非骨水泥型全髋关节假体治疗强直性脊柱炎

Cementless total hip arthroplasty in the treatment of patients with ankylosing spondylitis

目的:评价非骨水泥型全髋假体治疗强直性脊柱炎中期疗效。方法:对29例(33髋)选用非骨水泥型全髋假体行全髋置换术的强直性脊柱炎患者进行随访,年龄34～57岁,平均42.4岁,术后随访2.2～5.6年(平均为4.3年)。对手术前后关节疼痛、活动度、畸形矫正、松动及患者整体功能的改善情况进行对比研究,临床随访根据Har-ris系统进行评分比较。结果:本组失访5例,术后除6侧髋关节轻度疼痛,2侧髋关节明显疼痛外,其余关节均无疼痛。关节活动度由术前平均46.5°改善为术后75.2°。髋关节屈曲畸形由术前平均32.6°改善为7.5°。术前Harris评分18～65分,平均44分;术后68～92分,平均86分。术后所有患者生活均可自理或部分自理。术中及术后并发症包括:股骨上端微型劈裂骨折5例,坐骨神经损伤1例,术后2个月脱位1例,股骨假体下沉4例,异位骨化4例。结论:使用非骨水泥型假体行全髋置换术是治疗强直性脊柱炎的一种可靠而有效的方法。

Objective：To evaluate intermediate-term results of cementless total hip arthroplasty in the treatment of patients with ankylosing spondyihis（AS）. Methods：Thirty-three hips of 29 patients with AS underwent cemenieless total hip arthroplasty were reviewed. The mean duration of follow-up was 4.3 years （ range, 2.2 to 5.6 years ）. The pre-and postoperatively comparative study on pain, range of motion, correction of the deformity, loosening and functional evaluation were conducted. The clinical results were evaluated according to the Harris hip scorring system. Results：Pain relief was obtained in all but 4 hips. Mean range of motion was improved from 46.5° to 75.2° and the flexion deformity of the involved hip was corrected from mean 32.6° to 7.5°, all of the patients could take care of their daily living by themselves. Preoperative Harris scores ranged from 18 to 65, with an average of 44. The postoperative Harris score were 68 to 92, with an average of 86. Complications included split fractures of proximal femur in 5 ,sciatic nerve injury in 1 ,early dislocation of the hip in 1 ,and sinking of the femoral prosthesis in 4 ,ectopic ossification in 4. Conclusion：Lementless total hip arthroplasty is a very important and effective treatment for patients with AS.