36 Diameter Femoral Head Total Hip Arthroplasty & Hip Resurfacing Arthroplasty For Ankylosing Spondylitis

Background:AS (ankylosing spondylitis), is a form of chronic inflammatory arthritis that mainly affects the joints of lower back, spine,soft tissue beside spine and peripheral joint,The serious patients may suffer from spine malformation and ankylosing. AS, which tends to be familial inherited, mainly affects adolescents with a ratio of about 5:l between male and female. Only by operation can the AS patients whose hip joints became totally anchylosed be cured. Undertaking the development of over one century, THA (total hip arthroplasty) has been one of the classical operations to cure the diseases of hip joints and considered as the most outstanding achievement of modern orthopedics. With the advantages of relieving painfulness, improve joints functions and recovering body motions, it has been widely applied in clinical medicine. Because of the characteristics of AS patients, there are special demands for artificial joints, which are displayed in: the joints friction interface should have the endurance of ten years for fear that there is adverse reaction caused by abrasion debris (e.g. osteolysis); and there is also special demand for the movement after operation which needs the patients to participate in work and exercise actively. Hence it poses brand-new challenge to the traditional hip replacement operation. With the development of material science and metal tribology, THA of thigh bones with diameter of 36mm and hip resurfacing operations which are universally concerned provide better choices for the patients. However, these two kinds of operations have their own characteristics and which one is more suitable for the patients has been actively discussed among scholars from both home and abroad. The present research attempts to explore this heated topic to the depth.Purpose :Evaluate the two kinds of operations to find out which one is more suitable for the young AS patients with the help of the clinical and iconography results of THA of thigh bones with diameter of 36mm and HR operationsSubject investigated & Research method:1. Subject investigated:From August in 2008 to August in 2010, 16 AS patients, in which 11 are male and 5 are female with average age of 29.2(19-42) and BMI index of 23.2(18.1-26.7), had been undertaken THA of thigh bones with diameter of 36mm in our department. At the same time 11AS patients, in which 8 are male and 3 are female with average age of 28.8 ((20-31) and BMI index of22.9(17.7-26.6) had been undertaken HRA operation in our department. There is no significant difference in both age and BMI index between the two groups of patients.2. Research method:Make comparison of clinical and iconography results of THA of thigh bones with diameter of 36mm and HRA operations within and between groups; Analyze the advantages and disadvantages of the two system s of prosthesis.3. Observation method and index: Keep record of the operation time, the amount of bleeding, the operative incision length, blood transfusion proportion, deep vein thrombosis,dislocation, the rate of infection after operation. At the same time, assess the Harris Hip and the recovery situation of the two groups of patients. Assess the (ROM) with the help of standard anteroposterior and lateral pelvic film filmof hip joints during the period of investigation, and test the transplantation and survival situation of the prosthesis.4. Statistical method:Make comparison of the variable within groups through paired T-test, and variable between groups through independent T-test. The result is analyzed by SPSS 13.0. When P<0.05, the difference is considered of statistical meaning.Result:The two groups have made satisfying clinical effect and the Harris score has been significantly improved compared with before. There is no significant difference in the amount of bleeding, the operative incision length, blood transfusion proportion, dislocation of hip joints, the rate of lower limb deep vein thrombosis and hip joints movements after operation between two groups of patients. The patients undertaking THA of thigh bones with diameter of 36mm operation is superior to the patients of HRA operation in the operation time and the operative incision length and the difference is of significant meaning. Iconographical observation shows that all the prosthesis are of good function and there's no obvious radiolucent zone. Brooker I dislocation ossification happens to 2(9.5%) in THA of thigh bones with diameter of 36mm operation and 1 in HR operation.Conclusion: Trough the result of the report, THA of thigh bones with diameter of 36mm operation and HRA operation both can make satisfying clinical effect. There is no significant difference in dislocation of hip joints and hip joints movements after operation between two groups of patients. THA of thigh bones with diameter of 36mm operation is superior to the patients of HRA operation in the operation time and the operative incision length, while HRA operation has its own advantages in the amount of remaining bone and movement recovery of patients. HRA is a better choice for the AS patients.