陶对陶假体全髋关节置换术后早期脱位原因分析及预防

目的分析陶对陶假体全髋关节置换术后早期脱位原因,并探讨预防假体脱位的有效方法。方法笔者自2008-06—2011-06采用陶对陶假体行全髋关节置换术治疗216例髋关节疾患,观察术后早期假体脱位情况。结果所有患者获得随访平均16.4(1~38)个月。1例术后半年假体脱出,复位后1年假体再次脱出,脱位率0.46%,经闭合复位固定,末次随访未再脱出。结论术前评估患者有无神经、精神疾病及髋部肌力,术中充分考虑髋臼假体对股骨头假体覆盖情况,注意修复关节囊及髋周动力装置。脱位发生后,采用闭合复位固定可获得有效治疗。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访6～36个月。术后6个月随访时患者Harris评分为（94.5±4.7）分，临床效果评定：优15例、良4例，优良率100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后3个月X线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。     

经后路全髋关节置换术后前脱位的危险因素分析及治疗策略

目的分析经后路全髋关节置换(THA)术后发生前脱位的危险因素,并探讨术后前脱位的治疗对策。方法回顾性分析本院自2005-03—2014-03采用THA治疗的1 586例患者,术后6例发生前脱位(试验组),随机选取6例未发生脱位患者(对照组),分析经后路THA术后发生前脱位的危险因素。对2组性别、髋臼假体外翻角、髋臼和股骨假体前倾角、股骨头大小、软组织张力及术后体位等脱位危险因素进行比较。结果 2组性别(χ~2=7.40,P=0.667)和髋臼外展角(t=1.40,P=0.758)差异无统计学意义。2组髋臼和股骨假体联合前倾角(t=3.49,P=0.031)、股骨头大小(χ~2=24.00,P=0.025)、术后体位(χ~2=26.96,P=0.023)比较差异有统计学意义。试验组5例手法复位成功,1例闭合复位失败,行切开复位更换长颈股骨头,未再出现脱位。结论经后侧入路人工全髋关节置换术术后前脱位的发生率较低,但其发生时间较早。前脱位的发生原因为多因素,髋臼和股骨假体的前倾角较大,合并其他不稳定因素及其术后体位不当,是脱位发生的主要机制,针对脱位原因的治疗能够获得良好的预后效果。     

全髋关节置换术治疗成人Crowe Ⅳ型先天性髋关节发育不良的近期疗效

目的 :探讨成人Crowe Ⅳ型先天性髋关节发育不良行全髋关节置换术的手术方法和近期临床疗效。方法:2010年3月至2015年3月对20例20髋成人CroweⅣ型先天性髋关节发育不良行全髋关节置换术,其中男4例,女16例;年龄32~68岁,平均52岁。髋臼侧均采用生物型假体在真臼水平植入,股骨侧采用S-R0M假体结合股骨粗隆下横断截骨短缩行人工关节置换术,对临床结果采用改良Harris评分进行评价,术前及术后随访时均拍X线片进行观察。结果:患者切口均Ⅰ期愈合,无髋关节脱位、静脉血栓发生。所有患者获随访,时间8~60个月,平均38.1个月。术后X线片显示髋臼假体均位于真臼内,无髋臼假体松动。股骨侧截骨处均骨性愈合,Harris评分由术前平均(50.90±9.35)分提高至末次随访的(90.25±3.16)分,差异有统计学意义(P0.05)。有1例术中发生小转子劈裂,1例术后出现坐骨神经损伤症状,1例出现BrookerⅠ型异位骨化,所有患者术后髋关节活动度好,疼痛基本消失。结论:应用S-ROM假体结合粗隆下截骨全髋关节置换术是治疗成人CroweⅣ型先天性髋关节发育不良的有效手术方法,近期临床疗效满意。     

联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中的应用

目的探讨联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中应用的可行性及临床价值。方法回顾性分析自2016-09—2018-06采用联合前倾角技术行全髋关节置换术治疗的31例(36髋)成人发育性髋关节发育不良,比较手术前后髋臼前倾角、股骨前倾角、联合前倾角及髋关节功能Harris评分。结果31例均获得12个月以上随访。术后骨盆正位及髋关节侧位X线片显示假体位置及对应关系良好,无假体松动、下沉,无脱位表现。末次随访时所有患者步态均明显改善,髋部疼痛均消失,仅2例轻度跛行。术后髋臼前倾角、股骨前倾角、联合前倾角较术前明显减小,末次随访时髋关节功能Harris评分较术前明显增加,差异有统计学意义(P<0.05)。结论联合前倾角技术应用于成人发育性髋关节发育不良全髋关节置换术对于指导合适假体的选择、设计以及确定合适的髋臼前倾角、股骨柄前倾角具有重要意义,良好的联合前倾角能够有效预防术后假体脱位的发生。     

人工全髋关节置换术后早期假体脱位的原因分析及防治措施

目的探讨人工全髋关节置换术后早期假体脱位的原因分析及防治措施。方法对首次行人工全髋关节置换术98例,发生术后髋关节脱位5例,其中3例为后脱位,1例为前脱位,股骨假体下沉脱位1例。结果 5例脱位患者中3例麻醉后手法整复成功;1例前脱位以后脱位手法整复未成功,术中证实为髋臼前倾角过大;1例为股骨假体过小术后下沉,术中更换大一号股骨假体。结论假体位置异常是人工全髋关节置换术后早期假体脱位的主要原因;规范医生操作及假体放置、正确指导患者术后功能锻炼,能有效预防早期脱位的发生。     

Crowe Ⅳ型成人髋关节发育不良患者的全髋关节置换治疗

目的探讨人工全髋关节置换术治疗CroweⅣ型成人髋关节发育不良（Developmental dysplasia of the hip,DDH）的手术方法和疗效。方法 2000年3月至2009年5月,对12例（13髋）Crowe IV型成人髋关节发育不良患者进行人工全髋关节置换术,髋臼侧采用小臼杯结合髋臼内陷技术安置臼杯假体,股骨侧采用粗隆下短缩截骨放置股骨假体。结果所有患者随访8月～7年,平均42月,术后X线片显示髋臼假体均位于真臼内,无髋臼假体松动。股骨侧截骨处均骨性愈合。Harris评分由术前平均35分提高至末次随访87分,差异有统计学意义。结论对CroweⅣ型DDH患者行全髋关节置换术时,采用小臼杯、假体内陷技术、股骨短缩截骨能够提高全髋关节置换术的治疗效果。     

Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons

A survey was distributed to the American Association of Hip and Knee Surgeons (AAHKS) membership to evaluate surgical treatment preferences for displaced femoral neck fractures (DFNFXs). Of 718 members, 381 (54%) responded to the 16-question survey that was an adjunct to a multicenter, randomized study (funded by AAHKS/OREF) designed to prospectively evaluate efficacy of hemiarthroplasty vs total hip for treatment of DFNFXs. Hemiarthroplasty (85%) was the most preferred treatment option for DFNFXs (reduction with internal fixation 2%, total hip arthroplasty 13%). Prefracture hip pain/osteoarthritis, poor bone quality, and fracture comminution were the main reasons why arthroplasty was chosen over reduction with internal fixation. Ambulatory status and dislocation risk after arthroplasty were the main factors in choosing between unipolar (48%) and bipolar (52%) hemiarthroplasty. Total hip arthroplasty is used by 88% of responders. Dislocation risk and ambulatory status were influential factors against performing total hip arthroplasty. Arthroplasty is the preferred method of surgical intervention for the treatment of DFNFXs for AAHKS members.     

Open reduction of a chronic proximal dislocation after total hip arthroplasty

We report an unusual case of a chronic prosthetic dislocation that was caused by the buttonholing of a prosthetic femoral head by anterior soft tissue, which impeded reduction. A surprisingly good functional result was achieved by an open reduction and revision operation on a 56-year-old man, who had a chronic dislocation of a total hip prosthesis. Successful treatment with open reduction of a chronic proximal dislocation after total hip arthroplasty has not been reported previously in the literature.     

An Analysis of a National Administrative Dataset Demonstrating No Evidence of Increase in Elective Primary Total Hip Arthroplasty Dislocation Rates When Postoperative Hip Precautions are Not Used

BackgroundThe purpose of this study is to determine whether there is a higher dislocation rate when postoperative hip precautions are not used for primary total hip arthroplasty (THA).MethodsA survey was conducted of the hip precautions used by orthopaedic departments in England performing elective primary THA. From the responses to the survey an interrupted time series analysis was performed using the hospital admissions data from the Hospital Episode Statistics (HES) database during the period April 1, 2011 to December 31, 2019 and subsequent dislocations of these prostheses up to June 30, 2020. These were used to determine dislocations within 180 days of primary surgery and emergency readmissions within 30 days of discharge.ResultsRecords were reviewed from 229,057 patients receiving primary, elective THA across 114 hospitals. In total, 1,807 (0.8%) dislocations were recorded within 180 days of surgery. There were 12,416 (5.4%) emergency readmissions within 30 days of surgery. Within hospitals where hip precautions were stopped, the proportion of patients having a dislocation was 0.8% both before and after stopping precautions, with a significant postintervention trend towards fewer dislocations (P < .001). There was also a significant immediate change in median length of stay from 4 to 3 days (P < .001) but no significant trend in the proportion of emergency readmissions within 30 days.ConclusionThere is no evidence of an increase in early dislocation or 30-day readmission rates after stopping traditional postoperative hip precautions in primary THA. Potential reductions in length of stay will reduce the risks associated with an extended hospital admission, improve service efficiency, and reduce costs.     

保留股骨颈全髋关节置换的手术体会

目的探讨保留股骨颈的全髋关节置换在临床应用中的手术体会。方法2002年1月至2007年2月,12例13侧因各种原因需行全髋关节置换者接受了保留股骨颈的全髋关节置换,采用Gibson切口,在头下位置将股骨头截断,保留完整的股骨颈。选择合适的外杯,55°外翻角装入。内杯为超高分子聚乙烯,超半径设计保持外翻45°。术前、术后及随访中对患者髋关节功能进行Harris评分,随访时摄X线片以了解假体的位置、松动情况及异位骨化。结果全部患者获得1～4年的随访,13侧人工髋关节临床效果良好。人工髋关节的活动及功能良好,髋关节的Harris评分由术前的平均50分提高到末次随访时的平均91分;影像学检查显示人工髋关节位置良好,假体无松动和下沉。结论保留股骨颈的全髋关节置换术对因各种原因需行全髋关节置换者,是一种良好的选择,主要适用于无骨质疏松且股骨颈完整者。     

Redefining revision total hip arthroplasty based on hospital admission status

This study examined patient demographics, length of hospital stay, and discharge disposition in those undergoing nonelective revision total hip arthroplasty (rTHA) vs elective rTHA. Data from 23 000 patients with hip revisions from 2005 through 2007 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. We examined patient admission status, demographics, length of stay, and discharge location. We found that patients undergoing nonelective rTHA were older, were female, had more comorbidities, stayed an excess of 1.61 days in the hospital, and required a skilled care facility after discharge compared with those undergoing elective rTHA. We found that rTHA outcomes varied based on patient hospital admission status. Patients who elected to have rTHA had less comorbidities, cost, and likelihood of being discharged into a skilled care facility.     

Zweymuller系统全髋关节置换术治疗髋臼发育不良的中期疗效分析

目的：评价Zweymuller螺旋臼结合髋臼加深技术治疗髋臼发育不良的中期疗效。方法：自1998年1月至2004年12月,采用Zweymuller系统进行全髋关节置换术治疗髋臼发育不良继发髋关节骨性关节炎患者56例62髋,男14例（15髋）,女42例（47髋）;平均年龄48.6岁（30～67岁）。术前所有患者均有髋关节疼痛和功能障碍。观察项目包括术后并发症、影像学及功能恢复情况。髋关节功能采用Harris评分标准进行评定。结果：56例获得随访,时间5～11年,平均6.5年。X线检查显示髋臼假体位于真臼位置,与周围骨床结合紧密,髋臼假体外展角35°～45°,股骨假体内、外翻3°以内,术后患肢短缩平均（0.5±0.2）cm。术后近期发生深静脉血栓20例,予溶栓治疗后好转。近期脱位1例,复位、制动3周后下地行走。4髋发生异位骨化、均为BrookⅡ型。无感染、神经损伤病例发生。术后Harris评分（87.4±3.5）分,与术前（43.2±6.7）分比较,差异有统计学意义（P〈0.01）。结论：Zweymuller螺旋臼结合髋臼加深技术治疗髋臼发育不良继发髋关节骨性关节炎中期疗效优良。     

成人DDH患者保髋手术失败后的THA疗效分析

目的回顾性分析保髋手术治疗失败后的成人发育性髋关节发育不良患者再次行全髋人工关节置换术的中期疗效。方法选择2014年1月至2019年1月收治的22例(30髋)保髋手术失败后行全髋人工关节置换术(total hip arthroplasty,THA)的发育性髋关节发育不良患者作为研究对象,其中男7例,女15例;行保髋手术时年龄1~18岁,平均(7.9±3.4)岁;行THA时年龄22~63岁,平均(34.2±11.2)岁;单髋14例,双髋8例,左髋16侧,右髋14侧。手术前后采用Harris髋关节评分系统及疼痛视觉模拟评分法(visual analogue score,VAS)进行评价,并对手术前后的X线片进行分析。结果本研究病例全髋人工关节置换术后平均随访时间为(30.5±18.5)个月。全髋人工关节置换术后,Harris总评分从术前的平均(38.7±10.6)分提高至末次随访时的(89.4±9.7)分,差异有统计学意义(t=19.67,P<0.001),且患者的疼痛、行走、功能、活动度等各项指标的术后评分均高于术前且差异有统计学意义;疼痛VAS评分由术前的平均(7.9±0.9)分降低到末次随访时的(1.4±1.0)分,差异有统计学意义(t=30.67,P<0.01);患者双下肢长度差异由术前的平均(3.32±0.51)cm降低到术后(0.71±0.33)cm,差异有统计学意义(t=14.01,P<0.001)。所有患者均无发生手术切口及假体周围感染、假体松动、髋关节脱位、血管神经损伤、深静脉血栓及异位骨化等术后并发症,仅2例患者术中出现股骨近端纵行劈裂。结论保髋手术失败后的成人发育性髋关节发育不良患者行全髋人工关节置换术可获得满意的中期疗效。     

A Reduction Technique of Arthroplasty Without Subtrochanteric Femoral Shortening Osteotomy for the Treatment of Developmental High Dislocation of Hip: A Case Series of 28 Hips

In total hip arthroplasty for the treatment of developmental dysplasia of the hip (DDH) with high hip dislocation, it can be technically challenging to locate the true acetabulum and restore limb length without subtrochantric femoral shortening osteotomy. We explored and described total hip arthroplasty without subtrochanteric femoral shortening osteotomy in 28 hips with Crowe type III and IV dislocation by intravenous injection of rocuronium at 0.9 mg/kg 1 minute before reduction and hip reduction combined with continuous strong traction of the affected limb with patients in a position with hip and knee flexion. All patients did not show dislocation, prosthesis loosening, and other severe complications. It is thus a safe and feasible reduction technique for arthroplasty of Crowe type III or IV dislocation of DDH.     

Midterm Results of Hybrid Total Hip Arthroplasty for Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip-Chinese Experience

This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 ± 18.01, which improved to 91.78 ± 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia.     

A Systematic Review of Modern Metal-on-Metal Total Hip Resurfacing vs Standard Total Hip Arthroplasty in Active Young Patients

This systematic review compared 2 treatments for hip disease in active young patients: modern metal-on-metal total hip resurfacing and standard total hip arthroplasty. We conducted a literature search to identify relevant randomized and clinical controlled trials and included 968 patients from 4 trials in our analysis. Our results indicated increased rates of revision, femoral neck fractures, and component loosening among patients who received modern metal-on-metal hip resurfacing. No significant differences in the rates of mortality, dislocation, or deep hip joint infection were found between treatment groups. Hip function scores were similar between the 2 groups, but the resurfacing group showed higher activity levels. These results have provided insufficient evidence to determine whether modern metal-on-metal total hip resurfacing offers clinical advantages over standard total hip arthroplasty.