Dysplasia of the hip; a factor in the development of static osteoarthropathy

Dysplasia of the hip is associated with a shallow acetabulum. It may be present and unrecognized until middle age when arthritic changes develop as a result of repeated microtraumata. By that time the process is irreversible. It can be recognized in infancy by roentgenographic study of the hips, and corrective measures can be taken to develop a normal hip and so prevent the crippling arthritis of later life. Although it is not certain that dysplasia develops in every person having a shallow acetabulum, this structural abnormality is known to be a strongly predisposing factor and therefore should be corrected.     

成人先天性髋关节发育不良的围手术期护理

成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症。对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗。不论哪种手术方式,围手术期的护理对于患者的健康恢复都有着非常重要的意义。     

成人先天性髋关节发育不良的围手术期护理

成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症。对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗。不论哪种手术方式,围手术期的护理对于患者的健康恢复都有着非常重要的意义。     

髋关节撞击征的诊断和治疗*

摘要：髋关节撞击综合征(femoroacetabular impingement,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,从而导致髋关节盂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。     

Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease.

Hip joints (280) from 140 human fetuses, obtained from abortions and deaths in the perinatal period, were studied. The fetuses ranged from 8.7 to 40 cm in crown-rump length and are believed to be between 12 and 42 weeks in age. The joints were dissected, morphology inspected, and measurements taken of the depth and diameter of the acetabulum, the diameter of the femoral head, length and width of the ligament of the head, the neck-shaft, and torsion angles of the proximal femur. Regression models were fitted to determine which would best predict the growth pattern. Multivariate analysis of variance showed no significant differences between males and females or between the right and left sides. Acetabular depth was shown to be the slowest-growing hip variable, increasing less than fourfold in the period studied. Acetabular indices less than 50 percent indicate a shallow socket at term. Femoral head and acetabular diameter demonstrated a strong relationship (r = 0.860) and in many joints the femoral head diameter exceeded that of the acetabulum. Considerable variability was demonstrated in both femoral angles. The femoral angles showed only low correlation with the other hip variables. These observations indicate that soft tissue structures about the joint must play an important role in neonatal joint stability. The explanation of greater female and left side involvement in congenital hip disease must lie in factors other than growth changes of hip dimensions. Neither angle appears to be a useful indicator of normal joint development.     

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。     

Brief communication: developmental dysplasia of the hip in medieval London

Developmental dysplasia of the hip (DDH) is a spectrum of disease starting in childhood and in many cases persisting into adulthood. The spectrum ranges from acetabular dysplasia, through hip subluxation to dislocation. The aim of this research was to determine the prevalence and pathoanatomy of acetabular dysplasia and subluxation in excavated human skeletal remains, to complement past research on dislocation in DDH. The material under study was the medieval cemetery of St. Mary Spital in London, in use from c.1100 to 1539 AD. A series of 572 adults with both hips preserved were analyzed. Acetabular dysplasia was indicated by a shallow acetabulum with upward sloping roof. Subluxation was suggested by degenerative change along the margin of the acetabulum suggestive of labral tears, and degenerative change in the outer part of the acetabular roof suggestive of osteoarthritis. The prevalence of DDH (acetabular dysplasia, subluxation, or dislocation) was 1.7%. Because this a congenital musculoskeletal disorder of relatively high frequency, with significant variation in prevalence between populations around the world, it is a topic that warrants targeted research from physical anthropologists studying past populations.     

"In vivo" determination of hip joint separation and the forces generated due to impact loading conditions

Numerous supporting structures assist in the retention of the femoral head within the acetabulum of the normal hip joint including the capsule, labrum, and ligament of the femoral head (LHF). During total hip arthroplasty (THA), the LHF is often disrupted or degenerative and is surgically removed. In addition, a portion of the remaining supporting structures is transected or resected to facilitate surgical exposure. The present study analyzes the effects of LHF absence and surgical dissection in THA patients. Twenty subjects (5 normal hip joints, 10 nonconstrained THA, and 5 constrained THA) were evaluated using fluoroscopy while performing active hip abduction. All THA subjects were considered clinically successful. Fluoroscopic videos of the normal hips were analyzed using digitization, while those with THA were assessed using a computerized interactive model-fitting technique. The distance between the femoral head and acetabulum was measured to determine if femoral head separation occurred. Error analysis revealed measurements to be accurate within 0.75mm. No separation was observed in normal hips or those subjects implanted with constrained THA, while all 10 (100%) with unconstrained THA demonstrated femoral head separation, averaging 3.3mm (range 1.9-5.2mm). This study has shown that separation of the prosthetic femoral head from the acetabular component can occur. The normal hip joint has surrounding capsuloligamentous structures and a ligament attaching the femoral head to the acetabulum. We hypothesize that these soft tissue supports create a passive, resistant force at the hip, preventing femoral head separation. The absence of these supporting structures after THA may allow increased hip joint forces, which may play a role in premature polyethylene wear or prosthetic loosening.     

NEW GENUS OF DORUDONTINE ARCHAEOCETE (CETACEA) FROM THE MIDDLE-TO-LATE EOCENE OF SOUTH CAROLINA

A new archaeocete whale from the late middle or early late Eocene of South Carolina, Chrysocetus healyorum gen. et sp. nov., is described on the basis of a single subadult specimen. This individual includes: a partial skull; hyoid apparatus; lower jaws; teeth; all cervical, some thoracic and some lumbar vertebrae; ribs and sternum; left forelimb elements; and pelves. The specimen includes portions of much of the body, but while some of the bones are fairly complete, others are damaged, particularly the skull. The pelves resemble those of Basilosaurus , documenting a similar stage of hind limb reduction in dorudontines and suggesting that Chrysocetus was not able to support its body on land. The acetabulum for articulation of the femur is well formed and indicates that the hip joint was functional. Chrysocetus is distinguishable from other described dorudontines based on body size, characteristics of the teeth, and forelimb elements. Absence of deciduous teeth in a subadult individual of Chrysocetus may be indicative of an early stage of the evolution of monophyodonty.     

医学文眉深浅探讨

本文认为医学文眉是古代文身术与近代医学的结合,是永久性画眉。详细地介绍了医学文眉的材料,方法与适应证。首次将文眉分为追求自然型与润色修饰型。正常求美者和眉型不足者都适合于文眉。鉴于目前除皮肤切除术外,尚无彻底消除文眉痕迹的方法,本文还分析了文眉术后的近期、远期效果,及文眉效果不满意时的补救措施,强调高水平的文眉。讨论了选色深浅、针刺深浅及皮肤深浅与文眉的关系,各深浅的优缺点,并提议文眉时针刺的深度以浅为妙。文中所介绍和讨论的方法。同样适用于文身术。     

HEMIARTHROPLASTY OF THE HIP

Hemiarthroplasty of the hip is a simplification of the Smith-Petersen cup arthroplasty in which half of the joint or femoral head is reshaped to fit the vitallium cup. This procedure shortens hospitalization to 10 to 14 days and has been successful in the relief of hip pain and in increasing hip motions. It is indicated when the disease is localized for the most part to the femoral head.     

记中国南方广东省南雄盆地晚白垩世一新的窃蛋龙类化石

文中记述的窃蛋龙类一新属新种：遗忘始兴龙Shixinggia oblita gen.et sp.nov.是由北京自然博物馆于1995年采自中国广东省南雄盆地的始兴县。它具有以下特征：相对短的肠骨前突,肠骨高度与长度之比率大,并且肠骨的前突及后突的腹边缘均高于髋臼的背边缘。遗忘始兴龙还显示另一特征为股骨近端转子嵴内表面具有一大的气孔,胫骨近端也有类似的相对小的孔,而这些孔在其他已知的窃蛋龙类中均没有报道。这是继2003年报道的黄氏河源龙之后,中国南方第二个新的窃蛋龙类化石。     

Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

ABSTRACT: INTRODUCTION: Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. CASE PRESENTATION: We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day) for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. CONCLUSIONS: Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.     

Regional load bearing of the canine acetabulum

OBJECTIVE: To determine the load bearing areas of the canine acetabulum. MATERIALS AND METHODS: A kinematic study of four healthy dogs was used to determine the orientation of the femur to the pelvis at mid-stance. Femora and pelves from 10 canine cadavers were loaded with the physiological canine hip reaction force and angle being replicated. Impression material placed within the acetabulum was extruded from areas of load bearing. Digital images before and after loading were used to assess if six different regions of the acetabulum were fully, partially or non-load bearing. RESULTS: All areas of the acetabulum were partially or fully load bearing. The cranial and caudal thirds of the acetabulum were 7.9 and 13.1 times more likely to be fully load bearing than the central third, respectively. There was a significant difference in load bearing between the axial, middle and abaxial thirds of the acetabulum in all tests, with the middle and abaxial thirds 72.4 and 351 times more likely to be fully load bearing than the axial third, respectively. CONCLUSION: The cranial and caudal thirds and the middle and abaxial thirds of the canine acetabulum are fully load bearing. CLINICAL RELEVANCE: The caudal third of the canine acetabulum is loaded and therefore recommendations that fractures in this area be managed conservatively need to be reconsidered.     

太行山猕猴髋臼性别二态性研究

本文使用几何形态测量法探讨42例成年太行山猕猴Macaca mulatta tcheliensis髋臼的性别二态性。结果显示,太行山猕猴雌雄个体的髋臼形态具有明显的性别二态性,利用髋臼可以正确判别92.3%的雌性和87.5%的雄性个体。髋臼的形态差异主要分布于月状面的后上部,即与髋臼切迹相对的月状面区域的宽度表现为雄性大于雌性,另外雄性髋臼大小的波动范围也比雌性更广。造成髋臼性别二态性的生物学原因可能与其功能有关,髋臼作为髋关节的组成部分,起着支撑身体和协同运动的功能,能够优化关节接触面的压力分布。推测雄性髋臼受到的体质量压力更大可能是雄性进化出比雌性更宽大的月状面的主要原因。     

Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living

Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. These biomechanical data were estimated utilizing a generic hip model, the Discrete Element Analysis technique, and the in vivo hip joint contact force data. The three-dimensional joint potential contact area was obtained from the anteroposterior radiograph of a subject and the actual joint contact area and pressure distribution in eight activities of daily living were calculated. During fast, normal, and slow walking, the peak pressure of moderate magnitude was located at the lateral roof of the acetabulum during mid-stance. In standing up and sitting down, and during knee bending, the peak pressures were located at the edge of the posterior horn and the magnitude of the peak pressure during sitting down was 2.8 times that of normal walking. The peak pressure was found at the lateral roof in climbing up stairs which was higher than that in going down stairs. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, and prosthetic component wear and fatigue test set up. The same model and analysis can provide further insight to soft tissue loading and pathology such as labral injury. When the pressure distribution on the acetabulum is inverted onto the femoral head, prediction of subchondral bone collapse associated with avascular necrosis can be achieved with improved accuracy.     

Congenital Dislocation of the Hip

Congenital dislocation or subluxation of the hip (congenital acetabular dysplasia) is a complete or partial displacement of the femoral head out of the acetabulum. The physical signs essential for diagnosis are age related. In newborns the tests for instability are the most sensitive. After the neonatal period, and until the age of walking, tightness of the adductor muscles is the most reliable sign. Early diagnosis is vital for successful treatment of this partially genetically determined condition. Various therapeutic measures, ranging from abduction splinting to open reduction and osteotomy, may be required. Following diagnosis in the first month of life, the average treatment time in one recent series was only 2.3 months from initiation of therapy to attainment of a normal hip. When the diagnosis was not made until 3 to 6 months of age, ten months of treatment was required to achieve the same outcome. When the diagnosis is not made, or the treatment is not begun until after the age of 6, a normal hip will probably not develop in any patient.     

MULTIMINERAL CALCAREOUS DEPOSITS IN THE MARINE ALGA ACETABULARIA ACETABULUM (CHLOROPHYTA; DASYCLADACEAE)

The ultrastructure and mineralogy of cultured and wild specimens of the green algae Acetabularia acetabulum were studied. Sites of calcification were clarified using TEM and SEM. Minerology was determined via electron diffraction, energy-dispersive x-ray microanalysis, and Fourier transform infrared spectral analyses of the calcareous deposits. These deposits were found covering the surface and within the cell wall of the cultured juveniles and adult wild specimens of A. acetabulum. Deposits within and directly over the wall were amorphous calcium carbonate (ACC) in granular form. In-wall and outer cell wall ACC appear to develop independently from each other. The formation of the in-wall ACC may be mediated by the wall structure and/or chemistry, whereas mucin may be the factor mediating formation of outer cell wall ACC. In contrast to the stable in-wall ACC, outer cell wall ACC could be transitory, transforming into aragonite. In cultured cells, a small amount of monohydrocalcite crystals and calcite were found. It is possible that these were transformation products of ACC. In wild specimens, whewellite (calcium oxalate monohydrate) was present inside and outside of the cap wall. It is unclear if whewellite is present within the cytoplasm. Local and temporal differences in the microenvironments for the multiphase mineralization are suggested.     

滇南热区光萼猪屎豆的栽培及其利用研究

本文探讨了光萼猪屎豆(Crotalaria usaramoensis Baker.f.)在滇南热区的裁培及其利用。试验中系统地观测了光萼猪屎豆在滇南热区的生长发育特性和生物学产量以及利用情况。研究结果表明,光萼猪屎豆具有适应性广,生长快,产草量高,根瘤多以及产粒多,繁殖系数大等特点。它系一种具有多用途的优良绿肥作物,对培肥土壤,控制杂草生长均有明显的效果,是建立良好的热带农业生态系统的重要途径,是改革现行不合理的刀耕火种游耕制,实现合理轮作的有效措施,所以值得在滇南热区大力推广。     

Association of a single nucleotide polymorphism in growth differentiate factor 5 with congenital dysplasia of the hip: a case-control study

Introduction

Congenital dysplasia of the hip is an abnormal seating of the femoral head in the acetabulum, mainly caused by shallow acetabulum and lax joint capsule. Genetic factors play a considerable role in the pathogenesis of congenital dysplasia of the hip. The gene growth differentiate factor 5 (GDF5) has been implicated in skeletal development and joint morphogenesis in humans and mice. A functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of GDF5 (rs143383) was reported to be associated with osteoarthritis susceptibility. As a key regulator in morphogenesis of skeletal components and soft tissues in and around the joints, GDF5 may be involved in the aetiology and pathogenesis of congenital dysplasia of the hip. Our objective is to evaluate if the GDF5 SNP is associated with congenital dysplasia of the hip in people of Han Chinese origin.

Methods

The GDF5 SNP was genotyped in 338 children with congenital dysplasia of the hip and 622 control subjects.

Results

The SNP was significantly associated with congenital dysplasia of the hip (p = 0.0037; odds ration (OR) = 1.40; 95% confidence interval (CI) = 1.11 to 1.75). A significant difference was detected in female samples when stratified by gender (p = 0.0053; OR = 1.46; 95% CI = 1.21 to 1.91), and in hip dislocation when stratified by severity (p = 0.0078; OR = 1.43; 95% CI = 1.11 to 1.85).

Conclusions

Our results indicate that GDF5 is important in the aetiology of congenital dysplasia of the hip. To the authors' knowledge this is the first time that a definite association with the congenital dysplasia of the hip susceptibility has been detected.