摘要
目的探讨强直性脊柱炎(AS)髋关节骨性强直行全髋关节置换术(THA)的特点,寻找提高手术疗效,减少并发症的方法。方法对本组18例AS患者29个骨性强直的髋关节行THA手术,术前髋关节强直在屈曲0～65°(平均23.6°),术后平均随访4.2年,Harris评分进行术后临床疗效评定,X线检查观察假体有无松动、脱位及异位骨化。结果所有患者治疗经过顺利,无关节松动、脱位、骨折、感染等严重并发症发生,髋关节的屈曲和内收畸形得到纠正。平均髋关节屈伸活动度81°,屈伸、内收外展、内外旋总活动度142°,Harris评分平均81.6分,X线照片见假体位置良好,未见松动和下沉。2例2髋长期行走时轻度疼痛,异位骨化2例:BrookerⅠ级1例,BrookerⅡ级1例。结论THA是AS髋关节骨性强直重建关节功能的有效方法,个体化手术方案的设计包括手术入路的选择、假体位置的正确安放、术中软组织松解与平衡、髋臼周围骨赘的清除等是影响手术疗效的关键。
Objective To evaluate the efficacy of total hip replacement in bony ankylosis hip of patients with ankylosing spondylitis, and to find out the approach that improves operation efficacy and reduces complications. Methods Between August 1996 and August 2007, 29 total hip arthroplasties were performed in bony ankylosis hip of 18 patients with ankylosing spondylitis and all of them were available for clinical follow-up study. The average flexion deformity of the 29 hips was 32.6~ （ ranged form 0~ to 65~）. The mean follow-up period was 4.2 years. Harris hip score and X-ray examination were used to evaluate the curative effects. Results All of the patients had substantial improvement of function and the range of motion. Flexion deformity and endoduction deformity were rectify in all patients. No complication such as sciatic nerve/ femoral nerve injuries, dislocation, fracture or deep infection happened. The mean postoperative Harris hip score was improved to 81.6 point. The average total range of motion of hip joint was improved to 142~. In radiographic photos, all prostheses were on right location and there were no sign of prostheses migration and aseptic loosening either on the cup side or on the stem side. 2 patients （2 hips） had mild pain. Acetabular heterotopic ossification was seen in 2 hips： 1 were Brooker grade I , 1 were grade lI. Conclusions Total hip arthroplasty is an effective solution to facilitate rehabilitation of hip bony ankylosis in patients with ankylosing spondylitis. The individuation design of surgical project including approach selection, prostheses positioning, soft tissue balance and osteophyte elimination at the margins of the acetabulum are key factors affecting therapeutic results.
出处
《中华关节外科杂志（电子版）》
CAS
2010年第1期40-43,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
脊柱炎
强直性
关节成形术
置换
髋
治疗结果
Spondylitis, ankylosing
Arthroplasty, replacement, hip
Treatment outcome
