全髋关节置换治疗强直性脊柱炎髋关节骨性强直

目的：探讨全髋关节置换术在治疗强直性脊柱炎髋关节骨性强直的临床疗效及安全性。方法：自2008年1月至2012年1月,采用全髋关节置换术治疗强直性脊柱炎髋关节骨性强直12例（24髋）,其中男11例,女1例,年龄27~62岁,病程5~32年。统计患者术前及术后髋关节活动度及Harris功能评分,术中及术后并发症。结果：所有患者获得随访,时间60~96个月,平均72.6个月,所有患者术后Harris评分较术前提高,髋关节活动度提高;优3例,良6例,中3例。异位骨化1例,为BrookerⅠ级,无临床症状未处理。1例术前严重屈曲畸形患者术后出现股神经牵拉损伤,随访1年后恢复。末次随访均未出现假体下沉及臼杯松动,无关节脱位、急性感染及下肢深静脉血栓形成等并发症发生。结论：全髋关节置换术是治疗强直性脊柱炎晚期髋关节骨性强直的有效方法。     

全髋置换治疗强直性脊柱炎髋关节强直

目的探讨强直性脊柱炎髋关节强直行全髋关节置换术的方法及疗效。方法回顾分析采用经外侧入路全髋关节置换治疗强直性脊柱炎髋关节强直19例（28髋）。结果所有患者均进行了随访,随访时间14～52个月,平均36个月。根据Harris评分系统对功能进行评价。术前Harris评分15～52分,平均26.8分;术后65～92分,平均84.6分,前后比较差异有统计学意义（P〈0.01）。术后无并发感染,无血管、神经损伤。术后发生髋关节疼痛1例,再强直1例,异位骨化2例,随访无髋关节脱位,未发现无菌性松动。结论经外侧入路全髋置换是强直性脊柱炎髋关节强直患者重建髋关节、恢复关节功能、提高生活质量的理想方法。     

强直性脊柱炎髋屈曲挛缩畸形的全髋关节置换术

目的观察对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。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患者行全髋关节置换术。术后平均随访3.2年,对手术前后疼痛、活动度、畸形矫正等进行了对比。结果术后除6侧髋关节轻度疼痛外,其余均无疼痛。关节活动度明显增加,Harris评分由术前平均31分改善为76分(配对t检验P<0.1)。结论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有效方法。     

强直性脊柱炎髋屈曲挛缩畸形的全髋关节置换术

目的：观察对于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。方法：自1998年7月至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行全髋关节置换术,术后平均随访3．2年,对手术前后疼痛、活动度、畸形矫正等进行了对比。结果：术后除6侧关节轻度疼痛外,其余关节均无疼痛。关节活动度明显增加,Harris评分由术前平均31分改善为76分（配对t检验,P〈0．1）。结论：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。     

全髋关节置换术治疗强直性脊柱炎严重屈髋畸形

目的分析全髋置换术治疗强直性脊柱炎严重屈髋畸形的临床疗效。方法28例（40髋）强直性脊柱炎髋关节屈曲畸形患者行全髋关节置换术，均为男性；年龄21-48岁，平均34．68岁；病程3～16年，平均8．53年；屈曲畸形角度30°-90°平均60．13°。单侧16例，双侧12例，16例（24髋）合并髋关节强直。采用改良的髋关节前外侧与外侧联合切口，生物型假体21例（29髋），混合型假体7例（11髋）。采用Harris评分对术前及术后髋关节功能进行评价。股骨侧假体采用Gruen的14分区法，髋臼侧假体采用DeLee和Charnley方法进行影像学观察。结果随访时间12,＇-64个月，平均42个月。末次随访时，关节总活动度由术前平均29．88。（0°-95°）增加至术后平均124．75°（90°～175°）。屈曲畸形程度由术前平均60．13°（30°-90°）减少至术后平均6°（0°～10°）。Harris评分由术前平均32．88分（12-58分）提高为随访时平均88．23分（69-98分），优20髋（50％），良15髋（37．5％），可3髋（7．5％），差2髋（5％），优良率87．5％。除1例术中出现股骨干穿通骨折和1例出现髋关节早期脱位外，X线检查均未显示假体松动移位迹象。8髋（20％）出现异位骨化。生物型假体和混合型假体随访时Harris评分差异无统计学意义（P〉0．05）。结论全髋关节置换术是治疗强直性脊柱炎严重屈髋畸形的有效方法。     

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。     

全髋置换术治疗强直性脊柱炎致髋关节强直

2000年3月～2009年3月,我科对17例(23髋)强直性脊柱炎致髋关节病变患者予以人工全髋关节置换治疗,近期效果良好,报道如下。1材料与方法1.1病例资料本组17例,男12例,女5例,年龄20～51岁。血清HLA-B27     

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。     

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.     

双侧全髋关节置换治疗强直性脊柱炎性髋关节强直

目的观察强直性脊柱炎性髋关节强直行双侧全髋关节置换术的效果,并对术中常见问题的处理进行探讨。方法通过对16例(32髋)强直性脊柱炎性髋关节强直行全髋关节置换术,对手术前后髋关节功能的改善情况进行对比研究。结果关节活动度由术前0°改善为平均68°,髋关节屈曲畸形由术前平均42°改善为8°,术后所有患者生活均可自理。结论全髋关节置换术是治疗强直性脊柱炎性髋关节强直的有效方法。     

Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips

The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. The mean age of patients at surgery was 47 years. Before surgery, 42 hips (23.2%) were ankylosed. Revision surgery was carried out in 25 hips (13.8%). Heterotopic ossification was present in 21 hips (11.6%); however, no patients had functional impairment or reankylosis. At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.     

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

Ankylosing spondylitis (AS) is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function. Functional impairment is significant, with spine and hip involvement, and is predominantly seen in the younger age group. Total hip arthroplasty (THA) for fused hips with stiff spines in AS results in considerable improvement of mobility and function. Spine stiffness associated with AS needs evaluation before THA. Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis. Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern. Care should be taken to reduce acetabular component anteversion at THA in these fused hips, as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation. Fused hips require femoral neck osteotomy, true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome. Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA. Risks at THA in AS include intraoperative fractures, dislocation, heterotopic ossification, among others. There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.     

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.     

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。     

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.     

Total hip arthroplasty for arthrodesed hips

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.     

全髋关节置换术治疗强直性脊柱炎髋关节强直的临床研究

目的探讨全髋关节置换术治疗强直性脊柱炎髋关节强直的手术方法及术后疗效。方法 2005年5月至2008年5月,对13例(18髋)强直性脊柱炎髋关节强直患者行全髋关节置换术,患者均为男性,平均年龄35岁(22～51岁)。术后平均随访3.8年(2～5年),根据Harris评分进行评分,根据Gruen股骨分区法和DeLee-Charnley髋臼分区法对股骨假体和髋臼假体作影像学分析。结果 13例(18髋)患者Harris评分由术前平均24.3分(0～38分)提高至术后平均87.3分(54～94分),疗效优6髋,良10髋,可2髋,优良率为88.9%。髋关节总活动度由术前平均35.4°(0°～105°)提高至术后平均192.6°(78°～225°)。X线片未见假体松动、脱位或折断,异位骨化发生率11.1%(2髋)。结论全髋关节置换术是重建强直性脊柱炎髋关节强直患者髋关节功能,提高生活质量的有效方法。     

强直性脊柱炎的人工全髋关节置换术(附18例/31髋中期随访分析)

目的探讨强直性脊柱炎患者行全髋关节置换术的手术方法并分析中期疗效.方法对18例(31髋)强直性脊柱炎患者行人工全髋关节置换术,并进行了平均5.2年(2～9.2年)的随访.临床随访根据Harris评分系统进行评分,X线随访根据Gruen等和Delee and Charnley分区法分别进行股骨柄和臼杯X线片分析.结果至最近1次随访,Harris评分由术前的平均27.6分(3～52分)提高到了术后的平均83.3分(54～92分)优良率为87.1%,其中,优5髋,良22髋,可3髋,差1髋.髋关节的总活动度由术前的平均35.6°(0～115°)提高到了术后的平均185.6°(54～215°).X线片未见假体松动、脱位或折断;异位骨化发生率9.7%(3髋).结论人工全髋关节置换术是强直性脊柱炎患者重建髋关节,恢复关节功能,提高生活质量的有效方法.