系统性红斑狼疮全髋关节置换的临床效果  

Clinical outcomes of total hip arthroplasty for femoral head necrosis secondary to systemic lupus erythematosus

作　　者：史为鹏 赵旋 赵志平[1] 李涛[1] 王英振[1] SHI Weipeng;ZHAO Xuan;ZHAO Zhi-ping;LI Tao;WANG Ying-zhen(Department of Joint Surgery,The Affiliated Hospital,Qingdao University,Qingdao 266000,China;Department of Rheumatology and Immunology,The Affiliated Hospital,Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院关节外科,山东青岛266000 [2]青岛大学附属医院风湿免疫科,山东青岛266000

出　　处：《中国矫形外科杂志》2021年第9期769-774,共6页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81802151);山东省自然科学基金资助项目(编号:ZR2016HQ05,ZR2017BH089,ZR2019MH012);中国博士后科学基金面上资助项目(2018M642616);青岛市应用基础研究青年专项项目(编号:19-6-2-55-cg)。

摘　　要：[目的]评估全髋关节置换术(total hip arthroplasty,THA)治疗系统性红斑狼疮(systemic lupus erythematosus,SLE)股骨头缺血性坏死(avascular necrosis of the femoral head,AVNFH)的中远期临床效果。[方法]回顾性分析2011年~2017年因SLE导致AVNFH,在本院接受THA手术的患者13例,并以同期因创伤、酒精等因素导致的AVNFH行THA的14例患者为对照组,比较两组患者VAS评分和Harris评分,以及实验室相关检查结果。[结果]两组患者均顺利完成手术,术中未出现并发症。两组在手术切口长度、手术时间和术中失血量的差异均无统计学意义(P>0.05)。两组患者术后随访56~123个月,平均(89.54±21.48)个月。与术前相比,末次随访时两组患者VAS评分显著减少(P<0.05),而Harris评分均显著增加(P<0.05)。相应时间点,两组间VAS和Harris评分的差异均无统计学意义(P>0.05)。实验室检测方面,随时间推移,两组患者Alb、ESR、CRP、Hb、WBC和PLT均无显著变化(P>0.05)。术前,两组间Alb、CRP、WBC和PLT的差异均无统计学意义(P>0.05),但是SLE组术前ESR显著高于对照组(P<0.05),SLE组术前Hb显著低于对照组(P<0.05);末次随访时,SLE组的Hb、WBC均显著低于对照组(P<0.05),而SLE组的ESR和CRP显著高于对照组(P<0.05),两组间Alb和PLT的差异无统计学意义(P>0.05)。[结论]疾病活动性较低的SLE患者,行THA手术前经过规范激素及抗生素的治疗,重视术后并发症的预防及处理,可以取得与酒精性股骨头坏死类似的早期及中远期疗效。[Objective]To evaluate the mid-and long-term clinical outcomes of total hip arthroplasty(THA)for avascular necrosis of the femoral head(AVNFH)secondary to systemic lupus erythematosus(SLE).[Methods]A retrospective study was conducted on 13 patients who received THA for AVNFH caused by SLE from 2011 to 2017 in our hospital.In addition,14 patients who underwent THA for AVNFH due to trauma,alcohol and other factors in the same period were used as the control group.The VAS and Harris scores,as well as the results of laboratory tests were compared between the two groups.[Results]The patients in both groups had THA performed successfully without any serious intraoperative complications.There was no significant difference in the length of surgical incision,operation time and intraoperative blood loss between the two groups(P>0.05).The patients in the two groups were followed up for 56 to 123 months,with an average of(89.54±21.48)months.The VAS scores significantly reduced(P<0.05),while the Harris scores significantly increased at the latest follow-up in both groups compared with those preoperatively(P<0.05).At the corresponding time point,the differences in VAS and Harris scores between the two groups were not statistically significant(P>0.05).In terms of laboratory testing,there were no significant changes in Alb,ESR,CRP,Hb,WBC,and PLT in the two groups over time(P>0.05).Before operation,the differences in Alb,CRP,WBC and PLT between the two groups were not statistically significant(P>0.05),but SLE group got significantly higher preoperative ESR(P<0.05),while significantly lower preoperative Hb than the control group(P<0.05).At the last follow-up,the SLE group had significantly lower Hb and WBC(P<0.05),whereas significantly higher ESR and CRP than the control group(P<0.05).The differences in Alb and PLT were not statistically significant between them(P>0.05).[Conclusion]The THA for SLE with low disease activity,treated with standardized hormones and antibiotics before surgery,and with prevention of postoperative compl

关 键 词：系统性红斑狼疮 全髋关节置换术 股骨头坏死 中远期 疗效 

分 类 号：R687.4[医药卫生—骨科学]