The Influence of Heterotopic Ossification on Functional Status of Hip Joint Following Total Hip Arthroplasty

Purpose:  

The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure.     

Preoperative Irradiation for Prevention of Heterotopic Ossification Following Prosthetic Total Hip Replacement

BACKGROUND: The effectiveness of pre- or postoperative radiotherapy for prevention of heterotopic ossification (HO) following total hip replacement (THR) has already been demonstrated in the past. Thereby, in most studies using preoperative radiotherapy patients were irradiated < 6 h before surgery. The purpose of this prospective study was to analyze the effectiveness of preoperative irradiation on the evening before surgery and to identify risk factors for HO in a homogeneous collective of patients. PATIENTS AND METHODS: From July 1997 to July 2001, 416 patients (462 hips; 235 males, 227 females) received preoperative radiotherapy of the hip on the evening before surgery with a 7-Gy single fraction. The patients' median age was 67.1 years. The most frequent indication for radiotherapy was hypertrophic osteoarthritis (383 hips, 82.9%). Treatment results were assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). The analysis of radiographs was performed according to the Brooker score. RESULTS: The overall incidence of HO was 18.1% (n = 84), Brooker score 1 12.3% (n = 57), score 2 3.9% (n = 18), score 3 1.5% (n = 7), and score 4 0.4% (n = 2). Sex, body height, hypertrophic osteoarthritis of higher degree, size of the femoral component of the prosthesis, previous ipsi- or contralateral HO, and short course of nonsteroidal anti-inflammatory drug (diclofenac) therapy significantly influenced the HO rate in univariate analysis. In multivariate analysis, an interdependence of prosthesis size, sex and patient's height was found. From these three variables, only prosthesis size was statistically significant in multivariate analysis. The cumulative dose of diclofenac (< or = 300 mg or > 300 mg) within the first 7 postoperative days and previous ipsi- or contralateral HO influenced the incidence of HO in multivariate analysis. CONCLUSION: Preoperative radiotherapy on the evening before surgery is an effective treatment modality to reduce overall (Brooker 1-4) and clinically relevant, severe HOs (Brooker 3-4), and includes several advantages compared to postoperative irradiation. Previous ipsi- and contralateral HOs were identified as high risk factors for HO in this study. In patients with these risk factors, the incidence of HO increased.     

全髋关节置换术后的康复护理与指导

目的　探讨全髋关节置换术后的早期护理和后期康复指导 ,以减少假体松动、感染、脱位、柄折断等并发症的发生。方法　对我院 6 5 4例全髋关节置换病人的术后早期护理及康复指导方法进行分析总结。结果　保持正确体位 ,密切观察负压引流 ,早期、中期功能锻炼和后期康复指导减少了并发症的发生。结论　术后正确的护理 ,循序渐进的功能训练与后期的康复指导对保持关节稳定 ,增强假体牢固程度 ,延长置换关节使用寿命 ,降低髋关节返修率起到了十分重要的作用     

股骨颈骨折内固定失败后行全髋关节置换术治疗的效果分析

目的分析探讨股骨颈骨折内固定失败后行全髋关节置换术(total hip arthroplasty,THA)治疗的临床疗效。方法回顾性分析2018年1月至2019年1月南阳市骨科医院关节科收治的股骨颈骨折内固定失败后行THA治疗的36例患者的病历资料,对比THA治疗前后髋关节Harris评分及简明健康状况调查量表(SF-36)评分变化情况,评估患者髋关节功能及生活质量。结果治疗后6个月患者髋关节Harris评分为(66.21±6.42)分,治疗后12个月为(88.45±7.19)分,均明显高于治疗前的(43.11±7.25)分(t=14.310、26.640,P均=0.000);治疗后12个月,患者简明健康状况调查量表(SF-36)中的躯体功能、躯体疼痛、生理职能、社会功能、精神健康、情感职能、精力、一般健康状况评分均明显高于治疗前(t=12.790、22.190、7.367、12.760、12.630、6.332、12.160、12.160,P均=0.000)。结论股骨颈骨折内固定失败后予以THA治疗,能够有效提高患者的髋关节功能及生活质量,临床应用价值较高。     

保留股骨颈型人工全髋关节置换术25例分析

目的探讨保留股骨颈型人工全髋关节置换的治疗价值。方法2000年9月—2006年12月,我科应用保留股骨颈型人工全髋关节置换治疗髋关节骨关节病25例(30髋),单侧20例,双侧5例。结果本组经过0.5~6年随访,30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,X线摄片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符合股骨近端生理顺应性,使假体适应应力分布。防止股骨近端骨质疏松引起假体松动和下沉。同时为今后需要假体翻修提供骨结构基础。     

Preoperative Arterial Embolization for Heterotopic Ossification of the Hip

PurposeTo investigate the efficacy and safety of preoperative arterial embolization for neurogenic heterotopic ossification (NHO) of the hip.Materials and MethodsThis single-center retrospective study reviewed outcomes in 16 consecutive patients who had surgical resection of NHO of the hip: 8 of whom underwent preoperative arterial embolization and 8 of whom did not. Both patient cohorts had similar baseline characteristics. A mean of 2.62 ± 1.9 arteries per patient, including the gluteal, lateral circumflex femoral, and deep circumflex iliac branches, were embolized using an n-butyl cyanoacrylate (NBCA)–ethiodized oil mixture. Data from both cohorts regarding intraoperative blood loss, volume of blood transfused, complications, and duration of hospitalization were compared.ResultsA mean of 2.6 ± 1.9 arteries were embolized with NBCA–ethiodized oil, mainly the gluteal arteries, lateral circumflex femoral artery, and deep circumflex iliac artery. In the embolization group, mean intraoperative blood loss was 875 mL ± 320, mean number of units of blood used was 0.5 ± 0.7, and mean number of days of hospitalization was 6.4 days ± 1.6. In the control group, mean intraoperative blood loss was 1,350 mL ± 120, mean number of units of blood used was 2 ± 1.1, and average number of days of hospitalization was 11.5 days ± 1.4. The embolization group had a mean reduction in blood loss of 40.7% (P = 0.035), reduction in units of blood administered of 75% (P = 0.021), and reduction in days of hospitalization of 44.7% (P = 0.014). No procedural complications were recorded.ConclusionsPreoperative arterial embolization is effective and safe in reducing intraoperative blood loss, number of hospitalization days, and need for blood transfusions in surgical resection of NHO of the hip.     

综合运动训练对全膝关节置换术功能及预后的影响

目的研究综合运动训练对全膝关节置换术功能及预后的影响,为临床治疗提供一定的理论依据。方法按照入院先后顺序入选64例全膝关节置换术患者,根据随机数字方法分成两组,每组32例,其中对照组予以单纯的持续被动运动训练,而研究组在持续被动运动的基础上再综合其它的运动训练以及超短波和超声波治疗。治疗随访6周后,分析两组患者的相关临床资料。结果与对照组相比较,研究组在膝关节的功能、活动度、稳定度、疼痛、肌力及屈曲畸形等方面的HSS评分明显改善(P<0.05)。同时,通过统计发现,对照组的优良率为53.13%,而研究组的优良率为84.38%,明显高于对照组(P<0.05)。结论综合运动训练的康复治疗方式可以很好的改善全膝关节置换术患者的膝关节功能及其预后。     

Observations on para-articular uptake of radiophosphate after hip replacement

A correlation was made between the incidence and intensity of ^99mTc-methylene diphosphonate (MDP) concentration and the rediographic incidence and volume of heterotopic calcium deposition in 44 patients with hip arthroplasties, as well as with the duration of the hip implants. The incidence of soft tissue para-articular MDP concentration was 95% compared to a 68% incidence of radiographically visible heterotopic calcium, bone or both. The concentration of MDP did not decrease on average with the age of the implant, which ranged from 6 months to 15 years, even though radiographs showed evidence of mature ossification in many of them. The cause of these sustained high uptakes is open to speculation, but the findings indicate that radiophosphate imaging is not a reliable means of assessing maturation of heterotopic bone associated with hip arthroplasty.     

Imaging Evaluation of Complications of Hip Arthroplasty: Review of Current Concepts and Imaging Findings

Total hip arthroplasty has evolved along with improvements in component materials and design. The radiologist must accurately diagnose associated complications with imaging methods and stay informed about newer complications associated with innovations in surgical technique, prosthetic design, and novel materials. This pictorial essay presents clinical and imaging correlation of modern hip arthroplasty complications, with an emphasis on the most common complications of instability, aseptic loosening, and infection as well as those complications associated with contemporary metal-on-metal arthroplasty.     

护理干预在人工全髋关节置换术后深静脉血栓形成中的应用

目的研究护理干预在人工全髋关节置换术后深静脉血栓形成中的应用。方法将44例患者随机分成两组,即对照组和实验组,每组22例,对照组采用人工全髋关节置换术的常规护理,实验组在对照组基础上加强对患者的护理干预,比较两组患者术后下肢肿胀、浅静脉充盈及腓肠肌压痛等症状的发生率及对护理人员的满意度。结果对照组患者术后下肢肿胀、浅静脉充盈及腓肠肌压痛等症状的发生率为36.36%,实验组为4.55%,对照组高于实验组,两组比较差异有统计学意义(P<0.05);对照组患者对护理人员的满意度为63.64%,实验组为90.91%,实验组对护理人员的满意度高于对照组,两组比较差异有统计学意义(P<0.05)。结论加强对人工全髋关节置换术后深静脉血栓形成的护理干预,利于减少深静脉血栓的发生,提高患者对护理人员的满意度,提高患者的生活质量。     

全膝关节置换术中髌股关节轨迹不良的处理策略及疗效探讨

目的总结分析全膝关节置换术(total knee arthroplasty,TKA)中髌股关节轨迹不良的个体化处理策略及其治疗效果。方法选取2012年8月至2017年8月广州医科大学附属第二医院骨外科收治的145例(184膝)拟初次行保留髌骨TKA的膝关节病变患者作为研究对象,术中根据髌股关节轨迹不良情况酌情采用假体位置调整、髌骨修整成形、髌骨内外侧支持带张力调整及Goldthwait-Roux术处理,评估术前及术后疼痛视觉模拟评分法(visual analogue scale,VAS)评分、美国膝关节协会评分(knee society score,KSS)、Feller髌骨评分以及胫骨角、股骨角、胫骨后倾角及股骨屈曲角等假体力线相关参数变化情况,记录假体松动、髌骨坏死、髌骨骨折和骨溶解等并发症发生情况。结果术后所有患者均无假体松动、髌骨坏死、髌骨骨折和骨溶解等并发症发生;随访(16.72±4.16)个月,患者VAS评分明显低于术前(t=38.483,P=0.000),KSS评分、Feller髌骨评分均明显高于术前(t=36.110、17.700,P均=0.000),胫骨角、股骨角、胫骨后倾角、股骨屈曲角均明显大于术前(t=99.997、87.499、14.084、4.101,P均=0.000)。结论 TKA术中根据患者髌股关节轨迹不良情况个性化采用假体位置调整、髌骨修整成形、髌骨内外侧支持带张力调整及Goldthwait-Roux术处理,可纠正患者髌股关节轨迹不良,缓解膝前痛,改善膝关节功能,临床应用价值较高。     

骨形态发生蛋白4、脱钙骨基质和切断跟腱诱导的异位骨化动物模型的研究

目的:建立骨形态发生蛋白4(bone morphogenetic protein 4,BMP4)、脱钙骨基质和切断跟腱诱导的异位骨化动物模型,并初步探讨其形成机制,为异位骨化的研究奠定实验基础。方法:制备动物模型:(1)构建BMP4重组腺病毒,实验组裸鼠的一侧腓肠肌内注入50μl1×107pfu BMP4重组腺病毒液,对照组腓肠肌内注入50μl1×107pfu空病毒液。4周后行X线和组织学检查。(2)无菌条件下,股后外侧入路,将50mg脱钙骨基质植入裸鼠股后肌群内,4周后行X线和组织学检查。(3)20只小鼠于跟腱中点行跟腱切断术,10周后行X线和组织学检查。结果:X线和组织学检查显示4周后,注射BMP4重组腺病毒的动物均出现异位骨,注射空病毒组未见异位骨形成。4周后,植入脱钙骨基质的动物均出现异位骨。10周后,行跟腱切断术的动物均在跟腱部位出现异位骨。结论:BMP4、脱钙骨基质和切断跟腱可有效诱导异位骨化,结果稳定可靠。     

双动全髋关节置换治疗老年股骨颈骨折疗效观察

目的 探讨双动全髋关节置换术治疗老年股骨颈骨折的近期及远期疗效.方法 选取2016年1月至2017年12月济源市人民医院收治的60例老年股骨颈骨折患者作为研究对象,并按照随机数表法将其随机分为研究组(30例)与对照组(30例),研究组患者采用双动全髋关节置换术治疗,对照组患者采用传统全髋关节置换术治疗,对比两组患者手术...     

股骨颈骨折患者全髋关节置换术治疗的临床效果及对手术时间、出血量的影响

目的 探讨股骨颈骨折患者全髋关节置换术治疗的临床效果.方法 选择2018年7月-2019年8月就诊的股骨颈骨折患者92例,采用随机数字表法分为两组,各46例.对照组和观察组分别采用人工股骨头置换术和全髋关节置换术治疗.对比两组临床效果、手术情况及并发症情况.结果 观察组优良率高于对照组(93.48％vs 76.09％,...     

滑膜切除对同期双侧全膝关节置换术后失血及功能恢复的影响

目的:探讨同期双侧全膝关节置换术(TKA)时行滑膜切除术对术后失血量及膝关节功能恢复的影响。方法:2014年11月至2017年12月间因患原发性膝骨关节炎在我院行同期双侧全膝关节置换的患者62例,其中32例术中进行滑膜切除(实验组),30例术中不进行滑膜切除(对照组)。对比两组患者手术时间、术中出血量、住院时间、术后第3天血色素较术前降低值、术后隐性出血量、术后输血率以及术后4周、12个月疼痛视觉模拟评分(VAS)和美国膝关节协会评分(KSS)。结果:两组患者均获得12个月随访。两组患者手术时间、术中出血量差异均无统计学意义(P>0.05);实验组术后输血率明显高于对照组(25%vs. 10%),但差异无统计学意义(P>0.05);实验组住院时间、术后第3天血色素较术前血色素降低值、隐性失血量均高于对照组,差异有统计学意义(P<0.05)。两组术后4周及术后12个月VAS评分、KSS评分(包括临床评分、功能评分)均较术前明显改善,差异有统计学意义(P<0.05)。两组间术前、术后4周及术后12个月VAS评分及KSS评分(包括临床评分、功能评分)差异无统计学意义(P>0.05)。结论:在行同期双侧全膝关节置换治疗骨性关节炎时,与保留滑膜相比,滑膜切除在缓解术后疼痛及改善膝关节功能方面未带来明显获益,且增加了隐性失血量及术后输血率。     

冲和药物速渗疗法对腰部软组织伤病患者生理功能位及代偿功能位的影响

目的评价冲和疗法(CHT)对腰部伤病患者生理功能位及代偿功能位的影响。方法将80例患者随机分为冲和组和常规组,应用VAS疼痛视觉模拟量尺、SF-36健康状况调查问卷、脊柱运动范围测量腰椎活动度观察CHT对其的影响;观察随访1年腰部损伤事件发生率。结果治疗前后两组VAS指数、SF-36得分、腰椎活动度均有统计学意义(P<0.01);观察随访1年,冲和组腰部损伤事件发生率明显低于常规组(P<0.01)。结论CHT能引导损伤肌组织向生理功能位修复和阻止损伤代偿功能位的形成,从而调节腰椎活动的力学平衡,能有效地控制腰痛发作,减少腰部损伤事件发生率。     

膝关节等速测试中角度和时间因素的研究

利用BIODEX多关节等速测试及康复系统对 2 0例正常男性膝关节等速向心收缩进行测试 ,研究了角度和时间因素对测试结果的影响 ,提示二者对结果影响显著 ,尤以角度因素更为明显