BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Ber...BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.展开更多
For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosi...For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoralhead and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage(generally over age 10), including adolescents and young adults(generally up to around age 40), the Bernese periacetabular osteotomy(PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.展开更多
Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We inv...Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.展开更多
[目的]评价髋臼周围截骨术(Peri-acetabular osteotomy,PAO)治疗髋关节发育不良(developmental dysplasia of the hip,DDH)合并股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析2017年—2023年在本院接...[目的]评价髋臼周围截骨术(Peri-acetabular osteotomy,PAO)治疗髋关节发育不良(developmental dysplasia of the hip,DDH)合并股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析2017年—2023年在本院接受PAO治疗的7例8髋DDH合并ONFH患者的临床资料,评价临床及影像结果。[结果]患者均顺利完成手术,与术前相比,末次随访时iHOT-12评分[(65.5±13.0),(85.0±25.0),P=0.024]、Harris评分[(63.8±10.6),(81.9±15.5),P=0.013]、髋后伸ROM[(8.9±2.3)°,(11.7±3.5)°,P=0.015]、髋内旋ROM[(11.1±7.5)°,(22.2±10.0)°,P=0.013]均显著增加。影像方面,与术前相比,末次随访时髋臼覆盖率[(66.1±5.7)%,(92.4±3.4)%,P<0.001]、Sharp角[(45.4±2.2)°,(33.9±5.5)°,P<0.001]、LCEA[(16.3±5.8)°,(43.4±3.2)°,P<0.001]、T?nnis角[(18.0±6.5)°,(-7.0±5.6)°,P<0.001]均显著改善。[结论]PAO在改善DDH髋臼包容的基础上,也可将ONFH的坏死区位置转移至非负重区,可达到促进骨修复、改善髋关节功能和延缓关节炎的目的。展开更多
目的建立健康志愿者、髋关节发育不良(development dysplasia of the hip,DDH)患者手术前后股骨-骨盆-腰椎模型,研究弧形髋臼截骨术对腰椎生物力学影响。方法利用CT扫描获取4名DDH患者手术前后以及1名健康志愿者股骨-骨盆-腰椎DICOM数据...目的建立健康志愿者、髋关节发育不良(development dysplasia of the hip,DDH)患者手术前后股骨-骨盆-腰椎模型,研究弧形髋臼截骨术对腰椎生物力学影响。方法利用CT扫描获取4名DDH患者手术前后以及1名健康志愿者股骨-骨盆-腰椎DICOM数据,构建三维有限元模型。在Geomagic中采用偏移命令划分皮质骨与松质骨,在SolidWorks中添加腰椎软骨、骶髂关节、耻骨联合等软骨,在ANASYS中对模型进行有限元分析,步态为慢走中的单腿支撑中期相。分析对比DDH患者手术前后腰椎生物力学变化,将患者术后腰椎生物力学数据与健康志愿者进行对比。结果建立了4组患者和1组健康志愿者股骨-骨盆-腰椎模型,模型在各工况下结果均在所参考的文献范围内,证明模型有效。患者术后腰椎、股骨颈、纤维环与髓核所受应力远小于患者术前的状态,患者术后腰椎、股骨颈、纤维环与髓核所受应力与健康志愿者相近。结论弧形髋臼截骨术在治疗DDH后会显著降低腰椎、椎间盘所受应力,纤维环与髓核受力也更加均匀,说明弧形髋臼截骨术会将患者调整到健康状态。研究结果为临床治疗DDH提供了生物力学依据,有助于优化手术方案。展开更多
目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。...目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。对比两组患者的手术情况,术前及术后采用髋骨X线检查测定髋关节情况,采用非骨关节炎髋关节评分(Non-Arthritis Hip Score,NAHS)测定患者关节功能,采用日常生活能力量表(Hip Outcome Score Activity of Daily Living Scale,HOS-ADL)测定患者活动能力,记录患者术后并发症发生情况。结果:两组患者手术情况,术后3 m术后髋关节情况对比均无明显差异(P>0.05),髋关节镜组相较于关节囊切开组术后3 m NAHS、HOS-ADL得分更高,坐骨神经损伤表现发生率明显更低(P<0.05)。结论:髋关节镜截骨术在短期改善成人发育性髋关节不良患者关节功能方面优势明显,可防止坐骨神经损伤。展开更多
目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采...目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采集自体血)的45例患者作为对照组;采用AAA技术进行单采深度自体储血患者,按照对照组患者的年龄、性别、体质指数、术前Hb和Plt、手术失血量、术中自体血回收量为条件,配对选择上述条件相似且均无统计学差异的45例患者作为深度自体组。配对比较分析2组患者自体浓缩红细胞采集量和采集率、异体红细胞和血浆输注量和输注率,围术期Hb和Plt变化,住院天数及住院费用。结果深度自体组和对照组患者术前采集自体红细胞量分别为146 U和14 U,自体血采集率分别为100.00%和17.78%;2组患者围术期异体红细胞和血浆的输注量分别为4 U vs 40 U和0 U vs 24 U,异体红细胞和血浆的输注率分别为4.44%vs40.00%、0.00 vs 26.67%;2组患者围术期Hb和Plt水平变化情况无统计学差异(P>0.05);2组患者的住院时间分别为11.0(9.5,12.0)vs 12.0(10.0,15.0)(P<0.05);2组的总住院费用、治疗费用、检查检验费用和输血相关费用分别为4.01(3.72,7.72)vs 4.47(3.58,7.70)(P>0.05),3.30(2.98,6.95)vs 4.00(23.04,7.14)(P>0.05),0.48(0.45,0.53)vs 0.47(0.44,0.50)(P>0.05),0.26(0.25,0.28)vs 0.06(0.04,0.15)(P<0.05)。结论对于发育性髋关节发育不良的髋臼周围截骨手术,单采深度自体储血技术能使90%以上患者避免异体血输注,同时缩短了住院时间,减少了患者的住院费用负担。展开更多
文摘BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.
文摘For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoralhead and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage(generally over age 10), including adolescents and young adults(generally up to around age 40), the Bernese periacetabular osteotomy(PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.
文摘Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.
文摘[目的]评价髋臼周围截骨术(Peri-acetabular osteotomy,PAO)治疗髋关节发育不良(developmental dysplasia of the hip,DDH)合并股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析2017年—2023年在本院接受PAO治疗的7例8髋DDH合并ONFH患者的临床资料,评价临床及影像结果。[结果]患者均顺利完成手术,与术前相比,末次随访时iHOT-12评分[(65.5±13.0),(85.0±25.0),P=0.024]、Harris评分[(63.8±10.6),(81.9±15.5),P=0.013]、髋后伸ROM[(8.9±2.3)°,(11.7±3.5)°,P=0.015]、髋内旋ROM[(11.1±7.5)°,(22.2±10.0)°,P=0.013]均显著增加。影像方面,与术前相比,末次随访时髋臼覆盖率[(66.1±5.7)%,(92.4±3.4)%,P<0.001]、Sharp角[(45.4±2.2)°,(33.9±5.5)°,P<0.001]、LCEA[(16.3±5.8)°,(43.4±3.2)°,P<0.001]、T?nnis角[(18.0±6.5)°,(-7.0±5.6)°,P<0.001]均显著改善。[结论]PAO在改善DDH髋臼包容的基础上,也可将ONFH的坏死区位置转移至非负重区,可达到促进骨修复、改善髋关节功能和延缓关节炎的目的。
文摘目的建立健康志愿者、髋关节发育不良(development dysplasia of the hip,DDH)患者手术前后股骨-骨盆-腰椎模型,研究弧形髋臼截骨术对腰椎生物力学影响。方法利用CT扫描获取4名DDH患者手术前后以及1名健康志愿者股骨-骨盆-腰椎DICOM数据,构建三维有限元模型。在Geomagic中采用偏移命令划分皮质骨与松质骨,在SolidWorks中添加腰椎软骨、骶髂关节、耻骨联合等软骨,在ANASYS中对模型进行有限元分析,步态为慢走中的单腿支撑中期相。分析对比DDH患者手术前后腰椎生物力学变化,将患者术后腰椎生物力学数据与健康志愿者进行对比。结果建立了4组患者和1组健康志愿者股骨-骨盆-腰椎模型,模型在各工况下结果均在所参考的文献范围内,证明模型有效。患者术后腰椎、股骨颈、纤维环与髓核所受应力远小于患者术前的状态,患者术后腰椎、股骨颈、纤维环与髓核所受应力与健康志愿者相近。结论弧形髋臼截骨术在治疗DDH后会显著降低腰椎、椎间盘所受应力,纤维环与髓核受力也更加均匀,说明弧形髋臼截骨术会将患者调整到健康状态。研究结果为临床治疗DDH提供了生物力学依据,有助于优化手术方案。
文摘目的:探究关节囊切开与髋关节镜分别结合髋臼周围截骨术治疗成人发育性髋关节发育不良的疗效。方法:回顾分析72例2021年5月至2022年6月入住我院的成人发育性髋关节发育不良患者的临床资料,分为关节囊切开组(n=35)和髋关节镜组(n=37)。对比两组患者的手术情况,术前及术后采用髋骨X线检查测定髋关节情况,采用非骨关节炎髋关节评分(Non-Arthritis Hip Score,NAHS)测定患者关节功能,采用日常生活能力量表(Hip Outcome Score Activity of Daily Living Scale,HOS-ADL)测定患者活动能力,记录患者术后并发症发生情况。结果:两组患者手术情况,术后3 m术后髋关节情况对比均无明显差异(P>0.05),髋关节镜组相较于关节囊切开组术后3 m NAHS、HOS-ADL得分更高,坐骨神经损伤表现发生率明显更低(P<0.05)。结论:髋关节镜截骨术在短期改善成人发育性髋关节不良患者关节功能方面优势明显,可防止坐骨神经损伤。
文摘目的分析单采深度自体储血技术(AAA)在髋臼周围截骨术中避免输注异体血的临床应用效果。方法统计2014年2月-2016年12月行髋臼周围截骨术治疗发育性髋关节发育不良手术病例,采用配对研究方法,将未采用AAA技术(即常规贮存自体全血及未采集自体血)的45例患者作为对照组;采用AAA技术进行单采深度自体储血患者,按照对照组患者的年龄、性别、体质指数、术前Hb和Plt、手术失血量、术中自体血回收量为条件,配对选择上述条件相似且均无统计学差异的45例患者作为深度自体组。配对比较分析2组患者自体浓缩红细胞采集量和采集率、异体红细胞和血浆输注量和输注率,围术期Hb和Plt变化,住院天数及住院费用。结果深度自体组和对照组患者术前采集自体红细胞量分别为146 U和14 U,自体血采集率分别为100.00%和17.78%;2组患者围术期异体红细胞和血浆的输注量分别为4 U vs 40 U和0 U vs 24 U,异体红细胞和血浆的输注率分别为4.44%vs40.00%、0.00 vs 26.67%;2组患者围术期Hb和Plt水平变化情况无统计学差异(P>0.05);2组患者的住院时间分别为11.0(9.5,12.0)vs 12.0(10.0,15.0)(P<0.05);2组的总住院费用、治疗费用、检查检验费用和输血相关费用分别为4.01(3.72,7.72)vs 4.47(3.58,7.70)(P>0.05),3.30(2.98,6.95)vs 4.00(23.04,7.14)(P>0.05),0.48(0.45,0.53)vs 0.47(0.44,0.50)(P>0.05),0.26(0.25,0.28)vs 0.06(0.04,0.15)(P<0.05)。结论对于发育性髋关节发育不良的髋臼周围截骨手术,单采深度自体储血技术能使90%以上患者避免异体血输注,同时缩短了住院时间,减少了患者的住院费用负担。
