采用Singh指数评价股骨近端防旋髓内钉固定治疗股骨粗隆间骨折临床疗效

目的根据Singh指数,对股骨粗隆间骨折采用股骨近端防旋髓内钉（PFNA）内固定治疗,并对其临床疗效进行分析。方法回顾性分析72例采用PFNA内固定治疗并获得完整随访的股骨粗隆骨折,按照Singh指数将其分成非骨质疏松组（A组）及骨质疏松组（B组）。记录每位患者的手术出血量及手术时间,按照Harris功能评分系统对术后髋关节功能进行评分,并对两组进行比较。结果A组较B组手术时间短（t=-3．956,P〈0．001）、术中出血量少（t=-8．782。P〈0．001）,但两组Harris评分优良率差异无统计学意义（x2=0．176,P=0．675）。结论Singh指数作为临床常用的判断骨质疏松的方法,可以在术前对PFNA内固定治疗股骨粗隆骨折的手术创伤做出正确评估。     

Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

Objective：To discuss the curative effect of the dynamic hip system blade （DHS-blade） on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods：A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of （66.8±3.2） years.According to the Singh Index Classification,all the patients＇ Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results：All patients were followed up for 12-17 months （mean 14 months）.No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months （average 3.5 months）.According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively （P＜0.05）.Conclusion：DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.     

HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures

This study was done to determine if elderly patients with trochanteric fractures and with osteoporosis could benefit from treatment with a dynamic hip screw fixed with HA-coated AO/ASIF screws. One hundred twenty patients with AO, A1, or A2 trochanteric fractures were selected. Patients were divided into two groups and randomized to receive a 135 degree-four-hole dynamic hip screw fixed with either standard lag and cortical AO/ASIF screws (Group A), or HA-coated lag and cortical AO/ASIF screws (Group B). Lag screw cutout occurred in four patients in Group A, but not in any patients in Group B. In Group A, the femoral neck shaft angle was 134 degrees +/- 5 degrees postoperatively and 127 degrees +/- 12 degrees at 6 months. In Group B, the femoral neck shaft angle was 134 degrees +/- 7 degrees postoperatively and 133 degrees +/- 7 degrees at 6 months. The Harris hip score at 6 months was 60 +/- 25 in Group A and 71 +/- 18 in Group B. The superior results of Group B can be attributed to the increased screw fixation provided by the HA-coated screws. We recommend lag screws coated with HA for dynamic hip screw fixation, especially in osteoporotic bone.     

Singh指数与髋关节置换术后关节功能的相关性研究

目的 分析髋关节正位DR片Singh指数与髋关节置换术后关节功能间的相关性,评价Singh指数对髋关节置换术后功能的预测能力.方法 对2010年1月至2012年1月在山西医科大学第二医院行髋关节置换术的175例患者进行随访,分析患者术前髋关节正位DR片Singh指数与术后1年患者髋关节Harris评分的Spearman相关性.结果 共获得资料完整病例175例,男81例,女94例.其中骨关节炎病例28例,男12例,女16例;股骨颈骨折病例106例：男38例,女68例;股骨头坏死41例：男30例,女11例.股骨颈骨折患者Singh指数与Harris评分相关性较高（r=0.708,P〈0.01）,股骨头坏死患者Singh指数与Harris评分相关性较低（r=0.642,P〈0.01）,骨关节炎患者Singh指数与Harris评分相关性最低（r=0.541,P〈0.01）,均有统计学意义,男患者Singh指数与Harris评分相关性较女患者高,但差异没有统计学意义.结论 股骨颈骨折行人工股骨头置换术患者可根据股骨近端Singh指数预测术后关节功能状态,但对于股骨头坏死和髋关节骨性关节炎行全髋关节置换术患者Singh指数对术后关节功能预测能力相对较差.     

人工关节置换术治疗老年股骨颈骨折的疗效研究

目的总结人工关节置换术治疗老年股骨颈骨折的疗效。方法对312例应用人工髋关节置换术治疗老年股骨颈骨折患者进行了1~10年的随访观察,获得完整资料276例。采用Harris髋关节评分标准,对股骨颈新鲜骨折和陈旧性骨折应用骨水泥固定与未用骨水泥固定,进行了临床疗效比较和评价。结果本组优108例,良143例,尚可22例,差3例。结论人工股骨头置换术是治疗老年股骨颈骨折的一种较好方法,特别适用于老年新鲜股骨颈头下型骨折。对陈旧性股骨颈骨折髋臼已有病变者,宜选用全髋置换术。是否应用骨水泥固定,比较其中、长期疗效无显著差异,但有骨质疏松者以采用骨水泥固定为好。     

Distal femoral bone mineral density after total knee arthroplasty: a comparison with general bone mineral density

The bone mineral density (BMD) of the distal femur may decrease after cemented total knee arthroplasty (TKA) as a result of the stress shielding effect of the femoral component. The purpose of the study was to determine the changes in BMD of the distal femur compared with those of the femoral necks and the lumbar spine after cemented TKA. BMD of two regions of interest in the distal femur, both femoral necks and the lumbar spine was measured with dual-energy X-ray absorptiometry in 10 patients (age range 41–80 years, mean 62 years) with 12 TKAs preoperatively and during follow-up for 1 year after surgery. The hip and spine measurements were performed for comparison to assess if general changes in BMD occurred after TKA. The median decrease in BMD in the region behind the anterior flange of the femoral component was 22% (95% CI: 12%–33%), while the average decrease in the region just above the femoral component was 8% (95% CI: 2%–13%). The difference in change of BMD between both regions before and 1 year after TKA was significant (p = 0.03).We found less than 1% difference in BMD of both femoral necks and the lumbar spine on average between the preoperative and 1 year follow-up measurements (not significant). A significant periprosthetic distal femoral bone resorption occurred after TKA. BMD of the femoral necks and lumbar spine did not differ 1 year after TKA. Received: 21 March 2000     

Hydroxyapatite-coated total hip arthroplasty in osteoporotic patients

A prospective review was performed on 22 osteoporotic patients (rated from 1 to 3 on the Singh Index) with hydroxyapatite-coated total hip replacements. These results were compared with a control group (Singh Index 4 to 6) of 45 patients (48 hips) with respect to clinical and radiographic data. Surgery was performed over a six-year period (1991 to 1996) and the time to follow-up evaluation averaged 5 years (range: 2 to 7 years). All patients, in both groups, were over 65 years old with an average age of 71 and 73 years, respectively. The pre-operative diagnoses and Harris hip scores were also similar for both groups. Clinical evaluation was based on the Harris Hip score and radiographic evaluations using Engh's criteria. There was no significant difference between the final average Harris hip score in the osteoporotic bone group, which was 87 points, and that for the control group, which was 91 points (p > 0.05). Radiographic evaluation demonstrated confirmed bone ingrowth in most patients in each group; one patient in each group had suspected bone ingrowth. No stems were revised for aseptic loosening and no endosteal lysis was found. Progressive bone formation was seen around the femoral stem proximally. The acetabular components demonstrated no sign of mechanical loosening or osteolysis. Bone formation was found in most patients in zone I, and in a few patients also in zone III. On the basis of the results of this study, it is believed that osteoporotic bone as a factor by itself should not compromise the early results of hydroxyapatite total hip arthroplasty and should provide good results in the long term.     

全髋置换术治疗陈旧性股骨颈骨折

目的：探讨陈旧股骨颈骨折有效治疗方法及临床疗效。方法：自2002年1月～2008年10月,采用全髋置换术治疗60例陈旧股骨颈骨折患者。结果：60例患者平均年龄为65岁,术后平均随访30个月,平均Harris评分由术前的37．70分增加到术后90．6分,1例患者在术后1周内功能锻炼时出现1次假体脱位,手法复位后未再发生脱位。6例患者术后6月行走时有轻微疼痛,对症处理后缓解。日常生活自理,余患者无严重疼痛、功能障碍及术后早期脱位、人工假体下沉、断裂、松动等并发症发生,疗效满意。对术前、术后Harris评分及术后1年评分结果加以统计分析,发现术后评分明显高于术前（P〈0．05）,与术后1年随访结果比较,差异无显著性意义（P〉0．05）。根据Harris评分,手术治疗优良率为90％。结论：全髋置换术是治疗陈旧性股骨颈骨折比较有效的方法。     

Femoral trabecular-pattern index and bone mineral content measurement by photon absorption in senile osteoporosis.

A comparative study of the usefulness of the femoral trabecular-pattern index (Singh index) and bone mineral content measurement by photon absorption in senile osteoporosis was performed in 106 white women, seventy to ninety-five years old. In 17% of the subjects adequate hip roentgenograms could not be obtained. Interpretation of the Singh index was not found to be simple and easily reproducible. A positive correlation was noted between the bone mineral content and the Singh index. The incidence of previous vertebral and non-vertebral fracture was noted to be inversely related to both bone mineral content and the Singh index, but neither method clearly separated subjects with fracture from those without fracture.     

经伤椎固定与经伤椎植骨在治疗胸腰段爆裂骨折的病例对照研究

目的：比较经伤椎固定与经伤椎植骨治疗胸腰段单节段爆裂骨折的临床疗效。方法：对2008年8月至2010年8月收治的48例胸腰段单节段爆裂骨折患者（均为A3型）进行回顾性分析,其中24例采用短节段固定联合伤椎椎弓根螺钉固定（A组）,24例采用短节段固定联合伤椎椎体植骨（B组）。A组中男14例,女10例,平均年龄（44．0±7．4）岁（34—56岁）;B组中男13例,女11例,平均年龄（42．5±7．1）岁（31-54岁）。比较两组术前和术后相关影像学参数及手术时间、出血量、并发症。结果：两组患者的性别、年龄、损伤部位、手术出血差异无统计学意义。手术时间A组少于B组。两组患者术后即刻椎体高度、后凸角均明显恢复;术后3个月与术后即刻比较,A组椎体高度、后凸角无明显丢失,但B组椎体高度、后凸角有明显丢失;术后1年与术后3个月比较,两组椎体高度、后凸角无进一步丢失。A组手术失败率小于B组。结论：对胸腰段单一爆裂骨折,经伤椎椎弓根固定手术时间少,比经伤椎植骨更有利于维持术后伤椎高度和矢状位排列,值得推广应用。     

Singh指数在骨质疏松性髋部骨折中的应用研究

老年骨质疏松性髋部骨折一直是骨科工作者重点关注问题,其致死致残率逐年上升。传统的评价骨质疏松指标Singh指数在临床工作中广泛应用。普通X线上即可快速评定其级别,在预测髋部骨折是可作为重要参考指标,同时Singh指数与骨密度、股骨解剖结构及多种生化指标相结合提高了预测髋部骨折的准确率。而对已存在的髋部骨折治疗时评估骨骼质量、内固定物选择及降低固定失败率方面具有指导意义,对术后关节功能的早期恢复,避免长期卧床并发症的发生也都具有应用价值,可对髋部骨折手术创伤作出正确评估。现对其研究及进展状况做简单综述。     

Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography: an experimental study in dogs

Objective: To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis (AVN) of the femoral head by single photon emission computerized tomography and computerized tomography (SPECT/CT). Methods: Totally 18 adult beagle dogs were divided randomly into three equal-sized (n=6) groups. Subsequently different degrees of ischemia model were developed by destroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tissues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/ CT was performed. Laser Doppler Flowmetry (LDF) measurements were also obtained at three different time points (before operation, immediately and three hours after operation) in order to assess the change process of blood supply to the femoral head. Results: SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femoral heads in Group A (t=-0.09, P=0.94) and Group B (t= 0.52, P=0.62). However, in Group C, it was 261 ±62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from (45.0±3.3) PU to (39.1±3.7) PU in Group A, from (44.0±2.7) PU to (34.3±2.6) PU in Group B, and from (47.3 ±2.1) PU to (4.96±0.6) PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. Conclusion: SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN.     

唑来膦酸盐(5mg)干预绝经后骨质疏松症对骨量的影响

 目的 观察唑来膦酸盐(5 mg, 单次)治疗绝经后骨质疏松症妇女骨密度和跌倒风险的作用。方法 采用随机对照研究, 观察期为1 年。91 例绝经后骨质疏松症妇女经知情同意后, 随机分为两组。唑来膦酸盐组45 例院唑来膦酸盐5 mg(30 min 静脉滴注, 1 次), 骨化三醇0.25 ug 和钙剂600 mg 及维生素D 125 ID(1 次/d, 1 年); 对照组46 例院骨化三醇0.25 滋g 和钙剂600 mg 及维生素D 125 ID(1 次/d, 1 年)。用药前和用药12 个月后测量腰椎尧髋部及股骨颈骨密度和跌倒风险, 并进行患者不良反应和随访情况进行比较。结果 干预1 年后, 两组各有41例患者得到随访。与干预前自身比较, 唑来膦酸盐组患者腰椎尧髋部总量和股骨颈骨量均明显增加, 分别为5.8%, 3.9%和2.9%, 差异均有统计学意义; 对照组患者腰椎骨量与干预前自身比较有明显增加, 达4.4%。两组患者经治疗后跌倒风险较治疗前均明显降低, 组间比较差异无统计学意义。唑来膦酸盐组患者未见无法耐受的不良反应。结论 唑来膦酸盐(5 mg, 单次)治疗绝经后骨质疏松症可明显提高腰椎尧髋部和股骨颈骨密度, 联合应用活性维生素D 能进一步降低跌倒风险。唑来膦酸盐(5 mg)是临床骨质疏松症长期治疗疗效得以保证的重要手段。     

强直性脊柱炎股骨近段形态学改变对全髋关节置换术假体选择的意义

目的分析强直性脊柱炎股骨近段的形态学改变,及其改变对全髋关节置换术假体选择的意义。方法1999年1月~2004年6月,将13例(16髋)强直性脊柱炎患者设为选择组,患者均已出现关节强直,需行全髋关节置换术。另16例(19髋)为对照组,为非强直性脊柱炎患者而拟行全髋关节置换术。两组患者均摄髋关节正侧位X线片,测量Singh指数、髓腔张开指数、皮质形态指数及皮质骨指数,并进行统计学分析。结果选择组Singh指数、髓腔张开指数及皮质形态指数分别为3.81±0.54、2.63±0.41及2.02±0.38,对照组分别为4.63±0.62、3.03±0.27及2.76±0.28,两组比较差异均有统计学意义(P<0.05)。选择组皮质骨指数为1.69±0.69,对照组为2.12±0.24,两组比较差异无统计学意义(P>0.05)。选择组患者髓腔呈烟囱型10例13髋,普通型3例3髋;对照组烟囱型3例3髋,普通型13例16髋。结论强直性脊柱炎的全髋关节置换术应采用骨水泥型人工关节假体,并根据患者髓腔形态使用定制型骨水泥假体,以达到更好的近段固定效果。对于有严重骨质疏松者应按关节翻修术处理。     

新型骨囊袋填充椎体成型术在骨质疏松性压缩骨折后不同时期干预的临床疗效

摘要：目的 探讨分析发生骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCF）后不同时期行新型骨囊袋填充椎体成型术（Vesselplasty）干预，在临床症状、影像学和术后并发症等方面的区别。方法 对自2018年1月至2020年1月在首都医科大学附属北京友谊医院采用Vesselplasty治疗的125例OVCF患者的临床资料进行回顾性分析，根据手术时机分为两组：早期手术组（4周内手术）72例，共115个椎体；延迟手术组（4周后手术）53例，共73个椎体。比较所有患者手术前、术后1 d和术后1年的VAS评分、ODI评分、伤椎前缘高度比、脊柱后凸角（LKA）和手术并发症等情况。结果 两组患者术后1 d和术后1年的VAS、ODI和LKA与术前相比均明显减小（P＜0.05），两组间同随访时期的VAS、ODI评分无明显差别（P＞0.05），但A组的LKA明显小于B组（P＜0.05）。两组中所有患者术后1 d与1年的椎体前缘高度与术前相比均明显恢复（P＜0.05），但同随访时期A组的椎体前缘高度比明显大于B组（P＜0.05），且在术后1年时B组伤椎高度丢失明显大于A组（P＜0.05）。两组间的骨水泥渗漏率无明显差别（P＞0.05），术后1年相邻椎体继发骨折患者例数与再手术率B组高于A组（P＜0.05）。结论 对OVCF早期与延迟行Vesselplasty干预在改善VAS、ODI和在骨水泥渗漏方面无明显差别，但早期Vesselplasty治疗可更好地恢复椎体高度，减轻术后椎体再塌陷和减少相邻椎体继发骨折。     

骨水泥型全髋关节置换术后预防血肿的措施

目的探讨骨水泥型全髋关节置换（total hip arthroplasty,THA）术后血肿形成的原因及相应的处理措施,以最大限度减少并发症。方法对2000年3月～2006年10月收治的103例骨水泥型THA患者进行对比研究,其中男44例,女59例;年龄36～89岁,平均55.3岁。股骨颈骨折49例（均为Garden4型）,股骨头无菌性坏死26例（均为Ficat4期）,骨关节炎28例（均为Tonnis3期）。病程1d～8年,术前Harris评分19～48分,平均36分。2000年3月～2003年12月收治的43例按常规THA术进行操作（A组）;2004年1月～2006年10月收治的60例在常规THA的基础上,采用术中缝扎外旋肌断端、拔管后加压包扎、延长术后卧床时间等改进方法（B组）。结果A组术后9例假体周围发生血肿,9例抽出积血量为110～410ml,平均317.8±75.3ml;第1次抽出积血量为50～125ml,平均86.7±30.7ml;抽血2～7次,平均4.2次。B组术后2例假体周围发生血肿,2例抽出积血量分别为110ml和160ml;第1次抽出积血量分别为40ml和60ml;抽血3次和4次。两组比较差异有统计学意义（P〈0.05）。两组术后共91例（A组39例,B组52例）获随访1.2～5.5年,平均3.7年,采用Harris评分评定髋关节功能,A组平均78分,B组85分。其中,疼痛项评分：A组A级（44分）16例,B级（40分）24例,C级（30分）3例;B组A级48例,B级12例,无C级。两组间Harris评分比较差异无统计学意义（P〉0.05）。结论采用缝扎外旋肌断端、拔管后加压包扎、延长术后卧床时间等方法,可有效减少骨水泥型THA术后假体周围血肿的发生率及积血量。     

Minimally invasive direct anterior approach versus standard lateral approach in the management of tumors of the femoral neck

BackgroundTo compare the clinical outcomes of patients with benign or aggressive tumors of the femoral neck who underwent surgical curettage with the use of the direct anterior approach (DAA) and a standard lateral approach.MethodsThose patients from 2010 to 2017 were retrospectively enrolled. The patients were divided into two groups: group A, consisting of patients who had undergone surgery via the lateral approach; and group B, consisting of patients who had undergone the same procedure via the DAA.ResultsFifty-eight patients were divided into group A (n = 46) and group B (n = 12). The median follow-up was 43 months (15–97 months). There was no significant difference in the 1-year and 3-year recurrence rates (p = 0.74). Group B had comparable operation time and a significantly shorter incision length, less intraoperative blood loss, less postoperative drainage, a shorter hospital stay and less pain on the first postoperative day. Group B also had better hip function as assessed by the Harris Hip Score one month and one year postoperatively. One patient in group B experienced intraoperative incomplete fracture of the femoral neck, which was treated conservatively.ConclusionsSurgical curettage for patients with benign or aggressive tumors of the femoral neck via the DAA had a comparable local control rate and a better perioperative and functional outcome than via the lateral approach. Certain quality of the femoral neck should be required to avoid pathological fracture, which is difficult to treat by internal fixation in the DAA.     

髋关节骨关节炎与骨质疏松的关系

作者采用随机区组设计比较了１２６名老年人中髋关节骨关节炎及骨质疏松患者与正常对照组的Ｓｉｎｇｈ指数及骨关节炎程度。结果表明，三组之间的Ｓｉｎｇｈ指数及骨关节炎程度均相差非常显著（Ｐ＜０．０１），其中骨关节炎组的Ｓｉｎｇｈ指数高于股骨颈骨折组（Ｐ＜０．０１）和正常对照组（Ｐ＜０．０５）。股骨颈骨折组的骨关节炎程度则轻于骨关节炎组（Ｐ＜０．０１），但与正常对照组相比并无显著之统计学意义（Ｐ＞０．０５）。研究结果提示：髋关节的骨关节炎与骨质疏松之间存在着十分明显的负相关。     

人工股骨头置换与动力髋螺钉治疗老年股骨颈基底部骨折并骨质疏松的疗效比较

目的 分析人工股骨头置换术(artificial femoral head replacement,AFHR)与动力髋螺钉(dynamic hip screw,DHS)内固定在治疗老年股骨颈基底部骨折并骨质疏松患者中的应用,对比两者在疗效上的差异.方法 回顾性分析我科2008年6月至2014年6月期间收治的47例老年骨质疏松股骨颈基底部骨折患者,按照手术方式进行分组:AFHR组22例,DHS组25例.详细记录并比较两组患者术中的出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后第6、12个月髋关节功能的Harris 评分.根据骨盆平片及患髋侧位X线片观察股骨假体及钢板周围骨质的变化情况.结果 AFHR组的术中出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后髋关节功能Harris评分优于DHS组,差异有统计学意义(P＜0.05).结论 对于合并有骨质疏松的股骨颈基底部骨折的老年患者,AFHR手术时间短、出血少、近期髋关节功能恢复良好,临床效果较DHS更具优势.