全髋关节置换治疗系统性红斑狼疮合并股骨头缺血性坏死6例

Total hip arthroplasty for avascular necrosis of the femoral head in 6 patients with systemic lupus erythematosus

背景:全髋关节置换是目前治疗髋关节疾患终末期的主要方法,疗效确切,但是对于伴有股骨头缺血性坏死的系统性红斑狼疮患者,常合并如严重骨质疏松症等其他疾患,目前国内外对于此类患者接受髋关节置换的效果尚不清楚。目的:探讨系统性红斑狼疮合并股骨头缺血性坏死行全髋关节置换的临床效果。方法:回顾性分析本科1998-06/2008-06行全髋关节置换的系统性红斑狼疮合并股骨头缺血性骨坏死患者临床资料。共6例(共6髋)获得随访,其中男1例,女5例,年龄46(28～67)岁,5髋使用生物固定型假体,1髋使用骨水泥型假体。治疗效果评估选用WOMAC骨关节炎指数,SF-36和Harris评分标准。结果与结论:平均手术时间为141(85～210)min,平均出血量为522(180～1500)mL;平均随访时间3.5(1～10)年,1例于术后1.5年死于颅内出血。术后早期出现1例泌尿系统感染,其他病例在随访期间无假体感染、松动、脱位及深静脉血栓等并发症出现。随访时Harris评分、WOMAC骨性关节炎指数、SF-36评分均较术前明显改善(P<0.05)。结果提示全髋关节置换可明显提高系统性红斑狼疮合并股骨头缺血性坏死患者的生活质量,中期临床效果良好。

BACKGROUND：Total hip arthroplasty （THA） is the major method for treating hip joint disease at terminal stage with a precise effect. However,avascular necrosis of the femoral head （AVNFH） patients with systemic lupus erythematosus （SLE） are often complicated with severe osteoporosis or other disease. The effect of THA for these patients remains unclear. OBJECTIVE：To explore the clinical outcome of THA for AVNFH in patients with SLE. METHODS：A retrospective study was conducted for SLE patients with AVNFH from June 1998 to June 2008. A total of 6 patient were followed up （6 hips）,including 1 male and 5 females,aged 46 years old （range 28 to 67 years）,5 bio-typed and 1 bone-cemented type. The treatment effects were evaluated using Western Ontario and McMaster Universities Osteoarthritis Inde （WOMAC）,Medical Outcome Survey Short Form 36 （SF-36） and Harris hip score. RESULTS AND CONCLUSION：The mean operation time was 141 minutes （85 to 210 minutes）,bleeding 522 mL （180 to 1 500 mL An average follow-up of 3.5 years （range from 1 to 10 years） were assessed. One patient died of hypertension 1.5 years after surgery,and 1 case developed urinary system infection early following postoperation. No infection,loosening,dislocation or dee venous thrombosis was observed. The average Harris Hip score,WOMAC scores and SF-36 were significantly improved compared with preoperative scores （P 0.05）. THA significantly improves quality of life of patients with SLE and AVNFH with good mid-term results after THA.