血友病性髋关节炎患者的全髋关节置换四例报告

目的 探讨全髋关节置换术治疗血友病性髋关节炎的短、中期临床疗效。方法 回顾分析 2004 年５月至 2010 年９月，采用人工髋关节置换术治疗晚期血友病性髋关节炎患者４例。患者均为男性，年龄 34～56 岁，平均年龄 45 岁。按 Arnold and Hilgartner 分级：IV 级２例，Ｖ级２例。围手术期给予患者凝血因子替代治疗的基础上，对４例患者行人工髋关节置换术，手术采用髋关节前外侧标准入路。术中、术后监测相应凝血因子活性水平控制术后出血，密切关注并发症的发生。术后根据关节功能改善情况、Harris 评分、假体生存情况、术后并发症等评估手术治疗效果。结果 本组４例患者均获随访，随访时间９个月至７年，平均 40 个月。４例患者术后髋关节疼痛均明显减轻，３例患者术后髋关节疼痛消失，１例患者术后偶诉疼痛，但不影响生活。术后 Harris 评分：85～90 分 （优２例，良２例），平均 87.7 分。术中出血量及引流量：平均每侧髋关节为 1210 ml。本组第１例患者术后 84 个月右侧髋臼处出现松动迹象，现拟行翻修手术治疗；余患者均未出现假体周围骨溶解及松动的征象，假体位置和力线水平均满意。１例术后出现关节内出血并切口渗血，无 DVT 和 PE 形成，无大出血及伤口感染。手术切口均Ｉ期愈合。结论 人工髋关节置换术可明显缓解晚期血友病性关节炎患者的关节疼痛，明显改善病变髋关节功能，短、中期疗效较好。合理的围手术期凝血因子替代治疗非常重要，血友病性髋关节炎行人工关节置换术难度较大，对手术技术要求很高，需要专业的手术团队并在内科医师配合下施行。

Total hip arthroplasty in the treatment of patients with hemophilic hip arthritis: 4 cases report

Objective To investigate the short- and mid-term clinical outcomes of total hip arthroplasty （THA） for hemophilic arthritis of the hip. Methods From May 2004 to September 2010, 4 patients with end-stage hemophilic arthritis of the hip received artificial hip joint replacement, whose data were retrospectively analyzed. The average age of the 4 male patients was 45 years old （range; 34-56 years）. According to the Arnold and Hilgartner classification, there were 2 cases of grade IV and 2 cases of grade V. In the perioperative period, patients were treated with clotting factor replacement therapy. All patients were performed with artificial hip joint replacement through anterolateral approach. During and after the operation, the level of clotting factor activity was monitored to control postoperative bleeding, and close attention was paid to the occurrence of complications. The postoperative outcomes were assessed with joint function improvement, Harris scores, survival of the prostheses, postoperative complications and so on. Results All of the 4 patients were followed up for an average period of 40 months （range; 9-84 months）. The hip pain of all patients were significantly relieved after the operation, which disappeared in 3 patients and occurred occasionally in 1 patient whose daily life had not been affected by it. The postoperative Harris hip score was 85-90 points （excellent in 2 cases and good in 2 cases）, with an average of 87.7 points. The perioperative blood lose and drainage amount： the average amount of bleeding on each side of the hip was 1210 ml. Some loose signs appeared in the right hip of the first patient 84 months after the operation, and a revision surgery was planned to perform on him. Other patients did not show any bone dissolving or loosening signs around the prostheses, with satisfactory prosthesis position and force line level. 1 patient showed joint hemorrhage and incision bleeding, without dementia of vascular type （DVT） and polyethylene （PE） formation, hemorrhea or wound infection. All incisions healed by first intention. Conclusions Artificial hip joint replacement can significantly relieve the joint pain of patients with end-stage hemophilic arthritis and improve their hip functions, with satisfactory short- and mid-term outcomes. Reasonable perioperative clotting factor replacement therapy is very important. The artificial joint replacement surgery for patients with hemophilic arthritis is very difficult, which requires high-leveled surgery technique. So professional surgical team and effective cooperation with the physicians are needed in this surgery.