同期或分期全髋关节置换治疗僵直髋的早期疗效分析

An analysis of early curative results of simultaneous versus staged total hip arthroplasty for hip joint ankylosis

目的分析双髋僵直或强直的患者双侧全髋关节置换(total hip arthroplasty,THA)间隔时间对术后关节功能的影响。方法回顾分析2008年4月至2010年5月,31例双髋僵硬或强直患者不同手术间隔时间进行双侧THA的效果。将纳入的31例分为:A组:同期手术;B组:一个住院周期分期手术;C组:两个住院周期分期手术3个组。比较患者THA术后1个月、3个月及1年双髋关节活动度的差异以及术后1年患者Harris评分的差异。结果 A组和B组术后1个月、3个月和1年先置换侧和后置换侧的髋关节的活动度差异无统计学意义,但C组关节活动度术后1个月,先置换侧(171±19.5)小于后置换侧(217±26.3),差异有统计学意义(t=-39.752,P<0.001);术后3个月先置换侧(177±26.6)小于后置换侧(235±23.2),差异有统计学意义(t=-51.375,P<0.001);术后1年先置换侧小于(192±20.9),后置换侧(236±25.1),差异有统计学意义(t=-35.437,P<0.001)。A组和B组术后1个月、3个月及1年的髋关节活动度差异无统计学意义。C组后置换侧的髋关节活动度在术后1个月、3个月及1年与A组和B组差异无统计学意义,而先置换侧的髋关节活动度术后1个月:C组(171±19.5)小于A组(221±24.1)和B组(225±19.8);术后3个月:C组(177±26.6)小于A组(244±20.2)和B组(239±22.3);术后1年C组(192±20.9)小于A组(242±22.8)和B组(242±22.8)。3组患者术后1年的Harris评分较术前均有明显提高。A组、B组和C组后置换侧术后1年的Harris评分差异无统计学意义。Harris评分:C组先置换侧(80.3±9.8)明显低于A组(91.4±7.9)、B组(93.5±9.1)和C组后置换侧(90.8±7.3)。结论对于双髋僵硬或强直的患者,为获得术后关节活动度和关节功能最大程度的恢复,双侧THA手术间隔时间应在确保患者安全的条件下尽量缩短。

Objective To analyze the impact of interval time of bilateral total hip arthroplasty （ THA ） on the postoperative joint function in the patients with bilateral hip joint ankylosis.Methods From April 2008 to May 2010, 31 patients with bilateral hip joint ankylosis underwent bilateral THA at different time intervals, whose clinical data were retrospectively analyzed. The patients were divided into 3 groups. In group A, simultaneous surgery was performed. In group B, staged surgery was performed, but within a single hospitalization period. In group C, surgery was performed in 2 hospitalization periods. The differences in bilateral hip joint range of motion （ ROM ） were compared among the 3 groups at 1 month, 3 months and 1 year after the surgery. The Harris scores at 1 year after the surgery were recorded.Results There were no statistically signiifcant differences in the hip joint ROM between the prior side and the lateral side in group A and group B at 1 month, 3 months and 1 year after the surgery. But statistically signiifcant differences existed in the hip joint ROM in group C between the prior side （ 171±19.5 ） and the lateral side （ 217±26.3 ） at 1 month after the surgery （t=-39.752,P〈0.001 ） and also between the prior side （ 177±26.6 ） and the lateral side （ 235±23.2 ） at 3 months after the surgery （t=-51.375,P〈0.001 ）. There were statistically signiifcant differences in the hip joint ROM in group C between the prior side （ 192±20.9 ） and the lateral side （ 236±25.1 ） at 1 year after the surgery （t=-35.437,P〈0.001 ）. No statistically signiifcant differences existed in the hip joint ROM between group A and group B at 1 month, 3 months and 1 year after the surgery. There were no statistically signiifcant differences in the hip joint ROM of the lateral side in group C at 1 month, 3 months and 1 year after the surgery when compared with that in group A and group B. The hip joint ROM of the prior side at 1 month after the surgery was （ 171±19.5 ） in group C, which was smaller than （ 221±24.1 ） in group A and （ 225±19.8 ） in group B. The hip joint ROM of the prior side at 3 months after the surgery was （ 177±26.6 ） in group C, which was smaller than （ 244±20.2 ） in group A and （ 239±22.3 ） in group B. The hip joint ROM of the prior side at 1 year after the surgery was （ 192±20.9 ） in group C, which was smaller than （ 242±22.8 ） in group A and （ 242±22.8 ） in group B. In all 3 groups, the Harris scores at 1 year after the surgery was significantly higher than the preoperative scores. No statistically significant differences existed in the Harris score of the lateral side in 3 groups at 1 year after the surgery. The Harris score of the prior side in group C was （ 80.3±9.8 ）, which was obviously lower than （ 91.4±7.9 ） in group A, （ 93.5±9.1 ） in group B and （ 90.8±7.3 ） on the lateral side in group C.Conclusions To acquire optimal recovery of joint ROM and function, the interval time of bilateral THA should be shortened as much as possible in the patients with bilateral hip joint ankylosis.