全髋关节置换术治疗脊柱骨骺发育不良患者Tönnis 3级髋关节骨关节炎的早期疗效

Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia

目的:脊柱骨骺发育不良(spondyloepiphyseal dysplasia,SED)患者因骨骼、关节发育异常,生物力学改变和早年手术干预等往往导致严重的髋关节骨关节炎。本研究探讨人工全髋关节置换术治疗SED患者Tönnis 3级髋关节骨关节炎的早期疗效及可能的影响。方法:2017年1月至2019年6月,将由高年资医生完成人工全髋关节置换术治疗的374例髋关节骨关节炎患者作为研究对象,其中因SED行人工全髋关节置换术的患者9例(男6例,女3例,12髋)符合纳入排除标准,观察人工全髋关节置换术对该类患者的早期疗效。结果:所有患者均选用强生陶瓷内衬-陶瓷股骨头,均获得随访,平均随访时间20个月,除1例出现肌间静脉血栓外,其余患者均未出现无菌性松动、脱位、骨折、血管神经损伤、深静脉血栓和感染等并发症。术前髋关节Harris评分平均35.55分,美国西部Ontario和McMaster大学骨关节炎指数评分(the Western Ontario and McMaster Universities osteoarthritis index,WOMAC)平均56.56分,SF-12生活质量量表评分平均41.56分,视觉模拟评分(visual analogue scale,VAS)平均7.44分;末次随访时Harris评分平均89.56分,WOMAC骨关节炎指数评分平均41.11分,SF-12评分平均56.33分,VAS评分平均2.67分。与全髋关节置换术术前相比,SED患者术后骨盆入射角、骨盆倾斜角和骶骨倾斜角等骨盆相关参数均有所增加,术前平均骨盆入射角为68.95°±4.60°、平均骨盆倾斜角为52.75°±1.06°、平均骶骨倾斜角为17.45°±1.77°,而术后则相应变为76.98°±5.12°、60.51°±4.35°和18.10°±2.02°。患者术后双下肢均基本等长。结论:人工全髋关节置换是治疗SED患者Tönnis 3级髋关节骨关节炎的一种有效手术方式,且早期疗效满意。

Objective:Severe hip osteoarthritis,caused by bone or joint maldevelopment,biomechanical transformation and previous surgical intervention,is inclusively existed in spondyloepiphyseal dysplasia(SED).To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED.Methods:From January 2017 to June 2019,374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons,of whom 9 patients(6 males and 3 females)with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation.The short-term outcomes were observed.Results:All the patients were implanted with Johnson&Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty.They were followed up for an average period of 20 months.Except for one muscular calf vein thrombosis case,no complications,such as aseptic loosening,joint dislocation,fracture,neurovascular injury,deep vein thrombosis and infection were observed in all the 9 patients.Before the surgery,the average Harris hip score was 35.55,while the average of the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)was 56.56.The level of quality of life indicated by SF-12 score was 41.56 on average.The mean pre-operation visual analogue scale(VAS)was 7.44.At the last follow-up,the average Harris hip score increased to 89.56,whereas the average WOMAC declined to 41.11.Compared with the baseline point,the average SF-12 score went up to 56.33.Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up.In addition,post-operative increase of several pelvic-related parameters including pelvic incidence,pelvic tilt and sacral slope could be observed in the SED patients.The average measured pelvic incidence,pelvic tilt and sacral slope were 68.95°±4.60°,52.75°±1.06°and 17.45°±1.77°before operation,respectively;whilst the mean value of these specific parameters increased to 76.98°±5.12°,60.51°±4.35°and 18.10°±2.02°,respectively.The even leg lengths of the lower extremities were obtained after total hip arthroplasty.Conclusion:Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.