目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关...目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关节镜手术的患者共32例,其中男8例、女24例,年龄39.41±16.27岁(18~59岁),平均髋臼外侧中心边缘角(lateral centre-edge angle,LCEA):21.25°±2.96°(18°~25°)。匹配同期的行髋关节镜手术治疗的髋臼股骨撞击症(femoral acetabular impingement,FAI)患者32例作为对照组,男15例、女17例,年龄42.78±12.18岁(24~70岁),平均LCEA:32.97°±4.96°(26°~42°)。所有患者均采用髋关节镜下盂唇修复、头颈区成形、关节囊缝合术治疗。采用改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)、视觉模拟评分(VAS),对患者术前、术后3月、术后12月、术后24月进行功能评分测量。结果:BDDH组和FAI组所有病例均获得随访,随访时间分别为27.6±5.4月、28.3±6.5月。FAI组和BDDH组术前m HHS、HOS-SSS、HOS-ADL和VAS评分的差异无统计学意义(P>0.05)。两组术后3月、12月、24月时mHHS、HOS-SSS、HOS-ADL评分均较术前明显提高,术后VAS评分均较术前明显降低,差异有统计学意义(P<0.001)。在术后3月、12月、24月时BDDH组的m HHS评分均较FAI组低,差异有统计学意义(P<0.05)。在术后3月时BDDH组的HOS-SSS、HOS-ADL分均较FAI组低,差异有统计学意义(P<0.05)。其他随访时间点,两组的各项评分指标无统计学差异(P>0.05)。所有患者在随访期间,均未因症状复发而行再次手术治疗。结论:髋关节镜技术治疗临界发育性髋关节发育不良可获得良好的短期疗效。展开更多
背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,...背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,分析总结其优势与不足,并探讨未来进一步研究的方向及应用前景。方法:应用计算机在Pub Med、SCI、CBM和中国知网数据库中检索2014年1月至2023年11月发表的相关文献,以“developmental dysplasia(dislocation) of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children”为英文检索词,以“发育性髋关节发育不良,发育性髋关节脱位,髋关节发育不良,儿童,有限元,Pavlik吊带,人字型固定,生物力学,骨盆截骨术,髋臼周围截骨术”为中文检索词,同时纳入少量远期文献,通过筛选最终纳入62篇文献进行分析。结果与结论:(1)儿童发育性髋关节发育不良髋关节力学环境异常,髋臼内部压力不均匀、应力增大并集中,关节接触面积减小,股骨颈局部应力集中;(2)在Pavlik吊带及人字型固定位患髋力学环境改善,集中的高应力区域消失,关节接触面积增加,但外展角度过大会导致髋臼及股骨头外侧应力增加;(3)骨盆截骨术治疗后髋关节及骶髂关节应力环境得到改善,3种截骨术没有单一的铰链,其应力负载部位因患儿年龄而存在差异;(4)髋臼周围截骨术治疗后关节接触压力接近正常,而非球形股骨头者恢复困难;(5)术后X射线片表现不能说明关节接触力学达到最佳;(6)提示利用有限元法可以获得体内无法测量的信息,其在虚拟环境中操作不受时间和伦理的限制;能直观地看到正常与发育性髋关节发育不良患者髋关节应力变化的区域,从力学角度说明治疗的有效性,为需要截骨手术治疗的患者建立特定的有限元模型、量身定做手术计划;发育性髋关节发育不良的有限元建模及儿童髋关节材料特性参数尚无规范、统一的标准,由于有限元固有的局限性,目前还不能分析同时包含骨骼、软骨、韧带、肌肉等元素的模型;有限元分析操作难度较大,虽有优势但不具普适性,且目前的研究样本量较少,还需进一步扩大及验证。展开更多
Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline d...Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.展开更多
目的观察3D打印模型及模拟手术在发育性髋关节发育不良(developmental dysplasia of the hip,DDH)全髋关节置换术(total hip arthroplasty,THA)中的应用效果。方法以2020年8月至2022年10月联勤保障部队第九二二医院骨一科收治的60例DDH...目的观察3D打印模型及模拟手术在发育性髋关节发育不良(developmental dysplasia of the hip,DDH)全髋关节置换术(total hip arthroplasty,THA)中的应用效果。方法以2020年8月至2022年10月联勤保障部队第九二二医院骨一科收治的60例DDH患者作为研究对象,采用随机数字表法进行分组,每组各30例。A组按照常规操作完成THA术,B组采用3D打印技术制作患髋实体模型进行手术方案设计和模拟手术。A组男13例,女17例;年龄36~69岁,平均(54.81±7.03)岁。B组男10例,女20例;年龄35~70岁,平均(52.09±7.44)岁。比较两组手术指标、术后恢复指标、术前及术后假体匹配率、术中股骨劈裂骨折发生率、术后髋臼-股骨联合前倾角、并发症发生率、术前及术后4周髋关节功能[Harris髋关节评分(Harris hip score,HHS)]。结果B组术中出血量较A组少,手术时间、术后下地时间、住院时间较A组短(P<0.05);B组术前、术后假体匹配率(90.00%)较A组(30.00%)高,术中股骨劈裂骨折发生率(0.00%)较A组(50.00%)低(P<0.05);术后4周,两组HHS评分均较术前上升(P<0.05),组间对比差异无统计学意义(P>0.05);两组术后髋臼-股骨联合前倾角比较差异无统计学意义(P>0.05);两组患者术后均未出现股神经及坐骨神经损伤、假体松动及脱位、肺栓塞、下肢深静脉血栓、假体周围骨折、关节感染等并发症。结论3D打印模型及模拟手术应用于DDH患者THA术中效果确切,能提高假体匹配率,降低术中股骨劈裂骨折发生率,缩短手术时间,减少术中出血量,促进康复,值得临床推广应用。展开更多
文摘背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,分析总结其优势与不足,并探讨未来进一步研究的方向及应用前景。方法:应用计算机在Pub Med、SCI、CBM和中国知网数据库中检索2014年1月至2023年11月发表的相关文献,以“developmental dysplasia(dislocation) of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children”为英文检索词,以“发育性髋关节发育不良,发育性髋关节脱位,髋关节发育不良,儿童,有限元,Pavlik吊带,人字型固定,生物力学,骨盆截骨术,髋臼周围截骨术”为中文检索词,同时纳入少量远期文献,通过筛选最终纳入62篇文献进行分析。结果与结论:(1)儿童发育性髋关节发育不良髋关节力学环境异常,髋臼内部压力不均匀、应力增大并集中,关节接触面积减小,股骨颈局部应力集中;(2)在Pavlik吊带及人字型固定位患髋力学环境改善,集中的高应力区域消失,关节接触面积增加,但外展角度过大会导致髋臼及股骨头外侧应力增加;(3)骨盆截骨术治疗后髋关节及骶髂关节应力环境得到改善,3种截骨术没有单一的铰链,其应力负载部位因患儿年龄而存在差异;(4)髋臼周围截骨术治疗后关节接触压力接近正常,而非球形股骨头者恢复困难;(5)术后X射线片表现不能说明关节接触力学达到最佳;(6)提示利用有限元法可以获得体内无法测量的信息,其在虚拟环境中操作不受时间和伦理的限制;能直观地看到正常与发育性髋关节发育不良患者髋关节应力变化的区域,从力学角度说明治疗的有效性,为需要截骨手术治疗的患者建立特定的有限元模型、量身定做手术计划;发育性髋关节发育不良的有限元建模及儿童髋关节材料特性参数尚无规范、统一的标准,由于有限元固有的局限性,目前还不能分析同时包含骨骼、软骨、韧带、肌肉等元素的模型;有限元分析操作难度较大,虽有优势但不具普适性,且目前的研究样本量较少,还需进一步扩大及验证。
文摘Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.
文摘目的观察3D打印模型及模拟手术在发育性髋关节发育不良(developmental dysplasia of the hip,DDH)全髋关节置换术(total hip arthroplasty,THA)中的应用效果。方法以2020年8月至2022年10月联勤保障部队第九二二医院骨一科收治的60例DDH患者作为研究对象,采用随机数字表法进行分组,每组各30例。A组按照常规操作完成THA术,B组采用3D打印技术制作患髋实体模型进行手术方案设计和模拟手术。A组男13例,女17例;年龄36~69岁,平均(54.81±7.03)岁。B组男10例,女20例;年龄35~70岁,平均(52.09±7.44)岁。比较两组手术指标、术后恢复指标、术前及术后假体匹配率、术中股骨劈裂骨折发生率、术后髋臼-股骨联合前倾角、并发症发生率、术前及术后4周髋关节功能[Harris髋关节评分(Harris hip score,HHS)]。结果B组术中出血量较A组少,手术时间、术后下地时间、住院时间较A组短(P<0.05);B组术前、术后假体匹配率(90.00%)较A组(30.00%)高,术中股骨劈裂骨折发生率(0.00%)较A组(50.00%)低(P<0.05);术后4周,两组HHS评分均较术前上升(P<0.05),组间对比差异无统计学意义(P>0.05);两组术后髋臼-股骨联合前倾角比较差异无统计学意义(P>0.05);两组患者术后均未出现股神经及坐骨神经损伤、假体松动及脱位、肺栓塞、下肢深静脉血栓、假体周围骨折、关节感染等并发症。结论3D打印模型及模拟手术应用于DDH患者THA术中效果确切,能提高假体匹配率,降低术中股骨劈裂骨折发生率,缩短手术时间,减少术中出血量,促进康复,值得临床推广应用。
