系统性红斑狼疮合并股骨头坏死全髋关节置换术的围手术期治疗

Perioperative treatment of total hip replacement for femoral head necrosis in systemic lupus erythematosus

目的探讨因系统性红斑狼疮（SLE）服用皮质类固醇糖皮质激素治疗导致股骨头缺血性坏死（ANFH）行全髋关节置换术（THA）患者的围手术期治疗,手术安全性和初步临床疗效。方法2010年3月到2015年1月,56例（72髋）SLE并发ANFH患者行THA手术,患者年龄20岁到47岁,平均32.6岁。围手术期予以补充激素治疗,规范预防感染、深静脉血栓和抗骨质疏松治疗。回顾性总结术后髋关节功能评价及并发症情况。结果 40例患者行单侧髋关节置换,16例（32髋）分二期行髋关节置换。1例术后2年发现切口感染,其余均Ⅰ级愈合,临床症状及髋关节活动度均得到明显改善。5例术后第2~3天出现不明原因的低血糖、脱水和呕吐,考虑发生肾上腺皮质危象。随访3~48个月,平均24个月。随访期末：Harris髋关节功能评分平均（82.5±8.2）分,SF-36平均（67.2±6.9）分,与术前比较改善明显（P〈0.05）。结论 SLE患者行THA治疗激素导致ANFH,如果做好围手术期治疗,手术安全、有效。

Objective To evaluate the perioperative treatment in total hip replacement for ischemic necrosis of femoral head caused by corticosteroids in the patients with systemic lupus erythematosus. Methods From March 2010 to January 2015,56 patients（ 72 hips） of systemic lupus erythematosus with ischemic necrosis of the femoral head underwent total hip arthroplasty,as well as hormone replacement therapy and preventive treatments for infection,deep vein thrombosis and osteoporosis during the perioperative period. The ages of the patients were 20 to 47 years,32. 6 years in average. The postoperative hip function and complications were retrospectively analysized. Results All the patients received follow-up from three months to 48 months（ average 24 months）. Forty cases underwent single-hip（ 40 hips） arthroplasty,16 cases underwent bilateral-hip（ 32 hips） arthroplasty. One case was found incision infection two years after the surgery,the other cases were primary healing. Clinical symptoms and hip joint activities had been significantly improved. Unexplained hypoglycemia,vomiting and dehydration occurred in five cases on the 2ndday and 3rdday after the surgery,which were considered as adrenal crisis.At the final follow-up,the Harris hip score was（ 82. 5 ± 8. 2） and SF-36 score was（ 67. 2 ± 6. 9）,which were significantly improved comparing with the preoperative data（ P〈0. 05）. Conclusion With proper peri-operative treatment,total hip arthroplasty is safe and effective for ischemic necrosis of femoral head caused by hormone therapy in patients with systemic lupus erythematosus.