目的 探讨人工全髋关节置换术(total hip arthroplasty,THA)中采用联合前倾角技术治疗强直性脊柱炎(ankylosing spondylitis,AS)累及髋关节的疗效.方法 回顾分析2018年8月-2021年8月采用THA治疗的73例AS累及髋关节患者临床资料.根据THA术中是否采用联合前倾角技术,分为研究组(37例,THA采用联合前倾角技术)和对照组(36例,行传统THA).两组患者性别、年龄、身体质量指数、病程及术前Harris评分、髋关节活动度(range of motion,ROM)、髋臼前倾角、髋臼外展角、股骨前倾角、联合前倾角等基线资料比较差异均无统计学意义(P＞0.05).记录并比较两组患者手术时间、住院时间及并发症发生情况;比较两组患者术前,术后1、3、6、12个月和末次随访时Harris评分和髋关节ROM,评价髋关节功能.术后测量髋臼假体前倾角、股骨假体前倾角、髋臼假体外展角、假体联合前倾角等影像学指标.结果 研究组手术时间短于对照组(P＜0.05),两组患者住院时间比较差异无统计学意义(P＞0.05).两组术中均未出现髋臼及股骨近端骨折、神经血管损伤等并发症;术后切口均Ⅰ期愈合.所有患者均获随访,随访时间2～3年,平均2.4年;两组随访时间比较差异无统计学意义(P＞0.05).随访期间两组均未发生髋关节脱位、切口感染、切口延迟愈合、下肢深静脉血栓形成及髋关节脱位等并发症.术后随时间延长,两组患者髋关节Harris评分及ROM均呈逐渐上升趋势,与术前比较差异有统计学意义(P＜0.05);术后各时间点研究组上述两指标均优于对照组,差异有统计学意义(P＜0.05).两组患者术后12个月髋关节正位X线片均可观察到假体表面广泛性骨长入表现,髋臼假体稳定性良好,无股骨柄下沉及假体周围骨溶解发生,未出现异位骨化.末次随访时,两组除髋臼假体外展角比较差异无统计学意义(P＞0.05)外,研究组髋臼假体前倾角、股骨假体前倾角及假体联合前倾角均优于对照组(P＜0.05).结论 对于AS累及髋关节患者,与传统THA相比,THA术中采用联合前倾角技术可有效促进髋关节功能恢复,提升患者生活质量.
Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint
Objective To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty(THA)for treating ankylosing spondylitis(AS)affecting the hip joint.Methods A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021.According to whether the combined anteversion angle technique was used in THA,the patients were divided into study group(37 cases,combined anteversion angle technique was used in THA)and control group(36 cases,traditional THA).There was no significant difference in baseline data such as gender,age,body mass index,disease duration,preoperative Harris score,range of motion(ROM),acetabular anteversion angle,acetabular abduction angle,femoral anteversion angle,and combined anteversion angle between the two groups(P＞0.05).The operation time,hospital stay,and complications of the two groups were recorded and compared.The Harris score and hip ROM were compared between the two groups before operation,at 1,3,6,12 months after operation,and at last follow-up.The acetabular component anteversion angle,femoral component anteversion angle,acetabular component abduction angle,and component combined anteversion angle were measured postoperatively.Results The operation time in the study group was significantly shorter than that in the control group(P＜0.05),and there was no significant difference in hospital stay between the two groups(P＞0.05).There was no intraoperative complication such as acetabular and proximal femoral fractures,neurovascular injuries in both groups,and the incisions healed by first intention.All patients were followed up 2-3 years,with an average of 2.4 years;there was no significant difference in the follow-up time between the two groups(P＞0.05).During the follow-up period,there was no complication such as hip dislocation,wound infection,delayed wound healing,deep venous thrombosis,and hip dislocation in both groups.The hip Harris score and ROM of the two groups gradually increased with time after operation,and the differences were significant when compared with those before operation(P＜0.05);the above two indicators of the study group were significantly better than those of the control group at each time point after operation(P＜0.05).Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation,and the acetabular components was stable without femoral stem subsidence,osteolysis around the components,and heterotopic ossification.At last follow-up,the acetabular component anteversion angle,femoral component anteversion angle,and component combined anteversion angle in the study group were significantly superior to those in the control group(P＜0.05),except that there was no significant difference in the acetabular component abduction angle between the two groups(P＞0.05).Conclusion For patients with AS affecting the hip joint,the use of the combined anteversion angle technique during TH A effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional TH A.
Combined anteversion angle techniquetotal hip arthroplastyankylosing spondylitis
万方数据
维普
