成人单侧发育性髋关节发育不良患者下肢长度测量与分析

目的 测量并分析成人单侧发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者影像学下肢长度差异的特点.方法 回顾分析2016年1月-2018年6月符合选择标准的112例单侧DDH患者临床资料.其中男16例,女96例;年龄20～76岁,平均42.9岁.DDH根据Crow...     

全髋关节置换术中不同下肢长度测量方法的应用效果比较

目的 比较全髋关节置换术中3种常用的下肢长度测量方法的临床应用效果,评价其在平衡下肢长度和防止术后双侧下肢不等长方面的作用。方法 回顾性分析自2021-01—2021-10完成的140例全髋关节置换术,A组42例术中采用屈膝触摸术侧与健侧长度对比法调节股骨假体颈长,B组42例术中参考对侧股骨头旋转中心与股骨大粗隆尖方向的垂直关系调节股骨假体颈长,C组56例采用C型臂X线机透视法调节股骨假体颈长。在不考虑患者性别、年龄差异的情况下,于术后第3天通过临床和影像学方法测量双下肢长度。结果 术后第3天摄X线片复查假体在位,未出现假体松动迹象。A组42例术后双下肢长度差值为（6.8±2.0）mm,其中3例下肢不等长超过10 mm;B组42例术后双下肢长度差值为（4.8±1.9）mm,C组56例术后双下肢长度差值为（3.1±1.2）mm;3组术后双下肢长度差值比较差异有统计学意义（P<0.001）,C组术后双下肢长度差值小于A组和B组,且B组术后双下肢长度差值小于A组。结论 参考对侧股骨头旋转中心与股骨大粗隆尖方向的垂直关系法与C型臂X线机透视法应用于全髋关节置换术中可更好地避免术后双下肢不...     

全髋关节置换术下肢等长探讨

目的：探讨全髋关节置换术中如何准确达到下肢等长。方法：1996年5月-2001年7月有88例（92侧）髋关节置换术,男52例。女36例。年龄40-96岁。平均62.5岁。其中有76例下肢术前不等长。下肢长短状态分为可变下肢长度与不可变下肢长度。所有患者术前均进行X线片模板测试及下肢长度测量。不可变下肢长度（即患肢长短固定。不发生变化）术中采用克氏针标记骨盆。股骨之间距离,置入假体后根据实际情况调整长度;可变下肢长度（即术前患肢长短随时可发生变化）靠“三要素”来衡量,结果：术前患肢缩短1-4cm的76例患者中,术后仅有6例患肢延长0.5-2cm。2例患肢缩短1cm和2cm;术前12例下肢等长患者中有2例患肢延长1.5cm和2cm。结论：术前模板测试及下肢长短准确测量,术中通过克氏针标记骨盆与股骨技术及“三要素”衡量。能准确达到下肢等长。可以预防下肢不等长。     

发育性髋关节脱位的遗传学研究进展

发育性髋关节脱位(developmental dislocation of the hip,DDH)是小儿骨科最常见的、严重危害儿童健康的先天性畸形之一。目前学者们认为DDH是一种复杂的多基因病,是遗传因素和环境因素共同作用的结果,但其具体病因不清。环境因素包括宫内环境及生后环境因素,前者如臀位妊娠、羊水过少等,后者如不恰当的襁褓方式,髋关节被异常地牵拉等[1]。流行病学调查显示,约有12%～33%的DDH患儿有阳性家族史[2～4]。目前DDH分子遗传学研究主要采取     

关节镜治疗婴幼儿发育性髋关节脱位

目的探讨关节镜治疗婴幼儿发育性髋关节脱位(DDH)的临床疗效。方法对13例DDH患儿(17髋)采用关节镜治疗。结果患儿均获得随访,时间3~7(5.3±2.1)年。至末次随访,患儿均获得正常步态及髋关节活动度,无一例患儿出现股骨头坏死。髋臼指数由术前32.9°~51.8°(39.4°±11.3°)改善至末次随访时的19.8°~33.1°(24.8°±6.5°)(P0.001)。除1例(1髋)继发DDH外,其他患儿均获得股骨头与髋臼同心圆复位,恢复Shenton线连续性。结论采用关节镜治疗婴幼儿DDH临床疗效满意,具有创伤小、并发症发生率低等优点。     

手术治疗小儿发育性髋关节脱位的护理

目的：探讨手术治疗小儿发育性髋关节脱位的护理方法。方法：对近一年来手术治疗小儿先天性髋关节脱位150例患儿的护理作回顾性总结分析。结果：全组病例经围术期精心护理,积极有效的手术治疗,髋关节能得以恢复,无下肢畸形、褥疮等并发症发生。结论：认真细致的病情观察和心理护理是护理小儿发育性髋关节脱位工作的重点。     

手术治疗小儿发育性髋关节脱位

目的 探讨手术治疗小儿发育性髋关节脱位的临床治疗效果.方法 小儿发育性髋关节脱位患者21例共33个髋关节作为研究对象,其中男5例7个髋关节,女16例26个髋关节.年龄为3～6岁,平均年龄为(4.12±1.23)岁.所有对象均接受pemberton截骨术和salter截骨术,并进行随访观察.结果 本组均获随访,随访时间为10～34个月,平均23个月.小儿发育性髋关节脱位患者手术后优良率为93.94％.X线结果显示,有19例达到同心圆复位,无再脱位发生,有2例患者分别发生股骨头缺血性坏死和关节僵硬.结论 对小儿发育性髋关节脱位患者,采用pem-berton髋臼截骨术和salter截骨术的改良手术有较好的临床治疗效果,值得临床推广使用.     

大龄难治性发育性髋关节脱位的联合手术治疗

目的探讨大龄儿童发育性髋关节脱位的手术方法及临床效果。方法对16例7～16岁大龄发育性髋关节脱位患儿(18髋)采用"切开复位+股骨转子下缩短旋转截骨+骨盆内移旋转截骨+髋臼成形"的联合手术治疗。结果术后2个月摄片复查髋关节复位位置好,股骨头及髋臼形态基本正常。骨盆截骨植入骨块及股骨缩短旋转截骨断端已骨性愈合。髋臼骨质与周围骨质密度基本一致,无坏死征象。患儿均获随访,时间1～7年。按疗效评定标准:优11髋,良6髋,差1髋。结论联合手术是治疗大龄发育性髋关节脱位较有效的方法。     

全髋关节置换术下肢长度均衡方法的临床研究

目的探讨全髋关节置换术中下肢长度均衡的方法及可行性。方法42例(44髋)接受全髋置换术的病人,男24例,女18例;患者平均年龄61.5岁(48～72岁)。左髋24例,右髋20例。术前Harris评分平均53.5分(46～62分)。术前拍摄双髋关节前后位X线片,健侧下肢内旋15°,用模板测量髋臼的旋转中心和股骨偏心距,标记出需切除骨距位置。对单侧置换的患者,术中依健侧股骨偏心距重建患侧偏心距;对双侧同时置换的,采用双侧偏心距一致的方法。术中假体试模安装完毕后,测量股骨头中心与股骨大粗隆顶点高度是否一致。麻醉下牵拉患肢测试关节间隙为4～5 mm,比较双侧膝关节是否在同一水平等,据此选取人工股骨头的颈长,以避免下肢的不等长。结果经上述方法完成的全髋置换术,36例(83%)下肢长度一致,使下肢不等长的发生率大大降低。平均随访时间3～15个月,术后Harris评分平均89.6分(82～93分)。结论通过术前测量和术中综合应用上述方法,使全髋关节置换术后下肢长度均衡的问题得以很好地解决。     

Pemberton髋臼成形术治疗发育性髋关节脱位

目的：探讨分析Pemberton髋臼成形术在发育性髋脱位的治疗上具有哪些优势。方法：采用Pemberton髋臼成形术治疗儿童发育性髋脱位106例116髋,男19例29髋,女87例87髋。左侧46髋,右侧50髋,双侧20髋。年龄18个月～13岁,平均7岁3个月,其中18个月～6岁99髋,7～13岁17髋。116髋均采用Pemberton髋臼成形术或内收肌、髂腰肌切断加Pemberton髋臼成形术加转子下股骨短缩、旋转截骨术。95髋单纯行Pemberton髋臼成形术,余21髋行全套手术。双侧髋脱位患儿均先做一侧,1年后再做另一侧,同时将第1次手术股骨内固定钢板取除。结果：病例随访时间2～10年,平均6年。按照Mullerh和Seddon标准进行功能评定,优67髋,良34髋,可10髋,差5髋,优良率87%。结论：Pemberton髋臼成形术适用于多个年龄段的儿童发育性髋脱位患者,疗效肯定,在发育性髋脱位的治疗中占有重要地位。     

单侧髋关节完全脱位患者下肢不等长及膝关节畸形的特点

目的 观察骨骼发育成熟的单侧发育性髋关节完全脱位的患者脱位侧下肢长度的变化特点及伴随膝关节畸形的情况.方法 选择201 1年3月至2012年12月因单侧髋关节完全脱位接受治疗且符合纳入排除标准的28例患者作为观察对象,其中男性6例,女性22例;年龄13.4～66.2岁,平均29.8岁.脱位侧为中低位脱位(HartofilakidisⅡ型)17例(60.7％),高位脱位(HartofilakidisⅢ型)11例(39.3％).患者均行站立位双下肢全长正位X线检查,于X线片上进行双侧股骨及胫骨绝对长度、下肢相对长度的测量,并观察脱位侧与非脱位侧膝关节畸形情况.对股骨绝对长度、胫骨绝对长度、双下肢相对长度及双侧膝外翻角采用配对资料t检验进行统计学分析;对膝外翻分布规律及不同脱位程度下肢相对长度的分布规律采用x2或校正x2检验.结果 脱位侧股骨绝对长度较非脱位侧延长者17例(60.7％),最长延长32.7 mm,平均延长9.5 mm,差异无统计学意义(t=1.328,P=0.197).脱位侧胫骨绝对长度较非脱位侧延长者21例(75.0％),最长延长10.9 mm,平均延长4.5 mm,差异有统计学意义(t=3.039,P=0.006).脱位侧下肢相对长度较非脱位侧延长者20例(71.4％),最长延长25.0 mm,平均延长9.4 mm,差异有统计学意义(t=2.451,P=0.022).脱位侧膝外翻角为3.±4°,非脱位侧膝外翻角为-3°±4°,双侧对比差异有统计学意义(t=5.642,P=0.000);其中脱位侧膝外翻畸形12例,膝内翻1例;而非脱位侧膝内翻畸形15例,膝外翻畸形1例,差异有统计学意义(x2=18.139,P=0.000).结论 大多数单侧髋关节完全脱位患者脱位侧患肢长度较非脱位侧延长,其中股骨和胫骨均有延长.脱位侧出现膝外翻畸形的发生率较高,而非脱位侧膝内翻的发生率高.     

Evaluation and compensation of lower limb length discrepancy after surgical treatment of developmental hip dysplasia

Summary The aim of this study was to find a solution for lower limb length discrepancy following surgical treatment of developmental hip dysplasia (DDH) in neglected cases. For this purpose, radiographic examination of 49 hips of 33 children with DDH was made. They were surgically treated by one-stage combined procedure that consisted of open reduction, modified innominate osteotomy and proximal femoral osteotomy. Mean age was 3.5 years and mean follow-up was 34.3 months. In bilateral cases this procedure did not cause notable lower limb length discrepancy. In unilateral cases, it was seen that limb length could be balanced by performing a modified innominate osteotomy producing transiliac lengthening in children older than 4 years. In children younger than 4 years there was no need to perform an acetabuloplasty producing transiliac lengthening because extensive femoral shortening was not needed and femoral overgrowth was sufficient to balance the length of lower limbs. Also avascular necrosis of the femoral head was observed as one of the important factors producing limb length discrepancy in variable degrees.This study was presented in part at the 20th World Congress of SICOT in Amsterdam, The Netherlands, 18–23 August 1996.     

全髋置换术下肢不等长的预防

目的探讨全髋置换术下肢不等长预防方法.方法对50侧（56髋）行全髋置换术,在股骨转子下垂直打入第1枚克氏针（股骨颈骨折者先复位）, 在该针纵轴线相对应的髂嵴上打入第2枚克氏针,测量两针之间的距离.股骨柄假体在试模时将髂嵴上和股骨转子下克氏针插回去, 再次测量两针之间的距离与原先比较,差距用不同尺寸的柄颈和头作相应的调整.结果 50例（56髋）术后经平均1.8年的随访,患者日常生活自理,均不扶拐.两下肢等长48例,相差2.0 cm以内2例.结论该方法实用,疗效较好,有一定的推广价值.     

髋关节置换术中下肢不等长的预防

目的探讨预防或减少髋关节置换术后下肢不等长的有效方法。方法选取需行髋关节置换的患者40例,随机分为实验组和对照组,每组20例。术前测量双下肢长度差异值,实验组术中使用自行设计的下肢等长测量装置,根据术前测量值调节手术侧肢体长度;对照组采用常规手术方法。术后第2天测量患者双下肢长度差异值。术后6个月通过问卷调查,对患者进行满意度调查及患髋的Harris评分。结果术后6个月两组患者均满意,但在满意程度上存在差异;实验组与对照组术后双下肢长度差异值比较,差异有统计学意义（P〈0.05）;实验组与对照组术后患髋Harris评分,差异无统计学意义（P〉0.05）。结论在髋关节置换术中使用下肢等长测量装置,可有效减少或消除髋关节置换术后双下肢不等长,提高患者的满意度。     

In situ leg length measurement technique in hip arthroplasty

In situ femoral preparation refers to implanting a femoral component before the femoral neck osteotomy and without dislocating the hip joint, which allows the implanted femoral component to be used to measure leg length and offset. One hundred hip arthroplasty surgeries among 93 patients were compared with a control group of 15 patients. A modular neck femoral component was implanted in a technique similar to implanting a femoral nail. The differences between the in situ measurements and the preoperative and postoperative radiograph measurements averaged −0.1 mm for leg length (r = 0.89) and −0.37 mm for offset (r = 0.57). In situ leg length measurement allows accurate measurement of leg length and offset and guides surgeons in selecting appropriate modular components to attain a near anatomical hip arthroplasty.     

骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因分析

目的 探讨骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因.方法 采用骨盆Salter截骨治疗63例儿童发育性髋关节脱位.7例术后发生渐发脱位,分析其发生原因.结果 患儿均获得随访,时间12～89个月.术后发生渐发脱位7例中,3例因术后关节囊松弛,不能有效维持关节稳定性,通过佩带髋外展支具后髋关节恢复稳定;2...     

Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip

The precise relationship between developmental dysplasia of the hip and dislocation among patients after total hip arthroplasty has not been well clarified. A total of 820 patients with developmental dysplasia of the hip who underwent total hip arthroplasty from January 2000 to December 2009 were categorized according to Crowe classification, and postoperative dislocation rates were analyzed among subgroups. The overall dislocation rate was 2.93%. No statistically significant differences in dislocation rates were observed between these with and without subtrochanteric osteotomy. Femoral head size was the only factor with significant difference between the dislocated and stable groups, especially when femoral head diameter increased from 28 to 32 mm. Of all dislocations, 69.6% were anterior dislocation, and the degree of cup anteversion and combined anteversion of anterior dislocators was higher than that of the posterior dislocators (P = .0082 and P = .001).     

Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip

A surgical technique, which uses a transverse osteotomy, for subtrochanteric femoral shortening and derotation in total hip arthroplasty for high-riding developmental dislocation of the hip is described. Anteversion is set by rotating the osteotomy fragments, and torsional stability is augmented with allograft struts and cables when indicated. Eight patients with 9 total hip arthroplasties were followed for an average of 43 months (range, 24–84 months). Good to excellent results were obtained in 87% of patients (7 of 8). Eight of 9 osteotomies (89%) demonstrated radiographic evidence of healing at an average of 5 months. One patient had an asymptomatic nonunion of the osteotomy site but still had a good overall clinical result. Another patient suffered fatigue failure of a distally ingrown porous device, which necessitated revision total hip arthroplasty 18 months after surgery. Subtrochanteric osteotomy in total hip arthroplasty for developmental dislocation of the hip allows for acetabular exposure and diaphyseal shortening while facilitating femoral derotation. Furthermore, proximal femoral bone stock is maintained and some of the potential complications of greater trochanteric osteotomy may be avoided.     

The importance of submalleolar deformity in determining leg length discrepancy

Background and purposeThe association of leg length discrepancy (LLD) with a number of clinical disorders has made its determination a significant part of the physical examination. We believe that submalleolar causes of LLD may be under-acknowledged. The most common clinical method used to measure LLD is by tape from the anterior superior iliac spine (ASIS) to medial malleolus which disregards the potential for LLD arising from asymmetry in the foot distal to the tibiotalar joint.MethodsThe present pilot study involves a group of 5 volunteers (experimental group) and a group of 3 patients with flexible flat feet (clinical study). The differences in tibial tubercle height from the ground between full pronation and full supination were measured using the CODA MPX 30^® system (Charnwood Dynamics Limited, Leicestershire, England). Correlations of the patterns within each group were produced.ResultsA significant relationship with leg lengths was found in the experimental group when they induced maximum pronation (R-squared = 0.62, p = 0.007) while an inverse relationship occurred with supination, although marginally significant (R-squared = 0.37, p = 0.064).ConclusionsWe have demonstrated that significant leg length discrepancy can occur in patients who do not have obvious deformity when non weight bearing. We recommend using the blocks method routinely. Appropriately measuring LLD is of vital importance to properly diagnosing and treating patients with unequal leg lengths or related symptoms.