软组织平衡在全髋关节置换术中的重要性

随着全髋关节置换手术（total hip arthroplasty,THA）的大量开展,临床医师和康复医务人员越来越认识到软组织平衡在THA术中的重要性。笔者知道,THA对于缓解髋部疼痛、改善髋部功能是十分可靠的。但为了优化术后患髋的功能,应该尽可能地恢复正常髋部的解剖结构以及生物力学,     

软组织平衡在全髋关节置换中的意义

目的研究和探讨全髋置换术中软组织平衡的处理方法以及其对并发症的影响。方法对2000年6月～2003年12月年收治的123例全髋关节置换术回顾性分析术前软组织挛缩、肌力的评估、术中软组织平衡的处理及术后肌力的康复锻炼。结果临床结果显示122例全髋关节置换术患者髋关节评分由术前的平均34．8分增加到平均74．5分,全髋置换术后经积极康复训练软组织肌力较术前明显改善。结论全髋关节置换术中软组织的平衡同膝关节的软组织平衡同样重要,有助于全髋关节置换术后的功能的恢复及矫正畸形,预防手术后早期和晚期的不稳定。     

人工髋关节置换术在帕金森病人中的应用

目的：探讨人工关节置换术在患有髋关节病变的帕金森病人中应用价值和手术方法。方法：1999年4月～2002年8月对9例患有髋关节病变的帕金森病人进行人工关节置换术。结果：9例患者术后伤口均一期愈合，经2～4年随访，按Harris评分标准：优2例；良3例；可3例；差1例。结论：人工关节置换术在帕金森病人中的应用是一种安全有效的方法。术前综合评估患者，对术中发现髋关节内收挛缩的患者需行内收肌切断，同时避免广泛的软组织剥离是防止髋关节脱位的关键。     

全膝关节置换术中的软组织平衡

软组织平衡(soft tissue balance)是全膝关节置换术(total knee arthroplasty，TKA)中的重要环节，其处理的好坏直接影响到术后膝关节的稳定性及功能。随着国内TKA的广泛开展，人们对软组织平衡的认识逐渐加深。     

人工髋关节置换术患者护理体会

目的 使全髋关节置换术病人得到有效的护理。方法 对46例人工髋关节置换术患者给予护理干预。结果 术后均治愈出院。结论 通过人工髋关节置换术护理，能有效减少并发症的发生，术后病人能早期下床活动和早期康复出院。     

人工全髋关节置换术前后护理

人工全髋关节置换术可以达到解除髋部疼痛、保持关节稳定、关节活动较好及调整双下肢长度等治疗目的，其手术近期效果往往为其他手术所不及，是成年人髋关节成形手术中最常用的手术方法之一。我院自１９９４年来对５４例病人作了人工全髋关节置换术，通过这些病例，体会到...     

人工髋关节置换术在帕金森病人中的应用

目的:探讨人工关节置换术在患有髋关节病变的帕金森病人中应用价值和手术方法.方法:1999年4月～2002年8月对9例患有髋关节病变的帕金森病人进行人工关节置换术.结果:9例患者术后伤口均一期愈合,经2～4年随访,按Harris评分标准:优2例;良3例;可3例;差1例.结论:人工关节置换术在帕金森病人中的应用是一种安全有效的方法.术前综合评估患者,对术中发现髋关节内收挛缩的患者需行内收肌切断,同时避免广泛的软组织剥离是防止髋关节脱位的关键.     

全膝关节置换术中软组织平衡问题

本文探讨全膝关节置换术中软组织的平衡问题,适当而充分地完成软组织平衡有助于膝内外翻的矫正,预防手术后早期和晚期的不稳定。     

人工髋关节置换术后松动研究进展

人工髋关节置换术（ＴＨＲ）疗效的确切性及可预期性，使更多的病人乐意接受ＴＨＲ。人工关节长期使用导致的无菌性松动是ＴＨＲ失败的最主要原因。病人关节疼痛，最终需要作翻修术。由于初次ＴＨＲ病人增长迅速，翻修的总人数明显增加。防治ＴＨＲ松动是目前人工关节外科...     

全髋关节置换术的软组织平衡

目的探讨THA术后股骨偏心距恢复的重要性及重建方法,恢复髋关节的软组织平衡。方法对73例单侧THA术患者进行随访,手术均采用髋关节后外侧入路。X线片上测量股骨偏心距及髋外展肌的力臂,使用Cybex测量髋外展肌力量,对X线片测量数据进行统计学处理。结果股骨偏心距是否能够重建与髋最大外展肌肌力存在显著性差别(t=3.859;P=0.002);髋关节外展活动范围与股骨偏心距存在明显回归相关关系(r=0.593,P<0.001)。结论THA术中重建股骨偏心距可以增加髋外展肌的力臂,改善髋外展肌的力量,增强髋关节的稳定性。术中应选用近似解剖颈干角的股骨柄假体,适当地增加假体颈的长度。     

屈曲挛缩畸形膝关节置换的软组织平衡

目的：探讨屈曲挛缩畸形的膝关节行关节置换的方法,重点关注术中膝关节周围软组织平衡的方法。技巧及术后疗效。方法：自2010年6月～2012年6月共收治晚期膝关节疾病合并屈曲挛缩畸形患者156例,213膝,采取人工膝关节置换进行治疗,分别记录术前术后膝关节畸形程度,HSS评分,活动范围。并进行比较。本组病例平均年龄60．2岁（44～81岁）,女92例136膝,男64例77膝。膝骨性关节炎85例,类风湿性关节炎58例,创伤性关节炎13例。膝关节活动范围平均52．6°（33．5°～94．1°）。本组病例轻度屈曲畸形：83例117膝,中度屈曲畸形：58例76膝,重度屈曲畸形：15例20膝。平均屈曲畸形程度：45．8°。每例患者均进行术前及术后1年HSS评分进行疗效评价。结果：所有病例获得随访,屈曲挛缩畸形均得到改善,膝关节HSS评分由术前20．7分提高到术后平均73．6分。膝关节活动范围术前平均52．6°提高到术后平均92．7°。结论：晚期膝关节病所致的屈曲挛缩畸形的膝关节行膝关节置换术,除了在术中注意准确截骨外,应着重注意软组织松解,调整力线。     

人工全髋置换术中偏心距与软组织平衡

目的：分析标准股骨假体行人工全髋关节置换术股骨假体颈长和股骨矩保留对偏心距重建的作用，并研究偏心距重建对软组织平衡的影响。方法：68例（71髋，男30例，女38例；年龄17～89岁，平均63．5岁）行初次全髋关节置换术的患者并获得随访，采用Harris评分，Cybex-6000等速测定患髋外展肌力，测得偏心距、股骨矩、假体颈长，综合评估手术结果。结果：假体颈长对偏心距的影响较股骨矩大（t=3．07，P〈0．01），并与偏心距呈正相关关系（r=0．642，P〈0．001，但两者对Harris评分影响的差异无统计学意义（t=0．22，P〉0．05）。股骨头坏死患者术后偏心距较髋关节骨性关节炎患者和股骨颈骨折患者小（t=2．91，3．31，P〈0．01）。偏心距获得重建的髋关节术后外展肌力较偏心距重建不足者优（P〈0．05）。结论：采用标准股骨假体行全髋关节置换术，股骨假体颈长对人工全髋关节置换术后偏心距的重建作用大于股骨矩的保留，偏心距的重建在全髋关节置换术软组织平衡中主要起到增强术后外展肌力的作用。     

Soft tissue balancing in total hip arthroplasty for patients with adult dysplasia of the hip

Objective: To summarize our surgical experience of release and balance of soft tissues around the hip in total hip arthroplasty (THA) for patients with adult dysplasia of the hip (ADH). Methods: From January 2001 to January 2006, 29 adult patients with dysplastic hips (31 hips) were included in this study. Among them, there were 19 women and 10 men, aged from 38 to 65 years. According to the Crowe classification system, there were 8 type I, 12 type II, 6 type III and 5 type IV. THA was performed via a lateral approach. All acetabular cups were reconstructed at the original anatomic location through soft tissue releasing around the hip to restore limb length, and techniques of balance of soft tissue were applied to extend the strength of the hip abductor and improve its function. Results: All patients had restoration of limb length (range, 1.5–4.5 cm). One postoperative dislocation occurred due to slight enlargement of the angle of abduction of the acetabulum. At 1.5‐year follow‐up (mean, 3.2 years) in 29 patients, the Harris score had increased from 42.6 preoperatively to 85.4. All hips were pain free with good function. Conclusion: In order to restore the anatomic structure and physiologic function of the affected hip, the technique of release and balance of soft tissues around the hip should be applied cautiously in arthroplasty of ADH.     

Soft tissue balance of the hip

Release of static and dynamic contractures around the hip provides significant immediate benefits for the patient and accelerates postoperative rehabilitation. Knee pain is decreased, groin pain is eliminated, range of motion of the hip is increased, and functional leg-length difference is reduced. This article emphasizes the importance of techniques used to ensure soft tissue balance.     

Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system

Using a tensor for total knee arthroplasty (TKA) that is designed to facilitate soft tissue balance measurements with a reduced patello-femoral joint, we intraoperatively measured the joint gap and ligament balance of 30 osteoarthritic knees at extension and 90 degrees flexion, with the patella both everted and reduced, while performing primary posterior-stabilized TKA. At the same time, we performed the same measurements with a navigation system and identified correlations between this system and the tensor. Specifically, the R(2) values obtained with the knee in extension and 90 degrees flexion were higher with the patella reduced than with the patella everted. We thereby suggest that the navigation system we describe is reliable for obtaining accurate measurements of soft tissue balancing with the patella reduced.     

软组织平衡在全髋关节置换术治疗成人高位髋关节发育不良中的应用

目的 评价软组织平衡技术在全髋关节置换术治疗成人高位髋关节发育不良的效果.方法 2000年12月至2006年8月应用全髋关节置换术治疗21例(26髋)高位髋关节发育不良患者(CreweⅢ型20髋;Ⅳ型6髋).通过软组织松解及股骨转子下短缩截骨重建髋臼于真臼水平,评价其术后临床及影像学结果.术前Harris评分平均41.2分.结果 21例患者获得13个月～7年随访,平均随访时间4.8年.16例患者术后跛行程度明显改善;通过软组织松解可显著纠正下肢不等长,有效减少手术截骨长度.术后Harris评分平均89.6分.患者术后未见脱位、感染及假体松动.结论 适当的软组织松解和平衡可使高位髋臼重建于真臼,有效地恢复髋关节的形态和功能,获得满意的近期效果.     

Soft tissue balancing in total condylar knee arthroplasty

Soft tissue balancing and correct bone cuts are an entity in correcting malalignment in total knee arthroplasty, and cannot be considered isolated. Distinct bony deformations/deviations need enlarged soft tissue management. The extent of resection of the bone stock has to be planned exactly before the operation. Exact soft tissue balancing is necessary to stabilize the corrected knee. Soft tissue balancing has to be done primarily on the side of the contracture by lengthening of the shortened and contracted structures. After balancing the ligaments should have the same tension in extension and flexion together with the same height of the extension and flexion gap. Because of the classic resection of the tibial head, the femoral resection must follow the Insall-Line, that means 3 degrees to 5 degrees outer rotation in relation to the condyles. Only in this way a symmetric flexion gap can be achieved in combination with ligamentous stability in extension and flexion.     

Soft tissue sarcoma associated with aluminum oxide ceramic total hip arthroplasty. A case report

Malignant tumors around fracture fixation implants have been reported sporadically for many years. Recently, however, reports of sarcomatous degeneration around a standard cemented hip arthroplasty and around cobalt-chromium-bearing hip arthroplasties raise new questions of the malignant potential of metallic ends prostheses. Sarcomatous changes around aluminum oxide ceramics seem not to have been reported in the literature. The present report may be the first documented case of an aggressive soft tissue sarcoma detected 15 months after the patient had an uncemented ceramic total hip arthroplasty. If a causal relationship exists, the incidence of this phenomenon in the United States is 250 times greater than would be expected from statistics on soft tissue sarcoma at the hip. Because of the similarity on plane roentgenograms of this tumor to lesions known to be caused by wear debris, tumors should be included in the differential diagnosis of cases of total hip loosening.