股骨头坏死患者行全髋关节置换术后中远期异位骨化分析

目的探讨股骨头无菌性坏死患者行全髋关节置换术术后中远期异位骨化(HO)的发生情况及对功能的影响。方法对由同一术者完成且采用同一类型假体、获得5～11年随访的48例(60髋)全髋关节置换术患者的资料进行分析,包括临床评估和放射学评估。结果 30例37髋(61.7%)出现不同程度HO,按Brooker分级,0级23髋(38.3%),1级13髋(21.7%),2级17髋(28.3%),3级7髋(18.9%),4级0髋。Ficat分级3级和4级的患者HO发生率分别为58.6%和64.5%(P>0.05)。多元回归分析显示Harris评分、年龄、出血量、手术时间、体质指数等与HO无关(P>0.05),男性是HO的危险因素(P<0.05)。男性及女性HO发生率分别为75.0%和46.4%(P<0.05)。Brooker分级1、2级HO患者Harris评分与3级患者比较差异无统计学意义(P>0.05)。27例术后5年内HO的严重程度与术后1年内相比无明显进展;3例术后5年内HO程度呈进展性,但术后5年后无再进展。结论股骨头坏死行全髋关节置换术后中远期异位骨化发生率高;全髋关节置换术后HO可呈进展性,需密切观察。     

大头径陶瓷-陶瓷全髋关节置换的早期疗效

背景：36 mm大直径陶瓷球头较28 mm常规直径陶瓷头增加了跳越距离,具有活动范围大,稳定性好,脱位率低等特点,适用于年轻,要求活动范围大,追求高生活质量患者。 目的：观察36 mm大头径陶瓷-陶瓷全髋关节假体行关节置换的早期疗效。 方法：2009-06/2010-07采用Depuy公司的PinnacleTM 36 mm大头径陶瓷-陶瓷全髋假体行初次人工全髋关节置换治疗18例(18髋)髋关节疾病患者。对照组为同期行PinnacleTM 28 mm直径陶瓷-陶瓷人工全髋关节置换治疗20例(20髋)髋关节疾病患者。 结果与结论：所有患者均获得随访,随访时间13~26个月。置换后切口均Ⅰ期愈合,未发生假体脱位、感染及下肢深静脉血栓形成等并发症。两组患者置换后Harris各项评分较置换前均明显改善(P < 0.05),且直径36 mm组置换后活动范围评分较直径28 mm组改善明显(P < 0.05);但两组置换后Harris总评分及疼痛、功能评分比较差异无显著性意义(P > 0.05)。结果初步表明现代陶瓷-陶瓷人工关节假体能有效减少因关节界面磨损导致的骨溶解及关节松动等并发症。36 mm大头径陶瓷-陶瓷全髋假体设计具有活动范围大,稳定性好,脱位率低等特点,在术中条件允许情况下,可作为首选型号。       

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

髋关节置换术中及术后股骨假体周围骨折的原因及其防治策略

目的探讨髋关节置换术中、术后股骨假体周围骨折的原因、治疗方法及预防策略。方法回顾性分析2007-2012我院治疗的34例股骨假体周围骨折,包括20例术中骨折及14例术后骨折。按Vancouver分型,AG型骨折4例,AL型骨折11例,B1型骨折12例,B2型骨折7例。结果 34例中31例获得随访,平均随访时间2.8年（1～4年）,均达到骨性愈合,末次随访时髋关节Harris评分平均为88.4分,VAS评分为1.2分。末次随访时所有患者均不需扶拐行走,25例步态正常,6例轻度跛行,4例诉偶有大腿疼痛。所有病例假体稳定性良好,无松动迹象。所有切口均甲级愈合,无骨折不愈合、钢板断裂、感染、症状性血栓形成等并发症出现。31例患者均对手术效果表示满意。结论按Vancouver分型规范化治疗股骨假体周围骨折能取得令人满意的疗效。完善的术前准备、规范的手术操作及术后定期随访是预防股骨假体周围骨折的有效策略。     

人工颈椎间盘置换术的研究进展

自20世纪50年代以来，颈前路减压植骨融合术（anterior cervical discectomy and fusion，ACDF）一直是治疗颈椎间盘突出引起的脊髓病变和神经根病变最有效的手段，随着研究的深入，其引起的并发症逐渐被人们认识，主要表现为：（1）颈椎的正常生物力学改变，手术节段丧失运动功能，相邻节段退变加速。目前认为这是由于术后相邻节段应力和活动度代偿性增加所致，颈椎屈曲时融合节段上、下节段椎间盘内压可分别增加73％和45％（2）植骨不愈合，假关节形成。Bohlman的一项研究显示此并发症的发生率为13％，其中67％的患者出现相关症状，17％需要重新手术治疗。ACDF出现的并发症迫使人们探索新的手术方式，人工颈椎间盘置换术（total disc replacement，TDR）因其独有的优势得到迅速发展。     

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

结构性植骨治疗全髋关节置换术中髋臼骨缺损的疗效观察

[目的]探讨结构性植骨治疗全髋关节置换术中髋臼骨缺损的疗效.[方法]对2008年1月至2014年12月在本院骨科诊治且获得随访的31例髋关节置换术中进行结构性植骨患者的临床资料.随访5.8(4~10)年,手术原因:发育性髋关节发育不良CroweⅡ型9例9髋,CroweⅢ型16例16髋,髋臼骨折术后感染并股骨头坏死、髋臼缺损6例6髋.25例采用自体股骨头行结构性植骨,6例采用同种异体结构性植骨,观察临床疗效.[结果]所有患者切口均一期愈合,未出现感染、血栓形成病例,未出现血管、神经损伤病例.所有病例均不需扶拐行走,VAS评分由术前的(6.2±1.3)分降低到随访时的(1.6±0.3)分(P<0.05),Harris评分由术前的(56±6.2)分提高至随访时的(87±4.5)分(P<0.05).4髋偶尔仍有轻度疼痛,无中、重度疼痛病例,无大腿疼痛病例.23例步态正常,8例轻度跛行.31例患者均对手术效果表示满意.所有病例植骨块均与髂骨骨床骨性愈合,但其中2髋可见植骨块部分吸收,2髋植骨块与骨床间可见少许不连续透亮带.未出现螺钉断裂及植骨块移位病例,未出现假体松动而需再次翻修病例.术后早期外展角、前倾角与术后末次随访外展角及前倾角无差异(P>0.05).[结论]把握好手术适应证及遵循操作规范,结构性植骨治疗全髋关节置换髋臼骨缺损中期疗效满意,值得临床推广应用.