全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义  

Clinical effects of total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis and significance of postoperative rehabilitation

作　　者：曹沛宏[1] 于建华[1] 张福江[1] 任凯晶[1] 高志国[1] 

机构地区：[1]天津医院关节外科,300211

出　　处：《中华骨科杂志》2009年第7期644-647,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨全髋关节置换术治疗强直性脊柱炎致髋关节骨性强直的疗效及术后康复锻炼的意义。方法1998年10月至2007年5月，对28例（46髋）强直性脊柱炎致髋关节骨性强直患者施行全髋关节置换术，男27例，女1例；年龄22-58岁，平均38．9岁；病程5-35年，平均17年2个月；髋关节屈曲强直7例（14髋），伸直强直21例（32髋）。采用髋关节后外侧切口34髋，改良前外侧与外侧联合切口12髋；其中应用全生物型假体40髋，混合型假体6髋。术后24h即开始进行系统性康复锻炼。对手术前、后患者Harris评分、VAS评分、髋关节总活动度及患者整体功能改善情况进行比较。结果所有患者均获得随访，随访时间10-64个月，平均38．2个月，随访期间未发生坐骨神经或股神经麻痹、皮肤压疮、肺部感染、关节松动等并发症。1例患者术后2周出现髋关节脱位，经闭合复位治愈。8髋出现异位骨化，其中BmokerⅠ级6髋，Ⅱ级2髋。7例髋关节屈曲强直患者，屈曲角度由术前34．3°±16．3°改善为术后4．2°±3．3°。Harris评分由术前平均（28．3±10．3）分提高至术后平均（82．7±7．6）分。VAS评分：术前（3．5±1．4）分，术后（3．8±1．8）分。髋关节总活动度由术前平均15．6°±9．3°改善至术后133．7°±17．6°。术前28例患者生活均不能自理；术后1年，除3例患者行走时仍需借用单拐、生活需他人帮助外，其余25例患者生活均可自理，并可从事家务或轻体力劳动。结论全髋关节置换术是治疗强直性脊柱炎晚期严重髋关节病变的一种有效方法，早期系统康复锻炼有助于关节功能的恢复。Objective To investigate the clinical effects of total hip arthroplasty （THA） for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth- ods From October 1998 to May 2007, 28 patients （46 hips） suffered from ankylosing spondylitis with hip bony ankylosis underwent THA, There were 27 males, I female, with the mean age of 38.9 years （range 22 to 58 years）. Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied eementless THA and 6 hips applied mixed THA. Harris scores, VAS scores and total hip range of motion in all patients were compared pre- and postoperatively to evaluate the clinical effects. Results All patients were followed up from SO months to 64 months, with the mean time of 38.2 months. No paralysis, deeubitus, and lung infection were found. Joint dislocation happened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preoperatively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postoperatively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved significantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondyfitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.

关 键 词：脊柱炎 强直性 关节成形术 置换 髋 关节强直 

分 类 号：R686[医药卫生—骨科学]