转子下斜行截骨外固定器治疗成人髋内翻

我科 1996～ 2 0 0 0年收治 12例成人髋内翻 ,其中 5例合并肢体缩短 ,采用股骨转子下斜行截骨 ,单侧成角外固定架外展位固定 ,通过随访 ,效果满意。1　材料与方法1.1　病例资料 　本组 12例 ,男 9例 ,女3例 ,年龄 2 1～ 6 5岁。均为单髋。 8例并发于股骨转子间骨折 ,1例并发于股骨上端骨纤维异样增生症 ,3例为先天性髋内翻。术前颈干角 75°～ 10 0° ,平均87° ,其中 5例合并肢体不等长 ,相差 2～5ｃｍ ,平均 3ｃｍ。1.2　器械和方法1.2 1　手术设计　术前摄骨盆平片 ,了解健侧的颈干角 ,设计出手术所需要的角度 ,手术方法见图 1。图 1　…     

转子下外展截骨治疗先天性髋内翻长期疗效观察

[目的]分析股骨转子下外展截骨治疗先天性髋内翻的长期疗效。[方法]对17例（2l髋）先天性髋内翻行股骨转子下外展截骨术，术后平均随访13．6a。[结果]所有股骨头骺板早期闭合，平均10．6（5～13）岁；股骨颈部三角骨块于术后5（3～10）个月闭合；14髋股骨大转子过度增长，所有患者均有不同程度股骨颈短缩；1例术后6a发生膝外翻。[结论]手术促进股骨近端骺板和三角骨块早期闭合，稳定髋关节，但引发髋关节周围形态的畸形。截骨同时行股骨大转子骺阻滞是防止股骨大转子过度增长的方法之一。     

应用改良Borden截骨术治疗严重髋内翻

作者参照Ｂｏｒｄｅｎ等截骨术，自行设计了一种新的截骨及内固定方法治疗严重髋内翻１５例（１７髋）。术前颈干角５０°～１０６°，平均８２°。１５例均得到１～１３年随访，平均随访时间４年４个月。１髋颈干角为１１５°，余１６髋均在１２５°以上。该方法是用按设计的转子下斜形截骨替代横断截骨，用直钢板贯穿于大转子固定替代１４０°角度钢板股骨颈固定。通过股骨力线内移和增大颈干角，使原来垂直的骨骺线变为近似水平的骺线。年龄越小，纠正角度应越大。小于９岁者，纠正角度应大于１５０°，１０～１７岁者应该为１４０°～１５０°，成年人１３０°左右即可。该术式方法简单，固定可靠，对合严密，愈合迅速，增加了手术的准确性，避免了对股骨头骺软骨的损伤。     

Y型截骨术治疗先天性髋内翻

[目的]探讨Y型截骨、鹅头钢板内固定治疗先天性髋内翻。[方法]对7例9髋先天性髋内翻采用股骨小粗隆下截骨、股骨大粗隆外侧截骨。截骨线呈Y型,股骨远侧断端与股骨大粗隆外侧截骨面相对合,以鹅头钢板内固定。[结果]本组随访1~5年(平均3.6年),按史颖奇评定标准,优4髋,良4髋,可1髋。[结论]Y型截骨、鹅头钢板内固定能够改善股骨上端异常结构,增加患肢真性长度,是治疗先天性髋内翻的有效方法。     

楔形截骨推移术矫治先天性髋内翻畸形9例报告

楔形截骨推移术矫治先天性髋内翻畸形９例报告黄开荣，郝延科先天性髋内翻，又称为颈性髋内翻；还称之为婴儿性髋内翻和发育性髋内翻等。在治疗上方法很多，但有些并非效果理想，有较高的复发率。笔者采用楔形截骨推移托顶股骨颈部，并以鸭嘴样钢板螺丝钉固定法治疗本病，...     

单纯闭合楔形截骨术治疗儿童肘内翻畸形

目的探讨儿童肘内翻畸形的手术治疗方法.方法回顾30例采用无内固定的肱骨髁上闭合楔形截骨术治疗的肘内翻畸形,其中男27例、女3例,平均随访5年,最长达8年.结果术前患侧提携角平均-25°,术后提携角平均6.83°,术后较术前平均改变31°,无复发及神经损伤、感染等并发症的出现.结论无内固定的单纯闭合楔形截骨术手术时间短、患者创伤小、避免二次手术,是简便、安全、有效的治疗儿童肘内翻的方法.     

股骨近端内翻截骨术治疗Perthes病的现状

般骨近端内翻截骨术的发展已有半个多世纪的历史,该技术经过长期发展,已经逐渐成熟.现已有多种手术方式及固定方式应用于Perthes病的治疗中,近年来还出现了新的微创治疗方法.随着研究的不断进展,内翻截骨术的手术原理、手术适应证逐渐清晰,在提高治疗效果、术后常见并发症如大转子过度生长及Trendelenburg症的预防性治疗方面也取得了进步,各种术式的治疗效果被大量报道.本文对股骨近端内翻截骨术治疗Perthes病的原理及其适应证、治疗现状做一综述.     

单纯闭合楔形截骨术治疗儿童肘内翻畸形

目的:探讨儿童肘内翻畸形的手术治疗方法。方法:回顾30例采用无内固定的肱骨髁上闭合楔形截骨术治疗的肘内翻畸形,其中男27例、女3例,平均随访5年,最长达8年。结果:术前患侧提携角平均-25°,术后提携角平均6.83°,术后较术前平均改变31°,无复发及神经损伤、感染等并发症的出现。结论:无内固定的单纯闭合楔形截骨术手术时间短、患者创伤小、避免二次手术,是简便、安全、有效的治疗儿童肘内翻的方法。     

髋臼旋转与转子间外翻联合截骨术治疗成人扁平髋骨关节炎

髋臼旋转与转子间外翻联合截骨术治疗成人髋臼发育不良合并股骨头扁平畸形继发的中期髋骨关节炎６例（６髋）。年龄２５～４７岁（平均３６．４岁）。男２例，女４例。均有半脱位和骨关节结构的变化，临床表现为行走疼痛和跛行。手术方法在ニノ宫旋转截骨术基础上进行部分改进。平均随访时间２．５年（１４～４２个月）。结果以Ｌａｃｋ的改良Ｔｎｉｓ标准评定，优４例，良２例。手术前后的形态变化对照Ｘ线片的Ｓｈａｒｐ角（示臼关节面倾斜度）、ＡＨＩ（示股骨头覆盖率）、ＩＣＤ和ＨＸ（示股骨头向外偏离度）、ＡＴＤ（示大转子高度）等指标，取得了明显的矫正效果。     

Trochantoplasty for Total Hip Arthroplasty in Patients With Coxa Vara Deformity

Background

In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed “trochantoplasty.” In this procedure, the medial half of the greater trochanter was removed during THA.

Total Hip Arthroplasty After Periacetabular and Intertrochanteric Valgus Osteotomy

Background

We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO.

Distal Transfer of the Greater Trochanter in Coxa Vara

Seven patients (nine hips) who suffered from coxa vara were treated by distal transfer of the greater trochanter. the operation eliminated or markedly diminished the preoperative Trendelenburg sign, thus improving gait. in three patients (four hips) operated upon at the ages of 9 and 12 years, the initial coxa vara was converted into an almost normal valgus femoral neck. There was one poor result due to technical failure.     

Fractures of the Proximal Femur in Childhood: A Review

BackgroundFemoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications.PurposeTo review the current knowledge, discuss controversial aspects, and provide suggestions for future research.MethodsWe have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed.ConclusionThere is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.     

Intertrochanteric Osteotomy in the Treatment of Perthes' Disease

Intertrochanteric osteotomy has been carried out in 34 children with Perthes' disease. Five weeks after the operation the patients were allowed to move about freely. The average postoperative follow-up period was 27 months. At that time the results seemed to be at least as good as those of Thomas' splint therapy. The varus-derotation osteotomy performed in the initial stage accelerated the process of reossifi-cation and seemed to prevent subluxation. According to our findings it is worthwhile correcting the subluxation even in cases with irreversible changes.     

The Spike Osteotomy for Hallux Valgus: A Clinical and Radiological Evaluation

A distal metatarsal osteotomy with soft tissue correction is a frequently performed operation to correct mild to moderate hallux valgus deformity. This is a prospective study of 28 feet in 25 patients who underwent spike osteotomy of the first metatarsal with medial capsulorraphy for symptomatic hallux valgus. The osteotomy is a distal metatarsal osteotomy with a spike fashioned in the plantar and lateral quarter of the proximal fragment and impacted into the trough created in the center of the distal fragment, providing lateral and plantar shift of the distal fragment. The American Orthopaedic Foot and Ankle Society's rating scale was used for functional assessment, and a visual analog scale gauged pain. The average follow-up was 27 months. The rating scale score improved from a mean preoperative value of 39/100 to 84/100. Twenty-six feet had complete pain relief, whereas 2 feet had a lesser degree of persistent metatarsalgia. A review of preoperative and postoperative radiographs showed that the hallux valgus angle improved from a mean 36 degrees preoperatively to 18 degrees postoperatively. Likewise, the mean 1 to 2 intermetatarsal angle improved from 13 degrees to 7.3 degrees. There was no incidence of avascular necrosis. Fourteen patients (16 feet) rated the outcome as excellent, 10 (11 feet) as good, and 1 patient with asymptomatic mild hallux varus deformity rated the result as fair. These results demonstrate that the spike osteotomy is a suitable operation for treatment of mild to moderate hallux valgus.