骨盆矢状位畸形对强直性脊柱炎患者全髋关节置换髋臼假体位置的影响

Effects of sagittal pelvis deformity on the orientation of the acetabular component in patients with ankylosing spondylitis in total hip arthroplasty

目的探讨骨盆矢状位畸形对强直性脊柱炎(ankylosing spondylitis,AS)患者行全髋置换髋臼假体位置的影响因素。方法研究对象为2010年2月至2016年5月于我院行全髋关节置换术(total hip arthroplasty,THA)治疗的37例AS致髋关节破坏患者,其中男33例,女4例,年龄20~66岁,平均33.9岁。所有患者均行单侧人工THA,术后随访至少1年。分别于术前及术后1年采用Harris髋关节评分系统(harris hip score,HHS)、髋关节活动度、疼痛视觉模拟评分(visual analog score,VAS)及生活指数评分(SF-36)评价患者的髋关节功能恢复情况。分别以骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)及骶骨倾斜角(sacral slope,SS)与术后1个月髋臼假体前倾角、外展角比较相互关系,再比较术前、术后1个月及术后1年时髋臼前倾角、外展角的变化趋势。结果随访至少1年,HHS评分:术前(28.8±13.8)分,术后(82.5±9.9)分,疼痛VAS评分:术前(5.6±0.7)分,术后(1.4±0.5)分;SF-36评分:术前(17.5±11.6)分,术后(75.2±12.8)分,差异有统计学意义(P<0.05);末次随访时屈曲、后伸、内收、外展、内旋、外旋角度依次为(108.9±11.7)°、(8.4±4.6)°、(13.2±3.7)°、(40.5±5.8)°、(11.8±3.7)°、(37.1±5.7)°,均分别明显高于术前的(57.9±27.4)°、(1.1±2.6)°、(5.5±7.6)°、(14.7±13.4)°、(2.9±4.4)°、(12.9±16.4)°,差异有统计学意义(P<0.05)。术后1个月髋臼假体前倾角与PT正相关,相关系数=0.447,P<0.01;术后髋臼假体前倾角较术前明显增大(P<0.05),且随骨盆后倾的纠正有所减小(P<0.05)。结论AS患者骨盆矢状位畸形PT与髋臼假体前倾角显著相关,术后髋臼假体前倾角较术前增大,但随着脊柱-骨盆关系的有限平衡而相对减小。人工THA治疗AS致髋关节破坏能显著改善患者的髋关节功能,提高生活质量。

Objective To explore effects of sagittal pelvis deformity on the acetabular component orientation in patients with ankylosing spondylitis(AS)in total hip arthroplasty.Methods Clinical data of 37 cases with AS induced hip rigidity deformity were analyzed from February 2010 to May 2016.There were 33 males and 4 females with an average of 33.9 years(range:20-66 years).All patients underwent unilateral total hip arthroplasty and were followed up at least 1 year.Harris Hip Score(HHS),hip joint mobility,Visual Analog Score(VAS)and life index(SF-36)were adopted to evaluate hip functions before and 1 year after surgery.Pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS)were compared respectively with the acetabular anteversion and acetabular abduction of the acetabular component 1 month after the surgery;the changes in acetabular anteversio and acetabular abduction before surgery,1 month and 1 year after surgery were also compared.Results HHS:(28.8±13.8)preoperatively,(82.5±9.9)postoperatively;VAS:(5.6±0.7)preoperatively,(1.4±0.5)postoperatively;SF-36:(17.5±11.6)preoperatively,(75.2±12.8)postoperatively;differences were statistically significant(P<0.05).Flexion,extension,adduction,abduction,internal rotation,external rotation at the last follow-up:(108.9±11.7)°,(8.4±4.6)°,(13.2±3.7)°,(40.5±5.8)°,(11.8±3.7)°,(37.1±5.7)°;(57.9±27.4)°,(1.1±2.6)°,(5.5±7.6)°,(14.7±13.4)°,(2.9±4.4)°,(12.9±16.4)°preoperatively;differences were statistically significant(P<0.05).The acetabular anteversion angle was positively correlated with PT 1 month after operation,and the correlation coefficient was 0.447,P<0.01.It was significantly increased after operation(P<0.05),and was reduced along with the pelvic correction(P<0.05).Conclusions Sagittal deformity PT is significantly correlated with the AVA of the acetabular component.The AVA of the acetabular component increases after surgery,but decreases with the limited balance of the spinal-pelvic relationship.Total hip arthroplasty can significantly improve hip functions and life quality.