[1]柯伟杰,王海彬,何伟,等.全髋关节置换术治疗强直性脊柱炎髋关节骨性强直[J].中医正骨,2017,29(10):69-72,75.
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全髋关节置换术治疗强直性脊柱炎髋关节骨性强直()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年10期
页码:
69-72,75
栏目:
临床报道
出版日期:
2017-10-20

文章信息/Info

作者:
柯伟杰; 王海彬; 何伟; 陈德龙
广州中医药大学第一附属医院,广东 广州 510405
关键词:
关节成形术; 置换; 髋;  脊柱炎; 强直性;  关节强直;  髋关节
摘要:
目的:观察全髋关节置换术(total hip arthroplasty,THA)治疗强直性脊柱炎(ankylosing spondylitis,AS)髋关节骨性强直的临床疗效及安全性。方法:2011年10月至2015年12月,采用THA治疗AS髋关节骨性强直患者21例(35髋),均为男性。年龄22～50岁,中位数24岁。左侧20髋,右侧15髋。血清人类白细胞抗原-B27检测均为阳性。发病年龄13～48岁,中位数18岁。所有患者髋关节总活动度为0°。13例患者存在髋关节屈曲畸形。病程2～18年,中位数9年。末次随访时,测量所有患者髋关节屈伸活动度,并采用Harris髋关节功能评分标准评定髋关节功能恢复情况; 测量13例髋关节屈曲畸形患者畸形程度; 采用12项简明健康状况调查表(12-item short-form health survey,SF-12)和主观4级标准(非常满意、比较满意、比较不满意及非常不满意)评价患者满意度; 记录引起患者不满意的原因。随访观察并发症发生情况。结果:手术时间44 min至5 h,中位数113 min。术中失血量100～3100 mL,中位数450 mL。术后住院时间5～30 d,中位数11 d。所有患者均获随访,随访时间5个月至5年,中位数2年。末次随访时,所有患者髋关节屈伸活动度及Harris髋关节功能评分均较术前增加[0.00°±0.00°,77.74°±8.25°,t=54.945,P=0.000;(43.29±10.01)分,(74.69±8.30)分,t=22.032,P=0.000]; 13例髋关节屈曲畸形患者畸形程度较术前降低(40.20°±30.87°,8.05°±2.30°,t=5.478,P=0.000); 采用SF-12与主观4级标准评定患者满意度,非常满意14例、比较满意2例、比较不满意5例; 引起患者不满意的主要原因包括疼痛(1例)、髋关节屈曲及旋转受限(2例)、双下肢不等长(1例)和跛行(1例)。所有患者均未出现神经血管损伤、下肢深静脉血栓形成、切口感染、假体松动或移位、异位骨化等并发症。结论:THA治疗AS髋关节骨性强直,可以增加髋关节屈伸活动度、促进髋关节功能恢复、减轻髋关节屈曲畸形程度,且安全性和患者满意度较高,值得临床推广应用。

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更新日期/Last Update: 2018-03-10