髌股关节骨性关节炎的病因探讨及关节镜诊治

目的:探讨髌股关节骨性关节炎的发生原因及关节镜诊治效果。方法:回顾总结1998年以来本院行关节镜诊治的192例膝关节骨性关节炎资料,分析髌股关节骨性关节炎的发生率、发生原因及关节镜诊治效果。结果:192例212膝中,有髌股关节骨性关节炎者177例189膝,占89.15％,发生原因包括髌股关节生物力学关系紊乱、滑膜皱壁挤夹磨损、髌髁骨赘阻挡干扰及细胞因子等生化原因,关节镜治疗优良率为86.77％。结论:髌股关节是膝关节骨性关节炎最好发部位,其病因是多方面的,关节镜诊治由于能直观准确地反映病变的部位和程度,有助于病因的判定并进行相应的治疗,故比传统的诊治方法效果好,值得优先选用。

髌股关节软骨退变的MRI和关节镜对照研究

目的 :以关节镜为标准 ,确定 3D -Volume -FFE -T1WI对髌股关节软骨退变的诊断价值。方法 :48个人膝关节行关节镜检查及 3D -Vloume -FFE -T1WI矢状位扫描。矢状位图像行多平面重建 (MPR)处理。MR图像每个髌股关节分内、外侧髌骨面、股骨滑车面与关节镜图像逐一对照分析。结果 :关节镜下发现 10 2个病变软骨面 ,3D -Volume -FFE -T1WI对软骨病变的分级和关节镜分级间有显著正相关性 (P <0 .0 1)。结论 :3D -Volume -FFE -T1WI结合MPR评价髌股关节软骨退变和关节镜评价关节软骨有很好的相关性。

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。

3D Finite Element Analysis of a Man Hip Joint Femur under Impact Loads

Objective： The biomechanical characters of the bone fracture of the man femoral hip joint under impact loads are explored. Methods ：A biosystem model of the man femoral hip joint by using the GE （ General Electric） lightspeed multi-lay spiral CT is conducted. A 3D finite element model is established by employing the finite element software ANSYS. The FE analysis mainly concentrates on the effects of the impact directions arising from intense movements and the parenchyma on the femoral hip joint on the stress distributions of the proximal femur. Results：The parenchyma on the hip joint has relatively large relaxation effect on the impact loads. Conclusion：Effects of the angle δ of the impact load to the anterior direction and the angle γ of the impact load to the femur shaft on the bone fracture are given;δ has larger effect on the stress and strain distributions than the angle γ,which mainly represents the fracture of the upper femur including the femoral neck fracture when the posterolateral femur is impacted, consistent with the clinical resuits.

Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture

Objective： To compare the clinical effects between closed reduction and internal fixation （CRIF） and total hip arthroplasty （THA） for displaced femoral neck fracture. Methods： In this prospective randomized study, 285 patients aged above 65 years with hip fractures （Garden III or IV） were included from January 2001 to December 2005. The cases were randomly allocated to either the CRIF group or THA group. Patients with pathological fractures （bone tumors or metabolic bone disease）, preoperative avascular necrosis of the femoral head, osteoarthritis, rheumatoid arthritis, hemiplegia, long-term bed rest and complications affecting hip functions were excluded. Results： During the had significantly higher 5-year follow-up, CRIF group rates of complication in hipjoint, general complication and reoperation than THA group （38.3% vs. 12.7%, P〈0.01; 45.3% vs. 21.7%, P〈0.01; 33.6% vs. 10.2%, P〈0.05 respectively）. There was no difference in mortality between the two groups. Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores. Conclusion： For displaced fractures of the femoral neck in elderly patients, THA can achieve a lower rate of complication and reoperation, as well as better postoperative recovery of hip joint function compared with CRIF.

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.

Total hip arthroplasty for treatment of elderly patients with comminuted intertrochanteric fracture accompanied by femoral head necrosis

Objective： To assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures. Methods： Total hip arthroplasty was carried out in 9 cases of severe intertrochanteric fracture. The patients included two men and seven women. The average age of the patients was 68 years （48-75 years）. The period from fracture to operation was 5 days （2-10 days）. The mean follow- up period lasted for 11 months （3 months-2 years）. There was one patient with comminuted intertrochanteric fracture accompanied by femoral head necrosis and 2 patients with intertrochanteric fracture and stroke. Other 6 patients had severe osteoporosis. The Harris score before operation was 63 points （45-71 points）.Results： At the last follow-up, the patients gained 86points （70-100 points） according to the Harris score. The effects of the 8 cases were good. The Harris score of all patients improved after treatment. Only two hemiplegia patients needed sticks to walk. The others could walk without hip pain. No radiographic evidence of acetabular wear and prosthesis dislocation or other major complications happened during the follow-up. Conclusions： Prosthetic replacements can well treat unstable intertrochanteric fracture if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.

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.

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.

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.

Femoral head fracture without hip dislocation

Femoral head fractures without disloca- tion or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, pos- sible mechanism involved and a novel classification system to classify such injuries.

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.