联合术式治疗发育性髋关节脱位临床观察

选择在我院手术治疗的发育性髋关节脱位患者31例（36髋），年龄3—6岁的21例中，行Salter截骨术13例，行关节囊旁截骨术8例；年龄7-11岁的10例患者在Salter截骨术后配合耻骨联合与耻骨结节之间截骨。所有病例股骨近端旋转短缩截骨。术后均得到随访，临床功能评定：优13例、良13例、可3例、差2例，优良率84％；X线评定：优14例、良13例、可2例、差2例，优良率87％。提示发育性髋关节脱位的术式选择，应根据年龄、髋臼发育状况、股骨头脱位高度以及前倾角大小综合因素采用联合术式。     

一期联合手术治疗先天性髋关节脱位：附60例报告

一期联合手术治疗先天性髋关节脱位（附６０例报告）山东医科大学附属医院（２５００１２）王克来，谭国华，陈雨历１９８７～１９９４年，我们采用一期转子下截骨（缩短＋旋转）配合髋关节单纯切开复位、Ｓａｌｔｅｒ骨盆截骨和髋臼造架治疗较大年龄的先天性髋脱位６０例...     

臼顶弧形截骨术治疗小儿发育性髋关节脱位疗效观察

小儿发育性髋关节脱位(DDH)是临床上常见的先天性畸形之一，治疗方法很多，仅手术治疗方法就有Salter骨盆截骨术、Pemberton髋臼成形术、髋臼加盖术、Chiari氏手术等。2001年11月至2002年11月，我们对27例2～3岁DDH患儿，一期行臼顶弧形截骨手术，对其术后1年髋关节的形态结构和功能进行了观察，并与同期以传统术式治疗的35例患儿进行了对比观察。现报告如下。     

手术治疗儿童先天性髋关节脱位20例

近年来,我们对非手术疗法失败的儿童先天性髋关节脱位采用内收肌切断、切开复位,加深扩大髋臼、松解紧张挛缩的髂腰肌、粗隆下旋转截骨纠正前倾角的联合手术,治疗20例。近期随访效果满意。     

髋臼成形、股骨旋转缩短术治疗先天性髋脱位81例

1978～1991年,我院采用髋臼成形、股骨旋转缩短截骨术治疗较大儿童先天性髋脱位81例,取得较好效果。     

联合手术治疗先天性髋关节脱位

1985年6月以来,我们应用髋臼造盖术加深扩大髋臼及粗隆下旋转截骨术治疗先天性髋关节脱位18例、21个髋,效果满意。一、临床资料本组男4例,女14例。2～6岁13例,     

改良Chiari截骨术治疗髋臼发育不良疗效观察

髋臼发育不良是由于先天性的原因导致髋臼发育异常,髋臼变浅,头臼对合关系不好,股骨头半脱位.患者表现为髋关节活动度减小,活动后患髋疼痛,行走时跛行.1966～2006年,我们采用改良Chiari截骨术治疗髋臼发育不良患者76例,取得了良好疗效.     

Salter骨盆截骨术的几点改进

Salter骨盆截骨术是治疗发育性髋关节脱位的经典手术，能有效使股骨头复位，还能改变异常的髋臼方向，但在实际操作中，步骤比较复杂，我们对此作了几点改进，使手术变得相对易于操作。①切口选择：Salter骨盆截骨术通常选用SmithPeterson切口，我们在实际操作中将该切口的下半部偏向外侧，一是能更好地避开股外侧皮神经，二是若需行股骨粗隆下旋转截骨，该切口会更方便一些。②髂骨翼骨块选择：标准术式是截取髂前上棘处的三角形骨块，这样会造成该处骨突体表标志的缺失，更多术者愿意选择从髂骨翼上直接截取三角形骨块。笔者也赞同此法，     

低应力环境下儿童坏死股骨头修复效果观察

对28例股骨头缺血性坏死患儿行应力手术治疗:基础麻醉或连续硬膜外麻醉,髋关节多功能外固定支架行髋关节支撑,保持下肢外展内旋,允许髋关节在矢状面上的部分屈伸功能活动。观察比较手术前后影像学变化;术前与术后2 a的X线片(共行6次检查)头骺高度、髋臼指数、CE角、髋臼覆盖百分率变化。结果术后髋关节间隙增宽,高密度坏死影术后3个月内逐渐缩小,股骨头影渐饱满,头骺高度增加;骺核碎裂累及骺板者股骨头大颈粗、髋关节半脱位;与健侧相比,头骺高度在不同年龄段和C atterall分期均明显大于术前(P<0.05),除C atterallⅣ期外,髋臼指数、CE角、髋臼覆盖百分率均有明显好转(P<0.05),16例(17髋)股骨头M ose环术后恢复圆弧。证实儿童坏死股骨头在低应力环境下修复效果好;其预后与C atterall分期有关,头骺塌陷累及骺板者往往发生头大颈粗的扁平髋畸形,甚至并发半脱位。     

发育性髋关节脱位手术截骨中股骨颈前倾角度的选择

探讨发育性髋关节脱位截骨手术中股骨颈的最佳前倾角度。对26髋发育性髋关节脱位截骨手术后疗效评价为优的患儿行髋关节CT扫描,并行三维重建,测量股骨颈前倾角的度数。结果股骨颈前倾角在4~30,°平均16.93°。提示发育性髋关节脱位截骨手术中股骨颈的前倾角应纠正到10~25°。     

Femoral varus derotational osteotomy without pelvic osteotomy in nonambulatory children with cerebral palsy: Minimum 5 years follow-up

Whether femoral varus derotational osteotomy (VDRO) alone or a combination of femoral and pelvic osteotomies should be performed for hip dislocation in nonambulatory children with cerebral palsy (CP) remains controversial. Few studies have reported radiographical results after the surgical treatment in nonambulatory children with CP. This study aimed to assess the results and determine predictors indicating progressive hip subluxation and redislocation after VDRO without pelvic osteotomy. We retrospectively analyzed 22 hips in 15 nonambulatory children with CP. All patients underwent VDRO without pelvic osteotomy and were followed up for at least 5 years. The mean follow-up period was 7.3 ± 1.9 years. In radiological assessments, we investigated migration percentage (MP), center-edge angle, neck-shaft angle, teardrop distance, break in Shenton''s line (SL), sharp''s angle, acetabular ridge angle (ARA), and the change ratio of MP (Change MP). We classified patients with an MP of <40% at final follow-up in the Good group and those with an MP of ≥40% in the Poor group. The Good group included 10 children (14 hips), and the Poor group included 8 children (8 hips). No preoperative differences were found in the means of all the radiographical parameters. However, MP was significantly different between the groups from 1 year postoperatively. ARA showed improvement 5 years after surgery in the Good group. Change MP in the Good group was maintained from immediately after surgery to the final follow-up. Multivariate logistic regression analyses revealed that preoperative break in SL and Change MP immediately after surgery were parameters to predict MP at the final follow-up. In the receiver operating characteristic analysis, the cut-off values were estimated to be 19.2 mm for preoperative SL and 79.0% for Change MP immediately after surgery. Within 7.3 years of follow-up, 63.6% of the patients who underwent VDRO without pelvic osteotomy had good results. Preoperative SL and postoperative Change MP can be considered as predictors of postoperative subluxation and/or dislocation.     

Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study

OBJECTIVE: To investigate the association between acetabular dysplasia and the incidence of radiographic osteoarthritis (OA) of the hip in a population-based sample of elderly subjects. METHODS: Radiographs of the hip at baseline and at followup (mean followup time 6.6 years) were evaluated in 835 men and women (age >or=55 years) from the Rotterdam Study. Subjects with a baseline Kellgren/Lawrence grade of 0 or 1 in both hips were included in the study. Incident radiographic OA of the hip was defined as a decrease of joint space width of the hip (>or=1.0 mm) at followup. Acetabular dysplasia was assessed using the center-edge angle and the acetabular depth. The association between acetabular dysplasia and incident radiographic hip OA was assessed by calculating odds ratios using multivariate regression analysis. RESULTS: In this study population with a mean +/- SD age of 65.6 +/- 6.5 years, 9.3% developed incident radiographic hip OA. Subjects with acetabular dysplasia (center-edge angle <25 degrees ) had a 4.3-fold increased risk for incident radiographic OA of the hip (95% confidence interval 2.2-8.7) compared with subjects without acetabular dysplasia. These associations were independent of known determinants of hip OA such as age, sex, and body mass index (BMI), but tended to be enhanced by female sex, heavy mechanical load, and low BMI. CONCLUSION: In a study population age >or=55 years, acetabular dysplasia is still a strong independent determinant of incident radiographic hip OA.     

Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures

OBJECTIVE: To determine if acetabular dysplasia increases the risk of incident hip osteoarthritis (OA) among elderly white women. METHODS: Baseline and followup anteroposterior pelvic radiographs were obtained a mean of 8 years apart, and read for individual radiographic features (IRFs) of hip OA; summary grades (0-4) were then assigned based on the IRFs present. Acetabular dysplasia was defined by the results of measurements of the acetabular depth (<9 mm) or the center-edge angle (<30 degrees). Logistic regression analyses were performed to determine the association between acetabular dysplasia and incident hip OA, and all analyses were adjusted for age, current weight, body mass index, affected side, and investigational site. RESULTS: The odds ratios for the association of abnormal center-edge angle and acetabular dysplasia with incident hip OA were 3.3 (95% confidence interval 1.1-10.1) and 2.8 (95% confidence interval 1.0-7.9), respectively. CONCLUSION: Acetabular dysplasia, defined by a decrease in the center-edge angle, is associated with a modestly increased risk of incident hip OA in elderly white women.     

Radiographic hip osteoarthritis and acetabular dysplasia in Turkish men and women

The prevalence of hip osteoarthritis (OA) varies with different regions, and the reasons for this remain unclear. Mild acetabular dysplasia has been considered a risk factor for hip OA, but recent studies have not confirmed this. In Turkey, the prevalence of significant radiographic hip OA, i.e. Kellgren-Lawrence (K-L) grades 3 and 4, is lower than in Western populations. We aimed to investigate the potential effects of radiographic measures of acetabular dysplasia on this discrepancy. Ninety-two Turkish patients (65 males, 27 females) aged 55 and over were studied. Plain supine abdominal radiographs and intravenous pyelographs were evaluated. Centre-edge (CE) angle and acetabular depth (AD) of each hip were measured, and K-L grading was done. The mean CE angles ± SD of right and left hips were 34±7° and 35±7° (range 14–52 and 18–50), respectively. The mean AD±SD of right and left hips was 13.7±3.4 and 13.6±3.4 (range 6–23 and 8–25), respectively. Mean CE angle or acetabular depth of the hips with K-L grade 2 did not differ from those with grades 0 and 1. There was no patient with grade 3 or 4. The prevalence of acetabular dysplasia based on a CE angle of <25° was 9.8% in both right and left hips. When it was defined as having an AD of <9 mm, the prevalence was 4.3% and 1.1% in the right and left hips, respectively. Overall, 10.4% of the hips (13% of the men and 3.7% of the women) had acetabular dysplasia based on at least one of these measurements. Mild acetabular dysplasia appears to be relatively common among Turks aged 55 and over. However, it does not seem to play a major role in the development of radiographic hip OA.     

Femoral Version,Neck-Shaft Angle,and Acetabular Anteversion in Chinese Han Population: A Retrospective Analysis of 466 Healthy Adults

Anatomic data regarding femoral version, neck-shaft angle, and acetabular anteversion are still limited in Chinese Han adult population. The aim of this study was to investigate the effects of age, sex, and body laterality on the 3 important anatomic indicators in Chinese Han healthy adults.Measurements were performed independently by 3 experienced observers using the picture archiving and communication system (PACS) in healthy adults who had received imaging tests of the femur and acetabulum between January 2009 and October 2014. Relevant data were measured and analyzed.A total of 466 adults (353 males and 113 females) were included. The mean femoral version, neck-shaft angle, and acetabular anteversion for all were 10.62, 133.02, and18.79, respectively. Age-based analysis showed that adults younger than 60 years had a significantly higher neck-shaft angle (P < 0.001) but a significantly lower acetabular anteversion (P < 0.001) than those older than 60 years. Sex-based analysis revealed that females had significantly higher values of femoral version (P < 0.001) and acetabular anteversion (P < 0.001) than males. Laterality-based analysis found the left side had a significantly lower acetabular anteversion (P < 0.001) than the right side. Outcomes of multiple linear regression analysis indicated that femoral version may be associated with sex (P < 0.001) but not age (P = 0.076) or laterality (P = 0.430), neck-shaft angle may be associated with age (P < 0.001) but not sex (P = 0.378) or laterality (P = 0.233), and acetabular anteversion may be associated with age (P < 0.001) and sex (P < 0.001) but not laterality (P = 0.060).In this representative Chinese cohort, neck-shaft angle may decrease, whereas acetabular anteversion may increase with age, females may have higher values of femoral version and acetabular anteversion than males, and the right body side may have a higher value of acetabular anteversion than the left side.     

Nonarthroplasty hip surgery for early osteoarthritis

Subtle anatomic abnormalities of the hip, such as acetabular retroversion, acetabular overcoverage, and decreased head-neck offset of the femoral head-neck junction, are important anatomic variants that may lead to pain and osteoarthritis in the young adult population. Advances in surgical techniques, such as the periacetabular osteotomy, safe surgical dislocation of the hip, and hip arthroscopy, are providing us with more effective and safer tools to correct these anatomic problems. The limiting factor in treatment outcome in many mechanically compromised hips is the amount of cartilage damage that has occurred before treatment. This article is a guide to these subtle anatomic abnormalities and the options for treatment.     

Arthroscopic validation of radiographic minimum joint space width associated with the subchondral bone exposure in symptomatic hip dysplasia

Objective: The purpose of this study was to clarify the minimum joint space width (MJSW) that leads to subchondral bone exposure (SBE) in patients with hip dysplasia.

Methods: We included 82 subjects (86 hips) who had hip dysplasia with center-edge angle less than 20° and who underwent periacetabular osteotomy combined with hip arthroscopy. The acetabular and femoral cartilages were divided into three regions: anterosuperior, superior, and posterosuperior; for each region, we analyzed the correlation between the incidence of SBE and the MJSW measured on plain radiographs. The disease stage was defined according to the Kellgren and Lawrence grades (KL grade).

Results: SBE was found in 51 hips (59.3%) in total, involved the acetabulum in 49 hips (57.0%), and involved the femoral head in 26 hips (30.2%). SBE was more frequent in the acetabulum, with the highest incidence in the anterosuperior region, followed by the superior region. SBE was present in six hips (22.2%), 17 hips (56.7%), and 28 hips (96.5%), at KL-1, KL-2, and KL-3, respectively. MJSW of hips with SBE was significantly smaller than those without SBE (2.3 vs 4.0?mm, p?Conclusions: Cartilage degeneration is more advanced than would be predicted on plain radiographs. The cut-off value of MJSW for SBE was 3.7?mm in patients with symptomatic hip dysplasia.     

Acetabular osteotomy for osteoarthritis of the hip joint due to congenital dysplasia

There are several reports of the treatment for osteoarthritis due to congenital dysplasia of the hip joint. Rotational acetabular osteotomy, Chiari osteotomy and shelf operation has been introduced as the representative acetabular osteotomy. In this paper, we presented our indication of these procedures for dysplastic hip and showed indicative cases.     

Relationship Between Developmental Dislocation of the Hip in Infant and Acetabular Dysplasia at Skeletal Maturity

Previous reports demonstrated 8–60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH.A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17–59 years).Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle.Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH.     

全髋关节翻修术后髋臼旋转中心变化对髋关节稳定性的影响

目的探讨全髋翻修手术前后髋臼旋转中心的变化对髋关节稳定性的影响。方法回顾性分析102例（132髋）全髋关节翻修术患者的临床资料,对比手术前后双髋关节正位片,测量术后髋臼假体的旋转中心与解剖髋臼旋转中心的符合率和再翻修率。结果旋转中心恢复者89髋（67.42%）,未恢复者43髋（32.78%）,术后5 a旋转中心恢复者中因人工髋关节松动、脱位、髋部痛等再行髋关节假体翻修术为6髋（6.74%）,大大低于旋转中心未恢复者11髋（25.58%）,P〈0.01。结论髋臼旋转中心的恢复对人工髋关节翻修术后的关节稳定性产生直接影响。