【作者】 张晓东；

【导师】 张伟；

【作者基本信息】 吉林大学 ， 临床医学， 2013， 硕士

【摘要】 目的：分析与评价全髋关节置换术对于髋脊柱综合征患者腰痛及腰椎功能的影响；进一步证实髋脊柱综合征的假设。方法：2010年9月至2012年3月，对30例合并腰痛的髋关节疾病患者行全髋关节置换术，男11例，女19例；年龄30～77岁，平均56.5岁；其中包括髋关节骨性关节炎10例，股骨头缺血性坏死10例，先天性髋关节发育不良10例，所有患者均为单侧发病。于术前对患者进行髋关节Harris评分（Harris Hip Score，HHS），髋痛及腰痛VAS评分(visual analogue scales，VAS)，腰椎功能Oswestry评分(Oswestry disability index，ODI)。术后在病房及出院后要求患者进行系统的功能康复训练，并于术后3个月及术后1年再次接受随访及评分。所有入组患者在此期间均未接受针对腰部症状的任何特殊治疗。使用SPSS19.0软件对所得数据进行统计分析，配对t检验及Wilcoxon检验检测术前及术后患者腰部与髋部疼痛、髋关节功能和脊柱功能评分的变化。以P＜0.05为差异有统计学意义。结果：术后3个月30例患者全部获得随访；术后1年，25例患者获得随访，2例死亡，3例失随访。患者腰部和髋部疼痛及腰椎功能均获得了明显的改善，术后3个月的Harris评分从44.62±4.67提高至80.07±4.21（P＜0.05），腰痛的VAS评分从5.27±1.32降到3.67±1.07（P＜0.05），髋痛的VAS评分自7.18±1.32降至2.89±1.17（P＜0.05），腰椎功能的Oswestry评分从37.69±6.81降到24.22±3.89（P＜0.05）。在术后1年随访时，患者腰痛VAS评分基本与术后3个月随访结果相似，从3.67±1.07降到3.56±0.89（P=0.133）。其余各指标均有相应程度的进一步改善,Harris评分从80.07±4.21提高至87.09±2.95（P＜0.05），髋痛的VAS评分自2.89±1.17降至0.98±0.62（P＜0.05），腰椎功能的Oswestry评分从24.22±3.89降到19.60±2.88（P＜0.05）。结论：对合并腰痛的髋关节疾病患者行全髋关节置换术后，腰部疼痛及腰椎功能在3个月后得到显著改善，1年后仍保持并提高；本研究进一步证实髋脊柱综合征的假设；对于其他的涉及髋关节的疾病，如髋关节滑膜炎、弹响髋、强直性脊柱炎等，是否能引起髋脊柱综合征则需要进一步的基础及临床研究才能得以证实。更多还原

【Abstract】 Objective: To analysis and assess the effect of low back pain andspinal function after total hip arthroplasty in patients with hip-spinesyndrome; clinically validate hip-spine syndrome as hypothesized.Method: From September2010to March2012,30adult patientswith hip joint diseases coexisting low back pain were included. Amongthem, there were11males and19females, age from30years to77years,The mean age of thepatients was56.5years.There were10patients withosteoarthritis of the hip,10patients withavascular necrosis of the femoralhead(ANFH) and another10patients withdevelopmental dysplasia of thehip (DDH).All of the patients had unilateral hip disease. They wereperformed total hip arthroplasty. Before operation, the Harris Hip Score,visual analogue scales (VAS) and Oswestry Disability Index (ODI)wereused to evaluate hip and spine symptoms in the patients. After operation,all of the patients were asked to do rehabilitation training in the yard andat home.3months and1year later, the patients were evaluated and the3methods of marking were used again. The patients in the study were notgiven any specific therapy for the back pain during this period. Then usethe SPSS19.0software statistical analysis of the data obtained. Paired ttests and Wilcoxon tests were used to identify changes inpain andfunction before and afterTHA.P <0.05was considered statisticallysignificant.Result: After3months，all of the thirty patients were evaluated, butonly twenty-five patients were evaluated in1year’follow up,2patientsdied and3lost follow-up. Both hip and spinal pain and function were significant improved. In3months’ follow up, Harris score improved from44.62±4.67to80.07±4.21（P＜0.05）.VAS of low back pain decreasedfrom5.27±1.32to3.67±1.07（P＜0.05）. VAS of hip pain decreased from7.18±1.32to2.89±1.17（P＜0.05）. Oswestry score decreased from37.69±6.81to24.22±3.89（P＜0.05）. These index were furtherimproved1year after the operation except that the VAS of low back painwas similar with the result of3months’ follow up.VAS of low back paindecreased from3.67±1.07to3.56±0.89（P=0.133）. Harris score improvedfrom80.07±4.21to87.09±2.95（P＜0.05）. VAS of hip pain decreasedfrom2.89±1.17to0.98±0.62（P＜0.05）. Oswestry score decreased from24.22±3.89to19.60±2.88（P＜0.05）.Conclusion: Spinal function and low back pain were improved aftertotal hip arthroplasty in patients with hip joint diseases at3months,which is maintained and enhanced in1year．And our research clinicallyvalidate hip-spine syndrome as hypothesized.Whether the other diseasesthat involved hip joint, just like hip synovitis, snapping hip, ankylosingspondylitis can cause hip-spine syndrome requires further basic andclinical research to be confirmed.更多还原