髋关节强直人工关节置换术治疗分析

Experience of hip artificial joint replacement in the treatment of ankylosis of hip joint

目的探讨髋关节强直人工关节置换手术的临床疗效和技术要点。方法回顾性分析自2010年7月至2013年6月在北京市通州区中西医结合医院住院的19例髋关节强直患者经过人工关节置换手术后的临床资料。其中强直性脊柱炎髋关节融合15例，先天性髋臼发育不良伴骨性关节炎3例，股骨头缺血性坏死1例。患病时间5～40年。其中15例髋关节完全强直，各方向均没有活动度，强直体位在双髋内收、屈髋10°～45°位。对术前、术中、术后的处理进行总结，提出预防和解决方法。结果本组19例均获得随访，随访时间6个月至3．5年，平均（2．5±0．5）年。患者手术后切口均为Ⅰ期愈合。无神经、血管损伤，肺栓塞、急性心功能不全、急性肾功能不全、肺内感染、深静脉血栓等早期并发症。在随访期间无髋关节脱位，假体松动或下沉，无术后迟发性感染，髋关节活动度比术前明显增加。有3例发生异位骨化，占15．8％。结论 人工关节置换是治疗髋关节强直的理想方法，能明显改善关节功能，提高生活质量。手术技术直接影响术后效果，髋臼的处理是术中难点。髋关节外侧入路操作简便，出血少，能有效预防人工关节置换术后髋关节脱位。

Objective To investigate the clinical curative effect and the technique of hip artificial joint re- placement in the treatment of ankylosis of hip joint. Methods A retrospective data of 19 patients with hip joint ankylosis operated by artificial joint replacement was reviewed between July 2010 and June 2013 in our hospital. The hipfusion due to ankylosing spondylitis was in 15 cases ; congenital acetabular dysplasia and osteoarthritis were in 3 cases; ischemic necrosis of femoral head was in 1 case. The history of all the cases was 5-40 years in which 15 cases of hip joint was complete rigidity and no activity with hip 10° -45° of adduction and flexion. The preoperative, intraoperative and postoperative data were summarized. Results Totally 19 cases were all followed up and the follow-up time was 0. 5 -3.5 years. All the patients had no complications after operation, such as nerve, vascular injury, acute pulmonary embolism, acute renal and heart failure, pulmonary infection and deep vein thrombo- sis. During the follow-up period, all the patients had no dislocation, loosening prosthesis and delayed infection. The postoperative activity of hip joint was significantly improved after operation. There were 3 cases （ 15.8% ） of heterotopic ossification. Conclusions Artificial joint replacement is an ideal method in the treatment of hip joint ankylosis, which can significantly improve the joint function and the quality of life. Intraoperative technology di- rectly affects the effect after operation. The lateral approach of hip joint has a lot of advantages and can effectively prevent the dislocation after artificial joint replacement.