强直性脊柱炎双侧髋膝关节骨性强直的功能重建

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1、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3d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

2、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。13【关键词】强直性脊柱炎；双侧髋膝关节；骨性强直；功能重建

3、Abstract：［Objective］Toinvestigatethefeasibility,operationdesignandpostoperativerehabilitationinankylosingspondylitispatientswithbilateralhipsandkneesbonyankylosis,whowereoperatedonthe4jointsduringonehospitalizationperiod.［Method］Twooperationswereperformedinonehospitalizationperiodinthreean

4、kylosingspondylitispatientsonthe2hipjointsand2kneejointsrespectively.Onecase,thelefthipreplacementwasoperatedinthefirstoperation,andtherighthipandthedoublekneeswereoperatedinthesecondoperation;theothertwocases,unilateralhipandkneewereoperatedintwooperationsrespectively.Patientsbegantocontr

5、acttheirlowerlimbsmusclesinitiativelyafternarcosis.ThelimbswereputontheCPM,thehipsandkneeswerebentandextendedrepeatedlyonthethirddayafteroperations.Thepatientsbegantoleavebedandlearnedtowalk2weeksafteroperations.Theycouldwalk100stepswithaidswhentheyleafthospital.［Result］Insix-monthfollow-

6、up,therangeofhipmotion（degree）were105°～145°（average135°）;the13rangeofkneemotion（degree）was45°～60°（average54°）.ThehipfunctionscoreadoptedHarrisscoresystem:theaverageof83andwereallgood;thekneefunctionscoreadoptedAmericanAssociationofKneeSurgeryscoresystemin1989:allwereexcellentexceptagoodo

7、ne（leftkneeoffirstcase,thescorewas74/75）.［Conclusion］Performingoperationsonthe2bonyankylosishipsand2bonyankylosiskneesintheankylosingspondylitispatientsinonehospitalizationperiodcanshortenthetreatmentcycle,releasethedistress,andlightentheeconomicload,meanwhile