强直性脊柱炎的人工全髋关节置换术(附18例/31髋中期随访分析)

Total hip arthroplasty in ankylosing spondylitis(an intermediate-term follow up study of eighteen cases/thirty one hips)

目的探讨强直性脊柱炎患者行全髋关节置换术的手术方法并分析中期疗效。方法对18例(31髋)强直性脊柱炎患者行人工全髋关节置换术,并进行了平均52年(2～92年)的随访。临床随访根据Harris评分系统进行评分,X线随访根据Gruen等和DeleeandCharnley分区法分别进行股骨柄和臼杯X线片分析。结果至最近1次随访,Harris评分由术前的平均276分(3～52分)提高到了术后的平均833分(54～92分)优良率为871%,其中,优5髋,良22髋,可3髋,差1髋。髋关节的总活动度由术前的平均356°(0～115°)提高到了术后的平均1856°(54～215°)。X线片未见假体松动、脱位或折断;异位骨化发生率97%(3髋)。结论人工全髋关节置换术是强直性脊柱炎患者重建髋关节,恢复关节功能,提高生活质量的有效方法。

Objective:To discuss the total hip arthroplasty(THA)surgical technique in patients with ankylosing spondilitis(AS),and evaluate the intermediate term efficacy of THA Method:Thirty one THA were performed in eighteen patients who had AS,and the results were analyzed retrospectively with an average follow up period of 5 2 (range,2 to 9 2 years)years The clinical results were evaluated by the Harris hip scoring system Radiographic analysis by Gruen’s zonal method for the stem and the zonal classification of Delee and Charnley for the cup implants Result:For the latest follow up,the average Harris hip score improved from 27 6 points(range,3 to 52 points)preoperatively to 83 3 points(range,54 to 92 points)at the final postoperatively evaluation Based on Harris hip score,5 hips were rated excellent results,22 hips good results,3 hips fair results and 1 poor result The overall clinical results were rated as good or excellent in 87 1% The average total range of motion of hip improved from 35 6°(0 ～115°)preoperatively to 185 6°(54～215°)postoperatively There were no sign of loosening,dislocation or fracture of the prosthesis According to the system of Brooker et al,the incidence of heterotopic ossification was 9 7%(3 hips) Conclusion:THA is an effective method for the patients who have AS to reconstruct the function of hip joint and improve their life quality