EPSTR技术在髋臼后壁骨折固定中的应用

目的报告EPSTR技术在髋臼后壁骨折固定中的临床应用结果。方法自2006年1月至2011年1月,对46例髋臼后壁骨折患者行内固定后应用EPSTR技术修复髋关节后侧软组织,其中男36例,女10例;年龄25~55岁,平均42.5岁,伤后手术时间2~7 d,平均5 d。髋关节后侧软组织采用"T"形切开,行髋臼内固定后,关节囊和外旋短肌作为一层再次附着到大粗隆。结果术后随访2.5~6.0年,平均4.5年。随访期间没有发生髋关节脱位和股骨头缺血性坏死,有2例发生骨关节炎,没有出现与本项技术相关的并发症。按Harris评定标准进行疗效评定,优良率为93.5%,取得了满意的效果。结论髋臼后壁骨折固定后采用EPSTR技术,有利于术后功能恢复和加强髋关节稳定性。     

An In Vivo Comparison of the Orientation of the Transverse Acetabular Ligament and the Acetabulum

Aligning the acetabular component with the Transverse Acetabular Ligament (TAL) to ensure optimal anteversion has been reported to reduce dislocation rates. However, to our knowledge in vivo measurement of the TAL angle has not yet been reported in a large cohort of normal hips. CT scans of 218 normal hips were analyzed. The TAL and four acetabular rim anteversion angles were measured (superiorly to inferiorly) relative to the anterior pelvic plane. The mean TAL anteversion angle was 20.5° ± 7.0°, and the acetabular rim angles from superior to inferior were 11.0° ± 12.9°, 19.9° ± 8.8°, 20.9° ± 6.2° and 25.1° ± 6.2° respectively. Both the TAL and the acetabular rim were significantly more anteverted in females than in males. The TAL anteversion angle was comparable to the predominant orientation (central rim section) of the native acetabulum while the superior acetabulum was comparatively retroverted and the inferior was relatively more anteverted.     

髋臼后柱螺钉固定安全性的解剖学研究

目的 :探讨髋臼后柱的解剖学结构和螺钉放置的安全角度和范围。方法 :取 2 0具骨盆标本 ,在X线透视下确定髋臼上缘距坐骨大切迹顶点和髋臼下缘距坐骨棘基底中点的距离 ,CT垂直扫描后柱 ,测量距髋臼上缘 0 .5 ,1.0 ,1.5 ,2 .0 ,2 .5 ,3 .0 ,3 .5 ,4.0cm的CT断面上后柱宽、髋臼宽。根据髋臼在后柱表面的投影 ,将后柱分为髋臼区 ,相对危险区和危险区 ,并测量距后柱内缘 1cm处 2 .5cm螺钉进钉的安全角度。结果 :髋臼上缘在坐骨大切迹顶点下 (1.0± 0 .2 )cm ,髋臼下缘在坐骨棘基底中点下 (1.2± 0 .2 )cm ,距髋臼上缘 0 .5 ,1.0 ,1.5 ,2 .0 ,2 .5 ,3 .0 ,3 .5 ,4.0cm的CT断面上 ,后柱宽分别为 (5 0 .6± 3 .8)、(4 7.9± 3 .0 )、(4 6.1± 3 .6)、(4 1.5± 4.8)、(4 3 .5± 4.8)、(4 3 .0± 4.4)、(4 3 .2± 4.6)、(4 2 .6± 4.3 )mm ;髋臼宽分别为 (15 .4± 3 .6)、(2 0 .3± 3 .3 )、(2 3 .7± 3 .4)、(2 4.7± 3 .5 )、(2 6.0± 3 .6)、(2 4.7± 3 .0 )、(2 1.7± 4.6)、(18.3± 7.2 )mm ;在不同断面上只要进钉角度小于 10 9°均可满足螺钉放置的安全要求。结论 :危险区内不能垂直打钉 ,相对危险区内可以以适当的角度放置螺钉。     

髋臼骨折手术治疗21例临床分析

目的探讨移位髋臼骨折经手术治疗后临床疗效和并发症发生的原因及其预防措施。方法本组移位髋臼骨折21例,简单骨折选用单纯腹股沟入路3例,单纯后入路13例,复杂骨折采用前、后联合入路5例。其中3例行可吸收螺钉,4例行松质骨螺钉内固定,14例行重建钢板内固定。结果所有患者随防6-19个月,平均11．2月。按Matta标准,优14例,良5例,可1例,差1例,优良率达90．5％。坐骨神经损伤1例;异位骨化1例;可吸收螺钉断裂1例;髋关节骨性强直1例。并发症的发生率为 19．1％。结论手术治疗是移位髋臼骨折的首选方法,手术前应明确骨折类型,把握手术时机,选择正确的手术入路及合适的内固定。术中仔细操作,避免切口周围组织过度牵拉,骨折尽可能达到解剖复位或近解剖复位,并予以坚强内固定。术后持续患肢牵引两周,两周后逐渐进行患肢主动或被动功能锻炼。     

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup

Background

Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell.

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。     

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。     

Differences in acetabular morphology related to side and sex in a Chinese population

The purpose of the present study was to determine the side and sex differences in acetabular dimension and orientation in normal Chinese adults, which are not known well but are important in hip joint replacement surgery. The acetabular parameters, including anteversion angle (AV.A), abduction angle (AB.A), center edge angle (CE.A), acetabular width (Ac.W) and acetabular depth (Ac.D), were measured on CT images in 100 healthy Chinese adults. The acetabular index of depth to width (Ac.D/Ac.W) was calculated by depth/width × 100. Percentage side difference (PSD) was calculated for each parameter. The absolute numbers of PSD (aPSD) were compared between the groups of right positive (right PSD > left PSD) and left positive (left PSD > right PSD) groups. There was no significant side difference in any of the parameters. Compared to men, a significant increase in AB.A (P = 0.001) and significant decreases in Ac.W (P < 0.001), Ac.D (P < 0.001) and Ac.D/Ac.W (P < 0.05) occurred in women. The differences in Ac.W and Ac.D became insignificant when adjusted for body height. aPSD did not show a significant difference between right and left positive groups in both sexes. In conclusion, the side differences in acetabular parameters in a normal individual are likely to be associated with measurement error. In addition, the larger acetabular dimension in men is attributed to greater body height independent of sex.     

髋关节脱位合并髋臼骨折的外科治疗（附26例报告）

目的　探讨髋关节脱位合并髋臼骨折的外科治疗方法及疗效。方法　根据髋关节脱位及髋臼骨折的具体情况，采用硬膜外麻醉下行闭合手法复位或手术切开复位，对较大骨块复位后用螺丝钉固定，对粉碎骨折取自体髂骨重建修复髋臼。结果　２２ 例髋关节脱位并髋臼骨折者复位满意，非持重下髋关节功能良好。４ 例髋关节脱位虽复位，但髋臼骨折仍错位＞ ３ｍ ｍ ，活动功能受限、疼痛。２６ 例中２３ 例随访２ ～１０ 年，优６ 例，良７ 例，可６ 例，差４ 例。结论　根据病情，早期采用闭合手法复位或手术修复髋臼，有利于恢复髋关节功能，减少创伤性关节炎的发生。     

Three dimensional finite element analysis of acetabulum loaded by static stress and its biomechanical significance

Objective：To explore the mechanical behavior of acetabulum loaded by static stress and provide the mechanical basis for clinical analysis and judgement on acetabular mechanical distribution and effect of static stress. Methods：By means of computer simulation, acetabular three dimensional model was input into three dimensional finite element analysis software ANSYS7.0. The acetabular mechanical behavior was calculated and the main stress value, stress distribution and acetabular unit displacement in the direction of main stress were analyzed when anterior wall of acetabulum and acetabular crest were loaded by 1 000 N static stress. Results ：When acetabular anterior wall loaded by X direction and Z direction composition force, the stress passed along 4 directions： （1）from acetabular anterior wall to pubic symphysis along superior branch of pubis firstly, （2）from acetabular anterior wall to cacroiliac joint along pelvic ring, （3）in the acetabulum, （4）from the suffered point to ischium. When acetabular crest loaded by X direction and Y direction composition force, the stress transmitted to 4 directions： （1）from acetabular crest to ilium firstly, （2）from suffered point to cacroiliac joint along pelvic ring, （3） in the acetabulum , （4）along the pubic branch, but no stress transmitted to the ischium branch. Conclusion：Analyzing the stress distribution of acetabulum and units displacement when static stress loaded can provide internal fixation point for acetabular fracture treatment and help understand the stress distribution of acetabulum.