断骨丹外敷用于全髋关节置换术后肢体肿胀的活血通络效果观察

目的 观察断骨丹外敷用于全髋关节置换术后肢体肿胀的活血通络效果.方法 选择2013年2月至2015年5月间在本院进行全髋关节置换术后肢体肿胀的患者共60例,按随机数字表随机分为两组,对照组和观察组各30例.对照组采用冰敷消肿,观察组以断骨丹外敷.分别测量两组患者下肢肿胀度及血清指标(TNF-α、IL-1、IL-6)水平,并对患者治疗效果进行评价,比较两组患者视觉模拟评分(VAS)和髋关节HSS功能评分.结果 观察组总有效率显著优于对照组,差异有统计学意义(P<0.05);观察组患者经治疗后肿胀程度在术后第3天、第7天明显低于对照组,差异有统计学意义(P<0.05);治疗后两组患者TNF-α、IL-1、IL-6水平均显著降低,观察组水平明显低于对照组(P<0.01);治疗后观察组疼痛VAS评分明显低于对照组(P<0.01),髋关节HSS功能评分明显高于对照组(P<0.01).结论 断骨丹外敷可有效缓解全髋关节置换术后肢体肿胀,起到良好的活血通络效果.     

股骨近端防旋髓内钉治疗股骨转子间骨折的临床疗效及对围术期失血量的影响

目的比较股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)内固定治疗股骨转子间骨折的临床疗效及围术期失血量。方法选择股骨转子间骨折患者54例,根据手术治疗方法不同分为PFNA组28例和DHS组26例,观察两组患者手术时间、失血量(术中失血量、术后总引流量及隐性失血量)、骨折愈合时间、髋关节功能及并发症等。结果 PFNA组手术时间(66.1±7.4)min,DHS组手术时间(85.6±9.2)min;PFNA组骨折愈合时间(10.5±2.1)周,DHS组骨折愈合时间(13.8±2.5)周,组间比较差异有统计学意义(P0.05)。术后6个月,PFNA组患者Harris评分明显优于DHS组,差异有统计学意义(P0.05)。DHS组患者术中失血量、术后24 h显性失血量均明显高于PFNA组,而PFNA组患者术后24 h隐性失血量明显高于DHS组,差异有统计学意义(P0.05)。PFNA组患者术后并发症发生率为10.7%,低于DHS组的30.8%,差异有统计学意义(P0.05)。结论 PFNA内固定治疗股骨转子间骨折手术时间短、骨折愈合快、并发症少,但术后隐性失血量多,术后应严密监测生命体征。     

髋部骨肿瘤的全髋关节置换和保肢

目的：研究髋部骨肿瘤的全髋关节置换和保肢疗效。方法：总结分析29例29髋髋部骨肿瘤病例，男18例，女11例，年龄32－67岁，平均43．7岁。骨巨细胞瘤14例，软骨肉瘤4例，骨成纤维细胞瘤2例，骨肉瘤4例，复发性软骨瘤2例，骨囊肿骨折3例，27例采用肿瘤型人工全髋关节假体置换，2例采用人工半骨盆全髋关节假体置换。股骨切除长度14－21cm。结果：29例均安全渡过围手术期，获平均4年10个月随访，除2例髋骨肿瘤人工半骨盆全髋置换术后分别于2年后急性肺炎和1年7个月肿瘤复发转移死亡外，其余27例均存活，并从事家务和工作，结论：根据髋骨肿瘤的类型，切除后选择适当假体和治疗方法，对重建髋关节功能、保留肢体是安全可行的。     

改良关节囊旁髂骨截骨术治疗先天性髋关节脱位

目的：评估改良关节囊旁髂骨截骨术治疗先天性髋关节脱位的临床效果。方法：切开关节囊，加深加宽髋臼，复位股骨头，股骨近端旋转截骨，纠正前倾角；短缩截骨，降低关节囊内压力；关节囊旁髂骨截骨骨块及短缩截骨块嵌入髋臼上缘，增加股骨头的包容，结果：经1．6－5．6年随访，按照周永德先天性髋脱位的疗效评定标准：优34例，良19例，可5例，差2例，手术优良率88．3％，结论：改良关节囊旁髂骨截骨术是治疗先天性髋关节脱位的一种较为有效的方法。     

蛙式架外固定治疗先天性髋关节脱位

目的　观察自行设计的蛙式架外固定治疗先天性髋关节脱位的疗效。方法　根据患儿脱位程度、脱位方向及年龄给予充分牵引 ,手法闭合复位 ,依据髋臼指数大小穿戴不同的蛙式架。结果　6 8例患儿经 8个月～ 4年观察随访 ,6 6例髋关节功能完全恢复 ,髋臼指数在正常范围 ,股骨头位于髋臼内 ,股骨头骨化核发育良好。 1例髋臼指数约 70°,骨化核明显较对侧小 ;1例发生后脱位。结论　蛙式架外固定治疗 3岁以内的先天性髋关节脱位操作简单 ,固定可靠 ,护理方便 ,疗效满意。     

关节镜在诊断和治疗髋关节疾患中的应用

目的：探讨关节镜在诊治髋关节疾患中的价值。方法：对54例（68髋）髋关节疾患进行了关节镜手术,其中男性36例,女性18例。年龄17-64岁,平均44岁。左侧18例,右侧22例,双侧14例。髋臼软骨肉瘤2例行关节镜下组织活检,髋臼盂辰损伤2例、髋关节感染3例、骨性关节炎21例均行关节镜清理术;股骨头缺血性坏死在关节镜监视下钻孔减压和滑膜切削清理术16例,髋关节滑膜软骨瘤病关节镜游离体取出7例,强直性脊柱炎滑膜清理术3例。结果：髋臼软骨肉瘤、关节盂唇损伤和髋关节感染经关节镜检查、活检明确了诊断并得到了有效治疗;股骨头坏死和髋骨性关节炎和强直性脊柱炎关节镜术后解除了疼痛,延缓了发展,改善了关节功能,提高了生活质量。术后Harris评分提高27分。结论：关节镜手术对髋关节疾患具有重要的诊断和治疗价值。     

股骨转子间骨折与股骨颈骨折内固定失效后行人工髋关节置换术的比较

目的将股骨转子间骨折行动力髋部螺钉(DHS)内固定术后的人工髋关节置换术与股骨颈骨折AO螺钉内固定术后行全髋关节置换术的临床结果相比较,总结股骨转子间骨折行DHS内固定术后的人工髋关节置换术经验以及治疗过程中的困难和随访结果。方法将1984年6月～2001年8月有完整资料的19例股骨转子间骨折行DHS内固定术后和配对的19例股骨颈骨折AO螺钉内固定术后行人工髋关节置换术的结果进行比较。使用SPSS软件中的配对T检验方法对本组病人的年龄、性别、DHS失效的原因、骨折至关节置换术时间、早期并发症、失血、手术时间及临床Harris的评分进行统计分析。结果在DHS组中,术后早期并发症(术中股骨近端骨折或术后髋关节脱位)的发生率明显高于AO螺钉组(0.01相似文献   

非骨水泥全髋关节置换术治疗股骨头缺血性坏死的疗效观察

[目的]对使用非骨水泥全髋关节置换术治疗股骨头缺血性坏死的患者进行临床及影像学随访,探讨其疗效、并发症及其影响因素。[方法]选取2000年3月~2007年11月以来因股骨头缺血性坏死在本院行非骨水泥全髋关节置换术并具有完整临床及影像资料的76例(91髋)患者进行随访。临床随访包括术前术后Harris评分及各种并发症。影像学评估包括双侧髋关节正位、患髋侧位片,判断股骨及髋臼假体的位置及其周围骨质的变化,并测量髋臼内衬线性磨损量。[结果]截至末次随访时,68例(82髋)获得随访,随访率为90.1%,随访时间平均为48.8个月。术前Harris评分平均为42分(5~86分),末次随访时为93分(53~99分),优良率为90.2%。术后1例患者发生与活动相关的大腿痛,影像学上9髋股骨假体发生早期不稳定,14髋发生应力遮挡,5髋发生异位骨化。无假体松动或翻修病例。[结论]非骨水泥全髋关节置换术治疗晚期股骨头缺血性坏死疗效确切,但存在一过性大腿痛、应力遮挡、异位骨化、假体磨损等并发症,故需长期随访。     

Early Post-operative Periprosthetic Femur Fracture in the Presence of a Non-cemented Tapered Wedge Femoral Stem

Non-cemented femoral fixation in hip arthroplasty has become the standard of practice in the USA. However, recent literature has brought attention to an increasing incidence of periprosthetic femur fractures with certain stem designs. This study examines reasons for early periprosthetic femur fractures in patients with a hip arthroplasty performed using a non-cemented tapered wedge stem design. A multivariate analysis using a matched-cohort design was performed to assess any potential risk factors that may predispose to such fractures. Six of 2,220 hips (0.3%) suffered a periprosthetic femur fracture within the first year after surgery; five of six were Vancouver Type B2. The average time to fracture was 9 weeks. This group of patients had a significantly higher canal–flare index and lower canal–calcar ratio. This complication may be preventable by having a better appreciation of the fit between the implant and the bone during pre-operative planning, with the goal of avoiding a proximal–distal mismatch.     

Systematic effects of surgical treatment of hip fractures: Gliding screw-plating vs intramedullary nailing

Aim

Numerous studies have been published regarding the comparison between intramedullary nail and the dynamic hip screw and plate for the fixation of intertrochanteric fractures in elderly patients. In this paper we present a comparative study of these two methods regarding their systemic effects on this group of patients.

Materials-methods

This is a randomized trial of 120 consecutive patients with an intertrochanteric fracture treated with either extramedullary fixation (dynamic hip screw and plate; DHS, Synthes-Stratec, Oberdorf, Switzerland) or intramedullary nail (Gamma nail, Stryker Howmedica, Freiburg, Germany and Endovis BA, Citieffe, Bologna, Italy).The parameters that we assessed pre-operatively, in addition to their demographics, included their mental state (MMSE), their nutritional and immune state and their pulmonary function. Intra-operatively we calculated the amount of radiation exposure, the amount of blood loss and the length of operative time for each procedure. Postoperatively we repeated the calculation of the mental and pulmonary state and the blood loss, during days 1, 3, and 10 and related them to the ease of the patient's mobilization.

Results

Decreased bleeding and post-operative pain, reduced post-operative morbidity and faster recovery of function were better but not significant in the group of intramedullary fixation (all p > 0.05). However, in the same group there were slightly more patients in whom the MMSE was falling, together with their pulmonary function, suggesting that this method probably predisposes to higher chances of pulmonary dysfunction and the possibility of pulmonary embolism.

Conclusion

We found no significant differences between the two methods of stabilization of these fractures regarding their systemic effects perioperatively. The classic dynamic hip screw can preserve its position as a safe and effective solution for these already vulnerable patients having sustained a trochanteric fracture against the novel intramedullary techniques.