Comparison Of The Therapeutic Effects Of Total Hip Arthroplasty With Femoral Neck Osteotomy Traction And Stage Ⅰ Total Hip Arthroplasty In The Treatment Of Severe Hip Flexion Contracture Deformity In Ankylosing Spondylitis

Objective:To discuss the clinical effects of total hip arthroplasty(THA)and stageⅠtotal hip arthroplasty in the treatment of severe hip flexion contracture deformity in ankylosing spondylitis(AS),and to evaluate and analyze the clinical value of femoral neck osteotomy traction combined with total hip arthroplasty in the treatment of severe hip flexion contracture deformity in ankylosing spondylitis(AS)Value.Methods:We analyzed the clinical data of 18 patients with ankylosing spondylitis with severe hip flexion contracture deformity treated by orthopaedic surgery in Chengdu No.2 People’s Hospital from 2008 to 2018.They were divided into group A(13 hips in 7 cases)and group B(17 hips in 11 cases)according to the difference of surgical methods.The operation mode of group A was stage Ⅰ femoral neck osteotomy traction combined with stage Ⅱ THA,while that of group B was stage Ⅰ THA.The two groups matched each other in gender,age and complications.The hip flexion deformity angle,hip mobility,Harris score(preoperative,6 months and 1 year after surgery),pelvic parameters(sacral inclination angle SS,pelvic inclination angle PT,pelvic incidence angle PI),bleeding volume and complications were evaluated before and after operation in both groups.Results : After 1 year follow-up,(1)The hip flexion angle of the two groups was significantly improved,and the hip abduction and flexion and extension activities of the two groups were significantly improved compared with those of the preoperative group,while group A(stage Ⅰ femoral neck osteotomy and traction combined with stage Ⅱ THA)was significantly better than group B(stage Ⅰ THA)(P < 0.05).(2)The Harris score of the two groups was significantly improved after operation.The Harris score of group A was significantly better than that of group B at 6 months after operation(P < 0.05),but there was no significant difference in Harris score between the two groups one year after operation.(3)The amount of bleeding in group B was significantly less than that in group A(P < 0.05),with an average decrease of about 100 ml.In terms of complications,heterotopic ossification was more likely in group A,while traction injury of femoral nerve was more likely in group B.(4)No thrombosis,infection or dislocation of prosthesis occurred in both groups.(5)There was no significant difference in PI,PT and SS values between the two groups before and after operation(P > 0.05).Conclusion: Stage Ⅰ femoral neck osteotomy traction combined with stage Ⅱ THA has obvious advantages in improving hip deformity,mobility and reducing traction injury of femoral nerve in the treatment of severe flexion contracture deformity of AS hip joint,and its bleeding volume,heterotopic ossification and hospitalization days are significantly higher than those of phase_THA.Both groups can’t correct the pelvic sagittal imbalance to some extent.In conclusion,stage Ⅰ femoral neck osteotomy traction combined with stage Ⅱ THA has a good clinical effect,which is a better surgical method for the treatment of severe hip flexion contracture deformity in ankylosing spondylitis.