全髋关节置换术治疗强直性脊柱炎并髋关节强直的临床疗效分析

目的探讨人工全髋关节置换术治疗强直性脊柱炎并髋关节强直的技术要点及临床疗效。方法2011-03~2014-03对确诊为强直性脊柱炎并髋关节强直的患者17例(32髋)行人工全髋关节置换术,平均随访25.4(13~35)个月,对比手术前、后及末次随访时关节疼痛、关节屈曲畸形矫正度、关节总活动度及Harris评分改善情况。结果术前14例患者(27髋)髋关节呈屈曲挛缩畸形平均(35.42±3.15)°,术后平均(4.63±2.12)°,术后较术前明显改善(P0.01);术前关节总活动度(屈曲+后伸+内收+外展+内旋+外旋)平均(5.81±3.32)°,术后平均(152.47±3.76)°,术后较术前明显改善(P0.01);术前Harris评分平均(27.73±6.41)分,术后平均(82.31±6.58)分,术后较术前明显改善(P0.01);术前患者重度疼痛3例,中度疼痛6例,轻度疼痛8例,术后轻度疼痛7例,无中重度疼痛;无坐骨神经损伤、骨折、感染并发症出现,术后1例患者出现髋关节前脱位,给予手法复位、皮肤牵引后未再脱位。结论全髋关节置换术治疗强直性脊柱炎并髋关节强直能迅速解除患者疼痛,改善关节功能,恢复生活自理能力,是一种安全、有效的治疗方法。     

老年患者行金属对聚乙烯全髋关节置换术后4年内随访结果

目的探究金属对聚乙烯全髋置换术(MP-THA)对老年患者治疗的临床体会及中远期疗效。方法 2007年3月至2009年3月该院对100例(112髋)老年患者运用金属对聚乙烯全髋关节假体完成髋关节置换手术。其中股骨头缺血性坏死40例,强直性脊柱炎15例,骨关节炎20例,髋关节发育不良10例,类风湿性关节炎15例。结果患者都进行为期4年的随访调查,患者Harris评分从术前(38.80±7.44)分至术后4年的(94.85±2.57)分。4例术后偶感疼痛,3例术后出现轻微疼痛,无严重疼痛者。髋关节活动度达到了屈髋(120.65±8.86)°,外展(29.35±3.12)°,内收(24.35±4.12)°,外旋(34.75±4.43)°,内旋(36.75±4.11)°。X线显示所有患者髋关节假体位置均符合要求,109例髋股骨假体位于中立位,其中3例髋假体处于轻度外翻位,其余假体为初始固定优良。术后四年髋关节平均总活动度与术前比较有统计学差异(P<0.05)。髋臼假体外展角与理想值比较差异有统计学意义(P<0.05),前倾角与理想值比较差异无统计学意义(P>0.05)。结论 MP-THA适应证范围广泛,术后效果良好,关节活动范围增加,关节稳定性较好,使患者术后的生活质量得到了明显改善。     

全髋关节置换术治疗强直性脊柱炎并髋关节强直（附22例报告）

目的观察人工全髋关节置换术治疗强直性脊柱炎合并髋关节强直的临床疗效。方法对强直性脊柱炎引起的22例髋关节强直（26个髋关节）患者行人工全髋关节置换术治疗,回顾性分析其临床疗效。结果22例术后平均随访26个月,髋关节活动度明显改善,步态基本正常,元严重并发症发生。结论人工髋关节置换术可明显增加髋关节活动度,改善髋关节功能,提高生活质量,是治疗强直性脊柱炎并髋关节强直的有效方法。     

MOM髋关节表面置换术治疗AS累及髋关节效果观察（附21例报告）

目的观察金属对金属髋关节假体（MOM）髋关节表面置换术治疗强直性脊柱炎（AS）累及髋关节的疗效。方法对21例AS累及髋关节患者行MOM髋关节表面置换术,比较手术前后关节活动度、Harris评分、美国加州大学肩关节评分（UCLA）,观察并发症发生情况。结果术后髋关节活动度提高为148°～201°,平均169°,Harris评分、UCLA评分较术前显著提高,未见明显术后并发症。结论 MOM髋关节表面置换术治疗AS累及髋关节效果好,术后关节功能改善明显。     

强直性脊柱炎伴双侧全髋关节置换术后患者髋膝功能锻炼的康复护理

目的 探讨强直性脊柱炎伴双侧髋关节炎患者进行双侧全髋关节置换术后髋膝关节僵硬患者的护理及功能锻炼.方法 对8例患者进行术后包括体位护理、疼痛护理、心理护理、功能锻炼、CPM锻炼的观察.结果 8例患者术后在麻醉镇痛下经进行关节被动活动器(CPM)锻炼,有效改善了关节活动度,经4～15个月的随访,髋膝关节功能良好,能基本满足患者的日常生活要求.结论 对强直性脊柱炎进行双侧全髋关节置换术后患者加强髋膝关节功能锻炼,是提高生活质量,降低致残率的重要手段.     

不同直径股骨头在全髋关节置换术中的疗效对比

目的观察不同直径股骨头在全髋关节置换术中的应用对比。方法选择2007年10月至2009年6月收入的62例行金属人工全髋关节置换术的患者,根据使用的金属头直径不同分为大头金属-金属髋关节组(观察组)及普通假体组(对照组),患者术后进行长程随访,随访时间为2年。对比内容包括患者基本情况,术前、术后Harris评分,术前、术后髋关节活动度对比以及并发症发生情况。结果两组患者术前、术后Harris评分对比中,患者术后1个月、3个月、1年及2年的Harris评分均显著高于术前(P<0.05),而观察组术后1个月、3个月、1年及2年的Harris评分均显著高于对照组(P<0.05)。两组患者术前、术后髋关节活动度对比中,术后1个月、术后2年的屈曲、外展、内收、外旋、内旋程度均高于术前(P<0.05),术后1个月观察组内收、外旋程度高于对照组(P<0.05),术后2年观察组屈曲、内收、外旋程度高于对照组(P<0.05)。两组患者术后并发症对比中,观察组术后大腿疼痛3例,深静脉血栓3例;对照组术后大腿疼痛2例,脱位2例,假体松动2例,深静脉血栓4例;观察组总并发症发生率20%,对照组为31.25%,两组患者并发症对比差异有统计学意义(P<0.05)。结论采用金属大头髋行全髋关节置换术能够提高患者术后Harris评分、髋关节活动度,并且具有脱位、假体松动发生率低等优点,适合于年龄较轻及对关节活动度要求较高的中老年患者。     

全髋关节置换术中非水泥锥形股骨柄假体临床应用研究

目的 探讨非骨水泥锥形股骨柄在全髋关节置换术中的临床效果和意义.方法 回顾性分析48例(56髋)于我科行人工全髋关节置换术患者的临床资料,所有患者采用侧后方入路,手术股骨侧均采用同一种非水泥锥形股骨柄假体,术后平均随访15个月.结果 术前Harris评分平均56分,术后最后一次随访时Harris评分92分,有2例发生大腿痛,所有病例未发现不稳定征象,无翻修病例.结论 非水泥锥形股骨柄假体有着可靠的远期固定疗效和优异的临床效果.     

中青年髋关节疾病行金属对金属全髋关节表面置换术的疗效及安全性

目的 探讨中青年髋关节疾病患者行金属对金属人工全髋表面置换术的可行性.方法 选择各类髋关节疾病患者28例（35髋）,年龄28 ～ 54岁,平均42岁;其中股骨头缺血性坏死16例、骨性关节炎5例、先天性髋关节发育不良4例和创伤性关节炎3例.患者均行混合型金属人工全髋表面置换术,术后检查髋关节功能、计数Harris评分、评估疼痛程度、观察髋关节影像学形态.结果 28例平均随访34个月,髋关节功能优32髋,良2髋,可1髋,优良率96.9％.未发现股骨颈骨折、股骨头坏死及假体固定失败等并发症.结论 金属对金属全髋关节表面置换术治疗中青年髋关节疾病近期疗效满意,可作为传统全髋置换术的过渡性手术.     

全髋关节置换术和双极半髋关节置换术治疗老年股骨颈骨折的疗效比较

目的比较全髋关节置换术和双极半髋关节置换术治疗老年股骨颈骨折的临床疗效。方法股骨颈骨折老年患者193例,根据手术方式不同分为观察组和对照组,观察组98例采用全髋关节置换术,对照组95例采用双极半髋关节置换术。比较两组术中情况、围术期并发症发生率及住院时间;随访期间两组髋关节功能评分(Harris评分)及生活质量EURo-QoL(EQ-5D)评分及变化趋势。结果手术时间、住院时间、术中出血量两组比较均有显著差异(均P<0. 01),但两组术后血液需求量及血栓、房颤、感染、疼痛等术后并发症的比较两组未见显著差异(P>0. 05)。两组随访期间Harris评分比较均具有显著差异(P<0. 01)。两组术前和术后6个月EQ-5D评分比较无显著差异(P>0. 05),术后12、24、48个月比较有显著差异(P<0. 01)。结论对于预期寿命短、活动量少的老年患者使用双极半髋关节置换术效果明显,对于预期寿命长、活动量大的老年患者使用全髋关节置换术优势显著。     

强直性脊柱炎严重髋关节畸形的手术治疗

强直性脊柱炎 (ａｎｋｙｌｏｓｉｎｇｓｐｏｎｄｙｌｉｔｉｓ ,ＡＳ)是一种血清学阴性的慢性进行性炎症性疾病 ,主要侵犯骶髂关节、脊柱和髋关节等关节 ,至今病因不明。对ＡＳ引起的髋关节严重畸形施行全髋关节置换术 ,是目前公认的改善关节功能的有效方法[1] 。 1995年 10月至 2 0 0 0年 4月我院对 12例 (2 4髋 )ＡＳ并发髋关节骨性强直Ⅰ期施行双侧全髋置换术 ,疗效满意 ,现报道如下。1　资料与方法1 1　临床资料 :12例患者均为肯定的ＡＳ (根据 1984年修订的诊断标准[2 ] )。男性 8例 ,女性 4例。ＡＳ患者的发病年龄为 13～ 36岁 ,平均 2…     

Prevention of hip fracture with hip protectors

The prevention of fractures amongst older people consists of (i) prevention and treatment of osteoporosis, (ii) prevention of falling and (iii) prevention of fractures using injury-site protection. As the great majority of hip fractures are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one approach to prevention is the use of an adequately configured padded, firm-shield external hip protector. With this type of two-part design, the impacting force and energy are, at the time of the fall-impact, first weakened by the padding part of the protector and then diverted away from the greater trochanter by the shield part of the same. Following this line, a series of consecutive studies by the Accident & Trauma Research Center at the UKK Institute, Tampere, Finland, found that a padded, strong-shield hip protector was effective in preventing hip fractures. In the context of the wider literature on hip protectors, these more encouraging results suggest the need for a more rigorous regulation of protector design and characteristics. Alongside inadequacies of design, the other most frequent general problem with hip protectors is compliance. Not all elderly people with a high risk of hip fracture will agree to use hip protectors and in those who do, long-term adherence may decrease. Caregiver motivation and involvement appear therefore to be crucial.     

Prevention of hip fractures using hip protectors

Based on the results of 13 randomized controlled trials, programs for the use of hip protectors in institutionalized elderly people with particularly high risks of hip fractures seem to decrease the incidence of hip fractures. On the other hand, there is little indication for the use of hip protectors by elderly people dwelling independently in their own homes. Compliance greatly influences the effect of hip protectors, and continues to be serious problem.     

Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy

Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.     

Sonography for hip joint effusion in adults with hip pain

OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences. RESULTS: "Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION: This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.     

Bilateral hip osteonecrosis: influence of hip size on outcome

OBJECTIVE: To measure the volume of osteonecrosis in 30 patients with disease in both hips (one side with collapse and the other without at Ficat stage I). METHOD: The volume of the osteonecrosis was measured by magnetic resonance imaging. RESULTS: The progression to collapse was influenced by the size of the lesion in each patient. The first collapsed hip was that with the largest volume of osteonecrosis. CONCLUSION: The volume of the osteonecrotic lesion on the second hip (stage I without collapse) is a good predictor of the time to collapse of this second hip.