脊柱矫形对强直性脊柱炎胸腰段后凸畸形患者髋关节相关活动能力及生活质量的影响

Changes of activities and qualities of life related to hip joints after spinal correction of thoracolumbar kyphosis in ankylosing spondylitis

目的:观察脊柱矫形术对强直性脊柱炎(ankylosing spondylitis,AS)胸腰段后凸畸形患者髋关节相关活动能力及生活质量的影响,为脊柱矫形术及全髋关节置换术(total hip replacement,THR)的合理设计提供理论依据。方法:选取我科随访资料齐全的37例AS胸腰段后凸畸形患者,根据患者髋关节是否受累将其分为2组:A组,患者自述髋关节无痛、屈伸活动不受限制且客观查体屈伸活动良好(≥120°);B组,患者自述髋关节疼痛或活动受限或客观查体屈伸活动受限(<120°)或行THR。将B组患者再分为三组:B1组,髋关节活动轻度受限,无需行THR;B2组,髋关节活动明显受限,脊柱矫形术后行THR;B3组,髋关节活动明显受限,THR后行脊柱矫形术。收集患者SRS-22、BASFI评分表、Harris评分表功能部分,分析组间及组内异同,并分别对其进行分析总结;收集患者因髋关节运动受限所致生活不便主诉及是否严重影响正常生活。结果:矫形前,A组SRS-22功能评分、BASFI平均分、Harris功能评分分别为2.8±0.7、3.8±1.4、40.8±4.7分,矫形后分别为4.1±0.6、2.1±1.3、43.6±2.6分;矫形前B组分别为2.4±0.6、6±1.5、30.7±8.1分,矫形后分别为3.5±0.6、4.5±1.1、37.2±4.2分。脊柱矫形术使A、B两组患者整体活动能力及生活质量不同程度提高,尤其直立相关活动能力(站立、行走、够高物等)明显改善,而屈曲相关活动能力(穿袜、弯腰捡物等)有所下降;矫形前后A组患者活动能力均优于B组。B1组患者脊柱矫形术后活动能力低于预期;B2组患者主诉脊柱矫形术后活动能力下降,但行THR后恢复并提高;B3组患者主诉THR后活动能力不同程度提高,脊柱矫形后再次提高,但部分患者坐立困难。结论:脊柱矫形术会改变AS患者髋关节有效运动范围,充分认识此点,是AS后凸畸形伴髋关节受累患者成功实施脊柱矫形术及全髋置换术的关键。

Objectives：To investigate clinical effects of spinal osteotomy for ankylosing spondylitis（AS）thoracolumbar kyphosis with hip involvement.Methods：37 AS thoracolumbar kyphotic patients were studied and were divided into 2 groups according to hip involvement[group A,patients without hip pain and range of flexion-extension motion ≥120°; group B,patients with hip pain or range of flexion-extension motion 120°or with total hip replacement（THR）].Moreover,patients with hip involvement were divided into 3 groups（group B1,patients with no need for THR; group B2,patients with spinal correction before THR; group B3,patients with THR before spinal correction）.Chief complaint at post-operation of each patient and whether it leaded to poor life were studied; SRS-22,BASFI and Harris were used to assess the quality of life of patients at pre- and post-operation.Results：Pre-operative SRS-22 function,average BASFI,and Harris function values in group A were 2.8±0.7,3.8±1.4 and 40.8±4.7 respectively,and the post-operative values were 4.1 ±0.6,2.1±1.3 and 43.6±2.6 respectively.Pre-operative values in group B were 2.4±0.6,6±1.5 and 30.7±8.1 respectively,and the post-operative values were 3.5 ±0.6,4.5±1.1 and 37.2±4.2 respectively.Both group A and group B had better activities after spinal surgery to some degrees,especially activities such as standing and walking,though some other activities（squating,putting on socks et al）became worse.Group A had better activities than group B at pre- and post-operation.Clinical results associated with hip activities were not as good as expected in group B1; patients in group B2 had poor activities after spinal correction,but good results were obtained after subsequent THR; patients in group B3 with THR firstly had improved activities after the surgery,and better results were abtained after subsequent spinal correction.However,some patients in group B3 had difficulty to sit.Conclusions：Spinal correction changes the useful range of hip flexion-extension motion in AS thoracolumbar kyphotic patients.It is significant for both spinal correction and THR.