手术治疗强直性脊柱炎脊柱后凸伴髋关节强直并重度屈曲挛缩的效果观察

The surgical treatment of kyphosis and severe hip flexion contracture in patients with ankylosing spondylitis

目的探讨强直性脊柱炎脊柱后凸伴髋关节强直并重度屈曲挛缩的手术治疗效果。方法 2010~2014年收治的43例强直性脊柱炎脊柱后凸伴髋关节强直并屈曲挛缩患者,均先行脊柱截骨矫形手术,4~6周后行髋关节松解手术,术后胫骨结节牵引至髋关节屈曲挛缩角度小于30°时,行全髋关节置换术。比较术前、术后Cobb＇s角,评估脊柱矫形效果;对比术前、术后髋关节屈曲挛缩角度,并行Harris评分,评估髋关节功能。结果 43例患者脊柱后凸及髋关节屈曲挛缩均得到较好纠正,术后Cobb＇s角（26±2.1）°,髋关节屈曲挛缩角度（7.5±1.4）°,髋关节Harris评分（93.5±1.7）分,各项指标明显优于术前（P〈0.05）。全部患者术后均无脊髓损伤症状出现,7例患者在牵引过程中出现股神经牵拉症状。结论采用一期手术行脊柱截骨矫形,二期行髋关节松解并胫骨结节牵引,三期行全髋关节置换术治疗强直性脊柱炎脊柱后凸伴髋关节强直并重度屈曲挛缩,手术疗效满意,并发症少。

Objective To discuss the surgical treatment of kyphosis and severe hip flexion contracture in patients with ankylosing spondylitis（AS）. Methods During 2008 to 2012,43 AS patients with kyphosis and hip flexion contracture were treated in our department. Firstly, all patients were accepted orthopaedic spinal operations. Secondly,4 to 6 weeks later, hip joint loosening was actualized,and then, tibial tubercle traction was implemented. After operation, if the angle of tibial tubercle traction to hip flexion was less than 30° ,we took the total hip replacement. The Cobb＇s angles and hip flexion angles were compared before and after operation. Harris score was used to evaluate the hip function. Results All the 43 patients of kyphosis and hip flexion contracture were well cured. After operation, the Cobb＇s angle was （26 ＋ 2. 1 ）. The hip flexion angle was （7.5 ~ 1.4）. The Harris score was （93.5 ~ 1.7 ） points. Each in- dex was significantly improved（P 〈 0. 05 ）. All patients had no symptoms of spinal cord injury and femoral nerve injury symptoms except that there were 7 cases with femoral nerve pull symptoms during the tibial tubercle traction. Conclusion It has a satisfying effect and less complications with the first stage operation for spinal osteotomy, the second stage operation for hip joint loosening and tibial tubercle traction and the third stage operation for total hip replacement in the treatment of kyphosis and severe hip flexion contracture for patients with AS.