成人严重先天性髋脱位的人工全髋关节置换术

[目的]探讨成人严重先天性髋关节脱位行人工全髋关节置换术的方法及治疗效果。[方法]13例CroweⅣ级的患者行人工全髋关节置换手术，术前进行骨牵引治疗2周，术中在松解延长的基础上，重建髋关节旋转中心及髋关节外展功能。术后评估肢体延长长度及髋关节功能。[结果]术后平均随访18个月，髋关节Harris评分平均90分，患肢长度平均延长3．1cm，有1例出现坐骨神经牵拉症状，短期未出现假体失败现象。[结论]通过松解延长、重建关节功能、选择合适的假体，并注重对神经血管的保护，成人严重先天性髋脱位可以通过人工全髋关节置换术获得满意的治疗效果。     

人工全髋关节置换治疗成人先天性髋关节脱位19例(23髋)初步随访报告

[目的]探讨人工全髋关节置换手术治疗成人先天性髋关节脱位的疗效。[方法]自1999~2005年共有19例成人先天性髋关节脱位的患者23髋施行了人工全髋关节置换手术,其中1例髋臼过浅而采用特别小型人工髋臼,1例髋臼上缘缺损采用取下的股骨头修整成形螺钉固定后安装人工髋臼假体,其他均采用常规手术方法及关节假体。[结果]19例患者均获得随访,随访时间为14~72个月,平均34.5个月。Harrris评分由术前34.9分(29~42分)转为术后84.8分(70~96分),髋关节疼痛消除。其中有1例患者稍有跛行,持手杖行走,其他18例患者功能明显改善,可以从事正常生活和体力劳动。[结论]人工全髋置换手术方法能恢复髋关节正常位置,增加稳定性和灵活性,使之成为无痛性关节,是治疗成人先天性髋脱位的理想方法。     

12例(12髋)全髋关节置换术后围手术期人工关节脱位分析

1 临床资料 1.1 一般资料本组12例(12髋)均为初次置换,男8例,女4例;年龄55～79岁,平均(66.3±2.5)岁;右髋7例,左髋5例;新鲜股骨颈骨折3例,陈旧股骨颈骨折2例,髋关节脱位并股骨头骨折1例,股骨头无菌性坏死3例,髋臼发育不良并骨性关节炎1例,脑梗塞后遗症2例.采用骨水泥假体8例,生物型假体3例,混合型(髋臼非骨水泥型,股骨柄骨水泥型)1例.     

人工全髋关节置换术后假体松动误诊误治一例

<正>笔者于2009年8月,收治人工全髋关节置换术后假体松动误诊为坐骨神经痛1例。报告如下。1病例报告患者男性,41岁,因右下肢麻木、放射痛1个月余入院。2007年12月因右股骨头无菌性坏死在当地医院行右侧人工全髋关节置换术,术后髋关节功能恢复良好。2009年7月骑摩     

Hardinge入路人工全髋关节置换术治疗髋关节骨关节病分析(附86例报告)

目的 对髋关节骨关节病行Hardinge入路全髋关节置换(THR)进行评价.方法 对86例(98髋)髋关节骨关节病行Hardinge 入路THR治疗.结果 本组79例(88髋)得到随访,Harris评分由术前平均为55.65分,提高至术后平均87.57分.本组未出现神经副损伤,术后感染、脱位及下肢静脉血栓形成等并发症....     

全髋关节置换术后脱位的原因分析及处理

[目的]探讨全髋关节置换术后发生脱位的原因、处理及预防方法.[方法]自1996～2004年在本院行全髋关节置换患者共850例,发生置换术后脱位7例,其中男4例,女3例;平均年龄67岁;通过对术前病史、手术入路、术后脱位的时间以及发生脱位的方向进行回顾性研究以探讨脱位的原因、处理以及如何预防.[结果]本组发生全髋关节置换术后脱位7例,其中5例(5/7)为初次全髋关节置换术后脱位,2例(2/7)为翻修手术后脱位;4例(4/7)有既往髋部手术史;1例有脑部手术后精神异常,不配合治疗;脱位方向均为前脱位;所有患者均采用正外侧入路即改良Hardinge入路.髋臼假体外展角2例(2/7)大于55°.发生脱位时间自术后当天至术后27个月,其中5例发生于术后3个月以内.所有7例患者在脱位后均首先给以麻醉下闭合复位、下肢皮牵引6周治疗,其中6例患者获得稳定并未再复发性脱位;1例患者在复位后3个月内又连续2次脱位,并在复位过程中发生髋臼松动,给以手术翻修髋臼调整外展角后获得稳定.[结论]导致全髋关节置换术后脱位的危险因素主要包括髋部手术史、术后患者不能严格按照医嘱进行康复训练、手术人路以及假体位置不良等.对于大多数脱位患者而言,闭合复位以及皮牵引6周是有效的治疗方法,对于复发性脱位的患者在分析脱位原因后可通过翻修手术获得髋关节的稳定.     

人工髋关节置换术后并发症的预防和护理

人工髋关节置换术是治疗股骨颈头下型骨折、股骨头缺血性坏死及严重髋关节骨性关节炎的有效措施.但其并发症是造成手术失败,影响手术疗效,甚至再行二次手术的主要原因.     

人工全髋关节置换术治疗髋臼发育不良继发骨性关节炎

[目的]探讨人工全髋关节置换术治疗髋臼发育不良继发骨性关节炎的疗效。[方法]对2000年1月～2004年12月间施行全髋关节置换术的38例（42髋）髋臼发育不良继发骨性关节炎病例进行了回顾性分析。[结果]随访3．5年（2．6～5年），Harris评分从46分（25～60分）提高到86分（60～98分），优良率为90．9％，X线片示无假体松动迹象。[结论]人工全髋关节置换术可解决髋臼发育不良继发骨性关节炎所致的髋关节疼痛，恢复关节功能。     

全髋关节置换术后复发性脱位的治疗

[目的]探讨全髋关节置换术后假体复发性脱位的原因及治疗方法。[方法]自1999年7月～2007年1月，共收治全髋关节置换术后假体脱位病人47例，其中复发性脱位13例。对该13例病人做CT及X线检查，了解假体是否松动及假体位置，分析脱位原因。利用稳定实验判断假体稳定情况。根据稳定情况及患者意愿，分别采取手法复位、假体部件调整及翻修治疗。[结果]13例患者均有假体位置异常，11髋稳定实验显示有异常。8例保守治疗中，5例手法复位后未再出现假体脱位；3例手法复位后仍出现脱位，每年脱位1～2次，患者认为可以接受。5例手术治疗中，4例通过组件调整而显示稳定，其中2例采用加长股骨头；1例调整防脱位内衬位置并采用加长股骨头；1例采用防脱位内衬及加长股骨头治疗。1例经部分假体组件调整治疗仍不稳定，更换髋臼和股骨假体。随访6个月～5年，平均2．7年，均未再出现假体脱位。[结论]假体位置异常是全髋关节置换术后假体复发性脱位的主要原因，稳定实验显示有不稳定。治疗应根据脱位原因、关节稳定情况及患者意愿选择不同的治疗方法。     

应用双动髋杯假体预防初次全髋关节置换术后脱位:384例平均15年随访分析

Bousquet教授在1974年首次提出双动髋杯假体的概念,在初次全髋关节置换与翻修术中应用此假体,可以提高术后关节的稳定性.本研究的目的是通过对384例初次手术应用此假体患者的连续观察,评价假体稳定性和体内生存率.随访时间12～20年,平均15.3年.无早期或晚期不稳,13髋的髋臼假体无菌性松动,14髋假体内脱位,7髋聚乙烯内衬磨损,需要更换.以双动髋假体无菌性松动需要翻修为终点,术后18年假体累积生存率是95.5%±4.1%.本组病例证明初次全髋关节置换术应用双动髋杯假体具有良好的远期效果,不仅生存率高,还不发生假体不稳,这增加了应用此假体的信心.     

Conversion of ankylosed hips to total hip arthroplasty

Between 1970 and 1979, 17 patients underwent conversion of ankylosed hip to total hip arthroplasty. The patients' ages ranged from 38 to 82 years and the duration of fusion prior to conversion ranged from five to 60 years. The primary indication for conversion to total hip replacement in all patients was disabling pain in the low back, the ipsilateral knee, and the contralateral hip. The reason for ankylosis varied: five patients had previously undergone fusion for posttraumatic arthritis, two patients for tuberculous arthritis, six patients for osteoarthritis, one for a previous old slipped capital femoral epiphysis which had undergone spontaneous fusion after internal fixation, and two patients for ankylosing spondylitis. Relief of preoperative pain in the lower back was seen in 12 of 13 patients, knee pain was relieved in four out of four patients, and contralateral hip pain was relieved in seven out of 10 patients. Complications included heterotopic ossification, infection, perforation of the posterior shaft of the femur, and failure of trochanteric fixation with subsequent dislocation. Predictable pain relief from pain in the contralateral hip was less predictable and directly related to the degree of osteoarthritis in the contralateral hip. In these patients it is suggested that conversion of the fused hip to total hip arthroplasty be staged with total hip replacement in the contralateral hip as well. The end results were least satisfactory in patients with ankylosing spondylitis.     

Bilateral synchronous total hip arthroplasty for ankylosed hips

Purpose  

We investigated the effect of bilateral total hip replacement (THR) for patients with ankylosed hip joints caused by late ankylosing spondylitis (AS) and to discuss its related pre- and postoperative problems.     

非骨水泥型全髋关节置换术：228髋陶瓷承重面无异响

目的探索减少陶瓷对陶瓷承重面全髋关节置换术后关节异响与碎裂的技术要点。方法2001年4月至2008年4月,199例患者（228髋）应用陶瓷对陶瓷承重面行非骨水泥假体植入,男101例,女98例,年龄19—68岁,平均48．4岁;体重指数19．6～36．5,平均24．3。病因：晚期股骨头坏死（激素、酒精、创伤、特发）115例,髋关节发育不良继发骨关节炎25例,原发性骨关节炎（FAI、陈旧骨骺滑脱）24例,股骨颈骨折（陈旧、移位新鲜）13例,强直性脊柱炎（AS）累及髋关节12例,色素沉着绒毛结节滑膜炎、类风湿关节炎等10例。患者均由同一医师采用改良后外侧入路手术。结果所有患者均获得随访。随访时间1～8年。1髋强力外力后股骨头碎裂,1髋术后脱位,3髋从卧位到坐位及负重时有咔嚓响声。其余患者功能良好。结论选择合适的适应证,遵循规范技术操作,可使陶瓷承重面的全髋关节置换术的异响与碎裂降低到最小程度。     

Cementless total hip arthroplasty in the treatment of severe hip dysplasia or dislocated hips

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy.     

Total hip arthroplasty for arthrodesed hips

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.     

Intermediate-term results after hybrid total hip arthroplasty for the treatment of dysplastic hips

BACKGROUND: In recent studies, good intermediate-term results have been reported after primary hybrid total hip arthroplasty (a cementless acetabular component with a cemented femoral stem) for the treatment of primary osteoarthritis. However, few studies have described the results of this technique in patients with developmental dysplasia of the hip. METHODS: One hundred primary hybrid total hip replacements were performed in ninety patients to treat degenerative arthritis of the hip secondary to developmental dysplasia. Seventy-one patients (eighty-one hips) were available for clinical and radiographic evaluation. The average duration of follow-up was 10.6 years. There were ten men and sixty-one women. Seventy hips were classified as type 1 (dysplasia); seven, as type 2 (low dislocation); and four, as type 3 (high dislocation), according to the classification system of Hartofilakidis et al. RESULTS: At the time of the final follow-up, the average Harris hip score was 86 points. Structural autograft was used in fifteen hips to supplement acetabular coverage. Within five years postoperatively, the acetabular component in six of the fifteen hips had an average of 4.5 mm of vertical migration and an average increase in vertical rotation of 3 degrees, but the position appeared to stabilize thereafter. Revisions were performed in two hips because of recurrent dislocation. No acetabular or femoral component was revised because of aseptic loosening. Osteolysis was identified around two acetabular components and two femoral components. The average rate of polyethylene wear was 0.09 mm per year. CONCLUSIONS: Hybrid total hip arthroplasty for the treatment of symptomatic degenerative arthritis secondary to developmental dysplasia provides favorable results at intermediate-term follow-up. With lower grades of dysplasia, the majority of patients can be treated effectively without a structural bone graft by placement of the cementless acetabular component at a medial or high position.     

Cementless total hip arthroplasty using the omnifit system: An 8.2 year follow-up study of 166 hips

One hundred and sixty-six cementless primary total hip arthroplasties were performed in 133 patients with porous coated Omnifit prosthesis. The average age was 49.7 years. The mean follow-up period was 8.2 years with a minimum of 5 years. Good to excellent clinical results were achieved in 93% of patients. The overall revision rate was 5.4%. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions appeared at an average of 3.8 years postoperatively. Femoral and pelvic osteolysis were seen in 21% and 4% of the surviving hips respectively. All femoral osteolytic lesions were found in the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately one-third of the hips were observed to have excessive wear. Our experience with cementless Omnifit total hip prosthesis is encouraging. Of significant concern is the high incidence of excessive polyethylene wear and osteolysis.     

Total hip arthroplasty for bilaterally ankylosed hips

The purpose of this study was to evaluate the results of bilateral total hip arthroplasties (THAs) with special regard to angle of cup position in patients with bilaterally ankylosed hips. Twenty-four ankylosed hips were converted to THAs in 12 patients. Their mean age was 36 years and they were followed up for more than 3 years (average, 11 years). The mean Harris hip score increased from 55.4 to 82.3 points. Osteolysis and loosening were found in 3 and 2 hips, respectively. Eleven cups of 24 hips (46%) were outside the safe ranges of Lewinnek. Overall outcome after bilateral conversion of bilaterally ankylosed hips to THA was favorable, but the fused position of the contralateral limb had the tendency to define the direction of the malposition of the acetabular cup.     

Surgical challenges in complex primary total hip arthroplasty

Complex primary total hip arthroplasty (THA) is defined as primary THA in patients with compromised bony or soft-tissue states, including but not limited to dysplastic hip, ankylosed hip, prior hip fracture, protrusio acetabuli, certain neuromuscular conditions, skeletal dysplasia, and previous bony procedures about the hip. Intraoperatively, provisions must be made for the possible use of modular implants and/or bone grafts. In this article, we review the principles of preoperative, intraoperative, and postoperative management of patients requiring a complex primary THA.     

The ScanHip total hip arthroplasty: radiographic assessment of 72 hips after 10 years

We analyzed the radiographic and clinical outcome of the ScanHip total hip arthroplasty in 70 patients after 10 years. The Swedish National Hip Register, in which the end-point of the survival analysis is defined as revisions, reported a 10-year survival rate of 94% with the ScanHip, but in the present series 13% of the femoral stems and 29% of the sockets met the criteria for aseptic loosening. Focal osteolysis was found around 8 sockets (11%) and 23 stems (32%) and had occurred significantly oftener around loose sockets, but not around femoral stems. Linear polyethylene wear was significantly increased in loose sockets, but no relationship was noted between polyethylene wear and stem loosening or was there a correlation between clinical symptoms or patients' satisfaction and component loosening. Therefore precise serial long-term radiographic follow-up is the only satisfactory method for detecting aseptic loosening of total hip arthroplasty. It gives the surgeon more detailed information about each case than survival analysis alone.