摘要
目的:评价全髋关节置换术(THA)治疗合并髋关节骨性融合的强直性脊柱炎(AS)患者的中期随访结果。方法:回顾性分析2003年1月至2020年9月因AS合并单侧或双侧髋关节受累而行THA的431例(627髋)患者的临床资料。根据术前骨盆正位X线片判定是否存在髋关节骨性融合,并将患者分成骨性融合组137例(218髋)和非骨性融合组294例(409髋)。收集并比较两组患者的基线资料,包括人口学资料、疾病相关数据、实验室检查结果及手术相关数据。结果:全部患者获得103(61,146)个月随访。围手术期并发症方面,骨性融合组包括术中假体周围骨折10例、坐骨神经损伤2例、脱位2例及术后关节弹响2例,非骨性融合组包括术中假体周围骨折12例、坐骨神经损伤2例、假体周围感染2例、术后关节弹响3例,两组总的并发症发生率差异无统计学意义(P=0.239)。临床随访结果显示,骨性融合组患者Harris髋关节评分(HHS)从术前33.0(17.5,44.0)分提高至末次随访时的86.0(78.0,94.0)分(P<0.001),但显著低于非骨性融合组(P<0.001)。骨性融合组的巴氏AS疾病活动度指数(BASDAI)和巴氏AS功能指数(BASFI)均显著高于非骨性融合组(P均<0.001);术后穿鞋袜困难程度显著高于非骨性融合组(P=0.035)。结论:AS合并髋关节骨性融合患者进行THA重建股骨近端存在多种并发症风险,总体临床疗效逊于非骨性融合患者,但整体疗效值得肯定。
Objective:To evaluate medium-term clinical outcomes of total hip arthroplasty(THA)for the treatment of bony ankylosis in patients with ankylosing spondylitis(AS).Methods:Clinical data of 431 AS patients(627 hips)with unilateral or bilateral bony ankylosed hip who underwent THAs between January 2003 and September 2020 were retrospectively analyzed.The patients were divided into bony ankylosis group(137 patients,218 hips)and non-bony ankylosis group(294 patients,409 hips)according to preoperative pelvic X-ray results.The demographics,disease-related data,laboratory parameters and surgery-related data were collected and compared.Results:All patients were followed-up for 103(61,146)months.Perioperative complications were as follows:in bony ankylosis group,there were 10 cases of intraoperative periprosthetic fracture,2 cases of sciatic nerve injury,2 cases of dislocation and 2 cases of joint snapping;in non-bony ankylosis group,there were 12 cases of intraoperative periprosthetic fracture,2 cases of sciatic nerve injury,2 cases of periprosthetic infection and 3 cases of joint snapping.There was no statistical difference in the overall incidence of perioperative complications between the two groups(P=0.239).The Harris hip score(HSS)increased from 33.0(17.5,44.0)before surgery to 86.0(78.0,94.0)at the last follow-up in the bony ankylosis group(P<0.001).At the last follow-up,the bony ankylosis group had a significantly higher Bath ankylosing spondylitis disease activity index(BASDAI,P=0.001),higher Bath ankylosing spondylitis functional index(BASFI,P=0.001),lower HSS(P<0.001)and a higher degree of difficulty in putting on shoes and socks(P=0.035)than the non-bony ankylosis group.Conclusions:Although there are high risks of perioperative complications associated with THA reconstruction in patients with AS combined with bony ankylosis and its overall clinical efficacy is inferior to that in patients with non-bony ankylosis,the overall efficacy is reliable.
作者
于志永
张亮
边涛
满斯亮
李宏超
张浩天
周一新
李为
YU Zhiyong;ZHANG Liang;BIAN Tao;MAN Siliang;LI Hongchao;ZHANG Haotian;ZHOU Yixin;LI Wei(Department of Orthopaedics,General Hospital of Benxi Iron&Steel Industry Group of Liaoning Health Industry Group,Benxi 117000,Liaoning;Department of Adult Joint Reconstructive Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035;Department of Rheumatology and Immunology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)
出处
《中华骨与关节外科杂志》
CSCD
2023年第8期706-712,共7页
Chinese Journal of Bone and Joint Surgery
基金
北京积水潭医院青年基金(QN-202104)。
