全髋关节置换术治疗强直性脊柱炎致髋关节病变的中期疗效  

Intermediate-term outcomes after total hip arthroplasty in patients with ankylosing spondylitis

作　　者：谢守宁[1] 韩生寿[1] 李洪[2] 

机构地区：[1]青海省人民医院骨科,青海西宁810000 [2]青海大学附属医院骨科,青海西宁810001

出　　处：《中国现代医学杂志》2014年第30期56-59,共4页China Journal of Modern Medicine

摘　　要：目的探讨全髋关节置换术（THA）治疗强直性脊柱炎（AS）致髋关节病变的中期疗效及其注意事项。方法 2002年2月-2007年2月,对44例（73髋）强直性脊柱炎致髋关节病变患者行THA,男31例（56髋）,女13例（17髋）;平均年龄39.5岁（26-69岁）;平均病程17年（5-35年）。手术前后的髋关节功能采用Harris评分;影像学评估分别采用Gruen分区和Delee分区法进行股骨侧和髋臼侧X线分析;术后异位骨化采用Brooker标准分级。结果平均随访为7年（5-10年）,Harris评分由术前平均（26.4±10.3）分（5-65分）,提高至末次随访时（81.4±9.2）分（48-90分）（P=0.003）;其中优15髋,良48髋,中6髋,差4髋,优良率为86.3%;髋关节总体活动度由术前平均26.5°（0-58°）提高到末次随访时159.7°（49-195°）;术后3（4.1%）例发生股骨头假体后脱位;末次随访时X线片分析未发现假体松动,10髋（13.7%）发生异位骨化。结论 THA治疗AS致髋关节病变患者中期疗效满意,术后髋关节疼痛和髋关节活动度明显改善,彻底的软组织松解和精确的假体安放是手术成功的关键。【Objective】To evaluate the intermediate-term clinical outcomes and operative technique in patients with ankylosing spondylitis（AS） underwent total hip arthroplasty（THA）.【Methods】From February 2002 to 2007,44 patients（73 hips） who underwent THA for AS. There were 31 males（56 hips）, 13 females（17 hips）, with the mean age of 39.5 years（range 26 to 69 years）. The clinical outcomes were assessed by the Harris hip scoring system. The femoral stems were evaluated radiographically using the system of Engh and the bone-prosthesis interface was evaluated for radiolucencies and recorded according to the zonal system described by Gruen; acetabular evaluation was performed using the criteria described by Delle and Charnley; postoperative heterotopic ossification was classified using the described by Brooker. 【Results】The mean duration of follow-up was 7 years（range 5 to 10years）. The average preoperative Harris Hip Score of 26.4 improved to 81.4 postoperatively. Of these hips, 15 hips was excellent, 48 hips was good, 6 hips was fair and 4 hips was poor, the incidence of good to excellent outcomes was 86.3%. The average total range of motion of hip improved from 26.5°（0°-58°） preoperatively to 159.7°（49°-195°）postoperatively.There were no sign of loosening, but 3（4.1%） hips were occurred posterior dislocation. Heterotopic ossification was seen in 10（13.7%） hips. 【Conclusions】THA is an effective treatment for AS, can reconstruct the function of hip and improve quality of life.

关 键 词：强直性脊柱炎 髋关节 关节成形术 中期疗效 

分 类 号：R593.23[医药卫生—内科学] R687.4[医药卫生—临床医学]