Objective To find out whether three-dimensional reconstruction of CT images in preoperative plan before total hip replacement(THA)in developmental dysplasia of the hip(DDH),compared to X-ray could improve the precision of prosthesis matching with the anatomical morphology of proximal femur medullary canal.Methods From Jan 2013 to Dec 2015,38 cases(46 hips)of DDH undergone THA in the orthopedics department of the first affiliated hospital of Guangzhou Medical University were selected in the study,except for the cases which were suffering osteoarthritis of hip,avascular necrosis of femoral head,DDH of Crowe Ⅳ,or accepted osteotomy of hip.All the cases were randomly divided into two groups: standard X-ray images were used in the X-ray group(23 hips)and 3D reconstructions of CT images were used in the CT group(23 hips)respectively in the preoperative plans.All the femur prostheses were cementless fitted.The size of femur prosthesis both anticipated in the preoperative plan and used in THA was recorded and the coincidence rates of the two groups were compared.CT scan was performed at two weeks after the surgery.Parameters of femur medullary and prosthesis,including anteroposterior and trans-diameters at the sites of femoral neck osteotomy,25mm and 75mm distal to the sites of femoral neck osteotomy,and femoral isthmus were measured with CT software.D-value of diameter between femur medullary and prosthesis was calculated and the indices of compatibility were compared between the two groups by paired t test.Results The coincidence rate of anticipated and actual size of femur prosthesis in the X-ray group were lower than the CT group(χ2=5.03,P<0.05).The indices of compatibility of femur medullary and prosthesis in X-ray group were lower than the CT group,including anteroposterior and trans-diameters at the sites of femoral neck osteotomy,25mm and 75mm distal to the sites of femoral neck osteotomy,and femoral isthmus(D-value of anteroposterior diameter,t=2.234,2.081,2.449,2.245,P<0.05;D-value of trans diameter,t=2.435,2.033,2.145,2.296,P<0.05).Conclusion With the benefit of higher coincidence of anticipated and actual sizes of femur prosthesis and the compatibility index of femur medullary and prosthesis,it is worthy to choose 3D reconstruction of CT scan for preoperative plan before THA in DDH patients.

Objective:To study the bone microstructure characteristics in femoral intertrochanter biopsy tissue of the elderly and their correlation with the activity of osteoblast and osteoclast.Methods:A total of 36 elderly patients with femoral intertrochanteric fracture caused by low-energy trauma who received artificial hip replacement in our hospital between May 2012 and December 201 5 were selected as elderly group,and 28 young patients who were diagnosed with pelvic fractures in our hos-pital during the same period were selected as young group.Femoral intertrochanter tissue biopsy was performed during opera-tion,the histochemical staining was used to determine trabecular number (Tb.N),trabecular width (Tb.Wi)and trabecular separation (Tb.Sp),the micro-CT scan was used to determine Tb.N,trabecular spacing (Tb.Sp),trabecular thickness (Tb. Th)and connection density (Conn.D),and the enzyme-linked immunosorbent assay was used to determine the levels of osteo-blast and osteoclast marker molecules.Results:Tb.N,Tb.Wi,Tb.Th and Conn.D of elderly group were significantly lower than those of young group while Tb.Sep and Tb.Sp were significantly higher than those of youth group;ALP,OCN,OPN, Runx2 and SP7 content in femoral intertrochanter biopsy tissue of elderly group were significantly lower than those of young group,positively correlated with Tb.N,Tb.Wi,Tb.Th and Conn.D,and negatively correlated with Tb.Sep and Tb.Sp;RANK,TRAP,CTSK,CTR,NF-κB and NFATc1 content in femoral intertrochanter biopsy tissue of elderly group were sig-nificantly higher than those of young group,negatively correlated with Tb.N,Tb.Wi,Tb.Th and Conn.D,and positively cor-related with Tb.Sep and Tb.Sp.Conclusions:Bone microstructure in femoral intertrochanter biopsy tissue of the elderly is char-acterized by reduced trabecular number,thinned thickness and increased spacing,and the above bone microstructure character-istics are associated with the decreased osteoblast activity and increased osteoclast activity.

目的 探讨人工髋关节置换术后股骨假体周围Vancouver B型骨折患者,进行假体翻修、内固定治疗的效果.方法 2005年1月至2009年12月间,广州医科大学大学附属第一医院关节外科收治人工髋关节置换术后股骨假体周围B型骨折患者16例,其中11例为全髋,5例为半髋;男4例,女12例;年龄平均69岁(59 ～81岁);Vancouver分类B1型3例,B2型5例,B3型8例.B1型骨折采用内固定、或加异体皮质骨板移植治疗;B2型骨折选择加长股骨柄翻修、捆扎带环扎;B3型骨折选择加长股骨柄翻修、加同种异体皮质骨板移植和捆扎带环扎固定.所有患者均进行随访,随访时间平均90个月(5～9年).采用Harris髋关节功能评分、X线片对治疗结果进行评价.结果 12例患者获得随访,骨折全部愈合,患者能自由行走,末次随访髋关节功能评分(Harris评分)平均90分(76 ～ 93分).结论 针对人工髋关节置换术后股骨假体周围骨折的不同类型,分别采取切开复位内固定、加长股骨柄假体翻修、异体皮质骨板移植治疗,能取得较好疗效.

背景:在因骨溶解和内衬失败进行翻修手术时,用骨水泥将新聚乙烯内衬固定于稳定金属髋臼内是可选择的手术方式.如果金属髋臼外翻或前倾角度不良,单纯更换内衬可有脱位的风险.目的:了解聚乙烯内衬在一定范围内改变接触面积以骨水泥固定于金属髋臼内的早期力学强度.方法:选用40个60 mm外径的金属髋臼、40个28 mm内径的聚乙烯内衬,其中8个聚乙烯内衬外径51 mm为标准锁定组即对照组,32个聚乙烯内衬外径47 mm按内衬与髋臼赤道面交角不同平均分为0°、10°、20°、30°四个实验组.内衬外表面纹理化后以骨水泥固定于金属髋臼内,各组分别进行杠杆及扭转力学实验,观察内衬或内衬-骨水泥界面失败的情况,测量标准锁定装置及骨水泥固定内衬的最大抗杠杆力及抗扭力扭矩.结果:对照组所有内衬均出现分离或移位,实验组各组均未出现内衬-骨水泥界面的失败.4个实验组的最大抗杠杆力及抗扭力扭矩均优于对照组(P<0.05).实验组各组间最大抗杠杆力及最大抗扭力扭矩的差异无统计学意义(P>0.05).结论:聚乙烯内衬以骨水泥固定于金属髋臼内可以获得足够的初始固定力学强度.聚乙烯内衬外表面纹理化后,内衬与骨水泥、金属髋臼接触面积减少在一定范围内不会影响内衬-骨水泥界面的初始固定力学强度.

Objective To compare the clinical outcomes of different drains in total knee arthroplasty .Methods Thirty-two patients , who had undergone TKA from October 2011 to September 2012, were included in the comparative study .The same operative procedure and postoperative care were&nbsp;provided to all the patients .The patients were randomized to have either a subcutaneous indwelling or an intra-articular indwelling catheter and two months after surgery , the two groups were compared for blood loss ( hemoglobin decrease , transfusion requirements , hypotension episode ) , incidence of wound problems (requirements for dressing reinforcement , oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes ( value score , American Knee Society ) .Results The mean vacuum drainage volume was less in the subcutaneous indwelling group [(142.5 ±140.3) ml] than in the intra-articular indwelling group [(421.2 ±231.7) ml] (t=4.116, P<0.05).There were differences between the two groups in allogenic transfusion requirements ( 6.25% versus 43.75%, χ2 =4.167, P <0.05 ) .There was no difference between the two groups in HB decrease , incidence of wound problems and functional scores . Conclusion Subcutaneous indwelling closed suction drainage in total knee arthroplasty could reduce blood loss and chances of allogenic blood transfusion .It is a reasonable alternative to intra-articular indwelling closed-suction drainage .

静脉血栓栓塞症（ venous thromboembolism ， VTE）是骨科大手术后常见并发症，严重危害患者生命健康，致死致残。随着华法林、低分子肝素等药物在骨科大手术后应用经验的增加和对药物作用理解的深入，以及国内骨科同道对美国胸科医师协会（ ACCP）、美国骨科医师协会（ AAOS）、中国骨科大手术静脉血栓栓塞症预防指南（2009）等抗凝系列指南的解读，预防抗凝这一观念开始推广并深入人心。在这一过程中，新型口服抗凝药物（ NOAC）--Ⅹa因子抑制剂，以独有的优势获得骨科医师的关注和接受。口服方便，生物利用度高，抗凝效果好，无需监测凝血功能，是这类药物的特点。随着预防抗凝用药经验的增加，以及专家讨论和形成共识，国内外指南对骨科术后VTE的预防亦作了大幅更新，主要侧重点为对NOAC的推荐、术后预防时长及强度的建议、转换治疗及阿司匹林推荐地位的改变等，以便与时俱进地、更切实地为临床实践做出最佳指导，提高临床治疗质量。在按照指南进行抗凝的同时注意个体化预防，获益风险平衡这一概念逐渐被骨科同道所接受。本文对在国内上市的两种新型口服Ⅹa因子抑制剂--阿哌沙班、利伐沙班的药理学特性、研究进展及在各国指南中的定位予以综述和解读。

There is a new knowledge for clinical presentations and findings of imagine in patients with osteonecrosis of the femoral head (ONFH) in recent more than ten years. According to clinical data in Chinese huge patients with ONFH, the guideline for diagnosis and treatment of ONFH has been put forward by Chinese specialists. The newer contents of guideline include the definition for predisposing risk factors of ONFH, the new knowledge for clinical manifestations, the new interpretation for changes of imagine, important differential diagnosis. Based on the supplementary and revision for widely used staging and classification system, the new Chinese staging and classification system have been established. The advantages of Chinese staging and classification system accord with clinical and pathological features, it could be predicted the prognosis, and clinical applications are convenient. The guideline gives a brief account of principles for treatment selection and treatment methods for enhancement of diagnosis and treatment for ONFH.

Objective To investigate the clinical effects on the prevention of deep venous thromboembolism (DVT) in total hip arthroplasty (THA) and total knee arthroplasty (TKA), which is based on“Chinese orthopedic major surgery venous thromboembolism prevention guidelines” ( Guidelines, published in 2009) .Methods A retrospective analysis was carried out on 1683 patients of primary total hip (626 cases)or knee(582 cases) replacements in the First Affiliated Hospital of Guangzhou Medical University, Guangdong Kaiping Central Hospital and Guizhou Hospital of Shunde City in the past five years.The patients were divided into two groups, 1208 patients in the prevention group were treated according to the Guidelines and 475 cases of the control group did not receive any treatments.Occurrences of DVT, bleeding and early complications were observed.The measurement data were compared with each other using the T test.The count data for evaluation of incidence rate were compared with each other using the chi-square test.P <0.05 was chosen as statistical significant effect.Results In the prevention group, the incidences of DVT, proximal DVT, distal DVT and pulmonary embolism were respectively 7.83%, 4.15%, 3.67%, 0.16%after THA and were 9.62%, 1.89%, 7.73%, 0 after TKA, while in the control group, the incidences of DVT, proximal DVT, distal DVT and pulmonary embolism respectively were 27.34%, 14.75%, 12.59%, 1.80% after THA and were 36.04%, 9.14%, 26.90%, 1.52%after TKA.The data of the two groups showed statistically significant difference (P<0.01).Between the prevention group and the control group, the hemorrhage incidences showed no statistical difference ( massive haemorrhage incidences:THA group:χ2 =0.11, P>0.05;TKA group:χ2 =0.88, P>0.05. Slight haemorrhage incidences:THA group:χ2 =0.004, P>0.05;TKA group: χ2 =1.37, P>0.05). The volume of drainage and the incidence of early systematic complications were not statistically different either ( volume of drainage: THA group:t =1.365, P >0.05; TKA group: t =1.145, P >0.05. Incidences of early systematic complications:THA group:χ2 =0.003, P>0.05;TKA group:χ2 =0.03, P>0.05) .Conclusion The Guidelines is safe and effective for prevent deep venous thromboembolis after THA and TKA, which can reduce the risks of DVT and PE with no increase of hemorrage.

This article reviewed the development history of joint replacement surgery in China from 1960 to 1995, and summarized the contributions and accomplishments made by the pioneers of Chinese orthopedics and joint surgery which pomoted the improvements of joint replacement.

Objective To explore the relationship between D-dimer and the perioperative deep vein thrombosis ( DVT) and to analyze the efficacy and safety of rivaroxaban versus low molecular weight&nbsp;heparin (LMWH) for the prevention of DVT after primary total hip or knee arthroplasty .Methods A prospective analysis was carried out on 70 patients.The patients were divided into two groups according to the results of ultrasound for bilateral venae profundae of both the lower extremities on the 7th day after the surgery: the thrombus group and the non-thrombus group . The preoperative and postoperative concentrations of D-dimer were detected and analysed .Meanwhile all the patients were divided into the rivaroxaban group and the LMWH group according to the anticoagulants that were adopted .The incidence of DVT and the drainage volume of the two groups were measured and compared respectively .Results There was significant difference in the preoperative concentration of D-dimer between the thrombus group and the non-thrombus group ( P<0.01) and there was no significant difference in the postoperative concentration of D-dimer 7 days after the operation between the two groups (P>0.05).Comparing the preoperative and the postoperative concentrations of D-dimer, there were significant differences in both the thrombus group and the non-thrombus group ( P<0.01 ) .The postoperative concentration of D-dimer was significantly higher than the preoperative one in both the two groups .As all the patients were taking anticoagulant drugs , the incidence of DVT was 15.71%.There was no significant difference in the incidence of DVT between the rivaroxaban group and the LMWH group ( P >0.05 ); also there was no significant difference in the drainage volume of the two groups ( P>0.05 ) .Conclusions D-dimer is not a specific indicator for the prediction of DVT .The incidence of DVT may decrease significantly when using anticoagulant drugs after primary total hip or knee arthroplasty .The effecacy of DVT prevention shows no difference in rivaroxaban and LMWH.

Background:Because of a wide range of soft tissue release during the TKA(total knee arthroplasty),acute pain after the surgery for osteoarthritis with flexion deformity is serious.This will lead to a poor early functional recovery and thus affect the surgical effect.Currently there are a variety of peri-operative analgesic methods,of which the injection of mixed analgesic drugs around the joint is quite easy and practicable.It can ease the early pain after the surgery and also reduce the adverse reactions.Objective:To observe the analgesic effects of the ropivacaine local injection in TKA for flexion deformity,as well as its effects on the early functional recovery.Methods:60 cases of osteoarthritis with flexion deformity were randomly divided into 2 groups.All of them accepted the unilateral TKA for the first time.The control group(n=30) were treated with intravenous postoperative self-control analgesia(PCA).The experimental group(n=30) accepted the same PCA,but were injected with mixed analgesic drugs(ropivacaine hydrochloride + adrenaline) during the operation.Evaluate the visual analog scores(VAS) of the rest and motion knee,and also the rang of motion(ROM) of the knee,and compare the early analgesic effects and early functional recovery of the two groups.Results:At 8,12,24,36 hours after the TKA,the rest and motion VAS in the experimental group was lower than that in the control group(P<0.05),while the ROM of the former was larger than that of the later(P<0.05).At 48 hours and 3 days after the TKA,the motion VAS in the experimental group was lower than that in the control group(P<0.05),and the ROM of the former was also larger than that of the later(P<0.05);while there was no significant difference in rest VAS between the two groups(P>0.05).At 7 days after the TKA,there was no significant difference in the rest and motion TKA and ROM scores between the two groups(P>0.05) Conclusions:Ropivacaine injection around the joint in TKA for flexion deformity can ease the early postoperative pain and improve the joint mobility.It is helpful to early functional recovery.

Objective To investigate the efficacy of nerve damage prevention using electrophysiological monitoring techniques during reconstruction of pelvic fracture combined with sacroiliac joint dislocation. Methods Intraoperative real-time monitoring by motor evoked potentials with trans-cranial electrical stimulation (TES-MEP) and spontaneous electromyogram (EMG) were performed during surgical treatment for the patient of pelvic fracture combined with sacroiliac joint dislocation. The preventive effects on iatrogenic injury of sciatic nerve and L5 nerve root were observed. Results The TES-MEP volatility of biceps femoris, tibialis anterior muscle and posterior tibial muscle dropped on the surgical side when resetting sacroiliac joint, but the waveform could be elicited. The TES-MEP waveform was stable when resetting pubis. Some short, high-amplitude EMG response appeared in extensor digitorum brevis and posterior tibial muscle due to surgical operation, so that the surgeons could be immediately aware of avoiding irritation for nerve tissues. Sacroiliac joint and pubis were restored well and iatrogenic nerve injury was not observed after operation. Conclusion During reconstruction of pelvic fracture combined with sacroiliac joint dislocation, application of both TES-MEP and EMG can improve surgical accuracy by synchronous monitoring the status of the sciatic nerve and L5 nerve root. This technique is worthy of recommendation in clinic.

Objective:To investigate the clinical effects on the prevention of venous thromboembolism (DVT) in total hip arthroplasty (THA), which is based on"Chinese orthopedic major surgery venous thromboembolism prevention guidelines"(Guidelines, published in 2009). <br> Methods:Retrospective analysis was carried out in 914 patients of cementless THA in Guangdong Kaiping Central Hospi-tal, Guizhou Hospital of Shunde City and our hospital in the past three years. The patients were divided into two groups, the 631 cases in prevention group were treated with the Guidelines and 283 cases of control group did not receive any treat-ment. Occurrence of DVT, bleeding and early complications were observed. <br> Results:In the prevention group , the incidences of DVT, proximate DVT and pulmonary embolism were 6.49%, 5.86%, and 0.47%; while in the control group, the incidences of DVT, proximate DVT and pulmonary embolism were 26.85%, 24.02%, and 2.82%The two groups had statistically significant dofferemce(P<0.01). In the prevention group and control group, the hemorrhage incidence was 0.63%and 2.82%respectively, and there was statistical significance (P<0.05). The in-cidence of early systematic complications was 3.16%in prevention group and 7.77%in control group, which was also sig-nificantly different (P<0.01). <br> Conclusion:The Guidelines is safe and effective for venous thromboembolis prevention after THA.

骨质疏松症是最为常见的一种代谢性骨病,骨质疏松骨折,又被称为脆性骨折,常发生于低于站立体位跌倒之后.骨质疏松骨折直接导致患者急慢性疼痛,活动受限,精神受挫,与髋部骨折相关联的患者的死亡率增加了大约20%[1].因此,以减少骨折发生风险为目的的骨质疏松治疗至关重要,但是,由于骨量丢失通常在无症状的情况下发生,甚至2/ 3的脊柱骨折不伴有临床症状,在诊疗中通常被忽视[2].显然,评估患者个体骨折风险,及时给予临床干预以期降低骨质疏松骨折发生风险至关重要.本文旨在对骨质疏松骨折风险评估进行综述.

<正>骨质疏松症(osteoporosis,OP)是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病(世界卫生组织,WHO)。2001年美国国立卫生研究院(NIH)提出骨质疏松症是以骨强度下降、骨折风险性增加为特征的骨骼系统疾病。骨质疏松症分为原发性和继发性二大类。原发性骨质疏松症又分为绝经后骨质疏松症(Ⅰ型)、老年骨质疏松症(Ⅱ)和特发性骨质疏松3类。特发性骨质疏松主要发生在青少年,病因尚不明。继发性骨质

双膦酸盐是治疗骨质疏松的重要药物,属骨吸收抑制剂类.其通过抑制破骨细胞介导的骨吸收,减缓骨骼重建,增加骨密度,降低骨折的发生率.国外文献报道双膦酸盐有致非典型骨折的风险,并且骨折不愈合或延迟愈合的风险增高[1].迄今为止,中国大陆境内尚未有该类药物致非典型骨折的报道.现报道1例口服阿仑膦酸钠(商品名:福善美)致右股骨中段非典型骨折病例,并结合文献对双膦酸盐相关性非典型骨折的流行病学、临床表现、发病机制及其治疗和预防进行讨论.

Objective To assess cup inclination of THAs by measuring the abduction angle and to find out if the abduction angle relate to polyethylene wear or not.Methods Cup abduction angle and polyethylene wear were measured on the X-ray with a series of 145 hips undergone THA before 2011 May.The rates of abduction angle greater than 50 degree and 55 degree were calculated.The relationship between cup abduction angle and polyethylene linear wear was evaluated.Results It happened in 32(22.1%,95% CI: 15.3%~28.9%) hips that abduction angle exceeded 55 degree and 61(42.1%,95%CI: 34.1%~50.1%) hips'abduction angle greater than 50 degree.Abduction angle that greater than 50 degree significantly caused polyethylene liner wear.In 107 unilateral THA,positive correlation between abduction angle and liner wear was revealed by a scatter diagram and then a curve estimation was taken.R square was up to 0.697 using Quadratic curve.Regression equation was y=4.431-0.21x+0.003x2.Conclusions Incorrect abduction angle may cause polyethylene wear in THA.Measurement should be made to place the cup at appropriate position.

OBJECTIVE:To evaluate the strength of polyethylene linercement interface when cementing a new liner into a fixed acetabular cup in revision. METHODS:Twenty-five pairs of metal acetabular cups with polyethylene liners were randomly divided into 5 groups: 1 group with standard locking device as control group (group A), other liners were cemented into acetabular cups as 4 experimental groups. According to different intersection angles of metal acetabular cups with polyethylene liners and the polyethylene liners with or without metal ball, the 4 experimental groups were no ball 0 degrees group (group B), 0 degrees group (group C), 10 degrees group (group D), and 20 degrees group (group E), metal acetabular cups intersected with polyethylene liners without metal ball in group B, with metal ball in groups C, D, and E, respectively. The lever-out biomechanical test reproduced in vivo failure mechanism was then performed to evaluate the lever-out failure strength of liner-cement-metal cup interface. RESULTS:The values of liver-out failure force were (626.68 +/- 206.12), (915.04 +/- 197.49), (449.02 +/- 119.78), (814.68 +/- 53.89), and (1 033.05 +/- 226.44) N in groups A, B, C, D, and E, respectively, showing significant differences for comparison among groups (F = 8.989, P = 0.000). The values of liver-out failure force in groups B and E were significantly higher than that in group A (P < 0.05), but no significant difference was found between groups C, D and group A (P > 0.05). CONCLUSION:Cementation of polyethylene liner into a malposition shell meeting within 20 degrees can provide enough fixed strength.

金属对金属髋关节假体主要指全髋关节表面置换假体、金属对金属大直径股骨头全髋关节假体以及金属对金属小直径股骨头全髋关节假体.金属对金属髋关节假体置换术在20世纪50年代首先开展,但在临床应用过程中由于磨损、松动、股骨颈骨折等并发症发生率较高而一度被束之高阁.随着材料学的改进、假体设计制造水平的提高、手术技术及器械的完善,其耐磨性能及术后假体生存率大大提高.20世纪90年代,该术式再次引起临床重视并得到迅速发展.但是金属对金属界面带来的金属离子释放、过敏等问题引起很大的争议,尤其在"陶瓷对陶瓷"摩擦付同样得到迅速发展的时候,对"金属对金属"摩擦付的质疑也随之增加.