ObjectiveTo introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. MethodsBetween March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). ResultsNo complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2±10.5)° and (33.7±9.7)° respectively, showing no significant difference (t=0.84, P=0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained. ConclusionThe preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.
【Abstract】 Objective To explore the effectiveness of multiple joint arthroplasty in treating lower limb joint disease. Methods Between January 2000 and December 2007, 5 patients with lower limb joint disease (three or more joints were involved) were treated with total hip and knee arthroplasty. There were 3 males and 2 females, aged from 27 to 59 years (mean, 41.8 years). Two patients had ankylosing spondylitis and 3 had rheumatoid arthritis, whose hip and knee joints were involved. Four patients lost the ability of walking preoperatively, 1 patient could only walk with crutch. The Harris score was 24 ± 24 and the Hospital for Special Surgery (HSS) score was 28 ± 15. All patients underwent multiple joint arthroplasty simultaneously (2 cases) or multiple-stage (3 cases). Results Wounds healed by first intention in all patients. In 1 patient who had dislocation of the hip after operation, manipulative reduction and immobilization with skin traction were given for 3 weeks, and no dislocation occurred; in 2 patients who had early sign of anemia, blood transfusion was given. All patients were followed up 46-140 months with an average of 75 months. The patients could walk normally, and had no difficulty in upstairs and downstairs. The stability of the hip and knee was good, and no joint infection or loosening occurred. The Harris score was 88 ± 6 at last follow-up, showing significant difference when compared with the preoperative score (t=8.16, P=0.00); the HSS score was 86 ± 6, showing significant difference when compared with the preoperative score (t=13.96, P=0.00). Conclusion Multiple joint arthroplasty is an effective treatment method in patients with lower limb joint disease, which can significantly improve life quality of patients.
Objective To investigate the effect of the morphological changes in the proximal femur on the prothesis selection in the total hip arthroplasty in the patients with ankylosing spondylitis. Methods The experimental group was composed of 13 patients (16 hips) with ankylosing spondylitis, which was treated with the total hip arthroplasty, and the control group was composed of 16 patients（19 hips）with non-ankylosing spondylitis，which was also treated with the total hip arthroplasty. In the two groups, the measurements of Singh index，canal flare index，morphological index of the cortex and cortical index were performed in the two groups. Results The results of the statistical analysis on Singh index，canal flare index, morphological index of the cortex and cortical index in the experimental group were 3.81±0.54, 2.63±0.41, 2.02±0.38 and 1.69±0.69, respectively, but 4.63±0.62, 3.03±0.27, 2.76±0.28 and 2.12±0.24, respectively in the control group. Therewas a significant difference in Singh index, canal flare index, and morphological index of the cortex between the two groups (Plt;0.05)，while there was no statistical difference in cortical index between the two groups (P＞0.05). The patientswith ankylosing spondylitis had more serious osteoporosis in their proximal femur. Conclusion Cemented femoral prosthesis should be used in the total hip replacement in patients with ankylosing spondylitis, and the revision total hip arthroplasty should be performed on patients with more serious osteoporosis.
Objective To assess the efficacy and safety of Etanercept for Ankylosing spondylitis. Methods We searched The Cochrane Library (Issue 4. 2008), MEDLINE (1966 to September 2008), EMBASE (1974 to September 2008), CBM (1978 to 2008), CNKI (1994 to 2008), VIP (1989 to 2008), and Wanfang (1999 to 2008). The quality of included studies was critically evaluated. Data analyses were performed with The Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials with total of 949 patients met the included criteria. The metaanalysis showed the effective rate of ASAS 20 or ASAS 50 receiving Etanercept was significantly higher than in patients receiving placebo, while no significant differences were noted between the Etanercept and placebo group in other indices. There was no statistical significance among different dosages. Patient Injection-site reaction rate for Etanercept was higher than that for placebo. No significant differences were observed in other adverse effects. Conclusions Etanercept is safe and effective for patients with Ankylosing spondylitis, however, some trials included in the review were of poor quality, so we needed the multi-center, large-scale randomized controlled trials of higher quality and the same course of treatment to confirm this.
Objective To evaluate the efficacy and toxicity of methotrexate (MTX) in the treatment of ankylosing spondylitis (AS). Methods Randomized controlled trials (RCTs) were identified from CENTRAL (The Cochrane Library Issue 4, 2005); MEDLINE (1966 to November 2005); EMBASE (1980 to November 2005); CINAHL (1982 to November 2005). The quality of included trials was evaluated. Data were extracted by two reviewers independently using a specially designed extraction form. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis. Results Three trials involving 116 patients were included. One 12-month trial compared naproxen plus MTX with naproxen alone. Two 24-week trials compared different doses of MTX with placebo. No statistically significant differences were found for the primary outcome measures of physical function, pain, spinal mobility, peripheral joints/entheses pain, swelling and tenderness, changes in spine radiographs and patient and physician global assessment. The response rate in one trial showed statistically significant benefits of 36% in the MTX group compared with the placebo group (RR 3.18, 95% CI 1.03 to 9.79). This response rate was a composite index including assessment of morning stiffness, physical well-being, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), health assessment questionnaire for spondyloarthropathies (HAQ-S), and physician and patient global assessment. However, no single outcome showed a statistically significant difference between the MTX and placebo groups when endpoint results were compared. Therefore, this benefit of MTX was questionable. No serious side effects were reported in these studies. Conclusions There is no enough evidence to show any benefit of MTX in the treatment of AS. High quality randomized controlled trials of longer duration and with larger sample size are needed to clarify the effect of MTX on AS.
ObjectiveTo understand the self management status of patients with ankylosing spondylitis (AS). MethodsSixty inpatients and outpatients with AS in the Department of Rheumatology between December 2011 and December 2012 were selected as the study subjects by judgment sampling method. A self-made questionnaire was used for investigation. ResultsThe self-management skills of 10.0% of the patients were poor, 78.3% were moderate and 11.7% were fine. The self-management skills of functional training and keeping healthy lifestyle were relatively poor. The factors with a score from the highest to the lowest were:the mental self-management, symptom management, keeping healthy lifestyle, and the self-management of functional training. ConclusionsThe self-management skills of patients with ankylosing spondylitis range from moderate to relatively poor. Our results suggest that cultural factors and the course of disease may be the main influence factors for self-management skills of patients. Clinical medical personnel should know the situation of patients sufficiently, improve the processes of health education and take corresponding intervention measures to the lack of self management ability. By the above ways, we can improve the compliance obedience and the self-management skills of patients, then the patients' condition and living quality will be greatly improved.
ObjectiveTo investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of hip arthrosis in patients with ankylosing spondylitis (AS). MethodsA retrospective analysis was made on the clinical data from 131 patients (195 hips) who underwent THA for AS between September 2001 and August 2011 with a follow-up period of more than 2 years. There were 100 males (152 hips) and 31 females (43 hips), aged 17-69 years (mean, 33.7 years). The average interval between AS onset and THA was 13.7 years (range, 1-50 years). The left hips were involved in 30 cases, the right hips in 37 cases, and bilateral hips in 64 cases. Preoperative Harris hip score was 18.0±13.7; the sum passive range of motion was (36.2±51.2)°; and the hip passive-flexion arc was (23.4±32.6)°. In 175 hips with passive flexion of less than 90°, 134 hips had flexion contracture. Based on preoperative X-ray films and CT scan, 195 hips were divided into the non-ankylosed subgroup (86 hips), fibrous ankylosed subgroup (43 hips), and bony ankylosed subgroup (66 hips); and the recovery of hip function was compared between subgroups after operation. ResultsIntraoperative complications included linear fractures of femoral calcar in 4 hips, fractures of acetabular posterior column in 1 hip, femoral shaft fractures in 2 hips, and iatrogenic sciatic nerve injury in 3 hips; postoperative complications included anterior dislocation in 2 hips. The average follow-up period was 51.3 months (range, 24-143 months). Bone healing was observed at 3-6 months after operation (mean, 3.9 months). At last follow-up, the average Harris hip score increased to 86.4±14.1, the sum passive range of motion increased to (202.0±28.0)°, and the hip passive-flexion arc increased to (93.2±15.3)°, all showing significant differences when compared with preoperative ones (P<0.05). Based on a four-class scale for subjective satisfaction, the patients were very satisfied, satisfied, and not satisfied with the results of THA in 100, 80, and 15 hips respectively. X-ray films showed radiolucent line (<2 mm) in 5 acetabular components (zones I and II); heterotopic ossification was observed in 49 hips after THA. There was no significant difference in the Harris hip score among 3 subgroups after THA at last follow-up (P>0.05). At last follow-up, the degree of passive flexion in the fibrous ankylosed subgroup and bony ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P<0.05), and the sum passive range of motion in the fibrous ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P<0.05), but no significant difference was found in the other variables among the 3 sub groups (P>0.05). ConclusionFor severe hip arthrosis in patients with AS, the overall outcomes after THA are ideal with a good midterm prosthetic survivorship, a low complication rate, and a high satisfaction of patients. However the hip function after THA is still less satisfactory.
ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.
ObjectiveTo evaluate the inflammatory markers in patients with ankylosing spondylitis (AS) or non-inflammatory diseases undergoing total hip arthroplasty (THA) and to ascertain the variation trend of perioperative inflammatory markers and the influence of inflammation markers after THA. MethodsBetween January 2013 and December 2014, 153 consecutive patients with AS were included. According to the range of motion (ROM), the patients were divided into ankylosis group (ROM: 0°; group A, n=92) and stiff group (ROM: 3-46°; group B, n=61); 120 noninflammatory diseases patients having no bacterial infection and undergoing primary THA served as non-inflammatory group (group C). The inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) concentrations were measured before operation and at 1, 3, 5, and 7 days after operation, and the complication was observed. ResultsPerioperative serum CRP, IL-6, and ESR increased at first after operation, and then decreased in 3 groups. There were significant differences in CRP and ESR between at pre- and post-operation (P<0.05); the IL-6 at 1, 3, and 5 days after operation were significantly higher than that at preoperation (P<0.05), but no significant difference was found between at 7 days and at preoperation (P>0.05). CRP, IL-6, and ESR of group B were significantly higher than those of group A at preoperation (P<0.05); CRP and IL-6 of groups A and B were significantly higher than those of group C at preoperation and at 1 day after operation (P<0.05); ESR of groups A and B was significantly higher than that of group C at preoperation, and at 1 day and 3 days after operation (P<0.05); and no significant difference was shown among 3 groups at the other time points (P>0.05). No inflammatory activity or increased complication was observed. ConclusionAS and non-inflammatory diseases show similar change trend of inflammatory markers at preand post-operation. The inflammatory activity of AS has no significant effect on the changes of inflammation markers and does not increase the incidence of postoperative complications.