摘要
SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.
El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Physical Therapy Modalities , Arthroplasty, Replacement, Hip/rehabilitation , Quadriceps Muscle/physiology , Logistic Models , Retrospective Studies , Muscle Strength , Isometric Contraction摘要
Abstract Total hip arthroplasty (THA) is a successful surgery in the treatment of hip pain, but there are potential complications, of which dislocation is one of the most common. Dislocation management is a challenging problem that requires a multimodal approach, and the use of dual mobility implants is an option. We present a patient with a history of femoral neck fracture who underwent THA with a double mobility implant. On the 18th postoperative day, after a fall to the ground, she developed prosthesis dislocation and had a complication after closed reduction, a subsequent intraprosthetic dislocation. After a radiographic diagnosis, the patient presented mechanical signs of hip flexion caused by a disassociated double mobility implant. The revision surgery was indicated, but the patient chose not to perform the necessary surgical procedure. A careful postoperative study of the radiographs revealed an eccentric femoral head and evidence of disassociated implantation in the surrounding soft tissues. Radiographs after closed reduction of intraprosthetic dislocations should be examined thoroughly.
Resumo A artroplastia total do quadril (ATQ) é uma cirurgia bem-sucedida no tratamento da dor no quadril, mas existem complicações potenciais, das quais a luxação é uma das mais comuns. O gerenciamento das luxações é um problema desafiador que requer uma abordagem multimodal, e o uso de implantes de mobilidade dupla é uma opção. Apresentamos uma paciente com história de fratura do colo do fêmur que foi submetida a ATQ com um implante de dupla mobilidade. No 18° dia pós-operatório, após queda ao solo, a paciente evoluiu com luxação da prótese e teve uma complicação após redução fechada, uma luxação intraprotética subsequente. Após um diagnóstico radiográfico, a paciente apresentou sinais mecânicos na flexão do quadril causados por um implante de mobilidade dupla desassociado. A cirurgia de revisão foi indicada, mas a paciente optou por não realizar o procedimento cirúrgico necessário. O estudo pós-operatório cuidadoso das radiografias revelou uma cabeça femoral excêntrica e evidências do implante desassociado nos tecidos moles circundantes. As radiografias após a redução fechada das luxações intraprotéticas devem ser examinadas minunciosamente.
摘要
Abstract Small osteolabral avulsions of the hip can be easily missed, and postreduction stress testing and computed tomography (CT) scans of the hip should be performed to look for these injuries. The usual modality of treatment of these unstable osteolabral avulsions is suture anchors, Herbert screws or spring plates. But when the bony avulsion is small, the use of these implants becomes a tedious job. We present a novel technique to fix small osteochondral avulsion fractures not amenable to fixation using screws or spring plates. We performed a retrospective analysis of 57 cases of patients who underwent open reduction and internal fixation for posterior fracture dislocation of the acetabulum, and we identified 6 cases of small posterior labral osteochondral fragments leading to instability. These injuries were fixed using a novel method. The mean Harris Hip Score at the final follow-up was of 92.5. Fixation of osteochondral avulsions associated with posterior hip fracture dislocation can be a difficult task if the bony fragment is small. Our technique is a simple, cost-effective and reliable way of fixing such avulsions with satisfactory outcomes.
Resumo Pequenas avulsões osteolabrais do quadril podem passar despercebidas, e testes de estresse pós-redução e tomografia computadorizada do quadril devem ser realizados para sua detecção. O tratamento dessas avulsões osteolabrais instáveis geralmente é feito com âncoras de sutura, parafusos de Herbert ou placas-molas. Em avulsões ósseas pequenas, porém, o uso desses implantes é um trabalho tedioso. Apresentamos uma nova técnica de fixação de pequenas fraturas com avulsões osteocondrais não passíveis de fixação com parafusos ou placas-molas. Realizamos uma análise retrospectiva de 57 casos de pacientes submetidos à redução aberta e fixação interna de fratura-luxação posterior do acetábulo, e identificamos 6 casos em que um pequeno fragmento osteocondral labral posterior causava instabilidade. Essas lesões foram corrigidas com um novo método. A pontuação média no Harris Hip Score no último acompanhamento foi de 92,5. A fixação de avulsões osteocondrais associadas a fratura-luxação posterior do quadril pode ser difícil se o fragmento ósseo for pequeno. Nossa técnica é uma maneira simples, econômica e confiável de corrigir tais avulsões com resultados satisfatórios.
摘要
Abstract Objective To evaluate surgeons' performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. Methods An arthroscopic simulator was created using low-cost materials with the help of a GTMax Core A1 3D printer and the programs Invesalius and Meshmixer 2017, which were used to develop femoral head parts in ABS material, with the presence of a CAM-type deformity, to mimic a femoroacetabular impact situation. After the operations were performed by 16 surgeons, the femurs were compared to a previous model with deformity and another without, using Cloudcompare, and parameters such as the volumetric difference between the operated femurs, with and without deformity, the minimum and maximum distance between them, the percentage of the deformity resected, the estimated time for total resection of the deformity, as well as a qualitative analysis based on the images and graphs provided by the program representing the areas of the parts resected, were evaluated at the end. Results The average resection speed was 34.66 mm3/min (SD = 46 mm3/min, max = 147.33; min = −2.66). The average resection rate was 26.2% (SD = 34.7%, max = 111; min = −2). Qualitative analysis showed hyporesection of deformities and sometimes hyperresection of nondeformed areas. The simulator was highly rated by the surgeons, with a tactile sensation very similar to real surgery, according to them. Conclusion Arthroscopic simulators have proved very useful in training less experienced surgeons.
Resumo Objetivo Avaliar o desempenho de cirurgiões na ressecção de deformidades tipo CAME fazendo uso de um simulador realista de cirurgia artroscópica. Métodos Um simulador artroscópico foi criado a partir de materiais de baixo custo com auxílio de uma impressora 3D GTMax Core A1 e dos programas Invesalius e Meshmixer 2017, que foram utilizados para criar peças de cabeça de fêmur em material ABS, com a presença de uma deformidade tipo CAME, a fim de mimetizar uma situação de impacto femoroacetabular. Após as operações serem realizadas por 16 cirurgiões, os fêmures foram comparados a um modelo prévio com e outro sem deformidade pelo programa Cloudcompare, sendo avaliados ao final parâmetros como diferença volumétrica entre os fêmures operados, com e sem deformidade, distância mínima e máxima entre eles, porcentagem da deformidade ressecada, tempo estimado para ressecção total da deformidade, além de uma análise qualitativa feita com base nas imagens e gráficos fornecidos pelo programa representando as áreas das peças efetivamente ressecadas. Resultados A velocidade média de resseção foi de 34,66mm3/minuto (DP = 46 mm3/min, max = 147,33 mm3/min; min = −2,66 mm3/min). A média de ressecção obtida foi de 26,2% (DP = 34,7%, max = 111%; min = −2%). A análise qualitativa demonstrou uma hiporresecção das deformidades e, por vezes, hiperresecção de áreas não deformadas. O simulador foi muito bem avaliado pelos cirurgiões, tendo uma sensação tátil bem semelhante à cirurgia real segundo os mesmos. Conclusão Simuladores artroscópicos se mostraram muito úteis no treinamento de cirurgiões menos experientes.
Subject(s)
Humans , Arthroscopy , Femoracetabular Impingement , Simulation Training , Hip摘要
Objetivo: Determinar o perfil epidemiológico de pacientes atendidos pelo Sistema Único de Saúde (SUS), em determinado município do interior de Minas Gerais, bem como os gastos financeiros e o repasse financeiro para os centros de atendimento de traumas. Material e métodos: Trata-se de um estudo ecológico, descritivo, realizado a partir da coleta de dados pelo SIH-SUS, no período de janeiro de 2011 a dezembro de 2021, em um município do interior de Minas Gerais. Resultados: Foi identificado um total de 14.138 pacientes, com maior acometimento de pessoas do sexo masculino, com idade entre 15 e 44 anos. Como causas mais frequentes, destacaram-se os traumatismos de quadril e coxa, seguidos de traumatismos de membros superiores (ombro, antebraço, braço, punho e mão) e cabeça. Como tempo médio de permanência hospitalar, houve 4.693 diárias entre 2011 e 2021 secundárias a complicações em enfermarias e unidade de terapia intensiva, elevando cerca de 2,37% os valores repassados pelo SUS no período estudado. Em resumo, a análise da incidência de traumas nas emergências de um município do interior de Minas Gerais revela uma preocupante tendência em que homens na faixa etária de 15 a 44 anos emergem como as principais vítimas. Esse padrão pode ser influenciado por fatores como ocupação, comportamentos de risco e mobilidade. Conclusão: A compreensão dessa demografia específica é crucial para direcionar estratégias de prevenção e resposta adequadas. A implementação de medidas educativas, segurança no trânsito e promoção da saúde mental pode contribuir para mitigar os impactos dos traumas nesse grupo demográfico, melhorando sua qualidade de vida e a saúde geral da comunidade.
Objective: To determine the epidemiological profile of patients assisted by the unified health system, in a certain municipality in the interior of Minas Gerais, as well as the financial expenses and the financial transfer to trauma care centers. Material and methods: This is an ecological, descriptive study, carried out from data collection by SIH-SUS, from January 2011 to December 2021 in a municipality in the interior of Minas Gerais. Results: a total of 14,138 patients were identified, with greater involvement of male people aged between 15 and 44 years. As the most frequent causes, trauma to the hip and thigh stood out, followed by trauma to the upper limbs (shoulder, forearm, arm, wrist and hand) and head. As for the average length of hospital stay, there were 4,693 daily stays between 2011 and 2021 secondary to complications in wards and the intensive care unit. Increasing about 2.37% in the values transferred by the unified health system between the studied decade. In summary, the analysis of the incidence of trauma in emergencies in a municipality in the interior of Minas Gerais reveals a worrying trend in which men aged 15 to 44 years emerge as the main victims. This pattern can be influenced by factors such as occupation, risky behavior and mobility. Conclusion: Understanding this specific demographic is crucial to targeting appropriate prevention and response strategies. The implementation of educational measures, road safety and mental health promotion can help to mitigate the impacts of trauma in this demographic group, improving their quality of life and the general health of the community.
Subject(s)
Wounds and Injuries , Unified Health System , Hip Injuries , Public Expenditures , Craniocerebral Trauma摘要
OBJECTIVE@#To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture.@*METHODS@#From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect.@*RESULTS@#Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose.@*CONCLUSION@#THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Arthroplasty, Replacement, Hip/methods , Prosthesis Failure , Retrospective Studies , Quality of Life , Acetabulum/injuries , Hip Prosthesis , Hip Fractures/surgery , Spinal Fractures/surgery , Arthritis/surgery , Treatment Outcome , Follow-Up Studies摘要
Objective To analyze the lumbar/hip imaging and surface electromyography data of professional equestrian riders,to understand the incidence of chronic diseases in the hip and lower back of the rider,and to explore the causes of chronic pain in riders.Methods Twenty-five equestrian riders from the Shanghai Equestrian Sports Management Center were divided into chronic lower-back pain and chronic hip pain groups.Twelve healthy subjects without hip or lower-back pain were included in the control group.Medical history,X-ray,and magnetic resonance imaging of the hip and lower back,and surface electromyography data of the core muscle were collected.Results The JOA score of the lumbar spine in patients with chronic lower-back pain was significantly lower than that in the control group(P<0.05).The riders had relatively mild chronic hip pain,but the Harris score was significantly lower than that of the control group(P<0.05).The JOA score of the equestrian rider's waist significantly correlated with the Pfirrmann grading.However,the visual analog scale and Harris hip pain scores were not significantly correlated with imaging parameters.The root mean square amplitudes of the rectus abdominis,erector spinalis,rectus femoris,gluteus medius,and multifidus were greater in the riding position than in the normal sitting position(P<0.05).Conclusions The cause of chronic lower-back pain in riders may be related to soft tissue overwork and lumbar degeneration.Changes in the lumbar-hip sagittal sequence pelvic and sacral inclination angles can reflect the degree of lumbar stiffness of the riders.
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Objective To compare the application effects of low-dose esketamine and sufentanil on perioperative analgesia in patients undergoing hip arthroplasty(HA).Methods A total of 124 patients who underwent HP in our hospital were divided into the control group and the observation group according to random number table,with 62 cases in each group.Patients in the control group were given sufentanil for analgesia,and patients in the observation group were given low-dose esketamine for analgesia.The hemodynamics changes of the heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)and oxygen saturation(SpO2)of patients before anesthesia(T1),at the time of incising skin(T2),after 30 minutes of anesthesia(T3)and at the end of surgery(T4)in both groups were observed.The visual analogue scale(VAS)scores of patients in resting state and active state before surgery(T5),6 hours after surgery(T6),12 hours after surgery(T7)and 24 hours after surgery(T8)were recorded.The number of postoperative analgesic pump compression,need of supplemental analgesic drugs and occurrence of adverse reactions during surgery and 24 hours after surgery of patients in the two groups were recorded.Results There was no statistically significant difference in HR,MAP or RR at T1 of patients between the two groups(P>0.05).The levels of HR,MAP and RR at T2,T3 and T4 of patients in the observation group were higher than those in the control group(P<0.05).There was no statistically significant difference in SpO2 at each time points between the two groups(P>0.05).There was no statistically significant difference in the VAS scores at T5 of patients in resting state or active state(P>0.05).The VAS scores at T6,T7 and T8 of patients in resting state and active state in the observation group were lower than those in the control group(P<0.05).The number of postoperative analgesic pump compression and the proportion of patients with the need of supplemental analgesic drugs in the observation group were less/lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of intraoperative and postoperative adverse reactions of patients between the two groups(P>0.05).Conclusion Compared with sufentanil,low-dose esketamine has better analgesic effect for IA patients,with milder perioperative pain degree,more stable intraoperative hemodynamics,and better safety.
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Objective To evaluate the effects of ketamine combined with sufentanil on postoperative analgesia and depression in patients undergoing hip arthroplasty.Methods A total of 60 patients who underwent elective hip arthroplasty were selected and divided into the S group,the SK1 group and the SK2 group according to the patient-controlled intravenous analgesia regimen,with 20 cases in each group.Patients in the S group were received 2 μg/kg of sufentanil for postoperative analgesia,patients in the SK1 group were received 1 mg/kg of esketamine and 2 μg/kg of sufentanil for postoperative analgesia,and patients in the SK2 group were received 2 mg/kg of esketamine and 2 μg/kg of sufentanil for postoperative analgesia.At 1,4,24,and 48 hours after surgery,the analgesic effect of patients was evaluated using the numeric rating scale(NRS),and the sedation effect of patients was evaluated using the Ramsay sedation score.Depression of patients before and 48 hours after surgery was assessed by self-rating depression scale(SDS).The adverse reactions such as nausea and vomiting,dizziness and headache,respiratory depression,and mental symptoms within 48 hours after surgery of patients were recorded.Results The NRS scores 1,4,and 24 hours after surgery of patients in the SK1 group and the SK2 group were lower than those in the S group(P<0.05);there was no statistically significant difference in the NRS scores 48 hours after surgery of patients among the three groups(P>0.05);there was no statistically significant difference in the NRS scores at different postoperative points of patients between the SK1 and SK2 groups(P>0.05).The SDS scores 48 hours after surgery of patients in each group were lower than those before surgery(P<0.05).There was no statistically significant difference in the Ramsay scores at different postoperative points of patients among the three groups(P>0.05).The incidence of adverse reactions 48 hours after surgery in the SK2 group was higher than those in the S group and the SK1 group(P<0.05).Conclusion Using 1 mg/kg of esketamine combined with 2 μg/kg of sufentanil after hip arthroplasty has a good analgesic effect without obvious increase of adverse reactions or significant effect on improving depression of patients.
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Objective To explore the application value of stage rehabilitation intervention under the Health action process approach(HAPA)model(SRI-HAPAM)combined with tranexamic acid(TXA)in elderly patients with femoral neck fracture(FNF)undergoing total hip arthroplasty(THA).Methods Elderly FNF patients with unilateral THA in the First Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 were enrolled.According to the random number table method,the patients were divided into routine nursing(RN)group and TXA+SRI-HAPAM group.The RN group received conventional treatment after surgery,and the TXA+SRI-HAPAM group received TXA combined with SRI-HAPAM after surgery.The bleeding indexes[hidden blood loss(HBL),explicit blood loss(EBL)and blood transfusion volume(BTV)],and the levels of hemoglobin(Hb),C-reactive protein(CRP)and D-dimer(DD)were compared between the two groups at 24 h after surgery.The hip function[joint deformity(JD),joint function(JF),joint pain(JP),joint motion(JM)and total hip function(THF)],anxiety and depression[self-rating anxiety scale and self-rating depression scale],satisfaction with care,and complications were compared between the two groups at 3 months after surgery.Results A total of 100 elderly patients with unilateral THA due to FNF were included in the study,including 54 in the TXA+SRI-HAPAM group and 46 in the RN group.Before operation,there was no significant difference in Hb,CRP,DD,JD,JF,JP,JM,THF and SAS between the two groups(P>0.05).At 24 hours after operation,Hb decreased in the two groups,while CRP and DD increased(P<0.05),and the decrease in Hb and the increase in CRP and DD,as well as HBL,EBL and BTV in the TXA+SRI-HAPAM group,were lower than those in the RN group(P<0.05).At 3 months after operation,JD,JF,JP,JM and THF in both groups increased compared with those before operation,while SAS and SDS decreased compared with those before operation(P<0.05),and the functional scores of JD,JF,JP,JM and THF in the TXA+SRI-HAPAM group were significantly higher than those in the RN group,and the scores of SAS and SDS were lower than those in the RN group(P<0.05).3 months after surgery,the nursing satisfaction of the TXA+SRI-HAPAM group was significantly higher than that of the RN group,and the total complication rate was lower than that of the RN group(P<0.05).Conclusion Compared the Routine nursing,TXA combined with SRI-HAPAM more effectively promotes postoperative recovery in patients with THA.
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Objective:To explore the application effect of remazolam besylate in elderly hip fracture surgery and its impact on anesthesia recovery quality and bone metabolism indicators.Methods:A total of 100 elderly patients with hip fractures admitted to Ningde Hospital from January 2021 to April 2022 were selected, all of whom underwent hip replacement surgery. According to the random number table method, they were divided into an observation group ( n=50) and a control group ( n=50). We observed the use of drugs such as remifentanil besylate combined with sufentanil for anesthesia induction and remifentanil combined with other drugs for anesthesia maintenance; The control group received anesthesia induction with drugs such as midazolam combined with sufentanil, and anesthesia maintenance with drugs such as remifentanil. Comparisons were made between the analgesic effects of anesthesia, the quality of anesthesia recovery, and the levels of hemodynamic and bone metabolism indicators at different time points between the two groups. Results:The postoperative recovery time, eye opening time, and extubation time of the observation group were shorter than those of the control group (all P<0.05); The total incidence of restlessness and coughing was lower in the control group than in the control group ( P<0.05); There was no statistically significant difference in the levels of serum osteocalcin (BGP), parathyroid hormone (PTH), and bone alkaline phosphatase (BALP) between the two groups after treatment (all P>0.05); The heart rate (HR) and mean arterial pressure (MAP) of the observation group during skin cutting (T 2) and 5 minutes after extubation (T 3) were lower than those of the control group (all P<0.05), and SpO 2 was higher than that of the control group ( P<0.05). The excellent rate of anesthesia and analgesic effect in the observation group was significantly higher than that in the control group ( P<0.05). Conclusions:Remazolam besylate has a good clinical effect in hip surgery, and the quality of anesthesia recovery is relatively high, but it has little effect on the postoperative bone metabolism indicators.
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Objective:To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures.Methods:A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years; 16 left and 15 right sides; 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years; 13 left and 13 right sides; 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] ( P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference ( P>0.05). Conclusion:Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.
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Objective:To characterize the biomechanics of distal dynamic locking and distal static locking of proximal femur bionic nails (PFBN) in fixation of intertrochanteric fractures by a finite element analysis.Methods:The CT image data from the hip to the upper tibia from an adult male volunteer were used to establish a three-dimensional model of the femur by Mimics 20.0 and Geomagic 2013 which was processed further into a model of Evans type I intertrochanteric fracture by software NX 12.0. With reference to the internal fixation parameters commonly used, 4 models of PFBN fixation were established: distal single transverse nail dynamic locking (model A), single oblique nail dynamic locking (model B), single nail static locking (model C) and double nail dynamic locking (model D). Abaqus 6.14 software was used to load and analyze the internal fixation stresses and displacements of fracture ends.Results:Under a 2100N loading, the peak stress was located upon the main nail in the 4 models. The smallest peak stress upon the main nail was in Model D (161.9 MPa), decreased by 15.9% compared with model A (192.5 MPa), by 15.6% compared with model B (191.9 MPa), and by 0.9% compared with model C (163.3 MPa). The peak stress upon the fixation screw was the largest in model A (95.3 MPa), the smallest in model B (91.5 MPa), and 91.5 MPa and 92.2 MPa in models C and D, respectively. The overall displacements of the implants, in a descending order, were 10.14 mm in model A, 10.10 mm in model B, 10.09 mm in model C, and 10.05 mm in model D. Similarly, the displacements of fracture ends were 0.125 mm in model A, 0.121 mm in model B, 0.110 mm in model C, and 0.098 mm in model D.Conclusion:Compared with dynamic locking, distal static locking of PFBN provides a better mechanical stability and reduces stress concentration upon internal fixation.
摘要
Objective:To analyze the clinical efficacy of arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip.Methods:A total of 30 patients (12 males and 18 females) with bilateral external snapping hip underwent arthroscopic transverse release of the iliotibial band through peritrochanteric space in Department of Sports Medicine, Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital were retrospectively analyzed from May 2021 and June 2022. The average age was 32.5±8.2 years (range, 17-51 years). At the same time, 30 patients who underwent arthroscopic external release of the iliotibial band through the external surface of the iliotibial band (external iliotibial band group) were selected as control group, including 13 males and 17 females, aged 29.5±6.8 years (range, 11-45 years). The visual analogue scale (VAS), modified Harris hip score (mHHS), and gluteal muscle contracture disability scale (GDS) were compared between the two groups at preoperative, 6 months postoperative, and final follow-up.Results:All patients successfully completed the operation and were followed up for 17.5±3.3 months (range, 12-25 months). The VAS scores of the two groups at the last follow-up were lower than those before operation ( P<0.05). The mHHS scores before operation, 6 months after operation and at the last follow-up in the peritrochanteric space group were 76.5 (67.0, 85.5), 98.5 (94.8, 100.0) and 100.0 (97.0, 100.0), respectively, and those in the external iliotibial band group were 80.5 (70.0, 86.0), 100.0 (96.0, 100.0) and 100.0 (99.5, 100.0). The differences in mHHS scores between the two groups were statistically significant for intragroup comparisons ( P<0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in mHHS scores between groups at different time points ( P>0.05). The GDS before operation, at 6 months after operation and at the last follow-up were 47.0 (35.8, 64.5), 90.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the peritrochanteric space group, and 51.0 (38.0, 64.5), 50.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the external iliotibial band group, respectively. The differences in GDS between the two groups were statistically significant for intragroup comparisons ( P< 0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in GDS between groups at different time points ( P>0.05). Conclusion:Arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip can effectively reduce hip pain and improve hip function, with satisfactory clinical results, and can be used as an alternative treatment to transverse release through the external surface of the iliotibial band.
摘要
Objective:To investigate the clinical efficacy of arthroscopic surgery for the treatment of femoral acetabular impingement (FAI) in athletes.Methods:A total of 18 FAI athletes (athlete group) who underwent hip arthroscopy in the Department of Sports Medicine, Peking University Third Hospital from April 2014 to June 2021 were retrospectively analyzed, including 12 males and 6 females, aged 20.44±3.45 years (range, 15-27 years). According to gender, age, body mass index and follow-up time, 36 non-athlete FAI patients (non-athlete group) were matched at a ratio of 1∶2 by propensity score matching method. There were 18 males and 18 females, aged 20.81±4.68 years (range 14-31 years). The hip pain visual analogue scale (VAS), modified Harris hip score (mHHS), hip outcome score-activity of daily living scale (HOS-ADL) and hip outcome score-sports scale (HOS-SS) scores were compared between the two groups before and after surgery. The minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were also compared between the two groups.Results:All patients successfully completed the surgery and were followed up for 33.56±19.20 months (range, 24-77 months). The VAS score at the last follow-up decreased from 6.22±1.52 points before surgery to 1.28±1.67 points in the athletes group, and decreased from 6.28±1.37 points before surgery to 1.67±1.69 points in the non-athletes group. There was no significant difference between the two groups ( P>0.05). The mHHS score at the last follow-up increased from 65.53±12.90 points before surgery to 92.28±13.59 points in the athletes group, and increased from 61.01±11.96 points before surgery to 86.82±11.98 points in the non-athletes group. There was no significant difference between the two groups ( P>0.05). The HOS-ADL score at the last follow-up increased from 72.77±18.86 points before surgery to 94.00±11.36 points in the athletes group, and increased from 70.35±13.12 points before surgery to 90.78±9.36 points in non-athletes group. There was no significant difference between the two groups ( P>0.05). The HOS-SS score at the last follow-up increased from 49.77±22.93 points before surgery to 87.28±17.62 points in the athletes group, and increased from 44.08±19.66 before surgery to 72.57±20.16 in the non-athletes group. The HOS-SS scores in the athletes group at the last follow-up were higher than those in the non-athletes group ( P<0.05). Furthermore, 61% (11/18) in the athletes group achieved MCID in HOS-ADL after surgery, which was lower than the non-athletes group's 81% (31/36), with a statistically significant difference (χ 2=4.339, P=0.037). Conclusion:Hip arthroscopy in the treatment of FAI in athletes can achieve satisfactory pain relief and motor function.
摘要
Objective:To assess the effectiveness and postoperative stability of proximal femoral varus derotational osteotomy combined with modified triple innominate osteotomy in treating hip dislocation in cerebral palsy.Methods:A total of 28 hips (11 left, 17 right) from 23 patients with cerebral palsy-induced hip dislocation who underwent the said surgical procedures were retrospectively examined between November 2018 and September 2022. The median age at the time of surgery was 7.7 years. Preoperatively, 29% of hips exhibited pain. Intraoperatively, a three-dimensional subtrochanteric osteotomy was performed with internal fixation using a Pediatric Hip Plate, alongside a modified triple innominate osteotomy via the Smith-Petersen and perineal approaches. Clinical assessments included pre- and postoperative evaluations of hip pain and joint mobility, as well as imaging evaluations, including migration percentage, acetabular index, acetabular offset, neck shaft angle, and femoral neck anteversion.Results:With a median follow-up of 15 months (range: 12 months to 20 months), all patients were successfully monitored. The median surgery duration was 6.1 hours, with blood loss averaging 400±153 ml (range 200-800 ml). The difference between the median postoperative (1 week after operative) MP 0% (0%, 0%) and the median preoperative MP 50.5% (38.2%, 75.8%) was statistically significant ( Z=4.624, P<0.001). The difference between the median postoperative AI 1.0° (-3.3°, 11.8°) and the median preoperative AI 29.4° (26.3°, 38.0°) was statistically significant ( Z=4.623, P<0.001). The difference between the median postoperative AO 69.8 (66.0, 76.0) mm and the median preoperative AO 72.3 (69.1, 81.1) mm was statistically significant ( Z=4.099, P<0.001). The difference between the median postoperative NSA 124.3° (118.7°, 129.9°) and the median preoperative NSA 145.6° (139.6°, 153.5°) was statistically significant ( Z=4.541, P<0.001). The difference between the median postoperative FNA 13.0° (5.4°, 24.1°) and the median preoperative FNA 33.6° (27.8°, 39.8°) was statistically significant ( Z=4.407, P<0.001). The pain was relieved postoperatively in 7 hips (88%) and residual hip pain in 1 hip. The postoperative range of motion was preserved. No case of avascular necrosis of the femoral head was observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. No case of redislocation was observed at the last follow-up, and no revision was performed recently. There was no significant difference between the median MP at the last follow-up of 0% (0%, 10.0%) and the median postoperative MP ( Z=0.561, P=0.575). Conclusion:The modified triple innominate osteotomy proved to be an effective intervention for correcting acetabular deformity in cerebral palsy-induced hip dislocation. The combination of proximal femoral varus derotational osteotomy with the modified triple approach not only significantly corrected hip dislocation but also alleviated pain and maintained joint mobility in pediatric patients with cerebral palsy.
摘要
Objective:To explore the efficacy of long intramedullary nails versus short intramedullary nails in the treatment of AO/OTA 31-A3 intertrochanteric fractures.Methods:A retrospective analysis was conducted on 60 patients with AO/OTA 31-A3 intertrochanteric femur fractures treated between March 2019 and August 2022. The patients were randomly divided into two groups (the long nail group and the short nail group). Thirty-four patients were treated with long intramedullary nails, including 16 males and 18 females, aged 68.41±17.84 years old (range 31-96 years). Twenty-six patients were treated with short intramedullary nails, including 13 males and 13 females, aged 72.23±13.97 years old (range 31-90 years). The causes of injury, fracture classification (AO/OTA classification), intraoperative blood loss, operation time, fracture healing time, imaging indexes (fracture reduction quality, postoperative neck trunk angle, and medial support), Harris score of the hip joint at the last follow-up, one-year mortality rates and complications were compared between the two groups.Results:The follow-up time was 24.26±6.67 months in the long nail group and 24.31±5.60 months in the short nail group, and the general information of the two groups were comparable. Between the long nail and short nail group, the intraoperative blood loss was 281.47±235.28 ml vs. 121.92±84.14 ml and the operation time was 110.44±24.63 min vs. 81.15±28.54 min with significant differences ( P<0.05). While the length of hospital stay was 12.35±4.81 d vs. 10.89±4.30 d, the good rate of fracture reduction was 55.9% vs. 61.53%, the fracture healing time was 120.44±16.43 d vs. 128.07±18.33 d, the presence rate of medial support was 67.6% vs. 79.4%, and the excellent rate of Harris score was 65.4% vs. 65.4% with no significant difference between the two groups ( P>0.05). One-year mortality rates was 5.3% vs. 7.1% and complications was 11.7% vs. 15.4% with no significant difference between the two groups ( P>0.05). Conclusion:Both long intramedullary nails and short intramedullary nails are effective in the treatment of AO/OTA 31-A3 intertrochanteric femur fractures. However, surgical time and intraoperative blood loss was less in the short nail group.
摘要
Developmental dysplasia of the hip (DDH) is a developmental disease with abnormal position and morphology of the acetabulum and femoral head. DDH ranges from mild dysplasia to complete dislocation, including simple acetabular dysplasia, subluxation, and total dislocation. DDH is one of the most common hip diseases in children, and its onset begins in infancy. The anatomical structure of the hip joint is complex, and there are some practical problems in the large -scale clinical diagnosis and screening work, such as heavy workload, high misdiagnosis rate and missed diagnosis rate, and a long learning period of surgery. Artificial intelligence (AI) is an emerging technology science used to research and develop theories, methods, technologies and application systems that can simulate human intelligence. The main goal is to enable machines to complete complex tasks that require human intelligence. At present, artificial intelligence is mainly used in the diagnosis and treatment of DDH. Artificial intelligence combined with X-ray or ultrasound is used to diagnose and screen DDH, which avoids subjectivity to a certain extent and improves the accuracy of diagnosis and screening. In the preoperative planning of periacetabular osteotomy and total hip arthroplasty, it can more accurately track the position of the bone block and design the size of the prosthesis, which makes the surgical planning more accurate to a certain extent. Artificial intelligence technologies such as 3D navigation system, surgical robot and robotic arm are helpful to improve the accuracy and safety of surgery. Artificial intelligence has the characteristics of simplicity, speed, high repeatability and deep learning ability, which to a certain extent saves manpower, material resources and time costs for DDH diagnosis and treatment, facilitates medical workers to share DDH diagnosis and treatment experience and reduces the burden of patients, families, society and the country. The application of artificial intelligence in DDH diagnosis and treatment is becoming more and more extensive, but at present, artificial intelligence in DDH screening is still in its preliminary stage. There are few reports on artificial intelligence technology in DDH hip preservation treatment and other surgical methods, and there is insufficient research on artificial intelligence in DDH conservative treatment, postoperative complications and prognosis prediction. It is worth exploring new ideas by researchers. At present, the application of artificial intelligence in DDH still has certain limitations, including problems such as difficult to control the quality of image data, difficult to develop and promote technology, and lack of laws and regulations. Based on the literature database and relevant data sharing network, this paper reviews the application of artificial intelligence in the diagnosis and treatment of DDH at home and abroad in recent years, summarizes the current application status of artificial intelligence in the diagnosis and treatment of DDH, and provides new ideas for the future application of artificial intelligence in the diagnosis and treatment of DDH.
摘要
Objective:To analyze the feasibility and clinical efficacy of mirror reconstruction in total hip arthroplasty (THA) assisted by visual treatment solution (VTS) for patients with Crowe type II-III developmental dysplasia of the hip (DDH).Methods:Included in this study were 67 patients (67 hips) with unilateral Crowe type II-III DDH undergoing primary THA from June 2022 to August 2023. According to the reconstruction position of the rotation center, the patients were divided into mirror group and high group. There were 37 patients (37 hips) in the mirror group, reconstructed by referring to the rotation center of contralateral normal hip, with 8 males and 27 females, aged 40.9±16.7 years old and 30 patients (30 hips) in the high group, reconstructed by the "high hip center" strategy, with 7 males and 23 females, aged 38.3±11.1 years old. The radiographic results between the affected hip and the normal hip in 12 months postoperatively and the clinical results before and after the operation were compared.Results:All the operations for patients with Crowe type II-III DDH were completed successfully. The operation time, intraoperative blood loss and the follow-up time in the mirror group were 113.9±22.9 min, 287.8 ±181.6 ml and 12.8±1.8 months, respectively, while those in the high group were 118.0±26.2 min, 293.3±125.8 ml and 13.7±2.3 months respectively without significant difference between the two groups. In 12 months postoperatively the rotation center height, greater trochanter height and femoral offset of 37 hips in the mirror group were 16.1±3.8 mm, 17.7±5.2 mm and 34.4 ±5.1 mm, respectively, which were not significantly different from those of the normal side, while the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 32.3±5.3 and 76.9±5.4 points to 84.3±6.3 and 9.4±2.5 points ( t=-34.222, P<0.001; t=64.486, P<0.001). In the high group, the rotational center height, greater trochanter height and femoral offset of 30 hips were 27.9±3.7 mm, 25.4 ±7.9 mm and 35.4 ±6.2 mm, respectively, which were significantly higher than those in the normal side ( t=-15.706, P<0.001; t=-6.494, P<0.001; t=-2.555, P=0.016), and the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 30.9±4.8 and 78.7±5.3 points to 79.5±4.9 and 13.9±3.3 points ( t=-37.339, P<0.001; t=64.375, P<0.001). The HHS and WOMAC osteoarthritis index in the mirror group significantly improved compared with the high group in 12 months postoperatively ( t=3.404, P=0.001; t=-6.315, P<0.001). The X-ray at last follow-up showed that all prostheses were in a stable position. Conclusion:Compared with the high hip center reconstruction, satisfactory outcomes in terms of functional recovery and radiographic evaluation could be achieved in patients with Crowe type II-III DDH undergoing VTS-assisted THA of mirror reconstruction. The application of mirror reconstruction is expected to achieve the goal of restoring the anatomical structure and function of the primary hip after THA.
摘要
Objective:To investigate the effect of pelvic rotation around coronal axis on the placement angle of acetabular prosthesis after total hip arthroplasty.Methods:According to Murary's definition, the angle between the acetabular axis and the sagittal plane was defined as the acetabular abduction angle, and the angle between the acetabular axis and the coronal plane as the anterior inclination angle. A simple mathematical solid geometry model was established by using the mathematical software GeoGebra to simulate the dynamic changes of the acetabular prosthesis when it rotated around the coronal axis, and the calculation formula of the dynamic changes of the anterior inclination and abduction angle of the acetabular prosthesis was derived. MatLab software was used to generate the function graph of pelvis forward inclination and abduction angle and deduce the motion of acetabular prosthesis.Results:The dynamic changes of acetabular tilt angle and abduction angle when the pelvis rotated around the coronal axis were functionally related to the anterior-posterior tilt of the pelvis in a nonlinear pattern. When the pelvis rotates around the coronary axis, the anterior inclination angle formula is α 1=arcsin (sinβ 1×cosα×cosθ+cosβ 1×sinα); When the acetabulum axis faces downwards the abduction angle formula is θ 1=arccot (cosβ 1×cotθ-sinβ 1×tanα/sinθ); When the acetabulum axis faces upwards the abduction angle formula is θ 1=π-abs[arccot (cosβ 1×cotθ-sinβ 1×tanα/sinθ)] withα being the initial acetabular forward angle, θ being the initial acetabular abduction angle, α 1 being the forward angle of the acetabular prosthesis after pelvic rotation, θ 1 being the external expansion angle of the acetabular prosthesis after pelvic rotation and β 1 being the rotation angle of the pelvis around the coronal axis. When the pelvis is tilted backward, the anterior inclination angle of the acetabular prosthesis increases first and then decreases, and the abduction angle continues to increase. When the pelvis is tilted forward, the abduction angle decreases first and then increases, and the anterior inclination angle continues to decrease to negative. Conclusion:When the initial anterior inclination angle and abduction angle of acetabular prosthesis change, the curve of anterior inclination and abduction angle change accordingly. The larger the initial anterior inclination angle is, the faster it reaches its peak value, and the larger the peak value is, the faster the abduction angle changes. The larger the initial abduction angle is, the slower the initial anterior inclination angle and the abduction angle change.