ObjectiveTo investigate the diagnostic value of MRI hip joint unilateral oblique coronary scanning in the diagnosis of femoroacetabular impingement (FAI).MethodsFrom February to October 2014, 75 patients with hip joint pain who were highly suspected of FAI after X-ray or CT examination were selected as subjects. Using Siemens 1.5 T MR, fat-suppressed T2-weighted imaging sequences, T1-weighted imaging sequences, and proton density-weighted imaging sequences were used. For each patient two scan methods were used. Method A: on the sagittal image of the hip joint, the line of sight was parallel to the oblique coronal plane scan of the (one-sided) long axis of the femoral neck. Method B: on the cross-sectional image of the hip joint, the positioning line was parallel to the conventional hip joint coronal scan of the left and right femoral heads. McNemar test was used to compare the detection rates of FAI of the two methods.ResultThe detection rate of FAI of A-scanning [62.6% (47/75)] was higher than that of B-scanning [30.6% (23/75)], and the difference was statistically significant (P<0.001).ConclusionAn image obtained from a diagonal coronal scan parallel to the long axis of the femoral neck can more fully display the pathological changes of the acetabular labrum and the anatomy of the femoral head and neck joints, and the damage of the femoral head and neck junction, which provides a more reliable imaging basis for the clinician to diagnose FAI.
From Jan. 1991 to Jan. 1994, 11 cases ofdifferent hip lesions with flexon contracture deformity were treated by combination of SmithPeterson and WatsonJones incisions in replacement of hip joint. All of them were followed-up for 1 to 3 years (an average of 1.9 years). According to pain, joint function, the excellent and good results were rated at 90.9%. This showed that from using the combined incisions, the hip joint was very well exposed, and release of hip flexion contracture could be acomplished in the same time. Bleeding fromoperation was reduced and the procedure was simple.
It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.
Eight cases(10 hips) of avascular necrosis of femoral head in adults were treated with transplantation of sartorius musculo-skeletal graft through the greater trochanter since August 1990. The patients were followed up for 12 to 20 months,with disappearance of pain in 7 cases. The degree of hip motion was markedly increased. The good results rated 87.5 percent.
Objective To evaluate the values of magnetic resonance imaging (MRI) in the diagnosis of acetabular labral tears (ALT) by meta-analysis. Methods The studies concerning the diagnosis of ALT tears by using MRI from January 1990 to October 2016 were searched in the databases such as CBM, VIP, WanFang Data, CNKI, PubMed, EMbase, The Cochrane Library and Web of Science. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (–LR) and the diagnostic odds ratio (DOR) were calculated, and the summary receiver operating characteristic curve (SROC) was drawn and the area under the carve was calculated. Results A total of 25 studies from 21 articles were included, involving 1 123 hips from 1 099 patients. The results of meta-analysis showed that, the pooled Sen, Spe, +LR, –LR, DOR and area under SROC curve of MRI for diagnosing ALT were 0.66 (95% CI 0.38 to 0.86), 0.72 (95% CI 0.47 to 0.89), 2.37 (95% CI 1.18 to 4.67), 0.48 (95% CI 0.25 to 0.92), 4.97 (95% CI 1.60 to 15.47), 0.75 (95% CI 0.71 to 0.79). The pooled Sen, Spe, +LR, –LR, DOR and area under SROC curve of MRA for diagnosing ALT were 0.86 (95% CI 0.80 to 0.90), 0.71 (95% CI 0.55 to 0.83), 2.91 (95% CI 1.77 to 4.80), 0.20 (95% CI 0.13 to 0.32), 14.44 (95% CI 5.80 to 35.95), 0.87 (95% CI 0.84 to 0.90), respectively. Conclusion MRI is efficiency diagnostic method for acetabular labral tears.
Objective To evaluate the clinical results of cementless total hip replacement (THR) in treating osteoarthritis and identifying the factors affecting the results. Methods From January 1995 to December 1999, 76 patients(85 hips) with osteoarthritis of hip joint were treated. These patients were assessed according to Harris hip score and X-ray film. The average follow-up time was 49.3 months. Results The average Harris score in the patients was 90.9 points. The excellent or good rate was 91.9%(75/85). Pain in the thigh existed in 23 hips (27.5%). The femoral osteolysis occurred in 14 hips(16.5%). The radiographical result demonstrated femoral loosening in 2 hips. harris score became lower when the femoral component of osteoarthritis of hip jointl. Pain in the thigh may be related to the varus placement of femoral component and femoral osteolysis. Femorla osteolysis is one of important factors affectin the long-term outcomes.
ObjectiveTo summarize the short-and medium-term effectivenesses of stemless hip arthroplasty for treating hip joint disease in young and middle-aged patients. MethodsBetween June 2005 and December 2010, 25 cases (27 hips) of hip joint disease were treated with stemless hip arthroplasty. There were 17 males (19 hips) and 8 females (8 hips) with an average age of 45.6 years (range, 30-57 years), including 13 left hips, 10 right hips, and 2 bilateral hips. The causes included avascular necrosis of the femoral head (ANFH) secondary to femoral neck fracture in 5 cases (5 hips), ANFH in 15 cases (16 hips), osteoarthritis of the hip joint caused by ankylosing spondylitis in 2 cases (3 hips), osteoarthritis of the hip joint caused by dysplasia of acetabular in 2 cases (2 hips), and rheumatoid arthritis in 1 case (1 hip). The disease duration was 1-17 years (mean, 6.1 years). Before operation, the Harris score was 47.6±14.2. ResultsThe incision healed by first intention in all patients, and no complications occurred, such as infection, periprosthetic fracture, and deep vein thrombosis of lower extremity. Twenty-five patients (27 hips) were followed up 36-96 months (mean, 51 months). One case (1 hip) had sciatic nerve injury after operation, which was relieved by symptomatic treatment. One case (1 hip) had prosthesis loosening, which was relieved after revision. The survival rate of prosthesis was 96.3% (26/27). At last follow-up, the Harris score was 92.1±3.6, which was significantly better than preoperative score (t=18.241, P=0.000). The excellent and good rate was 88.9% (excellent in 19 hips, good in 5 hips, fair in 2 hips, and poor in 1 hip). The X-ray films showed good location of prosthesis, and no evidence of dislocation, bone resorption, osteolysis, and heterotopic ossification. ConclusionBecause of reserving femoral neck, biomechanics conduction and distribute of the proximal femur achieve natural biomechanics state of the human body. The short-and medium-term effectivenesses of stemless hip arthroplasty for treating hip joint disease in young and middle-aged patients are satisfactory, but the long-term effectiveness need further observation.
ObjectiveTo investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip (DDH) in adults. MethodsBetween August 2012 and April 2014, 16 patients with DDH were treated with Bernese osteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 4 males and 12 females with an average age of 27.8 years (range, 18-35 years). The left side was involved in 6 cases and the right side in 10 cases. The visual analogue scale (VAS) score was 4.8±0.5, and the Harris hip score was 81.2±5.4. The lateral center edge (CE) angle (the angle between the vertical center of the femoral head and the lateral edge of the acetabulum) was (6.5±8.7)°;the horizontal tilt angle was (25.6±5.9)°;and the femoral head extrusion index was 36.5%±6.5%. According to the Tonnis osteoarthritis classification, 12 hips were rated as Grade 0, 3 hips as Grade I, and 1 hip as Grade II. ResultsThe operation time was 90-135 minutes;the intraoperative blood loss was 400-800 mL;10 cases accepted blood transfusion and the amount of blood transfusion was 200-600 mL;the postoperative drainage volume was 100-300 mL;and the hospitalization time was 7-12 days. All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area. All patients were followed up 12-26 months (mean, 20 months). The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks (mean, 13.5 weeks). No acetabulum fracture, heterotopic ossification, osteonecrosis, and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was (27.7±6.8)°;the horizontal tilt angle was (16.2±4.8)°;the femoral head extrusion index was 19.7%±5.3%;VAS score was 0.8±0.3;the Harris hip score was 96.8±6.7;and all showed significant differences when compared with preoperative ones (P<0.05). ConclusionFor DDH adults, Bernese osteotomy can effectively increase the acetabulum tolerance, improve the joint function, and slow progress in osteoarthritis, and the short-term effectiveness is satisfactory.
Objective To evaluate the effectiveness of arthroscopy for synovial chondromatosis of hip joint. Methods Between April 2012 and September 2015, 32 patients with synovial chondromatosis of hip joint were treated by arthroscopy. There were 19 males and 13 females, with an average age of 42.1 years (range, 22-64 years). The synovial chondromatosis located at right hip in 15 cases and left hip in 17 cases. The main clinical symptoms were pain and swelling of hip joint. Of all patients, 6 cases were hip hinge, 2 cases were lower limb weakness, and 1 case was snapping hip. The " 4” sign was positive in 9 cases, Thomas’ sign positive in 4 cases, and rolling test positive in 2 cases. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 16-48 months (mean, 33.8 months). The visual analogue scale (VAS) was 1.4±0.8 at last follow-up, which was significantly lower than that before operation (4.8±1.2) (t=6.382, P=0.013). The hip Harris score was 92.6±6.7 at last follow-up, which was significantly higher than that before operation (63.2±8.3) (t=9.761, P=0.006). At last follow-up, the " 4” sign and Thomas’ sign were positive in 3 cases and 1 case, respectively. The others had no positive sign. X-ray film showed no recrudescence in all cases. Conclusion Treating synovial chondromatosis of hip joint under arthroscopy has advantages of less trauma, complete debridement, quick postoperative recovery, and the satisfactory short-term effectiveness.
Objective To evaluate the clinical valueof the revision of total hip replacement(THR), to analyse the reason of the rev isions, and to discuss the main difficulties and measures to manage it.Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on totalhip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR,especially the broken femoral stem and the cements; the loss of localbone. The measures to remove the broken femoral stem were described.ResultsAll cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others.No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement.Conclusion The revision of THRis a more difficult operation, so that the special instrument and equipment andoperative experience are required.