BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Ber...BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.展开更多
For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosi...For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoralhead and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage(generally over age 10), including adolescents and young adults(generally up to around age 40), the Bernese periacetabular osteotomy(PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.展开更多
Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We inv...Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.展开更多
目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。...目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。对比两组患者的手术情况,术前及术后采用髋骨X线检查测定髋关节情况,采用非骨关节炎髋关节评分(Non-Arthritis Hip Score,NAHS)测定患者关节功能,采用日常生活能力量表(Hip Outcome Score Activity of Daily Living Scale,HOS-ADL)测定患者活动能力,记录患者术后并发症发生情况。结果:两组患者手术情况,术后3 m术后髋关节情况对比均无明显差异(P>0.05),髋关节镜组相较于关节囊切开组术后3 m NAHS、HOS-ADL得分更高,坐骨神经损伤表现发生率明显更低(P<0.05)。结论:髋关节镜截骨术在短期改善成人发育性髋关节不良患者关节功能方面优势明显,可防止坐骨神经损伤。展开更多
目的对比年龄≥30岁伴股骨前倾角异常增大(>40°)髋关节发育不良患者(developmental dysplasia of the hip,DDH)接受髋臼周围截骨术(periacetabular osteotomy,PAO)联合股骨近端去旋转截骨术(derotational osteotomy,PFDO)与单纯...目的对比年龄≥30岁伴股骨前倾角异常增大(>40°)髋关节发育不良患者(developmental dysplasia of the hip,DDH)接受髋臼周围截骨术(periacetabular osteotomy,PAO)联合股骨近端去旋转截骨术(derotational osteotomy,PFDO)与单纯PAO的手术效果。方法选取2012年1月至2020年1月在解放军总医院第四医学中心骨科医学部接受PAO联合PFDO的年龄≥30岁伴股骨前倾角异常增大(>40°)的DDH患者,共计55例,按照接受手术方式不同,分为联合手术组(n=29)和PAO组(n=26)。联合手术组接受PAO联合PFDO治疗,PAO组仅接受PAO治疗。比较两组患者的LCEA、ACEA、Tönnis角术前及术后1年的差异,比较两组患者术前、术后6个月、术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分。结果共计随访55例患者,随访时间为2年1个月~9年11个月。术后6个月,联合手术组与PAO组的改良Harris评分和iHot-12评分相近(P>0.05)。术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分,联合手术组优于PAO组(P<0.05)。结论对于年龄≥30岁伴股骨前倾角异常增大(>40°)的髋关节发育不良患者而言,PAO联合PFDO手术效果优于单纯PAO手术。展开更多
临界型髋关节发育不良(borderline hip dysplasia,BHD)是从定义到治疗均具争议的概念。传统上将外侧中心边缘角(lateral center-edge angle,LCEA)20°~25°作为BHD的影像学诊断标准。由于BHD患者髋关节畸形的多态性,可能存在髋...临界型髋关节发育不良(borderline hip dysplasia,BHD)是从定义到治疗均具争议的概念。传统上将外侧中心边缘角(lateral center-edge angle,LCEA)20°~25°作为BHD的影像学诊断标准。由于BHD患者髋关节畸形的多态性,可能存在髋关节不稳定和/或髋股撞击。但迄今缺乏诊断及鉴别诊断的“金标准”。因此,术前需从症状、体征和影像学三方面全面评估BHD患髋,以明确是否存在髋关节不稳定和/或髋股撞击,以采取合适的治疗手段。展开更多
目的探讨改良Smith-Peterson入路行髋臼周围截骨术(periacetabular osteotomy,PAO)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)的近中期疗效。方法回顾分析泉州市正骨医院2018年4月至2021年1月采用改良Smith-Peter...目的探讨改良Smith-Peterson入路行髋臼周围截骨术(periacetabular osteotomy,PAO)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)的近中期疗效。方法回顾分析泉州市正骨医院2018年4月至2021年1月采用改良Smith-Peterson入路行PAO治疗的21例成人DDH,其中男1例(1髋),女20例(20髋);左髋12例,右髋9例;年龄18~44岁,平均(32.15±10.81)岁;改良T9nnis骨关节炎分期0期5例(5髋),Ⅰ期14例(14髋),Ⅱ期2例(2髋)。记录所有患者术中出血量、手术时间、住院时间、并发症发生情况以及术前术后髋关节Harris评分,通过X线片记录所有患者外侧中心边缘(lateral center edge,LCE)角、臼顶倾斜角(T9nnis角)、股骨头超出指数(extrusion index,EI)及前方中心边缘(anterior center edge,ACE)。结果患者术中出血量(779.52±29.60)mL,手术时间(115.95±4.44)min,住院时间(7.29±0.35)d。术后均获得随访,随访时间24~48个月,平均(33.73±9.12)个月。所有患者均未出现血管损伤、髋臼后柱骨折、切口愈合不良、感染、下肢深静脉血栓。2例(2髋)术后出现股外侧皮神经支配区麻木,未予特殊处理,术后3个月后自行恢复。末次随访Harris评分(89.67±3.44)分优于术前(72.67±4.32)分,差异有统计学意义(P<0.05)。术后12个月X线片示所有患者截骨均愈合,均未出现截骨块骨坏死。术后LCE角(31.67±3.86)°优于术前(9.86±3.25)°,T9nnis角(6.57±2.44)°优于术前(15.05±2.48)°,EI(11.33±2.96)%优于术前(29.19±2.89)%,ACE角(30.67±3.71)°优于术前(8.62±3.31)°,差异均有统计学意义(P<0.05)。结论改良Smith-Peterson入路行PAO治疗成人DDH严格把控手术适应证,重视常见手术并发症的防治,可有效改善髋关节骨性覆盖,显著改善髋关节功能,近中期疗效满意。展开更多
目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采...目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采集自体血)的45例患者作为对照组;采用AAA技术进行单采深度自体储血患者,按照对照组患者的年龄、性别、体质指数、术前Hb和Plt、手术失血量、术中自体血回收量为条件,配对选择上述条件相似且均无统计学差异的45例患者作为深度自体组。配对比较分析2组患者自体浓缩红细胞采集量和采集率、异体红细胞和血浆输注量和输注率,围术期Hb和Plt变化,住院天数及住院费用。结果深度自体组和对照组患者术前采集自体红细胞量分别为146 U和14 U,自体血采集率分别为100.00%和17.78%;2组患者围术期异体红细胞和血浆的输注量分别为4 U vs 40 U和0 U vs 24 U,异体红细胞和血浆的输注率分别为4.44%vs40.00%、0.00 vs 26.67%;2组患者围术期Hb和Plt水平变化情况无统计学差异(P>0.05);2组患者的住院时间分别为11.0(9.5,12.0)vs 12.0(10.0,15.0)(P<0.05);2组的总住院费用、治疗费用、检查检验费用和输血相关费用分别为4.01(3.72,7.72)vs 4.47(3.58,7.70)(P>0.05),3.30(2.98,6.95)vs 4.00(23.04,7.14)(P>0.05),0.48(0.45,0.53)vs 0.47(0.44,0.50)(P>0.05),0.26(0.25,0.28)vs 0.06(0.04,0.15)(P<0.05)。结论对于发育性髋关节发育不良的髋臼周围截骨手术,单采深度自体储血技术能使90%以上患者避免异体血输注,同时缩短了住院时间,减少了患者的住院费用负担。展开更多
文摘BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.
文摘For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoralhead and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage(generally over age 10), including adolescents and young adults(generally up to around age 40), the Bernese periacetabular osteotomy(PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.
文摘Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.
文摘目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。对比两组患者的手术情况,术前及术后采用髋骨X线检查测定髋关节情况,采用非骨关节炎髋关节评分(Non-Arthritis Hip Score,NAHS)测定患者关节功能,采用日常生活能力量表(Hip Outcome Score Activity of Daily Living Scale,HOS-ADL)测定患者活动能力,记录患者术后并发症发生情况。结果:两组患者手术情况,术后3 m术后髋关节情况对比均无明显差异(P>0.05),髋关节镜组相较于关节囊切开组术后3 m NAHS、HOS-ADL得分更高,坐骨神经损伤表现发生率明显更低(P<0.05)。结论:髋关节镜截骨术在短期改善成人发育性髋关节不良患者关节功能方面优势明显,可防止坐骨神经损伤。
文摘目的对比年龄≥30岁伴股骨前倾角异常增大(>40°)髋关节发育不良患者(developmental dysplasia of the hip,DDH)接受髋臼周围截骨术(periacetabular osteotomy,PAO)联合股骨近端去旋转截骨术(derotational osteotomy,PFDO)与单纯PAO的手术效果。方法选取2012年1月至2020年1月在解放军总医院第四医学中心骨科医学部接受PAO联合PFDO的年龄≥30岁伴股骨前倾角异常增大(>40°)的DDH患者,共计55例,按照接受手术方式不同,分为联合手术组(n=29)和PAO组(n=26)。联合手术组接受PAO联合PFDO治疗,PAO组仅接受PAO治疗。比较两组患者的LCEA、ACEA、Tönnis角术前及术后1年的差异,比较两组患者术前、术后6个月、术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分。结果共计随访55例患者,随访时间为2年1个月~9年11个月。术后6个月,联合手术组与PAO组的改良Harris评分和iHot-12评分相近(P>0.05)。术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分,联合手术组优于PAO组(P<0.05)。结论对于年龄≥30岁伴股骨前倾角异常增大(>40°)的髋关节发育不良患者而言,PAO联合PFDO手术效果优于单纯PAO手术。
文摘临界型髋关节发育不良(borderline hip dysplasia,BHD)是从定义到治疗均具争议的概念。传统上将外侧中心边缘角(lateral center-edge angle,LCEA)20°~25°作为BHD的影像学诊断标准。由于BHD患者髋关节畸形的多态性,可能存在髋关节不稳定和/或髋股撞击。但迄今缺乏诊断及鉴别诊断的“金标准”。因此,术前需从症状、体征和影像学三方面全面评估BHD患髋,以明确是否存在髋关节不稳定和/或髋股撞击,以采取合适的治疗手段。
文摘目的探讨改良Smith-Peterson入路行髋臼周围截骨术(periacetabular osteotomy,PAO)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)的近中期疗效。方法回顾分析泉州市正骨医院2018年4月至2021年1月采用改良Smith-Peterson入路行PAO治疗的21例成人DDH,其中男1例(1髋),女20例(20髋);左髋12例,右髋9例;年龄18~44岁,平均(32.15±10.81)岁;改良T9nnis骨关节炎分期0期5例(5髋),Ⅰ期14例(14髋),Ⅱ期2例(2髋)。记录所有患者术中出血量、手术时间、住院时间、并发症发生情况以及术前术后髋关节Harris评分,通过X线片记录所有患者外侧中心边缘(lateral center edge,LCE)角、臼顶倾斜角(T9nnis角)、股骨头超出指数(extrusion index,EI)及前方中心边缘(anterior center edge,ACE)。结果患者术中出血量(779.52±29.60)mL,手术时间(115.95±4.44)min,住院时间(7.29±0.35)d。术后均获得随访,随访时间24~48个月,平均(33.73±9.12)个月。所有患者均未出现血管损伤、髋臼后柱骨折、切口愈合不良、感染、下肢深静脉血栓。2例(2髋)术后出现股外侧皮神经支配区麻木,未予特殊处理,术后3个月后自行恢复。末次随访Harris评分(89.67±3.44)分优于术前(72.67±4.32)分,差异有统计学意义(P<0.05)。术后12个月X线片示所有患者截骨均愈合,均未出现截骨块骨坏死。术后LCE角(31.67±3.86)°优于术前(9.86±3.25)°,T9nnis角(6.57±2.44)°优于术前(15.05±2.48)°,EI(11.33±2.96)%优于术前(29.19±2.89)%,ACE角(30.67±3.71)°优于术前(8.62±3.31)°,差异均有统计学意义(P<0.05)。结论改良Smith-Peterson入路行PAO治疗成人DDH严格把控手术适应证,重视常见手术并发症的防治,可有效改善髋关节骨性覆盖,显著改善髋关节功能,近中期疗效满意。
文摘目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采集自体血)的45例患者作为对照组;采用AAA技术进行单采深度自体储血患者,按照对照组患者的年龄、性别、体质指数、术前Hb和Plt、手术失血量、术中自体血回收量为条件,配对选择上述条件相似且均无统计学差异的45例患者作为深度自体组。配对比较分析2组患者自体浓缩红细胞采集量和采集率、异体红细胞和血浆输注量和输注率,围术期Hb和Plt变化,住院天数及住院费用。结果深度自体组和对照组患者术前采集自体红细胞量分别为146 U和14 U,自体血采集率分别为100.00%和17.78%;2组患者围术期异体红细胞和血浆的输注量分别为4 U vs 40 U和0 U vs 24 U,异体红细胞和血浆的输注率分别为4.44%vs40.00%、0.00 vs 26.67%;2组患者围术期Hb和Plt水平变化情况无统计学差异(P>0.05);2组患者的住院时间分别为11.0(9.5,12.0)vs 12.0(10.0,15.0)(P<0.05);2组的总住院费用、治疗费用、检查检验费用和输血相关费用分别为4.01(3.72,7.72)vs 4.47(3.58,7.70)(P>0.05),3.30(2.98,6.95)vs 4.00(23.04,7.14)(P>0.05),0.48(0.45,0.53)vs 0.47(0.44,0.50)(P>0.05),0.26(0.25,0.28)vs 0.06(0.04,0.15)(P<0.05)。结论对于发育性髋关节发育不良的髋臼周围截骨手术,单采深度自体储血技术能使90%以上患者避免异体血输注,同时缩短了住院时间,减少了患者的住院费用负担。
