RA伴骨质疏松患者行同期双侧髋关节置换疗效分析

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摘要目的探讨晚期类风湿关节炎伴骨质疏松中年患者行同期双侧髋关节置换术的临床疗效。方法对2010年1月至2014年12月采用Synergy假体行全髋关节置换术(total hip arthroplasty，THA)的晚期类风湿关节炎(rheumatoid arthritis，RA)伴骨质疏松中年患者13例(26髋)进行回顾性分析。其中男5例，女8例；年龄39～48岁，平均42.5岁。髋关节RA病程平均12.7年。髋臼全部采用生物型假体，均采用陶瓷内衬，股骨头采用全陶瓷头。所有手术均采用后外侧切口，术后3、6、12个月及以后每年随访一次，置换术后行X线片检查评估假体柄位置，Engh标准评价骨假体界面稳定性，Harris评分评估髋关节功能，并比较术前和末次随访时的髋关节活动度变化。结果全部病例随访时间2.5～5.3年，平均3.8年。13例(26髋)Harris髋关节评分由术前(44.00±10.00)分，提高到末次随访时(92.50±15.00)分，差异有统计学意义(P＜0.01)；髋关节活动度由(46.00±8.00)°(0°～60.00°)，提高到末次随访时(105.50±18.00)°(90.00°～130.00°)，差异有统计学意义(P＜0.01)。所有病例术后均未发生无菌性松动、假体周围感染、异位骨化、下肢静脉血栓/肺栓塞及假体脱位等并发症。术后正侧位X线片提示Synergy假体在位、与髓腔紧密压配。结论对于晚期RA伴骨质疏松患者，行同期双侧髋关节置换术近期疗效满意，利于恢复肢体功能，但需要术前精细评估及术中精准操作。

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关键词 ：关节成形术, 髋关节置换, 类风湿性关节炎, 同期, 双侧

Abstract：Objective To investigate the clinical outcomes of Synergy prosthesis in simultaneous bilateral total hip arthroplasty(THA) for advanced RA and young patients.Methods young patients(5 males and 8 females，ranging in age from 39 to 48 years old，with an average of 42.5 years old)including 26 hips with rheumatoid arthritis were treated with Synergy prosthesis from January 2010 to December 2014.The hip RA duration was 12.7 years in average.The acetabular prostheses were all biological prosthesis，with the ceramic lining in all cases the ceramic femoral head was used in all the cases.The posterior-lateral hip incision was adopted in the surgery.The follow-up was carried out in 3，6，12 months after the surgery，and later once a year.The Harris score system and Engh score of bone in growth of femoral side described were used to assess the joint function of the patients before and after the surgery.Results All the patients were followed up with an average time of 3.8 years(2.5 to 5.3 years).The Harris score increased from preoperative(44.00±10.00) to (92.50±15.00) at the end of the follow-up，There were statistically significant differences in before and after surgery groups(P＜0.01).The joint activity by the (46.00±8.00)°(0°～60.00°)to improve the final follow-up (105.50±18.00)°(90.00°～130.00°)in the follow-up，There were statistically significant differences before and after surgery groups(P＜0.01).All the incisions healed well and there were no complications such as femoral fracture，infection，dislocation and neurovascular injuries.All the joints had good or excellent clinical results.Conclusion The simultaneous bilateral of THA had the advantages in rapid recovery of hip function for the advanced RA and osteoporosis patients，but it required precise preoperative assessment and precise operation.

Key words： arthroplasty replacement rheumatoid arthritis simultaneous bilateral

基金资助:国家自然科学基金(81371983)
甘肃省青年科技基金(1606RJYA300)
甘肃省自然科学基金(1606RJZA208)
甘肃省科技支撑计划(S04671)

通讯作者: 何晓乐

作者简介: 刘军(1982－ )，男，主治医师，兰州军区总医院全军骨科中心关节外科，730050

引用本文:

刘军 1，李旭升 1，甄平 1，周胜虎 1，田琦 1，何晓乐 2. RA伴骨质疏松患者行同期双侧髋关节置换疗效分析[J]. 实用骨科杂志, 2017, 23(2): 105-113.
Liu Jun，Li Xusheng，Zhen Ping，et al. Application of Synergy Prosthesis in Simultaneous Bilateral THA for Advanced Young RA Patients with Osteoporosis. sygkzz, 2017, 23(2): 105-113.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I2/105

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