*These authors contributed equally to this work
收稿日期: 2023-12-19
网络出版日期: 2024-10-16
版权
Therapeutic effect of modified femoral neck osteotomy on the surgical treatment of ankylosing spondylitis with severe flexion deformity
Received date: 2023-12-19
Online published: 2024-10-16
Copyright
目的: 评估改良股骨颈截骨术(modified femoral neck osteotomy, mFNO)在合并严重脊柱后凸和髋关节屈曲强直的强直性脊柱炎(ankylosing spondylitis, AS)患者手术治疗过程中的疗效。方法: 回顾性分析2019年1月1日至2023年11月15日期间进行经椎弓根椎体截骨矫形术(pedicle subtraction osteotomy, PSO)和人工全髋关节置换术(total hip arthroplasty, THA)手术治疗的合并脊柱后凸和髋关节屈曲强直的AS患者资料，总共61例患者，103髋。记录患者mFNO的手术时间、手术失血量、术前和术后下肢体干角(angle of the trunk and lower limb, ATL)度数、髋关节被动活动度(range of motion，ROM)、视觉模拟评分(visual analogue scale，VAS)和院内并发症的发生率，并采用配对样本t检验进行统计学分析，P < 0.05为差异有统计学意义。结果: 最终纳入病例10例，其中男性9例，女性1例，平均年龄(41.30±9.03)岁。10例患者总接受手术次数为52次，其中接受mFNO和THA各19髋，接受PSO 14次。9例双侧mFNO手术的平均手术时间为(133.11±34.81) min，失血量为(433.33±187.10) mL；1例单侧mFNO手术时间为60 min，出血量200 mL。19髋的mFNO术前ATL度数为40.37°±13.66°，术后ATL度数为88.47°±12.46°，差异有统计学意义(P < 0.05)。mFNO术前VAS评分为0，术后VAS评分为5.95±1.51，差异有统计学意义(P < 0.05)。髋关节被动伸直ROM在mFNO术前为37.37°±18.13°，术后为-4.95°± 21.24°，差异有统计学意义(P < 0.05)；髋关节被动屈曲ROM在mFNO术前为37.37°±18.13°，术后为50.79°±20.36°，差异有统计学意义(P < 0.05)。院内并发症共有3次(3/52，5.67%)，其中1次为PSO术后肺不张(1/52，1.92%)，1次为THA术中发现大粗隆骨折(1/52，1.92%), 1次为THA术后早期脱位(1/52，1.92%)。结论: mFNO能够明显改善合并严重脊柱后凸和髋关节屈曲强直的AS患者的ATL角度，为PSO和THA提供可行性。
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 . DOI: 10.19723/j.issn.1671-167X.2024.05.020
Objective: To evaluate the efficacy of modified femoral neck osteotomy (mFNO) in the surgical treatment of patients with ankylosing spondylitis (AS) and severe spinal kyphosis combined with hip flexion contracture. Methods: A retrospective analysis was conducted on 61 AS patients (103 hips) with spinal kyphosis and hip flexion contracture who underwent pedicle subtraction osteotomy (PSO) and total hip arthroplasty (THA) from January 1, 2019 to November 15, 2023. Data on mFNO operation time, blood loss, preoperative and postoperative values of the angle of the trunk and lower limb (ATL), hip passive range of motion (ROM), visual analogue scale (VAS), and incidence of in-hospital complications were recorded. Statistical analysis was performed using paired-samples t test. P < 0.05 was considered statistically significant. Results: The study ultimately included 10 cases, 9 males and 1 female, with an average age of (41.30±9.03) years. These patients underwent surgery for a total of 52 times, including 19 hips both receiving mFNO and THA, and 14 times PSO. The average operation time for nine bilateral mFNO was (133.11±34.81) min, with blood loss of (433.33±187.10) mL. A unilateral mFNO took 60 min with 200 mL of blood loss. The preoperative ATL of 19 hips was 40.37°±13.66°, and the postoperative ATL value was 88.47°±12.46° (P < 0.05). The preoperative VAS score was 0, while the postoperative VAS score was 5.95±1.51 (P < 0.05). The preoperative hip extension ROM was 37.37°±18.13°, while the postoperative hip extension ROM was -4.95°±21.24° (P < 0.05). Hip flexion ROM improved from 37.37°±18.13° to 50.79°±20.36° after FNO (P < 0.05). There were three cases of in-hospital complications (3/52, 5.67%): One case of postoperative atelectasis following PSO (1/52, 1.92%), one greater trochanter fracture identified during THA (1/52, 1.92%), and one early dislocation post-THA (1/52, 1.92%). Conclusion: mFNO significantly improves the ATL in AS patients with severe spinal kyphosis combined with hip flexion contracture, facilitating PSO and THA surgeries.
| 1 | Luan H , Liu K , Kahaer A , et al. Pedicle subtraction osteotomy for the corrective surgery of ankylosing spondylitis with thoracolumbar kyphosis: Experience with 38 patients[J]. BMC Musculoskelet Disord, 2022, 23 (1): 731. |
| 2 | Oommen AT , Hariharan TD , Chandy VJ , et al. Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis[J]. World J Orthop, 2021, 12 (12): 970- 982. |
| 3 | Guo HZ , Yang CX , Tang ZP , et al. The effects of total hip arthroplasty in treating hip bony fusion in young and middle-aged patients with ankylosing spondylitis[J]. J Orthop Surg Res, 2019, 14 (1): 253. |
| 4 | Blizzard DJ , Penrose CT , Sheets CZ , et al. Ankylosing spondylitis increases perioperative and postoperative complications after total hip arthroplasty[J]. J Arthroplasty, 2017, 32 (8): 2474- 2479. |
| 5 | Chung BC , Stefl M , Kang HP , et al. Increased dislocation rates following total hip arthroplasty in patients with ankylosing spondylitis[J]. Hip Int, 2023, 33 (6): 1026- 1034. |
| 6 | Li Y , Qian BP , Qiu Y , et al. Influence of lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis-related thoracolumbar kyphosis following pedicle subtraction osteotomy[J]. J Neurosurg Spine, 2021, 36 (4): 624- 631. |
| 7 | Suwal SK , Songming P , Gang L , et al. Clinical evaluation of fused/ankylosed hip with severe flexion deformity after conversion to total hip arthroplasty[J]. J Nepal Med Assoc, 2016, 54 (202): 63- 66. |
| 8 | Idulhaq M , Park KS , Diwanji SR , et al. Total hip arthroplasty for treatment of fused hip with 90 degrees flexion deformity[J]. J Arthroplasty, 2010, 25 (3): 498.e5- 498.e9. |
| 9 | Zeng Y , Huang Q , Ma H , et al. Two-stage treatment for ankylosing spondylitis with severe hip contracture[J]. Orthopedics, 2019, 42 (6): e502- e506. |
| 10 | Yang X , Wang Q , Meng Z , et al. A femoral neck osteotomy for the patients with ankylosing spondylitis and thoracolumbar kyphosis combined with hip flexion contracture[J]. Orthop Surg, 2024, 16, 245- 253. |
| 11 | 曾勇, 何睿, 李庆, 等. 脊柱楔形截骨并人工全髋关节置换术治疗强直性脊柱炎后凸畸形并髋关节重度屈曲挛缩畸形[J]. 中国修复重建外科杂志, 2014, 28 (8): 942- 946. |
| 12 | Gupta MC , Gupta S , Kelly MP , et al. Pedicle subtraction osteotomy[J]. JBJS Essent Surg Tech, 2020, 10 (1): e0028.1- e0028.11. |
| 13 | Song DY , Zhang ZF , Wang TH , et al. Pedicle subtraction osteo-tomy in lateral position: A new strategy for correcting severe thoracolumbar kyphosis combined with hip flexion contracture in ankylosing spondylitis[J]. Orthop Surg, 2021, 13 (8): 2396- 2404. |
| 14 | Rego P , Mascarenhas V , Mafra I , et al. Femoral neck osteotomy in skeletally mature patients: surgical technique and midterm results[J]. Int Orthop, 2021, 45 (1): 83- 94. |
| 15 | Faure PA , Zaltz I , C?té K , et al. Morscher osteotomy through surgical dislocation approach for true femoral neck lengthening with greater trochanter transposition[J]. J Bone Joint Surg Am, 2020, 102 (Suppl 2): 66- 72. |
/
| 〈 |
|
〉 |
