本文關(guān)鍵詞： 強(qiáng)直性脊柱炎 全髖關(guān)節(jié)置換術(shù) 異位骨化 危險(xiǎn)因素 中醫(yī)證型　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討強(qiáng)直性脊柱炎Ankylosing spondylitis(AS)患者行初次人工全髖關(guān)節(jié)置換術(shù) total hiparthroplasty(THA)后發(fā)生異位骨化 heterotopic ossification(HO)的危險(xiǎn)因素。方法:回顧性分析2011年6月—2015年12月因AS行初次人工THA且隨訪達(dá)6個(gè)月以上的87例(132髖)患者,男76例(115髖),女11例(17髖);平均年齡34.8歲(18～80歲);平均隨訪時(shí)間28.2月(6～65月)。對(duì)患者的手術(shù)前后臨床資料和影像學(xué)資料進(jìn)行收集整理。臨床資料包括患者的年齡、性別、病程、中醫(yī)辨證分型、術(shù)前髖關(guān)節(jié)是否強(qiáng)直、術(shù)前CRP、術(shù)前ESR、術(shù)中出血量、手術(shù)時(shí)間、假體類型、麻醉方式。影像學(xué)資料包括患者術(shù)前及術(shù)后的髖關(guān)節(jié)正側(cè)位X光片。觀察末次隨訪X線片假體周圍異位骨化的范圍,并按Brooker分型分為Ⅰ～Ⅳ型。術(shù)前和末次隨訪的髖關(guān)節(jié)功能評(píng)估采用Harris評(píng)分。用SPSS20.0軟件建立數(shù)據(jù)庫并進(jìn)行統(tǒng)計(jì)學(xué)分析,組間差異采用獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料采用X2檢驗(yàn)。t檢驗(yàn)和X2檢驗(yàn)中有統(tǒng)計(jì)學(xué)意義(即P0.05)的資料繼續(xù)采用二分類logistic回歸進(jìn)行相關(guān)分析,PK0.05為有統(tǒng)計(jì)學(xué)意義,即有相關(guān)性。結(jié)果:AS 術(shù)后 HO 的發(fā)生率為 32.6%。Brooker Ⅰ 型 17 髖(12.9%),Ⅱ 型 17 髖(12.9%),Ⅲ型8髖(6.1%),Ⅳ型1髖(0.7%)。其中男性42髖,女性1髖。平均Harris評(píng)分從術(shù)前的36.7分(0～62)上升到了術(shù)后最后一次隨訪的82.9分(49～99)。危險(xiǎn)因素分為可變因素和不可變因素。男性(P = 0.045)、術(shù)前髖關(guān)節(jié)強(qiáng)直(P0.001)是HO發(fā)生的不可變因素,增加了異位骨化的發(fā)生率。在眾多的可變因素中,手術(shù)時(shí)間過長(P = 0.044)、術(shù)中使用全麻(P = 0.009)中醫(yī)證型為實(shí)證(p=0.049)也會(huì)增加HO的發(fā)生率�；颊叩哪挲g、病程、術(shù)前ESR及CRP、術(shù)中出血量和假體類型與術(shù)后HO的發(fā)生無明顯相關(guān)性。結(jié)論:AS全髖關(guān)節(jié)置換術(shù)后HO的發(fā)生率與手術(shù)時(shí)間長短,術(shù)中軟組織損傷程度,以及是否全麻等可變因素密切相關(guān)�？梢酝ㄟ^改善患者體質(zhì),縮短手術(shù)時(shí)間,減少術(shù)中軟組織損傷以及術(shù)中盡量避免使用全麻,來降低HO的發(fā)生率。
[Abstract]:Objective: to study the Ankylosing spondylitis (ASA) of ankylosing spondylitis. Primary total hip arthroplasty (total hithroplasty). Heterotopic ossification of heterotopic. Methods: a retrospective analysis was made on 87 patients with primary artificial THA who were followed up for more than 6 months from June 2011 to December 2015. There were 76 males (115 hips) and 11 females (17 hips). The average age was 34.8 years old and 1880 years old. The average follow-up time was 28.2 months from 6 to 65 months. The clinical data and imaging data before and after operation were collected and sorted. The clinical data included age, sex, course of disease, TCM syndrome differentiation and classification. Preoperative hip ankylosis, preoperative CRP, preoperative ESRs, intraoperative bleeding, operative time, type of prosthesis. Methods of anesthesia. The imaging data included the positive and lateral radiographs of hip joint before and after operation. The range of heterotopic ossification around the prosthesis was observed during the last follow-up. According to the Brooker classification, the hip function was divided into 鈪，

本文編號(hào)：1459818