Ischemic Necrosis Of Femoral Head Research Articles

The analysis of Modified Qing' E Formula on the differential expression of exosomal miRNAs in the femoral head bone tissue of mice with steroid-induced ischemic necrosis of femoral head.

ObjectiveTo investigate the differential expression of exosomal miRNAs in the bone marrow tissue of Modified Qing’ E Formula (MQEF) on steroid-induced ischemic necrosis of the femoral head (INFH) model.MethodsSteroid hormones were used to establish the INFH model and treated with MQEF. After successful modeling, femoral tissue exosomes were isolated for miRNA sequencing to obtain femoral tissue exosomal differential miRNAs. By GO analysis and KEGG analysis of the differential genes in both groups, the major exosomal miRNAs of MQEF exerting anti-INFH as well as the major signaling pathways were identified. Next, a quantitative metabolomic validation of MQEF with broad targeting was performed to obtain the main active components of MQEF and to perform biological analysis and signaling pathway prediction of the active components by network pharmacology. Finally, the sequencing results were validated by using RT-qPCR. The results of miRNA sequencing were verified by double examination of network pharmacology and RT-qPCR, and the exosomal miRNAs regulated by the anti-INFH effect of MQEF and the specific signaling pathway of the effect were clarified.ResultsA total of 65,389 target genes were predicted in the exosomes of two groups of mice, and 18 significant differentially expressed miRNAs were obtained, of which 14 were up-regulated and 4 down-regulated. GO enrichment analysis showed that these predicted target genes were enriched in 12371 biological processes, 1727 cell components, and 4112 molecular functions. KEGG analysis showed that the predicted miRNA target genes were annotated to 342 signal pathways, in which the highly enriched pathways closely related to bone metabolism were PI3K-Akt signal pathway, MAPK signal pathway, and Wnt signal pathway. The most significantly up-regulated miRNAs were miR-185-3p and miR-1b-5p and the most significantly down-regulated miRNAs were miR-129b-5p and miR-223-5p, of which the targeted genes were closely related to the PI3K-Akt signal pathway. MQEF aqueous decoction extract targeted metabolomics quantitatively combined with network pharmacology predicted targets also closely related to PI3K-Akt signaling pathway. Real-time quantitative PCR validation showed that miR-185-3p was up-regulated 7.2-fold and miR-129b-5p was down-regulated 2.2-fold in the treatment group, and the difference was significant (P < 0.05).ConclusionsMQEF can regulate exosomal miRNA expression in steroid-induced INFH models, miR-185-3p or miR-129b-5p/PI3K-Akt signal axis may be part of the mechanism of MQEF against steroid-induced INFH.

Orthopaedic robot-assisted free vascularised fibular grafting for the treatment of avascular necrosis of the femoral head

Objective To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel. Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the procedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients. Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface. One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation. However, joint movement was restricted for the left hip and the pain was significant. An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula. The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum. The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after operation. The difference in Harris scores was statisticly significant (P<0.05). Conclusion With the assistance of an orthopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted into the optimal anatomical position and maximising its mechanical efficacy. In theory, it is the best choice for performing fibular bone transplantation in ANFH. And the early effect of treatment is good. Key words: Avascular necrosis of femoral head; Orthopaedic robot; Fibula grafting; Microsurgical technique

Research progress in animal model of Perthes disease

Perthes disease is the ischemic necrosis of femoral head in children.It was also called osteochondrositis of femoral head in children, aseptic necrosis of femoral head, avascular necrosis of femoral head, etc., which reflected people′s understanding of this disease in different periods.The disease has a certain tendency of self-healing.The femoral head deformity left behind by some of the children may lead to the hip joint weight-bearing and mobility dysfunction, or even disability and deformity, and the clinical effect is worrying.Despite more than 100 years of research, the etiology and pathogenesis are still unclear, mainly due to the lack of ideal animal models for the corresponding research.Over the years, many efforts and attempts have been made by scholars.At present, the recent studies on animal model of Perthes disease have been reviewed in order to provide references for children′s orthopaedic doctors to further understand this disease. Key words: Perthes disease; Animal model; Etiology

Comparison of early effectiveness between different approaches in primary total hip arthroplasty

To compare the early effectiveness between by anterior approach via Bikini incision and by OCM approach in the primary total hip arthroplasty (THA). Between June 2015 and March 2016, 60 patients with ischemic necrosis of the femoral head who accorded with the inclusion criteria were chosen in the study, who were divided into 2 groups according to different surgical approaches. THA was performed on 30 patients by anterior approach via Bikini incision (group A), and on 30 patients by OCM approach (group B). There was no significant difference in age, gender, body mass index, side of affected hip, Steinberg stage of ischemic necrosis of femoral head, preoperative hemoglobin, preoperative Harris score, and preoperative visual analogue scale (VAS) between 2 groups ( P>0.05). The operation time, length of incision, intraoperative blood loss, transfusion rate, starting time of straight leg raising exercise, starting time of active abduction of hip, hospitalization time, the incidence of limb length discrepancy, postoperative Harris score and VAS score were recorded and compared between 2 groups. Anteroposterior pelvic X-ray films were taken to measure acetabular abduction and acetabular anteversion. Primary healing of incision was obtained in all patients of 2 groups, and there was no significant difference in complication between 2 groups ( χ2=0.144， P=0.704). All the patients of 2 groups were followed up 3 to 12 months, averaged 6 months. There was no significant difference in operation time, length of incision, intraoperative blood loss, transfusion rate, hospitalization time, and starting time of straight leg raising exercise between 2 groups ( P>0.05). Group A was significantly shorter than group B in starting time of active abduction of hip ( t=-4.591, P=0.000), and was significantly lower than group B in the incidence of limb length discrepancy ( χ2=5.455, P=0.020). After operation, neither Harris score at 2 weeks, 6 weeks, 3 months, and 6 months nor VSA score at 24 hours and 6 weeks showed significant difference between 2 groups ( P>0.05). The anteroposterior pelvic X-ray films showed that all the prostheses were in good position, and there was no femoral prosthesis subsidence, acetabular cup displacement or dislocation. No significant difference was found in acetabular abduction and acetabular anteversion at 2 days after operation between 2 groups ( t=0.887, P=0.379; t=0.652, P=0.517). Both of two approaches in THA can avoid muscle damage and achieve favorable short-term effectiveness. But, anterior approach via Bikini incision is superior to OCM approach in starting time of active abduction of hip and the incidence of limb length discrepancy.

Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures

To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group ( t=2.290, P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group ( t=-10.650, P=0.000; t=18.320, P=0.000; t=-16.625, P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups ( t=0.208, P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference ( t=0.333, P=0.741). Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.

Clinical evaluation of ultrasound screening in follow-up visits of infants with cerebral palsy at high risk for developmental dysplasia of the hip.

The aim of the study was to assess the clinical value of ultrasound screenings for the developmental dysplasia of the hip (DDH) and explore its etiology in high-risk infants with cerebral palsy in follow-up visits. A group of 98 cases of infants at high-risk of cerebral palsy who received rehabilitation treatment between July, 2009 and July, 2010 were selected. Infants included 58 men and 40 women, aged <6 months and not lost to follow-up visits. Ultrasound (using Graf static inspection) screening of hips was performed and the infants with abnormalities were given clinical intervention, and 1- to 2-year-old infants were given outpatient follow-ups. The results were analyzed and there were 40 abnormal cases among the 98 cases of infants at high risk of cerebral palsy, including 18 cases of unstable hip joint, and 22 cases of DDH (12 cases of hip dysplasia, 3 cases of hip subluxation and 7 cases of hip dislocation). Early clinical intervention for infants with hip dysplasia and outpatient follow up for infants aged 1–2 years was carried out and had ischemic necrosis of femoral head, with the exception of 1 case of femoral detorsion that was poorly restored. In conclusion, the probability of DDH was higher in infants at high-risk of cerebral palsy compared to the normal infants. Hip ultrasound is a safe, simple, and effective screening method for these infants, which is of great clinical significance for an earlier diagnosis and treatment of DDH in infants with cerebral palsy.

Efficacies of percutaneous multiple needle puncturing for releasing hip adductor muscle during total hip arthroplasty

To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice. From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited. The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 (60-78) years. According to the Ficat system, there were type III (n = 24) and type IV (n = 12) . The affected leg shortening of this group prior to surgery was over 2 cm. The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 (60-82) years. According to the Garden system, there were type III (n = 16) and type IV (n = 20). All cases underwent THA with Press-fit prosthesis. After fixing prosthetic components, leg length discrepancy was corrected. And percutaneous multiple needle puncturing was applied for releasing adductor muscle in experiment group. The follow-up period was 2 years. The safety and efficiency were evaluated by HHS (Harris Hip Score) and the range of motion (ROM) of hip extorsion and abduction. There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up. The range of hip motion of extorsion and abduction: (1) in experimental group, the postoperative ROM (abduction:44.9 ± 0.8, extorsion:45.1 ± 0.9) was significantly larger than that of preoperative (abduction: 30.0 ± 4.6, extorsion:31.5 ± 4.6) ; (2) the postoperative ROM of experimental group had no significant changes until the final follow-up (abduction: 44.7 ± 0.9, extorsion:45.25 ± 0.81); (3) at the last time of follow-up, no significant inter-group difference existed in ROM (abduction:44.86 ± 0.68, extorsion:45.6 ± 0.8). HHS: (1) in experimental group, HHS increased significantly from 39.64 ± 3.93 preoperatively to 82.8 ± 3.6 at 3 months postoperatively; (2) in two groups, HHS of 2 years postoperation (experimental group: 88.6 ± 4.1, control group: 89.1 ± 4.0) was significantly larger than that of 3 months postoperation (experimental group: 82.8 ± 3.6, control group:83.1 ± 3.1); (3) at the time of 3 months and 2 years postoperation, no significant inter-group difference existed in HHS. The technique percutaneous multiple needle puncturing for releasing adductor muscle during THA for ischemic necrosis of femoral head is both safe and efficacious. And it solves the problems of soft tissue balancing mini-invasiveness.

English

This study aims to investigate the effect of ultra-short wave on hormone-induced ischemic necrosis of femoral head in early stage by using an Avascular necrosis of the femoral head (ANFH) rabbit model. Horse serum was administered to male rabbits via the marginal ear vein, whereas control rabbits received saline. After five weeks, the rabbits with horse serum were injected with methylprednisolone. Blood-lipoids and hemodynamic parameters were analyzed. Collagen type I was analyzed by using immunohistochemistry. Pathological examination of femoral head was analyzed by hematoxylin-eosin (HE) staining; Expression of vascular endothelial growth factor (VEGF) and BMP-2 mRNA was analyzed by RT-PCR. Results revealed that when compared with control group, the difference in model group was significant (P&lt;0.05 or P&lt;0.01), with regard to TXB2, 6-keto-PGF1&alpha;, blood fat level, T/P, and hemodynamic parameters, while compared with model group, the difference of USW group was significant (P&lt;0.05 or P&lt;0.01). The expression of collagen type I was significantly lower in the model animals than that in the controls, while that of the USW diathermy group was significantly higher than the control group (P&lt;0.05). Pathology index was significantly different in the USW diathermy animals than that in the controls (P&lt;0.05). Real-time PCR showed that VEGF mRNA and BMP-2 mRNA levels in the model group were higher significantly as compared to those in the control group (P&lt;0.01), while that in the diathermy group were significantly higher than those in the model group (P&lt;0.01). The study thus revealed that ultra-short wave has a positive curative effect on ANFH. &nbsp; Key words: Ultra-short wave, Avascular necrosis of the femoral head (ANFH), Collagen Type I, VEGF mRNA, BMP-2 mRNA.

Experimental research into using bone-strengthening pill to treat ischemic necrosis of femoral head

ObjectiveTo study the use of a bone-strengthening pill to treat ischemic necrosis of the femoral head. MethodsA model of castration in rats with osteoporosis and a model of ischemic necrosis in the bilateral femoral heads of young rats were used to detect bone density, bone formation measurements, lipid deposition in the femoral head, the distribution of capillaries in the femoral head and other relevant biochemical indices. ResultsIn model rats, bone-strengthening pills were able to increase the bone density, the unit volume of bony trabeculae, the width of bony trabeculae, and the unit volume of the bony cortex. They could also enhance the mineral apposition rate in the femoral head and the seam width of osteoid deposition. Furthermore, there was a reduction in lipid deposition in the femoral head, and enriched distribution of arteries in the femoral head. Bone-related biochemical detections showed an increase in alkaline phosphatase staining and a decrease in tartaric acidic phosphatase staining. ConclusionThe results show that bone-strengthening pills can obviously promote bony growth, cause an increase in bone density, restore blood circulation, inhibit the occurrence and development of bony necrosis, and accelerate the repair of necrotic bones, with no toxic side-effects.

Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism: more effective and safer

Objective To evaluate the efficacy and safety of Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism used for patients undergoing hip replacement.Methods A comparison was made between patients whose management was not guided by Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism (groups A) and those whose management was guided (group B). In group A, there were 402 patients undergoing hip replacement from January 2001 to January 2005. They were 119 men and 283 women, with a mean age of 63. 2 years. There were 278femoral neck fractures, 78 cases of ischemic necrosis of femoral head and 46 cases of hip osteoarthritis. In group B, there were 120 patients undergoing hip replacement from January 2009 to January 2010. They were 36 men and 84 women, with a mean age of 62. 9 years. There were 83 femoral neck fractures, 23 cases of ischemic necrosis of femoral head and 14 cases of hip osteoarthritis. Events of venous thromboembolism and bleeding complications were recorded in each group for statistical comparison. Results In group A, 83cases (20. 6%) of deep venous thrombosis and 28 cases (7.0%) of bleeding complication were found. In group B, 15 cases (12. 5%) of deep venous thrombosis and 8 (6. 7%) cases of bleeding complication occurred. There were statistically significant differences between the 2 groups in incidence of venous thrombocmbolism (χ2 = 4. 022, P = 0. 045), but not in incidence of bleeding complications (χ2 = 0. 002, P =0. 960) . Conclusion It is more effective and safer to perform hip replacement under the guidance of Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism. Key words: Arthroplasty, replacement, hip; Venous thrombosis; Preventive medicine

Core decompression and implantation of calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of femoral head at Stages I, II and III of antigen reactive cell opsonization

To introduce a new method using calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of the femoral head and evaluate its curative effect. From May 2000 to June 2005, 48 adult patients (54 hips) with ischemic necrosis of the femoral head at Stages I, II and III of antigen reactive cell opsonization (ARCO) were treated with implantation of calcium phosphate cement/Danshen drug delivery system in the involved femoral head. The operation consisted of removal of the necrotic bone under weight-loading cartilage and the implantation of phosphate cement/Danshen drug delivery system, and all manipulations were made percutaneously through a bone tunnel in the trochanter. The functions of the hip joint were evaluated and X-ray films were taken preoperatively and postoperatively. Postoperative follow-up was 45.5 months on average, ranging from 27 to 78 months. According to the evaluation criterion of "Dandong 1995" for therapeutic effect of adult ischemic necrosis of the femoral head, the therapeutic effects were excellent in 33 hips, good in 17, fair in 3 and poor in 1, with the excellent and good rate of 92.6%. This method is relatively simple with little invasion. It not only improves the microcirculation of the femoral head by local application of traditional Chinese medicine, but also provides mechanic buttress in the weight-loading area to prevent collapse during repairing, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimal invasion surgery for ischemic necrosis of the femoral head at Stages I, II and III of ARCO.

Effect of Chinese Drugs for Promoting Blood Circulation and Eliminating Blood Stasis on Vascular Endothelial Growth Factor Expression in Rabbits with Glucocorticoid-induced Ischemic Necrosis of Femoral Head

To probe into the mechanism of Chinese drugs for promoting blood circulation and eliminating blood stasis in the prevention and treatment of glucocorticoid-induced ischemic necrosis of femoral head. Thirty New Zealand adult white rabbits were randomly divided into a normal control group (n=5) and a model group (n=25). Hydroxyprednisone acetate was intramuscularly administered to the rabbits in the model group in a dosage of 7.5 mg/kg, twice per week for 6 weeks, to induce ischemic necrosis of femoral head and normal saline of the equal volume was intramuscularly administered to the rabbits in the normal control group, twice per week for 6 weeks. Then, the 5 rabbits from the normal control group and 5 rabbits selected randomly from the model group were sacrificed and the changes in histopathology and the expression of Vascular Endothelial Growth Factor (VEGF) were observed. The other 20 rabbits in the model group were randomly divided into the treatment group 1 and the treatment group 2, and the control group 1 and the control group 2, 5 rabbits in every group. Taohong Siwu Tang ([Chinese characters: see text] Decoction of Four Drugs with Addition of Peach Kernel and Safflower) was orally administered to the rabbits in the treatment group 1 and the treatment group 2 in a dosage of 7 ml/kg, once daily and normal saline of the equal volume was orally administered to the rabbits in the control group1 and the control group, 2 once daily. After 10 weeks the rabbits in the treatment group 1 and the control group1 were sacrificed and after 13 weeks the rabbits in the treatment group 2 and the control group 2 were sacrificed, and the expression of VEGF was detected in these rabbits. The expression of VEGF was significantly enhanced in rabbits of the model group as compared with the normal control group (P < 0.01), and gradually reduced with the lapse of time. The expression of VEGF in the control groups was significantly reduced as compared with the treatment groups (P < 0.001). Chinese drugs for promoting blood circulation and eliminating blood stasis can improve the microcirculation of femoral head in rabbits with glucocorticoid-induced ischemic necrosis of femoral head by promoting the expression of VEGF.

Titanium alloy cage implantation for the treatment of ischemic necrosis of femoral head in dogs

To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.

Choice of operational program for ischemic necrosis of femoral head

股骨头缺血性坏死是骨科领域中至今尚未解决的疑难疾病之一,未经及时、有效治疗大多数患者的病情将进行性发展,并最终导致严重的髋关节骨性关节炎,使患者丧失劳动能力甚至生活不能自理.人工全髋关节置换术作为一项成熟和经典的骨科治疗技术已经在髋关节疾病的治疗中取得了巨大的成功[1],但对于中青年股骨头缺血性坏死患者应用人工关节置换并发症发生率较高,远期效果并不理想,不少患者一生中不得不接受一次甚至数次的关节翻修手术,而目前关节翻修手术从手术难度、术中创伤到远期效果都仍存在诸多问题[2].因此,青壮年股骨头缺血性坏死治疗的主要目的应是改善症状和功能,尽量保留股骨头,延缓进行关节置换的时间并最终避免人工关节置换而作出努力[3,4]。

Treatment of ischemic necrosis of femoral head with vascularized bone graft under the surveillance of arthroscope

目的 报道在关节镜监视下应用带血管蒂骨瓣转移微创治疗股骨头缺血性坏死的临床效果.方法对FicatⅡ～Ⅲ期股骨头缺血性坏死施行关节镜监视下带旋股外侧血管升支髂骨瓣转移术、带旋股外侧血管横支大转子骨瓣逆行转移术、带旋股外侧血管升支臀中肌支大转子骨瓣转移术治疗53例,切口长度为9～15 cm.结果术后随访1.5～4年,根据疼痛、行走距离、关节活动度和X线检查评价分析,疗效满意.结论关节镜监视下带血管蒂骨瓣转移微创治疗股骨头缺血坏死具有对髋关节周围组织损伤小,能保持关节完整性,清除坏死骨准确、彻底等优点。

Application of AO compressed hollow screws in treatment of femoral neck fracture in aged patients

目的 探讨老年人股骨颈骨折围手术期治疗的重要性及应用AO中空加压螺丝钉治疗老年人股骨颈骨折的可行性、优越性及相关注意事项.方法回顾分析应用AO中空加压螺丝钉治疗老年人股骨颈骨折43例的临床资料.其中Garden Ⅰ型6例,Ⅱ型13例,Ⅲ型17例,Ⅳ型7型,均有不同程度的并存症,进行治疗后用AO中空加压螺钉固定,术后均进行追踪随访.结果经平均4.8年的随访,无术中和住院期间死亡病例.近期并发症8例,发生率为18.6%;远期并发症4例,发生率为9.3%,除1例发生骨折不愈合及1例股骨头缺血性坏死外,余均一期愈合.骨折愈合率为95.12%.按Harris评分标准:优良率达90.24%.恢复伤前生活行走功能.结论老年人股骨颈骨折往往有并存症,应重视围手术期治疗及采用简单有效方法治疗,以减少并发症发生.AO中空加压螺丝钉治疗老年人股骨颈骨折操作简单、符合生物力学特点、固定牢固可靠、骨折愈合率高,是治疗老年人股骨颈骨折的理想方法之一。

Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship.

Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from ischemic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD. In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head. All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or intermediate signal intensity on T1- and T2-weighted images. Ischemic necrosis involving the entire femoral head may represent one of the causes of RDHD.

Adaptations of ligamentum teres in ischemic necrosis of human femoral head.

Little is known about the biomechanical properties of human ligamentum teres. To more fully understand the ligamentum teres, its dimensions and mechanical properties were measured in 22 cases of acute fracture of the femoral neck and 21 cases of ischemic necrosis of the femoral head. The specimens first were preconditioned and then loaded to failure with a testing machine at a fast strain rate of 100% s(-1). The ischemic necrosis group had a significantly larger volume (3.09 +/- 1.81 ml versus 1.30 +/- 0.62 ml) and cross section area (65.3 +/- 59.1 mm2 versus 30.6 +/- 27.2 mm2) than did the acute fracture group. The former also had a significantly greater ultimate load (234 +/- 168 N versus 130 +/- 111 N) and strain energy to failure (1.22 +/- 1.04 J versus 0.41 +/- 0.39 J), but a significantly smaller linear modulus (4.72 +/- 3.31 MPa versus 8.69 +/- 7.97 MPa) than did the latter. Histologic studies showed differences in the amount of organized collagen and components of subsynovial tissue between the 2 groups. Mechanical and morphologic adaptations of the ligamentum teres in a group of ischemic femoral heads are described, and a possible biomechanical role is suggested for the ligamentum teres in the hip joint in conjunction with the ischemic necrosis of the femoral head.