Osirix图像处理软件在老年髋部骨折快速诊断与手术决策中的应用初探

[目的]以外科医生对影像学检查特有的要求,采用OsiriX图像处理软件对急诊CT检查结果DICOM图像实现3D重建和处理,以期对老年髋部骨折实现快速、客观、全面的描述以利手术决策.[方法]调阅2010年1月～10月期间143例因髋部骨折而住院的老年患者的急诊CT检查结果.采用OsiriX软件的2D图像查看器、图像3D处理器、图像优化等功能,对上述急诊CT的DICOM图像进行3D处理、判读结果,并与急诊CT报告对照以验证准确性.[结果]所有患者急诊CT检查DICOM图像均可实现2D查看和3D处理.143例患者中,发现急诊CT检查报告中未提及但不影响手术决策的髋部骨裂1例.[结论]OsiriX在老年髋部骨折的快速、全面、客观、准确的诊断和于.术决策方面具有实用性和指导意义.能够实现从外科手术和治疗的要求出发,审阅并处理影像学检查的结果.其在其他骨科创伤中的应用尚需进一步实践和研究.     

Antiresorptive treatment,when initiated after a first hip fracture,may not protect of a second contralateral episode in elderly population: A study with 685 patients

IntroductionOsteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised.Patients and methodsWe reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised.ResultsA 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1–122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p = 0.2).DiscussionWe identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised.     

Successful Fixation of an Intertrochanteric Fracture After Hip Resurfacing Arthroplasty Using Cannulated Screws

We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. The fracture was fixed using three 6.5-mm cannulated screws, and he has returned to his normal level of activities 8 months after the fixation. We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.     

Improved Antibiotic Impregnated Cement Prosthesis for Treating Deep Hip Infection : A Novel Design Using Hip Compression Screw

A 2-stage revision arthroplasty has been suggested as the optimal treatment for deep infections in the hip joint. Improvement of the surgical technique to increase the interim function is subject to investigation. From 2004 to 2007, we collected a cohort of 15 consecutive patients who were treated by a novel design augmented with a modified hip compression screw. No fracture of the cement spacer occurred. We believe the modified hip compression screw is a good alternative for the functional endoskeleton of an antibiotic loaded cement prosthesis in the treatment of deep hip infection.     

髋臼骨折的全髋关节置换术治疗

目的探讨全髋关节置换术（THA）治疗髋臼骨折的手术技术及近期疗效。方法1998年10月至2005年6月,本组采用THA治疗髋臼骨折合并创伤性髋关节骨关节炎患者27例28髋,其中13例初期采用切开复位内固定治疗,14例初期采用保守治疗。术前骨折分型（根据Letoumel—Judet分型系统）：后壁骨折（16例）,横行骨折（1例）,后柱＋后壁骨折（3例）,横行＋后壁骨折（4例）,T形骨折（1例）,双柱骨折（3例）。根据Harris髋关节评分系统分别对术前和术后疼痛程度、髋关节功能及活动度进行综合评分。结果随访资料完备者23例患者（24髋）,随访时间5—78个月,平均24．7个月。术前Harris髋关节评分21-76分,平均50．1分;术后评分56～100分,平均90．2分．较术前有显著性提高（P〈0．001）。其中18例优秀,4例良好,1例一般,1例较差。术前髋关节疼痛评分10—40分,平均24．6分;术后评分30—44分,平均41．1分。各有1例骨水泥型和非骨水泥型臼杯周围出现非连续性透亮带但未伴假体下沉或移位表现。术后未出现关节脱位、深部感染、严重异位骨化、医源性坐骨神经损伤或原有神经症状加重、下肢深静脉栓塞或肺栓塞等并发症。至最后一次随访尚无翻修患者。结论针对髋臼骨折合并创伤性髋关节骨关节炎患者施行THA,可有效缓解疼痛,改善髋关节功能及活动度且并发症少见。     

浮动髋的治疗(附11例报告)

浮动髋系同侧骨盆骨折和股骨骨折。我院自1985年以来收治浮动髋11例。按Tile分类,骨盆骨折A_1型1例,A_2型3例,B_1型1例,B_2型2例,C_2型2例,C_3型2例。同侧股骨干骨折8例,股骨粗隆间骨折2例,股骨颈骨折1例。骨盆骨折均给予保守治疗,下肢骨折内固定4例,保守治疗7例。9例获平均4年的随访,结果优6例,良2例,差1例。     

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.     

Anatomic and Patient Risk Factors for Postoperative Periprosthetic Hip Fractures: A Case-Control Study

BackgroundPeriprosthetic fracture remains a major source of reoperation following total hip arthroplasty (THA). Within 90 days of surgery, fractures may occur spontaneously or with minor injury and are therefore more likely related to patient factors including anatomic variation.MethodsFrom 2008 to 2018, 16,254 primary THAs were performed at our institution; of those, 48 were revised for periprosthetic fracture within 90 days of surgery. A control group of 193 patients undergoing THA for hip osteoarthritis (OA) was randomly selected from the source population. We excluded patients with genetic bone disease and THA performed for hip fracture. We used logistic regression to analyze associations between patient factors (demographics, anatomical factors, comorbidities, surgical technique, and implants) and odds of 90-day periprosthetic fracture.ResultsIncreased age was significantly associated with fracture (P = .002), as was female gender (P = .046). After adjusting for age and gender, absence of contralateral OA was associated with increased odds of fracture relative to patients with contralateral OA (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.60-9.29), as was having a contralateral THA in place (OR 3.70, 95% CI 1.59-8.60). The neck-shaft angle, femoral offset, and the Dorr classification were not associated with increased odds of fracture. Additionally, the distance from the tip of the trochanter to the top of the femoral head was associated with increased odds of fracture per half centimeter (OR 1.48, 95% CI 1.14-1.93).ConclusionRisk of early postoperative periprosthetic fracture following THA is increased with age, female gender, and increasing distance from the greater trochanter to the top of the femoral head; and decreased in the setting of contralateral hip OA. The trochanter-head distance correlation with periprosthetic hip fracture indicates that the preoperative anatomy may influence PPF, particularly regarding how that anatomy is reconstructed.     

Fatigue Fracture in Dual Modular Revision Total Hip Arthroplasty Stems : Failure Analysis and Computed Tomography Diagnostics in Two Cases

We report on two patients with fracture of a modular, tapered and distally fixed, uncemented titanium revision hip stem, not previously described. A failure analysis revealed that the cause of the fractures was the development of fatigue cracks in the mid-stem cobalt–chromium modular junction ending in corrosion-fatigue failure. No material defects or stress risers were found in any of the implants. The diameter of the mid-stem modular junction might be undersized for use in heavy and active patients. We also report a new way of detecting an undisplaced fracture at the modular junction, using the scout image from a computed tomography (CT) scan; a technique that can be used when plain radiographs are inconclusive.     

Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures

A retrospective study of the management of 23 cases of ipsilateral hip and femoral shaft fractures, between January 1998 and December 2001, is presented. All except two cases were managed by a single implant, i.e. reconstruction nail. There was delayed diagnosis of femoral neck fracture in two cases where the "miss a nail" technique was used for fixation of the femoral neck fracture. All patients managed by reconstruction nail were simultaneously operated on for both fractures and operative treatment was executed as early as the general condition of the patient permitted. Delay in treatment was generally because of the associated injuries (head, chest or abdominal). There were 22 males and 1 female patient with an average age of 34.5 years. Average follow-up was 30.9 months. There was one case of non-union of the femoral neck fracture, one case of avascular necrosis and one femoral neck fracture united in varus. There were four cases of non-union and six cases of delayed union of femoral shaft fractures. Mean time for union of the femoral neck fracture was 15 weeks and for the shaft fracture was 22 weeks. In this series femoral shaft fracture determined the total union period. Complications involving the femoral shaft fracture were more common than those related to femoral neck fractures. Shaft complications were more manageable with or without secondary procedures as compared to femoral neck complications, which usually require more extensive procedures. This stresses the need to realise the significance and seriousness of both components of this complex injury, in evaluation, management and post-operative care. We conclude that, though technically demanding, reconstruction nail is an acceptable alternative for management of concomitant fractures of the femoral neck and shaft with acceptable rates of complications and good results.