• 中山大學附屬第一醫(yī)院關節(jié)外科（廣州，510080）;

目的探討慢性自身免疫性疾病患者行初次人工全髖關節(jié)置換（total hip arthroplasty，THA）術后的中遠期療效。 方法1990年1月－2006年6月，對42例（51髖） 慢性自身免疫性疾病患者行初次THA。男15例（18髖），女27例（33髖）；年齡22～70歲，平均36.9歲。左側29髖，右側22髖。其中系統(tǒng)性紅斑狼瘡11例（13髖），類風濕性關節(jié)炎16例（22髖），強直性脊柱炎15例（16髖）。髖關節(jié)置換原因：股骨頭缺血性壞死26例（34髖），髖關節(jié)僵硬15例（16髖），股骨頸骨折1例（1髖）。術前髖關節(jié)Harris評分為（32.49 ± 9.50）分；簡明健康調查量表（SF-36量表）中體能方面總分（physical component summary，PCS）為（25.53 ± 4.46）分，精神方面總分（mental component summary，MCS）為（42.28 ± 6.27）分。 結果術后患者切口均Ⅰ期愈合。42例患者均獲隨訪，隨訪時間 5～21年，平均9.1年。末次隨訪時Harris評分為（89.25 ± 8.47）分； SF-36量表評分PCS為（51.35 ± 4.28）分， MCS為（55.29 ± 8.31）分；與術前比較差異均有統(tǒng)計學意義（P  lt; 0.05）。術后并發(fā)癥包括跛行（4例）、假體脫位（2例2髖）、假體周圍骨折（1例1髖）、假體無菌性松動（2例2髖）以及異位骨化（3例3髖）。 結論對于慢性自身免疫性疾病引起的髖關節(jié)功能喪失，采用THA治療可獲得較好療效。

引用本文： 康焱,張紫機,張志奇,楊子波,傅明,盛璞義,何愛珊,徐棟梁,廖威明. 慢性自身免疫性疾病患者初次人工全髖關節(jié)置換術后中遠期療效. 中國修復重建外科雜志, 2012, 26(9): 1033-1036. doi: 復制

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1. Zangger P, Gladman DD, Urowitz MB, et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol, 2000, 27(4): 919-923.
2. Chong RW, Chong CS, Lai CH. Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties. Int J Rheum Dis, 2010, 13(3): 235-239.
3. Pietrzak K, Strzyzewski W, Kaczmarek W, et al. Total hip replacement in treatment of patients with deformity of the hip caused by ankylosing spondylitis. Chir Narzadow Ruchu Ortop Pol, 2010, 75(5): 282-286.
4. Keats AS. The ASA classification of physical status—a recapitulation. Anesthesiology, 1978, 49(4): 233-236.
5. Harris WH, McCarthy JC Jr, O’ Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg (Am), 1982, 64(7): 1063-1067.
6. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
7. Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A (9): 1333-1338.
8. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
9. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
10. Zizic TM, Marcoux C, Hungerford DS, et al. Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med, 1985, 79(5): 596-604.
11. Mont MA, Glueck CJ, Pacheco IH, et al. Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol, 1997, 24(4): 654-662.
12. Mok MY, Farewell VT, Isenberg DA. Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: is there a role for antiphospholipid antibodies? Ann Rheum Dis, 2000, 59(6): 462-467.
13. Nagasawa K, Tada Y, Koarada S, et al. Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI. Lupus, 2005, 14(5): 385-390.
14. Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, et al. Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus. J Rheumatol, 2001, 28(4): 761-765.
15. Prupas HM, Patzakis M, Quismorio FP Jr. Total hip arthroplasty for avascular necrosis of the femur in systemic lupus erythematosus. Clin Orthop Relat Res 1981, (161): 186-190.
16. Hanssen AD, Cabanela ME, Michet CJ Jr. Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Joint Surg (Am), 1987, 69(6): 807-814.
17. Ito H, Matsuno T, Hirayama T, et al. Health-related quality of life in patients with systemic lupus erythematosus after medium to long-term follow-up of hip arthroplasty. Lupus, 2007, 16(5): 318-323.
18. Takahashi R, Tsutsumi A, Ohtani K, et al. Anti-mannose binding lectin antibodies in sera of Japanese patients with systemic lupus erythematosus. Clin Exp Immunol, 2004, 136(3): 585-590.
19. Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med, 2006, 119(8): 700-706.
20. Orban H, Cîrstoiu C, Adam R. Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis. Rom J Intern Med, 2007, 45(1): 123-129.
21. Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty, 2008, 23(6): 859-866.
22. Smilowicz M, Kowalczewski JB. Long term results after total hip replacement—cemented and cementless in young rheumatic patients. Chir Narzadow Ruchu Ortop Pol, 2005, 70(5): 319-323.
23. Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
24. Brinker MR, Rosenberg AG, Kull L, et al. Primary noncemented total hip arthroplasty in patients with ankylosing spondylitis. Clinical and radiographic results at an average follow-up period of 6 years. J Arthroplasty, 1996, 11(7): 802-812.
  1. 1. Zangger P, Gladman DD, Urowitz MB, et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol, 2000, 27(4): 919-923.
  2. 2. Chong RW, Chong CS, Lai CH. Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties. Int J Rheum Dis, 2010, 13(3): 235-239.
  3. 3. Pietrzak K, Strzyzewski W, Kaczmarek W, et al. Total hip replacement in treatment of patients with deformity of the hip caused by ankylosing spondylitis. Chir Narzadow Ruchu Ortop Pol, 2010, 75(5): 282-286.
  4. 4. Keats AS. The ASA classification of physical status—a recapitulation. Anesthesiology, 1978, 49(4): 233-236.
  5. 5. Harris WH, McCarthy JC Jr, O’ Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg (Am), 1982, 64(7): 1063-1067.
  6. 6. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
  7. 7. Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A (9): 1333-1338.
  8. 8. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
  9. 9. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
  10. 10. Zizic TM, Marcoux C, Hungerford DS, et al. Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med, 1985, 79(5): 596-604.
  11. 11. Mont MA, Glueck CJ, Pacheco IH, et al. Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol, 1997, 24(4): 654-662.
  12. 12. Mok MY, Farewell VT, Isenberg DA. Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: is there a role for antiphospholipid antibodies? Ann Rheum Dis, 2000, 59(6): 462-467.
  13. 13. Nagasawa K, Tada Y, Koarada S, et al. Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI. Lupus, 2005, 14(5): 385-390.
  14. 14. Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, et al. Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus. J Rheumatol, 2001, 28(4): 761-765.
  15. 15. Prupas HM, Patzakis M, Quismorio FP Jr. Total hip arthroplasty for avascular necrosis of the femur in systemic lupus erythematosus. Clin Orthop Relat Res 1981, (161): 186-190.
  16. 16. Hanssen AD, Cabanela ME, Michet CJ Jr. Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Joint Surg (Am), 1987, 69(6): 807-814.
  17. 17. Ito H, Matsuno T, Hirayama T, et al. Health-related quality of life in patients with systemic lupus erythematosus after medium to long-term follow-up of hip arthroplasty. Lupus, 2007, 16(5): 318-323.
  18. 18. Takahashi R, Tsutsumi A, Ohtani K, et al. Anti-mannose binding lectin antibodies in sera of Japanese patients with systemic lupus erythematosus. Clin Exp Immunol, 2004, 136(3): 585-590.
  19. 19. Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med, 2006, 119(8): 700-706.
  20. 20. Orban H, Cîrstoiu C, Adam R. Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis. Rom J Intern Med, 2007, 45(1): 123-129.
  21. 21. Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty, 2008, 23(6): 859-866.
  22. 22. Smilowicz M, Kowalczewski JB. Long term results after total hip replacement—cemented and cementless in young rheumatic patients. Chir Narzadow Ruchu Ortop Pol, 2005, 70(5): 319-323.
  23. 23. Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
  24. 24. Brinker MR, Rosenberg AG, Kull L, et al. Primary noncemented total hip arthroplasty in patients with ankylosing spondylitis. Clinical and radiographic results at an average follow-up period of 6 years. J Arthroplasty, 1996, 11(7): 802-812.