Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predomin...Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.展开更多
BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is s...BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.展开更多
背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接...背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接受全髋关节置换后隐性失血的危险因素。方法:人工全髋关节置换治疗的60例(70髋)强直性脊柱炎累及髋关节的患者,平均年龄35.12岁。根据Gross方程计算隐性失血量,收集和分析手术时间、血沉、C-反应蛋白、体质量指数、是否骨质疏松、强直性脊柱炎髋关节放射指数、异体输血量等对患者全髋关节置换后隐性失血的影响,并按隐性失血量分为高隐性失血组(≥480 m L)和低隐性失血组(<480 mL),通过单因素相关分析及多因素Logistic回归分析(SPSS17.0)影响强直性脊柱炎患者初次全髋关节置换术后高隐性失血的危险因素。结果与结论:(1)患者初次全髋关节置换后隐性失血量为(737.76±419.18)mL,总失血量为(1 312.83±487.41)mL,隐性失血占总失血量的51.48%。高隐性失血组41髋,低隐性失血组29髋,比例为41∶29;(2)单因素相关分析结果显示手术时间、强直性脊柱炎髋关节放射指数、是否骨质疏松、异体输血量、血红蛋白下降量与高隐性失血显著相关;(3)多因素Logistic回归分析结果显示强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量与高隐性失血显著相关;(4)结果说明,隐性失血量是强直性脊柱炎患者初次全髋关节置换后总失血量的重要组成部分,强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量是高隐性失血的危险因素。展开更多
目的:观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法:对37例(52髋)强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了24～172个月,平均69个月的随访。临床随访根据Harris的评分方法进行评分,X线随访根据Gruen等和De...目的:观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法:对37例(52髋)强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了24～172个月,平均69个月的随访。临床随访根据Harris的评分方法进行评分,X线随访根据Gruen等和DeLee and Charnley分区法分别进行股骨柄和臼杯X线分析,根据Brooker等0～4级分级法进行异位骨化分级。结果:患者髋关节屈伸、收展、内外旋总活动度由术前的平均27°提高到术后平均152°。术后无脱位、感染等并发症发生。Harris评分术前平均为32(8～64)分,术后平均为82(64～96)分,其中优38髋,良8髋,可6髋,优良率88.5％。X线片分析未见假体松动,11髋(21.2％)发生异位骨化。结论:人工全髋关节置换术治疗强直性脊柱炎髋关节病变,中期可取得满意的临床效果。展开更多
文摘Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.
文摘BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.
文摘背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接受全髋关节置换后隐性失血的危险因素。方法:人工全髋关节置换治疗的60例(70髋)强直性脊柱炎累及髋关节的患者,平均年龄35.12岁。根据Gross方程计算隐性失血量,收集和分析手术时间、血沉、C-反应蛋白、体质量指数、是否骨质疏松、强直性脊柱炎髋关节放射指数、异体输血量等对患者全髋关节置换后隐性失血的影响,并按隐性失血量分为高隐性失血组(≥480 m L)和低隐性失血组(<480 mL),通过单因素相关分析及多因素Logistic回归分析(SPSS17.0)影响强直性脊柱炎患者初次全髋关节置换术后高隐性失血的危险因素。结果与结论:(1)患者初次全髋关节置换后隐性失血量为(737.76±419.18)mL,总失血量为(1 312.83±487.41)mL,隐性失血占总失血量的51.48%。高隐性失血组41髋,低隐性失血组29髋,比例为41∶29;(2)单因素相关分析结果显示手术时间、强直性脊柱炎髋关节放射指数、是否骨质疏松、异体输血量、血红蛋白下降量与高隐性失血显著相关;(3)多因素Logistic回归分析结果显示强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量与高隐性失血显著相关;(4)结果说明,隐性失血量是强直性脊柱炎患者初次全髋关节置换后总失血量的重要组成部分,强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量是高隐性失血的危险因素。
文摘目的:观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法:对37例(52髋)强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了24～172个月,平均69个月的随访。临床随访根据Harris的评分方法进行评分,X线随访根据Gruen等和DeLee and Charnley分区法分别进行股骨柄和臼杯X线分析,根据Brooker等0～4级分级法进行异位骨化分级。结果:患者髋关节屈伸、收展、内外旋总活动度由术前的平均27°提高到术后平均152°。术后无脱位、感染等并发症发生。Harris评分术前平均为32(8～64)分,术后平均为82(64～96)分,其中优38髋,良8髋,可6髋,优良率88.5％。X线片分析未见假体松动,11髋(21.2％)发生异位骨化。结论:人工全髋关节置换术治疗强直性脊柱炎髋关节病变,中期可取得满意的临床效果。
