谁需要对强直性脊柱炎的手术？

如果你有ankylosing spondylitis，一种主要影响脊柱的炎症类型的关节炎，好消息是你可能永远不需要手术治疗这种情况。但有些人这样做，所以要了解标志和预期的迹象非常重要。

Treatment for ankylosing spondylitis often includes a combination of nonsteroidal inflammatory drugs (nsaids.），生物药物和物理治疗。作为medicationsfor ankylosing spondylitis improve, surgeries are becoming less common, saysAli Ajam, MD， 一种风湿病学家at The Ohio State University Wexner Medical Center in Columbus.

Surgery is typically performed in the case of a fracture or severe joint damage that impacts your mobility or ability to perform everyday tasks.

您可能需要手术的迹象

There are some warning signs that you may need surgery to help treat your ankylosing spondylitis. If you have any of the following signs or symptoms, make sure to discuss them with your doctor.

• 严重的painthat can’t be controlled with your regular medications, including pain medications
• Spinal fracture
• 无法抬起头部，由于脊柱融合而期待
• Not being able to drive because you can’t position your body correctly
• 用脊髓和神经压力引起的手臂或腿部麻木和刺痛
• 有限的运动和痛苦,当你在你的臀部区域have to bear any weight on your hip

强直性脊柱炎手术类型

When people with ankylosing spondylitis do need surgery, it's most often a total髋关节置换术或者根据苏珊古德曼，MD， 一种风湿病学家at Hospital for Special Surgery in New York City.

“强调脊柱炎典型地影响脊柱，”耶和华博士说。“在严重的情况下，臀部和肩膀，较少，膝盖也可能受关节炎损坏。”如果这些关节严重受损，您可能需要联合替代手术。

髋关节替代是用于强直性脊柱炎的最常见的关节置换手术。据A.审查发表于2019年1月The Journal of Rheumatology，高达40％的带状肌脊柱炎的髋关节受累，12％至25％的条件最终需要总髋关节置换。在总髋关节置换术中，也称为关节成形术，髋关节的患病部分被移除，大腿骨和臀部插座的末端被人造零件取代，根据国家关节炎和肌肉骨骼和皮肤病研究所(NIAMS).

Although it’s common for ankylosing spondylitis to affect both hips, it’s not usually severe enough to require surgery, Goodman says. If ankylosing spondylitis started when you were young and severely affected your spine, it’s more likely that you will have hip damage, she says.

如果你是一个孩子，开始脊柱炎，你可能更有可能需要髋关节替代，而是根据研究的情况，他们是成年人的情况。在2015年5月发表于2015年期刊关节炎护理与研究。Those with childhood- and adult-onset ankylosing spondylitis appear to be about equally likely to need a procedure calledhip resurfacingor hip arthroplasty revision or re-revision, the study suggested.

People whose knees, shoulders, or joints of the hands or feet are affected by ankylosing spondylitis may require replacement surgery for these joints. As in髋关节替代手术，这些关节的手术涉及拆除损坏的部件并用人造零件取代它们，以帮助缓解疼痛和改善功能，根据NIAMS。

There are several types of spinal surgery that may be performed in people who have ankylosing spondylitis. If your spine has fused into a curved position, you may require an osteotomy of the spine. The procedure helps restore the alignment and balance of the spine. It’s a complex surgery that usually involves opening and straightening vertebrae in the spine and is used to help correct forward flexion, or kyphosis, of the spine. If not treated, this kind of spinal deformity can turn into severe ankylosing spondylitis, Goodman says.

After osteotomy, spinal fusion surgery may be performed to help stabilize the spine in areas where bone has been damaged or removed. The surgeon will insert instruments such as metal rods or screws to fuse bones together and help keep your spine straight.

A procedure called a椎体切除术可用于缓解脊髓和神经上的压力。又称减压手术，椎板切除术涉及去除椎板 - 覆盖脊柱管的椎骨的一部分 - 为脊髓产生更多空间。

There aren’t concrete, recent statistics that show how many people with ankylosing spondylitis end up having these procedures, but doctors say the need for surgery, especially an osteotomy, is infrequent.

手术的好处

如果你确实需要对脊柱静脉炎的手术，你的生活质量应该改善。

“你能做的更多，比如抬起头脑，期待和驾驶，”阿哈姆博士说。“还有痛苦的缓解。”Goodman说，截骨术可以恢复正常姿势可能有一个限制。

如果你有a total hip replacement, surgery can help reduce pain and make it easier to move around again.

虽然没有任何东西被证明是为了防止对强直性脊柱炎的手术需要手术，但有些步骤可以帮助管理条件并降低关节损坏的风险。AJAM提供了这个建议：“无论具有强直性脊柱炎，如关注良好的营养和常规运动，所以还有每个人都应该做的建议。”他建议改善肌肉和韧带的健康状况yoga, stretching, and strengthening exercises。您还应按照医生的规定遵循您的治疗计划。