带大转子血管骨瓣移植术与髋关节置换术治疗类风湿性关节炎的临床疗效对比分析

Linical efficacy of vascularized bone grafting with greater trochanter and hip replacement for rheumatoid arthritis

目的探讨带大转子血管骨瓣移植术与髋关节置换术治疗类风湿性关节炎的临床疗效。方法 32例类风湿性关节炎伴髋关节功能受限患者,按照其手术方式不同,分为髋关节置换术组(A组)及带大转子血管骨瓣移植术组(B组),比较两组手术时间、术中出血量、术后引流量、住院时间、术后下床活动时间等一般情况,对患者行术后随访,观察术后并发症以及术后不同时间髋关节Harris评分,统计分析两组临床疗效。结果两组患者术后引流量以及住院时间比较,差异均无统计学意义(均P>0.05);A组手术时间[(150.4±25.3)min比(122.3±30.4)min,P<0.001]以及术中出血量[(384.6±65.5)ml比(300.8±65.4)ml,P<0.001]显著多于B组;但术后下床活动时间[(2.3±0.5)周比(5.2±0.8)周,P<0.001]显著短于B组,差异均有统计学意义。两组患者术前Harris评分比较,差异无统计学意义(P>0.05),两组患者行手术治疗后以及术后6月行Harris评分,发现A组显著高于B组(P<0.05);术后1年时,两组患者Harris评分无显著性差异(P>0.05);术后随访24个月,发现B组Harris评分显著高于A组,差异具有统计学意义(P<0.05)。术后随访24个月,发现两组未发现植入物感染,A组切口感染2例,B组1例。B组术后发现髋关节功能较差,再行手术2例,而A组仅1例再行手术治疗。A组术后2例患者出现内固定松动,而B组仅1例出现固定螺钉松动。A组术后发现1例患者较对侧肢体缩短,两组患者术后总并发症率比较,差异无统计学意义(42.9%比22.2%,P=0.39)。结论髋关节置换术及带大转子血管骨瓣移植术均能有效恢复类风湿关节炎患者髋关节功能。髋关节置换术短期髋关节功能恢复较带大转子血管骨瓣移植术好,但带大转子血管骨瓣移植术长期疗效较髋关节置换术好。

Objective To explore the clinical efficacy of vascularized bone grafting with greater trochanter and Hip replacement for rheumatoid arthritis.Methods 32 cases of rheumatoid arthritis with hip dysfunction,according to its operation methods,Divided into Hip replacement group(group A)andvascularized bone grafting with greater trochanter group(group B),compared the operative time,blood loss,postoperative drainage,length of stay,postoperative ambulation time of the two groups,patients were followed up,and postoperative complications and Harris hip score at different time were observed,analysis the clinical efficacy.Results The postoperative drainage and length of stay at the two groups had no significant difference(P>0.05);Operative time and intraoperative blood loss of group A was significantly more than group B(P<0.05);the postoperative ambulation time of Group B significantly longer than group A(P<0.05).The Harris score of preoperative and postoperative 12 months at the two groups had no significant difference(P>0.05);the Harris score of postoperative and postoperative 6 months of group A was better than group B,but the Harris scores of hip function at postoperative 24 months in group A were significantly worse than in group B(P<0.05).The postoperative complications of two groups had no difference(P>0.05).Conclusion Hip replacement and vascularized bone grafting with greater trochanter an effectively restore function of rheumatoid arthritis.Hip replacement had better short-term recovery than the vascularized bone grafting with greater trochanter,but vascularized bone grafting with greater trochanter had better long-term recovery than hip replacement.