儿童髋关节滑膜嵌顿症的关节镜诊断与治疗

儿童髋关节滑膜嵌顿症是一种临床较常见的小儿骨科疾病，由滑膜皱襞嵌压在关节间隙而引起。有学者报道MRI和B型超声可以观察到嵌顿的滑膜。笔者尝试应用关节镜手术诊断和治疗这一疾病。     

小儿髋关节一过性滑膜炎的动态超声研究

目的探讨小儿一过性髋关节滑膜炎的超声影像学表现特征及动态超声监测价值。方法回顾性分析我院超声动态监测的一过性髋关节滑膜炎病例35例。对所有病例双侧髋关节进行超声动态检查研究,测量髋关节滑膜厚度和前隐窝积液情况并行分型记录,及观察股骨头前颈升动脉血流信号等。于就诊时、治疗期间1周1次,直至临床症状、体征消失,记录病程。恢复后1个月超声检查1次,随访半年以上。结果 35例患儿患髋共50个,超声图像均显示股骨颈颈前间隙增宽,32个合并关节腔积液,1例为一侧髋关节滑膜嵌顿。首次发病为单纯髋关节囊肿胀型恢复较快,关节腔积液型症状较重、病程较长;关节囊肿胀声像恢复慢于积液;彩色多普勒超声检查患侧髋关节血流信号较健侧丰富,追踪半年至1年未出现股骨头软骨增厚、破碎及骨膜掀起等。结论小儿一过性髋关节滑膜炎具有一定的超声影像学表现特征,动态超声检查能够弥补其他影像学检查的不足,不仅有助于髋关节一过性滑膜炎的早期诊断,观察疗效,指导治疗,还可早期发现滑膜嵌顿症及Perthes病,具有重要临床应用价值。     

牵引治疗儿童髋关节滑膜嵌顿症

<正> 髋关节疼痛、跛行、活动受限以及不同程度的姿势畸形是儿童髋关节疾病的常见临床表现,但合并有患肢假性增长的则不多见,这是儿童髋关节滑膜嵌顿症的典型临床表观。我科自1998年3月～2003年4月共收治儿童髋关节滑膜嵌顿症病例22例,采用皮牵引治疗,收到满意效果。 1 临床资料 1.1 一般资料:本组23例,男18例,女5例,年龄2～11岁,平均7.5岁。左侧8例,右侧15例。所有病例均有行走时骨盆明显倾斜、患侧抬高、患肢有典型的假性增长、髋关节疼痛、跛行、姿势畸形、髋关节前内侧压痛、关节活动明显受限,尤其以内外旋转为主。患儿均在外伤后一周就诊,髋关节X线平     

儿童髋关节滑膜嵌顿症48例临床治疗体会

髋关节滑膜嵌顿症系指髋关节滑膜嵌入股骨头与髋臼之间，引起的以髋关节疼痛、活动受限为主的症候群，儿童多见。我们自１９９５年３月～１９９９年３月治疗本病４８例，疗效满意。１　临床资料１－１　一般资料　本组男２７例，女２１例。年龄最大１４岁，最小３岁，平均４－７岁，其中６～８岁占８３－５％。均为单髋，左侧２９例，右侧１９例。有高处跃下过量活动者３３例，髋部轻度扭伤史者１５例。１－２　临床表现　表现为发病急、髋关节疼痛。髋关节活动受限不明显，患儿双腿不能完全并拢、跛行、无体温增高。髋关节前部深压痛，股内…     

侧位推拉旋转法治疗下腰段滑膜嵌顿症

目的探讨下腰段滑膜嵌顿症的发病机制及复位法。方法 2005年8月～2010年2月对138例下腰段滑膜嵌顿症患者采用侧位推拉旋转法整复。结果患者随访3～54个月,平均32个月,获得随访的113例患者中一次治愈81例,好转4例;二次治愈22例,好转6例,全部患者均有效。结论患侧在上的侧卧推拉旋转法治疗下腰段滑膜嵌顿症是一种显效快、不受时间地点限制、操作简单的有效方法。     

手法整复滑膜嵌顿性腰痛50例体会

腰椎滑膜嵌顿是引起急性腰痛的常见原因之一,临床上多是由于轻度闪挫扭腰或弯腰猛然站起使小关节滑膜被夹于关节间隙,造成小关节滑膜嵌顿而立即出现剧烈腰痛,活动受限,严重影响人们的正常生活和工作。     

小儿髋关节两种不同方法的压力测定及其与不同体位变化规律？…

作用两种测定方法对９５个小儿尸体髋关节不同体位的压力测定，结果发现关节压力主要取决于髋关节体位，伸直极度外展内旋体最高，屈曲４５°外展４５°最低。不同测定方法关节内压力绝对值不同，但无论任何方法和年龄，就每个关节而言，不同体位的变化规律均完全相同，髋关节压力与不同体位的关系有利于解释关节滑膜嵌顿的发病机理，指导先髋脱位，Ｐｅｒｔｈｅｓ病，化脓性髋关节炎的体检疗法，先髋脱位患儿在其他体位能获得复位     

按点结合治疗腰椎滑膜嵌顿性腰痛

腰椎滑膜嵌顿是引起急性腰痛的常见原因之一,祖国医学则称之为“弹背”或“闪腰”。临床上多是由于轻度闪挫扭腰或弯腰猛然站起,使小关节滑膜被夹于关节间隙,造成小关节滑膜嵌顿而产生剧烈的腰痛。近几年来,笔者认为按摩配合指腹及肘部点穴(简称按点结合)是有效的治疗方法。     

骶髂关节滑膜嵌顿治疗体会

骶髂关节滑膜嵌顿治疗体会陈汴生陈海如在临床由诸多原因所引发的腰腿痛疾患中，骶髂关节滑膜嵌顿所表现的刺痛或撕裂样痛亦不乏常见，我院自１９９１年来用骶髂关节内注射法治疗该病３０例，收到良好效果，现小结如下：１临床资料本组３０例，男１２例，女１８例，年龄３...     

手法治疗腰椎关节突间滑膜嵌顿70例

腰椎关节突间滑膜嵌顿中医称之为岔气，是临床常见病。本病独具特点，即伤后立即出现异乎寻常的腰部剧烈疼痛以至病人无法忍受，采用理疗、口服非激素类消炎止痛药见效慢。我院采用手法治疗腰椎关节突间滑膜嵌顿70例，疗效显著。现报告如下：     

In situ fixation for slipped capital femoral epiphysis: perspectives in 2011

Slipped capital femoral epiphysis is usually treated with in situ fixation to prevent progression of deformity. However, slipped capital femoral epiphysis always is associated with structural risk factors for hip dysfunction in addition to the risk of slip progression. Femoro-acetabular impingement causes some mechanical abnormality in every hip affected by slipped capital femoral epiphysis, even when the slip is mild. The severity of femoro-acetabular impingement caused by slipped capital femoral epiphysis depends on several factors. Cumulative injury to the articular cartilage can result from impingement, and it is better to prevent this type of injury than to treat it later. In situ fixation alone rarely relieves femoro-acetabular impingement in slipped capital femoral epiphysis. Skillful and precise in situ fixation allows careful analysis of hip function in the stabilized slip by eliminating the major risk of acute instability. The more subtle risk of long-term articular damage caused by femoro-acetabular impingement must be considered. The treatment of femoro-acetabular impingement in patients who have slipped capital femoral epiphysis is a separate issue from instability of the proximal femoral physis. Femoro-acetabular impingement must be assessed in every hip that is affected by slipped capital femoral epiphysis, even when the deformity is mild. Several treatment options exist for treating femoro-acetabular impingement associated with slipped capital femoral epiphysis.     

Trends in femoroacetabular impingement research over 11 years

Femoroacetabular impingement is the abutment between the proximal femur and the rim of the acetabulum. It is a common cause of labral injury that has been identified as an early cause of hip osteoarthritis. The diagnosis of femoroacetabular impingement of the hip is currently well defined in orthopedic surgery but should attract the attention of physicians in other disciplines. Conversely, much less is known about the etiology and natural history of femoroacetabular impingement.The goal of this study was to assess the number of articles published on femoroacetabular impingement over 11 years in orthopedic vs nonorthopedic medical journals, and to evaluate the quality of available evidence. PubMed and OvidSP databases were searched for articles on femoroacetabular impingement published from 1999 to 2009. Articles were characterized by publication type and journal type per year. Regression analysis was used to determine the effect of publication year on number of publications of each type. The search yielded 206 publications on femoroacetabular impingement during the evaluation period. Seventy-two percent were published in orthopedic journals. Overall, the number of publications increased exponentially with time. There was an increase in clinical trials over the course of the study period. However, studies with high-quality evidence were scarce. The increase in data from orthopedic and nonorthopedic disciplines is welcome. Nevertheless, high-quality evidence on femoroacetabular impingement is lacking. We believe the current trend toward evidence-based orthopedic surgery will impact future research on this relatively new disorder.     

髋臼盂唇损伤的关节镜手术

目的 探讨髋臼盂唇损伤的诊断方法和关节镜治疗结果.方法 2008年11月至2009年12月收治单侧髋臼盂唇损伤行关节镜手术且随访时间超过半年的患者21例,男9例,女12例;年龄17～65岁,平均37.1岁.术前行体格检查、X线和MR关节造影明确诊断.于髋关节镜下行盂唇清理术14例、盂唇清理及股骨头颈区成形术5例、盂唇修复及股骨头颈区成形术2例.结果 Fadir试验阳性21例(100%,21/21),Fabir试验阳性15例(71%,15/21),McCarthy试验阳性9例(43%,9/21).X线片显示11例存在凸轮型撞击(其中6例合并钳夹型撞击),2例为单纯钳夹型撞击.MR关节造影均显示前上象限不同程度的盂唇损伤信号,阳性率100%;所有盂唇损伤均经关节镜证实,准确率100%.全部病例随访6～19个月,平均11.6个月.术后症状明显缓解,疼痛视觉模拟评分由术前(5.3±1.3)分降至术后6个月(1.4±0.9)分,Harris髋关节评分由术前(63±9)分提高至术后6个月(84±10)分,差异均有统计学意义.结论 髋臼盂唇损伤与股骨髋臼撞击有关.撞击试验和MR关节造影具有较高的诊断阳性率和准确率.关节镜下髋臼盂唇损伤的清理、修复与骨成形术可获得满意的早期临床效果.     

Clinical diagnosis and arthroscopic treatment of acetabular labral tears

Objective: To investigate the clinical diagnosis and arthroscopic treatment of acetabular labral tears. Methods: Twenty‐one patients with unilateral acetabular labral tears hospitalized from November 2008 to December 2009 were included in this retrospective study. A definitive diagnosis was made preoperatively on the basis of physical examination, plain radiography and magnetic resonance arthrography (MRA). All cases were treated with arthroscopic surgeries: labral debridement (14 cases), labral debridement plus femoral osteoplasty (5 cases), and labral repair plus osteoplasty (2 cases). All patients were followed‐up and the results evaluated using the visual analogue scale (VAS) and Harris hip score. Results: A positive flexion, abduction and internal rotation (FADIR) impingement sign was found in all 21 affected hips, a positive flexion, abduction and external rotation (FABER) impingement sign in 15, and a positive McCarthy test in 9. Plain radiography showed 11 cases had cam type impingement, in 6 of whom it was combined with pincer type impingement; and 2 cases had acetabular retroversion alone. Labral tears were observed on MRA in all cases and were all confirmed by arthroscopy. All patients were followed up for an average of 11.6 months (range, 6 to 19 months). The VAS decreased from (5.3 ± 1.3) preoperatively to (1.4 ± 0.9) 6 months postoperatively. The mean Harris hip score improved from (63 ± 9) preoperatively to (84 ± 10) 6 months postoperatively. All these differences were statistically significant. Conclusions: Acetabular labral injury is closely correlated with femoro‐acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome.     

Range of Motion in a Modular Femoral Stem System with a Variety of Neck Options

Modular femoral stem systems decouple leg length, offset, and version. The hip ROM and type of impingement for 162 femoral head/neck combinations were measured at four extreme hip positions in a Sawbones pelvis and femur to identify constructs that lead to early impingement. Hip ROM increased in all positions with increasing head size and neck length. We identified a new type of impingement created by the build-up of the proximal femoral stem: femoral stem on acetabular liner impingement. Seventy percent of neutral neck options achieved our definition of acceptable ROM. In general, when utilizing a modular femoral stem, surgeons can minimize impingement by choosing the longest femoral neck that does not over-lengthen the limb, using the largest femoral head accommodated by the cup, and avoiding neck version unless the cup or stem is malaligned.     

Hip Abduction Can Be Considered the Sole Posterior Precaution Strategy to Lower the Rate of Impingement After Posterior Approach Total Hip Arthroplasty With Large Femoral Head: A Computer Simulation Study

BackgroundStudies suggest that posterior hip precautions are unnecessary after total hip arthroplasty; however, many surgeons and patients choose to follow these precautions to some extent. In this study, we hypothesized that 20° of hip abduction would be sufficient to prevent impingement and dislocation in motions requiring hip flexion when using larger prosthetic heads (≥36 mm) when the acetabular implant is placed within a reasonable orientation (anteversion:15-25° and inclination: 40-60°).MethodsUsing a robotic hip platform, we investigated the effect of hip abduction on prosthetic and bony impingement in 43 patients. For the flexed seated position, anterior pelvic tilt angles of 10 and 20° were chosen, while anterior pelvic tilt angles of 70 and 90° were chosen for the bending forward position. An additional 10° of hip external rotation and 10 or 20° of hip internal rotation were also added to the simulation. One hip received a 32-mm head; otherwise, 36-, 40-mm, or dual-mobility heads were used. The study power was 0.99, and the effect size was 0.644.ResultsIn 65% of the cases, bone-bone impingement between the calcar and anterior-inferior iliac spine was the main type of impingement. The absolute risk of impingement decreased between 0 and 16.3% in both tested positions with the addition of 20° hip abduction.ConclusionWith modern primary total hip arthroplasty stems (low neck diameter) and an overall acceptable cup anteversion angle, small degrees of hip abduction may be the only posterior hip precaution strategy required to lower the risk of dislocation among patients. Future studies can potentially investigate the concept of personalized hip precautions based on preoperative computer simulations, utilized implants, hip-spine relations, and final implant orientation.     

Arthroskopie nach Trauma des Hüftgelenks

Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. Arthroscopically guided fracture reduction and fixation has been described. We present two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral tear and loose bodies after closed hip reduction. The second case is a man with a large anterior labral tear with preexisting femoroacetabular impingement. Both of them were treated by arthroscopic debridement of the unstable labrum. In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.     

Osteoid Osteoma of the Femoral Neck Mimicking Monarthritis and Causing Femoroacetabular Impingement

Different aetiologies including the femoroacetabular impingement (FAI) may cause a painful hip, especially in young pa - tients. Two general types of femoroacetabular impingement have been described, the pincer- and the cam type impingement. The latter is characterized by a femoral deformity, usually a bump on the head-and-neck junction that impinges on the acetabular rim. The authors describe the case of a 21-year-old male, bodybuilder, suffering from progressive hip pain with impairment of exercise tolerance, gait and other daily activities. Besides limitation of hip internal rotation physical examination was normal. He had a transitory response to non-steroid anti-inflammatory drugs. Initially performed MRI of the pelvis shows predominant inflammation of the hip joint. In external performed arthroscopy the biopsies of the capsule demonstrated chronic synovitis. In the follow up hip pain remains, however, diagnosis was still unclear. Re-evaluation of the formerly performed and a follow up MRI, and of an additional CT, the findings were compatible with an osteoid osteoma in the femoral cervico-cephalic transition causing itself a cam impingement and monarthritis. The adopted therapeutic strategy consisted on arthroscopic excision of the nidus and trimming of the femoral neck, with clinical recovery after surgical intervention. Key words: femoroacetabular impingement, FAI, osteoid osteoma, monarthritis.     

髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤

[目的]介绍髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤的手术技术与初步临床疗效。[方法]2015年8月~2018年4月,采用髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤23例(23侧),"凸轮"型6例,"钳夹"型2例,混合型15例。患者取健侧卧位,采用髋关节后外侧入路,在大转子下方1.5 cm处截骨,"Z"形切开关节囊,剪断圆韧带,脱出股骨头。去除部分骨性髋臼缘和股骨头颈部多余的骨质,修整盂唇用2.8 mm的带线锚钉缝合固定,大转子骨折块并用2枚7.3 mm的空心钉固定。[结果]23例患者均顺利完成手术并获随访,随访时间12~24个月,平均(15.92±4.63)个月。术后12个月Harris、WOMAC、SF-36和Merle D’Aubignéand Postel评分与术前比较均显著改善,差异均有统计学意义(P<0.05)。末次随访时未出现大转子截骨不愈合和股骨头缺血性坏死的现象。[结论]髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤,临床疗效满意,并发症少。