Email Alert | RSS

北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1089-1095. doi: 10.19723/j.issn.1671-167X.2025.06.011

• 论著 • 上一篇    下一篇

中轴型脊柱关节炎合并髋关节终末期受累的长期影像学参数：单中心24年大样本回顾研究

吴昕峰1,*, 满斯亮2,*, 陈大召3, 华勇4, 温锡杰5, 丁盈月2, 张亮3,*(), 侯秀娟6,*()   

  1. 1. 首都医科大学附属北京积水潭医院脊柱外科，北京 100035
    2. 首都医科大学附属北京积水潭医院风湿免疫科，北京 100035
    3. 首都医科大学附属北京积水潭医院矫形骨科，北京 100035
    4. 高唐县中医院骨科，山东聊城 252800
    5. 河北省沧州中西医结合医院骨科，河北沧州 061000
    6. 北京中医药大学东方医院风湿病科，北京 100078
  • 收稿日期:2025-08-12 出版日期:2025-12-18 发布日期:2025-10-28
  • 通讯作者: 张亮, 侯秀娟
  • 作者简介:

    * These authors contributed equally to this work

A long-term review for radiographic parameters of hips in axial spondyloarthritis patients with end-stage hip involvement: A 24-year trend analysis from a single high-volume tertiary center

Xinfeng WU1, Siliang MAN2, Dazhao CHEN3, Yong HUA4, Xijie WEN5, Yingyue DING2, Liang ZHANG3,*(), Xiujuan HOU6,*()   

  1. 1. Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    2. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    3. Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    4. Department of Orthopedics, Gaotang County Hospital of Traditional Chinese Medicine, Liaocheng 252800, Shandong, China
    5. Department of Orthopedics, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei Province, Cangzhou 061000, Hebei, China
    6. Department of Rheumatology and Immunology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
  • Received:2025-08-12 Online:2025-12-18 Published:2025-10-28
  • Contact: Liang ZHANG, Xiujuan HOU

RICH HTML

   

PDF (PC)

摘要：

目的: 回顾单中心24年的大样本影像学数据，分析中轴型脊柱关节炎(axial spondyloarthritis, axSpA)终末期髋关节受累的重要影像学参数特点及其变化趋势。方法: 回顾性分析2001—2024年710例接受全髋关节置换术(total hip arthroplasty, THA)的axSpA患者共998例髋关节的术前X线片影像学趋势。测量指标包括：骨性融合、髋臼内陷、脱位(包括半脱位)、闭孔率(obturator foramen ratio，OFR)、髓腔张开指数(canal flare index, CFI)和颈干角(neck shaft angle, NSA)，同时收集术前基线人口学参数、疾病相关参数和实验室检查数据。使用Jonkheere-Terpstra检验或Cochran-Armitage检验对临床和影像学参数进行趋势分析。根据axSpA患者手术时间，将998例髋关节分成2001—2012入院组和2013—2024入院组，对两组的临床和影像学参数进行组间比较。结果: axSpA患者术前，基线骨性融合、髋臼内陷和脱位的整体发生率分别为40.2%、14.8%和9.8%；中位OFR、CFI和NSA分别为1.5 (1.2, 1.7)、3.2 (2.6, 3.8)和141.0° (135.0°, 148.0°)。在影像学参数的趋势研究中，仅有OFR呈现显著上升(P=0.001)；临床参数中，血红蛋白(hemoglobin, Hb)(P < 0.001)、白蛋白(albumin, ALB)(P < 0.001)、12项健康评估简表(short form 12-item health survey, SF-12)的躯体功能评分(physical component summary, PCS)(P=0.005)和Harris髋关节评分(Harris hip score, HHS)(P=0.003)呈现显著的上升趋势，红细胞沉降率(erythrocyte sedimentation rate, ESR)(P < 0.001)、C反应蛋白(C-reactive protein, CRP)(P < 0.001)、Bath强直性脊柱炎病情活动指数(Bath ankylosing spondylitis disease activity index, BASDAI)(P=0.013)和Bath强直性脊柱炎功能指数(Bath ankylosing spondylitis functional index, BASFI)(P < 0.001)呈现显著的下降趋势。在2001—2012入院组(n=421)和2013—2024入院组(n=577)的组间比较中，性别(P=0.004)、体重指数(body mass index，BMI)(P=0.002)、发病年龄(P < 0.001)和HHS(P < 0.001)差异有统计学意义，但两组间的影像学参数差异均无统计学意义。结论: axSpA合并终末期髋关节受累病例的髋关节影像学参数并未随疾病活动度的控制和功能状态的缓解而出现改善趋势，这为后续外科重建提出了诸多技术挑战。

关键词: 强直性脊柱炎, 髋关节, 影像学参数, 全髋关节置换术

Abstract:

Objective: To evaluate the characteristics and their change trends of major radiographic parameters of hips in axial spondyloarthritis (axSpA) patients with end-stage hip involvement from a single high-volume tertiary center over a 24-year period. Methods: Between 2001 and 2024, the radiographic trends of hips in axSpA patients with end-stage hip involvement were retrospectively reviewed. These radiographic parameters included bony ankylosis, acetabular protrusio, dislocation, obturator foramen ratio (OFR), canal flare index (CFI) and neck shaft angle (NSA). The baseline demographic, disease-related and laboratory parameters before surgery were also collected. Trend analyses over the study period were assessed using the Jonkheere-Terpstra trend test or the Cochran-Armitage trend test for clinical and radiographic parameters. All the joints were divided into the 2001-2012 group and 2013-2024 group according to the year of surgery, and the intergroup comparisons were conducted to further elucidate temporal changes. Results: The overall incidence of bony ankylosis, acetabular protrusio and dislocation before operation were 40.2%, 14.8% and 9.8%, respectively. The median value of OFR, CFI and NSA were 1.5 (1.2, 1.7), 3.2 (2.6, 3.8) and 141.0° (135.0°, 148.0°), respectively. Notably, only the value of OFR demonstrated increasing trend (P=0.001) among these radiographic parameters of hip, although some clinical parameters demonstrated increasing trend [hemoglobin (Hb) (P < 0.001), albumin (ALB) (P < 0.001), short form 12-item health survey (SF-12) physical component summary (PCS) (P=0.005), Harris hip score (HHS) (P=0.003)] or decreasing trend [erythrocyte sedimentation rate (ESR) (P < 0.001), C-reactive protein (CRP) (P < 0.001), Bath ankylosing spondylitis disease activity index (BASDAI) (P=0.013), Bath ankylosing spondylitis functional index (BASFI) (P < 0.001)]. The results of intergroup comparisons between 2001-2012 inpatient group (n=421) and 2013-2024 inpatient group (n=577) showed that no significant differences were found for these radiographic parameters of hip, although some clinical parameters were significantly different, including gender (P=0.004), body mass index (BMI) (P=0.002), age at disease onset (P < 0.001) and HHS (P < 0.001). Conclusion: The radiographic parameters of hip in axSpA patients with end-stage hip involvement did not show a trend of improvement over time, despite observed improvements in disease activity control and functional status. This dissociation between clinical improvement and persistent structural damage presents considerable technical challenges for subsequent surgical reconstruction with total hip arthroplasty.

Key words: Ankylosing spondylitis, Hip joint, Radiographic parameters, Total hip arthroplasty

中图分类号: 

  • R593.23

图1

影像学参数测量示意图"

表1

2001—2012入院组和2013—2024入院组患者临床及影像学参数的比较(以髋关节数量计算)"

Items Total 2001-2012 inpatient group 2013-2024 inpatient group Statistic P value
Gender χ2=8.40 0.004
    Male 866 (86.8) 350 (83.1) 516 (89.4)
    Female 132 (13.3) 71 (16.9) 61 (10.6)
BMI/(kg/m2) 23.0 (19.6, 26.0) 22.2 (19.1, 25.3) 23.5 (20.2, 26.2) Z=-3.04 0.002
Surgical side χ2=0.07 0.796
    Left 512 (51.3) 218 (51.8) 294 (51.0)
    Right 486 (48.7) 203 (48.2) 283 (49.1)
Age at onset/years 21.0 (16.0, 23.0) 19.0 (16.0, 23.0) 21.0 (18.0, 24.0) Z=-3.58 < 0.001
Age at diagnoses/years 29.0 (22.0, 38.0) 28.00 (21.0, 37.0) 29.0 (22.0, 39.0) Z=-1.93 0.054
Age at surgery/years 40.0 (31.0, 50.0) 38.0 (29.0, 50.0) 41.0 (32.0, 50.0) Z=-1.71 0.087
Diagnostic delay/years 8.0 (4.0, 16.0) 8.0 (4.0, 15.0) 8.0 (4.0, 16.0) Z=-0.62 0.537
Treatment interval/years 19.0 (12.0, 28.0) 19.0 (12.0, 28.0) 20.0 (12.0, 27.0) Z=-0.62 0.534
RDCI 0 (0, 0) 0 (0, 0) 0 (0, 0) Z=-0.26 0.794
HLA-B27 positive (hips) 908 (91.0) 383 (91.0) 525 (91.0) χ2=0.00 0.994
Hb/(g/L) 134.0 (118.0, 145.0) 135.0 (118.0, 146.0) 134.0 (118.0, 145.0) Z=-0.38 0.707
ESR/(mm/h) 22.0 (11.0, 40.0) 23.0 (11.0, 41.0) 22.0 (10.0, 39.0) Z=-0.98 0.326
CRP/(mg/L) 12.6 (5.4, 28.7) 14.8 (6.2, 31.0) 12.2 (5.3, 26.1) Z=-1.87 0.062
ALB/(g/L) 42.4 (39.3, 45.4) 42.2 (39.3, 45.2) 42.5 (39.4, 45.7) Z=-0.38 0.700
BASDAI 3.9 (2.9, 5.1) 3.8 (2.9, 5.0) 3.9 (2.9, 5.1) Z=-0.48 0.634
BASFI 57.0 (45.0, 74.0) 59.5 (45.8, 75.0) 56.0 (45.0, 72.0) Z=-1.38 0.166
HHS 36.0 (25.0, 44.0) 34.0 (23.0, 41.0) 37.0 (25.0, 45.0) Z=-4.08 < 0.001
SF-12 MCS 43.0 (38.4, 48.8) 43.0 (38.2, 48.9) 43.2 (38.5, 48.7) Z=-0.80 0.424
SF-12 PCS 33.4 (25.6, 38.7) 33.9 (25.6, 38.7) 33.1 (26.0, 38.7) Z=-0.43 0.671
Bony ankyloses (hips) 401 (40.2) 167 (39.7) 234 (40.6) χ2=0.08 0.778
Protrusion (hips) 148 (14.8) 61 (14.5) 87 (15.1) χ2=0.07 0.796
Dislocation (hips) 98 (9.8) 46 (10.9) 52 (9.0) χ2=1.01 0.316
OFR 1.5 (1.2, 1.7) 1.5 (1.2, 1.7) 1.5 (1.2, 1.8) Z=-1.28 0.201
CFI 3.2 (2.6, 3.8) 3.2 (2.6, 3.8) 3.2 (2.6, 3.8) Z=-0.15 0.882
NSA/(°) 141.0 (135.0, 148.0) 141.0 (135.0, 148.0) 141.0 (134.0, 148.0) Z=-0.08 0.939

图2

影像学评价参数的趋势分析"

图3

实验室检查结果和疾病相关参数的趋势分析"

1
马祝一, 张亮, 满斯亮, 等. 强直性脊柱炎全髋关节置换术治疗最新研究进展[J]. 中华骨与关节外科杂志, 2021, 14 (12): 1039- 1045.
2
Navarro-Compán V , Sepriano A , El-Zorkany B , et al. Axial spondyloarthritis[J]. Ann Rheum Dis, 2021, 80 (12): 1511- 1521.

doi: 10.1136/annrheumdis-2021-221035
3
Harrison SR , Marzo-Ortega H . Have therapeutics enhanced our knowledge of axial spondyloarthritis?[J]. Curr Rheumatol Rep, 2023, 25 (3): 56- 67.

doi: 10.1007/s11926-023-01097-7
4
于志永, 张亮, 边涛, 等. 全髋关节置换术治疗强直性脊柱炎合并髋关节骨性融合的中期随访研究[J]. 中华骨与关节外科杂志, 2023, 16 (8): 706- 712.
5
Li X , Pan J , Li H , et al. Factors predisposing to limited flexion after total hip arthroplasty for the treatment of axial spondyloarthritis[J]. Clin Rheumatol, 2025, 44 (3): 1135- 1140.

doi: 10.1007/s10067-025-07338-7
6
Rudwaleit M , van der Heijde D , Landewé R , et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part Ⅱ): Validation and final selection[J]. Ann Rheum Dis, 2009, 68 (6): 777- 783.

doi: 10.1136/ard.2009.108233
7
Garrett S , Jenkinson T , Kennedy LG , et al. A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index[J]. J Rheumatol, 1994, 21 (12): 2286- 2291.
8
Calin A , Garrett S , Whitelock H , et al. A new approach to defining functional ability in ankylosing spondylitis: The development of the Bath Ankylosing Spondylitis Functional Index[J]. J Rheumatol, 1994, 21 (12): 2281- 2285.
9
Busija L , Pausenberger E , Haines TP , et al. Adult measures of general health and health-related quality of life: Medical outcomes study short form 36-item (SF-36) and short form 12-item (SF-12) health surveys, Nottingham health profile (NHP), sickness impact profile (SIP), medical outcomes study short form 6D (SF-6D), health utilities index mark 3 (HUI3), quality of well-being scale (QWB), and assessment of quality of life (AQoL)[J]. Arthritis Care Res, 2011, 63 (Suppl 11): S383- S412.
10
Michaud K , Wolfe F . Comorbidities in rheumatoid arthritis[J]. Best Pract Res Clin Rheumatol, 2007, 21 (5): 885- 906.

doi: 10.1016/j.berh.2007.06.002
11
Sotelo-Garza A , Charnley J . The results of Charnley arthroplasty of hip performed for protrusio acetabuli[J]. Clin Orthop Relat Res, 1978, 132, 12- 18.

doi: 10.1097/00003086-197805000-00005
12
Tang WM , Chiu KY . Primary total hip arthroplasty in patients with ankylosing spondylitis[J]. J Arthroplasty, 2000, 15 (1): 52- 58.

doi: 10.1016/S0883-5403(00)91155-0
13
Noble PC , Alexander JW , Lindahl LJ , et al. The anatomic basis of femoral component design[J]. Clin Orthop Relat Res, 1988, 235, 148- 165.

doi: 10.1097/00003086-198810000-00015
14
Mertelsmann-Voss C , Lyman S , Pan TJ , et al. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis[J]. Arthritis Rheumatol, 2014, 66 (6): 1432- 1439.

doi: 10.1002/art.38384
15
马远, 张亮, 郭邵逸, 等. 强直性脊柱炎全髋关节置换术患者基线数据特征分析[J]. 中华骨与关节外科杂志, 2022, 15 (12): 939- 944.
16
张亮, 李宏超, 张浩天, 等. 类风湿关节炎髋关节终末期受累髋臼内陷临床特征和相关因素分析[J]. 中华骨与关节外科杂志, 2022, 15 (8): 619- 625.
17
Li H , Zhang L , Man S , et al. Protrusio acetabuli in ankylosing spondylitis patients with end-stage hip involvement[J]. Chin Med J, 2022, 135 (10): 1249- 1251.

doi: 10.1097/CM9.0000000000001792
18
Zhang L , Yang D , Yin X , et al. Risk factors for poor hip flexion after total hip arthroplasty for the treatment of ankylosing spondylitis a multivariate analysis[J]. Clin Rheumatol, 2014, 33 (9): 1295- 1301.

doi: 10.1007/s10067-014-2575-5
19
van der Heijde D , Braun J , Deodhar A , et al. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis[J]. Rheumatology, 2019, 58 (3): 388- 400.

doi: 10.1093/rheumatology/key128
[1] 王晓林, 郭邵逸, 陈大召, 温锡杰, 华勇, 张亮, 张秦. 全髋关节置换术治疗系统性红斑狼疮继发股骨头缺血性坏死的随访研究[J]. 北京大学学报（医学版）, 2025, 57(6): 1081-1088.
[2] 汪琪伟, 包鹏宇, 洪士皓, 杨昕, 王宇, 曹永平. 改良股骨颈截骨术在伴严重屈曲畸形强直性脊柱炎患者手术治疗过程中的疗效[J]. 北京大学学报（医学版）, 2024, 56(5): 884-889.
[3] 傅强,高冠英,徐雁,林卓华,孙由静,崔立刚. 无症状髋关节前上盂唇撕裂超声与磁共振检查的对比研究[J]. 北京大学学报（医学版）, 2023, 55(4): 665-669.
[4] 柯岩,张蔷,马云青,李儒军,陶可,桂先革,李克鹏,张洪,林剑浩. 全髋关节置换术治疗脊柱骨骺发育不良患者Tönnis 3级髋关节骨关节炎的早期疗效[J]. 北京大学学报（医学版）, 2021, 53(1): 175-182.
[5] 李森磊,杨先腾,田晓滨,孙立. 直接前入路和前外侧入路全髋关节置换术后的早期功能恢复对比[J]. 北京大学学报（医学版）, 2019, 51(2): 268-272.
[6] 张翠平,刘佩佩,傅强,高冠英,崔立刚,徐雁,王健全. 超声引导下髋关节药物注射在关节镜盂唇修复术后康复中的应用[J]. 北京大学学报（医学版）, 2019, 51(2): 265-267.
[7] 刘晓东，崔立刚，徐雁，孙洋，郝云霞，宋琳. 超声在髋关节前上盂唇撕裂中的应用[J]. 北京大学学报(医学版), 2017, 49(6): 1014-1018.
[8] 刘蕊, 孙琳, 李常虹, 翟佳羽, 刘湘源. 强直性脊柱炎的脊柱手术原因分析[J]. 北京大学学报(医学版), 2017, 49(5): 835-839.
[9] 吕明， 张金庆， 王兴山， 黄野， 李为， 张春雨. 直接前入路髋关节置换术及其早期临床疗效[J]. 北京大学学报(医学版), 2017, 49(2): 206-213.
[10] 张永进，李甲，綦珂，薛晨晨，徐卫东. 全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析[J]. 北京大学学报(医学版), 2017, 49(2): 201-205.
[11] 周靖, 党育, 张培训, 王静, 付中国, 张殿英, 王天兵, 徐海林, 薛峰, 陈建海, 杨明, 王钢, 沈惠良, 王光林, 吴新宝, 姜保国, . 60岁以下股骨颈骨折手术治疗术后功能及影响因素分析[J]. 北京大学学报（医学版）, 2011, 43(5): 703-706.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部