全髋关节置换术治疗强直性脊柱炎髋关节强直的中期疗效随访

Medium term follow up outcomes of total hip arthroplasty for patients with ankylosing spondylitis

目的：对全髋关节置换治疗强直性脊柱炎髋关节强直的中期疗效进行回顾性研究。方法：自2000年1月至2008年12月，采用全陶界面全髋置换术治疗67例88髋强直性脊柱炎髋关节强直患者，共获得有效随访55例74髋，男30例，女25例；年龄19～58岁，平均32，6岁。其中应用全生物型假体6l髋，混合型假体13髋。进行最少5年以上随访，平均随访时间（75．2＋8．6）个月。对有效随访的患者进行临床和影像学检查评估疗效。结果：髋关节Harris评分由术前30．8±7．0提高至末次随访时85．2±5．5；髋关节总活动度（屈伸、内收、外展、内旋、外旋等6个方向总和）由术前（21．2±8．5）。提高至术后（142．0±10．2）°。以翻修为终点的5年假体生存率为95．9％。1例因外伤致陶瓷内衬破裂而翻修，1例因术后感染翻修，1例因股骨柄假体周围骨折而翻修。1例术后脱位，经保守治疗成功；3例术后关节异响，非手术治疗后消失。7例术后异位骨化，无临床症状未处理；2例术后大腿疼痛，保守治疗好转。其余病例无论骨水泥或非骨水泥假体，假体周围无骨溶解，股骨侧和髋臼侧假体均无松动和下沉。结论：全髋关节置换是治疗强直性脊柱炎强直髋的一种有效而可靠的方法，其中期随访结果满意。

To retrospectively study medium-term follow-up outcomes of total hip arthroplasty （THA） for pa tients with ankylosing spondylitis （AS）. Methods：From January 2000 to December 2008,67 patients （ 88 hip joints） with AS were treated with all ceramic interface THA. And 55 patients （74 hips） were finally followed up. Among them,there were 30 males and 25 females, with an average age of 32.6 （ranged 19 to 58） years old. Sixty-one hips were treated with biological pros- thesis and 13 hips were treated with hybrid prosthesis. Fifty-five patients were followed up at least 5 years, with an average of （75.2_＋8.6） months. Clinical symptoms and radiography information were evaluated after follow-up. Results： Harris hip score were significantly improved from 30.8＋7.0 preoperatively to 85.2±5.5 at the last follow-up （P〈0.01）. The hip movement range increased from （21.2±8.5）° preoperatively to （142.0±10.2）° postoperatively （P〈0.01）. The 5-year survival of prosthesis was 95.9%. One patient were renovated because of internal wall broken caused by injury, 1 was renovated for infection, 1 was reno- vated for fracture arround femoral stem prostheses, and 1 was treated with conservative treatment by dislocation. Three cases with abnormal sound were cured with non-operation. 7 cases with heterotopic ossification were not treated, 2 cases with thigh pain received conservative treatment. Bone dissolve around prosthesis ,loose and sink of femur and acetabulum prosthesis were occurred in other cases. Concluslon：THA for the treatment of AS is a reliable method, which has a satisfied medium-term fol low-uo outcomes