强直性脊柱炎髋关节屈曲挛缩全髋关节置换术随访及体会

目的]观察强直性脊柱炎髋屈曲挛缩畸形实施全髋关节置换术的临床效果,并对常见问题的处理进行探讨。方法]自1998年7月～2005年9月对18例（36髋）强直性脊柱炎髋屈曲挛缩畸形的患者进行全髋关节置换术,其中同期双侧全髋关节置换10例;平均年龄34岁（17岁～58岁）。结果]术后随访1～6年（平均3.2年）,对手术前后关节疼痛、活动度、畸形矫正及患者整体功能的改善情况进行了对比。除6侧关节轻度疼痛外,其余关节均无疼痛。关节活动度由术前髋关节屈曲平均20.5°改善为70.5°,髋关节外展由术前平均8.2°改善为45°,Harris评分由术前7～58分（平均31分）改善为56～89分（平均76分）,较术前平均提高45分,有显著性差异（配对t检验P〈0.01）。结论]双侧全髋关节置换术是治疗严重的强直性脊柱炎髋屈曲挛缩畸形的一种有效的方法,特别是术中仔细松解前方挛缩组织,外侧入路可较好地实施手术,同期双侧手术可使患者尽早恢复功能,节约费用,减少二次手术的痛苦。

Treatment of ankylosing spondylitis hip flexion deformity with total hipreplacement

Objective]To observe the effect of total hip replacement in treatment of hip flexion deformity caused by ankylosing spondylitis(AS).Method]Thirty-six hips in 18 cases of hip deformity of AS accepted total hip replacement from July 1998 to September 2005. Patients' age ranged from 17 to 58 years (mean 34 years).Result]Postoperative follow-up ranged from 1 to 6 years (mean 3.2 years). Pain, range of motion, correction of deformity, total functional improvement (Harris' score) were Compared pre- and postoperatively.All cases achieved pain relief but in 6 hips. IX/Lean range of flexion was improved from 20.5° to 70.5° and abduction range was corrected from mean 8.2° to mean 45°. Harris' score improved from mean 31 degrees (7～58 degrees) preoperatively to mean 76 degrees (56-89 degrees) postoperatively, with a significantly average improvement of 45 degrees (P<0.10).Conclusion]Total hip replacement is a kind of effective method for treatment of flexion deformity caused by AS. Bilateral total hip replacement could reconstruct the function of hip earlier and avoid pain from second-time operation.