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。     

髋臼周围组织松解治疗婴幼儿先天性髋脱位的效果观察

[目的]探讨髋臼周围组织松解治疗婴幼儿先天性髋关节脱位的临床应用价值。[方法]采用Smith-Peterson切口，对38例50髋的髋关节脱位患者进行髋臼周围组织松解复位。[结果]术后随访12个月～5a，平均18．3个月。获准确复位者50髋，达同心圆复位者31髋，内侧间隙仍宽者11髋，头臼覆盖欠佳者8髋。随访末期髋臼指数恢复正常者36髋，股骨头骨骺坏死0髋，再（半）脱位0髋。[结论]髋臼周围组织松解术是治疗先天性婴幼儿髋脱位的重要、有效手段。     

先天性髋关节脱位B超早期诊断价值的研究

本文介绍新生儿髋关节的超声解剖和先天性髋关节脱位的Ｂ超早期诊断方法。１０８３名新生儿两侧艘关节Ｂ超检查，发现先天性髋关节半脱位１例。在髋关节冠状面声像图上分别测量新生儿髋关节的ａ角、ａ角、髋臼指数和股骨头骨性髋臼覆盖率，其正常值分别为：６５．１０±５．１０°、４０．２７°±１６．１４°、２４．７５°±４．２９°、６４．６６±５．６３％（平均值±标准差）。研究结果表明：Ｂ超能早期发现先天性髋关节脱位及发育不良，操作简单、经济、无痛、无放射性损害。     

改良髋臼周围截骨术治疗成人髋臼发育不良

先天性髋臼发育不良或髋关节脱位(DDH)是年轻人继发性髋关节骨性关节炎的常见原因。治疗目的是解除症状、延迟或防止骨性关节炎的发生。发育不良髋的特征主要为平直、陡斜的髋臼顶，不能充分覆盖股骨头。如出生后早期采用蛙式位支架治疗，大多数患者可以治愈。未予治疗或治疗不恰当的患者，经常残留髋臼发育不良。骨骼生长结束后，残留的髋臼发育不良不能自然恢复正常解剖结构，较为严重的患者需要手术治疗。     

髋臼成形术治疗大龄儿童先天性髋脱位

[目的]探讨髋臼成形术治疗大龄儿童先天性髋脱位（congenital dislocation of the hip，CDH）的并发症及防治措施。[方法]采用髋臼成形术治疗大龄儿童CDH128髋，平均随访5a2个月。[结果]股骨头坏死15髋（11．7％），髋关节障碍28髋（21．8％），髂骨变形、变小18髋（14％），髋臼发育不良复发4髋（3．1％）。[结论]脱位高者术中短缩股骨，避免损伤髋臼上缘软骨，截骨距髋臼上方0．5～1cm处，截开的髂骨问嵌插入足量的髂骨松质骨骨块和短缩的股骨或异体骨，保护髂骨骨骺及附着的肌肉血管束，术后3个月内避免持重，髋关节功能障碍者，给予松解后，应用CPM（continuous passitive motion），对预防减少并发症有重要意义。     

Bernese髋臼周围截骨术治疗先天性髋关节发育不良1例

先天性髋关节发育不良（developmental dysplasia of the hip,DDH）是由于髋臼对股骨头的覆盖减少,导致股骨头与髋臼对应关系不良,使得局部应力集中于髋臼边缘,因非正常应力刺激而导致股骨颈前倾角与颈干角异常改变、股骨近端髓腔狭窄等,而股骨近端的变化又加重了髋臼在发育过程中的畸形[1]。由于不正常的关节应力和损伤,先天性髋关节发育不良已成为髋骨关节炎的常见病因之一。     

髋臼发育不良动物模型的建立及其临床意义

目的探讨髋臼发育不良在先天性髋关节脱位发病过程中的意义。方法将１２只幼犬通过外科手术造成单侧髋关节脱位,术后３、４周通过大体标本、组织学及Ｘ线摄片,观察髋臼变化。结果术后３周幼犬实验性髋关节脱位侧即出现髋臼发育不良,髋臼上部呈斜坡状,髋臼浅,Ｘ线片上可见髋臼指数增大,由实验前平均１３２±１３度增大为平均２７８±１５度,组织学观察见髋臼软骨退行变化。结论髋臼发育不良为髋关节脱位的继发病变,不是髋关节脱位的原因;如果髋关节脱位或髋关节松驰得到及时治疗,髋臼发育不良可以恢复正常     

部分切除髋臼外缘诱发髋关节骨关节炎的实验研究

骨关节炎 (ＯＡ)是一种慢性进行性骨关节病 ,临床上所见的继发性髋关节骨关节炎的疾病 ,大多数是由于先天性髋关节脱位 ,Ｐｅｒｔｈｅｓ病 ,髋臼发育不良占大多数[1,2 ] 。但通过实验对其发病机制 ,髋臼及股骨头动态变化的研究非常少见。众多学者通过动物实验 ,证实并强调 ,骨关节炎是关节软骨在异常负重情况下 ,软骨基质的变化与之相辅相乘 ,导致骨、软骨、滑膜及周围肌肉病理改变的结果。临床上研究也证实应力增加是导致该病的一个重要原因 ,但对其动态改变的了解上还存在着许多不明之处。我们模拟髋臼发育不良症切除家兔一侧髋臼外缘 ,由…     

髋臼加深全髋置换治疗成人先天髋臼发育不良

目的：探索成人先天性髋臼发育不良伴髋关节半脱位的手术治疗方法。材料和方法：12例成人先天性髋臼发育不良伴髋关节半脱位患者采用髋臼加深髋关节置换的方法治疗。结果：经1－8年随访,段体稳定,髋关节疼痛症状消失,关节功能基本正常。结论：髋臼加深全髋关节置换是成人先天性髋臼发育不良伴髋关节半脱位的有效治疗方法。     

Chiari截骨加髋臼造盖术治疗高龄儿童先天性髋关节脱位

目的：探讨Ｃｈｉａｒｉ截骨加髋臼造盖术治疗先天性髋关节脱位的疗效。方法：分析４２例高龄儿童先天性髋关节脱位,采用单纯Ｃｈｉａｒｉ截骨治疗１５ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术治疗２７ 例的临床资料。结果：随访４０ 例中,单纯Ｃｈｉａｒｉ截骨１３ 例,Ｃｈｉａｒｉ截骨加髋臼造盖术２７ 例,术后髋臼指数１４°～３２°,平均２６°。前倾角２５°～４０°,平均２８°。颈干角１３４°～１４６°,平均１３６°。单纯Ｃｈｉａｒｉ截骨优良率为６９．２％ ,３ 例发生股骨头缺血性坏死,１ 例发生头臼骨质硬化。Ｃｈｉａｒｉ截骨加髋臼造盖术的优良率为８８．８％ ,无股骨头缺血性坏死的发生。Ｃｈｉａｒｉ截骨加髋臼造盖术由于髋臼指数能得到有效的纠正,股骨头复盖接近正常,能很好的恢复正常的髋关节的生物力学关系,因此是治疗高龄儿童先天性髋关节脱位的有效方法之一。     

Experimental study of hypertrophy of the femoral head--with special reference to the effects of the surgical procedure on the hip joint

This experimental study was performed to clarify how a surgical procedure to the hip joint causes hypertrophy of the femoral head. Young rabbits were used for this experiment. The following results were obtained. In the rabbits with sectioned ligamentum teres, some cases showed complete dislocation on X-ray. The incidence of the hypertrophy of the femoral head was very low in this group. Except in these rabbits with dislocation, the hypertrophy of the femoral head appeared in any group subjected to surgical procedure, and at especially high rates in those subjected to the section of ligamentum teres and/or edge resection of acetabular cartilage. In the cases in which the edge of the acetabular cartilage was resected, and in other cases of surgical procedure as well, acetabular dysplasia often resulted. In these cases the hypertrophy of the femoral head was observed more frequently than in others. In summary, surgical procedure to the hip joint and postoperative abnormal stress to the femoral head contribute to the development of the hypertrophy of the femoral head especially in the cases in which acetabular factors are not negligible.     

股骨偏心距和髋臼旋转中心对人工全髋置换术后关节功能影响的回顾性研究

[目的]通过股骨偏心距及髋臼旋转中心手术后测量,探讨其变化对人工全髋置换术后关节功能的影响。[方法]临床随访本院人工全髋置换术后患者87例(92髋),均为首次行全髋关节置换术患者,平均随访时间2年1个月,测量手术后双髋关节X线片,比较术后假体股骨偏心距、旋转中心与解剖股骨偏心距、旋转中心符合率,对患者术后髋关节功能进行Harris评分并分组进行统计学分析。[结果]股骨偏心距及髋臼旋转中心均恢复(A组)27例(29.35%),(B组)仅FO恢复23例(25.00%),(C组)仅HJC恢复31例(33.70%),(D组)FO及HJC均未恢复11例(11.96%),Harris评分优良率A组96.30%,B组为73.19%,C组为74.19%,D组为27.27%,Harris评分优良率A组与B组(P=0.039),A组与C组(P=0.029),A组与D组(P=0.000)差异均有统计学意义。[结论]股骨偏心距及旋转中心的恢复对人工全髋置换术后关节功能有直接影响。     

Biomechanics of large femoral heads: what they do and don't do

The stability and durability of total hip reconstruction is dependent on many factors that include the design and anatomic orientation of prosthetic components. An analysis of femoral component head size and acetabular component orientation shows an interdependency of these variables and joint stability. Increased femoral component head size can increase hip stability by increasing the prosthetic impingement-free range of hip motion and by increasing the inferior head displacement required before hip dislocation. Increasing the femoral head size from 22 mm to 40 mm increases the required displacement for dislocation by about 5 mm with the acetabular component at 45 degrees of abduction; however, increasing acetabular component abduction greatly diminishes this stability advantage of larger femoral heads. Vertical acetabular component orientation and femoral component head subluxation are each predicted to more than double the tensile stress with acetabular component polyethylene compared with components at 45 degrees of abduction. With a desirable acetabular component orientation, the use of larger femoral heads may result in improved joint stability and durable use of polyethylene. With high abduction acetabular component orientation, the use of larger femoral heads contributes little to joint stability and contributes to elevated stress within the polyethylene that may result in implant failure.     

髋臼重建手术在儿童髋关节病理性脱位的应用

目的总结髋臼重建手术在儿童髋关节病理性脱位中的应用及临床疗效。方法 2006年1月-2011年1月,共收治59例(59髋)儿童髋关节病理性脱位,采用髋关节切开复位联合髋臼重建手术治疗。男22例,女37例;年龄1～15岁,平均4.9岁。化脓性髋关节炎后遗病理性脱位33例,髋关节结核26例;病程1个月～10年。髋关节半脱位9例,髋关节全脱位50例。术前Harris髋关节功能评分为43～78分,平均61分。14例髋臼指数基本正常,32例轻度增大,13例明显增大。合并髋臼破坏28例;股骨头缺血性坏死25例,股骨头部分缺失12例,股骨头完全缺失6例,股骨头颈同时缺失3例;前倾角增大25例;髋内翻畸形9例。结果术后即刻摄X线片示所有髋关节均达中心性复位。55例切口Ⅰ期愈合,4例切口延期愈合。53例获随访,随访时间2～5年,平均3年。随访期间无髋关节再脱位。38例髋臼指数基本正常,15例轻度增大。前倾角15～25°,平均20°;颈干角110～140°,平均125°,头颈解剖关系基本恢复正常。术后2年髋关节活动度完全恢复正常18例,屈曲及旋转轻度受限30例,纤维强直5例;Harris髋关节功能评分为62～95分,平均87分。结论儿童髋关节病理性脱位常合并严重的髋臼及股骨头颈部骨质破坏及后遗畸形,治疗上应严格遵循个体化原则,根据患髋主要病理改变选择适当的髋臼重建术式,并结合股骨头颈重建处理,可获得满意疗效。     

Study on the surface quality of prosthetic hip joints

To evaluate the quality of the joint surface of a prosthetic hip joint, such parameters were measured as roundness, sphericity and roughness of joint surfaces for conventional prosthetic hip joints. Roundness was measured at two cross-sections for spherical and semi-spherical parts; sphericity was deduced from measurements at 25 points using a coordinate measuring machine, and surface roughness was estimated from measurements at two points on the joint surface. The measured values were ranked in three levels, A (five marks), B (three marks) and C (one mark). The marks were totaled for a given prosthetic hip joint, and classified into the following 4 stages as a criterion for evaluation. The stages comprised A (more than 21 marks), B (20 to 18), C (17 to 15) and D (less than 14). The prosthetic hip joint evaluated as A has, on average, roundness, sphericity and roughness of the femoral head and acetabular cup, respectively of less than 0.1 and 20 microns, 5 and 50 microns, and 0.1 and 0.5 microns. (The maximum roughness of the acetabular cup was less than 5 microns.) Only a few products ranked A not only in individual measurements, but also in the total evaluation. This fact strongly supports the view that to be an effective product a prosthetic hip joint should meet at least the A criteria set up for evaluating the surface quality of its femoral head and acetabular cup.     

Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes

The purpose of this study was to evaluate, via experimental models, the effect of larger head sizes for total hip arthroplasty on the type of impingement, range of motion (ROM), and joint stability. Testing was conducted using an anatomic full-size hip model (anatomic goniometer) and a novel anatomic dislocation simulator with 28-, 32-, 38-, and 44-mm diameter femoral heads within a 61-mm acetabular shell. Femoral heads >32-mm provided greater ROM and virtually complete elimination of component-to-component impingement. A significant increase in both flexion before dislocation and displacement between the femoral head and acetabulum to produce dislocation occurred with femoral heads >32-mm in diameter. These data indicate that larger femoral heads offer potential in providing greater hip ROM and joint stability.     

Transacetabular Arthrotomy of the Hip Joint

Removal of a loose body or some other lesion in the acetabular fossa by an ordinary arthrotomy of the hip joint can be extremely difficult and may necessitate dislocation of the femoral head with the ensuing risk of vascular disturbances. A method has been developed to overcome these difficulties. Essentially it implies that a hole is made centrally in the acetabular fossa from the intrapelvic side via an inferior midline abdominal incision and extraperitoneal dissection. After the hole has been made in the bone, the fat pad in the acetabular fossa (pulvinar acetabuli) is incised and the pathological lesion, e.g. a loose body, can easily be removed. Large areas of the femoral head can be inspected by movements of the joint in different directions. If indicated, the whole acetabular fossa can be removed leaving only the cartilage-covered part of the acetabulum (facies lunata) intact. The method has been successfully used in four hip joints in three patients.     

Diagnosis by ultrasound of congenital dislocation of the hip joint

Two hundred thirty-four hips of 117 babies from one day to 18 months of age were examined ultrasonographically for congenital dislocation of the hip joint. Ten hips in eight babies were dislocated or subluxated and there were 11 hip dysplasias in seven babies. In the normal hip, the adaptation between the acetabulum and the femoral head is well demonstrated, and there is no apparent interposition of the limbus between the acetabular roof and the cartilaginous head. In the dislocated hip, the protrusion of the acetabular rim is not so clear as that of the normal hip, and the limbus is seen to be interpositioned between the acetabular roof and the cartilaginous head. In severe cases, the acetabular rim is hidden under the shade of the femoral head. Ultrasonography is an effective method of determining the incidence of dislocation and of diagnosing hip subluxation as well as dysplasia and does not have the hazards of x-ray examination.     

The effect of femoral component head size on posterior dislocation of the artificial hip joint

BACKGROUND: Posterior dislocation continues to be a relatively common complication following total hip arthroplasty. In addition to technical and patient-associated factors, prosthetic features have also been shown to influence stability of the artificial hip joint. In this study, a dynamic model of the artificial hip joint was used to examine the influence of the size of the head of the femoral component on the range of motion prior to impingement and posterior dislocation following total hip replacement. METHODS: Six fresh cadaveric specimens were dissected, and an uncemented total hip prosthesis was implanted in each. Each specimen was mounted in a mechanical testing machine and loaded with use of a system of seven cables attached to the femur and pelvis that simulated the action of the major muscle groups crossing the hip joint. The hip was taken through a range of motion similar to that experienced when rising from a seated position. The three-dimensional position of the femur at the points of impingement and dislocation was recorded electronically. The range of joint motion was tested with prosthetic femoral heads of four different diameters (twenty-two, twenty-six, twenty-eight, and thirty-two millimeters). RESULTS: Significant associations were noted between the femoral head size and the degree of flexion at dislocation in ten (p = 0.001), twenty (p < 0.001), and thirty (p = 0.003) degrees of adduction. Increasing the femoral head size from twenty-two to twenty-eight millimeters increased the range of flexion by an average of 5.6 degrees prior to impingement and by an average of 7.6 degrees prior to posterior dislocation; however, increasing the head size from twenty-eight to thirty-two millimeters did not lead to more significant improvement in the range of joint motion. The site of impingement prior to dislocation varied with the size of the femoral head. With a twenty-two-millimeter head, impingement occurred between the neck of the femoral prosthesis and the acetabular liner, whereas with a thirty-two-millimeter head, impingement most frequently occurred between the osseous femur and the pelvis. CONCLUSIONS: With the particular prosthesis that was tested, increasing the diameter of the femoral head component increased the range of motion prior to impingement and dislocation, decreased the prevalence of prosthetic impingement, and increased the prevalence of osseous impingement. CLINICAL RELEVANCE: These results suggest that femoral heads with a twenty-eight-millimeter diameter increase the range of motion after total hip replacement. This may be beneficial when additional factors compromising joint stability are encountered.     

三维CT重建对先天性髋关节脱位的临床价值

目的探讨三维CT重建在先天性髋关节脱位(CDH)的临床应用.方法本组CDH患儿22例,其中双髋脱位15例,单髋脱位7例,另有正常髋2例,共计患髋37个,正常对照髋11个.采用Picker公司PQ6000螺旋CT机,在独立工作站进行表面遮盖成像(SSD)、最大密度投影(MIP)、多平面重建(MPR)和相关数据测量.结果分别对股骨头颈、髋臼及头臼关系行三维直观显示,运用MPR技术测量了髋臼指数(AI)和股骨颈前倾角(FNA).结论三维CT可以直观、全面及分解地显示髋关节结构,对于股骨头、髋臼形态和头臼关系的显示具有常规X线和普通CT平扫所无法比拟的优越性,加之更加精确的测量,大大提高了术前诊断的科学性和手术的预见性,为手术方案的制定提供了新的客观依据.