AI-HIP系统在全髋关节置换中的假体型号及联合偏心距和截骨的作用研究

目的:探讨AI-HIP辅助手术规划系统在初次单侧全髋关节置换术(total hip arthroplasty,THA)中的规划效果及其临床结果。方法:回顾性分析2022年3月至2022年11月连续性应用AI-HIP系统行初次单侧THA的36例患者的临床资料,男16例,女20例,年龄43~81(62.2±10.9)岁,将其纳入AI-HIP组;根据配对原则选择同期采用传统模板方法规划的患者36例,男16例,女20例,年龄40~80(60.9±12.1)岁,作为对照组。比较两组假体的准确率,以及术前规划和术后实际联合偏心距差值、下肢长度差值、距小转子上缘截骨高度和顶肩距以评价规划效果,采用Harris评分和疼痛视觉模拟评分(visual analogue scale,VAS)评价其临床疗效。结果:两组均获得随访,时间12~18(14.5±2.1)个月。AI-HIP组规划髋臼杯和股骨柄假体型号的完全准确率、近似准确率分别为72.2%、100%和58.3%、88.9%,均优于对照组的44.4%、83.3%和33.3%、66.7%(P<0.05);规划股骨头假体型号差异无统计学意义(P>0.05)。AI-HIP组术后实际联合偏心距差值、联合偏心距差值(实际-规划)分别为1.0(0.2,2.4)mm、1.1(-2.1,3.2)mm,优于对照组的3.0(1.4,4.9)mm、3.5(-1.6,6.5)mm(P<0.05)。两组间术后实际距小转子上缘截骨高度比较,差异无统计学意义(P>0.05)。AI-HIP组术后实际下肢长度差值、下肢长度差值(实际-规划)、距小转子上缘截骨高度(实际-规划)、术后实际顶肩距、顶肩距差值(实际-规划)分别为1.5(0.2,2.8)、1.1(-0.3,2.2)、2.1(-2.3,4.1)、(15.3±4.1)、-2.2(-4.8,0.3)mm,优于对照组的2.6(1.3,4.1)、2.5(0.3,3.8)、5.8(-2.4,7.7)、(13.0±4.3)、-5.7(-9.4,-2.2)mm(P<0.05)。末次随访,两组Harris评分中功能、疼痛、功能、畸形、总分及VAS比较,差异均无统计学意义(P>0.05);而AI-HIP组Harris评分中活动度评分(4.8±0.6)分,高于对照组(4.4±0.8)分(P<0.05)。结论:AI-HIP辅助手术规划系统较传统模板规划,在初次单侧THA中对髋臼杯和股骨柄假体型号的预测、恢复联合偏心距、规划下肢长度、截骨高度和顶肩距方面具有良好的准确性,临床效果满意。

高温HIP对难熔金属显微组织与性能的影响

使用1800℃的高温HIP,研究了纯钨、钨镧、TZM和MHC等材料的微观组织和力学性能。试验发现:经过HIP1800处理后,钨镧合金的晶粒未发生明显变化,硬度高于纯钨;去应力状态的TZM和MHC钼合金性能差异在经过HIP1800后得到了消除,具有相似的显微组织和室温力学性能。

螺杆组合对阻燃HIPS产品性能及能耗影响的研究

采用不同长径比的双螺杆挤出机制备HIPS阻燃料,对阻燃HIPS的阻燃性能进行了比较,通过测量挤出机的功率来计算其能耗并测试了试样的抗拉强度。结果表明,在一定的长径比范围内,大长径比耗能相对最低,能够节省大量能源,有利于工业化生产。

Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting

Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome.

Intermediate Hip Arthroplasty in Gabon: Blood Loss and Risk Factor for Transfusion

Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. Method: It was a retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion and intraoperative data. The primary outcome was intraoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 97 patients included, the average age was 74.2 years ± 10, male predominance was 73.2%, the average ASA score was 1.9 ± 0.5, and transfusion incidence was 38.1%. The average number of RBCs transfused was 1.2 ± 0.6. Tranexamic acid was used in 11.3% of patients. The average bleeding was 450 ± 453 ml. Preoperative anemia was predictor of transfusion to be significant. Conclusion: The incidence of transfusion is law compared to total hip arthroplasty. The implementation of a patient blood management protocol is difficult given the urgency of bone repair. However, a better use of tranexamic acid could reduce this transfusion incidence.

Evaluation of Some Treatment Options Inlate and Neglected Hip Fractures Using the Modified Harris Hip Score

Background: The choice of the appropriate operative intervention in patients with late and neglected hip fracture continuous to be a huge dilemma for orthopedic surgeons. Purpose: To evaluate the satisfaction or otherwise of some treatment options using the modified Harris-hip score (HHS) in resource poor setting. Materials and Methods: A retrospective cross-sectional study conducted at ATBUTH, Bauchi. Data of 60 patients over the age of 18 years with hip fractures (femoral neck, intertrochanteric and sub trochanteric fractures) who had operative intervention between 1st September 2019 and 31st August 2020 with cannulated screws, Proximal femur lock compression plate (PFLCP), cementlessor cemented bipolar hemiarthroplasty (BHA). Results: The mean age of studied patients was 65.7 ± 16.1 years, with age ranging from 19 - 101 years. M:F ratio was 1.2:1 across all age groups and 1:1.4 amongst those >60 years. 51 patients (85%) presented > 1 week after injury with 24 patients (40%) sustaining hip fractures from low energy trivial indoor fall and 28 patients (46.7%) mostly younger sustaining fractures from high energy motor vehicular accident (MVA). The prevalence rate for femoral neck, intertrochanteric and subtrochanteric fractures were 32 (53.3%), 17 (28.3%) and 11 (18.3%) respectively. From the data retrieved, 21patients (35.0%), 17 patients (28.3%), 20 patients (33.3%) and 2 patients (3.3%) had PFLCP, cemented BHA, cementless BHA and cannulated screw fixation respectively. Most (66.7%) of those who had PFLCP achieved satisfactory radiologic union and there was also 94.1% and 85% satisfactory outcome rate amongst the patients with cemented BHA and cementless BHA respectively. Irrespective of the operative intervention method at 1 year follow-up, there was a statistically significant improvement in post-operative HHS (P value 0.02), with 83.4% having good to excellent results. Conclusion: There is highrate of late and neglected hip fracture in our environment. Satisfactory outcome with statistically significant improvement in Post-operative HHS was achieved in patients treated for hip fractures.

髋臼周围截骨治疗对发育性髋关节发育不良骨盆矢状位倾斜的影响

背景:发育性髋关节发育不良指髋臼、股骨近端存在骨性结构畸型,可导致髋关节不稳及髋骨关节炎。髋臼周围截骨术是青少年及成年人非终末期发育性髋关节发育不良治疗的主要方式。骨盆倾斜在髋关节生物力学中发挥至关重要的作用,它決定了髋关节的应力方向。在髋关节疾病中可出现骨盆代偿性倾斜,以尽量减少髋关节的异常应力。目的:观察发育性髋关节发育不良患者行髋臼周围截骨治疗是否改变患者骨盆矢状位倾斜,并探讨髋臼覆盖对骨盆矢状位倾斜的影响。方法:回顾性分析2019年8月至2022年6月在四川大学华西医院因发育性髋关节发育不良行髋臼周围截骨的患者29例,收集患者术前及术后6个月站立位骨盆正位X射线片,测量髋关节外侧中心边缘角、通力氏角、耻骨联合到骶髂关节距离、耻骨联合到骶髂关节连线中点距离、骶骨-股骨头-耻骨角及骨盆矢状位倾斜;所有患者均于术前及术后6个月采用髋关节残疾及骨关节炎评分及Harris评分行髋关节功能评估。结果与结论:(1)与术前相比,术后6个月髋关节外侧中心边缘角、耻骨联合到骶髂关节连线中点距离、骶骨-股骨头-耻骨角均较术前显著增大(P <0.05);而通力氏角及骨盆矢状位倾斜则显著减小(P <0.05);耻骨联合到骶髂关节距离与术前无明显差异(P> 0.05);(2)术后6个月髋关节残疾及骨关节炎评分及Harris评分均较术前显著提高(P <0.01);(3)提示髋臼周围截骨显著改善了发育性髋关节发育不良患者的髋臼覆盖,且骨盆出现显著前倾改变。

保留假体清创联合更换组配式部件治疗全髋关节置换后急性假体周围感染

背景:全髋关节置换后假体周围感染是影响假体使用寿命的常见原因,保留假体清创联合更换组配式组件成为治疗全髋关节置换后急性期假体周围感染的新方法。目的:观察采用保留假体清创联合更换组配式部件治疗人工全髋关节置换后急性期假体周围感染的临床疗效。方法:选择2018年7月至2022年2月在黄石市中心医院骨科进行手术治疗的22例初次全髋置换后急性期假体周围感染患者,所有患者感染时间均为初次置换3周以内,术中取关节液及感染滑膜行细菌培养均证实为急性期感染,采用保留假体清创联合更换组配式组件治疗。术前、术后3,6个月以及末次随访,以白细胞计数、血沉、C-反应蛋白评价感染情况,以Harris髋关节功能评分量表评价髋关节功能改善情况,以疼痛目测类比评分了解患者疼痛缓解情况,采用配对样本t检验分析手术前后各指标改善情况。结果与结论:(1)非假体周围感染原因死亡1例后失访,予以排除,其余21例患者均获得临床随访,随访时间均在1年以上,平均随访时间为(19.52±3.88)个月,其中20例患者手术治疗成功,1例失败,感染控制率为95%;(2)患者术后3,6个月以及末次随访的白细胞计数、血沉、C-反应蛋白水平均较术前下降(P<0.05),Harris髋关节功能评分均较术前提高(P<0.05),疼痛目测类比评分均较术前下降(P<0.05),差异均有显著性意义(P<0.05);(3)提示全髋关节置换后急性期假体周围感染患者选择保留假体清创联合更换组配式组件的治疗方法能有效控制髋关节感染,改善髋关节功能,缓解感染导致的髋部疼痛。

纳米TiO_2对HIPS高性能化的改性研究

为使高抗冲聚苯乙烯 (HIPS)高性能化 ,该文通过对纳米TiO2 表面预处理及选择特定的高分子分散剂和母料法制备工艺制备了HIPS/纳米TiO2 复合材料。测试结果表明 ,在纳米TiO2 含量为 2 %时 ,复合材料的缺口冲击强度、拉伸强度及弹性模量上升至最大值 ,显示出纳米TiO2 对HIPS具有同时增强增韧效果 ,且复合材料的耐热性能、阻燃性能和抗热老化性能都得到提高 。

高性能纳米TiO_2/HIPS复合材料的研制

采用溶胶—凝胶法制备纳米TiO_2,并对纳米TiO_2进行表面处理,在大分子分散剂存在下,通过母料法工艺制备了纳米TiO_2/HIPS复合材料。实验结果表明,制备的纳米TiO_2/HIPS复合材料的缺口冲击强度、拉伸强度和弹性模量在纳米TiO_2含量为2％时上升为最大值,且复合材料的硬度、耐热性能、阻燃性能随纳米TiO_2含量的增加而提高。

纳米TiO_2填充改性HIPS废料的研究

将表面改性后的纳米TiO_2填充于HIPS废料中,制备纳米复合材料。研究了纳米材料的表面处理方式及添加量对复合材料力学性能的影响。利用SEM考察了纳米TiO_2在基体中的分散状况。结果表明,添加1％经适宜表面处理剂处理的纳米TiO_2可有效地提高复合材料的力学性能。

主机标识协议(HIP)研究综述

TCP/IP协议一开始就没有考虑主机的移动和多宿主问题,也没有提供对主机的安全性和认证机制.主机标识协议(HIP)成为同时解决主机移动、多宿主及安全问题的有效方案.文本介绍了主机标识协议(HIP)的体系结构及基本交换,详细阐述了HIP对主机移动、多宿主和安全的解决方案以及对现有系统和应用程序的迁移,文中也分析了HIP存在的问题.

创伤性股骨头坏死病人术前临床病史与全髋关节置换术后深静脉血栓的相关性分析

目的研究创伤性股骨头坏死(FHN)病人术前临床病史与全髋关节置换术(THA)后深静脉血栓的相关性。方法回顾性分析2014年8月至2022年5月共172例因创伤性FHN来南京中医药大学常熟附属医院行单侧THA术的病人临床资料。所有病人均在THA术后行常规低分子肝素(LWMH)抗凝,并于术后第3天行双下肢静脉B超检查。按检查结果将病人分成DVT组(男22例,女4例,平均年龄64.35岁)和非DVT组(男102例,女44例,平均年龄62.35岁)。分别比较两组病人术前基本临床病史如既往VTE病史、糖尿病、高血压、冠心病(CHD)等与DVT的具体相关性并通过多变量分析DVT发生的危险因素。结果DVT组中CHD发病率为73.08%(19/26),显著高于非DVT组的31.51%(46/146)。创伤性FHN病人合并CHD[OR=6.63,95%CI:(1.49,29.59),P=0.013]或长期吸烟史[OR=4.58,95%CI:(1.26,16.62),P=0.021]是THA术后DVT的发生危险因素。结论冠心病和吸烟史是创伤性FHN病人行单侧THA术后DVT发生的危险因素,对于此类病人需重视术前疾病控制,同时应规范手术操作以减少术后DVT的发生。

HIPS-g-GMA相容剂对PC/HIPS共混物相容性的影响

The compatibitily and morphology of HIPS/PC and HIPS g GMA/PC blends were studied.The compatibility and morphology of HIPS/PC blends were characterized by DSC and SEM,respectively.The result of DSC shows that T g of PS doesn’t change with the blend composition,and T g of PC decreases with the increase in weight fraction of HIPS,which indicates that the PC/HIPS blend is a partially miscible system.Results of SEM indicate that the decrease in T g of PC results from PS interpenetrating into the phase of PC,and no change in T g of PS results from PC not interpenetrating into the phase of PS.The copolymer of HIPS g GMA was prepared by reactive grafting method.The IR spectrum shows that GMA is grafted on the chain of HIPS.The compatibility and morphology of HIPS g GMA(35)/PC(65) were studied by DSC and SEM.PC(65)/HIPS g GMA(35) blend exhibits reduced size of disperse phase,enhanced interface adhesion and lower T g of PC phase as compared with the PC(65)/HIPS(35) blend.It implies that HIPS g GMA is an effective compatibilizer of the HIPS/PC blend.

纳米Sb_2O_3表面原位(共)聚合处理对HIPS纳米复合材料力学性能的影响

The nano-sized antimony trioxides（NSb2O3） were modified by in situ polymerization of styrene（St） and in situ copolymerization of vinyl silane（VS） and St,respectively,and then compounded with high impact polystyrene（HIPS） in molten state.The results showed that the surface of NSb2O3 was coated with polystyrene,subsequently the dispersion of NSb2O3 in HIPS matrix is remarkably enhanced.Thereby,the tensile and impact properties of HIPS/Sb2O3 nanocomposites are improved,and there is a critical PS-coating thickness on the surface of NSb2O3.Because the in situ copolymerization of NSb2O3/VS/St is useful for PS to be grafted on the surfaces of NSb2O3,as a result of the enhanced interfacial adhesion between NSb2O3 and HIPS matrix the Young’s modulus,tensile yielding strength and impact strength of HIPS/NSb2O3 nanocomposites are higher than those in HIPS/NSb2O3 nanocomposites modified by the in situ polymerization of NSb2O3/St.

直接HIP成形FGH95合金组织和性能的研究

研究了直接热等静压成形工艺FGH95合金的组织和性能 ,确定了低成本的HIP工艺可以获得组织均匀 ,综合性能良好的FGH95合金制件 ,在保证粉末质量的前提下可以成为FGH95合金大型涡轮盘坯的制造工艺 .

HIPS/PP反应共混物的热性能研究

研究了高抗冲聚苯乙烯（ＨＩＰＳ）／聚丙烯（ＰＰ）在过氧化二异丙苯（ＤＣＰ）存在下熔融反应共混物的热学性能。ＨＩＰＳ在ＤＣＰ存在下以ＰＳ的降解为主，ＰＳ的Ｔｇ明显下降，ＰＰ在ＤＣＰ存在下也以降解为主，ＰＰ的结晶完善性受到破坏，ＨＩＰＳ／ＰＰ共混物在ＤＣＰ存在下以ＰＰ同ＨＩＰＳ的反应接枝为主，分子运动的特征及热性能较前两者发生明显变化，ＰＳ的Ｔｇ略有下降，ＰＰ分子链的规整性降低，结晶熔点降低，完善性变差。

磷酸酯和环氧树脂在阻燃HIPS中的协同作用

通过测试分析了两种环氧树脂和磷酸酯(TPP)对高抗冲击聚苯乙烯(HIPS)阻燃性能的影响。研究结果表明,环氧树脂和TPP对HIPS的阻燃具有协同作用,当环氧树脂和TPP用量各为10phr时,HIPS的阻燃效果最好,酚醛环氧A/TPP体系的协同作用优于酚醛环氧B/TPP体系。

运动疗法激活臀肌改善青年男性膝前痛患者的下肢肌力

背景:目前发现膝前痛与下肢生物力学有关,但仍缺少臀肌训练对膝关节及下肢日常活动影响的研究。目的:探究臀肌激活运动疗法对青年男性膝前痛患者髋、膝关节肌群肌肉力量和疼痛的影响。方法:纳入25例男性青年膝前痛患者,随机分为2组,臀肌激活组12例和空白对照组13例。臀肌激活组进行40 min/次、3次/周、为期6周的臀肌激活运动;空白对照组不进行任何干预。入组和干预6周后评估患侧髋关节、膝关节在60(°)/s和180(°)/s下等速屈伸运动测试的相对峰力矩、总功、屈伸肌群比值、肌肉耐力值,爬楼运动测试中停止爬楼的楼层,以及目测类比评分。结果与结论:①等速屈伸运动测试:髋关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高29.74%和25.95%(P=0.022,P=0.024);空白对照组在180(°)/s时的肌耐力较干预前降低12.12%(P=0.000)。膝关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高18.69%和7.27%(P=0.006,P=0.033);空白对照组各指标干预前后无著性变化(P>0.05)。②爬楼运动测试:臀肌激活组爬楼运动停止时的楼层数较空白对照组高(6.41±6.1)层(P=0.024),干预后较干预前增高(P=0.016);空白对照组干预前后无显著改变(P>0.05)。③疼痛评估:干预后臀肌激活组目测类比评分显著低于空白对照组(P=0.036),干预后较干预前降低(P=0.000);空白对照组干预前后无显著性变化(P>0.05)。结果表明:6周臀肌激活运动疗法可改善下肢肌群的爆发力和耐力,减轻膝前痛程度,对于膝前痛患者有必要进行臀肌训练,以促进康复。

HIP-Re组织及力学性能

采用粉末冶金热等静压技术制备了HIP-Re纯铼材料,分析了不同热处理状态对材料微观结构及室温和高温性能的影响。结果表明,热处理温度对材料拉伸性能影响较大,经1 800℃/1.5 h真空处理HIP-Re抗拉强度达到1 196 MPa,伸长率为19.1%;2 000℃抗拉强度达到69 MPa,伸长率达17%以上。粉末冶金铼的晶粒组织多为2～8μm细小等轴晶,HIP-Re断裂方式为沿晶断裂与穿晶断裂共同作用,高温断裂方式为晶间断裂与滑移断裂,在拉伸形变过程中,Re材料内部产生了大量协变的裂纹及微孔,裂纹扩展连接导致断裂。