髋关节结核人工全关节置换术后感染因素分析

髋关节结核人工全关节置换术后感染因素分析２７７５００山东省枣庄市王开结防院赵海英，李玉景髋关节结核人工全髋关节置换术最严重的并发症是感染。我院自１９８６年４月以来对４２例此类患者行人工全髋关节置换术，现将感染原因分析如下：１临床资料１．１全组共４２例...     

髋关节融合术后人工全髋关节置换术

过去受技术或经济原因限制，髋关节结核、髋关节骨关节炎，甚至股骨头无菌性坏死采用髋关节融合术。导致髋关节僵直，活动受限，严重影响患者的生活质量。随着医学技术进步及经济条件改善，人工全麓关节置换术THR普及推广和经验积累，髋关节融合术后运用THR技术改善髋关节功能，使提高生活质量成为可能。作者就我院骨伤科采用THR技术治疗髋关节融合术后患者6例，进行随访观察，近期疗效满意。     

人工全髋关节置换术后近期并发症的护理

焦虑综合症、术后感染、假体脱位、腓总神经牵拉伤、髋关节僵硬等是人工全髋关节置换术后常见的近期并发症。如何预防和护理这些并发症,是保证该手术成功的关键。我科自1994年12月至1997年4月收治42例人工全髋关节置换术患者。在预防和护理近期并发症方面取得了一定的经验,收到了良好的效果。     

人工全髋关节置换术治疗先天性髋关节发育不良的效果

目的探讨人工全髋关节置换术(THA)治疗先天性髋关节发育不良(DDH)的临床效果。方法对新乡医学院第三附属医院2007年2月至2019年2月行THA治疗的50例DDH患者的临床资料进行回顾性分析。通过Harrs评分标准评价患者的髋关节功能恢复情况,分析手术情况及不良反应情况。结果所有患者均顺利完成手术,手术时间(118.45±8.90)min,住院时间(10.10±1.46)d,术中出血量(707.74±244.48)ml。出院时,所有患者均为Ⅰ期切口愈合,术后股骨近端出现骨折裂隙、坐骨神经损伤、髋半脱位各1例,不良反应发生率为6%。术后,患髋Harris评分明显提高,双下肢长度差明显减小(P0.05)。结论 THA是治疗DDH的可靠手段,可有效改善肢体长度差及髋关节功能,具有推广价值。     

人工全髋关节置换术的护理166例

人工髋关节置换术就是用人造髋关节代替已无法正常使用的病损髋关节，解决疼痛、畸形和功能障碍，恢复和改善髋关节运动功能的手术。2002年1月-2005年12月，我科对166例人工全髋关节置换患者实施系统护理，取得了满意的效果，现报道如下。     

人工全髋关节置换术前后的护理侧重

目的：探讨人工全髋关节置换术前后早期执行科学的康复训练计划的效果。方法：术前采取预防性训练，术后按时间顺序采用计划性护理训练。结果：37例患均无并发症发生，按Harris功能评定标准总有效率达83．8％。结论：此法具有康复快、并发症少的特点。系统的康复护理是手术成功的重要条件之一。     

全髋关节置换术的护理

人工髋关节置换术治疗某些髋部疾患的有效方法。置换成功后，可解除关节疼痛，重建关节功能。我院外二科2000年起共对35例患髋关节疾病的病人进行了人工髋关节置换术，效果良好。现将这项手术的护理体会浅述如下：     

人工髋关节置换术的护理进展

1963年Charnley首先成功的报道了人工全髋关节置换术，从此人工髋关节置换术在临床广泛应用。我国在60年代开始进行关节置换术，近年来已在全国范围内广泛开展。人工关节能有效的恢复关节功能，解除疼痛，且近期疗效明显优于其他手术，提高病人生活质量。现将人工髋关节置换术的护理进展综述如下。[第一段]     

人工全髋关节置换术后功能训练指导

近年来对68例髋关节置换术后患进行主、被动功能训练并配合全面康复护理，有效地降低了合并症及并发症的发生率，明显地提高了患关节功能。     

植骨加盖行生物学固定型全髋关节置换治疗严重成人髋关节发育不良

背景：由于髋关节的异常变,使关节置换手术难度加大、处理困难,其中又以髋臼侧为甚。因此,对髋关节发育不良患者施行全髋关节置换时,对髋臼的处理尤为重要。目的：探讨采用植骨加盖行生物学固定型全髋关节置换治疗 CroweⅢ、Ⅳ型成人髋关节发育不良患者的临床疗效。方法：回顾分析14例髋关节发育不良成人患者,按Crowe方法分型Ⅲ型11例,Ⅳ型3例。所有患者均进行全髋关节置换,置换过程中采用自体般骨颈在髋臼周围做植骨加盖,对置换后及随访时X射线片的影像学资料进行分析,临床疗效采用Harris标准评定。结果与结论：14例髋关节发育不良成人患者均获得随访,随访时间1-9年,平均4.5年。4例患者置换后1年内植骨块发生部分吸收,2年后又重新生长,所有植骨块经X 射线平片证实均与宿主骨愈合,植骨块对髋臼的平均覆盖率为36%,至今无一髋需行翻修,髋关节功能从置换前Harris评分平均35分（26-52分）恢复至末次随访时的平均91分。证实采用自体股骨颈植骨加盖的生物学固定型全髋关节置换是治疗CroweⅢ、Ⅳ型成人髋关节发育不良的有效方法。     

Differences in preoperative function and outcome of patients with versus without sarcopenia after total hip arthroplasty

[Purpose] Public attention regarding sarcopenia has increased in recent years. Patients with sarcopenia reportedly show worse return home rates and activities of daily living at discharge. However, no reports have described the function and outcomes of hip osteoarthrosis patients with sarcopenia after total hip arthroplasty. This study aimed to clarify differences in preoperative physical function and outcomes of hip osteoarthrosis patients with versus without sarcopenia after total hip arthroplasty. [Participants and Methods] Twenty-five patients with hip osteoarthrosis who underwent total hip arthroplasty were included. Evaluation items were preoperative skeletal muscle mass of the extremities, isometric strength of the lower extremities (hip abduction and knee extension), grip strength, and the 10-m timed gait test results. [Results] The prevalence of sarcopenia was 8% (2/25 patients). The sarcopenic group displayed lower skeletal muscle mass index, grip strength, and 10-m timed gait test values. The sarcopenic group showed lower muscle mass in the upper and lower limbs and trunk and lower hip abductor strength than the non-sarcopenic group. [Conclusion] Eight percent of patients developed sarcopenia after total hip arthroplasty. Due to the low average age (66.0 ± 9.5 years), the prevalence was lower than that of other orthopedic diseases.     

全髋关节置换治疗CroweⅣ型成人髋关节发育性不良

背景：人工全髋关节置换为治疗髋关节发育性不良晚期患者的最佳选择,然而髋关节发育性不良的患者特别是CroweⅣ型因其髋关节解剖结构的显著异常,增加了手术难度且手术方法颇有争议。 目的：探讨人工全髋关节置换治疗CroweⅣ型成人髋关节发育性不良的疗效及髋臼重建与股骨侧处理的方法。 方法：纳入12例（14髋）CroweⅣ型成人髋关节发育不良患者进行人工全髋关节置换,Harris评分术前平均（35.0±6.8）分,髋臼侧采用小臼杯结合髋臼加深技术安置臼杯假体,股骨侧行转子下短缩截骨放置股骨假体,采用Harris评分评价置换后髋关节功能。 结果与结论：所有患者随访1-7年,平均4.6年,2例2髋发生置换过程中股骨大转子不全骨折,予钢丝固定。1例置换后出现坐骨神经刺激症状,1个月后恢复正常,无感染、假体松动及有明显临床表现的深静脉血栓形成等并发症。股骨侧截骨处均骨性愈合。置换后末次随访Harris评分平均为（84.0±7.0）分,置换后肢体延长4-6 cm,平均5 cm,短缩的肢体得到满意纠正。说明采用小臼杯、髋臼内陷技术、股骨短缩截骨对CroweⅣ型成人髋关节发育性不良患者行全髋关节置换能重建关节功能,恢复下肢长度,长期疗效有待于进一步观察。     

髋关节置换术围手术期护理及康复护理研究

目的探讨髋关节置换术围手术期的护理、康复指导及训练要点。方法选取2011年8月-2014年8月本院收治的168例髋关节置换术患者,对其围手术期采取有针对性的护理、康复指导及训练。结果术后随访,168例患者均安全度过围手术期,未发生并发症,Harris评分优77例,良82例,中6例,差3例,髋关节置换术的优良率达94.6%。结论加强对髋关节置换术患者围手术期的护理、康复指导及训练,能有效预防并发症的发生,是手术成功及提高患者生活质量的关键。     

小切口人工全髋关节置换术50例临床疗效分析

目的探讨应用外侧小切口行人工全髋关节置换术的临床疗效。方法选择本院2006年4月至2009年4月全髋关节置换术手术患者100例,随机分为观察组和对照组,观察组行外侧小切口全髋关节置换术,对照组行常规人工全髋关节置换术。记录两组患者手术时间、手术出血量、引流量、输血量以及切口长度;观察两组患者术后关节功能的恢复情况;对两组患者治疗前和治疗后进行Harris评分。结果观察组切口长度、术中出血量、引流量、输血量分别与对照组比较,差异有统计学意义,P〈0．05;两组患者术后Harris评分比较,差异无统计学意义,P〉0．05。结论外侧入路小切口行人工全髋关节置换术,手术创伤小,术后早期功能恢复快,但须严格掌握手术适应证。     

保留股骨颈型人工全髋关节置换术初步观察

目的：探讨保留股骨颈型人工全髋关节置换的近期疗效。方法：采用保留股骨颈型人工全髋关节置换术治疗髋关节骨关节病20例（24髋）。结果：本组经过0．5—5a随访，24个人工髋关节临床效果良好。人工髋关节的活动和其后关节功能良好，影像学检查显示人工髋关节位置良好，假体无松动和下沉。结论：保留股骨颈型人工全髋关节置换治疗髋关节骨关节病近期疗效较好，尤其适用于可能需要行假体翻修的中青年患者。     

Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now

The objective of this review is to summarize and analyze the survivorship and the reported results of the use of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head. In the past, THA was thought to have poor survivorship and poor clinical and radiological results in patients with this diagnosis. However, more recent reports have suggested an improvement in the survivorship, radiological results, and outcomes of THAs when performed for this condition. Surgeons have incorporated THA into their practice patterns to the point that an increasing percentage of patients with this particular diagnosis are currently being treated with it. When collapse and/or arthrosis of the necrotic femoral head are present, THA seems to be the most reliable and proven option for its treatment.     

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report

BACKGROUNDA patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARYWe report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSIONAlthough drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.     

Mixed qualitative and quantitative approach for validating an information booklet before total hip arthroplasty

Objective

Providing patients with validated information before total hip arthroplasty may help lessen discrepancies between patients’ expectations and the surgical result. This study sought to validate an information booklet for candidates for hip arthroplasty by using a mixed qualitative and quantitative approach based on a panel of patients and a sample of healthcare professionals.