Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors...Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors who suggest the routine use of internal fixation. Problems such as graft extrusion, rotation and absorption, leading to loss of acetabular correction, were often noted in cases previously treated at our National Hospital for Pediatrics. This retrospective study reviewed the radiographic results of this treatment protocol in 106 hips developmental dislocated hips which met our inclusion criteria. The efficacy of this method to achieve and maintain a well covered and stable hip was the main objective of the study. Methods: This retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were treated by modified Salter’s innomiate osteotomy and using a fibular allograft as the interposition material. Dislocations of the hip were graded using the T?nnis system. Measurement of the acetabular index (AI) was the main variable. The minimum follow up period was 2 years. Possible complications such as loss of acetabular correction, hip redislocation, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection or avascular necrosis (AVN) were documented in this series. Results: Between January 2004 and December 2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and ten (13.7%) were boys, thirteen patients (13.7%) were between twelve and eighteen months old at the time of the operation, the remaining eighty-two (86.3%) patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four (88.4%) patients were affected unilaterally. The right hip was involved in seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%), and Type 4 was in 72 hip (67.9%). All patients combined open reduction and modified Salter’s innomiate osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All of the fibulat allografts were completely incorporated mean 14 weeks (range, 12 weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections, none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%), Good 29 (27.4%), Fair 2 (1.9%), Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow interposition material by fibular allografting with a short operative incision, renders excellent osteotomy stability that eliminates the need for internal fixation. Surgical technique are safe and effective for Children between twelve and thirty-six months old.展开更多
Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia...Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.展开更多
An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a prox...An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a proximal femoral fracture of the residual dislocated hip in an elderly patient, the patient’s overall status, pre-fracture ability, hip joint configuration, and fracture pattern should be considered.展开更多
Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatmen...Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.展开更多
The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English langua...The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.展开更多
全身麻醉下闭合复位加髋人位石膏固定是治疗24月龄以下发育性髋关节脱位(developmental dislocation of the hip,DDH)的通用方法,但闭合复位后仍有约1/3的患儿存在残余髋臼发育不良。尽管骨盆截骨术正越来越多地应用于残余髋臼发育不良...全身麻醉下闭合复位加髋人位石膏固定是治疗24月龄以下发育性髋关节脱位(developmental dislocation of the hip,DDH)的通用方法,但闭合复位后仍有约1/3的患儿存在残余髋臼发育不良。尽管骨盆截骨术正越来越多地应用于残余髋臼发育不良的治疗,但其手术时机和手术指征仍不明晰。本研究拟通过一项多中心前瞻性非随机对照试验探讨DDH闭合复位后残余髋臼发育不良的手术干预时机和指征。研究设计拟纳入283例DDH闭合复位后残余髋臼发育不良患儿,包括观察组183例,手术组(采用骨盆截骨术)100例。手术组根据患儿年龄采用Salter、Pemberton、骨盆三联或髋臼周围截骨术。所有患儿随访10年,拟在DDH闭合复位后8个时间点(闭合复位术后1、2、3、4、5~6、7~8、9~10年以及10年以上)拍摄髋关节正位X线片,测量髋臼指数(acetabular index,AI)、中心边缘角(center-edge angle of wiberg,CEA)和Reimer指数(Reimer's index,RI),根据末次随访时正位X线片上髋关节Severin分级分为满意组(Severin分级为Ⅰ、Ⅱ级)和不满意组(Severin分级为Ⅲ、Ⅳ级),利用Logistic回归和Cox回归分析残余髋臼发育不良的风险因素,比较两组患儿AI、CEA、RI及Severin分级情况。这一多中心前瞻性研究可以为DDH闭合复位后残余髋臼发育不良的手术干预时机和指征提供循证医学证据。展开更多
目的:比较转子下截骨全髋置换术治疗Hartofilakidis C1和C2型成人髋关节发育不良的差异及安全性。方法:回顾性分析2007年1月至2011年12月就诊于北京积水潭医院的32例髋关节发育不良患者的临床资料,其中C1型17例,C2型15例,均行转子下截...目的:比较转子下截骨全髋置换术治疗Hartofilakidis C1和C2型成人髋关节发育不良的差异及安全性。方法:回顾性分析2007年1月至2011年12月就诊于北京积水潭医院的32例髋关节发育不良患者的临床资料,其中C1型17例,C2型15例,均行转子下截骨全髋关节置换术,术前评估和术后随访采用HSS(hospital for special surgery knee score)和WOMAC(the Western Ontario and Mc Master Universities)评分,拍摄髋关节X线片,测量双下肢不等长,记录跛行等并发症。结果:C1型HSS评分由43.7±4.6提升到87.2±7.1,WOMAC评分由43.6±4.3提升至87.5±6.7;C2型HSS评分由44.4±5.4提升到86.5±8.0,WOMAC评分由44.1±4.1提升至86.7±8.1,术后功能评分均较术前有明显改善(均P<0.001)。C2型中4例出现术中骨折,C1型中1例出现术中骨折,术后随访均愈合。术后X线片提示关节假体位置满意,无松动,股骨截骨处均愈合,无感染。结论:股骨转子下截骨全髋置换术治疗高位脱位的髋关节发育不良患者可以取得较好疗效,不同亚型(C1和C2型)在疗效上无明显差异,C2型应注意避免发生术中骨折。展开更多
目的利用计算机仿真技术模拟发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿不同股骨颈前倾角时股骨的应力分布,以明确DDH患儿股骨颈前倾角矫正的意义,并指导手术方案的制定。方法回顾性分析2021年6月在山西省儿童医...目的利用计算机仿真技术模拟发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿不同股骨颈前倾角时股骨的应力分布,以明确DDH患儿股骨颈前倾角矫正的意义,并指导手术方案的制定。方法回顾性分析2021年6月在山西省儿童医院骨科住院治疗的1例右侧DDH患儿影像学资料。患儿女,6岁,提取正常侧(左侧)髋关节股骨扫描数据,通过三维CT扫描重建股骨三维模型,分别设计股骨颈前倾角35°、25°、15°时的力学仿真模型,通过有限元软件进行仿真计算,观察不同股骨颈前倾角度时股骨的生物力学分布。结果DDH患儿股骨三维模型上股骨颈前倾角为35°、25°、15°时股骨模型受到的最大应力分别为21.18 MPa、17.36 MPa、9.85 MPa。股骨颈前倾角为35°时,股骨干应力集中;股骨颈前倾角为25°时,股骨远端骨骺的应力降低25%;股骨颈前倾角为15°时,股骨应力主要集中在股骨头颈至股骨干上段。股骨颈前倾角为35°时,位移大于1 mm的区间是股骨头至股骨干中段;股骨颈前倾角为25°时,位移大于1 mm的区间是股骨头至股骨干中上端;股骨颈前倾角为15°时,位移大于1 mm的区间是股骨头至股骨颈。股骨颈前倾角为35°、25°、15°时其股骨远端骨骺的最大位移分别为0.0041 mm、0.0018 mm、0.0012 mm。结论股骨颈前倾角对DDH患儿的股骨力学有着重要影响。股骨的应力分布随着股骨颈前倾角改变而改变,股骨颈前倾角度增大,股骨干应力逐渐增加,在股骨干位置出现应力集中现象;股骨颈前倾角越大,应力传递在股骨干区域受到的遮挡效应越大,股骨远端骨骺在横断面的变形也增加。股骨颈前倾角为15°时股骨应力分布较为理想。展开更多
文摘Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors who suggest the routine use of internal fixation. Problems such as graft extrusion, rotation and absorption, leading to loss of acetabular correction, were often noted in cases previously treated at our National Hospital for Pediatrics. This retrospective study reviewed the radiographic results of this treatment protocol in 106 hips developmental dislocated hips which met our inclusion criteria. The efficacy of this method to achieve and maintain a well covered and stable hip was the main objective of the study. Methods: This retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were treated by modified Salter’s innomiate osteotomy and using a fibular allograft as the interposition material. Dislocations of the hip were graded using the T?nnis system. Measurement of the acetabular index (AI) was the main variable. The minimum follow up period was 2 years. Possible complications such as loss of acetabular correction, hip redislocation, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection or avascular necrosis (AVN) were documented in this series. Results: Between January 2004 and December 2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and ten (13.7%) were boys, thirteen patients (13.7%) were between twelve and eighteen months old at the time of the operation, the remaining eighty-two (86.3%) patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four (88.4%) patients were affected unilaterally. The right hip was involved in seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%), and Type 4 was in 72 hip (67.9%). All patients combined open reduction and modified Salter’s innomiate osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All of the fibulat allografts were completely incorporated mean 14 weeks (range, 12 weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections, none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%), Good 29 (27.4%), Fair 2 (1.9%), Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow interposition material by fibular allografting with a short operative incision, renders excellent osteotomy stability that eliminates the need for internal fixation. Surgical technique are safe and effective for Children between twelve and thirty-six months old.
文摘Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.
文摘An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a proximal femoral fracture of the residual dislocated hip in an elderly patient, the patient’s overall status, pre-fracture ability, hip joint configuration, and fracture pattern should be considered.
文摘Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.
文摘The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.
文摘全身麻醉下闭合复位加髋人位石膏固定是治疗24月龄以下发育性髋关节脱位(developmental dislocation of the hip,DDH)的通用方法,但闭合复位后仍有约1/3的患儿存在残余髋臼发育不良。尽管骨盆截骨术正越来越多地应用于残余髋臼发育不良的治疗,但其手术时机和手术指征仍不明晰。本研究拟通过一项多中心前瞻性非随机对照试验探讨DDH闭合复位后残余髋臼发育不良的手术干预时机和指征。研究设计拟纳入283例DDH闭合复位后残余髋臼发育不良患儿,包括观察组183例,手术组(采用骨盆截骨术)100例。手术组根据患儿年龄采用Salter、Pemberton、骨盆三联或髋臼周围截骨术。所有患儿随访10年,拟在DDH闭合复位后8个时间点(闭合复位术后1、2、3、4、5~6、7~8、9~10年以及10年以上)拍摄髋关节正位X线片,测量髋臼指数(acetabular index,AI)、中心边缘角(center-edge angle of wiberg,CEA)和Reimer指数(Reimer's index,RI),根据末次随访时正位X线片上髋关节Severin分级分为满意组(Severin分级为Ⅰ、Ⅱ级)和不满意组(Severin分级为Ⅲ、Ⅳ级),利用Logistic回归和Cox回归分析残余髋臼发育不良的风险因素,比较两组患儿AI、CEA、RI及Severin分级情况。这一多中心前瞻性研究可以为DDH闭合复位后残余髋臼发育不良的手术干预时机和指征提供循证医学证据。
文摘目的:比较转子下截骨全髋置换术治疗Hartofilakidis C1和C2型成人髋关节发育不良的差异及安全性。方法:回顾性分析2007年1月至2011年12月就诊于北京积水潭医院的32例髋关节发育不良患者的临床资料,其中C1型17例,C2型15例,均行转子下截骨全髋关节置换术,术前评估和术后随访采用HSS(hospital for special surgery knee score)和WOMAC(the Western Ontario and Mc Master Universities)评分,拍摄髋关节X线片,测量双下肢不等长,记录跛行等并发症。结果:C1型HSS评分由43.7±4.6提升到87.2±7.1,WOMAC评分由43.6±4.3提升至87.5±6.7;C2型HSS评分由44.4±5.4提升到86.5±8.0,WOMAC评分由44.1±4.1提升至86.7±8.1,术后功能评分均较术前有明显改善(均P<0.001)。C2型中4例出现术中骨折,C1型中1例出现术中骨折,术后随访均愈合。术后X线片提示关节假体位置满意,无松动,股骨截骨处均愈合,无感染。结论:股骨转子下截骨全髋置换术治疗高位脱位的髋关节发育不良患者可以取得较好疗效,不同亚型(C1和C2型)在疗效上无明显差异,C2型应注意避免发生术中骨折。
