髋臼成形术治疗大龄儿童先天性髋脱位

[目的]探讨髋臼成形术治疗大龄儿童先天性髋脱位（congenital dislocation of the hip，CDH）的并发症及防治措施。[方法]采用髋臼成形术治疗大龄儿童CDH128髋，平均随访5a2个月。[结果]股骨头坏死15髋（11．7％），髋关节障碍28髋（21．8％），髂骨变形、变小18髋（14％），髋臼发育不良复发4髋（3．1％）。[结论]脱位高者术中短缩股骨，避免损伤髋臼上缘软骨，截骨距髋臼上方0．5～1cm处，截开的髂骨问嵌插入足量的髂骨松质骨骨块和短缩的股骨或异体骨，保护髂骨骨骺及附着的肌肉血管束，术后3个月内避免持重，髋关节功能障碍者，给予松解后，应用CPM（continuous passitive motion），对预防减少并发症有重要意义。     

髋臼成形术治疗大龄儿童先天性髋脱位

应用髋臼成形术治疗大龄儿童先天性髋脱位62例76髋,经1～9年随访,优良率为81.7％。认为该法按生理要求,将股骨头复位到原臼内,真正达到稳定关节、减少腰椎前凸、减轻髋痛及下腰痛的目的。介绍了手术方法及注意事项,并讨论了影响疗效的因素。     

镜下治疗股骨髋臼撞击综合征是否缝合关节囊

[目的]比较髋关节镜术治疗股骨髋臼撞击综合征合并盂唇损伤是否缝合关节囊的临床结果.[方法]回顾性分析2016年1月-2019年12月本院骨科采用关节镜下磨削股骨头颈凸轮骨赘或髋臼骨赘,并修复盂唇治疗股骨髋臼撞击综合征合并盂唇损伤52例患者,其中,28例术中修复关节囊,24例末修复关节囊.比较两组围手术期、随访和影像资料...     

Legg-Perthes病临床观察

目的观察滑膜切除、骺颈减压、复方丹参治疗Legg—Perthes病的效果。方法按Catterall’s分期选择Legg—Perthes病Ⅱ、Ⅲ、Ⅳ期病例共71例进行滑膜切除、骺颈减压，术后给予复方丹参治疗。结果获得随访64例，随访期1～10年，平均随访4．5年，按髋关节功能及X线改变为评价依据，优80％，良11．4％，优良率可达91．4％。结论该方法对Catterall’s分期Ⅱ、Ⅲ期患儿疗效优良，可明显恢复骨骺发育，减少病残。     

骨盆内移截骨术治疗大龄儿童Perthes病的长期随访研究

目的 评价Chiari骨盆内移截骨术治疗8岁以上儿童Perthes病的远期疗效，探讨影响儿童Perthes病预后的因素。方法 1986年6月至2002年12月，共手术包容治疗8岁以上、Herring外侧柱分型达B型以上Perthes病患儿103例（116髋），69例（72髋）获得长期随访，平均随访时间97个月（38-196个月）。69例（72髋）中，根据Herring分型，B型30髋，B／C型22髋，C型20髋；男48例（50髋），女21例（22髋）；8-10岁患儿47例（49髋），10-14岁患儿22例（23髋）。术前X线片显示25髋存在明显半脱位。全部患儿均接受Chiari骨盆内移截骨术治疗。结果全部病例术后均获得满意包容，无半脱位，未出现骨关节炎。按照改良Stulberg分级标准：（1）StulbergⅠ、Ⅱ级31髋，其中HerringB型19髋，B／C型9髋，C型3髋；StulbergⅢ级33髋，其中HerringB型10髋，B／C型11髋，C型12髋；StulbergⅣ、Ⅴ级8髋，其中HerringB型1髋，B／C型2髋，C型5髋。（2）男性患儿预后达StulbergⅠ、Ⅱ级者占48％，而女性患儿仅为23％。（3）8-10岁年龄组预后达StulbergⅠ、Ⅱ级者占55％，10-14岁年龄组仅为17％。结论 对发病年龄≥8岁的HerringB、B／C与C型患儿应给予手术包容治疗，Chiari骨盆内移截骨术可达到手术包容效果。Herring分型对Perthes病的严重程度和预后的评估有明确指导作用。     

Legg-Perthes病的研究进展

Legg-Perthes病是一种发生于儿童的、比较常见的、有自愈倾向但却极易导致患儿病残的疾病。本文主要介绍了该病的病因、病理、诊断、治疗及预后几方面的研究进展。     

镜下两种关节囊切开凸轮型股骨髋臼撞击治疗的比较

[目的]比较镜下T形关节囊切开与横形切开凸轮型股骨髋臼撞击治疗的临床疗效.[方法]回顾分析2017年7月-2018年6月关节镜手术治疗凸轮型髋关节撞击征的70例患者.其中,35例采用T形关节囊切开(T切组),另外35例采用横形关节囊切开(横切组).比较两组围手术期、随访与影像资料.[结果]两组患者均顺利手术,术中无重要...     

骨阻滞联合关节囊紧缩成形术治疗肩关节后不稳定

目的采用骨阻滞联合关节囊紧缩成形术治疗肩关节后不稳定，并观察其治疗效果。方法对5例创伤性肩关节后不稳定患者采用气碘双重造影检查，明确导致肩关节后不稳定的病理因素，针对其骨和软组织结构异常，采用骨阻滞联合关节囊紧缩成形术治疗。结果气碘双重造影检查显示患肩有关节盂后缘骨性破坏、关节囊松弛和盂唇撕裂表现。采用骨阻滞联合关节囊紧缩成形术治疗后，在随访5—38个月（平均19个月）期间无一例患者诉肩关节不稳定症状。结论包括骨和软组织异常在内的多种病理因素可导致肩关节后不稳定。正确的手术治疗需纠正患者存在的病理变化，而不是对所有患者实施一种“标准”的术式。对于存在多种病理因素的肩关节后不稳定患者宜采用联合手术的方法，以纠正其各种病理变化。     

马鞍型假体治疗髋臼周围恶性肿瘤

目的探讨马鞍型假体治疗髋臼周围恶性肿瘤切除后骨缺损的效果及风险。方法回顾分析复旦大学附属中山医院骨科白2004年6月至2006年10月共7例接受肿瘤大块切除术并同时行马鞍型假体重建手术的髋臼周围恶性肿瘤患者，术后随访时间为10个月至38个月。结果软骨肉瘤患者有5例，侵袭性骨巨细胞瘤患者有1例，恶性纤维组织细胞瘤患者有1例。其中1例患者死于肺转移，1例死于化疗，5例无瘤生存。术后功能Aboulafia评分系统，2例优秀，2例良好，1例一般，1例为差，另有1例因深部感染未行评分。结论马鞍型假体以相对简易的方式重建了髂骨和股骨之间的骨缺损，维持了下肢长度和一定的功能，但同时也具有较高的并发症发生率。     

髋臼加盖成形术治疗儿童股骨头缺血性坏死12例报告

目的探讨髋臼加盖成形术治疗儿童股骨头缺血性坏死的疗效。方法12例股骨头缺血性坏死患儿,平均年龄9.8(8～12)岁,Harris髋关节功能评分平均72.9±9.6,均行髋臼加盖成形术。在髋臼上方2.5cm处横行劈开髂骨外板,植入楔形同种异体骨,加深髋臼窝,增加股骨头包容,术后髋人字石膏完全制动3月。结果12例患者均获随访,平均时间12(7～18)个月。术后Harris髋关节功能评分平均92.2±6.7。采用功能改善率评定疗效,治愈9例,显效2例,有效1例。结论髋臼加盖成形术治疗儿童股骨头缺血性坏死具有术式简单,创伤小,治疗周期相对短,疗效良好等优点。     

Capsular contracture after breast reconstruction with the lateral thoracodorsal flap

Early postoperative manipulation of breast implants in patients who underwent breast reconstruction utilizing a lateral thoracodorsal falp is described. This manipulation did not reduce the rate of firm capsular contracture after the reconstruction with the flap, but only postponed its development. Open capsulotomies, however, yielded stationary soft breasts to a statistically significant extent. The patient's acceptance, of the reconstructed breast as a natural part of her own, body was high. It was not influenced by the occurrence of firm capsular contracture.     

The use of total femoral arthroplasty as a limb salvage procedure: the Sheffield experience

Over the last 25 years, 14 patients have undergone total femoral arthroplasty (TFA) after complications of revision arthroplasty surgery. These patients had previously undergone extensive surgery, which had failed, and required salvage surgery. The alternatives would have been amputation or hip disarticulation. A retrospective review of medical records and radiographs was undertaken, and clinical outcome was evaluated using the Musculoskeletal Tumour Society criteria. Before TFA, all patients had previously undergone multiple operations (range, 2-10). In 88% of cases, reconstructive options were not only limited by the availability of minimal host bone but also by deep sepsis. Results were encouraging, with most of the patients having greater mobility and less pain after surgery. A third of the patients achieved a 75% improvement in function. We believe that TFA has a definite role in the management of complex problems after extensive hip and knee revision arthroplasty surgery.     

A comparison of lateral release rates in fixed- versus mobile-bearing total knee arthroplasty

BackgroundWith increasing functional demands of patients undergoing total knee arthroplasty, mobile-bearing (MB) implants were developed in an attempt to increase the functional outcome of such patients. In theory, with MB implants, the self-alignment should reduce the rate of lateral release of the patella, which is usually performed to optimise patellofemoral mechanics. This study reports on the lateral release rates for the P.F.C. Sigma® MB posterior-stabilised total knee replacement (TKR) implant compared with its fixed-bearing (FB) equivalent.ResultsThe lateral release rate was the same for FB (10 %) and MB implants (10 %) (p = 0.9). However, patellar resurfacing resulted in lower lateral release rates when compared to patellar retention (6 vs 14 %; p = 0.0179) especially in MB implants (3 %).ConclusionsIt has been previously reported that alterations to the design of the P.F.C. system with a more anatomical trochlea in the femoral component improved patellar tracking. The addition of a rotating platform tibial component to the P.F.C. Sigma system has, on its own, had no impact on the lateral release rate in this study. Optimising patellar geometry by patellar resurfacing appears more important than tibial-bearing design. Although MB implants appear to reduce the need for lateral release in the P.F.C. Sigma Rotating Platform, this only occurs when the patellar geometry has been optimised with patellar resurfacing.

Level of evidence

Level 2.     

人工全膝关节置换术中联合股骨外髁滑移截骨术矫正股骨外弓畸形的疗效分析

目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中采用股骨外髁滑移截骨术(lateral condyle sliding osteotomy,LCSO)矫正股骨外弓畸形的疗效。方法回顾分析2018年7月—2020年7月TKA中采用LCSO治疗的17例伴股骨外弓畸形的骨关节炎患者临床资料。男3例,女14例;年龄58~68岁,平均63.2岁。股骨外弓畸形病因:股骨发育畸形12例,股骨骨折畸形愈合5例。膝关节骨关节炎KellgrenLawrence分级:Ⅲ级4例,Ⅳ级13例。术前生理外翻角为9.5°~12.5°,平均10.94°。病程3~25年,平均15.1年。术前及末次随访时测量股骨远端机械外侧角(mechanical lateral distal femur angle,mLDFA)、髋-膝-踝角(hip-knee-ankle angle,HKA)、机械轴偏向(mechanical axis deviation,MAD),评估关节外畸形在关节内矫正及下肢机械力线恢复情况;采用膝关节学会评分系统(KSS)膝评分和功能评分、疼痛视觉模拟评分(VAS)、膝关节活动度(range of motion,ROM)评估疗效;行膝内、外翻应力试验,X线片复查截骨片愈合情况,评估关节稳定性及LCSO的安全性。结果术后患者切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓形成等术后早期并发症发生。17例患者均获随访,随访时间12~36个月,平均23.9个月。截骨片均达骨性愈合,愈合时间2~5个月,平均3.1个月。术后膝内、外翻应力试验均为阴性,未发生外侧副韧带松弛、断裂,膝关节不稳,假体松动、翻修、感染等情况。末次随访时mLDFA、HKA、MAD及膝关节ROM、VAS评分、KSS膝评分和功能评分均较术前显著改善,差异有统计学意义(P<0.05)。结论在伴有股骨外弓畸形TKA中应用LCSO疗效确切且安全,关节外畸形在关节内矫正,一次手术可同时恢复下肢机械力线和关节平衡。     

The use of linezolid in the treatment of infected total joint arthroplasty

Fourteen patients with a diagnosis of infected total joint arthroplasty treated by 1 or 2-stage revision and a course of oral linezolid were reviewed. Patients were assessed according to McPherson stage, inflammatory markers, nature of surgery, use of antibiotics, pathogen isolated, and outcome at follow-up. Pathogens isolated were coagulase-negative staphylococcus, multiresistant Staphylococcus aureus, Enterobacter cloacae, and mixed growth. McPherson stages were 1 IB2, 1 IA3, 1 II A2, 3IIIA2, 2 IIIB1, 3 IIIB2, 1 IIIB3, 1 IIIC2, and 1 IIIC3. All patients showed resolution of infection, with normalization of inflammatory markers after treatment. Mean length of follow-up is 32.7 months (range, 9-44 months). Comparison is drawn with previous studies highlighting the good results achievable with the use of this antibiotic. Although no substitute for adequate surgical management, it does allow oral treatment and therefore avoids the difficulties associated with long-term intravenous antibiotic therapy.     

反肩置换在老年肱骨近端内固定失败翻修术中的疗效观察

目的：探讨反肩置换术在老年肱骨近端骨折内固定失败后翻修中的应用价值和效果。方法 ：回顾性分析2014年5月至2020年3月肱骨近端骨折内固定失败的患者8例,其中男3例,女5例;年龄65～75岁。8例均行反式肩关节置换术,病程8～16个月。记录并比较手术前和末次随访的关节活动度（range of motion,ROM）、加州大学（University of California at Los Angeles,UCLA）肩关节评分、肩关节视觉模拟评分（visual analogue scale,VAS）、焦虑自评量表（self-rating anxiety scale,SAS）评分、肩关节功能Constant-Murley评分,并分析手术并发症情况。结果：术后8例均获得随访,时间16～28个月。患肩关节活动度（前屈、外旋、外展、内旋）术后明显改善,术后VAS、SAS和UCLA评分也得到改善。肩关节功能Constant-Murley评分中末次随访疼痛、日常活动、活动范围、力量测试评分比术前均有明显提升,且总分比术前提高。1例发生肩胛盂切迹,影像学显示分级为1级,其余患者未发生相关特异性和非特...     

Capsular closure and piriformis preservation to prevent dislocation after total hip arthroplasty through the minimal posterior approach. Comparative series of 196 patients

Abstract: Purpose of the study: This study analyzes the incidence on hip dislocation of a posterior minimally invasive approach that combines the suture of the capsular joint and the preservation of the piriformis muscle. Material and methods: A first prospective series of 98 patients having undergone hip prosthesis by a posterior minimally invasive approach that combines piriformis preservation and capsular closure is analyzed regarding 7 criteria: age, weight, duration of the intervention, piriformis integrity and quality of the capsular closure at the end of the intervention, radiological position of the implants, and rate of dislocation at M12. This series is compared to another consecutive series of 98 hip prostheses performed by the same operator, by posterior access, consisting in capsular resection and cutting of the piriformis reinserted on the trochanter. Results: The two series were identical regarding patients' age and weight. The minimally invasive surgery lasted 20 minutes more than the other intervention. In both interventions, no effect was observed on the radiological position of the implants. The rate of hip dislocation after twelve months was significantly improved by the capsular closure combined with piriformis preservation (2.9% vs 0%). Discussion: The restoration of the capsular plane has been the subject of numerous works. The techniques described had some variants, with a related rate of dislocation less than 1%. Piriformis preservation participates in the joint coaptation. This muscle is stretched out during the first step of the dislocating movement. The presented series highlights the benefit of combining a capsular flap truly suturable and the preservation of the piriformis muscle aimed at creating a “hammock”, passive and active at the same time, at the upper posterior part of the joint, a strategic area with a high related risk of dislocation.     

全膝关节置换术中髌骨翻转对术后早期膝关节功能的影响

目的评价全膝关节置换术（TKA）中髌骨翻转对术后早期膝关节功能的影响。方法纳入2008年4月至2013年9月32例双侧同期TKA患者,随机分为髌骨翻转组（A组）与髌骨侧方移位组（B组）。比较分析双膝手术时间、术后并发症、实现主动直腿抬高时间和膝关节90°屈曲时间及术后7 d、3个月、6个月、1年膝关节主动活动度、膝关节被动活动度、疼痛视觉模拟评分（VAS）。结果 A 组与B组实现主动直腿抬高的时间分别为（2．6±0．8）d和（2．1±0．6）d（P＝0．043）。除术后6个月两组膝关节被动活动度无统计学差异外,其余各随访时间点A组膝关节主动活动度、被动活动度均较B组差。两组手术时间、术后并发症、实现膝关节90°屈曲时间及VAS评分均无统计学差异。结论 TKA 中髌骨翻转不利于术后早期膝关节功能康复,可延缓患者实现直腿抬高时间,减少术后膝关节活动度。     

Techniques in the treatment of the infected total knee arthroplasty

Infection of the total knee arthroplasty can be a devastating complication. Appropriate management can significantlydecrease morbidity and cost. This article outlines the management of the infected total knee arthroplasty. To optimize patient outcome adherence to strict guidelines and meticulous technique will greatly improve the results.