摘要
目的总结对强直性脊柱炎(ankylosing spondylitis,AS)髋关节屈曲强直患者行人工全髋关节置换术(total hip arthroplasty,THA)的手术方法、疗效及并发症。方法1992年5月-2004年7月,对56例71髋AS患者采用改良前外侧切口行THA治疗。男52例67髋,女4例4髋;年龄17～48岁,平均35.5岁。左侧32髋,右侧39髋。均有髋关节屈曲强直,角度为(43.1±7.2)°,其中15例为双侧强直。术前Harris评分为(42.6±5.3)分。根据美国风湿病学会标准分级髋关节病变均为Ⅳ级。病程3～11年。结果本组1例术中因严重骨质疏松出现股骨近端骨折,予钛丝捆绑固定,6周后骨折愈合。患者均获随访,随访时间3～15年,平均5.3年。1例1髋于术后第8天出现皮下组织感染,1例1髋于术后第11天出现伤口破溃,2例2髋分别于术后11个月及术后3年出现感染,对症治疗后均痊愈。其余患者术后切口均Ⅰ期愈合,无关节感染。术后X线片检查示,单纯髋臼假体松动4髋(5.6%),单纯股骨假体松动3髋(4.2%),髋臼及股骨假体均松动5髋(7.0%),总松动率为16.8%;其中8髋行翻修术,疗效满意;其余患者未作处理。15髋(21.1%)术后1年出现异位骨化,非甾体消炎药治疗后症状缓解。末次随访Harris评分为(82.7±4.1)分,与术前比较差异有统计学意义(P<0.05),其中优10髋,良43髋,可14髋,差4髋,优良率为74.7%。结论前外侧入路THA可有效治疗AS患者髋关节屈曲强直。
Objective To investigate the operative methods, clinical outcomes and complications of total hip arthroplasty （THA） in the treatment of patient with hip joint flexion rigidity due to ankylosing spondylitis （AS）. Methods From May 1992 to July 2004, 56 patients （32 left hips and 39 right hips） with AS received THA through a modified anterolateral approach, including 52 males （67 hips） and 4 females （4 hips） aged 17-48 years with an average of 35.5 years. All the hi ps were ankylosed in （43.1 ± 7.2）° of flexion and 15 patients had bilaterally ankylosed hi ps. Preoperatively, Harris hip score was （42.6 ± 5.3） points and all the hips were classified as stage Ⅳ according to the standard of American College of Rheumatology （ACR）. And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years （average 5.3 years）. Postoperatively, 1 patient （1 hip） got subcutaneous soft tissue infection at 8 days, 1 patient （1 hip） got wound disunion at 11 days, 2 patients （2 hips） got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips （5.6%） had loose acetabulum prosthesis, 3 hips （4.2%） had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis （7.0%）, and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hi ps had no further treatment. Fifteen hi ps （21.1%） had heterotopic ossification, which was re/ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was （82.7 ± 4.1） points, indicating there was a significant difference between before and after operation （P 〈 0.05）. Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第2期205-208,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
人工全髋关节置换术
强直性脊柱炎
屈曲强直
Artificial total hi p arthroplasty Ankylosing spondyl itis Flexion rigidity
