全髋关节置换术后异位骨化的X线观察

目的了解人工髓关节置换术（totalhiparthroplasty,简称THA）后异位骨化的发病情况及其X线表现。方法对333例（352个髋关节）接受THA的病例作了术后X线随访，时间最短者1年，最长者12年。按Brooker分级法加以分级记录，并与性别、年龄、手术原因等作了比较。结果在随访X线片上共发现异位骨化69例，检出率20.7％，男性较女性检出率高7.2％，但与年龄关系不大。85．5％（59例）的异位骨化出现在术后1年内，但也有迟至术后8年者(1例）。按Brooker分级方法，85．0％均属Ⅰ-Ⅲ级，Ⅳ级者仅15％。因强直性脊柱炎手术而发生严重异位骨化者要较其他病因为多。在X线片上早期的骨化皆位于髋关节外侧，以后在内侧也逐渐出现，形态各异以条片状为多，即使在Ⅳ期时仍以髓关节外侧骨化数量为多。结论异位骨化是THA术后常见的并发症，X线平片是诊断本病最简便经济的方法，也是临床确定治疗方案的主要依据。     

髋关节置换术后异位骨化的蛋白质组研究

目的使用蛋白质组方法,通过比较髋关节置换术后并发异位骨化与未并发异位骨化患者血清蛋白,寻找差异表达蛋白,筛选蛋白质标志物。方法收集2009年8月～2012年3月14例髋关节置换术后患者血清,以髋关节置换术后并发异位骨化（heterotopic ossification,HO）记为HO组,以未并发异位骨化为正常组,蛋白质芯片联合表面增强激光解析离子化飞行时间质谱（SELDI—TOF—MS）技术检测分析两组蛋白质表达谱,寻找差异蛋白。对每个质荷比峰值进行Wilconxon秩和检验,筛选P〈0．05的差异蛋白质峰。结果检测到154个高质量质谱蛋白质峰,其中质荷比为2748的蛋白点的峰值较正常组明显下调,匹配蛋白质为“一2一HS糖蛋白B链（Alpha一2一HS．glycoproteinchainB,AHSGB一链）。结论AHSGB一链的低表达与髋关节置换术后并发HO密切相关,可能为HO的敏感蛋白质标志物。     

Radiotherapy for the prophylaxis of heterotopic ossification after total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trails

Heterotopic ossification (HO) refers to the formation of lamellar bone in soft tissues and is a significant complication after total hip arthroplasty (THA). Radiotherapy has been proven as an effective prophylaxis especially for those patients with high risk of HO after THA. However the dose, timing, and frequency of radiation have yet to be determined. To compare HO progressions with different radiotherapy strategies and explore an optimal radiation option. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trails (through December 1, 2019; no language restrictions) collecting patients who accepted prophylaxis radiation for whom HO progression outcomes were reported. Of 87 identified studies, 10 randomized controlled trails including 1203 patients and 1268 hips were taken to this analysis. Compared with the low biologically effective radiation dose group (biologically effective dose [BED] < 20 Gy), the medium biologically effective radiation dose group (20 Gy ≤ BED ≤ 24 Gy) had statistically significant difference on the prophylaxis of HO (p = 0.003). But for overall incidence of HO, there was no statistically significant difference between low BED group and high BED group (BED > 24, p = 0.21). There was statistically significant reduction in the prophylaxis of HO progression with multiple fractions as opposed to single fraction radiotherapy (p = 0.04). Hips with preoperative radiation were no more likely to observe HO progression than those with postoperative radiotherapy (p = 0.43). Radiotherapy with medium dose (20 Gy ≤ BED ≤ 24 Gy) after THA is an effective dose for preventing HO. In the prophylaxis of HO, multiple fractions seem to be more effective than single fraction radiation. Preoperative radiotherapy could prevent HO progression with the same efficacy postoperative.     

Re-irradiation for prophylaxis of heterotopic ossification after hip surgery.

Heterotopic ossification (HO) may occur after total hip arthroplasty, but fortunately most patients are asymptomatic. Rick factors for HO include previous HO, hypertrophic osteoarthritis, diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, Paget's disease and post-traumatic arthritis. Both pre-operative and post-operative radiotherapy are effective in the prevention of HO in 85-95% of high-risk patients treated. In the few patients who needed re-operation for a variety of reasons, we found that re-irradiation is possible and safe. These case reports present our experience with single dose re-irradiation of the hip in an attempt to prevent post-operative HO.     

人工全髋关节不稳定的影响因素及防治

目的 探讨人工髋关节不稳定的影响因素，以期防止人工全髋关节置换术后髋关节脱位。方法 1995—2005年收治人工关节置换术后脱位患者19例，其中男8例，女11例；年龄54—78岁，平均62．1岁。原发病包括股骨颈骨折4例，病理性股骨颈骨折1例，先天性髋关节脱位5例，骨性关节炎4例，股骨头无菌性坏死2例，人工关节翻修术后3例。8例患者采用闭合复位石膏固定3—6周，1例在闭合复位时死亡，10例在闭合复位失败后或有明确脱位原因的患者，采用手术切开复位。结果 8例患者采用闭合复位、石膏固定3—6周后获得成功。2例患者经闭合复位后再次失败，采用手术切开复位获得成功。8例闭合复位不成功直接手术切开复位获得成功。术后随诊2年，未再出现脱位现象。术后髋关节Harris评分平均82分（72—96分）。结论 人工全髋关节脱位由多种因素造成，强调以预防为主，全面分析和研究患者的具体情况，制定相应的方案，使关节周围组织张力、关节位置和头臼间的匹配关系达到最佳，并选用合适的假体，才能彻底避免髋关节不稳定的发生。     

全髋关节置换术后股骨皮质的肥厚反应

目的 观察全髋转换术后股骨皮质的肥厚反应及其临床意义。方法 １９９３年１月～１９９５年８月，应用同一设计的骨水泥和非骨水泥股骨假体，共施行２４６髋全髋关节转换术。骨水泥组１１７髋，平均随访４．５年；非骨水泥组１２９髋，平均随访４．１年。结果骨水泥组无一例有股骨皮质肥厚，髋关节功能优良率８８．９％，无一例假体松体；非骨水泥组３６髋（２７．９％）出现股骨远侧皮质肥厚反应，髋关节功能优良率９５．３％，假     

Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty

The aim of this study was to investigate the association between preoperative sagittal spinopelvic alignment and postoperative clinical outcomes after total hip arthroplasty (THA). This retrospective study included 92 patients with hip osteoarthritis who underwent primary THA between May 2013 and October 2015. Patients’ characteristics, radiographic sagittal spinopelvic parameters and modified Harris Hip Scores, including function scores (gait scores and functional activities scores), were investigated. Multivariate linear regression analysis was performed to determine the associations between each preoperative sagittal spinopelvic parameter and postoperative hip function The preoperative sagittal spinopelvic parameters that were associated with postoperative gait scores were sagittal vertical axis (adjusted β-coefficient = − 0.28, P = 0.02), lumbar lordosis angle (adjusted β-coefficient = 0.29, P = 0.0089), pelvic tilt (adjusted β-coefficient = − 0.25, P = 0.045), sacral slope (adjusted β-coefficient = 0.27, P = 0.017) and pelvic incidence minus lumbar lordosis angle (adjusted β-coefficient = − 0.31, P = 0.01). The preoperative sagittal spinopelvic parameters that were related to the postoperative functional activities scores were sagittal vertical axis (adjusted β-coefficient = − 0.38, P = 0.0051) and pelvic incidence minus lumbar lordosis angle (adjusted β-coefficient = − 0.39, P = 0.0033). Patients with preoperative imbalanced sagittal alignment such as larger sagittal vertical axis, larger pelvic incidence minus lumbar lordosis and retroversion of pelvis had poorer clinical outcomes than others after THA. While, those preoperative imbalanced patients with anteversion of pelvis may have a compensatory ability which could correct the abnormal sagittal alignment after THA. Preoperative sagittal spinopelvic alignment affected postoperative clinical outcomes after THA.     

Bone imaging after total replacement arthroplasty of the hip joint

Bone imaging was done in patients after total replacement arthroplasty of the hip joint every 3rd month using ^99mTc-HEDP and ¹⁸F. Uptake ratios were estimated over cup/normal hip and femur prosthesis/normal thigh.Ratios decline rapidly and reach a stable level 6–9 months, postoperatively. Eight cases of late infection were predicted correctly 1–3 months before any radiologic evidence was present. In four cases there had been false-positive results with ^99mTc-HEDP while ¹⁸F gave always correct information except in cases of soft tissue inflammation. Here both ^99mTc-HEDP and ¹⁸F ratios were elevated.The early diagnosis of late complications after replacement arthroplasty seems to be possible. The clinical significance, however, is low: only one out of eight patients with manifest infection is still on conservative treatment. Bone imaging should be done to exclude late infection as a cause of pain after total replacement arthroplasty of the hip joint only.Presented in part at the 22nd meeting of the Society of Nuclear Medicine, Philadelphia, Pa, June 17, 1975     

A public health perspective on physical activity after total hip or knee arthroplasty for osteoarthritis

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common treatments for osteoarthritis (OA) with good-to-excellent outcomes. As the US population ages, rates of OA and THA/TKA will continue to rise. People with OA and THA/TKA are less active than those without arthritis or arthrosplasty, respectively. With the numerous documented health benefits obtained from physical activity, it is imperative from a public health perspective that patients are sufficiently active to maintain health after surgery. Increasing moderate-intensity physical activity is a safe, efficacious, and cost-effective mechanism for improving health and reducing health care costs in this population. The return to leisure/sporting activities after THA/TKA is not as well studied as other aspects of functional recovery. In particular, no evidence-based guidelines for physical activity after THA/TKA are available. Most recommendations have been derived from cross-sectional surveys of orthopedic surgeons. Based on the literature, the general consensus for recommendations appears to be to: 1) return to low- to moderate-intensity activities and no-, low-, or intermediate-impact activities within 3 to 6 months postoperatively, 2) discourage high-impact activities, 3) avoid high-contact athletic activities, and 4) educate rather than dissuade patients from resuming leisure/sporting activities. Sports medicine physicians are in an ideal position to counsel patients in regard to leading active lifestyles. The physician can evaluate and treat any remaining functional limitations postoperatively, as well as prescribe the appropriate dose (ie, type, intensity, frequency, and duration) of physical activity. The 2008 Physical Activity Guidelines for Americans can help guide physicians in prescribing the appropriate dose of activity. Finally, physicians can refer patients to evidence-based, community-delivered group exercise and/or behavioral change interventions that are approved by the Centers for Disease Control and Prevention for people with arthritis.     

全髋关节置换术后股骨假体周围骨折的治疗

目的探讨人工全髋关节置换术后发生股骨假体周围骨折的原因和治疗方法。方法2002～2008年第三军医大学大坪医院骨科共收治人工全髋关节置换术后股骨假体周围骨折16例。骨折发生时间为全髋关节置换术后3个月～5年,按Vancouver骨折分型为:A型2例,B1型6例,B2型3例,B3型3例,C型2例。非手术治疗3例,切开复位记忆合金环抱器内固定治疗8例,行长柄假体柄翻修联合记忆合金环抱器固定术2例,骨水泥长柄假体翻修术1例,长柄股骨假体柄翻修联合同种异体皮质骨板、形状记忆合金环环抱器固定术1例,单纯钢板钢缆系统固定1例。术后定期拍摄X线片观察骨折愈合情况,并采用髋关节功能评分标准(Harris评分)观察关节功能。结果除1例B2型患者术后第4天发生肺栓塞死亡外,其余15例均得到1～4年随访。术后半年X线片检查骨折均愈合良好,无感染、无内固定物及关节假体移位、断裂发生。术前Harris评分35分,术后1年评分80分9例,70～80分7例。结论应针对股骨假体周围骨折不同Vancouver类型采取个体化手术治疗。     

髋关节置换术后股骨假体周围骨折的处理

目的:探讨分析全髋关节置换术后股骨假体周围骨折的分型、治疗方法及临床疗效。方法:回顾分析性研究2007-03～2010-08治疗8例全髋关节置换术后股骨假体周围骨折的病例,根据Vancouver分型B1型3例、B3型3例、C型2例。B1型病例采用异体皮质骨板加钢丝环扎牢固固定骨折,B3型病例采用股骨加长柄行翻修术外加同种异体结构骨植骨钢缆环扎术,C型病例均采用柄部单皮质骨螺钉内固定远端骨折部双皮质螺钉钢板内固定并植骨术。结果:所有病例均获随访8～24个月,股骨假体固定可靠,骨折断端对位对线良好,骨折均达到骨性愈合,患肢无疼痛、无肌萎缩,功能恢复正常,Harris评分平均83分。结论:对于髋关节置换术后假体周围骨折治疗应根据其综合情况及骨折分型采用个体化的手术治疗方法,可取得较好的治疗效果。     

人工髋关节置换术后早期腹股沟区疼痛原因分析

目的探讨人工全髋关节置换术后早期腹股沟区疼痛的原因和预防措施。方法回顾性总结189例（193髋）人工髋关节置换患者，其中单侧置换185髋、双侧置换8髋；分析术后早期腹股沟疼痛常见的原因。结果9．3％（18／193）的髋关节在住院期间出现了腹股沟区疼痛，其中深部感染1．6％（3例），切口感染1．6％（3例），髋关节后脱位1％（2例）．患肢过长4．1％（8例），局部血肿1％（2例）。结论详尽的病史采集、仔细的体格检查以及必要的实验室和影像学检查，才能对腹股沟区疼痛做出正确的诊断。而术前适应证的掌握、X线片分析测量、术中外科技术标准化训练、术后正确的康复训练，才能尽量避免并发症的出现。     

点状接触钢板结合改良钢丝内固定治疗股骨假体周围骨折

对7例采用点状接触钢板结合改良钢丝内固定术治疗的股骨假体周围骨折患者的病例资料进行回顾性分析。7例骨折均为Vancouver分型的B1型,骨折均恢复良好,认为采用点状接触钢板结合改良钢丝内固定术治疗此类骨折是目前比较好的治疗方法。     

Bone imaging after cementless press fit total hip arthroplasty

In view of the high rate of loosening of conventional cemented hip prostheses, cementless implants are gaining popularity in Europe and North America. Smooth-surfaced "press fit" prostheses are designed for autolocking in the femoral canal at the time of installation. Fifteen patients were prospectively followed by bone imaging with Tc-99m MDP at three-month intervals after cementless "press fit" hip arthroplasty to define the "normal" distribution of mechanical stress to the surrounding bone, as well as the incorporation of bone allografts used for reconstruction of resorption sites in cases of revision surgery.     

非骨水泥人工髋关节置换术后股骨近端的骨反应--附41个关节X线片分析

目的：观察和分析非骨水泥人工髋关节置换术后股骨近端的骨反应。方法：对３８例４１个关节于术前和术后、术后第２，４，６，８，１０，１２个月及术后每年以同等条件摄骨盆正位像，观察和分析股骨近端的骨反应。结果：４１个关节中有３０个关节发生不同程度的骨反应，其中有些关节同时出现几种骨反应。本组病例所发生的骨反应可分为两类，既增生类和吸收类。增生类多发生在１、３、４、５、７区，这是一种有益的骨反应，能加强对假     

Arthrography after total hip arthroplasty: utility of postambulation radiographs

We compare pre-and postambulation arthrograms in 24 patients with total hip arthroplasty. In nearly half (42%) of these cases, the arthrographic evidence of a loosened prosthesis was more obvious after ambulation. Three patients (12.5%) had components which were normal by arthrographic criteria before walking, but were abnormal afterwards. We conclude that postambulation radiographs are valuable in patients who are examined for suspected loosening of prosthetic components.