Pietrzak Krzysztof, Strzyzewski Wojciech, Kaczmarek Wiesław, Pucher Andrzej, Ciesielczyk Błazej
Klinika Ortopedii i Traumatologii, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu.
Chir Narzadow Ruchu Ortop Pol. 2010 Sep-Oct;75(5):282-6.
Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip caused by advanced ankylosing spondylitis. The aim of this paper is to evaluate the results of THR in patients suffering from ankylosing spondylitis, operated from 1987 to 2007 at the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. Material. Material included 26 patients, 2 females and 24 males, on whom 34 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 27 to 77 years (mean 57). Follow-up ranged from 3 to 21 years (mean 10.5 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented totalhip arthroplasty was used during 16 of the THR, 17 of them were cementless and 1 as a hybrid.
The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.
The average preoperative Harris score for the group of patients was 27.3, WOMAC score 78.5. After an average of 10 years follow-up all hips and knees were considered excellent, with average Harris score of 91.4, WOMAC Score of 5.0. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. No ectopic ossification concentrations were found.
Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of severe deformity of the hip caused by advanced ankylosing spondylitis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. Ectopic ossification is not the clinical problem during THR in patients who suffer from spondylytis deformans.
全髋关节置换术（THR）目前是晚期强直性脊柱炎所致髋关节严重畸形患者公认的治疗方法。本文旨在评估1987年至2007年在波兹南医科大学骨科与创伤科接受手术的强直性脊柱炎患者的全髋关节置换术结果。材料。材料包括26例患者，2例女性和24例男性，共进行了34次全髋关节置换术，所有病例均采用外侧入路。手术时，患者年龄在27至77岁之间（平均57岁）。随访时间为3至21年（平均10.5年）。手术治疗是一个多阶段过程（一次手术仅置换一个关节）。34次全髋关节置换术中，16次采用骨水泥型全髋关节置换术，17次采用非骨水泥型，1次采用混合型。
对患者在术前、术后及最终检查时进行临床和放射学评估。临床状况采用Harris髋关节评分和WOMAC量表进行评估。我们的放射学检查基于髋关节协会系统。
该组患者术前Harris评分平均为27.3，WOMAC评分为78.5。平均随访10年后，所有髋关节和膝关节均被评为优秀，Harris评分平均为91.4，WOMAC评分为5.0。所有患者功能均有改善，疼痛减轻。所有患者的X线片显示髋臼和股骨假体位置正确，最后一次检查时无假体松动的影像学证据。未发现异位骨化聚集。
对我们的材料进行临床和放射学评估表明，全髋关节置换术治疗晚期强直性脊柱炎所致髋关节严重畸形可使下肢功能恢复良好，有助于患者减少对周围环境的依赖。在患有畸形性脊柱炎的患者进行全髋关节置换术时，异位骨化不是临床问题。
