人工全髋关节置换术治疗终末期血友病性关节炎的中期疗效观察

Midterm outcomes of total hip arthroplasty for patients with end-stage haemophilic arthropathy

背景：血友病性关节炎常累及多个关节,包括膝、踝和肘关节等,髋关节相对较少见,但其效果相对于其他髋关节疾病较差,骨结构异常、软组织挛缩、骨质较差以及术中术后出血是常见的影响因素。目的：评估THA治疗终末期血友病性髋关节病变的临床及影像学结果。方法：2002年5月至2012年6月行THA治疗21例（24髋）血友病性髋关节病变患者,20例为甲型血友病,1例为乙型血友病;年龄15~49岁,平均30.0岁。回顾性分析患者的一般资料、凝血因子水平、出血量和并发症情况,并随访髋关节Harris功能评分以及影像学结果。结果：随访12~133个月,平均66个月。平均总出血量、显性出血量和隐性出血量分别为3559 m（l1494~7576 ml）、1441 ml（600~3440 ml）和2118 m（l534~4402 ml）。术中出血量和术后引流量平均为721 m（l300~2000 ml）和720 m（l200~2950 ml）,平均输血量为5 U（0~14 U）。Harris评分由术前平均37分（15~81分）改善至末次随访时的平均93分（53~99分）。1例患者术中发生股骨近端劈裂骨折,1例发生深静脉血栓（DVT）。其他并发症包括皮肤溃疡合并血肿形成1例、一过性坐骨神经麻痹1例。所有假体均可见骨长入,无凝血因子抗体、感染、假体松动、骨溶解、应力遮挡、异位骨化和脱位等并发症。结论：THA治疗终末期血友病性髋关节病变的中期随访临床及影像学结果良好,其成功的关键在于娴熟的手术技术、有效的凝血因子替代、采用非骨水泥型假体以及相关科室的团体合作。

Background： Haemophilic arthritis usually affects multiple joints--most commonly, the knee, ankle and elbow. Less com- monly involved is the hip. The therapeutic effect of haemophilic hip is poorer than other hip arthropathies. Excessive periop- erative bleeding, abnormal bone anatomy, poor bone quality and soft tissue contractures are common trouble in total hip ar- throplasty （THA）. Objective： The goal of this study is to retrospectively evaluate the midterm clinical and radiological outcomes and complica- tions following THA for haemophilic arthropathy. Methods： From May 2002 to June 2012, 21 patients （24 hips） received primary THA due to haemophilic arthropathy in our hospital. Of them, 20 were diagnosed with haemophilia A and 1 with haemophilia B. The mean age of the patients at sur- gery was 30.0 years （range, 15-49 years）. Demographic data, hematological test results, blood loss and complications were recorded. Harris hip score and radiographic outcomes were followed up. Results： The mean duration of follow up was 66 months （12-133 months）. The amount of total blood loss, external blood loss and hidden blood loss were 3559 ml （1494-7576 ml）, 1441 ml （600-3440 ml） and 2118 ml （534-4402 ml）, respectively. The intraoper- ative blood loss and postoperative drainage were 721 ml （300-2000 ml） and 720 ml （200-2950 ml）, respectively. The amount of red blood cell transfusion was 5 U （0-14 U）. The average Harris score increased from 37 （ 15 - 81） preoperatively to 93 （53- 99） at the last follow up. Proximal femur splitting fracture happened in one patient intraoperatively and lower limb deep vein thrombo- sis in another patient postoperatively. Other complications included skin ulcer in one case, hematoma in one case, and transient neuropraxia in one case. Bony ingrowth was found in all the prostheses. No antibody of blood coagulation factor, infection, asep- tic loosening, osteolysis, stress shielding, heterotopic ossification, and dislocation appeared after surgery.Conclusions： Midterrn clinical and radiological results, in our study, are encouraging and comparable to previous reports. It may be related to experienced surgical technique, effective replacement of blood coagulation factor, application of non-bone cement prosthesis and team cooperation.