摘要
背景:全髋关节置换已经成为改善严重强直性脊柱炎髋关节病变患者关节功能和生活质量的有效选择,但与其他病因的全髋关节置换相比,存在较高的危险因素。目的:观察全髋关节置换治疗强直性脊柱炎髋关节病变的效果。方法:对24例(33髋)强直性脊柱炎髋关节病变患者行人工全髋关节置换,置换前患者日常活动均明显受限,其中拄拐9例,轮椅1例;严重疼痛22例;10例(15髋)关节强直。置换前Harris评分平均41.9分,髋关节活动度平均45.4°。所用假体包括生物型18例(24髋)、骨水泥型3例(5髋)、混合型3例(4髋),均为金属合金股骨柄对高分子聚乙烯内衬(摩擦界面)。结果与结论:全部病例获得随访,随访时间平均23.3个月。最后一次随访,28髋(84.9%)疼痛完全消失;仅有1例仍需单拐辅助行走,其余患者均可不扶拐自由行走,步态正常。Harris评分平均80.1分,其中优10髋,良18髋,可4髋,差1髋,优良率84.8%;髋关节活动度平均159.6°;髋关节Harris评分及关节活动度均显著高于置换前(P<0.05)。患者的主观满意度为87.5%。2髋(6.1%)出现异位骨化,分别为Brooker分级Ⅰ,Ⅲ级。无脱位、感染、骨折、神经损伤及假体松动下沉,尚无患者进行翻修。提示全髋关节置换是治疗强直性脊柱炎髋关节病变的有效手段,可以缓解关节疼痛,恢复关节功能,改善患者生活质量。
BACKGROUND： Total hip arthroplasty （THA） has become an effective treatment to improve joint function and life quality of patients with ankylosing spondylitis （AS）, but there are high risks compared with THA for other diseases. OBJECTIVE： To evaluate the clinical efficacy of THA in treating the hip joint involvement of AS. METHODS： A total of 24 AS patients （33 hip joints） underwent THA. All the patients had obvious restriction in daily life before operation： 9 cases had to walk with the help of crutches, 1 case had to sit on wheelchair, 22 cases had severe pain and 10 cases （15 hip joints） were stiff. The mean Harris score was 41.9 averagely and the mean total range of the hip joint movement was 45.4° before surgery. The prosthesis involved biotype in 18 cases （24 hips）, cemented 3 cases （5 hips）, and mixed type 3 cases （4 hips） and made of metal alloy shaft and polymer polyethylene liner. RESULTS AND CONCLUSION： All patients were followed up with an average of 23 months. Pain was totally relieved in 28 patients （84.9%） at the last time of follow-up. Only one patient still needed a crutch to walk. The Harris score of hip joint was 80.1 averagely, including 10 hips excellent, 18 good, 4 passable, and 1 poor, with an excellent and good rate of 84.8%. The mean total range of the hip joint movement was 159.6° after surgery. The subjective satisfactory rate was 87.5%. According to Brooker system, 2 hips （6%） appeared heterotopic ossification, one was of Class I and the other Class III. There was no dislocation, infection, fracture, nerve injury or loosening of the prosthesis. No revision was performed. THA is an effective method in treating affected hip joint of AS. It can relieve the pain of the joint, restore the hip function and improve the life quality of the AS patients.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第22期4056-4059,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
