Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia

Primary total hip arthroplasties were performed in 70 hips for the treatment of Crowe type IV developmental dysplasia of the hip. The patients were subdivided into 2 groups with or without iliofemoral osteoarthritis. Leg length change was measured radiographically. Preoperative hip motion was reviewed from medical records and defined as either higher or lower motion groups. The leg length change in patients without iliofemoral osteoarthritis was significantly greater than that in patients with iliofemoral osteoarthritis, and the higher hip motion group had greater leg length change in total hip arthroplasty than the lower motion group. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe type IV developmental hip dysplasia.     

全髋关节置换术治疗CroweⅣ型髋臼发育不良并骨性关节炎的疗效分析

[目的]探讨全髋关节置换术治疗成人CroweⅣ型髋臼发育不良的临床疗效。[方法]对26例(31髋)成人CroweⅣ型髋臼发育不良并骨性关节炎患者行全髋关节置换术,以术前、术后Harris评分和放射学检查评价疗效。[结果]26例均得到随访,随访时间平均为21个月(10个月～4年)。术前Harris评分平均(36.45±2.47)分,术后(82.84±3.58)分,(P﹤0.01)。1例出现坐骨神经完全损伤,经保守治疗6个月后部分恢复。[结论]人工全髋关节置换术治疗成人CroweⅣ型髋臼发育不良是安全、有效的手术方法。     

成人Crowe Ⅳ型髋关节发育不良行全髋关节置换术后并发症的预防及康复护理

目的 总结成人CroweⅣ型髋关节发育不良行人工全髋关节置换术患者术后并发症的预防方法.方法 所有患者均在手术前、后测量双下肢长度、评定外展肌肌力、采用髋关节功能评分(Harris)评定髋关节功能.结果 术前Harris评分5～46分,平均40分,术后6个月平均81分.除1例出现坐骨神经损伤,保守治疗6个月后恢复;另1例发生髓关节脱位外,其余病例均未出现严重并发症.结论 成人CroweⅣ型髋关节发育不良行人工全髋关节置换术患者术前进行系统评估,早期、规范的康复训练,可有效减少并发症的发生,保证手术效果.     

全髋关节置换术治疗成人CroweⅣ型髋关节发育不良疗效分析

目的探讨人工全髋关节置换术治疗成人CroweⅣ型髋关节发育不良的临床效果。方法对14例（20髋）成人CroweⅣ型髋关节发育不良患者行人工全髋关节置换术,其中男4例,女10例,平均年龄45.6岁。患肢短缩平均（4.88±0.95）cm,以术前、术后Harris评分和放射学检查评价疗效。结果14例均得到随访,随访时间平均23个月（8个月-4年）。下肢延长平均（4.46±0.94）cm,术前Harris评分平均（37.50±6.96）分,术后（88.31±6.77）分（P〈0.05）。1例出现坐骨神经损伤,对症治疗5-6个月后完全恢复。结论人工全髋关节置换术治疗成人CroweⅣ型髋关节发育不良是安全、有效的手术方法。     

复原髋臼窝在CroweⅢ型髋关节发育不良精准全髋置换中的作用及影像学量化评分

目的:探讨复原髋臼窝在CroweⅢ型髋关节发育不良(DDH)精准全髋置换中的作用,以及在标准骨盆X线平片上首次采用量化评分方法评价髋关节假体安装质量的可行性。方法:回顾性研究。纳入2014年3月—2019年4月蚌埠医学院第一附属医院行人工全髋关节置换术治疗的CroweⅢ型DDH终末期骨性关节炎患者86例(92髋),其中...     

Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study

BackgroundThe aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft.MethodsOne hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications.ResultsThe mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P = .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P = .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%.ConclusionTransverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.     

两种不同截骨方法治疗Crowe Ⅳ型先天性髋脱位的比较研究

目的 探讨对成人Crowe Ⅳ型先天性髋脱位患者(congenital dislocated hip,CDH)行人工全髋关节置换术(total hip arthroplasty,THA)时两种不同截骨方法的效果及适应证选择.方法 回顾性分析我科2003年4月至2007年10月行THA治疗的36例单侧Crowe Ⅳ型CDH患者的临床资料,通过测量下肢长度差、旋转中心高度差及Harris评分等指标比较股骨近端截骨和粗隆下截骨的效果.股骨近端截骨组20例,股骨粗隆下截骨组16例.结果 手术均成功复位,粗隆下截骨组手术时间较短,术后下肢长度差近端股骨截骨组平均为0.3 cm(-1.0～1.5 cm),粗隆下截骨组平均为0.6 cm(0～1.5cm).两组间比较无显著差异(P＞0.05).髋臼角、旋转中心高度差以及重力臂的比较无显著差异.术中、术后并发症的发生率股骨近端截骨组明显高于粗隆下截骨组.最近一次随访,Harris评分近端股骨截骨组为(83±8)分,粗隆下截骨组为(90±6)分,两组间比较差异具有统计学意义(P＜0.05).结论 严重的成人Crowe Ⅳ型CDH行THA时通过两种截骨方式均能有效恢复患肢长度、重建关节功能,但对于脱位过高的患者(＞4 cm)采用股骨近端截骨容易出现并发症,粗隆下截骨是一种很好的选择.     

Crowe Ⅳ型髋关节发育不良患者全髋关节置换术下肢长度平衡的调节

目的探讨CroweⅣ型髋关节发育不良（DDH）全髋关节置换术（THR）中肢体长度平衡的调整原则及方法。方法回顾性分析2009年7月—2012年6月行THR治疗的39例（41髋）CroweⅣ型DDH患者的临床资料,根据双髋脱位情况对其进行分型,按分型设计并实施手术,分析随访结果。结果根据双髋脱位情况分为4个亚型,其中Ⅰ型2例、Ⅱ型18例、ⅢA型6例、IIIB型9例、Ⅳ型4例。术前患者两下肢长度平均差异为5．1cm,术后为～1．4cm。患者随访时间12—36个月平均22．4个月。最终随访的平均SF-12健康评分为16分（区间为13～22分）。结论根据不同分型对CroweⅣ型DDH患者设计个体化重建手术方案,按设计方案可有效调整下肢长度差异。     

人工全髋关节置换术治疗 Crowe Ⅳ型髋关节发育不良术中应用粗隆下截骨的相关研究

目的探讨 Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）人工全髋关节置换术（total hip arthroplasty，THA）术中应用粗隆下截骨的临床效果。方法回顾分析 2008 年 4 月—2016 年 6 月采用 THA 治疗的 71 例单侧 Crowe Ⅳ型 DDH 患者临床资料，其中 44 例术中行粗隆下截骨（截骨组），27 例未行粗隆下截骨（未截骨组）。两组患者性别、年龄、体质量、身高、体质量指数、侧别以及术前 Harris 评分等一般资料比较，差异均无统计学意义（P>0.05），具有可比性。记录两组手术相关并发症发生情况，采用 Harris 评分评价髋关节功能。于手术前后摄骨盆正位 X 线片，测量术前股骨脱位高度和术后 SROM 近端假体植入深度。 结果截骨组随访时间 12～90 个月，平均 34.77 个月；未截骨组为 12～79 个月，平均 34.33 个月；两组比较差异无统计学意义（t=–0.088，P=0.930）。截骨组术中及术后共 11 例发生并发症，其中 1 例因感染致截骨处不愈合，于术后 20 个月行翻修手术；未截骨组术后 3 例发生并发症。两组患者假体位置良好、无松动，无关节脱位。两组术前股骨脱位高度及 SROM 近端假体植入深度比较差异均有统计学意义（t=–8.452，P=0.000；t=6.783，P=0.000）；截骨组患者 SROM 近端假体植入深度与截骨长度无相关（r=–0.038，P=0.806）。末次随访时，截骨组及未截骨组 Harris 评分比较差异无统计学意义（t=–1.160，P=0.254）。 结论Crowe Ⅳ型 DDH 患者 THA 术中应用粗隆下截骨可以获得良好的临床效果，术前股骨脱位较高和股骨近端髓腔严重狭窄的患者更倾向于术中行粗隆下截骨。     

Measurement of health literacy in patients with cardiovascular diseases: A systematic review

BackgroundWhile many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied.ObjectiveTo identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs.MethodsElectronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach.ResultsForty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs.ConclusionsThe S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.