Acetabular ossicles: normal variant or disease entity?

Ossicles located in the acetabular fossa may confuse diagnostic and therapeutic work-up. An accessory ossification centre may persist unfused as an os acetabuli centrale which is surrounded by intact hyaline cartilage representing an anatomic variant. Bone islands located in the pillars of the acetabulum can project into the acetabular fossa simulating acetabular ossicles. Osteochondrosis dissecans, posttraumatic articular bodies, degenerative disease and other rare lesions may be responsible for clinical symptoms and are of similar appearance than anatomic variants. Plain film radiography, X-ray tomography, CT and MRI are used to categorize these lesions. MRI is very valuable to assess cartilage integrity in a noninvasive way, but arthro-CT or arthro-MRI have to be used in unclear cases. Therefore the purpose of this presentation is to discuss the appearance, the possible etiology and the differential diagnosis of acetabular ossicles and how they can be evaluated to avoid an unnecessary arthrotomy. Received: 22 December 1998; Revised: 28 May 1999; Accepted: 8 July 1999     

MR arthrography of the hip: normal intra-articular structures and common disorders

This pictorial review illustrates the anatomical features of normal intra-articular components of the hip and their common disorders on MR arthrography. On T1-weighted MR arthrograms, the normal contrast-filled joint cavity shows a homogeneous high signal intensity. Normal acetabular labrum appears as a well-delineated triangle showing a low signal intensity, surrounded by contrast material in the perilabral recess. Intra-articular paramagnetic contrast outlines labral tears, loose bodies, communicating labral cysts and cartilage lesions (traumatic tears, focal defects, degenerative fissures and thinning), and improves their detection. Overall, MR arthrography enables accurate detection and staging of hip intra-articular structure abnormalities. Received: 6 June 1998; Revision received: 2 January 1999; Accepted: 2 April 1999     

A comparison of Rasch with Likert scoring to discriminate between patients' evaluations of total hip replacement surgery

The purpose of this study was to examine whether there are advantages in terms of outcome assessment of using Rasch methods of scoring the 12-item Oxford Hip Score (OHS) questionnaire over conventionally Likert scores. As part of a prospective cohort study of total hip replacements in five former regions of England the OHS was sent to patients pre-operatively, at 3 months and 1 year post-operatively. Post-operative data was collected on over 5000 cases. Based on the level of satisfaction with surgery, patients were divided into satisfied and dissatisfied. Analyses were performed to test the relative precision (RP) of Rasch scoring vs. conventionally Likert scores in discriminating the groups experiencing different level of satisfaction. Considerable gains in precision were achieved with Rasch scoring methods when groups were compared 3 and 12 months post-operatively. The results from the current study suggest that in some situations there may be substantial gains in measuring health related outcomes using Rasch-based scoring methods.     

Pavlik支具治疗婴儿髋关节脱位的随访观察

目的　观察 6个月以下髋脱位患儿初次治疗年龄与Pavlik支具应用时间之间的关系 ,探讨患儿各初次治疗年龄组和各Pavlik支具应用时间组髋臼指数和Y -协调指数的变化情况。方法　本研究共随访了 1994年 1月至 2 0 0 2年 12月间我院采用Pavlik支具治疗的先天性髋关节脱位患儿 30例 (4 2个髋关节 )。随访期限为 9.4～ 81个月 ,平均随访时间为 32 .9个月 ,初次就诊年龄介于生后 0 .5 3～ 8个月之间 (6个月以上者只有 1例 ) ,平均初次就诊年龄为生后 2 .9个月 ,Pavlik支具应用的时间为 3～ 9个月 ,平均应用时间为 4 .7个月。结果　本文所得的复位成功率为 91.2 % ,无一例患儿发生股骨头坏死。 6个月以下患儿各初治年龄组的支具应用时间之间差异不显著 ,各支具应用时间组的患儿初治年龄之间也没有差异。支具应用 6个月时 90 .5 %的患儿可以去除支具。具有完整资料的34个脱位髋关节初次治疗时的髋臼指数均值为 30 .6 2°,其标准差为 6 .5 6°。本次随访所得髋臼指数的均值为 18.75° ,其标准差为 5 .78°。髋臼指数的前后变化差异有非常显著性意义 (P <0 .0 0 1)。本次记录的反映髋关节脱位治疗前后股骨头与髋臼同心情况的Y 协调指数 ,在初次治疗时其均值为 0 .94 ,标准差为 0 .0 6 ;而在随访时所得的均值为 0 .8     

生化检查对人工髋关节感染的诊断价值

目的评价翻修术前生化检查对人工髋关节感染的诊断价值。方法对145例人工髋关节翻修患者进行回顾性分析,分别以血沉(ESR)和C-反应蛋白(CRP)作为诊断标准对人工髋关节感染进行诊断,并与“金标准”的诊断结果进行比较分析。结果血沉和CRP诊断人工髋关节感染的灵敏度分别为57.89%、68.42%,特异度分别为85.71%、88.89%,阳性预测值分别为37.93%、48.15%,阴性预测值分别为93.10%、94.92%,准确度分别为20.00、18.62,Youden指数分别为0.44、0.57。结论血沉和CRP作为人工髋关节翻修术前的常规检查,对人工髋关节感染的诊断具有筛选价值;两者结合起互补作用,可以增加诊断的准确性。     

发育性髋脱位髋臼容积的CT测量与分析

目的探讨髋脱位儿童髋臼容积的测量及意义。方法应用CT技术，测量正常组（34髋）和异常组（36髋）的髋臼容积、股骨头体积。结果正常组儿童的髋臼容积较脱位组明显增大，二者直线回归方程的截距差异有统计学意义。结论髋关节脱位的患儿髋臼发育差，与股骨头呈现明显的不匹配；早期手法复位时髋臼容积可以作为测量指标。手术复位前也应了解髋臼容积的变化。     

Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on eady postoperative gait restoration in patients undergoing total hip arthroplasty (THA). Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40-49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris1m postop - Harrispreop and Harris3m postop- Harrispreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal-SLaffected, (SLSnormal - SLSaffected)/CD, and SPnormal - SPaffocted in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected.(SLSnormal- SLSaffected)/CD, and SPnormal - SPaffected were not significant, but the mean of SPnormal - SPaffected in the BHR group was significantly lower than that in the conventional group.Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.     

成人先天性髋关节脱位的全髋置换术

目的:总结全髋关节置换术治疗成人先天性髋关节脱位的临床经验。方法:2001～2004年对22例先天性髋关节成人患者进行了全髋关节置换术,对其临床治疗效果进行回顾性分析。结果:术后随访6～27个月,平均Harris评分由术前的44分恢复到82 5分。结论:全髋关节置换术治疗成人先天性髋关节脱位疗效满意,成功关键是在充分认识先天性髋关节脱位的病理改变的基础上,术中彻底的髋关节周围松解,真臼改造重建,及恰当的股骨假体放置     

DHS治疗股骨转子部骨折的临床应用体会

随着社会人口老龄化,股骨转子部骨折的发生率不断增高。虽然股骨转子部血运丰富,骨折容易愈合;但是如果处理不当,仍然可能预后功能不良。笔者回顾了我科自2001年8月至2004年5月期间应用动力髋螺钉(DHS)内固定治疗89例股骨转子部骨折,报道如下。临床资料本组89例,男33例,女56例;     

旋股外侧动脉升支肌骨瓣治疗髋部病损

髋部病变造成的股骨颈骨缺损及股骨头缺血性坏死病例的治疗方法较多。80年代以来,随着显微外科及修复外科的发展,利用带血管蒂的肌骨瓣、骨膜瓣修复髋部病损的新方法开始用于临床[1~3]。作者近6年来采用旋股外侧动脉升支阔筋膜张肌髂骨与骨膜瓣转位治疗髋部病损31例,获得满意效