人工半肩关节置换9例的术后康复训练

肩关节是人体活动度最大的关节,人工肩关节置换的目的是最大程度恢复肩关节的功能和活动度[1,2].肩关节假体置换术按置换范围分为半肩关节置换和全肩关节置换两大类.我科2008-01- 2009-12对9例患者施行半肩关节人工假体置换术,经过术后康复训练指导,患者术侧肩关节功能恢复良好,观将康复训练体会报告如下.     

人工股骨头半髋关节置换术后疼痛翻修27例

目的:探讨人工股骨头长期使用后髋关节疼痛原因及其行人工全髋关节置换术翻修必要性。方法:①观察对象:选择1989-01/2000-12在赣南医学院第一附属医院住院治疗的人工股骨头半髋关节置换后翻修术患者27例(30髋),男7例,女20例;年龄65～80岁。②手术方法:采用髋关节外侧切口,取出陈旧股骨柄,尽量保留髋臼周围的骨组织,以使再次植入的髋臼假体获得良好的初始固定,残存的髋臼必须要有足够的骨量,髋臼前后柱、骨缺损区可以植入自体或异体骨。股骨柄取出后,用克氏针向髓腔远端钻导向孔,再用髓腔钻打通髓腔。术后3周开始下床扶拐非负重活动,6周后开始扶拐部分负重。③实验评估:采用患者自我评价法评估患者对手术满意度;采用Harris评分评价患者髋关节功能;X射线片观察假体位置及与周围骨质匹配情况,并观察不良事件及副反应。结果:27例患者随访时间36个月,全部进入结果分析。①患者对手术满意度:患者自我评价非常满意10髋,满意17髋,不满意3髋。②患者髋关节功能Harris评分:由术前的平均42.6分,提高到术后的平均84.2分。③患者X射线片观察结果:术后X射线片显示股骨柄和髋臼假体的位置以及假体与周围的骨质匹配良好,无一例出现松动和感染征象。④不良事件及副反应:无一例出现伤口感染、脱位、骨折和神经损伤等并发症,临床检查无任何松动迹象。结论:假体松动、髋臼退行性病变、髋臼底变薄、人工股骨头中心性脱位是造成髋关节疼痛的主要原因,全髋关节置换术翻修能明显改善这些患者的髋关节疼痛。     

人工全膝关节置换的术后康复

人工全膝关节置换术目前已成为治疗各种疾病导致膝关节毁损病变的重要手段.人工关节置换术后的康复治疗也已经成为手术不可缺少的一部分,使得最终疗效达到了一个很高的水平.并且经长期随访的主、客观指标及患者自我评价均较高 [1- 2].     

人工髋关节翻修术麻醉处理30例分析

我院自1995年以来行人工髋关节翻修术30例，手术创伤及出血量较大，麻醉处理较困难，总结分析如下。     

数字化人工髋关节置换的术前设计

目的应用数字化影像技术对人工髋关节置换进行术前设计。方法应用数字化影像和数字模板在计算机上进行术前测量并选择假体型号，并与手术中实际应用的假体型号进行比较。结果术前设计假体型号与术中实际应用假体型号相比较，髋臼假体的准确率达71．59％，股骨假体准确率达78．04％。结论应用数字化技术对人工髋关节置换行术前设计具有较高的准确率和可信度。     

人工髋关节翻修术80例临床分析

【目的】回顾分析80例人工髋关节翻修术的病因,并探讨相关翻修技术。【方法】1992年6月至2005年6月共进行了80例人工髋关节翻修术,对前次手术翻修的原因进行分析并对翻修术的技术问题作了讨论。【结果】翻修原因占第一位的为假体松动、假体周围骨溶解共48例,人工股骨头引起髋臼磨损18例,医源性因素如适应证选择不当、假体位置不良、手术操作失误等共10例,术后感染4例。随访时间2-10年,平均随访3.8年,按Harris评分,优46髋,良20髋,可14髋,优良率为82.5%。【结论】引起人工髋关节置换术后翻休的主要原因是假体无菌性松动,翻修术中应合理地选择髋臼的修复、重建方法,但也应重视提高首次手术质量。     

非肿瘤性肩关节损伤与人工肩关节置换

目的:分析假体的选择与手术操作技术对非肿瘤性肩关节损伤人工肩关节置换术治疗的影响。方法:选择2001-04/2006-10在上海长征医院、西藏军区总医院、扬州第一人民医院等进行肩关节置换术患者33例。肱骨急性近端粉碎性骨折28例:行单极人工肩关节置换术17例,双极人工肩关节置换术1例,全肩关节置换术3例。肱骨头缺血坏死2例、骨性关节炎3例,均行全肩关节置换术。术后9个月时22例患者参加随访,18个月时17例参加随访,30个月时5例参加随访。结果:33例患者均进入结果分析。①1例肱骨假体留置过长致肩关节上举运动痛、静止不痛,翻修术后缓解。其余32例完全不疼。②术后患者上举85°～130°,平均(98.7±6.0)°,外旋17°～36°,平均(30.0±5.7)°。内旋75°～101°,平均(82.5±4.8)°。③患者假体置位较好,除1例肱骨假体未完全插入髓腔,翻修后正常。④材料与组织的生物相容性能:符合美国FDA及欧洲CE标准。结论:针对患者的具体情况选用合适的人工肩关节假体,术中假体固定方法的选择以及术后外固定材料的佩戴对肩袖功能有重要影响。     

让昨天告诉今天:人工肩关节置换的P-术与技术进展

1892年,法国医生Julyes Pean在巴黎的Hospital St.Louls对一位患有肱骨近端大结节脓肿的年轻人进行了第1例有文献记载的人工肩关节置换手术.     

人工全髋关节翻修术16例的护理

目的通过16例全髋关节翻修术的临床案例,探索护理方法。方法应用术前、术后系统化护理,分析康复情况。结果 16例患者均康复出院,未发现感染、脱位、下肢静脉血栓等并发症。结论加强术前、术后护理,可以减少或避免并发症的发生。     

TKA术后感染翻修19例治疗分析

目的：对人工膝关节术后感染接受二次翻修术的膝关节进行评估。方法：2004-02/2005-12所遇到的全膝关节置换术后感染的病例19例,行二期翻修术即一期手术取出原假体,彻底清创,置入抗生素骨水泥占位器,术后使用6周以上的敏感抗生素,二期手术做假体翻修术。结果：平均随访1 a 6个月,没有翻修的膝关节发生感染或者无菌性松动,患肢功能恢复较满意。结论：应该尽量采用二期翻修术处理TKA术后感染,以彻底清除感染灶,使患者获得良好的功能。     

Total joint arthroplasty. The shoulder.

The experience with total shoulder replacement has led to a greater understanding of the large spectrum of pathology which is associated with glenohumeral cartilage loss. For the majority of patients, a simple "resurfacing" prosthesis with muscle repair is the best choice. With this type of implant, pain relief is consistent (92% in 50 shoulders), mechanical failures are rare (2%), and, with repair of all muscles, an opportunity is provided for maximal return of function.     

Reverse shoulder arthroplasty

The reverse shoulder arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total shoulder arthroplasty. Grammont revolutionized the design by medializing and distalizing the center of rotation and utilizing a large convex glenoid surface and concave humeral component with a neck-shaft angle of 155°. This design has been highly successful in cuff deficient shoulders, and indications continue to broaden. Many mid-term studies have improved upon the early encouraging results. Long-term studies are starting to emerge, demonstrating good survivorship, but progressive functional and radiographic deterioration continue to be concerning. Careful patient selection and attention to appropriate technique are required to reduce the current high rate of complications. New prosthesis designs are continuing to develop to address some of these limitations.     

Revision total hip arthroplasty

Endoscopic visualization and pneumatically-powered ballistic chisels that can be used to remove cement and cementless prostheses are recent developmental improvements for revision total hip arthroplasty (THA). Use of these new tools facilitates the revision procedure, reduces tissue trauma, and may reduce surgical time. Understanding the anatomy of the hip joint, pathophysiology that leads to the need for joint replacement, and the implant selection process can assist perioperative nurses in caring for and teaching patients who require revision THA and their family members. This article describes implant choices based on the type of bone deformity present and the use of the ballistic chiseling system during revision THA. Potential postoperative complications also are described. AORN J 76 (Sept 2002) 414-427.     

Platform systems in shoulder arthroplasty

A platform system for shoulder arthroplasty can include a convertible modular humeral stem and/or a metal-backed glenoid component to facilitate straightforward conversion from either a hemiarthroplasty or anatomic total shoulder arthroplasty to a subsequent anatomic total shoulder arthroplasty, or more frequently, reverse total shoulder arthroplasty without any revision to the stem and/or glenoid baseplate. Recent studies have demonstrated a decreased rate of intraoperative humeral fracture, complications, and blood loss when a platform system is used and the humeral stem is not exchanged during revision arthroplasty. Future studies with larger patient cohorts are necessary to truly evaluate the potential value and limitations of this technology.     

Kinematic impact of size on the existing glenohumeral joint in patients undergoing reverse shoulder arthroplasty

Background

Glenohumeral relationships in reverse shoulder arthroplasty patients have not been previously reported. The purpose of this study was to quantify and compare the shoulder spatial relationships and moment arms. Measurements were used to define general size categories and determine if sizes scale linearly for all metrics.

Methods

Ninety-two shoulders of patients undergoing primary reverse shoulder arthroplasty for functionally-deficient massive rotator cuff tear without bony deformity or deficiency were evaluated using three-dimensional CT reconstructions and computer-aided design software. Multiple glenohumeral relationships (including moment arm) were measured and evaluated for size stratification and linearity. Generalized linear modeling was used to investigate how predictive glenoid height, coronal humeral head diameter, and gender were of greater tuberosity positions.

Findings

The 92 shoulders were grouped based on glenoid height: small (< 33.4 mm), medium (33.4–38.0 mm), and large (> 38.0 mm). All relationships varied between groups. The humeral head size, glenoid width, lateral offset, and moment arm all independently increased linearly (r² ≥ 0.92) but the rate of increase varied (slope range: 0.59–1.92). Glenoid height, coronal humeral head diameter and gender predicted the greater tuberosity position within mean 1.09 mm (standard deviation (SD) 0.84 mm) of actual position in 90% of the population.

Interpretation

Distinct groups exist based on the size of the glenoid in shoulder arthroplasty patients. Shoulder modeling should account for size groups, sex, and non-uniform linear scaling of morphometric parameters. Prediction of the greater tuberosity offset can be made using sex and size parameters. Clinical implications include appropriate prosthetic size selection and avoiding large deviations in non-anatomic reconstructions.     

The glenoid in total shoulder arthroplasty

Management of glenohumeral arthrosis with a total shoulder prosthesis is becoming increasingly common. However, failure of the glenoid component remains one of the most common causes for failure. Our understanding of this problem has evolved greatly since the first implants were placed in the 1970’s. However glenoid failure remains a challenging problem to address and manage. This article reviews the current knowledge regarding the glenoid in total shoulder arthroplasty touching on anatomy, component design, implant fixation, causes of implant failure, management of glenoid failure and alternatives to glenoid replacement.     

人工膝关节置换治疗重症膝关节病118例

选择2000-06/2007-01贵州省人民医院骨科收治的行人工全膝关节置换患者118例(138膝),男45例,女73例;年龄52～81(61±8)岁;类风湿性关节炎28例(34膝),创伤性关节炎6例(6膝),严重骨性关节炎84例(98膝),其中合并外翻畸形14例(18膝),合并内翻畸形25例(28膝).所选假体类型Link Gemini假体38膝,Zimmer Nexgen 68膝,Depuy pfc sigma旋转平台32膝.全部患者均获得随访,随访时间10个月～6 年(平均28个月).置换前膝关节HSS评分(34.00±7.65)分,末次随访时 (81.00±6.89)分,其中优87膝(63%),良43膝(31%),可8膝(6%),优良率94%.118例患者中发生感染4例,3例单膝置换后下肢发生深静脉血栓形成,经抗凝及对症处理痊愈.3例(4膝)置换后2个月发生膝关节疼痛,检查膝关节无红肿,无压痛,活动度基本正常,摄X射线平片示假体位置良好,行股神经封闭后症状缓解.提示全膝关节置换是治疗重症膝关节疾病的有效方法.