全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

人工全髋关节置换术治疗56例强直性脊柱炎的临床研究

[目的]探讨人工全髋关节置换术治疗强直性脊柱炎的疗效。[方法]对56例（98髋）强直性脊柱炎患者行人工全髋关节置换术，其中42例（76髋）进行了平均5．6（2．5～10．5）a的随访。[结果]至末次随访时，Harris评分由术前的平均26．8（4～51）分提高到了术后的平均85．2（55～94）分，优良率为89．5％。1例感染行Ⅱ期翻修；2例在扩髓时出现股骨颈或股骨距裂缝骨折，但未到达小粗隆以下，未予特殊处置；1例出现足下垂，术后3个月后恢复，1例深静脉血栓，余病例无假体松动、断裂以及脱位发生。异位骨化发生率9．2％（7髋），但对功能无明显影响。[结论]人工全髋关节置换术治疗强直性脊柱炎可以明显缓解髋关节疼痛，恢复关节功能，与其它病因的全髋关节置换术相比，并无较高的危险因素。     

幼年型强直性脊柱炎诊断和治疗进展

目前,幼年型强直性脊柱炎(JoAS)越来越受到临床医生的重视.该病在早期的临床表现很不典型,往往延误了其诊断和治疗,给患儿身体功能造成极大影响.该文通过总结近年来国外关于JoAS的研究,讨论了其发病机制、临床表现、诊断和治疗措施,重点对JoAS的影像学检查、生物制剂治疗及物理治疗等方面进行阐述.     

HLA-B27阳性与阴性强直性脊柱炎患者多项免疫指标的对比

目的了解HLA-B27抗原与强直性脊柱炎(AS)患者机体免疫功能的关系.方法 T细胞亚群的检测采用桥联酶标法;免疫球蛋白、C反应蛋白的检测采用速率散射比浊法;白细胞介素-6(IL-6)、肿瘤坏死因子α(TNFα)的测定采用双抗体夹心ELISA.结果 HLA-B27抗原阳性患者各项免疫指标与正常人相比差异均有显著性,而HLA-B27阴性患者各项免疫指标与正常人的差异则较小.结论 HLA-B27抗原在AS发病过程中可能起了重要作用,并对机体的免疫功能产生了一定影响.     

强直性脊柱炎误诊1例

<正> 强直性脊柱炎多先发于下肢大关节,临床上易误诊为其他类型的关节炎。现将我院收治的1例曾误诊为“化脓性关节炎”病例报道如下。1病例 患儿女性,10岁。主因左膝关节红、肿、痛伴活动受限4年,加重伴左眼结膜充血20余天入院。患儿于4年前无明     

"五虎强督通痹汤"治疗强直性脊柱炎63例

笔者采用自拟五虎强督通痹汤治疗强直性脊柱炎(AS)63例取得满意效果,现报道如下. 1 临床资料     

药刀治疗强直性脊柱炎1例

病人,男,42岁。因腰骶部疼痛10余年,驼背及双髋关节疼痛5年,不能平卧,夜间翻身困难1月余入院。在院外曾服用布洛芬、双氯灭痛、泼尼松等治疗,病情未见好转。查体:脊柱后凸畸形,前屈、侧弯、后仰明显受限,全脊柱至骶髂部棘突面、棘旁均有压痛,颌胸试验(+),骨盆挤压、分离试验(+),双侧4字试验(+),颈椎左右活动度40°,颈椎前屈度45°,胸廓活动度1.8 cm,枕墙距35 cm,指-地距52 cm。血沉62 mm/h,C反应蛋白43.6mg/L,HLA-B27阳性。腰椎及骨盆平片示强直性脊柱炎。经给予以脊柱周围为中心,用痛点探测器寻找痛点,对痛点常规消毒局麻后,以刀行痛点…     

蒙中西医结合治疗强直性脊柱炎临床观察

采用中蒙西医结合治疗30例强直性脊柱炎的临床观察。结果总有效率96.66%,蒙西医治疗有较好的疗效。并且能够缩短疗程,治愈率和缓解率高,不宜复发,互补单用蒙药或西药的缺点,在临床中值得推广应用。     

苏励教授治疗强直性脊柱炎经验介绍

苏励教授认为，脊柱在人体的位置处于皮里膜外，半表半里。强直性脊柱炎病在脊柱，故痰瘀之邪也盘踞在半表半里。治疗宜内清外透结合，在清里基础上外透，使邪有出路，从而清除盘踞在半表半里之邪实。并结合外治法以增加疗效。