全髋关节置换术治疗强直性脊柱炎髋关节病变

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1、全髋关节置换术治疗强直性脊柱炎髋关节病变姜文明袁耀周云斌吴立东【摘要】目的探讨强直性脊柱炎髋关节受累病例进行全髋关节置换术的手术注意事项及其疗效。方法对35例(46髋)强直性脊柱炎髋关节受累的病例进行人工全髋关节置换术治疗。男31例，女4例;年龄21~72岁，平均39.7岁。术中1例(2髋)髋臼侧和股骨侧均为骨水泥型假体，29例(38髋)采用非骨水泥型假体，5例(6髋)为混合型固定(臼杯为非骨水泥型，股骨柄为骨水泥型)。20髋为陶瓷对陶瓷的关节面组合，26髋为金属对聚乙烯组合。平均随访时间为5.1年(2~8年)。采用Harris评分对结果进行评估，术前及随访时拍摄常规X线片观

2、察、评定，根据Brooker分级法进行异位骨化分级。结果Harris评分由术前平均31分增加到术后89分。术后无脱位、感染等并发症发生。患者髋关节活动度均得到改善，屈伸、收展、内外旋总活动度由术前的平均52°(0°~120°)提高到平均155°(65°~205°)。2例(3髋)长时间行走后出现轻微的关节疼痛，1例患者偶尔需服用镇痛药物，其余患者术前髋痛消失，疼痛完全缓解率为90.5%。X线分析未发现假体松动、移位，18髋(39.1%)发生异位骨化，其中依据Brooker分级，Ⅰ级12髋(26.1%)，Ⅱ级4髋(8.7%)，Ⅲ级2髋(4.3%)，没有Ⅳ17级严重的异位骨化发生。

3、结论使用人工全髋关节置换术治疗强直性脊柱炎髋关节病变的病例可获得良好的结果，可明显改善患者的生活质量。【关键词】强直性脊柱炎;治疗;全髋关节置换　　[Abstract]ObjectiveToevaluatetheoutcomesoftotalhiparthroplasty(THA)inpatientswithankylosingspondylitis,discusstheproblemsencounteredinthesurgeryandduringrehabilitation.MethodsAretrospectivestudywasmadeon46hipsin35pati

4、ents(31maleand4female)whohadankylosingspondylitisandhipinvolvement,theaverageageatoperationwas39.7years(range,21~72years).Onepatient(2hips)wasmanagedwithcementedTHA,5patientswithhybridTHA,theothersweremanagedwithuncementedTHA.Twentyhipshadceramiccouplingimplants,26hipsweretreatedwithmetalon

5、polyethyleneprostheses.Theaveragefollow-upperiodwas5.1years(range,2~8years).AllpatientswereevaluatedwiththeuseofHarrishipscoresystem.Radiographicevaluationswereperformedbypreoperativeandfollow-up,heterotopicossificationwasgradedaccordingtothesystemofBrooker.ResultsAccordingtotheHarrishipsys

6、tem,theaveragehipscoreincreasedfrom31beforesurgeryto89atthefinalreview.Nocomplicationssuchasdislocationordeepinfection17happened.Thecumulativerangeofmotionwasimprovedfrom52°preoperativelyto155°attherecentfollow-up.Twopatients(3hips)hadslightpainwhenwalkingmorethan30minutes,onepatientneededa

7、nodyneoccasionally,90.5%ofthepatientshadcompletepainrelief.Bythetimeofthefinalfollow-up,therewerenosignsoflooseningandmigrationeitheronthecupsideoronthefemoralside.Heterotopicossificationwasfoundin18hips(39.1%),withBrookerClassⅠin12hips(26.1%),andBrooker