Wang Qiwei, Bao Pengyu, Hong Shihao, Yang Xin, Wang Yu, Cao Yongping
Department of Orthopedics, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):884-889. doi: 10.19723/j.issn.1671-167X.2024.05.020.
To evaluate the efficacy of modified femoral neck osteotomy (mFNO) in the surgical treatment of patients with ankylosing spondylitis (AS) and severe spinal kyphosis combined with hip flexion contracture.
A retrospective analysis was conducted on 61 AS patients (103 hips) with spinal kyphosis and hip flexion contracture who underwent pedicle subtraction osteotomy (PSO) and total hip arthroplasty (THA) from January 1, 2019 to November 15, 2023. Data on mFNO operation time, blood loss, preoperative and postoperative values of the angle of the trunk and lower limb (ATL), hip passive range of motion (ROM), visual analogue scale (VAS), and incidence of in-hospital complications were recorded. Statistical analysis was performed using paired-samples test. < 0.05 was considered statistically significant.
The study ultimately included 10 cases, 9 males and 1 female, with an average age of (41.30±9.03) years. These patients underwent surgery for a total of 52 times, including 19 hips both receiving mFNO and THA, and 14 times PSO. The average operation time for nine bilateral mFNO was (133.11±34.81) min, with blood loss of (433.33±187.10) mL. A unilateral mFNO took 60 min with 200 mL of blood loss. The preoperative ATL of 19 hips was 40.37°±13.66°, and the postoperative ATL value was 88.47°±12.46° ( < 0.05). The preoperative VAS score was 0, while the postoperative VAS score was 5.95±1.51 ( < 0.05). The preoperative hip extension ROM was 37.37°±18.13°, while the postoperative hip extension ROM was -4.95°±21.24° ( < 0.05). Hip flexion ROM improved from 37.37°±18.13° to 50.79°±20.36° after FNO ( < 0.05). There were three cases of in-hospital complications (3/52, 5.67%): One case of postoperative atelectasis following PSO (1/52, 1.92%), one greater trochanter fracture identified during THA (1/52, 1.92%), and one early dislocation post-THA (1/52, 1.92%).
mFNO significantly improves the ATL in AS patients with severe spinal kyphosis combined with hip flexion contracture, facilitating PSO and THA surgeries.
评估改良股骨颈截骨术（mFNO）在强直性脊柱炎（AS）合并严重脊柱后凸畸形及髋关节屈曲挛缩患者手术治疗中的疗效。
对2019年1月1日至2023年11月15日期间接受椎弓根截骨术（PSO）和全髋关节置换术（THA）的61例AS合并脊柱后凸畸形及髋关节屈曲挛缩患者（103髋）进行回顾性分析。记录mFNO手术时间、出血量、术前及术后躯干与下肢角度（ATL）、髋关节被动活动范围（ROM）、视觉模拟评分（VAS）以及院内并发症发生率。采用配对样本检验进行统计学分析。P<0.05被认为具有统计学意义。
本研究最终纳入10例患者，其中男性9例，女性1例，平均年龄（41.30±9.03）岁。这些患者共接受手术52次，其中19髋同时接受了mFNO和THA，PSO手术14次。9例双侧mFNO的平均手术时间为（133.11±34.81）分钟，出血量为（433.33±187.10）毫升。单侧mFNO手术时间为60分钟，出血量200毫升。19髋术前ATL为40.37°±13.66°，术后ATL值为88.47°±12.46°（P<0.05）。术前VAS评分为0分，术后VAS评分为5.95±1.51分（P<0.05）。术前髋关节后伸ROM为37.37°±18.13°，术后髋关节后伸ROM为-4.95°±21.24°（P<0.05）。FNO术后髋关节屈曲ROM从37.37°±18.13°改善至50.79°±20.36°（P<0.05）。发生院内并发症3例（3/52，5.67%）：PSO术后肺不张1例（1/52，1.92%），THA术中发现大转子骨折1例（1/52，1.92%），THA术后早期脱位1例（1/52，1.92%）。
mFNO可显著改善AS合并严重脊柱后凸畸形及髋关节屈曲挛缩患者的ATL，有利于PSO和THA手术的进行。
