全髋置换治疗强直性脊柱炎髋关节高度屈曲强直畸形.docVIP

全髋置换治疗强直性脊柱炎髋关节高度屈曲强直畸形 　 作者：刘青春，张伟，李伟，孙水，王健，王先泉，吴帅 【摘要】 [目的]探讨强直性脊柱炎髋关节高度屈曲强直畸形患者行全髋关节置换术的方法和疗效。[方法]21例(29髋)强直性脊柱炎髋关节高度屈曲强直畸形患者行全髋关节置换术, 男20例(28髋)，女1例(1髋);年龄21～49岁,平均32.4岁;病程3～32年,平均15.6年;屈曲强直畸形30°～95°，平均58.6°;单侧13例, 双侧8例;15例(23髋)合并髋关节骨性强直。采用髋关节Watson-Jones外侧切口，生物型假体17例(22髋)，骨水泥型假体4例(7髋)。采用Harris评分对术前及术后髋关节功能进行评价。[结果]21例患者术后平均随访4.5年，髋关节功能均明显改善，Harris评分由术前平均21.7分提高到术后平均83.2分。髋关节屈曲畸形矫正，29个髋关节总活动度(屈伸、内收、外展、内旋、外旋等6个方向活动总和)由术前平均7°增加为术后平均196°。术后髋痛消失, 膝痛、腰骶痛明显改善，步态恢复正常, 生活能自理。[结论]全髋关节置换术是治疗强直性脊柱炎合并髋关节高度屈曲强直畸形一种有效的方法。 【关键词】 脊柱炎; 强直性; 关节成形术; 置换; 髋; 疗效 　　Abstract: [Objective]To investigate the means and effect of total hip arthroplasty(THA) for treating serious flexed hips caused by ankylosing spondylitis (AS). [Methods]A total of 20 male patients (28 hips) and 1 female patient(1 hip)with ankylosing spondylitis underwent THA.Eight patients had bilateral surgery. The mean age were 32.4 years(ranged 21～49 years).The disease course were 3～32 years, with the mean of 15.6 years.And the flexed deformation were 30°～95°,with the mean of 58.6 , including ankylosis in 23 hips(79.3%).There were 17 patients(22 hips)in the biological prosthesis group and 4 patients (7 hips) in the cement group.The clinical results were evaluated by the Harris hip scoring system.[Results]The mean duration of follow-up were 4.5 years,all hip joints function were improved,and the postoperative Harrris Score were 83.2 versus the preoperative Harrris Score of 21.7.The serious flexed deformity of the involved hips were disappeared.The average range of motion of hip joint were 196°. The pain of the hips were disappeared almost completely and pain of lowerwaists and knees were relieved obviously.Patients got their gait right and could care themselves approximately.[Conclusion]Total hip arthroplasty is an effective treatment for serious flexed hips caused by ankylosing spondylitis. 　　Key words：spondylitis; ankylosing; arthroplasty; replacement; hip; treatment outcome 　　强直性脊柱炎(ankylosing spondylitis,AS)常导致髋关节骨性强直