髋关节撞击征的诊断和治疗

髋关节撞击综合征（femoroacetabularimpingement,FAI）是以髋关节解剖结构异常而引发的股骨近端和髋臼间发生异常碰撞,从而导致髋关节孟唇和关节软骨的退行性变化,引起髋关节慢性疼痛的疾病。髋关节活动范围特别是屈曲和内旋受限,最终发展为髋关节骨关节炎。FAI在我国国内为一个较新的概念,临床能得到诊断的病例不多,但实际病例很多,相当一部分的髋关节疼痛是由撞击征造成,平常的药物止痛不能解除持续的撞击,最终会发生骨关节炎。由此早期的诊断及手术干预,可以消除疼痛,防止骨关节炎的发生。进而推迟或消除关节置换手术是有巨大的经济和社会价值。     

人工髋关节置换术围手术期护理

目的总结人工髋关节置换术患者围手术期的护理方法。方法对45例人工髋关节置换术患者给予完善术前准备,全面术后护理,合理康复锻炼及出院指导等围手术期护理。结果 45例患者均痊愈出院,关节功能恢复良好,无并发症发生。结论连续有效的围手术期护理可提高手术的成功率,最大限度恢复关节功能。     

转化生长因子5在发育性髋关节发育不良中的作用研究进展

发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是一种主要因髋臼、股骨近端和关节囊等存在结构性畸形而导致的不稳定关节病变,进而发展成为髋关节的脱位。髋关节内软骨发育不良、骨骼及肌腱的异常均可导致髋关节结构的畸形,最终造成DDH。因此,早期预防与诊断是DDH治疗的关键。研究表明,DDH具有遗传基础,其易感基因包括GDF5、HOXD9、COL2AL、PAPPA2等,其中遗传因子转化生长因子5(growth differentiation factor 5,GDF5)对软骨细胞的增殖、分化具有重要作用,是当前研究治疗DDH的热点之一。因而,了解GDF5基因对软骨发育及分化的影响,对于DDH的发病机制和治疗具有重要意义。基于此,综述了国内外近期探讨的GDF5在基因层面上对DDH的影响,以及通过关节内注射重组人GDF5等基于GDF5的DDH治疗方案,以期为DDH的临床治疗提供新的策略。     

人工髋关节置换术后护理

人工髋关节置换手术是利用人工材料将人体无法正常使用的病损股骨头和髋臼置换,具有解除关节疼痛,保持关节活动度,保持关节稳定性的综合优点,是一种较为有效的关节成形术,从而改善病人的自理能力。我院骨二科自2011年9月至2013年9月共对62个病人施行了人工髋关节置换术。术后进行系统护理,关节功能得到良好恢复,护理体会报告见下文。     

关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。     

骨关节炎相关细胞因子及蛋白的研究进展

骨关节炎（osteoarthritis,OA）是人体中轴关节及外周运动关节最常见的退行性疾病,该病的临床症状表现为疼痛、关节僵硬和关节活动受限,罹患该病非常痛苦,严重影响生活质量,是成年人疼痛、运动功能障碍和致残的常见原因之一。OA是临床上常见的骨关节疾病,老年人多发,是老年人丧失劳动力的重要原因,对社会经济影响很大。国内外对OA的发病机制做了大量的研究,但其确切的病因及病理机制尚未完全阐明。目前,OA没有特效治愈方法,治疗目标局限于使用止痛药来缓解疼痛,并最终行人工关节置换手术。即使人工关节置换手术成功,人造关节寿命也是有限的,其他严重问题还有植入物的松动和失败等。因此,对该病病因、病理机制的探索成为目前的热点和焦点,也是解决OA这个问题的关键。本文就近年来研究较热门的骨关节炎相关细胞因子及蛋白做一综述。     

老年患者髋关节置换术后并发症的预防及护理体会

人工全髋关节置换术目前已广泛应用于临床。作为髋关节疾患终末治疗的有效方法,它能有效解除关节疼痛,改善关节功能,迄今其效果明显优于其他手术。近年来的统计表明,人工全髋关节置换对于年老病人的效果是非常好的。随着人工髋关节置换术的普遍应用,越来越多的高龄患者接受该手术,而老年人由于全身性生理功能减退,常合并其他多种疾病,对手术的耐受力减低,手术风险明显高于青壮年,容易出现一系列并发症,如深静脉血栓形成、髋关节脱位、感染等主要并发症,而并发症的发生直接关系到手术的成败,给患者带来巨大的痛苦和经济负担,故对并发症的早期预防和护理至关重要。我科2002年3月～2008年5月,对100例65岁以上的老年患者进行髋关节置换术,我们采取了早期的预防和护理,取得良好的效果,现总结如下。     

人工髋关节置换术的护理进展

<正>人工髋关节置换术已广泛运用于临床,对髋关节疾病患者而言,该手术提高了治疗效果,并且缓解了疼痛,也缩短了疗程。而且该手术能较好地纠正患者的髋关节畸形,恢复髋关节功能,提高了患者生活质量。但由于人工髋关节置换术是一种创伤性手术,手术复杂,并发症多,因此,要加强护理。采用科学的预见性护理,不仅有利于患者恢复,而且还可减     

老年患者人工全髋关节置换术的护理体会

人工全髋关节置换术（THR）是用人造髋关节代替已无法正常使用的病损髋关节,解决疼痛、畸形和功能障碍,恢复和改善髋关节运动功能的手术Ⅲ。我院自2008年1月～2011年5月共实施老年患者THR64例,术后患者髋关节功能明显改善,生活质量得到很大提高,现将护理体会报告如下。     

人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床分析

目的:探讨人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效。方法:对2009年7月至2012年7月入住我院的60例成人髋关节发育不良并骨性关节炎患者行人工全髋关节置换术治疗。分析治疗优良率、手术前后不同Crowe分型Harris评分、手术前后行走及疼痛情况、手术前后生活质量。结果:1根据Harris评分,本组治疗优良率91.67%(55/60);2术后各Crowe分型患者Harris评分均显著高于术前,差异均具有统计学意义(P<0.05);3本组术前自行行走及辅助行走例数分别为23及37例,术后分别为39例及21例;术前疼痛情况:无、轻、中及重度疼痛例数分别为1例、6例、22例及31例,术后分别为18例、28例、12及2例,手术前后行走情况及疼痛情况差异均具有统计学意义(P<0.05);4根据SF-36生活质量评价标准,术后生活质量评分为(142.16±10.32)分,显著高于术前(115.24±7.34)分,差异具有统计学意义(P<0.05)。结论:人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效显著,术后患者髋关节功能及生活质量明显改善,应在临床上加以推广。     

Articular cartilage friction increases in hip joints after the removal of acetabular labrum

The acetabular labrum is believed to have a sealing function. However, a torn labrum may not effectively prevent joint fluid from escaping a compressed joint, resulting in impaired lubrication. We aimed to understand the role of the acetabular labrum in maintaining a low friction environment in the hip joint. We did this by measuring the resistance to rotation (RTR) of the hip, which reflects the friction of the articular cartilage surface, following focal and complete labrectomy. Five cadaveric hips without evidence of osteoarthritis and impingement were tested. We measured resistance to rotation of the hip joint during 0.5, 1, 2, and 3 times body weight (BW) cyclic loading in the intact hip, and after focal and complete labrectomy. Resistance to rotation, which reflects articular cartilage friction in an intact hip was significantly increased following focal labrectomy at 1-3 BW loading, and following complete labrectomy at all load levels. The acetabular labrum appears to maintain a low friction environment, possibly by sealing the joint from fluid exudation. Even focal labrectomy may result in increased joint friction, a condition that may be detrimental to articular cartilage and lead to osteoarthritis.     

Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition

Femoroacetabular impingement syndrome (FAIS) consists of abnormal hip joint morphology and pain during activities of daily living. Abnormal gait mechanics and potentially abnormal muscle forces within FAI patients leads to articular cartilage damage. Therefore, there is a necessity to understand the effects of FAI on hip joint muscle forces during gait and the link between muscle forces, patient reported outcomes (PRO) and articular cartilage health. The purposes of this study were to assess: (1) hip muscle forces between FAI patients and healthy controls and (2) the associations between hip muscle forces with PRO and cartilage composition (T_1ρ/T₂ mapping) within FAI patients. Musculoskeletal simulations were used to estimate peak muscle forces during the stance phase of gait in 24 FAI patients and 24 healthy controls. Compared to controls, FAI patients ambulated with lower vasti (30% body-weight, p = 0.01) and higher sartorius (4.0% body-weight, p < 0.01) forces. Within FAI patients, lower peak gluteus medius, gluteus minimus, sartorius and iliopsoas forces were associated with worse hip joint pain and function (R = 0.43–0.70, p = 0–0.04), while lower muscle forces were associated with increased T_1ρ and T₂ values (i.e. altered cartilage composition) within the hip joint cartilage (R = −0.44 to −0.58, p = 0.006–0.05). Although FAI patients demonstrate abnormal muscle forces, it is unknown whether or not these altered muscle force patterns are associated with pain avoidance or weak musculature. Further investigation is required in order to better understand the effects of FAI on hip joint muscle forces and the associations with hip joint cartilage degeneration.     

Herniation pits in human mummies: a CT investigation in the Capuchin Catacombs of Palermo, Sicily

Herniation pits (HPs) of the femoral neck were first described in a radiological publication in 1982 as round to oval radiolucencies in the proximal superior quadrant of the femoral neck on anteroposterior radiographs of adults. In following early clinical publications, HPs were generally recognized as an incidental finding. In contrast, in current clinical literature they are mentioned in the context of femoroacetabular impingement (FAI) of the hip joint, which is known to cause osteoarthritis (OA). The significance of HPs in chronic skeletal disorders such as OA is still unclear, but they are discussed as a possible radiological indicator for FAI in a large part of clinical studies.In this paleoradiological study we examined a sample of mummies from the Capuchin Catacombs of Palermo, Sicily, by a mobile computed tomography (CT) scanner. Evaluation of the CT examinations revealed HPs in six out of 16 (37.5%) adult male mummies.The first aim of this study was to compare the characteristics of HPs shown in our mummy collection to the findings described in clinical literature. Thereby CT evaluation revealed that their osseous imaging characteristics are in accordance, consisting of round to oval subcortical lesions at the anterior femoral neck, clearly demarcated by a sclerotic margin.The second aim was to introduce HPs to the paleoradiological and paleopathological methodology as an entity that underwent a renaissance from an incidental finding to a possible radiological indicator of FAI in the clinical situation. As FAI plays an important role in the development of OA of the hip, which is a very common finding in human skeletal remains, HPs should always be considered in paleoradiological evaluation of hip joint diseases.     

Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip

It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.     

The low permeability of healthy meniscus and labrum limit articular cartilage consolidation and maintain fluid load support in the knee and hip

The knee meniscus and hip labrum appear to be important for joint health, but the mechanisms by which these structures perform their functions are not fully understood. The fluid phase of articular cartilage provides compressive stiffness and aids in maintaining a low friction articulation. Healthy fibrocartilage, the tissue of meniscus and labrum, has a lower fluid permeability than articular cartilage. In this study we hypothesized that an important function of the knee meniscus and the hip labrum is to augment fluid retention in the articular cartilage of a mechanically loaded joint. Axisymmetric hyperporoelastic finite element models were analyzed for an idealized knee and an idealized hip. The results indicate that the meniscus maintained fluid pressure and inhibited fluid exudation in knee articular cartilage. Similar, but smaller, effects were seen with the labrum in the hip. Increasing the fibrocartilage permeability relative to that of articular cartilage gave a consolidation rate and loss of fluid load support comparable to that predicted by meniscectomy or labrectomy. The reduced articular cartilage fluid pressure that was calculated for the joint periphery is consistent with patterns of endochondral ossification and osteophyte formation in knee and hip osteoarthritis. High articular central strains and loss of fluid load support after meniscectomy could lead to fibrillation. An intact low-permeability fibrocartilage is important for limiting fluid exudation from articular cartilage in the hip and knee. This may be an important aspect of the role of fibrocartilage in protecting these joints from osteoarthritis.     

Structural Brain Changes in Chronic Pain Reflect Probably Neither Damage Nor Atrophy

Chronic pain appears to be associated with brain gray matter reduction in areas ascribable to the transmission of pain. The morphological processes underlying these structural changes, probably following functional reorganisation and central plasticity in the brain, remain unclear. The pain in hip osteoarthritis is one of the few chronic pain syndromes which are principally curable. We investigated 20 patients with chronic pain due to unilateral coxarthrosis (mean age 63.25±9.46 (SD) years, 10 female) before hip joint endoprosthetic surgery (pain state) and monitored brain structural changes up to 1 year after surgery: 6–8 weeks, 12–18 weeks and 10–14 month when completely pain free. Patients with chronic pain due to unilateral coxarthrosis had significantly less gray matter compared to controls in the anterior cingulate cortex (ACC), insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex. These regions function as multi-integrative structures during the experience and the anticipation of pain. When the patients were pain free after recovery from endoprosthetic surgery, a gray matter increase in nearly the same areas was found. We also found a progressive increase of brain gray matter in the premotor cortex and the supplementary motor area (SMA). We conclude that gray matter abnormalities in chronic pain are not the cause, but secondary to the disease and are at least in part due to changes in motor function and bodily integration.     

Osteoarthritis of the hands, hips and knees in an Australian twin sample--evidence of association with the aggrecan VNTR polymorphism.

Age-related changes in the composition of the cartilage matrix may be associated with the development of osteoarthritis, a relatively late-onset disease characterised by the destruction of joint cartilage. In order to investigate whether differences in the VNTR polymorphic region of aggrecan affect cartilage functionality and therefore the development of osteoarthritis, we examined the aggrecan polymorphic genotypes of a sample of 134 Australian twins aged over 50 (including 34 monozygotic and 27 dizygotic twin pairs). Clinical measures of hand, hip and knee osteoarthritis, as well as self-reported bone and joint pain, were tested for association with the aggrecan polymorphism. The results were consistent with either a deleterious effect of allele 27, or a protective effect of alleles 25 and 28, providing some additional evidence for an association between the aggrecan VNTR polymorphism and osteoarthritis of the hands, hips and knees.     

论股骨头坏死误诊的现状及分析

股骨头坏死是一种常见的疾病,在30岁至60岁年龄段的人群中较为常见,临床的症状包括疼痛以及髋部不适等,股骨头坏死在早期很难发现,由于没有得到准确的诊断,耽误了最佳的治疗时间和有效的治疗,随着病情的发展,最终将会造成股骨头变形以及塌陷,从而引起骨性关节炎,对髋关节功能的影响是很大的,甚至会丧失髋关节的基本功能。股骨头坏死的病状体征和早期症状存在一定的隐蔽性,因此,造成误诊的情况频繁发生。此外,有些疾病的症状表现为髋关节疼痛,最后反而容易被误诊为股骨头坏死。