全髋关节置换术治疗陈旧性髋臼后壁后柱骨折1例报道

年轻患者的髋臼骨折是一种高能量损伤,可能合并股骨头、髋臼软骨和关节盂损伤,该类患者移位的髋臼骨折通常需要切开复位内固定(open reduc-tion and internal fixation, ORIF)以恢复髋关节的解剖结构。但不论采用何种治疗方式,仍有一部分人最终发展为严重创伤性关节炎和股骨头缺血坏死,还可能存在骨折不愈合、畸形愈合、骨缺损、关节对合关系丧失等,导致髋关节疼痛和僵硬,严重影响生活质量,需要行全髋关节置换术(total hip arthroplasty,THA).

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。

后外侧小切口微创技术在骨水泥型全髋关节术中的应用

【目的】探讨后外侧小切口微创技术在骨水泥型全髋关节置换的方法与手术效果。【方法】自2003年3月至2004年6月,采用后外侧小切口微创技术,行骨水泥型人工全髋关节置换术,切口长7～9cm,平均8.2cm。【结果】所有患者手术均在术前设计的切口下顺利进行,切口7～9cm,平均8.2cm,术后平均随访24(12～30)个月,X线检查示假体位置良好,除1例术后切口轻度脂肪液化经治愈外,无术后并发症,功能评价按Harris评分由术前33(6～46)分,增加为93(75～100)分。【结论】后外侧小切口微创骨水泥全髋关节置换术具有创伤小、手术时间短、出血少、病人易接受等优点,但应严格掌握手术指征并且备有熟练的操作技术。

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.

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective： Total hip arthroplasty （THA） and hemiarthroplasty （HA） are effective methods currently used to treat femoral neck fracture in elderly patients, but the two options remain controversial in patients over 70 years old. The main purpose of our study was to determine whether THA or HA is a superior treatment of femoral fractures involving a displaced neck in patients who are over 70 years of age. Methods： A computer-based online search of Medline （1970-2011）, PubMed （1977-2011）, and the Cochrane Cen- tral Register of Controlled Trials （2002-201 l） was conducted. Six relevant randomized controlled trials with a total of 739 patients were included for the final analysis. The analysis was performed with software RevMan 5.0. Results： We found that compared with THA, HA needed shorter average time and lost less blood. While over the long-term follow-up, THA patients exhibited significantly less pain and better function and were less likely to require a revision hip surgery. Postoperative infection was equally common among HA and THA patients. Conclusions： The significant differences in outcomes suggest that THA is a valuable treatment option for active elderly hip fracture individuals. However, patients who are older, impaired or institutionalized benefit from HA.

Local infiltration analgesia following total hip replacement： a review of current literature

Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens.By reviewing 18 studies,we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain,length of hospital stay and opioid consumption.We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain.

Case report： A 10 years follow-up of periprosthetic femoral fracture after total hip arthroplasty in osteopetrosis

Osteopetrosis is an inherited disorder characterized by increased bone density and brittle bone quality. Degenerative changes often occur after the age of 40 in patients with osteopetrosis. Operative inter- vention is the primary treatment option if the clinical manifestation of secondary osteoarthritis is severe. A 44-year-old male suffering autosomal dominant osteopetrosis and progressive unilateral hip osteo- arthritis required a total hip arthroplasty. However, there were several technical challenges associated with this procedure including creating a femoral medullary canal and developing a Vancouver type B2 periprosthetic femoral fracture postoperatively. To afford some experience for the management of similar cases, we here present our technical solutions to these problems.

Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate. Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.

The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

Objective： To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty （THA） patients undergoing anterolateral minimally invasive （ALM1） approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture （FNF） patients than in non-femoral neck fracture （nFNF） patients. Methods： A total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg＇s sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities （WOMAC） score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P〈0.05. Results： The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear. Conclusion： This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA.

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.

Cementless total hip arthroplasty with structural allograft for massive acetabular defect in hip revision

Objective： To study retrospectively 20 hip revison patients treated by cementless total hip arthroplasty with structural allograft. Methods： Twenty patients suffering from aseptic loosening of an uncemented cup complicated by a large defect underwent cementless total hip arthroplasty with structural allograft and were followed up for at least 5 years. Clinical results were evaluated by Harris score and leg length measurements. Radiographic analysis included implants migration, graft absorbance, osteolysis and liner wear. Results： No cup loosening or graft reabsorption was found at final follow-up. Clinical improvements in pain and functional status were demonstrated during the follow-up period. The mean Harris hip scores improved from 29 preoperatively （range 20-41） to 81 postoperatively （range 73-89）. Conclusion： Our study shows that cementless total hip arthroplasty with allograft is a good way for massive defect in aeetabular bone stock.

Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

Total hip arthroplasty （THA） for an un- treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe- male patient with untreated column and comminuted poste- rior wall fracture of the acetabulum was treated in our insti- tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col- umn with cancellous grafting and cementless THA in a single stage. At 3 years＇ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon- struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision.