V形镍钛合金支架植入治疗犬髋臼发育不良的实验研究

目的 探讨Ｖ形镍钛合金（记忆合金）支架植入髋臼顶部后,对其髋臼发育不良的矫正及对其髋臼发育的影响。方法 选用髋臼发育不良的幼犬１０只,随机分为２组,在髋臼顶部距臼缘上０．５ｃｍ处用弧形骨刀做与髋臼弧度一致的截骨,其截骨深达Ｙ形软骨,将截骨后的骨瓣向下扳压,在骨瓣上方植入２￣３只Ｖ形镍钛合金支架,术后４、１２周行双髋关节Ｘ线摄片,进行大体及组织学观察。结果 术后１２周髋臼顶部由术前斜坡形恢复为弧形,     

髋臼发育不良的动物模型制作及其临床意义

目的: 该实验借助大体标本、X线片和组织病理切片观察, 阐述髋臼发育不良导致髋关节脱位的发病过程和评价动物模型的可靠性。方法: 将 12只 4个月龄兔通过外科手术造成单侧髋关节半脱位动物模型, 手术后 4、6、8周, 观察兔髋关节脱位和继发性假臼形成的过程。结果: 手术后 4周, X线片未发现髋关节脱位, 大体解剖和组织病理切片观察髋臼缘软骨面基本完好。手术后6、8周, X线片示完全性髋关节脱位, 大体解剖和组织病理切片观察髋臼顶缘软骨不同程度变性脱落坏死, 而且手术后 8周, 髋臼缘上部髂骨外板有假臼形成。结论: 本实验所建立的近似于髋臼发育不良导致先天性髋关节脱位的动物模型, 简单可靠, 为此类疾病的研究提供了必要的实验基础。     

髋臼Y形软骨损伤对髋关节发育影响的实验研究

目的探讨“Y”形软骨损伤后骨骺早闭对髋关节发育的影响。方法选用10只4~5周龄大白兔,切除、破坏右侧髋臼部分“Y”形软骨,左侧髋关节不行处理,作为对照。X线动态观察双侧髋关节发育状况,术后12周处死动物,进行形态学及组织学观察。结果手术侧术后3周“Y”形软骨均出现骨骺早闭,髋臼内壁增厚、髋臼变浅;术后6~9周髋臼浅且形态不规则,4例出现半脱位;术后12周全部出现关节发育不良,50%的髋关节发生半脱位。形态学观察见髋臼变浅,内壁厚度增加,股骨头增大、变扁,关节软骨失去光泽,部分缺失。HE染色见髋臼及股骨头软骨层变薄,软骨细胞排列紊乱,骺板扭曲、变薄。对照侧各髋关节形态结构正常。手术侧各期臼头指数、相对髋臼指数及臼壁厚度与对照侧相比差异均有显著性意义(P<0.05)。手术侧术后12周臼头指数及相对髋臼指数与术后第2d相比差异有非常显著性意义(P<0.01)。结论“Y”形软骨损伤可导致骨桥形成、骨骺早闭,使髋臼内壁增厚、髋臼变浅,继而引发髋关节发育不良和半脱位。     

Salter骨盆截骨术后骨关节炎发生的病理基础

目的：观察小儿Ｓａｌｔｅｒ骨盆截骨术后髋关节形态学的变化，探讨骨关节炎发生的病理基础。方法：对发育性髋脱位手法复位后失败的６０例，７２髋进行了Ｓａｌｔｅｒ骨盆截骨术。经过平均７．４年的追踪观察，采用系列Ｘ线片观察髋关节形态学的变化，如股骨头的发育，髋臼形态和髋臼硬化带的形态等。结果：７２髋中有６０％出现股骨头增大的改变，５０％髋臼内凹凸不平，髋臼硬化带为外三角形者占３６％。结论：股骨头增大，髋臼的改变成为Ｓａｌｔｅｒ骨盆截骨术后骨关节炎发生的潜在病理基础，应予以关注     

髋臼骨折（二）

２影像学检查２１Ｘ线平片为诊断髋臼骨折的常规检查。２１１投照位置Ｊｕｄｅｔ等认为对怀疑有髋臼骨折的病例至少应摄骨盆前后位片、患侧髋关节的前后位片及斜位片（图３）。左：髋关节前后位；中：ＯＯＶ；右：ＩＯＶ图３髋臼的Ｘ线标志骨盆前后位片有助于诊断双...     

髋臼造顶和股骨短缩截骨治疗先天性髋脱位的长期疗效观察

作者从１９７７年５月－１９８３年１０月，曾一期采取切开复位、髋臼造顶和股骨短缩截骨术治疗先天性髋脱位（ＣＤＨ）７５例，其中２６例３３个髋关节获得平均１２．７年的随访。没有文献中的Ｍｃｋａｙ临床评定标准和ＳｅｖｅｒｉｎＸ线评定标准对本组病例做了疗效评价。其临床优良率为８５％，Ｘ线优良率为７３％；术前髋臼指数平均为３５度，术后降到１８．１度，术前股骨头上移平均为３．５ｃｍ，术中短缩股骨２．１ｃｍ，结果     

利用计算机图像动态观察先天性髋脱位复位后髋臼的形态变化

目的 通过计算机图像处理技术对正常及脱位髋关节Ｘ线片进行处理。了解髋臼的形态变化。方法 先天性髋脱位经手法复位患儿３３例,共４９髋,男１２例,女２１例;单侧脱位１７例,双侧脱位１６例（其中２２髋随访期间行切开复位,故将该２２髋删除）。以单侧髋脱位患者的对侧正常髋关节为对照组（１７髋）,手法复位后髋臼发育良好组为１９髋,髋臼发育不良组为８髋,将复位前后各时期髋关节的正位Ｘ线片输入计算机,并叠加在一起,计算髋臼的横向生长速度、纵向缎斜速度及其比值。结果 髋臼横向生长与纵向倾斜速度的比值分别是：对照组２４．６９５,复位后发育良好组１０．３５０,复位后发育不良组２．１１５,对照组的髋臼顶壁沿水平方向向外侧生长,６～８岁以后髋臼外侧缘逐渐向下方生长,手法复位后发育良好组６～８岁以后无骨臼外侧缘逐渐向下方生长。手法复位后髋     

实验性髋臼发育不良的病理形态学研究

目的 :探讨造成髋关节发育不良的病理发病机制。方法 :将 18只幼兔的左髋关节屈曲膝关节伸直位石膏固定 4周 ,比较双侧髋关节的X线片及病理组织学变化。结果 :髋关节屈曲膝关节伸直位石膏固定 4周造成了髋关节发育不良的动物模型。髋臼变浅、股骨头变小、向外上方移位。X线片可见髋臼指数增大 ,由固定前的 (2 8.44± 3 .91)°增大为 (3 3 .17± 3 .65 )° ;臼头指数减小 ,由固定前的 (75 .2 0± 4.41) %减小为 (5 8.71± 8.2 1) %。组织学观察可见关节软骨退行性改变。结论 :髋关节屈曲膝关节持续伸直位状态 ,容易造成髋关节发育不良。随着时间的延长 ,病理变化加重。及早复位 ,髋关节可以恢复正常     

髋臼旋转截骨术治疗髋臼发育不良28例疗效分析

目的：探讨髋臼旋转截骨术治疗髋臼发育不良的临床效果。方法：采用田川法髋臼旋转截骨术治疗髋臼发育不良共２８例（２９髋），随访时间３．２年。手术前后Ｘ线变化及临床评定结果：全部病例术后可使髋关节疼痛消失，功能改善，髋臼和股骨头之间恢复了正常匹配关系。结论：髋臼旋转截骨术是从根本上治疗髋臼发育不良的最有效方法     

髋臼发育不良的X线参数

髋臼发育不良的Ｘ线参数马瑞雪吉士俊周永德杭俊德髋臼发育不良是先天性髋脱位手法复位后常见的残余畸形，或者是忽略了先天性髋臼发育不良，当髋关节疼痛就诊时，已失去了早期治疗的机会，故早期发现髋臼发育不良十分重要。国外有人提出了成人Ｓｈａｒｐ角和ＡＣＭ角（或...     

Experimental study on the etiology of pathogenesis of acetabular dysplasia in congenital dislocation of the hip

In order to investigate the etiology of pathogenesis of congenital hip dislocation and acetabular dysplasia, experiments using fetuses of pregnant rabbits were conducted. The following findings were obtained. (1) Dislocation occurred in approximately 40% of total animals used. The earliest dislocation was seen 2 days after birth. (2) The hip dislocation could be relatively and easily generated by exogenous factors during the perinatal period, even without such primary cause, as hip joint dysplasia. The acetabular dysplasia could be generated secondarily to dislocation. (3) There was a difference in the cause of acetabular dysplasia between areas of the acetabulum with and without load. (4) The acetabular depth growth in the dislocated hip was more seriously impaired than the longitudinal and transverse diameters of the acetabular entrance. These results have indicated that endochondral ossification of the epiphyseal cartilage of the acetabulum in the dislocated hip was more markedly impaired than that of Y epiphyseal cartilage.     

Acetabular dysplasia and hip dislocation after selective premature fusion of the triradiate cartilage. An experimental study in rabbits

Premature fusion of the triradiate cartilage was obtained surgically in 10 three-week-old rabbits, and compared with isolated fusion of the ilio-ischial and of the ilio-pubic limbs of the triradiate cartilage in two further groups of 10 rabbits. Complete fusion caused acetabular dysplasia five weeks after operation in all animals and hip dislocation at nine weeks in half of them; ilio-ischial fusion had a comparable effect. Ilio-pubic fusion had only a minimal effect on acetabular development. The posterior position of the ilio-ischial limb in the acetabulum and its predominance in the formation of the triradiate cartilage in quadrupeds may have contributed to its decisive effect on acetabular development.     

Acetabular dysplasia and osteoarthritis developed by an eversion of the acetabular labrum

To investigate adverse effects of acetabular labrumectomy on the growth and development of the acetabulum, the author subjected the hip joints of 20 young rapidly growing dogs to eversion of the acetabular labrum. It was found to produce acetabular dysplasia. The acetabulum gradually became shallower and more vertically oriented, and the femoral head gradually subluxed but never dislocated. The radiographic appearance of the hip dysplasia was similar to that seen in humans. Histologically, a substantial degenerative change in articular cartilage was observed in the subluxed hip, without any evidence of degenerative arthritis radiologically. When operating on congenital dislocation of the hip, a complete excision or eversion of the acetabular labrum should be avoided. Radial splitting of the acetabular labrum may safely avoid the risk of violating the acetabular epiphyseal cartilage.     

臼顶纵行楔状植骨成形治疗先天性髋脱位

目的 探讨臼顶纵行楔状植骨成形治疗衔天性髋脱位的方法。方法 臼顶囊外、纵行、楔状植骨髋臼成形。结果 １３髋治疗后经平均３年随访,Ｘ线结果：ＣＥ角、Ｙ指数、髋臼指数、ＡＨＩ值与对照组相比,差异无显著性（Ｐ〉０．０５）;临床结果：优１２髋,良１髋。结论 该方法可改善头臼覆盖,恢复同心圆结构,简便可靠,效果满意。     

The African neonatal hip and its immunity from congenital dislocation.

The hips of twenty full-term African neonates have been examined in detail to determine any anatomical factors which might explain the difference in the incidence of congenital dislocation of the hip in the African and in the Caucasian. Measurements included the degree of anteversion of the femoral neck and the acetabulum and the diameter and depth of the acetabulum. The acetabulum tended to be deeper and to vary within a much narrower range than that reported for Caucasians, lending indirect support to the theoretical role of acetabular dysplasia in the aetiology of congenital dislocation of the hip. Measurements of the anteversion of the acetabulum and femoral neck were similar to those given for Caucasians.     

Total hip replacement in high total hip dislocation by performing a Z-shaped shortening osteotomy

AIM: Total hip arthroplasty for severe chronic proximal femoral migration, most commonly seen in congenital dislocation of the hip, has been associated with high rates of complications. Placement of the acetabular component in the true acetabulum has yielded the most durable results, but leads to significant limb lengthening. In this paper six cases of a total hip arthroplasty combined with a Z-shaped osteotomy of the proximal femur are described. METHOD: All patients presented with a complete congenital dislocation of the hip. In all procedures the acetabular component was placed in the true acetabulum and the proximal femur was shortened according to a preoperative drawing in a Z-shaped manner. RESULTS: The clinical and radiological results of the patient collective are presented in this study, the mean follow-up period was 60 months. At the last follow-up no nerve palsy, osteotomy pseudarthrosis or dislocation were detected objectively. CONCLUSION: The performed procedure seems to be a viable technique in the treatment of coxarthritis in high total hip dislocation.     

Osteoarthrosis and congenital dysplasia of the hip in family members of children who have congenital dysplasia of the hip

Four hundred and eight siblings, parents, and grandparents of seventy-eight children from the New England area who had congenital dysplasia of the hip were evaluated, by clinical examination and by measurements of the acetabulum on pelvic radiographs, for the signs and sequelae of congenital dysplasia of the hip. Six siblings and four mothers (representing seven of seventy-eight families) had been diagnosed with congenital dysplasia of the hip during childhood. The other ninety-one siblings were asymptomatic and had no radiographic evidence of dysplasia of the hip. In the adults in these families, acetabular coverage (as measured by the center-edge angle of Wiberg) was no different from that in the control subjects. There was no difference between the study group and the control subjects in the prevalence of osteoarthrosis of the hip or of osteoarthrosis that could be considered secondary to congenital dysplasia of the hip. The results indicate that children born to families that have a history of congenital dysplasia of the hip have a greater prevalence of this problem compared with the general population, but also that examinations of the hip in newborns are effective in detecting congenital dysplasia of the hip in such families. The greater prevalence of congenital disease of the hip among the siblings and mothers in these families is consistent with a multifactorial inheritance. The fact that acetabular development in the family members who did not have congenital dysplasia of the hip was no different from that in the control subjects suggests that acetabular dysplasia, rather than being an inherited abnormality, is secondary to subluxation or dislocation.     

A clinical study on the development of the acetabulum after various treatment in congenital dislocation of the hip (author's transl)]

In the treatment of congenital dislocation of the hip, prognosis varies greatly according to the status of the development of the acetabulum. In most of the patients with osteoarthritis of the hip primary causes are found. In this series, 50% had congenital dislocation of the hip and 35% had acetabular dysplasia. In order to identify the conditions of hip joints in which the acetabular development can be expected from conservative treatment and to estimate the limit of age for indication of this treatment, the status of the development of the acetabulum was investigated after various treatment. This is expected to provide valuable data for the establishment of the method of treatment for cases without hope for the development of the acetabulum. According to the results, patients with acetabular angle of more than 30% at the age of 3 years have less possibility of normalization in the future and therefore active means for formation of the acetabulum should be considered in these patients. As such active means included are formation of the acetabulum through the pelvic osteotomy and the derotation-varus osteotomy are available in order to improve concentric position of the femoral head. It was also indicated that more favourable results could be obtained in patients who had undergone the pelvic osteotomy. The most favourable results were obtained in patients in whom both operations were used in combination. It was concluded from the results of the study that the best method is to perform the pelvic osteotomy first and to add the derotation-varus osteotomy as indicated.     

Aplasia of the pubic bone in conjunction with hip dislocation

We describe here unilateral left hip dislocation in a 2-year-old child in conjunction with ipsilateral absence of the pubic bone. He was admitted to our hospital at 1 year of age and diagnosed with teratogenic dislocation of the left hip, aplasia of the left pubic bone, an undescended palpable left testicle and hypospadias. We performed open reduction through an anterior approach with preliminary skin traction for 1 week and spica cast for 3 months. The acetabular index was high both on admission and in the last radiographic control. Computerized tomography demonstrated dysplasia of the acetabulum and absence of the pubic bone. We concluded that the congenital absence of the left pubis was the major cause of the residual acetabular dysplasia. To our knowledge the conjunction of hip dislocation, aplasia of pubic bone and genitourinary anomalies has not been reported in the orthopaedic literature previously.