强直性脊柱炎29例行人工全髋关节置换治疗回顾分析  

Clinical study on total hip arthroplasty of 29 cases with ankylosing spondylitis

作　　者：尚宏喜[1] 吴天顺[1] 蓝涛[1] 周勇[1] 丁强[1] 郝敏[1] 刘安庆[1] 

机构地区：[1]深圳市第二人民医院骨关节科,508035

出　　处：《中华关节外科杂志（电子版）》2017年第5期78-82,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨强直性脊柱炎患者行人工全髋关节置换术治疗的临床疗效。方法选取2009年1月至2015年12月深圳市第二人民医院骨关节科收治的强直性脊柱炎患者29例(36个髋关节)行人工全髋关节置换术的病例,其中男22例,女7例,对其手术情况、术后并发症及功能恢复情况进行观察记录。结果所有患者治疗过程顺利,无出现关节脱位、松动、感染、骨折等并发症,髋关节的屈曲和内收畸形予以纠正。术前患者髋关节活动度为(35.5±5.5)°(0°~110°),经过(38±3)个月随访,术后总的活动度为(181.8±4.5)°(55.5°~210.6°),其中屈髋(91.2±4.5)°;髋关节屈曲畸形程度由术前的(29.0±3.5)°降到术后的均(6.1±1.5)°;经过手术Harris评分也由术前的(15.8±3.5)分提高到术后(92.7±2.5)分。结论人工全髋关节置换术可明显增加髋关节活动度,改善髋关节功能,矫正髋关节畸形,提高患者的生活质量,是治疗强直性脊柱炎受累强直的髋关节的有效方法;而个体化手术方案的设计包括假体位置的正确安放、手术入路的选择、术中软组织松解与平衡等,是此手术疗效的关键。Objective To evaluate the clinical efficacy of total hip arthroplasty in treating the hip joint involvement of ankylosing spondylitis（ AS）. Methods A total of 29 patients whose the hip joint involvement of AS（ 36 hip joints） underwent THA from Shenzhen second people ＇s hospital bone joint clinical department from January 2009 to December 2015. There were 22 males（ 29 hips） and seven females（ seven hips）. The operation situation,postoperative complications and total function evaluation were conducted. Results The treatment processes went well; no complication such as dislocation,joint loosening,new fracture or deep infection occurred. The flexion and adduction deformities of all the hip joints were corrected. The preoperative mobility degree of the patients was 0° to 110°,（ 35. 5 ± 5. 5） ° on average. After the follow-up with an average time of（ 38 ± 3） months,the postoperative total mobility was55. 5°to 210. 6°,（ 181. 8 ± 4. 5） °on average; the average range of hip flexion was（ 91. 2 ± 4. 5） °. The hip flexion deformity improved from pre-operative（ 29. 0 ± 3. 5） ° to postoperative（ 6. 1 ± 1. 5） °. Harris score improved from preoperative（ 15. 8 ± 3. 5） points to postoperative（ 92. 7 ± 2. 5） points. Conclusion Total hip arthroplasty can significantly increase activity of the hip,correct the deformity of the hip joint,improve the hip joint function and the quality of life of patients,which is an effective treatment of ankylosing hip in AS; individualized surgical plan includes the choice of surgical approach, correct prosthesis position,soft tissue release and equilibrium,acetabular surrounding osteophyte removal,which are the key points of the operation efficacy.

关 键 词：关节成形术 置换 髋 脊柱炎 关节强直 

分 类 号：R687.4[医药卫生—骨科学]