Salter截骨术后并发症的预防

小儿先天性髋关节脱位是常见的先天性畸形,在我国因就诊晚患儿年龄偏大而错过了非手术治疗时机,故多采用手术治疗。Salter 骨盆截骨术是较为常用的术式,疗效较为满意,但术后并发症较多,如术后再脱位高达16%以上~(〔1〕),股骨头坏死也占有相当比例。为此,本文就其并发症的预防作一探讨。     

不同术式治疗儿童发育性髋关节脱位的体会

目的探讨不同术式治疗儿童发育性髋关节脱位的优缺点。方法选择42例46髋发育性髋关节脱位患儿,一组行Salter髂骨截骨术,一组行Pemberton髋臼成形术,比较两种术式的优缺点。结果两种术式各有其适应证。结论发育性髋关节脱位术式选择应综合考虑患儿的年龄、髋臼发育情况、股骨头脱位高度、前倾角大小、软组织挛缩程度等因素。     

围手术期护理在发育性髋关节脱位治疗中的应用

目的探讨围手术期护理在发育性髋关节脱位(PPH)治疗中的应用。方法选择2006年1月至2010年12月于本院就诊的35例DDH患儿为研究对象,对其进行围手术期护理,并对疗效进行评定(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,并征得受试对象监护人的知情同意,与之签署临床研究知情同意书)。结果本组35例PPH患儿中,疗效为优患儿为24例(68.6%),疗效为良患儿为7例(20.0%),疗效为好患儿为2例(5.7%),疗效为一般患儿为2例(5.7%)。治疗优良率为88.6%(31/35)。结论围手术期护理对PPH的治疗和预后尤为重要,可提高患儿及其家属参与治疗的主动性和积极性,增强康复训练的有效性,促进髋关节功能恢复,明显改善患儿生活质量。     

髋关节置换的围手术期护理

髋关节置换的目的是为患者缓解疼痛，矫正畸形，重建一个稳定的关节，恢复和改善关节的运动功能。由于手术创伤较大，而患者多为高龄，一旦手术不能平稳度过，后果不堪设想。围手术期的护理显得尤为重要，不仅帮助患者解决生理心理危机，     

人工髋关节置换术围手术期的护理观察

目的探讨髋关节置换术围手术期的护理,避免手术并发症,有效地恢复关节功能。方法对49例髋关节置换术的患者实施相应的护理措施。结果49例患者无术后并发症,全部痊愈出院。结论人工髋关节置换术后进行系统、科学、有计划的护理能减少髋关节并发症,提高生活质量。     

Pemberton关节囊周围髂骨截骨术治疗发育性髋关节脱位的临床疗效

目的探索Pemberton关节囊周围髂骨截骨术治疗发育性髋关节脱位的临床应用价值。方法选择2008年1月～2009年1月某科就诊的25例(28髋)发育性髋关节脱位患儿,回顾分析25例(28髋)发育性髋关节脱位患儿的术后疗效,对照分析治疗前后CE角、AI角及髋臼深度。结果本组25例(28髋),参照髋关节X线分级标准评定,优良率为92.9%,参照McKay临床疗效分级标准评定,优良率为85.8%。并发症情况:髋关节骨性关节炎1例,再脱位1例,其余无严重并发症发生。对照显示,治疗前后CE角差异有统计学意义(P﹤0.05),治疗后AI角[(16.3±5.2)°]比治疗前[(51.5±10.1)°]显著小(P﹤0.05),而治疗后髋臼深度[(11.4±4.2)mm]比治疗前[(6.5±4.4)mm]显著大(P﹤0.05)。结论 Pemberton关节囊周围髂骨截骨术治疗发育性髋关节脱位疗效确切,且较为安全,值得临床中推广应用。     

人工全髋关节置换术围手术期护理

目的研究人工全髋关节置换术围手术期护理方法及临床应用效果。方法我院骨科2010年1月-2013年2月间56例进行人工全髋关节置换术患者，平均分为两组，对照组和观察组，分别进行不同方式的护理。结果观察组患者在术后12周进行6min步行测试（观察组：平均最大的步行距离为（371．96±32．13）m；对照组：平均最大的步行距离为（282．49±43．11）和25m步行测试（观察组：步频（92．12±7．29）步／min，步速（0．91±0．19）m／s；对照组：步频（78．59±5．42）步／min，步速（0．59±0．1）m／s，结果均明显优于对照组（P〈0．05）。结论人工全髋关节置换术围手术期护理有助于快速地恢复髋关节的基本功能，取得了较好的临床效果。     

人工髋关节置换术围手术期的医疗护理

目的观察人工髋关节置换术围手术期规范化的医疗护理效果。方法选择进行人工髋关节置换手术患者指定规范的康复计划,包括术前宣教、术前医疗护理指导、术后分期训练及出院后的功能训练。结果本组应用Hairrs评分,优15例、良9例、中0例、差0例,优良率100%。结论人工髋关节置换术后进行规范化的医疗护理能提高患者的生活自理能力、改善生活质量。     

浅谈人工髋关节置换术围手术期的护理

目的 总结髋关节骨折患者行人工髋关节置换术围手术期护理对策及体会.方法 回顾性分析人工髋关节置换患者的围手术期护理过程资料.结果 人工髋关节置换术围手术期的护理能明显改善患者的愈后恢复.结论 在围手术期采取有效的护理措施是减少并发症提高手术成功率的保证.     

全髋关节置换术围手术期病人的护理

目的探讨全髋关节置换术病人围手术期的护理。方法对126例全髋关节置换病人进行系统的围手术期护理及功能锻炼指导。结果 126例全髋关节置换病人经过系统的围手术期护理,出院后生活基本能自理,全部没有发生假体松动、脱位等并发症。结论对全髋关节置换病人进行系统的、规范的围手术期护理和正确的功能锻炼指导,可提高手术成功率,减轻疼痛,改善关节活动度,减少并发症,促进髋关节功能恢复。     

Dega髋臼成形术治疗大龄发育性髋脱位的疗效

目的:探讨Dega髋臼成形术治疗大龄发育性髋脱位的临床疗效。方法:对48例发育性髋脱位患者均采用De-ga髋臼成形术治疗,观察髋臼形态、股骨头形态变化、髋关节功能及术后并发症。结果:髋臼指数和Sharp角平均矫正度数分别为18.3°和11.4°,平均矫正率为59%和23%;臼头指数中心边缘角均增大,平均达到91%和22°;股骨头发生再塑形改变;髋关节功能评价中68.1%为"优"。术后短期并发症存在不同程度的髋关节功能受限。结论:Dega髋臼成形术对髋臼指数的矫正能力强,股骨头可发生再塑形改变,注意髋关节功能术后短期受限,经过功能训练后,髋关节功能明显改善,是比较适于大龄发育性髋脱位的手术方法之一。     

对医院出生儿先天性髋脱位防治措施的研究

目的:探讨对医院出生儿先天性髋脱位(CDH)早期发现和有效防治的途径。方法:调查总结6年间3家医院11256例在医院出生儿的相关临床资料,根据Lehmann和Garvey评定标准〔1,2〕,从中筛选出CDH易患儿,常规为其应用外展尿布或兜带进行护理3~4个月,进行影像和病理学检查,从中确认不稳定髋(髋臼发育不良或半脱位)患儿,及时采取非传统关节切开手术治疗,总结分析临床疗效。结果:11256例医院出生儿中CDH易患儿为189例,占16·8‰。这些易患儿经采用简便防护措施3~4个月,确诊为不稳定髋者8例,占0·71‰,上述8例患儿经非传统手术等治疗6~18个月,均获治愈。脱位畸形预防成功率100%,无股骨头坏死发生。结论:通过对医院出生儿进行普查和跟踪随访,可尽早发现有CDH发生倾向的患儿,及时为这些患儿采取相应防护措施,能够达到避免关节切开手术,预防脱位发生的治疗目的。     

发育性髋关节脱位533例分析

目的:研究分析山西地区发育性髋关节脱位(DDH)的相关因素。方法:选取2000年1月至2012年11月确诊并接受治疗的533例患儿及369例健康小儿,采用病例对照研究方法,将其分为病例组(533例)和对照组(369例)。两组分别填写"山西地区发育性髋关节脱位患者发病因素调查问卷"(由患儿和健康小儿母亲完成)。结果:所调查患儿中,男性98人,女性435人,男、女之比为1∶4.4;患儿髋关节脱位的侧别中,左侧>双侧>右侧;通过单因素Logistic回归分析,臀位生产的小儿患病风险是头位生产小儿的6.484倍,95%可信区间为3.883～10.826;父母有遗传史的小儿患病风险是无遗传史小儿的4.115倍,95%可信区间为1.411～12.000;结论:山西地区DDH的发生受多因素影响,遗传因素不可控,因此应避免小儿在后天环境中接触到有关危险因素;患儿治疗年龄相对较晚,这与疾病相关知识未在农村得到广泛普及,人们对疾病认识不足有关。     

Cost of treatment of congenital dislocation of the hip

Early treatment for congenital dislocation of the hip is usually simple and inexpensive. However, if the disease is not detected by 6 months of age, treatment is often complicated and expensive. We evaluated the potential cost-saving of screening, by examining the costs in 36 late cases born in 1980 and found an average cost of pounds 6,674 per case for treatment to this date. This amount could justifiably be spent on each case detected in an effective screening programme.     

Management of hip dislocation with postural management

BACKGROUND: Hip dislocation in children with cerebral palsy has a well-documented history and morbidity. OBJECTIVE: This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants' postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment. METHODS: The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers' hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed. RESULTS: Children using 'All CAPS' before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05). CONCLUSIONS: Postural management interventions have an important role in the prevention of hip dysplasia.     

AO锁骨钩钢板治疗肩锁关节脱位的围手术期护理

对22例AO锁骨钩钢板治疗肩关节脱位的患者进行术前心理护理、术前准备及术后密切观察生命体征、预防感染、功能锻炼指导等围手术期护理,术后所有患者均获得良好的临床效果。全面细致的围手术期护理,对手术成功及术后康复起到至关重要的作用。     

The role of community screening for developmental dysplasia of the hip at the 8‐month baby check

Background Screening for developmental dysplasia of the hip (DDH) after the neonatal period is controversial. Due to recent changes in the screening policy in England & Wales, routine clinical screening for DDH at the 8‐month baby check is no longer recommended. Results This paper looks at the effectiveness of screening for DDH by health visitors in the Flintshire area. A total of 525 8‐month baby checks were performed in our area in 2007. Thirty babies were referred to their general practitioner of which six were referred on to a specialist children's orthopaedic surgeon. None of these required treatment for DDH. One patient who was screened by the health visitor but not referred was later diagnosed with DDH. Conclusion Screening for DDH at 8 months using clinical examination by a trained health visitor has a high false‐positive rate. This paper therefore supports the current UK National Screening Committee position.     

Preliminary results of surgical treatment of developmental dislocation of the hip in older children

Reduction of developmental dislocation of the hip is difficult to achieve in children after walking age and particularly in older children. In fact, at this age the important retraction of the muscles around the hip associated with a marked acetabular dysplasia and elongation of the joint capsule explain the difficulty and instability of reduction and the frequency of complications. In this study we reviewed retrospectively the clinical and radiological results of 26 developmental dislocations of the hip treated by open reduction, pelvic osteotomy and femoral shortening in 21 children aged more than 5 years. Age at surgery ranged from 5 to 11 years (mean 7.5 years) with a follow-up of 1 to 8 years (mean 2 years 7 months). According to the clinical classification of MC Kay, 17 hips had a good result while 9 hips had a fair or poor result. According to the Severin classification system 18 hips had an excellent and good radiological result. Ten hips developed an avascular necrosis of the femoral head following the reduction.