A modified technique of bone grafting pedicled with femoral quadratus for alcohol-induced osteonecrosis of the femoral head

Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.     

益智游戏(十二)

1.失踪了十文钱从前,有三个穷书生进京赶考,途中投宿在一家旅店中。这间旅店的房价是每间450文,三人决定合住一个房间,于是每人向店老板支付了150文钱。后来,老板     

何嘉欣 妇幼医院设计点滴心得

过去,一提起妇幼医院,很多人就会想到和其他医院一样,一张张病床、四壁白墙。如今,很多大中城市的妇幼医院都在悄然发生着变化：房间内有了单独的洗手问,孕妇还可以躺在床上上网,家具成了床外必备的设施,更意想不到的是,有的房间还设置了厨房,孕妇可以随时吃到像家里一样的饭菜。     

孩子为什么跟我不亲

背景故事周三中午,齐女士走进了我的心理小屋:"人家都说女儿是妈妈的小棉袄,可我的女儿小轩却跟我一点不亲。每天放学回到家,如果不是喊她吃饭,小轩就会一直窝在自己的房间里。即便是看电视,也要坐到离我最远的沙发边沿,生怕我碰到她。有时节假日一家人出去踏青或出外旅游,小轩也不愿挨近我,总是一个人走在我和她爸爸的后面。有时我伸手去牵她,轩就像触了电似猛地     

沦陷在“魔兽世界”的高才生

30岁的陈亮,宁愿躲进网络游戏,也不愿面对这个世界。在他这样的网瘾者背后,是一个个有病的家庭。 陈亮是被母亲骗来的。由于抗拒治疗,起初,医生把陈亮单独关在一个房间。房间里,他声嘶力竭地喊：“我是成年人,     

十招远离空调病

夏季天气炎热,白领一族整天处于空调房中,长时间室温过低、空调不洁净等都有可能让病魔趁虚而入,危害身体健康。那么,夏季怎样才能远离空调病呢?笔者给你支10招,请大家参考。1.空调器在每年重新使用前一定要清洗,每个月还要清洗一次,主要是清洗过滤网。清洗消毒后应开启门窗半小时左右,使用通风功能运行至残存消毒剂挥发完再投入正常使用。也可以经常用吸尘器对     

住在走廊的病人

每年冬天,总有病人会住走廊,这些人入院时大多病情较重,有时还会是夜间来的急诊。病房挤不下,他们又不能离开医院,只有走廊这唯一的选择。     

双房同步起搏:请严格选择适应证——再论双房同步起搏适应证的选择问题

20 0 0年 6月《中国心脏起搏与心电生理杂志》刊出了朱中林教授的述评“正确掌握双房起搏的适应证及加强随访观察”一文[1] ,旨在为国内医师选择双房起搏治疗作出导向。笔者在查寻国外相关文献的基础上结合自己的实践经验再次对双房起搏的适应证进行较深入的探讨。房间传导阻滞 (ＩＡＣＢ)是指右房的电活动经Ｂａｃｈｍａｎｎ束向左房传导的时间明显延缓或阻滞。由ＩＡＣＢ引起的房性快速性心律失常 (ＡＴＡ)药物疗效差 ,电刺激治疗也无效 ,多需体内或体外电转复。从 1989年 1月起 ,Ｄａｕｂｅｒｔ等[2 ] 首次为ＩＡＣＢ患者施行双房同步起…     

阵发性心房颤动患者心房内阻滞的评价

目的对阵发性心房颤动(房颤)患者心房内阻滞的情况进行评价.方法入选78例阵发性房颤患者和8创无阵发性房颤的射频消融患者,电生理检查时分别放置高位右心房、希氏束、冠状静脉窦电极导管作起搏和标测用,在高位右心房进行S1S2程序刺激,S1刺激固定于500ms,S2从450ms开始,-10ms扫描,记录不同刺激时心房内和心房间传导时间及心房不应期.结果S1刺激时阵发性房颤组和对照组S1-AHB间期分别为(56.7±15.4)ms和(60.8±14.2)ms;S1-ACSd间期在两组分别为(110.2±24.3)ms和(107.5±25.6)ms;差异均无显著性(P＞0.05).S2刺激时,心房内传导时间最长延长1倍以上的患者在两组分别为15/78例和11/80例,心房间传导最长延长1倍以上的患者在两组间分别为13/78例和9/80例,两组间差异无显著性(P＞0.05).心房不应期在两组分别为(218.0±28.2)ms和(216.0±24.7)ms,两者间差异无显著性(P＞0.05).结论多数阵发性房颤患者无明显的心房内阻滞和不应期改变,传导时间延长也并非特异地发生在阵发性房颤组,提示心房内阻滞和不应期缩短在阵发性房颤的发生中的作用尚不明确.     

双房同步起搏治疗房性快速性心律失常

双房起搏是心脏起搏技术的一项最新进展,可用于治疗由房间传导阻滞引起的房间折返性房性快速性心律失常。在常规右房、右室双腔起搏的 基础上,植入冠状窦电极起搏左房,建立双房右室三心腔起搏系统,实现双房电活动的同步化,消除房间传导阻滞和房间折返,防治由房间传导阻滞引起的房性快速性心律失常。