目的本研究对因膝关节前内侧关节炎进行Oxford单髁置换的中国患者前瞻性收集数据和术中观察髌股关节情况,并探讨这一结论的正确性。方法研究包括本单位从2009年8月至2011年5月连续进行的50例(45例患者)单髁置换病例。术前记录膝关节疼痛的部位,放射学检查发现的髌股关节退变用Ahlback系统分级。对于术中观察到的股骨滑车软骨磨损情况用Weidow 5级分级系统记录,其将软骨状况从无磨损到全层磨损分为0至Ⅳ级。在术后1年随访是用Hospital for Special Surgery膝关节评分系统和自我满意度评分对临床疗效进行评定。结果术前放射学检查发现17膝(34%)存在髌股关节退变。术中观察发现27膝(54%)存在股骨滑车软骨面磨损,其中19例(38%)位于滑车沟偏内侧,6例(12%)位于滑车沟中央,1例(2%)位于滑车沟偏外侧,共有3例(6%)全层软骨磨损,2例(4%)位于滑车沟偏内侧,1例(2%)位于滑车沟偏外侧。不论是放射学发现的髌股关节退变还是术中发现软骨磨损病例与髌股关节相对正常病例相比,临床疗效没有显著性差异。结论术前放射学发现的髌股关节退变和术中发现髌股关节软骨磨损均不能作为Oxford内侧单髁置换的反指征。因外侧髌股关节退变的相关数据较少,对这类患者选择单髁置换时应慎重。
Background The imaging evaluation of pain in patients who have had a hip arthroplasty （HA） is challenging,and traditional imaging techniques,including magnetic resonance imaging （MRI） and computerized tomography （CT）,are limited by metallic artifact.The purpose of the present study was to investigate the use of modified MRI techniques to visualize periprosthetic soft tissues and the bone-implant interface,and to evaluate the value of MRI for the assessment of patients with painful hip arthroplasty.Methods Fifty-six painful hips in fifty-six patients following primary HA were assessed using optimized MRI,CT and standardized radiographs.The diagnosis of MRI was correlated with intraoperative findings as well as with microbiological and histological examinations （when available）.The sensitivity and the specificity of MRI diagnosis were determined according to final diagnosis.The chi-square test was performed to detect a difference between MRI and final diagnosis.Results Forty-eight patients have received revision surgery and final diagnosis were established.MRI was demonstrated high sensitivity and specificity in detecting aseptic loosening （93％ and 95％）,periprosthetic infection （94％ and 97％）,adverse local tissue reaction （100％ and 100％） and periprosthetic fracture （100％ and 100％）.MRI was determined to be the most sensitive technique in detecting implant loosening for any reason,with a sensitivity of 93.8％ for acetabular shell and 97.1％ for femoral stem,compared to 81.3％ and 80.0％ on CT,75.0％ and 77.1％ on radiographs.Conclusions Optimized MRI was effective for the assessment of the periprosthetic soft tissues and bone.The use of modified magnetic resonance imaging parameters provided a useful adjunct to conventional examinations for the evaluation of patients with painful hip arthroplasty.
He ChuanLu YongJiang MeihuaFeng JianminWang YiLiu Zhihong
目的外侧髌股关节退变被认为是膝内侧单髁置换术后预后不良的危险因素,本研究通过对因膝关节前内侧骨关节炎行Oxford单髁置换的中国病人前瞻性研究探讨这一结论的正确性。方法对本单位从2009年8月至2013年12月连续进行的126例(104位病人)单髁置换病例进行前瞻性数据收集,术前记录膝关节疼痛部位,并根据Ahlback系统分级记录放射学检查发现的髌股关节退变。术中观察股骨滑车软骨磨损情况,根据Weidow 5级分级系统记录磨损程度,同时记录磨损部位。术后1年随访用Hospital for Special Surgery膝关节评分系统和能否深蹲对临床疗效进行评定。根据术中观察的股骨滑车软骨磨损部位,将病人分为无磨损组(N组)、外侧磨损组(L组)和中内磨损组(M组),比较三组间术后疗效、满意度、术后并发症是否有差异。计量资料采用单因素的方差分析,计数资料采用的是卡方检验。结果共118膝(98病人)纳入统计分析。根据术中发现共81膝(68.6%)存在股骨滑车软骨面磨损,外侧磨损组(L组)11膝,中内侧磨损组(M组)70膝。三组病人术后1年HSS评分有显著提高,M组与N组相比,L组与N组相比提高均无明显差异,但L组提高程度轻度高于M组;术后能够自主行深蹲和起立动作共88例,其中N组28例,M组52例,L组8例,组间无统计学差异;术后轻度膝前痛9例,其中N组2例,L组1例,M组6例,组间无统计学差异。结论术前放射学发现的髌股关节退变和术中发现外侧髌股关节软骨磨损均不能作为Oxford内侧单髁置换的反指征。
目的评估自体股骨头旋转植骨填充技术重建髋臼治疗发育性髋关节发育不良(developmental dysplasia of the hip, DDH)的中期疗效。方法回顾性分析2012年3月至2016年12月,16例(16髋)采用全髋关节置换术(total hip arthroplasty, THA)合并自体股骨头旋转植骨技术治疗的DDH病人,女13例,男3例;手术时病人年龄为37~72岁,平均51.0岁;CroweⅢ型DDH 14例,Ⅳ型2例;均为单侧手术,其中左侧10例,右侧6例。所有髋关节置换假体均为非骨水泥型。收集记录其术前、术后的Harris评分及各种并发症;通过双侧髋关节正位(或骨盆正位)、患侧髋关节侧位X线片,以判断人工假体位置及植骨愈合情况。结果本组16例病人的随访时间为18.0~74.4个月,平均40.8个月。术前Harris评分为28~58分,平均为41.8分;所有病人末次随访时均无需辅助行走,术后末次随访时的Harris评分为84~96分,平均为89.6分。所有病例末次随访时均显示植骨块愈合迹象,假体位置良好,无移位或周围透亮线出现,也无螺钉断裂情况出现。1例病人外伤后同侧耻骨支、坐骨支骨折,予以保守治疗后痊愈,髋关节功能良好。结论应用自体股骨头旋转植骨填充技术对DDH病人行髋臼侧重建,疗效满意,植骨愈合率高,能为将来可能的髋关节翻修提供更多的骨量储备。
