Tagawa髋臼旋转截骨术治疗髋臼发育不良的评价

目的　评价Tagawa髋臼旋转截骨术治疗髋臼发育不良的临床效果。方法　采用Tagawa髋臼旋转截骨术治疗髋臼发育不良 ,用Harris评分和测量X线髋臼指数来评估手术的临床效果和髋臼 股骨头解剖关系的变化。结果　Harris评分从术前的平均 ( 80± 7.7)分提高到 ( 95± 1.8)分 ,主要表现为疼痛明显改善。X线显示髋臼CE角、AC角、AHI获得明显改善 ,但HLI没有变化。所有病例没有重大并发症发生。结论　Tagawa髋臼旋转截骨术治疗髋臼发育不良能较好地重建髋臼和股骨头的解剖关系 ,可以明显改善患者髋部疼痛症状 ,延迟髋关节骨关节病的发生     

复杂髋臼骨折的手术治疗

目的总结复杂髋臼骨折的治疗效果。方法手术治疗复杂髋臼骨折16例,根据骨折类型采用重建钢板及拉力螺钉固定。结果患者均获随访,时间3～24个月。复位情况按Matta标准:解剖复位10例,满意复位6例。关节功能按改良D′Aubigne和Postel评定标准:优8例,良5例,可2例,差1例。结论术前明确骨折分类、手术时机适当、合适入路、可靠内固定及满意复位是提高髋臼骨折治疗效果的关键。     

全髋关节置换术治疗成人髋关节发育不良

目的探讨全髋关节置换术(THA)治疗成人髋关节发育不良的临床疗效。方法采用THA治疗45例髋关节发育不良患者(50髋)。记录术后感染、髋关节脱位、假体松动、神经损伤情况,末次随访时采用Harris评分评定髋关节功能。结果患者均获得随访,时间2~65(24.1±16.0)个月。术后无感染、髋关节脱位、神经损伤等并发症发生。Harris评分由术前7~77(38.0±15.4)分增加到末次随访68~96(87.2±6.0)分,末次随访与术前比较差异有统计学意义(P<0.05)。末次随访时,所有患者患侧髋关节疼痛症状消失,关节活动功能满意;摄髋关节X线片复查显示关节假体位置、宿主骨对臼杯覆盖良好,假体骨骼界面稳固、无松动。结论THA治疗成人髋关节发育不良疗效满意,术中髋臼处理、真臼重建以及股骨假体的选择与安放是手术成功的关键因素。     

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     

改进Zahradnicek手术治疗先天性髋脱位疗效观察

目的 :探讨先天性髋脱位治疗优化方法 ,减少并发症。方法 :自 1 986～ 1 998年应用改进Zahradnicek手术治疗先天性髋脱位 1 0 3例、1 36个关节 ,用特制的小儿髋臼钻有限切削臼软骨 ,重建髋臼孤形结构 ,恢复其头臼同心圆关系 ,同时矫正前倾角至 5°～ 1 0°,颈干角至1 2 0° ,用专用的 1 2 0°鹅颈钢板固定。结果 :术后疗效评定 :优 76髋 ,为 5 3% ,良 45髋 ,为 33% ,可 9髋 ,为 6 6 % ,差 6髋 ,为 4 4% ,优良率占 89%。结论 :此种手术在一次手术中使股骨头、髋臼、股骨颈及股骨干恢复或接近恢复正常解剖和功能的方法     

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.     

Fragility fractures of the acetabulum

There are limited epidemiological data dedicated to geriatric acetabular fractures. The incidence in individuals older than 60 years of age has more than doubled in the past three decades and expected to double further over the next 20 years. These fractures represent a challenging subset of acetabular trauma patients to treat. Conservative treatment is a valid option in those with minimal displaced fractures and a preserved congruent hip joint. Similarly the frail patient with multiple medical co-morbidities and those unlikely to tolerate surgical intervention should have appropriate analgesia and their fracture managed or ignored by watchful neglect. Surgical treatment options include percutaneous fixation or open reduction and internal fixation techniques. Good outcomes may be expected should a concentric reduction be achieved. Age-related involutional osteoporosis associated with fracture comminution and acetabular dome impaction complicate surgical fixation with higher complication rates and the need for further surgery recognised. Historically described as central fracture dislocations, stoved in hip or burst fracture, acute arthroplasty is advocated in the setting of femoral head damage and in significant acetabular impaction injuries. Controversy remains whether geriatric patients should be treated by open reduction and internal fixation or total hip arthroplasty either acute or delayed and needs to be assessed based on the patient and personality of the fracture.     

(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.     

Acetabular fractures,anatomy and implications for treatment

Acetabular fractures are relatively uncommon and their definitive treatment tends to be focused on specialist major trauma centres. This can make both accurate diagnosis and management challenging, particularly in hospitals where they are rarely seen. Contemporary management of these injuries owes a lot to the work of Judet and Letournel undertaken in the 1970s. The key to understanding these injuries is to know the embryology and development of the pelvis and then be able to appreciate its three-dimensional structure from two-dimensional X-rays. This can then be overlaid with the Judet classification and the action of force vectors encountered in various mechanisms of injury. It is also important to realise the ageing demographics of this group of patients and the complexities this adds to classification and ultimately treatment. Finally, the presence of an acetabular fracture is often seen in association with a number of other injuries. It is imperative that these are appropriately and contemporaneously diagnosed so that a comprehensive management plan may be instituted to give the best outcomes. However, even with optimal management the prognosis is guarded with a majority of patients suffering some degree of functional loss and this must be made clear to the patient from the outset.     

Clinical Anatomy of the Ligament of the Head of Femur

The ligament of the head of femur (LHF) has gained clinical attention recently and is reported to contribute to hip stability. This study explores its morphology and morphometry, information that may help inform surgical decision making. Gross anatomical dissections were undertaken on 229 embalmed hips from European (n = 105) and Thai (n = 124) adult cadavers to examine LHF anatomy. Ligament morphometry was statistically compared at different sites, between sexes and sides. The origin of ligamental arteries and absence of the ligament were documented. The LHF was pyramidal or quadrangular in shape. Sub‐synovial fibrous bands originated from the transverse acetabular ligament, edges of the acetabular notch, and acetabular floor; less frequently from the hip joint capsule. Distally, the ligament flattened and converged onto the fovea capitis. The ligament was 22.3 ± 4.4 mm long and was significantly wider (P = 0.001) and thicker (P = 0.0003) at the fovea, compared to its mid‐zone. Branches of the obturator artery entered the acetabular foramen inferomedially and penetrated the middle third of the LHF. Blood vessels ran within the LHF and appeared to enter the fovea. The ligament was absent in 2.8% of Thai hips and there were no significant sex or side differences in ligament dimensions. The morphology of the LHF is complex. While individual variation was apparent, blood vessels were seen in the distal ligament. Precise information on LHF morphometry and attachment sites will help inform appropriate graft dimensions and choice of fixation sites necessary for ligament reconstruction. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.