动力髋螺钉治疗高龄患者股骨转子间骨折临床分析

目的观察动力髋螺钉（DHS）治疗高龄患者股骨转子间骨折的疗效。方法应用动力髋螺钉内固定治疗70岁或70岁以上高龄患者股骨转子间骨折27例，平均年龄78岁。按Evans分型：Ⅱ型3例，ⅢA型12例，ⅢB型7例，Ⅳ型5例。结果经6～24个月随访，所有病人骨折均愈合，除1例病人出现股骨头、颈切割，其余病人均较好地康复。恢复了伤前的日常生活及行走。结论动力髋螺钉治疗高龄患者股骨转子间骨折，内固定坚强，利于患者早期活动与康复，可减少并发症、提高患者的生活质量，疗效满意。     

微创动力髋螺钉治疗老年股骨转子间骨折效果观察

目的探讨微创动力髋螺钉内固定术治疗老年股骨转子间骨折的临床效果。方法对26例老年股骨转子间骨折患者实施经微创动力髋螺钉内固定手术治疗,回顾分析患者的临床资料。结果本组手术平均时间(58±11)min。术中平均出血(160±40)mL,术后10~14周骨折愈合,平均12周。随访12~26个月,出现髋内翻3例,患肢短缩0.5~1.0 cm者3例。无明显跛行,无骨折移位、螺钉断裂、螺钉拔出、内固定折断等并发症发生。术后12个月髋关节功能恢复优良率88.5%。结论微创动力髋螺钉内固定治疗老年股骨转子间骨折手术时间短、创伤小、术后髓关节疼痛轻、康复时间快。     

股骨转子间骨折小转子固定方法探讨

目的 评价股骨转子间骨折小转子固定方法的临床效果。方法 2002年1月～2003年12月，对26例股骨转子间骨折应用动力髋螺钉或动力髁螺钉内固定，并加用皮质骨螺钉固定小转子。其中男13例，女13例；年龄47～88岁。骨折按Evans分型：Ⅰ型6例，Ⅱ型13例，Ⅲ型4例，Ⅳ型3例。结果 术后伤口Ⅰ期愈合。获随访6～14个月，X线片示患肢无明显短缩畸形，无内固定物断裂、螺钉穿出，无骨折不愈合发生，骨折平均愈合时间12周。患者均恢复行走。按照黄公怡等关节功能评定标准，优17例，良8例，差1例，优良率96．1％。结论 动力髋螺钉或动力髁螺钉加用皮质骨螺钉固定小转子，方法简便，固定可靠，是治疗股骨转子间骨折的一种理想内固定方法。     

闭合复位DHS内固定治疗老年股骨转子间骨折61例

目的探讨老年股骨转子间骨折的治疗方法。方法采取闭合复位动力髋螺钉(DHS)内固定治疗老年股骨转子间骨折61例。结果随访1～3.3年,术后1年死亡4例,其余骨折在12～14个月内骨愈合,无髋内翻畸形、内固定断裂及松脱发生,患肢轻度外旋畸形2例,7例偶见髋关节行走痛、屈髋活动稍受限。结论闭合复位DHS内固定是治疗老年股骨转子间骨折的可靠方法。     

中老年人股骨转子间骨折动力髋螺钉内固定术疗效分析

目的探讨中老年人股骨转子间骨折经动力髋螺钉内固定的方法及临床疗效。方法在C型臂X线机透视下闭合复位，应用动力髋螺钉（DHS）内固定治疗中老年人股骨转子间骨折31例，其中男23例，女8例；年龄49～65岁，平均57.3岁。结果术后随访9～17个月，平均13．1个月。骨折均达到满意复位并愈合，无髋内翻，髋螺钉切割、拔出或穿透股骨头现象。结论中老年人多存在不同程度的骨质疏松，应用DHS内固定治疗股骨转子间骨折，固定牢，创伤小，术后并发症少，疗效满意。     

老年股骨转子间骨折三种手术方法的疗效比较

目的比较老年股骨转子间骨折三种手术方法疗效。方法对218例老年股骨转子间骨折分别采用动力髋螺钉(DHS)，Gamma钉和股骨近端髓内钉(PFN)进行手术治疗，随访8～28个月。结果DHS组76例中有2例延迟愈合，2例移位愈合，2例髋内翻，3例伤口感染；Gamma钉组64例中有1例延迟愈合，2例移位愈合；PFN内固定组78例中无1例延迟愈合。结论PFN对骨折端的血循环影响和骨质破坏较小，固定更为牢靠，是对老年股骨转子间骨折新的有效手术治疗方法。     

老年人股骨转子间骨折动力髋螺钉的手术治疗

目的探讨老年人股骨转子间骨折的动力髋螺钉(dynamic hip screw,DHS)内固定手术治疗的方法及临床评价.方法对43例老年股骨转子间骨折按AO分类(A1型24例、A2型13例、A3型6例),采用DHS内固定治疗.结果39例获得10-19个月(平均13.5个月)随访,优良率达到87%,仅3例发生术后并发症.结论DHS手术创伤小、卧床时间短、骨折愈合快、肢体功能恢复好、髋内翻等并发症少,是治疗老年股骨转子间骨折的理想方法.     

下肢

骨水泥人工关节置换术治疗老年不稳定股骨转子间骨折33例;动力髋螺钉内固定治疗老年股骨粗隆间骨折;逆行股骨髓内钉治疗股骨远端骨折22例疗效分析;人工股骨头置换及动力髋螺钉治疗股骨粗隆间骨折的比较分析     

动力髋螺钉治疗老年不稳定性股骨转子间骨折

目的探讨动力髋螺钉(DHS)内固定钢板治疗老年不稳定性股骨转子间骨折的临床疗效。方法1997年1月~2003年12月采用动力髋螺钉内固定治疗老年不稳定性股骨转子间骨折患者43例,其中EvansⅢA型25例,E-vansⅢB型18例;年龄65~83岁,平均71岁。所有病例均在C型臂X线机透视下行135°DHS内固定手术,术后第2d起逐渐进行股四头肌等长收缩锻炼,术后1周用CPM机行髋、膝、踝关节的被动活动。结果术后随访6~38个月,平均18个月。所有骨折全部愈合,愈合时间4~9个月,平均6.5个月,1例术后出现浅表感染,经局部换药伤口愈合,无伤口深部感染及骨髓炎发生。1例EvansⅢB型患者发生髋内翻,无肢体短缩等畸形愈合,无神经损伤、内固定物松动、脱位发生;按疗效标准评定:优27例,良12例,可3例,差1例,优良率90.7%。结论DHS内固定是治疗老年不稳定性股骨转子间骨折有效方法。术中尽可能恢复股骨转子后内侧皮质的完整性、标准的DHS固定位置及术后加强功能锻炼是取得良好效果的关键。     

小切口治疗老年股骨转子间骨折

目的探讨小切口微创技术治疗老年股骨转子间骨折的方法和疗效。方法对18例老年股骨转子间骨折行小切口动力髋螺钉内固定治疗。结果患者骨折全部愈合,按黄公怡疗效评价:优15例,良3例。结论小切口治疗股骨转子间骨折创伤小,适用于老年股骨转子间骨折的治疗。     

Hip Arthroplasty After Surgical Treatment of Intertrochanteric Hip Fractures

Background

Although use of intramedullary hip screws (IMHS) for intertrochanteric (IT) hip fractures has become more common, limited data have suggested difficulties in conversion to hip arthroplasty. The present study investigates whether conversion of failed IT fracture fixation with an intramedullary vs extramedullary device leads to different rates or types of complications or decreased arthroplasty survivorship.

Inferomedial Hip Center Decreases Failure Rates in Cementless Total Hip Arthroplasty for Crowe II and III Hip Dysplasia

Background

We sought to evaluate the outcomes of cementless acetabular components used in patients with Crowe II and III dysplasia, and to compare outcomes between cups placed within vs outside of an “anatomic” zone. Our specific aims were to (1) plot hip centers in these patients at our institution to characterize “anatomic” vs “nonanatomic” positions, (2) evaluate the association between hip center and radiographic loosening, (3) determine whether hip center was associated with acetabular component revision, and (4) compare patient-reported outcome scores between groups.

Total Hip Arthroplasty After Hip Arthroscopy Has Increased Complications and Revision Risk

BackgroundThere has been an increase in hip arthroscopy (HA) over the last decade. After HA, some patients may ultimately require a total hip arthroplasty (THA). However, there is a scarcity of research investigating the outcomes in patients undergoing THA with a history of ipsilateral HA.MethodsThe PearlDiver research program (www.pearldiverinc.com) was queried to capture all patients undergoing THA between 2015 and 2020. Propensity matching was performed to match patients undergoing THA with and without a history of ipsilateral THA. Rates of 30-day medical complications, 1-year surgical complications, and THA revision were compared using multivariate logistic regression. Kaplan-Meier analysis was conducted to estimate survival probabilities of each of the groups with patients undergoing THA .ResultsAfter propensity matching, cohorts of 1940 patients undergoing THA without prior HA and 1940 patients undergoing a THA with prior HA were isolated for analysis. The mean time from HA to THA was 1127 days (standard deviation 858). Patients with a history of ipsilateral HA had an increased risk for dislocation (odds ratio [OR] 1.56, P = .03) and overall decreased implant survival within 4 years of undergoing THA (OR 1.53; P = .05). Furthermore, our data demonstrate the timing of previous HA to be associated with the risk of complications, as illustrated by the increased risk for dislocation (OR 1.75, P = .03), aseptic loosening (OR 2.18, P = .03), and revision surgery at 2 (OR 1.92, P = .02) and 4 years (OR 2.05, P = .01) in patients undergoing THA within 1 year of HA compared twitho patients undergoing THA more than 1 year after HA or with no previous history of HA.ConclusionPatients undergoing THA after HA are at an increased risk for surgical complications, as well as the need for revision surgery.     

全髋关节置换治疗髋关节发育不全

目的：研究全髋关节置换治疗髋关节发育不全（ＤＤＨ）的外科技术。方法：４７例（５４髋）因髋关节发育不全引起严重骨性关节炎的患者行全髋关节置换治疗，其中男８例，女３９例。随访１２个月～１４年，平均５３个月。结果：根据ＭｅｒｌｅＤ＇Ａｕｂｉｇｎｅ评分方法，优８例（１７～１８分）、良３０例（１３～１６分）、中８例（９～１２分）、差１例（＜８分）。结论：根据髋关节脱位的程度可将髋关节发育不全分成四度，其中Ⅰ度、Ⅱ度为半脱位型；Ⅲ度、Ⅳ度为全脱位型。ＤＤＨⅠ度，即低位半脱位，髋臼加深为其手术要点；ＤＤＨⅡ度，即高位半脱位，通过上移髋臼假体可以避免植骨；对于ＤＤＨⅢ度、Ⅳ度则使用小型髋臼假体并且植骨。我们提出的分类方法较Ｃｒｏｗｅ方法简便且实用，特别是对髋臼的处理有指导意义。对髋关节发育不全进行全髋关节置换应严格掌握适应证，只有当疼痛和功能障碍非常明显而保守治疗无明确效果时采用     

人工全髋置换治疗成人髋臼发育不良合并骨关节炎

目的探讨人工全髋关节置换术治疗成人髋臼发育不良的方法。方法 2002年5月至2009年1月,对17例21髋成人髋臼发育不良患者,应用人工全髋关节置换术予以治疗。其中男4例,女13例,年龄40~72岁。双髋4例,单髋13例。髋关节脱位按C row e分期,Ⅰ期4髋,Ⅱ期9髋,Ⅲ期7髋,Ⅳ期1髋。结果本组均获随访,随访时间6个月~6年,平均3.2年。采用H arris髋关节评分法进行评分,平均83.4分。结论人工全髋置换是治疗成人髋臼发育不良型骨关节炎的有效方法,但手术较常规置换复杂,宜严格手术适应证。     

An Initial Experience with Hip Resurfacing Versus Cementless Total Hip Arthroplasty

Background

Hip resurfacing is an alternative to total hip arthroplasty.

Questions/Purpose

We aimed to compare an experienced hip surgeon’s initial clinical results of hip resurfacing with a new cementless total hip arthroplasty (THA).

Methods

The first 55 consecutive hip resurfacing arthroplasties were compared to 100 consecutive cementless THAs using a cylindrical tapered femoral stem. The learning curve between the two procedures was compared utilizing the incidence of reoperation, complications, Harris Hip Scores (HHS), and implant survivorship.

Results

The reoperation rate was significantly higher (p = 0.019) for hip resurfacing (14.5%) versus THA (4%). The overall complication rate between the two groups was not significantly different (p = 0.398). Preoperative HHS were similar between the two groups (p = 0.2). The final mean HHS was similar in both the resurfacing and THA groups (96 vs. 98.3, respectively, p < 0.65). Kaplan–Meier survival analysis with an endpoint of reoperation suggests complications occurred earlier in the resurfacing group versus the THA group (log-rank test, p = 0.007).

Conclusions

In comparison to our initial experience with a cementless THA stem, operative complications occur earlier and more often after hip resurfacing during the learning period. The clinical outcomes in both groups however are similar at 5 year follow-up.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9333-0) contains supplementary material, which is available to authorized users.     

成人DDH患者保髋手术失败后的THA疗效分析

目的回顾性分析保髋手术治疗失败后的成人发育性髋关节发育不良患者再次行全髋人工关节置换术的中期疗效。方法选择2014年1月至2019年1月收治的22例(30髋)保髋手术失败后行全髋人工关节置换术(total hip arthroplasty,THA)的发育性髋关节发育不良患者作为研究对象,其中男7例,女15例;行保髋手术时年龄1~18岁,平均(7.9±3.4)岁;行THA时年龄22~63岁,平均(34.2±11.2)岁;单髋14例,双髋8例,左髋16侧,右髋14侧。手术前后采用Harris髋关节评分系统及疼痛视觉模拟评分法(visual analogue score,VAS)进行评价,并对手术前后的X线片进行分析。结果本研究病例全髋人工关节置换术后平均随访时间为(30.5±18.5)个月。全髋人工关节置换术后,Harris总评分从术前的平均(38.7±10.6)分提高至末次随访时的(89.4±9.7)分,差异有统计学意义(t=19.67,P<0.001),且患者的疼痛、行走、功能、活动度等各项指标的术后评分均高于术前且差异有统计学意义;疼痛VAS评分由术前的平均(7.9±0.9)分降低到末次随访时的(1.4±1.0)分,差异有统计学意义(t=30.67,P<0.01);患者双下肢长度差异由术前的平均(3.32±0.51)cm降低到术后(0.71±0.33)cm,差异有统计学意义(t=14.01,P<0.001)。所有患者均无发生手术切口及假体周围感染、假体松动、髋关节脱位、血管神经损伤、深静脉血栓及异位骨化等术后并发症,仅2例患者术中出现股骨近端纵行劈裂。结论保髋手术失败后的成人发育性髋关节发育不良患者行全髋人工关节置换术可获得满意的中期疗效。     

Pediatric Hip Fusion

The management of young patients with severe hip arthritis is very difficult, as treatment options, such as total hip arthroplasty, which is excellent for relieving pain while preserving function, are often avoided because of a high requirement for subsequent revision surgeries. Hip arthrodesis, although perceived as having inferior functional outcomes in these young individuals, offers a treatment option that relieves pain, maintains function, and allows for conversion to a total hip arthroplasty in future, if desired. This article reviews the indications and technique of hip fusion.     

全髋关节置换术治疗成人先天性髋关节发育不良

目的探讨成人先天性髋关节发育不良（developmental dysplasia hip,DDH）髋臼假体的选择和手术方法。方法全髋关节置换术治疗成人先天性髋关节发育不良24例26个髋;年龄41～68岁,平均52岁。按照Perner分型,其中Ⅰ度10髋应用普通髋臼假体置换,Ⅱ度9髋选用螺旋臼假体,Ⅲ度5髋及度Ⅳ2髋选用小号髋臼假体,真臼部位安置髋臼假体,均为生物型固定,无结构性植骨。结果随访0．5～3．5年,假体与骨床结合牢固,患髋关节疼痛消失,关节功能基本正常,Harris评分平均86分。结论全髋关节置换术是治疗成人先天性髋关节发育不良的有效方法,针对髋臼病变程度的不同分别采用不同类型髋臼假体置换,配合术中的正确操作能简化手术,减少并发症,提高疗效。