Treatment of bilateral developmental dysplasia of the hip joint with an improved technique:A case report

BACKGROUND Developmental dysplasia of the hip(DDH)is a common osteoarticular deformity in pediatric orthopedics.A patient with bilateral DDH was diagnosed and treated using our improved technique"(powerful overturning acetabuloplasty)"combined with femoral rotational shortening osteotomy.CASE SUMMARY A 4-year-old girl who was diagnosed with bilateral DDH could not stand normally,and sought surgical treatment to solve the problem of double hip extension and standing.As this child had high dislocation of the hip joint and the acetabular index was high,we changed the traditional acetabuloplasty to"powerful turnover acetabuloplasty"combined with femoral rotation shortening osteotomy.During the short-term postoperative follow-up(1,3,6,9,12,and 15 months),the child had no discomfort in her lower limbs.After the braces and internal fixation plates were removed,formal rehabilitation training was actively carried out.CONCLUSION Our"powerful overturning acetabuloplasty"combined with femoral rotational shortening osteotomy is feasible in the treatment of DDH in children.This technology may be widely used in the clinic.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip:A case report

BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.

Effect of local blocking on osteoarthritis of the hip

Objective:To provide an effective treatment for the Osteoarthritis of the hip by observing the effect of local blocking of HongHua injection on relieving hip pain.Methods:Methods from June 2015 to May 2017,60 patients with Osteoarthritis of the hip in Wangjing Hospital of Chinese Academy of Sciences were randomly divided into treatment group and control group,30 cases in each group.The treatment group was given local blockingof HongHua injection treatment,control group using Compound Betamethasone Injection local closed treatment.Visual analogue scale(VAS)score,pericoxal local tenderness and hip mobility were used to evaluate the therapeutic effect.The therapeutic indicators at six different time points after 1 days,3 days,7 days,2 weeks and 1 months after treatment were compared.Results:All the 60 cases completed treatment and follow-up,and there were no cases of abscission.There was no significant difference in gender,age,etiology,classification and Harris score before treatment between the two groups(P>0.05),which was comparable.VAS score:There was no significant difference between the two groups on the 1st,3rd,7th and 2nd week after treatment(P>0.05),but the treatment group was lower than the control group on the 1st month after treatment(P<0.01).Hip joint activity:There was no significant difference in hip joint activity between the two groups 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Local tenderness around hip:The efficacy of the midpoint inguinal tenderness score was similar between the two groups at 1 day,7 days,2 weeks and 1 month after treatment(P>0.05);the treatment group was lower than the control group at 3 days after treatment(P<0.01);the adductor starting tenderness score had no significant difference at 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Conclusion:Local blockingof HongHua injection is effective and effective in treating hip pain in Osteoarthritis of the hip.The HongHua injection has many advantages,such as good safety and wide indications.It is worthy of further clinical application.

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

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.

Intra- and Periarticular Ganglia (Synovial Cysts) of the Hip with Compression of the Obturator Nerve, Concomitant with Lesions of the Ligamentum Teres—A Report of 3 Cases

Background: Synovial cysts of the hip are commonly found in patients with intra- or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases, this was feasible by hip arthroscopy, as a minimally invasive and safe technique.

Application of spiral CT three dimentional reconstruction on developmental dysplasis of the hip in children

Objective To evaluate the value of surface shaded reconstruction (SSD) of CT scanning on developmental dysplasia of the hip (DDK). Methods Unilateral DDH in 39 cases was examined with Picker 2000S spiral CT to perform SSD of the affected pelvis. All patients were females with the age ranging from 3.5 to 8 years old ( average 4.25 years). Of 39 cases, 22 cases were complete dislocation the hip, 17 cases were subluxation of the hip. The measurement of SSD included of the depth and surface area of normal and affected acetabulum; the distances from the lowest point of the bottom of the acetabulum (O point) to the anterior end (A point) of the lateral margin of anterior acetabular column (OA), the middle point (point) of the acetabular roof (OB) and the posterior end (C point) of lateral margin of the posterior acetabular column (OC). Results In normal hip, the medial and lateral margin of the acetabular roof was overlapping, and in DDH, a bony defect was found in the lateral acetabular margin in

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults： A Cross-sectional Survey

Background： The prevalence of developmental dysplasia of the hip （DDH） is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults. Methods： In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression. Results： We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units （street districts in urban areas and townships in rural areas）. The survey and examination were completed in 25,767 people （I 0,296 men and 15,471 women）. DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age （odds ratio = 1.53 [1 .03-2.27], P = 0.036）, was significantly higher among women than men （2.07% vs. 0.75%, P 〈 0.001）, and was higher among rural residents than urban residents （1.75% vs. 1.29%, P 〈 0.001）. Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education~ or current smoking or drinking and risk of DDH （P 〉 0.05）. Conclusions： DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.

Inverted Acetabular Labrum： An Analysis of Tissue Embedment in Hip Joint in 15 Patients with Developmental Dysplasia of the Hip

The acetabular labrum is a triangular fibrocartilaginous structure that forms a horseshoe-shaped attachment to the acetabular rim, which connects the acetabulum to the underlying transverse acetabular ligament [Figure la].m Up to 90% of symptomatic patients with developmental dysplasia of the hip （DDH） are found to combine with lesions of acetabular labrum.

Developmental dysplasia of the hip： A special pathology

Developmental dysplasia of the hip （DDH） is one of the most common congenital disorders in childhood. Its diverse pathological changes require different treatments and result in different outcomes. Although many studies have been conducted on DDH, some special pathology is still unrecognized. We here presented a rare case of a one-year and eleven-month old girl with DDH; a half-free intra-articular osteocartilaginous tissue was found in her right hip joint. X-ray, computer assisted tomography （CT） and magnetic resonance imaging （MRI） were performed to evaluate the pathological changes. MRI revealed some positive findings. The patient experienced open reduction and histopathological examination of the small tissue. Through gross anatomy it is a half-free intra-articular osteocartilaginous tissue, which can fully match a fossa observed at the femoral head. Histopathological examination found that the tissue was composed of collagenous fiber and cartilage-like tissue. Interestingly, we found the expression of type l collagen according to immunohistochemical analysis, which indicated that the cartilage-like tissue was formed due to laceration of the articular cartilage. This kind of disorder should be included as one of the pathologies of DDH. The most possible origin of this tissue is the femoral head which we speculate may have been fractured before.

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

Developmental dysplasia of hip seriously affects the health of children,and pelvic osteotomy is an important part of surgical treatment.Improving the shape of the acetabulum,preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies.Re-directional osteotomies,reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy.The influence of different pelvic osteotomy on acetabular morphology is different,and the acetabular morphology after osteotomy is closely related to the prognosis of the patients.But there lacks comparison of acetabular morphology between different pelvic osteotomies,on the basis of retrospective analysis and measurable imaging indicators,this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.

Joined at the Hip

Sino-U.S. relations have deep regional and global implications for maintaining peace and ushering in prosperity in the 21st

THE WAVELET ANALYSISOF EVOKED POTENTIALS

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.

Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery

Background:Hypothermia is associated with many adverse clinical outcomes in pediatric patients,and thus,it is important to an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients.This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β(TGF-β),tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip(DDH).Methods:The study included 123 children undergoing surgery for DDH under general anesthesia.The patients were randomly assigned to three groups,using a random number table:the 32,38,and 43°C groups according to the temperature setting of the forced-air warming blankets.For each patient,body temperature was recorded immediately after anesthesia induction and intubation(T0),at initial incision(T1),at 1 h after incision(T2),at2 h after incision(T3),at the end of surgery(T4),immediately upon return to the ward after surgery(T5),and then at 12 h(T6),24 h(T7),36 h(T8),and 48 h(T9)after the surgery.The serum levels of TGF-β,TNF-α,IL-1β,and IL-10 were measured at To and T4 for all groups.Results:The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups(x^2=6.630,P=0.036).At To,the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group(F=17.992,P<0.001).At T2,the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups(F=12.776,P<0.001).Moreover,at T4,the serum levels of TGF-β(F=3286.548,P<0.001)and IL-10(F=4628.983,P<0.001)were significantly increased in the 38°C group,and the serum levels of TNF-α(F=911.415,P<0.001)and IL-10(F=322.191,P<0.001)were significantly decreased in the 38°C group,compared with the levels in the 32 and 43°C groups.Conclusion:Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.

Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults

Background： Total hip arthroplasty （THA） in developmental dysplasia of the hip （DDH） is more complex than the normal hip, with large replacement risks and many complications.Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries.This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.Methods： Data on 48 DDH patients who underwent THA were analyzed retrospectively.The patients were divided into two groups： Group A 29 cases （nonosteotomy）, and group B 19 cases （osteotomy）.Harris and Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） scores, limb length discrepancy （LLD）, radiological data on the hip, and claudication were evaluated.Data were analyzed by using paired-sample Student＆#39;s t-test, independent-sample Student＆#39;s t-test, and Pearson＆#39;s Chi-square test;the test level was α =0.05.Results： Postoperative Harris （90.7 ＆#177; 5.1） and WOMAC scores （88.0 ＆#177; 10.6） were significantly improved compared with preoperative Harris （44.8 ＆#177; 5.7） and WOMAC scores （42.0 ＆#177; 5.3） in group A （P 〈 0.05）.Postoperative Harris （90.4 ＆#177; 2.8） and WOMAC scores （88.2 ＆#177; 5.9） were significantly improved compared with preoperative Harris （44.4 ＆#177; 4.2） and WOMAC scores （43.2 ＆#177; 4.3） in group B （P 〈 0.05）.One case of dislocation occurred in group A;after closed reduction, dislocation did not recur.In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment.Postoperative LLD 〉2 cm was seen in one case in group A and five cases in group B.Postoperative claudication showed no significant difference between the two groups （P 〉 0.05）.No patients developed infection;postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.Conclusions： THA is effective and safe for DDH.For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.