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
Abstract: In this paper,we use the orthogonal wavelet based on 3-order splines function to processthe somatosensory evoked potentials and cognitive event-related potentials. The experiments onhuman subjects have showe...Abstract: In this paper,we use the orthogonal wavelet based on 3-order splines function to processthe somatosensory evoked potentials and cognitive event-related potentials. The experiments onhuman subjects have showed that this method is valuable and practicable.INTRODUCTIONEvoked potentials(EP' s) are electrical responses of the central nervous system to stimulusapplied in a controlled manner. They can not only be used to diagnose the diseases on the sensorypathway and brain but also be frequently monitored intraoperatively to assess the effects ofsurgery or to detect unexpected neurological injury [1][2]. But the Signal-to-Noise ratios (SNRIs) of EP' s are vary low. The: are many methods in order to improve the SNR' S and identify theEP' s signal perfectly with less stimuli such as ensembl averaging,post-wiener filtering,adaptedfiltering and parametric modeling and even single stimulus. The purpose of this paper is to applyrnultiresolution wavelet analysis method for identification of short-latency somatosensory evokedpotentials and long-latency evoked--related potentials.METHODMultiresolution Wavelet analysis and pyramid algorithm was constructed by Mallat [3] andwidely used in signal processing pattern recognition and image processing. Here,we applyed thisto decompose EP' S signal into different frequency bands and reconstructed them with time-varying weight method.Based on 3-order splines functions,we constructed orthogonal wavelet and scale function. According to the dual-scale function,we could get transform function h and its mirror filter g,theyare related by gn(- l)nhn+1. More detail could see Mallat' theory[3]. Through fast pyramid algorithm,the EP' S signal can be decomposed into detail and coarse parts on a dyadic scales by scalefunction like this Here Cj is coarse signal and Dj is detail signal. C, is signal on scale 0 and is the same as originalsignal. With j increasing,the EP' S signal were projected to different frequency bands. The reconstructed function for signal on j scale to j-1 scale isAccording to the character of EP' S signals and their decomposition on different scales ,we choosethe following signal processing principle.To somatosensory EPI S (SEP),we choose coarse and detail signal on scale 6 to reconstructsignalS(t) ~W, (t) o C,(t) +WZ(t) o D,(t)W, and W, are time--varying weight and are decided by the amplitude of detail and coarse signalson scale 6.To Event--related optentials (P300 waveform),because the noise is mainly on high frequencyband gwe choose coarse signal of scale 6 to reconstruct signal.RESULTThere are ten subjects taking part in the experiment. The instrument is SPECTRUM32 ofCADWELL corporation. To SEP signals,The medial nerve of left wrist was stimulated,activeelectrode was attached to Cll (3 cm lateral to the midline and posterior to the coronal suture).reference electrode at Al (left ear) and ground electrode at Fpz according to 'the international 10-20system of electrode placement.Figurel is the original SEPI S signal and processed signal, (a) is the SEPI S signal averaged by250 times. (b) is the signal averaged by 30 times and (c) is the signal of (b) be processed. Fromthe figure,we could see that the method is effectively,noise ate inhibited greatly and the waveform of (c) is almost the same as the signal (a).Figure 2 .The EPRI S signal and processed signalTo ERP,active electrode was attached to Cz.reference electrode at Al and ground electrodeat Fpz. The stimulus is auditory and the probability of target stimulus is 20 percent.FigureZ is the EPR signal, (a) is the signal average 40 times, (b) is the single trial signal and(c) is the processed signal of (b). From the figure, we could say that multiresolution waveletanalysis can get single trial signal of ERP. The signal (c) is almost the same as signal of (a).From the experiments,we could say that the time--varying weighted multiresolution waveletanalysis method is suitable and practicable and may be vary useful in identification of single trialEPI s signal.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
Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large f...Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip （DDH） has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases （Crowe type Ⅰ and Ⅱ）. Methods Between September 2005 and May 2007, twenty-one consecutive patients （twenty-six hips） with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years （range, 37-59 years）. Six patients （28.6%） were male and fifteen （71.4%） were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly. Results All patients were followed for a mean of 18 months （9-29 months）. During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepancy of 0.8 to 1.2 cm, all regained equal limb length postoperatively. In addition the pain was nearly completely relieved, the range of motion was remarkably improved and no restriction was needed after operation regarding early exercise. Conclusions The new generation of metal-on-metal resurfacing arthroplasty may be a reasonable option for DDH of the Crowe types Ⅰ and Ⅱ.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
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:分析533例超声筛查婴幼儿发育性髋关节发育不良(Developmental dysplasia of hip,DDH)的结果,随访治疗效果,为临床治疗提供依据。方法:回顾分析2012年5月—2017年6月我院临床疑似DDH患儿共21281例,通过观察上述病例的超声检查结果...目的:分析533例超声筛查婴幼儿发育性髋关节发育不良(Developmental dysplasia of hip,DDH)的结果,随访治疗效果,为临床治疗提供依据。方法:回顾分析2012年5月—2017年6月我院临床疑似DDH患儿共21281例,通过观察上述病例的超声检查结果中髋臼形态及α、β角测量值,应用Graf法对髋关节发育情况进行分型,统计DDH的分布情况,并随访治疗效果。结果:临床疑似DDH 21281例患儿(42562髋)中,DDH检查阳性率为2.50%(533/21281),DDH患儿中,女婴413例,男婴120例;双侧DDH患儿95例(190髋);左侧DDH 457例,右侧DDH 171例。176例DDH患儿接受髋关节外展操锻炼,164例恢复正常。115例DDH患儿接受Pavlik吊带治疗,104例恢复正常。5例接受闭合复位后石膏固定术,全部恢复正常。结论:DDH患儿女婴多于男婴,单侧多发,左侧较右侧明显多发。临床疑似DDH患儿检查阳性率约2.50%。髋关节外展操锻炼是Ⅱ型髋关节保守治疗的首选方式,尤其是Ⅱa型髋关节。Pavlik吊带治疗是DDH患儿保守治疗的首选方式。闭合复位后石膏固定术对于月龄较大、髋关节外展操锻炼和Pavlik吊带治疗失败的患儿尤其适用。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Abstract: In this paper,we use the orthogonal wavelet based on 3-order splines function to processthe somatosensory evoked potentials and cognitive event-related potentials. The experiments onhuman subjects have showed that this method is valuable and practicable.INTRODUCTIONEvoked potentials(EP' s) are electrical responses of the central nervous system to stimulusapplied in a controlled manner. They can not only be used to diagnose the diseases on the sensorypathway and brain but also be frequently monitored intraoperatively to assess the effects ofsurgery or to detect unexpected neurological injury [1][2]. But the Signal-to-Noise ratios (SNRIs) of EP' s are vary low. The: are many methods in order to improve the SNR' S and identify theEP' s signal perfectly with less stimuli such as ensembl averaging,post-wiener filtering,adaptedfiltering and parametric modeling and even single stimulus. The purpose of this paper is to applyrnultiresolution wavelet analysis method for identification of short-latency somatosensory evokedpotentials and long-latency evoked--related potentials.METHODMultiresolution Wavelet analysis and pyramid algorithm was constructed by Mallat [3] andwidely used in signal processing pattern recognition and image processing. Here,we applyed thisto decompose EP' S signal into different frequency bands and reconstructed them with time-varying weight method.Based on 3-order splines functions,we constructed orthogonal wavelet and scale function. According to the dual-scale function,we could get transform function h and its mirror filter g,theyare related by gn(- l)nhn+1. More detail could see Mallat' theory[3]. Through fast pyramid algorithm,the EP' S signal can be decomposed into detail and coarse parts on a dyadic scales by scalefunction like this Here Cj is coarse signal and Dj is detail signal. C, is signal on scale 0 and is the same as originalsignal. With j increasing,the EP' S signal were projected to different frequency bands. The reconstructed function for signal on j scale to j-1 scale isAccording to the character of EP' S signals and their decomposition on different scales ,we choosethe following signal processing principle.To somatosensory EPI S (SEP),we choose coarse and detail signal on scale 6 to reconstructsignalS(t) ~W, (t) o C,(t) +WZ(t) o D,(t)W, and W, are time--varying weight and are decided by the amplitude of detail and coarse signalson scale 6.To Event--related optentials (P300 waveform),because the noise is mainly on high frequencyband gwe choose coarse signal of scale 6 to reconstruct signal.RESULTThere are ten subjects taking part in the experiment. The instrument is SPECTRUM32 ofCADWELL corporation. To SEP signals,The medial nerve of left wrist was stimulated,activeelectrode was attached to Cll (3 cm lateral to the midline and posterior to the coronal suture).reference electrode at Al (left ear) and ground electrode at Fpz according to 'the international 10-20system of electrode placement.Figurel is the original SEPI S signal and processed signal, (a) is the SEPI S signal averaged by250 times. (b) is the signal averaged by 30 times and (c) is the signal of (b) be processed. Fromthe figure,we could see that the method is effectively,noise ate inhibited greatly and the waveform of (c) is almost the same as the signal (a).Figure 2 .The EPRI S signal and processed signalTo ERP,active electrode was attached to Cz.reference electrode at Al and ground electrodeat Fpz. The stimulus is auditory and the probability of target stimulus is 20 percent.FigureZ is the EPR signal, (a) is the signal average 40 times, (b) is the single trial signal and(c) is the processed signal of (b). From the figure, we could say that multiresolution waveletanalysis can get single trial signal of ERP. The signal (c) is almost the same as signal of (a).From the experiments,we could say that the time--varying weighted multiresolution waveletanalysis method is suitable and practicable and may be vary useful in identification of single trialEPI s signal.
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。
文摘Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip （DDH） has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases （Crowe type Ⅰ and Ⅱ）. Methods Between September 2005 and May 2007, twenty-one consecutive patients （twenty-six hips） with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years （range, 37-59 years）. Six patients （28.6%） were male and fifteen （71.4%） were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly. Results All patients were followed for a mean of 18 months （9-29 months）. During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepancy of 0.8 to 1.2 cm, all regained equal limb length postoperatively. In addition the pain was nearly completely relieved, the range of motion was remarkably improved and no restriction was needed after operation regarding early exercise. Conclusions The new generation of metal-on-metal resurfacing arthroplasty may be a reasonable option for DDH of the Crowe types Ⅰ and Ⅱ.
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。
