缺血再灌注对幼年兔股骨头损伤的影响

目的探讨缺血再灌注对幼年兔股骨头损伤的影响。方法采用新西兰幼年兔作为研究对象，兔龄1个月，体重约1kg，雌雄不限。将36只兔根据缺血及不同再灌注时间将其分为12组，每组3只。在部分阻断股骨头血供6h、12h、18h、24h后，分别恢复血供0h、24h、168h，取兔双股骨头标本进行形态学检查。结果单纯缺血6h，股骨头软骨、骨骺骨、股骨头骨髓、股骨头骺板软骨细胞均变性不明显；缺血6h再灌注24h后，细胞核发生固缩，缺血24h再灌注168h，细胞发生核碎裂及部分核溶解。结论缺血再灌注可引起幼年兔股骨头的损伤，并随缺血及再灌注时间的延长，细胞损伤逐渐加重。     

机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究

目的观察儿童股骨头骨骺滑脱在机器人导航下经皮原位固定的临床应用效果。方法以2010年1月至2021年1月佛山市中医院收治的20例儿童股骨头骨骺滑脱病例为研究对象。根据治疗方法不同分为试验组(n=8)和对照组(n=12)。试验组患者采用机器人导航下经皮原位固定治疗,共8例(8髋),其中男5例(62.5%),女3例(37.5%),平均年龄为(10.7±2.9)岁;对照组患者采用传统经皮闭合原位固定治疗,共12例(12髋),其中男8例(67%),女4例(33%),平均年龄(11.9±1.6)岁。术前及末次随访时,采用Harris髋关节评分评估髋关节功能,测量术后X线片上的Southwick角。结果 20例(20髋)均获得随访,随访时间最短2个月,最长37个月,平均随访时间(15.3±6.0)个月。试验组Harris髋关节功能评分从术前的(35.1±15.7)分提高到末次随访时的(86.6±8.60)分,髋关节功能改善,差异有统计学意义(t=-8.23,P0.05);术后Southwick角较术前平均减小29.7°(95%CI:16.9°～42.4°,P0.05)。对照组Harris髋关节功能评分从术前(50.8±22.2)分提高到末次随访时(82.2±7.9)分,髋关节功能改善,差异有统计学意义(t=5.50,P0.05);术后Southwick角较术前平均减小16.5°(95%CI:2.2°～30.8°,P0.05)。截至末次随访时无一例伤口感染、断钉、骨不连、股骨头缺血坏死等不良事件及并发症发生。结论机器人导航下经皮原位固定治疗儿童股骨头骨骺滑脱安全有效,具有精准、微创、操作方便的优势,可最大程度减少儿童髋部医源性损伤,预后优良。     

先天性髋关节脱位闭合复位的治疗体会

目的总结1994年1月￣2004年12月采用闭合复位治疗的先天性髋关节脱位262例(316髋)的疗效,探讨其影响因素。方法于全麻下行内收肌松解,手法复位,蛙式位或人体位支架固定,复位后定期作X线检查。结果262例患儿平均随访5年3个月(2￣8.5年),优良率为93%。复位后因髋臼发育不良仍有半脱位的13髋经再次手术痊愈。26髋发生股骨头骨骺发育不良(即无菌性坏死),占8%,其中14个髋术前股骨头骺未出现。结论先天性髋关节脱位早期治疗是成功的关键,闭合复位后支架固定是减少股骨头坏死的重要因素。     

血管束植入,复方丹参治疗股骨头无菌性坏死89例

小儿股骨头无菌性坏死，又称潘西氏病，自1910年Legg、Calve、Perthes分别报道以来，国外国内屡有报道。对该病的手术治疗近10余年来报道较多。手术方法众说纷云，骨科学者各执一景，尚在探索阶段。我们采用血管束植入治疗，经过5～8年随访的89例，效果满意。临床资料男57例，女32冽，左侧48例，右侧41例，年龄6岁～14岁，病程4个月～18个月。均以跛行，走路疼痛就诊。X线正位片均示有股骨头骨骺变扁，有碎块，股骨颈不同程度的变短变粗，髋臼基本正常。髋关节间隙变窄8例，6例曾按“关节结核”抗痨治疗，9例有跌伤史。疗效评定采用一般文…     

Pavlik吊带早期治疗发育性髋关节脱位的疗效观察

目的 报道Pavlik吊带早期治疗发育性髋关节脱位(developmental dislocation of the hip,DDH)的临床效果.方法 2005～2007年,应用Pavilk吊带早期治疗发育性髋关节脱位78例,57例资料完整,随访超过1年.其中,男19例,女38例,单侧34例,双侧23例,总共80例异常髋关节(左侧44髋,右侧36髋),平均诊断时间66.8d(5～122d).超声波分型:Graf Ⅱa/b17髋,Ⅱc 34髋,Ⅲ及以上29髋.治疗采用Pavlik吊带,定期超声波观察及吊带调整,至超声波正常后维持4周.若Pavlik吊带3周,超声波指标未好转,改用石膏治疗.随访最少至1岁,摄片评价髋关节发育情况及股骨头骨骺变化.结果 Pavlik吊带应用最短3周,最长5个月.21例(28髋)Pavlik吊带治疗直至超声指标正常,26例(38髋)Pavlik吊带使用超过年龄8个月后,继续使用支具治疗;4例(5髋)Pavlik吊带治疗超过年龄6个月后,改换石膏治疗;6例(9髋),3周后中断Pavlik吊带治疗,改换石膏固定.Pavlik吊带治疗总有效率82.46%.无股骨头AVN发生.7例(10髋)随访时髋臼指数大于25°;3例(4髋)随访至18个月,因AI大于25°,Shenton线连贯欠佳,接受了囊外Salter骨盆截骨手术治疗,手术治疗比率为5.26%.结论 Pavlik吊带早期治疗DDH显示,初始病变严重、治疗年龄超过7周将影响预后.超声波监测是做好早期治疗工作的重要保障.     

发育性髋脱位手法复位后半脱位的成因与转归

目的　观察婴幼儿发育性髋脱位手法复位后髋关节形态学的变化。方法　对发育性髋脱位手法复位后 117例 ,共 16 1髋进行平均 7.4年的随访。临床上对髋关节功能和肌力进行了测定 ,对复位前后系列X线片进行了观察 ,正常侧作为对照组 ,X线观察的指标有 :髋臼指数、臼头指数、股骨头发育情况及髋关节间隙等。结果　全部病例髋关节的活动范围及肌力与对照组无差异。在X线上有 131个髋关节的发育与对照组的发育无差异 ,其中有 2 3髋在复位后 6个月去掉金属外展固定支架时出现了半脱位及关节间隙增大的改变 ,经平均 3年左右观察 ,逐渐恢复发育至正常。脱位侧股骨大转子骨骺出现时间比对照组延迟 1年左右。结论　发育性髋脱位手法复位后出现的半脱位及关节间隙增大不应急于手术 ,因其有逐渐发育至正常的可能。     

Gd-DTPA增强动态核磁共振和动态核素肾扫描评估幼猪正常和梗阻肾脏

目的：Gd-DTPA增强动态核磁共振(MRI)和动态肾扫描评估猪正常和梗阻肾脏形态和功能的意义。方法：用Gd-DTPA(0．1mmol／kg BW)增强动态MRI评估4～7月大小幼猪(n=10)肾脏，其中正常对照组7例，单侧输尿管梗阻3例。分别对0．1～60min记录的肾脏影像进行分析并计算出肾皮质、髓质和肾盂的相对信号强度。MRI后用动态核素扫描对肾脏进行评估并对肾脏进行解剖学检查。结果：使用Gd-DTPA后，对照组肾皮质、髓质和肾盂信号强度迅速增强，1min后开始下降，肾盂最明显可降至正常的44％，以后逐渐恢复。输尿管不全梗阻肾脏的变化明显较对照组慢。扫描肾图得到的肾功能信息和MRI一致，但后者能提供更清楚的形态变化。结论：Gd-DTPA增强动态MRI除了提供更清楚的正常和梗阻肾脏形态变化外，还能提供详细功能变化信息。Gd-DTPA增强动态MRI能帮助鉴别输尿管不全梗阻。     

手术复位内固定治疗小儿移位股骨颈骨折的疗效分析

目的回顾性分析14例不同类型移位股骨颈骨折患儿的临床资料,分析手术复位内固定治疗后的并发症及疗效。方法对2010年9月至2014年6月间经本院手术治疗的14例移位股骨颈骨折患儿进行回顾性分析。其中男9例,女5例;右髋3例,左髋11例;头下型2例,经颈型11例,基底型1例;平均年龄10.1岁。急诊手术首选闭合复位,髋关节囊予以抽吸淤血减压;如不成功,予以切开复位,同时清除关节囊内积血等减压。复位后常规予空心钉或克氏针内固定,再予髋人字石膏固定至少2个月。采用Ratliff评分评估功能恢复情况。结果 14例患儿中高处坠落伤4例,车祸2例,跑步、骑自行车摔倒等外伤7例,无明显外伤史1例。受伤至手术时间间隔平均77.6 h(20～240 h)。手术时间平均136 min(60～220 min)。闭合复位+关节囊抽取积血减压9例,切开复位5例。内固定时间平均为11.2个月。术后患儿随访时间平均为22.6个月(10～50个月)。术后股骨头缺血性坏死(AVN)发生率头下型1例(50%),经颈型2例(18%),基底型无一例。出现AVN的3例患儿受伤至手术时间均大于24 h。结论小儿单纯摔倒和骑车摔倒甚至无明显重大外伤史情况下也可出现股骨颈骨折。由于儿童股骨头血供特点和儿童自身发育,越接近股骨头处骨折因血供不足越易出现股骨头缺血性坏死,头下型和经颈型分别占前二位。伤后需急诊早期手术复位骨折内固定,关节囊减压,术后坚强外固定,这三者都有利于防止股骨颈骨折并发症的发生。     

造影与磁共振成像在儿童发育性髋关节发育不良评估中的一致性分析

目的验证髋关节造影与磁共振成像对儿童髋臼的骨性与软骨性覆盖评估的一致性, 发掘两者之间优势交叉点或互补之处。方法收集2020年11月至2021年11月在西安交通大学附属红会医院儿童骨病医院经历过至少一次闭合复位石膏固定的16例发育性髋关节发育不良(developmental dysplasia of the hip, DDH)患儿(行3次石膏固定的有2例, 2次4例, 1次10例)的临床资料。其中男3例, 女13例;双侧为8例, 单侧为8例(左侧为6例, 右侧为2例), 共测量了32个髋关节(24个患侧髋关节和8个正常髋关节), 患儿初次手术年龄为(11.88±5.29)个月, 年龄范围4～22个月。选取同体位的术中造影片与术后2 d内MRI片, 分别测量骨性髋臼指数(acetabular index, AI)与盂唇AI, 按照排除标准, 最终纳入40组数据。先分为MRI组与造影组并采用组内相关系数(intra-class correlation coefficient, ICC)评估两者对同一指标的测量是否有一致性;再分为AI组与盂唇AI组进行Pearson相关性分析以明确骨性覆盖与...     

骨骺损伤对发育性髋关节发育不良大鼠术后髋外翻的影响研究

目的髋外翻(coxa valga)是发育性髋关节发育不良(Developmental dysplasia of the hip,DDH)患儿术后并发症之一,术中大转子骨骺受损被推测是可能因素,但尚无实验证实,本研究拟证实股骨大转子骨骺损伤与髋外翻的关系。方法在建立大鼠DDH模型后,通过切开复位左侧髋关节同时损伤大转子骨骺的方法,探讨DDH术中骨骺损伤因素对预后颈干角、前倾角的影响。将43只新生SD大鼠下肢伸直襁褓位固定10 d,待出生1个月时行骨盆正位X线片,确诊其中41个左侧髋关节发生脱位(41/43)。将41只DDH大鼠随机分为骨骺损伤组(21只)和对照组(20只)。对照组于大鼠出生1个月时切开复位左侧髋关节,骨骺损伤组在切开复位左髋的同时用1 mm克氏针钻孔损伤左股骨大转子骨骺。术后1个月处死并取得左股骨标本,使用超微立体扫描仪(Epson)测取颈干角及前倾角。结果骨骺损伤组颈干角为130.56°±3.44°,前倾角为28.57°±9.25°;对照组颈干角为126.57°±6.04°,前倾角为28.83°±7.85°。骨骺损伤组颈干角显著大于对照组(P=0.015),前倾角比较差异无统计学意义(P=0.925)。结论术中大转子骨骺受损的DDH大鼠颈干角更大,提示该损伤可能是发生DDH术后髋外翻的因素之一。手术中减少对大转子骨骺的干扰和损伤,或可改善术后颈干角的变化,减少髋外翻的发生。     

Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets

Purpose To determine whether gadoliniumenhanced MR imaging can detect early reversible ischemia of the capital femoral epiphysis and physis induced by hip hyperabduction in piglets.Materials and methods Thirteen 1-to 3-week-old piglets were placed in maximal abduction of both hips and studied with dynamic gadolinium-enhanced MR imaging 1–6 h later to assess ischemia of the 26 femoral heads. They were then allowed to ambulate freely for 1 or 7 days, and reimaged in neutral position to assess reperfusion. Enhancement was evaluated on MR images and compared with histologic findings.Results Ischemia after hyperabduction developed in all 26 cartilaginous epiphyses and in 85% of the physes. The most frequent abnormality was a sharply marginated nonenhancing area in the anterior part of the femoral head. A smaller area of ischemia developed in the posterior part of the femoral head, adjacent to the acetabular rim. The secondary center of ossification was ischemic in 56% of the hips after 1 h of abduction and in all hips after 4 or 6 h (p=0.02). The overall severity of ischemia was greater with increasing abduction time (p<0.001) and increasing degree of abduction (p<0.01). There was partial reperfusion in 83% of the hips after 1 day of ambulation and complete reperfusion in all 26 hips (100%) after 1 week.Conclusion Enhanced MRI detects early ischemia of the epiphyseal and physeal cartilage and the epiphyseal marrow. In piglets, ischemia due to hyperabduction is reversible if corrected within 6 h.Editor's note The publication by Dr. Jaramíllo et al.Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets, represents the 1995 Caffey Award winning paper at The Society for Pediatric Radiólogy annual meeting. This paper will be published in bothPediatric Radiology and theAmerican Journal of Roentgenology in recognition of its award winning excellence. This joint publication is an honor andnot a double publication. From now on, each year's Caffey Award winning paper will be so honored in both journals.     

Épiphysiolyse fémorale supérieure

Slipped capital femoral epiphysis (SFCE) is a disorder of the hip, characterized by a displacement of the capital femoral epiphysis from the metaphysic through the femoral growth plate. The epiphysis slips posteriorly and inferiorly. SCFE occurs during puberty and metabolic and epidemiologic risk factors, such as obesity are frequently found. Most chronic slips are diagnosed late. Sagittal hip X-rays show epiphysis slip. In case of untreated SCFE, a slip progression arises with an acute slip risk. Treatment is indicated to prevent slip worsening. The clinical and radiological classification is useful to guide treatment and it is predictive of the prognosis. In situ fixation of stable and moderately displaced SCFE with cannulated screws gives excellent results. Major complications are chondrolysis and osteonecrosis and the major sequelae are femoroacetabular impingement and early arthritis.     

牵引加原位穿针(钉)治疗儿童股骨头骺滑脱

目的 研究改良Russell牵引加原位穿针(钉)在治疗儿童股骨头骺滑脱中的应用.方法 回顾1995年8月至2006年8月,我科收治并获得随访的SCFE病例 42 例,其中男 30 例,女12例.所有患儿术前均行改良Russell牵引,评价该牵引方法 对股骨头骺复位的作用,然后行原位穿针(钉)术,术后对患儿进行随访,观察该治疗方法 对患儿髋关节功能的影响情况.结果 Russell牵引可明显改善股骨头骺脱位情况,42 例SCFE患儿中,采用牵引加原位穿针(钉)固定方法 治疗的共 33例,其中除 2 例患儿牵引无效及术后髋关节功能恢复差之外,其余患儿均得到满意效果.结论 改良Russell牵引加原位穿针(钉)治疗可最大限度保留SCFE患儿髋关节功能,临床疗效满意.     

MR evaluation of femoral neck version and tibial torsion

Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min.     

Slip of the capital femoral epiphysis: Revival of a method of assessment

A simple and exact method for evaluation of suspected or overt slip of the femoral capital epiphysis is revived. This procedure gives an estimate of all degrees of abnormality from the early stages to those with gross deformity. In our experience slip of the femoral capital epiphysis is always posterior and in approximately 80% of cases bilateral. Therefore, both hips should be examined whenever this condition is suspected. The method provides for examination of each hip separately. Strict adherence to the procedure also provides a precise way of assessing the femoral anteversion angle, significant in many orthopedic disorders. For the latter purpose access to a particular nomogram is mandatory.     

Silent slipped capital femoral epiphysis in overweight and obese children and adolescents

Abnormal loading of the hip in obese children may lead to anatomic alterations and an increased prevalence of slipped capital femoral epiphysis (SCFE). The aims of this study were to examine the hip motion in obese children and adolescents and to estimate the prevalence of SCFE in a subgroup of patients characterized by pathological clinical examination and/or pain in the knee or hip joint. A total of 411 individuals (196 males), mean age 14.5?±?2.5?years (7.8-20.4), mean BMI of 32.9?±?5.6?kg/m(2) (20.3-51.5, z score +2.65) who were consecutively admitted for an inpatient weight loss program were included in the study. Twenty-six percent of the patients had load-dependent and 11.7?% had load-independent pain in the knee joint. A total of 9.3?% had load-dependent and 4.7?% had load-independent pain in the hip joint. Two patients (0.5?%) underwent surgical treatment of SCFE prior to entry. A total of 18.2?% of the patients showed a reduced range of motion for hip flexion (<90°) and 18.5?% a pathological decreased internal rotation (<10°). Radiological evaluation of the hips in the clinically conspicuous subgroup (n?=?54) revealed an abnormal head-neck ratio as a sign of prior silent slipped capital femoral epiphysis in 11 patients (20.4?% of the 54 patients, 2.7?% of total cohort). In conclusion, these data show a high prevalence of SCFE-like tilt deformities in a selected group of severely obese children. Mild deformation of the epiphysis at young age might be a major predisposing factor for the development of hip osteoarthritis in obese adults.     

Reliable X-ray diagnosis of slipped capital femoral epiphysis by combining the conventional and a new simplified geometrical method

BACKGROUND: The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. OBJECTIVE: To test a simplified geometrical method and compare it to the conventional method (AP and frogleg views). MATERIALS AND METHODS: The two methods were compared in 95 normal children 9-14 years old and 100 children 9-20 years old with SCFE. RESULTS: The slipping angle (SA) measurements had very high reproducibility, and the new method was diagnostically superior to the conventional method ( P<0.05). CONCLUSION: An exactly defined and reproducible lateral view is recommended for the X-ray diagnosis of SCFE. Nontraumatic SCFE appears to be bilateral in all cases.     

Erkrankungen des kindlichen Hüftgelenks

The 6 infantile hip diseases described in the present article were selected, because they are either common or may lead to lifelong disability when not diagnosed or diagnosed too late. This is especially the case regarding congenital dysplasia of the hip, slipped capital femoral epiphysis, and spastic hip dislocation. These diseases can generally be successfully treated, if they are diagnosed early and treated immediately. Legg-Calvé-Perthes disease occupies a special position, as it may also result in treatment difficulties even among experienced colleagues. Commonly seen, but in the end harmless, in daily pediatric practice are infantile intoeing gait and transient coxitis. The latter, however, has to be differentiated from Legg-Calvé-Perthes disease.     

Clinical practice

Hip problems in children are relatively rare but usually serious, potentially causing lifelong disability. Early diagnosis and treatment is, therefore, mandatory. The aim of this review is to discuss the most frequent diseases of the hip from birth to adolescence. The different affections are relatively closely related to age periods. After birth and in infancy, developmental dislocation of the hip (DDH) and septic arthritis are more prominent. DDH is not always present at birth and should regularly be checked for in the first 6 months of life. Septic arthritis is an emergency and should be adequately treated within 4 days of the beginning of the infection with open drainage of the hip. Transient synovitis and Legg–Calvé–Perthes disease (LCPD) are mostly found between 4 and 10 years of age. Transient synovitis is the most frequent hip disorder in that age group. It is a self-limiting noninfectious effusion in the joint without serious consequences. Differential diagnosis with septic arthritis should, however, be made. LCPD is an idiopathic avascular necrosis of the hip causing flattening and deformity of the femoral head, depending on the extent of the necrosis. Treatment by containment is aimed at favoring the remodeling of the deformed femoral head. Finally, between the age of 10 and 15 years, slipped capital femoral epiphysis (SCFE) should be the preferential diagnosis, especially in the limping obese boy. SCFE is an inferior and posterior displacement of the proximal epiphysis of the femur in the growth plate. It should be treated as an emergency with a screw fixation.