全髋关节置换术治疗强直性脊柱炎并髋关节强直的临床疗效分析

Clinical effect of total hip replacement in the treatment of ankylosing spondylitis and hip joint stiffness

目的探讨人工全髋关节置换术治疗强直性脊柱炎并髋关节强直的技术要点及临床疗效。方法2011-03~2014-03对确诊为强直性脊柱炎并髋关节强直的患者17例（32髋）行人工全髋关节置换术,平均随访25.4（13~35）个月,对比手术前、后及末次随访时关节疼痛、关节屈曲畸形矫正度、关节总活动度及Harris评分改善情况。结果术前14例患者（27髋）髋关节呈屈曲挛缩畸形平均（35.42±3.15）°,术后平均（4.63±2.12）°,术后较术前明显改善（P〈0.01）;术前关节总活动度（屈曲＋后伸＋内收＋外展＋内旋＋外旋）平均（5.81±3.32）°,术后平均（152.47±3.76）°,术后较术前明显改善（P〈0.01）;术前Harris评分平均（27.73±6.41）分,术后平均（82.31±6.58）分,术后较术前明显改善（P〈0.01）;术前患者重度疼痛3例,中度疼痛6例,轻度疼痛8例,术后轻度疼痛7例,无中重度疼痛;无坐骨神经损伤、骨折、感染并发症出现,术后1例患者出现髋关节前脱位,给予手法复位、皮肤牵引后未再脱位。结论全髋关节置换术治疗强直性脊柱炎并髋关节强直能迅速解除患者疼痛,改善关节功能,恢复生活自理能力,是一种安全、有效的治疗方法。

Objective To explore the technical points and clinical effects of total hip replacement in the treatment of ankylosing spondylitis and hip joint stiffness. Methods Total hip arthroplasty was performed in 17 patients（ 32 hips） with ankylosing spondylitis and hip joint stiffness from March 2011 to March 2014. The mean follow-up was 25. 4 months（ from 13 months to 35 months）. The improvement of knee joint pain,joint flexion deformity correction,joint activity score and Harris score were compared before and after the surgery,and at the end of the followup. Results The average flexion contracture deformities of the hips in 14 patients（ 27 hips） were（ 35. 42 ± 3. 15） °and（ 4. 63 ± 2. 12） ° before and after the surgery respectively with a significant difference（ P〈0. 01）. The average total ranges of motions（ including flexion,extension,pronation,abduction,adduction and external rotation） were（ 5. 81 ± 3. 32） ° and（ 152. 47 ± 3. 76） ° before and after the surgery respectively with a significant difference（ P〈0. 01）. The average Harris scores were（ 27. 73 ± 6. 41） and（ 82. 31 ± 6. 58） before and after the surgery respectively with a significant difference（ P〈0. 01）. Severe pain was found in 3 cases,moderate pain in 6 cases,mild pain in8 cases before the surgery and mild postoperative pain in 7 cases,no case with severe pain after the surgery. No fracture,infection and sciatic nerve injury occurred. Conclusion Total hip replacement can quickly relieve pain,improve joint function and make the patients regain the ability to take care of themselves in the treatment of ankylosing spondylitis and hip joint stiffness.