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[1]柯偉杰,王海彬,何偉,等.全髖關(guān)節(jié)置換術(shù)治療強(qiáng)直性脊柱炎髖關(guān)節(jié)骨性強(qiáng)直[J].中醫(yī)正骨,2017,29(10):69-72,75.
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全髖關(guān)節(jié)置換術(shù)治療強(qiáng)直性脊柱炎髖關(guān)節(jié)骨性強(qiáng)直()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年10期
頁碼:
69-72,75
欄目:
臨床報(bào)道
出版日期:
2017-10-20

文章信息/Info

作者:
柯偉杰王海彬何偉陳德龍
廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院,廣東 廣州 510405
關(guān)鍵詞:
關(guān)節(jié)成形術(shù)置換 脊柱炎強(qiáng)直性 關(guān)節(jié)強(qiáng)直 髖關(guān)節(jié)
摘要:
目的:觀察全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)治療強(qiáng)直性脊柱炎(ankylosing spondylitis,AS)髖關(guān)節(jié)骨性強(qiáng)直的臨床療效及安全性。方法:2011年10月至2015年12月,采用THA治療AS髖關(guān)節(jié)骨性強(qiáng)直患者21例(35髖),均為男性。年齡22~50歲,中位數(shù)24歲。左側(cè)20髖,右側(cè)15髖。血清人類白細(xì)胞抗原-B27檢測均為陽性。發(fā)病年齡13~48歲,中位數(shù)18歲。所有患者髖關(guān)節(jié)總活動度為0°。13例患者存在髖關(guān)節(jié)屈曲畸形。病程2~18年,中位數(shù)9年。末次隨訪時(shí),測量所有患者髖關(guān)節(jié)屈伸活動度,并采用Harris髖關(guān)節(jié)功能評分標(biāo)準(zhǔn)評定髖關(guān)節(jié)功能恢復(fù)情況; 測量13例髖關(guān)節(jié)屈曲畸形患者畸形程度; 采用12項(xiàng)簡明健康狀況調(diào)查表(12-item short-form health survey,SF-12)和主觀4級標(biāo)準(zhǔn)(非常滿意、比較滿意、比較不滿意及非常不滿意)評價(jià)患者滿意度; 記錄引起患者不滿意的原因。隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:手術(shù)時(shí)間44 min至5 h,中位數(shù)113 min。術(shù)中失血量100~3100 mL,中位數(shù)450 mL。術(shù)后住院時(shí)間5~30 d,中位數(shù)11 d。所有患者均獲隨訪,隨訪時(shí)間5個(gè)月至5年,中位數(shù)2年。末次隨訪時(shí),所有患者髖關(guān)節(jié)屈伸活動度及Harris髖關(guān)節(jié)功能評分均較術(shù)前增加[0.00°±0.00°,77.74°±8.25°,t=54.945,P=0.000;(43.29±10.01)分,(74.69±8.30)分,t=22.032,P=0.000]; 13例髖關(guān)節(jié)屈曲畸形患者畸形程度較術(shù)前降低(40.20°±30.87°,8.05°±2.30°,t=5.478,P=0.000); 采用SF-12與主觀4級標(biāo)準(zhǔn)評定患者滿意度,非常滿意14例、比較滿意2例、比較不滿意5例; 引起患者不滿意的主要原因包括疼痛(1例)、髖關(guān)節(jié)屈曲及旋轉(zhuǎn)受限(2例)、雙下肢不等長(1例)和跛行(1例)。所有患者均未出現(xiàn)神經(jīng)血管損傷、下肢深靜脈血栓形成、切口感染、假體松動或移位、異位骨化等并發(fā)癥。結(jié)論:THA治療AS髖關(guān)節(jié)骨性強(qiáng)直,可以增加髖關(guān)節(jié)屈伸活動度、促進(jìn)髖關(guān)節(jié)功能恢復(fù)、減輕髖關(guān)節(jié)屈曲畸形程度,且安全性和患者滿意度較高,值得臨床推廣應(yīng)用。

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更新日期/Last Update: 2018-03-10