全髋关节置换术治疗误诊型髋脊柱综合征疗效观察

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摘要目的观察全髋关节置换术(total hip arthroplasty，THA)对于误诊型髋脊柱综合征(hip- spine syndrome，HSS)的临床疗效。方法回顾性分析2019—2020年在山东中医药大学附属医院关节骨科住院，既往接受过后路腰椎椎间融合术(posterior lumbar interbody fusion，PLIF)的误诊型HSS患者15例，其中男8例，女7例；年龄50~78岁，平均(64.40±8.17)岁。其中单侧股骨头坏死6例，双侧股骨头坏死1例，单侧髋关节骨关节炎7例，单侧发育性髋关节发育不良1例。15例HSS患者均行THA治疗。通过手术前后的疼痛视觉模拟评分(visual analogue scale，VAS)、日本骨科协会(Japanese orthopaedic association，JOA)腰椎评分、Harris髋关节评分(Harris hip scores，HHS)及影像学改变评定临床疗效。结果随访时间0.5~2.0年，平均(1.42±0.55)年。15例患者中有13例获得完整随访，2例于术后1年失访，随访期间无假体脱位、感染、松动等并发症。15例患者VAS、腰椎JOA评分术后6个月内有持续改善，差异有统计学意义(P＜0.05)；13例患者术后1年腰痛VAS及HHS有持续改善，差异有统计学意义(P＜0.05)。结论 THA对于误诊型HSS具有较为确切的疗效，可明显改善患者下肢疼痛症状，改善脊柱与髋关节功能。通过详细问诊、仔细查体、影像检查、综合分析来避免漏诊及误诊，明确病因、对症治疗才能取得良好效果。

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	张泽丞 1
	邱红明 2

关键词 ：髋关节置换, 髋脊柱综合征, 腰椎手术, 诊断

Abstract：Objective To observe the clinical effect of total hip arthroplasty on misdiagnosed hip spine syndrome (HSS).Methods This study retrospectively analyzed 15 patients with misdiagnosed HSS who were hospitalized in the Department of Joint Orthopedics of the Affiliated Hospital of Shandong University of TCM from 2019 to 2020 and previously underwent posterior lumbar interbody fusion (PLIF)，including 8 males and 7 females.The age ranged from 50 to 78 years，with an average age of (64.40±8.17)years.Among them，there were 6 cases of unilateral necrosis of femoral head，1 case of bilateral of necrosis femoral head，7 cases of unilateral hip osteoarthritis and 1 case of unilateral developmental dysplasia of the hip.All of the patients were treated with THA.Clinical efficacy was evaluated by preoperative and postoperative visual analogue scale (VAS)，lumbar JOA score，Harris Hip Score (HHS)and radiographic changes.Results The patients were followed up for 0.5~2.0 years.The mean follow-up time was(1.42±0.55)years.13 patients were followed up completely，and 2 cases were lost one year after operation.There were no complications such as prosthesis dislocation，infection and loosening during the follow-up.The VAS and lumbar JOA Scores of the 15 patients were continuously improved within 6 months after operation(P＜0.05)，13 patients showed continuous improvement in VAS and HHS at 1 year after surgery(P<0.05).Conclusion THA has a definite effect on misdiagnosed HSS.It can significantly improve the symptoms of lower limb pain and improve the function of spine and hip joint.Through detailed inquiry，careful physical examination，imaging examination and comprehensive analysis to avoid missed diagnosis and misdiagnosis，clarify the etiology and symptomatic treatment can achieve good results.

Key words： hip arthroplasty hip-spine syndrome lumbar spine surgery diagnosis

作者简介: 张泽丞(1996－ )，男，研究生在读，山东中医药大学中医学院，zzczhangzecheng@163.com。

引用本文:

张泽丞 1，邱红明 2. 全髋关节置换术治疗误诊型髋脊柱综合征疗效观察[J]. 实用骨科杂志, 2022, 28(4): 300-303.
Zhang Zecheng 1，QIU Hongming 2. Observation of Total Hip Arthroplasty in the Treatment of Misdiagnosed Hip Spine Syndrome. sygkzz, 2022, 28(4): 300-303.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I4/300

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