Guo Chen, Liang Yan, Zhu Zhenqi, Xu Shuai, Liu Haiying
Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, PR China.
Orthop Surg. 2025 Jan;17(1):45-52. doi: 10.1111/os.13974. Epub 2024 Dec 11.
Ankylosing spondylitis (AS) is a debilitating rheumatic condition that significantly impairs mobility and quality of life through chronic inflammation and spinal fusion. The aim of this study is to investigate the optimal sequencing of spinal osteotomy and total hip replacement (THR) as treatment options, a topic that remains a subject of debate among medical professionals.
In a retrospective cohort study spanning from 2017 to 2021, we assessed adult patients with AS who underwent both spinal osteotomy and THR, outcome measures involved radiographic assessments like Global Cobb angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), as well as clinical metrics such as the Harris hip score. For the same surgical group, paired t-tests were performed for pre- and postoperative data, while independent sample t-tests were used for comparing different surgical groups. The study aims to elucidate the optimal sequencing of these surgical procedures based on these comprehensive metrics.
Among the 14 patients included, demographic and clinical variables were comparable between the two procedural groups. At the 3-month follow-up, all major metrics showed significant postoperative improvements. Specifically, the Global Cobb angle reduced from 98.88 ± 38.54 to 54.48 ± 18.14 (p = 0.018), and the Harris hip scores, evaluated at the 3-month follow-up, dramatically increased from 15.14 ± 10.12 to 72.57 ± 14.12 (p = 0.001). Furthermore, the Spine First Group exhibited more pronounced changes in pelvic parameters (p = 0.009), albeit at the expense of longer operation times and increased blood loss. No major complications were encountered.
Contrary to the prevalent belief that spinal osteotomy should precede THR, our study argues that under certain conditions, opting for hip surgery first can be both viable and advantageous. This approach may mitigate the risk of complications and even facilitate subsequent spinal surgery. Surgical decisions must be highly tailored, focusing on patient-specific needs and anatomical considerations. The ultimate goal remains consistent: to improve patients' functional abilities in daily activities and thereby enhance their overall quality of life.
强直性脊柱炎(AS)是一种使人衰弱的风湿性疾病,通过慢性炎症和脊柱融合显著损害活动能力和生活质量。本研究的目的是探讨脊柱截骨术和全髋关节置换术(THR)作为治疗选择的最佳顺序,这一话题在医学专业人员中仍是一个有争议的问题。
在一项涵盖2017年至2021年的回顾性队列研究中,我们评估了接受脊柱截骨术和THR的成年AS患者,结局指标包括影像学评估,如整体Cobb角、胸腰椎后凸(TLK)、腰椎前凸(LL)、骨盆入射角(PI)、骨盆倾斜度(PT)和骶骨斜率(SS),以及临床指标,如Harris髋关节评分。对于同一手术组,对术前和术后数据进行配对t检验,而独立样本t检验用于比较不同手术组。本研究旨在根据这些综合指标阐明这些手术程序的最佳顺序。
在纳入的14例患者中,两个手术组的人口统计学和临床变量具有可比性。在3个月的随访中,所有主要指标术后均有显著改善。具体而言,整体Cobb角从98.88±38.54降至54.48±18.14(p = 0.018),在3个月随访时评估的Harris髋关节评分从15.14±10.12大幅提高至72.57±14.12(p = 0.001)。此外,脊柱优先组的骨盆参数变化更为明显(p = 0.009),尽管手术时间更长且失血增加。未遇到重大并发症。
与普遍认为的脊柱截骨术应先于THR的观点相反,我们的研究认为在某些情况下,先选择髋关节手术既可行又有利。这种方法可能会降低并发症风险,甚至便于后续的脊柱手术。手术决策必须高度个体化,关注患者的特定需求和解剖学因素。最终目标始终一致:提高患者日常活动中的功能能力,从而提高他们的整体生活质量。