OBJECTIVE: To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint. METHODS: A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997. RESULTS: Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal. CONCLUSION: It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.
Objective To compare the biomechanical effects between rotational acetabular osteotomy and Chiari osteotomy for developmental dysplasia of the hip (DDH) by biomechanical test. Methods Sixteen DDH models of 8 human cadaver specimens were prepared by resecting the upper edge and posterior edge of acetabulum. And the Wiberg central-edge angle (CE) of the DDH model was less than 20°. Then the rotational acetabular osteotomy was performed on the left hip and Chiari osteotomy on the right hip. When 600 N loading was loaded at 5 mm/minute by a material testing machine, the strain values of normal specimens, DDH specimens, and 2 models after osteotomies were measured. Results In normal specimens, the strain values of the left and right hips were 845.63 ± 533.91 and 955.94 ± 837.42 respectively, while the strain values were 1 439.03 ± 625.23 and 1 558.75 ± 1 009.46 respectively in DDH specimens, which was about 2 times that of normal hips. The morphology and X-ray examinations indicated that the DDH model was successfully established. The strain value was 574.94 ± 430.88 after rotational acetabular osteotomy, and was significantly lower than that of DDH specimens (t=4.176, P=0.004); the strain value was 1 614.81 ± 932.67 after Chiari osteotomy, showing no significant difference when compared with that of DDH specimens (t=0.208, P=0.841). The strain value relieved by rotational acetabular osteotomy was significantly higher than that by Chiari osteotomy (t= — 2.548, P=0.023). Conclusion Rotational acetabular osteotomy is better than Chiari osteotomy in relieving hip joint stress of DDH.
Objective To compare the efficiency of secondary total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture and the primary THA for non-traumatic ONFH and to evaluate if the two groups have significant difference. Methods From June 2004 to July 2007, 203 cases of ONFH were treated by THA. In group A, 83 patients (83 hips) with ONFH after failed internal fixation included 56 males (56 hips) and 27 females (27 hips) with an average age of 58.3 years (range 45-75 years). According to Ficat classification, there were 61 cases atstage III and 22 cases at stage IV. The Harris score was 37.6 ± 2.0. The disease course was 1-6 years with an average of 2.6 years. In group B, 120 patients (167 hips) with non-traumatic ONFH included 67 males (94 hips) and 53 females (73 hips) with an average age of 52.6 years (range 41-67 years). According to Ficat classification, there were 56 cases (83 hips) at stage III and 64 cases (84 hips) at stage IV. The Harris score was 38.2±1.0. The disease course was 1.5-5.0 years with an average of 2.6 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All 203 cases were followed up for 2 to 5 years (average 3.4 years). There were no significant differences in the operation time of single-hip, the blood loss, the blood transfusion between two groups (P gt; 0.05). Intraoperative fractures occurred in 4 hips (4.8%) of group A and 2 hips (1.2%) of group B, showing significant difference (P lt; 0.05). There were no significant differences (P gt; 0.05) in the incidence of dislocation [3 hips (3.6%) in group A and 1 hip (0.6%) in group B], continuous femoral pain [2 hips (2.4%) in group A and 1 hip (0.6%) in group B] and infection [1 hip (0.6%) in group B] between two groups. There were no significant differences (P gt; 0.05) in acetabular abduction, anteversion, femoral anteversion, and combined anteversion angles as well as the recovery rate of acetabular rotational center between two groups. The Harris scores of groups A and B after 2 years were 79.4 ± 2.1 and 84.2 ± 3.5.There was no significant difference between two groups (P gt; 0.05). The Harris score postoperation had significant differences compared with preoperation (P lt; 0.05). Conclusion Compared to the primary THA to non-traumatic ONFH, secondary THA to ONFH after failed internal fixation has no significant increase in operative difficulty, the postoperative hip function isgood, but the incidence of intraoperative fracture is higher.
Objective To evaluate the clinical results of cementless total hip replacement (THR) in treating osteoarthritis and identifying the factors affecting the results. Methods From January 1995 to December 1999, 76 patients(85 hips) with osteoarthritis of hip joint were treated. These patients were assessed according to Harris hip score and X-ray film. The average follow-up time was 49.3 months. Results The average Harris score in the patients was 90.9 points. The excellent or good rate was 91.9%(75/85). Pain in the thigh existed in 23 hips (27.5%). The femoral osteolysis occurred in 14 hips(16.5%). The radiographical result demonstrated femoral loosening in 2 hips. harris score became lower when the femoral component of osteoarthritis of hip jointl. Pain in the thigh may be related to the varus placement of femoral component and femoral osteolysis. Femorla osteolysis is one of important factors affectin the long-term outcomes.
Total hip arthroplasty is an end-stage treatment for hip diseases such as hip osteoarthritis and osteonecrosis of the femoral head. Traditional surgery models are still mostly used in China, and related day surgery models abroad have shown that day surgery for total hip arthroplasty is as safe and feasible as traditional pattern without increase in complications and readmission. It can also shorten the length of hospitalization for patients, reduce hospitalization costs, thereby speeding up bed turnover and increasing the utilization of medical resources. This article reviews the patient admission, perioperative management, anesthesia and surgical techniques, post-discharge rehabilitation and nursing care of patients undergoing day surgery for total hip arthroplasty, and aims to providea reference for the development of day surgery for total hip arthroplasty in China.
fter total hip replacement ,massive bone defect occured freqently due to wearing and loosening of the prcathesis.The use of deep-freezing allograft to su pport a new implant was an attractive solution. Deep-freezing decreased the immune antigenicity of the transplanted allograft.From 1972 to 1990. the deep-freezing allografts were used in rcvision total hip replacement in 212 cases,in which 187 cases(198 hips) were followed-up for over 1 year.The general effective rate was 85%....
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
目的:对同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制及诊断进行分析探讨。方法:对2007年1月至2008年6月收治的7例同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤患者的临床资料、诊治经过和随访结果进行总结分析。结果: 胫腓骨开放性骨折3例(42.9%),闭合性骨折4例(57.1%);髋关节均有后脱位,其中伴有髋部骨折5例(71.4%)。膝后交叉韧带实质部断裂4例(57.1%),胫骨止点撕脱骨折3例(42.9%)。7例患者获平均14.7个月(12～18个月)随访。Lysholm膝关节功能评分术后6月95.8±3.71,术后12月97.6±2.7。结论:明确同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制,全面、准确、系统的问诊查体和完善的辅助检查是早期确诊、提高疗效的关键。