目的 观察在无痛病房模式下塞来昔布联合曲马多对单侧全膝关节置换术(TKA)后膝关节早期功能康复的影响.方法 回顾性分析2016年4月至2019年6月北京朝阳中西医结合急诊抢救中心骨科行单侧TKA共70例患者.将采用无痛病房模式下口服塞来昔布联合曲马多患者归为A组,仅口服曲马多患者归为B组;其中A组40例,B组30例.对两组的一般资料及术后第1、3、7天主动活动时视觉模拟疼痛评分(VAS)、膝关节主动屈曲活动度(ROM)、美国特种外科医院膝关节功能评分(HSS)进行对比.结果 共70例患者纳入本研究,在术后第1天和术后第3天,两组患者被动练习屈伸活动时VAS评分差异无统计学意义[(2.27±0.86)分比(2.42±0.95)分,P=0.492;(3.10±1.09)分比(3.41±1.18)分,P=0.260)].而在术后第7天,A组主动锻炼时的VAS评分较B组低,两组患者的VAS评分比较差异有统计学意义[(3.51±0.21)分比(4.67±0.36)分,P<0.001].在术后第1、3天,两组患者膝关节的主动曲屈活动度(ROM)比较差异无统计学意义[(90.6±30.3)°比(89.5±15.6)°,P=0.853;(92.1±30.1)°比(90.7±14.7)°,P=0.808].而在术后第7天,A组患者膝关节的主动曲屈活动度较B组大,比较差异有统计学意义[(115.9±9.9)°比(109.0±10.9)°,P<0.05].两组患者术后3个月HSS评分差异无统计学意义[(77.8±4.0)分比(76.3±3.4)分,P=0.119].结论 无痛病房管理模式下塞来昔布联合曲马多对全膝关节置换术后早期功能康复有帮助.

背景:关节置换手术后预防下肢深静脉血栓形成(DVT)的物理治疗方式多样,临床医护人员急待明确可降低DVT发生率的有效方法.本研究两种不同频次治疗方式均可降低DVT发生率,临床医护人员可根据患者特点选择合理的方式进行物理治疗.目的:探讨不同频次使用间歇式充气加压装置(IPC)预防关节置换术后患者下肢DVT的效果.方法:将2013年12月至2014年9月入院行关节置换术患者160例随机分为对照组和观察组各80例,两组患者基线资料无统计学差异.两组患者术后第1日均给予穿抗血栓压力带、口服抗凝药物等常规防血栓治疗.对照组患者于术后第1日使用IPC,使用频次为每日上午2 h;观察组患者于术后第1日使用IPC,使用频次为每日上、下午各lh.两组患者均于术后3～5 d常规行双下肢深静脉彩超,观察下肢DVT发生情况.结果:观察组患者7例发生下肢DVT,占8.75％,肌间血栓24例,占30％;对照组患者5例发生下肢DVT,占6.25％,肌间血栓占20例,占25.0％.两组患者下肢DVT发生率无统计学差异(P＞0.05).结论:不同频次使用IPC对预防关节置换术后下肢DVT的效果相同,但每日上午2h集中使用IPC可降低医务工作者的工作量,同时使患者有充足的时间进行术后康复训练,更不会延误术后各项检查的筛查工作,有助于提高住院期间的满意度.

OBJECTIVE:To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans. METHODS:In 32 total hip arthroplasty (THA), we performed CT scans before and after operation. Four possible levels (lesser trochanter, 5 mm above, 10 mm above and 15 mm above the lesser trochanter) of broach version were calculated based on the preoperative CT scan. Stem versions were measured on the postoperative CT scan. We determined the difference between the preoperative broach version and the postoperative stem version using the Student's t test for paired samples assuming equal variance. RESULTS:For the operated hips, preoperative hip version differed according to the level of measurement. Our findings showed that the average femoral version was 37.0°±11.0° at the level of the lesser trochanter (section 1), 34.3°±10.6° at 5 mm above the lesser trochanter (section 2), 28.1°±10.9° at 10 mm above the lesser trochanter (section 3), and 22.4°± 13.7° at 15 mm above the lesser trochanter (section 4), and that the average version for the femoral neck (FNV) was 12.9°±13.8°. The postoperative hip version was the stem version (FSV), which we found to be an average of 26.1°±11.0°. The mean femoral version for section 1 and 2 was larger than the mean postoperative stem version (P<0.01); the mean version for sections 3 and 4 did not differ from the mean postoperative stem version (P>0.05). The mean femoral neck version was less than the mean postoperative stem version (P<0.01); the difference was 13.2°±11.1° of the increased anteversion on average for the FSV compared with FNV. CONCLUSION:The accuracy of estimated femoral version after arthroplasty depends on broach level. When it is 10 mm above the lesser trochanter, stem version estimation is accurate, but below that level, there is a tendency to overestimate.

Objective To explore the influence of Tri-lock and Summit prosthesis on femoral anteversion angle. Methods A compar-ative prospective study was performed on 64 patients with total hip arthroplasty( THA) ,32 cases with Tri-lock prosthesis and other 32 cases with Summit prosthesis. CT images were used to calculate the preoperative autologous femoral anteversion angles and postopera-tive femoral-prosthesis angles,and they were compared between the two groups. Meanwhile,the anteversion angles between preoperative CT image and postoperative image were also compared in each case. Results Postoperative femoral-prosthesis angle increased when compared with preoperative autologous femoral anteversion angle in all cases(P<0. 01). While,there were no statistical differences of the femoral-prosthesis angles between Tri-lock group and Summit group(P>0. 05). Conclusion Tri-lock and Summit prosthesis have the equivalent effect on the adjustment of femoral angle in THA.

OBJECTIVE:To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life (QOL) and function improvement.METHODS:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications. In this study, 13 patients admitted to Department of Adult Reconstructive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included. Questionnaires SF-36 were used to evaluate the QOL. Harris hip score, American Knee Society Score (KSS) were used to evaluate the joint function. The patients were evaluated before surgery to the latest follow up.RESULTS:SF-36 has changed as follow: physical function 4.17 ± 14.43 → 65.83 ± 24.76, role physical 25.00 ± 26.11 → 60.42 ± 45.8, bodily pain 23.83 ± 21.41 → 76.88 ± 20.89, general health 53.33 ± 33.87 → 76.67 ± 14.67, vitality 50.42 ± 17.25 → 71.67 ± 16.28, social functioning 29.17 ± 33.50 → 73.96 ± 33.90, role emotional 22.08 ± 35.61 → 77.77 ± 41.03, mental health 53.33 ± 25.70 → 82.67 ± 14.41, which indicated that they all improved greatly after the surgery (P < 0.05). Harris score increased from 37.68 ± 14.71 before the surgery to 83.36 ± 13.54 after the surgery. KSS has also showed sharp improvement (P < 0.001) in both clinical score (42.52 ± 23.83 → 77.74 ± 20.67) and function score (-2.61 ± 22.56 → 65.65 ± 30.76).CONCLUSION:Multiple arthroplasty is one of the most effective methods which can markedly improve the quality of life in patients with multiple joints disease. But complications are common and joint functions are relatively poor.

Objective To examine the feasibility of a modified ilioinguinal approach to Bernese periacetabular osteotomy for congenital acetabular dysplasia.Methods From May 2008 to June 2012 ,15 patients (17 hips) with an average age of 35.6 years (range:16 to 48 years ,1 male and 16 females) were treated with Bernese periacetabular osteotomy with a modified ilioinguinal approach.The CE angle and AC angle were evaluated radiographically before and after the operation.Hips were evaluated with the use of osteoarthritis index and Harris score postoperatively.Results The coverage of the femoral head was enhanced after surgery in all patients.Significant improvement was seen radiographically with regard to the CE angle which changed from (4.50°±4.18°)to(28.80°±6.71°),andACanglewhichchangedfrom(26.54°±5.73°)to(4.20°±5.22°).Follow-upwas performed for an average of 3.5 years (1-5 years).Hip pain was found to be alleviated in the 17 hips and osteoarthritis was controlled after surgery.Harris score was improved from (81 .21 ± 5 .45) to (96 .82 ± 6 .76).Complications ,such as nonunion of bone osteotomy and important nerve injury ,did not occur.Conclusion The modified ilioinguinal approach to Bernese periace-tabular osteotomy can safely and effectively treat acetabular dysplasia with satisfactory outcomes achieved.

Objective Our goal was to summarize the clinical data of the combined anteversion of both stem and cup measured by CT method after total hip arthroplasty and to evaluate the accuracy of conventional freehand technique for positioning the combined anteversion by comparing the results to the Dorr′s “safe zone” .Methods We prospectively studied 206 primary total hip arthro-plasties .For all the arthroplasties ,we used posterior lateral approach and conventional freehand technique without any alignment guides .12 surgeons performed all the 206 arthroplasties .Postoperatively all the patients were examined by CT scan within one week .We measured radiographic anteversion of acetabular components using a 3D CT method and measured femoral components anteversion using CT scans .Acetabular anteversion ,femotal component anteversion and combined anteversion were statistically ana-lyzed .Results In all the 206 hips ,the mean acetabular components anteversion was 16 .23° ± 8 .27° ,76 .21% of cases was in Lewin-neck′s safe range of 5°-25° .The mean femoral components anteversion was 23 .79° ± 10 .70° .The mean combined anteversion was 40 .02°± 13 .50° ,65 .05% was in safe range of 25°-50°recommended by Dorr .The acetabular components anteversion ,femoral com-ponents anteversion and combined anteversion placed by senior surgeons was no significantly different from those placed by junior orthopedic surgeons(P>0 .05 ,0 .726 ,0 .143 ,0 .061 ,respectively) .Conclusion The conventional freehand technique is an inaccurate method for positioning the cup anteversion or the combined anteversion .The experience of surgeons can not significantly improve this accuracy .

Objective To summarize the status of acetabular component orientation placing by using the conventional freehand technique,studied with a three-dimensional computed tomography(3D CT) method that measures acetabular component inclination and anteversion;to evaluate the accuracy of this method by comparing the results to Lewinnek' s safe zone;and to assess the influence of the surgeon' s experience on the accuracy of acetabular component orientation.Methods:We prospectively studied 206 primary total hip arthroplasties performed between September 20 and November 20,2011.The posterior lateral approach and conventional freehand technique,without any alignment guides,were used for all arthroplasties.A total of 12 surgeons performed all 206 arthroplasties.Six senior orthopedic surgeons operated on 131 hips,and 6 junior surgeons operated on 75 hips.All patients underwent CT scanning within a week of surgery.We proposed a 3D CT method for measuring the acetabular inclination and anteversion and assessed the reliability of our method through this study.We summarized the mean values of acetabular component inclination and anteversion.These components were placed by using the conventional technique.By comparing with Lewinnek' s safe range(inclination 40°±10° and anteversion 15°±10°),we evaluated the accuracy of the conventional freehand technique for acetabular component orientation.We also assessed the influence of the surgeon' s experience on the accuracy of acetabular component orientation.Results:The 3D CT method for measuring acetabular component inclination and anteversion was reliable with an Interclass Correlation Coefficient of0.99 for both interobserver and intraobserver measurements.In all 206 hips,the mean inclination angle was(36.07±6.72)° and 78.16% of cases were in Lewinnek' s safe range;the mean anteversion angle was(16.27±8.26)°and 76.21%were in Lewinnek' s safe range.When both inclination and anteversion were considered,only 60.19% of the cases were in the safe range.The orientations of cups placed by the senior orthopedic surgeons were not significantly different from those placed by the junior surgeons(P0.05).ConclusionThe 3D CT method used in our study is reliable for measuring acetabular component orientation.The current status of acetabular component orientation when placed by using the conventional free hand technique in our hospital is that the mean inclination is(36.07±6.72)° and mean anteversion is(16.27±8.26)°;the chance of accurate placement is only 60.19%.Therefore,when using the conventional freehand technique,we cannot rely solely on the surgeon' s experience to improve the accuracy of placement of the acetabular component.

<正>1病例简介患者男,67岁,主因"右髋疼痛,活动受限20余年,加重1年"入院。入院查体:患者持拐行走,右下肢不能负重,右髋固定屈曲30°外旋20°畸形,有10°主动屈曲活动度,内收外展内旋外旋活动度均为零,活动痛明显,可见脊柱下腰段后凸畸形,脊柱各节段均无活动度。Thomas征(+),右侧髂腰肌股四头肌肌力4级,余髋关节肌群因髋关节活动受限无法准确检查。

[Objective]The aim of this study was to evaluate the accuracy and reliability of seven methods those are reported in literature and to suggest a precise and convenient method for clinical use.[Method]In 60 consecutive patients with 60 THAs performed between September 20th to October 20th 2011 in our hospital,both CT scan and plain anteroposterior plain radigraphs were taken.Anteversion of the acetabular component was measured by three independent examiners on plain radiographs using these seven methods.Measurements using 3D CT were used as the gold standard reference to assess the validity of the seven methods.The intra-and interobserver reliabilities of each measurement were also evaluated.[Result]All measurements on plain anteroposterior radiographs had excellent intra-and interobserver reliability.Measurements made using the methods of Widmer and of Visser were significantly different from the 3D CT measurements(both P<0.001),whereas measurements made using the remaining five methods were similar to the CT measurements.Whereas measurements using the method of Visser were strongly correlated with the anatomical anteversion measured on 3D CT.[Conclusion]The methods of Lewinneck,Hassan,Ackland,Liaw and Pradhan are reliable and accurate,whereas the methods of Widmer and Visser are not accurate.But the method of Visser can be used to measure anatomical anteversion on plain anteroposterior radiographs.With regard to validity and convenience for calculation,we recommend the use of the method described by Lewinnek and Liaw for measurement of anteversion of the acetabular component.

OBJECTIVE:To summarize the detailed failure mechanisms of revision hip arthroplasties and related risk factors.METHODS:From November 1988 to July 2008 revision of total hip arthroplasties was performed in 327 patients. The medical history, clinical and imaging material and operation records were investigated.RESULTS:Regarding revision as the end point of the study, the reasons for 327 revision arthroplasties were aseptic loosening in 226 hips (69.1%), infection in 52 hips (15.9%), periprosthetic fracture in 22 hips (6.7%), instability in 17 hips (5.2%), stem fracture in 5 hips (1.5%) and liner dissociation in 5 hips (1.5%).CONCLUSIONS:The main failure mechanisms of primary hip arthroplasties are aseptic loosening and infection of implants, which could be attributed to improper selection of operation indications and implants and limitations to surgical philosophy and technique.

OBJECTIVE:To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery.METHODS:From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E).RESULTS:Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no patients was found osteolysis and cup migration.CONCLUSION:The trabecular metal has strong capacity of bone conductive and bone inducement.

目的探讨旋转平台人工全膝关节置换术的临床效果。方法对49例患者行70膝的Sigma旋转平台人工全膝关节置换术,其中21例为双侧膝关节置换。男7例,女42例;年龄38～78岁,平均63岁。术前诊断膝骨关节炎42例,类风湿关节炎7例。采用正中切口髌旁内侧人路、后稳定型假体,所有膝关节都未进行髌骨置换,但对髌骨进行去神经化和修复术。结果本组随访时间6～22个月,平均12.7个月,共70膝。影像学显示均无松动,无髌骨脱位。对膝关节临床评定采用美国膝关节学会评分(KSS评分),术前膝评分49分(35～70分),膝功能评分40分(30～60分),术后最后一次随访膝评分为96分(83～100分);功能评分为95分(65～100分),没有旋转平台的旋出,没有翻修或者感染的发生。结论旋转平台人工全膝关节置换术在运动学分析和实验室磨损试验的数据上有潜在的优势,尤其是在年轻的活动能力强的患者,近期随访获得了满意的疗效,远期的疗效还需进一步随访。

Objective To evaluate the short-term results of total metatarsophalangeal arthroplasty (TMPA) for OA, RA, hallux valgus with severe OA, hallux rigidus, and osteonecrosis of metatarsal heads. Methods From March 2002 to March 2005, total metatarsophalangeal arthroplasty was performed in 30 patients (11 males and 19 females, age from 33 to 77 years old, average 62.5 years old) and 47 feet. Fifteen were bilateral. The preoperative underlying diagnosis was RA in 7, hallux rigidus in 5, hallux valgus with severe OA in 21, avascular osteonecrosis in second metatarsal head in 6, old metatarsophalangeal dislocation in 2, complications after McBride operation in 2 feet. Totally, 33 first metatarsoplangeal joints, 11 second metatarsophalangeal joints, 2 third metatarsophalangeal joints and 1 fourth metatarsophalangeal joint were replaced with metal bushed silicon Swanson prostheses. Two patients (4 feet) with abnormal first-second intermetetarsal angle (19°-20°) received simultaneous proximal metatarsal osteotomy. The osteotomed metatarsal were fixed with Biofix absorbable screws. Two patients (3 feet) received simultaneous metatarsal head (2-5) resection arthroplasty. Twenty-nine (46 feet) were followed-up for average 26.5 (3-36) months with Maryland metatarsal joint scoring system. Oriented by the Maryland scoring system, pain, joint function, and objective messurements were recorded and scored. Results The preoperative and postoperatvie Maryland score was 72 (55-82) and 91 (67-96), respectively. Excellent result was achieved in 41 feet (89.13%), good in 2 feet(4.35%), fair in 2 feet(4.35%), and poor in 1 foot(2.17%). The good-excellent result rate in this group was 93.48%. The complications included: delayed wound union in 2 feet, implant dislocation in 1 foot, reactive synovitis in 1 foot. Conclusion The short-term result of total metatarsophalangeal arthroplasty for treatment of OA, RA, hallux rigidus, old dislocation of metatarsophalangeal and avascular osteonecrosis of metatarsal heads is satisfying.