文档介绍：强直性脊柱炎双侧髋膝关节骨性强直的功能重建
作者:杨玉辉,张远鹰,王金成,高忠礼,刘强,洪森
【摘要】[目的]探讨双侧髋、膝关节骨性强直的强直性脊柱炎患者一次住院治疗,行全部4个关节置换的可行性以及手术方法的设计和术后的康复。[方法]对3例同时发生双侧髋、膝关节骨性强直的强直性脊柱炎患者一次住院,分两次手术行下肢4个大关节的人工关节置换术,其中1例,第1次手术行左侧髋关节置换,第2次手术行右侧髋关节及双侧膝关节置换术;另2例两次手术分别行同侧髋、膝关节置换术。病人麻醉清醒后即开始进行下肢肌肉主动收缩,术后3 d将下肢置于CPM机进行髋、膝关节屈伸练习,术后2周下床学习行走,出院前达到在支具扶助下行走100步。[结果]术后6个月随访时,髋关节活动范围为105°~145°,平均135°,膝关节活动范围为45°~60°,平均54°;髋关节功能评分采用Harris评分系统:平均83分,均为良,膝关节功能评分采用1989年美国膝关节外科协会评分系统:第1例左侧膝关节74/75分,为良,其余5个膝关节均为优。[结论]双侧髋、膝关节骨性强直的强直性脊柱炎患者一次住院治疗、行全部4个关节置换不仅可以缩短治疗周期,减轻病人痛苦和经济负担,同时便于术中操作和术后康复,其中以单次手术行同侧髋膝关节置换效果更佳。
【关键词】强直性脊柱炎; 双侧髋膝关节; 骨性强直; 功能重建
Abstract:[Objective]To investigate the feasibility,operation design and postoperative rehabilitation in ankylosing spondylitis patients with bilateral hips and knees bony ankylosis,who were operated on the 4 joints during one hospitalization period.[Method]Two operations were performed in one hospitalization period in three ankylosing spondylitis patients on the 2 hip joints and 2 knee joints case,the left hip replacement was operated in the first operation,and the right hip and the double knees were operated in the second operation;the other two cases,unilateral hip and knee were operated in two operations began to contract their lower limbs muscles initiatively after limbs were put on the CPM,the hips and knees were bent and extended repeatedly on the third day after patients began to leave bed and learned to walk 2 weeks after could walk 100 steps with aids when they leaft hospital.[Result]In six-month follow-up,the range of hip motion(degree)were 105°~145°(average 135°);the range of knee motion(degree)was 45°~60°(average 54°).The hip function score adopted Harris score system:the average of 83 and were all good;the knee function score adopted American Association of Knee Surgery score system in 1989:all were excellent except a good one(left knee of first case,the score was 74/75).[Conclusion]Per