幼年发病型强直性脊柱炎人工全髋关节置换术中期临床疗效

Midterm follow-up outcomes of total hip arthroplasty in treatment for patients with juvenile-onset ankylosing spondylitis

目的评估幼年发病型强直性脊柱炎(juvenile-onset ankylosing spondylitis,JAS)接受人工全髋关节置换术(total hip arthroplasty,THA)的中期临床随访结果。方法回顾性分析2004年1月—2018年3月的81例(127髋)JAS患者(年龄≤16岁,JAS组)和267例(391髋)成年发病型强直性脊柱炎(adult-onset ankylosing spondylitis,AAS)患者(年龄>16岁,AAS组)行THA手术重建的临床随访结果。常规收集患者术前基线人口学数据、临床参数、影像学参数和实验室数据;术前及末次随访时评价指标包括疾病整体活动度[巴氏强直性脊柱炎疾病活动指数(Bath ankylosing spondylitis disease activity index,BASDAI)]和功能状态[巴氏强直性脊柱炎功能指数(Bath ankylosing spondylitis functional index,BASFI)],髋关节主观评分[Harris髋关节评分(HHS)]和客观评分[12项健康评估简表(SF-12),包括生理状态评分(PCS)和心理状态评分(MCS)]及患者满意度,同时记录随访期间出现的主要骨科并发症,包括假体周围感染、脱位、假体周围骨折、切口愈合不良。结果术前基线参数比较显示,JAS组体质量、身体质量指数、发病年龄、手术年龄、病程、合并吸烟史比例显著低于AAS组,双侧手术比例、葡萄膜炎比例、合并家族史比例、C反应蛋白、白蛋白及术前BASFI显著高于AAS组,差异均有统计学意义(P<0.05);其余基线参数比较差异均无统计学意义(P>0.05)。两组患者均获随访,其中JAS组随访时间29~199个月,平均113个月;AAS组35~199个月,平均98个月。两组切口均Ⅰ期愈合。随访期间JAS组发生假体周围骨折1例、脱位1例以及陶瓷碎裂1例,AAS组发生假体周围感染1例、假体周围骨折6例,两组并发症发生情况比较差异无统计学意义(P>0.05)。末次随访时两组BASDAI、BASFI、SF-12 MCS、SF-12 PCS及HHS评分均较术前显著改善(P<0.05);两组间比较上述各参数手术前后差值以及患者满意度差异均无统计学意义(P>0.05)。结论JAS患者在成人期接受THA重建的中期临床疗效确切,发病年龄过低对于AS患者的THA重建结果并未产生显著负面影响。

Objective To assess the midterm follow-up outcomes of total hip arthroplasty(THA)for the treatment of patients with juvenile-onset ankylosing spondylitis(JAS).Methods The clinical data of 81 patients(127 hips)with JAS(age≤16 years,JAS group)and 267 patients(391 hips)with adult onset ankylosing spondylitis(AAS)(age>16 years,AAS group)between January 2004 and March 2018 were retrospectively analysed.The baseline demographics,clinical,radiographic,and laboratory parameters were collected.Before operation and at last follow-up,the overall disease activity[Bath ankylosing spondylitis disease activity index(BASDAI)]and function status[Bath ankylosing spondylitis functional index(BASFI)],hip subjective score[Harris hip score(HHS)]and objective score[12-item short form health survey(SF-12),including physical component score(PCS)and mental component score(MCS)],and patient satisfaction for THA were reviewed.The major orthopedic complications,including periprosthetic infection,dislocation,periprosthetic fractures,and poor incision healing,were also recorded during the follow-up period.Results The comparison of preoperative baseline parameters showed that the body mass,body mass index,age of onset,age of surgery,disease duration,and the proportion of combined smoking history in the JAS group were significantly lower than those in the AAS group(P<0.05),the proportion of bilateral surgeries,proportion of uveitis,proportion of combined family history,C-reactive protein,albumin,and preoperative BASFI were significantly higher than those in the AAS group(P<0.05).Both groups were followed up.The follow-up time in the JAS group was 29-199 months,with an average of 113months;in the AAS group was 35-199 months,with an average of 98 months.Incisions in both groups healed by first intention.During the follow-up period,there were 1 case of periprosthetic fracture,1 case of dislocation,and 1 case of ceramic fragmentation in the JAS group,1 case of periprosthetic infection and 6 cases of periprosthetic fracture in the AAS group.There was no significant difference in the incidence of complications between the two groups(P>0.05).At last follow-up,the BASDAI,BASFI,SF-12 MCS,SF-12 PCS,and HHS score of the two groups were significantly improved when compared with those before operation(P<0.05);but there was no significan difference in the difference of the above parameters before and after operation and the patient satisfaction between the two groups(P>0.05).Conclusion The midterm follow-up outcomes of THA for the treatment of JAS patients were reliable.A low age at disease onset did not exert a significant negative effect on THA reconstruction for the treatment of ankylosing spondylitis.