髋臼发育不良性髋关节的三维有限元非线性接触压力分析

目的 从生物力学角度探讨髋臼覆盖程度(CE角)在髋臼发育不良引起的髋关节继发性骨关节炎中的作用。方法 建立正常、髋臼发育不良及髋臼过渡覆盖的髋关节三维有限元模型,应用非线性接触压力分析方法,观察髋臼发育不良性髋关节的关节软骨接触压力及软骨下骨应力分布。结果在所有的模型中,接触压力及应力均发生在股骨头最上部及与其相对应的髋臼顶穹部。在髋臼发育不良的模型中,另有过度不正常的接触压力发生在髋臼的后上缘区域。随着CE角的减小,接触压力和峰应力明显增高,接触面积下降。当CE角大于30°,压力分布类型及接触压力和峰应力改变不明显。结论髋臼覆盖程度降低所导致的生物力学改变在髋关节继发性骨关节炎中起重要作用。     

髋臼结构植骨在Crowe Ⅲ或Ⅳ型髋关节发育不良关节置换术中的应用

目的探讨髋臼结构植骨在CroweⅢ、Ⅳ型髋关节发育不良（DDH）人工全髋关节置换术（THR）中应用的短期效果。方法对2008年7月—2011年6月,全髋关节置换术（THR）中采用结构性植骨结合非骨水泥臼杯进行髋臼侧重建治疗的38例43髋Crowe Ⅲ型或Ⅳ型DDH患者的短期疗效进行回顾性分析。男5例（5髋）,女33例（38髋）,平均年龄41岁。术前Harris评分平均51分,19髋术中联合行转子下横行短缩截骨,平均1．6cm。结果术后平均随访39个月。末次随访Harris评分平均92分。肢体长度差异由术前的平均4．4cm减少至术后0．7cm。术后髋关节旋转中心平均下移3．2cm,内移2．8cm。所有髋臼假体无松动或感染,髋臼结构植骨块均愈合。术后异位骨化1髋,关节脱位1髋,闭合复位成功。结论自体结构性植骨结合非骨水泥臼杯重建Crowe Ⅲ、Ⅳ型髋关节发育不良的旋转中心,短期效果令人满意,无植骨不愈合、骨块吸收或松动等并发症。     

全髋关节置换术中不同截骨方式行股骨短缩治疗Crowe Ⅳ型髋关节发育不良的疗效分析

目的 研究Crowe Ⅳ型髋关节发育不良(DDH)患者行人工全髋关节置换时采用转子间截骨与转子下截骨治疗的疗效及安全性。方法 回顾性分析1999年5月—2013年12月期间收治的33例(37髋)Crowe Ⅳ型DDH患者,年龄17～67岁,平均35.9岁。在行人工全髋关节置换术中时采取了不同的截骨方式,其中28例(30髋)接受了改进的转子间截骨、5例(7髋)采用了转子下截骨。两组患者均用改良的Merled Aubigné和Postel部分评分进行效果评定,术前平均分别为9.4分、9.7分,下肢长度差异平均分别为44.7 mm、57.5 mm,收集评估临床及影像学检查数据。 结果 平均随访时间为83.6个月,术后转子间截骨与转子下截骨患者下肢的平均长度差异分别是9.2 mm、9.4 mm,末次随访Merled Aubigné评分平均分别为15.9分、15.8分。转子间截骨组患者中有2例术后出现坐骨神经麻痹,但是6个月内症状完全缓解。末次随访中转子间截骨组有2例Trendelenburg征阳性。在随访期内均无假体翻修的患者。各组手术前后Merled Aubigné和Postel部分评分差异均有统计学意义(P值均＜0.05),两组间统计学差异均无统计学意义 (P＞0.05)。结论 人工全髋关节置换术中股骨缩短治疗Crowe Ⅳ型髋关节发育不良时,无论是转子间截骨还是转子下截骨均安全有效。     

Stress and strain analysis of the hip joint using FEM.

Many disorders of the hip can be treated with a suitable osteotomy based on the improvement of mechanical conditions in the hip joint. These operations, such as osteotomies are very complex. The surface replacement has also been developed as an alternative to a total hip replacement for young and more active people. It is up-to-date to concern with biomechanics of pathological hips and it is necessary to supplement the existing clinical findings with the results of mechanical analyses. Several finite element (FE) models are presented in this paper. The first one offers solutions to the strain-stress analysis of the physiological hip. The second one represents dysplastic hip joint. Another two computational models of both hips of a young patient were created (FE model of physiological hip and pathological hip affected by Perthes disease with a deformed shape of the femoral head). Also a computational model is presented, which enables us to investigate strain and stress parameters in the hip joint with applied surface replacement. The strain and stress analysis was performed by means of finite element method (FEM) in ANSYS system.     

第二髋关节与髋臼发育不良

目的探索第二髋关节与髋臼发育不良的关系。方法观察髋臼周围旋转和周旋转联合转子间外翻截骨治疗髋臼发育不良15例15髋,术前、后X线片影像变化。A组髋臼发育不良15例15髋,测量马蹄角,计算平均值 计算术前、后角度差平均值。B组正常10例10髋马蹄角做对照。结果髋部截骨术使马蹄角与头赘相关节-启动第二髋关节。马蹄角均值：A组术前30.80±3.93°,术后19.27±1.58°,术前、后角度差11.53±3.74°。B组20.00±1.77°。A组术后与B组比较,统计学无差异。A组术前与A组术后和B组比较,差异显著。结论圆形股骨头、马蹄角〉23°,行髋臼周围前外侧12°旋转截骨术 椭圆形股骨头、马蹄角﹤23°,行转子间外翻30°截骨术 椭圆形股骨头、马蹄角〉23°,行联合截骨术。     

成人大骨节病与骨关节炎患者髋关节影像学表现的对比研究

目的：研究成人大骨节病髋关节病变的影像学特点,并与骨关节炎患者进行对比。方法：对四川省壤塘县112例（224髋）确诊为成人大骨节病的患者进行髋关节摄片,观察髋关节髋臼侧、股骨侧有无影像学改变,测量髋关节Sharp角、CE角、髋臼指数、头转子间距离、头颈指数和颈干角,并将测量结果与我院40例（80髋）原发性骨关节炎患者进行对比分析。结果：224髋中有22髋（9．8％）出现髋部异常改变,主要表现为髋臼软骨下骨硬化或囊变、股骨头形态不规则伴密度异常、颈干角变小。112例患者Sharp角平均37．92°、CE角平均30．26°、髋臼指数平均43．86、头转子间距离平均1．69cm、头颈指数平均1．80、颈干角平均121．8°。与骨关节炎患者相比,大骨节病组患者颈干角较小,其组间差异有统计学意义（P〈0．05）,但均在正常范围内;其余测量指标两组比较均无统计学差异。结论：成人大骨节病部分患者髋关节在影像学方面具有异常改变,主要表现为髋臼软骨下骨硬化或囊变、股骨头形态不规则伴密度异常、颈干角变小。上述影像学改变与骨关节炎患者相比无明显特异性。     

Crowe Ⅳ型髋关节发育不良患者全髋关节置换术下肢长度平衡的调节

目的 探讨Crowe Ⅳ型髋关节发育不良(DDH)全髋关节置换术(THR)中肢体长度平衡的调整原则及方法。方法 回顾性分析2009年7月—2012年6月行THR治疗的39例(41髋)Crowe Ⅳ型DDH患者的临床资料,根据双髋脱位情况对其进行分型,按分型设计并实施手术,分析随访结果。结果 根据双髋脱位情况分为4个亚型,其中Ⅰ型2例、Ⅱ型18例、ⅢA型6例、ⅢB型9例、 Ⅳ型4例。术前患者两下肢长度平均差异为5.1 cm, 术后为-1.4 cm。患者随访时间12～36个月平均22.4个月。最终随访的平均SF-12健康评分为16分(区间为13~22分)。结论 根据不同分型对Crowe Ⅳ型DDH患者设计个体化重建手术方案,按设计方案可有效调整下肢长度差异。     

Hip stress reduction after Chiari osteotomy

A mathematical model was developed to study the effect of the Chiari osteotomy on the distribution of contact hip stress over the weight-bearing area. It was shown that Chiari osteotomy can increase the weight-bearing area directly (on the lateral side), owing to the additional area formed by theala ossis ilii segment, and indirectly (on the medial side), owing to the shift of the stress pole in the medial direction. As a consequence, the contact hip stress is reduced after Chiari osteotomy. The indirect effect is important and often larger than the direct one. Using the proposed mathematical model and standard anteroposterior roentgenographs from archives, the average peak stress on the weight-bearing area, normalised with respect to the body weight (p_max/W_B), was determined before and after Chiari osteotomy (8310m⁻² and 4480m⁻², respectively) on a population of 29 dysplastic hips. The difference was statistically significant (p<0.005). Based on the results presented, it can be concluded that the hip joint contact stress in dysplastic hips considerably decreases after Chiari osteotomy, indicating a favourable biomechanical effect of this operation.     

全髋关节置换术治疗脊髓灰质炎后遗症患者非瘫痪侧髋关节发育不良的效果观察

目的 探讨全髋关节置换术(THA)治疗脊髓灰质炎后遗症患者非瘫痪侧髋关节发育不良(DDH)的临床效果。方法 回顾性分析2015年1月-2018年4月解放军东部战区总医院骨科收治的12例非瘫痪侧因DDH行THA的脊髓灰质炎后遗症患者的临床资料。其中男5例,女7例;年龄35～52岁,平均40.2岁;CroweⅠ型6髋,CroweⅡ型5髋,CroweⅢ型1髋。患者均采用后外侧入路治疗。观察患者手术时间、术后住院时间、出血量及并发症;对比手术前后患者Harris 髋关节评分和疼痛VAS变化,采用Harris髋关节评分评定疗效。结果 本组12例患者均顺利完成手术。手术时间51～91(64.9±11.0)min;术中出血量203～347(282.7±44.4)mL,术后急性失血量353～485(414.2±51.6)mL;术后住院时间4～9 d。术后无感染、骨折、神经血管损伤等并发症发生,手术切口均获得一期愈合。术后患者均获随访6～24个月,平均18个月。随访期间,患者下地行走良好,无假体脱位及假体松动发生。末次随访髋关节Harris评分较术前明显增加,分别为(62.8±7.52)和(90.2±2.64)分;末次随访VAS较术前明显降低,分别为0.00(0.00, 0.00)分和4.00(3.00, 6.00)分,差异均有统计学意义(t=11.913、Z=10.864,P值均＜0.05)。术后髋关节Harris 评分评定:优10髋,良2髋。结论 通过对髋关节假体安放位置进行合理设计,采用THA治疗脊髓灰质炎后遗症患者非瘫痪侧DDH可以取得满意的疗效。     

经髋臼顶及耻骨上、下支骨盆三处截骨矫正髋臼发育不良的应用解剖

目的：探讨经髋臼顶、耻骨上、下支骨盆三处截骨术矫正髋臼发育不良的耻骨上支截骨角度和耻骨下支截骨长度,为临床截骨矫形,达到理想股骨头覆盖提供解剖学依据。方法：选取15具成人湿性骨盆标本（30侧髋关节）,随机分成A组、B组,每组15侧髋关节;再将其随机分为3个亚组,每组5侧髋关节。将髋臼CE角打磨成0。,制作髋臼发育不良模型,再按Salter截骨将髂骨截断。A、B两组分别在耻骨上支中点由内上向外下与矢状面成30。和45。截断,各亚组依次将耻骨下支在耻骨联合以远分别截去1．0cm、1．5cm、2．0cm骨块。截骨后将髋臼向前外及下方旋转,并用克氏针固定髂骨截骨端。测量A、B各亚组耻骨上支断端的接触面积,摄x线片,测量各亚组的cE角、Sharp角、臼头指数等几项数据。所得数据用SPSS13．0软件进行统计学处理。结果：A组各亚组耻骨上支的接触面积均小于B组,差异有统计学意义（P〈0．01）,A、B组内3个亚组间的cE角、Sharp角以及臼头指数值比较差异有统计学意义（P〈0．01）;A、B两组间的各亚组的cE角、Sharp角以及AHI值比较差异无统计学意义（P〉0．05）。结论：经髋臼顶及耻骨上、下支骨盆三处截骨术中,在耻骨上支中点由内上向外下与矢状面成45。截骨条件下,耻骨下支截除2．0cm骨块,能够达到最佳的耻骨上支断端接触面积和实现股骨头满意覆盖的CE角、Sharp角及臼头指数值。     

全髋关节置换并结构性植骨治疗CroweⅢ型髋臼发育不良性骨关节炎

背景：CroweⅢ型髋关节发育不良在继发骨关节炎时需要行全髋关节置换,置换中髋臼的重建是重点和难点。 目的：观察全髋关节置换并结构性植骨治疗CroweⅢ型髋臼发育不良性骨关节炎的效果。 方法：选择北京朝阳医院骨科2006-01/2009-08收治的CroweⅢ型髋关节发育不良继发骨关节炎患者15例(18髋),均施行了全髋关节置换+髋臼自体结构性植骨。 结果与结论：全部患者均获得随访,随访时间12-24个月,平均18个月。所有病例髋臼旋转中心都接近正常,置换前双下肢长度差为2.0-3.5 cm,置换后双下肢长度差为0-1.5 cm。至末次随访,Harris评分由置换前的平均38分(17-69分)升高至92分(86-96分)。提示CroweⅢ型髋关节发育不良继发骨关节炎的全髋关节置换中,将髋臼重建于真臼内、把髋臼旋转中心内移、辅以结构性植骨,可有效恢复髋臼覆盖、维持臼杯稳定并恢复下肢长度。     

全髋关节置换治疗CroweⅣ型成人髋关节发育性不良

背景：人工全髋关节置换为治疗髋关节发育性不良晚期患者的最佳选择,然而髋关节发育性不良的患者特别是CroweⅣ型因其髋关节解剖结构的显著异常,增加了手术难度且手术方法颇有争议。 目的：探讨人工全髋关节置换治疗CroweⅣ型成人髋关节发育性不良的疗效及髋臼重建与股骨侧处理的方法。 方法：纳入12例(14髋)CroweⅣ型成人髋关节发育不良患者进行人工全髋关节置换,Harris评分术前平均(35.0±6.8)分,髋臼侧采用小臼杯结合髋臼加深技术安置臼杯假体,股骨侧行转子下短缩截骨放置股骨假体,采用Harris评分评价置换后髋关节功能。 结果与结论：所有患者随访1-7年,平均4.6年,2例2髋发生置换过程中股骨大转子不全骨折,予钢丝固定。1例置换后出现坐骨神经刺激症状,1个月后恢复正常,无感染、假体松动及有明显临床表现的深静脉血栓形成等并发症。股骨侧截骨处均骨性愈合。置换后末次随访Harris评分平均为(84.0±7.0)分,置换后肢体延长4-6 cm,平均5 cm,短缩的肢体得到满意纠正。说明采用小臼杯、髋臼内陷技术、股骨短缩截骨对CroweⅣ型成人髋关节发育性不良患者行全髋关节置换能重建关节功能,恢复下肢长度,长期疗效有待于进一步观察。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Tissue engineering of oral dysplasia

Keratinocytes and fibroblasts isolated from dysplastic oral lesions were combined to provide a renewable source of epithelia. A dysplasia-scoring index was devised to compare the architectural and cytological features and used together with robust immunophenotyping to show that the engineered epithelia showed most of the characteristics of the clinical lesions. The strains of dysplastic oral keratinocytes with an extended or immortal lifespan provided a reproducible resource of epithelia showing mild (DOK), moderate (POE9n) or severe (D20) dysplasia when maintained under defined conditions. The dysplasia score was influenced by growth conditions, with KGF polarizing proliferation to the basal layer and reducing the severity of dysplasia. When compared to the normal counterparts, dysplasia-associated fibroblasts expressed MMP9, secreted more HGF, increased the dysplasia score for epithelia generated with mortal dysplastic keratinocytes and induced morphological changes in normal keratinocytes, highlighting the role of the microenvironment in determining the phenotype of dysplastic epithelia.     

全髋关节置换治疗成人髋关节发育不良继发骨关节炎

目的探讨全髋关节置换治疗成人髋关节发育不良继发骨关节炎的手术方法。方法 2004年1月至2009年7月,对26例（26髋）髋关节发育不良继发骨关节炎患者行全髋关节置换术。其中女25例,男1例,平均年龄48.7岁。按Crowe分型：Ⅰ型8例,Ⅱ型13例,Ⅲ型3例,Ⅳ型2例。采用Harris评分和X线检查评价疗效。结果随访6～72个月,平均36个月。Harris评分：术前平均49.6分（28～65分）,术后平均87.4分（72～92分）。术后无坐骨神经麻痹、下肢深静脉栓塞、切口感染和人工关节脱位等并发症,X线显示假体位置良好,所有病例髋臼均为真臼重建,未见无菌性松动和假体下沉等征象。结论全髋关节置换是治疗髋关节发育不良继发骨关节炎的有效方法。     

Salter及Pemberton截骨术治疗DDH的疗效比较

目的 比较Salter及Pemberton截骨术治疗发育性髋关节发育不良（DDH）临床疗效。方法 选取2016年2月~2018年2月我院治疗的58例发育性髋关节发育不良患儿为研究对象,采用随机数字表法分为Salter组和Pemberton组,各29例。Salter组采用Salter截骨术治疗,Pemberton组采用Pemberton截骨术治疗,比较两组临床治疗优良率、AI 角、CE 角、髋臼深度以及并发症发生情况。结果 Salter组临床治疗优良率（89.65%）与Pemberton组优良率（93.10%）比较,差异无统计学意义（P＞0.05）;术后两组CE角、髋臼深度均大于术前,AI角均小于术前（P＜0.05）;Pembert组CE角、髋臼深度与Salter组比较,差异无统计学意义（P＞0.05）;Pemberton组术前AI角大于Salter组（P＜0.05）;随访1年,Pemberton组并发症发生率（6.89%）与Salter组（10.34%）比较,差异无统计学意义（P＞0.05）。结论 Salter及Pemberton截骨术治疗发育性髋关节发育不良均具有确切的疗效,且并发症少,应用安全性良好,但Pemberton截骨术应用范围更广,可作为临床首选术式。     

Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer.

The aim of this study was to investigate the occurrence of (pre)neoplastic lesions in overtly normal Fallopian tubes from women predisposed to developing ovarian carcinoma. The presence of (pre)neoplastic lesions was scored in histological specimens from 12 women with a genetically determined predisposition for ovarian cancer, of whom seven tested positive for a germline BRCA1 mutation. A control group included 13 women. Immunohistochemistry was used to determine the expression of p21, p27, p53, cyclin A, cyclin D1, bcl-2, Ki67, HER-2/neu, and the oestrogen and progesterone receptors. Loss of heterozygosity (LOH) analysis on the BRCA1 locus was also assessed on dysplastic tissue by PCR studies. Of the 12 women with a predisposition for ovarian cancer, six showed dysplasia, including one case of severe dysplasia. Five harboured hyperplastic lesions and in one woman no histological aberrations were found in the Fallopian tube. No hyperplastic, dysplastic or neoplastic lesions were detected in the Fallopian tubes of control subjects. In the cases studied, morphologically normal tubal epithelium contained a higher proportion of Ki67-expressing cells (p=0.005) and lower fractions of cells expressing p21 (p<0.0001) and p27 (p=0.006) than in the control group. Even higher fractions of proliferating cells were found in dysplastic areas (p=0.07) and accumulation of p53 was observed in the severely dysplastic lesion. Expression patterns of other proteins studied, including the hormone receptors, were similar in cases and controls. One subject, a germline BRCA1 mutation carrier, showed loss of the wild-type BRCA1 allele in the severely dysplastic lesion. In conclusion, the Fallopian tubes of women predisposed to developing ovarian cancer frequently harbour dysplastic changes, accompanied by changes in cell-cycle and apoptosis-related proteins, indicating an increased risk of developing tubal cancer.     

Crowe Ⅳ型髋关节发育不良患者全髋关节置换术下肢长度平衡的调节

目的探讨CroweⅣ型髋关节发育不良（DDH）全髋关节置换术（THR）中肢体长度平衡的调整原则及方法。方法回顾性分析2009年7月—2012年6月行THR治疗的39例（41髋）CroweⅣ型DDH患者的临床资料,根据双髋脱位情况对其进行分型,按分型设计并实施手术,分析随访结果。结果根据双髋脱位情况分为4个亚型,其中Ⅰ型2例、Ⅱ型18例、ⅢA型6例、IIIB型9例、Ⅳ型4例。术前患者两下肢长度平均差异为5．1cm,术后为～1．4cm。患者随访时间12—36个月平均22．4个月。最终随访的平均SF-12健康评分为16分（区间为13～22分）。结论根据不同分型对CroweⅣ型DDH患者设计个体化重建手术方案,按设计方案可有效调整下肢长度差异。     

髋关节表面置换术治疗Crowe Ⅰ、Ⅱ型髋关节发育不良

目的 研究Crowe Ⅰ型和Ⅱ型髋关节发育不良(DDH)患者行髋关节表面置换术(HRA)的临床结果。方法 前瞻性将2005年3月—2006年12月80例Crowe Ⅰ 型和Ⅱ型DDH患者随机分入HRA组和全髋关节置换术(THR)组。HRA组中3例改行THR、3例失随访,THR组中2例失随访,故34例37髋接受HRA,38例39髋接受THR。在术后6周、3个月、1年,以后每年1次进行随访,接受放射学及临床评价。结果 HRA组和THR组分别平均随访59.4个月(52～70个月)及60.6个月(50～72个月),2组都未出现假体失败。2组间术后Harris评分差异无统计学意义(P=0.073),但HRA组的屈髋活动度显著优于THR组(P＜0.01)。两组间髋臼假体的平均外展角差异无统计学意义(P=0.982)。HRA组的髋臼假体直径大于THR组(49.5 mm vs 46.1 mm,P=0.001)。结论 Crowe Ⅰ型和Ⅱ型DDH行HRA的临床结果与THR相近,但HRA术后屈髋活动度更佳,HRA在使用较大股骨假体的同时,髋臼会有额外骨量丢失。     

Comparative molecular and histological grading of epithelial dysplasia of the oral cavity and the oropharynx

Histological grading of epithelial dysplasia in the oral cavity and oropharynx is used to predict the risk for cancer and to determine the treatment strategy. This grading, however, is subjective and not well reproducible. Recent publications have shown that molecular markers are promising in cancer risk assessment. The aim of the present study was to compare classical histological and molecular grading and to relate these to the proliferation rate by quantitative assessment of Ki-67 staining. Forty-three samples were analysed from the margins of patients who had undergone resection of their squamous cell carcinoma in the oral cavity/oropharynx. Three experienced pathologists performed the histological grading. With the consensus score, 12 samples were classified as normal and 31 as dysplastic (21 mild, six moderate, and four severe). Loss of heterozygosity (LOH) was assessed in the same samples with 15 microsatellite markers at chromosomes 3p, 9p, 17p, 8p, 13q, and 18q, and was present in 28 of the 43 samples. Twenty-four of the 28 cases (86%) with LOH were classified as dysplastic and four as normal. All ten samples with moderate and severe dysplasia and 14 of 21 samples with mild dysplasia contained LOH. In four of 12 biopsies classified as normal, LOH was found. A very striking and significant difference of the Ki-67 index was observed between LOH-positive and LOH-negative cases, 36.6 +/- 11.1% versus 19.4 +/- 2.8% positive cells, respectively. In mild dysplasia, 13 of 14 lesions containing LOH had a higher Ki-67 index than all seven lesions without LOH. Thus, in the oral cavity/oropharynx, LOH is more frequently found in the histologically higher-grade lesions (moderate dysplasia or worse) and in the lower grade lesions when a high proliferation rate is present. Assessment of proliferation with Ki-67 is a better surrogate for LOH than histological grading.