聚焦式体外冲击波联合离心锻炼治疗大转子疼痛综合征

目的:探讨聚焦式体外冲击波联合离心锻炼治疗股骨大转子疼痛综合征的临床疗效.方法:2017年9月至2019年6月,将符合研究标准的53例股骨大转子疼痛综合征(greater trochanteric pain syndrome,GTPS)的患者分为观察组(29例)和对照组(24例).观察组,男8例,女21例,年龄38～6...     

A novel single-leg squat test with speed and accuracy requirements: Reliability and validity in anterior cruciate ligament reconstructed individuals

BackgroundSome traditional single-leg squat tests focused on number of repetitions may not demand precise control of lower limb dynamic alignment, especially in the frontal and transverse planes. The primary objective of this study was to evaluate test–retest reliability and construct validity of a novel single-leg squat test – the ‘precision-squat test’ (PST) – designed to assess performance under varying task demands that can impact the execution of lower limb movements. A secondary objective was to investigate whether musculoskeletal factors predict performance in the PST in healthy individuals.MethodsThirty healthy participants were assessed to verify test–retest reliability. To verify the test’s construct validity, we compared the performance of 21 anterior cruciate ligament reconstructed (ACLR) individuals and 21 matched controls. Finally, 36 healthy individuals were assessed to verify the musculoskeletal factors related to PST performance. All participants performed the PST: they executed single-leg squats while moving a laser pointer (attached to the thigh) between two targets. We varied target size and distance between targets to manipulate the task difficulty.ResultsReliability of the PST was excellent at all demand levels (intraclass correlation coefficient (ICC)_(3,2) > 0.93). Squat time increased under test conditions involving higher task difficulty (P < 0.001) and in ACLR individuals compared with age-matched controls (P < 0.05). Regression analyses revealed that reduced knee extensors and hip external rotators torques are related to increased squat time (P < 0.05).ConclusionsPST is a valid and reliable tool to assess performance of healthy and ACLR individuals. In addition, hip and knee strength are associated with performance during the test.     

韶关地区50岁以上人群人群髋部骨折住院治疗患者的预后分析

目的调查韶关市（含所属县区）50岁以上人群髋部骨折的住院时间及预后结局。方法在韶关市主要收治髋部骨折病人的14所医院的病案,筛选出2003-2006年之间股骨头骨折、股骨颈骨折、股骨粗隆间骨折和股骨多发骨折的病例,对50岁以上的患者的住院时间预后结局等方面进行统计学分析,采用chi-square检验比较各区域、各年龄段的男性、女性预后结果。结果2003-2006年韶关地区髋部骨折病人的治愈率为58．6％,病死率为4．1％;其中男、女性病人的治愈率分别为56．0％、60．9％,住院期间病死率分别为5．1％、3．2％。以80岁以上年龄组为对照组,50岁年龄组的治愈率是对照组的2．47倍;60岁年龄组的治愈率是对照组的2．26倍;70岁年龄组的治愈率是对照组的1．86倍。三级医院的治愈率是二级医院的2．63倍。结论城市居民的治愈率、病死率均高于乡镇居民。随着年龄增大治愈率降低、病死率升高。     

玻璃酸钠治疗髋关节骨性关节炎的临床疗效

目的观察玻璃酸钠注射液治疗髋关节骨性关节炎的临床疗效。方法髋关节骨性关节炎患者36例，治疗组18例在关节腔内注射玻璃酸钠2ml，每周1次，5次为1疗程。结果治疗组治疗前VAS评分≥7．0，治疗后6个月时VAS评分为（2．75±0．06），差异有统计学意义（P〈0．05）；6个月时总有效率高达89％（16／18例）。结论玻璃酸钠注射液治疗髋关节骨性关节炎疗效确切、持久，关节功能改善良好。     

Total hip replacement for hip fracture: Surgical techniques and concepts

When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality.Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures.     

Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture

In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group.We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.     

Insufficiency fracture of the acetabulum without apparent trauma

Abstract

A 76-year-old woman presented history of left hip joint pain on walking, which occurred after she bent to move a planter. Plain radiographs showed no fracture. Bone scintigraphy revealed accumulation, and magnetic resonance imaging showed a low signal area on T1-weighted images. We diagnosed an insufficiency fracture and pain decreased naturally on conservative treatment. Insufficiency fracture of the acetabulum should be considered when elderly patients have hip joint pain. Magnetic resonance imaging and bone scintigraphy is most useful for the diagnosis.     

髋部骨折术后物理措施预防血栓形成的有效性分析

目的探讨髋部骨折围手术期物理措施预防血栓形成的有效性和安全性。方法把96例符合条件的患者分为A和B两组,A组术后应用物理措施预防血栓形成,B组术后应用低分子肝素钙预防血栓形成,通过对比两组深静脉和肺栓塞的发生率及出血性并发症的发生率,比较两组治疗措施的效果。结果 A组48例物理措施预防血栓形成的患者血栓形成的发生率为8.33%,出血性并发症的发生率为2.08%;B组48例应用低分子肝素钙血栓形成的发生率为6.25%,出血性并发症的发生率为4.17%。结论在髋关节骨折术后中单独应用物理措施预防血栓形成的效果并不比单独应用低分子肝素差。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.