全髋关节置换术髋臼旋转中心的回顾性研究

[目的]通过手术前后对髋臼旋转中心的X线测量，探讨髋臼旋转中心的变化对髋关节平衡稳定性的影响。[方法]追溯调查近年本院收治120例155髋，均为首次行全髋关节置换术患者，对比术前术后双髋关节正位X线片，比较术后髋臼假体的旋转中心（HJC1）与解剖髋臼旋转中心（HJC0）的符合率。[结果]旋转中心恢复者98髋（63．23％）（A组），未恢复者57髋（36．77％）（B组）；A、B两组中因人工髋关节松动、脱位、髋部痛等行髋关节假体翻修术分别为6髋（6．12％）、17髋（29．82％）。[结论]髋臼旋转中心的恢复对人工髋关节置换术后的关节稳定性有直接影响。     

人工全髋关节翻修术治疗假体置换术后感染

目的：探讨全髋关节置换术后假体周围感染的治疗方法。方法：1998年1月～2002年6月共收治7例全髋关节置换术后感染患者。采用一期全髋关节翻修术3例，二期全髋关节翻修术4例，术后平均随访14个月。结果：患者髋关节评分平均提高37．6分(Harris评分)，经随访无一例感染患者复发。结论：人工全髋关节置换术后感染患者经过彻底清创和使用有效抗生素治疗后，可一期或二期进行全髋关节翻修术，治疗假体周围感染，改善患肢关节功能。     

全髋关节置换术并发坐骨神经损伤的防治措施

目的 探讨初次行全髋关节置换术(THA)及翻修术并发坐骨神经(SN)损伤的原因及防治措施.方法 行THA 139例及翻修术6例,结果并发SN损伤5例,功能采用LSUHSC评分,对损伤者采取相应处理.结果 5例SN损伤,1例电刀热损伤,2例髋臼板钩压迫性损伤,2例牵拉性损伤.治疗后3例完全恢复,2例部分恢复.结论 THA...     

人工股骨头置换与全髋关节置换治疗老年股骨颈骨折

目的 评价人工股骨头置换与全髋关节置换治疗老年股骨颈骨折的临床疗效。方法 对134例老年股骨颈骨折行髋关节置换术，其中人工股骨头置换55例，全髋关节置换79例。结果 3例人工股骨头置换术后2年因髋臼磨损、髋关节疼痛明显行髋臼翻修，1例全髋关节置换术后半年因髋臼松动行髋臼翻修，其余病例均无明显髋部不适，髋关节活动良好。结论 老年股骨颈骨折治疗方法的选择取决于患者全身健康状况、术前的生活状态和活动量、骨的质量和年龄等因素。通过严格的术前评估，人工股骨头置换与全髋关节置换同样能取得良好的临床疗效。     

髋关节置换术后翻修原因分析

１９７４年～１９９１年对２６４例老年股骨颈骨折、股骨头缺血坏死、髋关节骨性关节炎患者行髋人工关节置换，其中人工股骨头置换１５０例，全髋关节置换１１４例。术后因假体松动、下沉、脱位，髋臼磨损等原因，引起患者疼痛，功能障碍而行翻修术１５例，翻修率为５．７％，翻修时间为术后５年～１６年，平均７．４年。翻修手术为人工股骨头再置换术３例，全髋关节置换术１２例。翻修术后随访２年～６年，平均４．７年。按Ｊａｃｏｂｓ法评价，优１１例，占７３％；良３例，占２０％；可１例，占７％。翻修原因主要与假体松动、下沉，髋臼磨损，髋臼软骨切取不彻底，臼窝太浅，植入假体时存有血迹等有关。     

人工全髋关节置换术后假体松动的原因分析（附31例报道）

目的探讨人工全髋关节置换（THA）术后假体松动的原因,以提高全髋关节翻修术的治疗效果。方法回顾性分析自2000-06—2010-06诊治由于THA术后假体松动而行人工全髋关节翻修术31例,探讨THA术后假体松动的诊断、原因和翻修注意事项。结果假体取出后31例中27例关节内出现灰黑色颗粒样物质,27例髋臼假体与31例股骨假体中骨水泥或假体与骨质间形成界膜。31例经全髋关节翻修术后30例疼痛消失,髋关节功能恢复满意;1例翻修术后1周出现脱位,经制动6周后髋关节功能恢复满意。结论 THA术后假体松动与患者自身原因、假体的选择和手术技术操作有密切关系,早期翻修手术要有针对性。     

保留金属臼杯的全髋关节翻修术

目的探讨对于全髋关节翻修术中髋臼臼杯稳定并难以取出的患者,行保留金属臼杯的全髋关节翻修术的疗效。方法行全髋关节翻修术9例,术中测试髋臼臼杯稳定并难以取出,使用骨水泥将聚乙烯内衬固定在金属臼杯中。结果 9例术后随访平均3年8个月,复查X线片均未见髋臼及股骨侧松动发生。结论严格把握手术适应证,行保留金属臼杯的全髋关节翻修术早期随访结果满意。     

复杂全髋关节置换术中应用体感诱发电位监测的初步报告

目的：利用体感诱发电位在复杂全髋关节置换手术中进行监测，以预防坐骨神经损伤。方法：自2002年8月～2003年4月对12例复杂全髓关节置换手术患者术前清醒状态下行体感诱发电位检查．术中麻醉后行体感诱发电位监测。均采用全身麻醉．麻醉药品的使用和单位体重的用药剂量尽量相同。本组复杂全髋关节置换手术患者选择的标准是下肢短缩在4cm以上的初次手术和短缩3cm以上的翻修手术者，术中判断诱发电位异常标准是波幅峰值下降50％并持续10min以上和(或)潜伏期延长10％。重点监测时段为手术中坐骨神经周围暴露和关节复位后。结果：与术前清醒状态下比较，麻醉后患者的体感诱发电位波幅峰值和潜伏期均有不同程度的改变；而与麻醉后体感诱发电位的波幅峰值和潜伏期比较，12例患者术中监测的结果也发生改变、但是两者改变程度均未超过体感诱发电位异常的判断标准。术后下肢延长最短3cm，最长6cm，平均3．9cm，除1例手术前就有腓总神经损伤的患者外，其余患者术后均未出现下肢神经损伤症状.结论:体感诱发电位监测对颈防全髋关节置换术中坐骨抻经损伤有一定帮助．尤其对下肢短缩或翻修病例．术中体感诱发电位监测更有价值。     

人工全髋关节翻修术治疗假体置换术后感染

目的:探讨全髋关节置换术后假体周围感染的治疗方法.方法:1998年1月～2002年6月共收治7例全髋关节置换术后感染患者.采用一期全髋关节翻修术3例,二期全髋关节翻修术4例,术后平均随访14个月.结果:患者髋关节评分平均提高37.6分(Harris评分),经随访无一例感染患者复发.结论:人工全髋关节置换术后感染患者经过彻底清创和使用有效抗生素治疗后,可一期或二期进行全髋关节翻修术,治疗假体周围感染,改善患肢关节功能.     

人工全髋关节翻修术治疗假体置换术后感染

目的:探讨全髋关节置换术后假体周围感染的治疗方法。方法:1998年1月～2002年6月共收治7例全髋关节置换术后感染患者。采用一期全髋关节翻修术3例,二期全髋关节翻修术4例,术后平均随访14个月。结果:患者髋关节评分平均提高37.6分(Harris评分),经随访无一例感染患者复发。结论:人工全髋关节置换术后感染患者经过彻底清创和使用有效抗生素治疗后,可一期或二期进行全髋关节翻修术,治疗假体周围感染,改善患肢关节功能。     

Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty

Twenty-three peroneal and sciatic nerve palsies occurred in 21 patients following hip arthroplasty. Apparent risk factors included revision operations, being female, and significant lengthening of the extremity. The amount of lengthening was correlated with the development of either a peroneal palsy or sciatic nerve palsy. In cases of peroneal palsy the average lengthening was 2.7 cm (1.9 cm-3.7 cm) in comparison with 4.4 cm (4.0 cm-5.1 cm) for sciatic nerve palsies. Seven of these nerve palsies occurred among 614 consecutive patients treated at one institution during the period 1983-1985. This corresponded to an overall incidence of 1.1%. Electromyography demonstrated that peroneal stretch palsies originated primarily at the level of the neck of the fibula with some diffuse but lesser involvement along the proximal course of the peroneal division of the sciatic nerve.     

Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.     

The use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplasty

Sciatic nerve palsy is an uncommon complication after total hip arthroplasty (THA) but can cause permanent functional impairment in the extremity. The goal of this study was to identify specific intraoperative maneuvers that may increase the risk of sciatic nerve injury during revision THA. Motor-evoked potentials (MEPs) were used in combination with electromyography (EMG) monitoring during revision THA in 27 consecutive patients to identify intraoperative events that cause conduction abnormalities through the sciatic and peroneal nerves. MEP monitoring required general anesthesia and a neurophysiologist in the operating room throughout the procedure. Significant electrical events occurred, most commonly during acetabular reconstruction. Hip flexion should be avoided during posterior acetabular retraction when using the posterior approach with posterior dislocation. The position of the sciatic nerve should be clearly identified when complex structural acetabular augmentation with allograft is performed during revision THA. MEP monitoring was used as a research tool for this study. However, we do not use MEP monitoring in our revision THA clinical practice.     

人工髋关节置换术后翻修病例分析

目的分析人工髋关节置换术后翻修的原因,评价全髋翻修术的临床效果。方法本组33例34髋。初次关节置换类型:全髋置换21例,双杯髋关节置换1例,人工股骨头置换11例。翻修原因:无菌性松动23例24髋,髋臼位置不良1例1髋,股骨头置换后髋臼磨损5例5髋,感染4例4髋。翻修距初次手术时间:1年以内5髋,1～2年1髋,5～10年18髋,10～13年10髋。翻修假体类型:非骨水泥型假体20髋,混合型假体7髋,骨水泥型假体7髋。结果平均随访3.5年。1例术后半年发生股骨柄松动进行再翻修,其余病例假体保留,优良率为82.4%。结论翻修的最常见原因为无菌性松动,人工股骨头置换时髋臼磨损也是翻修原因之一,对较年轻的股骨颈骨折患者,如行假体置换,最好采用全髋关节置换。翻修术采用非骨水泥型假体较好。     

采用计算机辅助技术精确实施全髋关节置换术治疗成人发育性髋脱位

目的评价采用计算机辅助技术精确实施全髋关节置换术治疗成人发育性髋脱位的价值。方法对12例12髋成人发育性髋脱位患者行薄层CT扫描及三维重建,术前模拟手术,制定手术方案,所有病例均采用全髋关节置换术。结果 12例患者均获得3～31个月术后随访,平均随访10.8月。术前Harris评分为（35.2±4.5）分,随访时评分为（89.5±5.3）分,差异有统计学意义（t=26.38,P〈0.01）。优5例,良7例。术后患肢短缩畸形、跛行步态明显改善。X线片提示所有病例均显示髋臼假体位于真臼位置,与周围骨床结合紧密。并发症：术后1例出现坐骨神经损伤,1例股骨假体下沉。结论采用计算机辅助技术精确全髋关节置换术治疗成人发育性髋脱位,疗效优良,能达到个体化治疗水平。     

全髋关节置换术治疗成人发育性髋关节脱位

目的回顾性分析成人发育性髋关节脱位（DDH）患者的全髋关节置换手术（THA）方法及手术疗效。方法对1999年5月至2007年5月接受THA的174例（229髋）DDH患者进行随访。其中女128例，男46例，平均年龄32．6岁。分型采用Hartofilakidis分型：其中Ⅰ型（发育不良）92例（123髋）；Ⅱ型（低位脱位）33例（49髋）；Ⅲ型（高位脱位）49例（57髋）。Harris评分术前平均41．2分。手术入路采用后外侧入路，臼杯置于或接近于真臼水平。结果平均随访47个月，术后Harris评分平均为87．5分，术后并发症为8例神经损伤，其中坐骨神经2例，股神经6例，术后1年随访均完全恢复。结论成人DDH的THA难度较大，但对此类患者来说是一种较为理想的治疗方法，从很大程度上提高了患者的生活质量。     

Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement

Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of < 0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the sciatic nerve. Cases, which were recognised early and surgically-evacuated promptly, showed earlier and more complete recovery. Those patients for whom the diagnosis was delayed, and who were therefore managed expectantly, showed little or no recovery. Unexpected pain and significant swelling in the buttock, as well as signs of sciatic nerve irritation, suggest the presence of haematoma in the region of the sciatic nerve. It is, therefore, of prime importance to be vigilant for the features of a sciatic nerve palsy in the early post-operative period as, when recognised and treated early, the injury to the sciatic nerve may be reversed.     

Incidence of Sciatic Nerve Palsy After Revision Hip Arthroplasty Through a Posterior Approach

Sciatic nerve palsy after revision hip arthroplasty is rare, but can have substantial impacts. The purpose of this study is to report the safety and reliability of limited sciatic nerve exposure during revision surgery. A retrospective case series of 350 revision hip surgeries performed by a single surgeon underwent sciatic nerve identification. In each case, the sciatic nerve was identified and tagged loosely with a Penrose drain. Three hundred forty-eight of 350 patients (99.4%) underwent successful revision hip arthroplasty. One patient developed a transient sensory palsy; and another patient, a delayed palsy. Both nerve palsies recovered by the 1-year visit. We advocate visual nerve identification and tagging in revision hip surgery as 1 possible method to potentially reduce the risks of sciatic nerve injury.