CAJ | 학술논문

背景：全髋关节置换常被用来治疗强直性脊柱炎累及髋关节的患者，以提高其生活质量。但全髋关节置换对脊柱-骨盆矢状面平衡参数的影响如何目前仍不清楚。 　　目的：探讨全髋关节置换对强直性脊柱炎累及髋关节患者脊柱-骨盆矢状面平衡及生活质量的影响。 　　方法：对于2008年12月至2013年12月因强直性脊柱炎累及髋关节行全髋关节置换并获得术后1年以上随访的47例患者资料进行回顾性分析，测量其置换前后脊柱-骨盆矢状面平衡参数；根据患者置换前后SF-36调查表，计算各维度评分，评估其生活质量；运用Pearson检验分析置换前各平衡参数与各维度评分间的相互关系，并比较置换前后的平衡参数及SF-36评分变化。 　　结果与结论：患者矢状面正平衡与生理职能、躯体疼痛、活力呈负相关；胸椎后凸角与生理功能、总体健康呈负相关；腰椎前凸角与生理职能呈正相关；骨盆倾斜角与活力、社会功能呈负相关；骨盆入射角与躯体疼痛、活力和情感职能呈负相关。骶骨倾斜角与SF-36各条目之间无明显相关性。置换后腰椎前凸角、骶骨倾斜角较置换前增加，矢状面偏移、骨盆倾斜角较置换前减小，差异有显著性意义。置换后胸椎后凸、骨盆入射角与置换前比较，差异无显著性意义。置换后SF-36评分均较置换前增加，差异有显著性意义。提示矢状面偏移、胸椎后凸角、腰椎前凸角、骨盆入射角、骨盆倾斜角是影响强直性脊柱炎累及髋关节患者生活质量的可能因素。全髋关节置换能增加患者腰椎前凸角和骶骨倾斜角，减小矢状面偏移和骨盆倾斜角，并能达到改善患者生活质量的目的。
배경：전관관절치환상피용래치료강직성척주염루급관관절적환자，이제고기생활질량。단전관관절치환대척주-골분시상면평형삼수적영향여하목전잉불청초。 　　목적：탐토전관관절치환대강직성척주염루급관관절환자척주-골분시상면평형급생활질량적영향。 　　방법：대우2008년12월지2013년12월인강직성척주염루급관관절행전관관절치환병획득술후1년이상수방적47례환자자료진행회고성분석，측량기치환전후척주-골분시상면평형삼수；근거환자치환전후SF-36조사표，계산각유도평분，평고기생활질량；운용Pearson검험분석치환전각평형삼수여각유도평분간적상호관계，병비교치환전후적평형삼수급SF-36평분변화。 　　결과여결론：환자시상면정평형여생리직능、구체동통、활력정부상관；흉추후철각여생리공능、총체건강정부상관；요추전철각여생리직능정정상관；골분경사각여활력、사회공능정부상관；골분입사각여구체동통、활력화정감직능정부상관。저골경사각여SF-36각조목지간무명현상관성。치환후요추전철각、저골경사각교치환전증가，시상면편이、골분경사각교치환전감소，차이유현저성의의。치환후흉추후철、골분입사각여치환전비교，차이무현저성의의。치환후SF-36평분균교치환전증가，차이유현저성의의。제시시상면편이、흉추후철각、요추전철각、골분입사각、골분경사각시영향강직성척주염루급관관절환자생활질량적가능인소。전관관절치환능증가환자요추전철각화저골경사각，감소시상면편이화골분경사각，병능체도개선환자생활질량적목적。
BACKGROUND:Total hip arthroplasty is usualy taken to cure patients with ankylosing spondylitis combined with affected hip, to increase their life quality. But, its effects on sagittal balance of the spine-pelvis are not wel known. OBJECTIVE:To analyze the effects of total hip arthroplasty on sagittal balance of the spine-pelvis and life quality in patients with ankylosing spondylitis combined with affected hip. METHODS: Clinic data of 47 consecutive patients with ankylosing spondylitis combined with affected hip who had total hip arthroplasty and were folowed up for more than one year after operation from December 2008 to December 2013 were retrospectively analyzed. The spine-pelvis sagittal balancing parameters were measured. According to the SF-36 questionnaire, the dimensional scores were calculated to assess the life quality. Pearson correlation analysis was performed to analyze the correlation between the balancing parameters and SF-36 scores pre-operation, and the change of the balancing parameters and SF-36 scores pre- and post-operation were analyzed. RESULTS AND CONCLUSION:According to the data before total hip arthroplasty, sagittal vertical axis was negatively correlated with physiological function, body pain and vitality. Total kyphosis was negatively correlated with physiological function and general health. Lumbar lordosis was positively correlated with physiological function. Pelvic tilt angle was negatively correlated with the vitality and social function. Pelvic incident angle was negatively correlated with body pain, vitality and emotional role. No significant correlation was shown between sacral inclination angle and SF-36 items. After total hip arthroplasty, lumbar lordosis and sacral inclination angles were significantly increased, while sagittal vertical axis and pelvic tilt angle were significantly decreased compared with those before surgery. Total kyphosis and pelvic incident angle showed no significant differences before and after surgery. The SF-36 scores al got a statisticaly significant increase. Results showed that, sagittal vertical axis, total kyphosis, lumbar lordosis, pelvic incident angle and pelvic tilt angle are the potential factors influencing the life quality in patients with ankylosing spondylitis combined with affected hip. The total hip arthroplasty, which induces a better sagittal balance with an increased lumbar lordosis and sacral inclination angle, and a decreased sagittal vertical axis and pelvic tilt angle, can result in better life quality.