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全髋关节置换术治疗强直性脊柱炎髋关节病变刘勇;王业华;蒋健;柯明池;徐峥【摘要】目的：探讨全髋关节置换术治疗强直性脊柱炎髋关节病变的效果。
方法对20例（27髋）强直性脊柱炎髋关节病变患者行人工全髋关节置换手术。
置换前患者日常活动均明显受限，其中需要使用助行器7例，生活完全不能自理4例，8例（11髋）关节强直。
比较手术前后髋关节 Harris 评分和关节活动度及术后并发症。
1例患者后期行脊柱后凸矫形术。
结果全部病例获得随访，平均随访时间4.2年（1.2~7.8年）。
最后一次随访，23髋（85.2%）疼痛完全消失；仅有1例仍需双拐辅助行走，其余患者均可不扶拐行走，步态正常。
术前 Harris 评分平均14.9分，髋关节活动度平均40°。
术后 Harris 评分平均82.9分，其中优8髋，良10髋，可7髋，差2髋，优良率74.1%；髋关节活动度平均190.5°；髋关节Harris 评分及关节活动度均显著高于置换前（P <0.05）。
4髋（7.4%）出现异位骨化，分别为Brooker 分级Ⅰ、Ⅱ级。
假体无菌性松动1例。
结论全髋关节置换术是治疗强直性脊柱炎髋关节病变的有效手段，可以缓解关节疼痛，恢复关节功能，改善患者生活质量。
%Objective To evaluate the clinical results of the total hip replacement in the patients with ankylosing spondy-litis. Methods A total of 20 ankylosing spondylitis patients(27 hip joints)underwent totalhip replacement. All the patients had obvious restriction in daily life before operation:7 cases had to walk with the help of crutches,4 cases had to siton wheel-chair,and 8 cases(11 hip joints)were stiff. The range of motion of the hip joint,the Harris score,and the postoperative compli-cations were compared and analysed in this study. Additional spinal operation for their kyphosis was required in 1 patient. Re-sults The patients were followed upfor an average age of 4. 2 years(ranged from 1. 2 to 7. 8 years)in our department. The pain was completely released in 23 hips(85. 2% )at the last time of follow-up. Only one patient still needed two crutchs to walk. The mean Harris score was 14. 9 averagely and the mean total range of the hip joint movement was 40°before surgery. The Harris score of hip joint was 82. 9 averagely,including 8 hips excellent,10 good,7 possible,and 2 poor,with an excellent and good rate of 74. 1% . The mean total range of the hip joint movement was 190. 5°after surgery. 4 hips(14. 8% )appeared hetero-topic ossification in all patients according to Brooker's calssification,one was of Class Ⅱ and the other ClassⅢ,and 1 hip ap-peared aseptic loosening. Conclusion The total hip replacement is an effective solution for the treatment of affected hip with ankylosing spondylitis. It can relieve the pain of the joint,restore the hip function and improve the life of the patients with an-kylosing spondylitis.【期刊名称】《实用骨科杂志》【年(卷),期】2014(000)009【总页数】5页(P780-784)【关键词】强直性脊柱炎;全髋关节置换术;髋关节;活动度;Harris 评分【作者】刘勇;王业华;蒋健;柯明池;徐峥【作者单位】徐州医学院附属医院骨科，江苏徐州 221006;徐州医学院附属医院骨科，江苏徐州 221006;徐州医学院附属医院骨科，江苏徐州 221006;徐州医学院附属医院骨科，江苏徐州 221006;徐州医学院附属医院骨科，江苏徐州221006【正文语种】中文【中图分类】R687.4+2强直性脊柱炎(ankylosing spondylitis，AS)是一种慢性炎症性自身免疫性疾病，主要侵犯骶髂关节、脊柱和髋关节，并可累及外周关节、肌腱韧带附着点及其他组织，有较强的致残性[1]，严重者造成脊柱畸形和关节强直，髋关节受累后，造成患者髋部疼痛和步态异常。
人工全髋关节置换术治疗强脊炎髋关节强直摘要】目的：本研究主要是对采用人工全髋关节置换术对强直性脊柱炎髋关节的强直进行治疗的临床疗效进行分析和研究。
方法：为了保证研究结果的准确性，主要选择的是2010年6月-2013年6月某医院收治的所有采用人工全髋关节置换术治疗强脊炎髋关节强直的患者，患者总人数为27例，共包括38个髋关节。
对治疗过程中的临床资料进行回顾。
结果：在手术之后，对这些患者进行回访可知，在进行手术之前患者髋关节无法进行活动，但是经过手术之后活动度可以达到147.4°，平均的屈髋也达到了92.6°。
另外，髋关节屈曲畸形程度；Harris评分等都有明显的好转。
经过手术治疗之后，患者的髋痛现象消失，能够正常行走，而且很少出现或者是几乎不出现并发症的现象。
结论：在对强脊炎髋关节强直的治疗中可知，采用手术的治疗方式可以提升髋关节的灵活程度，矫正关节畸形的现象，满足患者的基本要求，完善其生活的质量。
人工髋关节置换手术的方式可以被广泛推广。
【关键词】全髋关节置换；强直性脊柱炎；髋关节强直强直性脊柱炎是慢性疾病的一种，可以累及到中轴关节，在疾病后期会出现脊柱的凸起或者是强直的现象。
从目前的治疗方式上看，采用人工全髋关节置换技术的疗效显著。
通过对强直性脊柱炎患者进行随访，可知，患者的恢复速度较快，基本达到治疗的效果。
在今后的临床治疗工作中可以将这种手术技术进行推广。
1、资料与方法1.1一般资料在本组研究中，患者的总数为27人，其中男性占据23例，而女性为4例。
其中男性的髋关节共34个，女性仅为4个。
这27例患者的平均年龄为47.6岁。
患者的病程从6年到30年不等，平均的病程为13.4年。
经过临床诊疗，患者出现的而主要病症为侧髋关节强直，屈曲畸形等，畸形程度达到31°，角度小于40°，Harris评分为16.6分。
患者的髋关节间隙变小，设置消失，所有的患者都采用人工全髋关节置换术的治疗方式。
大直径陶瓷－陶瓷全髋关节置换术治疗强直性脊柱炎髋关节病变【摘要】目的评价应用大直径陶瓷-陶瓷股骨头人工全髋关节置换术治疗强直性脊柱炎（AS）髋关节病变的早期临床疗效。
方法对25例（40髋）AS累及髋关节的患者行大直径陶瓷-陶瓷股骨头人工全髋关节置换术，术后定期随访，比较手术前后髋关节屈伸活动度、Harris评分及影像学变化。
结果本组2例因骨质疏松术中出现股骨近端骨折，用钢丝捆绑，8周复查骨折愈合。
患者均获随访，术后平均随访1.8年（1～4年），髋关节屈伸活动度由术前平均为（27.5±18.6）°上升为术后（89.3±15.4）°，Harris评分由术前（31.2±10.8）分上升为术后（91.7±12.5）分。
无感染、关节脱位、深静脉血栓形成等并发症发生，X线检查无假体松动和移位。
异位骨化3例，Brooker 1级2例，Brooker 2级1例。
结论大直径陶瓷－陶瓷全髋关节置换术治疗AS髋关节病变能够明显缓解患者症状，改善关节功能，近期疗效满意。
【关键词】关节成形术，置换，髋；脊柱炎，强直性；陶瓷制品The short-term outcome of large-diameter ceramic-on-ceramic femoral head prothesis for ankylosing spondylitis【Abstract】Objective To evaluate the short term clinical outcome of large-diameter ceramic-on-ceramic femoral head prothesis for ankylosing spondylitis. Methods 25 patients (with 40 hips) were performed with large-diameter ceramic-on-ceramic femoral head prothesis, and all patients were followed up. The preoperative and postoperative motion of hip joint in flexion, Harris score and X-ray examination were compared. Results Intraoperatively, 2 patients suffering from proximal femur fracture due to severe osteoporosis were treated with steel wire fixation, and the fractures were healed 8 weeks later. All the patients were followed up for average 1.8 years (ranging from 1 to 4 years). The motion of hip joint in flexion increased from （27.5±18.6）°preoperative to （89.3±15.4）°postoperative, and the average Harris hip score increased from （31.2±10.8）preoperative to （91.7±12.5）postoperative. There were no complications such as infection, dislocation and deep vein thrombosis. All cases had no prosthesis displacement and loosening in X-ray. Acetabular heterotopic ossification was seen in 3hips, 2 were Brooker grade 1, 1 was grade 2. Conclusions Large-diameter ceramic-on-ceramic femoral head prothesis has a good short-term effect in treatment of ankylosing spondylitis, which can relieve symptoms and improve joint function significantly.【Key words】Arthroplasty, replacement, hip; Spondylitis, ankylosing; Ceramics 强直性脊柱炎（ankylosing spondylitis，AS）是一种血清阴性的结缔组织疾病，好发于年轻男性患者。
强直性脊柱炎应用人工全髋关节置换的临床分析【摘要】目的探讨强直性脊柱炎(AS)应用人工全髋关节置换的临床效果。
方法回顾分析25例患者的临床资料。
结果均得到随访,随访时间12~48个月；术后近期均未发生大血管损伤、关节脱位、感染等并发症；术中术后引流量1100~2500 ml；术后1年测量髋关节总活动度,作Harris评分,满意度测评。
髋关节总活动为120°~230°,平均187°;Harris评分86~95分; 17例术后生活均能自理,术后患者满意度达100%。
结论我们认为人工全髋关节置换术治疗强直性脊柱炎,与其他病因的全髋关节置换术相比,并无较高的危险因素。
但目前对全髋关节置换术治疗AS的研究较少,病例随访时间也不长，要想更进一步了解其治疗效果，需长时间的随访及进一步的观察。
【关键词】强直性脊柱炎；人工全髋关节置换；效果强直性脊柱炎(ankylosing spondylitis,AS)是一种累及全身多个脏器的免疫性疾病,多发于青壮年。
表现为进行性脊柱、髋关节强直,晚期患者可产生严重的髋关节、膝关节强直、僵硬,是致残率很高的慢性全身性免疫性疾病,以骶髂关节、脊柱受累为特征,髋关节受累的发病率约为42%,而且双侧受累多见,畸形,严重者甚至引起非功能位强直,生活不能自理,对生活质量影响较大1，2］。
全髋人工关节置换术(totalhip arthrop lasty,THA)可有效改善因关节疾患而残疾的强直性脊柱炎患者的生活质量,但通常认为与其他病因的全髋关节置换术相比,存在较高的危险因素3］。
我院于2006年10至2011年5月收治了25例AS患者,现总结分析,报告如下。
1 资料与方法1.1 一般资料本组25例，其中男22例,女3例。
AS病程4～32年；THA 时年龄21～55岁；双髋同时置换3例,分次置换2例,间隔时间分别为1年及3年。
术前类风湿因子(RF)均为阴性,血沉(ESR)、C反应蛋白(CRP)无异常,HLA B27均为阳性,25例髋关节屈伸活动范围为0～64°,所有患者生活自理受限;4例伴轻至中度脊柱后凸畸形;本组病例中未发现病变累及膝关节。
强直性脊柱炎全髋关节置换术的常见问题及处理作者：郭晓东来源：《中国社区医师》2014年第18期doi：10.3969/j.issn.1007-614x.2014.18.35摘要目的：分析强直性脊柱炎全髋关节置换术的常见问题，并探讨处理对策。
方法：2012年1-12月收治强直性脊柱炎全髋关节置换术患者48例，分析术后常见的并发症问题，并予以相应的处理措施，观察患者预后情况。
结果：48例患者术后发生并发症6例（12.50%），其中假体周围骨折1例（2.08%）、假体松动2例（4.17%）、脱位1例（2.08%）、感染1例（2.08%）、下肢静脉血栓1例（2.08%）。
结论：全髋关节置换术用于治疗强直性脊柱炎可改善患者髋关节功能，但术后并发症问题较严重，在今后的临床工作中应予以重视。
关键词强直性脊柱炎全髋关节置换术常见问题处理对策The common problems and treatment of ankylosing spondylitis hip replacementGuo XiaodongTh e Ninth People’s Hospital of Shenyang City，Liaoning 110024AbstractObjective：To analyze the common problems of ankylosing spondylitis hip replacement，and to explore the countermeasures.Methods：48 cases with ankylosing spondylitis total hip replacement were selected from January to December 2012.We analyzed the common postoperative complications，and give corresponding treatment measures.We observated the prognosis of cases.Results：In 48 cases，6 cases（12.50%）were with postoperative complications.1 case（2.08%） was fracture around the prosthesis.2 cases（4.17%） were prosthesis loosening.1 case（2.08%） was dislocation.1 case （2.08%）was infection.1 case（2.08%） was venous thrombosis.Conclusion：The total hip arthroplasty for the treatment of ankylosing spondylitis can improve the hip joint function in patients with postoperative complications，but the problem is more serious after operation，so we should pay more attention in the clinical work in the future.Key wordsAnkylosing spondylitis；Total hip replacement；Common problem；Treatment countermeasures强直性脊柱炎是一种慢性自身免疫性疾病，病变常累及髋关节，引起关节破坏、关节周围骨质硬化，从而导致髋关节纤维性强直和骨性强直。
人工全髋关节置换术在强直性脊柱炎中的应用目的探讨强直性脊柱炎全髋置换术的手术特点，评价其术后疗效。
方法14例强直性脊柱炎患者行人工全髋置换术，其中全髋单髋置换4例，全髋双髋置换10例。
结果随访时间2～10年，平均5.25年。
Harris评分由术前的平均26.33分（12～46分）提高到随访时的平均82.96分（74～96分），髋关节术前总活动度由术前的100.04°（0°～172°）改善为术后的185.38°（186°～247°）。
14例术后均可生活自理。
结论全髋置换术治疗强直性脊柱炎可获得满意疗效，选择合理的手术策略及合适的假体对手术效果尤为关键。
[Abstract] Objective To explore the surgery characteristics of total hip arthroplasty (THA) for patients with ankylosing spondylitis (AS), and to evaluate the postoperative curative effect. Methods Forteen patients with AS were were given THA, in which 4 patients were given unilateral total hip arthroplasty, 10 patients were given bilateral total hip arthroplasty. Results The follow-up time were 2 to 10 years with the mean of 5.25 years. Harris Scores increased to 82.96 scores（74-96 scores）from the mean of 26.33 scores before the surgery(12-46 scores). Hip total mobility improved of 185.38°(186°-247°) after the surgery from the mean of 100.04°(0°-172°) before the surgery. Forteen patients all could take care of themselves after operation. Conclusion Total hip replacement therapy of ankylosing spondylitis can be obtained satisfactory curative effect, chosing reasonable operation strategy and suitable prosthesis are keys to the operation effect.[Key words] Ankylosing spondylitis; Artificial total hip replacement; Orthopaedics; Application强直性脊柱炎是脊椎的慢性进行性炎症，也可累及内脏及其他组织，而髋关节是最常受累的大关节，严重者出现髋关节畸形，非功能位强直，严重影响患者生活质量。
关于全髋关节置换术治疗强直性脊柱炎髋关节病变姜文明袁耀周云斌吴立东【摘要】目的探讨强直性脊柱炎髋关节受累病例进行全髋关节置换术的手术注意事项及其疗效。
方法对35例(46髋)强直性脊柱炎髋关节受累的病例进行人工全髋关节置换术治疗。
男31例，女4例;年龄21~72岁，平均39.7岁。
术中1例(2髋)髋臼侧和股骨侧均为骨水泥型假体，29例(38髋)采用非骨水泥型假体，5例(6髋)为混合型固定(臼杯为非骨水泥型，股骨柄为骨水泥型)。
20髋为陶瓷对陶瓷的关节面组合，26髋为金属对聚乙烯组合。
平均随访时间为5.1年(2~8年)。
采用Harris评分对结果进行评估，术前及随访时拍摄常规X线片观察、评定，根据Brooker分级法进行异位骨化分级。
结果Harris评分由术前平均31分增加到术后89分。
术后无脱位、感染等并发症发生。
患者髋关节活动度均得到改善，屈伸、收展、内外旋总活动度由术前的平均52°(0°~120°)提高到平均155°(65°~205°)。
2例(3髋)长时间行走后出现轻微的关节疼痛，1例患者偶尔需服用镇痛药物，其余患者术前髋痛消失，疼痛完全缓解率为90.5%。
X线分析未发现假体松动、移位，18髋(39.1%)发生异位骨化，其中依据Brooker分级，Ⅰ级12髋(26.1%)，Ⅱ级4髋(8.7%)，Ⅲ级2髋(4.3%)，没有Ⅳ级严重的异位骨化发生。
结论使用人工全髋关节置换术治疗强直性脊柱炎髋关节病变的病例可获得良好的结果，可明显改善患者的生活质量。
【关键词】强直性脊柱炎; 治疗; 全髋关节置换[Abstract]ObjectiveTo evaluate the outcomes of total hip arthroplasty (THA) in patients with ankylosing spondylitis， discuss the problems encountered in the surgery and during rehabilitation.MethodsA retrospective study was made on 46 hips in 35 patients (31 male and 4 female) who had ankylosing spondylitis and hip involvement， the average age at operation was 39.7 years (range， 21~72 years). One patient (2 hips) was managed with cemented THA， 5 patients with hybrid THA， the others were managed with uncemented THA. Twenty hips had ceramiccoupling implants， 26 hips were treated with metal on polyethylene prostheses. The average follow-up period was 5.1 years(range，2~8 years). All patients were evaluated with the use of Harris hip score system. Radiographic evaluations were performed by preoperative and follow-up，heterotopic ossification was graded according to the system ofBrooker.ResultsAccording to the Harris hip system， the average hipscore increased from 31 before surgery to 89 at the final review. No complications such as dislocation or deep infection happened. Thecumulative range of motion was i mproved from 52° preoperatively to 155° at the recent follow-up. Two patients (3 hips)had slight pain when walking more than 30 minutes， one patient needed anodyne occasionally，90.5% of the patients had complete pain relief. By the time of the final follow-up， there were no signs of loosening and migration either on the cup side or on the femoral side. Heterotopic ossification was found in 18 hips (39.1%)，with Brooker ClassⅠ in 12 hips (26.1%)， and Brooker Class Ⅱ in 4 (8.7%)，Class Ⅲ in 2 (4.3%). There w as no case with Class Ⅳ.ConclusionTHA is an effective treatment for patients who had ankylosing spondylitis with involvement of the hip. It can get substantial pain relief， and improve the patients' life quality.[Key words]Ankylosing spondylitis;Treatment; Total hip joint replacement强直性脊柱炎(Ankylosing Spondylitis，AS)是以骶髂关节、脊柱受累为特征的慢性全身性炎症性疾病，可伴有不同程度的髋、膝、肩等关节受累，严重影响患者的生活质量。
强直性脊柱炎全髋关节置换术在髋关节治疗中的应用目的探讨在强直性脊柱炎患者中采用置换术治疗的临床效果。
方法对来我院接受治疗的40例患者资料进行分析，根据患者治疗时间顺序分为两组。
对照组进行一般方法治疗，实验组则采用强直性脊柱炎全髋关节置换术治疗，比较两组效果等指标。
结果本次调研中，实验组髋关节活动度为（175.50±15.50）°、髋关节屈曲程度为（85.50±5.25）°、Harris评分（85.55±5.25）分高于对照组（P ＜0.05）；实验组手术（10.1±2.1）d后痊愈出院。
结论临床上采用强直性脊柱炎全髋关节置换术治疗强直性脊柱炎效果较好，值得推广使用。
标签：强直性脊柱炎；全髋关节置换术；髋关节；临床效果强直性脊柱炎（AnkylosingSpondylitis，AS）是临床上常见的骨科疾病，这种疾病属于慢性炎性疾病，且侵犯人体髋关节发病率较高（30%～50%），患者发病后容易引起髋关节畸形、强直、疼痛等，严重患者甚至生活不能自理，给患者带来很大痛苦。
对于这种疾病目前医学界缺乏科学的根治方法，很多患者治疗后并发症较多。
近年来，伴随着先进的医疗技术强直性脊柱炎全髋关节置换术得到广泛使用，并且其效果得到肯定[1]。
为了探讨在强直性脊柱炎患者中采用置换术治疗的临床效果。
对2011年1月～2013年10月来我院治疗的40例患者资料进行分析，分析报告如下。
1资料与方法1.1一般资料对来我院治疗的40例患者资料进行分析，将患者按照治疗时间分为实验组和对照组。
调研中，共有27例男性患者，13例女性患者，其年龄在39～84岁，平均年龄为（49.5±1.5）岁。
入院时均伴有不同程度疼痛感，且部分患者髋关节功能出现障碍，经过影像学检查发现患者关节结构遭到破坏，部分患者髋关节出现一定变形。
1.2方法对照组采用常规方法治疗，实验组采用强直性脊柱炎全髋关节置换术治疗，具体方法如下：患者手术过程中采用连续硬膜外法麻醉。
