先天性髋关节脱位闭合复位失败原因分析

总结闭合复位治疗先天性髋关节脱位共192例,复位失败14例,影响复位成败的因素有:髋关节病理情况、外固定的位置、年龄、牵引及固定时间、复位手法熟练度等.小儿先天性髋关节脱位的保守治疗,要严格掌握适应症,以提高复位成功率及减少并发症.     

高频超声在先天性髋关节脱位早期诊断中的应用价值

目的探讨先天性髋关节脱位的超声表现及高频超声技术在诊断先天性髋关节脱位中的应用价值。方法选择我院就诊的先天性髋关节脱位患儿125例,同期随机选取正常儿50例,应用高频超声检查髋关节,包括髋臼窝外形、髋臼骨性缘、软骨纤维肾唇及α,β角,分析这些指标在先天性髋关节脱位组与正常对照组间的差异。结果 125例先天性髋关节脱位患儿的超声检查正确诊断105例,漏诊15例,误诊5例。结论高频超声能较好地显示先天性髋关节脱位的形态学表现,可为临床提供较可靠地诊断依据,其无创、价廉及可重复性操作为先天性髋关节脱位的诊断及预后判断提供一种好的途径,值得推广。     

异体骨移植治疗小儿先天性髋关节发育不良

背景：骨盆截骨治疗先天性髋关节发育不良需取自体髂骨植入截骨间隙,对年龄较小的患儿取髂骨植骨存在一定的局限性。 目的：观察同种异体骨移植治疗小儿先天性髋关节发育不良的效果。 方法：对年龄1.5~3.0岁先天性完全性髋关节脱位36例患儿截骨后采用同种异体骨块移植治疗,影像学评价髋关节脱位治疗效果。 结果与结论：治疗后随访1.0~2.5年,未出现伤口渗液,疼痛,无排斥反应,无同种异体骨骨块移位及吸收病例。影像学评价髋关节脱位疗效显示,优良38髋(90%),中3髋(7%),差1髋(3%)。表明在小儿先天性髋关节发育不良骨盆截骨治疗中,选用同种异体骨移植,随访效果满意。     

一项改良手术治疗成人先天性髋关节脱位效果好

一项改良手术治疗成人先天性髋关节脱位效果好中华医学会信息，白求恩医科大学一院骨科徐莘香教授等，采用改良Ｃｈｉａｒｉ手术治疗１９例成人先天性髋关节脱位共２０个髋关节，获得满意疗效。成人先天性髋关节脱位患者伴有严重的行走痛及畸形步态，治疗困难，以往报道的...     

比基尼切口微创髋关节置换术治疗髋关节发育不良的临床疗效

目的 研究比基尼切口直接前方入路(DAA入路)微创人工髋关节置换术治疗先天性髋关节发育不良(DDH)伴骨关节炎的临床疗效和并发症.方法 回顾性研究2019年1月至2019年12月上海交通大学附属第一人民医院收治的78例DDH髋关节骨关节炎患者,38例行比基尼切口 DAA入路人工全髋关节置换术,40例行传统后外侧入路人工...     

先天性髋关节脱位闭合复位失败原因分析

总结闭合复位治疗先天性髋关节脱位共192例，复位失败14例，影响复位成败的因素有：髋关节病理情况、外固定的位置、年龄、牵引及固定时间、复位手法熟练度等。小儿先天性髋关节脱位的保守治疗，要严格掌握适应症，以提高复位成功率及减少并发症。     

先天性髋关节脱位新生儿期筛查的价值

目的：探在新生儿时期进行先天性髋关节脱位筛查的价值，旨在为临床上进行先天性髋关节脱位筛查提供参考依据。方法选取我辖区2012年~2013年出生的578例新生儿，于新生儿出院后第3~7 d进行产后家庭访视，作髋关节的常规检查，先筛查登记可疑阳性新生儿，再转诊北京积水潭小儿骨科进行确诊。结果经筛查，我辖区筛查登记的可疑新生儿有65例，男32例，女33例，经转诊北京积水潭小儿骨科进行确诊后，确诊为先天性髋关节脱位的有5例，其余均正常。结论在新生儿早期发现先天性髋关节脱位，尽早筛查出其病情，对其治疗有一定的意义。     

人工全髋置换联合髋臼造盖治疗先天性髋关节脱位

背景：以往采用单纯的人工关节置换、截骨重建等治疗成人CrownⅣ型先天性髋关节脱位的效果都不是很满意。 目的：探讨人工全髋置换联合髋臼造盖重建治疗成人CrownⅣ型先天性髋关节脱位的疗效。 方法：回顾性分析采用人工全髋置换联合髋臼造盖重建治疗23例成人CrownⅣ型先天性髋关节脱位的患者,其中男2例,女21例,年龄20-35岁,平均(24.26±3.56)岁。重建治疗后按Harrris髋关节功能标准评定术后疗效并进行统计学分析。 结果与结论：23例患者均获得随访,随访时间为12-60个月,平均(26.60±13.16)个月。采用SPSS19.0进行统计学比较后发现,手术前后髋关节功能Harrris评分差异有显著性意义(P < 0.01)。人工全髋置换联合髋臼造盖能重建髋关节正常结构,缓解疼痛,增加髋关节稳定性,是治疗成人CrownⅣ型先天性髋关节脱位的理想方法。     

不同年龄段小儿髋关节异常的治疗策略

髋关节发育不良（development displasia of hip，DDH）也称髋关节脱位，过去称为先天性髋关节脱位（congenital dislocation of hip，CDH），是一种与出生有关的髋关节疾病。它指在出生时髋关节就存在异常，并在出生后的发育过程中不断恶化的病变，包括从轻微的髋关节不稳定到髋关节完全性脱位。     

联合术式治疗3～6岁儿童先天性髋关节脱位

目的：探讨3～6岁儿童先天性髋关节脱位手术治疗的方法及效果。方法：对72例（88髋）3～6岁先天性髋关节脱位患者采用切开复位、关节囊紧缩,Salter骨盆截骨,股骨转子下缩短旋转截骨三种联合术式进行治疗。结果：随访18～30个月,根据Mckay评定标准,优良率达89．8％。结论：对3～6岁儿童先天性髋关节脱位联合手术是一种有效的方法。     

Total hip arthroplasty in healed tuberculous hip

Total hip arthroplasty was performed in a patient who had tuberculous hip, quiescent for the last 15 years, without pre or postoperative anti-tuberculous chemotherapy. At a 27 month follow up, there has been no evidence of reactivation. A brief review of relevant literature is also presented.     

Pathology of the capsular and synovial hip nerves in chronic hip diseases

Nerves of the synovial membrane and of the capsule of the hip have been studied with the usual techniques of optical neuropathology. We studied 52 hips from 46 patients: 13 hips of post-fracture states of the femoral neck, 13 hips of idiopathic osteonecrosis, 6 hips of rheumatoid arthritis, 6 hips of ankylosing spondylitis and 14 hips of osteoarthrosis. Small capsular and synovial nerves mainly located close to blood vessels are modified by the lesions of the surrounding tissue (inflammatory, vascular, traumatic and mechanical disturbances). The degree of involvement is related to the disease and its evolution. The peri- and endoneurium is thickened and demyelination is mostly observed. Nerve lesions begin focally and for some time are segmental. The final lesions correspond to a complete fibrous transformation of the nerve with loss of axons. We suggest a correlation between nerve lesions and the existence or absence of pain in the hip.     

Subsequent hip fracture in osteoporotic hip fracture patients

Purpose: A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs. Materials and Methods: We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively. Results: The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05). Conclusion: Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.     

全髋关节置换后髋关节内收外展活动范围计算

目的 探讨全髋关节置换术后髋关节内收外展活动范围与髋臼杯前倾角、股骨假体前倾角的关系.方法 人工髋关节不同臼柄水平截面摆动角的计算方法:①绘制臼杯截面分别为半圆、大于半圆、小于半圆的臼柄水平截面示意图;②设截面上股骨假体颈柄的宽度2 L,臼杯截面开口宽度为2 L',截面所在圆的半径为R;③求得臼杯截面大于半圆时摆动角、臼杯截面小于半圆时摆动角、臼杯截面等于半圆时摆动角.人工髋关节内收和外展时臼柄撞击平面位置的数学表达式:①假设臼杯(人工股骨头)的半径为R,股骨假体颈柄的半径为L,股骨假体前倾角为a,臼杯的前倾角为A;②通过复合函数求导数的方法确定人工髋关节内收和外展时臼柄截面摆动角最小值时的截面位置;③人工髋关节内收和外展时臼柄撞击平面位于旋转中心后方h ＝ sina√(R2-L2) + L(sinAR + sinaL)/ √(R2-L2),此时A∈[0,arcsin(cosa √(R2-L2)- sinaL)/R],且该撞击平面随A和或a的增大而逐渐后移至h ＝ Lcosa平面.推导人工髋关节内收和外展活动范围的计算公式.结果 人工全髋关节置换术后髋关节内收和外展活动范围ROM = 2{90° - arcsin (√1-[(sinAk+sina)2/cos2a(k2-1)]/ √k2-[(sinAk+sinak2)/√k2-1]2-arccos(√k2-[(sinAk+sinak2)/cosA √(k2-1)]2/ √k2-[(sinAk+sinak2) √k2-[(sinAk+sinak2)/ (k2-1)]2] }(k为头颈比).结论 全髋关节置换术后髋关节内收外展活动范围与髋臼杯前倾角、股骨假体前倾角呈负相关,与头颈比呈正相关.     

人工全髋关节假体置换治疗运动性髋损伤的理论与实践☆

背景：全髋关节表面置换尽可能保持了髋关节原有的力学性能,置换后关节稳定性及活动度好,且无明显的年龄限制。 目的：探讨人工髋关节假体在髋关节运动损伤治疗中的临床应用,以及髋关节假体置换治疗的材料与方法进展。 方法：应用计算机检索1998-01/2011-10 PubMed数据库及中国知网数据库有关生物材料与组织工程髋关节的文献,英文检索词“hip joint injury,artificial hip joint,hip replacement,hip resurfacing arthroplasty”,中文检索词“髋关节损伤,人工髋关节,人工髋关节置换,全髋关节表面置换”。最终纳入符合标准的文献41篇。 结果与结论：严重髋关节运动损伤应行人工髋关节置换,以恢复患者的生活能力,甚至一定程度的运动能力。目前人工髋关节假体置换的关键因素在于假体材料,假体材料主要有金属材料、陶瓷材料高分子材料、新一代骨水泥等,各自具有一定优点与缺点,由于随访时间和临床观察周期较长,各种材料的疗效还需要进一步研究。计算机模拟髋关节的三维有限元分析成为研究的热点,将运动生物力学与材料科学结合,对新材料的研发与检验是制造满足组织工程学人工髋关节假体的要求,达到修复和重建目的的重要途径。     

Total hip arthroplasty using S-ROM prosthesis for dysplastic hip

Purpose

The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a dysplastic hip.

Materials and Methods

Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after undergoing primary total hip arthroplasty using an S-ROM proximal modular femoral stem. The average follow-up was 80 months (range: 60 to 96 months). Clinical and radiological assessments were performed based on the Harris hip score and the radiological changes around the prosthesis.

Results

The average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation; there were 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stem were found at the last follow-up. Forty-one hips (91.9%) revealed excellent or good clinical results at the most recent follow-up.

Conclusion

For advanced secondary coxarthrosis, total hip arthroplasty with the use of the proximal modular femoral stem yielded good mid-term results with respect to the clinical and radiological criteria.     

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。 关键词：再发对侧髋部骨折;髋部骨折;股骨颈骨折;转子间骨折;骨密度;骨质疏松 doi:10.3969/j.issn.1673-8225.2012.04.042     

人工髋关节置换后脱位与前外侧入路修复髋关节囊的关系

背景：研究指出,前外侧入路修复髋关节囊对人工髋关节置换后脱位有很大的影响,但目前尚未明确。 目的：观察前外侧入路修复髋关节囊对人工髋关节置换后脱位的影响。 方法：选取广西钦州市第一人民医院2010年1月至2014年1月接诊并进行人工髋关节置换的480例患者作为研究对象,按照入院顺序分为对照组(2010年1月至2012年1月)和观察组(2012年2月至2014年1月),各240例。对照组细分为全髋关节置换组(A1组)和人工股骨头置换组(A2组),各120例;观察组也细分为全髋关节置换组(B1组)和人工股骨头置换组(B2组),各120例。A1组和A2组采用前外侧入路行人工髋关节置换;而B1组和B2组采用前外侧入路行人工髋关节置换并修复关节囊。分别对比分析A1组患者和B1组患者置换后早期脱位率,以及A2组患者和B2组患者置换后早期脱位率。 结果与结论：A1组患者置换后早期脱位率为6.7%,而B1组患者仅为0.8%,A1组患者的置换后早期脱位率明显高于B1组(P < 0.05)。A2组患者置换后早期脱位率为3.3%,而B2组患者仅为0.8%,但两组差异无显著性意义(P > 0.05)。提示前外侧入路修复髋关节囊可以有效降低人工全髋关节置换后脱位的发生率,但是对人工股骨头置换后脱位无明显影响。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程