髋关节前脱位合并同侧股骨转子间骨折一例

1病例报告 患者男性,21岁.骑车跌伤致右髋疼痛、畸形、活动障碍2 h入院.伤时右髋部疼痛、活动受限并腹股沟部裂伤.查体:右下肢外展外旋,屈膝畸形,右腹股沟部顺腹股沟韧带裂伤15 cm×7 cm大小,深至肌层,精索外露挫伤肿胀.腹股沟部皮下可触及股骨头,伤肢无感觉障碍,足背动脉博动存在.摄X线片示:右髋关节前脱位,右股骨转子间骨折.急诊全麻下先清创缝合腹股沟伤口,经Watson-Jones 切口显露股骨转子,见骨折位于转子间,伴远、近折端冠状位裂折,股骨头突破关节囊及髂股韧带脱出于髋臼前上方.试行夹持近骨折端复位股骨头困难,且导致近骨折端裂块分离,遂上延切口能触及股骨颈上下缘后,直视下拧入DHS主钉将骨折复位固定成一个整体,手法整复脱位成功.术后摄X线片示复位固定满意(图1).     

阿尔茨海默病合并心肺功能不全高龄患者髋关节置换术的麻醉与围术期管理

(1)一般情况:患者男性, 年龄93岁, 身高170 cm, 体质量70 kg。因"摔倒致右髋关节疼痛、活动受限12 h"入院, 伤时右髋部着地, 伤后髋部疼痛、活动受限, 无昏迷及呼吸困难, 无明显胸腹部不适。当地医院骨盆X光检查示:右侧股骨颈骨折, 为求进一步诊治转来我院。     

人工全髋关节置换术后24年伴严重骨溶解1例

1 病例资料患者,女,62岁,因“右髋关节疼痛伴活动受限6年余”于2010年11月27日入院,患者于1987年因“右侧股骨颈骨折”,于当地医院行“右侧人工全髋关节置换术”.查体:右髋部见一20 cm的手术瘢痕,右下肢短缩外旋畸形,患肢较对侧缩短约10 cm.右髋部压痛感明显,右侧髋关节活动受限,右下肢肌肉萎缩,肌力减退(Ⅲ级).其余肢体关节无畸形,活动可.生理反射存在,病理反射未引出.辅助检查:X线片及CT提示右侧人工全髋关节置换术后,假体松动,周围骨质破坏(图1、2).于2010年12月6日行“右侧人工全髋关节置换术后假体翻修术”.     

儿童股骨颈骨折合并对侧髋关节脱位一例

患儿女性,8岁,从高处坠落,左髋部先着地,左侧大转子部压痛及叩击痛均阳性;X线片示左侧股骨颈基底部骨折并有嵌插,颈干角变小为111°(对侧135°),右侧股骨头脱出髋臼窝,向外上后方移位。诊断为:左股骨颈基底部嵌插型骨折,右髋关节后脱位。立即行右髋关节闭合手法复位成功后,双下肢皮牵引,保持左下肢外展位,右下肢中立位。3d后拍X线片见股骨颈骨折对位好,颈干角恢复到131°;12周     

全髋关节置换术后假体周围骨折1例

患者,男,82 岁,2019 年7 月10 日因右股骨颈骨折行右侧全髋关节置换术.出院后在家活动时不慎摔倒再次入院,行X线检查显示:右侧全髋关节置换术后假体周围骨折( Vancouver B2型).腰硬联合麻醉下行右侧假体周围骨折切开复位钢板及钛缆环扎固定术+右侧全髋关节翻修术.     

鳞癌误诊为人工股骨头置换术后感染一例

1病例介绍患者男,80岁。因右侧人工股骨头置换术后3年右髋关节肿胀、疼痛、活动受限1年,加重6个月入院。患者3年前因摔伤致右股骨颈骨折于我院行人工股骨头置换术治疗,术后功能恢复良好。1年前因出现右髋关节肿胀、疼痛、活动受限,再次入院就诊。查体:体温正常,右髋关节后外侧略红肿,皮     

股骨颈骨折内固定术后感染行Ⅱ期全髋关节置换术1例

1临床资料患者,男,52岁,1年前因车祸伤致右髋部疼痛、不能站立行走,当地医院X线片检查示右侧股骨颈骨折并骨折移位,查体发现右下肢短缩畸形,右下肢轴向叩击痛明显,右髋关节活动受限,右髋部压痛阳性,完善术前检查后于当地医院行骨折切开复位内固定术,术后长期卧床,持续发热,术后3个月未下床活动,经抗感染治疗后退热,手术切口愈合后出院。     

股骨转子间骨折术后股骨头缺血性坏死1例报告

正股骨转子间骨折非常常见,其不同于股骨颈骨折,作为关节囊外骨折,极少出现术后股骨头缺血性坏死。本科收治1例老年股骨转子间骨折术后股骨头缺血性坏死病例,现报道如下,以增加对股骨转子间骨折术后股骨头缺血性坏死的认识。1临床资料患者,女,78岁,行走时摔伤致右髋关节疼痛、肿胀、活动受限4 h来院。既往高血压病史,否认冠心病、糖尿病、类风湿相关病史。入院查体:右髋关节肿胀、压痛明显,存在外旋、外展、短缩畸形,     

巨人症伴股骨颈骨折一例

笔者于2010年12月收治1例巨人症伴股骨颈骨折,报告如下。1病例报告患者,男,47岁,因"摔倒后右髋部疼痛伴活动受限1 d"入院。患者于2010年12月4日下午行走时不慎摔倒,当时即感右髋部疼痛,无法站立,稍活动右下肢即感疼痛加剧,根据急诊X线、CT结果以"右侧股骨颈骨折"收入院。查体:生命体征平稳,身高217 cm,体重126 kg,典型肢端肥大面容,眉弓及颧骨     

胫骨上端骨骺分离一例

患者男性,18岁.因打篮球时不慎摔倒,主诉争抢篮球跳起后落下时踩在他人脚上摔倒,当即感右膝疼痛难忍,局部明显肿胀、畸形,行走困难.急诊检查后以"右胫骨卜段骨折"入院.入院后X线检查侧位片示:右胫骨上端骨骺分离,移位明显,右胫骨后内侧干骺端骨折(图1a).急诊手法复位失败,遂予右下肢石膏托临时外固定,防感染、消肿等对症治疗4 d后右膝肿胀明显消退,遂在持续硬膜外麻醉下行右胫骨上段骨折切开复位内固定术[1].     

股骨头毁损三联征:股骨头骨折-脱位合并股骨颈骨折

股骨头合并同侧股骨颈骨折是一种严重而复杂的创伤,保髋手术大多会失败。其治疗的难点及预后的关键在股骨颈骨折上。鉴于股骨颈骨折的发生与股骨头骨折-脱位之间存在明显的、前后关联的贯序特点,笔者认为以股骨头毁损三联征（disastrous triad of femoral head,DTFH）来概括这种类型的损伤,更能反映其损伤机制和预后特点。结合临床观察和文献资料,DTFH可分为3个类型：Ⅰ型,普通型DTFH,股骨颈骨折的发生紧随于股骨头骨折-脱位之后,是同一暴力造成的损伤;Ⅱ型,医源型DTFH,是在股骨头骨折-脱位的诊疗过程中发生了医源性股骨颈骨折;Ⅲ型,应力型DTFH,发生于股骨头骨折-脱位的治疗之后,在股骨头骨折面的远侧缘发生应力性股骨颈骨折。本文对各型DTFH的临床特点进行了初步的讨论。     

Distal femoral allograft for massive proximal femoral deficiency

Background?Although indomethacin is effective in preventing heterotopic ossification (HO) after primary total hip arthroplasty, side effects are frequently observed. In the last decade a new class of drugs—the COX-2 selective nonsteroidal anti-inflammatory drugs—has been developed. To investigate the effect of these COX-2 selective NSAIDs on heterotopic ossification (HO) after primary total hip arthroplasty (THA), we conducted a randomized controlled trial using either indomethacin or rofecoxib for 7 days.

Methods?186 patients received either indomethacin 3 times daily, or rofecoxib twice, and 1 placebo, daily for 7 days. HO was graded according to the 1-year postoperative radiographs according to the Brooker classification.

Results?12 of the 186 patients included discontinued their medication before the end of the trial due to side effects. The remaining 174 patients were included in the analysis. In the indomethacin group (n = 89), 77 patients (87%) showed no HO, 9 showed HO of grade 1 and 3 showed HO of grade 2 according to the Brooker classification. In the rofecoxib group (n = 85) 73 patients (86%) showed no ossification, 9 showed grade 1, and 3 showed grade 2.

Interpretation?The prophylactic effect of rofecoxib for 7 days in preventing heteropic ossification after primary total hip arthroplasty is comparable to the effect of indomethacin given for 7 days. These results indicate that the development of HO follows a COX-2 pathway.     

Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum

Whereas excess femoral anteversion and its related symptoms have been described many times, excess femoral retroversion is less well documented. We report the case of a 30-year-old woman who had a history of chronic bilateral hip and knee pain and evidence of excess femoral retroversion, genu valgum, early-onset lateral and patellofemoral compartment osteoarthritis of both knees, and hip arthritis. She experienced symptomatic relief after undergoing staged bilateral simultaneous proximal femoral rotational and distal femoral lateral opening wedge osteotomies. Although this combination of alignment problems is not an infrequent clinical occurrence, we have found no literature on this condition or treatment. The patient provided written informed consent for print and electronic publication of this case report.     

Extensively porous-coated femoral revision for severe femoral bone loss

Of 275 femoral revisions done at our institution from 1982 to 1986, we identified 34 patients (35 hips) who represented the senior author's (C.A.E., Sr.) most difficult revision cases as a result of extensive femoral bone loss at least 10 cm below the lesser trochanter. The patients were revised with fully porous-coated femoral components ≥190 mm. We evaluated 25 of the patients (26 hips) who had a minimum 10-year follow-up (mean, 13.3 years). Survivorship was 89% at 10 years with femoral revision as the endpoint (Kaplan-Meier). The femoral aseptic loosening rate was 15% (4 of 26). Three stems were loose but did not warrant reoperation. One stem was revised for aseptic loosening, 1 was revised for septic loosening, and 1 was revised for a fractured femoral component. Bypassing weak or absent femoral bone with an extensively porous-coated stem is an effective reconstructive technique for patients with extensive femoral bone loss.