全髋表面置换术治疗强直性脊柱炎

目的：研究金属对金属全髋表面置换术治疗强直脊柱炎性髋关节病的近期疗效，探讨该病行全髋表面置换术的适应证和技术要点。方法：对2006年2月至2008年4月11例（15髋）行全髋表面置换术的强直性脊柱炎性髋关节病患者进行随访，男9例，女2例；年龄16～53岁，平均32．5岁。对手术前后关节疼痛、活动度、畸形矫正、松动及功能的改善进行对比研究，根据Harris评分系统进行比较，分析强直性脊柱炎患者行全髋表面置换术的可行性和技术难点。结果：失访1例，实际得访10例（14髋），10例疼痛缓解：随访时间平均16．2个月（8-34个月）。术前Harris评分平均（30．9±3．4）分（2-47分），术后16个月平均（85．1±3．1）分（46-94分）；术前屈髋度0°-75°，术后16个月35°～105°；术前外展度0°-30°，术后16个月15°～55°。评价：优10髋，良3髋，差1髋。9例术后生活自理，其中6例可奔跑。1例疼痛部分缓解，关节功能恢。复差。无术后股骨颈骨折发生，无异位骨化。结论：经过适当患。者选择，全髋表面置换术治疗强直性脊柱炎性髋关节病可以获得满意的疗效，术中的精细操作和个体化手术设计至关重要。

Hip resurfacing arthroplasty in patients with ankylosing spondylitis

Objective： To study the short-term results of metal on metal hip resurfacing arthroplasty （HRA） for the treatment of patients with ankylosing spondylitis （AS）, to explore the indications and .technology of this surgery. Methods：From February 2006 to April 2008,11 patients （15 hips）with ankylosing spondylitis were treated with metal on metal total hip resurfacing arthroplasty. Among them,9 patients were male,and 2 patients were female,with an average age of 32.5 years （ ranged from 16 to 53 years）. The comparative study on preoperative and postoperative pain,range of motion,correction of deformity and function evaluation were performed. The preoperative and postoperative Harris scores were compared and the feasibility and technical difficulty were analyzed. Results ：Ten patients were followed up for an average period of 16.2 months （ranged from 8 to 34 months） and 1 patient was lost. Pain disappeared in 10 patients. There were no heterotopic ossification,no femoral neck fracture, no dislocation, no infection and no revision in all patients. From preoperation to present, the mean flexion angle of hip was improved from preoperative 0° to 75° to postoperative 35° to 105° ;the mean abducting angle of hip was improved from preoperative 0° to 30° to postoperative 15° to 55°; and the average Harris hip score improved significantly from （30.9±3.4） （2-47） to （85.1±3.1 ） （46-94）. According to evaluation criteria, 10 hips got an excellent result, 3 good and 1 poor. Conclusion： The total hip resurfaeing arthroplasty is an effeetive solution for the treatment of the younger and active patients with AS and it shows satisfaetory short-term results. It is very significant to analysis the different eonditions of patients so as to choose proper strategy.