人工全髋关节置换在骨性强直髋治疗中的临床及放射学评估

目的:对人工全髋关节置换(THA)在骨性强直髋治疗中的临床及放射学效果进行评估。方法:自2003年1月至2009年8月,20例(30髋)骨性强直的髋关节患者采用THA治疗,其中男12例,女8例;平均年龄36岁。术后临床随访根据Harris评分、患者疼痛缓解满意度、肢体长度差异、髋关节活动范围以及髋关节外展肌力进行评价。X线影像学随访包括对髋臼及股骨柄假体周围骨溶解、假体松动、透光线及异位骨化进行评价。术后平均随访时间为4年。结果:Harris评分由术前的平均(40.75±6.52)分提高至术后平均(86.40±5.42)分;邻近受累关节疼痛完全缓解13例,部分缓解7例;13例外展肌力量恢复满意,跛行症状明显缓解,肢体短缩下降至小于0.5cm;髋关节活动范围较术前显著改善。放射学评估发现2例髋关节周围异位骨化,1例股骨假体周围透光线,无关节假体脱位及翻修的病例。结论:近期随访发现THA在治疗骨性强直的髋关节中可以获得满意的临床疗效,矫正髋关节畸形,恢复髋关节功能,减轻患髋邻近关节的疼痛,改善患者的生活质量。

Clinical and radiographic evaluation for total hip arthroplasty in treatment of bony ankylosis of hips

Objective:To evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips. Methods:From January 2003 to August 2009,20 patients(30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females,with an average age of 36 years old. After operation,the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score,satisfaction of pain relief,limb length discrepancy,ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis,prosthesis loosening,radiolucent and heterotopic ossification. Results:The average following-up was 4 years. The mean preoperative Harris score was (40.75±6.52) as opposed to postoperative Harris score of (86.40±5.42). Total pain relief was 65% and partial pain relief was 35% around the affected hips. The recovery of abductors strength was satisfactory in 13 cases,with limp symptoms was relieved obviously,and limb shortening decreased to less than 0.5 cm. The postoperative ROM of hip was significantly improved compared with the preoperative ROM. Radiographic analysis showed that heterotopic ossification in 2 cases,and radiolucent around prosthesis in one case. There were no dislocation and revision cases. Conclusion:The THA can provide satisfactory clinical results in bony ankylosis of hips,which not only correct the deformity and recover the functions of hip,but also relieve the pain of hip to improve quality of life.