强直髋的全髋关节置换术

Total Hip Arthoplasty for the Treatment of Ankylosed Hips

目的报告关节强直髋患者行全髋关节置换术的长期结果.方法对45例强直髋行全髋关节置换术.手术时平均年龄为55.8岁(28～80岁).20例系自发性髋关节强直,25例为术后强直.关节强直的平均时间36年(3～65年),全部病例均获随访,平均随访6.5年.结果根据Merled Aubigne评分标准在最近的随访评价中,髋关节平均分数是165±1.5分.髋关节功能45例中41例疗效满意.在最近的随访中平均屈曲范围是88.(30.～130.).大多数病人在邻近关节有减轻疼痛的效果.积累8年的生存率,随访最后分数的修定是96.7%(95%可信度,间隔90.2%～100%).结论作为治疗强直髋的手术方法,全髋关节置换的长期疗效在该关节和邻近关节的最近研究中获得证明.当考虑手术时,应仔细的评价术前和术中臀中肌的功能,这是预测最后行走能力的方法之一.

Objective To report the long- term results of total hips arthroplasty following a ankylosed hip. Methods Forty- five total hip were performed in forty - five patients and their mean age of the patients was 55.8 years (twenty - eight to eighty years) . Ankylosis of the hip was spontaneous in twenty patients and postoperative in twenty - five patients, the mean duration of the ankylosis was thirty - six years (range, three to aixty five year) . The mean duration of follow- up was 6.5 years (range, two to forteen years) . No patient was lost to follow- up. Results The mean hip score, according to the scale of merled' Aubigene, was 16.5 ± 1.5 points at the latest follow- up evaluation. Hip function was considered to be satisfactory in forty -one (91%) of the forty -five patients the definitive score for walking ability was not achieved by the evaluation, it improved no stably for two to three years and then it remained stable. At the time of the latest follow- up, the mean flexion was 88° (range, 30° to 130°) , the forty- three (96% ) of forty - five patients had no pain in the involved joint. Pain relief in the meighboring joint and the cumulative survival rate was at eight years, with revision as the end point was 96.7 % (95 % confidence interval, 90.2 % to 100 % ). Conclusion The long term effectiveness of total hip arthroplasty for the treatment of an aakylosed hip is clearly demonstrated in both the involved joint and the nighboring joints in the present study. However, the preoperative and intraoperative status of the gluteal muscles would be carefully evaluated when this procedure is being considered, as this was the only factor that was predictive of the final walking ability.