髋膝四关节同时置换治疗晚期强直性脊柱炎

目的探讨髋膝四关节同时置换治疗晚期强直性脊柱炎髋膝关节高度屈曲强直的可行性及疗效。方法全身麻醉下一期双侧髋膝四关节行关节置换手术,术中术后监控各项指标及时调整,指导置换术后的关节功能康复。结果手术顺利完成,术后3个月,患者完全站立行走。结论髋膝四关节一期置换是治疗晚期强直性脊柱炎髋膝屈曲强直的有效方法。     

下肢多关节病变的同期多关节置换术

目的探讨同期双髋关节或同侧髋膝关节置换术治疗下肢多关节病变畸形的经验。方法对6例严重晚期风湿性疾病并发下肢多关节畸形患者,在同次手术施行双侧髋关节置换4例,同侧髋膝关节置换2例。结果术后经6个月～3年的随诊,髋关节活动度由术前平均47°恢复到148.5°,膝关节活动度由术前17.5°恢复到95°。全部病例均可独立或扶拐下地行走。结论下肢多关节病变的同期双髋或同侧髋膝关节置换术,对于严重的下肢多发畸形的治疗,具有省时、康复方便、见效快等优点。但难度大,应严格掌握适应证。     

晚期强直性脊柱炎已融合髋膝关节置换术后活动度研究

[目的]探讨双侧髋关节、膝关节骨性融合的强直性脊柱炎患者,关节置换术后活动度角度变化.[方法]对4例强直性脊柱炎累及双髋、双膝,四关节融合的患者,行双侧全髋、全膝关节置换术.术前、第2次手术后1周和半年观察各关节活动度,研究其活动度变化.[结果]膝术后1周:髋屈曲度(91.25±5.82)°;膝屈曲度(99.38±5....     

关节成形术治疗强直性脊柱炎晚期严重髋关节畸形

目的探讨强直性脊柱炎晚期严重髋关节畸形的术式选择。方法观察股骨头颈切除术、髋关节双金属杯成形术和全髋关节置换术的中、远期疗效。共计４０例患者,５８个够关节,术前屈髋畸形平均５１．３°,已呈纤维性或骨性强直者占８６．２％。结果随访时间平均５．９年。全髋关节置换术组疼痛指数平均改善１．１级,屈髓畸形平均改善４０．６°,术髋活动范围平均改善５８．４°,术后２４髋（６８．６％）可单腿负重。股骨头颈切除术组虽疼痛指数较术前加重,但屈髋畸形平均改善５８．９°,术髋活动范围平均改善７４．３°。双金属杯成形术组虽各项观察指标均劣于全髋关节置换术组,但仍可获得平均２５．６°的矫形效果和平均４７．２°的关节功能改善。结论对于屈髓畸形＜５０°,年龄大于３０岁的绝大多数ＡＳ患者,全髋关节置换术应作为首选术式。股骨头颈切除术和双金属杯成形术仍有其特定适应证,前者适用于屈髋畸形＞６０°,对关节活动范围有特殊职业需求者;后者可用于屈髋畸形＜３０°,年龄小于２０岁的年轻患者,以推迟初次接受全髋关节置换术的年龄。     

表面置换治疗中青年强直性脊柱炎伴髋关节炎初步经验

目的 总结髋关节表面置换术(HRA)治疗中青年强直性脊柱炎(AS)伴髋关节炎的初步经验.方法 2008年4月至2009年12月期间采用HRA治疗AS伴髋关节炎患者共9例(11髋),术前常规行X线、双髋CT等检查,并模板测量髋臼侧假体和股骨头侧假体大小(按15%放大率).记录手术时间、术中出血量,评价术后X线片、术前及术...     

强直性脊柱炎合并双髋关节融合晚期手术治疗

[目的]探讨强直性脊椎炎髋关节晚期病变行全髋关节置换术的疗效及并发症处理和对策。[方法]对38例(65髋)强直性脊柱炎患者行人工全髋关节置换术,其中男28例,女10例;年龄20～45岁,平均34岁。采用国际医学科学组织委员会国际诊断标准进行疾病诊断,随访平均3年。[结果]术后疗效根据Harris评分标准。术后除了2例患者外,病人有轻微疼痛或者无疼痛,髋关节活动范围增加了平均45.5°。对于关节纤维强直的患者,术后髋关节屈曲改善了平均57.3°。对于术前活动范围局限在室内的12例患者,11例活动范围明显得到改善,但是需要指出的是强直性脊柱炎患者术后行走功能较其他疾病的患者要差。术后无深静脉血栓、假体松动、断裂以及脱位发生。异位骨化发生率13.7%(7髋),但对功能无明显影响。[结论]强直性脊椎炎髋关节晚期病变适宜行全髋关节置换术。选择髋关节外侧切口,术中强直髋关节处理措施得当,人工假体选择合适,术后康复手段完善和规范,可以明显恢复关节功能,但与其他病因的全髋关节置换术相比,具有很高的骨化性肌炎发生率。     

全髋关节置换治疗强直性脊柱炎髋关节骨性强直

目的：探讨全髋关节置换术在治疗强直性脊柱炎髋关节骨性强直的临床疗效及安全性。方法：自2008年1月至2012年1月,采用全髋关节置换术治疗强直性脊柱炎髋关节骨性强直12例（24髋）,其中男11例,女1例,年龄27~62岁,病程5~32年。统计患者术前及术后髋关节活动度及Harris功能评分,术中及术后并发症。结果：所有患者获得随访,时间60~96个月,平均72.6个月,所有患者术后Harris评分较术前提高,髋关节活动度提高;优3例,良6例,中3例。异位骨化1例,为BrookerⅠ级,无临床症状未处理。1例术前严重屈曲畸形患者术后出现股神经牵拉损伤,随访1年后恢复。末次随访均未出现假体下沉及臼杯松动,无关节脱位、急性感染及下肢深静脉血栓形成等并发症发生。结论：全髋关节置换术是治疗强直性脊柱炎晚期髋关节骨性强直的有效方法。     

加速康复下肢关节置换深静脉血栓形成的相关因素

[目的]探讨加速康复下下肢关节置换术后深静脉血栓（deep vein thrombosis, DVT）形成的相关因素。[方法] 2021年12月—2022年12月于本院行下肢关节置换的330例患者纳入本研究,观察术后DVT的发生情况,采用单因素和多因素二元逻辑回归分析探索DVT形成的相关因素。[结果]330例患者中,术后46例患者被诊断为下肢深静脉血栓,血栓总体发生率为13.9%。血栓组患者年龄[(71.9±7.2)岁vs (64.4±14.2)岁, P<0.001]、女性占比[男/女,(7/39) vs (84/200), P=0.046]、脑梗史占比[是/否,(12/34) vs (32/252), P=0.006]及病因为OA患者占比[CD/ON/OA/RA/FX,(5/2/35/0/4) vs (42/50/157/10/25), P=0.048]、术前CRP [(9.3±8.2) mg/L vs (3.5±3.2) mg/L, P<0.001]、术后第1 d CRP [(21.4±18.5) mg/L vs (14.7±12.8) mg/L, P=0.004]显著...     

全髋置换治疗强直性脊柱炎髋关节高度屈曲强直畸形

[目的]探讨强直性脊柱炎髋关节高度屈曲强直畸形患者行全髋关节置换术的方法和疗效.[方法]21例(29髋)强直性脊柱炎髋关节高度屈曲强直畸形患者行全髋关节置换术, 男20例(28髋),女1例(1髋);年龄21～49岁,平均32.4岁;病程3～32年,平均15.6年;屈曲强直畸形30°～95°,平均58.6°;单侧13例, 双侧8例;15例(23髋)合并髋关节骨性强直.采用髋关节Watson-Jones外侧切口,生物型假体17例(22髋),骨水泥型假体4例(7髋).采用Harris评分对术前及术后髋关节功能进行评价.[结果]21例患者术后平均随访4.5年,髋关节功能均明显改善,Harris评分由术前平均21.7分提高到术后平均83.2分.髋关节屈曲畸形矫正,29个髋关节总活动度(屈伸、内收、外展、内旋、外旋等6个方向活动总和)由术前平均7°增加为术后平均196°.术后髋痛消失, 膝痛、腰骶痛明显改善,步态恢复正常, 生活能自理.[结论]全髋关节置换术是治疗强直性脊柱炎合并髋关节高度屈曲强直畸形一种有效的方法.     

Bone mineral density after total joint arthroplasty of lower extremities in rheumatoid arthritis patients

We studied the effects on the axial bone mass of total joint arthroplasty (TJA) for lower extremities in 48 female rheumatoid arthritis (RA) patients by using dual-energy X-ray absorptiometry (DXA). Twenty-nine postmenopausal RA patients treated only with nonsteroidal anti-inflammatory drugs (NSAIDs) served as controls. They were studied for an average duration of 63 months. The reduction in the bone mineral density (BMD) of the lumbar spine (L2–4) was significant in both groups (p < 0.01∼0.05), but it was not statistically different between the two groups. The BMD of the femoral neck decreased significantly in both groups (p < 0.01–0.05) after 2 years, but it was not statistically different between the two groups. Our data suggest that TJA slowed the rapid axial bone loss usually associated with advanced RA. Received: 7 February 2000     

人工髋关节置换术患者康复期下肢关节的运动功能锻炼

目的：探讨人工髋关节置换术患者康复期下肢关节的运动功能锻炼方法与效果。方法：2011年7月到2015年1月选择在我院行择期人工髋关节置换术患者104例,根据随机数字表法分为治疗组与对照组各52例,两组都顺利完成人工髋关节置换术,术后对照组给予常规护理在此基础上治疗组采用积极地流程化运动功能锻炼。结果：治疗组的第1次下地时间明显少于对照组(P<0.05),而在手术之后两周治疗组的最长步行距离要比对照组高很多,P<0.05。痊愈后在髋关节功能优良率方面,治疗组和对照组分别是86.5%和61.5%,治疗组明显高于对照组(P<0.05)。治疗组康复期间的尿潴留、便秘、感染、褥疮、肌肉萎缩等并发症发生情况明显少于对照组(P<0.05)。康复后在总体健康、躯体疼痛、生理职能、生理功能等方面,治疗组的得分均要比对照组高很多,P<0.05。结论：人工髋关节置换术患者康复期下肢关节的运动功能锻炼能减少术后卧床时间,提高髋关节康复的速度,减小并发症出现的几率,使患者的生活品质得到改善。     

类风湿性关节炎全膝关节置换的临床疗效观察

目的:观察人工全膝关节置换术治疗严重类风湿性关节炎的临床疗效.方法:我院2003年3月-2005年12月对11例严重类风湿关节炎患者行人工全膝关节置换术,平均随访13个月,按美国特种外科医院膝关节评分系统(HSS)进行疗效评定.结果:所有患者没有一例行翻修手术,X线显示所有置换假体植入位置满意,没有假体松动、移位现象出现.11个膝关节的术后情况比较满意.HSS评分平均指数从术前的41分提高到术后的90分.结论:人工全膝关节置换术可作为类风湿性关节炎患者保存关节功能,改善疼痛的一种有价值的治疗方法.     

Thromboembolic disease in patients with rheumatoid arthritis undergoing joint arthroplasty: Update on prophylaxes

The risk of venous thromboembolism (VTE) in rheumatoid arthritis (RA) and the higher incidence of RA patients undergoing major orthopedic surgery is well recognized. The objective of the present study is to describe the incidence of VTE and discuss the correct prophylaxis in RA patients undergoing knee or hip replacement. A systematic review of studies on thromboprophylaxis in RA patients undergoing major orthopedic surgery was performed. Detailed information was extracted to calculate the rate of VTE in RA orthopedic patients and analyze the thromboprophylaxis performed and bleeding complications. Eight articles were eligible for full review. No difference in the overall rate of VTE was observed between RA patients and controls. No significant differences were found in RA patients in terms of bleeding complications. The data on the optimal prophylaxis to be used in RA patients were insufficient to recommend any of the several options available. In the absence of dedicated guidelines for the care of RA patients undergoing orthopedic surgery, management must be individualized to obtain favorable patient outcome, weighing up all the factors that might put the patient at risk for higher bleeding and thrombotic events.     

Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty

PURPOSE: Primary silicone metacarpophalangeal (MCP) joint arthroplasties have good results that deteriorate with time. The purpose of this study was to assess indications, patient satisfaction, and clinical and radiographic results following revision surgery in rheumatoid patients who had previously undergone silicone MCP arthroplasty. METHODS: Twenty hands in 18 patients (62 implants) had revision silicone MCP arthroplasties between 1986 and 2005 and had a greater than 1-year follow-up period (mean 5 y). A retrospective chart review was performed to collect preoperative and intraoperative data. Patients were then re-examined and administered a questionnaire addressing subjective outcome and satisfaction. RESULTS: Intraoperatively, 76% of the implants were fractured. Thirteen of 17 synovial biopsies revealed giant cell foreign body reaction. Preoperatively, the average arc of motion was from 16 degrees to 50 degrees , and ulnar drift was 24 degrees . Postoperatively, the average arc of motion was from 20 degrees to 54 degrees , and ulnar drift was 13 degrees . X-rays of 14 hands revealed that 15 of 44 revised implants had fractured. Sixteen patients (18 hands) were available to complete questionnaires. Twelve patients (14 hands) were satisfied and 3 were dissatisfied. Five of 16 patients would not have the revision again. These patients had worse average postoperative ulnar drift (30 degrees vs 9 degrees ) than the other 11 patients. All patients except one who had preoperative pain had at least moderate pain relief, and of the 6 patients who had revision surgery because of pain, 5 were satisfied. CONCLUSIONS: Revision silicone arthroplasty provides excellent pain relief, and the majority of patients were pleased with their results. Objective results, however, were generally poor. Soft tissue reconstruction is more difficult to achieve than the primary procedure, as evidenced by minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

髋关节置换术后病人下肢关节运动功能锻炼

目的 探讨人工髋关节置换术后病人康复期下肢关节的运动功能锻炼方法与效果.方法 2011年7月至2015年1月于湖北医药学院附属东风医院骨科择期行人工髋关节置换术病人104例,病人均顺利完成人工髋关节置换术.根据随机数字表法的平行对照原则分为常规组和改进组各52例,常规组给予常规护理,改进组在常规护理基础上采用流程化运动功能锻炼.比较两组病人首次下地时间、最长步行距离、髋关节Harris评分、并发症和36条目健康调查量表(36-item short-form health survey questionnaire,SF-36)的情况.结果 改进组病人首次下地时间明显早于常规组,术后2周改进组的最长步行距离比常规组长(均P<0.05).康复后,改进组病人的髋关节功能Harris评分优良率为86.5%优于常规组的61.5%(P<0.05).改进组康复期间的尿潴留、便秘、感染、褥疮、肌肉萎缩等并发症发生情况明显低于常规组(P<0.05).康复后在总体健康、躯体疼痛、生理职能、生理功能等方面,改进组的得分均高于常规组(P<0.05).结论 人工髋关节置换术病人康复期下肢关节的运动功能锻炼能减少病人术后卧床时间,提高髋关节康复的速度,降低并发症出现的概率,术后病人康复更好,病人的生活质量得到更好的改善.     

老年股骨颈骨折全髋关节置换术后下肢不等长的预防

目的探讨术前应用软尺测量双下肢的长度及术中测量患肢长度结合髋关节松紧度的方法来预防老年股骨颈骨折全髋关节置换(THA)术后下肢不等长的有效性。方法自2010-01—2012-12诊治老年单侧股骨颈骨折124例,62例术前应用软尺测量双下肢长度及术中测量患肢长度结合髋关节松紧度预防THA术后下肢不等长(试验组),62例进行传统THA手术操作(对照组)。结果 124例均获得随访1~12个月。2组切口均愈合良好,术后无髋关节脱位、下肢深静脉血栓形成及深部感染发生。试验组25例下肢延长平均4.0(1~10)mm,下肢延长患者没有出现步态异常。对照组30例下肢延长平均5.3(1~10)mm,没有出现步态异常;15例下肢延长平均12.7(11~20)mm;1例下肢延长30 mm,出现跛行、髋关节疼痛及下肢痛。对照组46例下肢延长平均7.6(1~30)mm。试验组术后肢体延长程度明显较对照组轻,差异有统计学意义(t=2.3,P0.05)。结论术前采用软尺测量双下肢长度及术中测量患肢长度结合髋关节松紧度可有效地预防老年股骨颈骨折THA术后下肢不等长。     

人工全髋关节置换术治疗56例强直性脊柱炎的临床研究

[目的]探讨人工全髋关节置换术治疗强直性脊柱炎的疗效。[方法]对56例（98髋）强直性脊柱炎患者行人工全髋关节置换术，其中42例（76髋）进行了平均5．6（2．5～10．5）a的随访。[结果]至末次随访时，Harris评分由术前的平均26．8（4～51）分提高到了术后的平均85．2（55～94）分，优良率为89．5％。1例感染行Ⅱ期翻修；2例在扩髓时出现股骨颈或股骨距裂缝骨折，但未到达小粗隆以下，未予特殊处置；1例出现足下垂，术后3个月后恢复，1例深静脉血栓，余病例无假体松动、断裂以及脱位发生。异位骨化发生率9．2％（7髋），但对功能无明显影响。[结论]人工全髋关节置换术治疗强直性脊柱炎可以明显缓解髋关节疼痛，恢复关节功能，与其它病因的全髋关节置换术相比，并无较高的危险因素。     

膝关节单髁置换术下肢力线纠正及假体位置角度研究进展

下肢力线与单髁假体位置角度是影响单髁置换术假体长期生存率及临床疗效的重要因素。下肢力线矫正不足将加速假体磨损进而减少假体生存率,下肢力线矫正过度会加速对侧间室关节炎的进展。通常认为单髁置换术下肢力线应纠正轻度内翻,然而部分学者的研究认为术后下肢力线对单髁置换术后功能评分和假体生存率无影响。股骨、胫骨假体位置不佳将造成患者膝关节不明原因疼痛甚至假体磨损,但股骨胫骨假体最佳位置存在争议。通常认为单髁置换术胫骨平台后倾角应纠正在3°~7°,但部分学者认为胫骨平台后倾角的改变过大也将影响膝关节间隙平衡及膝关节活动度。本文研究认为单髁置换术下肢力线的纠正至轻度内翻仍是单髁置换术最佳下肢力线,股骨与胫骨假体最佳位置有待进一步生物力学研究证实,胫骨平台后倾角的纠正应该根据术前患者具体原始解剖角度而变化。     

Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism

Fall from height is a common cause of unintentional injuries in children and accounts for 6％ of all trauma-related childhood deaths,usually from head injury.We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason.A child fell from a height of around 15 feet after toppling from a balcony.He developed multiple fractures involving the right femoral shaft,right distal femoral epiphysis （Salter Harris type 2）,right distal metaphysis of the tibia and fibula,and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia.There were no head,abdominal or spinal injuries.The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids,blood transfusion,and splintage of both lower limbs.Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails.Distal femoral physeal injury required open reduction and fixation with K wires.Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs.All the fractures united in four weeks.At the last follow-up,the child had no disability and was able to perform daily activities comfortably.We also proposed the unique mechanism of injury in this report.