Ⅰ期双侧全髋关节置换治疗系统性红斑狼疮合并股骨头坏死的早中期疗效

Short and medium term results of one-stage bilateral total hip arthroplasty for systemic lupus erythematosus patients with avascular necrosis of the femoral head

目的分析Ⅰ期双侧全髋关节置换(THA)治疗系统性红斑狼疮(SLE)合并中晚期股骨头缺血性坏死(ANFH)的早中期疗效。方法中山大学附属第三医院骨科对17例SLE合并中晚期ANFH患者均行Ⅰ期双侧THA,按照ARCO分期分为ⅢB期7髋、ⅢC期12髋,Ⅳ期15髋,结合患者年龄与骨质条件选择股骨假体不同的固定方式。采用Harris评分结合SF-36评分方法进行疗效比较与随访,平均随访时间28个月。结果术后2例切口延迟愈合,1例假体脱位,1例大腿痛10月,1例急性肾衰,均经治疗后好转。6例经彩超发现无症状下肢深静脉血栓,无肺栓塞、假体深部感染发生,无肾上腺皮质危象表现,随访期间髋关节疼痛及活动度明显改善,无假体松动。Harris髋关节功能评分(平均91.6分)与术前(平均42.6分)相比差异有统计学意义(P<0.01),SF-36评分(平均84.5分)与术前(平均51.4分)相比差异有统计学意义(P<0.01);不同ARCO分期病例术后Harris评分差异无统计学意义(P>0.05);不同假体固定方式术后Harris髋关节功能评分、SF-36评分均差异无统计学意义(P>0.05)。结论Ⅰ期双侧人工髋关节置换术对SLE合并中晚期ANFH的早中期疗效良好,应严格掌握手术适应证和手术时机,加强围手术期处理,选择合适的假体固定方式。

Objective To analyze the short and medium term results of one-stage bilateral total hip arthroplasty （THA） for the systemic lupus erythematosus （SLE） patients with avascular necrosis of the femoral head （ANFH）. Methods The study was designed prospectively. Sevent patients who were diagnosed as SLE with bilateral ANFH were treated by one-stage bilateral THA. There were 1 male and 16 female. The average age was 38.6 （ from 28 to 67）. According to ARCO stage system, 34 hips were divided into 7 Ⅲ B, 12 ⅢC and 15 Ⅳ. Two different fixation ways for femur prosthesis were chosen according to different age and bone quality. All patients were followed up and the mean follow-up time was 28 months. The clinical results were evaluated by Harris hip score and SF-36 self-administered health outcome questionnaire. Results There were 2 cases with delayed incision healing, 1 with early prosthesis dislocation, 1 with thigh pain for 10 months and 1 with acute renal failure postoperatively, which were improved and recovered after proper treatments. Asymptomatic deep vein thrombosis （DVT） in low extremities were detected by color Doppler ultra sonography in 6 cases. There were no pulmonary embolism and no deep infection around prosthesis. There was no Addisonian crisis postoperatively. The pain was relieved and the motion of joint was improved during follow-up. There was no radiological evidence of implant loosening. There was significant difference of the mean Harris hip score between preoperative score （42.6） and postoperative score （91.5） （ P 〈 0.01 ）. There was also significant difference of the mean SF-36 score between preoperative score （51.4） and postoperative score （84.5） （P 〈 0.01 ）. There was no significant difference of the mean postoperative Harris hip score between different ARCO stage （P 〉 0.05 ）. There was no significant difference of the mean postoperative Harris hip score and SF-36 score between two different fixation for femur prosthesis （P 〉 0.05）. Conclusion In the short and medium term follow-up, one-stage bilateral THA has good resuits for the patients with SLE and AVNH. The key points include operation indication, operation timing, management during perioperative period and suitable fixation for femur prosthesis.