全髋关节置换术治疗强直陛脊柱炎严重屈髋畸形

The efficacy of total hip arthroplasty for treating serious flexed hips in ankylosing spondilitis

目的分析全髋置换术治疗强直性脊柱炎严重屈髋畸形的临床疗效。方法28例（40髋）强直性脊柱炎髋关节屈曲畸形患者行全髋关节置换术，均为男性；年龄21-48岁，平均34．68岁；病程3～16年，平均8．53年；屈曲畸形角度30°-90°平均60．13°。单侧16例，双侧12例，16例（24髋）合并髋关节强直。采用改良的髋关节前外侧与外侧联合切口，生物型假体21例（29髋），混合型假体7例（11髋）。采用Harris评分对术前及术后髋关节功能进行评价。股骨侧假体采用Gruen的14分区法，髋臼侧假体采用DeLee和Charnley方法进行影像学观察。结果随访时间12,＇-64个月，平均42个月。末次随访时，关节总活动度由术前平均29．88。（0°-95°）增加至术后平均124．75°（90°～175°）。屈曲畸形程度由术前平均60．13°（30°-90°）减少至术后平均6°（0°～10°）。Harris评分由术前平均32．88分（12-58分）提高为随访时平均88．23分（69-98分），优20髋（50％），良15髋（37．5％），可3髋（7．5％），差2髋（5％），优良率87．5％。除1例术中出现股骨干穿通骨折和1例出现髋关节早期脱位外，X线检查均未显示假体松动移位迹象。8髋（20％）出现异位骨化。生物型假体和混合型假体随访时Harris评分差异无统计学意义（P〉0．05）。结论全髋关节置换术是治疗强直性脊柱炎严重屈髋畸形的有效方法。

Objective The purpose of this study was to evaluate the efficacy of the total hip arthro- plasty （THA） for treating serious flexed hip deformation in patients with ankylosing spondilitis （AS）. Methods A total of 28 male patients （40 hips） with ankylosing spondylitis underwent THA. 12 patients had bilateral surgery. The mean age was 34.68 years （ranged 21-48 years）; the disease course was 3-16 years, with the mean of 8.53 years; and the flexed deformation was 300-90°, with the mean of 60.13°, including ankylosis in 24 hips （60%）. There were 21 patients （29 hips） in the cementless group and 7 patients （11 hips） in the hybrid group. The clinical results were evaluated by the Harris hip scoring system, and the radiographic analysis were observed by Gruen zonal method for the stem and the zonal classification of DeLee and Charnley for the cup implants. Results All patients followed up for 12 to 64 months, with the mean of 42 months. At final follow-up examination, the average total range of hip motion improved from 29.88°（0°-95°） preoperatively to 124.75° （90°-175°） postoperatively, and the flexed deformation of the total replaced hips were improved from 60.13°（30°-90°） to 6°（0°-10°）. The average Harris hip score improved from 32.88 （12-58） preoperatively to 88.23 （69-98）, among them 20 hips （50%） got excellent results, and 15 hips （37.5%） good, 3 hips （7.5%） fair and 2 hips （5%） poor, the overall clinical results were rated as good or excellent in 87.5%. Except for one hip fractured during operation and one hip dislocated at the early time after operation, there was no sign of prosthesis loosening. According to the system of Brooker et al, the incidence of heterotopic ossification was 20% （8 hips）. There were no significant differences in Harris scores between the cementless and the hybrid THA （P 〉0.05）. Conclusion THA is the effective method for treating serious flexed hip deformation in patients with ankylosing spondilitis.