Efficacy analysis of T?nnis triple osteotomy for developmental dysplasia of the hip in older children / 中华实用儿科临床杂志

Objective:To explore the outcomes of T?nnis triple osteotomy for developmental dysplasia of the hip (DDH) in older children.Methods:Clinical data of 21 children (22 hips, 12 left and 10 right hips) treated by T?nnis triple osteotomy from October 2016 to June 2019 were retrospectively analyzed.There were 8 males and 13 females with a mean age of operation at 13.5 (8.6-16.8) years.Based on the T?nnis classification, all the cases were in Grade Ⅰ.Statistical analysis was performed using the SPSS 22.0 statistical software.Results:All recruited patients were followed up for 1.5-3.5 years.Compared with preoperative values and those at the last follow-up visit, the mean Sharp acetabular angle of the affected side recovered from 53.5°±5.2° to 40.8°±2.3°.The mean center-edge angle increased from 10.5°±2.9° to 35.4°±5.6°.The mean acetabular roof angle decreased from 38.6°±2.8° to 6.7°±1.3°.The mean acetabular head index enhanced from (54.3±5.2)% to (86.2±2.7)%.The differences between the preoperative and postoperative values were statistically significant ( t=24.3, 17.6, 50.1, 27.5; all P<0.05). According to the Harris classification, there were 17, 3 and 2 hips achieved excellent, good and fair outcomes at the last follow-up visit, respectively, with the percentage of excellent and good outcomes up to 90.9%(20/22 hips). Accor-ding to the Severin radiographic classification, 8, 12 and 2 hips were in grade Ⅰ, Ⅱ, and Ⅲ, respectively, with the percentage of excellent and good hips at 90.9%(20/22 hips). At the last follow-up visit, the bone healing of iliac and pubic bones was well, and the nonunion of ischial bones were reported in 3 cases (13.6%). Conclusion:The outcome of the T?nnis triple osteotomy is satisfactory for DDH in older children.

Effects of sevoflurane and propofol on coagulation function and postoperative recovery in children with congenital dislocation of hip joint / 中国输血杂志

【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.

Prevention measures and reasons analysis of the elder patients early anti-dislocation after total hip arthroplasty / 现代临床护理

Objective To explore the reasons and preventive measures of early dislocation after total hip arthroplasty in elder patients. Method A retrospective study was done to analyze dislocation time, reason and time of 168 elderly patients with early anti-dislocation after total hip arthroplasty in joint surgery. Results Only 7 patients (4.1%) had type I joint dislocation, including 2 male and 5 female patients aged 65~89 years. The dislocation happened in 4~5 weeks postoperatively, mainly resulting from hip joint over flexion when urinating in bed, sleep-turning, loaded-moving, walking and stoop and diachoresis. Conclusions For the elderly patients after total hip replacement, it is type I dislocation which happened 4 ~ 5 weeks after operation, more femal than male, reasons including over-exercrse. Effective prevention measures includes regular rehabilitation training, early precautions enhanced mental support and safety nursing.

Analysis about reason of congenital infantile coxa vara being misdiagnosed as infantile dislocation of hip join / 中国矫形外科杂志

[Objective]To analyze reason of congenital infantile coxa vara to be misdiagnosed as infantile dislocation of hip joint.[Method]There were 6 patients(6 hip join)congenital infantile coxa vara being misdiagnosed as infantile dislocation of hip join in 54 patients(73 hip join)and treated by expectant treatment as infantile dislocation of hip join.The curative effect of 6 patients were not good,after serious medical examination,careful reading image data,paying attention to curative effect,6 patients were confirmed to be diagnosed as infantile dislocation of hip join and not infantile dislocation of hip join.[Result]The features for diagaosis of congenital infantile coxa vara were:the big greater trochanter of femur and its position moving up,short spacious neck of femur,spacious medial blank in hip joint,superposed neck of femur and lesser trochanter of femur,praeter propter exponent of acetabulum,acceptable succession of Shenton’s line,enlarged angle of femoral head epiphysis,late center of ossification,incorporated abnormity such as breves femoral bone,bowing of femoral bone,abortive clavicle and bones of cranium,equines.[Conclusion]The second center of ossification of femoral head is appeared 6～9 monthes after birth,and it is difficult to discriminate congenital infantile coxa vara and infantile dislocation of hip join before this.Early to realize symptom,physical sign and character of image of congenital infantile coxa vara is significant for correct diagnosis and can avoid misdiagnosis and mistreatment.

Reinfusion of blood salvage during the operation of the developmental dysplasia of the hip in children / 中国矫形外科杂志

[Objective]To evaluate the results of intraoperative autologous blood transfusion in pediatric orthopaedic operation.[Method]Intraoperative blood salvage was reinfusioned in 17 patients by Cell Saver 5.The volume of reinfusion blood and complications were recorded.[Result]Among 17 patients,an average of(171?53)ml autologous blood was transfused intraopratively.The use of Cell Saver 5 was directly responsible for a 80% reduction in the total amunts of homologous blood.Four patients has experienced transient hemoglobinuria.No other complications appeared.[Conclusion]Reinfusion of blood salvage during pediatric orthopaedic operation is safe and effective.It is able to reduce the amount of homologous blood transfusion.