直接前入路全髋关节置换术治疗强直性脊柱炎髋关节屈曲畸形的短期疗效观察

Short term effect of total hip arthroplasty through direct anterior approach for the treatment of ankylosing spondylitis with hip flexion deformity

目的:探讨强直性脊柱炎(ankylosingspondylitis,AS)髋关节屈曲畸形行直接前入路(directanteriorapproach,DAA)全髋关节置换术(totalhiparthroplasty,THA)的短期临床疗效,评估DAA入路在AS患者THR中的运用价值。方法:2014年9月至2017年6月对15例AS髋关节屈曲畸形患者采用DAA入路行THR,男12例(17髋),女3例(4髋);年龄21～57岁,平均34.4岁。手术前后采用髋关节Harris评分系统(Harrishipscoring,HHS)评估髋关节功能,以髋关节总活动度及视觉模拟疼痛评分(visual analogue scale,VAS)评价临床效果。结果:15例患者均获得随访,时间8～32个月,平均26.2个月。术中1例大粗隆撕脱给予钢丝捆扎,1例股骨距线性劈开给予钢丝捆扎。患者切口均Ⅰ期愈合,无血肿、神经损伤及下肢深静脉血栓形成等并发症发生。术后随访X线片未见假体松动、下沉等现象发生。术后无异位骨化,术后髋关节疼痛完全缓解18髋,存在髋关节行走时疼痛3髋,均满足日常生活自理要求。术后1个月时Harris评分、髋关节总活动度及VAS疼痛评分与术前比较差异有统计学意义(P<0.05);术后1、6个月的HHS评分、髋关节总活动度及VAS疼痛评分比较差异无统计学意义(P>0.05)。结论:DAA入路THR治疗AS髋关节非功能位强直效果良好,创伤小,恢复快,可有效提高患者的生活质量,短期疗效确切。

Objective:To investigate the short term clinical efficacy of direct anterior approach(DAA)total hip arthroplasty for the treatment of ankylosing spondylitis with hip flexion deformity.Methods:From September 2014 to June 2017,15 cases of ankylosing spondylitis with flexion deformity of the hip were treated with total hip arthroplasty through DAA approach including 12 males(17 hips)and 3 females(4 hips)with an average age of 34.4 years old ranging from 21 to 57 years old.Harris score system was used before and after operation to evaluate hip function,total hip activity and visual analogue scale(VAS)were used to evaluate the clinical efficacy.Results:All 15 patients were followed up for an average of 26.2 months.In the operation,1 case of great trochanter avulsion was given wire binding,and 1 case of linear split of the femur were given by wire binding.There were no hematoma,nerve injury and deep vein thrombosis of lower extremity.No prosthesis loosening and sinking were observed in the follow-up of X-ray film after operation.There was no heterotopic ossification after operation.After operation,18 hips pain were relieved completely,and 3 hips pain were found when walking,which all satisfied with the daily life self-care requirements.Harris hip score,total hip motion and VAS score at 1 week after operation were significantly different from those before operation(P<0.05).There was no significant difference in the scores of HHS,total hip motion and VAS at 1,6 months after operation(P>0.05).At the final follow-up,the Harris score was 91.2±5.3,the total hip mobility was(217.1±29.7)°,and the postoperative VAS pain score was 1.2±0.5,which was significantly different from the preoperative score(P<0.05).Conclusion:DAA approach THA has good effect in treating AS hip nonfunctional ankylosis with less trauma,less pain and quick recovery.It has a good short term effect,which can effectively improve the quality of life of patients.