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【Objective】 To investigate the effects of sevoflurane and propofol on coagulation function and postoperative recovery in children with congenital dislocation of hip joint. 【Methods】 A total of 92 children with congenital dislocation of hip joint admitted to our hospital from June 2017 to June 2020 were studied. According to the random sampling method, the subjects were divided into sevoflurane group and propofol group with 46 cases in each group, Sevoflurane and propofol were administered to the sevoflurane group and the propofol group during anesthesia induction and maintenance, respectively, The changes of hemodynamic index, body temperature, coagulation function before and after operation, postoperative outcome and the incidence of complication were compared between the two groups at different time points of anesthesia. 【Results】 Few significant differences in SBP, DBP, HR at different time points of anesthesia were noticed between the two groups (P>0.05). The body temperature of children in the study group at T1, T2 and T3 was significantly lower than that of the sevoflurane group (P0.05) between the two groups. In the propofol group, there was no statistically significant difference in coagulation indexes before and after surgery (P>0.05), while in the sevoflurane group, all coagulation indexes after surgery were significantly higher than before surgery (P<0.05). The retention time, wake time, extubation time and hospital stay length of the children in the propofol group were significantly shorter than those in the sevoflurane group (P<0.05). The incidence of complication in the propofol group was significantly lower than that of the sevoflurane group (P<0.05). 【Conclusion】 Compared with sevoflurane, propofol anesthesia maintenance is more beneficial to reduce the incidence of intraoperative hypothermia, and does not affect the hemodynamic indexes and coagulation function of the body, which is of positive significance for promoting postoperative anesthesia recovery and shortening the recovery time of children with congenital dislocation of hip joint.
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Introduction: The femoral neck anteversion can be defined as the angle between femoral bicondylar plane and aplane passing through the centre of the neck and head of femur. Adult femoral anteversion has been documentedat the range between 7-16 degrees.This angle is widely recognized as an important factor for hip stability. Thepresent study aimed to evaluate the normal anteversion range in adult Indian femur which would be of great helpin explorative orthopedic procedures and in designing of hip prosthesis.Materials and Methods: Study conducted in 202 femurs of 94 male (48 right and 46 left) and 108female bones (52right and 56 left). And the angle was measured using Kingsley Olmsted Method.Observation and Results: The mean value of anteversion angle of femurwas 7.61 degrees for male and 12.71degrees for females.Mean anteversion angle for both male and female femur was 10.37 degrees. Retroversionwas observed in 10 femurs(5%) and neutral version was observed in12 femurs (5.9%).Conclusion:Determining the anteversion angle is crucial for the diagnostic and therapeutic planning of patientswith various pathologies such as hip development dysplasias, cerebral palsy, varum thigh, flat thigh,epiphysiolysis, congenital club foot, congenital dislocation of the hipand other development abnormalities.Statistical analysis revealed sexual dimorphism in anteversion in Indians being greater among females thanmales
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BACKGROUND:The effects of artificial joint replacement, osteotomy and reconstruction in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult are not very satisfied. OBJECTIVE:To evaluate the effect of artificial total hip arthroplasty and hip-self procedure in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult patients. METHODS:Twenty-three adult patients with Crown Ⅳ-type congenital dislocation of hip were treated with artificial total hip arthroplasty and hip-self procedure. There were 2 males and 21 females with an average age of (24.26±3.56) years ranging 20 to 35 years. The effect was evaluated according to the Harrris evaluation standard, and the statistical analysis was performed. RESULTS AND CONCLUSION:Al of the patients were fol owed-up for 12-60 months, averaged of (26.60±13.16) months. Statistical comparison with the SPSS 19.0 system showed there was significant difference of the Harrris scores between preoperation and postoperation period (P<0.05). The artificial total hip arthroplasty and hip-self procedure can be used to reconstruct the normal function of hip joint, relieve pain and increase the joint stability, which is considered as the best method for the treatment of Crown Ⅳ-type congenital dislocation of hip in adult.
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Objective To determine the prevalence of talipes equinovarus, congenital dislocation of the hip, cleft lip/cleft palate, Down syndrome and neural tube defects among live newborns at Anuradhapura General Hospital, Sri Lanka. Method Babies born from February 2002 to January 2003 were examined for the above five congenital anomalies. Anomalies were recorded in a register and live birth prevalence rate (LBPR) for each anomaly was calculated. Results 9105 newborns were examined for the 5 selected congenital anomalies. LBPR per 10,000 live births of the 5 anomalies were as follows: talipes equinovarus 31.8, congenital dislocation of hip 26.3, cleft lip/cleft palate 21.9, Down syndrome 20.8 and neural tube defects 13.2.
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The congenital dislocation. of the hip is a common congenital disease in the orthopedic field. It is well known that the early diagnosis and effective treatment is very important for the patient to provide a favorable function in the whole life. The Pavlik harness made an important contribution to the treatment of children before standing age. The authors report a clinical experience of 34 patients(35 hips) with congenital dislocation of hip who were treated with Pavlik harness at the Department of Orthopedic Surgery of Chonnam University Hospital. There were total 230 patients(237 hips) diagnosed as congenital dislocation of hip for 10 years from 1978 to 1987. Fifty-one patients(52 hips) of them were treated with Pavlik harness. Only 34 patients(35 hips) were included in this study excluding 17 patients(17 hips) because of inappropriate records or follow-up. The follow-up period ranged from 1 year to 6 years with an average of 2 years and 5 months. The results are as follows ; 1. The most patients were girls, comprising 33 girls and 1 boy. 2. The age of children was 124.6days in average ranging from 13 to 201 days. 3. Of the 35 hips treated with Pavlik harness, satisfactory reduction was obtsined in 30 hips(85.7%). For 5 failed cases, the authors performed closed reduction under the general anesthesia in 3 cases and open reduction in 2 cases. 4. The causes of reduction failure were impossible reduction in 3 cases, nonconcentric reduction in 1 case and repeated redislocation in 1 case. 5. The acetabular and metaphyseal-edge angle improved from the average 33 and 5.8 degrees at the first visit to the average 19.9 and 30.6 degree at the final follow-up (20.7 and 29.2 degrees in normal side). 6. When compared with the value of the 30 hips which were reduced successfully, the initial acetabular angle of 5 failed cases was similar but the metaphyseal-edge angle of them was very low. 7. There was no reduction failure in 27 hips which had metaphyseal-edge angle above 10 degrees. But 5 reduction failures were observed in 8 hips with below −11 degrees. 8. An avascular necrosis was observed in only one patient. In conclusion, the Pavlik harness proved to be a successful means in treating patients with congenital dislocation of hip under 7 months of age with particularly above −10 degrees in metaphyseal-edge angle.
Subject(s)
Child , Female , Humans , Male , Acetabulum , Anesthesia, General , Joint Dislocations , Early Diagnosis , Follow-Up Studies , Hip , Necrosis , OrthopedicsABSTRACT
In the instance wherein concentric reduction cannot be achieved by closed method, open reduction is indicated. Prolonged and forceful attempts to reduce the refractory hips are not without risk to the circulation of the femoral head and open reduction is certainly a less traumatic way to obtain reduction in these hips. The authors performed clinical analysis in 30 patients with congenital dislocation of hip who were treated by open reduction between 1978 and 1987, The results are as follows :1. The results of treatment in 30 patients were acceptable in 22(73.3%), uncertain in 4(13. 3%), and unacceptable in 4 patients(13.3%). 2. Comparing the results depending on the presence of prior treatment or not, acceptable results were obtained in 86.4%(19 out of 22) of patients without prior treatment and in only 37.5%(3 out of 8) of patients with prior theatment by such as Pavlik harness and closed reduction. 3. The surgical approaches for open reduction were medial and anterior routes. The approach was selected depending on the age of patients and the severity of dislocation. The medial approach was used in patients under the age of 18 months. In mild degree of dislocation, the age limit of medial approach was extended to 24 months of age. The anterior approach was used in patients over 19 months of age.
Subject(s)
Humans , Joint Dislocations , Head , Hip , MethodsABSTRACT
Avascular necrosis of the femoral head has been recognized as one of the most serious and frequent complications following the initial treatment of congenital dislocation of the hip. It is now well accepted that this particular complication is iatrogenic and may be avoided by careful and adequate treatment. The reported incidence of avascular necrosis is variable because of various methods of treatment and different diagnostic criteria. We retrospectively reviewed 130 patients(144 hips) with congenital dislocation of the hip, who were treated at Seoul National University Hospital during 10 year-period from January 1974 to December 1983, and found 13 patients (13 hips) with avascular necrosis of the femoral head. We analyed avascular necrosis following treatment of congenital dislocation of the with respect to various methods of treatment, possible causes, types of avascular necrosis, to radiological findings, and to functional results. 1. The incidence of avascular necrosis following treatment of congenital dislocation of the hip in our series was 9.0%(13/144 hips). 2. The average age of the patients with avascular necrosis was 3 years, the youngest being 4 months and the oldest being 10 years. The average follow-up period was 2 year and 2 months. 3. The incidence of avascular necrosis in the closed reduction series was higher in those between 6 months to 18 months with 10.5%, as compared to 7.1% in those 6 months and under 6.7% in those 18 months and over. In the open reduction series, the incidence increased as the age increased, being 5.9%, 12.4%, 15% in the groups 18 months to 3 years, 3 to 6 years, and 6 years and over, respectively. 4. The incidence of avascular necrosis in those who had priliminary traction was 8.3%, where as that in those who had not was 16.6%, being twice as much. 5. The incidence of avascular necrosis decreased as the traction time prolonged, being 9.0% in 7 days or less, 7.7% in 8 to 14 days, 7.1% in 15 to 21 days and nil in 22 days or more. 6. The incidence of avascular necrosis in the skin traction group was 5 times as much with 11.5%, as in the skeletal traction group with 2.2%, despite older age in the latter. 7. The incidence of avascular necrosis in the open reduction group was slightly higher with 9.5%, than in the closed reduction group with 8.6%. 8. All 6 cases of avascular necrosis following closed reduction occurred when Lorenz or frog-leg cast was applied initially after reduction despite attention to avoid extreme abduction. Avascular necrosis were not encountered in those who had Lange or human position cast as the initial form of immobilization. 9. In the closed reduction, avascular necrosis occurred 8.1% in those who had adductor tenotomy and 10.0% in those who had not. In the open reduction, avascular necrosis occurred 7.9% in those who had adductor tenotomy and 18.1% in those who had not, suggesting significant role of adductor tenotomy in the prevention of avascular necrosis. 10. Avascular necrosis was attributable to excessive abduction in 7 hips, to undue pressure of femoral head in one hip, to open reduction in 3 hips, to post-operative infection in one hip, and to non-union of subtrochanteric osteotomy in one hip. 11. Of the 13 hips, following roentgenograms were available in 11. According to the classification of Bucholz and Ogden, type I, II, III, IV were 7, 0, 3, and 1 hips, respectively. 12. Functional results of the 13 hips of avascular necrosis, according to Kalamchi and MacEwen's criteria, were Good, Fair, Poor in 9, 3, and 1 hips, respectively.
Subject(s)
Humans , Classification , Joint Dislocations , Follow-Up Studies , Head , Hip , Immobilization , Incidence , Necrosis , Osteotomy , Retrospective Studies , Seoul , Skin , Tenotomy , TractionABSTRACT
Arched rotational osteotomy of the innominate bone is adopted to the treatment of congenital dislocation of the hips. The key of technique is osteotomy in an arched line from the anteroinferior iliac spine to the greater sciatic noch, and then turn the distal segment downward and outward for 30. This operation can effectively adjust the acetabular index and direction to keep the femoral head stable in position after reduction. Since 1986, 17 cases (23 hips) have been operated. 15 cases (20 hips) of them were foliwed up for more than 1 year, and satisfactory result was found. The advantages of the op-eration were:as the distal segment is turned downward and outward, there was less downward displacement of the upper rim of the acetabulum, or that no pressure would be exerted on the femoral head. The acetabular direction is accurately adjusted to well restore the weight-bearing relationship between the head and acetabulum. The operation was less complicated, less traumatic, and bone grafting was not necessary. The line of osteotomy healed repidly and early exercises were facilitated.