全髋关节置换术对强直性脊柱炎累及髋关节患者脊柱-骨盆关系的影响

Study on the influence of total hip replacement on relationship between spines and pelvis in patients with ankylosing spondylitis

目的研究全髋关节置换术治疗强直性脊柱炎(AS)累及髋关节患者的疗效以及对脊柱-骨盆关系改善的作用。方法回顾性选取2011~2016年选择全髋关节置换术治疗的AS累及髋关节患者40例作为观察组,选取同期接受体检的健康人40例作为对照组。测定观察组患者术后髋关节前屈角度和后伸角度。测定对照组以及观察组治疗前后的骨盆倾斜角(PT)、入射角(PI)、骶Ⅰ椎体的倾斜角(SS)、腰椎前凸角(LL)、胸椎后凸角(TK)。在观察组患者手术前以及术后1个月、3个月、6个月随访过程中检测患者的Harris髋关节评分。结果观察组术后髋关节前屈角度平均(83.48±2.46)°,后伸角度平均(9.2±0.3)°。观察组治疗前后的PI均相比对照组明显增加(P<0.05),观察组患者治疗后PT、TK均相比治疗前明显降低(P<0.05),SS、LL均相比治疗前明显升高(P<0.05);观察组治疗前后的PT、TK均明显高于对照组(P<0.05),SS、LL均明显低于对照组(P<0.05)。观察组患者术后1个月、3个月、6个月的Harris评分均相比术前明显升高(P<0.05)。结论全髋关节置换术治疗AS累及髋关节患者,可以有效提高髋关节的功能性评分,提升髋关节的运动以及活动能力,同时能够有效调节脊柱-骨盆的物理受力关系,改善结构的稳定性,但是仍然无法使患者的脊柱-骨盆关系恢复到正常状态。

Objective To study the curative effect of total hip replacement in patients with ankylosing spondylitis(AS)involving the hip and spines,and improvement in relationship between spines and pelvis.Methods A total of40patients with ankylosing spondylitis involving hip with total hip replacement during2011to2016were allocated in observation group,and40cases of healthy persons for healthy physical examination at sme period listed as control group.Determination of observation group of patients with postoperative The degree of hip flexion angle before and after stretching had been determined between control group and observation group before and after treatment of pelvic tilt angle(PT),angle of incidence(PI)and sacral1tilt angle of vertebral body(SS),lumbar lordotic angle(LL)and thoracic vertebra protrudent angle(TK)in patients of observation group before surgery and1month,3months and6months after the operation for follow-up process detection in patients with Harris hip scores.Results The hip flexion angle in observing group,the average angle(83.48±2.46)°,and the angle after stretching was(9.2±0.3)°.Harris scores in patients of observation group in1month,3months and6months after the treatment were compared with those preoperation were significantly elevated(P<0.05).PI in observation group before and after treatment were compared with that of control group was significantly increased(P<0.05).PT and TK in patients of observation group after treatment were significantly lower than those before treatment(P<0.05),SS and LL were significantly increased than those before treatment(P<0.05).The PT and TK in observation group before and after treatment were significantly higher than those of paatients in control group(P<0.05),SS and LL were significantly lower than those of control group(P<0.05).Conclusion The application of total hip replacement in treatment of patients with ankylosing spondylitis(AS)involved hip can effectively raise the functional scores of hip joint,and improve the capacity of hip movement and activity,at the same time it can effectively adjust the physical force of spine and pelvis,and improve the stability of structure,but it is still unable to normalize the relationship between pelvis and spines in patients for returning to normal status.