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Objective@#To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty.@*Methods@#A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients′ prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation.@*Results@#All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing "femur first" principle and combined anteversion techniqueis was (36.6±6.8)°. Also, range of motion of the patients′ hip conforms to the D′Lima criterion and no patients had experienced dislocation and some other serious complications.The follow-up ended at August 2017, which lasted for 12.2 months(6-18 months), and 88 cases(119 hips) were interviewed. The Harris hip score for the affected sides of the hip joints 6 months after the surgery was 94.6(86-100). Compared with the score of 29.8(12-43) before surgery, the t-test had proven its statistical significance(t=12.82, P=0.003).@*Conclusion@#Based upon the "femoral first" principle and "combined anteversion technique" during total hip arthroplasty, these operations has been carried out well enough to meet the patients′ needs of performing normal daily activities.
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BACKGROUND:Recently,open reduction and internal fixation has become an important therapy for pelvic and acetabular fracture. However,screw penetration sometimes occurs,which damage vessels or nerves in the pelvic cavity. OBJECTIVE:To measure the best entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique. DESIGN,TIME AND SETTING:Measurement experiment was performed at the Department of Anatomy,Medical School of Shandong University from June to October 2008. MATERIALS:A total of 20 semi-pelvic specimens of adult male cadavers were used to make serial cross-sections of the acetabular anterior column. METHODS:In single screw technique,the horizontal distance OP and vertical distance PQ from entry point O to apex of greater sciatic notch Q were measured,and screw length was measured. In double screw technique,the horizontal distance O1P1,O2P2 and vertical distance P1Q,P2Q from entry point O1 of the inner screw and entry point O2 of the outer screw,respectively to apex of greater sciatic notch Q were measured. The length of inner screw and outer screw were measured respectively. Angle ? on sagittal plane and the angle ? on coronal plane of the screw were determined. All data were put into software SPSS 10.0 for statistical analysis. MAIN OUTCOME MEASURES:The entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique RESULTS:Single screw technique:the length of OP and PQ was (23.5?2.2) mm and (16.8?1.6) mm respectively; the length of lag screw was (84.9?4.7) mm. Double screw technique:the length of O1P1 and P1Q was (26.3?2.3) mm and (13.6?1.4) mm,respectively,and the length of medial lag screw was (69.8?4.1) mm; the length of O2P2 and P2Q was (20.7?2.1) mm and (20.1?1.8) mm,and the length of lateral lag screw was (61.2?3.7) mm. Angle ? was (123.4 ? 4.1)? and angle ? (62.2 ? 5.8)?. CONCLUSION:The entry point of single screw technique lies in the summit of greater sciatic notch 17 mm outward,vertical to the medial margin of the posterior column,24 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 85 mm. The entry point of medial screw in double screw technique lies in 14 mm outward,vertical to the medial margin of the posterior column,and 26 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 70 mm. The entry point of lateral screw in double screw technique lies in 20 mm outward,vertical to the medial margin of the posterior column,and 21 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 61 mm. The angle of lag screw with respect to the parallel line of the medial margin of the posterior column is 123?,and the angle lag screw with respect to the vertical line of the medial margin of the posterior column is 62?. The position of the lag screw must be confined by intraoperative fluoroscopy in multiple projections.
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[Objective] To study the effect of arthroscopic reconstruction of anterior cruciate ligament using RIGIDfix and Intraflx system with quadruple-strand hamstring tendons.[Method]Thirty-six cases of anterior cruciate ligament ruptures were reconstructed arthroscopically with four strands of hamstring tendons,and the grafts were fixed with RIGIDfix and Intrafix system.Ptients were treated with systematic rehabilitation therapy and relevant complications were managed post-operatively.The patients were followed up for 6~12 months,ask the patients' subjective symptom,examine the knee range of motion,anterior drawer test,Lachman test and Pivot shift test,were managed to evaluate clinical result according to Lysholm rating.[Result]All patients had no serious complication,and were followed up for 6~12 months post-operatively.All patients had returned his post,knee range of flexion achieved 130?,extention achieved 0?.Three cases sometimes felt his knee soft and instabilization during exercise violently,the other patients had no sensation of soft and instabilization.When patients were followed up,anterior drawer test:negative 35 cases,positive 1 case;Lachman test:negative 33 cases,positive 3 cases;Pivot shift test of all patients were negative.The Lysholm score increased from 51.3?4.2 to 85.6?4.6,the difference was significant(P
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Objective To explore the treatment of fractures of symphysiolysis /superior and inferior ramus of pubis and sacrum. Methods We treated 11 cases of fractures of symphysiolysis / superior and inferior ramus of pubis and sacrum with pubic symphysis double plate +sacrum rods, and analyzed the clinical results of the operation. Results All the 11 cases were followed up for a period of 6 months to 2 years. 2 cases had numbness of perineum and foot drop which were cured with posterior tibial muscle tendon translocation. 1 case had chronic pain in sacroiliac region, and needed antalgica occasionally. The others had a satisfactory recovery. Conclusion For fracture of symphysiolysis /superior and inferior ramus of pubis and sacrum, pubic symphysis double plate +sacrum rods can get a good clinical result.