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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 884-889. doi: 10.19723/j.issn.1671-167X.2024.05.020

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Therapeutic effect of modified femoral neck osteotomy on the surgical treatment of ankylosing spondylitis with severe flexion deformity

Qiwei WANG, Pengyu BAO, Shihao HONG, Xin YANG*(), Yu WANG, Yongping CAO*()   

  1. Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
  • Received:2023-12-19 Online:2024-10-18 Published:2024-10-16
  • Contact: Xin YANG, Yongping CAO E-mail:Yangxinbjmu@126.com;freehorse6666@163.com

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Abstract:

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.

Key words: Ankylosing spondylitis, Modified femoral neck osteotomy, Spinal kyphosis, Hip flexion contracture

CLC Number: 

  • R687.3

Figure 1

Angle of the trunk and lower limb before and after modified femoral neck osteotomy A, preoperation angle of the trunk and lower limb (30°); B, postoperation angle of the trunk and lower limb (85°); Label a and a′ represent axis of trunk, b and b′ represent axis of lower limb."

Figure 2

Images of AS patients with severe kyphosis and hip joints flexion deformity A, postero-anterior X-ray film of spine before mFNO; B, lateral X-ray of spine before mFNO; C, lateral X-ray of hips before mFNO; D, postero-anterior X-ray film of hips after mFNO; E, postero-anterior X-ray film of spine after FPT; F, lateral X-ray of spine after FPT. AS, ankylosing spondylitis; mFNO, modified femoral neck osteotomy; FPT, mFNO, PSO and THA; PSO, pedicle subtraction osteotomy; THA, total hip arthroplasty."

Table 1

Information of 10 patients who underwent FPT surgery procedure"

Cases Gender Age/years Procedure mFNO
1 Male 32 FPPTT Bilateral
2 Male 56 FPTT Bilateral
3 Male 54 FPTT Bilateral
4 Male 46 FPTTP Bilateral
5 Male 26 FPPTT Bilateral
6 Male 47 PFTT Bilateral
7 Male 41 FPTT Bilateral
8 Male 39 FPTT Bilateral
9 Female 35 PFPTT Bilateral
10 Male 37 FPT Unilateral/left
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[1] LIU Rui, SUN Lin, LI Chang-hong, ZHAI Jia-yu, LIU Xiang-yuan. Cause analysis of spinal surgery in ankylosing spondylitis [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 835-839.
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