全髋置换术治疗强直髋合并髋臼内陷的临床疗效观察

Clinincal outcomes of artificial hip replacement for ankylosed hip complicated with acetabular protrusion

目的探讨全髋置换术治疗强直性脊柱炎后期强直髋合并髋臼内陷症的围手术期管理、手术策略、中远期疗效观察。方法 2003年7月至2013年10月期间,青岛市海慈医疗集团创伤骨科收治强直性脊柱炎伴强直髋合并髋臼内陷患者19例,共23髋,均为符合国际脊柱关节炎协会(ASAS)2010年中轴型脊柱关节炎诊断标准的强直性脊柱炎,对其实施生物型人工全髋置换术,其中男16例,女3例,双髋病例4例。年龄32~65岁,平均(41. 5±0. 5)岁。组内患者强直性脊柱炎(AS)病程至手术前为10~42年,平均病程(22. 3±1. 3)年;术前术后进行Harris评分,并记录髋关节总活动度。采用配对样本t检验,对术前术后Harris功能评分及髋关节活动度进行分析。结果术后共有17例21髋得到随访,平均随访时间(45. 2±2. 7)个月。末次随访疼痛评分为(40. 50±0. 71),较术前评分(11. 80±3. 32)提高,差异有统计学意义(t=11. 17,P <0. 01)。功能评分由术前(7. 10±1. 10),提高到术后的(39. 70±2. 02),差异有统计学意义(t=8. 83,P <0. 01)。术后髋关节总活动度较术前明显改善(t=8. 78,P <0. 01)。结论人工全髋关节置换术治疗髋臼内陷症安全有效,髋臼重建尽可能使用植骨术及非骨水泥假体,以获得更好的中远期疗效。

Objective To evaluate peri-operation period management,operation strategy and the medi-term effectiveness of total hip arthroplasty in the treatment of ankylosed hip complicated with protrusio acetabuli in later stage of ankylosing spondylitis(AS).Methods Between July 2003 and October 2013,19 cases(23 hips with four bilater hips)of ankylosed hip complicated with protrusio acetabuli,all met the diagnostic criteria of 2010 ankylosing spondylitis diagnostic criteria of Assessment of Spondylo-Arthritis International Society(ASAS).The patients were treated with cementless total hip arthroplasty,16 males and three females,with an average age of(41.5±0.5)years(range,32~65 years).The AS disease duration was(22.3±1.3)years(range,10~42 years).Clinical results were evaluated by Harris scores and total range of motion(ROM)were assessed.The Harris scores and ROM before and after the operation were analyzed by paired sample t-test.Results Only 17 patients were followed up for(45.2±2.7)months.The pain score at the last follow-up was(40.50±0.71),which was significantly higher than the preoperative one(11.80±3.32)(t=11.17,P<0.01).The hip joint function score increased from preoperative(7.10±1.10)to postopreative(39.70±2.02);the difference was statistically significan(t=8.83,P<0.01).The X-ray showed that all the acetabular prostheses were in true acetabulum,and bone graft healed with no sign of re-protrusion.ROM was also significantly improved after the operation(t=8.78,P<0.01).Conclusion Total hip arthroplasty is safe and effective treatment of AS complicated with protrusio acetabuli with cementless prosthesis and bone grafting,which may have satisfactory mid-term clinical results.