老年髋部骨折后对侧髋部的再骨折

背景:老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。目的:阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。方法:于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。结果与结论:单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率(P=0.018)。再发对侧骨折组骨质疏松发生率高于单侧骨折组(P=0.032)。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。     

髋部骨肿瘤患者置换特制人工髋关节假体26例

回顾性分析武汉大学人民医院1999-03/2005-05收治的26例髋部原发肿瘤行特制人工假体置换患者的临床资料.所有诊断均经病理组织学证实,软骨肉瘤3例,骨肉瘤6例,滑膜肉瘤1例,骨巨细胞瘤14例,动脉瘤样骨囊肿2例.假体类型:特制全髋关节假体17例,特制人工双极股骨头7例,马鞍式关节假体2例.随访18个月～6年,平均4年3个月.其中10例恶性肿瘤患者局部复发率为40%,保肢率为60%:16例中间性及低度恶性肿瘤患者复发率为12.5%,保肢率为87.5%.肢体功能Enneking评分平均19分,优良率为76.9%.提示特制人工髋关节假体可以有效保持患肢的肢体功能,足髋部肿瘤较为满意的保肢治疗方法之一.     

Common sonographic findings in the painful hip after hip arthroplasty

Diagnosing the cause of hip pain in patients with hip arthroplasty can be challenging because of the numerous possible causes of pain and artifacts caused by the prosthetic components on computed tomography and magnetic resonance imaging. Sonography plays an important role in the diagnosis and management of these patients because the soft tissues surrounding the prosthetic joint are not obscured by artifacts and because sonography enables hands-on examination of the painful site, dynamic evaluation of moving structures, and comparison with the opposite side. Another advantage of sonography is the ability to perform sonographically guided diagnostic and therapeutic procedures. In this pictorial essay, we highlight commonly encountered sonographic findings in patients with hip pain after hip arthroplasty.     

Cemented versus uncemented hip replacement for fracture of the hip

PURPOSE: Review cemented versus uncemented hemi-arthroplasty hip replacement regarding morbidity and long term results. METHODS: A literature review searching PubMed and Medline was done. Publications applicable to hip fractures treated by hip replacement or hemi-arthroplasty replacement were reviewed. RESULTS: Several articles compared cemented femoral stems to fracture fixation. There were few articles comparing cemented and uncemented stems. Some noted increased problems with uncemented stems but did consider design factors. Unreamed tapered stems may have may have fewer problems. CONCLUSIONS: Prospective studies comparing cemented and uncemented femoral stems are needed to determine the best form of fixation for patients having hip surgery following hip fracture. Tapered uncemented stems may offer as good a result as cemented stems, with less morbidity.     

Cemented versus uncemented hip replacement for fracture of the hip

Purpose: Review cemented versus uncemented hemi-arthroplasty hip replacement regarding morbidity and long term results.

Methods: A literature review searching PubMed and Medline was done. Publications applicable to hip fractures treated by hip replacement or hemi-arthroplasty replacement were reviewed.

Results: Several articles compared cemented femoral stems to fracture fixation. There were few articles comparing cemented and uncemented stems. Some noted increased problems with uncemented stems but did consider design factors. Unreamed tapered stems may have may have fewer problems

Conclusions: Prospective studies comparing cemented and uncemented femoral stems are needed to determine the best form of fixation for patients having hip surgery following hip fracture. Tapered uncemented stems may offer as good a result as cemented stems, with less morbidity.     

Cemented versus uncemented hip replacement for fracture of the hip

Purpose: Review cemented versus uncemented hemi-arthroplasty hip replacement regarding morbidity and long term results.

Methods: A literature review searching PubMed and Medline was done. Publications applicable to hip fractures treated by hip replacement or hemi-arthroplasty replacement were reviewed.

Results: Several articles compared cemented femoral stems to fracture fixation. There were few articles comparing cemented and uncemented stems. Some noted increased problems with uncemented stems but did consider design factors. Unreamed tapered stems may have may have fewer problems

Conclusions: Prospective studies comparing cemented and uncemented femoral stems are needed to determine the best form of fixation for patients having hip surgery following hip fracture. Tapered uncemented stems may offer as good a result as cemented stems, with less morbidity.     

The Rheumatoid hip

Rheumatoid Arthritis (RA) is among the most common systemic diseases of connective tissue, affecting 1,5% of the population. In recent years about 30 000 new cases of RA have been reported annually. The rheumatoid process has a progressive course, leading to system-wide destruction of bones and joints, along with damage to many other organs and systems. The treatment team involved in managing cases of RA must be composed of specialists from many different fields: orthopedic surgeons, rheumatologists, physiotherapists, social workers, occupational therapists, and visiting nurses.
The treatment goal is to improve the patient's quality of life, to reduce or eliminate pain, and in the most severe cases to facilitate nursing care. In the surgical treatment of these patients the procedures used include synovectomy, joint debridement, soft tissue relaxation operations, arthrodesis, osteotomy, resection arthroplasty, and joint replacement. Among the more than 100 known connective tissue diseases, the hip joint is most commonly involved in cases of rheumatoid arthritis and ankylosing spondylitis. In cases of substantial destruction of the hip, the treatment of choice is joint replacement. Both cemented and cementless prostheses are used in the treatment of RA patients, depending on the surgeon's experience and the patient's age, general clinical status, and the quality of the bone tissue. Postoperative treatment in these patients does not differ from the generally accepted standards for the treatment of degenerative diseases. Based on the author's own experience in the Rheumatoorthopedic Department at the Institute of Rheumatology, it can safely be stated that hip joint replacement is a valuable and well tested method in the treatment of destructive changes to the hip joints in RA patients.     

老年髋部骨折后对侧髋部的再骨折

背景：老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。目的：阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。方法：于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。结果与结论：单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率（P=0.018）。再发对侧骨折组骨质疏松发生率高于单侧骨折组（P=0.032）。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。