全髋关节置换治疗继发于化脓性感染的髋关节炎

Background Suppurative arthritis of the hip occurred most often in children, and often had sequelae after infection resolusion because of delay in treatment. Due to the anatomic abnomalities of the bone and soft tissue, the relatively young age and potential risk of postoperative deep infection, the implementation of total hip arthroplasty (THA) in patients who had osteoarthritis secondary to hip pyogenic infection have more challenge. Methods We retrospectively analyzed 19 total hip arthroplasties that had been performed from April 2003 to July 2008 in adult patients who had osteoarthritis secondary to hip pyogenic infection, the average age of the patients at the time of the operation was 40.7 years (34 to 52 years). There were 7 males and 12 females, the average age of infection was 10.6 years (7 to 13 years), and the average quiescent period of infection was 29.5 years ranging from 22 to 41 years. The count of WBC, ESR and CRP were examined routinely with normal values before surgery. The duration of follow-up was 34 months ( 6 to 52 months). Results There were no evidence of infection by the means of laboratory values, intraoperative exploration, and bacterial culture of joint fluids and synovial tissue. Split fracture above the lesser trochanter occurred in two hips, and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flextion with complete resolution of motor symtoms one month later. There were no cases of dislocation, deep vein thrombosis or postoperative reinfection. The clinical symptoms and degree of hip joint activities had been significantly improved. The Harris hip scores and the range of motion improved from 47.3（27～63）and 53°±46°(0～140°) preoperatively to 89.7（75～96）and 125°±56°(70°～230°) at the latest follow-up. Conclusions It’s safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic sepsis of the hip in childhood when the infection was in a quiescent period. The key point to the success of surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years, and adequate intraoperative soft-tissue releases.     

Results of hip resurfacing for developmental dysplasia of the hip of Crowe type Ⅰ and Ⅱ

Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip （DDH） has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases （Crowe type Ⅰ and Ⅱ）. Methods Between September 2005 and May 2007, twenty-one consecutive patients （twenty-six hips） with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years （range, 37-59 years）. Six patients （28.6%） were male and fifteen （71.4%） were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly. Results All patients were followed for a mean of 18 months （9-29 months）. During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepan     

Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection

Background Pyogenic hip arthritis occurs most often in young patients. Delayed treatment causes significant anatomical deformation of bony and soft tissue structures leading to premature onset of secondary osteoarthritis. Total hip arthroplasty （THA） in patients who had osteoarthritis secondary to hip pyogenic infection has been associated with high complication rates. Methods We analyzed 19 THAs performed from April 2003 to July 2008 in adults with osteoarthritis secondary to hip pyogenic infection （average age 40.7 years; range 34-52 years）. There were 7 males and 12 females, the average age of infection was 10.6 years （range 7-13 years） and the average quiescent period of infection was 29.5 years （range 22-41 years）. The count of white blood cell （WBC）, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were examined routinely before surgery. The duration of followup was 34 months （range 6-52 months）. Results There was no evidence of infection according to laboratory values, intraoperative exploration and bacterial culture of joint fluids and synovial tissues. Split fracture above the lesser trochanter occurred in two hips and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flexion with complete resolution of motor symptoms one month later. There were no cases of dislocation, deep vein thrombosis, or postoperative reinfection. The symptoms and hip joint activities were significantly improved. The median Harris hip score improved from 47.3 preoperatively to 89.7 and the median range of motion from 53% to 125%. Conclusions It is safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic hip arthritis when the infection is quiescent. The key points of successful surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years and adequate intraoperative soft tissue releases.     

Ability of lower teardrop edge to restore anatomical hip center height in total hip arthroplasty

Background The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty （THA）.Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation.Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.Methods A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers,cup inclination,and anteversion were measured radiographically.The paired t-test was used to compare left and right hip center heights.Scatter plots and Pearson＇s correlation coefficients were used to evaluate differences in hip center heights,cup anteversion,inclination angles,and medialized cup center distance compared to the contralateral hip joint.Results Cup center height was significantly greater （P ＜0.01） than contralateral hip joint center height （93.4％ in the 0-5 mm range,6.6％ ＞5 mm）.There was a weak correlation between hip center height difference and inclination （r=0.376,P ＜0.01） and between difference and anteversion （r=0.310,P ＜0.01） but no correlation between difference and outer cup diameter （r=0.184,P=0.058） or difference and medialized cup center distance （r＝-0.098,P=0.318）.Conclusions Although this method did not exactly replicate anatomic hip center height,the clinical significance of cup center height and anatomic hip center height differences is negligible.This acetabular component placement method has high simplicity,reliability,and stability.     

磁悬浮关节:一种新的人工关节设计

Background Artificial joints present certain problems such as osteal absorption and lysis induced by wear debris which leads to loosening of the prosthesis over a period of time. Here we propose a design of an artificial magnetic suspension joint that was prepared by integrating the medical theories of modern material science, magnetism, and medical physics.Methods According to clinical characteristic of biological and mechanical for hip joint, we designed the appearance and dimensions of magnetic suspension joint and placed neodymium-iron-boron permanent magnets in the prosthesis.As the same time, we performed mechanical and biological experiments using artificial magnetic suspension hip joints models.Results By simulated the human hip structure and the external load, we discovered the artificial magnetic suspension hip joints models had much lesser amount and size of wear debris than the ceramic/ceramic artificial hip joint prosthesis in friction wear tests. The force between the artificial joints with magnetic materials that we have calculated is feasible for application of artificial joint. The design of artificial magnetic suspension hip joints models was plausible technically and safe biologically.Conclusion Artificial magnetic suspension hip joints may effectively reduce the incidence of the loosening of prosthesis over a period of time.     

In vivo testing of canine prosthetic femoral components with HA-Ti ladder-type coating on vacuum plasma-sprayed Ti substrate

The purpose of the present study was to observe the structure and functional change of the bone-coating-prosthesis interface in vivo and to evaluate the histocompatibility of self-made prosthetic femoral components in the body and the degree of their bonding with the surrounding bone tissues as well as their stability.Six mature beagle dogs underwent bilateral hip replacement with prosthetic femur components.Three groups were established in terms of different coating of prothesis (four joints in each group):atmosphere (A) plasma-sprayed pure titanium (Ti) prosthetic joint with hydroxyapatite (HA) coating (HA+Ti+A group);vacuum (V) plasma-sprayed pure Ti prosthetic joint with HA coating (HA+Ti+V group);vacuum plasma-sprayed pure Ti prosthetic joint with Ti-HA stepped coating (Ti+HAG+Ti+V group).The hip joints were functionally evaluated,and subjected to X-ray examination,biomechanics inspection,and histological examination.As a result,X-ray imaging revealed all prosthetic joints were in a good location and no dislocation of joint was found.Shear strength of interface was significantly higher in Ti+HAG+Ti+V group than in HA+Ti+V group (P<0.05) and HA+Ti+A group (P<0.05) at 28th week.Histological examination showed the amount of newborn bone in Ti+HAG+Ti+V group was more than in HA+Ti+V group and HA+Ti+A group after 28 weeks.It was suggested that vacuum plasma-sprayed pure Ti prosthetic joint with TI-HA stepped coating could improve the bonding capacity of bone-prosthesis,enhance the stability of prosthesis,and increase the fixion of prosthetic femoral components because of better bone growth.This new type of biological material in prosthetic femoral components holds promises for application in clinical practice.     

ACETABULAR ROTATION OSTEOTOMY IN THE TREATMENT OF ACETABULAR DYSPLASIA IN ADULTS

Acetabular dysplasia is one of the most important reasons for development ofsecondary osteoarthrosis of the hip joint. This paper introduced a method of modifiedWagner's procedure, called acetabular rotation osteotomy for the treatment of severeacetabular dysplasia in ten adults patients. These were followed up for 1-4 years. Fivecriteria including pain, gait, range of motion, measurement of roentgenographic changees,and CT scan were evaluated. From the limited information of this paper, it showed thatin all cases pain improved and range of motion did not reduced significantly. Comparingthe pre- and post-operative x-ray films, CE angle increased and exceeded the normal val-ue. Tonnis hip value decreased and approached the normal value, anteversion of theacetabulum improved, and the percentage of acetabular coverage increased as well.     

Artfaroplasty with transplantation of autogenous rib perichondrium for reconstruction of metacarpophalangeal joint

Objective To evluate the outcome of arthropiasty with transplantation of autogenous rib perichondrium for reconstruction of the metacarpophalangeal joint. Methods From 1982 to 2000,15 patients undergoing arthropiasty with autogenous rib perichondrium were analyzed retrospectively. The pain, range of motion and stability of the joint was assessed. Results Thirteen patients were followed up with 2 in loss. The average follow-up was 4 years. The pain at the metacarpophalangeal joint disappeared after operation. The active range of motion in metacarpophalangeal joint was 40° -82°(average 58. 5°), with an average increase of 46°(35°-58°) when compared with those before operation. The patients all went to the original job. Conclusion The arthropiasty with autogenous rib perichondrium transplantation is an efficient and practical method for reconstruction of the metaracrpophalangeal joint. 5 refs.     

Arthroscopic Debridement and Synovium Resection for Inflammatory Hip Arthritis

Objective To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis.Methods A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis.There were 17 cases of ankylosing spondylitis,11 cases of rheumatoid arthritis,and 8 cases of psoriatic arthritis.The joints were irrigated and the inflamed tissues were debrided with anthroscopy.The patients were followed up with Harris hip score,Oxford hip score,Visual Analog Scale(VAS),and magnetic resonance imaging(MRI).Statistical analysis was performed using Student t test.Results All of the 36 cases were followed up for 46-103 months,averaging 67.2±8.4 months.Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation,respectively(P<0.05).VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5(P<0.05).All the patients showed improved joint range of motion.MRI revealed alleviation of hip synovitis.The results were classified as excellent in 8 patients,good in 17 patients,fair in 8 patient,and poor in 3 according to Harris hip score.Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities.Conclusions Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis.The inflammatory lesion might be thereby controlled and the symptoms be relieved.     

Pelvis,acetabula

<正>209208 Analysis of the failure mechanisms of the revision hip arthroplasties/Zhang Liang(Dept Adult Joint Reconstruct Surg,Jishuitan Hosp,Beijing 100035)…∥Chin J Surg.-2009,47(3).-164~167Objective To investigate the failure mechanisms of revision hip arthroplasties and evaluate the effects of surgical technique,prosthesis design and patient-related risk factors on different failure mechanisms.Methods A review of all revision hip arthroplasities from November 1995 to June 2008 identified 30 patients who underwent 30 revisions with 18 males and 12 females.The overall mean age for primary arthroplasties was 49 years(range 25-68 years)and 53 years(rang 27-72 years)for index revision arthroplasties and the average interval between these two operations was 43.8 months(0-156 months).The failure mechanuisms of index revision arthroplasties and primary arthroplasties were assessed and compared.Direct comparisons were made of data for the different age categories in terms of time to failures and reasons for failures.Results Regarding rerevision or prosthesis removal as the end point of the study,the reasons for 30 revision arthroplasties were aseptic loosening in 22 hips(73.3%),infection in 4 hips(13.3%),periprosthetic fracture in 3 hips and instability in 1 hip(3.3%).The overall mean age for last arthroplasties or prosthesis removal was 58 years(range 38-77 years)with an average interval of 78.8 months(range 1-216 months)from previous revision arthroplasties.The mean time to failure for patients above 60 years of age was significantly shorter than patients below 60 years of age(P<0.01).     

全髋置换术中C臂X光机确定髋臼位相法的临床应用

目的在全髋关节置换术(THR)中,人工髋关节的稳定性取决于髋臼假体的精确安置。适当的髋臼角度,能够避免发生髋关节脱位以及撞击征和关节过度磨损,进而维持人工关节的活动度和稳定性。方法应用术中C臂X光机移位测量髋臼的前倾角、外展角来确定术中髋臼假体的置入角度,并与手术前后测定的髋臼位相参数和传统髋臼假体定位器置入假体的患者全髋术后的髋臼位相参数对比,探讨这种测定方法的应用价值。结果髋臼杯的精确安置可以使髋关节的生物力学得以优化,减少髋关节的脱位率和避免撞击。结论术中准确的纠正骨盆的前后倾斜、内外旋转和外展内收,以及髋臼杯的精确安放,可以提高假体置换术手术质量,减少术后脱位、假体撞击、关节活动受限以及聚乙烯磨损等并发症,促使人工关节的保存率得以延长。     

骨性关节炎全髋关节置换术术后脱位发生情况及其影响因素研究

目的研究骨性关节炎全髋关节置换术（total hip arthroplasty,THA）术后脱位发生情况及其危险因素分析。方法选取266例骨性关节炎病人,均采用THA治疗,术后随访6个月,记录髋关节脱位发生情况,将术后髋关节脱位病人设为脱位组,未脱位病人设为未脱位组。记录2组病人手术相关指标及病历资料,经单因素分析、logistic回归分析探讨骨性关节炎THA术后脱位的独立危险因素。结果266例骨性关节炎病人THA术后脱位25例,脱位率9.40%;2组病人年龄、人工股骨头直径、髋关节手术史、手术失血量、术后股骨假体前倾角、术后股骨偏心距差异有统计学意义（P < 0.05~P < 0.01）,而性别、BMI、手术入路、合并糖尿病、手术时间、术后输血率、术后引流量、手术侧别差异无统计学意义（P>0.05）。多因素logistic回归分析显示,年龄>75岁、女性、人工股骨头直径 < 30 mm、髋关节手术史、后外侧入路、术后股骨假体前倾角>10°是骨性关节炎THA术后脱位的独立危险因素（P < 0.05）。结论骨性关节炎THA术后容易发生髋关节脱位,年龄>75岁、女性、人工股骨头直径 < 30 mm、髋关节手术史、后外侧入路均可增加其脱位风险。     

单张X线片法在发育性髋关节脱位转子下旋转截骨矫形术中的应用

目的：探讨单张 X 线片法在发育性髋关节脱位转子下旋转截骨矫形术中的应用价值。方法回顾性分析在新疆医科大学第一附属医院2012年1月-2013年6月行手术治疗的56例小儿发育性髋关节脱位患者的临床资料,其中前倾角＞40°行转子下旋转截骨术者33例（46髋）,术中用单张 X 线片法 C 型臂透视机下测量前倾角决定是否要行股骨转子下旋转截骨术,矫正后同样方法测量前倾角确定矫正度数是否满意。结果单张 X线片法测量前倾角＞40°的33例发育性髋关节脱位患者行转子下旋转截骨术后,前倾角矫正至12°～30°,平均21°,术中前倾角矫正效果满意。结论在转子下旋转截骨矫形术中用单张 X 线片法测量发育性髋关节脱位患儿的前倾角简便、可靠。     

大直径股骨头髋关节假体的相关研究进展

大直径股骨头髋关节假体因为其较低的脱位率和较大的活动范围,近年来受到广泛的关注,越来越多的医师在为患者行全髋初次置换或翻修手术时首先考虑使用大直径股骨头髋关节假体。随着新材料和新技术的运用,大量的基础研究和临床疗效证实,目前大直径股骨头髋关节假体正在逐渐克服以往的高磨损和高松动率的问题,而成为关节外科发展的一大趋势。     

自制防髋关节脱位支架在手术后病人的使用

目的:对于髋关节置换手术后的病人关节稳定性差,用自制防脱位支架限制可能造成脱位的各种危险动作,从而避免脱位及其他并发症的发生。方法:通过对20例人工关节置换病人术后使用防脱位支架,观察术后下肢稳定性、肌力恢复、下地活动等情况,了解防脱位支架的功能情况。结果:使用防脱位支架,可以限制髋关节过度内收、屈曲、旋转等易造成脱位的动作,可早期肌肉锻炼,支架并不影响髋关节的屈伸、翻身及行走。结论:使用防脱位支架简便易行,使用后可以增加髋关节的稳定性,可早期下地行走,从而减少术后脱位及其他并发症。     

全髋关节置换术在股骨头缺血坏死中的治疗作用

目的:观察全髋关节置换术在股骨头缺血坏死中的疗效.方法:对2005年9月～2010年12月我院收治的56例股骨头缺血坏死患者,行全髋关节置换术,术后随访观察疗效及并发症,采用Harris髋关节功能评分并进行X线评价.结果:患者术后Harris评分明显提高,患肢长度及形状恢复较好,未发生肢体短缩、畸形;未发生感染、肺栓塞...     

全髋关节置换用于人工股骨头置换术后翻修的临床研究

目的探讨人工股骨头置换术后髋关节疼痛的原因及其行人工全髋关节置换翻修术的必要性。方法对26例人工股骨头置换术后髋关节疼痛患者行人工全髋关节置换术翻修并进行随访。结果26例患者随访时间1～7年，功能恢复、疼痛缓解率达92．3％。结论假体松动、髋臼磨损、人工股骨头脱位、关节周围骨化等并发症，是造成人工股骨头置换术后髋关节疼痛的主要原因，全髋关节置换术翻修能明显改善这些疼痛。     

全髋关节置换术后脱位的原因和处理

目的对人工全髋关节置换的病例进行分析总结,探讨术后脱位的发生原因、预防和处理.方法回顾调查1995年1月～2001年6月我院进行人工全髋关节置换术152例(157髋).男73例,女89例;平均年龄56岁.对术后脱位患者术前、术后和随访期间的症状、体征等进行总结评价,对术前准备、术中术后处理及预防进行探讨.结果152例(157髋)患者中5例现已死亡,失访5例,其余142例(143髋)患者随访1.5～8.0年,平均4.1年.4例髋关节脱位,脱位率为2.74%.结论通过使用合适的股骨头假体,保持适当的前倾角度,正确的搬运方法可有效的减少脱位的发生.     

全髋关节置换术后髋关节脱位的危险因素分析

目的:探讨人工全髋关节置换术后脱位的原因及最佳对策.方法:我科在2000年12月至2004年12月期间连续全髋关节置换术50例(51髋)患者,对术后脱位4例进行回顾性分析,并用Logistic回归分析方法进行了危险因素的评价.结果:平均随访24个月(8～56个月),分析其中期疗效,髋臼外翻角和前倾角的异常是造成人工全髋关节置换(THR)术后脱位的高危因素,术前病因、术中脱位倾向是危险因素.结论:最佳对策是正确安放髋臼假体的位置和角度,正确采用现代骨水泥技术,以及在医师指导下康复训练.     

全髋关节置换术后早期脱位及处理的新方法（附全髋关节置换300例早期脱位3例报告）

目的：探讨全髋关节置换术后早期脱位的原因及处理的新方法，方法：回顾性总结近年本院全髋关节置换术病人早期脱位的原因及处理的新方法。结果：300例全髋关节置换病例中有3例发生术后早期脱位，无因假体位置不良行翻修术者，脱位病例经树脂绷带短腿髋关节外展支具固定3周未再发生脱位。结论：术后早期脱位是全髋关节置换术早期的第二大并发症。若假体位置安放正确，采用树脂绷带短腿髋关节外展支具固定髋关节是一种好方法，假体位置不正确，反复脱位是早期翻修的主要原因。