全髋关节置换治疗成人髋关节发育不良继发骨关节炎

目的探讨全髋关节置换治疗成人髋关节发育不良继发骨关节炎的手术方法。方法 2004年1月至2009年7月,对26例（26髋）髋关节发育不良继发骨关节炎患者行全髋关节置换术。其中女25例,男1例,平均年龄48.7岁。按Crowe分型：Ⅰ型8例,Ⅱ型13例,Ⅲ型3例,Ⅳ型2例。采用Harris评分和X线检查评价疗效。结果随访6～72个月,平均36个月。Harris评分：术前平均49.6分（28～65分）,术后平均87.4分（72～92分）。术后无坐骨神经麻痹、下肢深静脉栓塞、切口感染和人工关节脱位等并发症,X线显示假体位置良好,所有病例髋臼均为真臼重建,未见无菌性松动和假体下沉等征象。结论全髋关节置换是治疗髋关节发育不良继发骨关节炎的有效方法。     

全髋关节置换术治疗成人发育性髋关节发育不良体会

目的探讨成人发育性髋关节发育不良的治疗方法。方法对我科于2004年1月～2005年12月9例9髋成人发育性髋关节发育不良病人应用全髋关节置换，男4例，女5例，年龄27～48岁，Crowe分期Ⅰ期4髋；Ⅱ期3髋；Ⅲ期1髋；Ⅳ期1髋。Harris髋关节功能评分在62～24分，平均42．6分。结果本组病例切口均一期愈合，无感染及血管神经损伤、脱位、深静脉血栓形成等并发症发生。7髋术后肢体恢复等长，2髋患肢较健侧短5～10mm。Trendlenburg征术前全部阳性，术后阴性8髋，阳性1髋。髋关节Harris评分为80～87分，平均85．6分。结论全髋关节置换是治疗成人发育性髋关节发育不良一种有效方法。     

微创髋关节手术不一定是正确选择

据美国WebMD医学新闻网（2016-06-08）报道,一项研究指出,微创髋关节手术不一定是舒缓严重、持续髋关节疼痛的最佳选择。研究人员发现,有超过1/3曾做过微创手术（如髋关节置换术）的60多岁年长者在2年内需要做髋关节置换。根据美国整形外科学会（AAOS）指出,髋关节镜是在髋关节周围做小切口,让微型摄影机作为手术工具进入。     

髋关节的几何参数测定

髋关节是人体的重要关节。在人工髋关节置换中,假体与股骨间匹配程度是影响其长期疗效的重要因素［１－４］Ｅｎｇｈ［２］等发现假体与股骨间匹配紧密的患者Ｄ’Ａｕｂｉｇｎｅｓｃａｌｅ得分较高。Ｓａｌｚｅｒ［５］等在对三种非骨水泥假体的研究发现,在下沉１０ｍｍ以上的假体中２５％与髓腔不匹配有关。Ｃｒｏｗｎｉｎｓｈｉｅｌｄ［６,７］用三维有限元分析来估算人工关节柄长度横截面等几何尺寸范围以及骨水泥和假体柄应力分布,发现将股骨假体柄长度从１００增加至１３０时,最大拉伸应力增加３１％,同时在骨水泥中的最大压应力…     

髋关节表面置换术治疗Crowe Ⅰ、Ⅱ型髋关节发育不良

目的研究CroweI型和Ⅱ型髋关节发育不良（DDH）患者行髋关节表面置换术（HRA）的临床结果。方法前瞻性将2005年3月—2006年12月80例CroweI型和Ⅱ型DDH患者随机分入HRA组和全髋关节置换术（THR）组。HRA组中3例改行THR、3例失随访,THR组中2例失随访,故34例37髋接受HRA,38例39髋接受THR。在术后6周、3个月、1年,以后每年1次进行随访,接受放射学及临床评价。结果HRA组和THR组分别平均随访59．4个月（52～70个月）及60．6个月（50—72个月）,2组都未出现假体失败。2组间术后Harris评分差异无统计学意义（P：0．073）,但HRA组的屈髋活动度显著优于THR组（P〈0．01）。两组间髋臼假体的平均外展角差异无统计学意义（P=0．982）。HRA组的髋臼假体直径大于THR组（49．5ramvs46．1mm,P=0．001）。结论CroweI型和Ⅱ型DDH行HRA的临床结果与THR相近,但HRA术后屈髋活动度更佳,HRA在使用较大股骨假体的同时,髋臼会有额外骨量丢失。     

初次人工全髋关节置换治疗髋关节疾病12例疗效分析

目的:探讨采用人工全髋关节置换治疗髋关节疾病的临床疗效。方法:采用人工全髋关节置换治疗髋关节疾病12例,术后按个性化康复计划指导患者功能锻炼。结果:术后平均随访6-18个月,12例关节功能恢复正常。结论:人工全髋关节置换治疗髋关节疾病,能早期进行功能锻炼,预防并发症,是治疗髋关节疾病的较好方法。     

髋关节表面置换术治疗Crowe Ⅰ、Ⅱ型髋关节发育不良

目的 研究Crowe Ⅰ型和Ⅱ型髋关节发育不良(DDH)患者行髋关节表面置换术(HRA)的临床结果。方法 前瞻性将2005年3月—2006年12月80例Crowe Ⅰ 型和Ⅱ型DDH患者随机分入HRA组和全髋关节置换术(THR)组。HRA组中3例改行THR、3例失随访,THR组中2例失随访,故34例37髋接受HRA,38例39髋接受THR。在术后6周、3个月、1年,以后每年1次进行随访,接受放射学及临床评价。结果 HRA组和THR组分别平均随访59.4个月(52～70个月)及60.6个月(50～72个月),2组都未出现假体失败。2组间术后Harris评分差异无统计学意义(P=0.073),但HRA组的屈髋活动度显著优于THR组(P＜0.01)。两组间髋臼假体的平均外展角差异无统计学意义(P=0.982)。HRA组的髋臼假体直径大于THR组(49.5 mm vs 46.1 mm,P=0.001)。结论 Crowe Ⅰ型和Ⅱ型DDH行HRA的临床结果与THR相近,但HRA术后屈髋活动度更佳,HRA在使用较大股骨假体的同时,髋臼会有额外骨量丢失。     

不同材料髋关节假体在髋关节置换中的应用

背景：金属材料、高分子材料和陶瓷材料等制作的人工髋关节关节都已成功应用于临床,产品也已经发展到比较成熟的阶段,但是每种材料依然存在各自的优缺点。 目的：评价不同材料髋关节假体的特点及临床应用。 方法：采用电子检索的方式在万方数据库中检索1999-01/2011-02有关髋关节假体材料的研究,关键词为“髋关节置换”。排除重复研究、普通综述或Meta分析类文章,筛选纳入18篇文献进行评价。 结果与结论：金属材料在髋关节置换中占有重要的地位,目前髋关节置换临床应用最多的是金属关节头和超高分子量聚乙烯髋臼的组合,但金属的弹性模量与人体骨骼相差甚远,导致应力遮挡效应,容易引起假体的疏松和不稳定;生物惰性陶瓷在活体内具有很高的稳定性和很好的机械强度,而生物活性陶瓷具有骨传导的特点以及与活骨整合的性能;复合材料假体因其可调的弹性模量和足够的力学强度,力学性能接近人体骨骼而逐渐被重视。但目前还缺乏生物相容性好、生物力学相容性好的理想假体材料。因此,应从改进人工髋关节设计和制造工艺,提高材料的耐磨性与力学性能,增强假体与宿主骨的结合性,减少应力遮挡,寻找新的人工髋关节假体材料等方面来提高置入物与宿主的生物相容性,从而能够更好地延长假体使用寿命。     

全髋关节置换治疗氟性髋关节重度骨关节炎*

背景：关节置换是目前治疗氟性髋关节重度骨关节炎的有效方法之一。 目的：分析全髋关节置换治疗氟性髋关节重度骨关节炎的策略及疗效。 方法：采用生物型假体行全髋关节置换治疗5例氟性髋关节重度骨性关节炎患者。 结果与结论：所有患者伤口均一期愈合;置换后1周摄X射线片示假体在位。所有病例平均随访13.8个月,未见假体松动下沉。置换后3个月Harris评分平均83.6分,6个月Harris评分平均87.8分,与置换前均分38.4分相比明显改善;发生异位骨化2例,按Brooker分级Ⅰ、Ⅱ级各1例。说明全髋关节置换治疗氟性髋关节重度骨关节炎短期无假体松动及下沉现象,关节功能改善优良,但置换后注意预防异位骨化。 关键词：氟骨症;髋关节骨关节炎;全髋关节置换;策略;疗效 doi:10.3969/j.issn.1673-8225.2012.09.006     

发育性髋关节发育不良患者不同髋关节外展角度下髋部应力分布的有限元分析

背景：目前对于髋关节发育不良的有限元研究相对较少,髋关节外展角度对髋关节生物力学分布的影响也不明确。目的：应用有限元方法分析不同外展角度下髋关节发育不良患者健侧及患侧的髋关节应力分布,为髋关节发育不良的预防、治疗、康复等提供方案。方法：选取1例左侧髋关节发育不良患者双侧髋关节CT薄层扫描数据,利用Mimics软件建立髋关节模型,Geomagic Wrap软件完成实体化,Solidworks软件进行皮质骨与松质骨的装配,然后应用Ansys Workbench软件加载关节负荷,分析不同外展角度下单足着地条件下髋关节应力分布情况。结果与结论：(1)该研究所建模型与实际情况相符合,随着髋关节外展角度增加,正常髋关节的股骨颈最大应力值逐渐增大,且一直位于股骨颈内侧,当健侧髋关节外展为15°时股骨头最大应力值最小,当髋关节外展20°时髋臼上方最大应力值最小;(2)发育性髋关节发育不良患者患侧髋最大应力值一直位于髋臼上方,且当髋关节外展为25°时,髋臼最大应力值最小,当髋关节外展20°时,股骨头最大应力值最小,当髋关节外展0°时,股骨颈部最大应力值最小,且位于股骨颈后方,随着髋关节外展角度增大,股骨...     

Total hip arthroplasty in healed tuberculous hip

Total hip arthroplasty was performed in a patient who had tuberculous hip, quiescent for the last 15 years, without pre or postoperative anti-tuberculous chemotherapy. At a 27 month follow up, there has been no evidence of reactivation. A brief review of relevant literature is also presented.     

Thiazide diuretic agents and the incidence of hip fracture

Thiazide diuretic agents lower the urinary excretion of calcium. Their use has been associated with increased bone density, but their role in preventing hip fracture has not been established. We prospectively studied the effect of thiazide diuretic agents on the incidence of hip fracture among 9518 men and women 65 years of age or older residing in three communities. At base line, 24 to 30 percent of the subjects were thiazide users. In the subsequent four years, 242 subjects had hip fractures. The incidence rates of hip fracture were lower among thiazide users than nonusers in each community; the Mantel-Haenszel relative risk of hip fracture, adjusted for community and age, was 0.63 (95 percent confidence interval, 0.46 to 0.86). The protective effect of the use of thiazides was independent of sex, age, impaired mobility, body-mass index, and current and former smoking status; the multivariate adjusted relative risk of hip fracture was 0.68 (95 percent confidence interval, 0.49 to 0.94). Furthermore, the protective effect was specific to thiazide diuretic agents, since there was no association between the use of antihypertensive medications other than thiazides and the risk of hip fracture. These prospective data suggest that in older men and women the use of thiazide diuretic agents is associated with a reduction of approximately one third in the risk of hip fracture.     

On morphology of consolidated UHMWPE resin in hip cups.

The microstructure of replacement hip cups made from ultra-high molecular weight polyethylene (UHMWPE) has been revealed by permanganic etching to bring out the fine details. Specimens are examined by optical microscopy according to the Nomarski technique, and by scanning and transmission electron microscopy. In all cups the original reactor particles are visible. Optical microscopy is most productive in revealing variations not only in the texture of different individual particles, but also in the degree of consolidation of a particle with its neighbours. Both these factors differ according to the material and process. Electron microscopy reveals the existence of pockets of lower molecular weight material which has been expelled from the particles by the original sintering process.     

羟基磷灰石涂层髋关节假体的研究与应用

背景：目前含有羟基磷灰石涂层的生物学髋关节假体已广泛应用于临床。 目的：复习相关文献,对羟基磷灰石涂层髋关节假体的生物学特性及临床应用效果进行综述。 方法：应用计算机检索1988/2011 PubMed数据库有关羟基磷灰石涂层髋关节假体生物学特性及临床应用效果的文章,检索词为“hydroxyapatite, hip arthroplasty,hip prosthesis”,排除发表时间早、重复及类似研究,纳入29篇文献进一步分析。 结果与结论：羟基磷灰石是一种具有良好生物相容性及生物活性的磷酸钙盐,通过处理,它可在金属表面形成薄层,这种处理方法可极大促进紧压配合假体的骨整合,能为假体提供骨性固定,直到骨长入到假体的多孔表面内。羟基磷灰石涂层的非骨水泥假体在置入早期即可促进骨长入,允许早期负重,具有良好的机械固定和长久的生物固定作用,且远期并发症如无菌性松动、假体周围骨溶解、假体下沉的发病率并不高于无羟基磷灰石涂层的髋关节假体。但目前在羟基磷灰石涂层的厚度、羟基磷灰石颗粒的大小、羟基磷灰石材料的结晶度等方面尚无统一意见,需要进一步的研究和探讨。     

The mechanism of genetic predisposition in congenital dislocation of the hip.

The important role of polygenic acetabular configuration and monogenic joint laxity has again been proved in the aetiology of congenital dislocation of the hip. According to the findings reported these two genetic predispositions seem to be unrelated. The time of diagnosis in accetabular dysplasia type and joint laxity type did not differ, thus the neonatal and late-diagnosed cases do not seem to be two clear-cut entities.     

3D打印技术在髋关节置换中的应用及价值

BACKGROUND: Three-dimensional (3D) printing technology is a new rapid prototyping technology, which has been initially applied in orthopedics, especially in the clinical application of hip replacement surgery.     

The morphology of degenerative hip disease in male breeding turkeys

A form of degenerative joint disease in male breeding turkeys has been studied. Initial lesions occurred in the antitrochanteric region of the acetabulum. A surface cleft appeared in antitrochanteric cartilage and free cartilage bodies were subsequently released into the joint cavity. Secondary osteoarthrosis developed, involving both the femoral and acetabular components of the coxofemoral joint. Lesions of the antitrochanter were graded according to their severity and provide a pathological sequence. Of 59 male breeding turkeys examined at approximately one year of age, antitrochanteric lesions were present in all but 5 of them. The disease was not seen in 20 females of comparable age.     

Namaqualand hip dysplasia: an autosomal dominant entity

A unique inherited skeletal disorder has been identified in 45 persons in five generations of a kindred of mixed ancestry in South Africa. Discomfort in the hip joints develops in childhood and the course is progressive, with handicap in middle age. General health is good, height is not reduced by any significant degree, and there is no nonskeletal involvement. The major changes are in the femoral capital epiphyses, which are flattened and fragmented; secondary degenerative arthropathy develops at a later stage. Platyspondyly of variable but mild degree is present in about 60% of affected persons. Other minor changes, including iliac exostoses, are present occasionally. Pedigree data indicate autosomal dominant inheritance, with a reasonably consistent phenotypic expression. In view of the geographic distribution of this condition we propose the designation "Namaqualand hip dysplasia" (NHD).     

Quantitative measurement of hip protector use and compliance

Hip protectors are often prescribed to the elderly who are at risk of falling, with the goal of preventing hip fractures. However, determining the effectiveness of hip protectors has been hampered by unreliable compliance data. This study reports a reliable objective method of measuring compliance and the developed method could be used in any climate, regardless of temperature. Custom compliance monitors were built and embedded inside hip protectors. An algorithm was developed to utilize both temperature and acceleration to determine compliance. Seven young volunteers (age 24.6 ± 4.2 years old) wore the protectors for a total of 667 h while closely recording their compliance. One female (77 years old) who had hip fracture history wore the compliance monitors for 91.6 % of the time during a 1-week stay in a hospital. From the volunteers’ trial, using temperature alone overpredicted compliance by 1.2 % and using acceleration alone overpredicted by 5.4 %, but using a combination of the two methods plus a correction factor only underestimated by 0.6 %. From the elderly data, the average compliance recorded from the temperature, acceleration, and combined methods with correction was 94.6, 88.9, and 90.2, respectively. The high accuracy of temperature sensors in this study will not be attainable in hot climates where most of the worldwide increase in hip fractures is occurring. The developed monitor with the algorithm provided high accuracy in determining compliance and was able to determine both the longitudinal and cross-sectional compliance at any time.     

Assessment of hip protectors and corresponding hip fracture risk using stress calculation in the femoral neck

As in many countries, a significant increase in the number of hip fractures is predicted due to the demographic changes in the population. To reduce the consequences for the patients and the social costs, hip protectors are considered to be effective in reducing the impact force on the hip and so to reduce the risk of hip fractures. The effectiveness of hip protectors has been investigated as well in experimental impact tests as in clinical studies, but there is still an uncertainty about their mechanical protection effect. Therefore, laboratory tests are an effective way to investigate the mechanical behaviour of hip protectors. A fracture is initiated by exceeding an ultimate compressive or tensile stress. In our model, stresses in the femoral neck are estimated by using the Euler beam formula. A standard femur was defined consisting of all mechanical parameters that have been identified to influence the mechanical resistance to external loads, such as the effective cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), femoral neck width (FNW), centre of mass and other geometric parameters of the femur. In this study the necessary formulae as well as first results of assessing hip protectors on the basis of stresses in the femoral neck are presented. The results show that the methodology facilitates assessment and improvement of hip protectors, as the biomechanical parameters of real femora are the basis of the model.