人工全髋关节置换治疗强直性脊柱炎髋关节强直畸形

Total hip arthroplasty for the treatment of ankylosing spondylitis-caused hip ankylosis deformity

背景:目前,人工全髋关节置换是治疗髋关节强直畸形髋关节晚期病变的最佳方案,但置换假体松动一直是置换后棘手的问题,主要与假体的界面应力和假体界面结合强度两方面有关。目的:总结对强直性脊柱炎髋关节强直畸形患者行人工全髋关节置换的方法及疗效和并发症发生的机制。方法:电子检索CNKI数据库、万方医学数据库等中文数据库和Pub Med,Springer Link等英文数据库1980/2011-12收录的人工全髋关节置换治疗髋关节强直畸形的临床病例研究和相关综述,关键词设定为:髋关节、强直畸形、人工全髋关节置换、假体松动、并发症等,分析人工全髋关节置换治疗髋关节强直畸形的研究进展及髋关节植入后相关并发症的研究进展。结果与结论:根据患者自身状况进行置换前后评估,选择合适型号、准备不同规格的假体对髋关节强直畸形疗效有促进作用。强直性脊柱炎晚期髋关节骨性强直年轻患者骨增生活跃,新骨可较多地长入假体表面微孔中,因此非骨水泥型假体显示了独特的优势。随着生物型假体设计的进步,尤其具有各种涂层和金属微孔表面人工全髋关节具有多部位负重和紧密匹配的特点,也使其初期的固定较以往的假体更加可靠。近年来该方法取得了很大的进展,但置换后假体的松动以及假体周围关节感染仍困扰着骨科医生和患者。

BACKGROUND： To data, total hip arthroplasty is the best treatment method of advanced disease of hip tonic deformity but the prosthesis loosening has been a thorny issue after replacement, which mainly related with the stress at the interface of the prosthesis and bonding strength of prosthesis interface. OBJECTIVE： To summarize the effect and the mechanism of total hip arthrplasty for the treatment of ankylosing spondylitis-caused hip ankylosis deformity. METHODS： A computer-based online search was performed in CNKI database, Wangfang database, PubMed database and Springer Link database for the articles on the treatment of ankylosing spondylitis caused hip ankylosis deformity with total hip arthroplasty that published between 1980 and December 2011. The clinical cases and the relevant reviews were concluded. The key words of ＂hip joint, hip ankylosis deformity, total hip arthroplasty, prosthesis loosening, complications＂ were used to analyze the research progress of ankylosing spondylitis caused hip ankylosis deformity treated with total hip arthroplasty and the relevant complications after hip implantation. RESULTS AND CONCLUSION： The assessment before and after replacement was performed based on the patient＇s own situation, choose the right model, prepare the prosthesis with different specifications and to analyze the promotion effect on the treatment of ankylosing spondylitis caused hip ankylosis deformity. Young patients with advanced ankylosing spondylitis caused hip ankylosis deformity have bone hyperplasia and the new bone can grows into the surface micropores of prosthesis, so the uncemented prosthesis shows unique advantages. With the advances in biological prosthesis design, especially the artificial hip joint with various coatings and metal microporous surface has the characteristics of multi-site weight-bearing and closely matching, and also make it more reliable than other prosthesis over past during the initial fixation. A great progress has made recent years, but the prosthesis loosening and periprosthetic joint infection after replacement is still plague the orthopedic surgeons and patients.