换髋术后实用新型防脱位枕的设计应用与专利技术分析

换髋术术后患者具有较高的髋关节脱位发生率,临床上需要借助一定的医疗器械辅助患者进行相关干预以避免术后关节脱位的发生,目前临床上所使用的传统防脱位器械遇到较多的问题,比如操作复杂繁琐、组装拆卸困难:繁琐复杂的组装拆卸过程大大降低了医务人员的工作效率,且严重影响了患者心理情绪,导致其配合度低;又比如其设计存在一定的安全隐患。本文通过讨论分析本领域技术发展现状及趋势、设计与应用、以及产品优势分析、探索重点技术发展战略及本领域技术空白点。并解析了本设计的重要优势,即具有操作简单可快速组装拆卸、安全性高,且具有避免中药块受损的功能,其设计符合人体构造,极大地满足了患者对舒适度的要求。

老年髋关节置换术应用不同麻醉方式的价值探析

目的探讨老年髋关节置换术应用不同麻醉方式的价值。方法回顾2016年1月—2017年2月84例老年髋关节置换术患者并分组。对照组用全麻方式,研究组用腰硬联合麻醉方式。比较两组老年髋关节置换术麻醉优良率;麻醉起效时间、麻醉后心率、血压变化;麻醉不良事件出现率。结果研究组老年髋关节置换术麻醉优良率高于对照组,P<0.05;研究组麻醉起效时间、麻醉后心率、血压变化优于对照组,P<0.05;研究组麻醉不良事件出现率低于对照组,P<0.05。结论老年髋关节置换术应用腰硬联合麻醉的价值高,可更快起效,稳定生命体征,减少并发症发生,安全和可行性高。

臀上神经最下支的解剖定位及其在髋关节外侧入路中意义

密切结合髋关节直接外侧入路，在２２具（４４侧）成人尸体标本上，重点解剖观测了与该入路关系紧密的臀上神经最下支的走行、入肌点，体表投影和安全区。①在以大转子尖分别作与髂后上棘连续、髂嵴垂直连线、髂前上棘上沿３ｅｍ处髂嵴和髂前上棘连线上，最下支距大转子尖平均分别为５．５±０．６、４．８±０．６、４．３±０．６、６．４±０．８ｃｍ；②在以大转子外侧最凸点分别作与髂后上棘连线、髂嵴连线、髂前上棘上沿６ｃｍ和３ｃｍ处髂嵴连续上，最下支距大转子外侧最凸点平均分别为１０．０±０．８、９，Ｏ士０．８、７．５±０．６、８．９±０．７ｃｍ。上述两组数值所在点作连线即为最下支神经的体表投影，投影以下至大转子尖或大转子外侧最凸点之间无明显血管神经分布，为手术入路的安全区，在安全区内撑开臀中、小肌肌纤维显露髋臼均不会损伤臀上神经。

Application progress on Omaha system in total hip arthroplasty nursing

This article analyzes the application of Omaha system in perioperative continuation nursing and discharge follow-up of patients undergoing total hip arthroplasty in China, and combine the Omaha system with mobile medical to design a mobile management platform APP suitable for patients with total hip arthroplasty, and strengthen professional training for nurses, with the cooperation of multi-disciplinary teams, will be widely applied and promoted in clinical, in order to better manage and improve the nursing outcomes of patients with total hip arthroplasty and enhance the quality of life of patients.

Clinical Trial on the Role of Tuina in Rehabilitation Therapy Following Total Hip Replacement

Objective： To observe the clinical effect of tuina in rehabilitation following total hip replacement. Methods： 60 cases were randomly allocated into a treatment group and control group, 30 cases in each group. Cases in the treatment were treated with combined tuina and rehabilitation, while cases in the control group were treated with rehabilitation alone. All treatment retained for two weeks. The results were observed 7 d, 2 weeks and 6 weeks following the total hip replacement using Harris scale and Hamilton Anxiety Rating Scale （HAMA）. Results： For Harris scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no statistical differences between the two groups 1 d, 7 d and 6 weeks following the total hip replacement （P〉0.05）; and there were statistical differences between the two groups 2 weeks following the total hip replacement. For HAMA scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no significant differences between the two groups 1 d following the total hip replacement; and there were substantial differences between the two groups 7 d, 2 weeks and 6 weeks following the total hip replacement. Conclusion： In a given unit time, combined tuina and rehabilitation is superior to rehabilitation alone in improving the patients＇ post-operative pain, articular range of motion and anxiety.

Prosthetic replacement in treatment of subcapital femoral neck fractures in the elderly

Objective: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF). Methods: Between May 1987 and July 1998, 56 elderly patients (65-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement. Results: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that in Group THR. Conclusions: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bipolar THR installed with cement is indicated for most elderly patients. Since the femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.

Influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations in total hip arthroplasty

Objective： To study the influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations, which meets the criteria for desired range of motion （ROM） for activities of daily living in total hip arthroplasty （THA）. Methods： A three-dimensional generic, parametric and kinematic simulation module of THA was developed to analyze the cup safe-zone and the optimum combination of cup and neck antetorsion. A ROM of flexion ≥ 120°, internal rotation ≥ 45° at 90° flexion, extension ≥ 30° and external rotation ≥ 40° was defined as the criteria for desired ROM for activities of daily living. The cup safe-zone was defined as the area that fulfills all the criteria of desired ROM before the neck impinged on the liner of the cup. For a fixed stemneck （CCD）-angle of 130°, theoretical safe-zones fulfilling the desired ROM were investigated at different general headneck ratios （GR=2, 2.17, 2.37, 2.61 and 2.92） and femoral anteversions （FA=0°, 10°, 20° and 30°）. Results： Large GRs greatly increased the size of safezones and when the CCD-angle was 130°, a GR〉2.37 could further increase the size of safe-zones. There was a complexinterplay between the orientation angles of the femoral and acetabular components. When the CCD-angle was 130°, the optimum relationship between operative acetabular anteversion （OA） and femoral antetorsion （FA） could be estimated by the formula： OA=-0.80×FA＋47.06, and the minimum allowable operative acetabular inclination （OImin） would be more than 2 10.5 ×GR^-2255. Conclusions： Large GRs greatly increase the size of safe-zones and it is recommended that the GR be more than 2.37 so as to extend the acceptable range of error that surgeons cannot avoid completely during operation. As to the optimum operative acetabular inclination （OI）, surgeons need to make a decision combining with other factors, including stress distribution, soft tissue and cup wear conditions, as well as patients＇ individual situations and demands. The data obtained from this study and the module of THA can be used to assist surgeons to choose and implant appropriate implants.

Effects of femoral quality on cementless hip replacement

Objective: To study the clinical influence of femoral quality on cementless hip replacement and to evaluate cortical index (CI) for femoral quality in order to guide prosthesis choice and rehabilitation. Methods: Forty nine cases of cementless hip replacement were followed up for average 3.5 years, 42 of whom had X ray films on preoperation or operation day. Results: Harris scores and patients satisfaction were low but pain was significant and prolonged when cortical indices were low. Conclusions: CI is a reliable semi quantity parameter for clinical evaluation of femoral quality. Osteoporosis patients predispose to thigh pain. Lag for full weight loading and avoidance for torsion motion can contribute to less pain when CI≤ 2.2 .