全髋关节置换治疗强直性脊柱炎髋关节骨性强直

Total hip arthroplasty for the treatment of bony ankylosis in patients with ankylosing spondylitis

目的:探讨全髋关节置换术在治疗强直性脊柱炎髋关节骨性强直的临床疗效及安全性。方法:自2008年1月至2012年1月,采用全髋关节置换术治疗强直性脊柱炎髋关节骨性强直12例(24髋),其中男11例,女1例,年龄27～62岁,病程5～32年。统计患者术前及术后髋关节活动度及Harris功能评分,术中及术后并发症。结果:所有患者获得随访,时间60～96个月,平均72.6个月,所有患者术后Harris评分较术前提高,髋关节活动度提高;优3例,良6例,中3例。异位骨化1例,为BrookerⅠ级,无临床症状未处理。1例术前严重屈曲畸形患者术后出现股神经牵拉损伤,随访1年后恢复。末次随访均未出现假体下沉及臼杯松动,无关节脱位、急性感染及下肢深静脉血栓形成等并发症发生。结论:全髋关节置换术是治疗强直性脊柱炎晚期髋关节骨性强直的有效方法。

Objective:To evaluate the efficacy of total hip arthroplasty for the treatment of bony ankylosis in patients with ankylosing spondylitis. Methods:From January 2008 to January 2012,12 patients(24 hips) with ankylosing spondylitis combined with hip ankylosis were treated with total hip arthroplasty,including 11 males and 1 females,ranging in age from 27 to 62 years old. The course of diseases ranged from 5 to 32 years old. Preoperative and postoperative hip mobility and Harris function score,intraoperative and postoperative complications were analyzed. Results:All the patients were followed up,and the duration ranged from 60 to 96 months,with an average of 72.6 months. The Harris hip scores of all patients were improved. Three patients got an excellent result,6 good and 3 fair. One case had heterotopic ossification of BrookerⅠwithout clinical symptoms.One patient with severe flexion deformity underwent femoral nerve traction injury after operation,and recovered after 1 year of follow-up. No prosthesis subsidence or cup loosening,no joint dislocation,acute infection or deep venous thrombosis occurred during the latest follow-up. Conclusion:Total hip arthroplasty is an effective method for the treatment of ankylosing spondylitis with hip ankylosis at the advanced stage.