Ke Y, Zhang Q, Ma Y Q, Li R J, Tao K, Gui X G, Li K P, Zhang H, Lin J H
Institute of Arthritis, Peking University People's Hospital, Beijing 100044, China.
First Section of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100037, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 18;53(1):175-182. doi: 10.19723/j.issn.1671-167X.2021.01.026.
Severe hip osteoarthritis, caused by bone or joint maldevelopment, biomechanical transformation and previous surgical intervention, is inclusively existed in spondyloepiphyseal dysplasia (SED). To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED.
From January 2017 to June 2019, 374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons, of whom 9 patients (6 males and 3 females) with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation. The short-term outcomes were observed.
All the patients were implanted with Johnson & Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty. They were followed up for an average period of 20 months. Except for one muscular calf vein thrombosis case, no complications, such as aseptic loosening, joint dislocation, fracture, neurovascular injury, deep vein thrombosis and infection were observed in all the 9 patients. Before the surgery, the average Harris hip score was 35.55, while the average of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was 56.56. The level of quality of life indicated by SF-12 score was 41.56 on average. The mean pre-operation visual analogue scale (VAS) was 7.44. At the last follow-up, the average Harris hip score increased to 89.56, whereas the average WOMAC declined to 41.11. Compared with the baseline point, the average SF-12 score went up to 56.33. Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up. In addition, post-operative increase of several pelvic-related parameters including pelvic incidence, pelvic tilt and sacral slope could be observed in the SED patients. The average measured pelvic incidence, pelvic tilt and sacral slope were 68.95°±4.60°, 52.75°±1.06° and 17.45°±1.77° before operation, respectively; whilst the mean value of these specific parameters increased to 76.98°±5.12°, 60.51°±4.35° and 18.10°±2.02°, respectively. The even leg lengths of the lower extremities were obtained after total hip arthroplasty.
Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.
脊柱骨骺发育不良（SED）中存在由骨骼或关节发育异常、生物力学改变及既往手术干预引起的严重髋关节骨关节炎。探讨全髋关节置换术治疗SED患者Tönnis 3级髋关节骨关节炎的短期疗效及可能影响。
2017年1月至2019年6月，374例髋关节骨关节炎患者接受资深专业外科医生进行的全髋关节置换术，其中9例（男6例，女3例）继发于SED的12髋骨关节炎患者符合纳入和排除标准并接受上述髋关节手术。观察短期疗效。
所有患者在关节置换术中均植入强生陶瓷对陶瓷非骨水泥型髋关节假体。平均随访20个月。9例患者除1例发生小腿肌肉静脉血栓外，未观察到无菌性松动、关节脱位、骨折、神经血管损伤、深静脉血栓形成及感染等并发症。术前Harris髋关节平均评分为35.55分，而西安大略和麦克马斯特大学骨关节炎指数（WOMAC）平均为56.56分。SF-12评分所表示的生活质量水平平均为41.56分。术前视觉模拟评分（VAS）平均为7.44分。末次随访时，Harris髋关节平均评分增至89.56分，而WOMAC平均降至41.11分。与基线相比，SF-12评分平均升至56.33分。末次随访时还观察到平均VAS值显著降至2.67分。此外，SED患者术后可观察到包括骨盆倾斜角、骨盆倾斜度和骶骨坡度在内的多个骨盆相关参数增加。术前测量的骨盆倾斜角、骨盆倾斜度和骶骨坡度平均值分别为（68.95°±4.60°）、（52.75°±1.06°）和（17.45°±1.77°）；而这些特定参数的平均值分别增至（76.98°±5.12°）、（60.51°±4.35°）和（18.10°±2.02°）。全髋关节置换术后双下肢等长。
全髋关节置换术治疗继发于SED的Tönnis 3级髋关节骨关节炎在短期疼痛缓解和功能恢复方面效果满意。
