本文選題：內(nèi)科治療　切入點(diǎn)：強(qiáng)直性脊柱炎　出處：《中國人民解放軍醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：研究人工全髖關(guān)節(jié)置換術(shù)后(Total Hip Arthroplasty, THA)使用TNF拮抗劑、傳統(tǒng)藥物與不進(jìn)行內(nèi)科治療的強(qiáng)直性脊柱炎患者術(shù)后髖關(guān)節(jié)功能的不同。方法：回顧分析2006年6月至2013年10月在解放軍總醫(yī)院骨科行THA的96例強(qiáng)直性脊柱炎患者。男89例(138髖),女7例(12髖);年齡16～60歲,平均31歲；強(qiáng)直性脊柱炎發(fā)病距關(guān)節(jié)置換間隔2-38年,平均12年。強(qiáng)直患者21例,僵直患者75例。根據(jù)術(shù)后是否進(jìn)行內(nèi)科治療分為3組,TNF組納入15例(18髖),傳統(tǒng)組納入27例(37髖),對照組納入54例(95髖)。三組患者在基礎(chǔ)資料如年齡、身高、體重、BMI等方面均無統(tǒng)計(jì)學(xué)差異(P0.05)。對三組組間進(jìn)行臨床療效評估,實(shí)驗(yàn)室指標(biāo)檢測及影像學(xué)評估。結(jié)果：TNF組、傳統(tǒng)組和對照組術(shù)前Harris評分分別為34.55±3.25分,32.51±3.21分,30.28±4.45分;術(shù)前疼痛評分分別為6.83±0.54分,7.13±0.63分,7.27±0.41分：術(shù)前總被動活動度分別為42.69±9.78°,40.41±7.98°,39.76±8.22°。對于隨訪時結(jié)果TNF組與對照組相比,髖關(guān)節(jié)Harris評分由術(shù)前34.55±3.25分、30.28±4.45分別提升至87.53±4.35分、81.52±6.72分,差異有統(tǒng)計(jì)學(xué)意義(P=0.03),疼痛評分6.83±0.54分,7.27±0.41分別降低至1.53±0.23分,2.24±0.71分,差異有統(tǒng)計(jì)學(xué)意義(p=0.05)。而活動度方面由術(shù)前42.69±9.78°39.76±8.22°分別提升至192.69±10.23°,191.54±10.41。(p=0.83),無明顯的統(tǒng)計(jì)學(xué)意義。TNF組與傳統(tǒng)治療藥物組相比,髖關(guān)節(jié)Harris評分由術(shù)前34.55±3.25分,32.51±3.21分分別提升至87.53±4.35分、82.17±5.97,差異有統(tǒng)計(jì)學(xué)意義(P=0.02)。疼痛評分由6.83±0.54分,7.13±0.63分分別降低至1.53±0.23分,1.44±0.77分,差異無統(tǒng)計(jì)學(xué)意義(p=0.10)。活動度方面由42.69±9.78°40.41±7.98°分別提升至192.69±10.23。,190.76±9.45°(p=0.66),差異無統(tǒng)計(jì)學(xué)意義。隨訪時間為15個月-97個月,平均49個月。隨訪三組患者均未發(fā)現(xiàn)假體周圍感染。生物制劑組發(fā)生不良反應(yīng)5例,上呼吸道感染2例,出現(xiàn)皮疹3例；傳統(tǒng)藥物組發(fā)生不良反應(yīng)11例,均為胃腸道反應(yīng),惡心嘔吐。隨訪x線片示,4髖于髖臼側(cè)Ⅰ、Ⅰ區(qū)出現(xiàn)寬度2mm的透亮線。結(jié)論：從隨訪結(jié)果來看,THA術(shù)后繼續(xù)使用藥物進(jìn)行內(nèi)科治療可以進(jìn)一步改善髖關(guān)節(jié)功能,但活動度變化不明顯。TNF拮抗劑的作用并沒有明顯強(qiáng)于傳統(tǒng)藥物組
[Abstract]:Objective: To study the total hip arthroplasty (Total Hip, Arthroplasty, THA) using TNF antagonists, traditional medicine and surgery in patients with ankylosing spondylitis medical treatment after different hip function. Methods: a retrospective analysis from June 2006 to October 2013 in 96 cases of ankylosing spondylitis patients Department of orthopedics of PLA General Hospital for THA. 89 male patients (138 hips) and 7 females (12 hips); the average age of 16~60 years, 31 years of age; the pathogenesis of ankylosing spondylitis from joint replacement interval of 2-38 years, an average of 12 years. 21 cases of tetanus patients, 75 cases of patients with postoperative stiffness. According to whether the medical treatment is divided into 3 groups, group TNF included 15 cases (18 hips), the traditional group included 27 patients (37 hips), the control group included 54 patients (95 hips). Three groups of patients with basic information such as age, height, weight, there was no significant difference (P0.05). BMI and other aspects of evaluation of clinical curative effect between the three groups, laboratory index detection and 褰卞儚瀛﹁瘎浼，

本文編號：1633727