人工全髋关节置换术治疗强直性脊柱炎髋关节病变的临床疗效

Therapeutic Effect of Artificial Total Hip Arthroplasty for the Treatment of the Hip Lesions in the Patients with Ankylosing Spondylitis

目的观察人工全髋关节置换治疗强直性脊柱炎髋关节病变的手术方法和临床效果。方法对2001年3月至2009年6月26例(31髋)强直性脊柱炎髋关节病变患者行人工全髋关节置换并随访,置换前患者日常活动均明显受限或者严重疼痛,Harris评分平均(43.2±5.8)分,髋关节活动度平均51.8°±9.7°。记录术后末次随访的Harris评分,X线检查结果,观察假体有无松动、脱位及异位骨化。结果所有病例得到随访,平均随访24.9(8～125)个月。末次随访患者均疼痛消失,步态正常。Harris评分平均(82.4±4.7)分;髋关节活动度平均148.6°±7.4°;髋关节Harris评分及关节活动度均显著高于置换前(P<0.05)。2髋出现异位骨化,为Brooker分级Ⅰ、Ⅲ级。无脱位、骨折及假体松动下沉,无患者进行翻修。结论人工全髋关节置换是治疗强直性脊柱炎晚期髋关节病变的有效方法,可以恢复关节功能,缓解关节疼痛并改善患者生活质量。

Objective To investigate the operative methods and clinical outcomes of total hip arthroplasty（THA） in the treatment of patients with hip lesions due to ankylosing spondylitis（AS）.Methods From March 2001 to June 2009,26 patients（31 hips） with AS received THA.All the hips were severe pain and ankylosed in average 51.8°±9.7° of flexion.Preoperative Harris hip score was（43.2±5.8） points.Radiographic examination and last Harris score were performed completely at the last time of follow-up.Results All the patients were followed up for average 24.9（8~125） month.Postoperatively,all patient get pain free and normal gait.According to Brooker system,2 hips appeared heterotopic ossification,one was of Brooker＇s Class Ⅰ and the other Class Ⅲ.No loosening or subsidence occurred in all patients.Harris hip score at final follow-up was（82.4±4.7） points（P〈0.05）,range of motion of hip were average 148.6°±7.4°（P〈0.05）.Conclusion THA is effective for the treatment of patients with hip lesions caused by AS.