Two different kinds of total hip arthroplasty for unilateral Crowe IV developmental dysplasia of the hip in adults / 中国骨伤

OBJECTIVE@#To compare the clinical effects of total hip arthroplasty(THA) with non-osteotomy and subtrochanteric osteotomy in the treatment of Crowe type IV hip dysplasia (DDH) in adults.@*METHODS@#Data of 35 Crowe type IV DDH patients who underwent THA were analyzed retrospectively, the patients were divided into two groups:15 cases of non-osteotomy and 20 cases of subtrochanteric osteotomy. There was no significant difference in age, gender, body mass index between two groups (>0.05). The operative time, bleeding volume, hospitalization duration, Harris hip score and the limb length discrepancy (LLD) were evaluated.@*RESULTS@#All of the patients were followed up for 12 to 48 months, no prosthesis loosening or infection occurred by the end of follow-up. In non-osteotomy group, 1 case had occurred by sciatic nerve injury and 1 case developed cutaneous branch injury of the femoral nerve, both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in subtrochanteric osteotomy group, after closed reduction, dislocation did not recur; three cases had proximal femoral crack fractures and received steel plate fixation; no reoperation was needed. There was significant difference in operation duration, bleeding volume, and hospitalization days between two groups(0.05). The postoperative discrepancy of bilateral lower limbs had significant difference(<0.05).@*CONCLUSIONS@#THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe IV developmental dysplasia of hip. Comparing with subtrochanteric osteotomy, the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening <=4 cm and good tissue conditions, THA without femoral osteotomy may be considered.

Clinical significance and expression of the inflammatory cytokines (IL-1, IL-2, IL-6 and IL-10) in blood serum of the patients after total hip replacement / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the changes in the expressions of the inflammatory cytokines (IL-1, IL-2, IL-6 and IL-10) in blood serum of the patients after total hip replacement (THR).</p><p><b>METHODS</b>From February 2010 to June 2010, thirty patients undergone primary total hip arthroplasty in one side including 18 male and 12 female with the mean age of (58.4 +/- 6.6) years (ranged from 52 to 70 years). Twenty patients were Ficat II type,and 10 patients were Ficat III type. The contents of IL-1, IL-2, IL-6 and IL-10 in blood serum were detected on the day before operation and 1 to 3 days after operation respectively by ELISA. At the same time, the content of C reactive protein was also detected, and the results were statistically analyzed.</p><p><b>RESULTS</b>The contents of IL-1, IL-6 and IL-10 in the serum of patients at the first day after THR were significantly higher than those before operation (t = 2.62, 3.51, 2.21, P < 0.05), and reached the peak at 1 to 3 days after operations, then subsequently decreased. However, the content of IL-2 in the serum of patients after operation was obvious lower (t = 2.16, P < 0.05),and recovered to normal level gradually.</p><p><b>CONCLUSION</b>It is the key time of treatment at 1 to 3 days after THR. Monitoring IL-1, IL-2, IL-6 and IL-10 after operation in time, and monitoring life sign at the same time could sensitively observe the effect of treatment and forecast the trend of diseases in patients.</p>

Controlled clinical trials on effective means of drainage after total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To explore effective means of drainage after total hip arthroplasty (THA).</p><p><b>METHODS</b>From March 2009 to September 2009, fifty patients who underwent primary total hip arthroplasty in one side were randomly divided into two groups. In the natural drainage group, there were 12 males and 13 females with a mean age of (58.0 +/- 15.2) years (from 23 to 79 years) and in the routine negative pressure drainage group there were 10 males and 15 females with a mean age of (55.0 +/- 17.8) years (from 30 to 75 years). The drainage volume, wound infection, abnormal exudation, the change of hemoglobin and the blood transfusion volume after operation were all observed and compared.</p><p><b>RESULTS</b>The wound of all patients in two groups got primary healing without infections. There were no differences in the changes of hemoglobin between the two groups (t = 0.532, P > 0.05). However, in the natural drainage group the drainage volume was much less than that in the routine negative pressure drainage group; moreover, less patients in this group needed blood transfusion. There were obvious differences in the two groups (t = 4.405, 2.496, P < 0.05).</p><p><b>CONCLUSION</b>After THA, the natural drainage can decrease the volume of blood loss and incidence of transfusion, and can not increase the infection rate, making it an ideal and deserved popularized drainage method.</p>