关节镜治疗强直性脊柱炎致髋关节早期病变的近中期疗效分析

Arthroscopic treatment for early stage hip joint disease caused by ankylosing spondylitis: an analysis of almost mid-term clinical efficacies

目的探讨对强直性脊柱炎(ankylosing spondylitis,AS)致髋关节早期病变的患者行关节镜下关节腔清理的临床疗效。方法研究对象为2010年11月至2014年4月于我院行关节镜手术治疗的24例AS致髋关节早期病变患者,其中男性21例,女性3例;年龄11～46(25. 2±5. 1)岁,AS病程2～17(6. 8±1. 5)年,髋关节受累时间6～32(21. 4±6. 8)个月。患者均行关节镜下关节腔清理与病变滑膜切除术,术后随访至少2年。分别于术前及术后2年采用Harris髋关节评分系统(Harris hip score system,HHS)和髋关节活动度评价患者的髋关节功能与髋关节活动度恢复情况,采取疼痛视觉模拟评分法(visual analogue scale,VAS)评价髋关节疼痛症状缓解情况,选用Westergren试管测定法检测血沉(ESR),运用化学发光法测定血清C反应蛋白(CRP)浓度。结果随访至少2年,24例患者ESR值由术前(46. 24±5. 36) mm/h降至术后的(20. 12±2. 84) mm/h,血清CRP水平亦由术前(32. 57±1. 24) mg/L减至术后的(14. 05±0. 86) mg/L(P <0. 001); HHS评分由术前的(61. 52±7. 24)分上升至术后的(88. 24±12. 52)分,而疼痛VAS评分也由术前的(5. 04±1. 48)分降低至术后的(2. 16±1. 15)分(P <0. 001);末次随访时屈曲角度、外展角度依次为(108. 42±8. 15)°、(36. 56±2. 75)°,均分别明显高于术前的(72. 74±7. 92)°、(28. 24±1. 95)°(P <0. 001)。结论关节镜下关节腔清理与病变滑膜切除治疗AS致髋关节早期病变能显著改善患者的髋关节功能,提高髋关节活动度,减轻疼痛程度,临床近中期疗效确切,且安全性高。

Objective To explore clinical effect of arthroscopic treatment for early stage hip joint disease caused by ankylosing spondylitis（ AS）. Methods A total of 24 cases with early stage hip joint disease caused by AS undergoing scheduled arthroscopic surgery in our hospital from November 2010 to April2014 were enrolled in this study. They were 21 males and 3 females,at a mean age of 25. 2 ± 5. 1（ 11 ～ 46）years,with AS course of 6. 8 ± 1. 5（ 2 ～ 17） years and hip involvement of 21. 4 ± 6. 8（ 6 ～ 32） months. After arthroscopic removal of joint cavity and synovectomy,all the patients were followed up for at least 2 years.Harris hip score system（ HHS） was used to evaluate hip function and recovery of hip motion preoperatively and at 2 year postoperatively. Pain visual analogue scale（ VAS） was employed to assess hip pain relief status.What＇s more,erythrocyte sedimentation rate（ ESR） was measured by Westergren blood test,and serum C-reactive protein（ CRP） level was by chemiluminescent assay. Results After at least 2 years＇ follow-up,the ESR was decreased from 46. 24 ± 5. 36 mm/h preoperatively to 20. 12 ± 2. 84 mm/h,and serum CRP was reduced from 32. 57 ± 1. 24 mg/L to 14. 05 ± 0. 86 mg/L in all the patients（ both P〈0. 001）. HSS was also decreased from 61. 52 ± 7. 24 to 88. 24 ± 12. 52,and VAS score was from 5. 04 ± 1. 48 to 2. 16 ± 1. 15（ P〈0. 001）. At the last follow-up,the range of flexion and extension and that of adduction and outreach were（ 108. 42 ± 8. 15） ° and（ 36. 56 ± 2. 75） °,respectively,significantly higher than the ranges preoperatively[（ 72. 74 ± 7. 92） °,（ 28. 24 ± 1. 95） °,P〈0. 001]. Conclusion Arthroscopic removals of joint cavity and synovectomy improve hip function in the patients with early stage hip joint disease caused by AS,promote hip mobility,and reduce pain,with signficant clinical effects and high safety in almost mid-term.