CAJ | 학술논문

目的：探讨全髋关节置换术治疗强直性脊柱炎髋关节病变的效果。方法对20例（27髋）强直性脊柱炎髋关节病变患者行人工全髋关节置换手术。置换前患者日常活动均明显受限，其中需要使用助行器7例，生活完全不能自理4例，8例（11髋）关节强直。比较手术前后髋关节 Harris 评分和关节活动度及术后并发症。1例患者后期行脊柱后凸矫形术。结果全部病例获得随访，平均随访时间4.2年（1.2~7.8年）。最后一次随访，23髋（85.2%）疼痛完全消失；仅有1例仍需双拐辅助行走，其余患者均可不扶拐行走，步态正常。术前 Harris 评分平均14.9分，髋关节活动度平均40°。术后 Harris 评分平均82.9分，其中优8髋，良10髋，可7髋，差2髋，优良率74.1%；髋关节活动度平均190.5°；髋关节 Harris 评分及关节活动度均显著高于置换前（P <0.05）。4髋（7.4%）出现异位骨化，分别为Brooker 分级Ⅰ、Ⅱ级。假体无菌性松动1例。结论全髋关节置换术是治疗强直性脊柱炎髋关节病变的有效手段，可以缓解关节疼痛，恢复关节功能，改善患者生活质量。
목적：탐토전관관절치환술치료강직성척주염관관절병변적효과。방법대20례（27관）강직성척주염관관절병변환자행인공전관관절치환수술。치환전환자일상활동균명현수한，기중수요사용조행기7례，생활완전불능자리4례，8례（11관）관절강직。비교수술전후관관절 Harris 평분화관절활동도급술후병발증。1례환자후기행척주후철교형술。결과전부병례획득수방，평균수방시간4.2년（1.2~7.8년）。최후일차수방，23관（85.2%）동통완전소실；부유1례잉수쌍괴보조행주，기여환자균가불부괴행주，보태정상。술전 Harris 평분평균14.9분，관관절활동도평균40°。술후 Harris 평분평균82.9분，기중우8관，량10관，가7관，차2관，우량솔74.1%；관관절활동도평균190.5°；관관절 Harris 평분급관절활동도균현저고우치환전（P <0.05）。4관（7.4%）출현이위골화，분별위Brooker 분급Ⅰ、Ⅱ급。가체무균성송동1례。결론전관관절치환술시치료강직성척주염관관절병변적유효수단，가이완해관절동통，회복관절공능，개선환자생활질량。
Objective To evaluate the clinical results of the total hip replacement in the patients with ankylosing spondy-litis. Methods A total of 20 ankylosing spondylitis patients(27 hip joints)underwent total hip replacement. All the patients had obvious restriction in daily life before operation:7 cases had to walk with the help of crutches,4 cases had to sit on wheel-chair,and 8 cases(11 hip joints)were stiff. The range of motion of the hip joint,the Harris score,and the postoperative compli-cations were compared and analysed in this study. Additional spinal operation for their kyphosis was required in 1 patient. Re-sults The patients were followed up for an average age of 4. 2 years(ranged from 1. 2 to 7. 8 years)in our department. The pain was completely released in 23 hips(85. 2% )at the last time of follow-up. Only one patient still needed two crutchs to walk. The mean Harris score was 14. 9 averagely and the mean total range of the hip joint movement was 40°before surgery. The Harris score of hip joint was 82. 9 averagely,including 8 hips excellent,10 good,7 possible,and 2 poor,with an excellent and good rate of 74. 1% . The mean total range of the hip joint movement was 190. 5°after surgery. 4 hips(14. 8% )appeared hetero-topic ossification in all patients according to Brooker's calssification,one was of Class Ⅱ and the other ClassⅢ,and 1 hip ap-peared aseptic loosening. Conclusion The total hip replacement is an effective solution for the treatment of affected hip with ankylosing spondylitis. It can relieve the pain of the joint,restore the hip function and improve the life of the patients with an-kylosing spondylitis.