微创人工关节置换治疗髋关节强直

Minimally invasive total hip arthroplasty on hip ankylosis

目的探讨微创全人工关节置换治疗髋关节强直的疗效。方法 2006年6月至2009年7月,13例(21髋)髋关节强直患者在微创入路下行人工全髋关节置换,年龄20～66岁(平均46岁),病因为:强直性脊柱炎5例(10髋),类风湿性关节炎4例(6髋),股骨头无菌性坏死继发严重骨性关节炎2例(3髋),髋关节感染后遗强直畸形2例(2髋)。患者患髋均无活动度,均选用生物型人工关节,13髋为解剖头金属对金属界面,8髋为陶瓷对陶瓷界面。结果手术顺利,手术时间(80±12)min(最短60 min),术中出血量(380±156)ml。所有患者术后获得随访,随访时间12～48个月,术后X线评价人工关节位置良好,术中无骨折,术后无假体松动、关节脱位、感染及深静脉栓塞等并发症。Harris评分由术前(45.6±6.2)分升到术后至最后1次随访(86.6±7.3)分,差异有统计学意义(P<0.05)。结论对于外展肌功能存在的髋关节强直患者行微创人工关节置换,能有效改善髋关节功能,提高患者生活质量,创伤小,恢复快。

Objective To discuss the technique and therapeutic effect of minimally invasive total hip arthroplasty on hip ankylosis.Methods From June 2006 to July 2009,13 patients（21 hips） with hip ankylosis,aged from 20 to 66（mean=46）,received minimally invasive total hip arthroplasty.The causes of hip ankylosis included ankylosing spondylitis（10 hips of 5 patients）,rheumatoid arthritis（6 hips of 4 patients）,severe osteoarthritis secondary to aseptic necrosis of femoral head（3 hips of 2 patients）,and ankylosing deformity after hip joint infection（2 hips of 2 patients）.The abducent muscle of all patients had the contractile function.The implants consisted of metal-on-metal hip implants（13 artificial hip joints） and ceramic-on-ceramic hip implants（8 artificial hip joints）.Results All the surgeries were successful,with surgical time of 80±12 min（minimum=60 min） and blood loss of 380±156 ml.Follow-ups of the patients were carried out for 12-48 months,and the X-ray results showed good artificial hip joint locations.There was no fracture during the surgeries.There was no implant dislocation,incision infection,deep venous thrombosis or other complications after the surgeries.The Harris scores before and after the surgeries were 45.6±6.2 and 86.6±7.3 points,respectively,exhibiting a statistically significant difference（P0.05）.Conclusion Minimally invasive total hip arthroplasty on hip ankylosis can effectively improve the function of hip joints,enhance the quality of life,reduce the wounds,and accelerate the recovery.