早期康复训练对成人髋关节发育不良致股骨头坏死全髋关节置换术后功能恢复的影响

目的 探讨早期康复训练对成人髋关节发育不良致股骨头坏死全髋关节置换术后功能恢复的影响.方法 成人髋关节发育不良致股骨头坏死全髋关节置换术后患者18例,22髋 随机分为早期康复训练组（A组：12例,14髋）和对照组（B组：6例,8髋）.患者髋关节功能进行：①Barthel 评分评定患者日常生活能力 ②采用简式Harris评分法评定患者关节运动功能情况.所有患者手术前和术后分别3个月、6个月及12个月时进行评定.结果 两组手术后各时间段的Barthel指数分别为（80.75±11.45）分、（66.73±14.04）分,简式Harris评分分别为（92.64±14.07）分、（70.03±15.88）分,比较差异有显著性（P＜0.05）.结论 早期康复训练能提高成人髋关节发育不良致股骨头坏死全髋关节置换术后患者的功能恢复.     

下肢伸直襁褓体位对髋臼发育影响的实验研究

目的 模拟婴儿下肢伸直襁褓体位建立动物模型,探讨该体位对髋臼发育的影响.方法 将29只新生Wista幼鼠用医用胶带将双小腿、双髋关节缠绕同定10 d.保持髋关节伸直内收位.模拟双下肢伸直襁褓体位,作为实验组;另29只新生幼鼠双下肢不予处置,作为对照组,同样条件正常喂养8周后.通过大体标本及X线摄片,观察髋臼变化.结果 实验组标本可见髋臼变浅周围软组织增生.髋臼上缘变钝、变直,向上倾斜,有45髋发生髋关节脱位(45髋/50髋),50髋全部发生髋臼发育不良(50/50),对照组无髋脱位、髋臼发育不良发生,实验组与对照组髋臼指数存在明显差异(P<0.05).结论 双下肢伸直襁褓体位可,导致髋臼发育不良.     

Paediatric orthopaedic surgery during the SARS-CoV-2 pandemic. A safe and pragmatic approach to service provision

The SARS-COV-2 pandemic has brought unparalleled challenges to healthcare provision. Being a newly discovered virus, there is a lack of previous experience and published evidence to guide healthcare providers on how to deliver services. We would like to share our approach to service delivery in a newly open children's hospital in the United Arab Emirates with a particular focus on paediatric orthopaedic services.     

The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip

Background  

The methods used for any screening programme for developmental dysplasia of the hip (DDH) can be controversial. This was an opportunistic audit of our selective ultrasound screening programme using an X-ray at 5 months to prevent inappropriate discharge due to the learning curve of ultrasound.     

浅述髋臼发育不良的诊治

目的：探讨髋臼发育不良的诊断与治疗。方法：通过对髋臼发育不良的基本概念、分型、影像学表现、手术方式等进行论述。结果：以髋臼发育不良为中心,重点阐述了髋臼发育不良的影像学表现及各式手术方式的适应证及优缺点。结论：髋臼发育不良是临床常见病,应早诊断、早治疗。     

全髋关节表面置换术治疗髋关节发育不良并发骨关节炎的初步体会

目的探讨全髋关节表面置换术(THRA)治疗髋关节发育不良(DDH)并发骨关节炎的可行性及注意事项。方法自2006～2009年,本组完成20例(23髋)THRA,其中DDH并发骨关节炎共11例(13髋),男4例(4髋),女7例(9髋);左髋5例次,右髋8例次;年龄平均(43.0±11.6)岁;术前Harris评分平均(56.9±17.8)分。按照KarlPerner法分度,13髋中Ⅰ度发育不良7髋,Ⅱ度发育不良3髋,Ⅲ度发育不良3髋。按照Hartofilakids法分度,Ⅰ度11髋,Ⅱ度2髋。采用金属对金属表面置换假体,股骨侧骨水泥固定、髋臼侧生物型固定。结果患者获得近期随访(0.5～2年),出院时及末次随访时间Harris评分同术前比较差异具有统计学意义。术前髋臼角(Sharp角)33.8～56.4°,平均(47.7±6.5)°;头颈比例1.29～1.64,平均(1.47±0.11);颈干角126.7～162.2°,平均(141.2±9.7)°;CE角-7.5～28.8°,平均(12.3±12.3)°。术后臼杯外展角22.4～69.3°,平均(46.8±12.9)°;假体柄干角126.8～159.1°,平均(143.0±9.2)°。髋臼假体完全被骨床覆盖6髋,外上缘外露小于0.5cm的2髋,外上缘外露超过0.5cm的5髋。1例患者术后2年随访时发现髋臼松动。结论对DDH并发骨关节炎的患者实施THRA,会面临头臼假体无法良好匹配、异常头颈比和异常颈干角等问题,加之患者髋臼表浅及髋臼角过大,容易导致术后假体位置不良,所以DDH导致的骨关节炎并非THRA的良好适应证。     

Seasonal variation in children with developmental dysplasia of the hip

Background

It has been postulated that developmental dysplasia of the hip (DDH) is more frequent in infants born in the winter months. It was the purpose of this study to ascertain if there was any seasonal variation in DDH at the author’s institution and compare/contrast our results with those in the literature using rigorous mathematical fitting.

Methods

All children with DDH treated at the author’s institution from 1993 to 2012 were identified. The month of birth was recorded and temporal variation was analyzed using cosinor analysis. Similar data from the literature was analyzed.

Results

There were 424 children (363 girls, 61 boys). An additional 22,936 children were added from the literature for a total of 23,360. Pearson’s Chi-square test demonstrated a non-uniform distribution in the month of birth for both our 424 children as well as the combined literature series in both the Northern and Southern hemispheres. Cosinor analysis of the 424 children demonstrated double peaks in mid-March and mid-October. For the entire 23,360 children, no seasonal variation was observed in 2,205 (9.4 %), a single winter peak in 16,425 (70.3 %), a single summer peak in 1,280 (5.5 %), and double peaks in the spring and autumn in 3,450 (14.8 %).

Conclusions

This study partly supports the hypothesis of tight clothing/cold temperature as one factor in the etiology of DDH with the tighter clothing/swaddling increasing the risk of DDH. However ~20 % of the DDH births demonstrated a non-winter peak. The single summer and double spring/autumn peaks, as well as in those series where no seasonal variation was noted, refutes the cold winter clothing hypothesis. Perhaps these different patterns in seasonal variation represent the heterogeneity of the genetic factors in DDH interacting with external factors (temperature and clothing) and internal factors (metabolic). Further study will be required to understand these different patterns in DDH seasonal variation.

Level of evidence

IV—case series.     

Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program

Background

Diagnosis and early treatment of developmental dysplasia of the hip (DDH) continue to be issues of discussion. In 1992, a nationwide general ultrasound screening program using Graf technique was introduced to detect DDH in Austria. We investigated the effects of this program on the rates of operative and conservative interventions and the influence of the program on the number of hospital admissions for the treatment of DDH.

Methods

All cases of DDH documented in Austrian hospitals from 1992 to 2008 were included in this retrospective study. The database of the Austrian Ministry of Health was used to extract documented diagnoses and treatments.

Results

Since the introduction of the screening program, the number of patients who require pelvic surgery to treat DDH has decreased by 46 % and the number of open reductions is as low as 0.16 per 1,000 live births. Hospital admissions for the treatment of DDH decreased from 9.5 to 3.6 per 1,000 live births. All noted results gained statistical significance.

Conclusion

Compared with routine clinically based screening programs, our results confirm low numbers of open reductions and pelvic surgeries. We, therefore, advocate a standardized nationwide general ultrasound screening program to reduce the rates of operative interventions and hospital admissions associated with the treatment of DDH.

Level of evidence

Level III, diagnostic