CAJ | 학술논문

目的：分析双髋僵直或强直的患者双侧全髋关节置换( total hip arthroplasty，THA )间隔时间对术后关节功能的影响。方法回顾分析2008年4月至2010年5月，31例双髋僵硬或强直患者不同手术间隔时间进行双侧 THA 的效果。将纳入的31例分为：A 组：同期手术；B 组：一个住院周期分期手术；C 组：两个住院周期分期手术3个组。比较患者 THA 术后1个月、3个月及1年双髋关节活动度的差异以及术后1年患者 Harris 评分的差异。结果 A 组和 B 组术后1个月、3个月和1年先置换侧和后置换侧的髋关节的活动度差异无统计学意义，但 C 组关节活动度术后1个月，先置换侧(171±19.5)小于后置换侧(217±26.3)，差异有统计学意义(t＝-39.752，P＜0.001)；术后3个月先置换侧(177±26.6)小于后置换侧(235±23.2)，差异有统计学意义(t＝-51.375，P＜0.001)；术后1年先置换侧小于(192±20.9)，后置换侧(236±25.1)，差异有统计学意义(t＝-35.437，P＜0.001)。A 组和 B 组术后1个月、3个月及1年的髋关节活动度差异无统计学意义。C 组后置换侧的髋关节活动度在术后1个月、3个月及1年与 A 组和 B 组差异无统计学意义，而先置换侧的髋关节活动度术后1个月：C 组(171±19.5)小于 A 组(221±24.1)和 B 组(225±19.8)；术后3个月： C 组(177±26.6)小于 A 组(244±20.2)和 B 组(239±22.3)；术后1年 C 组(192±20.9)小于 A 组(242±22.8)和 B 组(242±22.8)。3组患者术后1年的 Harris 评分较术前均有明显提高。A 组、B 组和 C 组后置换侧术后1年的 Harris 评分差异无统计学意义。Harris 评分：C 组先置换侧(80.3±9.8)明显低于 A 组(91.4±7.9)、B 组(93.5±9.1)和 C 组后置换侧(90.8±7.3)。结论对于双髋僵硬或强直的患者，为获得术后关节活动度和关节功能最大程度的恢复，双侧 THA 手术间隔时间应在确保患者安全的条件下尽量缩短。目的：分析雙髖僵直或彊直的患者雙側全髖關節置換( total hip arthroplasty，THA )間隔時間對術後關節功能的影響。方法迴顧分析2008年4月至2010年5月，31例雙髖僵硬或彊直患者不同手術間隔時間進行雙側 THA 的效果。將納入的31例分為：A 組：同期手術；B 組：一箇住院週期分期手術；C 組：兩箇住院週期分期手術3箇組。比較患者 THA 術後1箇月、3箇月及1年雙髖關節活動度的差異以及術後1年患者 Harris 評分的差異。結果 A 組和 B 組術後1箇月、3箇月和1年先置換側和後置換側的髖關節的活動度差異無統計學意義，但 C 組關節活動度術後1箇月，先置換側(171±19.5)小于後置換側(217±26.3)，差異有統計學意義(t＝-39.752，P＜0.001)；術後3箇月先置換側(177±26.6)小于後置換側(235±23.2)，差異有統計學意義(t＝-51.375，P＜0.001)；術後1年先置換側小于(192±20.9)，後置換側(236±25.1)，差異有統計學意義(t＝-35.437，P＜0.001)。A 組和 B 組術後1箇月、3箇月及1年的髖關節活動度差異無統計學意義。C 組後置換側的髖關節活動度在術後1箇月、3箇月及1年與 A 組和 B 組差異無統計學意義，而先置換側的髖關節活動度術後1箇月：C 組(171±19.5)小于 A 組(221±24.1)和 B 組(225±19.8)；術後3箇月： C 組(177±26.6)小于 A 組(244±20.2)和 B 組(239±22.3)；術後1年 C 組(192±20.9)小于 A 組(242±22.8)和 B 組(242±22.8)。3組患者術後1年的 Harris 評分較術前均有明顯提高。A 組、B 組和 C 組後置換側術後1年的 Harris 評分差異無統計學意義。Harris 評分：C 組先置換側(80.3±9.8)明顯低于 A 組(91.4±7.9)、B 組(93.5±9.1)和 C 組後置換側(90.8±7.3)。結論對于雙髖僵硬或彊直的患者，為穫得術後關節活動度和關節功能最大程度的恢複，雙側 THA 手術間隔時間應在確保患者安全的條件下儘量縮短。
목적：분석쌍관강직혹강직적환자쌍측전관관절치환( total hip arthroplasty，THA )간격시간대술후관절공능적영향。방법회고분석2008년4월지2010년5월，31례쌍관강경혹강직환자불동수술간격시간진행쌍측 THA 적효과。장납입적31례분위：A 조：동기수술；B 조：일개주원주기분기수술；C 조：량개주원주기분기수술3개조。비교환자 THA 술후1개월、3개월급1년쌍관관절활동도적차이이급술후1년환자 Harris 평분적차이。결과 A 조화 B 조술후1개월、3개월화1년선치환측화후치환측적관관절적활동도차이무통계학의의，단 C 조관절활동도술후1개월，선치환측(171±19.5)소우후치환측(217±26.3)，차이유통계학의의(t＝-39.752，P＜0.001)；술후3개월선치환측(177±26.6)소우후치환측(235±23.2)，차이유통계학의의(t＝-51.375，P＜0.001)；술후1년선치환측소우(192±20.9)，후치환측(236±25.1)，차이유통계학의의(t＝-35.437，P＜0.001)。A 조화 B 조술후1개월、3개월급1년적관관절활동도차이무통계학의의。C 조후치환측적관관절활동도재술후1개월、3개월급1년여 A 조화 B 조차이무통계학의의，이선치환측적관관절활동도술후1개월：C 조(171±19.5)소우 A 조(221±24.1)화 B 조(225±19.8)；술후3개월： C 조(177±26.6)소우 A 조(244±20.2)화 B 조(239±22.3)；술후1년 C 조(192±20.9)소우 A 조(242±22.8)화 B 조(242±22.8)。3조환자술후1년적 Harris 평분교술전균유명현제고。A 조、B 조화 C 조후치환측술후1년적 Harris 평분차이무통계학의의。Harris 평분：C 조선치환측(80.3±9.8)명현저우 A 조(91.4±7.9)、B 조(93.5±9.1)화 C 조후치환측(90.8±7.3)。결론대우쌍관강경혹강직적환자，위획득술후관절활동도화관절공능최대정도적회복，쌍측 THA 수술간격시간응재학보환자안전적조건하진량축단。
Objective To analyze the impact of interval time of bilateral total hip arthroplasty ( THA ) on the postoperative joint function in the patients with bilateral hip joint ankylosis.Methods From April 2008 to May 2010, 31 patients with bilateral hip joint ankylosis underwent bilateral THA at different time intervals, whose clinical data were retrospectively analyzed. The patients were divided into 3 groups. In group A, simultaneous surgery was performed. In group B, staged surgery was performed, but within a single hospitalization period. In group C, surgery was performed in 2 hospitalization periods. The differences in bilateral hip joint range of motion ( ROM ) were compared among the 3 groups at 1 month, 3 months and 1 year after the surgery. The Harris scores at 1 year after the surgery were recorded.Results There were no statistically signiifcant differences in the hip joint ROM between the prior side and the lateral side in group A and group B at 1 month, 3 months and 1 year after the surgery. But statistically signiifcant differences existed in the hip joint ROM in group C between the prior side ( 171±19.5 ) and the lateral side ( 217±26.3 ) at 1 month after the surgery (t=-39.752,P<0.001 ) and also between the prior side ( 177±26.6 ) and the lateral side ( 235±23.2 ) at 3 months after the surgery (t=-51.375,P<0.001 ). There were statistically signiifcant differences in the hip joint ROM in group C between the prior side ( 192±20.9 ) and the lateral side ( 236±25.1 ) at 1 year after the surgery (t=-35.437,P<0.001 ). No statistically signiifcant differences existed in the hip joint ROM between group A and group B at 1 month, 3 months and 1 year after the surgery. There were no statistically signiifcant differences in the hip joint ROM of the lateral side in group C at 1 month, 3 months and 1 year after the surgery when compared with that in group A and group B. The hip joint ROM of the prior side at 1 month after the surgery was ( 171±19.5 ) in group C, which was smaller than ( 221±24.1 ) in group A and ( 225±19.8 ) in group B. The hip joint ROM of the prior side at 3 months after the surgery was ( 177±26.6 ) in group C, which was smaller than ( 244±20.2 ) in group A and ( 239±22.3 ) in group B. The hip joint ROM of the prior side at 1 year after the surgery was ( 192±20.9 ) in group C, which was smaller than ( 242±22.8 ) in group A and ( 242±22.8 ) in group B. In all 3 groups, the Harris scores at 1 year after the surgery was significantly higher than the preoperative scores. No statistically significant differences existed in the Harris score of the lateral side in 3 groups at 1 year after the surgery. The Harris score of the prior side in group C was ( 80.3±9.8 ), which was obviously lower than ( 91.4±7.9 ) in group A, ( 93.5±9.1 ) in group B and ( 90.8±7.3 ) on the lateral side in group C.Conclusions To acquire optimal recovery of joint ROM and function, the interval time of bilateral THA should be shortened as much as possible in the patients with bilateral hip joint ankylosis.