Measuring blood flow change of osteonecrosis of femoral head with laser doppler flowmetry / 中华外科杂志

<p><b>OBJECTIVE</b>To detect the blood perfusion of the necrotic area and the femoral head and neck junction in the patients diagnosed as osteonecrosis of femoral head (ONFH) with laser doppler flowmetry (LDF).</p><p><b>METHODS</b>From 2007 to 2008, 50 patients with ONFH 82 hips were performed core decompression and autologous stem cells transplantation. Group A was for ARCO stage II 46 hips (IIA 6 hips, IIB 22 hips, IIC 18 hips), and Group B was for stage III 36 hips (IIIA 20 hips, IIIB 10 hips, IIIC 6 hips). Blood perfusion of necrotic area and femoral head and neck junction with LDP were detected during the operation. Statistical analysis was made.</p><p><b>RESULTS</b>In Group A, the perfusion volume of necrotic area was (30.2 +/- 3.0) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 4.4) PU. In Group B, the perfusion volume of necrotic area was (30.6 +/- 2.8) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 3.9) PU. In Group A and Group B, the perfusion volume of necrotic area was lower than that of femoral head and neck junction, and the difference was significant (P < 0.01).</p><p><b>CONCLUSIONS</b>LDF can effectively detect that the perfusion volume of ONFH decreased, which provides a theoretical basis in order to further study the pathogenesis of ONFH. Meanwhile, there is application value of LDF on the study of ONFH.</p>

Clinical research of correlation between osteonecrosis and steroid / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the correlation between the dosage of corticosteroid, time of onset and incidence of osteonecrosis (ON) in patients with SARS.</p><p><b>METHODS</b>From July 2003 to January 2004, general survey carried out for ON in 551 patients with SARS. Five hundred and fifty-one patients except 12 were administrated by corticosteroid from 80 mg to 30 000 mg. The age of patients was (33 +/- 9) years old ranging from 19 to 59 years old. One hundred and thirty-one were male, and four hundred and twenty were female. MRI and X-ray film were taken in all patients including both hips, knees, shoulders, ankles and wrists. CT scan was taken in partial patients. Common classification system were used for staging of hip (ARCO), knee (Lotka) and shoulder (Cruess). Independent test, rank-sum test and multiple factor logistic regression analysis were used for statistical analysis.</p><p><b>RESULTS</b>No osteonecrosis was detected in 12 patients without corticosteroid. Osteonecrosis was detected in 176 patients (32.7 percent) among 539 patients. There were ON of femoral head in 130 cases (210 hips), ON of knee in 98 cases (130 knees), ON of humeral head in 21 cases (36 shoulders), ON of talus and calcaneus in 16 cases (26 ankles), ON of scaphoid and lunate in 11 cases (17 wrists), ON of patella in 3 cases (4 patella), ON of ilium in 1 case and bone infarction (femur, tibia) in 18 cases. One hundred and nineteen cases (195 hips) with ONFH were in stage I (IA 45 hips, IB 77 hips, IC 73 hips). Eleven cases (15 hips) were in stage II. All osteonecrosis of the knee and humoral head was stage I. Thirty-four patients with ON had one joint affected, 45 patients had 2 joints, 93 patients had more than 3 joints. The dosage of corticosteroid was (5842 +/- 4988) mg in ON group and (2719 +/- 2571) mg in non-ON group (P < 0.0001). The duration of steroid was (38 +/- 17) d in ON group and (27 +/- 15) d in non-ON group (P < 0.01). The dosage of pulse treatment was (340 +/- 207) mg/d in ON group and (211 +/- 160) mg/d in non-ON group (P < 0.01). The duration of pulse treatment was (28 +/- 13) d in ON group and (18 +/- 11) d in non-ON group (P < 0.01). All patients with ON were detected within 6 months from administration.</p><p><b>CONCLUSION</b>About one-third patients with SARS who were treated with a high dose of corticosteroid occurred osteonecrosis. ON is frequently multiple focuses. The actual time of onset of ON is early of steroid used. MRI is golden standard for early diagnosis of ON. The patients who were treated with a high dose of corticosteroid should be inspected initially by MRI.</p>

Acetabular centralization in total hip arthroplasty for acetabular dysplasia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.</p><p><b>METHODS</b>A retrospective review was undertaken of 39 hips (33 patients) that had been performed a total hip arthroplasty for acetabular dysplasia with secondary osteoanthritis from September 1989 to January 2003. These patients were divided into two groups, 16 patients (20 hips) who were performed by regular THA of Harris method were defined as group A and the other 17 patients (19 hips) by acetabular centralization technique as group B. The hip function was evaluated using Harris hip score before and after operation. The horizontal location of the center of the hip (the distance along the intertear drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head), abduction angle of the cup, and femoral offset was measured.</p><p><b>RESULTS</b>At the most recent follow-up, the mean Harris hip score was 88.9 +/- 5.8, and 82.3 +/- 8.4 for the anatomical position reconstruction and the lateral displacement hips, respectively (P < 0.05). The horizontal distance between the teardrop and the hip center was significantly shorter in B group [(37.3 +/- 3.4) mm] than in A group [(46.1 +/- 5.3) mm] (P < 0.05). Two patients had bone resorption of autograft and malposition of the acetabular component during follow-up, while others had no revision, loosening, or migration of the acetabular component.</p><p><b>CONCLUSION</b>Accurately confirmed acetabular position, stable acetabular component, and appropriate techniques are important to guarantee the clinical efficacy of THA.</p>

Restoration of femoral offset in total hip arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the factors effecting restoring femoral offset and the relation between femoral offset and hip abductor strength during total hip arthroplasty (THA).</p><p><b>METHODS</b>Ninety-nine THA for 81 patients were performed from March 1998 to January 2002. And follow-up was finished. There were 53 women and 28 men and the average age was 57 years (29 to 80). The right hip had been replaced in 28 cases, the left in 35 cases and the bilateral in 18 cases. The mean duration of clinical and roentgenographic follow-up was 36.8 months (range, 19 approximately 66 months). A posterolateral approach was used in all THA. The femoral offset and the abductor lever arm were measured from each radiograph. The measurement of the hip abduction strength was made for some THA by the Cybex machine. Statistical data analysis was performed by SPSS10.0 software.</p><p><b>RESULTS</b>Femoral offset correlated positively with the length of the abductor lever arm (r = 0.613; P < 0.001). Simple regression analysis showed that femoral offset was significantly and positively related to the length of femoral neck and neck-shaft angle (r = 0.451, P = 0.001; r = 0.567, P < 0.001). There was a highly significant and positive correlation between femoral offset (and consequently abductor lever arm) and hip abductor strength (r = 0.500, P = 0.009; r = 0.477, P = 0.014).</p><p><b>CONCLUSIONS</b>It is very important to template both sides of hip preoperatively for restoring femoral offset in THA. Femoral component with more anatomical neck-shaft angle will be used with the increase in the femoral neck length.</p>

Transtrochateric rotational osteotomy for osteonecrosis of the femoral head / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the indications, operative technique and clinical results of the transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).</p><p><b>METHODS</b>Nineteen patients (23 hips) with ONFH underwent TRO from October 1992 to May 2001 were reviewed. There were 14 males and 5 females. The age was ranging from 22 to 43 years old with an average age of 33.4 years old. The etiology were as followed: alcoholism 10 cases (12 hips); steroid 6 cases (7 hips); trauma 2 cases (2 hips); caisson disease 1 case (2 hips). Ficat stage: II 8 cases 8 hips; III 11 cases 15 hips. Harris hip score 46 to 74 with mean score 56 preoperatively. In order to determine the location and extent of osteonecrosis, A-P view and accurate lateral view (the film should be placed parallel to the femoral neck with the hip in precisely 90 degrees and flexion 45 degrees of abduction and neutral rotation) were taken in both hips preoperatively. The surgical technique described by Sugioka were used in all patients.</p><p><b>RESULTS</b>Seventeen patients (19 hips) were followed up ranging from 18 to 11 years with mean 54 months. The Harris hip score was from 55 to 94 with mean 80.5. Fourteen hips score more than 80 and good to excellent rate was 73.2%. Harris score were less than 79 in 5 cases and 4 hips of these 5 hips were revised by total hip arthroplasty. The rotation angle was from 55 degrees to 80 degrees with mean 60 degrees .</p><p><b>COMPLICATIONS</b>The circumflex femoral medial artery injury was found in 1 hip; subtrochanteric fracture was found in 2 hips and 1 osteotomy site nonunion occurred.</p><p><b>CONCLUSION</b>TRO can be used to treat ONFH. The indications include: (1) younger patients (less than 45 years old). (2) Ficat stage II and III with more than one third intact articular surface of the femoral head. The better results could be obtained using posterior rotation and lager rotational angle. The Sugioka osteotomy should be used carefully because of its complicated surgical technique.</p>

Acetabular component centralization in total hip arthroplasty for acetabular dysplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.</p><p><b>METHODS</b>A retrospective review was undertaken of 44 hips (38 patients) that had had a total hip arthroplasty for acetabular dysplasia with secondary osteoarthritis from September.1989 to April. 2003. 14 were male (one bilateral) and 24 patients were female (5 bilateral). The mean duration of clinical and roentgenographic follow-up was thirty-six months (range, eight to one hundred and sixty-eight months), and the mean age of the patients was fifty-one years (range, twenty-nine to eighty years). Twelve hips were classified as type I; twenty-four as type II; seven as type III; and one as type IV, according to the criteria of Crowe. The horizontal location of the center of the hip (the distance along the interior drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head) was measured.</p><p><b>RESULTS</b>There were 24 acetabular components that were placed in the centralized position and the other 20 in no deepen placement post-operatively. At the most recent follow-up, the mean Harris hip score was 90.2, 86.3 for the centralized position and the undeepen placement hips respectively, there was a significant difference between these two groups.</p><p><b>CONCLUSIONS</b>In order to obtain the stability of acetabular component, deepen acetabular reaming is necessary for the most acetabular dysplasia in THA. In this way the anatomical rotational center can be obtained medially and lowly. The excellent long-term function will be maintained.</p>