微创式人工髋关节置换术的临床价值

目的探讨微创式人工髋关节置换术治疗股骨颈骨折、股骨头无菌性坏死的临床价值。方法 2006年11月至2009年11月采用微创式人工髋关节置换术取后外侧切口治疗股骨颈骨折、股骨头无菌性坏死38例,男21例,女17例,年龄48～96岁,平均72.3岁。全髋关节置换25例,人工股骨头置换13例,使用骨水泥3例。同期对照常规后外侧入路36例,全髋21例,人工股骨头置换15例,使用骨水泥3例。比较切口长度、术中出血量、术后疼痛程度、并发症、下地时间、患肢功能恢复情况。结果全部获得随访,随访时间5～36个月,平均15.4个月。微创组：切口平均长度8～9.8 cm,平均9.2 cm;术中出血量100～480 ml,平均230 ml;疼痛指数4～6分,平均5分;下地行走时间3～13天,平均8天;基本恢复步态25～38天,平均32天。术后并发下肢轻度肿胀1例。常规组：切口长度为16～18.2 cm,平均16.8 cm;术中出血220～690 ml,平均430 ml;疼痛指数6～8分,平均7分;下地时间7～35天,平均26天;基本恢复步态35～68天,平均48天。术后并发肺栓塞1例。结论微创式人工髋关节置换术用于股骨颈骨折、股骨头无菌性坏死患者,体重指数（BM=I）〈30%,对组织创伤小,术中出血少,术后疼痛程度轻,下地时间早,并发症少,加快康复患肢功能,无需特殊手术器械,有利于基层医院推广应用,但术者需要掌握常规全髋关节置换经验和微创手术操作培训。     

人工股骨头置换治疗股骨颈骨折327例

我科自 1983年以来 ,行人工股骨头置换术治疗股骨颈骨折 32 7例 ,随访15 0例 ,效果满意 ,报告如下。1　临床资料本组 32 7例中男 99例 ,女 2 2 8例 ;年龄最小 45岁 ,最大 92岁 ;就诊前诊断新鲜股骨颈骨折 2 43例 ,陈旧性股骨颈骨折 84例 ,均为单侧。2　治疗方法均采用硬膜外阻滞麻醉 ,行髋关节后外侧切口。术中应注意保护坐骨神经 ,保留股骨距 0 5～ 1ｃｍ。假体放置的位置应正确 ,假体均采用Ｍｏｏｒｅ型钛合金型。手术时间一般在 1小时左右。一般术毕不用引流条或负压吸引。手术后患肢行皮牵引一周 ,一周后改穿矫正丁字鞋 ,固定患肢于中…     

人工髋关节置换治疗高龄股骨颈骨折

目的探讨高龄股骨颈骨折人工髋关节置换的疗效。方法采用髋关节后外侧人路对58例（58髋）高龄股骨颈骨折患者行人工髋关节置换。结果经过3～19（8．5±0．5）个月随访,58例术后2～3周均恢复行走活动,无1例死亡。按髋关节功能Harris评分标准：优21例（21髋）,良31例（31髋）,可4例（4髋）,差2例（2髋）,优良率89．7％。结论人工股骨头或全髋关节置换术是治疗高龄股骨颈骨折的有效方法,可早期活动,恢复关节功能,提高生存质量。     

Ⅰ期人工全髋关节置换术治疗有移位的老年股骨颈骨折

目的探讨Ⅰ期人工全髋关节置换术治疗有移位的老年股骨颈骨折的临床效果。方法采用髋关节后外侧改良Gibson入路对有移位的老年股骨颈骨折32例32髋行Ⅰ期人工全髋关节置换。结果32例均获随访,平均时间23.4(12~36)个月。1例术后出现伤口脂肪液化,经清创及伤口换药后愈合;2例出现一侧下肢轻度肿胀,考虑为深静脉血栓所致,予抗凝、抬高患肢等对症处理后肿胀消退。无关节感染、肺部感染等早期并发症,亦未发生假体松动、断裂、脱位和假体周围骨折等严重远期并发症。髋关节功能按Harris评分:优11例,良18例,可3例,优良率90.6%。结论采用Ⅰ期人工全髋关节置换术能降低患者术后再手术率和术后髋关节疼痛发生率,是治疗有移位的老年股骨颈骨折的有效方法。     

前外侧小切口与后外侧切口人工股骨头置换术治疗高龄股骨颈骨折的疗效对比

目的比较研究前外侧小切口和后外侧切口人工股骨头置换术治疗高龄股骨颈骨折的临床疗效。方法2006年9月-2011年1月,我院对80例75岁以上高龄股骨颈骨折患者施行前外侧小切口（43例）和后外侧切口（37例）人工股骨头置换术,对两组患者的手术切口长度、手术出血量、末次随访髋关节评分、术后并发症及住院时间等进行回顾性研究。结果两组间手术切口长度、手术出血量、术后并发症发生率及住院时间方面差异有统计学意义（P〈O．05）;在末次随访髋关节评分方面差异无统计学意义（尸〉0．05）。结论前外侧小切口微创人工股骨头置换术切口小,创伤小,出血量少,恢复快,并发症少,治疗高龄股骨颈骨折效果好。     

外侧小切口髋关节置换术治疗老年股骨颈骨折

目的探讨外侧微创小切口髋关节置换术治疗老年股骨颈骨折的可行性。方法采用外侧小切口对30例患者行髋关节置换术,其中12例行全髋关节置换术,18例行单纯股骨头置换术。结果患者均获随访,时间6～24个月,未出现严重并发症。按Harris评分标准：优20例,良8例,可2例。结论外侧微创小切口髋关节置换术治疗老年股骨颈骨折可行,具有创伤小、出血少、安全、并发症少、恢复快等优点。     

微创小切口在人工全髋关节置换术中的应用

目的 观察微创小切口在人工全髋关节置换术中应用的近期临床疗效.方法 2007年12月～2009年4月,采用髋部后外侧小切口对32例患者进行人工全髋关节置换术;统计分析手术时间、术中出血量、术后伤口引流量、下地活动时间、髋部疼痛评估等.结果 切口长度在8～12 cm,平均9.4 cm;手术时间120～180 min,平均156 min;术中伤口出血量在400～800 ml,平均530 ml;术后引流时间72 h,引流量290～540 ml,平均370 ml;术后开始下地活动时间3～14 d,平均7.6 d;Harris评分:术前平均35分,术后平均94分.结论 应用髋部后外侧入路微创小切口进行全髋关节置换术,具有创伤小、康复快、髋部稳定性好、患者对于手术更易接受等优点,该方式只是适用于常规全髋关节(股骨头坏死、股骨颈骨折等)的初次置换术,不适于特殊髋关节(如先天性髋关节脱位等)的全髋关节置换术.     

两种切口在人工股骨头置换术中的应用

目的 探讨两种不同切口的人工股骨头置换术在老年股骨颈骨折患者中的治疗效果。方法 随机选出30例老年股骨颈骨折患者采用后外侧切口行人工股骨头置换术，与15例同期进行的采取外侧人路人工股骨头置换术进行疗效比较。结果 平均随访时间20个月（4～51个月），外侧切口组在手术时间、术中出血量、住院时间及Harry评分与后外侧切口没有显著差异（P〉0．05），术后切口引流量两组有明显差异（P〈0．05）。结论 人工股骨头置换术是治疗老年股骨颈骨折的一种有效方法，采取后外侧切口及外侧切口均可取得满意疗效。     

后外侧入路微创髋关节置换术治疗老年股骨颈骨折

目的探讨一种安全、创伤小的髋关节置换术治疗老年股骨颈骨折。方法观察后外侧入路微创髋关节置换术治疗老年股骨颈骨折的手术时间,切口大小,出血量等指标,并与传统髋关节置换术治疗老年股骨颈骨折相比较。结果后外侧入路微创髋关节置换术治疗老年股骨颈骨折具有创伤小,出血少,术后疼痛轻,康复快等优点。结论后外侧入路微创髋关节置换术治疗老年股骨颈骨折较传统术式更安全。     

改良前外侧入路对老年股骨颈骨折行髋关节置换术的安全性分析

目的探讨采用改良前外侧入路对老年股骨颈骨折施行人工髋关节置换术的安全性和疗效。方法回顾性分析自2010-01～2012—12采用改良前外侧人路行人工髋关节置换术的62例老年股骨颈骨折,评估改良前外侧入路手术的安全性。其中人工股骨头置换术52例,全髋关节置换术10例。结果本组均获得随访10～46个月,平均25．2个月。X线片显示假体位置正常,无假体松动及脱位,无假体周围骨折。术后髋关节功能按Harris评分标准评定：优54例,良8例。结论对于老年股骨颈骨折,采用改良前外侧人路行人工髋关节置换术对外展肌损伤小。不损伤外旋肌群,不易损伤坐骨神经。老年患者术后可以早期坐起及翻身,降低了脱位发生率,能较快恢复髋关节功能及正常生活。     

Total hip arthroplasty for developmental hip dysplasia

We reviewed 38 hip replacements in 33 female patients (mean age 55.3 years) with developmental hip dysplasia. One patient had died and the remaining 32 patients (36 hips) had a mean follow-up of 12.2 years (range 8–19 years). All hips were replaced using the Müller cemented implant, and in 32 hips bulk femoral head autograft was used. In 33 hips the socket was reconstructed at the level of the true acetabulum. Complications included one intra-operative femoral fracture and two early dislocations. Correction of leg length discrepancy was possible in 30 patients. The post-operative mean modified Merle d’Aubigne and Postel scores for pain, movement and walking were 5.9, 5, and 5.3 respectively. One cup was revised due to aseptic loosening at ten years. All grafts united, but minor graft resorption was noticed in 24 hips, moderate in 2 hips and major in 1 hip.

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Résumé Nous avons examiné 38 remplacements prothétiques de la hanche chez 33 femmes (age moyen 55,3 ans) avec une dysplasie de la hanche. Une patiente était décédée et les 32 autres (36 hanches) avaient un suivi moyen de 12,2 ans ( 8 à 19). Toutes les hanches ont eu un implant type Müller cimenté et pour 32 une autogreffe massive de tête fémorale a été utilisé. Pour 33 hanches la cavité a été reconstruite au niveau du paléo-cotyle. Les complications comprenaient une fracture fémorale opératoire et deux luxations précoces. La correction de l’inégalité de longueur des membres inférieurs était obtenue chez 30 malades. Le score postopératoire modifié de Merle d’Aubigné et Postel pour la douleur, la mobilité et la marche étaient en moyenne de 5,9, 5 et 5,3 respectivement. Une cupule a été révisée pour un descellement aseptique à 10 ans. Toutes les greffes ont consolidé, mais une résorption mineure de la greffe a été remarquée dans 24 hanches, une résorption modéré dans deux hanches et majeure dans une.

     

The infected hip after total hip arthroplasty

We studied the cases of fifty-two patients with an infection at the site of a prosthetic total hip replacement, and are reporting the significant clinical features, infecting organisms, methods of treatment, and results at long-term follow-up. Forty-eight per cent of the hips had had an operation prior to the index arthroplasty, and 42 per cent had a wound complication. All patients had pain in the infected hip, but only 54 per cent had an erythrocyte sedimentation rate of more than thirty millimeters per hour, 44 per cent had fever, and 15 per cent had leukocytosis. In 88 per cent of the patients a single organism was grown on culture, and Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli were present in about 75 per cent. When antibiotic therapy alone was the initial treatment, the infection was eradicated in only one patient. Excisional arthroplasty was the definitive surgical procedure in thirty-three patients and the infection was eradicated in twenty-seven of them, but the clinical result was satisfactory in only twenty. Of ten patients who had a true Girdlestone arthroplasty, none had recurrence of the infection and all had a clinically satisfactory outcome.     

Total hip arthroplasty for congenital hip disease

BACKGROUND: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease. METHODS: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips. RESULTS: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation. CONCLUSIONS: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.     

Total hip arthroplasty in the ankylosed hip

Altered biomechanics secondary to hip ankylosis often result in degeneration of the lumbar spine, ipsilateral knee, and contralateral hip and knee. Symptoms in these joints may be reduced with conversion total hip arthroplasty (THA) of the ankylosed hip. THA in the ankylosed hip is a technically challenging procedure, and the overall clinical outcome is generally less satisfactory than routine THA performed for osteoarthritis and other etiologies. Functional integrity of the hip abductor muscles is the most important predictor of walking ability following conversion THA. Many patients experience persistent limp, and it can take up to 2 years to fully assess final functional outcome. Risk factors cited for increased risk of failed THA include prior surgical ankylosis and age <50 years at the time of conversion THA.     

Total hip arthroplasty after hip joint ankylosis

Background

Back pain and knee pain are typical secondary degeneration symptoms after hip ankylosis. Take down of hip ankylosis and implantation of a total hip arthroplasty (THA) is believed to be a promising treatment option.

Methods

A total of 22 hip ankylosis patients [15 men, mean age 53.7 years (range 30–72 years); 7 women, mean age 50.8 years (range 42–61 years)] underwent THA during 1980–2000 after spontaneous (n = 10) or surgical (n = 12) fusion of the hip joint. The mean duration of ankylosis prior to THA was 32.5 years (range 2–61 years).

Results

At the mean follow-up of 13.2 years (range 2–19 years), the Harris hip score averaged 84.9 points (range 70.1–99.0 points). All patients (100%) confirmed that they would undergo conversion surgery again. Aseptic loosening of two stems (one cemented, one cementless; 9.5%) and two deep infections (9.5%) required revision surgery.

Conclusions

THA is a promising option for treatment of secondary long-term hip ankylosis sequelae. A conversion operation after spontaneous ankylosis provides better functional outcome than after surgical fusion. However, full function with complete pain relief and a negative Trendelenburg sign might be not attainable in all cases.     

Total hip arthroplasty in chronic unreduced hip fracture-dislocation

We treated 15 patients with chronic unreduced hip fracture-dislocations at our hospital; all patients sustained the fracture-dislocations in motor vehicle accidents. All presented to our institution more than 6 months after initial treatment at their local hospitals with uncontained femoral heads; all underwent 1-stage total hip arthroplasty with bone grafting. These patients were monitored for a mean of 71.5 months (range, 36-96 months). All patients had significantly decreased pain, increased function, and increased range-of-motion scores using the Merle d'Aubigné scoring system. All grafts showed radiographic evidence of union. There were 2 dislocations, 1 transient peroneal nerve palsy, and 1 superficial infection. Total hip arthroplasty is effective for relieving pain and restoring function in chronic unreduced hip fracture-dislocations.     

全髋关节置换术后关节不稳的处理策略

正对于晚期关节炎,全髋关节置换可明显减少疼痛,提高患者的功能,具有较高的满意度和较低的手术并发症[1-2]。全髋关节置换的目标是无痛,活动时关节稳定,获得最大限度的活动范围,没有撞击和下肢长度尽量相等[3]。术后一个重要的并发症就是关节不稳,这是引起关节翻修的原因之一。     

Total hip replacement in the previously septic hip

Total hip replacement was performed in either one or two stages in thirty-three hips with active sepsis. The sepsis had followed hemiarthroplasty in six hips, open reduction with internal fixation of a fracture in eight, cup arthroplasty in one, and total hip replacement in eight hips within six years prior to the second total hip replacement. Ten additional patients had total hip replacement following destruction of the hip joint by hematogenous sepsis in nine and by infection following a shrapnel wound in one. Of these thirty-three patients, twenty-three (70 per cent) reveal no signs of infection at three to nine years after prosthetic replacement. Of the remaining ten in whom an infection developed, six had definite recurrences of the original infection, three were infected with organisms different from the original one, and one was either a local recurrence or reseeding from a persistent pyelonephritis. The success rate when the original organism was gram-positive was 78 per cent, including two of three total hip replacements done in the presence of active infection with Staphylococcus epidermidis. The success with gram-negative organisms, however, was only 58 per cent. The prosthetic failure rate was highest in patients who had had a previous infection about a total hip replacement (37 per cent) and in patients who had had a previous infection but no prior prosthetic or internal fixation devices (37 per cent). The lowest prosthetic failure rates were in patients with an infected hemiarthroplasty (16 per cent), an infection around an internal fixation device (25 per cent), or an infected cup arthroplasty. A complete and differential blood-cell count, erythrocyte sedimentation rate, aspiration arthrogram, and radiographs did not effectively predict success or failure. For gram-positive infections, the success rates were similar following either a one or a two-stage procedure. We found that the success rates could be improved by a repeat course of parenteral antibiotics after the total hip replacement even if all preoperative and intraoperative studies failed to identify an infection. Patients with a successful total hip replacement achieved much better functional results than those who had to have a Girdlestone procedure. However, all patients must be carefully assessed prior to reimplantation of a prosthesis because of the high failure rate, especially with gram-negative organisms (Pseudomonas having the gravest prognosis), even when the procedure is done in two stages.(ABSTRACT TRUNCATED AT 400 WORDS)     

Total hip replacement in the congenitally dysplastic hip

Total hip replacement arthroplasty can relieve pain and improve function for many patients with end-stage arthritis.Patients with congenital hip dysplasia, however, present special problems because of the deformities of the acetabulum and femur.Noncemented porous-coated hemispheric acetabular components available in small sizes, and small, straight-stemmed, cemented, femoral components can be used to deal with the bony deformities and have considerably expanded the success of total hip replacement in such patients.The acetabular dysplasia can be managed in most cases by reaming to the medial wall, inserting small-diameter, porous-coated, acetabular components and stabilizing them with screws to provide rigid initial stability. Small portions of the components can be covered with bone graft chips. If necessary, the acetabular component can be placed more proximal than normal, thus increasing the height of the prosthetic hip center, while restoring the limb length with a longer neck prosthesis. a high total dislocation without the development of an adequate false acetabulum, however, requires trochanteric osteotomy, femoral shortening, placement of the acetabular component in the true acetabulum, and the use of straight-stem femoral components.