髋关节中心性骨折脱位

目的 探讨髋关节中心性骨折脱位的发病机理、治疗方法和影响预后的因素。方法 新鲜损伤１２例采用三向分力牵引治疗,陈旧损伤３例采用手术治疗。结果 新鲜损伤优良率占８３％,陈旧损伤,以髋关节功能作为评价标准,满意者２例,不满意者１例。结论 良好的治疗效果有赖于完整的髋臼拱顶和股骨头与髋臼的良好关系,治疗的关键是在砸碎的髋臼和向内变位的骨架塑造一个新的臼窝。     

陈旧性髋关节中心脱位治疗1例

<正>患者,女,64岁,因右髋部疼痛伴跛行43年,加重4年在当地医院就诊。患者43年前在农作时不慎摔伤后感觉右髋部疼痛,因条件受限,未予以任何检查及治疗。自行卧床3个月后可拄拐下床活动,伴右髋部轻度疼痛;经2个月拄拐下床非负重活动后,疼痛缓解,行走尚可,遂弃拐开始负重及田间劳作,之后间断出现髋部疼痛,并逐渐加重。当地医     

先天性髋关节脱位

先天性髋脱位是小儿骨科最常见的四肢畸形，治疗越早，效果越好。发病率与种族、不同国家、不同地区有很大差异，比如，意大利高达1％，法国为0．4％，中国沈阳为0．175％．上海为0．091％，香港为0．007％。一般认为白种人发病率高，黑种人低；中国北方发病率高，南方发病率低；女孩发病率高，男孩发病率低。     

切开复位内固定治疗严重移位的髋关节中心脱位

本文报导了21例髋关节中心脱位的手术方法及手术治疗体会。手术中内固定以克氏针及钢板螺丝钉为主,强调了手术前后牵引的重要性及方法。平均随访时间38.8个月。获得80.9％的优良率。是一种可供选择的治疗方法。     

髋关节中心型骨折脱位的手术治疗

本文报告２５例移位髋关节中心型骨折脱位的手术治疗，其中髋臼横形骨折１２例，横形加后壁骨折４例，后柱骨折６例，Ｔ形骨折３例。经手术治疗骨折达到解剖复位１８例，满意复位７例。受伤距手术时间５ｄ～８０ｄ，平均１６ｄ。术后随访１０月～３４月，平均２６月。髋关节屈曲８０°～１３０°，平均１１６°。作者认为髋关节中心型骨折块存在旋转移位，限制复位的主要因素是骶棘韧带和骶结节韧带。通过术前闭合整复牵引治疗试验，手术开放复位难度观察及局部病理解剖变化的情况，提出只有通过手术才能将移位的髋臼骨折复位。对于Ｔ形骨折前柱的暴露将传统的髂腹股沟切口改为髂股切口，强调治疗的重点应放在月状关节面而非整个髋臼的概念     

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。     

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。     

青少年先天性髋关节脱位手术治疗

目的 :探讨青少年先天性髋关节脱位的手术治疗。方法 :18例 2 2髋青少年先天性髋关节脱位 ,其中 16髋术前不牵引 ,一期综合手术矫正全部畸形。手术步骤包括彻底软组织松解 ,股骨粗隆下短缩、去旋转、内翻截骨 ,髋臼覆盖重建 ,准确地同心圆中心关节复位。双侧脱位 4髋行原位髋臼加盖术。结果 :本组 16髋术后均获得满意复位 ,其中 12例 14髋随访 18～ 72个月 ,平均 (3 8± 10 .5 )个月 ,按Muller和Seddon的标准 ,优 4髋 ,良 7髋 ,可 2髋 ,差 1髋。结论 :对青少年单侧先天性髋关节脱位应积极综合手术复位 ,对双侧脱位者应慎重选择复位术。     

学龄儿童先天性髋关节脱位的手术治疗

总结和探讨不同方法的手术治疗学龄儿童发育性髋关节脱位的经验。方法：采用Ｓａｌｔｅｒ法,Ｃｈｉａｒｉ法,髋臼加盖成形术和联合手术共治疗６岁半～１３岁患者５６例７０个髋关节。结果：４８例６０个髋关节获随访,时间５～２５年,平均１０．４年。优良率为８７％。结论：学龄儿童患者的手术应根据每人的具体病理情况严格掌握手术适应证,针对性极强地选择术式。其中,髋臼加盖成形术有效地增加了髋臼的宽度,很好地解决了股骨头的包容和覆盖,手术不用内固定,可使患者免受二次手术取除内固定之苦,是一种适应证较宽,疗效好和值得提倡的手术。     

Serum Enzymes After Hip Joint Surgery

The effect of hip joint surgery on routine serum enzyme values was studied. The increase in creatine kinase was most marked and normal levels were restored again after approximately 1 week. Asparatate aminotransferase was slightly elevated throughout the first two postoperative weeks. Alanine aminotransferase was essentially unchanged during the first three postoperative days in contrast to lactate dehydrogenase which reached preoperative values again after only 2–3 days. Alkaline phosphatase showed an increase after 1 week whereas S-amylase was essentially normal throughout the 2 weeks studied.     

Serum Enzymes After Hip Joint Surgery

The effect of hip joint surgery on routine serum enzyme values was studied. The increase in creatine kinase was most marked and normal levels were restored again after approximately 1 week. Asparatate aminotransferase was slightly elevated throughout the first two postoperative weeks. Alanine aminotransferase was essentially unchanged during the first three postoperative days in contrast to lactate dehydrogenase which reached preoperative values again after only 2-3 days. Alkaline phosphatase showed an increase after 1 week whereas S-amylase was essentially normal throughout the 2 weeks studied.     

Chopart关节骨折脱位的临床治疗

目的 探讨Chopart关节骨折脱位的临床治疗策略和方法.方法 回顾性分析自1999年12月～2008年12月收治的93例共95足Chopart关节骨折脱位患者的临床资料,运用美国足踝矫形外科协会(AOFAS)中足评分及视觉模拟评分(VAS)来评价其长期治疗效果.结果 86例获得平均8.4个月的随访,按AOFAS中足部分的评分标准:优62例,良19例,可4例,差1例:VAS评分平均2.6分.最初治疗即予以切开解剖复位者获得了更好的治疗结果(P<0.05).结论 通过急症手术治疗Chopart关节骨折脱位,可比单纯应用闭合复位方法获得更好的治疗效果.     

先天性髋关节脱位64例治疗分析

目的：探讨先天性髋关节脱位的治疗。方法：本组先天性髋关节脱位64例，男12例，女52例；非手术治疗12例，手术治疗52例；结果：随访46例，随访时间1．5－20年，根据邸氏评定标准，优19例，良15例，欠佳8例，失败4例，优良率为73％。结论：对先天性髋关节脱位的治疗要选择好适应证及术式，避免失误，争取最佳疗效。     

髋臼加深全髋置换治疗成人先天髋臼发育不良

目的：探索成人先天性髋臼发育不良伴髋关节半脱位的手术治疗方法。材料和方法：12例成人先天性髋臼发育不良伴髋关节半脱位患者采用髋臼加深髋关节置换的方法治疗。结果：经1－8年随访,段体稳定,髋关节疼痛症状消失,关节功能基本正常。结论：髋臼加深全髋关节置换是成人先天性髋臼发育不良伴髋关节半脱位的有效治疗方法。     

Patient-Reported Outcomes and Perioperative Complications of Total Hip Arthroplasty Following Joint Preservation Surgery for Hip Dysplasia

BackgroundThere is growing recognition of the importance of patient-reported outcome measures and assessment of patient satisfaction in the evaluation of outcomes following surgical interventions. This study aimed to evaluate patient-reported outcomes and complication rates after total hip arthroplasty following joint preservation surgery for hip dysplasia.MethodsPatient-reported outcomes and complication rates of 85 hips with previous joint preservation surgery (salvage group) were compared with those of 1279 hips without joint preservation surgery (primary arthroplasty group). As a patient-reported outcome measure, the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to evaluate the hip condition both preoperatively and 12 months postoperatively. Operative data and postoperative (within 12 months) complications were investigated.ResultsThe salvage group had a longer operative time (56.8 vs 44.9 minutes, P < .001) and a higher total complication rate (5.9% vs 1.1%, P < .001). Additionally, the salvage group exhibited a lower degree of improvement in the visual analog scale value for satisfaction (75.1 vs 83.1 mm, P = .011), the pain and movement category scores, and the total score of the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (14.2 vs 16.2, P = .031; 13.7 vs 16.0, P = .005; and 42.3 vs 47.9, P = .007, respectively) compared with the primary arthroplasty group.ConclusionThis study demonstrated a lower rate of improvement in patient satisfaction and worse self-reported outcomes in the salvage group. Furthermore, these patients had a longer operative time and a higher risk of operative complications.     

髋关节骨折脱位22例报告

作者在1987年1月至1994年3月间收治髋关节骨折脱位22例,占同期收治62例髋关节后脱位的34.9%.按改良的Stward分型,Ⅰ型2列,Ⅱ型5例,Ⅲ型4例,Ⅳ型6例,Ⅴ型5例.新鲜伤16例,陈旧伤6例.均为闭合性.误漏诊3例.对Ⅰ、Ⅲ型采取保守治疗;对Ⅱ、Ⅳ、Ⅴ型大部分采取手术治疗.其中16例随访平均3年8个月,疗效11例满意,3例基本满意,2例不满意,满意与基本满意率为87.5%.对髋关节骨折脱位的分型、治疗方法及内固定方法进行了讨论,主张有选择和有节制的手法复位,手法复位失败及陈旧性者采取早期切开复位及内固定.介绍一种可吸收性聚乙交酯(SR—PGA)螺钉及固定棒治疗股骨头骨折,认为此种可吸收性材料不需二次手术取出,对关节内骨折经软骨内固定具有特殊的优越性.     

Indomethacin Treatment in Osteoarthritis of the Hip Joint: Does the Treatment Interfere with the Natural Course of the Disease?

The course of osteoarthritis in 294 hips of 186 patients was evaluated by examining their radiographs. The development of the disease in patients treated with indomethacin was compared with that in a control material. In the indomethacin group the disease progressed more frequently and in one parameter the progress was more severe. The results support previous reports indicating that indomethacin might have a deleterious effect on osteoarthritic hip joints. Some possible explanations for this adverse effect of indomethacin treatment are discussed.     

骨折髋支撑关节治疗股骨颈骨折

目的介绍骨折髋支撑关节治疗股骨颈骨折的临床疗效。方法骨折髋支撑关节由骨折髋臼杯、塑料髋臼和骨折人工股骨头组成。股骨颈骨折多钉固定,髋关节内放置骨折髋支撑关节,加大股骨头包容,减少股骨头负重,使股骨头颈得以修复。结果放置骨折髋支撑关节30例(30髋),术后3周持拐行走,3～4个月逐渐恢复工作与生活。髋关节活动功能接近正常。X线片显示股骨颈骨折及股骨头愈合良好。结论骨折髋支撑关节为股骨颈骨折治疗提供了一种较理想的方法。