仿生双动全髋关节置换术治疗强直性脊柱炎累及髋关节病变的疗效观察

Effect of dual mobility total hip arthroplasty therapy on ankylosing spondylitis involving hip lesions

目的观察仿生双动全髋关节置换术治疗强直性脊柱炎累及髋关节病变的临床疗效,并探讨双动臼杯在脊柱僵硬患者中应用的优势。方法回顾性分析河南省洛阳正骨医院2017年2月至2019年3月行双动全髋关节置换术的21例(41髋)强直性脊柱炎患者的临床资料,其中男18例,女3例。临床随访根据X线检查、Harris评分系统及手术前后髋关节总活动度进行评价。结果21例(41髋)患者均得到随访,随访时间13~38个月,中位数为25个月,平均(25.47±6.59)个月。Harris评分由术前(40.80±10.35)分增加到术后末次随访的(87.41±10.18)分,髋关节总活动度由术前(51.87±15.71)°增加到术后的(198.53±18.83)°,差异均具有统计学意义(P<0.05)。X线检查显示所有髋关节假体位置良好,2例(3髋)出现异位骨化,所有患者均未出现关节脱位、假体松动、感染。结论双动全髋关节置换术治疗强直性脊柱炎累及髋关节病变可明显改善髋关节功能,减轻疼痛,双动臼杯高稳定性的特点,降低了 AS患者髋臼假体安放的手术技术要求,容错率较高,从而最小化脱位的风险。

Objective To evaluate the clinical efficacy of dual mobility cup total hip arthroplasty for the treatment of ankylosing spondylitis involving hip lesions,and discuss the advantages of dual mobility acetabular cup in patients with spinal stiffness.Methods From February 2017 to March 2019,a total of 21 patients(41 hips)with ankylosing spondylitis,consisting of 18 males and 3 females,they were performed with dual mobility total hip arthroplasty in Luoyang Orthopedic-Traumatological Hospital of Henan Province.Preoperative and postoperative motion of hip joint in flexion,X-ray examination and Harris scoring were compared.Results All the 21 patients(41 hips)were followed up for 13 to 38 months[mean(25.47±6.59)months]and the median was 25 months.Compared to preoperative data the postoperative Harris score and motion of hip joint in flexion were significantly improved,which increased from(40.80±10.35)and(51.87±15.71)°to(87.41±10.18)and(198.53±18.83)°respectively,with statistical difference(P<0.05).According to their X-rays,all hip prothesis position was still well.There were no dislocations,aseptic loosening and infection.However,2 cases(3 hips)occurred heterotopic ossification.Conclusion Dual mobility total hip arthroplasty is effective in treating patient with ankylosing spondylitis involving hip lesions,which can obviously improve hip function and relieve pain.On basis of the high stability features of dual mobility acetabular cup,it can reduce surgical requirement for placement of acetabular prosthesis in patients with AS.Meanwhile,being much higher tolerance rate,therefore,it also could minimize the risk of dislocation.