Objective To explore the effect of minimally invasive and mini-incision surgery (MIS) in total hip arthroplasty (THA) on late osteonecrosis of femoral head (ONFH). Methods From March 2003, Eighteen patients (22 hips) with ONFH underwent MIS in THA. Their ages ranged from 24to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1(24.6 on average). The Harris hip score was 46 points before operation. Modified posterior-lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. As a comparison, 18 patients (22 hips) were performed by conventional THA at the same period. The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow-ups were done for 6 to 20 months (11 months on average). Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm (9.3 cm on average) in MIS THA group, being statistically different (Plt;0.01). There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation (Pgt;0.05). The operative time was almost the same, but the bleeding volume in MIS THA group was less (Plt;0.05). The function recovery was faster in MIS THA group.Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.
【Abstract】 Objective To summarize techniques of the total hi p arthroplasty (THA) in the treatment of developmental dysplasia of the hi p (DDH) with severe osteoarthritis in adults. Methods From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, withthe average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients’ ill lower l imbs were 2-7 cm shorter than the healthy lower ones. Results All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely rel ieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. In 3 patients, the ill lower l imbs were more than 1 cm shorter than the healthy lower ones and the other patients’ ill lower l imbs were less than 1 cm shorter than the healthy lower ones. Two patients’ lower l imbs were been lengthened 4-5 cm. All the patients’ sciatic nerves were not injured. The Harris scores were 46.5 ± 7.2 preoperatively and 84.0 ± 5.7 postoperatively (P lt; 0.05). Conclusion THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.
Objective To investigate clinical significanceand surgical protocols about the balance of the lower limb lengths in the total hip arthroplasty. Methods Forty-eight patients undergoing the unilateral primary total hip arthroplasty from March 2000 to October 2004 were retrospectively studied. In 12 hips, the prostheses were of the cement type; in 36 hips, of the mixture type. Thirty patients with an equal limb length had a fractured femoral neck, 10 patients had a shortened (1.0-2.0 cm) limb, 6 patients had a shortened (2.0-4.0 cm)limb, and 2 patients had a shortened (4.0-6.0 cm) limb. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the hip prosthesis type was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the wearing of the acetabula properly, the best rotation point was found out during the operation. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve an intended limblength equalization. Results All the patients were followed up for 3-42 months.According to the Harris scoring system, clinical results were excellent in 30 patients, good in 12, fair in4, and poor in 2. Of the 30 patients with an equal limb before operation, 5 were lengthened 1.0-2.0 cm in their lower limbs, and 1 lengthened 2.5 cm postoperatively. Of the 18 patients with shortened limbs before operation, 10 returned to the same lengths in their lower limbs, 6 were lengthened 1.0-2.0 cm in their lower limbs, but 2 with seriously-shortened lower limbs for congenital dysplasia of the hipjoint were still shortened 2.0-3.0 cm in the limb length after operation. The Harris hip scores revealed an average of 92.3 points in the patients with an equal limb length, and 88.6 points in the patients with shortened limbs. 〖WTHZ〗Conclusion Many factors, such as surgical protocols, prosthesis type designs, and the management techniques during the operation, can affect the limb length after operation. As the limb length discrepancy will make the patients feel disappointed, the clinical measurements are very important before operation. Application of the comprehensive appraisal methods during the operation, use of the soft tissuebalance method, and skills for obtaining an equal limb length during the total hip arthroplasty are also important for improving the surgical result further.
Objective To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing. Methods A retrospective collection was performed for 74 children with Tönnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups (P<0.05), and there was no significant difference in gender, side, Tönnis typing, and preoperative acetabular index (AI) (P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria. Results All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant (P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups (P>0.05). There was no significant difference in AI between the two groups at each time point after operation (P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension (P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up (P<0.05). There was no significant difference in the incidence of ONFH between the two groups (P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.ConclusionSalter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat Tönnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.
目的 探讨强直性脊柱炎（AS）受累骶髂关节、腰椎小关节及髋关节的病变CT表现特点，以提高诊断与鉴别诊断水平。 方法 2011年1月－10月对临床确诊的强直性脊柱炎患者44例骶髂关节、28例腰椎及14例髋关节行CT扫描，回顾性分析骶髂关节、腰椎小关节及髋关节的CT表现。 结果 AS患者的CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧，腰椎小关节及髋关节则表现为关节间隙改变、关节面毛糙及囊状破坏、面下骨硬化或吸收等改变。 结论 AS骶髂关节、腰椎小关节及髋关节的CT表现具有一定特征，CT具有重要的诊断及鉴别诊断价值。
Objective To observe expression of Caspase-3 and apoptosis around the prosthesis and explore the relationship of the expression and the apoptosis with the periimplant osteolysis. Methods From April 2001 to August 2006, 16 patients (10 males, 6 females) underwent the revision total hip arthroplasty surgery, who had the primary total hip arthroplasty at the ages of 45-67 years and had the revision total hip arthroplasty at the ages of 55-78 years, with the implantation duration of 7-13 years. According to their preoperative X-ray films andthe findings during the operation, the patients were divided into two groups: theloose/osteolytic group (n=8) and the loose/non-osteolytic group (n=8). The interface tissues were obtained from the peri-implant region in the patients. The synovial samples were taken from another 6 patients (2 males, 4 females; age, 54-68years; illness course, 9-15 years), who underwent the primary total hip arthroplasty for osteoarthritis. These 6 patients were used as controls. The tissues were prepared for the immunohistochemical assays to determine the expression of Caspase-3. The TUNEL assays were performed to quantify the apoptotic cells. The quantitative analysis on the positive cells and the correlation with the presence of the particulate wear debris and the severity of osteolysis were also performed. Results The level of the expression for Caspase-3 and the apoptosis index inthe loose/osteolytic group were significantly increased when compared with those in the loose/non-osteolytic group and the control group (P＜0.01). The polyethylene particles were surrounded by more positive cells than the metal particles. The positive cells were present at a higher level in the tissue sections where the high-wear status was present when compared with the areas where the low-wear status was present (P＜0.05). Conclusion There is a statistical correlation of the Caspase-3 expression to the apoptosis index and to the presence of the particulate wear debris and the severity of osteolysis, which may be one of the key points for the bone reconstruction inhibition and the bone resorption at the boneimplant interface under the stimulation of the wear debris. The apoptosis is involved in the pathogenesis of the aseptic loosening, which is closely related to the signal transportation of Caspase-3.
Objective To evaluate the clinical valueof the revision of total hip replacement(THR), to analyse the reason of the rev isions, and to discuss the main difficulties and measures to manage it.Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on totalhip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR,especially the broken femoral stem and the cements; the loss of localbone. The measures to remove the broken femoral stem were described.ResultsAll cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others.No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement.Conclusion The revision of THRis a more difficult operation, so that the special instrument and equipment andoperative experience are required.
Objective To evaluate the therapeutic outcome of artificial total hip arthroplasty (THA) with collum femoris preserving for hip joint desease in young and middle-aged patients. Methods From March 2002 to March 2005, 26 cases (31 hips) of hip joint disease were treated with artificial THA with collum femoris preserving, including 19 males (23 hips)and 7 females (8 hips) and aged 32-48 years with an average of 37 years. In 31 hips, 17 left hips and 14 right hips were involved. There were 9 cases of osteoarthritis of the hip joint caused by avascular necrosis of the femoral head (ANFH), 7 cases of ANFH, 3 cases of femoral head necrosis caused by dysplasia of acetabular, 1 case of osteoarthritis of the hip joint caused by ankylosing spondyl itis, and 2 cases of rheumatoid arthritis; the course of disease was 2-11 years (5.6 years on average). Two cases of femoral neck fracture (Garden IV), and 2 cases of non-union femoral neck fractures (1 for Garden III and 1 for Garden IV), the course of disease was 5 days, 24 months, and 26 months. The prime symptoms were pain, difficult walk and l imp. All patients were taken X-ray to exclude osteoporosis. Results The right distal femur prosthesis of a bilateral patient cracked owing to excessive amputation of collum femoris, and fracture healed after symptomatic treatment. All the incisions healed by first intention and no compl ications occurred. All patients were followed up for 4-7 years, with an average of 5.6 years. One case had poor hip function because he did not follow rehabil itation procedure, and the others achieved good outcome with normal gait. One case complained of persistent pain 6 months after operation, and was rel ieved by administration of some non-steroidal antiinflammatory drugs and anti-osteoporosis drugs 6 months later. The X-ray films after operation and at last follow up showed good location of prosthesis and no bone resorption. Harris score at last follow-up was 91.31 ± 0.77, and it was significantly higher than that before operation (50.88 ± 0.90), (P lt; 0.05). The excellent and good rate was 93.5% (excellent in 11 hips, good in 18 hips, and fair in 2 hips). Conclusion Artificial THA with collum femoris preserving can retain more bone, be easier for revision, and has an excellent outcome.