保留股骨距的骨水泥型双动半髋人工关节置换治疗高龄转子间骨折

目的：探讨高龄转子间骨折行双动人工关节置换的手术适应症及手术方法。方法：对16例老年转子间骨折采取人工双动半髋关节置换术,男9例,女7例,年龄67-91岁,平均76．5岁。骨折分类按Evans分型,EvansⅠ型12例,EvansⅡ型4例,手术过程中保留股骨距,大转子行改良张力带钢丝固定后,行分次骨水泥双动人工关节置换。结果：手术时间最短52分钟-72分钟,平均68分钟;术中出血210ml-400ml,平均326ml;术后6月手术疗效评价按Harris评分,76分-93分,平均78．5分,无严重并发症发生。术后随访6～22个月,平均18．4月,随访期间未见假体松动及髋臼磨损。结论：以双动人工关节置换治疗高龄转子间骨折是一种较为有效、可行的方法;合适的手术适应症选择及正确的假体选择和手术操作是其关键。     

髋关节表面置换后股骨侧应力分布的有限元分析

目的通过有限元分析探讨髋关节表面置换后股骨侧的生物力学意义.方法采用有限元构建分析软件ANSYS workbench v10．0,通过对髋关节表面置换后股骨侧的结构进行拆分,分别将3部分构建后生成体积建立髋关节表面置换后股骨侧三维有限元模型,利用MSC patran2007计算软件,采用四面体10节点自由划分网格,共38147节点,187547单元,其中假体模型57446单元、水泥壳模型28265单元、股骨部分101836单元,分析髋关节表面置换后股骨侧的应力分布情况：结果所构建的三维有限元模型,逼真反映髋关节表面置换后股骨侧的真实几何形态及其生物力学。结论有限元模型的构建,可以为髋关节表面置换术的生物力学行为以及假体优化设计提供精确模型.     

关于人工髋关节置换术中应力研究的三维重建技术探析

人工髋关节置换术是现在应用很广的一项骨科手术,这个手术能为病患大大的提高生活质量,在这个手术中使用的假体有骨水泥和非骨水泥两种,应用这两种假体,都需要对股骨近端髓腔进行研究,使得手术效果更好,本文提供了一种利用X片进行股骨近端髓腔三维重建的方法 。     

130例骨科卧床患者便秘的原因及护理干预

1 临床资料 2005年1月至2006年12月共收治130例长期卧床后发生便秘的病人,其中男性90例,女性40例,年龄在8-90岁,胫骨骨折20例,腰椎病变42例,股骨颈骨折35例,人工髋关节置换术33例.     

老年肺癌手术患者围手术期处理

目的：探讨老年肺癌患者围手术期的治疗经验。方法：对68例60岁以上老年肺癌患者的外科治疗进行分析。结果：68例老年肺癌患者合并高血压病19例,糖尿病11例,冠心病4例,慢性支气管炎、肺气肿10例。均行手术治疗,术后并发症19例,并发症发生率28．0％,其中心肺并发症占89．5％（17／19）。无围手术期死亡。结论：老年肺癌患者术前合并心肺血管疾病增加了手术的风险性,术前全面了解病情,加强围手术期管理,是提高手术疗效的关键;采取适当的治疗措施,老年肺癌患者也可以取得满意的治疗效果。     

纳米羟基磷灰石/聚酰胺复合材料的人工肱骨头体内成骨中BMP-2及其基因表达研究

目的：对新型纳米晶骨修复和前建复合材料（n-HA／PA66）人工肱骨头的成骨能力及将其作为人工关节替代品的可行性进行评价。方法：新西兰大白兔20只,行双侧肱骨头切除,以nHA／PA人工肱骨头进行双侧肱骨头置换术。术后1、2、3、4、6、12、24周处死周分别处死动物。对假体与受体骨界面先行大体观察,然后分别用甲基丙烯酸甲酯（PMMA）制作硬组织片,甲苯胺兰染色和Masson染色后,对n-HA／PA人工肱骨头与受体骨界面进行BMP-2免疫组织化学检测和原位杂交BMP-2基因表达检测。结果：人工肱骨头在动物体内成骨的BMP-2及其基因表达研究显示,假体植入第3周,免疫组织化学染色显示BMP-2即有弱阳性表达,至6,12周为强阳性;第24周,BMP表达阳性率及阳性程度均有所降低。此外,原位杂交观察假体植入第1、2周,成骨细胞中BMP-2 mRNA表达呈弱阳性,第3周成骨细胞中BMP-2 mRNA表达呈强阳性,而在第4周,成骨细胞中表达阳性率和阳性程度均有所下降。研究显示人工肱骨头体内成骨的BMP-2及其基因表达高峰时间较文献报道的骨折模型晚。结论：n-HA／PA66人工肱骨头具有良好的成骨能力,作为新型人工关节材料为可与受体骨发生生物键合。     

股骨转子间骨折PFNA治疗的注意事项

目的:讲述PFNA-II治疗股骨转子间骨折的手术配合体会。方法:对60例老年患者实施手术,包含术前探访、进入手术室后的进一步安慰、复位、C一臂X线机透视检验复位状况、手术中供应PFNA-II专用器械作骨折内固定、全经过作老年有关作用监护等。结果:PFNA组患者的手术时间、术中出血量明显优于股骨头置换组,P0.05;但2组患者的髋关节的优良率、并发症的出现率和住院时间没有明显性差别,P0.05。结论:PFNA治疗老年股骨转子间骨折手术时间短、小创伤、并发症出现率小,值得临床宣传。     

关节镜辅助下治疗髌骨复发性脱位48例报告

探讨关节镜辅助下治疗髌骨复发性脱位的效果。2004年4月至2012年12月共收治48例复发性髌骨脱位患者,男23例,女25例;年龄19~55岁,平均28.3岁。平均复发性脱位4次,全部患者均采用关节镜监视下行髌外侧支持带松解、髌内侧支持带紧缩(或内侧髌股韧带重建)、胫骨结节移位手术,术后45例得到平均27.5个月的随访,平均随访3.6次。了解患者主观症状和客观体征,髌骨脱位复发,膝关节正位、髌骨轴位X线片及膝关节功能康复评分。得到随访的38例患者对治疗均满意,无再脱位。4例膝关节活动过多有酸痛感,3例膝关节有10°~15°的屈曲度减少,45例按Lysholm膝关节功能评分:术前(48.8±5.5)分,术后(93.6±3.3)分(p0.05)。依据病情行髌骨内侧髌股韧带重建、外侧支持带松解、结合胫骨结节内移微创手术治疗复发性髌骨脱位是有效的且创伤小、恢复快,可早期康复的一种方法。     

高粘度骨水泥注入椎体成形术治疗急性重度骨质疏松椎体压缩性骨折

目的：探讨应用高粘度骨水泥对急性重度骨质疏松椎体压缩性骨折（Osteoporotic vertebral compression fracture,OVCF）行经皮椎体成形术（Pereutaneous vertebraplasty,PVP）的临床疗效方法：收集2005年2月至2010年8月急性OVCF患者36例．体位复位后应用高粘度骨水泥行经皮椎体成形术治疗．手术前后进行视觉模拟疼痛评分（VAS）、伤椎高度与后凸畸形的X线片测量结果：全部病例于术均安全完成,术中骨水泥注入量平均3．0ml．术后平均随访16．4（12至30）个月。术后VAS评分较术前改薄（P〈0．05）,椎俸前缘、中线高度及后凸畸形较术前明显恢复（P〈0．0．5）。4例（11．1％）出现骨水泥渗漏．似无临床症状及体征,结论：应用商粘度骨水泥经皮椎体成形术结合体位复位及是治疗急性OVCF可行及有效的方法,     

全髋关节置换术后并发症的观察及干预护理

人工全髋关节置换术（TFIR）,是用模拟人体关节结构的人工生物材料置换病损的髋关节,以达到缓解患者髋部疼痛、保持关节稳定、部分或全部恢复关节功能、提高生活质量的目的。2010年1月-2010年12月,我科共行THR371例,经过严密观察和精心护理,有效地预防了并发症发生,现将护理体会报道如下。     

微创小切口大头金属-金属与常规金属-聚乙烯全髋置换术早期临床疗效的对比研究

目的：比较微创小切口大头金属-金属（large—diameter metal—on—metal,L—MoM）全髋置换术（total hip arthroplasty,THA）与常规金属-聚乙稀假体（metal on polyethylene,MoPE）THA的早期临床疗效。方法：2005年1月至2007年12月经后外侧小切口行L—MoM THA20例（22髋）、常规THA20例（22髋）。对两组分别进行临床功能、影像学评价及并发症评估并相互比较。结果：L—MoM组19例（21髋）、MoPE组18例（20髋）获得随访,平均随访时间14．1月。两组Harris评分、简易12项表（short form-12,SF-12）评分及并发症无显著性差异（P〉0．05）;影像学上股骨头相对髋臼中心的矢量位移L—MoM组较MoPE组显著降低（P〈0．01）,透亮线、股骨柄中置、异位骨化、骨溶解、假体松动、股骨距吸收、假体断裂两组无显著差异（P〉0．05）。结论：经后外侧小切口行L—MoM THA可取得与常规MoPE THA相似的早期临床疗效,并不会增加手术并发症,且髋臼磨损率更低,其中长期临床结果仍有待进一步研究。     

A new approach to the laboratory evaluation of the essential parameters of revision hip arthroplasty

It would be great if the parts used in a traditional hip replacement lasted forever, but they don't. The surgery performed when the parts need to be repaired is called revision hip arthroplasty. The best method of revision is decided by one of three situations: injury, change in the joint components, or severe loss of bone stock. Orthopedic surgeons have observed that soon after revision surgery, when the patient is walking, the joint may become loose from displacement of the acetabulum, or it becomes too stiff or nonweight bearing. The implant may experience unsuccessful results because of rejection or poor rebuilding of tissues. There is an increasing number of unsuccessful operations, and the possible causes are being investigated in many research centers. The causes may be material defects, excessive wear of polyethylene elements, loosening of the artificial acetabulum, or wrong surgical techniques. Considering the significant cost of revision hip arthroplasty, long-lasting functionality of the prosthesis would lead to considerable savings.     

疼痛规范化管理对人工膝关节置换术后早期功能恢复的影响

目的:探讨人工膝关节置换术围手术期疼痛的规范化管理对早期功能恢复的影响。方法:将我院自2012年1月至2013年8月收治的50例接受人工膝关节置换术的患者作为研究对象,按照随机分组的原则分为实验组和对照组,每组各25例,对照组实施常规护理,实验组根据患者的病情制定围手术期疼痛的规范化管理制度,按计划实施各管理方法。结果:与对照组相比,实验组患者在接受疼痛规范化管理后,疼痛明显减轻,术后功能恢复良好,住院时间缩短,患者及其家属的满意度显著提高。结论:人工膝关节置换术围手术期疼痛的规范化管理对促进患者膝关节功能的恢复,减轻患者的疼痛有重要的作用,应在临床加以推广应用。     

Automated segmentation of acetabulum and femoral head from 3-d CT images

This paper describes several new methods and software for automatic segmentation of the pelvis and the femur, based on clinically obtained multislice computed tomography (CT) data. The hip joint is composed of the acetabulum, cavity of the pelvic bone, and the femoral head. In vivo CT data sets of 60 actual patients were used in the study. The 120 (60 /spl times/ 2) hip joints in the data sets were divided into four groups according to several key features for segmentation. Conventional techniques for classification of bony tissues were first employed to distinguish the pelvis and the femur from other CT tissue images in the hip joint. Automatic techniques were developed to extract the boundary between the acetabulum and the femoral head. An automatic method was built up to manage the segmentation task according to image intensity of bone tissues, size, center, shape of the femoral heads, and other characters. The processing scheme consisted of the following five steps: 1) preprocessing, including resampling 3-D CT data by a modified Sine interpolation to create isotropic volume and to avoid Gibbs ringing, and smoothing the resulting images by a 3-D Gaussian filter; 2) detecting bone tissues from CT images by conventional techniques including histogram-based thresholding and binary morphological operations; 3) estimating initial boundary of the femoral head and the joint space between the acetabulum and the femoral head by a new approach utilizing the constraints of the greater trochanter and the shapes of the femoral head; 4) enhancing the joint space by a Hessian filter; and 5) refining the rough boundary obtained in step 3) by a moving disk technique and the filtered images obtained in step 4). The above method was implemented in a Microsoft Windows software package and the resulting software is freely available on the Internet. The feasibility of this method was tested on the data sets of 60 clinical cases (5000 CT images).     

Pemberton手术联合股骨近端截骨治疗先天性髋关节脱位

目的探讨儿童先天性髋关节脱位用Pemberton手术联合股骨近端截骨治疗的临床效果。方法采用Mckav的临床评价标准和WilletX线测量方法,对笔者1997年12月-2008年5月所做的190例（212个髋）Pemberton手术进行回顾性研究。手术年龄1．5-8岁（平均4．2岁）,男29例,女161例,男女比例1：5．55,左侧141例,右侧27例,双侧22例。结果其中181例获得随诊,随诊时间1～8年,平均29．6月,优183例,良33例,差8例,优良率96．4％,髋臼指数由术前30°-45°（平均36°）减少到术后4°-15°,平均10°。结论Pemberton手术联合股骨近端截骨疗效确定,是治疗儿童先天性髋关节脱位的理想术式之一。     

Fluoroscopy-based 3-D reconstruction of femoral bone cement: a new approach for revision total hip replacement

In revision total hip replacement the removal of the distal femoral bone cement can be a time consuming and risky operation due to the difficulty in determining the three-dimensional (3-D) boundary of the cement. We present a new approach to reconstruct the bone cement volume by using just a small number of calibrated multiplanar X-ray images. The modular system design allows the surgeon to react intraoperatively to problems arising during the individual situation. When encountering problems during conventional cement removal, the system can be used on demand to acquire a few calibrated X-ray images. After a semi-automatic segmentation and 3-D reconstruction of the cement with a deformable model, the system guides the surgeon through a free-hand navigated or robot-assisted cement removal. The experimental evaluation using plastic test implants cemented into anatomic specimen of human femoral bone has shown the potential of this method with a maximal error of 1.2 mm (0.5 mm RMS) for the distal cement based on just 4-5 multiplanar X-ray images. A first test of the complete system, comparing the 3-D-reconstruction with a computed tompgraphy data set, confirmed these results with a mean error about 1 mm.     

The evaluation of cortical bone remodeling with a new ultrasonictechnique

Total hip arthroplasty causes biomechanical changes in the normal femur including a redistribution and concentration of stress. These mechanical alterations in the femur cause local remodeling and resorption that affect the geometry and mechanical properties of the bone. Three complementary techniques were used to study the local adaptive remodeling of bone due to prosthesis implantation. A graphics package was used to obtain section geometrical information, an ultrasonic wave propagation technique to determine elastic properties, and a new scanning acoustic microscope (SAM) to map the acoustic impedance profile of each section. The effects of the implantation of two different types of hip prostheses were investigated, an uncemented bipolar prosthesis with an Austin-Moore type stem and a cemented Charnley prosthesis. Prosthesis implantation resulted in an increase in cortical area and mediolateral diameter and a decrease in anterio-posterior diameter. Both prostheses had a detrimental effect on local elastic properties as determined by acoustic velocity measurements. Finally, the SAM system provided information about local inhomogeneities in bone properties not obtainable by any other means. The acoustic impedance maps highlighted bone resorption and bone remodeling on a microstructural level.     

Fluoroscopic bone fragment tracking for surgical navigation in femur fracture reduction by incorporating optical tracking of hip joint rotation center

A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation.