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目的探讨强直性脊柱炎晚期严重髋关节畸形的术式选择.方法观察股骨头颈切除术、髋关节双金属杯成形术和全髋关节置换术的中、远期疗效.共计40例患者,58个够关节,术前屈髋畸形平均51.3°,已呈纤维性或骨性强直者占86.2％.结果随访时间平均5.9年.全髋关节置换术组疼痛指数平均改善1.1级,屈髓畸形平均改善40.6°,术髋活动范围平均改善58.4°,术后24髋(68.6％)可单腿负重.股骨头颈切除术组虽疼痛指数较术前加重,但屈髋畸形平均改善58.9°,术髋活动范围平均改善74.3°.双金属杯成形术组虽各项观察指标均劣于全髋关节置换术组,但仍可获得平均25.6°的矫形效果和平均47.2°的关节功能改善.结论对于屈髓畸形＜50°,年龄大于30岁的绝大多数AS患者,全髋关节置换术应作为首选术式.股骨头颈切除术和双金属杯成形术仍有其特定适应证,前者适用于屈髋畸形＞60°,对关节活动范围有特殊职业需求者;后者可用于屈髋畸形＜30°,年龄小于20岁的年轻患者,以推迟初次接受全髋关节置换术的年龄.“,”Objective To investigate the choice of operative procedures for severe deformity of hipcaused by late ankylosing spondylitis. Methods Forty patients (58 hips) were studied. The degree offlexion deformity of hip before operation averaged 51.3° and 86. 2% of hips had fibrous or osseous ankylosis.The mid and long term follow-up results of resection of femoral head and neck, arthroplasty of hip with doublemetal cups and total hip replacement were observed. Results The average duration of follow-up were 5.9years. In total hip replacement group, the painful indices were improved by 1.1 grade, the flexion deformityof hip decreased by 40. 6°, the range of motion of the operated hips increased by 58. 4°, and 24 hips(68. 6% )could bear weight on the leg. In resection of femoral head and neck group, the painful indices were exacerbated than preoperation, but the flexion deformity of hips decreased by 58.9° and the range of motion of theoperated hips increased by 74. 3°. In double metal cups group, all of the observed indices were worse thanthose of total hip replacement group, but in average, functional improvement of 47. 2° was obtained. Conclusion The total hip replacement should be chosen first for the most patients with ankylosing spondylitis inwhom the degree of flexion deformity of the hips is smaller than 50° and the ages are greater than 30. Theresection of femoral head and neck and arthroplasty of hip with double metal cups still have their specific indication. The former is appropriate for the patients with flexion deformity greater than 60° and the patients withspecific profession that need proper extent of exercise of the hip. The latter is appropriate for the patients withflexion deformity smaller than 30° and patients younger than 20 years old in order to postponed the age of theinitial total hip replacement.