Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

We retrospectively reviewed 54 patients (92 hips) who underwent cementless total hip arthroplasty for bony ankylosis in ankylosing spondylitis between September 1988 and 2002. The mean age of the patients was 25.5 years. The mean duration of follow-up was 8.5 years. The average preoperative Harris Hip Score of 49.5 improved to 82.6 postoperatively. Postoperatively, 10 hips had mild to moderate pain. Anterior dislocation occurred in 4 (4.3%) hips, and sciatic nerve palsy in 1 (1.1%) hip. Heterotopic ossification was seen in 12 patients; reankylosis rate was 0%. Thirteen (14%) arthroplasties were revised because of aseptic loosening. Kaplan-Meier survivorship analysis with revision as end point revealed 98.8% survival at 5 years and 85.8% survival at 8.5 years follow-up.     

非骨水泥型全髋关节假体治疗强直性脊柱炎

目的:评价非骨水泥型全髋假体治疗强直性脊柱炎中期疗效。方法:对29例(33髋)选用非骨水泥型全髋假体行全髋置换术的强直性脊柱炎患者进行随访,年龄34～57岁,平均42.4岁,术后随访2.2～5.6年(平均为4.3年)。对手术前后关节疼痛、活动度、畸形矫正、松动及患者整体功能的改善情况进行对比研究,临床随访根据Har-ris系统进行评分比较。结果:本组失访5例,术后除6侧髋关节轻度疼痛,2侧髋关节明显疼痛外,其余关节均无疼痛。关节活动度由术前平均46.5°改善为术后75.2°。髋关节屈曲畸形由术前平均32.6°改善为7.5°。术前Harris评分18～65分,平均44分;术后68～92分,平均86分。术后所有患者生活均可自理或部分自理。术中及术后并发症包括:股骨上端微型劈裂骨折5例,坐骨神经损伤1例,术后2个月脱位1例,股骨假体下沉4例,异位骨化4例。结论:使用非骨水泥型假体行全髋置换术是治疗强直性脊柱炎的一种可靠而有效的方法。     

强直性脊柱炎累及髋关节的全髋人工关节置换术

目的 探讨对强直性脊柱炎累及髋关节患者实施全髋人工关节置换术的临床特点、手术技术难点及中长期疗效.方法 对1986年5月～2004年6月34例(41髋)强直性脊柱炎累及髋关节患者施行全髋人工关节置换术并进行随访,所有患者均得到完整的临床及X 线片资料,平均随访时间为7.1年(2.2～19.3 年).结果 所有患者术后的临床症状及髋关节活动度均得到明显改善, Harris评分术前平均为33.9分(13.0～59.2分),术后改善为86.2分(72～96分).髋关节术前总活动度为45°(0～150°),术后改善为130°(70°～210°).随访时3例(4髋)出现假体的松动(均为骨水泥假体),其中1例患者术后10年行股骨柄及髋臼杯假体翻修术,其余患者无假体松动和下沉.2例(2髋)术后发生髋关节脱位, 2例(3 髋)髋关节周围出现轻度异位骨化.结论 强直性脊柱炎累及髋关节患者行全髋人工关节置换术后在髋关节活动度改善方面略差.术中应注意到此类患者因骨盆旋转对安放髋臼杯假体方向所产生的影响,减少术后关节脱位等并发症的发生,中、长期疗效令人满意.     

全髋关节置换术治疗强直性脊柱炎髋关节强直的中期疗效随访

目的：对全髋关节置换治疗强直性脊柱炎髋关节强直的中期疗效进行回顾性研究。方法：自2000年1月至2008年12月,采用全陶界面全髋置换术治疗67例88髋强直性脊柱炎髋关节强直患者,共获得有效随访55例74髋,男30例,女25例;年龄19～58岁,平均32,6岁。其中应用全生物型假体6l髋,混合型假体13髋。进行最少5年以上随访,平均随访时间（75．2＋8．6）个月。对有效随访的患者进行临床和影像学检查评估疗效。结果：髋关节Harris评分由术前30．8±7．0提高至末次随访时85．2±5．5;髋关节总活动度（屈伸、内收、外展、内旋、外旋等6个方向总和）由术前（21．2±8．5）。提高至术后（142．0±10．2）°。以翻修为终点的5年假体生存率为95．9％。1例因外伤致陶瓷内衬破裂而翻修,1例因术后感染翻修,1例因股骨柄假体周围骨折而翻修。1例术后脱位,经保守治疗成功;3例术后关节异响,非手术治疗后消失。7例术后异位骨化,无临床症状未处理;2例术后大腿疼痛,保守治疗好转。其余病例无论骨水泥或非骨水泥假体,假体周围无骨溶解,股骨侧和髋臼侧假体均无松动和下沉。结论：全髋关节置换是治疗强直性脊柱炎强直髋的一种有效而可靠的方法,其中期随访结果满意。     

Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis

Purpose

This study was a retrospective analysis of early and mid-term clinical effects and perioperative management of cementless bilateral synchronous total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) with bilateral hip ankylosis.

Methods

Fifteen AS patients (30 hips) with bilateral hip ankylosis were managed with cementless bilateral synchronous THA. Surgical outcome was evaluated using the visual analogue scale (VAS), the range of motion and the Harris score.

Results

The mean follow-up period was 29.3 months. At the last follow-up visit, the VAS score decreased from 7.53?±?0.99 before the operation to 2.40?±?0.91. The Harris score increased from 24.8?±?7.42 before the operation to 83.8?±?4.61. The total range of motion increased from 78.73?±?14.53 before the operation to 209.73?±?16.19 after the operation. After the operation, there was one case of early hip dislocation, one case of femoral nerve stretch injury and one case of superficial incision infection. There were no cases of deep venous thrombosis. X-ray examinations did not show prosthetic loosening or displacement.

Conclusion

AS patients with bilateral hip ankylosis can be treated with cementless bilateral synchronous THA, which could greatly improve hip joint function without significant complications. The clinical effects proved to be satisfactory.     

Long term results of total hip arthroplasty in patients with ankylosing spondylitis]

The results of total hip arthroplasty with the use of 5 different types of prostheses in 63 hips of 38 patients were presented. The range of follow up was from 7 to 14 years. The evaluation was done with the aid of M. d'Aubigné--Postel criteria and radiological assessment. Patients opinion and his ability to work was taken into consideration. The pain was reduced most significantly. Remarkable improvement was found in the gait and in the range of hip motion. In 24.5% of patients possible, probable or evident radiographic loosening was found. Ectopic ossifications of different degree were found in 38.8% of patients, mostly in hips previously operated on or severely destroyed. Ankylosing hips improved in movement to lesser extent. No deep infection was observed in early or late follow up.     

强直性脊柱炎非骨水泥型全髋关节置换术后中期随访

目的　观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法　对3 7例 ( 5 2髋 )强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了 2 4～ 172个月 (平均 69个月 )的随访。临床随访根据Harris的评分方法进行评分 ,X线随访根据Gruen等和DeLeeandCharnley分区法分别进行股骨柄和臼杯X线分析 ,根据Brooker等 0～ 4级分级法进行异位骨化分级。结果　患者髋关节屈伸、收展、内外旋总活动度由术前的平均 2 7°提高到术后平均 15 2°。术后无脱位、感染等并发症发生。Harris评分术前平均为 3 2分 ( 8～ 64分 ) ,术后平均为 82分 ( 64～ 96分 ) ,其中优3 8髋 ,良 8髋 ,可 6髋 ,优良率 88.5 %。X线片分析未见假体松动 ,11髋 ( 2 1.2 % )发生异位骨化。结论　非骨水泥型全髋关节置换术治疗强直性脊柱炎髋关节病变 ,中期可取得满意的临床效果。     

Total hip arthroplasty in Japanese patients with ankylosing spondylitis

The purpose of this study was to examine the postoperative results following THA for ankylosing spondylitis, which is very rare in Japanese. We performed uncemented THA in 31 hips between 1982 and 2007. Patients were followed up for a mean of 12 years. The 10-year survival rate was 100%, and the 15-year survival rate was 63.5%. Revision surgery was performed in 4 hips. Complications developed in 5 cases. Two patients sustained an intraoperative non-displaced fracture at the level of the calcar femorale. Three patients experienced postoperative dislocation. Although the study scale was small because of the very low prevalence (0.0065%) of the disease in Japan, the survival rate was similar to those reported overseas. All revision cases were due to mechanical loosening of the acetabular component of Lord THA, suggesting that the low survival rate was due to the performance of the prosthesis and not the pathology of ankylosing spondylitis.     

Iatrogenic paraplegia in 2 morbidly obese patients with ankylosing spondylitis undergoing total hip arthroplasty

The authors describe 2 cases of intraoperative thoracic vertebral body extension fractures in morbidly obese patients with ankylosing spondylitis (AS), undergoing total hip arthroplasty, with resultant acute traumatic paraplegia. The pathophysiology with regard to the surgical positioning and the associated risks of obesity and AS are reviewed. Additionally, strategies for avoiding these types of injuries are discussed.     

Heterotopic bone formation following total hip arthroplasty in ankylosing spondylitis

Heterotopic ossification is a well-recognized complication of total hip arthroplasty. In a retrospective survey of 98 total hip arthroplasties in ankylosing spondylitis performed between 1970 and 1977, 39.8% showed some evidences of heterotopic ossification. Restriction of hip movements was noted in only two. Heterotopic ossification occurred within one year and was higher (64.6%) in patients with bilateral hip replacements if there was evidence of heterotopic bone formation in one hip. The complications were relatively high in hips with previous operations (55%); trochanteric bursitis (50%); and trochanteric detachment (63.3%). No correlation was found between high erythrocyte sedimentation rate and the incidence or extent of heterotopic bone formation.     

Total hip arthroplasty in ankylosing spondylitis

Total hip arthroplasty was performed on 29 hips in 19 patients diagnosed with ankylosing spondylitis over a 13-year period. The results were analyzed retrospectively with an average follow-up period of more than four years. Complete pain relief was achieved in 97%, and significant gains were made in ambulatory capacity. The limited gains in total range of motion (average improvement 75 degrees) were felt to be primarily due to the high incidence of Brooker Class III and IV myositis ossificans (23%) and long-standing soft tissue contractures.     

Bipolar hip arthroplasty in ankylosing spondylitis

Nineteen severely affected hips in 12 young patients with ankylosing spondylitis were treated with bipolar hip arthroplasty followed by a comprehensive postoperative rehabilitation programme. Additional operative procedures of adductor tenotomy, knee flexion release, supracondylar femoral osteotomy for genu valgum and tendo Achillis lengthening for equinus contracture were required in 13 limbs. After a mean follow-up of 45.8 months, results were good in all cases with respect to relief from pain, and there was significant improvement in posture and function. All the patients resumed employment. The average gain in sum total range of hip movements was 194 deg, and the mean preoperative Harris hip score of 27.8 improved to 82.6 after bipolar arthroplasty. Ectopic ossification did not develop in any case. Bipolar hip arthroplasty appears to be ideally suited for young patients with ankylosing spondylitis.     

强直性脊柱炎髋关节非功能位骨性强直的人工全髋关节置换

[目的]探讨强直性脊柱炎髋关节非功能位骨性强直的患者行人工全髋关节置换效果的因素,包括手术时机、手术方式、假体选择等。[方法]2011年1月~2014年1月对14例强直性脊柱炎导致髋关节非功能位骨性强直的患者行人工全髋关节置换术,其中男12例23髋,女2例3髋;年龄18~45岁,术前Harris评分平均28分。[结果]14例患者均获得随访,平均随访时间24个月。假体位置良好,无脱位等情况,活动度良好。[结论]对于强直性脊柱炎髋关节非功能位骨性强直的患者应尽早进行手术,应用生物型假体及精确的手术技术,可以获得良好的效果。     

强直性脊柱炎髋关节骨性强直的功能重建

目的探讨强直性脊柱炎合并双侧髋关节骨性强直时的全髋关节置换方法及其注意事项。方法对17例24～52岁强直性脊柱炎患者骨性强直的34侧髋关节行Zweimüller非骨水泥型全髋关节置换手术。髋关节强直在屈曲0°～100°(平均37°),其中超过90°强直者3例6髋。术前需助行器者7例。生活不能完全自理者9例。所有患者均在一次性经口腔(10例)或鼻腔(7例)气管插管麻醉下完成双侧手术。3例患者后期行脊柱后凸畸形矫正术。结果患者髋关节活动度由术前的0°改善为术后复查时的屈伸平均77°(55°～120°),屈伸、收展、内外旋总活动度平均为150°(105°～230°)。术中有1例因股骨颈截骨造成髋臼后壁缺损,经修补后恢复。术后近期无神经血管损伤、关节脱位、感染等并发症发生,随访18～47个月无假体松动、移位。除2例3髋长时间行走有轻微疼痛外,其余患者无疼痛,患者的生活质量明显提高,1例患者仍需助行器。结论手术技术熟练者可一次顺利完成强直性脊柱炎双髋骨性强直的双侧髋关节置换术,采用Watson-Jones入路可在完成骨性强直的髋关节置换的同时完成髋关节前方的软组织松解;术中注意神经、血管的保护可顺利完成90°以上屈曲骨性强直畸形髋关节的置换;术后康复的重点是锻炼患者的肌力和肌肉活动的协调性;采用自体血回输可以     

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。     

强直性脊柱炎全髋关节置换患者术后臂丛神经损伤1例

正患者,男,53岁,因脊柱疼痛20余年,双髋疼痛5年余,加重3月至暨南大学附属广州红十字会医院就诊。入院查体:脊柱颈胸腰段强直,颈椎向右侧偏斜位强直,被动活动受限,胸腰段后凸增加,僵硬,活动度差,双肩关节无压痛,除前屈欠15°以外,其余方向活动度基本正常,双上肢肌力、感觉、关节活动正常,无肌肉压痛,无肌肉萎缩。左髋关节屈曲95°,后伸0°,外旋25°～30°,内收、外展10°。右髋屈曲80°,     

全髋关节表面置换术治疗强直性脊柱炎近期疗效观察

目的 探讨全髋关节表面置换术治疗强直性脊柱炎(AS)的可行性及临床疗效.方法 对12例AS患者行全髋关节表面置换术,术后规范功能锻炼.定期临床随访.结果 所有患者切口均一期临床愈合.12例均获得随访,时间3～7(5±1)个月.早期无股骨颈骨折、感染、关节脱位、血管神经损伤、深静脉栓塞、异位骨化等并发症.术后髋关节活动度明显改善,术后Harris评分由术前平均(36±6)分上升至平均(94±4)分.影像学检查假体位置良好.患者生活质量均明显提高.结论 全髋关节表面置换术治疗AS患者近期临床效果满意.     

嵌压植骨在强直性脊柱炎全髋关节置换术治疗中的应用

[目的]探讨自体骨嵌压植骨在非骨水泥型全髋关节置换术治疗强直性脊柱炎合并髋关节病变中应用的临床效果。[方法]1996年3月-2003年3月，采用自体骨嵌压植骨非骨水泥型全髋关节置换术治疗强直性脊柱炎合并股骨侧严重骨质疏松的髋关节病变17例（24髋）。手术时平均年龄35．1岁（20．52岁）；采用Harris评分方法及X线片观察进行临床疗效评定。[结果]17例患者24髋获得了完整随访，随访时间3—10年，平均7．25年。Harris评分从术前平均34分提高到术后平均84．4分，术后优良率87．5％。X线片见股骨假体与股骨近段紧密压配；无假体感染及脱位。1髋出现5mm的假体下沉，发生于术后1年内，经过5年以上随访观察，假体未进一步下沉，并与骨质接触良好，目前无松动表现。[结论]骨质量对非骨水泥假体置换的疗效影响较大，采用自体骨嵌压植骨技术进行骨质重建，为强直性脊柱炎合并严重骨质疏松患者全髋关节置换术提供了一种很好的解决方法，临床效果满意。     

全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的临床研究

目的探讨强直性脊柱炎(AS)髋关节骨性强直行全髋关节置换术(THA)的特点,寻找提高手术疗效,减少并发症的方法。方法对本组18例AS患者29个骨性强直的髋关节行THA手术,术前髋关节强直在屈曲0～65°(平均23.6°),术后平均随访4.2年,Harris评分进行术后临床疗效评定,X线检查观察假体有无松动、脱位及异位骨化。结果所有患者治疗经过顺利,无关节松动、脱位、骨折、感染等严重并发症发生,髋关节的屈曲和内收畸形得到纠正。平均髋关节屈伸活动度81°,屈伸、内收外展、内外旋总活动度142°,Harris评分平均81.6分,X线照片见假体位置良好,未见松动和下沉。2例2髋长期行走时轻度疼痛,异位骨化2例:BrookerⅠ级1例,BrookerⅡ级1例。结论THA是AS髋关节骨性强直重建关节功能的有效方法,个体化手术方案的设计包括手术入路的选择、假体位置的正确安放、术中软组织松解与平衡、髋臼周围骨赘的清除等是影响手术疗效的关键。