探讨应用生物型全髋关节置换术(THR)对强直性脊柱炎(AS)累及髋关节病变患者的疗效及其预后相关危险因素分析。

回顾性分析临沂市兰山区人民医院2016年2月至2019年1月间收治的84例行生物型THR术治疗的AS累及髋关节病变患者临床资料。纳入患者均符合AS的纽约诊断标准，伴有难以耐受的髋关节病变，符合手术指征，初次接受THR治疗。排除标准：过敏体质或对植入物排斥患者，股骨严重畸形，伴有严重心、肝、肺、肾及内分泌等内科疾病，妊娠及哺乳期妇女，病历资料不全。Harris评分、视觉模拟评分法(VAS评分)及关节活动度等用于评估患者预后情况。两两比较采用配对t检验，多组比较采用单因素方差分析。秩和检验分析血沉异常、风湿病家族史、发病年龄及病程等相关危险因素，采用多元logistic回归分析法分析预后独立危险因素。

84例患者随访率100%；平均随访时间(35±6)个月；术后骨性愈合时间(3.5±1.2)个月；末次随访时髋关节功能优良率为90.5%；所有患者末次随访时Harris评分、髋关节总活动度均显著升高，VAS评分、关节屈曲畸形角度均显著降低(t＝77.490、54.360、65.740、105.100，均为P<0.001)；治疗前，病程越长、风湿病家族史及血沉异常患者Harris评分越低(t＝34.240、4.246、3.522，均为P<0.001)；治疗后，病程越短、无风湿病家族史及血沉正常患者Harris评分越高(t＝53.190、8.642、6.351、P<0.001)；多元logistic回归分析结果显示：血沉异常、风湿病家族史、发病年龄≤50岁、病程>5年为影响AS累及髋关节病变患者预后的独立危险因素(χ²＝4.776、6.138、4.875、4.135，均为P<0.05)。

生物型全髋关节置换术可显著缓解AS累及髋关节病变患者疼痛程度，改善髋关节功能，临床疗效显著。术前血沉异常、风湿病家族史、发病年龄低及病程长为影响AS累及髋关节病变患者预后的独立危险因素。

To investigate the efficacy and prognostic risk factors of total hip replacement (THR) in the patients with ankylosing spondylitis (AS) involving hip joint lesions.

The clinical data of 84 AS patients with hip joint lesions treated by cementless THR in Linyi Lanshan District People's Hospital from February 2016 to January 2019 were retrospectively analyzed. All the patients met the New York diagnostic criteria and the surgical indications, were accompanied with intolerable hip joint lesions, and accepted the primary THR. Exclusion criteria: allergic history to implants, severe femoral deformity, severe cardiac or renal diseases, incomplete data. Harris hip score, visual analogue scale (VAS score) and range of motion of hip were used to assess the prognosis of the patients. Paired t test was used for pairwise comparison. Univariate analysis of variance was used for multi-groups comparison. Rank sum test was used to analyze the related risk factors such as abnormal erythrocyte sedimentation rate, family history of rheumatism, age of onset and course of disease. Multivariate logistic regression analysis was used to analyze the independent prognostic factors.

The follow-up rate of 84 patients was 100%, and the average follow-up time was (35±6) months. The bone healing time was(3.5±1.2)months, and the excellent and good rate of hip function was 90.48% at the last follow-up. Harris score and total hip motions significantly increased at the last follow-up, VAS score and angles of joint flexion deformity significantly decreased (t=77.490, 54.360, 65.740, 105.100, all P<0.001). Before the treatment, the longer of the disease course, the Harris score was lower in the patients with family history of rheumatism and abnormal erythrocyte sedimentation rate (t=34.240, 4.246, 3.522, all P<0.001). After the treatment, the shorter of the disease course, the Harris score was the higher in the patients without family history of rheumatism and normal erythrocyte sedimentation rate (t=53.190, 8.642, 6.351, all P<0.001). The results of multiple logistic regression analysis showed that abnormal erythrocyte sedimentation rate, family history of rheumatism, onset age ≤50 years, course > five years of the disease were independent risk factors affecting the prognosis of AS patients with hip joint lesions (χ²=4.776, 6.138, 4.875, 4.135, all P<0.05).

Cementless THR can significantly alleviate the pain of AS patients involved hip joint lesions, improve hip function, and has a significant clinical effect. Preoperative abnormal erythrocyte sedimentation rate, family history of rheumatism, low age of onset and long course of disease are independent risk factors affecting the prognosis.