深入认识强直髋及其全髋关节置换治疗

Ankylosed hip and total hip replacement

髋关节强直主要是由于强直性脊柱炎(ankylosing spondylitis,AS)、感染化脓性关节炎等相关系统或局部病变累及髋关节所致的关节活动度的丧失.此外还有部分患者是由于外伤、肿瘤等病因或早期做过髋关节融合手术而形成的关节强直.髋关节强直患者一般已无明显关节疼痛,但由于大部分患者髋关节均在非功能位强直,步态跛行、关节僵硬、原发或继发脊柱退变侧弯等诸多生活上的不便成为此类患者要求手术治疗改善髋关节功能、提高生活质量的原因.目前,全髋关节置换术(total hip arthroplasty,THA)是治疗终末期髋关节疾病、改善关节功能、提高生活质量的最佳术式.然而,此类患者髋关节局部软骨破坏、骨性融合、周围软组织弹性差、外展肌萎缩无力、屈伸肌力不平衡等病理生理改变又显著增加了手术治疗的难度,使得术后康复锻炼困难重重.由于我国地域广阔,不同地区经济文化发展不平衡等因素导致在临床工作中时常会遇到需要行THA治疗的髋关节强直患者.如何充分地进行围术期准备以及术中、术后如何避开的潜在风险提高治疗效果,已经成为目前关节外科临床治疗的关注热点.

Ankylosed hip is one of the most severe hip diseases caused by AS, infection, trauma, tumor, etc. Patients seek for surgery to eliminate claudication gait, limited ROM that produce daily inconvenience. Total hip arthroplasty, an optimized surgery for end-stage hip diseases, can improve functions and life quality. However, bone fusion, weak abductors, lack of elasticity in soft tissues make the procedure and rehabilitation much more difficult, which call for well-prepared operations to avoid complications and other risks.