metbod：25 patients who subjected to kyphosis caused by ankylosing spondylitis with hip malformation from June 2002 to June 2007 were analyzed. All patients accepted surgical treatment,there were 24 males and 1 females.28 hips of 25cases underwent total hip arthroplasty firstly for hip stiffness,including 22 cases of, unilateral side 3 bilateral sides,and cemented prosthesis was used in 13 cases,biological prosthesis in 15.Then wedged vertebral osteotomies were done one month later for the kyphotic deformity.The osteotomies were performed at level of Tl0-L5,and the vertebrae were fixed by pedicle screw and rods system.The clinical effect of kyphosis rectification and hip function between pre- or post-operation were evaluated by measuring Cobb＇s angle and Harris hip score respectively. Result：Mean time of unilateral THA was 1.Sh,bilateral THA was 3.Sh;the average blood loss was 200ml in unilateral THA,450ml in bilateral THA.1 patient was complicated with stress ulcer which was cured by the treatment.The mean operation time of spine was 3h and the mean blood loss was 400ml,The mean follow-up period was 32 months （range,10 to 60 months ）.The average Cobb＇s angle was 76.84°±13.29° before operation and 10.20°±3.85° after operation,rectification angle was 66.64°±13.26°（P〈0.01）.The mean Harris hip score improved from 15.84±7.50 preoperatively to 73.36±7.35 postoperatively （P〈0.01）.X-rays at last follow-up showed bony fusion in all osteotomied sites without loss of the corrected angles.Conclusion：Total hip arthroplasty combined with wedged vertebral osteotomy is a safe and efficient treatment for kyphosis caused by ankylosing spondylitis with hip malformation.

关 键 词：强直性脊柱炎 髋关节强直 脊柱后凸 手术 

分 类 号：R593.23[医药卫生—内科学] R682.3[医药卫生—临床医学]