留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

人工全髋关节置换术治疗强直性脊柱炎

刘德琳 徐卫东 张宸 朱戈 黄轩 李甲

刘德琳, 徐卫东, 张宸, 朱戈, 黄轩, 李甲. 人工全髋关节置换术治疗强直性脊柱炎[J]. 协和医学杂志, 2017, 8(4-5): 251-257. doi: 10.3969/j.issn.1674-9081.2017.05.011
引用本文: 刘德琳, 徐卫东, 张宸, 朱戈, 黄轩, 李甲. 人工全髋关节置换术治疗强直性脊柱炎[J]. 协和医学杂志, 2017, 8(4-5): 251-257. doi: 10.3969/j.issn.1674-9081.2017.05.011
De-lin LIU, Wei-dong XU, Chen ZHANG, Ge ZHU, Xuan HUANG, Jia LI. Total Hip Arthroplasty for Ankylosing Spondylitis Involving Hip Joint[J]. Medical Journal of Peking Union Medical College Hospital, 2017, 8(4-5): 251-257. doi: 10.3969/j.issn.1674-9081.2017.05.011
Citation: De-lin LIU, Wei-dong XU, Chen ZHANG, Ge ZHU, Xuan HUANG, Jia LI. Total Hip Arthroplasty for Ankylosing Spondylitis Involving Hip Joint[J]. Medical Journal of Peking Union Medical College Hospital, 2017, 8(4-5): 251-257. doi: 10.3969/j.issn.1674-9081.2017.05.011

人工全髋关节置换术治疗强直性脊柱炎

doi: 10.3969/j.issn.1674-9081.2017.05.011
详细信息
    通讯作者:

    徐卫东  电话:021-31161683,E-mail:xuwdshanghaichyy@126.com

  • 中图分类号: R687.4;R593.23

Total Hip Arthroplasty for Ankylosing Spondylitis Involving Hip Joint

More Information
  • 摘要:   目的   评价人工全髋关节置换术(total hip arthroplasty, THA)治疗强直性脊柱炎(ankylosing spondylitis, AS)髋关节病变的临床疗效。   方法   回顾性分析2015年7月至2016年8月上海长海医院23例(30髋)AS导致髋关节病变而行THA手术治疗的患者资料, 患者均为男性, 术前年龄平均(42.2±12.9)岁(23~65岁); 病程平均(20.2±8.4)年(5~46年); 体质量指数(body mass index, BMI)平均(21.6±3.7)kg/m2(16.4~30.1 kg/m2)。手术方式采用髋关节后外侧入路, 所有患者均应用生物型假体。采用BASFI评分对AS患者全身功能状况进行评价, Harris评分对临床效果进行评价, 比较患者术前、术后关节活动度及BASFI评分、Harris评分。   结果  患者平均随访(15.1±3.2)个月(10~21个月), 与术前相比, 末次随访时髋关节功能明显改善, 髋关节屈伸活动度由(44.3±39.6)°升高至(93.2±19.7)°; 髋关节总活动度由(64.8±54.8)°升高至(179.5±25.1)°; 髋关节Harris评分由(39.2±17.2)分升高至(87.5±4.5)分, 其中10髋优, 19髋良, 优良率96.7%(29/30);BASFI评分由(6.4±2.3)分降低至(2.2±0.9)分, 差异均有统计学意义(P均 < 0.001)。X片评估术后髋关节均未出现脱位、松动、下沉; 术后异位骨化Brooker分级:BrookerⅠ级2髋, 未见BrookerⅡ、Ⅲ、Ⅳ级异位骨化。   结论  THA可有效治疗AS髋关节病变, 缓解关节疼痛, 重建关节功能, 明显提高AS患者生活质量。
  • 图  1  患者术前站立位(A)或下蹲位(B)关节活动受限

    图  2  一例患者术前及术后骨盆X线正位相

    A.术前患者闭孔比率1.3;B.术后假体位置满意,髋臼假体外展角为37°,无脱位、松动、下沉等

    图  3  术后随访患者站立位(A)、坐位(B)和下蹲位(C)活动受限明显改善

    表  1  23例(30髋)AS患者THA手术前后髋关节活动度及功能比较

    项目 术前 $ \left( {\overline x \pm s} \right) $ 术后末次随访 $ \left( {\overline x \pm s} \right) $ P
    屈伸活动度(°) 44.3±39.6 93.2±19.7 0.000
    总活动度(°) 64.8±54.8 179.5±25.1 0.000
    BASFI评分 6.4±2.3 2.2±0.9 0.000
    Harris评分 39.2±17.2 87.5±4.5 0.000
    AS:强直性脊柱炎;THA:全髋关节置换术
    下载: 导出CSV
  • [1] Saglam Y, Ozturk I, Cakmak MF, et al. Total hip arthroplasty in patients with ankylosing spondylitis:Midterm radiologic and functional results[J]. Acta Orthop Traumatol Turc, 2016, 50:443-447. doi:  10.1016/j.aott.2016.06.010
    [2] Guan M, Wang J, Zhao L, et al. Management of hip involvement in ankylosing spondylitis[J]. Clin Rheumatol, 2013, 32:1115-1120. doi:  10.1007/s10067-013-2278-3
    [3] Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis[J]. Ann Rheum Dis, 2006, 65:442-452. doi:  10.1136/ard.2005.041137
    [4] van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984, 27:361-368 doi:  10.1002/art.1780270401
    [5] 齐海, 丁悦, 许杰, 等. Harris评分和X线在评价全髋关节置换术后疗效中的作用[J].中华关节外科杂志, 2009, 3:444-448. doi:  10.3969/j.issn.1674-134X.2009.04.007
    [6] Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis:the development of the Bath Ankylosing Spondylitis Functional Index[J]. J Rheumatol, 1994, 21:2281-2285 http://cn.bing.com/academic/profile?id=ed5521fd42fef3a9bb8235e0e8f476a4&encoded=0&v=paper_preview&mkt=zh-cn
    [7] Tang WM, Chiu KY, Kwan MFY, et al. Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty:Three-dimensional computer model analysis[J]. J Orthop Res, 2007, 25:766-771. doi:  10.1002/jor.20225
    [8] Gruen TA, Mcneice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening[J]. Clin Orthop Relat Res, 1979, (141):17-27. http://cn.bing.com/academic/profile?id=8b0f92827a12bc3c4e9e508b3f06d0b5&encoded=0&v=paper_preview&mkt=zh-cn
    [9] Charnley J. Proceedings:the histology of loosening between acrylic cement and bone[J]. J Bone Jt Surg Br, 1975, 57:245. http://www.ncbi.nlm.nih.gov/pubmed/1141290
    [10] Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification[J]. J Bone Joint Surg Am, 1973, 55:1629-1632. doi:  10.2106/00004623-197355080-00006
    [11] Zheng GQ, Zhang YG, Chen JY, et al. Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis:experience with 28 patients[J]. Bone Joint J, 2014, 96:360-365. http://cn.bing.com/academic/profile?id=9bdbe0782390a02672c031c1c682084b&encoded=0&v=paper_preview&mkt=zh-cn
    [12] LEE ML. Orthopaedic problems in ankylosing spondylitis[J]. Rheumatism, 1963, 19:79-82. http://cn.bing.com/academic/profile?id=a5a495cbc94e719b010219fb99ca9621&encoded=0&v=paper_preview&mkt=zh-cn
    [13] Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis[J]. J Arthroplasty, 2000, 15:52-58. doi:  10.1016/S0883-5403(00)91155-0
    [14] 宋凯, 张永刚, 付君, 等.脊柱矫形对强直性脊柱炎胸腰段后凸畸形患者髋关节相关活动能力及生活质量的影响[J].中国脊柱脊髓杂志, 2015, 25:871-882. doi:  10.3969/j.issn.1004-406X.2015.10.02
    [15] 常增林, 李锋, 陈安民, 等.强直性脊柱炎非骨水泥型全髋关节置换术后中期随访[J].中国矫形外科杂志, 2003, 11:1339-1342. doi:  10.3969/j.issn.1005-8478.2003.19.013
    [16] Sochart DH, Porter ML. Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis[J]. J Bone Joint Surg Am, 1997, 79:1181-1189. doi:  10.2106/00004623-199708000-00010
    [17] Vasileiadis GI, Sakellariou VI, Kelekis A, et al. Prevention of heterotopic ossification in cases of hypertrophic osteoarthritis submitted to total hip arthroplasty. Etidronate or Indomethacin?[J]. J Musculoskelet Neuronal Interact, 2010, 10:159. http://cn.bing.com/academic/profile?id=7f5116665df3f46b8c5694309c7d5cf5&encoded=0&v=paper_preview&mkt=zh-cn
    [18] Xu J, Zeng M, Xie J, et al. Cementless total hip arthroplasty in patients with ankylosing spondylitis[J]. Medicine, 2017, 96:e5813. doi:  10.1097/MD.0000000000005813
    [19] Thilak J, Panakkal JJ, Kim T, et al. Risk factors of heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis[J]. J Arthroplasty, 2015, 30:2304-2307. doi:  10.1016/j.arth.2015.06.013
  • 加载中
图(3) / 表(1)
计量
  • 文章访问数:  18
  • HTML全文浏览量:  5
  • PDF下载量:  1
  • 被引次数: 0
出版历程
  • 收稿日期:  2017-06-22
  • 刊出日期:  2017-09-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!