全髋关节置换治疗强直性脊柱炎双髋强直的疗效及相关影响因素分析  

Analysis of the effect and relative influenced factors towards total hip arthroplasty for treatment of ankylosing spondylitis patients with double hips ankylosis

作　　者：王涛[1] 张育民[1] 王军伟[1] 马涛[1] 宋伟[1] 王军[1] WANG Tao;ZHANG Yu-min;WANG Jun-wei;MA Tao;SONG Wei;WANG Jun(Dept of Joint Surgery,Xi′an Honghui Hospital,Xi′an Jiaotong University College of Medicine,Xi′an,Shaanxi710054,China)

机构地区：[1]西安交通大学医学院附属红会医院关节外科,陕西西安710054

出　　处：《临床骨科杂志》2018年第2期167-169,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨全髋关节置换术(THA)治疗强直性脊柱炎双髋强直的疗效,并对相关影响因素进行分析。方法对46例强直性脊柱炎双髋强直患者采用THA治疗,收集手术前后相关指标评价疗效同时进行影响因素的相关性分析。结果患者均获得3个月随访,髋关节活动度术前为0°~98°(36.4°±25.01°),术后为55°~224°(210.8°±175.01°),差异有统计学意义(P<0.01)。ESR:术前为(27.66±3.27)mm/1 h,术后3个月降至(6.25±1.08)mm/1 h,差异有统计学意义(P<0.01)。CRP:术前为(46.33±6.99)mg/L,术后3个月降至(23.69±3.87)mg/L,差异有统计学意义(P<0.01)。Harris总分:术前为(35.1±2.9)分,术后3个月为(86.1±2.5)分,差异有统计学意义(P<0.01)。术后3个月疼痛、功能和关节活动度评分分别为(42.1±2.1)分、(39.3±2.2)分、(6.5±0.9)分,各项评分分别高于术前的(15.5±2.1)分、(17.5±2.9)分、(2.6±0.3)分,差异均有统计学意义(P<0.01)。术后3个月疗效评价:优27例,良11例,可6例,差2例,优良率82.6%。在单因素logistic回归分析基础上进行多因素logistic回归分析发现,与术后疗效存在相关性的因素包括:术前ESR异常、术前CRP异常、有风湿病家族史、发病年龄低和病程长5个因素,OR值(95%CI)分别为1.580(1.437~1.737)、2.352(1.105~5.006)、1.252(1.120~1.399)、1.457(1.392~1.526)和1.091(1.081~1.102)。结论 THA治疗强直性脊柱炎双髋强直患者可有效重建髋关节、恢复关节功能、提高生活质量。患者术前ESR及CRP异常、有风湿病家族史、发病年龄低、病程长与THA治疗效果存在关联。Objective To investigate the efficacy of total hip arthroplasty(THA)in the treatment of ankylosing spondylitis patients with double hips ankylosis,and to analyze the influencing factors.Methods The 46 patients with ankylosing spondylitis were treated with THA,and the correlation analysis was carried out to evaluate the curative effect of the related indexes before and after the operation.Results All patients were followed up for 3 months.The motion range of the hip was 0°~98°(36.4°±25.01°)before operation,and 55°~224°(210.8°±175.01°)after operation,the difference was statistically significant(P<0.01).ESR:it was(27.66±3.27)mm/1 h before operation,and decreased to(6.25±1.08)mm/1 h at 3 months after operation,the difference was statistically significant(P<0.01).CRP:the preoperative was(46.33±6.99)mg/L,3 months after surgery was(23.69±3.87)mg/L,the difference was statistically significant(P<0.01).Total Harris scores:the preoperative was(35.1±2.9)points,3 months after surgery was(86.1±2.5)points,the difference was statistically significant(P<0.01).Postoperative 3 months of pain,joint function and activity score were(42.1±2.1),(39.3±2.2),(6.5±0.9)points,respectively,the scores were significantly higher than the preoperation of(15.5±2.1),(17.5±2.9),(2.6±0.3)points,respectively,the differences were statistically significant(P<0.01).The results of postoperative 3 months were excellent in 27 cases,good 11 cases,fair 6,poor 2,the excellent and good rate was 82.6%.Multivariate logistic regression analysis based on univariate logistic regression analysis showed that there were 5 factors such as preoperative abnormal ESR,preoperative abnormal CRP,rheumatism family history,lower onset age and longer duration,the value of OR(95%CI)were 1.580(1.437~1.737),2.352(1.105~5.006),1.252(1.120~1.399),1.457(1.392~1.526)and 1.091(1.081~1.102).Conclusions THA is an effective method to reconstruct hip joint,restore joint function and improve life quality of patients with ankylosing spondylitis with double hips ankylosis

关 键 词：全髋关节置换术 强直性脊柱炎 双髋强直 

分 类 号：R687.4[医药卫生—骨科学] R593.23[医药卫生—外科学]