目的:观察硬膜外麻醉与腰硬联合麻醉用于老年患者髋部骨科手术患者的效果。方法:选择ASA(American Society of Anesthesia,美国麻醉师协会)Ⅱ～Ⅲ级的老年髋部骨科手术患者87例,随机分为两组:治疗组采用为腰硬联合麻醉,对照组采用硬膜...目的:观察硬膜外麻醉与腰硬联合麻醉用于老年患者髋部骨科手术患者的效果。方法:选择ASA(American Society of Anesthesia,美国麻醉师协会)Ⅱ～Ⅲ级的老年髋部骨科手术患者87例,随机分为两组:治疗组采用为腰硬联合麻醉,对照组采用硬膜外麻醉。观察术中感觉及运动阻滞情况、镇痛效果及肌松效果。结果:治疗组麻醉感觉阻滞起效时间为(2.53±0.21)min,短于对照组的(6.72±0.34)min,两组比较差异有统计学意义(P<0.05),治疗组感觉阻滞完善时间为(7.33±0.32)min,短于对照组的(17.53±2.24)min,两组比较差异有统计学意义(P<0.01),治疗组的改良Bromage评分优于对照组(P<0.05,P<0.01);腰硬联合麻醉的镇痛优良率为92.8%,优于持续硬膜外麻醉的64.4%,两组比较差异有统计学意义(P<0.01),腰硬联合麻醉的肌松优良率为100%,优于持续硬膜外麻醉的73.3%,两组比较差异有统计学意义(P<0.05)。结论:腰硬联合麻醉技术应用于老年患者髋部骨科手术效果确切,是一种安全可靠的麻醉方法,值得临床采用。展开更多
Objective: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Methods: Between 1995 and 2002, we implanted 23 c...Objective: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Methods: Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was (4.7) years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made. Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2. Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.展开更多
文摘目的:观察硬膜外麻醉与腰硬联合麻醉用于老年患者髋部骨科手术患者的效果。方法:选择ASA(American Society of Anesthesia,美国麻醉师协会)Ⅱ～Ⅲ级的老年髋部骨科手术患者87例,随机分为两组:治疗组采用为腰硬联合麻醉,对照组采用硬膜外麻醉。观察术中感觉及运动阻滞情况、镇痛效果及肌松效果。结果:治疗组麻醉感觉阻滞起效时间为(2.53±0.21)min,短于对照组的(6.72±0.34)min,两组比较差异有统计学意义(P<0.05),治疗组感觉阻滞完善时间为(7.33±0.32)min,短于对照组的(17.53±2.24)min,两组比较差异有统计学意义(P<0.01),治疗组的改良Bromage评分优于对照组(P<0.05,P<0.01);腰硬联合麻醉的镇痛优良率为92.8%,优于持续硬膜外麻醉的64.4%,两组比较差异有统计学意义(P<0.01),腰硬联合麻醉的肌松优良率为100%,优于持续硬膜外麻醉的73.3%,两组比较差异有统计学意义(P<0.05)。结论:腰硬联合麻醉技术应用于老年患者髋部骨科手术效果确切,是一种安全可靠的麻醉方法,值得临床采用。
文摘Objective: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Methods: Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was (4.7) years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made. Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2. Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.
