BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium ...BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium sulfate wet compress,iodophor wet compress,and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic.METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups,the magnesium sulfate wet compress group,iodophor wet compress group,ice compress group and the control group.Data such as height,weight,age,duration of surgery,intraoperative blood loss,postoperative body temperature,swelling duration,pain score,and incidence of blisters were collected and analyzed.RESULTS There were no significant differences in height,weight,age,duration of surgery,intraoperative blood loss,and postoperative body temperature among the four groups of children.Statistical differences were observed between the intervention groups and the control group(P<0.05).CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation,reduced the duration of postoperative perineal swelling,reduced pain,and improved the quality of care.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
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
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
Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to impr...Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.展开更多
目的:探讨全髋关节置换术的CroweⅢ-Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的满意度及造成不满意的相关因素。方法:回顾性分析2013年3月至2018年3月行全髋关节置换术的169例CroweⅢ-Ⅳ型DDH患者,通过...目的:探讨全髋关节置换术的CroweⅢ-Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的满意度及造成不满意的相关因素。方法:回顾性分析2013年3月至2018年3月行全髋关节置换术的169例CroweⅢ-Ⅳ型DDH患者,通过微信进行调查问卷,调查患者对手术总体满意度、10项日常功能满意度和患者认为对自己日常生活影响比较大的前5个问题。手术前后采用髋关节Harris评分进行功能评价。结果:收到完整调查问卷145份,所有患者获随访,时间1~5(3.23±1.22)年。145例患者分成两组,其中对手术疗效满意的118例,不满意的27例,手术总体满意率81.38%(118/145)。患者认为对生活影响比较大的前5个问题分别是术后髋部疼痛,肢体明显不等长、行走、上下楼梯、蹲起。两组术前Harris评分比较,差异无统计学意义(P>0.05),不满意组术后Harris评分较低。术后髋关节疼痛、肢体不等长是影响手术不满意的直接因素。结论:采用全髋关节置换术治疗CroweⅢ-Ⅳ型DDH患者手术难度大;术后髋关节疼痛(轻度以上),肢体不等长(>2 cm)是术后不满意的独立危险因素。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
目的评价超声引导下右美托咪定混合罗哌卡因髂筋膜间隙阻滞(FICB)对小儿髋部手术的镇痛效果。方法选取2014年1月至2015年6月在佛山市中医院择期行单侧发育性髋脱位手术的患儿60例,采用随机数字表法,将患者分为两组(各30例)。观察组气管...目的评价超声引导下右美托咪定混合罗哌卡因髂筋膜间隙阻滞(FICB)对小儿髋部手术的镇痛效果。方法选取2014年1月至2015年6月在佛山市中医院择期行单侧发育性髋脱位手术的患儿60例,采用随机数字表法,将患者分为两组(各30例)。观察组气管插管全麻复合超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB,对照组单用气管插管全麻,两组术后均行芬太尼静脉自控镇痛(PCIA)。分别记录术中芬太尼用量,及术后1、2、4、8、12、24、48h的患儿哭泣、呼吸、循环、表情和睡眠疼痛行为学评分,PCIA按压次数,记录不良反应发生情况。结果与对照组比较,观察组术中芬太尼用量显著减少(49.68±15.29μg vs 68.55±20.03μg,t=4.102,P<0.05),术后各时点CRIES疼痛行为学评分(t=3.644~21.610)及PCIA按压次数(t=3.260~31.770)显著低于对照组(均P<0.05),两组均未见有呼吸抑制。观察组恶心呕吐发生2例(6.67%),对照组恶心呕吐发生6例(20.00%)(x~=2.308,P=0.129);观察组瘙痒发生1例(3.33%),对照组瘙痒发生4例(13.33%)(x^2=1.964,P=0.161)。结论超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB可有效缓解小儿发育性髋脱位(DDH)手术患者疼痛,且无明显不良反应,镇痛效果确切持久,实施方法简便易行。展开更多
发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿...发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿的治疗方式选择存在较大争议,由于疾病预后以及手术创伤、费用、时长等因素影响着治疗方式的选择,因此至今尚没有明确的治疗方案。目前采用的手术方法主要包括闭合复位、单纯切开复位及骨盆截骨术,然而每种治疗方式下都有部分患儿存在严重并发症,如残余发育不良(residualacetabular dysplasia,RAD)和股骨头缺血性坏死(avascular necrosis,AVN)。由于DDH患儿术后并发症的影响因素复杂,且18~24月龄这一年龄段髋臼发育的特殊性,如何选择适合不同患儿的手术方法已成为当前临床治疗的难点。本文就18~24月龄DDH患儿的手术治疗研究进展进行综述,旨在为该年龄段患儿选择合适的手术方案提供参考依据。展开更多
目的测定发育性髋关节脱位(Developmental dislocation of the hip,DDH)髋臼软骨组织中基质金属蛋白酶-3(Matrix metalloproteinase-3,MMP-3)的表达和观察DDH髋臼软骨的形态学改变,探讨DDH髋臼软骨细胞中MMP-3的表达与髋臼软骨发育不良...目的测定发育性髋关节脱位(Developmental dislocation of the hip,DDH)髋臼软骨组织中基质金属蛋白酶-3(Matrix metalloproteinase-3,MMP-3)的表达和观察DDH髋臼软骨的形态学改变,探讨DDH髋臼软骨细胞中MMP-3的表达与髋臼软骨发育不良及退变关系。方法对30例DDH患儿和15例非DDH患儿标本分别进行HE染色和运用免疫组化链霉亲和素-生物素-过氧化物酶复合物法(Strep Avidin-Biotin-peroxidase complex,SABC)检测抗MMP-3蛋白多克隆抗体的表达。结果 DDH组关节软骨中的MMP-3表达比对照组显著增高,其中大年龄组髋臼软骨组织中MMP-3阳性率高于小年龄组,MMP-3表达强弱与年龄呈正相关,随年龄增大表达增强(P<0.01)。结论 DDH组髋臼软骨组织形态学观察有软骨细胞发育不良和退变现象,表明MMP-3与DDH患儿髋臼软骨发育不良及退变有密切关系,在DDH的病理发展过程中可能起重要作用。展开更多
文摘BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium sulfate wet compress,iodophor wet compress,and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic.METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups,the magnesium sulfate wet compress group,iodophor wet compress group,ice compress group and the control group.Data such as height,weight,age,duration of surgery,intraoperative blood loss,postoperative body temperature,swelling duration,pain score,and incidence of blisters were collected and analyzed.RESULTS There were no significant differences in height,weight,age,duration of surgery,intraoperative blood loss,and postoperative body temperature among the four groups of children.Statistical differences were observed between the intervention groups and the control group(P<0.05).CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation,reduced the duration of postoperative perineal swelling,reduced pain,and improved the quality of care.
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Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.
文摘目的:探讨全髋关节置换术的CroweⅢ-Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的满意度及造成不满意的相关因素。方法:回顾性分析2013年3月至2018年3月行全髋关节置换术的169例CroweⅢ-Ⅳ型DDH患者,通过微信进行调查问卷,调查患者对手术总体满意度、10项日常功能满意度和患者认为对自己日常生活影响比较大的前5个问题。手术前后采用髋关节Harris评分进行功能评价。结果:收到完整调查问卷145份,所有患者获随访,时间1~5(3.23±1.22)年。145例患者分成两组,其中对手术疗效满意的118例,不满意的27例,手术总体满意率81.38%(118/145)。患者认为对生活影响比较大的前5个问题分别是术后髋部疼痛,肢体明显不等长、行走、上下楼梯、蹲起。两组术前Harris评分比较,差异无统计学意义(P>0.05),不满意组术后Harris评分较低。术后髋关节疼痛、肢体不等长是影响手术不满意的直接因素。结论:采用全髋关节置换术治疗CroweⅢ-Ⅳ型DDH患者手术难度大;术后髋关节疼痛(轻度以上),肢体不等长(>2 cm)是术后不满意的独立危险因素。
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。
文摘目的评价超声引导下右美托咪定混合罗哌卡因髂筋膜间隙阻滞(FICB)对小儿髋部手术的镇痛效果。方法选取2014年1月至2015年6月在佛山市中医院择期行单侧发育性髋脱位手术的患儿60例,采用随机数字表法,将患者分为两组(各30例)。观察组气管插管全麻复合超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB,对照组单用气管插管全麻,两组术后均行芬太尼静脉自控镇痛(PCIA)。分别记录术中芬太尼用量,及术后1、2、4、8、12、24、48h的患儿哭泣、呼吸、循环、表情和睡眠疼痛行为学评分,PCIA按压次数,记录不良反应发生情况。结果与对照组比较,观察组术中芬太尼用量显著减少(49.68±15.29μg vs 68.55±20.03μg,t=4.102,P<0.05),术后各时点CRIES疼痛行为学评分(t=3.644~21.610)及PCIA按压次数(t=3.260~31.770)显著低于对照组(均P<0.05),两组均未见有呼吸抑制。观察组恶心呕吐发生2例(6.67%),对照组恶心呕吐发生6例(20.00%)(x~=2.308,P=0.129);观察组瘙痒发生1例(3.33%),对照组瘙痒发生4例(13.33%)(x^2=1.964,P=0.161)。结论超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB可有效缓解小儿发育性髋脱位(DDH)手术患者疼痛,且无明显不良反应,镇痛效果确切持久,实施方法简便易行。
文摘发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿的治疗方式选择存在较大争议,由于疾病预后以及手术创伤、费用、时长等因素影响着治疗方式的选择,因此至今尚没有明确的治疗方案。目前采用的手术方法主要包括闭合复位、单纯切开复位及骨盆截骨术,然而每种治疗方式下都有部分患儿存在严重并发症,如残余发育不良(residualacetabular dysplasia,RAD)和股骨头缺血性坏死(avascular necrosis,AVN)。由于DDH患儿术后并发症的影响因素复杂,且18~24月龄这一年龄段髋臼发育的特殊性,如何选择适合不同患儿的手术方法已成为当前临床治疗的难点。本文就18~24月龄DDH患儿的手术治疗研究进展进行综述,旨在为该年龄段患儿选择合适的手术方案提供参考依据。
文摘目的测定发育性髋关节脱位(Developmental dislocation of the hip,DDH)髋臼软骨组织中基质金属蛋白酶-3(Matrix metalloproteinase-3,MMP-3)的表达和观察DDH髋臼软骨的形态学改变,探讨DDH髋臼软骨细胞中MMP-3的表达与髋臼软骨发育不良及退变关系。方法对30例DDH患儿和15例非DDH患儿标本分别进行HE染色和运用免疫组化链霉亲和素-生物素-过氧化物酶复合物法(Strep Avidin-Biotin-peroxidase complex,SABC)检测抗MMP-3蛋白多克隆抗体的表达。结果 DDH组关节软骨中的MMP-3表达比对照组显著增高,其中大年龄组髋臼软骨组织中MMP-3阳性率高于小年龄组,MMP-3表达强弱与年龄呈正相关,随年龄增大表达增强(P<0.01)。结论 DDH组髋臼软骨组织形态学观察有软骨细胞发育不良和退变现象,表明MMP-3与DDH患儿髋臼软骨发育不良及退变有密切关系,在DDH的病理发展过程中可能起重要作用。
