髋关节置换术对髋关节强直伴脊柱后凸患者脊柱-骨盆矢状位平衡的影响  

Influence of hip replacement on spinal-pelvic sagittal balance of patients with hip ankylosis and spinal kyphosis

作　　者：孔德付 高延征 余正红 母心灵 KONG Defu;GAO Yanzheng;YU Zhenghong;MU Xinling(Grade 2021,Xinriang Medical University,Xinriang,Henan 453000,China;Department of Spinal Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Departmentof Spinal Surgery,Zhengzhou First People's Hospital Affiliated to Xinriang Medical University,Zhengzhou,Henan 450004,China)

机构地区：[1]新乡医学院,河南新乡453000 [2]河南省人民医院脊柱外科、郑州大学人民医院,河南郑州450003 [3]新乡医学院附属郑州市第一人民医院脊柱外科,河南郑州450004

出　　处：《中华实用诊断与治疗杂志》2024年第9期894-898,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82372470)。

摘　　要：目的观察强直性脊柱炎髋关节强直伴轻中度脊柱后凸患者行髋关节置换术后脊柱-骨盆矢状位平衡的改善效果,探讨其安全性。方法2021年2月—2023年5月河南省人民医院诊治强直性脊柱炎髋关节强直伴轻中度脊柱后凸患者12例(23髋),均行髋关节置换术并进行随访。记录随访期间假体障碍、脱位及异位骨化发生情况,腰背痛、膝关节痛缓解情况。比较术前与末次随访时视觉模拟评分,髋关节Harris评分,SF-36生活质量评分,患侧髋关节活动度以及脊柱-骨盆矢状位平衡参数。结果(1)12例手术均顺利,术中均按照术前骨盆后倾程度放置假体,手术时间(321.25±69.12)min,术中出血量(529.17±253.57)mL。术后1周髋关节正侧位X线片示假体位置良好。随访(10.91±1.89)个月,12例均未发生假体障碍、脱位、异位骨化。末次随访时患者腰背痛、膝关节痛明显减轻。(2)末次随访时视觉模拟评分[(1.33±1.21)分]低于术前[(6.17±1.94)分](t=5.175,P<0.001),Harris评分[(90.09±9.46)分]、SF-36生活质量评分[(79.24±11.89)分]均高于术前[(32.08±20.93)、(20.50±13.23)分](t=-6.191,P<0.001;t=-8.090,P<0.001),髋关节屈曲[(95.17±8.38)°]、后伸[(11.67±4.68)°]、内收[(13.17±2.14)°]、外展[(36.50±6.89)°]、内旋[(11.17±3.06)°]、外旋[(35.50±3.94)°]角度均大于术前[(18.00±10.86)°、(2.95±2.50)°、(6.67±3.39)°、(8.33±5.57)°、(4.00±3.29)°、(5.17±4.79)°](t=-25.874、-3.841、-8.510、-8.431、-6.468、-9.941,P均<0.05),颌眉角[(6.6±5.3)°]、脊柱与骨盆的匹配度[(17.0±12.4)°]、矢状位平衡距离[(150.0±141.4)mm]均小于术前[(13.3±6.0)°、(28.5±14.6)°、(272.0±186.9)mm](t=4.250,P=0.008;t=3.136,P=0.026;t=4.029,P=0.010),脊柱整体后凸角、胸椎后凸角、胸腰椎后凸角、腰椎前凸角、骨盆倾斜角、骨盆入射角、骶骨倾斜角与术前比较差异均无统计学意义(P>0.05)。结论强直性脊柱炎髋关节强直伴轻中度脊柱后凸Objective To observe the effect of hip replacement on spinal-pelvic sagittal balance of ankylosing spondylitis patients with hip ankylosis accompanied by mild to moderate spinal kyphosis,and to explore its safety.Methods From February 2021 to May 2023,12 patients(23 hips)with ankylosing spondylitis and hip ankylosis accompanied by mild to moderate kyphosis were performed hip replacement and were followed up in Henan Provincial People's Hospital.The occurrence of prosthetic disorders,dislocation,and ectopic ossification during follow-up,as well as the relief of lower back pain and knee pain were recorded.The visual analogue scale score,hip Harris score,SF-36 score,activity of diseased hip,and spinal-pelvie sagittal balance parameters were compared before surgery and at the latest follow-up.Results(1)All 12 surgeries were successfully performed,and the prostheses were placed according to the presurgical pelvic retroversioa degree.The surgery lasted for(321.25±69.12)min,and the intrasurgical blood loss was(52.9.17±253.57)mL.One week postsurgically,the hip X-ray showed a good positioning of the prosthesis.During a follow-up of(10.91±1.89)months,no prosthetic disorders,dislocatioi,or ectopic ossification occurred.At the latest follow-up,lower back pain and knee pain were significantly alleviated.(2)The visual analogue scale score was lower at the latest follow-up(1.33±1.21)than that before surgery(6.17±1.94)(t=5.175,P<0.001),the Harris score and SF-36 score were higher at the latest follow-up(90.09±9.46,79.24±11.89)than those before surgery(32.08±20.93,20.50±13.23)(t=-6.191,P<0.001;t=-8.090,P<0.001).The hip flexion[(95.17±8.38)°],extension[(11.67±4.68)°],adduction[(13,17±2,14)°],abduction[(36.50±6.89)°],internal rotation[(11.17±3.06)°],and external rotation[(35.50±3.94)°]at the latest follow-up were all greater than those before surgery[(18.00±10.86)°,(2.95±2.50)°,(6.67±3.39)°,(8.33±5.57)°,(4.00±3.29)°,(5.17±4.79)°](t=-25.874,-3.841,-8.510.-8.431,-6.468,-9.941,all P values<0.05),The ch

关 键 词：强直性脊柱炎 髋关节强直 脊柱后凸 髋关节置换术 脊柱-骨盆矢状位平衡 

分 类 号：R687.4[医药卫生—骨科学]