全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

尽职尽责 造福人民——记天津市蓟县桑梓乡人民政府积极推行初级卫生保健工作

天津市蓟县桑梓乡人民政府,坚持为人民服务的宗旨,把初级卫生保健工作作为政府的重要工作内容,使全乡农民的生产、生活环境有了明显的改观,受到了群众的欢迎和赞扬。桑梓乡地处蓟县西南部洼区,距县城70华里,全乡17个行政村,共4957户,总人口19135人。农业以小麦、玉米为主,乡办企业以生产自行车零件为主。1988年     

成人髋关节发育不良不同Crowe分型的三维CT影像学特征

 目的 通过三维CT重建分析成人髋关节发育不良不同Crowe分型之间髋臼形态的演变规律。方法 2010年6月至2013年1月收治成人髋关节发育不良患者62例68髋,男6例8髋,女56例60髋;年龄47~59岁,平均（53.7±5.8）岁。CroweⅠ型14例17髋,Ⅱ型17例17髋,Ⅲ型15例17髋,Ⅳ型16例17髋。行标准髋关节CT扫描及三维重建。在侧位三维图像上标记Harris窝,确定髋臼旋转中心,利用十字坐标轴确定髋臼旋转中心的冠状面和横断面位置;在正位三维图像上利用Ranwant三角确定髋臼旋转中心的矢状面位置;在髋臼水平重建图像上确定髋臼旋转中心。观察髋臼前后缘增生及髋臼前后柱发育不良程度,测量并比较不同Crowe分型患者的髋臼前倾角、前覆盖角、后覆盖角和内壁宽度。结果 随Crowe分型增加,髋臼前倾角逐渐加大,两者呈正相关,除CroweⅠ型和Ⅱ型组间外,其余组间差异有统计学意义;髋臼前覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义,CroweⅢ、Ⅳ型组平均值小于50°;髋臼后覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义, CroweⅢ、Ⅳ型组平均值小于90° ;髋臼内壁宽度逐渐增加,两者呈正相关,各组间差异均有统计学意义。结论 不同Crowe分型成人髋关节发育不良的髋臼形态变化存在一定的演变规律。对CroweⅠ型和Ⅱ型髋臼的重建可充分利用髋臼前后柱骨量,对CroweⅢ、Ⅳ型髋臼的重建可适度上移和（或）内移髋臼中心。     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

目的 探讨全髋关节置换术治疗强直性脊柱炎致髋关节骨性强直的疗效及术后康复锻炼的意义.方法 1998年10月至2007年5月,对28例(46髋)强直性脊柱炎致髋关节骨性强直患者施行全髋关节置换术,男27例,女1例;年龄22～58岁,平均38.9岁;病程5～35年,平均17年2个月;髋关节屈曲强直7例(14髋),伸直强直21例(32髋).采用髋关节后外侧切口34髋,改良前外侧与外侧联合切口12髋;其中应用全生物型假体40髋,混合型假体6髋.术后24 h即开始进行系统性康复锻炼.对手术前、后患者Harris评分、VAS评分、髋关节总活动度及患者整体功能改善情况进行比较.结果 所有患者均获得随访,随访时间10～64个月,平均38.2个月,随访期间未发生坐骨神经或股神经麻痹、皮肤压疮、肺部感染、关节松动等并发症.1例患者术后2周出现髋关节脱位,经闭合复位治愈.8髋出现异位骨化,其中Brooker Ⅰ级6髋,Ⅱ级2髋.7例髋关节屈曲强直患者,屈曲角度由术前34.3°±16.3°改善为术后4.2°±3.3±.Harris评分由术前平均(28.3±10.3)分提高至术后平均(82.7±7.6)分.VAS评分:术前(3.5±1.4)分,术后(3.8±1.8)分.髋关节总活动度由术前平均15.6°±9.3°改善至术后133.7°±17.6°.术前28例患者生活均不能自理;术后1年,除3例患者行走时仍需借用单拐、生活需他人帮助外,其余25例患者生活均可自理,并可从事家务或轻体力劳动.结论 全髋关节置换术是治疗强直性脊柱炎晚期严重髋关节病变的一种有效方法,早期系统康复锻炼有助于关节功能的恢复.     

Short-term clinical outcomes of primary rotating hinge knee arthroplasty for knees with severe deformity

Objective: To observe short-term outcome and complication of primary rotating hinge knee arthroplasty for knees with severe deformity. Methods A retrospective study from Oct 2005 to Oct 2010 was conducted on 30 patients after receiving the TKA using the Endo-Model rotating hinge prostheses. There were 13 males(13 knees),17 females(17 knees),with the mean age of(65.2?8.3)years(ranged 53-78 years). X-ray image, the Knee Society Score(KSS) and ROM and the flexion angle were used to evaluate postoperative outcome. The average ROM before operation is 57.4??15.6? Results The average follow-up time was 33 months. No complications of infection, thrombosis, vascular or nerval injury were obaserved. The ROM of knees were improved from average 57.4??15.6?to 95.3??10.2?The KSS clinical score and function score were improved from average 38.6?12.7 and 36.3?15.1 to 87.9?12.5 and 68.8?18.1, respectively。There were 9 patients having anterior knee pain and patellars shift or tilt in the axial view of X-ray was observed. Conclusion The short-term clinical outcomes of Endo-Model rotating hinge TKA are ideal, and it is a good choice for knees with severe deformity. However, the high rate of patellofemoral joint complications should be encountered.     

强化统计信息 促进保健工作的开展

<正> 我县在妇幼卫生示范县建设中,把统计作为一项重要的工作内容,开发、利用了许多宝贵的信息资源,促进了妇幼卫生工作的深入发展.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.