多排螺旋CT及后处理技术在复杂型髋臼骨折中的应用

目的:探讨多排螺旋CT(MDCT)及其后处理技术在复杂型髋臼骨折中的临床应用价值。方法:回顾性分析X线、MDCT证实的复杂型髋臼骨折患者36例影像资料。结果:MDCT及后处理技术能发现X光片不能发现的隐匿性骨折和脱位,它能整体、直观的显示骨折的部位、受累的范围、骨折线的走行方向、碎骨片及股骨头移位情况,虽然在敏感性上和X光片无显著差异(P0.05),但是在分型上明显优于X线片,能准确的进行骨折分型,差异具有统计学意义(P0.05)。结论:MDCT及后处理技术对术前充分了解损伤情况、骨折的分型,对临床手术计划的制定具有重要的意义,成为复杂髋臼骨折术前诊断的首选检查方法。     

骨盆内入路治疗髋臼后柱骨折的研究进展

髋臼后柱的手术入路,一直是创伤骨科研究热点之一。目前常规使用的“后侧入路”和“前后联合入路”,各有优势,又均存在许多不足。随着临床与基础研究的不断深入,越来越多的术者选择骨盆内入路,取得了良好的效果。按照Letournel-Judet分型系统,髋臼骨折分为前柱骨折、后柱骨折、后壁骨折、前壁骨折、横行骨折、前柱加后半横行骨折、横行加后壁骨折、后柱加后壁骨折、T形骨折、双柱骨折。     

Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折

目的探讨应用Kocher-Langenbeck入路加大转子截骨手术治疗髋关节后脱位并髋臼后柱(壁)骨折的手术方法和疗效。方法收集14例采用Kocher-Langenbeck入路结合大转子截骨手术治疗的髋关节后脱位并髋臼后柱(壁)骨折病例,分析其手术方法、术中情况及术后恢复情况。结果平均手术时间为105 min,术中平均出血量为600 mL。术后解剖复位5例,良好复位8例,复位不满意1例。临床效果优7例,良4例,可3例。3例出现异位骨化,4例发生创伤性关节炎。髋臼后柱(壁)、大转子截骨断端均骨性愈合,无医源性坐骨神经损伤及股骨头缺血坏死。结论应用Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折,术中显露情况良好,有利于骨折、脱位的复位及固定。     

The Results of Acetabular Impaction Grafting in 129 Primary Cemented Total Hip Arthroplasties

Between 1995 and 2003, 129 cemented primary THAs were performed using full acetabular impaction grafting to reconstruct acetabular deficiencies. These were classified as cavitary in 74 and segmental in 55 hips. Eighty-one patients were reviewed at mean 9.1 (6.2–14.3) years post-operatively. There were seven acetabular component revisions due to aseptic loosening, and a further 11 cases that had migrated > 5 mm or tilted > 5° on radiological review — ten of which reported no symptoms. Kaplan–Meier analysis of revisions for aseptic loosening demonstrates 100% survival at nine years for cavitary defects compared to 82.6% for segmental defects. Our results suggest that the medium-term survival of this technique is excellent when used for purely cavitary defects but less predictable when used with large rim meshes in segmental defects.     

多排CT及重建技术检查髋臼骨折的临床应用价值

目的评价多排CT(multidetector CT,MDCT)及其多平面重建(multiplanar reformation,MPR)、容积再现(volumerendering,VR)重建技术检查髋臼骨折的临床应用价值。方法 32例接受手术治疗的髋臼骨折患者外伤后0～3 d进行MDCT薄层扫描,回顾性重建扫描数据后形成图像重建数据,用MPR、VR软件对图像重建数据进行后处理技术重建,分别得到MPR和VR图像。从髋臼骨折类型、骨碎片移位程度和髋关节腔内骨碎片3方面将MDCT原始图像、MPR和VR重建图像显示髋臼骨折的结果与手术结果进行对照分析。结果 MDCT原始图像、MPR和VR重建图像判断髋臼骨折类型的诊断符合率分别为78.13%、87.50%和100.00%,VR重建图像最高;检测骨碎片移位程度的诊断符合率分别为81.19%、100.00%和96.04%,MPR重建图像最佳;显示髋关节腔内骨碎片的诊断符合率分别为84.00%、100.00%和72.00%,MPR重建图像最好。结论 MDCT原始图像、MPR和VR重建图像检查髋臼骨折各有优缺点,三者结合能够互为补充,可靠判断髋臼骨折类型、准确检测骨碎片移位程度、全面显示髋关节腔内骨碎片,为髋臼骨折的诊断和治疗提供很有意义的影像学信息。     

Quantitative Analysis of the Growth of the hip jo Int: A Radiological Study

Growth of the hip joint is described on the basis of annual radiographs taken of the intact hip joints of 50 boys aged between 5–15 years. the ossification centre of the femoral head grows at a faster rate in breadth than in height. the growth rate in breadth of the bony centrum exceeds also that of the proximal metaphysis and, accordingly, in the case of normal ossification, the radio-anatomical condition of these two parts is characteristic of the age of the individual. the osseous acetabulum also grows at a faster rate in breadth than in depth. in the period studied up until the 15th year the width of the “articular space” gradually decreases. the ossification rate in the age group examined manifests—with slower and faster periods—a gradually declining tendency. the changes revealed by the radiographs have been interpreted from the viewpoint of bone development and an analysis is also given of the spatial conditions of ossification.     

(iii) Principles of acetabular fractures

Acetabular fractures are rare, significant injuries involving the articular surface of the acetabulum. They are typically associated with a high-energy mechanism of injury, though fragility type fractures are now increasingly seen. Associated injuries to another organ system are seen in half of all cases. Radiographic assessment is performed using antero-posterior pelvic radiographs and Judet views, as well as computerized tomography (CT). Classification is based on the column theory and describes fracture anatomy in relation to the anterior and posterior columns. Non-operative treatment is indicated when there is less than 2 mm of articular displacement or when patient factors (such as associated injuries/co-morbidities) or soft tissue injury are incompatible with surgery. Open reduction and internal fixation is indicated in displaced fractures, total hip arthroplasty being used in unreconstructable injuries. Operative treatment involves difficult exposures and technically demanding reduction and fixation techniques. Significant associated injuries include neurovascular injury, bleeding, open fracture wounds, soft tissue injury, hip dislocation and femoral fractures. Late complications include post-traumatic osteoarthritis, avascular necrosis and heterotopic ossification. The goals of treatment should be to give the patient a congruent, functional hip whilst minimizing the complications from both the injury and surgery. Poor results are more likely if the reduction is non-anatomical.     

髋关节表面置换与全髋关节置换疗效的Meta分析

背景：髋关节表面置换近年来得到了越来越广泛的应用,其与传统的全髋关节置换相比哪种方式的效果更好仍有较大争议。 目的：通过综合分析已发表的文献,探讨比较髋关节表面置换与传统的全髋关节置换的优缺点。 方法：检索1900年1月至2012年7月关于髋关节表面置换和全髋关节置换的随机对照研究,严格评价纳入研究质量并提取资料。采用RevMan5.1.6进行统计学Meta分析。 结果与结论：共纳入10个随机对照试验,Meta分析结果显示髋关节表面置换与全髋关节置换在平均手术时间、术中平均失血量、置换后1年Harris评分、置换后1年美国加州大学髋关节功能评分、置换后2年血清钴、铬离子水平方面均差异无显著性意义;髋关节表面置换组置换后平均髋臼倾斜角大于全髋关节置换组。结果说明髋关节表面置换和全髋关节置换的短期随访结果并无明显的差异,但二者远期效果如何需更多高质量、大样本临床随机对照试验进行评价。     

不同物种髋臼的骨小梁方向

背景：有研究认为骨的形态结构与其所处的应力环境密切相关。由于人类直立行走的运动方式,可能会影响髋臼骨小梁的方向。 目的：观察不同物种髋臼骨小梁方向的差异。 方法：X射线观察由解放军第二军医大学解剖教研室和山东大学生命科学院提供的成人双侧髋骨干燥标本和成年恒河猴髋骨标本,将采集到的图像输入Imagine pro plus 6.0,经快速傅里叶变换后,得出0°-180°的频谱值,计量不同的角度骨小梁的数量。 结果与结论：人类髋骨在0°及90°频谱值最大,与骶耻束与髂坐束的方向符合。而恒河猴髋骨的频谱值分布较为弥散,没有明显的峰值。说明人类髋臼区域骨小梁主要沿90°及180°方向分布,与特化的骶耻束与髂坐束的方向符合,说明髂坐束的出现是与直立行走密切相关的。