骨盆截骨延长术100例远期随访

本文通过对骨盆截骨延长术100例进行长期随访,结果是肯定的,总有效率93%。影响疗效的主要原因在于适应证的选择和并发症的防止。提出选择病人应注意年龄、肢体短缩程度、髋部肌力,髋脱位情况和其它畸形等因素。详细分析了手术后血肿、感染、神经损伤、骶髂关节分离等近期并发症和植骨块压缩等远期并发症的产生原因,并提出了防治措施。     

髂骨截骨延长术远期效果分析

髂骨截骨延长术远期效果分析江苏石油勘探局职工医院骨科（２２５２６１）曾祖诰下肢患侧缩短２．５ｃｍ以上即可出现步态、功能异常及骨盆、脊柱、足和关节畸形。为使两下肢等长需作下肢均衡术，即将患肢延长或将健肢缩短，由于美观原因后者多不被患者接受。髂骨截骨延长...     

胫骨骨骺牵伸分离延长术及干骺端截骨延长术

针对儿麻后遗症下肢短缩，我院开展了肥骨骺牵伸分离延长及干骺端截骨延长术２２例。本文讨论了其延长机理、方法，并提出骨延长中同时行跟腿延长，不缝合跟腿，使之相互重叠搭接，术后石膏托固定至停止延长后２个月，再开始行关节锻炼，具有能一期纠正术前及术后延长过程中所并发的一系列畸形，且骨愈合快，也不影响关节功能等优点。本组均采用此方法，随诊一年后临床效果均满意。     

保留骨膜的胫骨截骨骨延长术16例报告

保留骨膜的胫骨截骨骨延长术１６例报告赵宝权韩剑峰李志怀Ⅱ度以上胫骨开放性骨折易出现胫骨感染、缺损、骨不连接、凹陷性瘢痕或骨外露、窦道等，是临床治疗的难题。我们１９９３年～１９９６年应用Ｉｌｉｚａｒｏｖ外固定器，采用保留骨膜的胫骨截骨骨延长术治疗了１６...     

髂骨截骨延长术改善病人步态机理的探讨

髂骨截骨延长术能明显改善儿麻后遗症臀肌麻痹病人的步态。除延长患胶长度外，由于股骨头的内移、髋臼的旋转、髋部外展肌群肌力的增强，纠正了身体重心的偏移，增加了股骨头的承受能力，稳定了髋关节。这是通过髋部一系列生物力学变化实现的，总体上又与手术中髂骨撑开的距离（髂骨截骨间距）有关。本文从生物力学角度对髋关节稳定从而改善病人步态的机理进行了探讨     

胫骨上端截骨延长术后出院指导

由于各种原因 ,多数胫骨上端截骨延长术病人在延长早期带延长器出院 ,在家中度过延长中后期及骨愈合期。我们对 38例延长患者根据不同的情况给予具体编写有关功能锻炼、延长器等有关的出院指导内容 ,使其在没有医护人员指导下安全度过治疗康复期。1　出院指导1.1　使病人树立自信心 ,承担起自我护理的责任。向病人介绍有关的营养知识 ,多以高热量、高蛋白 ,丰富维生素和含钙的食物为主 ,如肉骨头、小鱼、虾皮等以便增强全身抵抗力 ,预防感染 ,促进骨质尽早达到骨性愈合。1.2　向病人、家属传授有关功能锻炼的知识 ,首先向病人说明功能锻炼是…     

保留骨内膜的胫骨截骨延长术：附30例报告

采用Ｉｌｉｚａｒｏｖ截骨，对３４例下肢短缩病人进行了胫骨延长，其中３０例已完全骨性连接，４例尚在延长或固定中。３０例平均年龄为２１．７岁，平均延长５．３ｃｍ。结束延长后平均骨愈合时间１２７天。手术的关键是要耐心地截断骨皮质，尽最大可能保留内外骨膜和骨髓。术后延迟１周开始延长，以１ｍｍ／ｄ的速度延长，每日延长的频率不少于６次，每次延长０．１７ｍｍ，是保证延长段骨的自然连接的重要因素     

一种挽救胫骨干骺端截骨延长术后膝关节活动障碍的术式

一种挽救胫骨干骺端截骨延长术后膝关节活动障碍的术式济南军区矫形外科中心（２７１０００）胡宏伟，宁志杰，李贵涛据文献报告，胫骨上干骺端截骨延长后，膝关节活动受限者发生率比较高，经过及时处理及功能锻炼，多数恢复正常或近于正常，但还有少数，大约３％～５％的...     

Salter骨盆截骨术联合股骨近端外翻截骨术治疗严重Perthes病

目的 观察Salter骨盆截骨联合股骨近端外翻截骨术治疗严重Perthes病的疗效。方法 回顾性分析自2016-10—2019-12采用Salter骨盆截骨联合股骨近端外翻截骨术治疗的11例（12髋）严重Perthes病。结果 11例均获得随访,随访时间平均4(2.2～5.4)年。术后患儿双下肢长度差值平均为1.4(1～2)cm,髋关节活动度正常,无跛行或轻度跛行步态。术后患侧中心角、髋臼深度比、股骨头覆盖率均较术前明显改善,差异有统计学意义（P<0.05）。见表1。根据髋关节功能Mckay评价标准：优8例、良3例,优良率100%。Stulberg分型：Ⅰ型9髋,Ⅱ型3髋,优良率100%。结论 Salter骨盆截骨联合股骨近端外翻截骨术治疗严重的儿童Perthes病具有良好的临床疗效,可极大程度避免或减小髋内翻、股骨大粗隆高位,以及臀中肌无力而出现的肢体短缩,走路摇摆步态。     

Chiari骨盆截骨术的生物力学基础及临床应用（附36例报告）

本文报告应用Ｃｈｉａｒｉ骨盆截骨术治疗髋臼发育不良、扁平髋等３６例４１个髋。３２个髋平均随防４年４个月。优良者２７个髋，占８４．３７％。术后Ｘ线片显示，截骨均获骨性愈合，髋臼对头覆盖完全，头臼相称。髋臼发育不良者，ＣＥ角平均增加２０°。作者分析此术式后认为：Ｃｈｉａｒｉ手术能增加髋臼面积，减少股骨头单位压强，截骨内移后能增加肌力臂，减少重力臂，从而减少髋关节的载荷，降低关节内压及髂骨髋内压，有利于缓解“休息痛”。为此提出成人先天性髋臼发育不良、扁平髋、股骨头无菌坏死以及髋的骨关节炎病人适合行此手术。     

Pelvic Muscle Exercise Effect on Pelvic Muscle Performance in Women

The aim of this study was to compare pelvic muscle (PM) characteristics (strength, endurance and contractability) before and after 12 weeks of pelvic muscle exercises in two groups of older women: the first composed of women with genuine stress incontinence, and the second made up of women with no symptoms of urinary incontinence or pelvic organ prolapse. This research also investigated the extent to which PM pressure and health-related characteristics could help discriminate between women with and without a clinical sign of PM dysfunction. Within a framework of skeletal muscle fitness, outcome measures were defined and compared. There was no significant difference in the baseline (P= 0.09) and post-PME (P= 0.63) strength, endurance and contractability of the two groups of women. The two groups did differ significantly on change scores (P= 0.05) following PME. A greater improvement in strength for women without a clinical sign of dysfunction was demonstrated. There was a probability of 91% that those with a history of gynecological surgery belonged to the group of women with SUI.     

Effect of Pelvic Osteotomy in the Skeletally Immature on Acetabular Coverage

Background

Although pelvic osteotomy in children has been effective in re-establishing containment of the hip joint, its impact on hip joint development with respect to acetabular coverage is ill defined.

Purpose

The purpose of this study is to determine the prevalence of acetabular overcoverage in patients who had pelvic osteotomy during childhood and its impact on patient function.

Patients and Methods

Between 1980 and 2008, all patients who had a pelvic osteotomy done at our institution for non-neuropathic hip dysplasia (DDH) or secondary to Legg–Calvé–Perthes disease (LCP) prior to skeletal maturity were reviewed. A clinical assessment and the WOMAC, UCLA Activity Score, Marx activity score, and SF-36 quality-of-life questionnaires were completed. A standardized AP pelvic X-ray was performed to determine the acetabular coverage, signs of retroversion, and degenerative changes.

Results

Twenty-eight patients (32 hips) were identified, of which 14 (9 DDH, 5 LCP) agreed to participate. Impingement sign was positive in eight patients (six DDH, two LCP). Crossover and ischial spine signs were each present in ten hips. Tonnis grades were: 0 in 1 hip, 1 in 10 hips, 2 in 2 hips, and 3 in 1 hip. The mean Tonnis angle was 11.6 ± 8.6°. The mean CE angle was 24.0 ± 15.9° with six hips having a CE angle <20° and one hip with a CE angle >40°. There was no correlation between crossover sign or ischial sign and Tonnis grade (p = 0.739), hip pain (p = 0.520), or impingement sign (p = 1.00).

Conclusions

Acetabular overcoverage is common in patients who underwent pelvic osteotomy during childhood. No correlation was identified between retroversion and hip pain in our patient cohort.     

Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty

BackgroundAlthough pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO.MethodsForty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years.ResultsPatients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up.Conclusion: THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.ConclusionTHA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.     

下颌角截骨整形术后咬肌肌电分析

目的通过肌电图检测,观察下颌角截骨整形术对咬肌功能的影响。方法 2010年10月至2015年6月,选取下颌角截骨整形术患者18例,分别在术前、术后1个月、术后1年行咬肌肌电图检测,并进行统计分析。结果术后1个月时与术前相比,咬肌肌力下降明显(P<0.05);术后1年时咬肌肌力基本恢复,与术前相比无明显差异(P>0.05)。结论下颌角截骨整形术后1年患者的咬肌功能基本恢复。     

Pelvic architectural distortion is associated with pelvic organ prolapse

The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral “spill” of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point ≥+1cm; N = 144) and normal controls (maximum point ≤−1cm; N = 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans. Women were categorized into three groups based on levator defects and architectural distortion. Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1–4.6). Pelvic organ prolapse is associated with the presence of visible architectural distortion on MR scans. This work has been presented in abstract form at the Annual Scientific Meeting of the Society of Gynecologic Surgeons, April 11th–14th 2007, Orlando, FL, USA.     

Pelvic floor muscle evaluation in incontinent patients

The aim of this study was to assess pelvic floor muscle (PFM) strength and perception and its correlation with stress urinary incontinence (SUI). One hundred and one women were divided into two groups according to the presence (G1=51 patients) or absence (G2=50 patients) of SUI. Subjective [urine stream interruption test (UST), visual survey of perineal contraction and transvaginal digital palpation to assess pelvic muscle contraction] and objective evaluations of pelvic floor muscles in all patients were performed (vaginal manometry). During the UST, 25.5% of G1 patients and 80% of G2 patients were able to interrupt the urine stream (p<0.05). Digital evaluation of pelvic muscular contraction showed higher strength in G2 than in G1 patients (p<0.0001). Perineometer evaluation of PFM strength was significantly higher in the continent group (p<0.001). Pelvic floor muscle weakness in incontinent patients demonstrates the importance of functional and objective evaluation of this group of muscles.This revised version was published online in February 2005 with corrections to the third authors name. The name of this author, De Oliveira Orsi Gameiro M, was not correctly rendered in the original version.     

Pelvic floor muscle function in women presenting with pelvic floor disorders

Introduction and hypothesis  This observational study was undertaken to determine knowledge, prior instruction, frequency of performance, and ability to perform pelvic floor muscle exercises in a group of women presenting for evaluation of pelvic floor disorders. Methods  Three hundred twenty-five women presenting for evaluation of pelvic floor disorders were questioned concerning knowledge and performance of pelvic floor muscle exercises (PMEs) and then examined to determine pelvic floor muscle contraction strength. Results  The majority of women (73%) had heard of PMEs, but only 42% had been instructed to perform them and 62.5% stated they received verbal instruction only. Only 23.4% of patients could perform pelvic muscle contractions with Oxford Scale 3, 4, or 5 strengths. Increased age, parity, and stage of prolapse were associated with lower Oxford scores. Conclusions  Although most women with pelvic floor disorders are familiar with PMEs, less than one fourth could perform adequate contractions at the time of initial evaluation.     

股骨髁上内翻截骨治疗髌骨软骨软化症

髌骨软骨软化症发病率与Ｑ角呈直线回归关系，Ｑ角越大，发病率越高。作者自１９８９～１９９５年收治１０例（１１个髌骨）因Ｑ角偏大或／及股胫角偏小所致的髌骨软骨软化症，采用股骨髁上楔形内翻截骨及髌外侧支持带松解术或加关节软骨削平术治疗，经平均２．９年随访，优良率８１．８％，满意率１００％。本文就该术与其它手术方法（胫骨结节抬高术、髌韧带止点内移术和经关节镜手术）进行比较分析。详细介绍了该术的适应证和手术方法