联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中的应用

目的探讨联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中应用的可行性及临床价值。方法回顾性分析自2016-09—2018-06采用联合前倾角技术行全髋关节置换术治疗的31例(36髋)成人发育性髋关节发育不良,比较手术前后髋臼前倾角、股骨前倾角、联合前倾角及髋关节功能Harris评分。结果31例均获得12个月以上随访。术后骨盆正位及髋关节侧位X线片显示假体位置及对应关系良好,无假体松动、下沉,无脱位表现。末次随访时所有患者步态均明显改善,髋部疼痛均消失,仅2例轻度跛行。术后髋臼前倾角、股骨前倾角、联合前倾角较术前明显减小,末次随访时髋关节功能Harris评分较术前明显增加,差异有统计学意义(P<0.05)。结论联合前倾角技术应用于成人发育性髋关节发育不良全髋关节置换术对于指导合适假体的选择、设计以及确定合适的髋臼前倾角、股骨柄前倾角具有重要意义,良好的联合前倾角能够有效预防术后假体脱位的发生。     

手术治疗小儿发育性髋关节脱位

目的 探讨手术治疗小儿发育性髋关节脱位的临床治疗效果.方法 小儿发育性髋关节脱位患者21例共33个髋关节作为研究对象,其中男5例7个髋关节,女16例26个髋关节.年龄为3～6岁,平均年龄为(4.12±1.23)岁.所有对象均接受pemberton截骨术和salter截骨术,并进行随访观察.结果 本组均获随访,随访时间为10～34个月,平均23个月.小儿发育性髋关节脱位患者手术后优良率为93.94％.X线结果显示,有19例达到同心圆复位,无再脱位发生,有2例患者分别发生股骨头缺血性坏死和关节僵硬.结论 对小儿发育性髋关节脱位患者,采用pem-berton髋臼截骨术和salter截骨术的改良手术有较好的临床治疗效果,值得临床推广使用.     

关节镜治疗婴幼儿发育性髋关节脱位

目的探讨关节镜治疗婴幼儿发育性髋关节脱位(DDH)的临床疗效。方法对13例DDH患儿(17髋)采用关节镜治疗。结果患儿均获得随访,时间3~7(5.3±2.1)年。至末次随访,患儿均获得正常步态及髋关节活动度,无一例患儿出现股骨头坏死。髋臼指数由术前32.9°~51.8°(39.4°±11.3°)改善至末次随访时的19.8°~33.1°(24.8°±6.5°)(P0.001)。除1例(1髋)继发DDH外,其他患儿均获得股骨头与髋臼同心圆复位,恢复Shenton线连续性。结论采用关节镜治疗婴幼儿DDH临床疗效满意,具有创伤小、并发症发生率低等优点。     

发育性髋关节脱位儿童与正常儿童软骨性髋臼前倾角的MRI研究

[目的]通过MRI观察发育性髋关节脱位(developmental dislocation of hip,DDH)患儿病变髋软骨性髋臼是否存在过度前倾,测量不同年龄组正常儿童的软骨性髋臼前倾角(articaginous acetabular anteversion,CAA)并分析其发育演变。[方法]回顾性收集55例DDH儿童和222例正常儿童的髋关节MRI影像学资料。病例组:男22例,女33例;年龄6⁶0个月,平均19个月。共有73例脱位髋、9例半脱位髋、10例发育不良髋和18例未受累髋。对照组:男132例,女90例;年龄3个月60个月,平均19个月。共有73例脱位髋、9例半脱位髋、10例发育不良髋和18例未受累髋。对照组:男132例,女90例;年龄3个月¹5岁,平均6.2岁。共444例正常髋,并以患者年龄(岁)为单位分为15个亚组。通过MRI测量各组髋关节的CAA,统计学分析对比病例组和对照组以及对照组各组间CAA是否存在统计学差异。[结果]DDH儿童脱位与半脱位髋关节的CAA均大于未受累髋关节和正常儿童髋关节的CAA,差异具有统计学意义(P<0.05)。DDH儿童脱位髋关节CAA大于发育不良髋关节的CAA,差异具有统计学意义(P<0.05)。正常对照组儿童髋关节CAA在不同年龄组间不存在相关性(r<0,P>0.05)。所有病例均未发现髋臼后倾现象。[结论]DDH儿童脱位与半脱位髋关节的CAA是存在过度前倾的;正常的CAA在人们出生时就已完全形成,并且不随年龄的增长而发生明显改变。作者认为CAA更能反映髋臼的真实前倾角,采用MRI对DDH患儿的软骨结构进行评估可用于指导DDH的术式选择。     

发育性髋关节脱位的遗传学研究进展

发育性髋关节脱位(developmental dislocation of the hip,DDH)是小儿骨科最常见的、严重危害儿童健康的先天性畸形之一。目前学者们认为DDH是一种复杂的多基因病,是遗传因素和环境因素共同作用的结果,但其具体病因不清。环境因素包括宫内环境及生后环境因素,前者如臀位妊娠、羊水过少等,后者如不恰当的襁褓方式,髋关节被异常地牵拉等[1]。流行病学调查显示,约有12%～33%的DDH患儿有阳性家族史[2～4]。目前DDH分子遗传学研究主要采取     

大龄儿童发育性髋关节脱位的手术治疗

目的 总结不同手术方法治疗大龄儿童发育性髋关节脱位的疗效.方法 1985年至2005年期间分别采用Salter截骨术、Pemberton截骨术和髋臼造盖成形术治疗6～15岁发育性髋关节脱位患儿56例(62髋).结果 31例(33髋)获平均8.5年(2.5～15年)随访,根据周永德疗效评定标准,优17髋、良11髋、中2髋、差3髋,总优良率为85%.Salter骨盆截骨术组优良率为87%;Pemberton截骨术组优良率为83%,1例股骨头坏死;髋臼造盖成形术组优良率为85%,1例股骨头坏死,1例严重髋关节僵硬;同时行股骨粗隆下截骨的22例(23髋)中无一例发生股骨头坏死和术后脱位.结论 正确选择术式是大龄儿童发育性髋关节脱位获得良好疗效的关键,术式的选择主要根据病理变化和年龄.股骨粗隆下截骨能有效降低头臼压力,减少股骨头坏死和再脱位发生率.     

成人发育性髋关节脱位分型及治疗策略

发育性髋关节脱位(DDH)是造成髋骨关节炎及股骨头坏死的常见病因,常于患者成年后发病,治疗困难.该疾病病理分型对于最佳治疗方案选择、手术计划制定和完善及术后随访评价均有重要意义.基于骨盆X线平片的Crowe分型和Hartofilakidis分型是目前临床上最常用分型方法.成人DDH治疗方式主要包括骨盆截骨术、髋关节置换术及髋关节融合术,其中髋关节置换术手术决策和方案制定与DDH准确分型密切相关.该文就基于骨盆X线平片的DDH分型的可靠性、优点和不足及治疗策略作一综述.     

手术治疗小儿发育性髋关节脱位的护理

目的：探讨手术治疗小儿发育性髋关节脱位的护理方法。方法：对近一年来手术治疗小儿先天性髋关节脱位150例患儿的护理作回顾性总结分析。结果：全组病例经围术期精心护理,积极有效的手术治疗,髋关节能得以恢复,无下肢畸形、褥疮等并发症发生。结论：认真细致的病情观察和心理护理是护理小儿发育性髋关节脱位工作的重点。     

发育性髋关节脱位的早期手术治疗

[目的]总结12～18个月龄发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿手术治疗的临床和影像学方面的结果,研究早期手术治疗的可行性。[方法]回顾性分析本院在2004～2006年年龄为12～18个月发育性髋关节脱位患儿采用手术治疗的59例72髋临床资料,其中男8例,女51例,左侧27例,右侧19例,双侧13例。手术方式:切开复位加Salter骨盆截骨53髋;切开复位加Pemberton骨盆截骨19髋。[结果]平均随访50个月,术后按改良的McKay标准进行临床评估;按Severin标准进行放射学评估;按Salter标准诊断有无股骨头缺血性坏死。SeverinX射线评分优良率为94.4%,McKay临床评估优良率为93%。按Salter标准有2髋(2.8%)发生股骨头缺血性坏死(avascular necrosis of the femoral head,AVN)。[结论]不必过分强调小年龄DDH患儿的保守治疗,放宽手术指征,早期手术治疗是可行的。     

Pemberton髋臼成形术治疗发育性髋关节脱位

目的：探讨分析Pemberton髋臼成形术在发育性髋脱位的治疗上具有哪些优势。方法：采用Pemberton髋臼成形术治疗儿童发育性髋脱位106例116髋,男19例29髋,女87例87髋。左侧46髋,右侧50髋,双侧20髋。年龄18个月～13岁,平均7岁3个月,其中18个月～6岁99髋,7～13岁17髋。116髋均采用Pemberton髋臼成形术或内收肌、髂腰肌切断加Pemberton髋臼成形术加转子下股骨短缩、旋转截骨术。95髋单纯行Pemberton髋臼成形术,余21髋行全套手术。双侧髋脱位患儿均先做一侧,1年后再做另一侧,同时将第1次手术股骨内固定钢板取除。结果：病例随访时间2～10年,平均6年。按照Mullerh和Seddon标准进行功能评定,优67髋,良34髋,可10髋,差5髋,优良率87%。结论：Pemberton髋臼成形术适用于多个年龄段的儿童发育性髋脱位患者,疗效肯定,在发育性髋脱位的治疗中占有重要地位。     

Femoral Anteversion in THA and its Lack of Correlation with Native Acetabular Anteversion

Several studies support the concept that, for optimum range of motion in THA, the combined femoral and acetabular anteversion should be some constant or fall within some “safe zone.” When using a cementless femoral component, the surgeon has little control of the anteversion of the component since it is dictated by native femoral anteversion. Given this constraint, we asked whether the surgeon should use the native anteversion of the acetabulum as a target for implant position in THA. Forty-six patients scheduled for primary THA underwent CT scanning and preoperative planning using a computer workstation. The native acetabular anteversion and the native femoral anteversion were measured. Prosthetic femoral anteversion was measured on the workstation by three-dimensional templating of a straight-stemmed tapered implant. The mean of the sum of the native acetabular anteversion and native femoral anteversion was 28.9°; however, 17% varied by 10° to 15° and 11% by more than 15°. The mean of native femoral anteversion and prosthetic femoral anteversion was 13.8° (range, −6.1°–32.7°) and 22.5° (range, 1°–39°), respectively. Based on our data, we believe the surgeon should not use the native acetabular anteversion as a target for positioning the acetabular component.     

Supernumerary Parathyroid Glands: Frequency and Surgical Significance in Treatment of Renal Hyperparathyroidism

Supernumerary parathyroid glands (SPGs) are found in 13% of random autopsies. The high incidence of SPGs could explain the persistence or trigger recurrence of renal hyperparathyroidism after surgery. The aim of this study was to assess the frequency and clinical relevance of SPG in patients operated on for renal hyperparathyroidism (HPT). In this retrospective study we reviewed the medical records of 290 patients with renal HPT who were initially treated in our department. We examined the anatomic and pathologic findings during cervical surgical exploration and the outcome of HPT during follow-up. SPGs were identified in 87 patients (30%) during the initial cervicotomy, corresponding to intrathymic parathyroid cell islets (one to four) in 70 cases and to extrathymic SPG in 17 patients. Among 260 patients available for follow-up, 11 experienced persistent HPT (4%), and 34 developed recurrent HPT (13%). A total of 25 patients were reoperated on, and SPGs were responsible for 4 of 8 cases of persistent HPT and 4 of 17 cases of recurrent HPT, representing an overall frequency of 32%. The anatomic distribution of SPGs found during reoperations included thymus, retroesophageal grove, carotid sheath, and mediastinum. SPGs are thus present in 30% of patients with renal HPT and are situated mainly in the thymus. Thymectomy should be performed routinely during the first surgical exploration to prevent recurrences arising from anterior mediastinal glands. SPGs were also responsible for 32% of persistent or recurrent HPT. In that setting, frankly ectopic SPGs are not rare, and preoperative imaging appears highly desirable prior to embarking on surgical reexploration.     

Historical Aspects of DDH

BackgroundLittle was known about developmental dysplasia of the hip (DDH) in the early historical era. Symptoms such as limping were caused by a variety of disease processes, many of which were life threatening. It was not until the discovery of X-ray in 1896 that clear understanding of childhood hip conditions, including DDH, could evolve.MethodsWe reviewed available literature and distilled it into this summary of the history of our understanding of DDH.ResultsThe development of non-operative methods relied on plaster of Paris cast reductions and later splints and harness systems leading to the Pavlik harness (1950’s). The development of ultrasound as a diagnostic technique made early diagnosis and treatment possible. Surgical approaches to DDH treatment required several key discoveries: invention of general anesthesia (1840s); development of sterilization techniques (1860–1880); discovery of X-ray (1890s); development of stainless steel (1920s); and the discovery of antibiotics (1930s). These surgical advances allowed the development of a remarkable variety of operations to treat DDH including open reduction techniques, and osteotomies of the acetabulum and proximal femur.ConclusionThe path to accurate diagnosis and predictable treatment of DDH parallels the many advances that application of the scientific method has allowed in the specialty of orthopedic surgery. The development of academic centers that focus on research and education in childhood hip disorders, as well as a growing number of centers that focus on hip problems in adolescents and young adults, assure a continuous and changing “history” of this common childhood hip condition.     

分化型甲状腺癌术中纳米碳示踪对颈淋巴结清扫的指导意义

分化型甲状腺癌是临床最为常见的恶性肿瘤之一,完整的外科手术切除是决定预后的重要因素,残余的转移淋巴结是术后复发的高危因素,淋巴结的彻底清扫可以改善总体预后。然而对于甲状腺癌的预防性/治疗性颈淋巴结清扫术尚存争议及挑战。纳±3碳混悬液作为新型的淋巴结示踪剂,对于甲状腺的淋巴结具有良好的示踪效果,可以显著提高术中的清扫效率,增加获取淋巴结的数目,更为准确地判断分期及预后。另外通过其"负显影"的特性可以有效保护喉返神经、甲状旁腺等重要结构,显著降低颈部淋巴结清扫中并发症的发生率,具有重要的临床意义。     

Anteversion of the femoral neck in Indian dry femora

 The purpose of this study was to estimate the average angle of femoral neck anteversion in an Indian population. A total of 300 dry femora were classified by standard anatomical norms into male and female types and left-side and right-side types. They were evaluated by the Kingsley Olmsted and parallelograph methods, and the data were statistically analyzed. The average angles of anteversion obtained were 8.1° and 8.3° by the Kingsley Olmsted and parallelograph methods, respectively. The average female-type bone showed about 3° more anteversion than the male-type bone. The average left-sided bone showed about 1.6° more anteversion than the right-sided bone. A statistically significant difference existed between the sexes and the sides. The Kingsley Olmsted and parallelograph methods were found to be comparable with a correlation coefficient of 0.99. Altogether, 42.33%, 57.66%, and 79.00% of bones had readings of 5°–10°, 0°–10°, and 0°–15°, respectively. Thus, femoral neck anteversion has been found to be less in the Indian population than in Western populations. Received: August 20, 2002 / Accepted: January 13, 2003 RID="*" ID="*" Offprint requests to: A.K. Jain