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1.
四川崇州市不明原因骨关节病临床表现及X线量化评价 总被引:1,自引:0,他引:1
目的对四川崇州市崇阳镇石埂村不明原因骨关节病的临床表现及影像学特点进行分析,为进一步研究奠定基础。方法对病区年龄≥3岁的116名村民进行流行病学调查、体格检查、髋、膝关节运动功能评定及摄X线片检查并对其进行量化评价。结果116名村民临床诊断不明原因骨关节病64例,患病率为55.2%;跛行17例,发生率26.6%,发病年龄主要集中在40岁以前。临床表现为髋或膝关节固定性疼痛,双侧痛明显多于单侧,局部发热、肿胀不明显。轻、中度疼痛占73.5%,劳动或活动时加重,不采取任何措施或休息后缓解。关节痛在较长时间内不影响其运动功能,晚期主要表现为髋关节运动功能障碍而跛行。体格检查:髋屈曲、内外旋活动受限。Harris评分:左髋86.5±17.1分,右髋86.3±17.2分;优良46例(72.8%),中差18例(28.2%)。HSS评分:左膝88.4±9.3分,右膝88.2±11.0分;优良61例(95.3%),中差3例(4.7%)。X线片主要表现为髋关节间隙狭窄,呈退行性改变、关节面硬化变形,其次为髋臼密度增高、扁平、变形、倾斜度增加,对股骨头包容不足,颈干角增大;膝关节主要为骨刺或骨桥形成,受累关节骨质疏松、关节面不平整、增厚、硬化变形及呈退行性改变。结论崇州不明原因骨关节病临床表现早期以双侧膝关节或膝关节伴髋关节固定性疼痛、晚期髋关节出现运动功能障碍为主,影像学改变主要为髋关节发生退行性改变,需进一步研究明确诊断。 相似文献
2.
Lehman WB Mohaideen A Madan S Atar D Feldman DS Scher D 《Journal of pediatric orthopedics. Part B》2004,13(1):57-62
A relatively simple triple pelvic osteotomy using two cosmetically small skin incisions can provide excellent coverage of the femoral head. An adductor approach and a bikini approach are used to do the osteotomy. The 'almost' percutaneous pelvic osteotomy successfully increases femoral head coverage in a concentric hip joint. The VCA angle of Lequesne and the center-edge angle of Wiberg both show significant improvement in the coverage of the femoral head. Three-dimensional computed tomography scanograms may provide a more graphic representation before and after surgery. Preoperatively, this is especially useful in evaluating posterior acetabular coverage of the femoral head. The almost percutaneous pelvic osteotomy is another possible triple pelvic osteotomy for procedures for hip dysplasia. It has a relatively low learning curve in comparison with other triple pelvic osteotomies for hip dysplasia in children aged 6-14 years. With careful patient selection, femoral head coverage can be improved with small incisions that are cosmetically acceptable. 相似文献
3.
目的通过计算机图像分析探讨髋关节脱位患儿Salter骨盆截骨手术前后股骨头覆盖率的变化。方法对20例单侧髋关节脱位患儿行Salter截骨手术并对术前术后影像学资料进行分析。测量CE角及股骨头的覆盖率,分别比较其手术前后的变化,以正常侧作为对照组。结果髋脱位患儿术后CE角与股骨头覆盖率较术前均有明显改善,术后CE角和CT的股骨头覆盖率无正相关关系。结论通过计算机图像分析可以更加清晰、直观地了解股骨头的覆盖情况;Salter骨盆截骨手术在空间上改变了髋臼的方向,对股骨头的覆盖明显增加. 相似文献
4.
Yosuke Morishima Harumoto Yamada Mitsuhiro Morita Yasuo Yoshihara Osamu Henmi Osuke Washimi Nobuki Terada 《Journal of orthopaedic science》2001,6(5):435-438
Necrosis of the transpositioned acetabulum after rotational acetabular osteotomy (RAO) is a major complication characteristic
of this procedure. This complication, although rare, has been thought difficult to treat. We report a patient with acetabular
osteonecrosis and subsequent collapse after RAO that was effectively treated with a shelf operation, providing satisfactory
remodeling of the hip joint. A 16-year-old female had undergone RAO for the treatment of developmental acetabular dysplasia.
Postoperative radiography showed that the osteotomized acetabular fragment was unusually thin, and that the osteotome entered
the hip joint during the surgery. Five months after the RAO, X-rays revealed significant collapse of the transpositioned acetabulum,
and femoral head subluxation caused by postoperative osteonecrosis. Seven months after the RAO, the patient underwent a hip-shelf
procedure. The remaining acetabular fragment was used in this procedure, according to the Spitzy method. Seven years after
the second operation, favorable remodeling of the hip joint was observed; however, early osteoarthritic changes, including
slight joint space narrowing, bone sclerosis of the new acetabulum, and bone cysts within the femoral head, were seen.
Received: November 30, 2000 / Accepted: April 16, 2001 相似文献
5.
Bastian JD Turina M Siebenrock KA Keel MJ 《Archives of orthopaedic and trauma surgery》2011,131(9):1273-1278
Introduction
Traumatic anterior dislocation of the hip joint is rare. Additional injuries to the hip due to dislocation are even more infrequent. Outcome is limited by osteoarthritic joint degeneration or the occurrence of avascular necrosis of the femoral head. 相似文献6.
《Journal of orthopaedic research》2017,35(5):1128-1136
7.
In total hip replacement for 12 aged women with advanced osteoarthritis of the hip joint, three types of lesioned articular cartilage with various degrees of severity and ivory bone were obtained together with their subchondral bone tissues. These specimens were processed and studied under scanning electron microscope and were compared with sex and age-matched non-osteoarthritic femoral head articular cartilage specimens. In osteoarthritic femoral heads, with deepening of the articular lesion, the articular cartilage gradually became thinned out and eventually lost. The subchondral bone plate became markedly thickened in most of the specimens. The epiphyseal trabeculae were also thickened and turned rough so that the meshwork pattern gradually disappeared. The thickened trabeculae finally fused into a large piece of dense bone tissues without microfracture. These changes could be accounted for by the increased stress imposed on the subchondral bone tissues as a result of incompetence of the diseased articular cartilage. Consequently, the changes on the part of subchondral bone tissues of the osteoarthritic femoral heads were the sequent, rather than the cause, of the articular lesions. 相似文献
8.
Osteonecrosis of the femoral head associated with pregnancy 总被引:3,自引:1,他引:2
Hasegawa Y Iwase T Iwasada S Kitamura S Iwata H 《Archives of orthopaedic and trauma surgery》1999,119(1-2):112-114
A 31-year-old pregnant woman suddenly complained of bilateral hip pain 2 weeks before delivery. She was delivered of triplets
by Caesarean section. She had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG) before
pregnancy. Radiograms of the hip joint showed collapse of the femoral heads bilaterally. Magnetic resonance imaging revealed
a band pattern of low signal intensity for both hips on T1- and T2-weighted images. She had no history of steroid therapy
or alcohol abuse. Osteonecrosis of the femoral heads bilaterally associated with pregnancy was confirmed. Pathology of the
femoral head showed typical empty lacunae and necrosis of the trabecula.
Received: 8 July 1997 相似文献
9.
Subchondral cysts arise in the anterior acetabulum in dysplastic osteoarthritic hips 总被引:3,自引:0,他引:3
The distribution of subchondral cysts in 57 dysplastic osteoarthritic hips of 38 patients was assessed by computed tomography and by a new computerized technique. The cyst count in osteoarthritic hips was inversely correlated with the width of the joint space. A greater accumulation of cysts was found in the acetabulum than in the femoral head, and more cysts were found in the anterior part of the hip than in the posterior part. Osteoarthritic change was more predominant in the acetabulum than in the femoral head, and was more predominant in the anterior part of the hip than in the posterior part. 相似文献
10.
Aleksandra Truszczyńska Piotr Walczak Kazimierz Rapała 《Journal of clinical densitometry》2012,15(4):467-471
The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient—a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr. 相似文献
11.
Amyloid in Osteoarthritic Hip Joints: Depositions In Cartilage And Capsule. Semiquantitative Aspects
《Acta orthopaedica》2013,84(4):587-590
Amyloid depositions in tissue from 116 osteoarthritic hip joints were examined. There was no significant correlation between amyloid and age although there was a tendency for joints from older patients to have more marked amyloid degeneration. We found significantly more amyloid in the joint capsules from male patients than from females. No difference in amyloid deposition was found between the right and left side, and pressure-loaded/less pressure-loaded parts of the femoral head contained equal amounts of amyloid. With the exception of two cases amyloid depositions in the joint capsule were always accompanied by amyloid in the joint cartilage (P < 0.001). Conversely the cartilage was often positive when the capsule was negative for amyloid. 相似文献
12.
Jacek Gaga?a Jan Blacha Andrzej Bednarek 《Chirurgia narzadów ruchu i ortopedia polska》2006,71(3):183-185
INTRODUCTION: [corrected] The aim of the study is early results evaluation of Chiari pelvic osteotomy. MATERIALS AND METHODS: In the years 1997-2003 36 patients (26 women and 10 men) in the age from 16 to 50 years old were operated on because of hip joint dysplasia. The indications for operative treatment were: pain, age less than 50 years, insufficient femoral head coverage without evidence of arthritic changes on X-ray. RESULTS: There were no intraoperative and postoperative complications. Harris Hip Score improved from 85 points before operation (from 82 to 90 pts.) to 95 points (from 92 to 100 pts.) after operative treatment. There was pain relief in most of the patients after osteotomy. Osteotomy healing was seen on X-ray examination usually after 6-12 weeks in 33 patients. Delayed osteotomy union till 6th postoperative month without influence on clinical hip improvement was seen in 3 patients. The increase in Wiberg CE angle from average 17.2 degrees (from 3 to 33 degrees) before operation to 44.9 degrees (from 19 to 78 degrees) after operation was statistically significant p< 0.00045. There was no loss in osteotomy correction. CONCLUSION: Supraacetabular osteotomy decreases pain, and increases hip function. Improvement in hip biomechanics and increase in femoral head coverage may lead to decrease in development of hip joint arthritic changes and time preserve before total hip arthroplasty. 相似文献
13.
We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis. 相似文献
14.
The authors recently encountered a 65-year-old osteoporotic woman who had had intractable pain in the hip joint that was diagnosed clinically as osteonecrosis. She was treated by total hip replacement. Histopathologically, the most striking finding was the presence of a subchondral fracture with associated callus formation and granulation tissue along both sides of the fracture line. There was no evidence of antecedent osteonecrosis. This case was diagnosed histopathologically as insufficiency subchondral fracture of the femoral head. This is the first case report to substantiate the presence of insufficiency subchondral fracture of the femoral head by both gross and microscopic examination. Because the treatment and management of insufficiency subchondral fracture are entirely different from osteonecrosis, it is important to differentiate between these two conditions. 相似文献
15.
Proteoglycan alterations during developing experimental osteoarthritis in a novel hip joint model 总被引:2,自引:0,他引:2
Sven Inerot Dick Heinegrd Sten-Erik Olsson Hans Telhag Lars Audell 《Journal of orthopaedic research》1991,9(5):658-673
Degenerative hip joint disease was induced in dogs by extra-articular surgery that created a condition that mimics hip dysplasia. Decreased acetabular coverage of the femoral head gave altered mechanical load, with ensuing cartilage degeneration. For comparison, degenerative knee joint disease was induced in other dogs by transection of the anterior cruciate ligament of the knee. The femoral head articular cartilage showed macroscopic signs of degeneration within a month. No macroscopical changes of synovitis were present. Chemical analysis of cartilage samples showed loss of proteoglycans. Guanidine hydrochloride extracts of the cartilage contained proteoglycan fragments that could be separated by equilibrium density gradient centrifugation in cesium chloride. The data indicate that proteoglycans are fragmented by proteolytic cleavage and lost from the cartilage. The proteoglycans remaining in the tissue are smaller and have lost the ability to aggregate with hyaluronic acid. Similarly, in experimental knee joint osteoarthritis, the proteoglycan content of the cartilage decreased. The structural changes of those proteoglycans remaining were of a different nature, with no changes in proteoglycan size or aggregation properties, possibly indicating that both degradation and repair took place in the knee articular cartilage and/or that fragments were rapidly lost from the tissue. This may follow from different surgical procedures, only the one used for the hip joint being extra-articular, or from the different anatomy and physiology of the hip joint and the knee joint. 相似文献
16.
A 40-year-old woman, who suffered from severe rheumatoid arthritis causing avascular necrosis of the femoral head and protrusio acetabuli of the right hip, developed a severe spontaneous disruption of the symphysis pubis concomitant with a stress fracture of the left ilium adjacent to the left sacroiliac joint. After successful total hip arthroplasty, the symphysiolysis improved, but a new stress fracture of the left superior pubic ramus developed. Fourteen months after operation both stress fractures are healed. Altered hip and pelvic girdle mechanics acting on osteoporotic bone may account for this sequence of events. 相似文献
17.
BACKGROUND: Acetabular dysplasia and hip instability are common in neuromuscular diseases such as spina bifida and cerebral palsy due to deranged muscle function around the hip. Occasionally in developmental dysplasia of the hip, persistent instability may be difficult to manage by standard treatments. It is in these contexts that we wished to investigate whether a dislocatable hip could be stabilized by means of a transarticular suture acting as a reconstructed ligamentum teres. The aim of this study was to investigate and assess the iatrogenic damage caused by such a procedure on the immature proximal femoral physis, epiphysis, and hip joint. METHODS: Four- to 6-week-old mixed breed European pigs (n = 18) were used in the study. Six animals with normal hips underwent the stabilization procedure to the right hip joint, the left hips serving as controls. The remaining 12 pigs were subjected to a model of hip dysplasia on the right hip. After 6 weeks, the dysplasia stimulus was removed, and half of the animals underwent the hip stabilization procedure, the remaining 6 animals served as a control for "untreated dysplasia." Animals underwent serial pelvic radiography until euthanasia at 18 weeks of age. Postoperative, morphometric, radiographic, and histological analyses were performed. RESULTS: The dysplasia model consistently produced an increase in the acetabular index, femoral head subluxation, and growth retardation of the capital epiphysis. We observed no detrimental effect on the capital ossific nucleus, proximal femoral physis, or acetabular development in terms of radiographic, morphometric, or histological findings after the transarticular suture procedure. CONCLUSIONS: The surgical technique of drilling across the immature porcine hip did not result in avascular necrosis of the femoral head, osseous bar formation across the proximal femoral physis, proximal femoral metaphyseal growth disturbance, chondrolysis, or disturbance in normal acetabular development. CLINICAL RELEVANCE: The described technique may be a useful augment to the definitive stabilization of the recalcitrant dysplastic or unstable hip where standard operative measures alone are likely to be unsuccessful. 相似文献
18.
Yasunari Hiranuma Takashi Atsumi Toshihisa Kajiwara Satoshi Tamaoki Yasuhiro Asakura 《Journal of orthopaedic science》2009,14(5):535-542
Background
Transtrochanteric anterior rotational osteotomy results in improvement of joint congruity and prevention of progressive collapse and osteoarthritic changes in patients with femoral head osteonecrosis. However, this procedure remains controversial for patients with extensive collapse due to potential osteoarthritis caused by postoperative instability. The purpose of this study was to evaluate hip instability after osteotomy and determine the relation between instability and radiological and clinical outcomes. 相似文献19.
高龄患者的人工髋关节置换疗效观察 总被引:4,自引:0,他引:4
目的观察人工髋关节置换治疗高龄老年股骨颈骨折及股骨头无菌性坏死的临床疗效。方法对70岁以上股骨颈骨折及股骨头无菌性坏死患者16例,经髋外侧切口施行半髋置换5例,全髋置换11例。结果随访1~4年,在3~6周患者扶拐下地逐渐负重行走,3个月屈髋>90°,后伸髋>5°。6~12个月基本恢复伤前功能,生活自理,髋关节无疼痛,无假体松动、下沉现象,Harris评分平均91±3.4分。结论高龄患者做好充分的术前准备是可以胜任人工髋关节置换术的,能在短时间内恢复一个无痛的髋关节,降低并发症的发生,提高生活质量。 相似文献
20.
Akkaya T Ersözlü S Ozgür AF Tandoğan NR 《Acta orthopaedica et traumatologica turcica》2006,40(2):169-172
Pigmented villonodular synovitis is a benign proliferative disorder of the joint and of the tendon sheath synovium. It has a predilection for the lower extremities, particularly the knee and the hip. The elbow joint is rarely affected. A 56-year-old woman had complaints of pain and swelling in the left elbow for three years. She had no history of trauma. On physical examination, she had swelling of the left elbow, varus deformity, and flexion contracture of 20 degrees. Active and passive joint movements were painful. Magnetic resonance imaging showed synovial thickening and signal changes. An incisional biopsy yielded a diagnosis of pigmented villonodular synovitis. She underwent subtotal synovectomy and excision of the radius head. No evidence of clinical or radiologic recurrence was detected within a follow-up of 16 months. 相似文献