Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
目的:探讨127°小颈干角和135°大颈干角假体行全髋关节置换术(total hip arthroplasty,THA)的疗效。方法:2014年1月至2016年6月行THA患者84例,男44例,女40例;年龄45~72(53.4±8.1)岁,股骨头坏死68例(左侧32例,右侧36例),...目的:探讨127°小颈干角和135°大颈干角假体行全髋关节置换术(total hip arthroplasty,THA)的疗效。方法:2014年1月至2016年6月行THA患者84例,男44例,女40例;年龄45~72(53.4±8.1)岁,股骨头坏死68例(左侧32例,右侧36例),其他原因导致严重髋关节骨性关节炎16例,病程9~36(24.0±5.5)个月。分别采用小颈干角(127°)和大颈干角(135°)假体,每组42例,术后两组患者进行髋关节Harris评分,疼痛视觉模拟评分(visual analogue scale,VAS)评分,双下肢长度测量,不同颈干角生物力学评估,比较术后并发症发生情况以及患者术后24个月生活质量。结果:两组患者各有2例患者失访,其余患者均获得随访,随访时间30~36(33.0±1.6)个月。术前及术后1、6、12、24个月进行Harris评分及双下肢长度测量,两组患者髋关节Harris评分及双下肢长度差与术前比较均得到明显改善(P<0.05),而组间差异无统计学意义(P>0.05)。两组术后1、6、12、24个月VAS评分均低于术前(P<0.05);两组VAS评分术前差异无统计学意义(P>0.05),但术后大颈干角组VAS评分明显低于小颈干角组(P<0.05)。两组术后并发症(包括假体松动、脱位)的发生率差异无统计学意义(P>0.05)。两组患者术后24个月生活质量较术前生活质量明显提高(P<0.05),且组间比较发现135°大颈干角组生活质量较127°小颈干角组生活质量更高(P<0.05)。结论:大、小颈干角假体的THA均能较好地恢复患者髋关节的功能,但是大颈干角更能降低术后疼痛程度,进而提高患者术后的生活质量。展开更多
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
文摘目的:探讨127°小颈干角和135°大颈干角假体行全髋关节置换术(total hip arthroplasty,THA)的疗效。方法:2014年1月至2016年6月行THA患者84例,男44例,女40例;年龄45~72(53.4±8.1)岁,股骨头坏死68例(左侧32例,右侧36例),其他原因导致严重髋关节骨性关节炎16例,病程9~36(24.0±5.5)个月。分别采用小颈干角(127°)和大颈干角(135°)假体,每组42例,术后两组患者进行髋关节Harris评分,疼痛视觉模拟评分(visual analogue scale,VAS)评分,双下肢长度测量,不同颈干角生物力学评估,比较术后并发症发生情况以及患者术后24个月生活质量。结果:两组患者各有2例患者失访,其余患者均获得随访,随访时间30~36(33.0±1.6)个月。术前及术后1、6、12、24个月进行Harris评分及双下肢长度测量,两组患者髋关节Harris评分及双下肢长度差与术前比较均得到明显改善(P<0.05),而组间差异无统计学意义(P>0.05)。两组术后1、6、12、24个月VAS评分均低于术前(P<0.05);两组VAS评分术前差异无统计学意义(P>0.05),但术后大颈干角组VAS评分明显低于小颈干角组(P<0.05)。两组术后并发症(包括假体松动、脱位)的发生率差异无统计学意义(P>0.05)。两组患者术后24个月生活质量较术前生活质量明显提高(P<0.05),且组间比较发现135°大颈干角组生活质量较127°小颈干角组生活质量更高(P<0.05)。结论:大、小颈干角假体的THA均能较好地恢复患者髋关节的功能,但是大颈干角更能降低术后疼痛程度,进而提高患者术后的生活质量。
