人工髋关节手术的麻醉处理

全髋手术创伤大、出血多，接受此手术的多为高龄患者，常合并高血压、冠心病、糖尿病及肺功能障碍。麻醉处理又因手术复杂程度和患者全身情况不同而异。在复杂手术中，如髋骨移植、长段股骨植入、拆除人工假体以及有可能进入盆腔或损伤髂血管的手术，麻醉和术中管理要求高，风险大。本文简要介绍人工髋关节手术的麻醉处理和注意事项。

正颌外科对下颌骨陈旧性骨折的整复手术

目的探讨陈旧性下颌骨折复位的准确性和内固定方法,恢复正常的面部美观。方法参照术前标本模型及正颌外科解剖形态,将错位、嵌入、粉碎性骨断端截开,植骨对位,钛合金夹板固定。结果本组210例患者经手术,外科整形,均改变了咬合不良症状及满足了面部美观要求。结论根据不同骨折的类型,选择正确的内固定法,可使骨折愈合期缩短,尽早恢复正常生理功能。

带旋髂深动脉髂骨块重建髋臼在全髋置换术中应用

目的：探讨用带旋髂深血管的髂骨移植重建发育不良的髓臼观察其能否改善先天性髂臼发育不良和扁平髋作全髋置换手术的疗效。方法：６例病人接受此手术重建髋臼，其中先天性髋臼发育不良２例，４例股骨头无菌性坏死扁平髋，临床上都有活动障碍及严重跛行，髋臼角＞４５°。结果：术后复查６个月～４年，移植骨均一期愈合，无１例髋杯松动移位，６级无痛５例，５级活动时轻痛１例。术后１个月下地行走功能评价，６级正常行走４例，５级跛行不用拐杖２例，髋关节活动度２１１°～２６０°者有２例，１６１°～２１０°有４例。结论：术后使发育不良的髋臼重建成近似正常，全髋置换的髋臼不会松动且能早期活动，承重力强。

Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures. Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised. Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.

Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis

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%.

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.