Chiari截骨加髋臼造盖术治疗高龄儿童先天性髋关节脱位

目的：探讨Ｃｈｉａｒｉ截骨加髋臼造盖术治疗先天性髋关节脱位的疗效。方法：分析４２例高龄儿童先天性髋关节脱位,采用单纯Ｃｈｉａｒｉ截骨治疗１５ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术治疗２７ 例的临床资料。结果：随访４０ 例中,单纯Ｃｈｉａｒｉ截骨１３ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术２７ 例,术后髋臼指数１４°～３２°,平均２６°。前倾角２５°～４０°,平均２８°。颈干角１３４°～１４６°,平均１３６°。单纯Ｃｈｉａｒｉ截骨优良率为６９．２％ ,３ 例发生股骨头缺血性坏死,１ 例发生头臼骨质硬化。Ｃｈｉａｒｉ截骨加髋臼造盖术的优良率为８８．８％ ,无股骨头缺血性坏死的发生。Ｃｈｉａｒｉ截骨加髋臼造盖术由于髋臼指数能得到有效的纠正,股骨头复盖接近正常,能很好的恢复正常的髋关节的生物力学关系,因此是治疗高龄儿童先天性髋关节脱位的有效方法之一。     

Chiari骨盆截骨治疗髋臼发育不良继发骨性关节炎并髋臼囊性病变

成人髋臼发育不良往往并发髋关节骨性关节炎，重者出现髋臼上方骨囊性病变，如截骨面上有较大囊变区，会影响Ｃｈｉａｒｉ骨盆截骨的效果，需采用一些特殊手段加以解决。本文总结１９９４～１９９５年资料完整的行Ｃｈｉａｒｉ骨盆截骨治疗的８例髋臼上方不同大小骨囊变区...     

改良Chiari骨盆截骨术治疗先天性髋脱位

改良Ｃｈｉａｒｉ骨盆截骨术治疗先天性髋脱位李雪陈立东宋盛晗丛智春⒇我院自１９９３年１月至１９９５年３月采用改良Ｃｈｉａｒｉ骨盆截骨术治疗先天性髋脱位５例５髋，随访至今，效果满意。１临床资料５例中男３髋，女２髋，年龄最小４岁，最大１３岁。髋臼角均大于４...     

髋臼发育不良继发股骨头缺血性坏死的外科治疗(91例129个髋随访报告)

髋臼发育不良继发股骨头缺血性坏死的外科治疗（９１例１２９个髋随访报告）王宝明陈峰赵振蒙王金池曹君喜杨玉文刘蕾李文英扈文海＊自１９８５年以来，我院应用Ｃｈｉａｒｉ骨盆截骨和旋股外动脉全支移植术，治疗髋臼发育不良继发股骨头缺血性坏死１００例。其中９１例１...     

Chiari骨盆截骨术的生物力学基础及临床应用（附36例报告）

本文报告应用Ｃｈｉａｒｉ骨盆截骨术治疗髋臼发育不良、扁平髋等３６例４１个髋。３２个髋平均随防４年４个月。优良者２７个髋，占８４．３７％。术后Ｘ线片显示，截骨均获骨性愈合，髋臼对头覆盖完全，头臼相称。髋臼发育不良者，ＣＥ角平均增加２０°。作者分析此术式后认为：Ｃｈｉａｒｉ手术能增加髋臼面积，减少股骨头单位压强，截骨内移后能增加肌力臂，减少重力臂，从而减少髋关节的载荷，降低关节内压及髂骨髋内压，有利于缓解“休息痛”。为此提出成人先天性髋臼发育不良、扁平髋、股骨头无菌坏死以及髋的骨关节炎病人适合行此手术。     

采用骨盆截骨术治疗先天性髋关节脱位36例报告

采用骨盆截骨术治疗先天性髋关节脱位３６例报告吴庆录梁志国黄唯勤王新华胡晓光自１９９１年１月～１９９３年１０月采用Ｓａｌｔｅｒ与Ｃｈｉａｒｉ术式共治疗先天性髋关节脱位３６例（４２个关节），疗效满意，报告如下。１临床资料本组男７例，女２９例。最小年龄４...     

枕颈部畸形合并颈脊髓空洞症的外科治疗

报告８例枕颈部畸形合并颈脊髓空洞症（Ｃｈｉａｒｉ畸形Ａ型）并经手术治疗。根据临床表现和影像学（ＭＲＩ）征象，应用枕骨大孔扩大，寰椎后弓切除减压，枕颈自体髂骨植骨融合及脊髓空洞蛛网膜下腔分流术。术后症状和体征明显改善７例，无变化１例。本文对有临床症状的Ｃｈｉａｒｉ畸形的发病和治疗进行了讨论．     

可展式金属支架器治疗Budd－Chiari综合征2例的护理

可展式金属支架器治疗Ｂｕｄｄ－Ｃｈｉａｒｉ综合征２例的护理浙江省金华市中心医院郑玉群Ｂｕｄｄ－Ｃｈｉａｒｉ综合征是一种少见病［１］，该症是因各种原因造成肝静脉开口水平以上的下腔静脉（ＩＶＣ）和（或）肝静脉狭窄或闭塞导致下腔静脉和（或）肝静脉回流障碍，...     

肝包虫囊肿术后并发Budd—Chiari综合征的治疗

肝包虫囊肿术后并发Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的治疗叶德存王喜艳哈尼帕我院自１９９０年以来收治肝包虫囊肿术后发生的布－加氏综合征（Ｂｕｄｄ－Ｃｈｉａｒｉｓｙｕｎｄｒｏｍｅ，ＢＣＳ）５例，均经手术治疗，效果良好，报告如下。１临床资料１．１一般资料本组５...     

胫骨高位截骨术治疗膝关节骨性关节炎（附26例报告）

胫骨高位截骨术治疗膝关节骨性关节炎（附２６例报告）孙仲，程斌，赵京龙，张俊杰本文着重介绍了采用胫骨高位截骨，自制骑缝钉内固定术治疗膝关节骨性关节炎的手术适应证、方法及疗效。１临床资料本组患者共２６例３１膝，其中男９例，女１７例，双膝内翻５例，单侧内翻...     

A modification on osteotomy of the pelvis (Chiari) for treatment in case of severe dysplastic acetabulum]

The paper presents a report on a modified osteotomy of the pelvis for surgical treatment in case of severe dysplastic acetabulum. This procedure combines the technique of acetabuloplasty and that one of Chiari's osteotomy of the pelvis.     

Guidelines for Chiari's osteotomy in the immature skeleton developed from a canine model

Three variations of Chiari's pelvic osteotomy were performed on 18 dysplastic hip joints in young, growing German shepherd dogs and rottweilers. The results of the operations and the reactions of the skeletal tissue were investigated radiologically and histologically after six and 12 months. By use of polyfluorochrome sequential labeling and microangiography, it was demonstrated that neither the formation of new bone nor the blood supply in the vicinity of the rim of the acetabulum (apophysis of the acetabular roof) was seriously impaired by the operation. Conversely, the operative technique was of decisive importance to the result of the operation. Only if the osteotomy was performed through the original acetabular rim, completely covering the femoral head, was the newly formed acetabular roof adequately biomechanically loaded, providing the conditions required for functionally adapted differentiation of skeletal tissue. Chiari's pelvic osteotomy can be performed on canine hips with good chances of success, provided one uses the proper operative technique. Apophyseal bone growth and the blood supply of the newly formed acetabular roof were apparently not disturbed by Chiari's operation.     

Fixation with poly-L-lactic acid screws in hip osteotomy: 68 hips followed for 18-46 months

This study evaluated 68 consecutive hip osteotomies in 61 patients using absorbable poly-L-lactic acid screws for fixation. 47 hips underwent a rotational acetabular osteotomy, 17 hips Chiari's pelvic osteotomy, and 4 hips transtrochanteric rotational osteotomy. Cortical screws were used to transfix the osteotomized acetabulum, and cancellous screws to reattach the intraoperatively osteotomized greater trochanter. The average age at surgery was 35 (12-49) years. The mean duration of follow-up was 32 (18-46) months. All the osteotomized acetabulums united well, but 4 of 54 trochanteric osteotomies failed to unite.     

Pelvic osteotomies in children and adolescents

The main types of pelvic osteotomies in children and adolescents are reviewed. Osteotomies in the first group aim at reorienting the acetabulum: Salter's innominate osteotomy is widely used; its technique, possible drawbacks and indications are analyzed; double and triple osteotomies are then reviewed (Sutherland, Le Coeur, Steel, T?nnis and Trousseau) with their prerequisites, drawbacks and specific indications. A second group of osteotomies do not involve complete transsection of the hemipelvis; they are acetabuloplasties following the techniques described by Dega and by Pemberton, the indications of which are also presented together with their prerequisites. Last comes Chiari's osteotomy: it appears as a palliative operation, with limited indications in children and adolescents. Finally, the indications for pelvic osteotomies are reviewed, according to patient's age, anatomical status of the hip and underlying pathology. Unstable and dysplastic DDH hips may be treated by Salter's osteotomy, Pemberton's acetabuloplasty of triple pelvic osteotomy if the hip is mobile, well centered and congruous. The more simple Salter and Pemberton operations are to be preferred to triple osteotomy as long as they are indicated, i.e. until the age of 5 to 8 years. Established congenital dislocations may be treated using Chiari's osteotomy in cases where a reorientation osteotomy or acetabuloplasty is no longer indicated, provided the hip remains mobile. The indications for pelvic osteotomy in Perthes disease are analyzed, and the arguments for a pelvic rather than femoral osteotomy in some cases are presented. Pelvic osteotomies with the numerous techniques developed over the years, have been a major advance in the treatment of hip anomalies in children. In older adolescents, their indication must be balanced against those of hip reconstruction; they must anyway never make subsequent arthroplasty in adult age difficult or impossible.     

Fixation with poly-L-lactic acid screws in hip osteotomy: 68 hips followed for 18-46 months

This study evaluated 68 consecutive hip osteotomies in 61 patients using absorbable poly-L-lactic acid screws for fixation. 47 hips underwent a rotational acetabular osteotomy, 17 hips Chiari's pelvic osteotomy, and 4 hips transtrochanteric rotational osteotomy. Cortical screws were used to transfix the osteotomized acetabulum, and cancellous screws to reattach the intraoperatively osteotomized greater trochanter. The average age at surgery was 35 (12-49) years. The mean duration of follow-up was 32 (18-46) months. All the osteotomized acetabulums united well, but 4 of 54 trochanteric osteotomies failed to unite.     

Chiari's pelvic osteotomy in the management of Perthes disease

Authors deal, on the basis of an analysis of 3 own cases and of the literary data, with the indication of Chiari's osteotomy in Perthes' disease. It is stated that the operation is to be performed over the age of 8-9 years, in severe lesion of the femoral head, and if the femoral head is so much flattened, widened and extruded from acetabulum that it can not be centralized with varisation. The operation promotes the rebuilding of the femoral head epiphysis, the biomechanical relations are improved and the early arthrosis can be prevented.     

Long-term results of combined operative reduction of the hip in older children

Long-term results of open reduction, combined with femoral shortening, iliac osteotomy, reorientation of the upper femur, and medial iliopsoas transfer, are analyzed in 144 hips, according to patients' answers to follow-up questionnaires. Age at surgery ranged from 7 to 15 years with a follow-up of 9-24 years (mean 13 years). Two-thirds of patients had good results, one-fourth had fair results, and one-tenth had poor results. This was in accordance with radiologic rating in 225 hips, with a mean follow-up of 5 years. Quality of results decreased with age at surgery. The combined procedure is not advised after the appearance of pubertal signs. Since radiologic results favored Chiari's iliac osteotomy and subjective results favored the Pemberton type, individual choice is advised, according to the severity of acetabular dysplasia and the age of the patient. Redislocations, when left alone, had better results than did hips that were operated on again.     

Familial hip dysplasia with short acetabular roofs

A longtime observation of a mother and her three children with too short but not flattened acetabular roofs as contrasted with shallow acetabuli is presented, probably on a hereditary basis. The development of these short roofs from acetabular dysplasia may be recognized towards the end of the first decade of life at the latest. The short roof as such seems to be little amenable to conservative treatment. Adduction osteotomies, if necessary, later are preferable to the acetabuloplasties aiming more at improvement of a shallow than a short acetabulum, with the exception of Chiari's osteotomy.     

Chiari's osteotomy in the treatment of Perthes' disease

Seventeen patients, with an average age of nine years 11 months, underwent 18 Chiari osteotomies for the treatment of painful subluxation of the hips following Perthes' disease. The average follow-up period was four years three months. The 13 patients reviewed clinically all did well and none complained of pain or instability. The radiographs were examined in all 17 cases. The average centre-edge angle and percentage femoral head cover were definitely improved by the operation. No significant medical displacement of the femoral head was achieved. The clinical success may result from improved femoral head coverage and diminished eccentricity. Chiari's osteotomy is recommended for adolescent patients with painful subluxation of the hip as a consequence of Perthes' disease.     

Cystic Mass on Right Atrium of Unusual Form of Chiari's Network: A Case Report

Chiari's networks are present in 1.5% to 4% of the population. They are a congenital disease characterized by a remnant of the right valve of sinus venosus and rarely have clinical significance. Chiari's network, as the name implies, has network-like shape, but there are other forms of appearance. We have experienced a case of a 60-year-old woman who had a cystic mass on the right atrium. Surgical treatment was performed forthe mass removal and differential diagnosis of the mass. There was no evidence of other tumor, but Chiari's network. As cystic form of Chiari's network have not been reported before, it is the first report of cystic form of Chiari's network.