多关节置换治疗重度强直性脊柱炎的临床疗效

doi:10.3877/cma.j.issn.1674-134X.2023.03.003

目的

探讨多关节置换治疗严重强直性脊柱炎(AC)患者的临床疗效。

方法

回顾性分析2015年1月至2020年12月就诊于深圳市第二人民医院骨关节外科患者资料共18例，其中男性12例，女性6例。纳入标准包括：重度AS致下肢髋、膝关节功能障碍，行初次全膝、髋关节置换；术后遵医嘱行康复训练且病例资料完整。排除术后失访或随访时间小于3个月的患者。全部患者根据病情接受髋和/或膝关节置换共40次。记录患者术前及术后关节功能评分及术后并发症，评估手术疗效及患者生活质量改善。t检验对比分析手术前后功能改善。

结果

所有患者平均随访时间(31±12)个月，术前膝关节美国特种外科医院评分(HSS)为(33±4)，术后1年为(67±5)，差异有统计学意义(t＝20.638，P<0.01)。术前髋关节Harris评分(16±5)，术后1年为(59±7)，差异有统计学意义(t＝37.181，P<0.01)。膝关节和髋关节活动度均得到改善(t＝18.096、48.908，均为P<0.001)。全部患者未出现关节脱位、感染、骨折等并发症。

结论

全膝及全髋关节置换是强直性脊柱炎下肢关节严重病变患者的有效治疗手段，可以有效缓解患者关节疼痛，改善关节功能，提高患者生活质量及满意度。

关键词: 脊柱炎，强直性, 骨关节炎, 关节成形术

Objective

To investigate the clinical effectiveness of multiple joint arthroplasty in the treatment of patients with severe ankylosing spondylitis.

Methods

A retrospective analysis was conducted on 18 patients at the Department of Orthopedics of the Second People's Hospital of Shenzhen between January 2015 and December 2020. Inclusion criteria: patients of severe AS with dysfunction of hip and knee underwent primary total knee and hip replacements; patients followed postoperative rehabilitation training according to the instruction and had complete medical records. The patients who were lost to follow up or followed up less than three months were excluded. A total of 40 hip and/or knee replacements were performed based on the patient's condition. The preoperative and postoperative joint functional scores and postoperative complications of the patients were recorded. The efficacy of surgery and improvement of the quality of life were evaluated.The t test was used to compare the functional improvement before and after surgery.

Results

All the patients had an average follow-up time of (31±12) months. The HSS knee score was (33±4) before the surgery, and was improved to (67±5) at one year after the surgery; the difference was statistically significant (t=20.638, P<0.05). The Harris hip score was (16±5) before the surgery, and was improved to (59±7) at one year after surgery; the difference was statistically significant (t=37.181, P<0.05). The mobility of knee and hip improved after the surgery(t=18.096、48.908, both P<0.001). None of the patients had experienced any complications such as joint dislocation, infection, or fracture.

Conclusions

Total knee and hip replacements are an effective treatment for lower limb joint disease in patients with ankylosing spondylitis. It effectively relieves joint pain, improves joint function, and improves quality of life and satisfaction of patients.

Key words: Spondylitis, ankylosing, Osteoarthritis, Arthroplasty

表1 本研究纳入的严重AS患者基本资料

Table 1 Basic information of severe AS patients enrolled in this study

性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	生活状态Living status		受教育水平Education
性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	独立Independent	与家庭成员With family	初中及以下Junior high school and below	高中或中专Senior high school	大专及以上College or above
男性	12	42.1±8.0	14.5±7.1	18.7±2.3	28.9±15.7	5	7	6	3	3
女性	6	43.8±6.7	14.0±5.9	18.5±2.3	32.5±10.2	3	3	4	2	0
统计值		t＝0.459	t＝0.149	t＝0.150	t＝0.504	χ²＝0.106		χ²＝1.149
P值		>0.05	>0.05	>0.05	>0.05	>0.05		>0.05

表1 本研究纳入的严重AS患者基本资料

Table 1 Basic information of severe AS patients enrolled in this study

性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	生活状态Living status		受教育水平Education
性别Gender	例数Case number	年龄(岁)Age	病程(年)Course of disease(year)	BMI(kg/m²)	随访时间(月)Follow-up period	独立Independent	与家庭成员With family	初中及以下Junior high school and below	高中或中专Senior high school	大专及以上College or above
男性	12	42.1±8.0	14.5±7.1	18.7±2.3	28.9±15.7	5	7	6	3	3
女性	6	43.8±6.7	14.0±5.9	18.5±2.3	32.5±10.2	3	3	4	2	0
统计值		t＝0.459	t＝0.149	t＝0.150	t＝0.504	χ²＝0.106		χ²＝1.149
P值		>0.05	>0.05	>0.05	>0.05	>0.05		>0.05

表2 AS患者关节置换术后功能评价

Table 2 Functional evaluation of AS patients before and after operation

时间Time	HSS-TJAES	HSS评分	Harris评分	膝关节ROM(°)Knee ROM	髋关节ROM(°)Hip ROM
术前Before surgery	40±8	33±4	16±5	18±6	0
术后1年One year after surgery	77±7	67±5	59±7	79±9	117±13
t值	12.899	20.638	37.181	18.096	48.908
P值	<0.001	<0.001	<0.001	<0.001	<0.001

表2 AS患者关节置换术后功能评价

Table 2 Functional evaluation of AS patients before and after operation

时间Time	HSS-TJAES	HSS评分	Harris评分	膝关节ROM(°)Knee ROM	髋关节ROM(°)Hip ROM
术前Before surgery	40±8	33±4	16±5	18±6	0
术后1年One year after surgery	77±7	67±5	59±7	79±9	117±13
t值	12.899	20.638	37.181	18.096	48.908
P值	<0.001	<0.001	<0.001	<0.001	<0.001

图1 典型病例骨盆影像学图片注：左侧为骨盆下位X线片，右侧为骨盆CT三维重建，示左髋关节呈外展屈曲强直状态，右髋关节呈内收屈曲强直状态

Figure 1 Radiographic images of pelvis of the typical patientNote: Left picture is lower positionX-ray image of pelvis, right picture is three-dimensional reconstruction in CT images of pelvis, showingthat the left hip joint wasin external rotation and flexional rigidity position, and the right hip joint was in adductional and flexional rigidity position

图2 典型病例双膝关节正侧位X线片。图A为左膝X线片，示左膝呈90°屈曲强直融合状态；图B为右膝X线片，示右膝呈70°屈曲强直融合状态

Figure 2 The anteroposterior and lateral views of X-ray of bilateral knee joints. A is radiograph of left knee, showing that left knee was in a flexional rigidity position of 90°；the right knee was in a flexional rigidity position of 70°

图3 典型病例双下肢全长X片，示双膝及双髋关节置换完成后，假体位置良好

Figure 3 Anteroposterior view of full-length X-ray of lower extremities，showing that after bilateral knee and hip replacements, the prostheses were in good position

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Clinical efficacy of multiple arthroplasties in treatment for severe ankylosing spondylitis

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Clinical efficacy of multiple arthroplasties in treatment for severe ankylosing spondylitis