The Rheumatoid hip

Rheumatoid Arthritis (RA) is among the most common systemic diseases of connective tissue, affecting 1,5% of the population. In recent years about 30 000 new cases of RA have been reported annually. The rheumatoid process has a progressive course, leading to system-wide destruction of bones and joints, along with damage to many other organs and systems. The treatment team involved in managing cases of RA must be composed of specialists from many different fields: orthopedic surgeons, rheumatologists, physiotherapists, social workers, occupational therapists, and visiting nurses.
The treatment goal is to improve the patient's quality of life, to reduce or eliminate pain, and in the most severe cases to facilitate nursing care. In the surgical treatment of these patients the procedures used include synovectomy, joint debridement, soft tissue relaxation operations, arthrodesis, osteotomy, resection arthroplasty, and joint replacement. Among the more than 100 known connective tissue diseases, the hip joint is most commonly involved in cases of rheumatoid arthritis and ankylosing spondylitis. In cases of substantial destruction of the hip, the treatment of choice is joint replacement. Both cemented and cementless prostheses are used in the treatment of RA patients, depending on the surgeon's experience and the patient's age, general clinical status, and the quality of the bone tissue. Postoperative treatment in these patients does not differ from the generally accepted standards for the treatment of degenerative diseases. Based on the author's own experience in the Rheumatoorthopedic Department at the Institute of Rheumatology, it can safely be stated that hip joint replacement is a valuable and well tested method in the treatment of destructive changes to the hip joints in RA patients.     

髋关节超声检查台架在Graf法髋关节超声检查中的作用

目的探讨髋关节超声检查台架在Graf法髋关节超声检查中的作用。方法经过培训的两名超声医师通过使用和未使用髋关节超声检查台架两种检测方式,分别对35例新生儿共70个髋关节进行Graf法髋关节超声检查,对两名医师使用和未使用台架时测量的髋关节α角、β角测值的差值进行比较分析。结果两名医师使用髋关节超声检查台架测量的髋关节α角、β角的角度差小于未使用时,且差异有统计学意义(P<0.05)。结论使用髋关节超声检查台架进行Graf法髋关节超声检查,能减少检查者间测量角度的差别,Graf法髋关节超声检查是标准的、可重复性强,能早期发现髋关节异常的检查方法。     

The influence of total hip replacement on hip pain and the use of analgesics

The influence of total hip replacement (THR) on pain and use of analgesics was evaluated in 511 patients with McKee-Farrar and Brunswik prostheses. The mean age of the patients was 63.8 years and the mean follow-up time 4.2 years. The average grade of pain decreased from 1.8 to 4.9 as evaluated according to Charnley. The proportion of regular users of all analgesics decreased from 75% to 17% (P less than 0.001). Indomethacin was the most common preoperative drug and the proportion of its regular use decreased from 47 to 12% (P less than 0.001). The preoperative association which existed between the grade of pain and the regular drug users in each pain grade decreased more than expected by the preoperative figures. Postoperatively those with previous hip operations, McKee-Farrar prosthesis, one hip replaced, reapplications and removal of the prosthesis gave inferior results with respect to pain than those without previous surgery, with Brunswik prosthesis, both hips replaced and with the original prosthesis in situ. In addition to previous THR operations, type of the hip prosthesis, bilateral or unilateral surgery, primary or secondary coxarthrosis and reapplication of the prosthesis influenced the use of drugs. THR, however, brought a marked drop in the use of analgesics and this effect should be taken into account when assessing the costs and benefits of THR.     

全髋关节置换后的康复训练程序

背景：全髋关节置换后的康复训练对置换后患者肢体康复起非常重要的作用。目的：回顾分析全髋关节置换后康复训练程序的组成、方法、效果评价、发展及存在的问题。方法：以＂全髋关节置换,康复,物理治疗,功能锻炼＂为中文关键词,以＂totalhip arthroplasty;total hip replacement;physical rehabilitation;rehabilitation trainning＂为英文关键词,采用计算机检索CNKI和Medline数据库1996-01/2012-02关于全髋关节置换后康复训练的文章。结果与结论：全髋关节置换后的康复训练内容主要以体位护理、运动疗法为主,并可配合以人工按摩及磁疗、电疗、超声波疗法等。采用运动疗法时,要注意循序渐进原则,由最初的被动运动,逐渐过渡到主动运动。根据手术类型、假体种类、患者情况等选择合适的康复训练程序可明显提高患者患侧髋关节功能恢复的速度和质量。     

Total joint arthroplasty. The hip.

Total hip arthroplasty, one of the most successful orthopedic procedures of this century, can provide relief of pain and improved function in a wide variety of hip conditions. Long-term follow-up has shown, however, that problems can occur, especially with the femoral prosthesis. As a result of this, surface-replacement total hip arthroplasty was developed, and at present it appears to be a very useful procedure for younger patients with concentric hip disease. Both procedures are discussed along with restrictions and complications inherent in their use.     

That old hip. The osteoporosis process

Osteoporosis is a major health concern that will contribute to an increasing number of hip fractures as the population ages. Researchers are continuing to evaluate the role that decreased level of estrogen at menopause and prolonged calcium insufficiency play in the development of osteoporosis. In addition, many health care recommendations are aimed at maximizing peak bone mass and preventing bone loss to decrease the chance of hip fracture. New studies are evaluating the efficacy of experimental medications to rebuild bone mass once osteoporosis has developed. Current prevention guidelines include adequate calcium and vitamin D intake and moderate exercise. At menopause, estrogen replacement therapy is recommended for those younger than 50 years or considered at high risk for developing osteoporosis. All people are encouraged to decrease the risk of fracture by evaluating their home environment for hazards that might contribute to falls. Nursing needs to develop new strategies and interventions to educate the public about osteoporosis, improve the quality of life for persons with osteoporosis, and decrease the osteoporotic hip fracture mortality rate. Will it rise to the challenge?     

髋关节固定支具在老年髋部骨折患者非手术治疗中应用研究

目的比较髋关节固定支具与下肢皮肤牵引治疗老年髋部骨折的临床护理效果。方法回顾性分析我院2016年1月至2017年4月间84例保守治疗的老年髋部骨折患者(髋关节支具固定组45例,下肢皮肤牵引固定组39例)住院期间资料。比较两组患者的平均住院天数,NRS疼痛评分,住院期间死亡率,压疮发生率,其它并发症发生率及护理满意度。结果患者入院时皮肤状况、皮肤护理质量、自理程度差异无统计学意义。髋关节支具固定组平均住院时间14±4.6天,住院期间NRS 评分4.8±1.4分,护理满意度93.3%,死亡1例(2.2%),压疮发生2例(4.4%),其它并发症(肺部感染,尿路感染,便秘,下肢静脉血栓,肺梗塞,应激性溃疡,心脑血管意外等)发生6例(13.3%);下肢皮牵引固定组平均住院时间13±3.8天,住院期间平均NRS 评分6.2±1.8分,护理满意度79.5%,死亡0例(0%),压疮发生7例(17.9%),其它并发症发生5例(12.8%)。两组患者之间平均住院时间,住院期间死亡率及其它并发症发生率差异无统计学意义(P>0.05)。两组患者之间,NRS评分、压疮发生率及护理满意度之间差异有统计学意义(P＜0.05)。结论髋关节固定支具可以明显降低老年髋部骨折后压疮发生发生率,而且能够明显改善骨折后早期疼痛,提高护理质量及满意度。     

动力加压髋螺钉内固定治疗股骨转子间骨折临床观察

目的观察动力加压髋螺钉(DHS)治疗股骨转子间骨折的临床疗效。方法回顾性分析采用DHS治疗股骨转子间骨折38例临床资料。结果临床治疗38例,随访时间4~15个月,平均随访时间8个月,关节活动优良者86.8%,骨折愈合率100%,髋内翻1例。结论DHS内固定治疗股骨转子间骨折是一种稳定可靠的方法,有利于骨折愈合,减少并发症。     

The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists

OBJECTIVE: Hip rating systems have been widely used in assessing severity of hip dysfunction but no uniform method has emerged. The current study was performed to determine the interobserver reliability of five different hip scores on patients with coxarthrosis. DESIGN: Test reliability among physical therapists for five commonly used hip scores. SUBJECTS: Thirty-five patients (48 hips) who had coxarthrosis and who were candidates for total hip arthroplasty were included in the study. METHODS: Patients were evaluated preoperatively by three physical therapists using five different hip rating systems; the Harris Hip Score, the Iowa Hip Score, the Charnley Hip Score, the Merle d'Aubigne Hip Score and the American Academy of Orthopaedic Surgeons' Hip Score. RESULTS: The average age of the patients was 58.8 +/- 2.2 years (range 28-76 years). For all scores, an excellent interobserver reliability between the physical therapists were found (kappa = 0.77-0.95). The best correlation between first and second observer was on Harris Hip Score (kappa = 0.91), between second and third was on Merle d'Aubigne Hip Score (kappa = 0.95) and between first and third was on Iowa Hip Score (kappa = 0.87). CONCLUSION: There was an excellent interobserver reliability for all hip scores between the physical therapists, suggesting that all these hip scores are suitable for use by physical therapists.     

人工髋关节置换患者的术后护理

人工髋关节置换术已被认为是髋关节疾病和骨折最佳的治疗手段，它能改善关节活动度及稳定性和有效地缓解疼痛，提高肢体的功能状态，改善患者总体生存质量。虽然髋关节置换术能解决受损关节的功能代偿，但术后能否达到预期目标、减少并发症发生、提高患者对术后康复的认识都是至关重要的问题。我院骨科2003年6月～2007年2月行人工髋关节置换术32例，对其采取科学的护理和指导，取得了良好的效果，现报道如下。     

The management of fractures of the hip.

Proximal femoral fractures are a common reason for admission to orthopaedic units, and one which may become even more regular as the population ages. Despite this, newcomers to the orthopaedic arena, such as nursing students, may be confused when faced by different hip fractures and the treatments which may be offered. This article seeks to clarify some of these points by outlining the anatomy of the proximal femoral region, various common fractures, the treatments available to the surgeon and aspects of nursing care associated with the pre and post operative phases of the patient's care.