先天性髋关节脱位的一期手术治疗

目的 改进先天性髋关节脱位的治疗。方法 对３８例５２髋先天性髋关节脱位术前不牵引,一期综合手术矫正全部畸形。手术步骤包括彻底软组织松解,股骨粗隆下短缩,去旋转、内翻截骨,髋臼覆盖重建,准确地同心圆中心关节复位。结果 本组５２髋术后获得满意复位,其中３０例４１髋随访８￣３０个月,按Ｍｕｌｌｅｒ和Ｓｅｄｄｏｎ的标准,优２８髋,良１０髋,可３髋。结论 一期综合手术治疗效果满意,具有住院时间短,病人痛苦小     

发育性髋关节发育不良兔模型中髋臼的改变

目的：探讨发育性髋关节发育不良（DDH）髋臼的变化.方法：采用管型石膏固定方法制作动物模型,取经X线检查存在DDH的大耳白兔,行ECT检查后解剖双侧髋臼.以GREENHILL方法进行测量.分别沿长短径并与两径平行取材切片观察其组织学改变.结果：ECT检查结果显示病变髋臼核素浓聚明显低于对照侧.病变髋臼向后上方延长,失去其近似圆形的结构而呈椭圆形.组织学观察,沿长径的切片显示病变髋臼后上缘关节软骨外翻,其关节软骨生长柱方向也发生改变,异位关节软骨明显增厚;而沿短径的切片可以看到透明软骨去机化及向纤维软骨转化.结论：DDH动物模型中存在微循环的改变,软骨翻转导致髋臼后上方的延长.     

髋臼横行骨折经前入路不同内固定的生物力学研究

目的比较髋臼横行骨折经前侧入路给予髋臼前柱3种内固定方式的稳定性。方法将制成髋臼横行骨折模型的18个新鲜标本,随机、平均分为3组。LS组:单纯拉力螺钉固定组;RP组:重建接骨板固定组;LP组:锁定重建接骨板固定组。本实验在美国BOSE-3500型生物力学试验机上进行,依据3枚克氏针所代表的三维坐标平面,将半骨盆标本调整至人体倒置单足站立位置固定于包埋盒中,实验进行连续性轴向加载直至三组内固定均达到失效。观察3组标本在同一载荷下的纵向移位、纵向位移均2.00mm时的载荷及此时的内固定轴向刚度。结果 LS组骨折的纵向位移大于RP组、LP组,轴向刚度小于RP组、LP组,差异具有统计学意义(P0.05),RP组与LP组的纵向位移及轴向刚度之间均无统计学差异(P0.05)。结论经前侧入路给予前柱内固定治疗髋臼横行骨折时,锁定重建接骨板固定组与重建接骨板固定组稳定性相似,无统计学差异,单纯拉力螺钉固定组稳定性较弱。     

重建锁定钢板在髋臼骨折中的应用

目的探讨不同类型髋臼骨折应用重建锁定钢板内固定治疗的效果,以提高患者生存质量,减少致残率。方法回顾总结23例不同类型髋臼骨折采用kohe-langbeck、髂腹股沟入路、延长的髂股入路、经粗隆外侧入路切开复位重建锁定钢板内固定术。结果 23例髋臼骨折均愈合,无退钉及断钉发生。髋关节功能按照Matta的评分标准:优20例,良2例,可1例。结论重建锁定钢板是治疗髋臼骨折的有效方法之一。     

桃红四物汤合五苓散联合人工全髋关节置换治疗陈旧性髋臼骨折并髋关节中心性脱位1例报告

报告一例桃红四物汤合五苓散联合人工全髋关节置换治疗陈旧性髋臼骨折并髋关节中心性脱位。40岁女性,车祸致多发骨折遗留左髋关节疼痛,功能受限,行左侧人工全髋关节置换术。术后48h内头孢替安预防感染,术后当天即兰索拉唑预防应激性溃疡,曲克芦丁脑蛋白水解物预防创伤性水肿,术后第2天加用丹参川芎嗪活血化瘀,低分子肝素钠预防下肢深静脉血栓,患肢保持外展中立位,加压泵促进下肢回流;术后第3天左下肢出现水肿,皮肤小片瘀斑,至第5天下肢肿胀明显,且出现大片瘀斑,按压皮肤有凹陷,恢复缓慢。辨证属瘀水互结,血瘀气滞,水停湿阻,治以活血化瘀,利水消肿,桃红四物汤合五苓散(酒当归、赤芍、三七粉、川芎、桃仁、藏红花、桂枝、炒白术、茯苓、泽泻、牛膝),口服7剂,外用自制冰硝散外敷3天,服药第5剂水肿明显消退,但瘀斑未见明显改善,7剂服毕瘀斑范围略见缩小,水肿基本消退,继续丹参川芎嗪活血化瘀。术后第7天指导患者功能锻炼,术后两周刀口拆线并指导患者在双拐辅助下患肢禁负重下地行走锻炼,术后三周出院,患者术后2个月复查,X线示假体位置良好,术后3个月复查指导患者负重锻炼,关节功能良好,无不适。此例同时应用曲克芦丁脑蛋白水解物、低分子肝素钠等,下肢水肿的治疗效果应为多种药物共同作用,中药具体效果还需进一步研究认证。     

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.     

Surgical stabilization of acetabular injuries: approaches and methods

Surgical approaches to the acetabulum are key to providing adequate exposure and reduction of fracture fragments thereby restoring articular congruity. Here, we discuss both the anterior and the posterior approaches in common practice but also the techniques available to help achieve reduction.     

改良Stoppa入路

Stoppa入路治疗骨盆髋臼骨折以来,其安全、方便等优点逐渐被广大医生所接受,特别是近年来对此入路的应用以及相关内植物的研究达到了空前的进步。大量文献报道通过此单一入路运用特殊的内植物治疗复杂骨盆髋臼骨折能够取得满意的临床疗效,说明Stoppa入路的发展为复杂骨盆髋臼骨折的治疗提供了一个重要的辅助手段。