本文選題：強(qiáng)直性脊柱炎　切入點(diǎn)：全髖關(guān)節(jié)置換術(shù)　出處：《中國(guó)修復(fù)重建外科雜志》2017年01期

【摘要】：目的總結(jié)全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)治療強(qiáng)直性脊柱炎(ankylosing spondylitis,AS)累及髖關(guān)節(jié)的中遠(yuǎn)期療效,并對(duì)影響療效的因素進(jìn)行探討。方法 1999年3月—2011年5月采用THA治療32例(42髖)AS累及髖關(guān)節(jié)患者。男26例,女6例;年齡20~78歲,平均39歲。病程2~41年,中位病程10年。假體摩擦界面采用金屬-聚乙烯者19髖,陶瓷-陶瓷者23髖;股骨頭假體采用36 mm直徑者15髖,28 mm直徑者27髖;假體均采用生物學(xué)固定。手術(shù)前后測(cè)量并記錄患者髖關(guān)節(jié)總活動(dòng)度(屈-伸、內(nèi)收-外展、內(nèi)旋-外旋活動(dòng)度總和),髖關(guān)節(jié)功能采用Harris評(píng)分、疼痛程度采用疼痛視覺(jué)模擬評(píng)分(VAS)評(píng)價(jià)。根據(jù)X線片,髖臼側(cè)和股骨側(cè)假體分別采用De Lee分區(qū)和Gruen分區(qū)描述;異位骨化程度采用Brooker標(biāo)準(zhǔn)。結(jié)果術(shù)后患者切口均Ⅰ期愈合,無(wú)麻醉意外、感染及神經(jīng)、血管損傷等并發(fā)癥。術(shù)后29例(39髖)獲隨訪,隨訪時(shí)間5~17年,平均9年。術(shù)后股骨頭假體28 mm直徑組24髖中發(fā)生髖關(guān)節(jié)前脫位2例(2髖),36 mm直徑組15髖無(wú)脫位發(fā)生。末次隨訪時(shí),所有患者VAS評(píng)分、Harris評(píng)分及髖關(guān)節(jié)總活動(dòng)度均較術(shù)前顯著改善(P0.05)。其中術(shù)前病程越短,術(shù)后Harris評(píng)分越高、髖關(guān)節(jié)總活動(dòng)度越大(P0.05);股骨頭假體直徑越大,術(shù)后髖關(guān)節(jié)總活動(dòng)度越大(P0.05)。末次隨訪時(shí)臼杯和股骨柄假體均固定良好。采用金屬-聚乙烯假體的18髖中,臼杯周圍顯示有廣泛性骨溶解者9髖(50%),但假體尚無(wú)松動(dòng);采用陶瓷-陶瓷假體的21髖中無(wú)任何骨溶解和假體松動(dòng)征象。7髖發(fā)生異位骨化,其中BrookerⅠ級(jí)5髖,Ⅱ級(jí)2髖。結(jié)論 THA是治療AS累及髖關(guān)節(jié)的有效手段;術(shù)前病程短,并采用大直徑股骨頭陶瓷-陶瓷假體行THA者,術(shù)后療效更好。
[Abstract]:Objective to summarize the middle and long term effects of total hip arthroplasty for ankylosing spondylitis (ASA) in the treatment of ankylosing spondylitis. Methods from March 1999 to May 2011, 32 patients (26 males and 6 females) with hip involvement were treated with THA. The age was 2078 years (mean 39 years). The course of disease was 2 ~ 41 years. The median course of disease was 10 years. There were 19 hips with metal-polyethylene interface, 23 hips with ceramic and ceramic prosthesis, 15 hips with 36mm diameter and 27 hips with 28mm diameter of femoral head prosthesis. The total motion of hip joint (flexion-extension, adduction-outreaching, total rotation and external rotation) was measured and recorded before and after operation. The hip function was assessed with Harris score. The degree of pain was evaluated by visual analogue score of pain (vas). According to X-ray film, acetabular side and femur prosthesis were described by de Lee partition and Gruen partition, ectopic ossification degree was evaluated by Brooker standard. There were no complications such as anesthesia accident, infection, nerve and vascular injury and so on. 29 cases (39 hips) were followed up for 5 ~ 17 years. The average was 9 years. In 24 hips with 28 mm diameter of femoral head prosthesis, there were 2 cases of anterior dislocation of hip joint in the group of 36 mm diameter of femoral head prosthesis. No dislocation occurred in 15 hips in the group of 36 mm diameter of femoral head prosthesis. The VAS score and total motion of hip joint in all patients were significantly improved compared with those before operation (P 0.05). The shorter the course of disease before operation, the higher the Harris score after operation, the larger the total motion of hip joint and the larger the diameter of femoral head prosthesis. The total motion of hip joint increased after operation (P 0.05). At the last follow-up, the prosthesis of acetabular cup and femur handle were all well fixed. In 18 hips with metal-polyethylene prosthesis, 9 hips with extensive osteolysis around the cup showed extensive osteolysis, but the prosthesis was not loosened. There were no signs of osteolysis and loosening of prosthesis in 21 hips with ceramic ceramic prosthesis. 7 hips showed ectopic ossification, including 5 hips of Brooker 鈪，

本文編號(hào)：1658915