Objective: To evaluate the efficacy of modified femoral neck osteotomy (mFNO) in the surgical treatment of patients with ankylosing spondylitis (AS) and severe spinal kyphosis combined with hip flexion contracture.
Methods: A retrospective analysis was conducted on 61 AS patients (103 hips) with spinal kyphosis and hip flexion contracture who underwent pedicle subtraction osteotomy (PSO) and total hip arthroplasty (THA) from January 1, 2019 to November 15, 2023. Data on mFNO operation time, blood loss, preoperative and postoperative values of the angle of the trunk and lower limb (ATL), hip passive range of motion (ROM), visual analogue scale (VAS), and incidence of in-hospital complications were recorded. Statistical analysis was performed using paired-samples t test. P < 0.05 was considered statistically significant.
Results: The study ultimately included 10 cases, 9 males and 1 female, with an average age of (41.30±9.03) years. These patients underwent surgery for a total of 52 times, including 19 hips both receiving mFNO and THA, and 14 times PSO. The average operation time for nine bilateral mFNO was (133.11±34.81) min, with blood loss of (433.33±187.10) mL. A unilateral mFNO took 60 min with 200 mL of blood loss. The preoperative ATL of 19 hips was 40.37°±13.66°, and the postoperative ATL value was 88.47°±12.46° (P < 0.05). The preoperative VAS score was 0, while the postoperative VAS score was 5.95±1.51 (P < 0.05). The preoperative hip extension ROM was 37.37°±18.13°, while the postoperative hip extension ROM was -4.95°±21.24° (P < 0.05). Hip flexion ROM improved from 37.37°±18.13° to 50.79°±20.36° after FNO (P < 0.05). There were three cases of in-hospital complications (3/52, 5.67%): One case of postoperative atelectasis following PSO (1/52, 1.92%), one greater trochanter fracture identified during THA (1/52, 1.92%), and one early dislocation post-THA (1/52, 1.92%).
Conclusion: mFNO significantly improves the ATL in AS patients with severe spinal kyphosis combined with hip flexion contracture, facilitating PSO and THA surgeries.
目的: 评估改良股骨颈截骨术(modified femoral neck osteotomy, mFNO)在合并严重脊柱后凸和髋关节屈曲强直的强直性脊柱炎(ankylosing spondylitis, AS)患者手术治疗过程中的疗效。
方法: 回顾性分析2019年1月1日至2023年11月15日期间进行经椎弓根椎体截骨矫形术(pedicle subtraction osteotomy, PSO)和人工全髋关节置换术(total hip arthroplasty, THA)手术治疗的合并脊柱后凸和髋关节屈曲强直的AS患者资料，总共61例患者，103髋。记录患者mFNO的手术时间、手术失血量、术前和术后下肢体干角(angle of the trunk and lower limb, ATL)度数、髋关节被动活动度(range of motion，ROM)、视觉模拟评分(visual analogue scale，VAS)和院内并发症的发生率，并采用配对样本t检验进行统计学分析，P < 0.05为差异有统计学意义。
结果: 最终纳入病例10例，其中男性9例，女性1例，平均年龄(41.30±9.03)岁。10例患者总接受手术次数为52次，其中接受mFNO和THA各19髋，接受PSO 14次。9例双侧mFNO手术的平均手术时间为(133.11±34.81) min，失血量为(433.33±187.10) mL；1例单侧mFNO手术时间为60 min，出血量200 mL。19髋的mFNO术前ATL度数为40.37°±13.66°，术后ATL度数为88.47°±12.46°，差异有统计学意义(P < 0.05)。mFNO术前VAS评分为0，术后VAS评分为5.95±1.51，差异有统计学意义(P < 0.05)。髋关节被动伸直ROM在mFNO术前为37.37°±18.13°，术后为-4.95°± 21.24°，差异有统计学意义(P < 0.05)；髋关节被动屈曲ROM在mFNO术前为37.37°±18.13°，术后为50.79°±20.36°，差异有统计学意义(P < 0.05)。院内并发症共有3次(3/52，5.67%)，其中1次为PSO术后肺不张(1/52，1.92%)，1次为THA术中发现大粗隆骨折(1/52，1.92%), 1次为THA术后早期脱位(1/52，1.92%)。
结论: mFNO能够明显改善合并严重脊柱后凸和髋关节屈曲强直的AS患者的ATL角度，为PSO和THA提供可行性。
Keywords: Ankylosing spondylitis; Hip flexion contracture; Modified femoral neck osteotomy; Spinal kyphosis.