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1.
Background
Despite significant pain relief following total hip arthroplasty (THA) in patients with ankylosing spondylitis, a small subset of patients presenting with extra-articular extension contracture of hips remains unsatisfied.Methods
We retrospectively evaluated the patients with ankylosing spondylitis who underwent simultaneous bilateral THA and had extensor tightness of both hips preoperatively. They were managed with modified Z-plasty of iliotibial band. Patients with windswept deformity, commonly seen in bilateral hip arthritis caused by ankylosing spondylitis, were excluded.Results
Between July 2011 and June 2015, out of 148 patients with bilateral hip involvement, 10 patients (20 hips) had extension contracture of both hips that was addressed during surgery. All patients were followed up for a minimum of 2 years. They could sit comfortably on a chair of height 18 inches with hips and knees flexed to at least 90°. The mean postoperative sum range of motion was 144.6° with an average hip flexion of 95° (range, 90°-105°). None of them had recurrence of extension contracture. There was significant improvement in range of motion and hence ambulation and function. No radiolucent lines exceeding 2 mm were seen in any of the zones around either of the components as evaluated in latest X-rays.Conclusion
Extension contracture of hip although rare is a noticeable problem and needs to be addressed during THA. Modified Z-plasty technique of iliotibial band is a reliable method in managing these patients. 相似文献2.
3.
颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩 总被引:2,自引:1,他引:1
目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法. 相似文献
4.
烧伤后手指瘢痕挛缩畸形综合治疗的临床研究 总被引:7,自引:1,他引:6
目的通过比较手术结合康复综合治疗方案与常规治疗方案对烧伤后手指瘢痕挛缩畸形的治疗效果,探讨综合治疗的优越性及经验。方法1999年6月~2004年6月,共56例烧伤后手指瘢痕挛缩畸形患者纳入试验。综合治疗组(A组)28例,男20例,女8例;年龄14~47岁,平均31岁;患手共47只129指,以手术结合系统康复治疗。常规治疗组(B组)28例,男17例,女11例;年龄18~51岁,平均30岁;患手共42只107指,采用常规手术,术后仅作简单的康复性锻炼指导,由患者在院外自己完成功能锻炼。采用Swanson法对患指运动功能进行评定,九孔柱试验法对患手整体运动功能进行评定,比较两组患者治疗前后手指和手整体运动功能的差异。结果A组患者术后均获随访12~19个月,B组患者均获随访13~20个月。治疗前A组患指的强直失能指数(indexofankylosis,IA)值为82%±20%,B组为78%±17%;治疗后A组为45%±13%,B组为52%±14%;治疗前后A组IA差值为37%±15%,B组为26%±15%,两组比较差异有统计学意义(P<0.05)。治疗前A组九孔柱测量值28.34±5.62s,B组为27.47±5.78s;治疗后A组为20.73±4.25s,B组为21.86±4.12s;治疗前后A组九孔柱测量差值为7.61±2.27s,B组为5.61±2.94s,两组比较差异有统计学意义(P<0.05)。结论烧伤后手指瘢痕挛缩畸形采用手术结合康复综合治疗的效果明显优于常规治疗,值得推广。 相似文献
5.
微创锁定加压接骨板内固定治疗胫骨骨折 总被引:2,自引:1,他引:1
臀肌挛缩症的手术治疗方法较多,我们采用大转子后上方双侧小“S”微创切口,每侧切口长约2~3 cm,对挛缩组织进行切断,广泛松解,重症患者行臀中小肌“Z”形延长,松解髋关节囊,并行屈膝屈髋、交叉架腿、划圈征等各项指标评价,配合术后早期功能锻炼治疗,效果满意,1997-2005年8月,共收治2 518例患者,重点研究讨论其病因、分类及治疗。1临床资料1·1诊断臀肌挛缩症的诊断包括病史,特别是婴儿期臀部反复肌肉注射史,特有的外“八”字步态,并膝下蹲困难,站立时的尖臀征,快步行走或跑步时呈跳步征。臀部触诊时可触及索带硬块,划圈征、二郎腿试验及平… 相似文献
6.
Hisham Abdel Ghani Ahmed El-Naggar Mohamad Hegazy Atef Hanna Yehia Tarraf Samia Temtamy 《Journal of children's orthopaedics》2007,1(5):313-322
Purpose Congenital clasped thumb is a deformity that is associated with heterogeneous congenital anomalies and it has been addressed
in many congenital syndromes. The aim of this study was to diagnose and evaluate cases of clasped thumb as regards the associated
congenital anomalies and syndromes, and evaluation of the results of treatment of such cases.
Methods A prospective study on 40 patients with 73 clasped thumbs was done. All the patients’ data regarding their personal, family,
pregnancy and developmental histories were recorded. All the patients were exposed to thorough clinical and radiological examination
and genetic assessment. The cases were classified using the Tsuyuguchi et al. (J Hand Surg [Am] 10:613–618, 1985) classification into three types. Conservative treatment was adopted in ten hands, and surgical treatment was performed for
28 hands in 17 patients, with an average follow-up of 26 months.
Results Positive consanguinity was recorded in 57.5% of cases. Associated anomalies were recorded in 77.5% of cases. Type I was the
most common one, followed by type III and then type II. Conservative treatment is effective in type I cases when presented
early, and all patients were satisfied with the results of surgical treatment.
Conclusions We reported associated anomalies which are to our knowledge have not mentioned before in the literature which include; congenital
blindness, radial deviation of the index finger and ventricular septal defect. We found that 68% of the patients had associated
syndromes, and this has not been mentioned before. In this study, we found that there were no difference between type II and
type III clasped thumb as regards the pathological findings, severity, the operative procedures, the treatment protocol and
the operative results. Properly planned treatment gives satisfactory results. 相似文献
7.
W. Ptzl P. Kümpers T. Szuwart T. Filler B. Marquardt J. Steinbeck 《Journal of orthopaedic research》2004,22(6):1345-1350
Despite widespread use of radiofrequency (RF)-shrinkage, there have been no studies on the influence of RF-energy on neural elements of collagenous tissue. The purpose of this study was to examine the effect of RF-shrinkage on neural structures of capsuloligamentous tissue and the recovery of neural elements under different postoperative treatment protocols. One patellar tendon of 46 New-Zealand-White rabbits was shrunk. Six rabbits were sacrificed immediately postoperative. Twenty rabbits were not immobilized, 10 were immobilized for 3 and 10 were immobilized for 6 weeks. A monoclonal antibody, specific against a neurofilament protein, was used to detect nerves and neural structures. Staining pattern of nerve fibres was significantly altered immediately postoperative. After 3 weeks the number of nerve fibres and bundles decreased significantly in immobilized and non-immobilized limbs. The loss of nerve fibres was significantly less in immobilized limbs. At 6 weeks the number of neural elements in immobilized limbs increased to the level of untreated control tissue. In non-immobilized limbs we found no recovery of neural elements 9 weeks postoperatively. At this time the number of nerve fibres and bundles was still significantly less compared to the untreated control limbs. RF-shrinkage causes significant alteration of neural elements. Under immobilization nerve fibres and bundles reach the level of normal untreated tissue. Careful rehabilitation is important after RF-shrinkage. Not only for biomechanical reasons, but also to allow the neural elements to recover, thermally modified tissue should be protected from normal physiologic loads. 相似文献
8.
目的探究隆乳术后包膜囊挛缩的手术治疗方法。方法采用原切口(腋窝顶或乳房皱襞下),对隆乳后包膜挛缩者采用包膜囊保留并在其浅层再置人假体的方法进行治疗。结果治疗12例14侧乳房包膜囊挛缩症均取得良好效果。结论保留挛缩的包膜囊并在其浅层置人假体的乳房假体包膜囊挛缩治疗术具有创伤小、出血少、操作简便、安全性高、复发率低、并可通过腋窝顶小切口完成等优点,是治疗乳房假体包膜囊挛缩的较好方法。 相似文献
9.
R. K. Gang 《European journal of plastic surgery》1986,8(4):199-202
Summary One stage reconstruction of the anterior axillary fold, in a case of severe post-burn axillary contracture, with the island latissimus dorsi musculocutaneous flap is described. Postoperatively the patient had a full range of active abduction and a good cosmetic result. 相似文献
10.
经尿道前列腺电切术后膀胱颈挛缩多因素分析 总被引:24,自引:2,他引:22
目的 :对经尿道前列腺电切术 (TURP)后膀胱颈挛缩 (BNC)发生的各种可能因素进行分析 ,探讨减少该并发症的途径。 方法 :对 10 17例行TURP患者中发生BNC的 2 4例进行统计学分析 ,在手术方法、前列腺电切重量、单位时间前列腺组织电切重量、置管时间、高频发生器类型及有无糖尿病、尿潴留及前列腺炎等方面进行比较 ,了解其可能发生的因素。 结果 :TURP术后BNC发生率明显高于开放手术病例 ,小前列腺、单位电切时间长、高频发生器功率大及术前前列腺炎患者易发生BNC(P <0 .0 5 ) ,而术前尿潴留、糖尿病及术后置管时间对BNC发生无明显影响 (P >0 .0 5 )。 结论 :小前列腺、前列腺炎及电流损伤是发生BNC的重要因素 ,患者的选择及熟练精确的电切技术可减少BNC的发生。 相似文献