中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (11): 1641-1646.doi: 10.3969/j.issn.2095-4344.2017.11.001

• 人工假体 artificial prosthesis •    下一篇

强直性脊柱炎患者全髋关节置换后异位骨化的危险因素

刘 勇1,霍少川2,周 驰3,唐宏宇3,陈德龙1,陈建发3,郭 海1,邓章荣1,王海彬3   

  1. 1广州中医药大学第一临床医学院,广东省广州市 510405;2广州中医药大学第三临床医学院,广东省广州市   5104053广州中医药大学第一附属医院骨科中心,广东省广州市   510405
  • 修回日期:2017-02-24 出版日期:2017-04-18 发布日期:2017-04-18
  • 通讯作者: 王海彬,主任医师,博士生导师,广州中医药大学第一附属医院骨科中心,广东省广州市 510405
  • 作者简介:刘勇,男,1988年生,湖北省钟祥市人,汉族,广州中医药大学第一临床医学院在读硕士,主要从事关节骨科研究。
  • 基金资助:

    国家自然科学基金(KBC110134K11)“组蛋白去甲基化酶JMJD2蛋白家族在补肾法防治骨质疏松症中的作用机制”;广东省自然科学基金(2015A030310203)“股骨头坏死症候异质性与其分子分型及临床MRI表现的相关性研究”

Risk factors for heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis   

Liu Yong1, Huo Shao-chuan2, Zhou Chi3, Tang Hong-yu3, Chen De-long1, Chen Jian-fa3, Guo Hai1, Deng Zhang-rong1, Wang Hai-bin3   

  1. 1the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2the Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 3Orthopedics Center, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Revised:2017-02-24 Online:2017-04-18 Published:2017-04-18
  • Contact: Wang Hai-bin, Chief physician, Doctoral supervisor, Orthopedics Center, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Liu Yong, Studying for master’s degree, the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. KBC110134K11; the Natural Science Foundation of Guangdong Province, No. 2015A030310203

摘要:

文章快速阅读:

 
 
 
文题释义:
异位骨化:是指在软组织出现成骨细胞,并形成骨组织。多半发生在大关节周围,例如髋关节、肘关节等,常见于神经瘫痪的患者,发病机制不清楚。诱发因素可能是创伤、神经和生物电因素。早期局部有明显肿痛,关节活动受限;晚期由于骨组织形成,导致关节活动限制。
神经源性异位骨化:是异位骨化的一种重要类型,它是在中枢神经损伤患者的关节周围不存在骨的部位出现新生骨。脊髓损伤后,机体的体液因子、神经免疫功能、机体代谢功能及局部环境都发生了相应改变,这些因素是如何诱导神经源性异位骨化形成的,其确切机制尚不清楚。极有可能是按照Kaplan等提出的异位骨化发生的“四要素”进行发展,最终形成了异位骨化。这些理论在一定程度上解释了本文所发现的全麻会增加异位骨化的发生率。
 

摘要
背景
:强直性脊柱炎患者初次人工全髋关节置换后发生异位骨化较常见,会对术后功能造成一定影响。

目的:探讨强直性脊柱炎患者行初次全髋关节置换后发生异位骨化的危险因素。
方法:纳入2011年6月至2015年12月因强直性脊柱炎行初次全髋关节置换且随访达6个月以上的87例(132髋)患者,对患者的手术前后临床资料和影像学资料进行收集整理,影像学资料包括患者术前及术后的髋关节正侧位X射线片。观察末次随访X射线片假体周围异位骨化的范围,并按Brooker分型分为Ⅰ-Ⅳ型。将与异位骨化相关的危险因素分为两大类,不可变因素包括年龄、性别、病程及术前髋关节是否强直;可变因素包括术前C-反应蛋白、术前红细胞沉降率、术中出血量、手术时间、假体类型及麻醉方式,从中找出与异位骨化发生相关的危险因素。
结果与结论:①有43髋在术后发生了异位骨化,发生率为32.6%;②男性(P=0.029)、术前髋关节强直(P < 0.001)、病程(P=0.029)是异位骨化发生的不可变因素,增加了异位骨化的发生率;手术时间过长(P=0.031)和术中使用全麻(P=0.003)是异位骨化发生的可变因素,也会增加其发生率;患者的年龄、术前红细胞沉降率及C-反应蛋白、术中出血量和假体类型与术后异位骨化的发生无明显相关性;③综上,异位骨化的发生率与手术时间长短以及是否全麻等可变因素密切相关,可以通过缩短手术时间以及术中尽量避免使用全麻来降低异位骨化的发生率。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-0112-1408(王海彬)

关键词: 骨科植入物, 人工假体, 强直性脊柱炎, 全髋关节置换, 异位骨化, 危险因素, 术前强直, 手术时间, 术中出血, 麻醉方式, 假体类型, 国家自然科学基金

Abstract:

BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.

OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.
METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.

RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003) were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Hip, Ossification, Heterotopic, Prosthesis Implantation, Tissue Engineering

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