强直性脊柱炎伴髋关节屈曲挛缩畸形行非骨水泥型全髋关节置换术疗效分析

Cementless total hip arthroplasty in ankylosing spondylitis combined with flexion contracture deformity

目的 探究强直性脊柱炎合并髋关节屈曲挛缩畸形患者行非骨水泥型全髋人工关节置换术的手术策略和临床疗效.方法 回顾2011年8月-2012年7月解放军总医院门诊收治入院的41例（82髋）临床确诊强直性脊柱炎合并髋关节屈曲挛缩畸形并行非骨水泥型全髋关节置换术的患者资料,平均随访时间24.6（21 ～ 32）个月.对比手术前后关节疼痛、关节畸形、活动度及关节功能改善状况,依据Harris评分评价髋关节术后功能状况.结果 术后髋关节屈曲挛缩畸形术前平均72.4°（64.8°～ 81.5°）,术后平均20.7°（8.6°～36.4°）（P＜0.01）;总活动度术前平均2.7°（0°～5.8°）,术后平均84.5°（78.7°～104.5°）（P＜0.01）;Harris评分术前平均25.7分,术后平均78.1分（P＜0.01）.末次随访（2014年4月18日）拍摄X线片,未见假体周围透亮区及关节脱位.结论 非骨水泥型全髋关节置换术是强直性脊柱炎合并髋关节屈曲挛缩畸形患者减轻疼痛并重建关节功能的有效方法.

Objective To investigate the clinical efficacy and surgical strategy of cementless total hip arthroplasty （THA） in patients with ankylosing spondylitis （AS） combined with flexion contracture deformity.Methods Eighty-two hip-joint lesions in 41 patients who admitted to our hospital from August 2011 to July 2012 were performed cementless THA.The average follow-up period was 24.6 months （range 21-32 months）.The degree of pain,deformity,motion and function of hip-joint were compared before and after surgery.The function of hip-joint was evaluated by Harris scoring system.Results The preoperative flexion contracture deformity of hip-joints was improved from 72.4° （64.8°-81.5°） to 20.7° （8.6°-36.4°） （P ＜ 0.01） after surgery.The motion and score of hipjoints before surgery were improved from 2.7° （0°-5.8°） to 84.5° （78.7°-104.5°） （P ＜ 0.01）,25.7 to 78.1 （P ＜ 0.01） after surgery,respectively.No looseness and dislocation of the prosthesis was showed on final follow-up X-Ray examination.Conclusion Cementless THA is the most effective treatment strategy to relieve pain and restore function for hip-joint lesions due to AS.