全髋关节置换术治疗强直性脊柱炎髋关节骨性强直畸形

An evaluation of total hip arthroplasty in treating hip deformity in patients with ankylosing spondylitis

[目的]评价全髋关节置换术(THA)治疗强直性脊柱炎(AS)致髋关节骨性强直的临床疗效。[方法]回顾性分析2004年4月~2011年3月本科18例(29髋)AS致髋关节骨性强直行THA患者资料,患者均为男性,手术时年龄28~58岁,平均36.83岁;病程5~23年,平均12.11年。髋关节各方向活动度为0°,屈曲畸形10°~55°,平均23.17°;单侧7例,双侧11例;其中1例合并内收10°畸形。采用髋关节外侧入路,所有患者均采用生物型髋关节假体。采用Harris评分对术前及术后髋关节功能进行评价,同时对术后随访影像学资料进行评价;采用SF-12量表对患者健康状况进行评价。[结果]所有患者平均随访3.39年,髋关节功能均明显改善,Harris评分由术前平均32.97分提高到术后平均82.24分,两者比较差异有统计学意义(t=-39.98,P【0.01),其中优1髋、良20髋,优良率72.41%。髋关节屈曲畸形明显矫正,18例(29髋)总活动度由术前平均0°提高到术后平均145.79°,两者比较差异有统计学意义(t=-72.58,P【0.01);髋关节屈伸活动度由术前0°提高到术后平均83.69°,两者比较差异有统计学意义(t=-53.56,P【0.01)。术后18髋(62.07%)疼痛完全消失,5髋(17.24%)出现轻微、偶尔疼痛;仅2例仍需扶单拐行走,其余均可自由活动,步态正常。X线见假体位置良好,未见松动、脱位;异位骨化3例(3髋),BrookerⅠ级2髋、Ⅱ级1髋。SF-12评分中PCS由术前的29.10分提高到50.07分,两者比较差异有统计学意义(t=-14.43,P【0.01);MCS由术前的40.49分提高到50.38分,两者比较差异有统计学意义(t=-5.80,P【0.01)。[结论]THA是治疗AS致髋关节骨性强直的有效方法,可提高患者的生活质量。

[Objective] To evaluate the clinical outcome of total hip arthroplasty(THA) in the treatment of bony ankylosis of the hip in patients with ankylosing spondylitis(AS).[Methods] A retrospective analysis was performed in 18 patients(29hips) with AS,who had undergone THA in the period April 2004- March 2011.Of these,11 patients had undergone bilateral THA.The mean age of the patients was 36.83 years(range,28 ~ 58 years).The mean disease duration was 12.11 years(range,5 ~23 years) and the mean hip flexion deformity was 23.17°(range,10° ~55°).All patients in this study had received a biological prosthesis.The clinical results were evaluated by using the Harris hip scoring system.The patients' health statuses were evaluated by using the Short Form 12- item Survey(SF- 12).[Results] The average follow- up duration in this study was 3.39 years.All functions of the hip joint improved after THA.The mean value of the scores based on the Harris hip scoring system improved from the preoperative score of 32.97 to 82.24 at follow- up(P<0.01,by paired t- test),with 26cases rated as excellent and 28 as good(excellent or good results rate of 72.41%).The serious flexion deformities of the involved hips had been corrected completely.The total hip motion improved from 0° preoperatively to 145.79° at follow- up and was statistically significant(P<0.01,by paired t- test).The average range of motion improved from 0° preoperatively to83.69°at follow- up and was statistically significant(P<0.01,by paired t- test).At the final follow- up,a total relief from pain was noted in 18 hips(62.07%) and occasional mild pain in 5 hips(17.24%).Only 2 patients continued to need a crutch for walking.The other patients were able to function and care for themselves appropriately.The prostheses were found to be at the correct location in the radiographs with no sign of aseptic loosening and dislocation of the prostheses on the cup or the stem side.Three patients(3 hips) presented with heterotopic ossification.Based on the Brooker grading system,2 hips were classified as Grade I and 1 as Grade II.The mean value of the scores based on the Short Form- 12 scores physical component summary showed an average improvement from 29.10 preoperatively to 50.07 at follow- up(P<0.01,by paired t- test).The mental component summary showed an average improvement from 40.49 preoperatively to 50.38 at follow- up(P<0.01,by paired t- test).[Conclusion] THA is an effective method of treating bony deformity of the hip in patients with ankylosing spondylitis and can be used to improve the patients' quality of life.