强直性脊柱炎患者全髋关节置换后异位骨化的危险因素  

Risk factors for heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis

作　　者：刘勇[1] 霍少川[2] 周驰[3] 唐宏宇[3] 陈德龙[1] 陈建发[3] 郭海[1] 邓章荣 王海彬[3] 

机构地区：[1]广州中医药大学第一临床医学院,广东省广州市510405 [2]广州中医药大学第三临床医学院,广东省广州市510405 [3]广州中医药大学第一附属医院骨科中心,广东省广州市510405

出　　处：《中国组织工程研究》2017年第11期1641-1646,共6页Chinese Journal of Tissue Engineering Research

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"~~

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(P<0.001)、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。BACKGROUND： Heterotopic ossification （HO） is common following primary total hip arthroplasty （THA） in patients with ankylosing spondylitis （AS）, which may cause certain influence on functional recovery.OBJECTIVE： To explore the risk factors for HO after primary THA in AS patients.METHODS： The clinical and radiological data from 87 patients （132 hips） with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors （age, sex, course and with or without ankylosed hip） and variable factors （preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods） to determine the pertinent risk factors.RESULTS AND CONCLUSION： （1） Totally 43 hips （32.6%） were found to have developed into HO. （2） Invariable risk factors including male （P=0.029）, preoperative ankylosed hip （P 〈 0.001）, and course （P=0.029） increased the prevalence of HO. Among the variable risk factors, prolonged operation time （P=0.031） and general anesthesia （P=0.003）were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. （3） These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

关 键 词：骨科植入物 人工假体 强直性脊柱炎 全髋关节置换 异位骨化 危险因素 术前强直 手术时间 术中出血 麻醉方式 假体类型 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]