双侧髋关节后脱位合并髋臼股骨头骨折1例

1　临床资料患者 ,男 ,2 1岁 ,因汽车相撞致双髋部肿痛、活动受限立即入院。查体 :双髋关节肿胀 ,压痛明显 ,双下肢内收、内旋、屈曲畸形且弹性固定 ,双臀部隆起 ,可触及股骨头。髋关节ＣＴ、Ｘ线片显示 :双侧髋关节后脱位、双侧股骨头内缘骨折、双侧髋臼后缘骨折、骨折块明显移位 (图 1)。髋臼骨折块较大 ,累及负重区 ;股骨头骨折难以闭合复位。行切开复位内固定术 ,双侧髋臼各用 2枚螺钉内固定 ,双侧股骨头各用 1枚螺钉内固定 ,螺帽埋于软骨面下。　　术后行股骨髁上牵引 ,6周去除骨牵引 ,双下肢不负重功能锻炼。 8个月后摄Ｘ线片复查 ,髋…     

髋臼前上缘型髋关节前脱位5例

髋关节前后脱位的区分是以Ｎｅｌａ ｔｏｎ线为标准 ,脱位后的股骨头位于该线前方为前脱位 ,位于该线后方为后脱位〔1〕。我院自 1992年以来共收治 5例特殊类型的髋关节脱位 ,其脱出的股骨头位于Ｎｅｌａｔｏｎ线前方 ,但Ｘ线征象及临床体征均与一般髋关节前脱位有所不同。笔者就这种脱位受伤机制、命名及治疗提出探讨 ,以供商榷。1　病例资料本组 5例 ,男 3例 ,女 2例 ,年龄 30～ 6 0岁。右髋 3例 ,左髋 2例。致伤原因 :高处摔伤 3例 ,车祸 2例。 5例均单2 0 0 1-0 2 -2 6收稿 ,2 0 0 1-11-0 6修回作者单位 :伊犁地区人民医院骨科 ,新疆伊…     

髋关节前脱位合并髋臼前壁骨折1例

创伤性髋关节前脱位是一种较为少见的髋部损伤,其发生率明显低于髋关节后方的骨折脱位,仅占到髋关节脱位的10.53%[1]。Mavin Tile曾记载关于髋关节前脱位损伤发生时可以合并髋臼前壁骨折的论述。我科也收治过1例,并且在手法复位后因髋关节内游离体而行手术治疗。     

髋臼方位与全髋置换术后脱位的关系

目的研究人工全髋置换术后髋臼方位对髋关节脱位的影响,并为临床提供评价标准。方法测量318例(326髋)X线片的髋臼外展角、前倾角及股骨头旋转中心垂直位置,通过平均2.7年随访来确定上述3因素与术后髋脱位的关系,并进行统计学处理。结果在最近随访时,326髋有10髋发生脱位。外展角≥55°,较<55°脱位发生率有显著性差异;股骨头旋转中心垂直位置≥30mm,较<30mm脱位发生率也有显著性差异;前倾角≥15°和<15°相比,脱位发生率没有显著性差异;前倾角与外展角没有交互作用。结论髋臼方位不当与全髋置换术后的脱位明显相关;外展角<55°,股骨头旋转中心垂直位置<30mm及合适的前倾角可以提供较稳定的髋关节,明显降低术后髋脱位的发生率。     

发育性髋关节脱位闭合复位后髋臼发育的影响因素研究

目的:探讨发育性髋关节脱位闭合复位后髋臼发育的影响因素,为提高发育性髋关节脱位闭合复位的疗效提供理论依据.方法:2002年1月至2005年12月,采用闭合复位治疗100例单侧发育性髋关节脱位患儿,测量患侧髋关节在复位后第12个月时的髋臼指数(AI)和髋臼深度与宽度比值[AI(D/W)].以性别、侧别、年龄、复往前患侧AI、复位前患侧AI(D/W)、脱位程度、股骨头宽度比值、复位前患侧股骨颈前倾角(FNA)、h/b比率及内收肌切断与牵引等10个因素作为自变量,分别以复位后第12个月患侧AI、AI(D/W)作为因变量,进行多重线性逐步回归分析,筛选出主要的影响因素.结果:年龄、性别、脱位程度、h/b比率、股骨头宽度比和复位前患侧FNA对AI、AI(D/W)有明显影响.年龄、脱位程度和复位前患侧FNA与AI成正相关,与AI(D/W)成负相关;股骨头宽度比和h/b比率与AI成负相关,与AI(D/W)成正相关.女性较男性髋臼发育快.结论:年龄、性别、脱位程度、是否同心复位、复位前患侧股骨头发育程度和股骨近端形态是发育性髋关节脱位患儿髋臼发育的主要影响因素.     

髋臼成形术并股骨近端旋转截骨治疗小儿发育性髋关节脱位

目的：评估髋臼成形术并股骨近端旋转截骨治疗发育性髋关节脱位的临床效果。方法：本组患儿48例,男12例,女36例,年龄2．6—8．5岁,平均5．4岁。采用S—P切口,切开关节囊,清理真臼内软组织,复位股骨头;股骨近端旋转截骨,纠正前倾角;髋臼缘上方沿关节囊附着点行弧形截骨,髂骨块植入截骨处,增加股骨头的包容。结果：48例患儿经1．6-5．6年的随访,按照周永德先天性髋脱位疗效评定标准,优32例,良16例,可3例,差4例,手术优良率为86．8％。结论：髋臼成形术并股骨近端旋转截骨是治疗小儿发育性髋关节脱位的一种较为有效的方法。     

利用计算机图像动态观察先天性髋脱位复位后髋臼的形态变化

目的 通过计算机图像处理技术对正常及脱位髋关节Ｘ线片进行处理。了解髋臼的形态变化。方法 先天性髋脱位经手法复位患儿３３例,共４９髋,男１２例,女２１例;单侧脱位１７例,双侧脱位１６例（其中２２髋随访期间行切开复位,故将该２２髋删除）。以单侧髋脱位患者的对侧正常髋关节为对照组（１７髋）,手法复位后髋臼发育良好组为１９髋,髋臼发育不良组为８髋,将复位前后各时期髋关节的正位Ｘ线片输入计算机,并叠加在一起,计算髋臼的横向生长速度、纵向缎斜速度及其比值。结果 髋臼横向生长与纵向倾斜速度的比值分别是：对照组２４．６９５,复位后发育良好组１０．３５０,复位后发育不良组２．１１５,对照组的髋臼顶壁沿水平方向向外侧生长,６～８岁以后髋臼外侧缘逐渐向下方生长,手法复位后发育良好组６～８岁以后无骨臼外侧缘逐渐向下方生长。手法复位后髋     

髋关节后脱位并髋臼后壁骨折15例治疗体会

髋臼骨折属关节内骨折,需解剖复位并有效固定,否则将严重影响髋关节功能.1998年6月-2003年6月,我院共收治髋后脱位32例,合并髋臼后壁性骨折18例,其中经手术治疗15例,效果满意.现报告如下.     

髋臼后壁骨折并髋关节脱位手术治疗的疗效分析

目的探讨髋臼后壁骨折合并股骨头后脱位的手术治疗方法及影响预后的因素。方法本组25例患者,伤后均急诊行手法复位．多数在伤后5～7天应用Kocher—langenback切口行手术治疗,髋臼后壁骨折复位后,应用螺丝钉或加钢板内固定,必要时植骨。结果全部患者均随诊6～36个月．根据相关资料评定：X线评定结果优19例、良4例、可2例,优良率：92％。临床功能评定优13例、良8例、可3例,差1例,优良率：84％。结论髋臼后壁骨折并关节脱位解剖复位及手术内固定可提高此类损伤疗效和减少并发症发生。     

Traumatic anterior dislocation of the hip joint with fracture of the acetabulum: a case report

A 67-year-old woman sustained a pubic-type anterior dislocation of the hip associated with a comminuted fracture of the anterosuperior part of the acetabulum and the anteroinferior iliac spine following a fall on the knee. Because of interposition of the iliopsoas tendon, closed reduction followed by skeletal traction failed to achieve reduction of the acetabular fragment. An abnormally high degree of anteversion of the femoral neck is suggested as a possible predisposing factor in this injury.     

Locked posterior dislocation of the hip: a case report

Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion.     

Sciatic nerve paralysis in posterior dislocation of the hip. A case report

This is a case report of a 19-year-old male with an unusual case of a complete sciatic nerve paralysis which happened during the treatment of posterior dislocation of the hip. It was presumed that open reduction played a role of a trigger for the sciatic nerve palsy; because an almost complete recovery was obtained by release of the nerve from the ectopic bone mass, it is reasonable to assume that paralysis developed from massive ectopic bone formation around the nerve.     

髋臼骨折合并髋关节脱位的手术治疗

[目的]探讨髋臼骨折的分型、手术入路、内固定方式及手术疗效.[方法]2001年11月～2006年8月,本院手术治疗的髋臼骨折合并股骨头脱位34例,根据髋臼骨折的AO分类标准:A型骨折24例,B型骨折10例,应用Kocher-Langenbeck(KL)手术入路20例,Gibson入路2例,KL改良入路4例,髂腹股沟入路4例,前后联合入路4例,内固定方式32例选用螺钉及钢板,2例应用钢丝环扎固定.[结果]所有患者获平均37.6个月随访.参照美国骨科学会(AAOS)提出的评价标准[1]:优12例,良12例,可4例,差6例,优良率为71%.[结论]结合全面的影像学资料,正确判断髋臼骨折的AO分型,恰当的手术入路及合适的内固定方式,同时注意手术时的微创操作及骨折复位的质量,才能提高疗效,减少并发症.     

Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip

We aimed to identify variables associated with clinical and radiological outcome following fractures of the acetabulum associated with posterior dislocation of the hip. Using a prospective database of 1076 such fractures, we identified 109 patients with this combined injury managed operatively within three weeks and followed up for two or more years. The patients had a mean age of 42 years (15 to 79), 78 (72%) were male, and 84 (77%) had been involved in motor vehicle accidents. Using multivariate analysis the quality of reduction of the fracture was identified as the only significant predictor of radiological grade, clinical function and the development of post-traumatic arthritis (p < 0.001). All patients lacking anatomical reduction developed arthritis whereas only 25.5% (24 patients) with an anatomical reduction did so (p = 0.05). The quality of the reduction of the fracture is the most important variable in forecasting the outcome for patients with this injury. The interval to reduction of the dislocation of the hip may be less important than previously described.     

可吸收螺钉加克氏针内固定治疗髋关节后脱位伴髋臼后壁骨折

髋关节后脱位常伴髋臼后壁骨折，处理不当可并发创伤性关节炎，严重者甚至影响髋关节功能。早期确诊、及时恰当地治疗则有利于髋关节功能早日恢复。我们采用可吸收螺钉加克氏针加强内固定治疗髋关节后脱位伴髋臼后壁骨折23例，髋关节功能恢复均较满意，现报告如下。     

双侧髋关节同时后脱位一例

患，女，38岁，2001年1月18日，因乘坐的小客车与火车相撞受伤，伤后头痛，头晕，双下肢不能活动3小时入院。专科检查：双下肢呈屈曲、内收、内旋、短缩畸形、双臀部可扪及上移的股骨头，双髋关节屈曲弹性固定，不能活动，双足背动脉搏动有力，足趾背伸，跖曲肌力正常，双下肢感觉正常，X光片示：双侧髋关节后脱位。临床诊断：双侧髋关节后脱位左侧伤。治疗：急诊在蛛