表面置换治疗中青年强直性脊柱炎伴髋关节炎初步经验

Preliminary experience of hip resurfacing arthroplasty for coxarthria with ankylosing spondylitis in young and middle-aged adults

目的总结髋关节表面置换术(HRA)治疗中青年强直性脊柱炎(AS)伴髋关节炎的初步经验。方法 2008年4月至2009年12月期间采用HRA治疗AS伴髋关节炎患者共9例(11髋),术前常规行X线、双髋CT等检查,并模板测量髋臼侧假体和股骨头侧假体大小(按15%放大率)。记录手术时间、术中出血量,评价术后X线片、术前及术后髋关节活动度、Harris评分。结果手术时间平均96 min(80～110 min),术中出血量平均300 ml(200～370 ml)。患者术后住院期间均无伤口感染、神经血管损伤、假体脱位和下肢深静脉血栓形成等并发症发生。9例患者均成功随访,随访时间为6～21.5个月,平均随访12.3个月,Harris评分由术前平均33.8±4.2改善为术后末次随访时平均82.3±2.4(P<0.05)。术后摄片显示假体在位,无脱位、异位骨化等并发症。结论 HRA治疗中青年AS伴髋关节炎可以保留更多骨量,明显增加髋关节活动度,提高生活质量。

Objective To investigate the preliminary experience of the hip resurfacing arthroplasty（HRA）for coxarthria with ankylosing spondylitis in young and middle-aged adults.Methods From April 2008 to December 2009,9 patients（11 hips） suffering from ankylosing spondylitis with coxarthria underwent HRA.The preoperative X-ray and CT scan of the patients were taken,and the prosthesis measured（15%multiplying power）.The operation time,blood loss.Harris score,range of motion of the hip joint were noted.And preoperative and postoperative X-ray in all patients were compared to evaluate the clinical effects. Results The mean operation time was 96 min（80 min to 110 min）and the mean blood loss was 300 ml（200 ml to 370 ml）.No wound infection,nerve or vascular injury,joint dislocation or DVT occured during the hospital stay.The follow-up of all patients were among 6 months to 21.5 months（mean 12.3 months）.Harris score increased from 33.8±4.2 preoperatively to 82.3±2.4 postoperatively（P〈0.05）.The X-ray showed no dislocation or ectopic ossification.Conclusions More bone mass could be reserved in HRA for coxarthria with ankylosing spondylitis in young and middle-aged adults,which may increase the range of motion of hip joint obviously,and improve patients＇ life quality.