生物型假体关节置换术治疗髋关节发育不良继发骨性关节炎

目的评估采用生物型假体行全髋关节置换术(THR)治疗髋关节发育不良(DDH)继发骨性关节炎的临床效果。方法自2001年1月～2006年3月,采用生物型假体行THR治疗44例(49髋)成人DDH继发骨性关节炎患者,根据Crowe分型:Ⅰ型10例(12髋),Ⅱ型19例(21髋),Ⅲ型11例(12髋),Ⅳ型4例(4髋)。结果随访2~8年(平均4年1个月),Harris评分由术前43.52分恢复到术后90.32分。假体均位于解剖位置,尚未见术后感染及松动发生,术前患者双下肢长度差为1~5cm,术后为0～1cm,41例46髋疼痛完全消失,3例3髋有轻度疼痛伴有轻度跛行,但能够生活自理且恢复正常工作,其余患者均步态正常。术前2例伴有腰部疼痛,均在术后1.5年消失。结论生物型假体行THR治疗成人DDH继发骨性关节炎,能够取得较好的临床效果。     

髋关节骨性关节炎的临床特征与全髋置换术

目的 探讨髋关节骨性关节炎的临床特征及全髋关节置换术的疗效。方法 明确诊断髋关节骨性关节炎81例，其中男49例，女32例，年龄48～72岁，平均55岁。14例髋关节置换术中，其中2例行双侧全髋置换术。术前Harris评分平均51分(38～64分)。结果 81例髋关节骨性关节炎据临床特征均得到确诊。术后14例病人均无髋脱位，髋关节疼痛消失。X线平片示假体位置良好。术后平均随访28个月(6～76个月)，患者Harris评分平均85分(81～88分)。结论 对髋关节骨性关节炎患者只要根据其临床特征和采取正确的诊断方法及标准，均能确诊。对髋关节骨性关节炎晚期病人，采取正确的全髋置换技术，均能恢复患者的髋关节功能，提高生活质量。     

全髋关节置换术治疗髋关节发育不良并骨性关节炎

目的探讨全髋关节置换技术治疗髋关节发育不良并骨性关节炎的临床效果。方法对19例(22髋)髋关节发育不良并骨性关节炎患者进行全髋关节置换术。对手术时间、术中出血量、髋关节功能及畸形矫正情况进行分析。结果手术时间60～110(85.2±11.8)min,术中出血量300～1 200(650.3±157.7)ml。髋关节Harris评分由术前平均47.65±7.85分提高至86.54±6.30分。短缩肢体延长1.5～4.0 cm。19例均获随访,时间14～42个月,随访期内影像学显示假体位置正常;关节活动度满意。2例患者仍遗留轻度跛行。结论全髋关节置换技术治疗髋关节发育不良并骨性关节炎能显著改善髋关节功能,纠正髋关节畸形,近期疗效满意。     

全髋关节置换术治疗髋臼发育不良继发骨性关节炎的临床研究

目的 探讨全髋关节置换术治疗髋臼发育不良继发骨性关节炎的手术方法 ,观察术后临床效果.方法 对16例19髋成人髋臼发育不良继发骨性关节炎进行人工全髋关节置换术,观察术后疼痛、功能活动、跛行症状的改善情况.结果 术后平均随访2年6个月,Harris评分由术前36分改善为88分,优9例,良4例,一般3例.结论 全髋关节置换术是治疗髋臼发育不良继发骨性关节炎的有效方法 .     

髋关节发育不良与骨性关节炎全髋置换术早期结果比较

为研究全髋置换术治疗髋关节发育不良（DDH）的疗效,作者利用新西兰关节登记中心的数据,分析比较了1 205例DDH患者和40 589例骨性关节炎患者的全髋置换术。早期随访结果显示,两组牛津髋关节功能评分和翻修率无显著差异。因此可以认为,全髋置换术治疗DDH继发关节退变是安全有效的。     

髋关节骨性关节炎选择全髋关节置换相关量化因素

目的 探讨髋关节骨性关节炎(OA)选择全髋关节置换术(THA)治疗的一些量化因素.方法 回顾性分析106例髋关节骨性关节炎,其中65例选择非手术治疗,41例选择全髋关节置换.分析两组年龄、经济收入、文化程度、发病持续时间、髋关节最狭窄处间隙值及Harris评分.结果 两组Harris评分、髋关节最狭窄处间隙值、经济收入及文化程度差异有统计学意义(P＜0.05);年龄及发病持续时间差异无统计学意义(P＞0.05).结论 患者的Harris评分值、髋关节最狭窄处间隙值、经济收入及文化程度4个指标的测量及综合分析可作为临床骨科专家决定髋关节骨性关节炎选择全髋置换重要的量化指标,而患者的年龄及发病持续时间仅可作为临床骨科医生决策的参考因素.     

髋关节骨性关节炎患者经髋关节置换术后发生股骨假体冠状面角度误差的原因分析

目的：分析髋关节骨性关节炎患者经全髋关节置换术（THA）后发生股骨假体冠状面角度误差的原因。方法：收集2017年3月—2022年2月于我院诊疗的髋关节骨性关节炎且行THA治疗的122例患者为研究对象。在PACS系统上通过Image-Pro Plus软件测量患者术前和术后的股骨假体外翻角（FPVA）、股骨侧弯角、股骨机械轴外侧角、股骨颈干角、股骨颈长度。依据术后6个月全长片冠状面FPVA分为2组：当FPVA>3°或<-3°时,纳入力线不良组（89例）,余33例纳入力线良好组。比较两组患者的一般临床资料及影像学参数。使用多元Logistic回归分析冠状面上预测假体角度误差的影响因素。构建Nomogram预测模型,并对模型进行验证。使用Spearman相关分析FPVA与其他因素间的相关性。结果：股骨机械轴外侧角、股骨颈干角、股骨颈长度和股骨侧弯角均是骨关节炎患者经THA术后发生假体角度误差的影响因素（P <0.05）。冠状面上构建的预测假体角度误差的Nomogram模型的区分度和内部验证结果均较好。FPVA与股骨侧弯角（r=-0.381,P <0.001）、股骨机械轴...     

人工全髋关节置换术治疗高龄股骨粗隆间骨折合并髋关节骨性关节炎

目的探讨高龄股骨粗隆间骨折合并髋关节骨性关节炎行人工全髋关节置换术的方法及疗效。方法对12例高龄股骨粗隆间骨合并重度髋骨性关节炎行全髋关节置换术,均采用生物型假体。结果术后12例均获得平均20(3~34)个月随访。末次随访时髋关节功能按Harris评分标准:优8例,良3例,可1例。结论高龄股骨粗隆间骨折合并髋关节骨性关节炎行人工全髋关节置换术操作可行、疗效满意。     

膝髋骨性关节炎关节置换术后下肢深静脉血栓发生的常见危险因素分析

[目的]分析膝、髋关节骨性关节炎(osteoarthritis,OA)人工关节置换术后下肢深静脉血栓(deep venous thrombosis,DVT)形成的常见危险因素。[方法]2010年8月²012年2月行全膝、髋关节置换术的患者456例,所有患者均在术后32012年2月行全膝、髋关节置换术的患者456例,所有患者均在术后3⁵ d行下肢深静脉造影。根据造影结果分为DVT组(男22例,女121例;平均年龄66.97岁)和非DVT组(男68例,女245例;平均年龄65.93岁),分析两组患者中年龄、性别、糖尿病、高血压、心血管疾病史、血栓史、恶性肿瘤史、体重指数(Body mass index,BMI)、吸烟史及手术类型与DVT发生风险的潜在相关性。[结果]OA患者中,BMI≥25 kg/m2(OR=1.716;95%CI=1.100-2.675;P=0.017)和心血管疾病史(OR=3.403;95%CI=1.129-10.260;P=0.030)能显著增加关节置换术后DVT的发生风险。[结论]高BMI和心血管疾病史是膝、髋OA患者行关节置换术后DVT发生的危险因素。     

步态分析在髋关节骨性关节炎患者中应用的研究概况

步态分析被用来检查步态差异,评估不同手术入路、手术策略以及非药物治疗的疗效。目前多数步态分析的研究是关于膝关节骨性关节炎,而对于髋关节骨性关节炎步态分析的研究较少且存在一定的局限性,如样本量小、患者医从性差、个体差异性、缺少步态评估基线,及衡量标准的不一致。未来更多研究需要更大的样本量,更好的患者依从性,术前和术后评估,以及在疾病早期检测出步态异常,来减少长期影响。纵观以往的研究,时间和距离参数通常被用来作为步态差异的综合测量。步态分析是一种用简单的方法来客观评估步态功能障碍和检查治疗进展的临床手段,本文总结步态分析尤其是关于关节运动学和动力学的三维步态分析,回顾髋关节骨性关节炎患者中常见的步态改变,并且比较了手术和非手术干预下的步态改变。     

非骨水泥型髋关节置换术治疗成人髋臼发育不良

目的探讨非骨水泥型髋关节置换术治疗髋臼发育不良的早期效果。方法回顾性分析2009—2013年我科非骨水泥全髋关节置换术治疗因髋臼发育不良导致的髋骨关节炎患者66例72髋,其中男9例11髋,女57例61髋;年龄46~75岁,平均55岁。按Crowe分型,Ⅰ型27例29髋,Ⅱ型17例18髋,Ⅲ型13例14髋,Ⅳ型9例11髋,均伴有不同程度的跛行、活动受限等症状。采用Harris评分及术前、术后X线片观察评价手术效果。结果术后患者肢体平均延长36 mm。66例患者均获得1~5年随访。除1例不遵守医嘱过度下蹲出现脱位后在全麻下闭合手法复位,所有患者髋臼重建侧植骨均获得愈合,髋关节假体均未出现假体松动。2例自体股骨头植骨区有少量骨吸收,未发现下肢因肢体延长致神经血管损伤症状。术前患者Harris评分(45.05±5.38)分、术前下肢不等长(23.29±19.36)mm、CE角(4±13.92)°改善至(88.62±3.38)°、(3.26±4.06)mm、(29.27±2.68)°,差异均有统计学意义(P0.05)。术后髋关节旋转中心距泪滴水平距离为(27.82±1.25)mm,垂直距离(24.14±2.59)mm。结论全髋关节置换治疗髋臼发育不良手术难度大,术前精心手术评估,真臼处髋臼重建及通过适度软组织松解、转子下截骨等方式的非骨水泥型髋关节置换术治疗成人髋关节发育不良可取得显著的早期疗效。     

The Relationship Between Body Mass Index and Postoperative Mortality from Critical Illness

Background Conflicting data exist regarding the effect of body mass index (BMI) on postoperative mortality from critical illness. Few studies have examined this issue in surgical patients specifically. We tested the hypothesis that BMI is associated with mortality from surgical critical illness. Methods Consecutive admissions to a university surgical intensive care unit (SICU) were analyzed from January 2005–August 2006. Admission BMI was analyzed as both a five-level categorical (underweight, < 18.5 kg/m²; normal weight, 18.5–24.9 kg/m²; overweight, 25.0–29.9 kg/m²; obese, 30.0–39.9 kg/m²; morbidly obese, ≥ 40 kg/m²) and dichotomous (≥ 40 kg/m² vs. < 40 kg/m²) variable among all patients as well as a subgroup of patients with a SICU length of stay (ULOS) ≥ 4 days. Multivariable logistic regression models were fit to determine the independent effect of BMI group on SICU mortality. Results The total sample size was 946, with 490 patients admitted to the SICU for ≥ 4 days (51.8%). Of the variables tested, age, acute physiology and chronic health evaluation III score, gender, diabetes mellitus, and need for insulin infusion varied significantly among the five BMI groups. After adjustment for these variables, BMI was not predictive of mortality when analyzed as either a five-level categorical or dichotomous variable, regardless of ULOS. Conclusion BMI is not related to mortality of surgical critical illness. Several factors, including modern ICU care, may mitigate the risks of obesity in the SICU. Poster Presentation at the 36th Annual Meeting of the Society of Critical Care Medicine, Orlando, FL, USA, February 17th–21st, 2007.     

Association Between Epidemiological Factors and Nonresponders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients

BackgroundWhile total joint replacement (TJR) is the most effective treatment for end-stage osteoarthritis (OA), one-third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for nonresponders and develop strategies to improve TJR outcomes.MethodsStudy participants were patients who underwent TJR (hip/knee) due to OA and completed the WOMAC before and on average 4 years after surgery. Nonresponders (pain nonresponders, function nonresponders, pain and function nonresponders) were determined using the WOMAC change score from baseline to follow-up under two previously reported criteria. Eighty-eight self-reported factors collected by a general health questionnaire were examined for associations with nonresponders.ResultsA total of 601 patients (30.8% hip and 69.2% knee replacement) were included; 18% of them were found to be either pain or function nonresponders. Nine factors were identified in the univariable analyses to be associated with nonresponders, and 5 of them (clinical depression, multisite musculoskeletal pain [MSMP], younger age, golfer’s elbow, and driving more than 4 hours on average per working day) remained significant in the multivariable analyses in at least one of six categories. Clinical depression, having MSMP, and younger age were the major factors to be independently associated with nonresponders across five categories. In addition, two factors (age at menopause and age at hysterectomy) were significantly associated with female nonresponders.ConclusionOur data suggested potential roles of pain perception, widespread pain sensitization, patient expectations, and early menopause in females in TJR outcomes, warranting further investigation.     

Bone Mineral Density, Body Mass Index, and Hip Axis Length in Postmenopausal Cretan Women with Cervical and Trochanteric Fractures

We assessed the bone mineral density (BMD), the body mass index (BMI), and the hip axis length (HAL) in 78 postmenopausal women with 38 cervical and 40 trochanteric hip fractures. The results were compared with those of age-matched, control postmenopausal women. No statistically significant difference was found in the values of BMD, BMI, and HAL between the groups of patients with cervical and those with trochanteric fractures, but lower BMD and BMI were found in fracture patients compared with the corresponding values of the control subjects. Contrary to the existing data, HAL was found to be shorter in the fracture patients compared with the controls. Thus, the type of hip fracture was found to be independent of the value of BMD, BMI, and the length of the patient's hip axis. The fact that a shorter hip axis was found in the group of fracture patients compared with that found in the control subjects raises questions about the significance of this parameter as an independent risk factor for hip fracture. Received: 9 February 1998 / Accepted: 24 June 1998     

A Prospective, Longitudinal Outcome Study of Patients with Carpal Tunnel Surgery and the Relationship of Body Mass Index

This study investigated whether body mass index (BMI) was associated with effectiveness of carpal tunnel release as measured by physical and self-assessment tests. This prospective, longitudinal study was conducted from March 2001 to March 2003 using 598 cases (hands) diagnosed with carpal tunnel syndrome and scheduled for surgery at The Curtis National Hand Center, Baltimore, Maryland, and at the Pulvertaft Hand Centre, Derby, England. Body mass index was calculated, and demographic, clinical, and functional data were collected preoperatively and at 6-month follow-up. Grip, pinch, and Semmes–Weinstein scores were measured preoperatively and at 6-month follow-up. Levine–Katz self-assessment scores for symptom severity and functional status were measured preoperatively and at 6-month follow-up. Grip and pinch increased, whereas Semmes–Weinstein, symptom severity, and functional scores decreased by 6-month follow-up. Cases with BMI >35 had lower grip strength and higher symptom severity in males and higher functional status in both sexes pre- and postoperatively compared to normal-weight BMI cases. BMI had no relationship to patient satisfaction. Although morbidly obese cases did worse on some physical and self-assessment tests compared to normal BMI cases preoperatively, all improved to the same extent postoperatively regardless of BMI.     

Metabolomics Signature for Non-Responders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients: The Newfoundland Osteoarthritis Study

Although total joint replacement (TJR) surgery is considered as the most effective treatment for advanced osteoarthritis (OA) patients, up to one-third of patients reported unfavorable long-term post-operative pain outcomes. We aimed to identify metabolic biomarkers to predict non-responders to TJR using a metabolomics approach. TJR patients were recruited and followed-up at least 1-year post-surgery; TJR outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales. Targeted metabolomic profiling was performed on plasma samples collected pre-surgery and pairwise metabolite ratios, as proxies for enzymatic reactions, were calculated. Association tests were performed between each metabolite ratio and non-responders. The metabolome-wide significance was defined as p < 2 × 10⁻⁵. A total of 461 TJR patients due to primary OA were included in the analysis. Fifteen percent of patients were classified as pain non-responders; 16% were classified as function non-responders. Lower baseline WOMAC pain and function scores were significantly associated with pain and function non-responders, respectively (both p < 0.03). Two metabolite ratios were significantly associated with pain non-responders; acetylcarnitine (C2) to phosphatidylcholine acyl-alkyl C40:1 (PC ae C40:1) was five times higher in pain non-responders whereas phosphatidylcholine diacyl C36:4 (PC aa C36:4) to isoleucine was twenty one times lower in pain non-responders than responders (all p ≤ 1.93 × 10⁻⁵). One metabolite ratio, glutamine to isoleucine, was significantly lower in function non-responders than responders (eight times lower; p = 1.08 × 10⁻⁵). Three metabolite ratios (C2 to PC ae C40:1, PC aa C36:4, and glutamine to isoleucine) related to inflammation and muscle breakdown could be considered as novel plasma markers for predicting non-responders to TJR and warrant further investigation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:793-802, 2020     

体重指数和骨折危险性预测

目的分析比较体重指数在两种不同类型骨折中的分布,借以探讨骨质疏松性骨折的保护机制.方法283例女性病人依骨折部位不同分为两组.其中髋部骨折组162人,平均年龄53.4岁;腕部骨折组患者121人,平均年龄50.2岁.按年龄分组,用独立样本t检验比较两组的体重指数;协方差分析体重指数和骨折类型间的关系.结果髋部骨折组患者的平均体重指数为21.3±4.0,低于WHO提出的标准体重指数的正常均值22;而腕部骨折组患者的平均体重指数为26.4±4.7,高于这个均值.二者之间存在着显著性差异(P<0.01).体重指数是骨折类型的重要预测因子.(P<0.001).结论髋部骨折患者呈低体重指数分布.正常体重指数或许可以保护髋部骨折,但不能保护腕部骨折.     

Influence of High BMI on Functional Outcome After Total Hip Arthroplasty

Background High body mass index (BMI) is associated with diseases of the hip joint and subsequent total hip arthroplasty (THA). Less is known about the effects of BMI on the functional postoperative status after THA in obese patients. The purpose of this study was therefore to quantify the role of high preoperative BMI on long-term pain status and functional outcome after THA. Methods In a multi-center cohort, study data of 20,553 primary THAs (18,968 patients) and 43,562 postoperative clinical examinations were analyzed for a follow-up period of up to 15 years. Patients were classified into three BMI groups (normal weight <25 kg/m², overweight 25 to <30 kg/m², and obese ≥30 kg/m²), and pain status and functional outcome were compared accordingly. Results High preoperative BMI is associated to an almost perfect dose–effect relationship with decreased ambulation during a follow-up period of 15 years, but pain relief of THA is equally efficient for all BMI groups. Conclusion Overweight and obesity are modifiable risk factors that may warrant physicians giving recommendations to patients before or after THA, to improve postoperative functional outcome quality.