带旋髂深动脉髂骨块重建髋臼在全髋置换术中应用

目的：探讨用带旋髂深血管的髂骨移植重建发育不良的髓臼观察其能否改善先天性髂臼发育不良和扁平髋作全髋置换手术的疗效。方法：６例病人接受此手术重建髋臼，其中先天性髋臼发育不良２例，４例股骨头无菌性坏死扁平髋，临床上都有活动障碍及严重跛行，髋臼角＞４５°。结果：术后复查６个月～４年，移植骨均一期愈合，无１例髋杯松动移位，６级无痛５例，５级活动时轻痛１例。术后１个月下地行走功能评价，６级正常行走４例，５级跛行不用拐杖２例，髋关节活动度２１１°～２６０°者有２例，１６１°～２１０°有４例。结论：术后使发育不良的髋臼重建成近似正常，全髋置换的髋臼不会松动且能早期活动，承重力强。     

Chiari截骨加髋臼造盖术治疗高龄儿童先天性髋关节脱位

目的：探讨Ｃｈｉａｒｉ截骨加髋臼造盖术治疗先天性髋关节脱位的疗效。方法：分析４２例高龄儿童先天性髋关节脱位,采用单纯Ｃｈｉａｒｉ截骨治疗１５ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术治疗２７ 例的临床资料。结果：随访４０ 例中,单纯Ｃｈｉａｒｉ截骨１３ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术２７ 例,术后髋臼指数１４°～３２°,平均２６°。前倾角２５°～４０°,平均２８°。颈干角１３４°～１４６°,平均１３６°。单纯Ｃｈｉａｒｉ截骨优良率为６９．２％ ,３ 例发生股骨头缺血性坏死,１ 例发生头臼骨质硬化。Ｃｈｉａｒｉ截骨加髋臼造盖术的优良率为８８．８％ ,无股骨头缺血性坏死的发生。Ｃｈｉａｒｉ截骨加髋臼造盖术由于髋臼指数能得到有效的纠正,股骨头复盖接近正常,能很好的恢复正常的髋关节的生物力学关系,因此是治疗高龄儿童先天性髋关节脱位的有效方法之一。     

Chiari骨盆内移截骨术治疗髋臼发育不良

髋臼发育不良指髋臼对股骨头的覆盖不全，关节有半脱位或脱位的趋势。Chiari骨盆内移截骨术由Chiari于1955年提出，该手术足将截骨远端内移，以增加股骨头外侧的包容，使身体的负重力线移向内侧，增强了髋外展肌群的力量，改善跛行步态。此术式主要用于治疗大龄儿童及成人髋臼发育不良。本文就其运用于髋臼发育不良治疗方面的进展进行综述。     

髋臼发育不良继发股骨头缺血性坏死的外科治疗(91例129个髋随访报告)

髋臼发育不良继发股骨头缺血性坏死的外科治疗（９１例１２９个髋随访报告）王宝明陈峰赵振蒙王金池曹君喜杨玉文刘蕾李文英扈文海＊自１９８５年以来，我院应用Ｃｈｉａｒｉ骨盆截骨和旋股外动脉全支移植术，治疗髋臼发育不良继发股骨头缺血性坏死１００例。其中９１例１...     

改良Chiari骨盆截骨术治疗先天性髋脱位

改良Ｃｈｉａｒｉ骨盆截骨术治疗先天性髋脱位李雪陈立东宋盛晗丛智春⒇我院自１９９３年１月至１９９５年３月采用改良Ｃｈｉａｒｉ骨盆截骨术治疗先天性髋脱位５例５髋，随访至今，效果满意。１临床资料５例中男３髋，女２髋，年龄最小４岁，最大１３岁。髋臼角均大于４...     

青少年和成人髋臼发育不良治疗新进展

髋臼发育不良是骨科较常见疾病。早期正确的治疗 ,不仅使髋关节稳定、功能正常 ,而且可防止继发骨性关节炎和关节疼痛。 6岁以下轻中度的髋臼发育不良 ,常可通过单纯髂骨截骨术 ,如Ｓａｌｔｅｒ术式 ,可获得满意效果。但对青少年和成人 ,治疗比较复杂。如Ｃｈｉａｒｉ术式覆盖股骨头的是纤维软骨 ;Ｐｅｍｂｅｒｔｏｎ术式应用的年龄及髋臼旋转范围有限 ;髋臼成型术容易增加对股骨头的压力 ,引起股骨头变形。Ｓｔｅｅｌ三联截骨术 ,由于截骨部位远离髋臼 ,手术效果有限。为此 ,Ｔ彲ｎｎｉｓ[1] 等人改进了骨盆三联截骨术 ,设计经髋臼基底的三…     

综合保髋手术治疗髋关节发育不良晚期病变远期疗效评价

目的:探讨Chiari截骨、血管束植入为基础的综合手术治疗髋关节发育不良晚期病变的远期疗效。方法:42例(61髋)髋关节发育不良晚期病变患者接受以Chiari截骨、血管束植入为基础术式的综合手术治疗。本组年龄27~42岁,平均36.1岁。61髋中行单纯Chiari骨盆截骨、股骨头内血管束植入术39髋,配合髋臼加盖术16髋,配合股骨近端旋转截骨术2髋,配合髋臼加盖术及股骨近端旋转截骨术4髋。结果:本组平均随访时间8.4年,最后随访时,5例5髋已行人工髋关节置换,其他37例56髋Harris评分术前平均58分,术后平均83分,疗效优良43髋(76.8%)。CE角:术前平均8.7°,术后平均28.5°。股骨头覆盖指数:术前平均61.4%,术后平均83.2%。结论:该综合手术方法对髋关节发育不良晚期病变可以显著缓解临床症状,改善髋关节功能,提高患者生活质量,大大延缓人工全髋关节置换术的时间。     

髋臼旋转截骨术治疗髋臼发育不良28例疗效分析

目的：探讨髋臼旋转截骨术治疗髋臼发育不良的临床效果。方法：采用田川法髋臼旋转截骨术治疗髋臼发育不良共２８例（２９髋），随访时间３．２年。手术前后Ｘ线变化及临床评定结果：全部病例术后可使髋关节疼痛消失，功能改善，髋臼和股骨头之间恢复了正常匹配关系。结论：髋臼旋转截骨术是从根本上治疗髋臼发育不良的最有效方法     

Salter骨盆截骨术后骨关节炎发生的病理基础

目的：观察小儿Ｓａｌｔｅｒ骨盆截骨术后髋关节形态学的变化，探讨骨关节炎发生的病理基础。方法：对发育性髋脱位手法复位后失败的６０例，７２髋进行了Ｓａｌｔｅｒ骨盆截骨术。经过平均７．４年的追踪观察，采用系列Ｘ线片观察髋关节形态学的变化，如股骨头的发育，髋臼形态和髋臼硬化带的形态等。结果：７２髋中有６０％出现股骨头增大的改变，５０％髋臼内凹凸不平，髋臼硬化带为外三角形者占３６％。结论：股骨头增大，髋臼的改变成为Ｓａｌｔｅｒ骨盆截骨术后骨关节炎发生的潜在病理基础，应予以关注     

经髋臼缘截骨术治疗成人髋臼发育不良(附56例报告)

目的：探讨手术治疗成人髋臼发育不良的一种新方法。方法：在Chiari骨盆内移截骨的基础上，于髋臼缘上3～mm处进行骨盆截骨；截骨远端内移后，可使畸形半脱位的股骨头，通过关节囊与髂骨近端对股骨头产生良好的覆盖和承重，股骨头覆盖面积明显加大。结果：平均随访25个月，疼痛缓解、髋关节功能优良率达87．5％，X线摄片示股骨头的覆盖率术前为70％，术后上升到95％。结论：经髋臼缘截骨术是治疗成人髋臼发育不良的有效方法。     

Late femoral osteotomy in congenital dislocation of the hip

We describe 95 patients with previously treated congenital dislocation of the hip who underwent femoral osteotomy after the age of five years. The commonest indication for surgery was progressive uncovering and subluxation of the femoral head; other reasons were coxa vara, long leg dysplasia and persistent anteversion. Femoral osteotomy for uncovering of the femoral head (Severin Grade III) in this age group gave good results at maturity only when the acetabular angle was less than 25 degrees before operation. Femoral osteotomy alone was inadequate for true subluxation of the hip (Severin Grade IV).     

Clinical study on coxa magna during the treatment in congenital dislocation in the hip (author's transl)]

Enlargement of the femoral head is frequently observed in roentgenographs during the treatment of congenital dislocation of the hip. Clinical study was performed to clarify the definition, etiology and clinical entity of coxa magna. Three hundreds and three hip joints in 247 patients were examined roentgenographically and follow up for an average of 3.1 years. By measuring the longitudinal and cross-sectional lengths of both the femoral heads and necks, we felt that "coxa magna" should be defined as the condition with enlargement of all of these parameters. The incidence of coxa magna was 47% after open reduction, but only 5% after closed reduction. In most cases, coxa magna was roentgenographically evident approximately 10 months after open reduction. On the other hand, it was noticeable 18 months after closed reduction. In the hips without coxa magna, the acetabular index improved remarkably for 6 months following open reduction, but in the hips with coxa magna, it hardly improved. Coxa magna frequently developed femoral head deformity, unless persistent acetabular dysplasia had improved. The incidence of coxa magna appeared to be closely related to surgical intervention performed on acetabular dysplasia.     

Subluxation of the femoral head in coxa plana

Twenty-two patients who had severe coxa plana had closed reduction for lateral subluxation of the femoral head, as determined radiographically. All had painful limitation of motion of the hip that prevented proper positioning of the femoral head using a brace. The average age when the patients were first seen was eight years and six months. General anesthesia was required in order to obtain the reduction, and percutaneous tenotomy of the adductor longus was done whenever necessary. After the reduction, a Petrie cast was worn for several months. The length of follow-up averaged three years and eight months (range, two years to six years and eight months). Radiographic evaluation at the time of the last follow-up showed nine hips to be spherically congruent, twelve to be spherically congruent, and one to be incongruent. Thus, in 95 per cent of the hips, a congruent joint was obtained using this method of treatment. These results strongly support the concept that all treatment should be directed at containing the femoral head within the acetabulum during the clinically active phase of coxa plana.     

The hip in hereditary multiple exostoses

We defined the characteristics of dysplasia and coxa valga in hereditary multiple exostoses (HME) by radiological analysis of 24 hips in 12 patients. The degree and effect of the 'osteochondroma load' around the hip were quantified. We investigated the pathology of the labrum and the incidence of osteoarthritis and of malignant change in these patients. Coxa valga and dysplasia were common with a median neck-shaft angle of 156 degrees, a median centre-edge angle of 23 degrees and Sharp's acetabular angle of 44 degrees. There was overgrowth of the femoral neck with a significantly greater ratio of the neck/shaft diameter in HME than in the control hips (p < 0.05), as well as correlations between the proximal femoral and pelvic osteochondroma load (p < 0.05) and between the proximal femoral osteochondroma load and coxa valga (p < 0.01). Periacetabular osteochondromas are related to Sharp's angle as an index of dysplasia (p < 0.05), but not coxa valga. No correlation was found between dysplasia and coxa valga. These data suggest that HME may cause anomalies of the hip as a reflection of a generalised inherited defect, but also support the theory that osteochondromas may themselves precipitate some of the characteristic features of HME around the hip.     

Coxa magna following surgical treatment of congenital hip dislocation

We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.     

Experimental studies on the reparative processes of infarcted capital femoral epiphysis in puppies--with special reference to the correlation of radionuclide (99mTc-MDP) uptake with radiological and pathohistological changes (author's transl)

To investigate the correlation of radiological and pathohistological changes with radionuclide (99mTc-methylene diphosphonate) uptake, avascular necrosis of the femoral capital epiphysis of puppies was produced after the modified method of Henard and Calandruccio, by casting the hip joint in the position of hyperextention, full internal rotation and abduction for eighteen to twenty hours. Seventy-six puppies were divided into three groups according to frequency and time intervals of casting; in group A the animals were cast once, in group B cast twice with one week interval between the 1st and 2nd casting and in group C cast twice as group B but with four-week interval. Radiological, pathohistological changes and RI uptake in the capital femoral epiphysis were sequentially studied at certain intervals (1, 3, 5, 9, 15 and 20 weeks after the 1st casting). The results were as follows: 1) The radiological and pathohistological changes in the upper parts of the femora were simulated to those of human LCPD. At three to five weeks after the 1st casting (in group B and C, after the 2nd casting) radionuclide (99mTc-MDP) accumulation in the capital femoral epiphysis decreased compared with the healthy side. At this point X-ray showed coxa plana or vara and sclerotic changes in ossific nucleus, and "head within a head" feature was recognized in several cases. Pathohistologically, osseous healing and connective tissue invasion into the marrow spaces were recognized surrounding the central necrotized focus with multifarious features. 2) Radiologically in the cases of groups B and C, more severe deformities of the femoral head such as coxa vara and/or coxa plana were noted than in group A. 3) As to the RI accumulation, for 3 to 5 weeks after the last casting RI uptake was shown to decrease and then gradually increase compared with the healthy side, and this tendency was more conspicuous in group C than in groups A and B. It can be concluded that 99mTc-MDP is accumulated greatly at the site of active osteogenesis.     

Five-year results following autogenous osteochondral transplantation to the femoral head

The rationale for autogenous osteochondral grafting into necrotic areas of the femoral head is to provide hyaline cartilage for areas of main articular contact pressure. The aim of this study was to present our results of autogenous osteochondral grafting to the femoral head in the treatment of avascular necrosis.The mean follow-up of the five patients was 57 months following autogenous osteochondral grafting to the femoral head using DBCS (diamond bone-cutting system). The number of transplanted cylinders varied between one and three, and the diameter of the cylindrical transplants between 9 and 13 mm.Results were unsatisfactory in four of five hips and these underwent total hip replacement a mean of 49 months following DBCS of the hip.In our hands, osteochondral grafting to the femoral head using DBCS had proven technically possible in restoring the articular surface of the femoral head; however, this operation was associated with unsatisfactory results in four of five cases.     

髋关节牵伸器在重度髋关节发育不良关节成形术中的应用

目的 探讨髋关节牵伸器在重度髋关节发育不良关节成形术中的应用价值.方法 2006年4月至2008年10月对6例(9髋)CroweⅣ型髋关节发育不良及1例(2髋)髋内翻继发髋关节发育不良患者行关节成形术,男2例,女5例;年龄12～5岁,平均30岁.术前用自行研制的髋关节牵伸器牵伸髋关节,首次牵开1.0～2.0 cm,次日开始以1 mm/d速度缓慢牵伸,直至股骨头降至真臼旋转中心水平.更换为皮牵引,重量3kg,牵引针眼愈合后行关节置换术6例(10髋)、臼盖成形术1例(1髋).结果 6例(9髋)的股骨头或大转子顶端牵伸至真臼旋转中心水平.牵伸距离4.0～5.5 cm,平均4.45 cm;牵伸时间30～60 d,平均43 d.无坐骨神经损伤及针眼严重感染发生.关节成形术中未行软组织松解及股骨短缩截骨.1例(2髋)在一侧髋关节牵伸至6.0 cm时加快牵伸速度为1.25 mm/d,12 h后出现腓深神经不全损伤.行分期全髋关节置换,术中股骨短缩截骨3 cm,腓深神经不全损伤半年后恢复.全部患者随访1.5～3.0年,平均2.5年.均获得双下肢等长,臀中肌肌力增加1～2级.Harris髋关节评分由术前平均56.2分提高至术后1年92.2分.结论 髋关节牵伸器可将股骨头牵伸至真臼旋转中心水平,行关节成形术时无须软组织松解及股骨短缩截骨,可减少创伤,缩短手术时间,改善外展肌功能.应严格按照1mm/d速度牵伸,以免引起神经损伤.     

青少年型锁定髓内钉治疗儿童股骨干骨折的疗效

目的 评估青少年型锁定髓内钉治疗儿童股骨干骨折的疗效.方法 采用经大转子外侧置入锁定髓内钉治疗21例儿童股骨干骨折.评估患侧髋、膝关节的功能,测量双下肢长度、股骨颈干角及股骨颈直径,记录切口感染、股骨头缺血性坏死、髋外翻和股骨颈狭窄等并发症发生情况.结果 患儿均获得随访,时间8～34个月.骨折均愈合,时间10～28周....