Sample records for acetabulum

  1. [Periprosthetic Acetabulum Fractures].

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G


    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered. Georg Thieme Verlag KG Stuttgart · New York.

  2. Periprosthetic fractures of the acetabulum.

    Helfet, David L; Ali, Arif


    Periprosthetic fractures of the acetabulum after total hip arthroplasty are uncommon, but are increasing in number and severity. These fractures may occur intraoperatively, during the perioperative period, or many years after the total hip arthroplasty. Periprosthetic fractures of the acetabulum vary in severity and may involve stress fractures of the pubis or medial wall, significant bone loss secondary to osteolysis and subsequent loss of column integrity, or complete pelvic discontinuity. Treatment differs depending on the complexity of the fracture and the stability of the acetabular prosthesis. Surgical treatment for an unstable acetabulum should stabilize the bony columns of the acetabulum, provide bone grafting of defects, and should maintain adequate bone stock for replacement of a stable acetabular implant. Strict adherence to the principles of fracture surgery is required to achieve bony union of the acetabular columns and provide a stable environment for reimplantation of an acetabular component.

  3. 49 CFR 572.198 - Pelvis acetabulum.


    ... 49 Transportation 7 2010-10-01 2010-10-01 false Pelvis acetabulum. 572.198 Section 572.198... Dummy, Small Adult Female § 572.198 Pelvis acetabulum. (a) The acetabulum is part of the lower torso... torso of the assembled dummy (drawing 180-0000). The dummy is equipped with a laterally oriented...

  4. Osteonecrosis of acetabulum after irradiation

    Ishihara, Gintaro; Matuda, Tatsuo; Takeuchi, Norihiro; Itoh, Haruo [Tokyo Koseinenkin Hospital (Japan)


    A case of osteonecrosis 8 years post irradiation was reported. The 70 years old female patient who, 8 years ago, received abdominal hysterectomy due to cervical cancer and then radiotherapy of 92.1 Gy within about 1.5 mo, had a pain at the left hip joint with a slight elevation of ALP. The roentgenography showed the fracture and callus of the left acetabulum; bone scintigraphy, a high accumulation of {sup 99m}Tc at the site; CT, abnormal fracture; MRI, low bright T1-weighted image and equi-bright T2-image; and MRI with Gd-DTPA, enhanced image. The hip joint was surgically reconstructed with cement (THR). Surgical and histopathological findings confirmed osteonecrosis without tumoral finding and the lesion was considered radiogenic. (K.H.)

  5. [Bilateral acetabulum fracture after suffering sport trauma].

    Trost, P; Kollersbeck, C; Pelitz, M; Walcher, T; Genelin, F


    This case study describes a 37-year-old male who suffered a bilateral transverse acetabulum fracture with a fracture of the posterior wall and a double-sided dorsal hip dislocation in combination with a left-sided femoral head fracture (Pipkin IV) while skiing in a "fun park". The accurate diagnosis and presurgical planning was made by means of a computed tomography (CT) scan and a subsequent 3D reconstruction. After a primarily executed shielded repositioning of the bilateral hip dislocationearly secondary and anatomical reconstruction of the double-sided acetabulum fracture was possible using the Kocher-Langenbeck approach. A consistent physiotherapy as well as rehabilitation finally led to a positive clinical result for the patient.

  6. Avascular Necrosis of Acetabulum: The Hidden Culprit of Resistant Deep Wound Infection and Failed Fixation of Fracture Acetabulum – A Case Report

    K, Kandhari V; M, Desai M; S, Bava S; N, Wade R


    Introduction: Chances of avascular necrosis of acetabulum are rare as it enjoys a rich blood supply. But cases of post - traumatic avascular necrosis of acetabulum following fracture of posterior column have been well documented. Importance of identifying and suspecting the avascular necrosis of acetabulum is essential in cases of failed fixation of fracture acetabulum, previously operated using extensile approach to acetabulum; either extended anterior ilio - femoral or tri - radiate approac...


    Leena Khobragade,


    Full Text Available Background: Hip joint represents an unique functional unit and has complex biomechanical construction. In today’s era where total hip replacement surgeries have made their way it has become imperative for the anatomists to know the variations in acetabular dimensions. Reconstruction of acetabulum in patients with significant acetabular bone deficiency remains a challenge. Hence the present study was carried out with the aim to study the morphometric measurement of volume of acetabulum in both the sexes. Materials and Methods: Material of the study consisted of 110 human hip bones (60 males and 50 females. Volume of Acetabulum (VA was measured on these hip bones on both the sides. Statistical analysis was done using SPSS (Statistical Package for the Social Sciences version 11 and Microsoft Excel 2007. Results: The mean volume of acetabulum in male was 23.13 ml and female was 17.88 ml. The mean volume of acetabulum on right side was 20.55 ml and left side was 20.91 ml. Volume of the acetabulum was greater in males as compared to females and the differences were statistically significant. Volume was greater on the left side as compared to the right side but the difference was statistically non significant. Discussion: Analysing the differences on human acetabulum is helpful in understanding not only morphological but also medicolegal aspects. Conclusion: Volume of the acetabulum was greater in males as compared to females.

  8. Treatment of posterior Wall fractures of acetabulum

    QI Xin; LIU Jian-guo; GONG Yu-bao; YANG Chen; LI Shu-qiang; FENG Wei


    Objective: To explore the treatment methods and outcome of posterior Wall fractures of the acetabulum.Methods: The data of 31 patients(25 males and 6females,aged 19-59 years,mean:40.5 years)with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study.The types of fractures,number of fragments,combined dislocations,and sciatic nerve function were documented before admission.All the fractures were treated with open reduction and internal fixation.Based on the fracture type and site,either screws alone or reconstructive plates were used.The Patients were immobilized for an average of 12 weeks before partial weight bearing was permitted.After follow-up for 12-70months(43.6months on average),modifled Merle d‘Aubigne score was adopted to evaluate the outcomes of the operations.Results: The percentages of the excellent,good,fair and poor results were 48.4%,41.9%,6.5%,and 3.3%,respectively.with a good to excellent rate of 90.2%.Idio-pathic sciatic nerve injury occurred in only one case.Conclusions: The sciatic nerve should be routinely exposed and protected during the surgery.The type of fixation should be based on the fracture type and site.Prolonged immobilization may be helpful in improving the final outcomes.

  9. Three-dimensional orientation of the acetabulum.

    Suzuki, Daisuke; Nagoya, Satoshi; Takashima, Hiroyuki; Tateda, Kenji; Yamashita, Toshihiko


    This study was designed specifically to determine the normal acetabular orientation and femoral head covering, and whether these are affected by age or sex. Computed tomographic images of normal Japanese hip joints were used (males 60, females 60; mean age 48.3 years, range 15-79 years). Male and female age profiles were matched. The reconstructed 3-D pelvic images were aligned in the anatomical pelvic coordinate system. The acetabular orientation angles and femoral covering angles were measured in the sagittal, coronal, and horizontal planes. In the sagittal plane, the acetabular orientation angle was operative anteversion (O-av), and the femoral covering angles were the anterior and posterior center-edge angles (ACE and PCE). In the coronal plane, they were the Sharp angle (SA) and the lateral center-edge angle (LCE). In the horizontal plane, they were anatomical anteversion (A-av) and the anterior and posterior sector angles (ASA and PSA). The O-av, SA, and A-av were smaller in the male than the female acetabulum (P Anat. 30:753-760, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. [Management of weight-bearing area fracture of acetabulum].

    Zhang, Yun-tong; Wang, Pan-feng; Zhang, Chun-cai


    Acetabulum, as the important factor for weight bearing of the upper body, has its unique anatomic features and complicated physiological function. The integrity and stability of the lunata articular surface in the dome region of acetabulum, is the important base to bear the physiological function of acetabulum. The fracture related to this part will cause relation change of contact area and stress between head of femur and acetabulum. Furthermore, the deep anatomical position of the dome region, the complicated surrounding anatomical relation, and the irregular bony structure will also increase the difficulty of surgical treatment. Especially for some complicated comminuted or compressed fracture, even with good explosions, it is hard to get satisfied anatomical reduction. Consequently,forward traumatic arthritis has greater probability of occurrence. Therefore, the clinical research on the fracture in the dome region of acetabulum was getting more and more attention worldly. This paper intended to review the relation of fracture classifications and anatomic features, physiological function,diagnostic criteria,and also its clinical treating countermeasure.

  11. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty.

    Potty, Anish G; Corona, Jacqueline; Manning, Blaine T; Le, Amanda; Saleh, Khaled J


    Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.

  12. Dislocation after Hemiarthroplasty due to Insufficiency Fracture of the Superior Acetabulum: A Case Report

    Masahiko Nozawa


    Full Text Available Insufficiency fracture of the superior part of the acetabulum after hemiarthroplasty has not been reported before. Here we report a case of dislocation after hemiarthroplaty due to insufficiency fracture of the acetabulum. In our patient, insufficiency fracture of the ilium immediately above the acetabulum produced obvious evidence of compression and collapse that led to dislocation of the outer head of the femoral component. This patient had subsequently been treated with a cementless socket inserted into the fractured acetabulum. We should remember the possibility of insufficiency fracture of the superior acetabulum after hemiarthroplasty, particularly in elderly patients suffering from chronic postoperative pain and disability.

  13. Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections

    Vivek Ajit Singh


    Full Text Available Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker and threaded rods. Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR designs in normal acetabulum and establish its mode of failure. Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA. These constructs were subjected to cyclic loading and load to failure. Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was 1738.6±200.3 Nmm−1 compared to the intact pelvis, which was 911.4±172.7 Nmm−1 (P value = 0.01. The mean load to failure for the standard acetabular cup construct was 3297.3±117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8±7.0 N. Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

  14. Assessment of acetabulum anteversion aligned with the transverse acetabulum ligament: cadaveric study using image-free navigation system

    Tomokazu Fukui


    Full Text Available The transverse acetabulum ligament (TAL has been used as an intraoperative anatomical landmark to position the acetabulum cup in total hip arthroplasty (THA. However, the validity of the use of TAL has not been clarified. The purpose of this study was to examine the orientation of the cup component aligned with the TAL in cadaveric study. The 31 hips in 25 whole-body embalmed cadavers were examined. The donors were 12 men and 13 women. Simulated THA procedure using image-free navigation system was performed and a trial cup with a diameter of approximately 2 mm less than the size of the acetabulum were inserted and snugly fitted on the TAL through the posterior wall of acetabulum. The orientation of the cup component was measured using an image-free THA navigation system. The measured radiographic anteversion and inclination angles averaged 18.2±7.2° (range: 2.0-33.2° and 43.5±4.2° (range: 33.1-51.0° respectively. Based on the Lewinnek’s safe zone criteria, 26 hips (80.6% were judged to be within the. Moreover, in the analysis of the gender difference of TAL angles, the average anteversion angle was shown to be significant larger in female than male population. The TAL can be effectively used an intraoperative landmark to align the acetabulum component helping reduce the risk of dislocation after surgery. In the intraoperative judgment, a gender difference in the alignment of the TAL should be taken into consideration.

  15. Dislocation after Hemiarthroplasty due to Insufficiency Fracture of the Superior Acetabulum: A Case Report

    Masahiko Nozawa; Takashi Nishiura; Katsuhiko Maezawa; Keiji Matsuda; Hidenori Morio


    Insufficiency fracture of the superior part of the acetabulum after hemiarthroplasty has not been reported before. Here we report a case of dislocation after hemiarthroplaty due to insufficiency fracture of the acetabulum. In our patient, insufficiency fracture of the ilium immediately above the acetabulum produced obvious evidence of compression and collapse that led to dislocation of the outer head of the femoral component. This patient had subsequently been treated with a cementless socket...

  16. Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum.

    Chitre, Amol; Wynn Jones, Henry; Shah, Nikhil; Clayson, Anthony


    Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components. This article explores the current literature on the epidemiology, etiology, and classification of periprosthetic acetabular fractures as well as offering potential treatment strategies.

  17. [Fractures of the acetabulum: complications and joint replacement].

    Herath, S C; Holstein, J H; Pizanis, A; Pohlemann, T


    Acetabular fractures assume a special role amongst the fractures of the pelvis, because they involve a major weight-bearing joint. As those fractures mostly result from exposure to great force, and because of their location in an anatomically complex region, a high rate of complications has to be anticipated. Besides general and perioperative complications long-term consequences, especially post-traumatic arthrosis, are relevant problems when it comes to treating fractures of the acetabulum. The primary reconstruction of the acetabulum, as well as a possibly necessary prosthetic replacement of the hip joint, makes high demands on the diagnostic and operative capabilities of the attending physician. Exact knowledge of the specific risks and pitfalls for each type of fracture and for the specific surgical techniques is crucial for a successful treatment. Due to the much worse long-term outcome when compared to primary total hip replacement in patients with osteoarthritis, acetabular fractures should, regardless of the patient's age, whenever possible be treated by operative reconstruction.

  18. Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants

    Владимир Евгеньевич Басков


    Full Text Available Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

  19. Three-dimensional computed tomography of the acetabulum

    Pozzi Mucelli, R.S.; Muner, G.; Pozzi Mucelli, F.; Pozzi Mucelli, M.; Marotti, F.; Dalla Palma, L.


    Acetabular fractures represent a complex variety that are classified in different types. Conventional radiology is often inadequate to demonstrate and classify the fractures. Computed tomography (CT) has already been shown to be superior in this field. A further advantage of CT is represented by the recent availability of three-dimensional (3D) images that are realized from axial CT scans by means of a new software. The Authors report the applications of this new software to the study of the normal acetabulum and in patients with fractures. 3D images allows an effective demonstration of the fracture, its irradiation and the dislocation of bone fragments. The information is contained in one or few images rather than many axial images. Therefore the role of 3D images may be considered complementary to axial CT scans.

  20. Acute osteomyelitis of the acetabulum induced by Staphylococcus capitis in a young athlete

    Seiji Fukuda


    Full Text Available Acute hematogenous osteomyelitis (AHOM of the acetabulum is a rare condition in children and usually caused by Staphylococcus aureus. We present an 11-year-old soccer athlete who suffered from acute osteomyelitis involving the acetabulum caused by S. capitis, a normal flora of the human skin but never reported in this condition. The disease was associated with repetitive skin injuries of the knee and potential osseous microtrauma of the hip joint by frequent rigorous exercise. This unusual case suggests that osseous microtrauma of the acetabulum, in addition to repetitive skin injuries, allowed normal skin flora to colonize to the ipsilateral acetabulum, which served as a favorable niche and subsequently led to AHOM.

  1. Reduction of the posterior column in displaced acetabulum fractures through the anterior intrapelvic approach.

    Kistler, Brian J; Sagi, H Claude


    The anterior intrapelvic approach can be used for the reduction and fixation of displaced fractures of the acetabulum. Reduction techniques and options for placement of fixation deviate to some degree from those used with the traditional ilioinguinal approach secondary to the surgeon's perspective and available vectors. Here, we present several techniques for the application of reduction clamps, reduction techniques, and fixation options for the posterior column in displaced fractures of the acetabulum treated through the anterior intrapelvic approach.

  2. Three dimensional finite element analysis of acetabulum loaded by static stress and its biomechanical significance

    SU Jia-can; ZHANG Ben; YU Bao-qing; ZHANG Chun-cai; CHEN Xue-qiang; WANG Bao-hua; DING Zu-quan


    Objective:To explore the mechanical behavior of acetabulum loaded by static stress and provide the mechanical basis for clinical analysis and judgement on acetabular mechanical distribution and effect of static stress. Methods:By means of computer simulation, acetabular three dimensional model was input into three dimensional finite element analysis software ANSYS7.0. The acetabular mechanical behavior was calculated and the main stress value, stress distribution and acetabular unit displacement in the direction of main stress were analyzed when anterior wall of acetabulum and acetabular crest were loaded by 1 000 N static stress. Results :When acetabular anterior wall loaded by X direction and Z direction composition force, the stress passed along 4 directions: (1)from acetabular anterior wall to pubic symphysis a long superior branch of pubis firstly, (2)from acetabular anterior wall to cacroiliac joint along pelvic ring,(3)in the acetabulum, (4)from the suffered point to ischium. When acetabular crest loaded by X direction and Y direction composition force, the stress transmitted to 4 directions: (1)from acetabular crest to ilium firstly, (2)from suffered point to cacroiliac joint along pelvic ring, (3) in the acetabulum , (4)along the pubic branch ,but no stress transmitted to the ischium branch. Conclusion:Analyzing the stress distribution of acetabulum and units displacement when static stress loaded can provide internal fixation point for acetabular fracture treatment and help understand the stress distribution of acetabulum.

  3. Simultaneous Periprosthetic Fractures of the Femur and the Acetabulum After Bipolar Hip Arthroplasty

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia-Paraskevi; Drosos, Georgios; Vogiatzaki, Theodosia; Tilkeridis, Konstantinos; Kazakos, Konstantinos


    Patient: Female, 68 Final Diagnosis: Periprosthetic fractures of the acetabulum and femur after bipolar hip arthroplasty Symptoms: Inability to walk Medication: — Clinical Procedure: Revision cup and internal fixation femur Specialty: Orhopedics and Traumatology Objective: Rare co-existance of disease or pathology Background: Although periprosthetic fractures of the femur are a recognized complication of total hip arthroplasty, periprosthetic fractures of the acetabulum are rare. Simultaneous periprosthetic fractures of both the acetabulum and the femur have not been reported, to our knowledge. Case Report: We report a simultaneous fracture of the acetabulum and the femur in a 68-year-old female patient who had previously sustained a subcapital fracture of the femur, treated with a bipolar uncemented prosthesis. We discuss the possible mechanism of this combination of fractures. Conclusions: Simultaneous periprosthetic fractures of the femur and the acetabulum can occur if, in the presence of osteoporotic bone, the metallic femoral head has migrated medially in the acetabulum while the femoral stem is not loose. PMID:28003639

  4. Fractures of the acetabulum in elderly patients: an update.

    Guerado, E; Cano, J R; Cruz, E


    The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

  5. Conventional versus virtual radiographs of the injured pelvis and acetabulum

    Bishop, Julius A.; Rao, Allison J.; Pouliot, Michael A.; Bellino, Michael [Stanford University School of Medicine, Department of Orthopaedic Surgery, Stanford, CA (United States); Beaulieu, Christopher [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)


    Evaluation of the fractured pelvis or acetabulum requires both standard radiographic evaluation as well as computed tomography (CT) imaging. The standard anterior-posterior (AP), Judet, and inlet and outlet views can now be simulated using data acquired during CT, decreasing patient discomfort, radiation exposure, and cost to the healthcare system. The purpose of this study is to compare the image quality of conventional radiographic views of the traumatized pelvis to virtual radiographs created from pelvic CT scans. Five patients with acetabular fractures and ten patients with pelvic ring injuries were identified using the orthopedic trauma database at our institution. These fractures were evaluated with both conventional radiographs as well as virtual radiographs generated from a CT scan. A web-based survey was created to query overall image quality and visibility of relevant anatomic structures. This survey was then administered to members of the Orthopaedic Trauma Association (OTA). Ninety-seven surgeons completed the acetabular fracture survey and 87 completed the pelvic fracture survey. Overall image quality was judged to be statistically superior for the virtual as compared to conventional images for acetabular fractures (3.15 vs. 2.98, p = 0.02), as well as pelvic ring injuries (2.21 vs. 1.45, p = 0.0001). Visibility ratings for each anatomic landmark were statistically superior with virtual images as well. Virtual radiographs of pelvic and acetabular fractures offer superior image quality, improved comfort, decreased radiation exposure, and a more cost-effective alternative to conventional radiographs. (orig.)

  6. Analysis of the acetabulum by CT scan in Japanese with osteoarthritis of the hip

    Ishibashi, Masanori [Keio Univ., Tokyo (Japan). School of Medicine


    The morphology of the acetabulum was analyzed by CT scan in 66 Japanese patients with osteoarthritis of the hip mainly following congenital dislocation or dysplasia. The CT scan data was analyzed to standardize the pelvic inclination in all directions. In these patients, the acetabular floor had thickened and the acetabulum was located in the anterolateral portion. The bilateral difference in the acetabular anteversion angle was not different between patients and normal individuals, but the acetabular sector angle in patients was smaller than in the normal subjects. As the stage of osteoarthritis of the hip advanced, the thickness of the acetabular floor in the center and posterior portions and the anterior sector angle increased, and the lateralization of the acetabulum advanced, but the anteversion angle decreased. A bone-forming change is characteristic of the anterior acetabulum and acetabular fossa in the center and posterior portions in Japanese patients with osteoarthritis of the hip. In comparison with data obtained by standard radiography, these changes detected by CT scan corresponded to an increase of the width of a tear drop, the lateralization of the femoral head and the lack of the support of the femoral head from the acetabulum. (author)

  7. A case report: periprosthetic acetabulum fracture with combined pelvic ring injury.

    Cha, Emily; Ertl, Janos P; Mullis, Brian H


    Periprosthetic fractures of the acetabulum are largely underreported in the literature, none of which describes the management of such injuries associated with a pelvic ring injury. Our case report discusses our approach to managing a periprosthetic both-column acetabulum fracture associated with an open-book pelvic ring injury. Instead of a revision total hip arthroplasty, we chose to perform an open reduction internal fixation to maintain sufficient bone stock for future revision, if necessary. At 18 months postoperative follow-up, the patient was ambulating independently and had sufficient range of motion that was comparable to the contralateral hip.

  8. Pathological fracture dislocation of the acetabulum in a patient with neurofibromatosis-1

    Balaji Saibaba


    Full Text Available Skeletal neurofibromatosis (NF commonly manifests as scoliosis and tibial dysplasias. NF affecting the pelvic girdle is extremely rare. Pathological fracture of the acetabulum leading to anterior hip dislocation in a patient with NF-1 has never been reported in the literature. The paper presents the clinical symptomatology, the course of management and the successful outcome of such a rare case of NF-1. Histopathological and immunohistochemistry studies showing abundant spindle cells, which are S-100 positive and of neural origin are the classical hallmarks of neurofibromatous lesions. Tumor resection and iliofemoral arthrodesis can be considered as a valid option in young patients with pathological fracture dislocation of the acetabulum.

  9. Periprosthetic fracture of the acetabulum after total hip arthroplasty.

    Peterson, C A; Lewallen, D G


    Eleven patients who had sustained a periprosthetic fracture of the acetabulum at a mean of 6.2 years (range, one month to thirteen years) after a total hip arthroplasty were managed at our institution between 1985 and 1991. Five patients had a fracture of the medial wall; three, a fracture of the posterior column; two, a transverse fracture; and one, a fracture of the anterior column. Six fractures were displaced by two millimeters or more. Eight fractures were caused by blunt trauma or a fall, and three occurred spontaneously. A fracture was classified as type 1 if the acetabular component was clinically and radiographically stable (eight patients) and as type 2 if the component was unstable (three patients). One patient, who had a displaced type-2 fracture of the posterior column, died of an associated intrapelvic vascular injury. The other two patients who had a type-2 fracture were managed with revision of the acetabular component without supplemental plate fixation, immediately after the diagnosis of the fracture. The eight patients who had a type-1 fracture initially were managed with limitation of weight-bearing or modification of activity; in six of these patients, the fracture united without additional treatment. The ten surviving patients were followed for a mean of sixty-two months after the fracture. Eight of these patients-including four in whom a type-1 fracture had united after non-operative treatment-had a revision of the acetabular component because of pain, loosening, or non-union by the time of the most recent follow-up. Two patients (one of whom had a type-1 fracture and the other, a type-2 fracture) had multiple revisions of the acetabular component; both had supplemental internal fixation with a plate. All ten patients ultimately had a stable, functioning prosthesis. We conclude that periprosthetic acetabular fractures are associated with a poor prognosis with regard to the survival of the acetabular component but that it is possible to

  10. Sex differences in anatomical parameters of acetabulum among asymptomatic Serbian population

    Jeremić Dejan


    Full Text Available Background/Aim. Anatomical parameters of the bony components of the hip joint are essential for better understanding of etiopathogenesis of diseases like primary osteoarthrosis of the hip joint. The aim of this reserch was to examine the normal acetabular morphometry in Serbian population and to determine whether there are sex differences in anatomical parameters of the acetabulum among asymptomatic subjects. Methods. Pelvic radiographics of 320 adult asymptomatic patients (640 hips were analyzed in 170 men and 150 women to determine the morphology of the acetabulum in Serbian population. For each hip the center edge angle of Wiberg (CEA, the acetabular angle of Sharp (AA, acetabular depth (AD, acetabular roof obliquity (ARO and roof angle (RA were measured. Results. The following average measurements for acetabulum geometry were obtained (X ± SD: CEA - 33.5 ± 6.5° (33.6 ± 5.8° in male, 33.3 ± 6.9° in female, AA - 38.0 ± 3.8° (37.5 ± 3.6° in male, 38.5 ± 3.9° in female, AD - 11.9 ± 2.8 mm (12.5 ± 2.7 mm in male, 11.2 ± 2.7 mm in female, ARO - 7.6 ± 5.7° (6.2 ± 4.9° in male, 9.0 ± 6.0° in female and RA - 18.4 ± 10.0° (19.6 ± 8.5° in male, 17.1 ± 9.5° in female. There were significant differences in the CEA, AA, AD, ARO and RA related to gender (p < 0.01, t-test. Conclusion. There are significant gender differences in Serbian population for all the examined anatomical parameters of acetabulum. We found sex-related differences in acetabular morphology, female acetabulum being marginally more dysplastic than male acetabulum. There is also a clear tendency of female hips to be more dysplastic than male ones.

  11. Insufficiency fracture in the medial wall of the acetabulum after total hip arthroplasty.

    Kanaji, Arihiko; Ando, Kenichi; Nakagawa, Masato; Fukaya, Eiichi; Date, Hideki; Yamada, Harumoto


    Insufficiency fracture following total hip arthroplasty (THA) frequently occurs in the superior and inferior pubic ramus, the puboischial rami, or the ischium around the obturator foramen, while it rarely occurs in the medial wall of the acetabulum. Here, we report three cases showing insufficiency fracture in the medial wall of the acetabulum following THA. In our three cases, two fractures resulted from the development of bone fragility due to osteolysis at the prosthesis site, and the convergence of mechanical stress on the acetabular load bearing point due to loosening of the cup. We consider it appropriate to describe these fractures as another entity of stress fracture, namely, osteolytic fracture, rather than either pathologic fracture or insufficiency fracture.

  12. Modified Kocher-Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum.

    Magu, Narender Kumar; Rohilla, Rajesh; Arora, Sanjay; More, Hament


    This article describes a modification of Kocher-Langenbeck approach for the treatment of select posterior wall fractures of acetabulum. The technique aims at achieving osteosynthesis by creating two windows: between the gluteus medius and piriformis superiorly and between the external rotators and ischial tuberosity inferiorly. The approach spares the division of external rotators and of the abductors of the hip, thus preventing iatrogenic damage to the vascularity of the head of the femur and of the fracture fragments. The reconstruction plate can be slid under the piriformis and the short external rotators, thus preserving the soft tissue sleeve of the hip posteriorly. The gluteus minimus is not stripped from the ilium. The technique is ideally suited for isolated, displaced, noncomminuted posterior wall fractures of acetabulum of less than 10 days' duration without marginal impaction. The technique is biologic, takes a shorter operative time in our hands, and prevents further damage to vascularity of the head of the femur and heterotopic ossification.

  13. Innovation aspects of rehabilitation methods of treatment of acetabulum dam-age

    Muhammad Shorustamov


    Full Text Available The article is devoted to solving improvement of rehabilitation treatment methods in acetabular injuries. Offered algorithm enables to improve rehabilitation treatment methods of acetabular injuries. Algorithm of rehabilitation includes blocks of conservative (including blocks ambulatory, treatment at a health resort, medicamentous and other methods of treatment of acetabulum damage as well as control block. Block of endoprosthetics of coxofemoral joint is also provided for in case of detection of signs of coxarthrosis. Innovation algorithm of perfecting rehabilitation methods of treatment of acetabulum damage (AD contributes to expansion of an implementation sphere in traumatic surgery and orthopedics practice. It allows practical physicians to build a clear algorithm of postoperative rehabilitation for this complicated cohort of patients with AD.

  14. Comparison of ESTs from juvenile and adult phases of the giant unicellular green alga Acetabularia acetabulum

    Grotewold Erich


    Full Text Available Abstract Background Acetabularia acetabulum is a giant unicellular green alga whose size and complex life cycle make it an attractive model for understanding morphogenesis and subcellular compartmentalization. The life cycle of this marine unicell is composed of several developmental phases. Juvenile and adult phases are temporally sequential but physiologically and morphologically distinct. To identify genes specific to juvenile and adult phases, we created two subtracted cDNA libraries, one adult-specific and one juvenile-specific, and analyzed 941 randomly chosen ESTs from them. Results Clustering analysis suggests virtually no overlap between the two libraries. Preliminary expression data also suggests that we were successful at isolating transcripts differentially expressed between the two developmental phases and that many transcripts are specific to one phase or the other. Comparison of our EST sequences against publicly available sequence databases indicates that ESTs from the adult and the juvenile libraries partition into different functional classes. Three conserved sequence elements were common to several of the ESTs and were also found within the genomic sequence of the carbonic anhydrase1 gene from A. acetabulum. To date, these conserved elements are specific to A. acetabulum. Conclusions Our data provide strong evidence that adult and juvenile phases in A. acetabulum vary significantly in gene expression. We discuss their possible roles in cell growth and morphogenesis as well as in phase change. We also discuss the potential role of the conserved elements found within the EST sequences in post-transcriptional regulation, particularly mRNA localization and/or stability.

  15. Pathological fracture dislocation of the acetabulum in a patient with neurofibromatosis-1

    Balaji Saibaba; Ramesh Kumar Sen; Manish Sharma; Uma Nahar


    Skeletal neurofibromatosis (NF) commonly manifests as scoliosis and tibial dysplasias. NF affecting the pelvic girdle is extremely rare. Pathological fracture of the acetabulum leading to anterior hip dislocation in a patient with NF-1 has never been reported in the literature. The paper presents the clinical symptomatology, the course of management and the successful outcome of such a rare case of NF-1. Histopathological and immunohistochemistry studies showing abundant spindle cells, which ...

  16. Report About the Design of External Fixator for Treatment of Pelvis and Acetabulum Fractures

    Martin JANEČKA


    Full Text Available Main point in this contribution is the design of external fixators applied in traumatology and orthopaedics. These fixators can be used in the treatment of open and unstable (i.e. complicated fractures of pelvis and its acetabulum. Numerical modelling (i.e. Finite Element Method, together with CAD modelling, experiments, material engineering, and nanotechnology are presented as a support for developing of a new design of external fixators.

  17. Periprosthetic fracture of the acetabulum during total hip arthroplasty in a patient with Paget's disease.

    McGrory, B J


    The case of a patient with Paget's disease of the pelvis (acetabulum) who had an intraoperative posterior wall fracture during the insertion of a noncemented acetabular component into an under-reamed acetabular bed of sclerotic Pagetoid bone is reported. This unusual complication has not, to my knowledge, been previously reported. Patients with sclerotic bone, like those with osteoporotic bone, may also be at risk for periprosthetic acetabular fractures when an under-reaming technique is used.

  18. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

    Daniel Howard Wiznia


    Full Text Available We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3 and left T-shaped acetabulum fracture (OTA classification 62-B2 in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries.

  19. Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty.

    Huang, Qiang; Shen, Bin; Yang, Jing; Zhou, Zong-ke; Kang, Peng-de; Pei, Fu-xing


    Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2 weeks, 6 months, 1 year and annually thereafter during the 3 years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P = .35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P = .029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P = .02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group.

  20. Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty.

    Atilla, Bulent; Caglar, Omur; Akgun, Rahmi Can


    While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. A 33-year-old man presented with acute left hip pain. He had chronic renal insufficiency and had undergone bilateral THA due to avascular necrosis. The night prior to his admission, he suffered a generalized convulsive attack with severe extremity contractions. Afterwards, he had acute left groin pain and had difficulty walking. Physical examination revealed moderate left hip pain as well as a 1-cm shortening of the affected limb. Radiological examination demonstrated an acetabular fracture with medial wall comminution. The acetabular component had migrated medially and rotated horizontally. Revision of the acetabular component with a reinforcement ring and implantation of a cemented acetabular component was realized. Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.

  1. 治疗髋臼四边体骨折的现状和进展%Present Situation and the Progress of Treatment Acetabulum Quadrilateral Area Fracture

    程鑫葵; 侯福山; 潘耀峰; 尹芸生


    髋臼四边体作为髋臼的内侧面支撑着髋臼,并联通髋臼前后柱的重要结构,其重要意义越来越被骨科医生所认识。四边体紧邻髋臼,手术中对于四边体的修复其实质是通过对四边体的复位间接复位髋臼。该文从复位四边体的常用手术入路、四边体的修复、手术新技术等方面进行综述,总结近几年复杂型髋臼骨折中四边体修复的现状和进展。%Acetabulum four sides bodies as the inner surface of the acetabulum supporting the acetabulum. Which is the medial aspect of the acetabulum supporting the acetabulum, and unicom important structure acetabulum anterior column and acetabulum posterior column, more and more orthopaedic surgeons to realize its importance. The quadrilateral area adjacent to the acetabulum, the real purpose of reset the quadrilateral area in the surgery is to hope that through reset the quadrilateral area to indirect reduc-tion the acetabulum fracture. In this paper, reviewed from Several aspects,such as commonly used surgical approach in the treat-ment of the acetabulum fracture surgery, the reset of the acetabulum quadrilateral area and the new technology of operation, to summarized the status and progress of that the technology of reset the acetabulum quadrilateral area in treatment of the complex acetabular fractures in recent years.

  2. Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.

    Hasegawa, Kazuhiro; Kabata, Tamon; Kajino, Yoshitomo; Inoue, Daisuke; Tsuchiya, Hiroyuki


    Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. In this study, using routine CT scans that were obtained as part of another primary hip arthroplasty study protocol, we retrospectively assessed (1) the prevalence of occult fractures of the acetabulum occurring during primary THA, (2) the location of occult fractures of the acetabulum during THA, and (3) risk factors contributing to such occult fractures. Between 2004 and 2013, our institute performed 585 primary THAs (cementless or hybrid) in 494 patients with DICOM pre- and postoperative CT; during the period in question, all patients undergoing THA underwent CT before and after surgery. Preoperative CT images were taken as part of a CT-based three-dimensional templating software and navigation system. Postoperative CT images were taken an average of 1 week after surgery as part of a different protocol to evaluate cup position, restoration of leg length and offset, volume of postoperative hematoma to assess anticoagulation effects after THA, and fractures that were not found on routine postoperative radiographs (which we defined as occult fractures). Patients with a history of prior pelvic osteotomy, trauma, and infection were excluded (88 patients/99 hips); 406 patients (102 males and 304 females; 486 hips) form the basis of this report. The mean age of the patients was 60 ± 11 years, with a mean BMI of 23 ± 4 kg/m(2). The mean followup of the patients with periprosthetic fracture of the acetabulum was 58 ± 28 months (range, 12-131 months). Potential risk factors for occult acetabular fracture including age, sex, BMI, preoperative diagnosis, additional dome screw fixation, composition and size of each

  3. Automated segmentation of acetabulum and femoral head from 3-D CT images.

    Zoroofi, Reza A; Sato, Yoshinobu; Sasama, Toshihiko; Nishii, Takashi; Sugano, Nobuhiko; Yonenobu, Kazuo; Yoshikawa, Hideki; Ochi, Takahiro; Tamura, Shinichi


    This paper describes several new methods and software for automatic segmentation of the pelvis and the femur, based on clinically obtained multislice computed tomography (CT) data. The hip joint is composed of the acetabulum, cavity of the pelvic bone, and the femoral head. In vivo CT data sets of 60 actual patients were used in the study. The 120 (60 x 2) hip joints in the data sets were divided into four groups according to several key features for segmentation. Conventional techniques for classification of bony tissues were first employed to distinguish the pelvis and the femur from other CT tissue images in the hip joint. Automatic techniques were developed to extract the boundary between the acetabulum and the femoral head. An automatic method was built up to manage the segmentation task according to image intensity of bone tissues, size, center, shape of the femoral heads, and other characters. The processing scheme consisted of the following five steps: 1) preprocessing, including resampling 3-D CT data by a modified Sinc interpolation to create isotropic volume and to avoid Gibbs ringing, and smoothing the resulting images by a 3-D Gaussian filter; 2) detecting bone tissues from CT images by conventional techniques including histogram-based thresholding and binary morphological operations; 3) estimating initial boundary of the femoral head and the joint space between the acetabulum and the femoral head by a new approach utilizing the constraints of the greater trochanter and the shapes of the femoral head; 4) enhancing the joint space by a Hessian filter; and 5) refining the rough boundary obtained in step 3) by a moving disk technique and the filtered images obtained in step 4). The above method was implemented in a Microsoft Windows software package and the resulting software is freely available on the Internet. The feasibility of this method was tested on the data sets of 60 clinical cases (5000 CT images).

  4. CT measurement of acetabulum geometric parameter%髋臼几何参数的CT测量

    胡荣慧; 贺斌; 刘力; 严睿; 刘嘉凯; 黄小波; 张剑; 丁薇


      背景:近年来尽管对髋臼形态特征的研究已经取得了一些成果,但由于髋臼结构和位置的特殊性,有关髋臼表面形态的定量描述至今尚未统一,这势必会影响髋关节病变诊断和治疗的准确性。目的:探讨髋臼几何参数的CT测量方法。方法:选取70例髋关节CT受检者,其中正常成人50例(两侧共100个髋关节),单侧先天性髋关节脱位患儿20例。对所有受检者髋关节CT图像进行冠状面重建和三维重建,比较正常成人髋臼上外倾角冠状位和三维测值,比较先天性髋关节脱位组患侧与正常侧髋臼上外倾角。选择配伍组设计方差分析,分别比较扫描床面为参照面和以身体冠状面为参照面测量左右侧髋臼后外展角、前髋臼指数及后髋臼指数。结果与结论:髋臼上外倾角在冠状位测值为(39.99±6.1)°,在三维图像上测值为(40.13±5.80)°,2者比较,差异无显著性意义(P >0.05)。先天性髋关节脱位患儿双侧上外倾角在冠状面的测量值,正常侧为(48.95±3.80)°,脱位侧为(63.56±6.35)°,二者之间差异有非常显著性意义(P 0.05)。提示以冠状面为参照平面测量双侧后外展角和前、后髋臼指数准确可靠,可客观反映髋臼情况,为髋关节区病变的诊断和治疗提供确切的量化指标。%  BACKGROUND: Although, the previous studies on acetabular morphological characteristics have yielded some results, quantitative description of the acetabular surface morphology has not yet been unified because of the special nature of acetabular structure and location, and this is bound to affect the accuracy of the diagnosis and treatment of hip disease. OBJECTIVE: To investigate the CT measuring methods to acetabulum geometric parameters. METHODS: Seventy cases performed CT scan were selected, including 50 normal adults (a total of 100 hips on both sides) and 20 cases with unilateral congenital

  5. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

    Daniel Howard Wiznia; Mike Wang; Chang Yeon-Kim; Paul Tomaszewski; Michael P. Leslie


    We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3) and left T-shaped acetabulum fracture (OTA classification 62-B2) in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surg...

  6. Factors affecting revenue from the management of pelvis and acetabulum fractures.

    Vallier, Heather A; Cureton, Beth Ann; Patterson, Brendan M


    The purpose was to define charges and reimbursement in the management of pelvis and acetabulum fractures and to identify opportunities for revenue enhancement. Retrospective review. Level 1 trauma center. Four hundred sixty-five patients with 210 pelvic ring injuries and 285 acetabulum fractures. All fractures were treated surgically. Professional and facility charges and collections were determined for each patient. Costs of care and profitability were calculated for patients with isolated pelvis or acetabulum fractures. : Definitive fixation was ≤ 24 hours of injury in 35% and >72 hours in 24%. Mean hospital length of stay (LOS) was 9.2 days, with mean 3.1 days in the intensive care unit (ICU). Mean facility charges were $51,069 with collections of $22,702 (44%). Mean orthopaedic professional charges were $20,184 with collections of $4629 (23%). Combined pelvis and acetabulum fractures had the highest facility collection rates (49%) with lower professional collections (21%) versus isolated fractures (25%, P = 0.03). The payer mix had significantly more commercial (27%), managed care (27%), and Bureau of Worker's Compensation (10%) versus the entire hospital, despite progressively more patients with Medicaid or no insurance during the study. Uninsured patients were significantly younger with lower injury severity score. Fractures managed definitively ≤ 24 hours had shorter LOS, shorter ICU stay, and fewer complications, with mean net facility revenue over costs of $2376. Longer LOS due to complications increased initial hospital costs by a mean of $14,829. Patients with multiple injuries generated higher facility charges and collection rates. Professional collection rates were lower in patients with more than 1 surgical procedure in the same setting. Trauma patients were more likely to have commercial, managed care, and Bureau of Worker's Compensation insurance versus the entire hospital. Fractures managed definitively within 24 hours were associated with

  7. The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men

    Halle, B; Halle, D M; Torfing, T;


    We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck and the cons......We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck...


    Dias, Marcus Vinícius Fernandes; Goldsztajn, Flavio; Guimarães, João Matheus; Grizendi, José Afraneo; Correia, Marcos; Rocha, Tito Henrique


    The purpose of this study was to review the epidemiological aspects of displacement fractures of the acetabulum that had been treated surgically at the National Institute of Traumatology and Orthopedics (INTO). We retrospectively analyzed 126 acetabulum fractures that had been treated surgically at INTO between March 2006 and November 2008. The following factors were taken into account: age, sex, trauma mechanism, injury classification, time elapsed between trauma and surgery, affected side and associated bone injuries. 76.8% were male; the mean age was 39.6 years. The trauma mechanism was traffic accidents in 59%; the time that elapsed between injury and surgery was on average 16.4 days; 55% of the cases were on the right side; 30% of the patients presented associated fractures. Most of the patients were male, in an economically active age group, and were victims of traffic accidents. Edge and/or posterior column fractures were the most frequent types. Associated injuries were common and most of the fractures operated in our service came to us late.

  9. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement.

    Sakellariou, Vasileios I; Christodoulou, Michael; Sasalos, Gregory; Babis, George C


    Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is challenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  10. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

    Vasileios Sakellariou


    Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  11. [Osteosynthesis and cup revision in periprosthetic acetabulum fractures using a Kocher-Langenbeck approach].

    Schwabe, P; Märdian, S; Perka, C; Schaser, K-D


    Reconstruction/stable fixation of the acetabular columns to create an adequate periacetabular requirement for the implantation of a revision cup. Displaced/nondisplaced fractures with involvement of the posterior column. Resulting instability of the cup in an adequate bone stock situation. Periprosthetic acetabulum fractures with inadequate bone stock. Extended periacetabular defects with loss of anchorage options. Isolated periprosthetic fractures of the anterior column. Septic loosening. Dorsal approach. Dislocation of hip. Mechanical testing of inlaying acetabular cup. With unstable cup situation explantation of the cup, fracture fixation of acetabulum with dorsal double plate osteosynthesis along the posterior column. Cup revision. Hip joint reposition. Early mobilization; partial weight bearing for 12 weeks. Thrombosis prophylaxis. Clinical and radiological follow-ups. Periprosthetic acetabular fracture in 17 patients with 9 fractures after primary total hip replacement (THR), 8 after revision THR. Fractures: 12 due to trauma, 5 spontaneously; 7 anterior column fractures, 5 transverse fractures, 4 posterior column fractures, 1 two column fracture after hemiendoprosthesis. 5 type 1 fractures and 12 type 2 fractures. Operatively treated cases (10/17) received 3 reinforcement ring, 2 pedestal cup, 1 standard revision cup, cup-1 cage construct, 1 ventral plate osteosynthesis, 1 dorsal plate osteosynthesis, and 1 dorsal plate osteosynthesis plus cup revision (10-month Harris Hip Score 78 points). Radiological follow-up for 10 patients: consolidation of fractures without dislocation and a fixed acetabular cup. No revision surgeries during follow-up; 2 hip dislocations, 1 transient sciatic nerve palsy.

  12. A modified cementing technique using BoneSource to augment fixation of the acetabulum in a sheep model.

    Timperley, A.J.; Nusem, I.; Wilson, K.; Whitehouse, S.L.; Buma, P.; Crawford, R.W.


    BACKGROUND AND PURPOSE: Our aim was to assess in an animal model whether the use of HA paste at the cement-bone interface in the acetabulum improves fixation. We examined, in sheep, the effect of interposing a layer of hydroxyapatite cement around the periphery of a polyethylene socket prior to fixi

  13. The use of computed tomography in the diagnosis of pelvic fractures involving the acetabulum in two fillies.

    Trump, M; Kircher, P R; Fürst, A


    Two fillies with hindlimb lameness and a tentative diagnosis of a pelvic fracture involving the acetabulum were examined using computed tomography (CT). The use of CT for these two cases revealed the exact course of the fractures and fissures, as well as the size and position of fragments, thus allowing for definitive diagnosis.

  14. External iliac artery thrombus masquerading as sciatic nerve palsy in anterior column fracture of the acetabulum

    Narender Kumar Magu


    Full Text Available We report a case of ischemic neuropathy of the sciatic nerve in a patient with an anterior column fracture of the acetabulum operated by ilioinguinal approach. It resulted from occlusion of the blood supply to the sciatic nerve. There were no signs of a vascular insult until ischemic changes ensued on the 6 th postoperative day on the lateral part of great toe. The patient underwent crossover femoro-femoral bypass grafting and there was a complete reversal of the ischemic changes at 6 months. The sciatic nerve palsy continued to recover until the end of 1 year; by which time the only deficit was a Grade 4 power in the extensor hallucis longus (EHL and the extensor digitorum longus (EDL. There was no further recovery at 2 years followup.

  15. An approach to comparative anatomy of the acetabulum from amphibians to primates.

    Canillas, F; Delgado-Martos, M J; Touza, A; Escario, A; Martos-Rodriguez, A; Delgado-Baeza, E


    The objective of this study was to investigate the anatomy, both macroscopic and microscopic, of the soft tissue internal structures of the hip joint in animal species and in three human hips (an adult and two fetuses). We dissected the hip joints of 16 species and compared the anatomical features of the soft tissue from the respective acetabula. In addition, a histological study was made of the specimens studied. In amphibians, we found a meniscus in the acetabulum, which was not observed in any of the other species studied. The isolated round ligament is observed from birds onwards. In the group of mammals analysed, including the human specimens, we found a meniscoid structure in the acetabular hip joint. Furthermore, we found that the meniscoid structure forms an anatomo-functional unit with the round ligament and the transverse ligament of the coxofemoral joint. These discoveries suggest the participation of the soft tissue anatomy in adaptative changes of species.

  16. Minimal-invasive posterior approach in the treatment of the posterior wall fractures of the acetabulum.

    Spagnolo, Rosario; Bonalumi, Matteo; Pace, Fabrizio; Capitani, Dario


    We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.

  17. Biomechanical comparison of different stabilization constructs for unstable posterior wall fractures of acetabulum. A cadaveric study.

    Yuntong Zhang

    Full Text Available PURPOSE: Operative treatment of unstable posterior wall fractures of acetabulum has been widely recommended. This laboratory study was undertaken to evaluate static fixation strength of three common fixation constructs: interfragmentary screws alone, in combination with conventional reconstruction plate, or locking reconstruction plate. METHODS: Six formalin-preserved cadaveric pelvises were used for this investigation. A posterior wall fracture was created along an arc of 40-90 degree about the acetabular rim. Three groups of different fixation constructs (two interfragmentary screws alone; two interfragmentary screws and a conventional reconstruction plate; two interfragmentary screws and a locking reconstruction were compared. Pelvises were axial loaded with six cycles of 1500 N. Dislocation of superior and inferior fracture site was analysed with a multidirectional ultrasonic measuring system. RESULTS: No statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation. In each group, the vector dislocation at superior fracture site was significantly larger than inferior one. CONCLUSIONS: All those three described fixation constructs can provide sufficient stability for posterior acetabular fractures and allow early mobilization under experimental conditions. Higher posterior acetabular fracture line, transecting the weight-bearing surface, may indicate a substantial increase in instability, and need more stable pattern of fixation.

  18. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement

    Weill, A.; Kobaiter, H.; Chiras, J. [Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France)


    The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief. (orig.) With 6 figs., 2 tabs., 20 refs.

  19. Clinical application of spiral-type acetabulum and press-fit acetabulum%螺旋型髋臼与压配型髋臼的临床应用分析

    张媺; 白鹏程; 江建平; 王辉; 冯孝志; 金绍林; 童绪军; 张昌奕; 李勇


    BACKGROUND: Most studies suggest that the spiral-type acetabulum of total hip arthroplasty (THA) could provide betterstability than the press-fit acetabulum.OBJECTIVE: To compare the effects of press-fit acetabulum and spiral-type acetabulum in THA.METHODS: The retrospective analysis on the clinical data of 39 THA patients with press-fit acetabulum and spiral-typeacetabulum was preformed.RESULTS AND CONCLUSION: ?AII cases were followed-up for 4-51 months, the average time was 32.6 months. ?Harrisscores: Postoperative Harris scores were significantly improved than preoperative in the final follow-up (P < 0.05), and the scoreof the spiral-type acetabular group was slightly higher than that of press-fit acetabular group, but the difference was not significant.?Adverse reactions: The postoperative complications of the press-fit acetabular arthroplasty group included looseness of hipprosthesis 1 case after 1 year, ambulation pain 3 cases, osteogenesis around acetabular prosthesis 6 cases, translucent aroundacetabular prosthesis 3 cases, osteosclerosis around acetabular prosthesis 1 case and bone resorption around acetabularprosthesis 1 case; the spiral-type acetabular group included osteogenesis around acetabular prosthesis 3 cases, translucentaround acetabular prosthesis 1 cases and bone resorption around acetabular prosthesis 1 case. Therefore, the initial stability ofthe spiral-type acetabular prosthesis was better than that of the press-fit acetabular prosthesis.%背景:在人工全髋关节置换髋臼假体的选择上,多数研究认为螺旋型髋臼较压配型髋臼能的稳定性好.目的:对比螺旋型髋臼与压配型髋臼两种不同全髋关节置换的临床疗效.方法:回顾性分析选择螺旋型髋臼与压配型髋臼两种不同人工全髋关节置换39例患者临床资料.结果与结论:①随访时间:随访4~51个月,平均32.6个月.②Harris评分:末次随访时两组Harris评分均较置换前明显提高(P < 0.05),且螺旋型髋

  20. Estimation of age-at-death for adult males using the acetabulum, applied to four Western European populations.

    Rissech, Carme; Estabrook, George F; Cunha, Eugenia; Malgosa, Assumpció


    Methods to estimate adult age from observations of skeletal elements are not very accurate and motivate the development of better methods. In this article, we test recently published method based on the acetabulum and Bayesian inference, developed using Coimbra collection (Portugal). In this study, to evaluate its utility in other populations, this methodology was applied to 394 specimens from four different documented Western European collections. Four strategies of analysis to estimate age were outlined: (a) each series separately; (b) on Lisbon collection, taken as a reference Coimbra collection; (c) on Barcelona collection, taken as a reference both Portuguese collections; and (d) on London collection taken as reference the three Iberian collections combined. Results indicate that estimates are accurate (83-100%). As might be expected, the least accurate estimates were obtained when the most distant collection was used as a reference. Observations of the fused acetabulum can be used to make accurate estimates of age for adults of any age, with less accurate estimates when a more distant reference collection is used.

  1. Evaluation of age estimation technique: testing traits of the acetabulum to estimate age at death in adult males.

    Calce, Stephanie E; Rogers, Tracy L


    This study evaluates the accuracy and precision of a skeletal age estimation method, using the acetabulum of 100 male ossa coxae from the Grant Collection (GRO) at the University of Toronto, Canada. Age at death was obtained using Bayesian inference and a computational application (IDADE2) that requires a reference population, close in geographic and temporal distribution to the target case, to calibrate age ranges from scores generated by the technique. The inaccuracy of this method is 8 years. The direction of bias indicates the acetabulum technique tends to underestimate age. The categories 46-65 and 76-90 years exhibit the smallest inaccuracy (0.2), suggesting that this method may be appropriate for individuals over 40 years. Eighty-three percent of age estimates were ±12 years of known age; 79% were ±10 years of known age; and 62% were ±5 years of known age. Identifying a suitable reference population is the most significant limitation of this technique for forensic applications.




    Full Text Available INTRODUCTION: Multicentric Giant Cell Tumor is extremely rare; here we are presenting a case of pathological neck femur fracture in case of multicentric giant cell tumor involving ipsilateral acetabulum along with femoral head and neck. CASE PRESENTATION: 24 years old male presented with pain in groin region and inability to walk after he fell down while walking. He had pain in left groin on weight bearing for last six months. Radiological examination shows pathological trans - cervical femoral neck fracture with sub - articular lytic lesion in femoral head and neck suggestive of Giant cell tumor. MRI has been done to define the extent of involvement and to rule out soft tissue infiltration. Fine needle aspiration cytology which was done through anterior route was inconclusive. After review of literature, patient has been planned for excisional biopsy and un - cemented total hip arthroplasty. Intra - operatively, frozen section confirms the giant cell tumor and surprisingly acetabulum was found to be involved which was curetted and hydrogen - peroxide treated. Post - operatively, patient was pain - free with good range of movements at hip. CONCLUSION: Giant cell tumor involving femoral head and neck with pathological fracture though uncommon, but may present as multicentric with acetabular involvement.

  3. Acetabular defect reconstruction with impacted morsellized bone grafts or TCP/HA particles. A study on the mechanical stability of cemented cups in an artificial acetabulum model.

    Bolder, S.B.T.; Verdonschot, N.J.J.; Schreurs, B.W.; Buma, P.


    In revision surgery of the acetabulum bone defects can be filled with impacted human morsellized bone grafts. Because of a worldwide limited availability of human bone, alternatives are being considered. In this study we compared the initial stability of acetabular cups after reconstructing a cavita

  4. Finite element analysis of the stability of combined plate internal fixation in posterior wall fractures of acetabulum.

    Liu, Xi-Ming; Pan, Chang-Wu; Wang, Guo-Dong; Cai, Xian-Hua; Chen, Lei; Meng, Cheng-Fei; Huang, Jin-Cheng


    This study aims to explore the mechanical stability of combined plate internal fixation in posterior wall fractures of the acetabulum. The fracture and internal fixation models were established in this study and they were divided into four kinds of internal fixation models, finite element analysis was performed. The four groups were 2 mini-plates and 1 reconstruction plate fixation (A), Reconstruction plate internal fixation group (B), 2 screws internal fixation group (C) and mini-plates internal fixation group (D). The displacement of each node was measured and evaluated. There was no distortion in the geometric shape of the finite element model. The results of stress showed that it was less in the anterior pelvic ring and distributed uniform in labrum acetabulare; the stress was bigger in the upper and middle of sacroiliac joint and sciatic notch in sitting position. Combined plate internal fixation for posterior wall fractures of acetabular were stable and reliable, it is better than the other three methods.

  5. Research on Damage in Trabecular Bone of the Healthy Human Acetabulum at Small Strains Using Nonlinear Micro-finite Element Analysis

    DING Hai; ZHU Zhen-nan; DAI Ke-rong; YE Ming; WANG Cheng-tao


    The mechanical properties of the pelvic trabecular bone have been studied at the continuum level. However, nothing is known about the tissue-level damage in the trabecular bone of the healthy human acetabulum at apparent small strains characteristic of habitual. By a DAWING 4000 A supercomputer, nonlinear micro-finite element (μFE) analysis was performed to quantify tissue-level damage accumulation in trabecular bone at small strains. The data indicate that damage in trabecular bone commence at 0.2% apparent strain. The findings imply that tissue yielding can initiate at very low strains in the trabecular bone of the healthy acetabulum and that this local failure has negative consequences on the apparent mechanical properties of trabecular bone.

  6. Osteoid Osteoma of the Acetabulum in Children:A Case Report%儿童髋臼骨样骨瘤一例报道

    段丽群; 尚希福; 张文志; 胡飞


    Osteoid is a kind of benign bone tumor and commonly seen in the backbone of the femoral and ibia.Osteoid osteoma of the acetabulum is very rare and its clinical and imaging features are different with the common places,such as the backbone.One case of acetabulum osteoid osteoma and its diagnsis and and treatment were introduced.%骨样骨瘤是一种良性的骨肿瘤,多见于股骨、胫骨的骨干.髋臼骨样骨瘤十分罕见,其临床及影像学表现和骨干等常见部位不同.我院收治髋臼骨样骨瘤1例,特将该病例的诊断及治疗进行介绍.

  7. Functional integrative analysis of the human hip joint: the three-dimensional orientation of the acetabulum and its relation with the orientation of the femoral neck.

    Bonneau, Noémie; Baylac, Michel; Gagey, Olivier; Tardieu, Christine


    In humans, the hip joint occupies a central place in the locomotor system, as it plays an important role in body support and the transmission of the forces between the trunk and lower limbs. The study of the three-dimensional biomechanics of this joint has important implications for documenting the morphological changes associated with the acquisition of a habitual bipedal gait in humans. Functional integration at any joint has important implications in joint stability and performance. The aim of the study was to evaluate the functional integration at the human hip joint. Both the level of concordance between the three-dimensional axes of the acetabulum and the femoral neck in a bipedal posture, and patterns of covariation between these two axes were analysed. First, inter-individual variations were quantified and significant differences in the three-dimensional orientations of both the acetabulum and the femoral neck were detected. On a sample of 57 individuals, significant patterns of covariation were identified, however, the level of concordance between the axes of both the acetabulum and the femoral neck in a bipedal posture was lower than could be expected for a key joint such as the hip. Patterns of covariation were explored regarding the complex three-dimensional biomechanics of the full pelvic-femoral complex. Finally, we suggest that the lower degree of concordance observed at the human hip joint in a bipedal posture might be partly due to the phylogenetic history of the human species.

  8. Management of weight-bearing area fracture of acetabulum%涉及臼顶负重区髋臼骨折的诊疗与对策

    章云童; 王攀峰; 张春才


    Acetabulum, as the important factor for weight bearing of the upper body, has its unique anatomic features and complicated physiological function.The integrity and stability of the lunata articular surface in the dome region of acetabulum,is the important base to bear the physiological function of acetabulum.The fracture related to this part will cause relation change of contact area and stress between head of femur and acetabulum.Furthermore,the deep anatomical position of the dome region ,the complicated surrounding anatomical relation,and the irregular bony structure will also increase the difficulty of surgical treatment.Especially for some complicated comminuted or compressed fracture,even with good explosions, it is hard to get satisfied anatomical reduction.Consequently ,forward traumatic arthritis has greater probability of occurrence.Therefore,the clinical research on the fracture in the dome region of acetabulum was getting more and more attention worldly.This paper intended to review the relation of fracture classifications and anatomic features, physiological function, diagnostic criteria, and also its clinical treating countermeasure.%髋臼作为承载上半身体重的重要关节,具有独特的解剖学特点及复杂的生理功能,而臼顶区月状关节面的完整性与稳定性是承担髋臼生理功能的重要基础,涉及此处骨折会导致股骨头与髋臼之间的接触面积和应力等关系发生改变,加之臼项区解剖位置深在,周围解剖关系复杂,骨性结构不规则,手术治疗难度较大,特别是一些复杂的粉碎压缩骨折,即使达到良好暴露也难以达到满意的解剖复位,从而使远期创伤性关节炎的发生概率大大增加.因此涉及臼顶负重区的髋臼骨折的基础及临床研究在国内外的重视程度逐年增高,本文就其解剖学特点及生理功能、诊断标准与骨折分型的关系、临床治疗对策等做一综述.

  9. Unusual combination of posterior femoral head dislocation with anterior and posterior wall fractures in the ipsilateral acetabulum.

    Chen, Wei; Su, Yanling; Zhang, Yingze; Zhang, Qi; Zheng, Zhanle; Pan, Jinshe


    Although hip dislocation combined with acetabular fracture is not an uncommon injury, anterior acetabular wall fractures rarely occur in patients who have posterior fracture-dislocations of the hip. This article presents a unique case of anterior and posterior wall fractures of the ipsilateral acetabulum in a patient who sustained traumatic posterior hip dislocation that resulted from a high-speed motor vehicle accident. The initial imaging evaluation, which did not include the obturator oblique view, revealed no concomitant anterior acetabular wall fracture. Repeated manipulative reductions were unsuccessful in reducing the displaced hip joint. Pelvic computed tomography (CT) scans revealed the initially missed anterior acetabular wall fracture fragments incarcerated in the left hip joint in addition to the hip dislocation and the posterior acetabular wall fracture. The incarcerated bone fragments lay between the anterior wall and the femoral head, and between the posterior wall and the femoral head, which appeared to derive from both anterior and posterior acetabular walls, respectively. Open reduction and internal fixation was performed to manage the posterior dislocation and associated acetabular fractures. Intraoperatively, the major anterior wall fragment was used to reconstruct the defected posterior wall. This case highlights the necessity of suspicion and pre- and postoperative monitoring of the obturator oblique view and CT scans to detect the potentially existing anterior acetabular wall fracture. Early surgical intervention is important to guarantee satisfactory outcomes of such complex fracture-dislocation injuries.

  10. Abmessung und Analyse der Bezugsfl(a)che von Acetabulum-Prothese-Transplantation in unterschiedlichen K(o)rperlagen

    ZENG Hui; Eckart Mayr; KANG Bin; XIONG Ao; XIN Feng; Michael Nogler; Martin Krismer


    Ziel ist die Analyse der Neigungslage des Beckens im Liegen und im Stehen bzw.die Beobachtung der Stabilit(a)t der Beckenfl(a)che als Beckenfl(a)che für die Acetabulum-Prothese Transplantation. 72 Testpersonen wurden je nach Status ihres Pfannengelenks in 3 Gruppen eingeteilt:Gruppe 1 "mit gesundem Pfannengelenk", Gruppe 2 "mit Arthritis" und Gruppe 3 "nach Implantation der Hüftendoprothese". Unter dem Einsatz von 3D- Digital-Instrument wurde die Fl(a)chen-Neigung vor dem Becken jeweils im Liegen und im Stehen gemessen und die Messwerte wurden verglichen. Die Fl(a)chen-Neigungen vor dem Becken bei allen 3 Gruppen (mit gesundem Pfannengelenk/mit Arthritis/nach Operation) im Liegen sind: 6.37°± 3.70°, 6. 47°± 3.52° und 4.56°±2.39°. Im Stehen sind es 7.33°±3.08°, 6.60°±3.45° und 6.74°±3.43°. Der Fl(a)chen-Neigungsunterschied vor dem Becken im Liegen und im Stehen hat keine grosse Bedeutung (P>0.05).Die (A)nderung der Fl(a)chen-Neigung vor dem Becken vom Liegen bis zum Stehen ist kleiner als 2.5°.Die Fl(a)che vor dem Becken (pelvic anterior plane, PAP) als Bezugsfl(a)che für Hüftpfanne-Prothese Transplantation bei klinischer Operation ist stabil und verlaβlich.

  11. Comparative study of W-shaped angular plate and reconstruction plate in treating posterior wall fractures of the acetabulum.

    Qi Zhang

    Full Text Available OBJECTIVE: This study aims to assess the medium-term results of the reconstruction of posterior wall fractures using a W-shaped acetabular angular plate (WAAP compared to those fixed using a reconstruction plate. METHODS: Between July 2006 and March 2009, we performed a retrospective study, which collected data for any patient treated for a posterior acetabular wall fracture. At the time of treatment, patients were either treated using a WAAP or a pelvic reconstruction plate. The intraoperative fluoroscopic images for both groups were compared. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on a modified Merle d'Aubigne and Postel scoring. RESULTS: 53 patients met the inclusion criteria and were followed up for an average of 38 months. 25 patients were treated with a WAAP (study group, and 28 patients were treated with a pelvic reconstruction plate (control group. The intraoperative fluoroscopic images of the study group confirmed extra-articular screw placement in all cases. In the control group, intra-articular screw placement was observed intraoperatively in 5 patients (17.86%, and the definitive location of the periarticular hardware could not be determined in 4 patients (14.29% during the operation. The differences between the two groups were statistically significant (p = 0.002. In contrast, the quality of fracture reduction, clinical outcomes, and radiological grading in the study group were not significantly different from those of the control group (p>0.05. The radiographic grade was strongly associated with the clinical outcomes in both the study and control groups (p<0.05. CONCLUSION: Reconstruction of posterior wall fractures of the acetabulum using a WAAP can help avoid screw penetration of the hip joint, provide a stable fixation of the posterior wall, and ensure good clinical outcomes.

  12. Late Growth and Development of Acetabulum After Innominate Osteotomy%骨盆截骨术后远期髋臼发育变化

    吉士俊; 周永德; 刘卫东; 赵群


    50 cases of congenital dislocation of the hip treated with Salter innominate osteotomy were followed up for average 6.7 years.The development of acetabulum,including acetabular index,CE angle,acetabular head index (AHI) and acetabular width,was observed.The result showed that the aeetabular width and AHI were slightly increaed in the operated group but no statistical difference from the normal.Socket pattern was observed in 86.9 percent of the cases.The inner diamet of pelvis was normal in 85.5 percent of the cases.Three dimentional changes of acetabulum,its biomechanics and mechanism of aeetabular widening were discussed.It is emphasized that the shape of femoral head is an important factor in the growth and development of the acetabulum.%本文报告通过分别测量髋臼指数、CE角、臼头指数和髋臼宽度,随访观察5年以上骨盆截骨术治疗50例先天性髋脱位的髋臼发育变化,发现该组病例髋臼宽度和臼头指数与正常组对比,差异无显著意义;髋臼呈球窝形占86.9%;骨盆内径正常者达85.5%.探讨了本术式的三维结构变化、生物力学和髋臼增宽的机理,强调股骨头形态是影响髋臼发育的重要因素.

  13. The upper part wall of acetabulum fractures:management and classification%髋臼上部骨折的分型与治疗体会

    王文; 李秉胜; 王平山; 刘立峰; 曹学成


    目的:探讨髋臼上部骨折的分型与治疗。方法回顾性分析2000年1月—2013年6月收治的10例患者,根据术前经X线及CT三维重建明确诊断,对其进行分型后,根据分型的不同采用了不同治疗方法。结果2例患者采用非手术治疗,8例患者采用手术治疗。随访6~12个月,平均8个月。治疗结果优良率为80%。结论应用髋臼上部骨折的单独诊断与分型标准指导治疗,是获得良好结果的基础。%Objective To discuss the classification and management of upper part wall of acetabulum fractures. Methods From January 2000 to June 2013,10 cases of upper part wall of acetabulum fractures were retrospectively analyzed. On the basis of the X-ray and three-dimensional computed tomography,they were diagnosed and classified,treated differently according to the classification. Results Among the 10 cases 2 were received conservative treatment,8 were treated with operation. All the cases were followed up for 6 to 12 months, with an average time of 8 months;8 cases of the series were rated as fine (80%). Conclusion The upper part wall of acetabulum fractures could obtain good outcome on basis of the diagnosis and classification of it.

  14. Role of bone morphogenetic protein 2 in early acetabulum development and dysplastic acetabulum remodeling%BMP-2在髋臼软骨发育早期及发育不良髋臼软骨可逆性恢复过程中的作用研究

    莫越强; 裴新红; 马瑞雪


    目的 研究BMP-2在髋臼软骨发育早期及发育不良髋臼软骨可逆性恢复过程中的作用.方法 通过伸髋内收、模拟襁褓体位固定新生大鼠双后肢,建立发育不良髋臼软骨模型.将髋臼标本经HE染色后观察比较正常及发育不良髋臼软骨组织形态学变化特点,同时用ELISA方法和PCR方法分别检测BMP-2、BMP-4、BMP-6、BMP-7的分泌及基因表达情况.将捆绑不同时间后的大鼠松绑,其中部分当场处死,其余大鼠继续喂养,最终至30日龄,建立发育不良髋臼软骨可逆性恢复模型.研究其髋臼软骨组织形态学恢复及BMP-2分泌变化情况.结果 正常大鼠髋臼软骨呈半圆形、容积大、表面光滑.发育不良髋臼软骨髋臼上缘肥厚,软骨发生变性,与周围组织分界不清.髋臼软骨BMP-2的分泌在正常大鼠7日龄和9日龄时出现高峰,分别为(13.7±0.29) ng/ml和(13.9±0.38) ng/ml.而在发育不良髋臼软骨中这一分泌高峰消失.在发育不良髋臼软骨可逆性恢复组,捆绑4d和6d的大鼠,BMP-2的分泌高峰出现延迟,都在15日龄时出现;而在捆绑8d及以上的大鼠,在松绑后继续喂养至30日龄,髋臼软骨组织形态无法恢复正常,并且BMP-2的分泌高峰未出现.结论 BMP-2的分泌可能是髋臼软骨早期发育情况的生物学标记之一.%Objective To explore the early-stage acetabulum development in normal and dysplastic acetabula and elucidate the function of bone morphogenetic protein 2 (BMP-2) in early acetabulum development and dysplastic acetabulum remodeling.Methods The rat model of dysplastic acetabulum was established by maintaining hips in a swaddling position.By analyzing the cartilage histologic characteristics,early-stage acetabulum developments were examined in normal and dysplastic acetabulum animals.Meantime,the mRNA expression and chondrocyte secretion of functional BMP-2,bone morphogenetic protein 4 (BMP-4),bone morphogenetic protein 6 (BMP-6) and bone

  15. Acetabulum protrusio and center edge angle: new MR-imaging measurement criteria - a correlative study with measurement derived from conventional radiography

    Chen, Lina; Resnick, Donald [VASDHS-Radiology, San Diego, CA (United States); UCSD Medical Center, San Diego, CA (United States); Boonthathip, Mayura; Cardoso, Fabiano; Clopton, Paul [VASDHS-Radiology, San Diego, CA (United States)


    The goal of this study was to identify a method of measurement for acetabulum protrusio and center edge angle (CEA) using MR imaging of the pelvis that correlated with classic methods using radiographic landmarks. MR images and radiographs of the pelvis in 67 patients (132 hips) were used to identify reliable MR-imaging methods for measuring protrusio acetabulum and CEA that correlated strongly with established radiographic measurements. Protrusio acetabulum was determined using the radiographic criterion that the acetabular line projects medial to the ilioischial line by 3 mm or more in men and 6 mm or more in women. Pearson correlation factor was used to determine inter-observer variability and those methods that demonstrated the strongest correlation. The mean and standard deviation of MR-imaging and radiographic measurements for both the normal and protrusio hips were established. Several MR methods correlated strongly with radiographic measurements. The preferred method employed axial MR images at the level of the ischial spine with measurement of the distance between the medial most point of the acetabular fossa and a line perpendicular to the horizontal axis that passed through the lateral margin of the posterior inner pelvic wall. The Pearson's correlation factor between radiographic and MR measurements using this method was 0.84, and inter-observer correlation was 0.80. There were 126 hips in 63 patients (17 female and 44 male) that did not meet the radiographic criteria for protrusio acetabula. In this group of normal hips, the mean and standard deviation of radiographic measurements were 1.9 and 2.8 mm in male patients and -0.5 and 1.7 mm in female patients, and the mean and standard deviation for the preferred MR method was 1.3 and 2.5 mm in male patients and -0.8 and 1.9 mm in female patients. A total of six hips in four patients (two female and two male) met the radiographic criteria for protrusio acetabula. In this group of patients, the mean

  16. Fractures of the acetabulum

    Heeg, Minne


    Acetabulumfracturen zijn zeldzaam. Veelal betreft het patienten met meervoudig ernstige, soms levensbedreigende verwondingen. De ernst van deze verwondingen bepaalt de aard en omvang van de eerste hulp aan de patient. Na deze eerste opvang zal een behandelingsplan voor de acetabulumfractuur gemaakt

  17. 髋臼周围恶性骨肿瘤的切除与重建%Resection and reconstruction for malignant bone tumors involving the acetabulum

    邹昌业; 王晋; 黄纲; 尹军强; 谢显彪; 王永谦; 沈靖南


    Background:The location of the malignant tumors involving the acetabulum are comparatively deep, and they are usually very closed to some vital blood vessels, nerves and visceral organs, thus are very difficult to be resected. Methods to restore the continuity of pelvis and the function of acetabulum still need further improving. Objective: To investigate the methods and effects of the resection and reconstruction for malignant tumors involving the acetabulum. Methods:Retrospectively study 22 cases of resection and reconstruction for malignant bone tumors involving the acetabu-lum during January 2004 to December 2010. Analyze the survival of the patients, the recurrence and metastasis of the tu-mor, and the complications after the surgery, then evaluate the function of the patients via MSTS score system. Results:All the 22 patients were followed up for a mean period of 37.0 months (7.1 to 84.3 months). 15 patients gained a disease-free survival, 5 patients died of recurrence and metastasis of tumor, and 2 patients survived with the tumor. 7 pa-tients underwent local recurrence, which leads to a local recurrence rate of 31.82%. The mean interval from the operation to the local recurrence was 17.1 months (3 to 41.2 months). 4 patients had lung metastasis with an interval of 5.8 to 38.1 months after the operation, the mean interval was 16.6 months. The mean MSTS score detected six months after the opera-tion was 68.6%(32.5%-83.7%). Conclusions:Treat the malignant bone tumor involving the acetabulum with extensive resection and reconstruct the acetabu-lum with customized modular prostheses according to the degree of bone defects can achieve satisfactory curative effects and good function of the acetabulum .%  累及髋臼的恶性肿瘤由于位置较深,毗邻重要的血管神经和内脏器官,因而切除困难。切除后如何恢复骨盆连续性和髋臼功能的方法仍需完善。目的:探讨累及髋关节恶性肿瘤切除和重建的方法和

  18. Selection of acetabulum prosthesis in total hip revision procedures and repair effect of the acetabulum bone defect%全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的修复效果

    刘如月; 郝玉梅


    目的:探讨全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理效果。方法选择2010年1月至2014年1月需行全髋关节翻修术患者24例,术前依据初次手术类型及骨缺损情况制作髋臼及股骨骨床断层模型,根据断层模型选择植骨材料及髋臼假体,均采取全髋关节翻修术治疗,观察患者疗效。结果24例患者均完成手术,术后 Harris 评分均高于术前,差异有统计学意义(P <0.05)。24例患者平均随访36个月,术后脱位1例,经手法复位及下肢固定2周维持,骨溶解伴有髋疼痛3例,经非甾体类药物治疗后好转,未见深静脉血栓、切口感染等术后并发症。结论全髋关节翻修术中髋臼假体的选择应结合患者初次手术类型及骨缺损情况,髋臼骨缺损少则采取自体髂骨颗粒骨移植,缺损较多则采取同种异体颗粒骨加自体颗粒骨混合应用,可取得较佳效果。%Objective To explore the selection of acetabulum prosthesis on total hip revision procedures and the repair effect of the acetabulum bone defect. Methods 24 patients requiring total hip revision procedures were selected from January 2010 to January 2014,and made acetabulum and femoral bone bed fault model according to the first surgery and bone defect in preoperative,and selected aggre-gate and acetabulum prosthesis according to the fault model. All of the patients were given total hip revi-sion procedures,and the effects of them were observed. Results Twenty-four patients had completed surgery,the postoperative Harris scores was higher than that of preoperative,and the difference was significant( P < 0. 05). The 24 patients were followed for 36 months,and there was 1 case of post-operative patients with dislocation by manual reduction and limb immobilization 2 weeks without dis-location,3 cases with bone dissolve with hip pain,and they had made improvement after treatment with non-steroidal drugs. There

  19. Novel fixation method of a periprosthetic fracture of the acetabulum using burr holes through the retained cup for locking screw fixation.

    Browne, James A; Weiss, David B


    The incidence of periprosthetic fractures of the acetabulum associated with a total hip arthroplasty is relatively low but may be increasing. Treatment options depend upon the stability of the prosthesis. In this case, we report an unusual fracture pattern where a large portion of posterior column remained osseointegrated to a displaced uncemented acetabular component and removal of the cup would have resulted in massive structural bone loss and potential pelvic discontinuity. A metal cutting burr was used to create additional screw holes in the cup to allow us to retain the original implant and also obtain fixation of the fracture. The patient had a good outcome at one year with a healed fracture, stable implant, and excellent function. To our knowledge, this technique has not been previously described and offers surgeons an approach to fix these challenging fractures.

  20. 手术治疗C型髋臼骨折的研究分析%Surgical Treatment for Type C Acetabulum Fracture

    纪少军; 康锦; 高杰


    目的:探讨C型髋臼骨折严重粉碎骨软骨关节面的手术重建方法、可行性及疗效分析。方法:回顾总结2009年10月至2011年6月手术治疗严重髋臼粉碎性骨折23例23髋( AO分型均为C型),均为C型髋臼骨折;选择髂腹股沟及髋臼后侧( Kocher-langebeck )联合入路。术中先纠正稳定且累及范围较广的髋臼周边部位骨折块,基本使头臼关系恢复,再采用可吸收螺钉、植骨、骨软骨折块镶嵌挤压等重建粉碎严重的髋臼关节面(碎裂软骨下骨及未游离的关节软骨),后用骨盆重建接骨板整体固定髋臼骨折部。术后根据稳定程度酌情给予矫形鞋或皮牵引制动4-6周,后床上进行静力肌肉舒缩功能锻炼及关节被动功能锻炼,术后3月渐进下地活动。结果:随访12个月至36月,平均16.6月。对位质量采用Matta标准:解剖复位21髋,不满意1髋,差1髋。临床结果评分依照改良Mered, Aubigne-Postel(3):优21髋,良1髋,差1髋。术后股骨头坏死率(5.3%),异位骨化率(46.8%)。结论:首先通过复位髋关节外骨盆骨折及复位髋关节对位关系,其次借助可吸收螺钉、植骨、骨软骨折块间的镶嵌挤压等方法可完成C型髋臼骨折的重建,术后达到满意关节功能。%Objective:To study the surgery feasibility and curative effect of articular cartilage recon-struction in severe type C crushed fracture at acetabulum .Method: A retrospective analysis was conducted from the data of 23 cases operated for severe acetabulum comminuted fracture from October 2009 to June 2011, AO classification showed Type C fractures in all the 20 males and 3 females.Koaher-langenbeck and ilioinguinal approaches were adopted .A wide range of stable area surrounding the acetabulum fracture were removed at first , to recover the relationshipof head mortar positions .Absorbable screw fracture , bone graft , cartilages

  1. 髋臼中心定位器在髋臼标本解剖学测量中的应用及其临床意义%Anatomy analysis of cadaver acetabulum using acetabulum center locator

    徐陈; 周建生; 程鸿远; 官建中; 王志岩; 吴敏; 张斌斌; 肖玉周


    .Methods The specimens of pelvis (40 hips) from 20 normal adults were selected.The soft tissues of pelvis were peeled,and then get the labrum acetabulare,acetabular notch and Harris fossa.The center point of acetabulum was determined according to the intersection point of vertical diameter and horizontal diameter of acetabular bone.The distance between vertical diameter and horizontal diameter was recorded.The ACL was used to measure the distance between the midpoints of line connected with acetabular notches to the acetabular center (MAC).The data were analyzed by using statistic analysis software.Results The vertical line and horizontal line were 45.50-55.60 mm,44.50-52.54 mm.MAC was 26.60-33.82 mm,the average value of MAC was 30.87 mm.The acetabular center near the head round Harris fossa was closed to the acetabular articular surface.The scatter diagram was drawn according to the data of MAC with each of vertical line,horizontal line and the sum of vertical line and horizontal line.There was correlation between MAC and vertical diameter,horizontal diameter and the sum of vertical diameter and horizontal diameter.The Pearson coefficients (r) were 0.89,0.81 and 0.91,respectively.The variables coefficient between MAC and the sum of vertical diameter and horizontal diameter were more close to 1 according to the pearson linear analysis,compare with MAC and vertical diameter,MAC and horizontal diameter.There were more significant linear positive correlation between MAC and the sum of vertical diameter and horizontal diameter.Conclusions The Pearson linear analysis suggest an obvious linear positive correlation between MAC and the sum of acetabular horizontal line and the vertical line,which means the value of the MAC can be obtained by measuring the distance between acetabular horizontal diameter and vertical diameter.Thus the acetabular center locator can be used in THA and revision to get positioning center of acetabular rapidly and accurately.This is a practical method for

  2. 髋臼隐匿性骨折CT与X线平片检查诊断率对比分析%Comparative Analysis of CT and X-ray Diagnosis Rate of Occult Acetabulum Fracture



    Objective To investigate the appropriate diagnostic imaging method for evaluating occult acetabulum fracture in order to improve the diagnostic accuracy. Methods Retrospective analysis of 48 patients with occult acetabulum fracture was undertaken by X-ray and CT scans. We evaluated the detection rate of occult acetabulum fracture between CT and X-ray. Results According to Letournel Classification, there were 16 cases of anterior wall, 14 cases of posterior wall, 8 cases of anterior column and 10 cases of posterior column fractures. 28 (58.3% ) patients were suspected as having fracture line on the X -ray film. On the contrary, 48 (100.0% ) patients demonstrated occult acetabulum fracture line on CT. Conclusion CT has higher sensitivity than X-ray in detecting occult acetabulum fracture. Compared with X-ray, CT scanning allows a more precise determination of the degree of occult acetabulum fracture involvement and therefore is helpful in the planning of orthopedic surgery.%目的 探讨髋臼隐匿性骨折适宜的影像学诊断方法,提高其诊断准确性.方法 回顾性分析48例髋臼隐匿性骨折CT与X线平片影像学资料,评价CT与X线平片检查对髋臼隐匿性骨折的诊断率.结果 本组48例按Letournel分类,骨折位于髋臼前壁16例、后壁14例、前柱8例、后柱10例.CT检查诊断髋臼隐匿性骨折48例,诊断率100.0%;X线平片检查疑有髋臼隐匿性骨折28例,诊断率58.3%.结论 CT检查对髋臼隐匿性骨折的诊断率明显高于X线平片检查,X线平片检查可作为髋臼隐匿性骨折的初筛方法,CT检查则可为髋臼隐匿性骨折及其伴随损伤提供更准确的诊断信息.

  3. Operative treatment for transverse plus posterior wall fractures of the acetabulum%髋臼横断伴后壁骨折的手术治疗

    张永林; 何久盛; 朱仕文


    目的 总结髋臼横断伴后壁骨折手术治疗的临床疗效.方法 1993年8月- 2005年1月北京市顺义区院骨科手术治疗有明显移位的髋臼横断伴后壁骨折45例46髋,获得完整随访.影像学结果采取Matta放射学标准进行评价,临床效果采取改良的Merle d'Aubigné和Postel评分系统进行评价.结果 45例患者均获随访,随访时间16 ~48个月,平均34个月,复查X线片显示骨折均获愈合,愈合时间3~5个月.根据Matta的X线片评估标准:优17髋,良18髋,中7髋,差4髋;优良率76%.根据改良的Merle d' Aubigné和Postel评分系统对临床结果评估:优14髋,良22髋,中8髋,差2髋;优良率78.3%.结论 髋臼横断伴后壁骨折行手术治疗可以取得满意疗效,选择合适的手术时机、合理的手术入路、骨折解剖复位、坚强内固定是取得满意疗效的关键.%Objective To evaluate the results of patients operatively treated transverse plus posterior wall fractures of the acetabulum.Methods Review forty-five patients who had operated for transverse plus posterior wall fractures of the acetabulum 1 retrospectively with fracture displacement,from August 1993 to January 2005 in Department of Orthopaedics,Beijing Shunyi Hospital.The radiographs were graded according to the criteria described by Matta.The functional outcome was evaluated using a modification of the clinical grading system developed by Merle d'Aubigné and Postel.Result Forty-five patients were followed up 16 to 48 months with an average of 34 months.The radiographic result was excellent in seventeen patients,good in eighteen,fair in seven,and poor in four.The clinical outcome at the time of final follow- up was graded as excellent in fourteen patients,good in twenty- two,fair in eight,and poor in two.Conclusion Operative treatment for transverse plus posterior wall fractures of the acetabulum has a satisfying therapeutic effect.The appropriate operation time,reasonable operation approach

  4. Application EPSTR Technique in Acetabulum Posterior Wall Fracture Fixation%EPSTR技术在髋臼后壁骨折固定中的应用

    张功林; 甄平; 陈克明; 安勇; 朱雄; 赵来绪; 杨军林; 周建华


    目的:报告EPSTR技术在髋臼后壁骨折固定中的临床应用结果。方法自2006年1月至2011年1月,对46例髋臼后壁骨折患者行内固定后应用EPSTR技术修复髋关节后侧软组织,其中男36例,女10例;年龄25~55岁,平均42.5岁,伤后手术时间2~7 d,平均5 d。髋关节后侧软组织采用“T”形切开,行髋臼内固定后,关节囊和外旋短肌作为一层再次附着到大粗隆。结果术后随访2.5~6.0年,平均4.5年。随访期间没有发生髋关节脱位和股骨头缺血性坏死,有2例发生骨关节炎,没有出现与本项技术相关的并发症。按Harris评定标准进行疗效评定,优良率为93.5%,取得了满意的效果。结论髋臼后壁骨折固定后采用EPSTR技术,有利于术后功能恢复和加强髋关节稳定性。%Objective To report clinical results of application EPSTR technique after the acetabulum posterior wall frac-ture fixation. Methods From January 2006 to January 2011,46 patients(36 men,10 women)after acetabulum posterior wall fracture fixation underwent posterior soft tissue repair of the hip joint. They ranged in age from 25 to 55 years( mean 42. 5 yeras). Operative time after injury was 3 to 9 days( mean 7 days). Posterior soft tissue of the hip joint was opened through a T-shaped incision. The posterior capsule and short external rotators was attached to the greater trochanter. Results Follow-up period ranged from 2. 5 to 6 years( mean,4. 5 years)postoperatively. There were no dislocation of the hip joint and avascular necrosis of the femoral head in this series. Two patients had osteoarthritis. No apparent complications related to the technique. The recovery rate was accessed with Harris scores. The rates of excellent and good were 93%. Satisfactory clinical results were obtained in this series. Conclusion The acetabulum posterior wall fracture fixation used EPSTR technique help the postopera-tive functional recovery and strengthen

  5. 手术治疗髋臼骨折的临床疗效%Clinical curative effect observation on surgical treatment of acetabulum fracture

    张发平; 李玉桥; 罗仕武; 何罗彬; 杨勇; 尚庆; 胡晓刚


    目的:探讨手术治疗髋臼骨折的临床疗效,并对相关因素进行分析。方法分别采用K-L入路、髂腹股沟入路、前后联合入路行切开复位骨盆重建钢板、螺钉内固定治疗48例髋臼骨折患者。结果术后按Matta影像学评分,解剖复位28例,满意复位14例,不满意复位6例。患者均获随访,时间12~58个月。按改良的Merle d’Aubigné和Postel评分标准:优28例,良9例,可7例,差4例。简单骨折和复合骨折临床优良率分别为94.4%和66.7%,解剖复位和非解剖复位的临床优良率分别为96.4%和50%,差异均有统计学意义( P<0.05)。结论手术治疗髋臼骨折可获得满意的疗效,骨折的复位质量、骨折类型与疗效密切相关。%Objective To investigate the clinical curative effect of surgical treatment of acetabulum fracture, and to analysis the related factors. Methods A total of 48 patients with fracture of acetabulum were treated with Kocher-Langenbeck approach, iliac inguinal approach, joint into the road line before and after pelvic reconstruction plate ( ORIF) and screw internal fixation. Results According to the Matta imaging score, 28 cases got anatomical reat-tachment, 14 satisfactory reattachment, and 6 poor reattachment. All the patients received a follow-up from 12 to 58 months. According to the improved Merle d’Aubigné and Postel rating standards, 28 cases were excellent, 9 good,7 fair, and 4 poor. Simple fractures clinical excellent-good rate was 94. 4% and composite fractures clinical excellent-good rate was 66. 7%, anatomy reset and non anatomy reset of clinical excellent-good rate were 96. 4% and 50% re-spectively, these difference comparison had statistical significance ( P<0. 05 ) . Conclusions Surgical treatment of acetabulum fracture can obtain satisfactory curative effect, the quality of fracture reduction and fracture type are close-ly related with curative effect.

  6. 活血灵在髋臼骨折围手术期的应用%Application of Huoxueling Decoction on Patients in Perioperative Period of Acetabulum Fracture

    汤金城; 谭旭仪; 成传德; 高书图


    目的:总结活血灵在髋臼骨折围手术期的应用效果。方法:75例髋臼骨折患者按时间分为观察组38例和对照组37例,对照组在围手术期间给以常规处理,观察组在对照组基础上结合活血灵口服,观察两组术后2周血液流变学指标,统计深静脉血栓发生情况。结果:观察组在术后14 d血液流变学指标与对照组比较,差异有统计学意义(P<0.05)。同时,观察组术后14 d时D-二聚体为(2.57±0.51)mg/L,较术前(4.26±1.72)mg/L比较,差异有统计学意义(P<0.05),且观察组术后14 d时D-二聚体、下肢深静脉血栓较对照组减少(P<0.05)。结论:髋臼骨折围手术期应用活血灵,能有效改善术后血液流变学和D-二聚体指标,减少下肢深静脉血栓的发生。%Objective To observe the therapeutic effects of Huoxueling decoction on patients in periopera⁃tive period of acetabulum fracture. Methods Seventy-five acetabulum fracture patients were randomly divid⁃ed into the observation group(38 patients) and the control group(37 patients);the control group attended symptom⁃atic treatment during perioperative period,while the observation group had Huoxueling decoction, then the wound drainage, hemorheology indexes,D-dimmer, and lower extremity deep venous thrombosis of both groups were ob⁃served. Results Compared with the preoperative conditions,the hemorheology indexes of observation group on the 14 d postoperative was lower(P<0.05). Meanwhile,the D-dimmer of observation group was declined from (4.26 ± 1.72) mg/L preoperatively to (2.57 ± 0.51) mg/L on 14 d postoperatively,the difference was statistically significant (P<0.05). In addition,the D-dimmer,lower extremity deep venous thrombosis of observation group on the 14 d was lower than that of control group (P<0.05). Conclusion The application of Huoxueling de⁃coction on patients in perioperative period of acetabulum fracture can effectively

  7. Treatment of Ischemic Necrosis of Femeral Head by Acetabulum Extension in Children%髋臼延伸术治疗儿童股骨头缺血性坏死

    王雅芹; 马承宣; 房论光


    Acetabulum extension procedures were performed on 20 cases of ischemic necrosis of femerai head.Among them,2 were classified as stage Ⅱ and 18 as stage Ⅲ or Ⅳ.Follow-up ranged from 8 months to 4 years.18 revealed excellent results and 2 good.This procedure improves the spherity of the femeral head and the congruency between femeral head and acetabulum.The late degenerative osteoarthritis would be avoided.Of course,the leg length discrepency and increase of the pressure against femeral head resulted from innominate osteotomy won't happen in acetabulum extension procedure.%报道髋臼延伸术治疗儿童股骨头缺血性坏死20例,Ⅱ期2例,Ⅲ~Ⅳ期18例.随访时间最短8个月,最长4年.疗效优者18例,良2例.本手术能明显改善股骨头骨骺的高度、弧度、直径,保证股骨头与髋臼的相容性塑造,防止退变性关节炎的发生,同时克服了髂骨截骨等造成肢体短缩以及股骨头承受压力增大的不足.

  8. Estudo prospectivo de 76 casos de fratura do acetábulo tratados cirurgicamente Prospective study on seventy-six cases of fractured acetabulum with surgical treatment

    André Gaudêncio Ignácio de Almeida


    Full Text Available OBJETIVO: Fazer estudo prospectivo sobre fratura instável e incongruente do acetábulo, comparativo com a literatura, abordando o tipo de acesso, material de fixação, grau de redução, tipo de fratura e seus resultados após cirurgia. MÉTODOS: Os autores avaliaram 76 pacientes com fratura instável e incongruente do acetábulo entre janeiro de 1999 e dezembro de 2009. A classificação utilizada foi a de Marvin Tile e todos foram tratados cirurgicamente segundo a técnica preconizada pelo grupo AO-ASIF. RESULTADOS: A avaliação radiológica foi feita segundo os critérios de Ruesch; foram obtidos resultados bons, ótimos e perfeitos em 64 pacientes (84,2%. Quanto à avaliação clínica, segundo os critérios de Harris, os resultados foram bons e ótimos em 62 pacientes (81,6%. As complicações foram avaliadas e, quando comparadas com a literatura, mostraram-se compatíveis mesmo após a análise estatística. CONCLUSÃO: Os autores concluem que a redução anatômica e a fixação estável são importantes para um bom resultado.OBJECTIVE: To conduct a prospective study on unstable and incongruent fractures of the acetabulum, in comparison with the literature, covering the type of access, fixation materials, degree of reduction, type of fracture and results after surgery. METHODS: The authors evaluated 76 patients with unstable and incongruent fracture of the acetabulum between January 1999 and December 2009. The Marvin Tile classification was used, and all cases were treated surgically using the technique recommended by the AO-ASIF group. RESULTS: The radiological evaluation was done in accordance with the Ruesch criteria, and good, excellent or perfect results were obtained for 64 patients (84.2%. The clinical evaluation was done in accordance with the Harris criteria, and good or excellent results were obtained for 62 patients (81.6%. The complications were assessed and, in comparison with the literature, were shown to be compatible

  9. The treatment of bone tumour around the acetabulum by semi-pelvic prosthesis made in China%国产人工半骨盆假体置换治疗髋臼周围骨肿瘤

    张敬东; 祖启明; 刘贵堂; 韩文锋; 孙蕊; 项良碧


    BACKGROUND: The treatment of bone tumour around the acetabulum is a challenge of orthopedics, but the limb-sparing surgeries of bone tumour around the acetabulum become the main trend along with the development of the diagnosis techniques and the application of neoadjuvant chemotherapy and the establishment of the tumour excision principle.OBJECTIVE: To analyze the treatment effect semi-pelvic prosthesis made in China on bone tumour around the acetabulum.METHODS: From 2001 to 2010, 19 patients with bone tumour around the acetabulum were enrolled and six patients were cured by removing the tumour and assembling the semi-pelvic prosthesis made in China. All the patients were followed-up for 6-72months (mean 50 months).RESULTS AND CONCLUSION: According to Enneking criteria, four cases were rated as good, two cases as fair. There was a good effect of semi-pelvic prosthesis made in China on the treatment of bone tumour around the acetabulum when the indications of resection and reconstruction of pelvic tumour were selected strictly.%背景 髋臼周围骨肿瘤的治疗对骨科医生来说是一种挑战,但随着诊断技术的提高、新辅助化疗方案的应用以及肿瘤切除原则的确立,保肢手术成为一种趋势.目的 分析应用国产人工半骨盆假体治疗髋臼周围骨肿瘤的效果.方法 2001/2010 共收治19 例髋臼周围骨肿瘤病人,其中6 例行国产半骨盆人工假体置换,术后随访6~72 个月(平均50个月).结果与结论 按Enneking 方法评估疗效,良4 例,一般2 例.提示只要严格掌握骨盆肿瘤切除重建的手术适应证,应用国产人工半骨盆假体治疗髋臼周围骨肿瘤具有较好的疗效.

  10. Modified ilioinguinal approach for anterior wall fractures of the acetabulum%改良髂腹股沟入路治疗髋臼前壁骨折

    陈戈; 欧艺; 陈仲; 赵航; 李欣


    目的 探讨改良髂腹股沟入路治疗髋臼前壁骨折的疗效. 方法 回顾性分析2004年2月至2011年2月采用手术治疗的12例髋臼骨折患者资料,男10例,女2例;年龄为26 ~60岁,平均33.5岁.髋臼骨折按Letournel分型均为前壁骨折.受伤至手术时间为1~15d,平均5.4d.手术均采用改良髂腹股沟入路,6例患者前壁骨折块较大,采用拉力螺钉结合重建钢板固定;另6例患者前壁骨折粉碎,且其中4例伴有压缩,首先对压缩骨折进行撬拨复位,撬起后残存的缺损区取髂骨填充,然后采用拉力螺钉加弹性钢板结合重建钢板固定.末次随访时采用改良的Merle d'Aubigné和Postel评分系统评定疗效. 结果 本组患者手术时间平均为100 min,术中出血量平均为350mL.12例患者术后获平均1.8年(1~5年)随访.术后骨折复位质量采用改良的Matta评分标准评定:优9例,良3例.骨折愈合时间平均为15周(11~18周).末次随访时根据改良的Merle d' Aubigné和Postel评分系统评定疗效:优8例,良3例,可1例.1例患者出现异位骨化,Brooker分级为Ⅰ级.1例患者术后3年出现创伤性关节炎.无切口感染、内固定物松动、断裂及血管、神经损伤等并发症发生. 结论 改良髂腹股沟入路能较好地显露髋关节前上方结构,直视下复位髋关节前上方骨折,治疗粉碎、压缩的髋臼前壁骨折效果良好.%Objective To evaluate the modified ilioinguinal approach in the treatment of anterior acetabulum wall fractures.Methods From February 2004 to February 2011,12 patients with comminuted acetabular fracture were treated with modified ilioinguinal approach.They were 10 men and 2 women,26 to 60 years of age (mean,33.5 years).All the fractures were anterior acetabulum wall ones according to Letournel classification.The time from injury to surgery ranged from 1 to 15 days (mean,5.4 days).All the operations were conducted via the modified ilioinguinal approach.In 6 patients

  11. [Scientific Assessment of 350 Failed Metasul-LDH® Hip Prostheses with DUROM® Acetabulum Component with Probable Conus Insufficiency, Implanted in a Single Centre During 2003 to 2008].

    Brauers, D; Rütschi, M; Pagenstert, G


    Introduction: The revision rates were high for patients with Metasul-LDH® hip prosthesis (LDH = large-diameter head) with DUROM® acetabulum components implanted in a single centre between 2003 and 2008. This suggested that there was a system-related weakness in total hip replacements with large diameter heads. It was suspected that the tapered connection between head and stem was responsible for the implantation failure. This led to a scientific reappraisal of the unsuccessful hip prostheses, in order to clarify whether there was a tribological problem or a cone failure. Method: To this end, data on serum metal concentrations, types of prosthesis and stem alloys were collected and analysed for the 315 patients with 350 DUROM®-LDH-HTP. Results: There were significant differences between blood metal concentrations in patients with different types of stem. For patients with titanium stems, there were more serious affects on bone substance surrounding the affected joint, and significantly higher serum cobalt concentrations. Conclusion: It was concluded that the problem did not lie with the tribology of the sliding surfaces, but with the cone-stem connection.

  12. Anatomic Study of Safe Zone for Screw Insertion Around the Acetabulum in Modified Stoppa Approach%改良Stoppa入路中髋臼周围螺钉安全区的解剖学研究

    王朝晖; 刘华武; 何波涌; 刘小龙; 熊波


    目的:通过测量改良Stoppa入路沿真骨盆缘钢板螺钉固定骨盆髋臼骨折时髋臼周围螺钉安全区,为安全置入螺钉提供解剖学依据。方法:24例成人干燥髋骨标本,平行真骨盆缘下移重建钢板宽度一半垂直真骨盆内表面完成截骨,再在白纸上拓印出髋骨的横切面,以髂耻隆起为基准作图分析、测量髋臼周围螺钉安全区、相对安全区和危险区。结果:髂耻隆起内侧(9.66±8.28)mm与外侧(12.58±7.94)mm之间区域为髋臼周围螺钉置入危险区,置入螺钉会穿入髋臼。髂耻隆起外侧(12.58±7.94)~(21.09±6.09)mm ,内侧(9.66±8.28)~(16.53±6.57)mm之间区域为髋臼周围螺钉置入相对安全区,以最大偏转角远离髋臼置入螺钉不会穿入髋臼。髂耻隆起外侧>(21.09±6.09)mm和内侧>(16.53±6.57)mm的区域为髋臼周围螺钉置入的安全区,垂直钢板或远离髋臼置入螺钉不会穿入髋臼。髋臼周围螺钉安全置入的最长长度为外侧(38.35±6.09)m m ,内侧(25.28±3.60)m m。左右侧比较无统计学差异。结论:改良Stoppa入路沿真骨盆缘钢板螺钉固定可以髂耻隆起为标志指导髋臼周围螺钉安全置入,应避开危险区,可在安全区和相对安全区内置入,建议首选安全区。%Objective :To study the safe zone for screw around the acetabulum in modified Stoppa approach for treating pelvic and acetabular fractures with plate and screws along pelvic brim ,and afford anatomical data for inserting screw around the acetabulum safely .Methods :24 dry human adult innominate bones were seen open vertically to the inner sur-face along the line parallel and inferior to the pelvic brim about half width of the reconstruction plate .Then copied the boundary of the transection of the acetabulum on the white paper and measured the safe zone ,relatively safe zone and danger

  13. Shape variability of the adult human acetabulum and acetabular fossa related to sex and age by geometric morphometrics. Implications for adult age estimation.

    San-Millán, Marta; Rissech, Carme; Turbón, Daniel


    This study aims to explore shape variability of the acetabulum during the human adult life span, in relation to sex and age. The human acetabular shape was analysed in 682 os coxae from three different documented skeletal collections from the Iberian Peninsula. Two landmarks and thirty-two sliding semi-landmarks were used for the geometric morphometric procedures and a clock-wise standard was used for orientation. The 180° meridian (6:00) line was positioned over the midpoint of the acetabular notch and 36 reference points in 10° increments along the rim were marked. Data showed that size, sex and age significantly influence acetabular shape variation. Sex differences were significant in individuals younger than 65 years old and were characterised by males exhibiting relatively extended acetabular rim profiles from 10:00 to 1:00, narrower acetabular notches, and reduced acetabular fossae. In addition, three main age-related changes occurred to the acetabular shape in both sexes: outer acetabular profile modification, with extension from 10:00 to 1:00 and reduction from 7:00 to 9:00, acetabular notch narrowing, and acetabular fossa reduction. The age-related changes that were observed are shared by both sexes and seem to be related to bone production associated with age. Specifically, age appears to affect the entire border of the lunate surface: the acetabular rim, both acetabular horns, and the outer edge of the acetabular fossa. Furthermore, shape data confirmed the clover-leaf shape of the acetabular fossa in both males and females. These results improve our understanding of acetabular shape, and assist in refining age-estimation methods and enhancing hip surgery and rehabilitation.

  14. Complications following operative treatment of acetabulum fracture: a meta-analysis%髋臼骨折术后并发症的荟萃分析

    周钢; 陈鸿奋; 王富民; 赵辉; 王钢


    目的 总结髋臼骨折术后并发症的发生率,探讨相应的防治措施. 方法 计算机检索Medline、Embase、中国生物医学文献数据库、万方数据库和中国知网等,检索文献发表时间为2001年1月至2013年3月,获取髋臼骨折术后并发症发生率的相关文献.通过R软件Meta软件包中的Meta prop函数进行统计分析,记录髋臼骨折术后常见并发症的发生率. 结果 共纳入41篇文献,其中前瞻性研究9篇,回顾性分析32篇.常见并发症包括异位骨化、骨关节炎、股骨头坏死、医源性神经损伤、感染和深静脉血栓形成,其发生率分别为20.1% [95% CI(14.6%,26.2%)]、15.2% [95% CI(11.8%,19.0%)]、5.6%[95%CI(4.6%,6.7%)]、5.1%[95%CI(3.3%,7.2%)]、3.3%[95% CI(2.2%,4.7%)]和1.4% [95% CI(0.4%,2.9%)].未使用消炎痛预防组与使用消炎痛预防组异位骨化发生率分别为21.1% [95% CI(12.6%,31.0%)]、19.6% [95% CI(12.6%,27.6%)],两组比较差异无统计学意义(P=0.793). 结论 异位骨化、骨关节炎、股骨头坏死及医源性神经损伤等髋臼骨折术后常见并发症的发生率较高,对患者预后影响显著,围手术期需积极采取预防措施以降低手术风险.%Objective To have a clear understanding of the complications following the operative treatment of acetabulum fracture through a meta-analysis.Methods A comprehensive search was conducted for all articles addressing the postoperative complications of acetabulum fracture published in English and Chinese from January 2001 to March 2013.A proportion meta-analysis across the studies was performed for the complications after acetabular operation with the use of R software.Results Forty one studies,9 prospective and 32 retrospective ones,were identified.The common complications included heterotopic ossification,osteoarthritis,avascular necrosis,iatrogenic nerve injury,infection and deep venous thrombosis

  15. The Analysis of the Clinical Outcome of the complicated Acetabulum fracture after Operation%复杂型髋臼骨折的临床疗效分析



    Objective: To investigate the clinical outcome of the complicated acetabulum fracture that had been treated by open reduction and internal fixation with reconstruction plate. Methods: twenty eight patients who had had open reduction and internal fixation with reconstruction plate for unstable complicated fracture of the acetabulum were studied. All the patients were followed up at a mean of 2.8 years(two to seven years). The functional outcome was evaluated with the clinical grading system adopted by Letourmel and Judet. Patients, fracture and radiographic variables were analyzed to identify associations with functional outcome. Results: The reduction of the fracture, as determined with plain radiography, was graded as anatomic in eighteen and as imperfect in one. The clinic outcome at the time of final follow-up was graded as excellent in fourteen patients, very good in twelve, good in one and poor in one. The radiographic result was excellent in thirteen patients , good in thirteen, fair in one and poor in one. There were significant association between the clinical outcome and the final radiographic grade. Variables identified as risk factors for clinical results included a delay of greater than twenty four hours before reduction of an associated hip dislocation, an age of sixty years or older at the time of injury, intra-articular comminution and osteonecrosis. Conclusions: The uncomplicated radiographic appearance and operative approach for fractures of the acetabulum belie the risk of poor results. Prompt reduction of an associated hip dislocation is imperative. Fractures in elderly patients and those with extensive comminution are more likely to have a poor clinical result. However, a high likelihood of a long term good to excellent result can be expected following anatomic reduction and internal fixation of these fractures.%目的 探讨切开复位重建钢板内固定治疗复杂型髋臼骨折的临床疗效.方法 28例切开复位内固定治疗的

  16. Clinical effect of operative treatment of acetabulum fractures through subinguinal approach%经髂腹股沟下入路治疗髋臼骨折32例疗效观察

    彭朝华; 杨军; 杨彬


    Objective To investigate the clinical effect of operative treatment of acetabulum fractures through subinguinal approach.Methods During the period from May 2007 to June 2011,32 cases with acetabulum fracture underwent surgical treatment through subinguinal approach while 27 cases through classic ilioinguinal approach.Surgical time,blood loss,fracture reduction and functional recovery were compared between the two approaches.Results The differences between the two groups were all statistically significant (P < 0.05).Conclusions The subinguinal approach is a good surgical approach for operational treatment of anterior acetabulum fractures.%目的 探讨经髂腹股沟下入路治疗髋臼骨折的临床疗效.方法 59例髋臼骨折患者按照随机数字表法分为两组,分别经髂腹股沟下入路及传统髂腹股沟入路进行手术治疗,比较两组患者手术时间、出血量、骨折复位、功能恢复情况.结果 两组各项观察指标比较,差异均有统计学意义(P<0.05).结论 髂腹股沟下入路是一种较好的髋臼前方手术入路,具有解剖结构简单、出血少,显露充分、复位质量高,临床效果满意等特点.

  17. A 24-year follow-up of a patient with giant cell tumor of bone in the acetabulum%髋臼骨巨细胞瘤随访24年

    周玉林; 祝天经; 徐萌; 陈湘


    @@ 临床资料 女性,45岁.1988年因左髋痛和跛行,照片发现左髋臼部骨质破坏约4cm×7cm,拟诊为骨巨细胞瘤(图1).1989年分2次行骨肿瘤刮除、骨胶填塞术.术中取组织活检确诊为左髋臼部骨巨细胞瘤(II级).术后疼痛消失,可弃拐跛行.%To report 1 case with giant cell tumor of bone in the acetabulum. The patient underwent subtotal hemipelvectomy, artificial hemipelvic displacement and Total hip armroplasty, on which basis autogenous bone grafting and biotic pelvic ring annuloplasty were applied to acliieve limb salvage and treat giant cell tumor of bone in the acetabulum, which belonged to the combination treatment of mechanical fixation and biotic fixation. In long-term follow-up, the feasibility and superiority of this method were observed

  18. Bernese Periacetabular Osteotomy in a Hip Extra-Articular Resection Followed by Reconstruction Using an Extracorporeal Irradiated Acetabulum Autograft with Megaprosthesis, for Proximal Femur Osteosarcoma in a Pediatric Patient

    Victor Barro


    Full Text Available Osteosarcoma is the most common primary malignant tumour of bone. The oncologic surgery of a proximal femur osteosarcoma affecting the hip joint can be very challenging. We present an 8-year-old boy with a 5-month history of right hip pain. Radiographs and magnetic resonance imaging (MRI showed a lytic lesion of the proximal femur extending 13 cm to the diaphysis. Histological evaluation was consistent with high-grade osteoblastic osteosarcoma. After completing chemotherapy we performed an extra-articular resection of the hip. Reconstruction was accomplished by reimplanting the acetabulum after irradiation and modular proximal femur megaprosthesis. Endoprosthetic reconstruction following proximal femur resection is a good treatment alternative achieving good postoperative function. Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability. Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority. We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

  19. Bernese Periacetabular Osteotomy in a Hip Extra-Articular Resection Followed by Reconstruction Using an Extracorporeal Irradiated Acetabulum Autograft with Megaprosthesis, for Proximal Femur Osteosarcoma in a Pediatric Patient.

    Barro, Victor; Velez, Roberto; Pacha, Daniel; Giralt, Jordi; Roca, Isabel; Aguirre, Marius


    Osteosarcoma is the most common primary malignant tumour of bone. The oncologic surgery of a proximal femur osteosarcoma affecting the hip joint can be very challenging. We present an 8-year-old boy with a 5-month history of right hip pain. Radiographs and magnetic resonance imaging (MRI) showed a lytic lesion of the proximal femur extending 13 cm to the diaphysis. Histological evaluation was consistent with high-grade osteoblastic osteosarcoma. After completing chemotherapy we performed an extra-articular resection of the hip. Reconstruction was accomplished by reimplanting the acetabulum after irradiation and modular proximal femur megaprosthesis. Endoprosthetic reconstruction following proximal femur resection is a good treatment alternative achieving good postoperative function. Extra-articular resection of the hip using a periacetabular osteotomy technique enabled us to achieve wide margins and leave an intact posterior column to optimize acetabular reconstruction stability. Extracorporeal irradiation and reimplantation is a valuable treatment option in a situation such as this where allograft geometric fit is a priority. We conclude that an extra-articular resection of the hip, followed by reconstruction with an extracorporeally irradiated acetabulum and a proximal femur modular megaprosthesis, is a useful combined treatment option for malignant lesions involving the hip joint, especially in paediatric patients.

  20. 桥接钢板技术治疗不稳定性髋臼骨折临床效果分析%Clinical effect analysis of bridging plate fixation in treatment of unstable acetabulum fractures

    沈影超; 王强; 顾云峰; 蒋晓伟


    Objective To observe the clinical effect of bridging plate fixation for the treatment of unstable acetabulum fractures. Methods The data of 12 patients with unstable acetabulum fracture who were treated by bridging plate fixation in our hospital from March 2014 to March 2015 were retrospectively analyzed.According to the OTA/AO type,8 cases were type B fracture,4 cases were type C fracture. Five patients were treated by ilioinguinal approach,4 patients recieved Stoppa approach.Through follow-up,the acetabulum fracture was eval-uated according to Matta evaluation standards,and the results was observed.Results All of 12 cases were followed up from 12 months to 16 months,with the average time of (14.1 ±2.2)months.The imaging showed that the postoperative femoral head-acetabulum matching was good,and there was no reset lost in a year.According to Matta evaluation standards,10 cases was excellent,1 case was good,1 case was in general.Conclusion The clinical curative effect of bridging plate fixation for instability of acetabulum fracture is excellent.Different approa-ches can not influence the way of functional recovery,but the time of the operation through Stoppa approach is shorter.%目的:观察桥接钢板技术治疗不稳定性髋臼骨折的临床疗效。方法回顾性分析2014年3月至2015年3月应用桥接钢板技术治疗的12例不稳定性髋臼骨折患者的临床资料,根据OTA/AO分型B型骨折8例,C型骨折4例;手术方式采用髂腹股沟入路5例,Stoppa入路4例。通过随访,Matta按髋臼骨折四级评定标准评分,并对上述结果进行评价。结果12例患者均获得随访,随访时间12~16个月,平均(14.1±2.2)个月。影像学显示术后股骨头-髋臼匹配良好,至术后1年无复位丢失。Matta髋臼骨折四级评定标准疗效,优10例,良1例,可1例。结论桥接钢板技术治疗不稳定性髋臼骨折的临床疗效优异;不同手术入路对功能恢复无影

  1. 真骨盆缘完整的髋臼高位前柱骨折的治疗%The characteristic and treatment of high anterior column fracture of acetabulum with intact true pelvic brim

    谭国庆; 周东生; 王伯珉; 何吉亮; 傅佰圣


    Objective To investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim.Methods From January 2006 to January 2010,12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified.There were 9 males and 3 females,with the average of 35.6 years (range,29-46).The injury was caused by crush in 7 cases,smash of heavy object in 3 cases,and fall-down from height in 2 cases.These fractures were classified into three types:isolated high anterior column fracture of acetabulum without involvement of true pelvic brim,high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture.Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approaches.One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach.Results The mean follow-up time of all patients was 26.7 months (range,14-37months).The quality of reduction was grade as anatomical in 8 patients,imperfect in 3,poor in 1 by Matta's score system.The fracture union was uneventful.There was nonunion and loss of internal fixation.At the final follow-up,the mean score was 16.8 (range,11-18),7 cases were graded as excellent,4 good,1 fair,according to modified Merle d'Aubigne and Postel score system.Heterotopic ossification and

  2. 全髋关节置换术中髋臼横韧带对髋臼假体前倾定位的作用%Total Hip Arthroplasty in the Transverse Ligament of Acetabulum Anteversion Positioning Function

    张宏宇; 辜念样


    Objective:Investigate the surgery in total hip arthroplasty acetabular transverse ligament of acetabulum anteversion positioning reference, for clinical reference. Methods:Choose 67 cases of total hip arthroplasty in our hospital as the research object, transverse acetabular ligament acetabulum anteversion positioning as the anatomical reference, after a follow-up of 12 months, observed postoperative healing, complication rate, measurement of acetabular anteversion angle, and with comparison of normal value. Results:All the patients achieved primary healing of incision, I stage healing rate was 100.00%;no patient of incision infection, dislocation of the hip and other complications, the complication rate was 0.00%. The postoperative acetabular anteversion angle was (15.20±3.96)°, with normal anteversion angle, there was no statistical difference (P>0.05). Conclusion:In total hip arthroplasty in the transverse acetabular ligament acetabulum anteversion positioning as the anatomical reference ideal.%目的:探讨在全髋关节置换术中髋臼横韧带对髋臼假体前倾定位的参照作用,以供临床参考。方法:以我院接受全髋关节置换术的患者67例为研究对象,术中将髋臼横韧带作为髋臼假体前倾定位的解剖参照物,术后随访12个月,观察患者术后愈合情况、并发症发生率,测量髋臼假体前倾角度,并与正常值进行比较。结果:所有患者切口均达到Ⅰ期愈合效果,Ⅰ期愈合率为100.00%;术后未发生一例切口感染、髋关节脱位等并发症,并发症发生率为0.00%。术后髋臼假体前倾角度为(15.20±3.96)°,与正常前倾角度比较,无统计学差异(P>0.05)。结论:将髋臼横韧带作为全髋关节置换术中髋臼假体前倾定位的解剖参照物效果较为理想。

  3. Application of 3D Printing Technology in the Acetabulum Fracture Intraoperative and Postoperative Rehabilitation%3 D打印技术在髋臼骨折术中及术后康复中的应用



    目的:分析3 D打印技术应用在髋臼骨折手术和康复中的临床方法和效果。方法选取我院收治的髋臼骨折患者,应用3 D技术将患者的骨盆模型仿真出来,按照模型对钢板螺钉位置、进入途径以及螺钉长度进行设计测量等模拟手术,参照模拟手术情况给予患者行复位手术,并在术后给予康复锻炼,分析术后效果。结果手术圆满成功,且手术时间短,伤害小,恢复快。结论应用3 D打印技术进行髋臼骨折手术治疗,临床效果更佳精确,术中创伤小,有效缩短手术周期,提高患者预后,降低成本。%ObjectiveAnalysis clinical methods and effects of 3 D printing technology application in the acetabulum fracture surgery and rehabilitation. Methods Selected our hospital patients with fracture of acetabulum, application of 3 D technology to patients with pelvic model simulation, according to the model of steel screw location, access, and the length of the screw design measurement simulation operation, such as reference simulation surgery to give patients reduction surgery, and to give rehabilitation training after surgery, postoperative effect were analyzed. ResultsThe success of operation and operation time was short, that small injury, rapid recovery. Conclusion The application of 3 D printing acetabulum fracture surgery treatment, clinical effect is better precision, intraoperative trauma is small, shorten the development period of operation, and improve the prognosis of patients, reduce the cost.

  4. Periacetabular Osteotomy Redirects the Acetabulum and Improves Pain in Charcot-Marie-Tooth Hip Dysplasia With Higher Complications Compared With Developmental Dysplasia of the Hip.

    Novais, Eduardo N; Kim, Young-Jo; Carry, Patrick M; Millis, Michael B


    .001), ACEA (mean difference, 18 degrees, 95% CI, 13-23 degrees, P<0.001) and Tönnis angles (mean difference, 13 degrees, 95% CI, 9-17 degrees, P<0.001) were also achieved in the DDH group. After PAO, 33% of the patients in the CMTHD group and 13% in the DDH group developed a complication that required treatment (odds ratio, 3.4; 95% CI, 1.1-10.4; P=0.035). The Bernese PAO is capable of comprehensively achieving improvement in patient-reported outcome scores and redirecting the acetabulum in symptomatic acetabular dysplasia secondary to CMTHD. However, patients with CMTHD have a higher risk for developing complications. Level III-therapeutic study.

  5. Generation mechanism and treatment progress of common complications of the acetabulum fracture%髋臼骨折常见并发症的产生机制及治疗进展



    With the development of the transportation, high-energy injuries caused by traffic accidents are on the rise, acetabular fractures have been increasing recently. We take surgical therapy or conservative therapy considering a variety of factors and the patient’s conditions. Due to the particularity of acetabular anatomy and the complexity of its physiological functions, there are many complications caused by the acetabular fractures and its treatment no matter what method we take, such as nerve injury, heterotopic ossiifcation, thromboembolism, traumatic arthritis et al. All these will seriously affect the patient’s daily activities. This paper aims to give a general review on the generation mechanism and treatment progress of common complications of the acetabulum fracture.

  6. Comparison of application value between spiral CT and DR plain film in diagnosis of acetabulum fracture%对比螺旋 CT 与 DR 平片在髋臼骨折诊断中的应用价值

    刘金全; 海忠; 崔凌; 郭锐


    目的:对比螺旋 CT 与 DR 平片在髋臼骨折诊断中的应用价值。方法58例髋臼骨折患者作为研究对象。所有患者均经手术证实为髋臼骨折,术前行螺旋 CT 与 DR 摄影,其中螺旋 CT 采用多平面重建(MPR)、三维表面重建(SSD)、容积重建(VR)等三维重建技术进行图像后处理,对比两种检查方案的诊断结果。结果CT 确诊髋臼骨折55例,高疑骨折3例, DR 确诊骨折42例,高疑8例,无骨折8例,两组确诊结果比较,差异有统计学意义(P<0.05);CT 诊断准确率更高。结论螺旋 CT 三维重建技术具有扫描快速、成像清晰的特点,在髋臼骨折诊断中具有重要的应用价值,较常规 DR 平片具有更高的确诊率,同时可有效评估患者骨折病情,为手术治疗方案提供指导。%Objective To compare the application value between spiral CT and DR plain film in diagnosis of acetabulum fracture. Methods There were 58 patients with acetabulum fracture as study subjects, and they were all diagnosed by operation. They received spiral CT and DR filming before operation. 3D reconstruction by multiple planar reconstruction (MPR), surface shading display (SSD), and volume reconstruction (VR) were applied for image postprocessing in spiral CT. Diagnosis results of the two examination methods were compared. Results CT showed 55 diagnosed acetabulum fracture cases and 3 highly suspected fracture cases. DR showed 42 diagnosed fracture cases, 8 highly suspected cases, and 8 cases without fracture. The difference between diagnosis results of the two groups had statistical significance (P<0.05). CT provided more accuracy in diagnosis. Conclusion Spiral CT 3D reconstruction method has advantages of quick scanning and clear imaging, and it contains important application value in diagnosis of acetabulum fracture. It provides higher diagnosis rate than common DR plain film with effective assessment of fracture condition, and it can

  7. One Stage Plasty for Acetabulum and Femoral Neck to Treat Congenital Hip Dislocation%先天性髋脱位髋臼股骨颈一次成形术

    朱葆伦; 严幼华; 应灏; 沈金根


    1971年9月~1988年8月,共手术治疗先天性髋脱位患儿101例.采用髋臼、股骨颈一次成形术,由于大部分畸肜得到矫正,股骨头获得满意的覆盖,符合生物力学的要求,远期效果良好者达80.2%.%From 1971 to 1988,101 children with congenital hip dislocation were treated.The method was to curet the acetabulum and correct the anteversion of femoral neck by one stage procedure.The femoral head has been got a nice cover.It was adapted to biomechanics of hip joint.96 patients were followed up for 6 months to 10 years with a satisfactory rate of 80.2%.

  8. 数字化仿真技术在髋臼前柱安全置钉的研究%The study of safe lag screw placement in the anterior column of acetabulum by the digital simulation technique

    李佳兵; 项舟


    目的:利用数字化仿真技术求解髋臼前柱的安全置钉通道。方法通过将48例正常成人骨盆CT图像导入Mimics15.0中进行数字化处理得到96例髋臼前柱阴模模型,结合立体解析几何求解髋臼前柱的安全置钉通道。结果安全置钉通道:最大半径男性为(4.65±0.54)mm,女性为(3.71±1.68) mm;进钉深度男性为(114.91±6.52)mm,女性为(102.97±6.24)mm;进钉最狭窄处位于髋臼前壁内,最狭窄处到顺行进钉点的距离:男性为(34.57±2.16)mm,女性为(29.82±1.94)mm;最狭窄处到逆行进钉点的距离:男性为(73.32±3.27)mm,女性为(69.49±2.52)mm;螺钉与水平面夹角男性为(45.22±1.54)°,女性为(43.59±3.24)°;螺钉与矢状面夹角男性为(41.65±5.37)°,女性为(47.82±4.12)°;螺钉与冠状面夹角男性为(18.71±2.36)°,女性为(19.23±2.49)°。安全进钉通道参数男女对比“最大半径”、“进钉深度”、“螺钉与矢状面夹角”有统计学意义(P<0.05)。结论利用数字化仿真技术能够精确求解髋臼前柱安全置钉通道。%Objective To find and measure the safe lag screw placement channel (SLSC) in the anterior column of acetabulum by the digital simulation technique (DST). Methods To find and measure the safe lag screw placement channel in the anterior column of the acetabulum under the standard 3D coordinate system and the three-dimensional coordinate system of the pelvis by establishing 96 cases of 3D finite element female die of the anterior column of acetabulum through 3D reconstruction of 48 cases of normal adult pelvic spiral CT data by Mimics 15.0. Results The parameters of SLSC of the anterior column of acetabulum:The max radius is(4.65±0.54)mm in male, and(3.71±1.68)mm in female;The depth is(114.91±6.52)mm in male, and(102.97±6.24)mm in female;The narrowest screw placement site is in the anterior wall of the

  9. 影响髋臼后壁骨折手术疗效的分析%Treatment of fractures of the posterior wall of the acetabulum

    吴新宝; 杨明辉; 王满宜; 朱仕文; 曹奇勇; 吴宏华


    目的 分析影响手术治疗髋臼后壁骨折疗效的因素并总结治疗经验. 方法 1993年8月至2006年8月手术治疗且符合纳入标准髋臼后壁骨折患者105例,用改良的Merle d'Aubigné和Postel评分系统评价临床效果,用Matta放射学标准评价影像学结果.通过统计分析说明年龄、性别、受伤至手术时间、合并伤、髋关节脱位情况、是否存在边缘压缩、骨折复位质量、有无合并股骨头骨折,异位骨化程度和有无股骨头坏死等与临床效果间的关系. 结果所有患者平均随访4.1年(2.0~10.6年).临床效果:优32例,良56例,可11例,差6例,优良率83.8%(88/105).影像学结果:优52例,良36例,可12例,差5例,优良率83.8%(88/105).患者年龄、性别、受伤至手术时间、合并伤及髋关节脱位与临床效果无显著相关.存在边缘压缩、合并股骨头骨折、骨折复位差、严重异位骨化和股骨头坏死与临床效果显著相关.临床效果与影像学结果存在强相关性(Kappa=0.772). 结论术中仔细探查、解剖复位、牢靠固定是关键.存在边缘压缩骨折、骨折复位差、合并股骨头骨折、严重异位骨化和股骨头坏死是影响治疗效果的主要因素.%Objective To analyze factors which may affect the operative outcome of the posterior wall acetabular fracture retrospectively. Methods In this retrospective study we included 105 patients who had received open reduction and internal fixation for fracture of the posterior wall of the acetabulum from August 1993 to August 2006. All patients were followed up for a mean of 4.1 (range, 2.0 to 10.6) years. Their functional outcomes were evaluated using a modified clinical grading system developed by Merle d' analyses were done to detect associations between clinical outcomes and age, time from injury to surgery, gender, complicated injury, hip dislocation, marginal impaction, reduction, complicated femoral head frac-ture, ectopic ossification and

  10. 髋臼后壁钢板螺钉固定安全区域的应用解剖学研究%Applied anatomic study of surgical safe zone for placement plates and screws in treatment of fracture of the posterior wall of acetabulum

    周程鹏; 高仕长; 刘杰; 倪卫东; 蒋电明; 孙善权; 李咏梅


    目的 测量髋臼后壁三维重建模型参数和行虚拟钢板螺钉固定,明确髋臼后壁钢板放置的安全位置及螺钉置入角度.方法 用Mimics软件对25例(50侧)骨盆薄层CT行三维重建,切割出髋臼后壁三维模型,测量相关参数.用SolidWorks2010软件设计髋臼后壁虚拟钢板,导入Mimics软件,得出髋臼后壁虚拟钢板放置位置和螺钉安全角度.然后在15具(30侧)尸体髋臼后壁标本上进行钢板螺钉固定.结果 髋臼纵径为55mm,横径为52 mm.髋臼后壁最宽处位于上缘,为51mm,最窄处位于髋臼后壁中下部,为38 mm.螺钉能够拧入Zimmer重建钢板钉孔所允许最小角度范围为50~66°.Mimics模拟置钉后,将钢板放置在距尸体标本髋臼后壁外缘6mm处行钢板螺钉固定,螺钉未进入髋臼.结论 重建钢板放置在距髋臼后壁外缘6mm以远时,螺钉可以安全置入,且钢板距外缘越远,螺钉的安全范围越大.%Objective To investigate the safe position of the plates and safe angles of the screws through measurement of the parameter of the acetabulum and virtual plate-screw placement in the three-dimensional posterior wall of the acetabulum. Methods The thin slice CT data of 50 pelvics and 15 normal cadavers were used in this study. Three-dimensional reconstruction of pelvics were achieved by Mimics 10.0; then the virtual 3-dimensional acetabulum was resliced ,and the transverse, longitudinal diameter of the acetabulum and the width of the posterior wall of the acetabulum were measured, respectively. The virtual plate was designed by the software of Solidworks2010 and was introduced into the software of Mimics 10.0. The position of the plates and the angle of the screws were measured and the safe zones of the plate and the safe angles of the screws were deduced. Based on the above-mentioned data, the plates were fixed on the 30 posterior walls of the acetabulum 6mm away from the posterior edge of the acetabulum. Results The longitudinal

  11. 幼鼠髋臼发育与机械应力相关性实验研究%Correlation between development of acetabulum in infant rat and mechanical stress force

    梁庆威; 李良满; 范广宇; 原银栋


    BACKGROUND: The previous researches on the hypogenesis of acetabulum concentrated on X-ray morphology. And there are few researches on the impact of mechanical stress force on the development of acetabulum and the evolution disciplinarian in the restoration of acetabular dysplasia after the removal of mechanical pressure.OBJECTIVE: To clarify the impact of abnormal mechanical stress force on the development of acetabulum, especially on the proliferation of chondrocytes in the chondral growth plate of acetabulum, for the discussion of the restorative methods in acetabular dysplasia.DESIGN: A randomized controlled study was conducted.SETTING and PARTICIPANTS: Setting was in China Medical University. Subjects were 60 females, 3-week old Wistar rats in cleanness grade with a body mass from 150 g to 200 g obtained from the Experimental Animal Center of China Medical University, which were fed at 18 - 25 ℃ and in the humidity of 40% to 70%.INTERVENTION: Three-week old Wistar rats were randomly allocated into 3 groups according to random number table with 20 rats each. The left hip joint was set as study side and the right side was set as control side. Group A: hit joint was repeated dislocated and repositioned by manipulation within 2 weeks; Group B: the knee joint was straightened for fixation by Kirschner wire to establish the animal model of acetabular dysplasia. Kirschner wire was removed after 2 weeks; Group C: the knee joint was straightened for continuous fixation.MAIN OUTCOME MEASURES: Molybdenum X-ray, histomorphologyand transmision electron microscope observations were operated at age of 5,7, 9 and 12 weeks respectively.RESULTS: Group A: at 5-week old, the acetabular angle increased about 5° compared with the other side, and polar derangement of chondrocyte was found in the proliferation layer of the chondral growth plate. The changes at age 7, 9 and 12 weeks were mild with no difference between two sides. Group B: at 5-week old, the acetabular angle

  12. 动态测量非生理状态下髋臼外展角及临床意义%The dynamic measurement of acetabulum abduction angle under non-physiological state and its clinical significance

    李颖; 耿左军; 赵秀娟


    目的:通过MSCT三维重建骨盆,测得骨盆在不同倾斜程度下髋臼外展角数值,探讨非生理状态下全髋关节置换术( THA)个体化置入髋臼假体的放置角度。方法选择100位患者(即200个髋臼)为研究对象行螺旋CT扫描,利用容积再现(VRT)技术把骨盆重建为立体图像,为模拟病理状态进而对骨盆进行不同程度的前倾(以10°为间隔,从10°前倾到90°),利用多平面重组(MPR)重建出冠状位图像,进而分别测得两侧髋臼外展角。计算平均值和标准差,绘制出非生理状态下髋臼外展角随骨盆倾度改变而发生变化的相关性变化曲线,找到规律。结果 MSCT法检测髋臼外展角结果如下:当骨盆倾度从10°逐渐增至90°时,外展角的变化曲线呈抛物线。当骨盆倾度为70°时,外展角最大为48°,说明此状态下的髋臼对股骨头覆盖最好,关节的稳定性也最佳。性别对髋臼外展角的影响结果表明在相同条件下,不同性别间的外展角差异无统计学意义( P >0殮.05)。结论髋臼的外展角随着骨盆倾度的变化而发生改变,外展角的变化曲线呈抛物线,不同性别之间的髋臼外展角没有显著性差异;说明性别因素对髋臼外展角的影响不大,髋臼外展角随骨盆倾度动态变化的规律,可以为临床THA髋臼假体放置角度提供理论依据。%Objective To detect acetabulum abduction angle of pelvis at different sloping degrees through multi -slice spiral CT ( MSCT ) three-dimensional reconstruction pelvis , and to explore the reasonable placing angle during total hip arthroplasty ( THA) under non-physiological state .Methods One hundred patients ( 50 males and 50 females ) including 200 acetabulums were scanned by MSCT to reconstruct pelvis into stereoscopic picture by means of valume rendering technique (VRT),then to make pelvis at different inclination (10°~90°) in

  13. Exchangeability of the b subunit of the Cl(-)-translocating ATPase of Acetabularia acetabulum with the beta subunit of E. coli F1-ATPase: construction of the chimeric beta subunits and complementation studies.

    Ikeda, M; Kadowaki, H; Ikeda, H; Moritani, C; Kanazawa, H


    The gene encoding the b subunit of the Cl(-)-translocating ATPase (aclB) was isolated from total RNA and poly(A)+ RNA of Acetabularia acetabulum and sequenced (total nucleotides of 3038 bp and an open reading frame with 478 amino acids). The deduced amino acid sequence showed high similarity to the beta subunit of the F type ATPases, but was different in the N-terminal 120 amino acids. The role of the N-terminal region was investigated using an F -ATPase beta-less mutant of E. coli, JP17. The JP17 strain expressing the aclB could not grow under conditions permitting oxidative phosphorylation, although ACLB was detected in the membrane fraction. The beta subunit was divided into three portions: amino acid position from 1 to 95 (portion A), 96 to 161 (portion B) and 162 to the C-terminus (portion C). The corresponding regions of ACLB were designated as portions A' (from 1 to 106), B' (from 107 to 172) and C' (from 173 to 478). Chimeric proteins with combinations of A-B'-C', A-B-C' and A'-B-C restored the function as the beta subunit in E. coli F0F1-complex, but those with combinations of A'-B'-C and A-B'-C had no function as the beta subunit. These findings suggested that portion B plays an important role in the assembly and function of the beta subunit in the F0F1-complex, while portion B' of ACLB exhibited inhibitory effects on assembly and function. In addition, portion A was also important for interaction of the beta subunit with the alpha subunit in E. coli F0F1-complex. These findings also suggested that the b subunit of the Cl(-)-translocating ATPase of A. acetabulum has a different function in the Cl(-)-translocating ATPase complex, although the primary structure resembled to the beta subunit of the F1-ATPase.

  14. Effect of Three - dimensional Computed Tomographin Pelvis and Acetabulum Fractures%螺旋CT三维成像对骨盆及髋臼骨折临床治疗的指导意义

    贾维东; 戈朝辉; 吕金捍; 李亚平; 杨海波; 乔永东


    Objectives To study the clinical significance of three dimensional computed tomograph reconatruction (3 - D CT)in effect of pelvis and aeetabulun fractures. Methods 24 cases of pelvis and acetabulum fractures were examined preoperatively under X - ray and 3 - D CT. Based on the images, the fractures were comparative analyzed, classified and appropriately treated. Results 21 cases were made definite diagnosis by X-ray. All patients were made definite diagnosis by 3 - D CT.The pattern displacement orientation and extent of fracture fragments were examined. According to 3 - D CT images,21 cases underwent opration. Conclusions Tluough diferent views of pelvis and acetabulum,3 - D CT helps to evaluate the pattern and degree of fractures, it plays an important role than X - ray and CT scan. It can supply the best choice of surgical approach and achieve good reduction and internal fixation.%目的 探讨用三维CT重建评价骨盆骨折及髋臼骨折的临床应用价值。方法 对24例骨盆骨折及髋臼骨折患者的X线片、三维CT重建进行对比分析,对骨折进行分型,选择合适的治疗方案。结果 通过X线平片确诊21例,漏诊3例(12.5%)。三维CT重建使24例均明确诊断,确诊率100%。并明确评价骨折形态和骨折移位方向。21例均接受了手术治疗。结论 三维CT重建能多方位,立体显示骨盆及髋臼骨折的形态。帮助术者正确估计骨折类型及移位程度,选择合适的手术人径,准确复位,合理固定,取得较好的疗效。

  15. 髋臼后柱骨折顺行拉力螺钉置钉导向器的研究%Clinical anatomic study of the lag screw guide device for the acetabulum posterior column

    徐勇强; 林创鑫; 王钢; 蔡道章; 彭赓; 赖剑强; 季中华


    Objective To measure anatomical parameters of the guide device for antegrade lag screw fixation of the fractures in the posterior column of acetabulum. Methods 17 females and 14 males semi pelvic bony specimens were collected for this clinical anatomic study. After successful implantation of the antegrade lag screw into the posterior column of acetabulum, the screw entry point and entry angle of inclination were separately measured and statistically analyzed. Results The average distance between the entry point and the arcuate margin was (0.96±0.32) cm in female and (0.92±0.16) cm in male (P>0.05), while the distance between the entry point and the sacroiliac joint front was (2.43 ± 0.66) cm in female and (1.87 ± 0.26) cm in male (P0.05), while the extraversion angulation was (41.27 ± 2.76)° in female and (34.31 ± 2.78)° in male (P0.05),进针点与骶髂关节前缘距离,女性为(2.43±0.66) cm,男性为(1.87±0.26) cm(P0.05)、进钉方向与髂骨内板的外倾角∠φ女性为(41.27±2.76)°,男性为(34.31±2.78)°(P<0.05)。结论髋臼后柱骨折顺行拉力螺钉进钉点和进钉方向的测量为导向器的设计提供了解剖学基础,有助于提高髋臼后柱骨折顺行拉力螺钉置钉的成功率和准确性,降低手术风险和减轻手术损伤。

  16. Gross distribution and biomechanical significance of bone trabecula of the cancellous around acetabulum%髋臼区域松质骨骨小梁束的大体分布及力学

    孙剑伟; 尹望平; 张春才; 任可; 高振巢; 朱行飞


    BACKGROUND: Although a variety of mechanics study on the mechanical characteristics of the pelvis has been performed, but the exact stress distribution in the region remains unclear. ONJECTIVE: To observe the gross distribution of bone trabecula around acetabulum and compare with existing biomechanical research results. METHODS: Four dry pelvic specimens were cut in accordance with the plane which composed of acetabular edge and the plane of obturator in order to observe the distribution patterns of trabecular bone on the cross-section, and to observe the gross distribution of trabecula around acetabulum. RESULTS AND CONCLUSION: The trabeculae of hip bone were divided into three groups. ㏒acropubic bundle: It ran from the auricular surface, posterior superior iliac spine and posterior inferior iliac spine to pubic symphsis along the iliopectinal line, and part of the trabecula terminated in the posterior superior acetabular. ㊣liocotyloid bundle: It ran from the greater sciatic notch of the auricular surface to the superior posterior acetabular, and located in the shallow layer of the sacropubic bundle. ㊣lioischial bundle: From the region of the iliac crest to the ischial tuberosity, part of the trabecula terminated in the anterior superior acetabular. High-density trabecular net transversely located at the level of the sciatic notch, defined by a distinct saltire-shaped crossing over the acetabulum between the sacropubic and the ilioischial bundles. The human hip acetabulum was constituted by iliocotyloid bundle, sacropubic bundle and ilioischial bundle. High-density trabeculum net transversely located at the level of the sciatic notch, iliopubic eminence and the cross-section of sacropubic and the ilioischial bundles. This is consistent with the stress distribution and loading of the acetabular region in the current research.%背景:虽然目前已采用多种力学研究方法对骨盆的力学特性进行了大量的研究,但是该区域的确切应力分

  17. The diagnosis and therapeutics of the juxta-articular bone cyst in the acetabulum%髋臼邻关节骨囊肿的诊断与治疗

    李伟栩; 严世贵; 叶招明; 陶惠民; 林秾; 杨迪生


    Objective To discuss the diagnosis, differential diagnosis and therapeutics of the juxtaarticular bone cyst in the acetabulum. Methods Between August 1990 to April 2009, nineteen cases of clinical data of the juxta-articular bone cyst in the acetabulum data were collected from hospital records and analyzed retrospectively. There were 11 males and 8 females, with an average age of 42.3 years (range, 18-59). Seventeen patients felt an aching pain in the hip. The duration of symptoms was from 2 months to 20years with the median 15 months. All the radiographs showed a well-demarcated oval or circular radiolucent defect, close to subchondral bone, and outlined by a thin rim of sclerotic bone. Five cases accompanied with developmental dysplasia of the hip. After curettage of the bone cyst, 14 patients received iliac crest autogenous bone grafts, 3 patients received xenoma spongy bone-graft particles, and 2 patients received artificial bone grafts. Results Fourteen patients were precisely diagnosed as bone cyst by radiograph, and 4 patients were diagnosed by CT and MRI. The major axes of the focus were 2-4 cm in 16 patients, and 4-8 cm in 3patients. The sizes of the focus had no relationship with the symptoms and the course of the disease. Seventeen cases of the focus were located at the anterior superior of the bearing surface of the acetabulum. All patients were successfully followed up from 11 months to 13 years, averaged 6.2 years, and no relapses occurred during the follow-up period in every case. Fourteen patients felt asymptomatic, 3 patients felt uncomfortable in hip occasionally, and 2 patients with developmental dysplasia of the hip felt ameliorated in the initial stage of the therapy, followed by aggravation accompanying the hip joint space narrow. Conclusion Bone graft after thorough curettage of the capsular space was an effective therapy for the juxta-articular bone cyst in the acetabulum, and the anatomic distribution of radiological lesions indicated that

  18. Total hip replacement in the treatment of traumatic arthritis after operation of acetabulum dislocation%全髋关节置换治疗髋臼骨折脱位术后创伤性关节炎

    许鹏雍; 凌尚准; 梁广权; 梁善校


    目的:探讨全髋关节置换治疗髋臼骨折脱位术后创伤性关节炎( traumatic ostcoarthritis,TOA)的临床疗效。方法选择2009年3月~2013年3月我院收治的髋臼骨折脱位术后并发创伤性关节炎行全髋关节置换术的患者27例为研究对象,男性16例,女性11例;年龄32~57岁,平均(45.2±8.7)岁。对其临床资料进行回顾性分析,并于术前和术后分别评定髋关节功能,评价手术疗效。结果27例患者均顺利完成手术,所有患者术后切口均Ⅰ期愈合;术后Harris评分为76~92分,其中80分以上的患者25例,优良率达到92.6%,平均(89.1±5.78)分,与术前的(45.3±5.86)分相比,存在显著差异(P<0.05);关节屈曲、内收、外展、外旋及内旋与术前对比差异均有统计学意义( P<0.05),髋关节功能得到明显改善。结论髋臼骨折脱位术后易并发创伤性关节炎(TOA),采用全髋关节置换术治疗具有术后并发症少、髋部功能改善明显、临床效果好、患者满意度高等优点,值得临床推广应用。%Objective To evaluate the clinical efficacy of total hip replacement in the treatment of traumat-ic ostcoarthritis ( TOA) after operation of acetabulum dislocation.Methods Twenty seven patients [16 males and 11 females aged from 32-57 years with an average age of (45.2 ±8.7) years] of acetabulum fracture from Mar.2009 to Mar.2013 in our hospital were performed total hip replacement for the treatment of TOA after operation of acetab-ulum dislocation were chosen and their clinical data was retrospectively analyzed.The preoperative and postopera-tive evaluation of hip function were performed and the effect of surgery was completed.Results All patients were successfully operated and all incisions achieved primary healing;postoperative Harris score was 76 to 92,of which 25 patients were more than 80 and the good and excellent rate was 92

  19. 内固定术治疗移位的髋臼骨折疗效分析%Internal fixation treatment of shifting the acetabulum fracture curative effect analysis



    大多数移位的髋臼骨折患者需手术治疗,复位与固定效果明显,同时也降低创伤后关节炎的发生,更有利于早期功能恢复锻炼。治疗上,可根据骨折类型选择合适的手术入路,一般来说应争取通过一个入路达到完全的复位和固定,采用的入路中,Kocher-Langenbeck 入路适于进入后柱,髂腹股沟入路则适于进入前柱和内侧部分,延伸的髂股入路适于同时进入前,后柱,使用可塑形接骨板,螺钉或钢丝做内固定,便于骨折复位,固定稳定,并发症少临床效果好。%Most of the shift of the acetabulum fracturepatients require surgery treatment,reduction and fixation ef ect is obvious,but also reduce the incidence ofpost-traumatic arthritis,more conduG cive to the early function exercise.Treatment,can choose appropriate surgical approach,depending on the type of fracture ingeneral should be reached toget through a complete reduction and fixation,into the road,after Kocher - Langenbeck approach is suitable for entering the column,iliac inguinal approach is suitable for entering the anterior column and the inside of thepart,extend the iliac femoral apG proach is suitable for the top at the same time,the column,use the moldable boneplate,screw or steel wire internal fixation.

  20. Comparison of acetabulum related parameters in different planes on CT images%髋臼相关参数在不同CT平面上的对比研究

    吴昊; 王渭君; 孙明辉; 翁文杰


    Objective To investigate the differences of acetabulum related parameters between the horizontal plane and true pelvis plane on CT images , and explore the impact on the operation .Methods The hip CT images of 80 normal cases in Affiliated Drum Tower Hospital ,Nanjing University ,were collected with natural supine position .Inclusion criteria:CT images contain all the pelvises , acetabula and femoral heads;no obvious pathological change in the acetabula ,femoral heads and sacroiliac joints; the inspected patients with no forced postures when scanning .Exclusion criteria: ankylosing spondylitis or other spine , hip and knee fixed deformity diseases; forced postures because of the emergency diseases; a history of trauma or fracture.There were 44 males,36 females,average age was (40 ±6) years (18-55 years).The direction of CT scanning was perpendicular to the horizontal plane .Bilateral acetabular anteversion angle , abduction angle ,center-edge angle ( CE angle ) , acetabular width , acetabular depth and acetabular angle were measured ,as well as the angle between the true pelvis plane and horizontal plane .All the CT images were performed three-dimensional reconstruction ,then the images were collected with the scanning direction perpendicular to the true pelvis plane .The same parameters were measured .Paired t test was used to compare the differences of the outcomes between the left and right sides of the acetabulum ,as well as the ones between the two reference planes .Group t test was adopted to compare the differences of parameters between male and female .Spearman correlation analysis was performed to indicate the association of the parameters differentials and the reference planes angle .P 0.05), (in true pelvis plane t=1.58,0.47,1.19,-1.25,0.27,0.36,P>0.05).Statistical significance was detected between the genders .In horizontal plane , the abduction angle , acetabular width and depth were remarkably higher in male (t =-4.01,-6.69,-7.19,P<0.01),and

  1. 基于多平面三维测量的髋臼骨折数字化内固定植入方案%A digital solution for fixation implant of acetabulum fracture based on multi-planes three-dimensional measurements

    张国栋; 林海滨; 陈宣煌; 郑锋; 陈国立; 陶圣祥


    目的 探讨髋臼骨折数字化内固定植入方案的实施方法 及相应规范.方法 绘制重建钢板及螺钉Solidworks零件文件,制备标准件库.将1具成人尸体骨盆标本进行薄层CT扫描及三维重建,以三维切割的方式按照AO分类进行髋臼骨折9个类型造模,虚拟复位后预设重建钢板的植入位置,进行长度及角度的三维测量,根据测量数据在Solidworks中预弯重建钢板并输出至Mimics,通过位移的方式将重建钢板植入至预设位置,测量钉孔至对侧骨面的距离,选择合适的螺钉,完成虚拟髋臼骨折内固定植入.结果 (1)完成髋臼骨折9个类型造模;(2)完成髋臼骨折9个类型的虚拟重建钢板及螺钉的内固定植入,全部重建钢板与骨面敷贴良好,所有螺钉均植入至对侧骨面.结论 多平面三维测量是实施髋臼骨折数字化内固定植入方案的决定因素.%Objective To investigate a digital solution and the corresponding standards for fixation implant of acetabulum fracture. Methods Solidworks files of reconstruction plates and screws were drawn for the preparation of standard parts library. One pelvic specimens of adult corpse was treated with thin-slice CT scan and three-dimensional reconstruction. Nine kinds of acetabulum fracture models were harvested by three -dimensional cutting according to the AO classifications. After virtual reduction ,the implanted position of reconstruction plate was presupposed to measure the three -dimensional length and angle . The prebending of reconstruction plate was performed in Solidworks and exported to Mimics , then was implanted to the presupposed position by means of reposition . The distance from countersunks of reconstruction plate to contralateral osseous surface were measured to selected suitable screws for virtual fixation implant of acetabulum fracture . Results (1 ) Nine kinds of acetabulum fracture models were made successful; (2) Virtual fixation implants of

  2. The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum%髋臼周围肿瘤切除股骨头旷置术

    黄洪超; 胡永成; 伦登兴; 马军; 夏群; 纪经涛; 苏秉成


    目的 探讨股骨头旷置术治疗髋臼周围肿瘤的可行性.方法 1999年10月至2009年8月采用髋臼肿瘤切除股骨头旷置术治疗累及髋臼的Enneking Ⅱ区肿瘤患者18例,男16例,女2例;年龄18~72岁,平均54岁.软骨肉瘤4例,骨肉瘤2例,骨巨细胞瘤4例,滑膜肉瘤1例,恶性纤维组织细胞瘤1例,Ewing肉瘤1例,转移瘤5例.3例行术前选择性动脉栓塞,4例行麻醉后腹主动脉或髂总动脉球囊临时阻断.术后门诊随访观察关节功能及影像学变化.结果 全部病例随访3~118个月,平均55个月.手术时间120~350min,平均170min.出血量600~2200ml,平均1200ml.切口均愈合,无一例发生伤口感染.1例骨肉瘤、3例转移癌患者于术后6个月至2年死于多脏器转移,其余病例无肿瘤局部复发.肢体不等长2.0~7.5 cm,平均5.0 cm,所有患者均需足跟垫高2~3 cm的矫形鞋进行矫正.术后3个月Enneking评分20~27分,平均23分.影像学资料提示,至随访期末无股骨头坏死发生,8例假臼磨造较好,1例发生轻度腰椎侧凸.结论 对于累及髋臼的Enneking Ⅱ区肿瘤采用肿瘤切除股骨头矿置术术后并发症发生率低,近期功能良好,肿瘤复发率低.%Objective To study clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum with less limb damage and complications.Methods From October 1999 to August 2009,18 patients with pelvic tumors around acetabalum (zone Ⅱ of Ennekingl were treated with tumor resection and femoral head exclusion,including 16 males and 2 females with an average age of 54 years(range,18-72).The diagnosis were chondrosarcoma(4 cases),osteosarcoma(2),giant cell tumor of bone(4),synoviosareoma(1),malignant fibrous histiocytoma(1),Ewing sarcoma(1),and metastatic carcinoma(5).Throe cases were treated by selective arterial embolization before operation and 4 cases by temporary block of lower abdominal aorta or common iliac arte.Regular follow-up in

  3. 三维影像处理技术在成人髋关节发育不良联合前倾角匹配中的应用研究%3D-CT used to determine an optimal combined anteversion angle of femoral neck-acetabulum in total hip arthroplasty for adult hip developmental dysplasia

    许燕飞; 常敏; 郭英; 吴继昆; 杨景帆; 王涛; 艾元亮; 张俊; 孙皓民


    目的 探讨三维影像处理(3D-CT)技术在成人髋关节发育不良(DDH)全髋关节置换术(THA)中对于股骨颈~髋臼联合前倾角匹配的指导作用. 方法 回顾性分析2011年3月至2014年3月通过3D-CT技术进行THA的21例(21髋)DDH患者资料,男5例,女16例(;年龄30 ~ 78岁,平均55.3岁.DDH按Crowe分型:Ⅱ型6例,Ⅲ型11例,Ⅳ型4例.所有患者术前行薄层CT扫描并将二维原始数据导入M3D可视数字化软件进行三维重建,通过3D-CT技术进行术前预演制定最合适的股骨颈~髋臼联合前倾角调整方案,拟定最佳的联合前倾角度进行THA.术后通过3D-CT技术评估臼杯的骨性覆盖情况、测量臼杯的前倾角度及联合前倾角度,验证术后联合前倾角度与术前拟定角度的吻合情况,并采用Harris评分标准评定疗效. 结果 21例患者术后获3~36个月(平均12.8个月)随访.末次随访时采用Harris评分评定疗效:优17例,良4例.术前Harris评分[(46.2±5.3)分]与末次随访时[(86.3±4.3)分]比较差异有统计学意义(P<0.05).所有患者髋臼杯的覆盖率均大于70%,术后髋臼杯前倾角度与术前拟定角度吻合率达95%,股骨颈~髋臼联合前倾角度在安全范围内,所有患者均未出现脱位.结论 3D-CT技术可以通过术前预演制定最佳的股骨颈~髋臼联合前倾角调整方案,对成人DDH患者THA股骨颈~髋臼联合前倾角的调整具有较高的指导价值,按拟定的方案进行手术臼杯可获得最好的骨性包容、最大的初始稳定性,同时可获得最佳的头臼匹配度,降低术后假体脱位率,提高假体生存率.%Objective To investigate how 3D-CT was used to determine an optimal combined anteversion angle of femoral neck-acetabulum in total hip arthro (THA) for adult developmental dysplasia of the hip(DDH).Methods 3D-CT was used in 21 adult patients(21 hips) with DDH who had been treated by THA from March 2011 to March 2014.They were 5 men and 16

  4. 不同锻炼时机在股骨骨折并同侧髋臼骨折患者中康复效果的对比%The effect of rehabilitation of femoral fractures and ipsilateral acetabulum fractures patients in different exercise

    梁卫良; 王国寿


    目的:探讨不同锻炼时机在股骨骨折并同侧髋臼骨折患者中康复效果的对比效果。方法分析2011年1月~2012年7月收治的50例股骨骨折并同侧髋臼骨折患者临床资料,依据术后锻炼时间不同进行分组,治疗Ⅰ组(术后40 d~2个月进行下地锻炼)30例和治疗Ⅱ组(术后2个月以后下地锻炼)20例,观察两组的康复效果。结果治疗Ⅰ组股骨骨折并同侧髋臼骨折患者术后6个月和术后1年Harris评分均优于治疗Ⅱ组,差异均有统计学意义(P<0.05)。结论股骨骨折并同侧髋臼骨折患者术后1.5~2个月进行负重锻炼,患者预后功能良好。%Objective To approach effect of rehabilitation of femoral fractures and ipsilateral acetabulum fractures patients in different exercise.Methods To analyze 50 cases clinical data of femoral fractures and ipsilateral acetabulum fractures patients from 2011.1 to 2012.7 in our hospital Third Department of Surgery,treatment Ⅰ group 30 cases and treatment Ⅱ group 20 cases.Results The Harris score of treatment Ⅰ group femoral fractures and ipsilateral acetabulum fractures patients after operation 6 months and 1 year were better than treatment Ⅱ group. The difference had statistical significance.Conclusion Femoral fractures and ipsilateral to acetabulum fracture patients after operation 1.5~2 months,prognosis of patients was good function.

  5. The mid - and long - term clinical outcomes of open reduction and internal fixation for dislocation of hip joint combined with posterior wall or/and column fractures of acetabulum%髋关节后脱位并髋臼后壁(柱)骨折手术治疗结果分析

    何长街; 刘志礼; 舒勇; 黄山虎


    目的 探讨髋臼后壁(柱)骨折伴髋关节脱位手术治疗的中远期疗效.方法 回顾性分析21例髋关节脱位伴髋臼骨折患者临床资料,其中20例髋臼脱位行闭合复位,1例行急诊切开复位内固定;所有合并的髋臼骨折均采用开放复位内固定术治疗.结果 完整随访19例,失访 2例,随访时间29~86个月.按髋关节功能恢复情况评分:优13例,良3例,可2例,差1例,优良率84.2%.结论 髋关节脱位伴髋臼骨折应尽早诊断,应尽快行髋关节复位,骨折应尽早开放复位内固定,早期功能锻炼,避免过早负重.%Objectives To investigate the mid - and long - term clinical outcomes of open reduction and internal fixation(ORIF) for treating the dislocation of hip joint with posterior wall or/and column fractures of acetabulum. Methods The clinic data of 21 patients with dislocation of hip joint and posterior wall fracture of acetabulum who were given close reduction( n = 20)or open reduction and internal fixation(ORIF) ( n = 1 ) for disclocation of hip joint and then were treated with ORIF for the fracture of acetabulum were retrospectively analyzed. Results A total of 19 patients were followed up for 29 to 86 mon. According to Letournel E's hip joint functional scoring system, clinical outcome was excellent in 13 patients,good in 3 patients,fair in 2 patients,and poor in one patient. The ratio of fineness of the midand long - term clinical outcomes was 84. 2%. Conclusion The dislocation of hip joint combined with posterior wall fracture of acetabulum should be diagnosed early, and reduction of the hip joint and ORIF should be performed as soon as possible. The positive functional exercise is necessary and the premature weight bearing on the hip joint should be avoided at early time.

  6. Influential factors of hip joint function recovery after surgical treatment for acetabulum fracture%髋臼骨折手术治疗后髋关节功能恢复的影响因素分析

    王志刚; 屈铁男; 崔书豪; 陈洪瑜


    Background:Acetabular fracture is intraarticular fracture and mostly caused by high-energy injury. Surgical management is thought the best choice of treatment therapy. It is thought that the classification of fracture, surgical approach, quality of re-duction, age and time of surgical treatment may influence the clinical outcome of treatment. So it is essential to explore the key influential factors related to therapeutic effect. Objective:To explore influential factors of recovery of hip joint function after surgical treatment for acetabulum fracture. Methods: A total of 42 patients with acetabulum fracture treated in our hospital between January 2010 and October 2013 were enrolled in the retrospective study. Open reduction and internal fixation were performed in 18 cases through Kocher-Langenbeck approach, 14 cases through iliac inguinal approach, 10 cases anterior and posterior approach. The reduction quality was assessed by the Matta standard. The function of hip joint was evaluated by modified Merled' Aubigne-Postel grading system. Logistic regression analysis for single factor and multiple factors was used to screen risk factors, such as gender, age, operation time, fracture type, surgical approach, reduction, etc) related to surgical curative effect. Results:Anatomical reduction was achieved in 14 cases, good reduction in 20 cases and fair reduction in 8 cases. Primary healing was seen in all incisions and no infection occurred. The mean period of follow-up was 19 months (range, 12-26 months). The mean fracture healing time was 14 weeks (range, 10-18 months). Injury of sciatic nerve occurred 4 cases, trau-matic arthritis in 4, ischemic necrosis of femoral head in 2, and heterotopic ossification in 7. The hip joint function was ex-cellent in 13 cases, good in 21, fair in 5, and bad in 3 at 6 months after surgery. Single factor analysis showed that gender, age, surgical approach, or dislocation of hip joint had no significant relation with therapeutic effect

  7. Fracture of Acetabulum Anterior Column of the Minimally Invasive Treatment of Experimental and Clinical Study%髋臼前柱骨折微创治疗的临床研究

    张聪林; 刘志斌; 屈小鹏; 陈军


    Objective Studies micro creates the treatment in the acetabulum front pillar bone fracture clinical practice result, discusses micro creates the technique the superiority aspect. Methods Take our hospital patients with the acetabular fractures,according to the classification, Letourne acetabular anterior column fracture into two groups, one group of traditional open reduction surgery the other group with a minimally invasive surgical treatment, the blood,the operative time complications and follow-up of results in accordance with the criteria for classification and Matta clinical outcome evaluation using hip scoring criteria (Harris scores). Results After discovery,using minimally invasive surgical treatment in the amount of bleeding and the time significantly smaller than the traditional open reduction and treatment,ratio and lower heterotopic ossification avascular necrosis rate has clear advantages. Conclusion Minimally invasive surgery acetabular fractures with feasibility before column,but also,the safety factor is higher than the traditional open reduction surgery.%目的 研究微创治疗方法在髋臼前柱骨折的临床疗效.方法 将我院收治的部分髋臼骨折按照Letourne型分成两组,其中一组为传统切开复位手术治疗,另一组为微创手术治疗,对其出血量、手术时间、并发症、随访结果按照Matta标准进行分级,临床结果评价采用髋关节功能评分标准(Harris评分)进行比较.结果 术后随访发现,采用微创手术治疗在出血量及操作时间上明显小于传统切开复位手术治疗,且有感染低、异位骨化轻、血管神经损伤少及恢复快等优点.结论 微创手术治疗在髋臼前柱骨折具有可行性,而且效果非常明显,安全系数高于传统切开复位手术治疗.

  8. 髋臼横行骨折两种内固定方式的有限元分析%Finite element analysis of two kinds of internal fixation methods for acetabulum transverse fracture

    王庆; 薛波; 安林; 毛伟民; 叶鹏翰


    Objective To compare the biomechanical property of two kinds of internal fixation methods for acetabulum transverse fracture.Methods The model of acetabular fractures was established by finite element analysis method and using computer software to simulate the fixed mode of conventional posterior two steel plate and stoppa two steel plate in the inner side of the square area of the road. The biomechanical property of two kinds of internal fixation methods was compared.ResultsIt was very close of the total displacement of fracture between two fixed form, which showed that there was a similar total fixed effect of acetabular fracture between two fixed form. The difference between the displacement of fracture between two fixed form was very small, which showed that there was a similar fixed effect in front and back, internal and external and up and down two fixed form. ConclusionThere is no significant difference between the biomechanics of two kinds of internal fixation. The internal fixation with two plates from posterior approach may be substituted by stoppa approach.%目的:比较髋臼横行骨折两种内固定方式的生物力学性能。方法利用有限元分析方法,使用计算机软件建立髋臼骨折模型。模拟常规后路两块钢板及Stoppa入路四方区内侧两块钢板固定方式,比较两种固定方式的生物力学性能。结果两种固定方式中骨折块的总位移非常接近,表明这两种固定方式对这类髋臼骨折总的固定效果基本一致。此外,两种固定方式中骨折块之间的各方向的相对位移及其位移之差非常小,表明两种固定方式在前后、内外及上下方向的固定效果也基本一致。结论两种固定方式生物力学性能没有差别,Stoppa入路四方区内侧两块钢板固定方式可代替常规后路两块钢板进行髋臼横行骨折的固定。




    We retrospectively reviewed 20 patients at three to 19 years after displaced anterior fracture-dislocations of the hip. Eighteen of them were treated by traction, after ensuring that the femoral head was adequately reduced beneath the undisrupted part of the weight-bearing dome. Two required operati

  10. 计算机辅助导航热塑膜定位固定无移位髋臼后柱骨折的实验研究%Computer.assisted thermoplastic elustomer film localization system for screw insertion to fix posterior column of acetabulum

    鲁洋; 潘进社; 张英泽; 翟福山; 郑占乐; 王涛; 郝睿峥


    目的 评估应用计算机辅助热塑膜定位系统微刨置入螺钉固定髋臼后柱骨折的准确性和有效性. 方法应用计算机辅助热塑膜定位系统将20枚空心钉置人10具标本的髋臼后柱.置入螺钉后,通过CR、CT检查螺钉的位置.结果 在计算机辅助热塑膜定位系统辅助下,直接置入螺钉,20枚髋臼后柱螺钉均在安全区内. 结论计算机辅助热塑膜定位系统为微创置入髋臼后柱螺钉提供准确的窄间定位和稳定的路径导航,操作时手术创伤明显减少,具备较好的安全性和准确性,为进一步应用于临床奠定了基础.%Objective To assess accuracy and efficacy of the mini-invasive screw insertion for fix-ation of the posterior column of acetabulum by the computer-assisted thermoplastic elastomer film localization system. Methods In a simulated surgical setup, 20 cannulated screws were placed into the posterior column of acetabulum in 10 corpses under the guidance of the computer-assisted thermoplastic elastomer film localization system. The positions of the screws were checked with CR and CT. Results All the 20 screws were in the safe area. Radiation exposure was totally avoided. Conclusion The system can pro-vide precise, effective and safe navigation for screw insertion to fix the posterior column of acetabulum, and markedly prevent the patient and the staff from exposure to the radiation.

  11. The Use and Analysis of Parvule- impacted Bone Graft in Revision Total Hip Arthroplasty with Bone Defect of Acetabulum%颗粒骨打压植骨治疗全髋关节翻修中髋臼侧骨缺损

    胡忠洲; 孟凡丁; 王韶进


    This study is to investigate the use and analysis of parvule - impacted bone graft in revision total hip arthroplasty with bone defect of acetabulum. Strike off or grind bone in acetabular fossa until bone surface with cribriform blood. Bone defection of inclusive type was covered directly with morselized bone by impaction bone grafting. For Bone defection of not inclusive type, first we used titanium mesh to cover it ,then covered it with morselized bone by impaction bone grafting in order to reconstruct the hip normal anatomical configuration and restore bone mass,then install biotype or cement type acetabulum prothesis. Parvule- impacted bone graft in revision total hip arthroplasty with bone defect of acetabulum is effective in short-term follow-up, but the final therapeutic effect couldn't be determined, because of the lack long term and large amount of follow up study.%探讨颗粒骨打压植骨治疗骨缺损在全髋关节翻修中的应用及疗效分析.包容型缺损直接颗粒骨覆盖,使用打压植骨技术;对于非包容型缺损采用钛网覆盖骨缺损,再用松质骨颗粒覆盖,使用打压植骨技术,重建髋关节的正常解剖形态,恢复骨量,安装生物型或水泥性髋臼假体.结果颗粒骨打压植骨在伴有髋臼侧骨缺损的全髋关节翻修术中可有效重建髋臼侧骨缺损,恢复骨量,并能提供良好的早期稳定性,术后短期随访效果良好,但是其远期结果有待于更长时间、更大规模的随访研究.

  12. Joint into the road before and after treatment in 42 modalities of acetabulum fracture care%对行前后联合入路治疗的42例复杂型髋臼骨折患者进行综合护理的效果研究



    objective: to study the discussion before and after the joint complexity into the road treatment acetabulum fracture clinical nursing measures. Methods: our hospital in February 2014 - February 2015 the complexity of the 42 patients with acetabulum fractures as the research object. All of the patients adopt joint into the road treatment before and after treatment, and also the corresponding nursing measures. Results: nursing, according to the results of all patients were recovered, and none of the patients with deep vein thrombosis or pulmonary embolism complications such as; At the same time, one year after the treatment of patients with follow-up, 35 patients with anatomical reduction and treatment effect to achieve optimal, the other 7 cases of patients with the reset. Conclusions:In the complexity of acetabulum fracture patients, give patients the corresponding nursing measures can maximum reduce patients disability.%目的:探讨对进行前后联合入路治疗的复杂型髋臼骨折患者实施综合护理的临床效果。方法:对2014年2月~2015年2月期间我院收治的42例复杂型髋臼骨折患者的临床资料进行回顾性研究。我院对所有患者均进行前后联合入路治疗,在其进行治疗期间,对其实施综合护理。治护结束后,观察所有患者的治护效果及结束治护一年后患者骨折部分的恢复情况。结果:经过治护,所有患者均痊愈,且无患者出现深静脉血栓或肺栓塞等并发症。在患者结束治护一年后对其进行随访,有35例患者达到解剖复位且治疗效果为优,有7例患者骨折部位恢复良好。结论:对进行前后联合入路治疗的复杂型髋臼骨折患者实施综合护理的临床效果显著。此护理方法值得在临床上推广应用。

  13. 髋臼横断骨折后柱长/短钢板内固定的有限元建模及分析%FEM Modeling and Analysis of Transverse Fractured Acetabulum with Fixations of Posterior Column Long Plate and Short Plate

    吴淑琴; 潘宏侠; 裴葆青


    目的 建立有效的髋臼横断骨折有限元模型,完成两种内固定方式的比较.方法 利用Mimics 10.0中建立髋臼骨骨折的三维模型,在逆向工程Geomagic中进行相应处理后,在ANSYS Workbench中生成短/长钢板固定模型,并进行加载分析.结果 相同加载方式下,短钢板模型的最大位移、模型整体及髋臼窝处的最大应力和最大应变,均大于长钢板模型.另外,短钢板模型更容易错位失效.结论 本文有限元模型能有效地反映骨盆应力分布,分析结果表明后壁钢板固定时,将钢板长度延伸至坐骨结节处能提供更大的稳定性.%Objective To establish a valid finite element model of the transverse fractured acetabulum and finish the analysis of inner fixation ways. Methods The three-dimensional image of the pelvis was reconstructed with the software Mimics 10. 0 and was modified with the software Geomagic. Then the 3D model of fractured pelvis was imported into ansys workbench and was established after some operations. After that the integrated 3D finite element models of transverse fractured acetabulums were established, which were fixed with posterior column long and short plates respectively. Finally the vertical load pressure was exerted on the upper terminal plate of the pelvis with some constrainer, and the distribution of stress was analyzed. Results With same loads , the maximum total deformation , von-mises stress and von-mises strain of short plate were bigger than them of long plate. In addition, the model with short plate was easier to lapse. Conclusion It was indicated that the proposed model was stable and valid to contribute the stress of pelvis. For the fixation of transverse fractured acetabulum with a posterior plate, extending the plate to hucklebone tuber was considered more stable.

  14. Hip arthroplasty for the severe comminuted proximal femoral fracture with psilateral acetabulum fracture%人工关节置换治疗修复困难的股骨近端粉碎性骨折合并同侧髋臼骨折

    吕波; 王跃; 朱建辛; 黄崇新; 廖天成; 王安


    Objective:To investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture. Methods:From June 2007 to September 2013,8 patients (8 hips) with se-vere comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain,function,range of motion to evaluate clinical effects. Results:There was no untoward reaction in 8 pa-tients. And bed rest at 3 months after operation ,waiting for acetabulum fracture healed to out of bed activity. There was no com-plications such as pneumonia ,bedsore and so on in the patients. Follow up time was from 9 to 72 months with an average of 35.8 months,the wound healed,there was no the subsidence and loosening of prosthesis,no dislocation and infection. The mean of Harris score was 87.5 points after operation. Conclusion:The effect of the hip replacement in treating severe comminuted proxi-mal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic compli-cation,may serve as a substitute for internal fixation of difficult operation. The long term efficacy is necessary to further observe.%目的:观察人工髋关节置换治疗修复困难的股骨近端严重粉碎性骨折合并同侧髋臼骨折的临床疗效。方法:对2007年6月至2013年9月收治的8例(8髋)股骨近端严重粉碎性骨折合并同侧髋臼骨折的患者采用人工髋关节置换,均为男性,年龄33~64岁,平均41.9岁。均采用生物型假体。采用Harris评分,从疼痛、功能及活动范围等方面进行随访,评价其疗效。结果:8例(8髋)患者术中无不良反应发生,术后卧床休息3个月,待髋臼骨折愈合后下床活动,无肺炎、褥疮等

  15. 骨盆Ⅰ-Ⅱ-Ⅳ区肉瘤整块切除后腰盆钉棒重建系统%Enbloc resection of pelvic sarcoma involving region Ⅰ , Ⅱ, IV and reconstruction with the prosthetic acetabulum pedicle screw and rod system

    沈靖南; 王晋; 尹军强; 黄纲; 雍碧城; 李浩淼; 邹昌业


    目的 探讨骨盆Ⅰ-Ⅱ-Ⅳ区肉瘤整块切除后新设计的腰盆钉棒重建系统的临床应用.方法 回顾性研究中山大学附属第一医院骨肿瘤科,2009年6月到2010年12月期间,行骨盆Ⅰ区、Ⅱ区和Ⅳ区肉瘤整块切除和腰盆钉棒系统重建术的病例资料,评价该术式的治疗效果及术后并发症.入选条件:穿刺活检证实骨盆原发性肉瘤:肺部CT未见转移灶,Eneking分期为ⅡB期;患者能完成规范的新辅助化疗;术前MRI评估证实肉瘤未侵犯髂外动静脉、坐骨神经和盆腔脏器,确认肉瘤累及骨盆Ⅰ-Ⅱ-Ⅳ三个区域.结果 4例累及骨盆Ⅰ区、Ⅱ区和Ⅳ区的原发性肉瘤患者接受肿瘤整块切除后腰盆钉棒系统重建.患者男3例,女1例;平均年龄29.75岁(18 ~45岁).病理类型包括:尤文肉瘤2例,软骨肉瘤1例和骨肉瘤1例,尤文肉瘤和骨肉瘤完成新辅助化疗.肉瘤整块切除范围包括骨盆Ⅰ区、Ⅱ区和Ⅳ区肿瘤、肿瘤累及的髂肌、臀中小肌和部分臀大肌,同时采用骨盆髋臼和腰椎椎弓根钉棒系统重建髋臼、骨盆环和腰骶连接.术后3周患者开始进行康复治疗,术后3个月可扶拐行走.术后平均隧访14个月(9~19个月),目前尚未发现复发和转移.MSTS功能评分平均为66.67% (63% ~73%);Harris髋关节评分良2例,差2例.结论 骨盆原发性肉瘤治疗的主要目标是通过广泛切除而获得治愈,通过骨盆环重建挽救下肢的主要功能.骨盆Ⅰ区、Ⅱ区和Ⅳ区肉瘤整块切除和腰盆钉棒系统既能完整的切除肿瘤,又能有效重建骨盆和腰骶连接功能.这种重建方式近期疗效观察能够达到患者及骨肿瘤专科医生的功能期望.%Objective This study is to evaluate the effect of en bloc resection of pelvic sarcoma involving region Ⅰ, Ⅱ , Ⅳ and reconstruction with the prosthetic acetabulum pedicle screw and rod system. Methods A continuous and retrospective analysis was

  16. Hollow lag screws combined with reconstruction plates for treatment of high anterior column fracture of the acetabulum with intact true pelvic brim%空心拉力螺钉联合重建钢板治疗真骨盆缘完整的髋臼高位前柱骨折

    周炎; 刘世清; 瞿新丛; 余铃; 廖琦; 黄涛; 赵奇; 张春


    目的 探讨真骨盆缘完整的髋臼高位前柱骨折采用空心拉力螺钉联合重建钢板固定的疗效.方法 2009年6月-2012年9月收治真骨盆缘完整的髋臼高位前柱骨折6例,其中挤压伤4例,高处坠落伤2例;参照谭国庆等分型:单纯型4例,粉碎型2例.采用髂股入路先行髋臼顶复位空心拉力螺钉固定,后复位、重建钢板固定髂骨翼及髂嵴.结果 6例术后随访12~24个月,平均18个月.所有患者骨折均愈合,愈合时间12 ~ 18周,平均16周.术后按Matta影像学评定标准,优5例,良1例,优良率100%.末次随访时按Matta改良的Merle d'Aubigne和Postel髋关节功能评分标准,优4例,良2例,优良率100%.术后2例出现股外侧皮神经麻痹,口服神经营养药物2~3个月后均恢复.结论 空心拉力螺钉联合重建钢板治疗真骨盆缘完整的髋臼高位前柱骨折固定可靠,临床疗效满意.%Objective To investigate the clinical effect of high anterior column fracture of the acetabulum with intact true pelvic brim fixed using hollow lag screws plus reconstruction plates.Methods All cases of high anterior column fracture of the acetabulum with intact true pelvic brim treated from June 2009 to September 2012 were included.Crush contributed to injury in 4 cases and high fall to injury in 2 cases.According to Tan Guoqing' s classification,4 cases were classified as simple type and 2 cases comminuted type.All cases were treated through iliofemoral approach to reduce and fix acetabular roof by hollow lag screws firstly,and then fix iliac wing and iliac crest by reconstruction plates.Results Six cases were followed up for mean 18 months (range,12-24 months).Fracture healed after mean 16 weeks (range,12-18 weeks).Radiological results assessed using Matta' s score system were excellent in 5 cases and good in 1 case with good to excellent rate of 100%.At the final follow-up,Merle d' Aubigne and Postel hip score was excellent in 4 cases and good in 2

  17. The curative effect analysis of acetabulum fracture treated with bridge combined fixation sys-tem or reconstruction plate%桥接组合式内固定系统与重建钢板治疗髋臼骨折的疗效比较

    关翔; 宋香全; 王洪炳; 周朝波


    Objective To investigate the clinical efficacy of reconstruction plate or bridge combined fixation system in the treatment of acetabulum fractures. Methods Fifty-five patients of acetabulum fractures treated by surgery were selected for a case-control study. Twenty-eight patients was treated by reconstruction plate, while twenty-seven pa-tients was treated by bridge combined fixation system. Operation time, intraoperative blood loss and hospital stay of two groups were observed and compared. Results The time of hospital stay, operative time, amount of bleeding of the group treated by bridge combined fixation system was better than the group treated by reconstruction plate. There are statistically significant difference between the two groups (P<0. 05). For the postoperative hip joint function of the reconstruction plate group,14 cases were excellent,9 good,4 fair, and 1 poor, and the rate of excellence and good results was 23/28. For the bridge combined fixation system group,13 cases were excellent,11 good,2 fair, and 1 poor, and the rate of excellence and good results was 24/27. There are statistically significant difference between the two groups of curative effect ( P<0. 05 ) . Conclusions The bridge combined fixation system has the advantages of less trauma, better functional recovery and less postoperative complications, which can be used as the preferred way for the surgical treatment of acetabulum fracture.%目的:探讨重建钢板与桥接组合式内固定系统治疗髋臼骨折临床疗效。方法手术治疗55例髋臼骨折的患者,分别行重建钢板(28例)和桥接组合式内固定系统(27例)内固定,观察两组的手术时间、术中出血量、住院时间,比较两组疗效。结果桥接组合式内固定系统组的手术时间、术中出血量、住院时间均优于重建钢板组,差异有统计学意义(P<0.05)。术后髋关节功能:重建钢板组优14例,良9例,可4例,差1例,优良率23/28;桥接

  18. The influence in anterior column with posterior hemi-transverse fractures of the acetabulum fixed by DPASQ which caused by the stability of the contralateral pelvic ring:a finite element analysis%对侧骨盆环稳定性对前柱伴后半横行髋臼骨折动力化前路方形区钛板螺钉系统内固定影响的有限元分析

    董石磊; 蔡贤华; 王志华; 刘曦明; 王威; 董鹏飞; 王锋


    Objective To study the influence of sitting position in anterior column with the hemi-transverse fractures of the acetabulum fixed by dynamic anterior plate-screw system for quadrilateral area (DAPSQ) which caused by the the stability of the contralateral pelvic ring.Methods Using the finite element analysis method to build the pelvis model of right high anterior column with posterior hemi-transverse lesion fractures of the acetabulum,and fixing the right side of the acetabulum fractures by DAPSQ,we construct three sets of internal fixation models individually:keep the contralateral pelvic ring in its integrity (A),complete for superior and inferior ramus of pubis fracture internal fixation (B) and keep the contralateral superior and inferior ramus of pubis fractures unfixed ?,finally contract the displacement and stress distribution on the right side of the fracture between groups under load 600 N of physiological load imitating sitting position.Results It has no significant sense in the differences of longitudinal displacement of the dome region of acetabulum between the three internal fixation models of group A,group B and group C.The lateral displacements of posterior column inner lining were (0.903 ± 0.034),(0.910 ±0.038),(1.117 ±0.380) mm,the force on DASPQ square area screw shows that A > B > C and the differences are significant.Conclusion The biomechanical stability of anterior column with posterior hemi-transverse fractures of acetabulum fixed by DAPSQ is well,under the premise that the contralateral pelvic ring is stable.%目的 利用有限元方法研究对侧骨盆环稳定性对动力化前路方形区钛板螺钉系统(DAPSQ)治疗前柱伴后半横行髋臼骨折的生物力学稳定性的影响.方法 运用有限元分析方法构建右侧高位前柱伴后半横行髋臼骨折的全骨盆模型,对右侧髋臼骨折采用DAPSQ固定,分别构建出3组内固定模型:对侧骨盆环完整(A)、对侧耻骨上下支骨折

  19. 髋臼横行骨折采用前后柱拉力螺钉结合重建钢板固定疗效分析%Analysis of the Effect of the Acetabular Transverse Fracture Using the Lag Screw of the Acetabulum and the Reconstruction Plate With the Reconstruction Plate

    张立峰; 冯卫; 包道日娜; 冬梅; 佟雁翔


    Objective To investigate the clinical effect of the application of the acetabular transverse fracture in the treatment of the acetabular fracture and the reconstruction of the plate fixation with the lag screw of the acetabulum. Methods 50 cases of patients with transverse acetabular fracture were selected,and subject to acetabular posterior column lag screw combined with reconstruction plate fixation treatment,Bleeding volume,operation time, the acetabulum repositioning and hip joint function recovery after surgical of patients were observed. Results The average operation time was 3.5 hours, the average amount of bleeding was 950ml, according to Matta reduction, 25 cases of anatomic reduction, satisfactory reduction in 21 cases, 4 cases of unsatisfactory reduction, and the excellent and good rate of hip joint function was 86.0%. Conclusion The clinical effect of the acetabular transverse fracture patients with the acetabular anterior and posterior column lag screw combined with the reconstruction plate fixation is worthy of promotion.%目的:探讨对髋臼横行骨折患者应用髋臼前后柱拉力螺钉结合重建钢板固定治疗的临床疗效。方法选取髋臼横行骨折患者50例,对其进行髋臼前后柱拉力螺钉结合重建钢板固定手术治疗,观察患者手术时出血量、手术时间等,手术治疗后患者髋臼复位情况以及髋关节功能恢复情况。结果平均手术时间为3.5小时,平均出血量为950 ml,根据 matta 复位,25例解剖复位,21例满意复位,4例复位不满意,髋关节功能优良率为86.0%。结论对髋臼横行骨折患者采取髋臼前后柱拉力螺钉结合重建钢板固定手术治疗临床疗效突出。

  20. Minimally invasive percutaneous fixation based on ISO-C3D computerized navigational system for fracture of the acetabulum%ISO-C3D计算机辅助导航技术经皮微创内固定治疗髋臼骨折

    马玉鹏; 周东生; 李连欣; 穆卫东; 何吉亮; 李庆虎


    BACKGROUND:Percutaneous hol ow screw under X-Ray fluoroscopy has been shown to treat fracture of acetabulum of the pelvis, but the time of internal fixation was long, and the amount of radiation exposure to the patients and physicians was large. OBJECTIVE:To test the application of the ISO-C3D METHODS:Thirty-one patients with fracture of the acetabulum were treated with percutaneous hol ow screw under a fluoroscopy-based ISO-C computerized navigational system for fracture of acetabulum. 3D computerized navigational system. The interval from injury to operation was 4 to 13 days. Al patients were fol owed up for one year. RESULTS AND CONCLUSION:The average bleeding volume during operation was only 18 mL, except that the bleeding volume of only one patient, who suffered from the sacroiliacjoint injury and received open reduction and internal fixation, was up to 300 mL. The total number of screws used in the operation was 42, among which 24 were screws for acetabular anterior column fracture and 18 for posterior column fracture. Al screws were implanted once precisely. The average time of internal fixation was 59 minutes, and the mean time for fluoroscopy was 39 seconds. The 31 patients were pain-free one week after the operation and no complication (infection, vascular nerve injury or implant breakage) was noted post-operatively. When the fol ow-up ended, radiography revealed fracture union with satisfactory screw fixation (no screw breakage or loosening). According to Matta functional scoring, results were excellent in 23 cases, good in 8 cases, with an excellent and good rate of 100%. According to Majeed functional scoring, the results were excellent in 22 cases, good in 6 cases and average in 3 cases, with an excellent and good rate of 90%. These results indicated that ISO-C3D computerized navigational system can supply stable internal fixation without an increase of complication.%背景:文献报道采用X射线透视下经皮空心螺钉治疗骨盆髋臼骨

  1. Analysis of the installation of acetabulum of total hip resurfacing arthroplasty in surgery of developmental ysplasia of hip%髋关节骨性关节炎及髋臼发育不良对髋关节表面置换术中髋臼安装角度的影响

    赵赞栋; 王健; 肖军; 兰天; 李郅涵; 卢坤; 周亚鹏; 史占军


    [ Objective] To observe the early clinical result and the location and angle of acetabulum of the total hip resurfacing arthroplasty (THRA) in surgery of osteoarthritis of hip and developmental dysplasia of hip (DDH) . [ Method ] A retrospective study was carried out in twenty patients (twenty - three hips) dealt with THRA from 2006 to 2009, including ten cases of osteoarthritis and thirteen cases of DDH. All patients were implanted with metal - on - metal prostheses of large diameter. Femoral head was fixed with cement and the acetabular cup was biologically fixed. [ Result] Totally twenty - three cases received the follow -up ,with an average 24 months(6 -36months)after discharge. There was no significantly statistical difference between the two groups in the Harris score. However, there were numerous disparities between the two groups in the anatomy parameter of acetabular prosthesis. In group of osteoarthritis, the average acetabular cup abduction angle was 43.9° ± 19.9° (25.6° ~ 56.0° ) and the average acetabular fraction of coverage was 95. 8%. In group of DDH,the average acetabular cup abduction angle was 46.8° ± 12.9° (22.4° -69.3°) and the average acetabular fraction of coverage was 84.3%. No complications such as dislocation or fracture were found. [ Conclusion]There is no statistical difference in the early clinical result of THRA between osteoarthritis and DDH. Meanwhile, because of the mismatching of the acetabular cup components due to malformation of acetabulum in DDH, it is more difficult to install the acetabulum prosthesis in a good angle and location.%[目的]研究全髋关节表面置换术中,单纯骨性关节炎及髋关节发育不良对髋臼安装角度的影响及两组病例疗效比较.[方法]自2006~2009年,本科共实施全髋表面关节置换术20例23髋,病因包括单纯骨性关节炎10髋及髋关节发育不良13髋.手术假体均采用金属对金属大直径表面置换假体,股骨侧骨水泥固定,髋臼

  2. Prevention of prosthesis dislocation in hemiplegic patients subjected to total hip replacement by decreasing the abduction angle of the acetabulum%减小髋臼杯外展角预防偏瘫患者全髋关节置换后的假体脱位

    刘志刚; 陈经勇; 陈如见; 李钟; 鲁丽莎


    背景:目前关于偏瘫患者股骨颈骨折关节置换后的脱位率报道差别很大.目的:通过减小外展角降低老年偏瘫患者患侧股骨颈骨折关节置换后的脱位率.方法:回顾性分析采用人工全髋置换治疗偏瘫侧股骨颈骨折19例患者资料.结果与结论:患者随访期为3个月~7年,平均4年3个月.除2例置换后2年内因其他疾病死亡外,所有伤口均一期愈合,无切口感染,无髋关节脱位,置换后3个月参照Harris评分标准,其中优5例,良12例,优良率达89%.说明通过减小髋臼外展角是预防偏瘫患者股骨颈骨折全髋关节置换后脱位较可行的方法.%BACKGROUND: Currently reports on dislocation rate of joint replacement in hemiplegic patients with femoral neck fracture are different.OBJECTIVE: To decrease the abduction angle can decrease dislocation rate in elderly hemiplegic patients with side of the femoral neck fractures after joint replacement.METHODS: Date of 19 patients who using total hip replacement for the treatment of hemiplegic side femoral neck fracture were retrospective reviewed.RESULTS AND CONCLUSION: All the patients were followed-up from 3 months to 7 years postoperatively (average of 4 years and 3 months). There were no infection and hip joint dislocation in all the patients whose wounds were healed except two patients died for other diseases at 2 years postoperation. At 3 months postoperation, Harries hip score showed excellent and good rate was 89%, evaluation excellent for 5 and good for 12. It is indicated that decreasing the abduction angle of the acetabulum during the joint replacement to prevent the dislocation of hip joint is a feasible method.

  3. 前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折%Quadrilateral plate fractures of the acetabulum treated by internal fixation with reconstruction titanium plate combined with trans-plate quadrilateral screws via the ilioinguinal approach

    蔡贤华; 刘曦明; 汪国栋; 徐峰; 王华松; 李世梁; 黄大伟; 徐洲发


    目的 探讨前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折的疗效. 方法 2005年1月至2011年5月共收治52例涉及方形区的髋臼骨折患者,其中36例获得随访,男21例,女15例;年龄21~59岁,平均43.5岁.骨折按Letournel分型:双柱骨折15例,横形骨折4例,前柱伴后半横形骨折8例,T形骨折9例.所有患者均采用髂腹股沟入路,复位后行重建钛板及经钛板3 ~5枚皮质骨螺钉(方形区螺钉)部分经骨表面内固定.术后应用Matta放射学标准评估骨折复位质量,末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能. 结果 36例患者术后获12 ~ 72个月(平均41.7个月)随访.术后骨折复位质量按Matta放射学标准评定:解剖复位19例,良好复位12例,不满意复位5例,复位优良率为86.1%.所有患者骨折均获临床愈合,愈合时间为2~4个月,平均3个月.末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能:优16例,良13例,可5例,差2例,优良率为80.6%.本组患者功能优良率与骨折复位质量呈明显正相关(r=0.513,P=0.001).无一例患者发生方形区螺钉松脱、断裂.结论 前路钛板结合方形区螺钉内固定可靠,无进入髋关节腔之虞,是治疗以前柱损伤为主的双柱骨折、向前移位的横形骨折、部分前柱合并后半横形骨折及部分T形骨折的有效方法之一.%Objective To explore the clinical efficacy of internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws in treatment of quadrilateral plate fractures of the acetabulum via the ilioinguinal approach.Methods Of the 52 quadrilateral plate fractures of the acetabulum which had been treated between January 2005 and May 2011,36 cases were followed up.They were 21 males and 15 females,with an average age of 43.5 years (from 21 to 59 years).By Letournel's classification,there were 15 double

  4. Quadrilateral plate fractures of the acetabulum: an update.

    White, Grace; Kanakaris, Nikolaos K; Faour, Omar; Valverde, Jose Antonio; Martin, Miguel Angel; Giannoudis, Peter V


    Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century.

  5. Current management of posterior wall fractures of the acetabulum.

    Moed, Berton R; Kregor, Philip J; Reilly, Mark C; Stover, Michael D; Vrahas, Mark S


    The general goals for treating an acetabular fracture are to restore congruity and stability of the hip joint. These goals are no different from those for the subset of fractures of the posterior wall. Nevertheless, posterior wall fractures present unique problems compared with other types of acetabular fractures. Successful treatment of these fractures depends on a multitude of factors. The physician must understand their distinctive radiologic features, in conjunction with patient factors, to determine the appropriate treatment. By knowing the important points of posterior surgical approaches to the hip, particularly the posterior wall, specific techniques can be used for fracture reduction and fixation in these often challenging fractures. In addition, it is important to develop a complete grasp of potential complications and their treatment. The evaluation and treatment protocols initially developed by Letournel and Judet continue to be important; however, the surgeon also should be aware of new information published and presented in the past decade.

  6. 动力化前路方形区钛板螺钉系统固定伴有对侧骨盆前环不稳的髋臼双柱骨折的站位有限元分析%Finite element analysis of standing position in both-column with posterior hemi-transverse lesion fractures of the acetabulum fixed by dynamic anterior plate-screw system for quadrilateral area

    林冠林; 陈庄洪; 蔡贤华; 刘曦明; 雷建银; 王志华; 张宝成


    Objective To explore biomechanical stability of fractures of the acetabulum fixed by dynamic anterior plate-screw system for quadrilateral area (DAPSQ) when pelvic ring was unstable.Methods To prepare right side of the anterior column with posterior hemi-transverse lesion fractures of the acetabulum (pelvis) by finite element analysis,DAPSQ (A),building on the left side of the superior ramus of pubis fracture and inferior ramus of pubis model on the basis of A model,prepare two kinds of model of the left side of the superior ramus fractures of pubis with fixed (B) and titanium plate fixation (C).Then,the same physiological load was exerted on different model respectively.At the end,the none-line solution was analyzed,analysis of the stress and displacement in model.Results After fracture fixation through the lateral and longitudinal displacement and the stress nephogram found after analysis and comparison,the transverse and longitudinal displacement is small with DAPSQ internal fixation when the stability of pelvic ring,accord with standard of reset,uniform stress distribution,no obvious phenomenon of highly concentrated,fixed intensity bigger,fixed the pelvis after more stable.But when accompanied by unstable pelvic ring road ahead for DAPSQ fracture line of vertical and horizontal displacement of the present B > C > A,A,B,C stations,the longitudinal displacement respectively (1.315 ±0.171),(1.490 ±0.247),(1.334 ±0.160) mm,lateral displacement of stations respectively (1.185 ±0.700),(1.337 ±0.080),(1.198 ± 0.103) mm.Conclusion The pelvic ring must be stable when treatment of anterior column with posterior hemi-transverse lesion fixed by DAPSQ.%目的 利用有限元技术探讨当对侧骨盆前环不稳时,动力化前路方形区钛板螺钉系统(DAPSQ)内固定治疗髋臼双柱骨折的生物力学稳定性.方法 利用有限元分析技术建立正常人体全骨盆有限元模型并进行有限元验证,建立3种骨折内固定模型:A:DAPSQ固

  7. 大臼杯在髋臼骨缺损患者的髋关节翻修术中的应用%Application of jumbo cups for acetabular deficiencies in hip revision procedures used in acetabulum defects of the hip revision procedures

    王北岳; 周利武; 张志强; 郭亭; 赵建宁


    Objective To investigate the application of jumbo acetabular cups for Paprosky type II and type III A acetabular deifciencies after total hip arthroplasty ( THA ).Methods The clinical data of 24 patients who were diagnosed as acetabular deifciencies of Paprosky type II or type III A after THA from March 2007 to May 2014 were retrospectively analyzed. There were 13 males and 11 females, whose average age was 61.46 years old ( range: 34-77 years ). As to the reason of acetabular revision, there were 21 cases caused by aseptic loosening, 2 cases by habitual hip dislocation and 1 case by low toxicity infection. Primary and unilateral revision was performed on all the patients. Cemented acetabular prostheses were used in 11 cases, cementless acetabular prostheses in 10 cases and artiifcaial femoral head arthrolasty in 3 cases. According to the Paprosky acetabular defect classiifcation, there were 7 hips of type II A, 6 hips of type II B, 5 hips of type II C and 6 hips of type III A. Jumbo acetabular cups or combined with bone grafts were used in acetabular revision with prostheses. For the patients with acetabular deifciencies of Paprosky type II, the acetabulum was reamed and enlarged on the premise that the stability of the prosthesis was not affected, and then morselized bone graft was performed or the acetabular prosthesis with a jumbo cup was directly put in. For the patients with acetabular deifciencies of Paprosky type III A, an appropriate amount of compacted and morselized bone graft was used. Structural bone graft or the acetabular notch sealing was carried out, so as to increase the bone mass. The implantation technique through the center of the high ball could be directly adopted, with jumbo acetabular cups embedded. The problems of the balance of both lower limbs and the eccentricity could be handled by adjusting the length of the prosthetic handle and neck. A regular follow-up was carried out after the operation. The Harris hip score and Visual Analogue

  8. Clinical Outcomes of Surgical Treatments for Primary Malignant Bone Tumors Arising in the Acetabulum

    Tomohiro Fujiwara


    Full Text Available The functional and oncologic results of eighteen patients with primary malignant periacetabular tumors were reviewed to determine the impact of surgical treatment. The reconstruction procedures were endoprosthesis (11, hip transposition (4, iliofemoral arthrodesis (2, and frozen bone autograft (1. After a mean follow-up of 62 months, 13 patients were alive and 5 had died of their disease; the 5-year overall survival rate was 67.2%. The corresponding mean MSTS scores of patients with endoprosthesis (11 and other reconstructions (7 were 42% and 55% (49%, 68%, and 50%, respectively. Overall, postoperative complications including deep infection or dislocation markedly worsened the functional outcome. Iliofemoral arthrodesis provided better function than the other procedures, whereas endoprosthetic reconstruction demonstrated poor functional outcome except for patients who were reconstructed with the adequate soft tissue coverage. Avoiding postoperative complications is highly important for achieving better function, suggesting that surgical procedures with adequate soft tissue coverage or without the massive use of nonbiological materials are preferable. Appropriate selection of the reconstructive procedures for individual patients, considering the amount of remaining bone and soft tissues, would lead to better clinical outcomes.

  9. A Simple Mathematical Standardized Measurement of Acetabulum Anteversion after Total Hip Arthroplasty

    Chen-Kun Liaw


    Full Text Available We invented a standardization method to measure the cup's anteversion after total hip arthroplasty without the influence of patient's position. We measured 68 radiographs of 10 patients after total hip replacement (THR and calculated the error of each measurement, defined as the difference with the average of the same measuring method on the same patient. We also calculated the repeatability standard deviation (RSD of each method according to the American Society for Testing and Materials, ASTM E691.

  10. Standard Approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach.

    Gänsslen, A; Grechenig, S; Nerlich, M; Müller, M


    Historically, standard approaches for surgical treatment of displaced acetabular fractures were the KocherLangenbeck approach, the ilioinguinal approach and the extended iliofemoral approach (12). Presently, several modifications of these approaches are accepted alternatives, especially anterior modifications based on the intrapelvic approach described by Hirvensalo (8). Single access approaches allowing visualization of one acetabular column are the posterior Kocher-Langenbeck approach and the anterior ilioinguinal approach (12) and the use of a single approach is favoured (9, 24). For more complex situations, in the 80s and 90s extended approaches (extended iliofemoral approach according to Letournel (12), its modification to Reinert (19) (Baltimore approach), and the Triradiate approach according to Mears (14)) were introduced. These approaches are presently rarely choosen due to the extensive soft tissue dissection and higher complication rates (28). Alternatively, the combination of an anterior and posterior standard approach was recommended (7, 21, 22) having the disadvantage of longer operating time and blood loss and showed no superior results compared to a single approach. The meta-analysis by Giannoudis et al. stated that 48,7% of patients were treated using the Kocher-Langenbeck approach, followed by 21,9% ilioinguinal approaches and 12,4% extended approaches (6). More recent data from the years 2005-2007, showed that anterior approaches are now predominantly used according to a higher number of acetabular fractures with anterior column involvement. Overall, more than 40% of all patients with acetabular fractures are still approached via the Kocher-Langenbeck approach (18). Therefore, the Kocher-Langenbeck approach is still a "working horse" in approaching displaced acetabular fractures. The Kocher-Langenbeck approach consists of two parts. In 1874 von Langenbeck described a longitudinal incision starting from above the greater sciatic notch to the greater trochanter, dissecting the gluteal muscles for treating hip joint infections (11). Theodor Kocher in 1911 described a curved incision starting from the posterior-inferior corner of the greater trochanter, running across the postero-superior tip of the greater trochanter passing oblique in line with the fibres of the gluteus maximus muscle in direction to the posterior superior iliac spine (10). The aim of the present analysis is the detailed anatomi - cal analysis of this standard approach, focusing on fracture indication, positioning of the patient, exposure, dissection, reduction techniques of special fracture types, approach modifications/extensions, complications and approach-specific results.

  11. 髋臼骨折的治疗体会%Treatment Comprehension of Fracture of Acetabulum




  12. Tomographic index as auxiliary criteria for surgery indication in fracture dislocation of acetabulum posterior wall

    Fujiki, Edison N; Yamaguchi, Eduardo N; Miachiro, Edison; Chikude, Takechi; Ikemoto,Roberto Y.; de Abreu, Luiz Carlos; Valenti, Vitor Engrácia [UNESP; Rodrigues, Luciano M. R.; Monteiro, Carlos B; Milani, Carlo


    There are situations which the tomographic exam is done on the affected hip or situations where the contralateral hip presents abnormalities that make it impossible to compare. In this study we aimed to evaluate a tomographic index that does not require comparison between the both hips. Twenty two patients with unilateral acetabular fracture dislocation with fracture of posterior wall were studied. We established the relationship between the remaining posterior wall and the femoral head diame...

  13. Fracture of the acetabulum in a 14-year-old patient: 20-year review

    Sprenger, T.R.; Howard, F M


    A case report of 14-year old female with an acetabular fracture involving the anterior column and posterior column-posterior wall is presented here and the findings on 20-year follow-up are described.

  14. 髋臼骨折的手术治疗%The operation treatment of acetabulum fracture

    程玉庆; 程学福; 姜建军


    目的 探讨髋臼骨折的分型、手术入路的选择及手术效果.方法 手术治疗22例髋臼骨折患者,后壁骨折和后柱加后壁骨折选择K-L入路,前柱、前壁骨折及横断骨折选择髂腹股沟入路,前后移位明显的横断骨折、T形骨折、双柱骨折选择前后联合入路.结果 22例均获随访,时间6个月~5年,骨折6~9个月均愈合.按Matta评定标准:解剖复位 9例,满意复位13例.根据改良的Merle d′Aubigne-Poster髋关节功能评分标准:优7例,良10例,可4例,差1例.1例股骨头坏死,3例创伤性关节炎,2例异位骨化.结论 按髋臼骨折的分型选择合适的手术入路和良好的骨折复位内固定是获得满意疗效的前提.%Objective To investigate the classification of acetabular fracture, operation approach and operation effect. Methods The operation treatment was done for 22 cases of patients with acetabular fracture. Posterior wall fracture and posterior column fracture with posterior wall were operated through K-L approach, anterior column, anterior wall fractures and horizontal fractures were operated through ilioinguinal approach. Anterior and posterior displaced transverse fracture, fracture of type T, double column fractures were operated through combined anterior and posterior approach. Results 22 cases were followed up for 6 months to 5 years. All fractures got healing in 6 ~ 9 months. According to Matta standards, anatomical reduction was obtained in 9 cases, and satisfactory reduction in 13 cases. According to the modified Merled Aubigne-Poster hip score criteria, the results were excellent in 7 cases, good in 10, fair in 4, and poor in 1. 1 patient was complicated with femoral head necrosis, 3 with traumatic arthritis, and 2 with heterotopic ossification. Conclusions The acetabular fracture type, appropriate operation approach and good fracture reduction fixation are keys to obtain satisfactory curative effect.

  15. Cup-cage construct for acute fractures of the acetabulum, re-defining indications.

    Chana-Rodríguez, Francisco; Villanueva-Martínez, Manuel; Rojo-Manaute, Jose; Sanz-Ruíz, Pablo; Vaquero-Martín, Javier


    Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically, the areas of morsellised autograft that surrounded the cups were seen to have incorporated uniformly well, and the acetabular fractures were healed within six months after surgery. No mechanical failure, screw breakage, loosening, or migration was noticed. This novel indication of the cup-cage construction that uses revision techniques, for selected patients and fractures, to achieve an acute stable reconstruction, should be considered as an alternative reconstruction option in elderly patients presenting with acetabular fractures.

  16. Virtual fracture reduction of the acetabulum using a rigid body biomechanical model

    Boudissa, Mehdi; Chabanas, Matthieu; Oliveri, Hadrien; Tonetti, Jérôme


    International audience; Acetabular fractures are a challenge in orthopaedic surgery. A simple rigid body biomechanical model of the hip is proposed to simulate the fracture reduction. The action of surgical tools can be simulated interactively, which enables clinicians to evaluate different strategies for a better surgical planning.

  17. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study.

    Ferguson, T A; Patel, R; Bhandari, M; Matta, J M


    Using a prospective database of 1309 displaced acetabular fractures gathered between 1980 and 2007, we calculated the annual mean age and annual incidence of elderly patients > 60 years of age presenting with these injuries. We compared the clinical details and patterns of fracture between patients > 60 years of age (study group) with those 60 years of age and the remaining 1074 were fractures increased by 2.4-fold between the first half of the study period and the second half (10% (62) vs 24% (174), p Fractures characterised by displacement of the anterior column were significantly more common in the elderly compared with the younger patients (64% (150) vs 43% (462), respectively, p fractures in the study group included a separate quadrilateral-plate component (50.8% (58)) and roof impaction (40% (46)) in the anterior fractures, and comminution (44% (30)) and marginal impaction (38% (26)) in posterior-wall fractures. The proportion of elderly patients presenting with acetabular fractures increased during the 27-year period. The older patients had a different distribution of fracture pattern than the younger patients, and often had radiological features which have been shown in other studies to be predictive of a poor outcome.

  18. Total hip arthroplasty in patients with bone deficiency of the acetabulum.

    Choplin, Robert H; Henley, Christopher N; Edds, Eric M; Capello, William; Rankin, James L; Buckwalter, Kenneth A


    Total hip replacement (THR) requires revision in only a minority of cases (approximately 17% of prosthetic hips fail), but when THR failures occur there may be significant acetabular bone deficiency. There is a variety of surgical hardware and strategies available to address this problem. The causes of primary THR revision include aseptic loosening or particle disease, infection, recurrent dislocation, implant failure, periprosthetic fracture, and leg length discrepancy. Almost all patients who need THR revision undergo a standard radiographic evaluation of the pelvis and hip. In general, CT is an excellent tool for evaluating loosening of the prosthesis caused by either mechanical reasons or infection, and MR imaging is best suited for evaluating the soft tissues surrounding the prosthesis. Nuclear medicine studies are performed when results of CT and MR imaging are inconclusive. When patients are evaluated for revision THR, radiologists must check for acetabular cup loosening, the amount and type of bone stock loss, the amount of component migration, and the presence or absence of liner wear. Before revision hardware is placed, bone stock loss must be repaired, either by using bone grafting or by placing accessory acetabular hardware such as cups, rings, or cages. The long-term success of revision acetabular surgery varies; there is acetabular cup presence at 5 years after surgery in 60%-94% of cases. Complications include postoperative infections, repeat liner wear, bone graft failure, periprosthetic or prosthetic fractures, dislocation, vascular injury, and nerve injury. Copyright RSNA, 2008.

  19. Acute periprosthetic fracture of the acetabulum associated with osteolytic pelvic lesions: a report of 3 cases.

    Sánchez-Sotelo, J; McGrory, B J; Berry, D J


    Three cases of acute acetabular fracture around uncemented porous-coated acetabular components associated with osteolytic lesions of the pelvis are reported. In each case, the fracture occurred through an area of severe osteolysis that contributed to the structural failure of the pelvis. None of the fractures were associated with significant trauma, and none of the implants demonstrated evidence of loosening before the fracture. When marked pelvic osteolysis develops around the acetabular component of a total hip arthroplasty, the possibility of pelvic fracture must be considered. Total hip arthroplasty patients with osteolysis should be followed with radiographs at regular and frequent intervals. When osteolysis progresses, early intervention should be strongly considered because appropriate treatment may prevent fracture occurrence.

  20. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

    Laflamme, G-Yves; Belzile, Etienne L; Fernandes, Julio C; Vendittoli, Pascal A; Hébert-Davies, Jonah


    Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement

    Penny, J O; Brixen, K; Varmarken, J E;


    It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into ...

  2. A test of a recently devised method of estimating skeletal age at death using features of the adult acetabulum.

    Mays, Simon


    Estimation of age at death from adult skeletal remains is highly problematic, due in great part to interpopulation variability in skeletal age changes. Thorough testing of aging methods is therefore of key importance. A method recently devised by Calce (Am J Phys Anthropol 148 (2012): 11-23) for placing adult skeletons into three broad age at death classes (17-39, 40-64, 65+ years) on the basis of acetabular morphology is tested on a collection of 18-19th century AD skeletons (N = 185) of documented age at death from London. Results showed that 45% were correctly assigned to age class using this method. This compares with 81% reported by Calce on 20th century North American material. This indicates significant interpopulation differences in the relationship between the Calce acetabular variables and age, even between populations of European ancestry. Until the sources of this variation are better understood, caution should be used before applying this method to estimate age in unknown skeletons.

  3. 移位髋臼骨折的手术治疗%Operative treatment for displaced fracture of the acetabulum

    占蓓蕾; 叶舟



  4. Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution.

    Uchida, Kenzo; Kokubo, Yasuo; Yayama, Takafumi; Nakajima, Hideaki; Miyazaki, Tsuyoshi; Negoro, Kohei; Takeno, Kenichi; Sawaguchi, Takeshi; Watanabe, Shuji; Sugita, Daisuke; Takeura, Naoto; Yoshida, Ai; Baba, Hisatoshi


    Acetabular fracture result in fairly good outcome after the anatomic reduction in the displaced fracture fragments and damaged joint structure, but some patients will inevitably suffer from hip joint problems during their courses after the insult. We retrospectively reviewed 91 patients with acetabular fractures to investigate the causes of clinical failure and relationship among the fracture types, selected treatment options and their courses. Ninety-one patients (73 men and 18 women) with an average age of 49 years (range 18-80) at the time of injury were followed up for an average of 8.6 years (range 2-18). Judet-Letournel classification of fracture type and Matta's rating regimen of functional and radiographic patient' assessment were conducted. Conservative treatment was provided in 20 patients, in which 19 attained excellent/good, and one fair clinical results. All achieved excellent/good radiographic outcome. Surgically treated patients (n = 71) with critical dislodgement of the fracture fragment showed that 64 (90%) attained excellent/good and 7 (10%) fair/poor clinical outcomes. Sixty-three (89%) attained excellent/good and 8 (11%) fair/poor postoperative radiographic outcome. Five patients with poor radiographic outcome after surgery subsequently required total hip arthroplasty, due to the development of hip joint osteoarthritis in 3 and femoral head avascular necrosis in 2. We conclude that displacement of the joint surface should be reduced to less than 3 mm in accordance with the selection of the most appropriate surgical approach for open reduction/fixation in each fracture type; however, comminuted fracture and avascular necrosis of the femoral head may be the cause of poor clinical results.

  5. A case report of the management and the outcome of a complete epiphyseal separation and dislocation with left anterior column fracture of the acetabulum

    Jesús Palencia


    Conclusion: Epiphyseal fracture with dislocation of the femoral head is rare among children and adolescents, especially when associated with an acetabular fracture. AVN in such cases can develop, and it represents a challenge to orthopedic surgeons due to the poor prognosis and the future functional limitations of the joint.

  6. 髋臼骨折的全髋关节置换术治疗%Total hip replacement for fractures of acetabulum



    髋臼骨折(acetabular fracture,AF)的全髋关节置换术(total hip replacement,THR)治疗分早期和晚期,前者主要用于早期AF,而后者则用于经非手术或切开复位内固定(open reduction and internal fixation,ORIF)治疗后继发创伤性关节炎(posttraamatic arthritis,PA)的手术治疗。

  7. Comparison of Isocentric C-Arm 3-Dimensional Navigation and Conventional Fluoroscopy for Percutaneous Retrograde Screwing for Anterior Column Fracture of Acetabulum: An Observational Study.

    He, Jiliang; Tan, Guoqing; Zhou, Dongsheng; Sun, Liang; Li, Qinghu; Yang, Yongliang; Liu, Ping


    Percutaneous screw insertion for minimally displaced or reducible acetabular fracture using x-ray fluoroscopy and computer-assisted navigation system has been advocated by some authors. The purpose of this study was to compare intraoperative conditions and clinical results between isocentric C-arm 3-dimensional (Iso-C 3D) fluoroscopy and conventional fluoroscopy for percutaneous retrograde screwing of acetabular anterior column fracture.A prospective cohort study was conducted. A total of 22 patients were assigned to 2 different groups: 10 patients in the Iso-C 3D navigation group and 12 patients in the conventional group. The operative time, fluoroscopic time, time of screw insertion, blood loss, and accuracy were analyzed between the 2 groups.There were significant differences in operative time, screw insertion time, fluoroscopy time, and mean blood loss between the 2 groups. Totally 2 of 12 (16.7%) screws were misplaced in the conventional fluoroscopy group, and all 10 screws were in safe zones in the navigation group. Percutaneous screw fixation using the Iso-C 3D computer-assisted navigation system significantly reduced the intraoperative fluoroscopy time and blood loss in percutaneous screwing for acetabular anterior column fracture.The Iso-C 3D computer-assisted navigation system provided a reliable and effective method for percutaneous screw insertion in acetabular anterior column fractures compared to conventional fluoroscopy.

  8. The progress of surgical treatment for the fracture of acetabulum%髋臼骨折的外科治疗进展

    刘欣伟; 王攀峰; 张春才


    @@ 髋臼骨折的治疗对于骨科医生依然是一大挑战.众所周知,切开复位内固定已经成为治疗移位髋臼骨折的金标准[1-4].本文拟对髋臼骨折的外科治疗及相关研究进展做一综述.

  9. Diagnosis and operation treatment of Fracture of acetabulum%髋臼骨折的诊断与手术治疗

    王俊平; 吕福庆



  10. 移位型髋臼骨折的手术治疗概述%Review on Operation for the Treatment of Shifting Fracture of Acetabulum




  11. 髋臼骨折的全髋关节置换术治疗%Replacement of total hip in fracture of acetabulum

    张亮; 周乙雄


    @@ 近年来随着交通及工伤事故的增多及人口老龄化,髋臼骨折的发生率呈现逐年上升的趋势.围绕髋臼骨折分型、治疗方法选择、疗效评估以及预后判断等方面的研究逐步深入,使得治疗的成功率显著提高[1-2].

  12. Uncemented Total Hip Replacement After Two Years of Neglected Hip Dislocation With Fracture of Posterior Column and Wall of the Acetabulum



    Full Text Available Introduction Posterior hip dislocation of the hip with acetabular fracture is a challenging problem to treat. Such dislocations are associated with avascular necrosis of the femoral head if neglected. Managing such conditions with total hip replacement (THR is very difficult because of associated altered anatomy. Case Presentation We hereby report a two-year neglected hip dislocation with associated acetabular fracture successfully treated with uncemented THR. The patient was successfully treated with uncemented THR and experienced significant improvement in his functional status, with a Harris hip score of 82 at the two-year follow up. Radiologically, there were no radiolucent areas or osteolysis, with good consolidation of the bone graft. Conclusions A neglected hip dislocation with acetabular fracture can be managed satisfactorily with uncemented THR. Bone reconstruction using chunk grafts and use of cementless components ensures long-term survival and also preserves adequate bone stock for revision, especially in young patients.

  13. Percutaneous Anterior Column Fixation for Acetabulum Fractures, Does It Have to Be Difficult?-The New Axial Pedicle View of the Anterior Column for Percutaneous Fixation.

    Zhang, Lihai; Zhang, Wei; Mullis, Brian; Liu, Daohong; Xiong, Qi; Lv, Houchen; Ji, Xinran; Peng, Ye; Tang, Peifu


    Anterior column percutaneous screw fixation can be challenging. The purpose of this new technique is to offer a rapid, simple, and safe method to place an anterior screw. The authors used a 3-dimensional reconstruction simulation, cadaver study, and a clinical case series to demonstrate this new alternative to standard previously described techniques.

  14. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement: two-year results from a randomised study.

    Penny, J O; Brixen, K; Varmarken, J E; Ovesen, O; Overgaard, S


    It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient's resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side.

  15. Anatomical Variance in Acetabular Anteversion Does Not Predict Hip Fracture Patterns in the Elderly: A Retrospective Study in 135 Patients

    Kamath, Megan Y.; Coleman, Nathan W.; Belkoff, Stephen M.; Mears, Simon C.


    It has been suggested that variances in the anatomy of the acetabulum determine the type of hip fracture in elderly patients. Based on this concept, an overly anteverted acetabulum would lead to impingement of the femoral neck against the posterior rim of the acetabulum, causing a femoral neck fracture, whereas with a retroverted acetabulum, external rotation of the hip would be limited by the capsular tissues attached to the trochanteric region, causing a trochanteric fracture. To test the h...

  16. After qia in inguen admission passage and (KL) union fixed treatment complex acetabulum bone fracture%经髂腹股沟入路和(KL)联合内固定治疗复杂髋臼骨折




  17. Can heterotopic ossification be removed early after surgery for fractures of acetabulum?%临床病例讨论——髋臼骨折术后异位骨化能否早期切除?

    朱仕文; 吴新宝; 王满宜


    @@ 病历摘要 患者,男性,21岁.因交通伤致右髋关节疼痛、活动受限12 d于2005年7月18日收入我院.入院诊断:颅腩损伤,右侧髋臼后壁骨折,右髋关节后脱位,坐骨神经损伤.

  18. 股骨干骨折并同侧髋脱位髋臼骨折的治疗%Stock backbone bone fracture and with side hip dislocation acetabulum bone fracture treatment




  19. 髋臼转位截骨(TAO)治疗DDH继发早期OA%Treatment of Developmental Dysplastic Hip with Early Stage of Osteoarthrosis by Transpositional Acetabulum Osteotomy

    刘朝晖; 马渡正明; 李子荣


    目的介绍一种治疗髋臼发育不良并早期骨性关节炎的髋臼转位截骨术并评价其结果.方法 43 例髋关节发育不良(DDH)并发骨关节病(OA),全部病人实施了髋臼转位截骨术.结果术后平均12个月(10~17个月)随访,术后Harris评分93分(85~100分),平均增加25分,两者比较有显著性差异;术后CE角20°~28°,平均24°,两者比较有显著性差异;术后髋臼指数37°~48°,平均45°,两者比较有显著性差异;术后AHI 81 %(75 %~98 %),两者比较有显著性差异.结论髋臼转位截骨术是治疗髋关节发育不良(Ⅰ型)并发骨关节病(Ⅰ期)有效的方法.

  20. Types and evaluation of reconstruction approach for malignant pelvic tumors around acetabulum%髋臼及其周围肿瘤的分区与重建方法

    郭卫; 燕太强; 汤小东; 杨毅


    目的 回顾性分析髋臼及其周围恶性肿瘤行整块切除、不同方法髋臼重建的疗效.方法 72例髋臼及其周围恶性肿瘤患者接受了肿瘤整块切除、髋臼重建手术,男42例,女30例;年龄16~78岁,平均41岁.软骨肉瘤39例、骨肉瘤10例、骨巨细胞瘤9例、Ewing肉瘤5例、恶性纤维组织细胞瘤3例、恶性神经鞘瘤2例、血管外皮瘤l例、单发转移癌3例.肿瘤累及Ⅱ区、Ⅰ+Ⅱ区、Ⅱ+Ⅲ区、Ⅰ~Ⅲ区、Ⅰ~Ⅳ区和Ⅱ+Ⅲ+Ⅴ区者分别为4、16、29、7、10和6例.髋臼重建包括组配式人工半骨盆50例、马鞍式关节置换7例、骨盆灭活再植8例、股骨近端与盆骨融合7例.结果 61例获得随访,平均随访3.5年(1~8年).11例局部复发,8例深部感染,6例脱位.45例行组配式人工半骨盆置换术患者ISOLS评分平均22分.优7例、良24例、可9例、差5例.其中优良病例均为累及Ⅱ区和Ⅱ+Ⅲ区者,评分差的病例均为累及Ⅳ区者.5例行马鞍式关节置换、5例骨盆灭活再植和6例股骨近端与盆骨融合术患者,ISOLS评分平均为10、17和14分.结论 髋臼周围肿瘤切除后重建方法以组配式人工半骨盆置换术后功能最好,骨盆灭活再植次之,马鞍式关节置换术后功能最差.组配式人工半骨盆置换对单纯Ⅱ区肿瘤切除重建功能最好,其次为Ⅱ+Ⅲ区、Ⅰ+Ⅱ区、Ⅰ~Ⅲ区、Ⅱ+Ⅲ+Ⅴ区,术后功能最差为Ⅰ~Ⅳ区.%Objective To evaluate the functional outcome of malignant periacetabular tumors treated by en bloc resection and reconstructed with different limb-salvage procedures. Methods Seventy-two pa-tients with tumors around acetabular were treated surgically in People's Hospital of Peking University be-tween July 2000 and July 2007, including 42 males and 30 females with an average age of 41 years (range,16-78). 39 patients were diagnosed with chondrosarcoma, and 10 with osteosarcoma, 9 with giant cell tumorand 5 with Ewing sarcoma, etc. Type Ⅱ, Ⅰ + Ⅱ, Ⅱ + Ⅲ, Ⅰ - Ⅲ, Ⅰ -Ⅳ, Ⅱ + Ⅲ +Ⅴ pelvic resection were 4,16, 29, 7, 10 and 6, respectively. Of 72 patients, 50 were reconstructed with modular hemipelvic prosthesis,7 with saddle prosthesis, 8 with cauterized tumor bone implantation and 7 with proximal femur and pelvicbone fusion. Results Sixty-one patients were successfully followed up, and the average time was 3.5 years.Eleven patients (18%) had local relapse, 8 deep infection and 6 dislocation. The average ISOLS evaluationscore was 22 for 45 patients with modular pelvic prosthetic reconstruction, including excellent in 7, good in24, fair in 9 and poor in 5, respectively. Type Ⅱ and Ⅱ +Ⅲ pelvic resection with reconstruction was ratedexcellent or good, in contrasted to type Ⅳ was poor. The average ISOLS evaluation score for 5 saddle pros-thetic reconstruction, 5 recycled tumor bone reimplantation and 6 proximal femur and pelvic bone fusion was11, 17 and 14, respectively. Conclusion Among the 4 different reconstruction methods, the patients withmodular pelvic prosthetic reconstruction had best function results, and the saddle prosthetic reconstructionhad the worst. In terms of different types of pelvic resection with modular pelvic prosthetic reconstruction,type Ⅱ had the best functional result, followed by type Ⅱ + Ⅲ, Ⅰ + Ⅱ, Ⅰ - Ⅲ, Ⅱ + Ⅲ + Ⅴ, and type Ⅰ - Ⅳhad the worst.

  1. Total hip replacement using hemi-circumferential interposition acetabuloplasty for acetabular deficiency in post-Perthes deformities: technique and long-term results

    D. Haverkamp; H. Eijer; R.K. Marti


    We describe a technique of hemi-circumferential interposition grafting that allows placement of the cup in the anatomical position of the original acetabulum in the rare cases of post-Perthes or Perthes-like deformities of the femoral head combined with a steep and shallow acetabulum. This technique


    Hu Xin; Xi Juntong; Jin Ye; Gu Dongyun; Dai Kerong


    Former research work about the modeling of hip joint focus on the upper segment of femoral, and assumes the acetabulum cup is sphere concave, and the acetabulum prostheses is semisphere. A method of acquiring the point data on the surface of the hipbone using the reverse engineering technology is presented. After analyzing the acetabulum surface fitting error, a rotation ellipsoid CAD model is applied to fit the acetabulum surface, and then optimization technique is used to find the geometric parameters of the model. The fitting error between the sphere and rotation ellipsoid is compared and gets the result that the fitting error of rotation ellipsoid is smaller than sphere, and the rotation ellipsoid can describe the shape of the acetabulum better.

  3. 髋关节表面置换术后股骨近端及髋臼骨密度初步研究%A priliminary study of bone mineral densities of the proximal femur and acetabulum after hip resurfacing arthroplasty

    屈瑾; 雷新玮; 展影; 张晨; 姜文学; 祁吉


    目的 评价髋关节表面置换术(RSAH)对股骨近端及髋臼侧骨量的影响.方法 选择符合入组标准的单侧RSAH病人26例,于术后1年行髋关节手术侧及健侧的股骨近端和髋臼的骨密度检查,参考Taylor及Wilkinson方法分别将术后股骨近端及髋臼分为6个(1~6区)和3个(A1~A3)兴趣区,测量各兴趣区骨密度,用t检验对各区手术侧与健侧骨密度值进行比较.结果 手术侧的股骨近端5、6区的骨密度值大于健侧的,两者差异有统计学意义(P<0.05);1、2、3、4区的骨密度值在手术侧与健侧间的差异无统计学意义(P>0.05).髋臼侧全部区域中髋臼头侧(A1区)密度值,手术侧小于健侧,两者差异有统计学意义(P<0.05);手术侧与健侧的髋臼内侧及尾侧(A2、A3区)的骨密度比较,其差异无统计学意义(P>0.05).结论 关节表面置换术后股骨近端骨量可以得到有效保存和恢复,而髋臼侧骨质有丢失可能.

  4. 经“Y”型软骨截骨髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤%Acetabulum salvage by osteotomy through triradiate cartilage for surgical management of type Ⅱ pelvic Ewing sarcoma in children and adolescents

    范宏斌; 王臻; 郭征; 付军; 吴志钢; 陈国景; 栗向东; 李靖


    目的 探讨采用经“Y”型软骨截骨髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤患者的生存率及疗效.方法 回顾性分析2001年1月至2010年10月采用经髋臼“Y”型软骨截骨、异体髋臼复合钢板重建、髋臼挽救术治疗8例骨盆TypeⅡ型尤文肉瘤患者资料,男6例,女2例;手术时年龄7~16岁,平均12.7岁.其中3例肿瘤位于“Y”型软骨上方,4例位于“Y”型软骨前下方,1例位于“Y”型软骨后下方;均为局部肿瘤,无远处转移.所有患者均行X线、CT、MRI等影像学检查,并经病理学诊断证实.化疗采用顺铂(CDP)、阿霉素(ADM)和异环磷酰胺(IFO)方案.所有患者术前均接受一个循环的新辅助化疗(即IFO-ADM+CDP-IFO),术后均接受三个循环的IFO-ADM+CDP-IFO和局部放疗;放射治疗覆盖时间内的化学治疗同期进行.3例采用传统切除重建手术,5例借助于计算机辅助导航系统接受了肿瘤的精确切除和重建手术.结果 依据实体瘤疗效评价标准对新辅助化疗进行评价,结果显示1例为完全响应,6例为部分响应,1例为病情平稳.无一例患者被诊断为疾病进展.术后8例患者均获得随访,随访时间为12~ 72个月,中位随访时间为37.8个月.7例患者无瘤生存时间为24~ 60个月,平均39个月.术后24个月1例患者死于肿瘤转移.两年生存率为100%,五年生存率为87.5%(7/8).肌肉骨骼肿瘤协会(MSTS)评分为18~ 27分,平均25.4分.国际保肢协会影像学评分为76%~ 94%,平均90.1%.结论 采用经髋臼“Y”型软骨截骨、异体髋臼复合钢板重建、髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤,术后患者生存率高,可恢复患者的肢体功能.“Y”型软骨有可能是抵御肿瘤侵袭的天然屏障.%Objective To analyze the survival rate and functional outcomes after osteotomy through acetabular triradiate cartilage for surgical management of type Ⅱ pelvic Ewing sarcoma.Methods Data of 8 patients (male:6; female:2) with type Ⅱ pelvic Ewing sarcoma receiving treatment in our department from January 2001 to October 2010 were retrospectively analyzed.The mean age was 12.7 years (range,7-16 years).The tumors were located above,anteiro-inferior,and posterior-inferior to triradiate cartilage in 3,4,and 1 case,respectively.All tumors were localized and no metastasis was found.All patients received X-ray film,CT scan,and MRI.The diagnosis was determined by biopsy.All patients had undergone neoadjuvant chemotherapy and radiotherapy (post operation).All patients received 1 cycle of IFO-ADM+CDP-IFO and 2 cycles of same reagents before and after surgery.All patients received radio-therapy after surgery.In these consecutive patients,three received conventional surgery and another 5 were operated with the help of computer-assisted surgical navigation system.Results According to response evaluationg criteria in solid tumors (RECIST),CR was in 1 case,PR in 6 cases and SD in 1 case.No patient was recorded as PD.All patients were followed up for 12 to 72 months (mean,37.8 months).There were 7 patients surviving from 24 to 60 months (mean,39 months) with disease-free survival.One patient died of metastasis at 24 months postoperatively.The cumulative survival rate at 2 and 5 years were 100% and 87.5%,respectively.The MSTS score ranged from 18 to 27 (mean,25.4) and radiological score of International Society of Limb Salvage (ISOLS) ranged from 76% to 94% (mean,90.1%).Conclusion Osteotomy through acetabular triradiate cartilage in combination with allograft reconstruction can maximally restore the hip function and increase the survival rate.The triradiate cartilage may be a natural barrier to prevent tumor invasion.

  5. Sexual dimorphism of the hip joint in Greeks.

    Papaloucas, Christos; Fiska, Aliki; Demetriou, Thespis


    The objective of the present study was to report our measurements of hip bones within the Greek population and review the possible implications of these differences in their health as well as in social life. For this purpose the remains of 100 male and 100 female pelvic and femoral bones were studied. The distance from the pubic tubercle to the anterior rim of the acetabulum, the acetabulum diameter between its rims, their ratio, the depth of the acetabulum, the diameter of the femoral head and the ratio between the femoral head and the diameter of the acetabulum were measured. It was found that in males, in comparison to the females, the distance from the pubic tubercle to the anterior rim of the acetabulum was smaller while the acetabulum diameter and its depth, the diameter of the femoral head and the ratio between femoral head and the acetabulum diameter were larger. The above differences reached strong statistical significance. Of the two ratios used only the first one reached statistical significance. Using this ratio alone offered the best discrimination rate of up to 99% and should be the preferred choice when available.

  6. Hip Implant Systems

    ... made of metal or ceramic, and the socket (acetabulum) is removed and replaced with a prosthetic cup. ... its socket in the hip bone (pelvis) Bone fracture Joint infection Local nerve damage with numbness/weakness ...

  7. Retrieval of a broken guide wire transfixing the hip through the proximal femoral nail hole

    Saurabh Jain; Abhishek Pathak; Rajeev Kant Pandey


    Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons.We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps.This method is little invasive,easy,time-saving and without need for changing the inital fixation.

  8. Intra-articular membranous interposition detected by MRI in developmental dysplasia of the hip

    Watanabe, W.; Itoi, Eiji; Sato, Kozo [Akita Univ. (Japan). Dept. of Orthopedic Surgery


    Intra-articular membranous interposition was detected by MRI in the hip joint with residual subluxation of a girl aged 5 years 10 months. This structure, which had low signal intensity on both T1- and T2-weighted images, separated the femoral head from the acetabulum. Histological examination revealed chondrometaplasia, which suggested that this interposition might be transformed to a surface cartilaginous tissue of the secondary acetabulum often observed in residual subluxation of the hip. (orig.)

  9. Retrieval of a broken guide wire transfixing the hip through the proximal femoral nail hole

    Jain Saurabh


    Full Text Available 【Abstract】Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons. We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps. This method is little invasive, easy, time-saving and without need for changing the inital fixation.

  10. Intact and Implanted Femur Behavior During Walking and Jogging


    particular for investigations including temporal effects such as studies on fracture healing, fatigue, micromotion and remodeling to examine the...directed superiorly. The resultant hip joint reaction force was applied on the near-hemispherical surface of the acetabulum -femoral head contact area of the...given system of coordinates during the cycle period. Second, the actual contact area of the acetabulum and the femoral head and the way the joint

  11. Internal Prosthetic Replacement of Skeletal Segments Lost in Combat Related Injuries.


    proceeds over a large strain range. There is no fracture but simply a progressive tearing as with a fabric. The tensile strength is very significantly...approach the problem of a cementless acetabulum as well and the site on a female baboon is too small. The femur component is monolithic incorporating...outer porosity available for bony ingrowth. This arrangement for a molded polyethylene acetabulum prosthesis is shown in Figure 16. In this case, the

  12. Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model

    Jacek Białecki; Marian Majchrzycki; Antoni Szymczak; Małgorzata Dorota Klimowicz-Bodys; Edward Wierzchoś; Krzysztof Kołomecki


    Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO)...

  13. Femoroacetabular impingement

    Anderson, Suzanne E., E-mail: [The University of Notre Dame Australia, School of Medicine Sydney, 160 Oxford Street, Darlinghurst 2010, NSW, Sydney (Australia); Department of Diagnostic, Pediatric and Interventional Radiology, Inselspital, University of Bern, Bern 3010 (Switzerland); Siebenrock, Klaus Arno; Tannast, Moritz [Department of Orthopedic Surgery, Inselspital, University of Bern, Bern 3010 (Switzerland)


    Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions. Pincer impingement generally involves the acetabular side of the joint where there is excessive coverage of the acetabulum, which may be focal or more diffuse. There is linear contact of the acetabulum with the head/neck junction. Cam impingement involves the femoral head side of the joint where the head is associated with bony excrescences and is aspheric. The aspheric femoral head jams into the acetabulum. Imaging appearances are reviewed below. This type is evident in young males in the second and third decades. The main features of FAI are described.

  14. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children

    Rubel, Ivan F.; Kloen, Peter; Helfet, David L. [Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY (United States); Potter, Hollis G. [MRI Department, Diagnostic Radiology, Hospital for Special Surgery, New York (United States)


    Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone. We present two cases of pediatric traumatic hip dislocation associated with posterior wall fractures of the acetabulum. In both cases, obvious postreduction instability was noted without conclusive findings of etiology on plain X-rays or CT scans. Magnetic resonance imaging (MRI) disclosed an extensive posterior wall traumatic involvement in both cases and helped to decide in favor of open reduction of the hip and internal fixation of the posterior wall fragment. (orig.)

  15. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.


    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  16. Research on Transverse Acetabular Fracture Fixation Using Different Plate Attachment Methods

    Gediminas Gaidulis


    Full Text Available The article deals with the problem of transverse acetabular fracture fixation using different plate attachment methods. A 3D model of pelvis and hip joint structure was created and the design of three different fixation plates using SolidWorks was made. The plates were fixed at distances of 10, 20 and 30 mm from the acetabulum. The model was meshed into finite elements, a static external load of 2500 N was added and the analysis of stress distribution in plates and fracture displacement was performed. The obtained results showed that fracture displacement was quite similar in all fixation methods. However, the maximal stress in the nearest from the acetabulum plate was higher than yield strength. Thus, this placement is not eligible. The plate fixed at a distance of 30 mm from the acetabulum appeared the most suitable because of the smallest and symmetrical stress distribution in the plate.

  17. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

    Sanjay Agarwala


    Full Text Available Vascular injury is one of the rare complications of primary total hip arthroplasty (THA. We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

  18. Specific inferior dislocation of the hip: one case report

    XU Chao


    @@ Hip joint dislocations are generally classified as anterior, posterior, and central dislocations. In 1970s, the anterior dislocation was divided into pubic type and obturator type.1 It is generally recognized that for anterior dislocation of the hip joint, the femoral head is located at anteriorinferior part of the acetabulum, characterized clinically as abduction, extorsion, slight flexion deformity, and longer limb than the opposite side. When posterior dislocation is present, the femoral head is located at posteriorsuperior part of the acetabulum and manifested clinically as flexion, adduction, intorsion, and shortening deformity.

  19. Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults

    Troelsen, Anders


    adults with symptomatic hip dysplasia. The surgical aim of this extensive procedure is to reorient the acetabulum to improve coverage and eliminate the pathological hip joint mechanics. Intraoperative assessment of the achieved acetabular reorientation is therefore crucial. The "classic" surgical......Hip dysplasia is characterized by an excessively oblique and shallow acetabulum with insufficient coverage of the femoral head. It is a known cause of pain and the development of early osteoarthritis in young adults. The periacetabular osteotomy is the joint-preserving treatment of choice in young...

  20. Total Hip Arthroplasty for The Treatment of End-stage Acetabular Dysplasia%全髋关节置换术治疗晚期髋臼发育不良

    李宇俊; 文立成; 曹永平; 杨昕


    Objective To explore the installing methods of hip prothesis in a total hip arthroplasty for patients of osteoarthritis secondary to end-stage acetabular dysplasia. Methods Between January 2002 and January 2008.a total of 60 hips in 52 patients with advanced osteoarthritis secondary to acetabular dysplasia underwent the total hip arthroplasty and were followed up. Among the patients,6 were male and 46 were female,with their ages ranging from 46 to 72 years and a average age of 62 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 44 patients. The main symptoms were pain and claudication. According to the developmental degree of acetabulums,three methods were adopted to perform the total hip arthroplasty,which were deepen acetabulum,inward deepening acetabulum and bone transplantation on external upper lip of acetabulum. The Harris scores were applied to evaluate function of the hip during follow-up. X-ray films for both joints were taken in order to learn the coalescence of acetablum with its bone bed after 3,6,9,12 months and every 1 years after operation. The follow-up time ranged from 2 years to 8 years,with an average of 4 years and 6 months. Results At the end of follow-up,the acetabulum prostheses contacted well with their beds of 45 years and the recovery of joint function was satisfactory and no sign of aseptic loosening among the cases of deepen acetabulum and inward deepened acetabulum. However,in 5 of 6 acetabulums which implanted bone on their external upper lip,there was a radiolucency between the implanted bone and the acetabulum prothesis after 2 years of the operation. No sign of aseptic loosening was found. Conclusion While performing total hip arthroplasty,various methods should be adopted according to the bed of acetabulum for the joints of osteoarthrosis due to acetabulum dysplasis. For the patient of enough bone at the bottom of acetabulum bed the acetabulum should be installed by the operation

  1. Campechetrema herrerai n. gen., n. sp. (Trematoda: Cryptogonimidae) from the intestine of Petenia splendida (Pisces: Cichlidae) from Campeche, Mexico.

    Lamothe-Argumedo, R; Salgado-Maldonado, G; Pineda-López, R


    Campechetrema herrerai n. gen, n. sp. is described from the cichlid fish Petenia splendida from EI Vapor lagoon, an oligohaline lagoon, Campeche, México. It is distinguished from other genera of Cryptogoniminae by the presence of a single gonotyl, a preequatorial acetabulum, few vitelline follicles, and lack of pars prostatica and prepharynx.

  2. Treatment of an old infection in a total hip replacement with an interim spacer prosthesis.

    Zilkens, K W; Casser, H R; Ohnsorge, J


    When treating a septic hip-joint prosthesis with bone loss of the proximal femur secondary to osteomyelitis, we implanted a specially designed prosthesis to act as a local antibiotic and spacer between the acetabulum and femur until the infection abated. Arthroplasty could then be carried out with no trouble and there was no recurrence of infection.

  3. [Favourable long-term results from cemented total hip arthroplasty combined with acetabular bone impaction grafting in patients under the age of 50

    Busch, V.J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.


    OBJECTIVE: Determination of long-term results of hip replacements in patients who, at the time of operation, were under the age of 50. Procedures whereby an existing acetabulum defect was filled with bone chips that were impacted into a strong layer, after which a cemented total hip prosthesis was i

  4. Four Helvella (Ascomycota: Pezizales: Helvellaceae species from the Cold Desert of Leh, Ladakh, Jammu and Kashmir, India

    K. Dorjey


    Full Text Available The present paper deals with four Helvella species namely Helvella acetabulum, H.corium, H.queletii and H.macropus from Leh district in Ladakh region of the state of Jammu and Kashmir. Of these, the first three species are new fungus records for India while H.macropus constitutes first authentic record from Ladakh.

  5. Shelf acetabuloplasty for Perthes' disease: 12-year follow-up.

    Geest, I.C.M. van der; Kooijman, H.M.; Spruit, M.; Anderson, P.G.; Smet, P.A.G.M. de


    The goal of all therapies for Perthes' disease is to achieve an optimal shape of the acetabulum and an optimal coverage of the femoral head. Thirty patients who were included in this follow-up study (mean follow-up 12 years) underwent a shelf acetabuloplasty for Catterall group III or IV. The mean I

  6. Am Investigation of the Hip Development in Fetus and Newborn Infants%胎儿及新生儿髋关节发育的大体观察

    许瑞江; 马承宣; 张喜恩


    The right hip joints from 47 fresh fetus and newborn infant cadavers were studied. Vernier calliper (precision of 0.02mm) was used for measuring the diameter of the femoral head and the depth of the acetabulum, and their ratio was calculated. The result shows that although the ratio between the diameter of the femoral head and the depth of the acetabulum decreased at birth, the acetabulum is big enough to hold the femoral head. So the hip joint is quite , stable. It is suggested that the relative shallowness of acetabulum do not cause CDH directly. CDH occurs readily when there are acetabular dysplasia, oligohydramnios, malposition in utero and after birth and so on.%本文对47例胎儿、新生儿尸体的右髋关节进行大体解剖研究.用游标卡尺测量股骨头直径和髋白深度.其结果发现:尽管头白比值在出生时有减少的趋势,但髋关节仍很稳定,提示单纯髋臼相对变浅不足以引起先天性髋脱位,只有在髋白发育不良、羊水过少和不良胎位或体位等因素的基础上才容易导致先天性髋脱位的发生.

  7. 关节囊周围的髂骨切骨术及其改良术在髋臼重建中的地位%Reconstruction of Acetabula With Pericapsular Iliac Osteostomy and Its Modification: a Report of 154 Cases

    彭明惺; 周素华; 周锡华; 刘利君


    作者采用关节囊周围的髂骨切骨术及其改良术式治疗先天性髋关节脱位154例170个髋关节,疗效满意,实践证明本手术不仅能改变髋臼指向,还能改变髋臼容积,加深髋臼的深度,是重建浅平髋臼的最佳方式,改良的手术更有针对性的重塑了髋臼后沿的缺陷(而后沿缺陷是其他骨盆切骨不能解决的难题),从而扩大了治疗范围.%From Dec.1980 to Jul.1991.154 cases,aged 1-14 years,were treated with Pemberton's and modified Pemberton's osteotomy of the ilium.The results were satisfactory showing that this operation not only changed the orientation of the acetabulum but also increased the depth of the acetabulum.Pemberton's osteotomy can be a good method to those having a shallow acetabulum.The modified Pemberton's osteotomy has the advantage to remould the dificient posterior edge of the acetabulum which can not be accomplished by any other pelvic osteotomies.

  8. No negative effects of bone impaction grafting with bone and ceramic mixtures.

    Arts, J.J.C.; Gardeniers, J.W.M.; Welten, M.L.M.; Verdonschot, N.J.J.; Schreurs, B.W.; Buma, P.


    Reconstructing large loaded bone defects with ceramic bone graft extenders is tempting considering the expected future donor bone shortage. However, whether there are negative effects is unknown. Standardized large defects in the acetabulum of goats were created and subsequently reconstructed with m

  9. Three-dimensional magnetic resonance imaging analysis of hip morphology in the assessment of femoral acetabular impingement

    Kavanagh, E.C. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Read, P.; Carty, F.; Zoga, A.C. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Parvizi, J. [The Rothman Institute of Orthopedics, Philadelphia, PA (United States); Morrison, W.B., E-mail: [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)


    Aim: To determine a possible association between femoral-acetabular impingement (FAI) volume and the development of labral tear using a three-dimensional (3D) model reconstruction of the acetabulum and the femoral head. Materials and methods: Magnetic resonance arthrography images of the hip in 42 patients with pain and suspected labral tear were acquired using a 1.5 T MRI machine. Using 3D analysis software, outlines of the acetabular cup and femoral head were drawn and 3D reconstruction obtained. To control for differences in patient size, ratios of acetabulum : femoral head volume (AFV) and acetabulum : femoral head surface area (AFA) were used for analysis. The association between volume of acetabulum : femoral head and FAI was investigated using ANOVA analysis. Results: There were 19 men and 23 women with a mean age of 39 years (range 18-78 years). The average AFV was 0.64 (range 0.37-1.05, SD 0.16) and AFA was 0.73 (range 0.36-1.26, SD 0.23). Herniation pit was significantly associated with a small AFV. Conclusion: Femoral neck herniation pits are associated with a low AFV. Gross volume and surface area ratios do not appear to correlate with labral tears or cartilage loss. This technique will enable more advanced analysis of morphological variations associated with FAI.

  10. Bilateral acetabular fracture without trauma

    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.


     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  11. Impaction bone grafting and a cemented cup after acetabular fracture

    Bronsema, E.; Stroet, M.A. Te; Zengerink, M.; Kampen, A. van; Schreurs, B.W.


    PURPOSE: Patients suffering from post traumatic osteoarthritis of the acetabulum often require a total hip arthroplasty at a relatively young age. Long-term data outcome studies for this population are lacking. We report on the long-term outcome of 20 acetabular fractures in 20 patients treated with

  12. Arthroscopic removal of intraarticular fragments following fracture dislocation of the hip

    Bagaria Vaibhav


    Full Text Available We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.

  13. Sharpley’s Bottom Historic Sites Interdisciplinary Investigations, Tombigbee River Multi-Resource District, Alabama and Mississippi. Phase II. Archeological Investigations.


    patterns of concoidal fracture and also 125 lk tend to grade into and include the so-called hotel china wares which exhibit a semivitreous or porcelaneous...Tombigbee River systems.) 22M0997 ,4 FlA Cattle 1 pc. 106.Og (Butchered right innominate. The series of saw- cut margins about the acetabulum

  14. The Mt. Gilead Cemetery Study: An Example of Biocultural Analysis from Western Georgia.


    acetabulum were extensively remodeled, and severe osteoarthritic lipping had formed on the lumbar vertebrae. All of the incisors were present and in...unreduced fracture of the left hip. The neck of the femur had broken and the leg had never healed properly due to insufficient immobilization after the

  15. Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

    Narender Kumar Magu


    Conclusion: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.

  16. Single- and dual energy QCT around acetabular cups in total hip arthroplasty using 3-dimensional segmentation

    Mussmann, Bo Redder; Andersen, Poul Erik; Torfing, Trine

    Introduction: Bone density measurements around hip implants are challenged by artifacts and the complex anatomy of the acetabulum. We developed 3D segmentation software and used dual energy CT to reduce artifacts. The between-scan agreement and reliability of the software was tested and bone mine...

  17. Clinostatic syndrome in Waldenström macroglobulinemia.

    Malick, Christine; de la Roque, Philippe Montané; About, Isabelle; Campistron, Evelyne; Delhomme, Olivier; Denat, Serge; Giauffret, Frédéric; Rochet, Nicole; Sicre, Chantal; Clarac, Annie


    We report a case of Waldenström macroglobulinemia revealed by clinostatic syndrome in an 81-year-old woman. A lytic lesion was found in the ilium and acetabulum. There was no evidence of transformation to high-grade lymphoma. Radiation therapy ensured complete resolution of the clinostatic syndrome within 1 month of treatment completion.

  18. Bernese periacetabular osteotomy for hip dysplasia. A modification to original technique and South American perspective.

    Lara, Joaquín; Tobar, Carlos; Besomi, Javier


    Bernese periacetabular osteotomy has become a secure and reproducible technique for treatment of hip dysplasia. It allows an adequate reorientation of the acetabulum and coverage of the femoral head improving biomechanical conditions of the hip joint. We present a review of literature and a modification of original technique that includes a smaller incision and preservation of the abductor muscles and rectus femoris tendon insertion.

  19. Acetabular anatomy and the relationship with pelvic vascular structures. Implications in hip surgery.

    Feugier, P; Fessy, M H; Béjui, J; Bouchet, A


    Most direct vascular trauma occurring during hip surgery results from injury to pelvic vascular structures which are not visible during the procedures of reaming, drilling holes or the fixation of screws. In this study, 5 pelves of fresh cadavers were injected with a radiopaque mixture and were visualised with a scanner according to 5 predetermined sections. Bone depth of the acetabulum was measured in each section. A calculation was made describing the minimal distance separating the inner cortex from the principal pelvic vessels. After an anatomic dissection of each pelvis, the relationship between the vessels and screws of the fixation cup, implanted identically on the quadranted acetabulum, was observed. The screws placed in the anterior and inferior quadrants and the center of the acetabulum endangered the external iliac v. and a. and the obturator pedicle. The depth of the periacetabular bone was greater in the superior and posterior quadrants. The inferior gluteal, pudendal and superior gluteal aa. were more than ten mm from the posterior wall. Conversely, the external iliac and obturator pedicles came in contact with the osseous surface on which they lay. A projection of the vessels on the acetabulum was made, and the reproducible character of the acetabular-quadrant system was verified. The superior quadrant offers all the characteristics of a vascular safe zone. A knowledge of these anatomic relationships explain vascular trauma in pelvic fractures and helps to prevent vascular injury in hip surgery.

  20. Gait and lower limb muscle strength in women after triple innominate osteotomy

    Kolk, S.; Fluit, R.; Luijten, J.; Heesterbeek, P.J.; Geurts, A.C.; Verdonschot, N.J.J.; Weerdesteyn, V.


    Background: In adult patients with developmental hip dysplasia, a surgical procedure (triple innominate osteotomy) of the pelvic bone can be performed to rotate the acetabulum in the frontal plane, establishing better acetabular coverage. Although common clinical hip scores demonstrate significant i

  1. Gait and lower limb muscle strength in women after triple innominate osteotomy

    Kolk, S.; Fluit, R.; Luijten, J.; Heesterbeek, P.J.; Geurts, A.C.H.; Verdonschot, N.J.; Weerdesteijn, V.G.M.


    BACKGROUND: In adult patients with developmental hip dysplasia, a surgical procedure (triple innominate osteotomy) of the pelvic bone can be performed to rotate the acetabulum in the frontal plane, establishing better acetabular coverage. Although common clinical hip scores demonstrate significant i

  2. Periprosthetic acetabular fracture associated with extensive osteolysis.

    Chatoo, M; Parfitt, J; Pearse, M F


    Periprosthetic fracture of the acetabulum is an uncommon complication of total hip arthroplasty. The management is reported to be difficult, and complications such as nonunion and implant loosening are common. We described herein a case of nontraumatic periprosthetic acetabular fracture associated with significant osteolysis, which was successfully managed by addressing the fracture and osteolysis independently.

  3. Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases.

    Ikemura, Satoshi; Mawatari, Taro; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki


    The prognosis of patients with a subchondral insufficiency fracture remains unclear. The purpose of this study was to investigate the correlation between locations of bone marrow edema (BME) lesions and clinical outcome in patients with a subchondral insufficiency fracture of the hip. We retrospectively reviewed 15 consecutive hips in 14 patients who were diagnosed with subchondral insufficiency fracture of the hip at our institution between April 2013 and September 2014. This study included five males (six hips) and nine females (nine hips), ranging from 36 to 83 years of age (mean age: 66 years). The mean duration from the onset of hip pain to MRI examination was 1.8 months (range 0.5-5 months). Both clinical and imaging findings were investigated. Based on the findings of MR images, BME lesion in the femoral head alone was observed in six patients (six hips), BME lesion in the acetabulum alone was observed in one patient (two hips) and BME lesions in both the femoral head and acetabulum were observed in seven patients (seven hips). 3 of 15 hips resulted in rapidly destructive arthrosis and their BME lesions were observed in both the femoral head and acetabulum. 8 of 15 hips successfully healed by conservative treatment and BME lesions in 7 of these 8 hips were observed in only the femoral head or acetabulum. The results of this study indicate that the locations of BME lesions (femoral side alone, acetabular side alone or both) may be related to the clinical outcome in patients with a subchondral insufficiency fracture of the hip. Patients with subchondral insufficiency fracture of the hip in whom BME lesions were observed in both the femoral head and acetabulum may have a higher risk to need to undergo total hip arthroplasty.

  4. Analysis of the Effect of Artificial Hip Replacement in the Treatment of Acetabular Defect%髋臼缺损畸形的人工髋关节置换手术疗效分析



    Objective To study the acetabulum defect deformity treatment methods of artificial total hip replacement. Methods 30 cases of acetabular defects were selected in our hospital, including 13 cases of acetabulum hypoplasia, acetabulum fracture malunion after trauma in 5 cases, 6 patients with rheumatoid arthritis, ankylosing spondylitis hip lesions, 6 cases were performed total hip replacement, take the acetabulum deepening, double cone spiral acetabulum, autologous bone graft and structural methods such as titanium mesh and bone graft line true acetabular reconstruction, all patients preoperative CT three-dimensional reconstruction, with Harris scoring criteria. Results Followed up for 6~36 months, has not occurred during the follow-up period of artificial hip prosthesis loosening and fracture around, etc. Harris scoring (36±6.5) preoperatively, postoperative (93±5.2). Conclusion Deformity of total hip replacement for defects of acetabulum, through the acetabulum, Zweymulle double cone spiral acetabulum, grain pressure distribution, structural bone graft autologous bone graft and titanium mesh and bone graft and so on the many kinds of methods can be a very good reconstruction of acetabulum, restore good stability and the Harris score, can achieve very good effect.%目的探讨髋臼缺损畸形的人工全髋关节置换术的处理方法。方法选取我院收治存在髋臼缺损畸形患者30例,包括髋臼发育不良13例、髋臼创伤骨折后畸形愈合5例、类风湿性关节炎6例,强直性脊柱炎髋关节病变6例,均行全髋关节置换术,采取髋臼加深、双锥  面螺旋型髋臼、自体结构性植骨及钛网加植骨等多种方法行真臼重建,全部病例术前行 CT 三维重建,评分标准采用 Harris 评分。结果随访6~36个月,随访期间未发生人工髋关节假体松动、周围骨折等。Harris 评分术前(36±6.5),术后(93±5.2)。结论对于髋臼缺损畸形的全髋关节置

  5. Computer Aided Technology Stimulation on Total Hip Replacement due to Adult Hip Developmental Dysplasia%计算机辅助技术在成人髋发育不良中的应用研究

    许燕飞; 罗雅; 李杰; 常敏; 郭英; 吴继昆; 杨景帆; 王涛; 艾元亮; 张俊; 孙皓民


    探讨计算机辅助技术在成人髋臼发育不良全髋关节置换术(THA )中的应用价值.选择单侧髋臼发育不良需进行全髋关节置换的患者21例,男性5例5髋,女性16例16髋.按Crowe分型,Ⅱ型6例(6髋),Ⅲ型11例(11髋),Ⅳ型4例(4髋).年龄30~78岁,平均年龄55.3岁.所有患者术前行薄层CT扫描并通过M3 D可视化软件进行三维重建、术前观察、测量,手术预演、制定手术方案并行全髋关节置换术.术后21例患者均获得3~32个月随访,平均随访12.8月.术前Harris评分为(48.5±6.2)分,随访时评分为(86.3±4.3)分,差异有统计学意义(P<0.05),优17例,良4例.所有病例术后通过骨盆标准前后位X线片测量,1例患者髋臼水平距离,1例髋臼垂直距离超出安全范围,1例影像前倾角超出安全范围,合格率85.7%.术中未出现髋臼戳穿、股骨假体周围骨折,术后所有病例均未出现术口感染,1例出现大腿疼痛,所有病例随访期间均为出现假体松动、下沉.成人髋臼发育不良行THA,计算机辅助技术可以术前把握真臼的解剖特点及其与假臼的相对关系、髋臼壁的缺损类型,量化指导如何选择合适的髋臼及股骨侧假体、选择合适的髋臼重建方式、髋臼假体安放角度等,对于恢复头臼假体同心复位,实现理想的头臼匹配,恢复髋关节解剖结构,重建关节功能具有重要作用.%To investigate the stimulation worth of computer aided technology on total hip replacement due to adult acetabulum developmental dysplasia.21 cases with unilateral acetabulum developmental dysplasia are selected to proceed total hip replacement operation.Among the selected cases,6 cases are type II,1 1 type Ⅲ and 4 typeⅣaccording to the classification system of CROWE;5 cases are male and 1 9 cases female.The ages range from 30 to 78,the average being 55.3.Thin

  6. Morphometric analysis of the hip joint in fetuses and neonates.

    Kossakowski, Dariusz; Popko, Janusz


    Background. Information's about prenatal development of hip joint are necessary for full understanding of it's neonatal abnormalities. Material and methods. Our research was carried out during autopsies on 43 cadavers of 20-40 week old fetuses and 7 cadavers of newborns which died before twelfth week. Observation of development of hip in the second half of the prenatal growth and the neonatal period was based on morphometric analysis. Results and Conclusions. In the hips of 20 to 40 weeks old fetuses, 3 cases of dysplasia were found. Morphometric analysis of hips in this age group, showed very complex developmental processes. The most important of them seems to be the decreasing overlay of acetabulum over femoral head in the last few weeks before the birth. This physiological process is an result of the relative decrease in acetabulum depth and simultaneous faster increase of femoral head diameter in two last weeks of prenatal development.

  7. MR-anatomy of infants hip: comparison to anatomical preparations.

    Krasny, R; Prescher, A; Botschek, A; Lemke, R; Casser, H R; Adam, G


    The correlation between anatomical preparations and MRI images of the most important structures of newborn hips in coronal and axial orientation was performed in 18 post mortem babies. T1-weighted images present a good differentiation between cartilage, bone, ligaments and surrounding soft tissues. Coronal images give the best opportunity to study the clinically important structures of the roof of acetabulum including the labrum and the ground of the acetabulum. The latter is shown in a more detailed way by MRI than by sonography. Axial images allow additional examinations of the ventral and dorsal parts of the joint. By using both coronal and axial images the exact determination of the centering of the femur head in the hip joint is possible.

  8. Unusual case of mixed form of femoroacetabular impingement combined with nonspecyfic synovitis of the hip joint in a young adult: A case report

    Mladenović Marko


    Full Text Available Introduction. Minimal bone changes in the acetabulum and/or proximal femur, through mechanism known as femoroacetabular impingement, during flexion, adduction and internal rotation lead to early contact between femoral head-neck junction and acetabular brim, in anterosuperior region. Each additional pathological substrate which further decreases specified clearance provokes earlier onset of femoroacetabular impingement symptoms. Case report. We presented a 20-year-old male patient with groin pain, limping, positive impingement test, radiological signs of mixed form of femoroacetabular impingement and unrecognized chronic hypertrophic synovitis with earlier development of clinical hip symptoms than it has been expected. Open surgery of the left hip was done. Two years after the surgery, patient was asymptomatic, painless, and free of motion, with stable x-rays. Conclusion. Hypertrophic synovial tissue further reduces the distance between the femoral head-neck junction and the acetabulum, leading to the earlier onset of femoroacetabular impingement symptoms. Surgical treatment is the method of choice.

  9. Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

    Narasimhan Ramani


    Materials and Methods: 35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years. Results: No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI of 35° and above. These were all from the group where open reduction alone was done. Conclusion: We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.

  10. Protrusio acetabuli (Otopelve

    Chueire Alceu Gomes


    Full Text Available Protrusio acetabuli is a disease characterized by a deformity of the medial wall of the acetabulum with a progressive migration of the femoral head into the pelvic cavity, resulting in some mechanical disorders, pain and limited limb hip movement. It was first described by Otto in 1824 as an intrapelvic protusion of the femoral head. It is considered multifactorial, and it is suggested that there is a heredity background to this disease. It is classified as primary (75,3% or secundary (24,7% according to aetiology; mild, moderate and severe radiologically. This review aims to present some treatment techniques using arthroplasties which are several and little explored. As in the literature, the choice was bone graft since there is no migration of the cemented acetabulum and no necessity of a titanium cup of great diameter.

  11. Triple pelvic osteotomy: Report of our mid-term results and review of literature

    Mimura, Tomohiro; Mori, Kanji; Kawasaki, Taku; Imai, Shinji; Matsusue, Yoshitaka


    A wide variety of pelvic osteotomies have been developed for the treatment of developmental dysplasia of the hip (DDH). In the present paper, we present a detailed review of previous studies of triple osteotomy as an alternative treatment for DDH. We also report our experience treating 6 adult cases of DDH by triple osteotomy in order to highlight the various aspects of this procedure.The mean age of our patients was 31.2 years with a mean follow-up period of 6 years. We assessed range of motion, center-edge angle, acetabular index angle, Sharp angle, acetabulum head index, head lateralization index, Japanese Orthopedic Association score, Harris hip score, patient satisfaction, and the difference between lower limb lengths before and after the procedure. At final follow-up, clinical scores were significantly improved and radiographic parameters also showed good correction of acetabulum. PMID:24649410

  12. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Gavaskar Ashok S


    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  13. Ranking of computed tomography in congenital hip dysplasia and hip dislocation

    Lingg, G.; Nebel, G.; Thomas, W.; Hering, L.


    A lot of methods of measurement have been developed to record precisely the degrees of luxation and the deviations from the normal form in the hip joints of the child and adult. The orthopaedic surgeon needs those data for a preoperative ''coxometric program'' before performing acetabuloplastic operations with osteotomia, osteotomia of the pelvis and combined operations. Computed tomography yields a series of informations and of possibilities of measurements which can determine the operative procedure in particular. These informations concern among other things the dimensions of the dysplasia of the acetabulum in the horizontal plane with the extension of the posterior lip and the angle of the acetabular opening, furthermore the physiological or pathological congruence between the head of the femur and the acetabulum, the angle of antetorsion of the neck of the femur and, in the small infant, the direct noninvasive imaging of the tube of the capsule with imaging of possible obstacles to reposition.

  14. Femoroacetabular impingement

    José Batista Volpon

    Full Text Available ABSTRACT The femoroacetabular impingement (FAI is as condition recently characterized that results from the abnormal anatomic and functional relation between the proximal femur and the acetabular border, associated with repetitive movements, which lead labrum and acetabular cartilage injuries. Such alterations result from anatomical variations such as acetabular retroversion or decrease of the femoroacetabular offset. In addition, FAI may result from acquired conditions as malunited femoral neck fractures, or retroverted acetabulum after pelvic osteotomies. These anomalies lead to pathological femoroacetabular contact, which in turn create impact and shear forces during hip movements. As a result, there is early labrum injury and acetabulum cartilage degeneration. The diagnosis is based on the typical clinical findings and images. Treatment is based on the correction of the anatomic anomalies, labrum debridement or repair, and degenerate articular cartilage removal. However, the natural evolution of the condition, as well as the outcome from long-term treatment, demand a better understanding, mainly in the asymptomatic individuals.

  15. Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

    Cibulka, Michael T


    Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.

  16. The homology of the pelvic elements of Zygaspis quadrifrons (Squamata: Amphisbaenia).

    Urben, Carling C; Daza, Juan D; Cadena, Cristhian; Lewis, Patrick J; Thies, Monte L


    Limb attenuation with element loss has occurred multiple times among the Squamata (lizards, snakes, and amphisbaenians). Although most of the attention has been focused on the appendicular bones, we found that the pelvic rudiments have been studied less thoroughly and recurring disagreement is common among different authors studying the same species. We studied the osteology of the pelvic region of female and male Zygaspis quadrifrons with high-resolution X-ray computed tomography data. We report an osteological landmark (acetabulum) not previously detected in this taxon, the presence of which has repercussions that call for a reconsideration of the primary homology hypothesis for the identity of these bones in amphisbaenians and other squamates. Finally, we observed that the acetabulum and limb rudiments in amphisbaenians (i.e., the stylopodium when present) are situated medial to the pelvic girdle, contrasting with the large majority of tetrapods where these structures are laterally oriented.

  17. Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage.

    Iwasaki, K


    The Pavlik harness was used in the treatment of complete congenital dislocation of one or both hips in a series of infants, on either an outpatient or an inpatient basis. The results in the two groups were compared. For the children treated as outpatients the incidence of avascular necrosis of the femoral head was 7.2 per cent and for the group treated as inpatients the rate was 28 per cent. Application of the Pavlik harness allowed reduction of the hip by shifting the femoral head first to the posterior part of the acetabulum through flexion of the hip, followed by movement of the femoral head anteriorly into the acetabulum through abduction of the hip, which is possible because of stretching of the adductor muscles by the weight of the lower extremity. When the reduction is obtained by forced abduction there is a greater danger of avascular necrosis of the femoral head.

  18. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail

    Pedro Luciano Teixeira Gomes


    Full Text Available ABSTRACT Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  19. Computed tomography in abnormalities of the hip

    Visser, J.D.; Jonkers, A.; Klasen, H.J. (Rijksuniversiteit Groningen (Netherlands). Academisch Ziekenhuis); Hillen, B. (Rijksuniversiteit Groningen (Netherlands). Lab. voor Anatomie en Embryologie)


    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip joint can be measured by means of computed tomography.


    Jiang, Jun; Ren, Shuang; Liu, Min


    To investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT. Between January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows: the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. There were significant differences in the AAI, PAI, and AAA between before and after surgery (P 0.05). There was a significant correlation between the forward rotation and AAA difference (r = 0.841). Salter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the

  1. Impingement of lesser trochanter on ischium as a potential cause for hip pain

    Patti, Jay W.; Ouellette, Hugue; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Radiology, Boston, MA (United States)


    The bony anatomy of the hip leads to a limited array of impingement syndromes, more frequently resulting from abnormal contact between the femoral neck and acetabulum. We report an unusual case of osseous impingement between the lesser trochanter and ischium, with involvement of the intervening quadratus femoris muscle. While the prevalence and etiology of this finding is unclear, it may represent a cause for hip pain. (orig.)

  2. Imaging of Developmental Dysplasia of the Hip (DDH

    Nazanin Ahmadi


    Full Text Available Ultrasound is not only the best method of screening in the diagnosis of DDH, but the best method of peroperative reduction of the hip joint and the best follow up method after treatment."nHowever, in older children with an abnormal pelvic x-ray, MRI coul be very helpful to assess the degree of ossification of the acetabulum and maturation and covering of the cartilaginous labrum.

  3. Research on the Application of Bone Allograft Acetabular Bone Defect Reconstruction in Hip Revision%同种异体骨移植在髋关节翻修髋臼骨缺损重建中的应用研究

    李强; 刘敏; 沈民仁; 钟进军


    目的:探讨同种异体骨移植在髋关节翻修髋臼骨缺损重建中的应用,评价同种异体骨在人工髋关节翻修术中的应用价值.方法:25例全髋关节翻修髋臼缺损病例,术中均应用同种异体松质骨重建髋臼骨缺损,随访时间8~24个月.结果:25例临床愈合,未发生并发症,有效率为100%.结论:同种异体松质骨治疗髋关节翻修髋臼骨缺损疗效可靠.达到了髋臼重建、修复骨缺损和固定假体的治疗目的.%Objective:To estimate the application value of allogeneic bone transplantation to reconstruct the defect of acetabulum in revision of total hip arthroplasty. Methods:In this study,retrospective analysis was conducted by using the data of 25 patients who had undergone the revision of total hip arthroplasty from December 2006 to March 2012. Bone defects of acetabulum in all of these cases were reconstructed using allogeneic bone transplantation. All patients had been followed from 8 to 24 months. Results: All these 25 cases were healed in clime without complications. The effective and excellent rate is 100%. Harris hip scores and imageological examination were used as healing standard. Conclusion: Reconstructing the defect of acetabulum with allogeneic bone is reliable in revision of total hip arthroplasty and could achieve the goal of rebuilding acetabulum, repairing bone defect and fixing prosthesis.

  4. Human Skeletal Material from 23JA277 Blue Springs Lake Project, Jackson County, Missouri


    cranium; Individual 23JA277-1 .......... 4 3 Healed bone fracture ; radius of Individual 23JA277-2 .......... 9 4 Lateral view showing relationship of ribs...characteristic quite common among American Indians (Ubelaker 1978). 8 Dos -’-I , ,1 Figure 3. Healed bone fracture ; radius of Individual 23JA277-2. 9...fragments of articulating Innominate surrounding the acetabulum nearly complete left tibial diaphysis portion of left fibula portions of both humeral

  5. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai


    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  6. One Hundred Ninety-five Cases of High-voltage Electric Injury


    Cervical spine: 2 Thoraco–lumbar spine: 5 Upper extremity (including two scapular fractures ): 7 Rib: 1 Femur/ acetabulum : 1 Tibia/fibula/ankle/foot: 5 Soft...the most common were fractures in 22 patients, soft- tissue lesions in 14, lung injuries in 9, and head inju- ries in 8. In addition to the...aforementioned 14 patients Table 1. Associated trauma A total of 49 of 195 (25.1%) sustained the following associated acute injuries Fracture : 22 Skull: 4

  7. Major Extremity Trauma Research Consortium (METRC) 2011 Annual Report


    ages of 18 and 84 who were admitted with fractures requiring surgery of the upper or lower extremity, pelvis or acetabulum , and foot (calcaneus...Contribute to the science of fracture and soft tissue repair; 6. Contribute to the science of conducting clinical trials in a challenging...talus or crush injuries only). Excluded from the registry are hip fractures in patients 60 years or older and fractures to the wrist, hand, ankle


    R. M. Tikhilov


    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  9. Biotechnology Symposium


    implant device is dependent in large part upon the quality and vitality of bone remodelling around the bone postop- ACETABULUM eratively. Bone resorption...Model of the Residual Strength and Life of Fatigue-loaded Composite Coupons," Composite Materials: Fatigue and Fracture . STP 907, H.T. Hahn, ed., ASTM...Materials Fatigue and Fracture . ASTM STP 907, D.J. Wilkins, Ed 1986, pp. 274- 297. 17. Tang, J.M., and Springer, G.S., Effects of Moisture and Temperature

  10. Hip dysplasia is more severe in Charcot-Marie-Tooth disease than in developmental dysplasia of the hip.

    Novais, Eduardo N; Bixby, Sara D; Rennick, John; Carry, Patrick M; Kim, Young-Jo; Millis, Michael B


    Patients with Charcot-Marie-Tooth disease may develop hip dysplasia. Hip geometry in these patients has not been well described in the literature. We compared the hip morphometry in Charcot-Marie-Tooth hip dysplasia (CMTHD) and developmental dysplasia of the hip (DDH) in terms of extent of (1) acetabular dysplasia and subluxation, (2) acetabular anteversion and osseous support, (3) coxa valga and femoral version, and (4) osteoarthritis. Fourteen patients with CMTHD (19 hips; mean age, 23 years) presenting for periacetabular osteotomy were matched to 45 patients with DDH (45 hips; mean age, 21 years) based on age, sex, and BMI. We assessed acetabular dysplasia and subluxation using lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), and acetabular roof angle of Tönnis (TA) on plain pelvic radiographs and acetabular volume, area of femoral head covered by acetabulum, and percentage of femoral head covered by acetabulum on three-dimensional CT reconstruction models. Acetabular version and bony support, femoral version, and neck-shaft angle were measured on two-dimensional axial CT scans. Hip osteoarthritis was graded radiographically according to Tönnis criteria. Acetabular dysplasia was more severe in CMTHD, as measured by smaller LCEA (p Hip subluxation was more pronounced in CMTHD, as demonstrated by lower area of femoral head covered by acetabulum (p = 0.034) and percentage of femoral head covered by acetabulum (p = 0.007). CMTHD was associated with higher acetabular anteversion (p hips were found in CMTHD. The extent of acetabular dysplasia, hip subluxation, acetabular anteversion, coxa valga, and hip osteoarthritis was more severe in CMTHD. These findings are important in choosing the appropriate surgical strategy for patients affected by CMTHD.

  11. Does radiographic coxa profunda indicate increased acetabular coverage or depth in hip dysplasia?

    Fujii, Masanori; Nakamura, Tetsuro; Hara, Toshihiko; Nakashima, Yasuharu; Iwamoto, Yukihide


    Although radiographic coxa profunda has been considered an indicator of acetabular overcoverage, recent studies suggest that radiographic coxa profunda is a nonspecific finding seen even in hip dysplasia. The morphologic features of coxa profunda in hip dysplasia and the frequency with which the two overlap are not well defined. We determined (1) the prevalence of radiographic coxa profunda in patients with hip dysplasia; (2) the morphologic differences of the acetabulum and pelvis between patients with hip dysplasia and control subjects; and (3) the morphologic differences between hip dysplasia with and without coxa profunda. We retrospectively reviewed the pelvic radiographs and CT scans of 70 patients (70 hips) with hip dysplasia. Forty normal hips were used as controls. Normal hips were defined as those with a lateral center-edge angle between 25° and 40°. Coxa profunda was defined as present when the acetabular fossa was observed to touch or was medial to the ilioischial line on an AP pelvic radiograph. CT measurements included acetabular version, acetabular coverage, acetabular depth, and rotational alignment of the innominate bone. The prevalence of coxa profunda was 44% (31 of 70 hips) in dysplastic hips and 73% (29 of 40 hips) in the control hips (odds ratio, 3.32; 95% CI, 1.43-7.68). Dysplastic hips had a more anteverted and globally shallow acetabulum with inwardly rotated innominate bone compared with the control hips (p hips with coxa profunda had a more anteverted acetabulum (p hip dysplasia, but rather indicates classic acetabular dysplasia, defined by an anteverted acetabulum with anterolateral acetabular deficiency and an inwardly rotated pelvis. Thus, the presence of coxa profunda does not indicate a disease in addition to hip dysplasia, and the conventional maneuvers during periacetabular osteotomy are adequate for these patients. Level IV, diagnostic study.

  12. Anterior dislocation of the sacroiliac joint with complex fractures of the pelvis and femur in children: a case report.

    Zhang, Hua; Jin, Libin; Li, Wanli; Li, Hang


    Pediatric sacroiliac joint injuries are uncommon lesions, especially when combined with anterior sacroiliac dislocation. Here, we present a rare case of anterior dislocation of the sacroiliac joint associated with ipsilateral acetabulum, subtrochanteric, and pubic rami fractures combined with a contralateral sacral fracture. This appears to be the first such case reported in the literature. At the 6-month follow-up, a favorable clinical outcome was achieved, with radiological healing of the lesion.

  13. Proximal Focal Femoral Deficiency

    Vishal Kalia, Vibhuti


    Proximal focal femoral deficiency (PFFD) is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contra...

  14. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail.

    Gomes, Pedro Luciano Teixeira; Castelo, Luís Sá; Lopes, António Lemos; Maio, Marta; Miranda, Adélia; Dias, António Marques


    Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  15. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Uchida Kenzo


    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  16. Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model

    Jacek Białecki


    Full Text Available Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS, triple pelvic osteotomy (TPO, total hip replacement (THR, and femoral head and neck resection (FHNE. The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

  17. Absence or interruption of the supra-acetabular line: a subtle plain film indicator of hip pathology

    Major, N.M. [Department of Radiology, University of California San Francisco, Box 0628, San Francisco, CA 94143 (United States); Helms, C.A. [Department of Radiology, University of California San Francisco, Box 0628, San Francisco, CA 94143 (United States)


    Objective. To show that absence or interruption of the supraacetabular line is a subtle plain film indicator of pathology in the acetabulum. Design. Nineteen hips from 17 patients with known disease processes involving the acetabulum as demonstrated by subsequent magnetic resonance imaging, bone scan or plain film follow-up were evaluated with antero-posterior (AP) plain films of the pelvis. Three additional cases were diagnosed prospectively using interruption of the supra-acetabular line as the criterion for inclusion. Fifty AP plain films of the pelvis in patients without hip pain were examined prospectively to determine normal imaging criteria. Results and conclusions. The normal supra-acetabular line measures 2-3 mm in thickness superiorly and is a thin sclerotic line in the medial aspect. In all 22 hips (with pathology) in this series, the line was interrupted or absent. Loss or interruption of the supra-acetabular line may thus be a subtle pain film indicator of a disease process involving the acetabulum. This plain film sign has not previously been reported. (orig.). With 8 figs., 1 tab.

  18. Cause and Management in the Failed Concentric Reduction of Femoral Head in Congenital Dislocation of Hip%先天性髋关节脱臼手术后半脱位的原因及处理

    冯家钧; 胡佐民; 王凤兰; 韩福友


    先天性髋关节脱臼病理变化比较复杂,有些病例术后发生半脱位.其原因有多种,在同一病例中可有两种以上原因,如髂腰肌短缩、股骨颈过短及头臼不对称等.作者根据术后发生半脱位的不同原因提出了处理方法.%In the open reduction of the congenital dislocation of hip,one of the common errors in the operative technique is failure to reduce the femoral head into the depth of the true acetabulum completely and concentrically.This error has occurred in 16 out of 275 hips treated by means of various procedures in our hospital since 1980.The causes of this error may be:1.the femoral head being poorly embedded in the acetabulum due to a tenotomy of the iliopsoas;2.shortening of the femoral neck;3.incongruity of the head and the acetabulum;4.incomplete excision of the reflected labium and poor capsulorrhaphy,and etc.According fo the different pathological changes procedures adopted appropriatly will acheieve satisfactory results.

  19. Efficacy of the use of templating in total hip arthroplasty

    Fábio Stuchi Devito


    Full Text Available OBJECTIVE: The aim was to evaluate the effectiveness of traditional preoperative planning with the use of templating. METHOD: Forty-three anteroposterior X-rays were analyzed by three experienced surgeons (A, B, C and compared. Cohen's Kappa concordance test and weighted Kappa indexes using quadratic weighting were used for statistical analysis with a confidence interval of 95%. RESULTS: The preoperative evaluations were divided into the analysis of the sizes of the acetabular cup, stem and plug of the distal femoral canal. Surgeon A obtained a moderate agreement in relation to the acetabular component and substantial agreements in relation to the stem and plug. Surgeon B had moderate agreement in relation to both the acetabulum and the stem and substantial agreement in relation to the plug. Surgeon C obtained moderate agreement in relation to the analysis of the acetabulum and the plug and substantial agreement for the stem. The intraobserver agreement test demonstrated a prevalence of slight agreement in relation to the acetabulum and substantial agreement in relation to the stem and to the plug. CONCLUSION: Templating used in preoperative planning proved effective; however, there was a prevalence of slight and moderate agreement in relation to the size of the acetabular component.

  20. The determination of male adult age at death by central and posterior coxal analysis--a preliminary study.

    Rougé-Maillart, Clotilde; Telmon, Norbert; Rissech, Carme; Malgosa, Assumption; Rougé, Daniel


    In forensic anthropological analysis, the pelvis is of particular interest as it is often a comparatively well-preserved part of the skeleton. This study in age determination uses the acetabulum, the central element of the pelvis, as a complement to the examination of the auricular surface. The test sample consisted of 30 individuals. First, the authors studied the auricular surface using the Lovejoy criteria. Second, they isolated four criteria based on chronological changes in the acetabulum. Third, they conducted an evaluation of each of these variables. The study examines the correlation between these criteria and the age of the individuals. A significant correlation was found between the acetabular criteria and age, and between the acetabular criteria and the Lovejoy criteria of the auricular surface. For forensic purposes, the acetabulum is an effective predictor in the determination of age. This newly proposed method explores the same criteria of ageing as the Lovejoy method. The combination of the two methods produces relatively consistent results in the estimation of age.

  1. Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture.

    Jo, Woo Lam; Lee, Woo Suk; Chae, Dong Sik; Yang, Ick Hwan; Lee, Kyoung Min; Koo, Kyung Hoi


    Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

  2. Propensity for hip dislocation in normal gait loading versus sit-to-stand maneuvers in posterior wall acetabular fractures.

    Marmor, Meir; McDonald, Erik; Buckley, Jenni M; Matityahu, Amir


    Treatment of posterior wall (PW) fractures of the acetabulum is guided by the size of the broken wall fragment and by hip instability. Biomechanical testing of hip instability typically is done by simulating the single-leg-stance (SLS) phase of gait, but this does not represent daily activities, such as sit-to-stand (STS) motion. We conducted a study to examine and compare hip instability after PW fractures in SLS and STS loading. We hypothesized that wall fragment size and distance from the dome (DFD) of the acetabulum to the simulated fracture would correlate with hip instability and, in the presence of a PW fracture, the hip would be more unstable during STS loading than during SLS loading. Incremental PW osteotomies were made in 6 cadaveric acetabula. After each osteotomy, a 1200-N load was applied to the acetabulum to simulate SLS and STS loading until dislocation occurred. All hip joints in the cadaveric models were more unstable in STS loading than in SLS loading. PW fragments at time of dislocation were larger (Pfracture size of 33% or more and a DFD of 20 mm or less.

  3. Outcome measures of bipolar hip arthroplasty for atraumatic hip disorders - A preliminary report

    Dudani Baldev


    Full Text Available Background: Bipolar hip arthroplasty was devised for fracture neck femur in elderly patients. Subsequently, indications have been expanded to include conditions affecting acetabulum like rheumatoid arthritis, osteoarthritis and avascular necrosis of femoral head. Materials and methods: We have studied the results of bipolar hip arthroplasty in 38 such patients, with severely involved acetabulum due to rheumatoid arthritis, avascular necrosis of femoral head and primary osteoarthritis. Acetabulum was reamed to get a tight ′equatorial′ or ′rim′ fit of the prosthesis. Prosthesis selected was 1 mm bigger than the maximum size of reamer used. Cement was used in femur whenever there was marked osteoporosis or wide medullary canal. Post operatively all patients were regularly screened for pain, range of movement, protrusio acetabuli, loosening / sinking of prosthesis and radiographic assessment of movement in the two bearings of prosthesis. Results: Overall results achieved were good to excellent in 80% of patients. Conclusions: The ultimate outcome is comparable to total hip arthroplasty. The added advantage is of low cost, simplicity of procedure and easy future revision.

  4. Early results of the use of oblong S-ROM cementless acetabular component

    Popović Zoran


    Full Text Available Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method statisfactory in certain types of bone defefects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.

  5. The distribution of Elongation Factor-1 Alpha (EF-1alpha), Elongation Factor-Like (EFL), and a non-canonical genetic code in the ulvophyceae: discrete genetic characters support a consistent phylogenetic framework.

    Gile, Gillian H; Novis, Philip M; Cragg, David S; Zuccarello, Giuseppe C; Keeling, Patrick J


    The systematics of the green algal class Ulvophyceae have been difficult to resolve with ultrastructural and molecular phylogenetic analyses. Therefore, we investigated relationships among ulvophycean orders by determining the distribution of two discrete genetic characters previously identified only in the order Dasycladales. First, Acetabularia acetabulum uses the core translation GTPase Elongation Factor 1alpha (EF-1alpha) while most Chlorophyta instead possess the related GTPase Elongation Factor-Like (EFL). Second, the nuclear genomes of dasycladaleans A. acetabulum and Batophora oerstedii use a rare non-canonical genetic code in which the canonical termination codons TAA and TAG instead encode glutamine. Representatives of Ulvales and Ulotrichales were found to encode EFL, while Caulerpales, Dasycladales, Siphonocladales, and Ignatius tetrasporus were found to encode EF-1alpha, in congruence with the two major lineages previously proposed for the Ulvophyceae. The EF-1alpha of I. tetrasporus supports its relationship with Caulerpales/Dasycladales/Siphonocladales, in agreement with ultrastructural evidence, but contrary to certain small subunit rRNA analyses that place it with Ulvales/Ulotrichales. The same non-canonical genetic code previously described in A. acetabulum was observed in EF-1alpha sequences from Parvocaulis pusillus (Dasycladales), Chaetomorpha coliformis, and Cladophora cf. crinalis (Siphonocladales), whereas Caulerpales use the universal code. This supports a sister relationship between Siphonocladales and Dasycladales and further refines our understanding of ulvophycean phylogeny.

  6. Quantitative measurement and analysis for detection and treatment planning of developmental dysplasia of the hip

    Liu, Xin; Lu, Hongbing; Chen, Hanyong; Zhao, Li; Shi, Zhengxing; Liang, Zhengrong


    Developmental dysplasia of the hip is a congenital hip joint malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Conventionally, physicians made diagnoses and treatments only based on findings from two-dimensional (2D) images by manually calculating clinic parameters. However, anatomical complexity of the disease and the limitation of current standard procedures make accurate diagnosis quite difficultly. In this study, we developed a system that provides quantitative measurement of 3D clinical indexes based on computed tomography (CT) images. To extract bone structure from surrounding tissues more accurately, the system firstly segments the bone using a knowledge-based fuzzy clustering method, which is formulated by modifying the objective function of the standard fuzzy c-means algorithm with additive adaptation penalty. The second part of the system calculates automatically the clinical indexes, which are extended from 2D to 3D for accurate description of spatial relationship between femurs and acetabulum. To evaluate the system performance, experimental study based on 22 patients with unilateral or bilateral affected hip was performed. The results of 3D acetabulum index (AI) automatically provided by the system were validated by comparison with 2D results measured by surgeons manually. The correlation between the two results was found to be 0.622 (p<0.01).

  7. Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis

    Yang, Ik; Ryu, Kyung Nam; Lee, Sun Wha; Choi, Woo Suk; Lee, Eil Seong [Kyung Hee University Hospital, Seoul (Korea, Republic of)


    Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints.

  8. Examination of the osteoarthritic hips by computed tomography

    Tajiri, Masahiro; Hieda, Hiroshi (Kurume Univ., Fukuoka (Japan). School of Medicine)


    Sixteen normal hips in 8 persons and 29 osteoarthritic hips in 19 patients were examined by a computed tomography (CT), calculating CT value of the femoral head and acetabulum. Atrophy of muscles around the hip joints was also measured on CT by planimeter. The results obtained were as follows: 1. The mean CT value of the normal femoral head was 238 +- 8.6 (H. U.) and that of the acetabulum was 199 +- 2.8. 2. The mean CT value of the osteoarthritic femoral head increased in accordance with degenerative stage, reaching to the maximum value of 351 +- 6.8 at the progressive stage, while it decreased to 285 +- 21.3 at the late stage. 3. The mean CT value of the acetabulum showed a high score of 285 +- 21.3 already at the early stage and remained stationary. 4. Atrophy of the gluteus medius muscle was observed at early stage; the gluteus maximus muscle at the progressive stage, and the tensor fasciae latae, gluteus minimus and iliopsoas muscle at the late stage.

  9. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    Christophe Boulay


    Full Text Available Acetabular cup orientation (inclination and anteversion is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter could determine the safe range of pelvis tilt (positional parameter for an individual and not a group.

  10. Hip joint replacement using monofilament polypropylene surgical mesh: an animal model.

    Białecki, Jacek; Majchrzycki, Marian; Szymczak, Antoni; Klimowicz-Bodys, Małgorzata Dorota; Wierzchoś, Edward; Kołomecki, Krzysztof


    Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

  11. Effect of clearance on cartilage tribology in hip hemi-arthroplasty.

    Lizhang, Jia; Taylor, Simon D; Jin, Zhongmin; Fisher, John; Williams, Sophie


    Hemi-arthroplasty of the hip (an artificial femoral head articulating against the natural acetabulum) is used to treat fractured necks of femur; however, there is evidence that articulation causes erosion of the cartilage, resulting in pain for the patient. Parameters that may influence this cartilage erosion include head material and roughness, clearance between the head and acetabulum and activity levels of the patient. This study has assessed the effect of clearance of hemi-arthroplasty articulations on the contact stress, friction and cartilage deformation in an in vitro tribological simulation of the hemi-arthroplasty joint that applied dynamic loads and motion. It has been demonstrated that peak contact stress increased from 5.6 to 10.6 MPa as radial clearance increased from small (1.8 mm). In all samples, friction factor increased with time and was significantly less with extra-large clearances compared to small (<0.6 mm), medium (0.6-1.2 mm) and large (1.2-1.8 mm) clearances. The cartilage deformation observed was significantly greater in acetabulum samples paired to give small or extra-large clearances compared to those with medium or large clearances.

  12. The Analysis of X-ray and CT Features of the Femoroacetabular Impingement Syndrome%股骨髋臼撞击综合征的X线及CT表现分析

    胡剑波; 刘冠霖; 肖林; 吴泽文; 陈焱君


    Objective Through analyzing the characteristic appearances on X-ray plain film and CT of hips with Femoroacetabular Impingement (FAI), to find and conclude the image features of FAI. Methods 78 cases FAI with 96 FAI hips in X-ray plain film and CT images were analysed and typed. Results ①The characteristic features include: aspheric femoral head, pistol-grip deformity, femoral neck Osseous bumps, deep acetabulum, cross-over sign or "eight" sign, acetabulum medial extrusion, "linear indentation sign", herniation pits; the non-characteristic features include: osteophytes, ossification or calcification in acetabulum superior, cystic lesions under the joint surface of acetabulum and femoral head, narrowed lateral joint space. ② In all 96 FAI hips, Cam-type 23 hips, Pincer-type 14 hips, Mixed-type 59 hips. Conclusion Femoral head-neck junction deformity and abnormality of acetabulum are the key image features of FAI diagnosis, the other abnormity of osseous arthritis can only be a indicative signs for diagnosis of FAI.%目的 通过对诊断为股骨髋臼撞击综合征(FAI)的髋关节的X线及CT表现的特征分析,归纳总结其影像特点.方法 对78例96个FAI髋关节的X线及CT片进行影像特征分析、分型.结果 ①、FAI的特征性X线及CT征象包括:非球形股骨头、股骨颈枪柄样畸形、股骨颈骨突.深髋臼、“交叉征”或“8”字征、髋臼内突、股骨颈前方凹痕征及皮质硬化、骨颈疝窝;FAI的非特异性改变包括:髋臼外上缘增生、髋臼外缘骨化或钙化,髋臼关节面下囊变、股骨头囊变、髋关节外侧间隙狭窄.②、96个FAI中,Cam型23个,Pincer型14个,混合型59个.结论 股骨头颈交界处的畸形和髋臼的异常形态是FAI诊断的主要征象,其他骨性关节炎的异常影像表现是诊断FAI的参考征象.

  13. 髋臼前倾角术前测量在全髋关节置换术中的临床意义%The clinical significance of preoperative measurement of acetabular anteversion in total hip replacement

    蒲超; 张珊珊; 李伟; 吴青霞; 候小倩


    Objective Discussion the clinical significance of preoperative measurement of acetabular antever-sion in total hip replacement .Methods 121 patients were randomly assigned into normal group and preoperative measurement group .Made the statistical analysis of postoperative differ between anteversion of artificial acetabulum with preoperative measuring value within 1° and 5° ,and contrast the postoperative anteversion of artificial acetabulum in two groups .Results Postoperative error within 1° and 5° was 3 .13% ,29 .69% in preoperative measurement group respectively .There was no statistically significans in the difference of postoperative anteversion of artificial acetabu-lum between two groups .Conclusion acetabulum The preoperative measurement can improve the accuracy in playing artificial acetabulum ,but the accuracy of lay need to improve .%目的:探讨髋臼前倾角术前测量在全髋关节置换术中的临床意义。方法将121例需行全髋关节置换术的患者随机分入常规组和术前测量组。常规组按照前倾15°安放人工髋臼,术前测量组按照术前测量角度安放人工髋臼,并统计分析术前测量组术后人工髋臼前倾角度与术前测量值相差1°和5°的比例以及两组患者术后人工髋臼前倾角度差异。结果术前测量组人工髋臼前倾角度术后误差小于1°和5°的比例分别为3.13%和29.69%,常规组与术前测量组术后人工髋臼前倾角度比较,差异有统计学意义( P<0.05)。结论髋臼前倾角术前测量可提高人工髋臼安放的精确度,但安放的准确性还需进一步提高。

  14. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

    Needell, Steven D.; Borzykowski, Ross M. [Boca Radiology Group, Boca Raton, FL (United States); Carreira, Dominic S.; Kozy, John [Broward Health Orthopedics and Sports Medicine, Fort Lauderdale, FL (United States)


    To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115 through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography. (orig.)

  15. Study of the morphology and biomechanics of sacral fracture

    QUAN Ren-fu; YANG Di-sheng; WANG Yi-jin


    Objective: To observe the morphological characteristics of sacral fracture under different impact loads.Method: Ten fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded.Morphological characteristics were observed under scanning electron microscope.Results: The form of sacral fracture was related to the impact energy. Under low-energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high-energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type Ⅰ fracture; sacral foramen cataclasm fracture, Type Ⅱ fracture; central vertebral canal fracture, Type Ⅲ fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture.The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different.When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury.When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 ~ 25 J, Type Ⅰ fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.Conclusions: In dynamic state, sacrum fracture mostly belongs to Type Ⅰ and Type Ⅱ, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

  16. Acetabular roof arc angles and anatomic biomechanical superior acetabular weight bearing area

    Thossart Harnroongroj


    Full Text Available Background: Acetabular fracture involves whether superior articular weight bearing area and stability of the hip are assessed by acetabular roof arc angles comprising medial, anterior and posterior. Many previous studies, based on clinical, biomechanics and anatomic superior articular surface of acetabulum showed different degrees of the angles. Anatomic biomechanical superior acetabular weight bearing area (ABSAWBA of the femoral head can be identified as radiographic subchondral bone density at superior acetabular dome. The fracture passes through ABSAWBA creating traumatic hip arthritis. Therefore, acetabular roof arc angles of ABSAWBA were studied in order to find out that the most appropriate degrees of recommended acetabular roof arc angles in the previous studies had no ABSAWBA involvement. Materials and Methods: ABSAWBA of femoral head was identified 68 acetabular fractures and 13 isolated pelvic fractures without unstable pelvic ring injury were enrolled. Acetabular roof arc angle was measured on anteroposterior, obturator and iliac oblique view radiographs of normal contralateral acetabulum using programmatic automation controller digital system and measurement tools. Results: Average medial, anterior and posterior acetabular roof arc angles of the ABSAWBA of 94 normal acetabulum were 39.09 (7.41, 42.49 (8.15 and 55.26 (10.08 degrees, respectively. Conclusions: Less than 39°, 42° and 55° of medial, anterior and posterior acetabular roof arc angles involve ABSAWBA of the femoral head. Application of the study results showed that 45°, 45° and 62° from the previous studies are the most appropriate medial, anterior and posterior acetabular roof arc angles without involvement of the ABSAWBA respectively.

  17. [Bernese periacetabular osteotomy (Ganz procedure). First experience].

    Chládek, Petr; Trc, T; Schejbalová, A; Rehácek, V


    Developmental dysplasia of the hip (DDH), treated either conservatively or surgically, may result in a dysplastic acetabulum. To treat this after bone maturation is completed, Bernese periacetabular osteotomy, also known as the Ganz procedure, has recently been used as the method of choice at our department. The evaluation of the first results is presented here. The group evaluated comprised 25 hips (21 female and 4 male) in 22 patients. Nineteen hips were treated for residual dysplasia of the acetabulum due to DDH, and six for a spastic hip. The average age was 26 years (range, 12 to 44) and 14 right and 11 left hips were involved On pre- and post-operative radiographs the AC index, Wiberg lateral CE angle, Wagner index, improvement in Shenton's line, and lateralisation and anteversion of the acetabulum were compared. Bernese periacetabular osteotomy is an extensive surgical procedure requiring special instrumentation. It may be associated with serious complications and has a relatively long learning curve. The average follow-up was 18 months (range, 2 to 36). The average duration of surgery was 2 hours and 44 min (range, 2 to 31/ 2 h). The average values improved in the AC index by 24 degrees, lateral CE angle by 29 degrees and Wagner index by 18 %. Shenton's line was corrected by surgery in 20 hips and lateral migration in 16 hips. In two hips lateralisation did not changed. Two serious complications were recorded: para-articular ossification requiring excision and concomitant acetabular trimming, and great intra-operative blood loss. Various mechanisms of damage to the hip are discussed and the methods of treatment outlined, together with prerequisites for successful surgery. Potential complications and their treatment are mentioned. Bernese periacetabular osteotomy makes the range of roofing procedures for hip joint treatment wider. These, as well as hip joint reduction techniques, should be performed in major specialized centres.

  18. Comparison of one-dimensional and two-dimensional functionally graded materials for the backing shell of the cemented acetabular cup.

    Hedia, H S


    Among the factors that have been suggested as contributing to the failure of a total joint replacement are stress shielding and the subsequent bone resorption. Recent studies have shown that when a backing shell made from a Ti alloy is used, high stresses are generated in the cement at the edges of the cup, and low stresses are generated at the dome of the bone in the acetabulum; thus, the bone at the dome suffers stress shielding and the cement edge suffers high stresses. The aim of this study was to investigate the effect of using a functionally graded material (FGM), instead of Ti alloy, for the backing shell (BS) on the stress distribution in the BS-cement-bone system. Finite-element and optimization techniques were used to obtain the optimal distribution of materials in the tangential direction only of the backing (1D FGM) as well as in the tangential and radial directions of the backing (2D FGM). It was found that the stress distribution in the BS-cement-bone system was about the same, regardless of whether the BS was fabricated from a 1D or 2D FGM. The stress-shielding factor in the bone at the dome of the acetabulum and the maximum von Mises stress in cement at the cement interfaces for 1D and 2D FGM were reduced by about 51%, 69%, and 50%, respectively, compared to the case when the shell was fabricated from a Ti alloy. The optimal elastic modulus of the 1D FGM was obtained with the materials graded from HA at the dome of the acetabulum to a Ti alloy at the rim of the shell. The optimal elastic modulus of the 2D FGM was obtained with the materials graded from Ti alloy at the right edge of the rim, to Bioglass 45S5 at the left edge of the rim, and to HA at the dome of the shell.

  19. Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction.

    Zwawi, Mohammed A; Moslehy, Faissal A; Rose, Christopher; Huayamave, Victor; Kassab, Alain J; Divo, Eduardo; Jones, Brendan J; Price, Charles T


    This study utilized a computational biomechanical model and applied the least energy path principle to investigate two pathways for closed reduction of high grade infantile hip dislocation. The principle of least energy when applied to moving the femoral head from an initial to a final position considers all possible paths that connect them and identifies the path of least resistance. Clinical reports of severe hip dysplasia have concluded that reduction of the femoral head into the acetabulum may occur by a direct pathway over the posterior rim of the acetabulum when using the Pavlik harness, or by an indirect pathway with reduction through the acetabular notch when using the modified Hoffman-Daimler method. This computational study also compared the energy requirements for both pathways. The anatomical and muscular aspects of the model were derived using a combination of MRI and OpenSim data. Results of this study indicate that the path of least energy closely approximates the indirect pathway of the modified Hoffman-Daimler method. The direct pathway over the posterior rim of the acetabulum required more energy for reduction. This biomechanical analysis confirms the clinical observations of the two pathways for closed reduction of severe hip dysplasia. The path of least energy closely approximated the modified Hoffman-Daimler method. Further study of the modified Hoffman-Daimler method for reduction of severe hip dysplasia may be warranted based on this computational biomechanical analysis. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:1799-1805, 2017. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society.

  20. Prediction of bone loss in elderly female subjects by MR perfusion imaging and spectroscopy

    Griffith, James F.; Yeung, David K.W. [Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, New Territories (China); Leung, Jason Chi Shun; Leung, Ping C. [Chinese University of Hong Kong, Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, Shatin (China); Kwok, Timothy C.Y. [Chinese University of Hong Kong, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin (China)


    To determine whether MR perfusion indices or marrow fat content at baseline can predict areal bone mineral density (BMDa) loss. Repeat dual x-ray absorptiometry (DXA) of the hip was performed in female subjects at 2 years (n = 52) and 4 years (n = 45) following baseline MR perfusion imaging and spectroscopy of the hip. Percentage reduction in femoral neck BMDa at 4 years post-baseline was greater in subjects with below median acetabulum enhancement slope (E{sup slope}) (-5.6 {+-} 1.2 Vs -1.1 {+-} 1.2 (mean {+-} standard error) p = 0.014) or muscle maximum enhancement (E{sup max}) (-5.7 {+-} 1.2 Vs -0.23 {+-} 1.2, p = 0.009) after adjusting for baseline co-variables. Baseline MR parameters correlated with reduction in BMDa at 4 years (acetabulum E{sup slope} r = 0.517, p = 0.0003; muscle E{sup max} r = 0.306, p = 0.043) as well as traditionally applied clinical risk factors. Acetabulum E{sup slope}, femoral neck E{sup max} and marrow fat content at baseline had sensitivities of 89%, 81% and 72% respectively at distinguishing between fast (>1%/annum) (n = 18) and slow (<1%/annum) (n = 27) BMD losers. Elderly female subjects with reduced perfusion indices at baseline had increased femoral neck bone loss at 4 years. Selected perfusion indices and marrow fat content have a moderate to high sensitivity in discriminating between fast and slow bone losers. (orig.)

  1. Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint

    Fritz Thorey


    Full Text Available An assortment of clinical trials have been done presenting the effectiveness of autologous matrix-induced chondrogenesis (AMIC for the regeneration of chondral leasions. The purpose of the study was to underline the accessability of the acetabulum and the femoral head through the known portals and prove i the feasibility of placing the AMIC in the different zones of the hip joint and ii check for dislocation after joint movement. Six human cadavers underwent hip arthroscopy on both hips. Two chondral lesions were set on each femoral head and two in the acetabulum to evaluate a total of 48 defects. After microfracturing an autologous matrix-induced chondrogenesis graft was placed on these lesions arthroscopically. After repeated joint movement the dislocation of the graft was checked. It was possible to place the AMIC graft in all 48 chondral lesions. The time needed for placing the graft was 8±2.9 minutes. A trend of time reduction could be detected throughout this study as the surgeon gained more experience. For the femoral head, after twenty cycles of joint movement 18/24 spots showed no displacement, 4/24 showed minor displacement (<3 mm and 2/24 showed major displacement (>3 mm. None showed total displacement. For the acetabulum 22/24 spots showed no displacement and 2/24 showed minor displacement. A combined microfracturing and placing of an AMIC graft of focal chondral lesions of the hip joint can be done arthroscopically. Prospective randomized in vivo studies should compare the results of arthroscopilally placed AMIC grafts with microfracturing and microfracturing alone.

  2. Septic Arthritis Resulting in Pathological Dislocation of the Hip in Newborns and Infants%新生儿小婴儿急性化脓性髋关节炎及晚期病理性髋脱位的治疗

    于凤章; 陈幼容; 潘少川


    From 1977 to 1991,36 newborns and infants with acute septic arthritis were admitted for treatment.Most patients ran a low grade fever or afebrile,refused feeding and appeared irritable.Passive motion of the affected hip,as during changing diapers,may cause pain and crying.Swelling of the affected hip is an important sign.In addition to the antibiotic therapy,repeated aspiration of the hip joint and keeping in Bryant traction are vital treatments.The sequelas were classified into five types:(1) pathological dislocation of the hip,the acetabulum and the femoral head remaining intact,(2)absorption of the femoral head leaving the femoral neck a nubbin,(3) total loss of the head and neck,(4) destruction of acetabulum but an intact femoral head and neck,and (5)total breakdown of the acetabulum,the femoral head and the neck.Proper selection of surgical procedures according to the individual condition was essential.The advantages and shortcomings of different kinds of surgical procedures were discussed.%1972至1991年共收治新生儿小婴儿急性化脓性髋关节炎36例,晚期病理性髋脱位24例.本文总结了新生儿小婴儿急性化脓性髋关节炎的临床表现、体征及治疗经验.并将晚期病理性髋脱位分为五型,按各种类型的病理改变采取各种手术方法.本文介绍了各种手术方法并分析总结了其优点和存在的问题.

  3. Late sequelae of juvenile rheumatoid arthritis of the hip: A follow-up study into adulthood

    Patriquin, H.B.; Camerlain, M.; Trias, A.


    A 4-13 year follow up study of 29 patients with juvenile rheumatoid arthritis into adulthood revealed several structural deformities of the hips: coxa magna, short femoral neck, subluxations associated with large cyst-like erosions of femur and acetabulum near the ligamentum teres, flattened, wide femoral head (without steroid treatment). The deformities evoke the possibility of ischemia of the femoral head in the presence of active, compressive synovial proliferation during the growth period in a joint with largely intra-articular nutrient vessels.

  4. Dumb-bell shaped tuberculous abscess across the greater sciatic notch compressing both sciatic nerves.

    Baba, H; Okumura, Y; Furusawa, N; Omori, H; Kawahara, H; Fujita, T; Katayama, K; Noriki, S


    We report an instructive case of a 65-year-old man who presented with a dumb-bell shaped tuberculous abscess across the greater sciatic notch bilaterally compressing both sciatic nerves. Clinical symptoms progressed slowly and mimicked lumbar radiculopathy, thus delaying an accurate diagnosis. Anterolateral retroperitoneal and posterolateral gluteal approaches of the greater sciatic notch as well as the acetabulum on both sides were followed in order to provide safe viewing and resection of the abscess. The abscess wall was adherent to the sciatic nerve and surrounding blood vessels. The symptoms completely disappeared after resection of the abscess.

  5. Management of sequelae of septic arthritis of hip

    Jagadishwer Rao K


    Full Text Available A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years follow-up of reconstruction of sequale of septic arthritis of hip joint.

  6. Features of radiological and anatomical changes in bone of the hip joint due to injuries


    Objective: To conduct a retrospective analysis of radiographs and CT scans for studying of typical changes in acetabulum (A) and proximal femur (F) in patients with the consequences of injuries in the area of the hip joint.Methods: We analyzed radiographs and CT scans in 106 patients. Patients were divided into groups: I — false joint of F neck, II – false joint at the level of per-, inter- and subtrochanteric area of F, III — post-traumatic avascular necrosis of F head, IV — posttraumatic co...

  7. Hip CT in congenital dislocation: appearance of tight iliopsoas tendon and pulvinar hypertrophy

    Hernandez, R.J.; Tachdjian, M.O.; Dias, L.S.


    The iliopsoas tendon can interpose between the femoral head and the acetabulum, preventing reduction or stability of reduction of a dislocated hip by a closed method. The tendon produces an infolding of the capsule and labrum. This infolding of the capsule and labrum creates an ''isthmus'' between the capital and the acetabular parts of the capsule. This deformity of the capsule was recognizable on computed tomography (CT) in 10 patients, all of whom had surgical confirmation of the findings. The presence of hypertrophied pulvinar can also be recognized by CT.

  8. A new genus and a new species of Cladorchiidae (Digenea: Dadayiinae) from Podocnemis expansa (Chelonia) of the neotropical region, State of Pará, Brazil.

    Knoff, Marcelo; Brooks, Daniel Rusk; Mullins, Maria Cristina; Gomes, Delir Corrêa


    A new species of amphistome digenean from the stomach and intestine of Podocnemis expansa (Pelomedusidae), of the tropical rain forest, from the State of Pará, Brazil, is described and allocated to a new genus ( Oriximinatrema noronhae ). The new species is characterized by the presence of an esophageal bulb, an esophageal extension uncovered by an extension of the pharyngeal sacs, a well-developed cirrus sac, post-bifurcal genital sucker, a ventro-terminal acetabulum with an anterior lip, and medium-sized eggs. This is the first report of a Dadayiinae trematode infecting a reptilian host.


    R. M. Tikhilov


    Full Text Available Degenerative-dystrophic changes in hip after treatment of acetabular fracture, over the time, develops about in 60% of affected people. In such cases, total hip replacement is used. Existing classifications (for example AO or Letournel are good for fracture treatment, but not for arthritis following acetabular fracture. The group of patients, with post traumatic arthritis, is heterogeneous with severity of post traumatic anatomic changes. Basis for surgical approach, could be current classification for post traumatic changes – taking into account features of anatomic functional changes in hip and the bone defects of acetabulum. In this article is demonstrated X-ray and clinical basing for current classification.

  10. Indirect reduction of posterior wall fragment using a suture anchor in acetabular posterior wall fracture with posterior labral root tear.

    Yoo, Je-Hyun; Chang, Jun-Dong; Lee, Ho-Won


    Posterior wall fractures, which are the most common type of acetabulum fracture, are frequently accompanied with an avulsion tear of the posterior labral root as well as hip dislocation due to the injury mechanism. In the treatment of these fractures with an avulsed posterior labral root attached to posterior wall fragment, the use of a suture anchor can induce indirect reduction of a posterior wall fragment as well as direct repair of a labral root tear simultaneously. We describe the simple and efficient technique using a suture anchor in posterior wall acetabular fractures and surgical outcomes of two cases treated with this technique.

  11. Femoral artery thrombosis after internal fixation of a transverse acetabular fracture in a patient with osteogenesis imperfecta type I

    Morgan Steven J


    Full Text Available Abstract Osteogenesis imperfecta is a genetic disorder characterized by increased susceptibility to fractures and vascular injuries due to connective tissue fragility. In this case report, we present a patient with osteogenesis imperfecta type I who sustained a transverse fracture of the right acetabulum while transferring from bed to chair. The fracture was repaired through an ilioinguinal approach. During the surgery, an iatrogenic injury to the femoral artery and vein occurred. This intraoperative complication was salvaged by immediate vascular repair. We discuss the possible causes of iatrogenic vascular injuries in patients with osteogenesis imperfecta. Orthopaedic surgeons should be aware of this potentially devastating complication in this particular patient cohort.

  12. Hip Arthroscopy for Incarcerated Acetabular Labrum following Reduction of Traumatic Hip Dislocation: Three Case Reports

    Hwang, Jung-Mo; Lee, Woo-Yong; Noh, Chang-Kyun; Zheng, Long


    Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation. PMID:27777919

  13. Central dislocation of the hip secondary to insufficiency fracture

    Moe Thaya


    Full Text Available We present a case report of a 45-year old man who sustained a central dislocation of the hip secondary to an insufficiency fracture of the acetabulum. At the time of presentation he was on alendronate therapy for osteoporosis which had been previously investigated. CT scanning of the pelvis was useful for pre-operative planning which confirmed collapse of the femoral head but no discontinuity of the pelvis. The femoral head was morcellized and used as bone graft for the acetabular defect and an uncemented total hip replacement was performed.

  14. CT classification of acetabular fractures

    Marincek, B.; Porcellini, B.; Robotti, G.


    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  15. The Contribution of Genotype to Heterotopic Ossification after Orthopaedic Trauma


    examined our database of long bone and  acetabulum /pelvic  fractures  (n=1313) for HO after  fracture .   Radiographs were reviewed by a musculoskeletal...potential contributing genetic factors (ADRB2, TLR4, CFH)in the development of heterotopic ossification (HO). HO development in long bone fractures ...Single Nucleotide Polymorphysms, Genetics, Fracture Healing W81XWH-08-1-0384 15 MAY 2011-14 APR 2011Annual01-05-2011 The Vanderbilt University

  16. Occult internal iliac arterial injury identified during open reduction internal fixation of an acetabular fracture: a report of two cases.

    Chaus, George W; Heng, Marilyn; Smith, Raymond M


    We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. There were no preoperative signs or symptoms indicative of a vascular injury. These cases emphasise the heightened awareness one must have when treating widely displaced posterior column fractures of the acetabulum, especially those fractures with extension into the greater sciatic notch, as previously formed clot can become dislodged and hemostasis lost. We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.

  17. 治疗先天性髋脱位的强力造盖术及其应用的选择%The Application of Reinforced Shelf Operation on Congenital Hip Dislocation In Children

    孙丹舟; 唐成林; 赵宝林; 季晓风; 孙冰


    Objective:To enhance the shelf supporting forces and intensity of resistence in shelf operation on congenital hip dislocation.Methods:The flat piece and fragments of bone were changed into three pieces of vertical triangle bone and added a vertical bone segment.The reinforced reversion shelf method should be adopted in acetabulum with enough width but a large acetabular index.If the false acetabulum was formed and narrowed the true acetabulum,the inserting shelf operation should be chosen to widen the true acetabulum.Results:The operation was adopted in 243 cases(315 hips),only one had fracture of the inserting shelf.Conclusions;The authors prefer the shelf operation to the used innominate osteotomy to treat the CDH.The problems of fracture and absorption of the shelf have been solved basically.%目的:为了增强治疗小儿先天性髋脱位造盖术造盖的支撑力及抗压强度.方法:将传统的翻转造盖术扁放骨片和碎骨块改为立放3枚三角形骨块,在传统插入造盖上方加1枚立式骨块,取名"强力造盖术".若真臼宽度够,只是髋臼指数大,应选用强力翻转造盖术;若假臼明显形成,将真臼顶挤压变窄,则应选用强力插入造盖术.结果:近5年来应用强力造盖术治疗小儿先天性髋脱位243例,315髋次,只发现1例1髋插入造盖折断.结论:基本上解决了造盖折断和吸收问题.因此,由原来多选用骨盆截骨术,改为现在多选用造盖术.

  18. [Rapidly vanishing hip--a mystery].

    Keren, Yaniv; Sigal, Amit; Greental, Arnan; Vlodavsky, Euvgeni; Soudry, Michael; Militianu, Daniela


    Rapidly destructive hip disease is a rare condition, the cause of which is yet to be clarified, and is described in the literature by scant case reports. The disease was first described by Forestier in 1957, and since then many names have been proposed to describe the rapid vanishing of the femoral head, and occasionally the acetabulum. This condition initially represents as acute hip pain, and rapidly progresses to complete vanishing of the proximal femur, within a few months. We briefly discuss the literature regarding this phenomenon, and describe a case of a female patient who suffered from complete disappearance of the femoral head within 9 weeks.

  19. Chronic septic arthritis of the adult hip: Computed tomographic features

    Resnik, C.S.; Ammann, A.M.; Walsh, J.W.


    Abnormalities on computed tomography (CT) are described in 12 adults in whom septic arthritis of the hip was diagnosed. Presenting symptoms varied, as did CT findings. Soft tissue abnormalities ranged from intra-articular effusion to large abscess formation, and bone changes ranged from minimal erosion of articular surfaces to gross destruction of the proximal femur and acetabulum. CT can be helpful in the evaluation of septic arthritis of the hip because of its superior demonstration of soft tissue detail. An accurate diagnosis can be established in unsuspected cases and can be confirmed when clinical indicators are vague.

  20. Risk of pelvic injury from femoral neck guidewires.

    Feeney, M; Masterson, E; Keogh, P; Quinlan, W


    Many of the devices used in the internal fixation of femoral neck fractures are cannulated and require the initial placement of one or more guidewires for accurate positioning. These wires are occasionally advanced inadvertently through the hip joint and the acetabulum. Pelvic visceral damage may follow. To assess this risk, we inserted three guidewires to a depth of 16 cm into each femoral neck of ten cadavers and explored the pelvis during autopsy. Thirty-two of the 60 guidewires had penetrated a pelvic organ. The literature on intrapelvic injuries associated with hip surgery is reviewed, and suggestions are offered on the avoidance of pelvic penetration during hip fracture fixation.

  1. Quantitative Anatomic Analysis of the Native Ligamentum Teres

    Mikula, Jacob D.; Slette, Erik L.; Chahla, Jorge; Brady, Alex W.; Locks, Renato; Trindade, Christiano A. C.; Rasmussen, Matthew T.; LaPrade, Robert F.; Philippon, Marc J.


    Background: While recent studies have addressed the biomechanical function of the ligamentum teres and provided descriptions of ligamentum teres reconstruction techniques, its detailed quantitative anatomy remains relatively undocumented. Moreover, there is a lack of consensus in the literature regarding the number and morphology of the acetabular attachments of the ligamentum teres. Purpose: To provide a clinically relevant quantitative anatomic description of the native human ligamentum teres. Study Design: Descriptive laboratory study. Methods: Ten human cadaveric hemipelvises, complete with femurs (mean age, 59.6 years; range, 47-65 years), were dissected free of all extra-articular soft tissues to isolate the ligamentum teres and its attachments. A coordinate measuring device was used to quantify the attachment areas and their relationships to pertinent open and arthroscopic landmarks on both the acetabulum and the femur. The clock face reference system was utilized to describe acetabular anatomy, and all anatomic relationships were described using the mean and 95% confidence intervals. Results: There were 6 distinct attachments to the acetabulum and 1 to the femur. The areas of the acetabular and femoral attachment footprints of the ligamentum teres were 434 mm2 (95% CI, 320-549 mm2) and 84 mm2 (95% CI, 65-104 mm2), respectively. The 6 acetabular clock face locations were as follows: anterior attachment, 4:53 o’clock (95% CI, 4:45-5:02); posterior attachment, 6:33 o’clock (95% CI, 6:23-6:43); ischial attachment, 8:07 o’clock (95% CI, 7:47-8:26); iliac attachment, 1:49 o’clock (95% CI, 1:04-2:34); and a smaller pubic attachment that was located at 3:50 o’clock (95% CI, 3:41-4:00). The ischial attachment possessed the largest cross-sectional attachment area (127.3 mm2; 95% CI, 103.0-151.7 mm2) of all the acetabular attachments of the ligamentum teres. Conclusion: The most important finding of this study was that the human ligamentum teres had 6

  2. Physical Rehabilitation for the Management of Canine Hip Dysplasia.

    Dycus, David L; Levine, David; Marcellin-Little, Denis J


    Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Hip arthropathy in a patient with primary hemochromatosis: MR imaging findings with pathologic correlation

    Papakonstantinou, Olympia [Veterans Affairs Medical Center, University of California, Department of Radiology, San Diego (United States); University Hospital of Heraklion, Department of Radiology, Heraklion, Crete (Greece); Mohana-Borges, Aurea V.R.; Campell, Loretta; Trudell, Debra; Resnick, Donald [Veterans Affairs Medical Center, University of California, Department of Radiology, San Diego (United States); Haghighi, Parviz [Veterans Affairs Medical Center, University of California, Department of Pathology, San Diego, California (United States)


    Arthropathy is a major clinical manifestation in primary hemochromatosis, typically affecting the metacarpophalangeal joints. Hip arthropathy is not uncommon, with radiologic features resembling osteoarthritis or calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. We describe the MR imaging findings of the hip in a patient with severe hip arthropathy and primary hemochromatosis and correlate them with the histopathologic findings. MR imaging showed severe degenerative changes, with large subchondral cysts and subchondral sclerosis in the femoral head and acetabulum. There was conspicuous correlation between MR imaging and pathologic findings of the resected femoral head. However, MR imaging failed to reveal intra-articular iron. (orig.)

  4. Paediatric acetabular fractures. Data from the German Pelvic Trauma Registry Initiative

    von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C


    and treatment of acetabular fractures in children (fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent......The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome......%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents....

  5. Simultaneous periprosthetic acetabular fracture and contralateral B-type compression injury of the pelvic ring: a case report of a rare injury combination.

    Märdian, Sven; Schaser, Klaus-Dieter; Wichlas, Florian; Schwabe, Philipp


    The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma.

  6. Stabilization of an acetabular fracture with cables for acute total hip arthroplasty.

    Mears, D C; Shirahama, M


    A critical stage of total hip arthroplasty for an acute acetabular fracture where extensive comminution, impaction, and osteopenia thwart the application of conventional open or closed methods, especially in the elderly, is stable fixation of the acetabulum. The use of 2-mm braided cables permits effective immobilization of the fracture for use in conjunction with a hybrid arthroplasty. The method is consistent with the use of a conventional arthroplastic incision and is suitable for other applications including the fixation of periprosthetic fractures, bulk allografts, and conventional acetabular fractures.

  7. Simultaneous Periprosthetic Acetabular Fracture and Contralateral B-Type Compression Injury of the Pelvic Ring: A Case Report of a Rare Injury Combination

    Sven Märdian


    Full Text Available The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma.

  8. Simultaneous Periprosthetic Acetabular Fracture and Contralateral B-Type Compression Injury of the Pelvic Ring: A Case Report of a Rare Injury Combination

    Märdian, Sven; Wichlas, Florian


    The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma. PMID:24222878

  9. The Issue of Age Estimation in a Modern Skeletal Population: Are Even the More Modern Current Aging Methods Satisfactory for the Elderly?

    Cappella, Annalisa; Cummaudo, Marco; Arrigoni, Elena; Collini, Federica; Cattaneo, Cristina


    The main idea behind age assessment in adults is related to the analysis of the physiological degeneration of particular skeletal structures with age. The main issues with these procedures are due to the fact that they have not been tested on different modern populations and in different taphonomic contexts and that they tend to underestimate the age of older individuals. The purpose of this study was to test the applicability and the reliability of these methods on a contemporary population of skeletal remains of 145 elderly individuals of known sex and age. The results show that, due to taphonomic influences, some skeletal sites showed a lower survival. Therefore, the methods with the highest percentage of applicability were Lovejoy (89.6%) and Rougé-Maillart (81.3%), followed by Suchey-Brooks (59.3%), and those with the lowest percentage of applicability were Beauthier (26.2%) and Iscan (22.7%). In addition, this research has shown how for older adults the study of both acetabulum and auricular surface may be more reliable for aging. This is also in accordance with the fact that auricular surface and the acetabulum are the areas more frequently surviving taphonomic insult. © 2016 American Academy of Forensic Sciences.

  10. The evolution, development and skeletal identity of the crocodylian pelvis: revisiting a forgotten scientific debate.

    Claessens, Leon P A M; Vickaryous, Matthew K


    Unlike most tetrapods, in extant crocodylians the acetabulum is formed by only two of the three skeletal elements that constitute the pelvis, the ilium, and ischium. This peculiar arrangement is further confused by various observations that suggest the crocodylian pelvis initially develops from four skeletal elements: the ilium, ischium, pubis, and a novel element, the prepubis. According to one popular historical hypothesis, in crocodylians (and many extinct archosaurs), the pubis fuses with the ischium during skeletogenesis, leaving the prepubis as a distinct element, albeit one which is excluded from the acetabulum. Whereas the notion of a distinct prepubic element was once a topic of considerable interest, it has never been properly resolved. Here, we combine data gleaned from a developmental series of Alligator mississippiensis embryos, with a revised interpretation of fossil evidence from numerous outgroups to Crocodylia. We demonstrate that the modern crocodylian pelvis is composed of only three elements: the ilium, ischium, and pubis. The reported fourth pelvic element is an unossified portion of the ischium. Interpretations of pelvic skeletal homology have featured prominently in sauropsid systematics, and the unambiguous identification of the crocodylian pubis provides an important contribution to address larger scale evolutionary questions associated with locomotion and respiration.

  11. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

    Pawel Zwolak


    Full Text Available Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.

  12. Cinco espécies de Lecithodendriidae (Trematoda en murcielagos de Colombia, incluyendo tres nuevos generos

    Imelda Velez


    Full Text Available Velez, I. & V.E. Thatcher: Five species of Lecithodendriidae (Trematoda in bats from Colombia, including three new genera. Three new neotropical genera and species of Lecithodendriidae (Trematoda are described from Colombian bats. Sturniratrema umbilicata gen. et sp. nov. from Sturnira lilium differs from other genera in having an oval ventral depression, a dorso-ventrally curved cirrus and a genital pore lateral to the acetabulum. Chiropterotrema antioquiense gen. et sp. nov. from Carollia perspicillata is distinguished by having the acetabulum within a triangular ventral pit as well as an separation between the the male and female genital pores. Topsiturvitrema verticalia gen. et sp. nov. from Carollia perspicillata has a different orientation of the body, being nearly spherical but somewhat flatened in an anterior-posterior direction. This genus also has a deep ventral cleft separating two ventral lobes which are filled with eggs. Castroia silvai Travassos, 1928, is also reported from Anoura caudifer and Peropteryx macrotis. The first of these represents a new host record for the species. Addiotionally, Limatulum gastroides Macy, 1935, is reported from Lonchophyla robusta wich is another new host record.

  13. Reliability of measures used in radiographic evaluation of the adult hip

    Bjarnason, J.A.; Reikeras, O. [Oslo University Hospital, Department of Orthopedics, Oslo (Norway); Pripp, A.H. [Oslo University Hospital, Department of Biostatistics, Oslo (Norway)


    The reliability of radiographic measurements has been studied in pediatric hips, but less has been published on the adult hip, and none have examined the reliability of measurements for the location of the center of rotation (COR) of the hip joint. We have investigated the reliability of various radiographic variables with a focus on the COR. The study was carried out on a standardized format for anterior-posterior radiographs of the pelvis. The measured variables were; (A) the distance from a sagittal reference line to the COR, (B) the distance from the sagittal reference line to the proximal end of the lateral cortical line of the femur, (C) the distance from the sagittal reference line to the medial rim of the acetabulum, (D) the distance from the horizontal reference line to the roof of the acetabulum, and (E) the distance from the horizontal reference line to the COR. One observer (JAB) conducted the measurements twice separated by a time interval of 45-60 days to assess intra-observer reliability, and the first measurements of JAB were compared to those performed by another observer (OR) to assess inter-observer reliability. Intraclass correlation coefficients were above 0.98 for all measurements, and the minimum and maximum values that statistically include 95 % of the observer differences were all within -3 to +3 mm. These measurements proved to have high reliability and agreement of both within the same observer and between two observers. They should therefore be reproducible in a clinical setting. (orig.)

  14. A new gorgoderid species of the urinary bladder of Rana zweifeli from Michoacán, Mexico Una nueva especie de gorgodérido de la vejiga urinaria de Rana zweifeli de Michoacán, México

    Rosario Mata-López


    Full Text Available Gorgoderina tarascae n. sp. is described from the urinary bladder of Rana zweifeli, from Cutzaróndiro, Michoacán, Mexico. Gorgoderina tarascae differs from the other species of the genus by possessing the following combination of characters: follicular vitelline glands, arranged in two clusters of 4-7 follicles dorsal to the ovary, compact and smooth reproductive organs situated far from each other and from the acetabulum, suckers close to each other, and a slender, spindle shaped body with a flexed position due to the situation of the acetabulum.Gorgoderina tarascae n. sp. se describe como parásita de la vejiga urinaria de Rana zweifeli de Cutzaróndiro, Michoacán, México. Gorgoderina tarascae difiere del resto de las especies del género por la siguiente combinación de características: posee glándulas vitelógenas arregladas en dos racimos de 4-7 folículos situados dorsalmente al ovario, órganos reproductivos compactos y de bordes lisos, muy separados entre si y con respecto del acetábulo, ventosas cercanas una de la otra y cuerpo delgado, en forma de huso y flexionado debido a la posición del acetábulo.

  15. Multiple osteolytic lesions in a 14-year-old boy with HIV disease

    S Murugan


    Full Text Available A 14 year old boy, said to have had multiple transfusions during infancy, was brought to the hospital for complaints of pain over right thigh for one week duration. MRI reveals multiple osteolytic lesions with enhancing hyperintense bone marrow lesions over iliac bones, right acetabulum and lumbar vertebral bodies and enlarged para-aortic, iliac and inguinal lymph nodes. CT of the whole body revealed osteolytic lesions on skull, mandible, right scapula, head of both humeri, L1 and L4 vertebrae, 5 th and 10 th ribs, both acetabulum and ala of sacrum along with enlargement of cervical, axillary and mesenteric, iliac and inguinal nodes. HIV ELISA was positive. Viral load was 141,700 copies/ml. CD4 count was 226 cells/mm 3 . Multiple biopsy from the lesions and bone marrow revealed no evidence of tuberculosis and malignancy. Now the boy is on ART (ZDV + 3TC + EFV since August 2013. His CD4 count improved and viral load became undetectable and he gained weight within 5 months of ART. Due to the rarity of its presentation, this case report is being reported.

  16. Design optimization of cementless metal-backed cup prostheses using the concept of functionally graded material

    Hedia, H S; El-Midany, T T; Shabara, M A N; Fouda, N [Production Engineering and M/C Design Department, Faculty of Engineering, Mansoura University, Mansoura (Egypt)


    Metal backing has been widely used in acetabular cup design. A stiff backing for a polyethylene liner was initially believed to be mechanically favourable. Yet, recent studies of the load transfer around acetabular cups have shown that a stiff backing causes two problems. It generates higher stress peaks around the acetabular rim than those caused by full polyethylene cups and reduces the stresses transferred to the dome of the acetabulum causing stress shielding. The aim of this study is to overcome these two problems by improving the design of cementless metal-backed acetabular cups using the two-dimensional functionally graded material (FGM) concept through finite-element analysis and optimization techniques. It is found that the optimal 2D FGM model must have three bioactive materials of hydroxyapatite, Bioglass and collagen. This optimal material reduces the stress shielding at the dome of the acetabulum by 40% and 37% compared with stainless steel and titanium metal backing shells, respectively. In addition, using the 2D FGM model reduces the maximum interface shear stress in the bone by 31% compared to the titanium metal backing shell.

  17. 全髋关节置换术中髋臼假体定位的研究进展%Progress of research on the orientation of the acetabular component in total hip arthroplasty

    胡海贝; 周建生


    目前全髋关节置换术已成为治疗终末期髋关节疾病的有效手段,由于髋臼侧结构的特殊性,髋臼杯位置的定位方法尚有争议。髋臼假体定位方法主要有根据术前、术中影像学资料定位,根据髋臼局部解剖特征和(或)结合机械设备定位等,本文就髋臼假体位置定位的研究进展作一综述。%At present,total hip arthroplasty has become an effective method for the treatment of end-stage hip disease.Because of the special structure of the acetabulum,the methods for determining the position of the ace-tabular cup are disputed.The orientation methods of the acetabular components are mainly determined by the preop-erative and intraoperative imaging data,local anatomical characteristics of the acetabulum in combination with the mechanical equipment.This paper reviews the progress in research on orientating acetabular prosthesis position.

  18. Proximal focal femoral deficiency: evaluation by MR imaging

    Biko, David M. [National Naval Medical Center, Department of Radiology, Bethesda, MD (United States); Uniformed Services University of Health Sciences, Department of Radiology and Radiological Sciences, Bethesda, MD (United States); Davidson, Richard [The Children' s Hospital of Philadelphia, Department of Orthopedic Surgery, Philadelphia, PA (United States); Pena, Andres; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)


    Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly characterized by abnormal development of the proximal femur. The most common radiographic classification (Aitken) does not evaluate the cartilaginous and soft-tissue abnormalities. To demonstrate MR findings of PFFD focusing on features not seen with radiographs. Nine MR examinations of the hip and femurs of seven children with PFFD were retrospectively reviewed. Imaging was quantitatively and qualitatively assessed comparing the affected limb to the contralateral limb and age-matched controls. The children were classified via the Aitken classification. All children had at least mild acetabular dysplasia, and one type D patient had no acetabulum. MR demonstrated that 4/6 children had labral hypertrophy with a decreased distance from the greater trochanter to the acetabular rim, suggesting impingement (P < 0.05). The proximal femoral physis was abnormal in all cases. The connection between the femoral head and shaft if present was fibrous or fibrocartilaginous. MRI can help in evaluation of PFFD by defining the anatomy. MR demonstrates features of the acetabulum and cartilaginous femoral epiphysis and depicts ligamentous abnormalities of the knee. (orig.)

  19. The use of a modular titanium endoprosthesis in skeletal reconstructions after bone tumor resections: method presentation and analysis of 37 cases

    Croci Alberto Tesconi


    Full Text Available We analyzed 37 patients who underwent segmental wide resection of bone tumors and reconstruction with a modular titanium endoprosthesis at the Orthopaedic Oncology Group, between 1992 and 1998. Twelve patients were male and 25 were female, with a mean age of 30 years (9 - 81. The mean follow-up was 14 months (2 - 48. The diagnoses were: osteosarcoma (14 cases, metastatic carcinoma (10, Ewing's sarcoma (4, giant cell tumor (4, malignant fibrous histiocytoma (3, chondrosarcoma (1, and aneurysmal bone cyst (1. Eleven articulated total knee, 8 partial proximal femur with bipolar acetabulum, 8 partial proximal humerus, 3 total femur, 2 partial proximal tibia, 2 diaphyseal femur, 2 diaphyseal humerus, and 1 total proximal femur with cementless acetabulum endoprosthesis implant procedures were done. The complications related to the procedure included: infection (5 cases, dislocation (3, module loosening (1, and ulnar nerve paresthesia (1. We used the following criteria for the clinical evaluation: presence of pain, range of motion, reconstruction stability, surgical and oncologic complications, and patient acceptance. The results were good in 56.8% of the cases, regular in 32.4% and poor in 10.8%.

  20. Relationship Between Mechanical Forces and Formal Head Necrosis: An Experimental Study%机械性压力与股骨头骨骺坏死关系的动物实验研究

    许瑞江; 马承宣; 赫荣国; 卢世壁; 房论光; 刘贵林; 张喜恩; 游联壁; 田嘉禾


    The etiology of avascular necrosis of the femoral head following the treatment for congenital dislocation of the hip(CDH)is believed to be secondary to mechanical forces between the femoral head and the acetabulum. A puppy experiment was designed to makea model of femoral head necrosis by increasing pressure between the femoral head and acetabulum. Intra-medullary pressure,isotopic scanning and histological changes of the femoral head were studied. The authors suppose the pathogenesis of the femoral head necrosis after the reduction of CDH. The prevention of the incidence of femoral head necrosis lies in avoidance of continuous compression between the femoral head and acetebulum.%本文模拟先天性髋脱位复位后股骨头受髋臼压迫的情形,将30只幼犬分为四组分别承受不同的压力,并于加压后1、2、3周进行骨内压测定、同位素骨扫描和组织学检查等.结果表明,随着股骨头与髋臼之间压力的增加,头坏死率增加,加压时间延长,坏死程度加重.

  1. Estimation of pelvic tilt on anteroposterior X-rays - a comparison of six parameters

    Tannast, M. [University of Bern, Department of Orthopedic Surgery, Inselspital, Bern (Switzerland); New England Baptist Hospital, Center for Computer Assisted and Reconstructive Surgery, Boston, MA (United States); Tufts University School of Medicine, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Murphy, S.B. [New England Baptist Hospital, Center for Computer Assisted and Reconstructive Surgery, Boston, MA (United States); Tufts University School of Medicine, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Langlotz, F. [University of Bern, MEM Research Center for Orthopaedic Surgery, Institute for Surgical Technologies and Biomechanics, Bern (Switzerland); Anderson, S.E. [University of Bern, Department of Diagnostic Interventional and Pediatric Radiology, Bern (Switzerland); Siebenrock, K.A. [University of Bern, Department of Orthopedic Surgery, Inselspital, Bern (Switzerland)


    To compare six different parameters described in literature for estimation of pelvic tilt on an anteroposterior pelvic radiograph and to create a simple nomogram for tilt correction of prosthetic cup version in total hip arthroplasty. Simultaneous anteroposterior and lateral pelvic radiographs are taken routinely in our institution and were analyzed prospectively. The different parameters (including three distances and three ratios) were measured and compared to the actual pelvic tilt on the lateral radiograph using simple linear regression analysis. One hundred and four consecutive patients (41 men, 63 women with a mean age of 31.7 years, SD 9.2 years, range 15.7-59.1 years) were studied. The strongest correlation between pelvic tilt and one of the six parameters for both men and women was the distance between the upper border of the symphysis and the sacrococcygeal joint. The correlation coefficient was 0.68 for men (P<0.001) and 0.61 for women (P<0.001). Based on this linear correlation, a nomogram was created that enables fast, tilt-corrected cup version measurements in clinical routine use. This simple method for correcting variations in pelvic tilt on plain radiographs can potentially improve the radiologist's ability to diagnose and interpret malformations of the acetabulum (particularly acetabular retroversion and excessive acetabular overcoverage) and post-operative orientation of the prosthetic acetabulum. (orig.)

  2. The relationship between the level of lesion and progression in Reimer's index of spina bifida patients.

    Gunay, Huseyin; Sozbilen, Murat Celal; Altınisik, Mahmut; Kacmaz, Ismail Eralp; Kaya Bicer, Elcil


    We aimed to evaluate the influence of the lesion level and acetabular displasia on the progression of hip dislocation in patients with spina bifida. Two hundred twelve hips of 106 cases with spina bifida were evaluated both clinically and radiologically. Their vertebral level of lesions, clinical examinations, radiological migration index, and acetabulum terms were noted and were evaluated in terms of their relations with the level of lesion-migration and dysplasia. Data analysis method was evaluated using SPSS 22.0 program. Deficiency of acetabulum was present in 33 % of the cases with spina bifida. Dysplastic floor was found to be as equally important as the level of lesion in the progression of hip dislocation (p = 0.002). Progression and dislocation incidences were observed to be higher in the thoracic level (p = 0.008). Reimer's progression index was seen to be a reliable way of assesment. The development of hip dislocation and progression are not solely connected with muscle imbalance. Encountered more frequently in these cases, acetabular dysplasia is a factor that is as important as the level of lesion in the formation of hip dislocation and progression. Hip dislocation is associated with more progression in the higher level lesions. Reimer's index is a reliable assessment criteria.

  3. CT findings of traumatic posterior hip dislocation after reduction

    Moon, Sung Kyoung; Park, Ji Seon; Ryu, Kyung Nam; Jin, Wook [Kyung Hee University Medical Center, Seoul (Korea, Republic of); Jin Wook


    To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intra-articular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%) the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in he posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients.

  4. Posterior acetabular column and quadrilateral plate fractures: fixation with tension band principles.

    Aly, Tarek A; Hamed, Hany


    Acetabular fractures can be classified into 5 simple and 5 associated fracture patterns. A significant amount of variation and complexity exists in these fractures patterns. Fractures of the posterior wall are the most common acetabular fractures. Comminution of the quadrilateral plate adds to fracture instability, and more rigid and stable internal fixation is mandatory. The goal of this study was to assess the results of reconstruction of comminuted posterior wall fractures of the acetabulum associated with quadrilateral plate fractures using the tension band technique. Twelve patients (9 men and 3 women) were included in the study. Mean patient age was 38.6 years (range, 24-47 years). Minimum follow-up was more than 2 years postoperatively. Reconstruction of the fracture included anatomic reduction of the fracture and fixation with a buttress plate for the posterior column and a prebent one-third tubular plate for the quadrilateral plate fracture. Clinical results were excellent in 58% of patients and good in 17% of patients. Radiologic results were excellent in 50% of patients and good in 17% of patients. Radiologically, based on the fracture gap postoperatively, 8 (66%) patients showed anatomic reduction, 2 (17%) showed good reduction, and 2 (17%) showed poor reduction. The study confirms that this method of reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum.

  5. An anatomical study of corona mortis and its clinical significance

    洪华兴; 潘志军; 陈欣; 黄宗坚


    Objective: To provide detailed information of corona mortis for ilioinguinal approach as an anterior approach to the acetabulum and pelvis.Methods: The course, branches and distribution of the vascular connection between the obturator system and the external iliac or inferior epigastric systems located over the superior pubic ramus were observed on 50 hemipelvises with intact soft tissues.Results: During the dissections, 72% of the cadaveric sides had at least one communicating vessel between the obturator system and the external iliac or inferior epigastric systems on the superior pubic ramus. The average diameter of the connecting vessel was 2.6 mm (range, 2.0-4.2 mm). It coursed over the superior pubic ramus or iliopubic eminence vertically to enter the obturator foramen and exit the pelvis. The average distance from pubic symphysis to the vascular connections between the obturator and external iliac systems was 52 mm ( range, 38-68 mm).Conclusions: Vascular connections between the obturator system and the external iliac or inferior epigastric systems were found over the superior pubic ramus with a high incidence. They are prone to damage during the ilioinguinal approach as an anterior approach to the acetabulum and pelvis. Thus, corona mortis located over the superior pubic ramus deserves great attention during the ilioinguinal approach.

  6. A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

    Samet Karabulut


    Full Text Available Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN developed on her right femoral head, the range of motion (ROM of the hip was restricted and she had minimal pain on her right hip. J Clin Exp Invest 2011;2(2:228-31

  7. Classification and treatment of acetabular fractures%髋臼骨折的分类与治疗策略



    Fracture of acetabulum is mostly caused by high energy trauma, which exists as a whole or a part of palvic fracture. Acetabulum is characterized by complex anatomical relationships irregular bone structures, which leads to the difficulties in surgery. The surgical approach is found to be closely related to the classification of cetabular fractures. And several factors are proved to influence the clinical efficacy. In this review, we present the progress on the classification and treatment of acetabular fractures.%髋臼为不规则骨,为丰厚软组织包裹,多为挤压或传导受力导致骨折,髋臼骨折与髋关节活动大有很大关联.髋臼的解剖关系复杂、骨性结构不规则,因而手术难度大.髋臼骨折的分类与手术入路的选择密切相关,此外,还有一些因素也会影响疗效.本文主要讨论髋臼骨折的分类及相应治疗的一些内容.

  8. Three-fin acetabular prosthesis for superior acetabular bone defects: a three-dimensional finite element analysis

    LIU Yu-zeng; HAI Yong; ZHAO Hui


    Background Given that three-dimensional finite element models have been successfully used to analyze biomechanics in orthopedics-related research,this study aimed to establish a finite element model of the pelvic bone and three-fin acetabular component and evaluate biomechanical changes in this model after implantation of a three-fin acetabular prosthesis in a superior segmental bone defect of the acetabulum.Methods In this study,three-dimensional finite element models of the pelvic bone and three-fin acetabular component were first established.The prosthesis model was characterized by three different conformational fins to facilitate and optimize the prosthetic design.The spongy and cortical bones were evaluated using a different modulus of elasticity in this established model.Results The maximum and minimum von Mises stresses on the fins of the acetabular component were 15.2 and 0.74,respectively.The maximum and minimum micromotion between the three-fin acetabular component and the acetabulum bone interface were 27 and 13 μm,respectively.A high primary stability and implied better clinical outcome were revealed.Conclusion Finite element analysis may be an optimal strategy for biomechanics-related research of prosthetic design for segmental acetabular bone defects.

  9. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center.

    Peters, Christopher L; Erickson, Jill A; Hines, Jerod L


    Most reports on the results of the Bernese periacetabular osteotomy for the treatment of developmental dysplasia of the hip have been by the originators of the procedure. In 1997, we began to use this osteotomy without direct training from the originators of the procedure. Seventy-three patients (eighty-three hips) underwent a Bernese periacetabular osteotomy between 1997 and 2003 and were followed prospectively with use of the Harris hip score to assess clinical results and with use of anteroposterior pelvic and false-profile lateral plain radiographs to assess radiographic results. The three-dimensional position of the acetabulum was recorded preoperatively and postoperatively. The mean duration of follow-up was forty-six months. The average Harris hip score improved from 54 to 87 points (p Bernese periacetabular osteotomy have been encouraging, with a 92% survival rate at thirty-six months. The occurrence of complications demonstrates a substantial learning curve. Recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decision-making. Therapeutic Level IV.

  10. Impingement-free hip motion: the 'normal' angle alpha after osteochondroplasty.

    Neumann, Mirjam; Cui, Quanjun; Siebenrock, Klaus A; Beck, Martin


    Femoroacetabular impingement is considered a cause of hip osteoarthrosis. In cam impingement, an aspherical head-neck junction is squeezed into the joint and causes acetabular cartilage damage. The anterior offset angle alpha, observed on a lateral crosstable radiograph, reflects the location where the femoral head becomes aspheric. Previous studies reported a mean angle alpha of 42 degrees in asymptomatic patients. Currently, it is believed an angle alpha of 50 degrees to 55 degrees is normal. The aim of this study was to identify that angle alpha which allows impingement-free motion. In 45 patients who underwent surgical treatment for femoroacetabular impingement, we measured the angle alpha preoperatively, immediately postoperatively, and 1 year postoperatively. All hips underwent femoral correction and, if necessary, acetabular correction. The correction was considered sufficient when, in 90 degrees hip flexion, an internal rotation of 20 degrees to 25 degrees was possible. The angle alpha was corrected from a preoperative mean of 66 degrees (range, 45 degrees - 79 degrees) to 43 degrees (range, 34 degrees - 60 degrees) postoperatively. Because the acetabulum is corrected to normal first, the femoral correction is tested against a normal acetabulum. We therefore concluded an angle alpha of 43 degrees achieved surgically and with impingement-free motion, represents the normal angle alpha, an angle lower than that currently considered sufficient.

  11. Design optimization of cementless metal-backed cup prostheses using the concept of functionally graded material.

    Hedia, H S; El-Midany, T T; Shabara, M A N; Fouda, N


    Metal backing has been widely used in acetabular cup design. A stiff backing for a polyethylene liner was initially believed to be mechanically favourable. Yet, recent studies of the load transfer around acetabular cups have shown that a stiff backing causes two problems. It generates higher stress peaks around the acetabular rim than those caused by full polyethylene cups and reduces the stresses transferred to the dome of the acetabulum causing stress shielding. The aim of this study is to overcome these two problems by improving the design of cementless metal-backed acetabular cups using the two-dimensional functionally graded material (FGM) concept through finite-element analysis and optimization techniques. It is found that the optimal 2D FGM model must have three bioactive materials of hydroxyapatite, Bioglass and collagen. This optimal material reduces the stress shielding at the dome of the acetabulum by 40% and 37% compared with stainless steel and titanium metal backing shells, respectively. In addition, using the 2D FGM model reduces the maximum interface shear stress in the bone by 31% compared to the titanium metal backing shell.

  12. 各种髋臼重建术治疗先天性髋关节脱位的评价(附261例报告)%Experience and Evaluation of Various Acetabular Recosnstructions in the Treatment of Congenital Dislocation of the Hip

    彭明惺; 胡廷泽; 陈绍基; 周锡华; 韦福康; 周素华


    From 1961 to 1983,various acetabular reconstructions were performed in 261 cases for 308 affected hips.The patients aged between 11/2 and 13 years.Salter Innomlnate osteotomy should be given priority on those at proper age,yet it cannot substitute other reconstruction operations.Perlcapsular illae osteotomy of Pemberton is indlctaed on those having a shallow acetabulum.However,serious incongruity between head and acetabulum and/or posterior dislocation are contraindications for the above mentioned operations.Shelf-acetabuloplasty works well for the reconstruction of the lateral edge of aceta bulum.When above-mentioned operations prove impossible,medial displacement osteostomy of the pelvis by Chlarl or capsular arthro plasty by Colonna become the chief salvage procedure.As any operation has its advantages and limitations,a good pediatric surgeon should possess the ability to choose the most appropriate operation.An operation based on the surgeon's personal preference or habit often lead to failure.%@@ 现将我院从1961年4月至1983年10月,应用各种髋臼重建手术治疗先天性髋关节位的体会总结如下.

  13. Arthroscopic validation of radiographic minimum joint space width associated with the subchondral bone exposure in symptomatic hip dysplasia.

    Nakashima, Yasuharu; Fujii, Masanori; Noguchi, Yasuo; Suenaga, Kenya; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Hara, Daisuke; Iwamoto, Yukihide


    The purpose of this study was to clarify the minimum joint space width (MJSW) that leads to subchondral bone exposure (SBE) in patients with hip dysplasia. We included 82 subjects (86 hips) who had hip dysplasia with center-edge angle less than 20° and who underwent periacetabular osteotomy combined with hip arthroscopy. The acetabular and femoral cartilages were divided into three regions: anterosuperior, superior, and posterosuperior; for each region, we analyzed the correlation between the incidence of SBE and the MJSW measured on plain radiographs. The disease stage was defined according to the Kellgren and Lawrence grades (KL grade). SBE was found in 51 hips (59.3%) in total, involved the acetabulum in 49 hips (57.0%), and involved the femoral head in 26 hips (30.2%). SBE was more frequent in the acetabulum, with the highest incidence in the anterosuperior region, followed by the superior region. SBE was present in six hips (22.2%), 17 hips (56.7%), and 28 hips (96.5%), at KL-1, KL-2, and KL-3, respectively. MJSW of hips with SBE was significantly smaller than those without SBE (2.3 vs 4.0 mm, p hip dysplasia.

  14. Magnetic resonance imaging of labral cysts of the hip

    Schnarkowski, P. [Department of Radiology, University of California, San Francisco, CA (United States)]|[Department of Radiology, Ludwig-Maximilians-University, Munich (Germany); Steinbach, L.S. [Department of Radiology, University of California, San Francisco, CA (United States); Tirman, P.F.J. [Department of Radiology, University of California, San Francisco, CA (United States)]|[San Francisco Magnetic Resonance Center, San Francisco, CA (United States); Peterfy, C.G. [Department of Radiology, University of California, San Francisco, CA (United States); Genant, H.K. [Department of Radiology, University of California, San Francisco, CA (United States)


    Objective. To present the magnetic resonance (MR) imaging findings in patients with labral cysts adjacent to the acetabulum and to examine their association with hip pathology. Design. MR images and conventional radiographs of seven patients with paralabral cysts were retrospectively reviewed by three musculoskeletal radiologists. Patients. The patients included three men and four women with hip pain, ranging in age from 29 to 82 years. Two patients had developmental dysplasia of the hip and six had a history of remote trauma/dislocation. Clinical history and follow-up were obtained in all patients. Surgery was performed on one patient. Results and conclusions. Paralabral cysts were located in the posterosuperior aspect of the hip joint in five patients and in the anterior aspect in two patients. A tear of the adjacent acetabular labrum was confirmed surgically in one patient, and in all patients the MR features suggested the presence of an abnormal labrum. Osteoarthritis was observed in three patients and there was associated subchondral cyst formation in the acetabulum adjacent to the cyst in three patients. The paralabral cyst of the hip is well visualized on MR imaging and is seen in patients with a predisposition to labral pathology. (orig.). With 3 figs., 1 tab.

  15. A Contemporary Definition of Hip Dysplasia and Structural Instability: Toward a Comprehensive Classification for Acetabular Dysplasia.

    Wilkin, Geoffrey P; Ibrahim, Mazen M; Smit, Kevin M; Beaulé, Paul E


    Hip dysplasia has long been known to be a risk factor for pain and degenerative changes in the hip joint. The diagnosis of dysplasia has historically been based on assessments of acetabular anatomy on the anteroposterior pelvic radiograph, most commonly the lateral center-edge angle. Recent advances in imaging of the dysplastic hip with computerized tomography scans have demonstrated that hip dysplasia is in fact a 3-dimensional (D) deformity of the acetabulum and that multiple patterns of hip instability exist that may not be completely assessed on 2D imaging. A more thorough understanding of acetabular anatomy permits an evolution away from vague terms such as "borderline dysplasia." A 3D assessment of the acetabulum and the resultant patterns of instability may be more appropriate since this would allow more accurate treatment to correct the structural instability with acetabular reorientation. With this information, we propose a diagnostic framework that groups symptomatic dysplastic hips into one of 3 categories based on the primary direction of instability: (1) anterior, (2) posterior, and (3) global. This framework may aid the clinician in developing a differential diagnosis for the assessment of hip pain and suspected instability, and for planning an appropriate surgical management. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Computer aided diagnosis and treatment planning for developmental dysplasia of the hip

    Li, Bin; Lu, Hongbing; Cai, Wenli; Li, Xiang; Meng, Jie; Liang, Zhengrong


    The developmental dysplasia of the hip (DDH) is a congenital malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Early diagnosis and treatment is important because failure to diagnose and improper treatment can result in significant morbidity. In this paper, we designed and implemented a computer aided system for the diagnosis and treatment planning of this disease. With the design, the patient received CT (computed tomography) or MRI (magnetic resonance imaging) scan first. A mixture-based PV partial-volume algorithm was applied to perform bone segmentation on CT image, followed by three-dimensional (3D) reconstruction and display of the segmented image, demonstrating the special relationship between the acetabulum and femurs for visual judgment. Several standard procedures, such as Salter procedure, Pemberton procedure and Femoral Shortening osteotomy, were simulated on the screen to rehearse a virtual treatment plan. Quantitative measurement of Acetabular Index (AI) and Femoral Neck Anteversion (FNA) were performed on the 3D image for evaluation of DDH and treatment plans. PC graphics-card GPU architecture was exploited to accelerate the 3D rendering and geometric manipulation. The prototype system was implemented on PC/Windows environment and is currently under clinical trial on patient datasets.

  17. Coxitis in patients with ankylosing spondylitis: clinicoradio logic comparisons

    A. G. Bochkova


    Full Text Available Objective. To analyze and compare clinical, radiological and ultrasonic signs of coxitis in pts with ankylosing spondylitis (AS. Material and methods. 35 pts with AS and clinical signs of coxitis were included. Median age was 26 years, AS duration 9 years, coxitis duration 5 years. 17 pts with AS without clinical signs of coxitis constituted control group. Pain on visual analog scale, hip joint mobility, radiological changes and ultrasonic signs of exudation were assessed. Results. Among the pts with AS prevailed those with the beginning of the disease before 20 years of age (77%. 71% of pts had bilateral coxitis. In 40% of pts coxitis signs during the first years were inconstant. Most frequent radiological signs of coxitis were narrowing of joint space (91,9%, femoral head or/and acetabulum cysts (77,4%, femoral head osteophytes (67,7%. Femoral head deformity (8,1%, partial bone anchylosis (6,5%, marginal bone erosions (3% acetabulum protrusion (1,6% were rare signs. Exudation was present in 84% of damaged hip joints. Bone destruction was significantly more frequent in pts with longer duration of AS and coxitis and was associated with more prominent functional disability and higher frequency of exudation. Hip joint exudation frequency and its volume did not influence pain intensity. Radiological changes were revealed in 12 hip joints of 7 pts of control group.

  18. Hip dysplasia in koalas (Phascolarctos cinereus) at the San Diego Zoo.

    Pye, Geoffrey W; Hamlin-Andrus, Chris; Moll, Jennifer


    A retrospective/prospective radiographic study documented 55 cases of moderate to severe hip dysplasia, with varying degrees of shallowing of the acetabulum, flattening or loss of the femoral head, widening or loss of the femoral neck, and femoral diaphyseal abnormalities in northern koalas (Phascolarctos cinereus) in the San Diego Zoo (San Diego, California, USA) collection. For the retrospective study, historic radiographs were examined when availble. For the prospective study, three standard views (ventrodorsal extended leg, ventrodorsal frog leg, and lateral extended leg) were used. A scoring system was developed using four areas (acetabulum, femoral head, femoral neck, and femur) and ranges of 0 to 5 (0 = not affected to 5 = severely affected) for each area, creating a total score out of 40. Scores were graded as follows: 0-2 = normal dysplasia; 3-6 = mild dysplasia; 10-19 = moderate dysplasia; and 20-40 = severe dysplasia. Thirty koalas were graded as severe, 25 koalas as moderate, and 38 koalas as excellent or mild. Affected koalas may or may not demonstrate gait abnormalities. Mild to severe degenerative joint disease may develop and symptoms may be alleviated with glucosamine/chondroitin sulfate and nonsteroidal anti-inflammatory drugs. The etiology of hip dysplasia in koalas is not currently understood.

  19. Habitual dislocation of the hip in children: report of eight additional cases and literature review.

    Song, Kwang Soon; Choi, In Ho; Sohn, Young Jin; Shin, Hyun Dae; Leem, Ho Seung


    The purpose of this study was to report eight additional cases of habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature. The authors attempted to investigate the various causative factors, outcomes, and indications for conservative and operative treatments. The results suggest that an unusual ability to dislocate the hip voluntarily at a young age constitutes a specific pediatric entity, and no single factor can be determined to be the definite cause of HDH. Multiple triggering factors (generalized ligamentous laxity, excessive anteversion of the femur and acetabulum, osteocartilaginous defect of acetabulum, coxa valga, psychiatric immaturity) appear to be associated with HDH. Treatment should be conservative in the first instance; it includes simple observation with or without psychiatric counseling and immobilization with cast or brace. Hip stabilization by surgical means is selectively indicated when the episodes of hip dislocation do not fade away in due time despite conservative treatment and when primary or secondary capsular laxity or osteocartilaginous deformation or defect of the hip is severe enough to cause repeated dislocation or residual subluxation, which may cause persistent pain or discomfort.

  20. Variations of relative anteversion of the femoral neck during walking.

    Quesnel, T


    Based on the geometric model developed by Netter [11], we determined the different positions of the femoral neck during monopodal support in walking in relation to a fixed frontal plane of reference (relative anteversion). This "relative anteversion" ranges on average from 24 degrees of retroversion at the beginning of support to 15 degrees of anterversion at the end if loading. We then studied the relations possibly existing between relative anteversion and acetabular orientation on the one hand, and the orientation of the resultant of the articular stresses on the other (both being variables during monopodal support in walking). The results showed that relative anteversion is well correlated with variations of position of the acetabulum since, at most, the deviation between the respective axes did not exceed the anatomic deviation due to absolute anteversion of the femoral neck and acetabulum. Lastly, analysis of the relations obtained with the orientation of the resultant of the articular stresses allowed a better comprehension of the functional distribution of forces.

  1. Prosthetic replacement in treatment of subcapital femoral neck fractures in the elderly

    徐莘香; 刘一; 刘建国; 李印良


    Objective: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF).   Methods: Between May 1987 and July 1998, 56 elderly patients (65-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement.   Results: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that in Group THR.   Conclusions: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bipolar THR installed with cement is indicated for most elderly patients. Since the femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.

  2. Calculating hominin and nonhuman anthropoid femoral head diameter from acetabular size.

    Plavcan, J Michael; Hammond, Ashley S; Ward, Carol V


    Femoral head size provides important information on body size in extinct species. Although it is well-known that femoral head size is correlated with acetabular size, the precision with which femoral head size can be estimated from acetabular size has not been quantified. The availability of accurate 3D surface models of fossil acetabular remains opens the possibility of obtaining accurate estimates of femoral head size from even fragmentary fossil remains [Hammond et al.,: Am J Phys Anthropol 150 (2013) 565-578]. Here we evaluate the relationship between spheres fit to surface models of the femoral head and acetabulum of a large sample of extant anthropoid primates. Sphere diameters are tightly correlated and scale isometrically. In spite of significant taxonomic and possibly functional differences in the relationship between femoral head size and acetabulum size, percent prediction errors of estimated femoral head size remain low regardless of the taxonomic composition of the reference sample. We provide estimates of femoral head size for a series of fossil hominins and monkeys. © 2014 Wiley Periodicals, Inc.

  3. Congenital dislocation of the hip. A review.

    Sherk, H H; Pasquariello, P S; Watters, W C


    Congenital dislocation of the hip usually results from capsular stretching caused by fetal malposition and crouching late in the third trimester. Early recognition of hip dislocation or instability soon after birth permits prompt treatment. Ortolani's and Barlow's maneuvers, respectively, reduce into and displace from the acetabulum a femoral head that is insecurely contained therein. The diagnosis of CDH in the first month of life usually depends on these clinical components of the physical examination of the newborn, because similar device, in this age group can usually maintain the displaced hip in sufficient flexion and abduction to permit reduction and normal development. By 3 months of age, the nuclei of the pelvis and upper femur have ossified enough to permit radiologic diagnosis of CDH. Problems related to treatment increase as the child grows older. In infants up to 6 months of age, closed methods with a harness usually succeed. Beyond 6 months, the soft tissues shorten and prevent easy reduction. These patients almost always require pre-reduction traction. An adductor tenotomy also facilitates reduction and apparently lessens compressive forces on the femoral head, an important consideration in preventing avascular necrosis of the head. Children over 1 year old develop bony changes, such as excessive femoral valgus and anteversion and deformity of the acetabulum. Treatment in these patients requires realignment of bony deformities with femoral or pelvic osteotomies in addition to the measures noted previously. The gentleness and high success rate of early treatment make early diagnosis of CDH an important consideration in infants and newborns.

  4. Total hip replacement for Crowel III and IV hip dislocation:prosthesis position and stability%全髋关节置换修复CroweⅢ和Ⅳ型髋关节脱位:假体位置及其稳定性

    丁良甲; 刘晓民; 刘莹丽


    BACKGROUND:Developmental dislocation of the hip is a type of adult hip dysplasia, including Crowe III and IV type; the type of dislocation of the hip is a severe prognosis. Total hip replacement is clinicaly used for the complex reconstruction of acetabulum. For injured acetabulum, autologous bone graft is effective to reconstruct acetabulum structure, provides good coverage and stability for the acetabulum. Postoperative combination with effective exercise can ensure the recovery of acetabulum function. OBJECTIVE:To analyze the correlation of prosthesis position selection during total hip replacement with clinical short- and middle-term effects of Crowel III and Crowel IV hip dislocation. METHODS:Clinical data of 28 cases of dysplasia and dislocation of the hip joint combined with severe osteoarthritis, who were treated in the Department of Joint Surgery, the Second Affiliated Hospital, Inner Mongolia Medical University from December 2011 to December 2012, were retrospectively analyzed. Al patients received total hip replacement. Implant was biological artificial total hip joint prosthesis. During 2-year folow-up, patients were rechecked by imaging regularly to analyze the imaging changes of acetabulum prosthesis position and bone graft fusion. Harris hip score was used to assess the recovery of hip function. The correlation of prosthesis position and short- and middle-term effects was analyzed. RESULTS AND CONCLUSION: The filing rate of medulary cavity of prosthesis was above 75%. The initial position was fixed and stable. The stability rate of femur-prosthesis interface reached 100%. Compared with pre-replacement, hip function was significantly improved at 6 months post surgery (t=25.55, 9.07;P < 0.05). These results indicate that total hip replacement for Crowel III and Crowel IV hip dislocation can effectively reconstruct the acetabulum, recover hip function, and stabilize prosthesis. Total hip replacement is characterized by good filing rate, high stability

  5. Applied anatomy of the sciatic nerve injury in the artificial total hip arthroplasty%人工全髋关节置换术中坐骨神经损伤的应用解剖学观察

    杨景武; 史晓林


    Human Anatomy Laboratory in the Medical Department of the Huzhou Normal University from March to May in 2003. There were 56 pelvis samples of the normal human adult cadaver, 27 males and 29 females.METHODS: The origins and the pathways of the sciatic nerves and the relation of the sciatic nerve and the acetabulum were analyzed, and the sciatic nerve injury induced by the clasp and the screw fixation in the THR was measured and analyzed.MAIN OUTCOME MEASURES: The location relation of the sciatic nerve and the acetabulum.RESULTS: The distance between the sciatic nerve and the bottom of the acetabulum was(6.00 ±0. 85) mm on the left and(6.00 ±0. 71) mm on the right. The distance between the sciatic nerve and the edge of the acetabulum was(13.00 ±0. 75) mm on the left and(14.00 ±0.06) mm on the right. The SN circumference on the edge of the acetabulum was(32.00 ± 0. 28) mm on the left and(31.00 ± 0.68) mm on the right. The distance between the bottom of the acetabulum and the greater sciatic foramen was(29.00 ±0. 36)mm on the left and(29.00 ±0.24) mm on the right.CONCLUSION: It is confirmed that the clasp and the screw fixation can be done on the safe region at the 1-3 o' clock and the 5-6 o' clock. The obsolete fracture and dislocation of the acetabulum, the unsuitable clasp location and the unsuitable location of screw fixation may induce the iatrogenic sciatic nerve injury.


    Scott M. Sporer


    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  7. Lateral shelf acetabuloplasty for severe Legg-Calvé-Perthes disease in patients older than 8 years: A mean eleven-year follow-up.

    Li, Wen-Chao; Xu, Rui-Jiang


    The natural history of Legg-Calvé-Perthes disease (LCPD) in children older than 8 years is usually poor without treatment. The treatment goal is to prevent deformity and incongruity of the hip by achieving a stable spherical femoral head in a deep, congruent, sharp-edged acetabulum, with a good range of hip movement at skeletal maturity. Lateral shelf acetabuloplasty in LCPD can increase the coverage of the femoral head, benefiting the remodeling of the femoral head and acetabulum. The aim of this study was to evaluate the efficacy of lateral shelf acetabuloplasty for severe LCPD in patients older than 8 years.We evaluated 51 patients with severe LCPD who underwent shelf acetabuloplasty between 1994 and 2005. Clinical and radiological examinations were evaluated preoperatively and over a mean follow-up of 132.35 months (range 102-183 months). According to the Catterall classification, the LCPD was classified as grade II in 11 (21.6%) patients, grade III in 15 (29.4%), and grade IV in 25 (49.0%). According to the Herring classification, there were 12 (23.5%) patients in grade B, 24 (47.1%) in grade B/C, and 15 (29.4%) in grade C. The mean ages at the onset of signs and at surgery were 103.39 months and 110.78 months, respectively.By the end of follow-up, all patients had a normal passive range of hip movement without pain. The mean Iowa hip score was improved from 69.5 ± 7.28 to 91.6 ± 5.14 (P shelf acetabuloplasty (P shelf acetabuloplasty for severe LCPD in patients older than 8 years. The procedure yields a favorable clinical outcome and Stulberg outcome for the hip. Shelf acetabuloplasty can improve femoral head coverage and reduce subluxation of the hip, with a benefit to the biological remodeling of the femoral head within the acetabulum.

  8. Six new species of Lepidapedon Stafford, 1904 (Digenea: Lepocreadiidae) from deep-sea macrourid fishes from the Gulf of Mexico and Caribbean Sea, with revised keys to the species of the genus.

    Blend, C K; Dronen, N O; Armstrong, H W


    Species of the genus Lepidapecon are divided into various groups and subgroups based on vitelline distribution relative to the acetabulum and anterior extent of the excretory vesicle. Members of this genus predominantly parasitise gadiform fishes and are commonly collected from relatively deep waters. A recent study of deep-sea helminths from macrourids of the Gulf of Mexico and Caribbean Sea revealed six new species of this genus. L. mexicanensis n. sp., of the elongatum group, elongatum subgroup, differs from other species in this subgroup in proportions (as % of body length), lacking confluent vitelline fields between both the ovary and anterior testis and the testes, and in having a smaller egg and body size. L. nezumiatis n. sp., of the elongatum group, desclersae oesophagus than prepharynx. L. caribbaei n. sp. and L. longivesicula n. sp., of the garrardi group, congeri sub-subgroup, differs from both L. filiformis and L. desclersae in having intermediate egg and body sizes, and a longer group, differ from L. congeri in having a sucker-ratio of 1: sucker, a similar-sized oesophagus and prepharynx, and a caecal bifurcation which is closer to the acetabulum than oral sucker, while L. longivesicula n. sp. has shorter, serrate or plate-like, lightly imbedded, widely to sporadically spaced spines, a more elongate body, a spherical to subspherical oral sucker, a longer oesophagus than prepharynx, and a caecal bifurcation which is closer to the oral sucker than acetabulum. L. desotoensis n. sp., of the rachion group, rachion subgroup, is distinct from both L. luteum and L. abyssensis in having a smaller size, lacking cervical glands or pharyngeal gland cells, and possessing dark-staining particles in the mesenchyme, while it differs from L. abyssensis specifically in having a much longer oesophagus than prepharynx, lateral vitelline fields that are not confluent intertesticularly, and wider eggs. L. zaniophori n. sp., also of the rachion subgroup, differs from both L

  9. The analysis on high-energy trauma surgical in the treatment of 72 cases with acetabular fracture%高能量损伤髋臼骨折手术治疗72例分析



    目的:回顾性分析高能量髋臼骨折的手术效果.方法:根据72例高能量髋臼骨折分型,采用合适的手术人路、复位骨折并内固定.结果:全部顺利完成手术,64例获得随访,依Matta等标准:解剖复位46例,满意复位12例.复位不良6例,满意复位率为90.63%.参照 Ceunnar A 髋关节功能评分标准,优41例,良16例,可4例,差3例;优良率为89.06%.6例出现异位骨化,3例发生股骨头缺血坏死.结论:手术治疗高能量复杂髋臼骨折,术前认真阅读影像资料、选择合适的人路和固定方法,术后早期功能锻炼可取得较好的临床效果.%Objective: To analyze the effect on the operation of high-energy acetabulum fractures. Methods: According to 72 cases with the types of high-energy acetabulum fracture, appropriate surgical was adopted to approach the complex fracture and made an intemal fixation. Results: All operation completed successfully, 64 cases were obtained for follow-up,in accordance with standard: 46 cases with anatomical restoration, 12 cases in satisfaction restoration, 6 cases with reset bad, satisfied reset rate was 90.63%. Reference Ceunnar A hip function evaluation criterion, 41 cases were optimal, 16 cases were good, 4 cases less good, 3 cases was poor, good rate was 89.06%. 6 cases with heterotopic ossification, 3 cases with femoral head ischemic necrosis. Conclusion: Surgical to treatment high-energy complex acetabulum fractures with carefully read image data before operation, appropriate approaches and fixation method. .Patients sh o uldimake a early function exercise in order to acquire the better clinical effects.

  10. Explore Combined Anterior and Posterior Approach in Treatment of Complex Acetabular Fractures Nursing%前后联合入路治疗复杂型髋臼骨折的护理要点探讨



    Objective To study the joint into the road before and after treatment modalities nursing key points of the acetabulum fracture and the results. Methods To select the joint into the road before and after treatment modalities of 48 patients with acetabulum fracture. It were randomly divided into observation group and control group, two groups of 24 each example, given targeted nursing intervention, the observation group patients give control group routine nursing intervention, patients with therapeutic efifcacy compared two groups of patients after treatment.Results The observation treatment group the total effective rate was 95.83%; control group total effective rate was 75.00%, two groups of data statistically signiifcant difference (P<0.05).Conclusion The treatment modalities for joint before and after entering the road of acetabulum fracture patients with targeted nursing, patient treatment effect is good, can effectively improve the success rate of the joint into the road before and after surgery to speed up the patients with fracture healing.%目的:研究前后联合入路治疗复杂型髋臼骨折的护理要点及效果。方法选取采用前后联合入路治疗的复杂型髋臼骨折患者48例,将其随机分为观察组与对照组,每组24例,给予观察组患者针对性护理干预,给予对照组患者常规护理干预,治疗后对比两组患者治疗效果。结果观察组的治疗总有效率为95.83%;对照组的治疗总有效率为75.00%,两组数据差异具有统计学意义(P<0.05)。结论对于前后联合入路治疗复杂型髋臼骨折的患者进行具有针对性的护理,患者治疗效果较好,能够有效的提高前后联合入路手术的成功率,加快患者骨折愈合速度。

  11. 三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较%Three-dimensional memory fixationversusreconstruction titanium plate to repair posterior wall acetabular fracture with posterior dislocation



    通过对髋臼三维记忆内固定系统在髋臼后壁骨折伴髋臼关节后脱位中临床应用效果的分析,了解其治疗髋臼后壁骨折伴髋臼关节后脱位的可行性与特点。研究发现,其在固定时间及术后功能恢复等方面较之重建钛板内固定都具有明显的应用优势。%BACKGROUND:Posterior wal fractures of the acetabulum with posterior dislocation of the acetabular joint mostly require the operation of open reduction and internal fixation. Different materials can be chosen for internal fixation operation. OBJECTIVE: To explore the effect of acetabular three-dimensional memory fixation system on acetabular posterior wal fractures accompanying the acetabulum joint dislocation. METHODS: A retrospective analysis was performed on clinical data of 92 cases of acetabular posterior wal fracture and dislocation at the Heze Municipal Hospital of Shandong Province from February 2010 to February 2014. Al patients received the operation of open reduction and internal fixation. They were divided into three-dimensional memory fixation group (45 cases) and reconstruction titanium plate group (47 cases) according to different fixators. Al patients were folowed up for 12 months after fixation. RESULTS AND CONCLUSION:The operation time and intraoperative blood loss were significantly longer or higher in the reconstruction titanium plate group than in the three-dimensional memory fixation group (P < 0.05). Harris score was significantly greater in the three-dimensional memory fixation group than in the reconstruction titanium plate group during final folow-up (P < 0.05). Thromboembolic complications or deep infection were not detected after fixation in both groups. These findings confirm that three-dimensional memory fixation system obtained good effects in the treatment of the posterior wal fractures of the acetabulum with posterior dislocation.

  12. Progress on treatment and research of quadrilateral plate fractures of acetabular%髋臼方形区骨折的治疗及研究进展

    彭烨; 张立海; 唐佩福


    Acetabular is an important human joint for weight bearing. Quadrilateral plate is a crucial structure of medial acetabulum with special morphology and important function. Quadrilateral plate fractures are common fracture in acetabulum. Quadrilateral plate fracture is hard to expose and reduction because it is in the medial of acetabulum. At the same time ,the bone in the quadrilateral plate is not easy to fixed for thinning bones and adjacent to the articular cavity. The operator should know well about the anatomy and choose the suitable internal fixation. After quadrilateral plate fractures ,the femur head may⁃be displace medially even break into pelvis. That make reduction and treatment always be a challenge. With different kinds of fractures,the efficacy of treatment is not the same. This paper intend to review the relation of anatomic features,approaches, internal fixations,key point of treatment and efficacy.%髋臼是人体的重要承重关节,髋臼方形区是髋臼内侧壁的重要结构,具有特殊的形态结构和重要功能。方形区骨折是髋臼骨折中常遇到的骨折,由于髋臼方形区处于骨盆内侧,所以手术中的显露及复位十分困难。同时,髋臼方形区骨质较薄较难固定,外侧有髋关节,选择合适的内固定和对相关解剖的了解十分重要。方形区骨折后,股骨头容易向内侧移位,甚至突入盆腔造成嵌顿,其复位和治疗一直是骨科中的难点。对于方形区骨折不同的治疗方法,其疗效也不一。本文就方形区的解剖学特点、手术入路选择、内固定治疗方式、治疗要点和疗效等做一综述。

  13. Not All Hip Dysplasias are the Same: Preoperative CT Version Study and the Need for Reverse Bernese Periacetabular Osteotomy.

    Thawrani, Dinesh P; Feldman, David S; Sala, Debra A


    Dysplastic hip may present with acetabular retroversion with or without femoral retroversion. This retroversion, if not accounted for when performing a periacetabular osteotomy (PAO), will lead to anterior hip pain and early osteoarthritis. A reverse PAO involves anteverting the acetabulum while still obtaining lateral coverage. The purpose of this study was to investigate the relationship between rotational malalignment of acetabulum and femur on 2-dimensional computed tomographic (CT) scans of hips that underwent Bernese PAO and its role in the surgical decision making. This retrospective, case-control study examined and compared preoperative 2-dimensional CT scans of hips that underwent reverse PAO to the hips that underwent traditional PAO. Twelve hips underwent reverse PAO from 2005 to 2010. Twelve hips were randomly selected from a cohort of 52 hips that underwent traditional PAO during same time period. Hips that underwent reverse PAO showed crossover sign on preoperative radiographs, but not on postoperative radiographs. Crossover sign was negative preoperatively and postoperatively on hips that underwent traditional PAO. The 2 groups were similar in regards to preoperative lateral center-edge angle, acetabular index, and anterior center-edge angle on plain radiographs and showed significant improvement after surgery.On preoperative CT scans both acetabulae and femurs were retroverted in reverse PAO group. Comparison of the 2 groups demonstrated that acetabular version (16.5±4.9 degrees vs. 25.3±5.6 degrees, P=0.001), femoral version (12.8±10.4 degrees vs. 31.9±8 degrees, P<0.001), and McKibbins Instability Index (29.3±11.9 degrees vs. 57.1±9.8 degrees, P<0.001) were significantly lower for the reverse PAO than the traditional PAO group. Anterior Acetabular Sector Angle (determines anterior coverage) was significantly higher in reverse PAO group, 53.1±13.7 degrees versus 39.7±10.4 degrees (P=0.013). Retroverted acetabulae seem to be associated with


    Chu, Linyang; Shang, Xifu; He, Rui; Hu, Fei


    To investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip (DDH) in adults. Between 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. The 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

  15. Lateral shelf acetabuloplasty for severe Legg–Calvé–Perthes disease in patients older than 8 years

    Li, Wen-Chao; Xu, Rui-Jiang


    Abstract The natural history of Legg–Calvé–Perthes disease (LCPD) in children older than 8 years is usually poor without treatment. The treatment goal is to prevent deformity and incongruity of the hip by achieving a stable spherical femoral head in a deep, congruent, sharp-edged acetabulum, with a good range of hip movement at skeletal maturity. Lateral shelf acetabuloplasty in LCPD can increase the coverage of the femoral head, benefiting the remodeling of the femoral head and acetabulum. The aim of this study was to evaluate the efficacy of lateral shelf acetabuloplasty for severe LCPD in patients older than 8 years. We evaluated 51 patients with severe LCPD who underwent shelf acetabuloplasty between 1994 and 2005. Clinical and radiological examinations were evaluated preoperatively and over a mean follow-up of 132.35 months (range 102–183 months). According to the Catterall classification, the LCPD was classified as grade II in 11 (21.6%) patients, grade III in 15 (29.4%), and grade IV in 25 (49.0%). According to the Herring classification, there were 12 (23.5%) patients in grade B, 24 (47.1%) in grade B/C, and 15 (29.4%) in grade C. The mean ages at the onset of signs and at surgery were 103.39 months and 110.78 months, respectively. By the end of follow-up, all patients had a normal passive range of hip movement without pain. The mean Iowa hip score was improved from 69.5 ± 7.28 to 91.6 ± 5.14 (P hips were classified as grade 1, 19 (37.3%) hips as grade 2, 14 (27.5%) hips as grade 3, and 7 (13.7%) hips as grade 4. The CE angle, Sharp angle, medial joint space ratio, epiphysis height ratio, and percentage of acetabular coverage were significantly improved by shelf acetabuloplasty (P hip. Shelf acetabuloplasty can improve femoral head coverage and reduce subluxation of the hip, with a benefit to the biological remodeling of the femoral head within the acetabulum. PMID:27828848

  16. Roles of radiograph, magnetic resonance imaging, threedimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases

    GU Gui-shan; ZHU Dong; WANG Gang; WANG Cheng-xue


    Objective: To evaluate the roles of radiograph, magnetic resonance imaging (MRI), three-dimensional computed tomography (3-D CT) in early diagnosis of femoro-acetabular impingement (FAI) in 17 cases. Methods: Plain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting (i.e. hip flexion). There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior (AP) view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral (General Electric Company, USA) at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto (Siemens Company, Germany)1.5T supraconducfion magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series. Results: The plain radiographs of the pelvis showed that among the 17 patients, 12 (70.59%) had "Cam" change of the femoral head, 6 (35.29%) had positive "cross-over" sign, and 17 (100%) had positive "Pincer" change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases (100%). The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases (88.33%), subchondral ossification in 3 cases (17.6%), and labium tears in 3 cases (17.6%). Conclusions: Plain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.

  17. Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures

    Oberst, Michael; Hauschild, Oliver; Konstantinidis, Lukas;


    BACKGROUND: This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a na....... In addition, the complication rate in the navigated group was significantly lower. CONCLUSION: We support the use of navigation systems and a 3D image intensifier as helpful tools during ORIF of displaced acetabular fractures. LEVEL OF EVIDENCE: Therapeutic study, level III....... acetabular fractures led to a significant increase in skin-to-skin time. Postoperative radiolographic analysis revealed an improvement in the quality of fracture reduction in the 3D navigation group. Navigation in combination with the 3D images of the ISO-C 3D limited the need for extended approaches...

  18. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik


    Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation....... Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction...... was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0...

  19. Time dependent human hip joint lubrication for periodic motion with stochastic asymmetric density function.

    Wierzcholski, Krzysztof


    The present paper is concerned with the calculation of the human hip joint parameters for periodic, stochastic unsteady, motion with asymmetric probability density function for gap height. The asymmetric density function indicates that the stochastic probabilities of gap height decreasing are different in comparison with the probabilities of the gap height increasing. The models of asymmetric density functions are considered on the grounds of experimental observations. Some methods are proposed for calculation of pressure distributions and load carrying capacities for unsteady stochastic conditions in a super thin layer of biological synovial fluid inside the slide biobearing gap limited by a spherical bone acetabulum. Numerical calculations are performed in Mathcad 12 Professional Program, by using the method of finite differences. This method assures stability of numerical solutions of partial differential equations and gives proper values of pressure and load carrying capacity forces occurring in human hip joints.

  20. Endotoxins in surgical instruments of hip arthroplasty

    Vania Regina Goveia


    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  1. Parasitic castration in Fissurella crassa (Archaeogastropoda due to an adult Digenea, Proctoeces lintoni (Fellodistomidae

    Marcelo E. Oliva


    Full Text Available Specimens of Fissurella crassa (Archaeogastropoda from Ilo, southern Perú, are infected with the adult stage of the digenetic trematode Proctoeces lintoni (Fellodistomidae. The histopatological analysis of the male and female gonads show a strong effect of the parasite on the structure and function of these organs. P. lintoni live unencysted in the gonads, and the main mechanical damage is originated by the action of a well developed acetabulum. Chemical actions of parasitic secretions may also be involved. The infected gonads show altered structure and the gametogenic processes is aborted. There is no evidence of hemocytic response, but leucocite infiltration is evident at least in male infected gonads. An increased content of polysaccarides is evident in infected gonads.

  2. Cementless Hydroxyapatite Coated Hip Prostheses

    Antonio Herrera


    Full Text Available More than twenty years ago, hydroxyapatite (HA, calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

  3. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert


    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

  4. Amphimerus bragai N. Sp. (Digenea: Opisthorchiidae, a Parasite of the Rodent Nectomys squamipes (Cricetidae from Minas Gerais, Brazil

    Antonio HA de Moraes Neto


    Full Text Available Amphimerus bragai n.sp. (Digenea, Opisthorchiidae from the bile ducts of a rodent from the State of Minas Gerais, Brazil, Nectomys squamipes (Cricetidae, is described. The new species was studied by both light and scanning electron microscopy. A table is presented comparing the measurements of the new species with those of A. lancea (Diesing, 1850 and A. vallecaucensis Thatcher, 1970, parasites of dolphins and marsupials, respectively. The new species is similar in size and body form to A. vallecaucensis from which it differs in having a vitellarium that extends to the acetabulum while that of the former species are limited to the posterior one-third of the body. Additionally, the new species is from a rodent.

  5. Amphimerus bragai n. sp. (Digenea: Opisthorchiidae), a parasite of the rodent Nectomys squamipes (Cricetidae) from Minas Gerais, Brazil.

    de Moraes Neto, A H; Thatcher, V E; Lanfredi, R M


    Amphimerus bragai n.sp. (Digenea, Opisthorchiidae) from the bile ducts of a rodent from the State of Minas Gerais, Brazil, Nectomys squamipes (Cricetidae), is described. The new species as studied by both light and scanning electron microscopy. A table is presented comparing the measurements of the new species with those of A. lancea (Diesing, 1850) and A. vallecaucensis Thatcher; 1970, parasites of dolphins and marsupials, respectively. The new species is similar in size and body form to A. vallecaucensis from which it differs in having a vitellarium that extends to the acetabulum while that of the former species are limited to the posterior one-third of the body. Additionally, the new species is from a rodent.

  6. Unusual presentations of osteoarticular tuberculosis in two paediatric patients

    Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung


    Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272

  7. 髋关节假体置换成形术并发症的探讨

    袁杰; 王志鑫; 陈森; 王国波


    Objective To analyze the complications of the hip joint prosthetic replacement. Method From 1994 to 2004,46 cases had been analyzed. (11 whole hip joint ,35 cases were artificial femoral replacements). Among them,23 cases were male,23 cases were female;the age is between 56 and 84;the longest time to make tracks for our study is 8.5 years and the shortest is 3 months.Result 46 cases had recovered from iUness;2 cases had become better;6 cases had complications (including 1 sudden death).Conclusion The transplant related complications include dislocation,luxation,the joint looseness, the acetabulum abrasion, infection, medicine complications etc. And we also put forward the preventions that can avoid these complications.

  8. 髋关节发育不良



    @@ 髋关节发育不良(Developmental dysplasia of the hip,DDH)既往又称先天性髋关节脱位(Congenital dislocation of the hip,CDH)、发育性髋关节脱(Developmental dislocation of the hip,DDH)、先天性髋关节半脱位(Congenital subdislocation of the hip)、髋臼发育不良(Dysplasia of acetabulum),是在胎儿和新生儿期因股骨头和髋臼关系紊乱,进而发育至不同程度的髋关节异常的一组疾病,包括髋臼异常、股骨头及股骨近端异常、髋关节囊与软组织异常.

  9. Techniques and results for open hip preservation

    David eLevy


    Full Text Available While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve ́-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/ or acetabulum. Chronic slipped capital femoral epiphysis (SCFE may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

  10. Clinical applications for multiplanar- and three-dimensional-reconstructions by helical-CT for the diagnosis of acetabular fractures; Klinischer Einsatz multiplanarer und 3D-Rekonstruktionen der Spiral-CT in der Diagnostik der Azetabulumfrakturen

    Stroszczynski, C. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Stoeckle, U. [Unfallchirurgische Klinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Wellmann, A. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Beier, J. [Deutsches Herzzentrum Berlin, Virchow-Klinikum, Abt. Innere Medizin und Kardiologie (Germany); Wicht, L. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Hoffmann, R. [Unfallchirurgische Klinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany)


    This review describes recent visualizations of computed tomography for the diagnosis of acetabular fractures. The techniques of conventional and helical-CT for the imaging of the acetabulum are compared. Furthermore, the different methods of multiplaner and three-dimensional reconstructions e.g. shaded surface display, maximum intensity projection, and volume rendering are presented. Figures of multiplanar and three-dimensional imaging for fractures of the pelvis is discussed. (orig.) [Deutsch] Es wird eine Uebersicht moderner computertomographischer Darstellungsmethoden der Azetabulumfrakturen vorgestellt. Auf die einzelnen Charaktersitika der konventionellen und Spiral-CT-Technik wird eingegangen, weiterhin werden die multiplanaren und verschiedenen 3dimensionalen Rekonstruktionsverfahren Shaded-Surface-Display (SSD), Maximum-Intensitaetsprojektion (MIP) und Volume-Rendering (VR) beschrieben und jeweils anhand von Abbildungen erlaeutert. Darueber hinaus wird das diagnostische Potential der einzelnen Methoden diskutiert. (orig.)

  11. MR evaluation of femoral neck version and tibial torsion

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)


    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  12. An Automated Size Recognition Technique for Acetabular Implant in Total Hip Replacement

    Shapi'i, Azrulhizam; Hasan, Mohammad Khatim; Kassim, Abdul Yazid Mohd; 10.5121/ijcsit.2011.3218


    Preoperative templating in Total Hip Replacement (THR) is a method to estimate the optimal size and position of the implant. Today, observational (manual) size recognition techniques are still used to find a suitable implant for the patient. Therefore, a digital and automated technique should be developed so that the implant size recognition process can be effectively implemented. For this purpose, we have introduced the new technique for acetabular implant size recognition in THR preoperative planning based on the diameter of acetabulum size. This technique enables the surgeon to recognise a digital acetabular implant size automatically. Ten randomly selected X-rays of unidentified patients were used to test the accuracy and utility of an automated implant size recognition technique. Based on the testing result, the new technique yielded very close results to those obtained by the observational method in nine studies (90%).

  13. Synovial hemangioma of the hip joint in a pediatric patient

    Demertzis, Jennifer L.; Loomans, Rachel; Wessell, Daniel E. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Kyriakos, Michael [Washington University School of Medicine, Division of Surgical Pathology, St. Louis, MO (United States); McDonald, Douglas J. [Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis, MO (United States)


    Hemangiomas of the articular synovium are rare and commonly associated with recurrent joint swelling and painful limitation of motion. The knee joint is the most commonly involved site, with most patients diagnosed in the second to third decade of life [1]. Although over 200 cases have been reported in the English-language medical literature, only three have originated within the hip joint, all of which were in adult patients reported in the surgical literature [2-4]. We describe a histologically proven synovial hemangioma of the hip joint in a pediatric patient that invaded the femur, acetabulum, and adjacent soft tissues, with a detailed discussion of the differential diagnosis based on the radiographic and magnetic resonance imaging (MRI) findings. (orig.)

  14. Trabecular metal acetabular revision system (cup-cage construct to address the massive acetabular defects in revision arthroplasty

    Rajesh Malhotra


    Full Text Available The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management options of type 3B Paprosky acetabular defects are limited with allograft and conventional cages. Trabecular metal technology has evolved to address these bone defects. Trabecular metal acetabular revision system (TMARS cup-cage construct is a new technique to address massive acetabular defects. We describe a case of failed hip reconstruction done for a Giant cell tumour of proximal femur managed by a two stage procedure, initial debridement and second stage reconstruction of acetabulum with TMARS cup-cage construct and femur with allograft prosthesis composite.

  15. Femoroacetabular impingement

    Kassarjian, Ara [Department of Radiology, Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)]. E-mail:; Brisson, Melanie [Department of Radiology, Centre Hospitalier Universitaire de Quebec, Que. (Canada); Palmer, William E. [Department of Radiology, Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)


    Femoroacetabular impingement is a relatively recently appreciated 'idiopathic' cause of hip pain and degenerative change. Two types of impingement have been described. The first, cam impingement, is the result of an abnormal morphology of the proximal femur, typically at the femoral head-neck junction. Cam impingement is most common in young athletic males. The second, pincer impingement, is the result of an abnormal morphology or orientation of the acetabulum. Pincer impingement is most common in middle-aged women. This article reviews the imaging findings of cam and pincer type femoroacetabular impingement. Recognition of these entities will help in the selection of the appropriate treatment with the goal of decreasing the likelihood of early degenerative change of the hip.

  16. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

    Brennan, S A


    PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

  17. Automated CT segmentation of diseased hip using hierarchical and conditional statistical shape models.

    Yokota, Futoshi; Okada, Toshiyuki; Takao, Masaki; Sugano, Nobuhiko; Tada, Yukio; Tomiyama, Noriyuki; Sato, Yoshinobu


    Segmentation of the femur and pelvis is a prerequisite for patient-specific planning and simulation for hip surgery. Accurate boundary determination of the femoral head and acetabulum is the primary challenge in diseased hip joints because of deformed shapes and extreme narrowness of the joint space. To overcome this difficulty, we investigated a multi-stage method in which the hierarchical hip statistical shape model (SSM) is initially utilized to complete segmentation of the pelvis and distal femur, and then the conditional femoral head SSM is used under the condition that the regions segmented during the previous stage are known. CT data from 100 diseased patients categorized on the basis of their disease type and severity, which included 200 hemi-hips, were used to validate the method, which delivered significantly increased segmentation accuracy for the femoral head.

  18. Automated measurement of diagnostic angles for hip dysplasia

    de Raedt, Sepp; Mechlenburg, I.; Stilling, M.


    A fully automatic method for measuring diagnostic angles of hip dysplasia is presented. The method consists of the automatic segmentation of CT images and detection of anatomical landmarks on the femur and acetabulum. The standard angles used in the diagnosis of hip dysplasia are subsequently....... These values correspond to values found in evaluating interobserver and intraobserver variation for manual measurements. The method can be used in clinical practice to replace the current manual measurements performed by radiologists. In the future, the method will be integrated into an intraoperative surgical...... automatically calculated. Previous work in automating the measuring of angles required the manual segmentation or delineation of the articular joint surface. In the current work automatic segmentation is established using graph-cuts with a cost function based on a sheetness score to detect the sheet...

  19. Two new species of Pseudotelorchis (Digenea, Telorchiidae, parasites of the Caiman, Caiman crocodilus yacare (Reptilia, Crocodylia from the Pantanal Mato-Grossense, Brazil

    Joäo B. Catto


    Full Text Available Pseudotelorchis caimanis n. sp. and P. yacarei n. sp. are described based on specimens collected from Caiman crocodilus yacare (Daudin in the Pantanal Mato-grossense, Brazil. This is the first record of any species of Telorchiidae Stunkard, 1924, parasitizing crocodilians. Pseudotelorchis caimanis n. sp. differs from P. comapactus, the only species described in the genus with seminal receptacle, testes in tandem, and genital pore lateral to acetabulum. Pseudotelorchis yacarei n. sp. differs from the two other species for its body shape, for infecting the intestine instead of the uterus, by having regularly disposed instead of irregulary disposed uterine loops, and by having the vitelline glands disposed in longitudinal lateral lines instead of in lateral bunches.

  20. Contribution to the lichen biota of the Stawy Milickie nature reserve and its adjacent area (Lower Silesia, southwestern Poland

    Edyta Kaźmierska


    Full Text Available The paper presents the results of lichenological investigations conducted in the eastern part of the Stawy Milickie nature reserve and its buffer zone (Barycz Valley, southwestern Poland. The study area is a famous waterfowl refuge, consisting of several fishpond complexes, together with adjacent forests, meadows, and villages. In total 72 lichen taxa were recorded, growing on bark and branches of trees and shrubs, stumps, wood, soil, and anthropogenic rock substrates (mortar, concrete, bricks, etc.. Six species, namely Evernia prunastri, Flavoparmelia caperata, Hypogymnia tubulosa, Parmelina tiliacea, Physconia distorta, and Pleurosticta acetabulum, are threatened in Poland. As represented by single young thalli, they indicate the recent improvement of environmental conditions. The lichen biota of the study area is typical for the lowland regions of western and southwestern Poland.

  1. A Multidisciplinary Approach to the Management of Atypical Osseous Epithelioid Hemangioendothelioma

    J. K. Ma


    Full Text Available Hemangioendothelioma is a rare vascular tumor of intermediate malignant potential. Though epithelioid hemangioendothelioma (EH is commonly found in soft tissues, it has been known to be present in skeletal tissues. The authors present a case of a 50-year-old woman diagnosed with EH of the iliac bone and acetabulum, who experienced pathological fracture at presentation. This report describes a multidisciplinary approach to the management that includes initial incisional biopsy, curettage, and bone grafting, followed by Intensity Modulated Radiation Therapy. The patient finally underwent hemipelvic resection with allograft reconstruction after recurrence. Histopathological study revealed osseous EH of low mitotic activity that stained positively for CD31, CD34, vimentin, and Factor VIII. Herein, the authors discuss the imaging characteristics, histopathological aspects, cytogenetic findings, and the radiobiological behavior of osseous EH. After an aggressive multidisciplinary intervention, the patient is able to achieve local control with no evidence of distal metastatic disease.

  2. Pulsatile lavage irrigator tip, a rare radiolucent retained foreign body in the pelvis: a case report

    Archdeacon Michael T


    Full Text Available Abstract Retained foreign bodies after surgery have the potential to cause serious medical complications for patients and bring fourth serious medico-legal consequences for surgeons and hospitals. Standard operating room protocols have been adopted to reduce the occurrence of the most common retained foreign bodies. Despite these precautions, radiolucent objects and uncounted components/pieces of instruments are at risk to be retained in the surgical wound. We report the unusual case of a retained plastic pulsatile lavage irrigator tip in the surgical wound during acetabulum fracture fixation, which was subsequently identified on routine postoperative computed tomography. Revision surgery was required in order to remove the retained object, and the patient had no further complications.

  3. 手术治疗35例髋臼后壁骨折的临床分析

    黄胜; 李建有; 李雄峰; 管国华


    @@ 髋臼骨折多为高能量损伤,常合并其他部位骨折和脏器损伤,治疗困难.髋臼后壁骨折(posterior wall fractures of the acetabulum,PWFA)是髋臼骨折中最常见的一种类型,约占所有髋臼骨折的25%~33%,由于其常伴有邻近关节面的塌陷、后壁骨折块的严重粉碎以及关节软骨损伤等,治疗效果不满意率高达30%.我院自1995至2006年共收治35例PWFA患者,采用手术治疗取得了满意的效果,现分析报道如下.

  4. Radiotherapy in massive angiomatous osteolysis (Gorham-Stout's syndrome)

    Bek, V.; Haicl, Z.; Kolar, J.; Bednar, B.


    The cases of two young men with the Gorham-Stout's syndrome of massive angiomatous osteolysis are presented. Attempted surgical removal of the pathological angiomatous tissue proved unsuccessful. Telegammatherapy with each patient receiving total focal dose of 40.0 Gy fractionated over a period of 4 weeks resulted in speedy and complete arrest of osteolysis, and in partial recalcification of the bone tissue destroyed. In one patient the favourable condition has been lasting for 9 years, in the other for 8 months from the end of the course of radiotherapy. The authors discuss the cause of a central fracture of the first patient's left acetabulum which was noted 5 years after the radiotherapy. Proceeding from their experience so far, the authors describe radiotherapy in the Gorham-Stout's syndrome as a method of choice, and give a list of the therapeutical principles.

  5. Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures

    Beall, Douglas P. [University of Oklahoma, Clinical Radiology of Oklahoma, Oklahoma City, OK (United States); D' Souza, Sharon L. [University of Oklahoma, Oklahoma City, OK (United States); Costello, Richard F.; Stapp, Annette M. [Clinical Radiology of Oklahoma, Edmond, OK (United States); Prater, Scott D. [University of Oklahoma College of Medicine, Edmond, OK (United States); Van Zandt, Bryan L. [University of Oklahoma College of Medicine, Oklahoma City, OK (United States); Martin, Hal D. [Oklahoma Sports Science and Orthopaedics, Oklahoma City, OK (United States)


    The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury. (orig.)

  6. A Modified Stoppa (Technique Approach for Treatment of Pediatric Acetabular Fractures

    Mehmet Elmadag


    Full Text Available Pediatric acetabular fractures are rare, and anterior column fractures are even rarer. Generally, conservative treatment is applied. If there is displacement of more than 2 mm or findings of instability or fragments within the joint, then surgical treatment is applied. Anterior and posterior approaches may be used in surgical treatment. With pediatric patients, even greater care should be taken in the choice of surgery to be performed according to the fracture pattern to avoid postoperative triradiate cartilage damage. Therefore, minimally invasive surgery is more appropriate. We herein present a case of an acetabulum anterior column posterior hemitransverse fracture following a traffic accident, which was treated surgically using a modified Stoppa (technique approach.

  7. Case report 490: Monostotic fibrous dysplasia of the pubis

    Buckwalter, J.A.; El-Khoury, G.; Bonfiglio, M.M.; Platz, C.C.


    An expansile lesion of the superior pubic ramus in a 32 year old man was discovered incidentally when roentgenograms were obtained to assess the possibility of fracture following an automobile accident. A technetium scan showed increased uptake in the lesion and computed tomography showed expansion of the superior pubic ramus and extension of the lesion from the pubic symphysis to the acetabulum. A needle aspirate of the lesion consisted of blood and giant cells. Based on the appearance of the lesion and the needle aspirate a preliminary diagnosis of giant cell tumor or aneurysmal bone cyst was made. When examined at the time of operation, the lesion was found to be firm and gritty. It was removed and the remaining bone surfaces curetted. Histological examination showed a pattern most consistent with fibrous dysplasia. The pubic ramus healed uneventfully.

  8. [Acetabular fractures].

    Gänsslen, A; Oestern, H J


    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.

  9. Correlation between the findings of magnetic resonance imaging and prognosis of patients with predisposing factors of aseptic necrosis of the femoral head

    Takatori, Yoshio; Nakamura, Shigeru; Nakamura, Toshitaka; Ninomiya, Setsuo; Kokubo, Takashi (Tokyo Univ. (Japan). Faculty of Medicine); Sugimoto, Hisayuki


    Eighteen patients with the predisposing factors for aseptic necrosis of the femoral head were followed up for more than two years after the initial magnetic resonance (MR) imaging. At the time of the initial examination, 24 femoral heads showed abnormal low-intensity areas on MR images without abnormal findings on plain radiographs. Among them, six femoral heads collapsed in the follow-up period. The initial mid-coronal T{sub 1}-weighted MR images of these femoral heads had shown characteristic findings, that is, band-shaped low-intensity areas with the lateral end not covered by the acetabulum. Subchondral fracture of the femoral head occurred in the vicinity of the lateral end of the band. The findings of initial MR imaging seem to predict subsequent collapse of the femoral head. (author).

  10. Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

    Iori Takigami


    Full Text Available Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA, typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

  11. Computed tomography of the acetabular fractures

    Jung, Ho Young; Suh, Jin Suck; Park, Chang Yun; Lee, Kil Woo [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.

  12. Bilateral Asymmetric Dislocations of Hip Joints: An Unusual Mechanism of Injury

    Rajesh Kumar Kanojia


    Full Text Available Asymmetric bilateral dislocations of the hips are rare injuries. Among the small number of reports in the literature, most have attributed the cause to high-velocity motor crashes. These dislocations are often seen to be associated with fractures of the proximal femur or the acetabulum. We present a case of a 45-year-old man with bilateral asymmetric dislocation of hips which were purely ligamentous in nature, without any fracture. He sustained his injuries due to a fall while getting on a moving bus. It was an unusual mechanism of injury as compared to the other cases of asymmetric hip dislocations reported in published studies. Both hips were reduced under general anaesthesia within three hours of the trauma. Skin traction and non-weight-bearing rehabilitation were continued for six weeks. After 35 months of followup, the patient remains asymptomatic. Early diagnosis and timely reduction of such dislocations under anaesthesia are necessary for prevention of complications.

  13. Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

    Sarkhell Radha


    Full Text Available Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR. The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation.

  14. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))


    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  15. Morphological and histological identification of Paramphistomum cervi (Trematoda: Paramiphistoma in the rumen of infected sheep

    Vijayata Chaoudhary


    Full Text Available Aim: This study was undertaken to identify Paramphistomum cervi on the basis of its morphology and histology to be the common cause of paramphistomosis in infected sheep and its differentiation from other similar Paramphistomes in Gujarat. Materials and Methods: Adult rumen flukes were recovered from the rumen of naturally infected sheep slaughtered in various abattoirs in Gujarat. Some adult flukes were flattened and stained in Borax carmine, and some were sectioned in the median sagittal plane and histological slides of the flukes were prepared for detailed morphological and histological studies. Result: Microscopic pictures of the parasite used in identification define the similarity in the morphology and histology of the anterior sucker, pharynx, esophagus, genital atrium, posterior sucker (acetabulum and testes to the P. cervi. Conclusion: It can be concluded that the most common species found in sheep infected with Paramphistomosis is P. cervi on the basis of its histo-morphological appearance in Gujarat.

  16. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Ashok S Gavaskar; Naveen Chowdary Tummala


    Total hip arthroplasty (THA) for an untreated acetabular fracture is technically challenging and the long-term result is not so favorable.A 45-year-old female patient with untreated column and comminuted posterior wall fracture of the acetabulum was treated in our institution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior column with cancellous grafting and cementless THA in a single stage.At 3 years' follow-up,the patient was independently mobile without limb length discrepancy.Radiological evaluation showed well integrated components and bone grafts.No evidence of aseptic loosening or osteolysis was found.This report aims to emphasize that bony acetabular reconstruction allows the use of primary hip components,which improves prosthesis longevity and preserves bone stock for a future revision.

  17. Determination of muscle effort at the proximal femur rotation osteotomy

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu


    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.


    张自明; 马瑞雪; 吉士俊; 牛之彬


    Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and flat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films.Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.

  19. Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy.

    Wenger, Dennis R; Pandya, Nirav K


    The goal of intervention in Legg-Calvé-Perthes disease has been to prevent femoral head deformation by containing the head within the acetabulum, using it as a mold for guiding femoral head development. With appropriate proximal femoral morphology, premature arthritis can hopefully be avoided. Both nonsurgical and surgical methods of treatment have evolved over time, from abduction casts and braces to advanced surgical containment methods, which are now the mainstay of treatment. The purpose of this study is to briefly review the evolution of surgical treatment of Legg-Calvé-Perthes disease, and to concentrate on 2 advanced surgical containment methods: combined Salter innominate osteotomy with femoral varus osteotomy and triple pelvic osteotomy.

  20. [Pelvic chondroblastoma in an adolescent. New treatment approach].

    Rico-Martínez, G; Linares-González, L; Delgado-Cedillo, E; Cerrada-Moreno, L; Clara-Altamirano, M; Pichardo-Bahena, R


    Surgical management of tumors located in the spine and the pelvis involves greater difficulty. Moreover, these tumors are usually very large and vascularized. Preoperative embolization of the internal iliac artery is a relatively safe procedure that may reduce the risk of bleeding and local recurrence in the case of benign tumors. Chondroblastoma is a tumor that is rarely located in the pelvis; its more frequent location is the triradiate cartilage. We describe a case of a chondroblastoma with a relapsing aneurysmal cystic component in the acetabulum of an adolescent patient. Treatment consisted of embolization of the internal iliac artery, fluid hyperthermia, hydrogen peroxide and bone marrow application. The patient was found to be asymptomatic at the 5-year postoperative follow-up. The technetium (99mTc) sestamibi scan was negative for tumor activity and found no lung metastases.

  1. Combined Anterior and Posterior Approach in Total Hip Arthroplasty for Crowe IV Dysplasia or Ankylosed Hips.

    Lee, Young-Kyun; Kim, Ki-Choul; Ha, Yong-chan; Koo, Kyung-Hoi


    We evaluated 70 patients (71 hips) who underwent complex total hip arthroplasty (THA) through the combined anterior and posterior approach. Sixty-five patients (32 dislocated hips and 34 ankylosed hips) were followed-up at a minimum of 3 years (median, 6 years; range, 3-10 years). Seven patients (10.6%), who had transient paresthesia on the anterior thigh, recovered within 3 months. All patients had a good clinical outcome in terms of range of motion, pain and recovery of walking. At the latest follow-up, all prostheses had bone-ingrown stability without any detectable wear or osteolysis. The combined approach allows an excellent exposure of the acetabulum for accurate cup alignment, leg lengthening and mobilization of joint in complex THA without trochanteric osteotomy, excessive abductor release and femoral shortening osteotomy. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy.

    Atilla, Bülent


    Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

  3. Rapidly destructive arthrosis of the hip joint in a young adult with systemic lupus erythematosus.

    Lee, Yongseung; Motomura, Goro; Yamamoto, Takuaki; Nakashima, Yasuharu; Ohishi, Masanobu; Hamai, Satoshi; Iura, Kunio; Iwamoto, Yukihide


    A 37-year-old female had been treated with corticosteroids for systemic lupus erythematosus clinically diagnosed at age 10. She suddenly had right hip pain without any antecedent trauma. Four months after the onset of pain, she visited her primary care physician. On magnetic resonance imaging, joint space narrowing at the weight-bearing area was already seen with bone marrow edematous lesions in both the femoral head and acetabulum. She was treated non-operatively; however, her pain continued to worsen in severity. Thirteen months after the onset of pain, she was referred to our hospital. A plain radiograph showed subluxation of the collapsed femoral head accompanied by destruction of the acetabular rim. Because of her severe intractable pain, she underwent total hip arthroplasty 1 month after her first visit. Histological examination of the resected femoral head revealed pseudogranulomatous lesions along with prominent callus formation, suggesting rapid destruction of the femoral head.

  4. Pelvic osteomyelitis in a 15-year-old girl: case report.

    Tural Kara, Tugce; Ozdemir, Halil; Fitoz, Suat; Ciftci, Ergin; Ince, Erdal


    Pelvic osteomyelitis is a rare infection. Ilium, ischium, pubis and acetabulum are commonly affected sites. Pelvic radiography, pelvic magnetic resonance and scintigraphy are useful imaging techniques for diagnosis. However, diagnoses should be confirmed with bone biopsy from the lesion. Sometimes diagnosis is delayed because of deep localization of infection site. Here in, we report a 15-year-old girl with left groin pain who was diagnosed as pelvic osteomyelitis one month after initial symptoms. Patient was successfully treated with antibiotics for 8 weeks. In conclusion, although pelvic osteomyelitis is an unusual infection in childhood, it should be considered as differential diagnoses of pain in groin, hips, thigh, abdomen and spine. If diagnosis is suspicious, empiric treatment should be started quickly, because it will be possible to achieve satisfactory clinical results with effective treatment.

  5. Arthroscopic excision of acetabular osteoid osteoma in a 7-year-old patient.

    Aşık, Mehmet; Erşen, Ali; Polat, Gökhan; Bilgili, Fuat; Tunalı, Onur


    The purpose of this study was to present the case report of a 7-year-old patient who was treated with hip arthroscopy for an acetabular osteoid osteoma. A 7-year-old patient was referred to our clinic with hip pain. In the assessment of the patient, an acetabular osteoid osteoma was detected in his right hip; it was adjacent to his triradiate cartilage. An arthroscopic surgery was planned as an alternative to open safe hip dislocation. The osteoid osteoma was completely removed with hip arthroscopy. Postoperative CT scanning and histopathological analysis confirmed the diagnosis. Exposure of the acetabulum can be problematic in paediatric patients due to the potential risks of open safe dislocation. Hip arthroscopy can safely be used for benign hip lesions in paediatric patients. Level of evidence Case report, Level V.

  6. Psoas abscess associated with infected total hip arthroplasty: a case report.

    Plaza, R; Soriano, A; Tomas, X; Gallart, X; Garcia, S


    Psoas abscess (PA) is an uncommon disease and its diagnosis is difficult. It can be primary or secondary. Primary abscesses are of unknown origin and are presumably caused by haematogenous or lymphatic spread from a distant infectious focus. Secondary PA is caused by spreading from a contiguous infected structure, such as vertebrae (espondilodiscitis) or mesenteric abscesses (Crohns disease). PA infrequently has been associated with an infection of total hip arthroplasty (ITHA). The correct diagnosis in these cases is difficult due to the clinical similarities between PA and ITHA. Since connection between PA and ITHA is established through the acetabulum, we consider that computed tomography (CT) is the most accurate radiological test because of its efficacy in evaluating the bone structure, and the optimum therapeutic strategy is two-stage replacement surgery. We report one case of PA associated with ITHA and a review of the previous literature.

  7. Early total hip arthroplasty for severe displaced acetabular fractures

    YANG Shu-hua; ZHANG Yu-kun; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Cao; LIU Yong; TIAN Hong-tao


    Objective : To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures.Methods: Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years (1-6 years) and the average period from fracture to operation was 8 days (5-21 day). The average age of the patients was 53 years (26-69 years).Results: At the final follow-up the Harris hip score averaged 82(69-100) points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of late loosening of the prosthesis. One patient had severe central displacement of the cup.Conclusions: In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.

  8. Primary multifocal osseous Hodgkin's lymphoma

    Kohler Janice


    Full Text Available Abstract Background Hodgkin's disease (HD most commonly presents with progressive painless enlargement of peripheral lymph nodes, especially around the cervical region. A few children have systemic symptoms and weight loss. At the time of diagnosis, osseous involvement is uncommon Case presentation A case is described of Primary Multifocal Osseous Hodgkin's Lymphoma in a seven-year-old boy. He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum. Conclusion The clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment. This is a very rare condition and we believe this to be the youngest reported case in the literature.

  9. Hip hemiarthroplasty: from Venable and Bohlman to Moore and Thompson.

    Hernigou, Philippe; Quiennec, Steffen; Guissou, Isaac


    In 1939, Frederick R. Thompson of New York and Austin T. Moore of South Carolina separately developed replacements for the entire ball of the hip. These were used to treat hip fractures and also certain arthritis cases. This type of hemiarthroplasty addressed the problem of the arthritic femoral head only. The diseased acetabulum (hip socket) was not replaced. This prosthesis consisted of a metal stem that was placed into the marrow cavity of the femur, connected in one piece with a metal ball fitted into the hip socket. Bohlman and Austin T. Moore (1939) collaborated for the fabrication and implantation of a custom made 12-inch-long vitallium (metal alloy invented by Venable) femoral head prosthesis for a patient with a recurrent giant cell tumour. This prosthesis functioned well and later on influenced the development of long stem femoral head prostheses.

  10. Proximal Focal Femoral Deficiency

    Vishal Kalia, Vibhuti


    Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

  11. 锥形束CT在夜磨牙患者颞下颌关节中的测量价值%Analysis of cone beam CT for the skeletal structure of temporomandibular joint in patients with sleep bruxism

    李佳; 张娟; 李泽奎; 高平


    Objective To analyze the skeletal structure features of temporomandibular joint (TMJ) by using cone beam computed tomography (CBCT) in patients with sleep bruxism. Methods CBCT scanning was performed in the intercuspal position in 30 patients with sleep bruxism (sleep bruxism group) and 30 health adults (normal group). The reconstruction of TMJ images were analysed by Invivo5 software. Measurements of horizontal section include antero-posterior diameter, medial-lateral diameter and axial angel. Measurements of sagittal section include acetabulum depth, aricular eminence inclination, anterior space, superior space and posterior space. Measurements of coronal section include force angle. Results There were no significant differences in both sides of TMJ between sleep bruxism group and normal group(P>0.05). Compared with control group, there were significant differences in antero-posterior diameter, medial-lateral diameter, acetabulum depth, anterior space and force angle in sleep bruxism group (P0.05)。夜磨牙组与对照组在前后径、内外径、关节窝深度、前间隙和受力角之间差异有统计学意义(P<0.05)。与对照组比较,夜磨牙组髁状突的前后径、内外径减小,前间隙、关节窝深度、受力角增大,其余TMJ测量值无明显差异。结论夜磨牙患者双侧TMJ骨性结构基本对称;髁突在关节窝位置无明显改变,髁突前斜面吸收,髁突有变小的趋势。

  12. Effect of transverse acetabular ligament positioning in total hip arthroplasty%髋臼横韧带在全髋关节置换术中的定位作用

    李建民; 李勃; 杨光; 金浪; 辛婕琛


    With the continuous advances of surgical technology and the extensive research of artificial prosthesis materials , the total hip arthroplasty technology has been widely used in the treatment of hip joint disease , while the placement of intraoperative acetabulum prosthesis imposes direct impact upon the therapeutic effects.Currently, lack of accuracy of clinical acetabulum prosthesis positioning is one of the main reasons for the total hiparthroplasty surgery complications .As a relatively fixed and common anatomic structure , transverse acetabular ligament may be used as a reliable standard reference for acetabular prosthesis imbedding in the process of the total hip arthroplasty surgery , which provides an easy-manipulating , effective and highly-repeatable alternative for the total hip arthroplasty .%随着外科手术技术和人工假体材料的不断发展,全髋关节置换术在治疗髋关节疾病方面的临床应用越来越广泛,而术中髋臼假体的安放位置是否合适对全髋关节置换术的效果可产生直接的影响。目前临床髋臼假体定位的准确度不够,这是引起全髋关节置换术术后并发症的重要原因之一。而髋臼横韧带作为一个较为固定且常见的髋臼解剖结构,在全髋关节置换手术过程中可将髋臼横韧带作为髋臼假体入位的可靠参照标准,为全髋关节置换提供一个简便、有效、重复性高的选择。

  13. Quantifying the contribution of pincer deformity to femoro-acetabular impingement using 3D computerised tomography

    Dandachli, Wael; Najefi, Ali; Iranpour, Farhad; Lenihan, Jonathan; Hart, Alister; Cobb, Justin [Imperial College London, Charing Cross Hospital, Department of Orthopaedic Surgery, London (United Kingdom)


    To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48 vs 37 , p < 0.001; and 216 vs 176 , p < 0.0001 respectively). Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190 suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190 may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. (orig.)

  14. Multislice CT of the pelvis: dose reduction with regard to image quality using 16-row CT

    Gurung, Jessen; Khan, M. Fawad; Maataoui, Adel; Herzog, C.; Vogl, Thomas J. [Johann Wolfgang Goethe University, Institute for Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Bux, R.; Bratzke, H. [Johann Wolfgang Goethe University, Institute for Forensic Medicine, Frankfurt am Main (Germany); Ackermann, Hanns [Johann Wolfgang Goethe University, Institute for Epidemiology and Medical Statistics, Frankfurt am Main (Germany)


    To optimize examination protocols of 16-row multi-detector CT (MDCT) of pelvis for dose reduction with regard to image quality. MDCT of pelvis was performed on 12 cadaver specimens with stepwise reduction of tube current from 160 mA (113, 80, 56, 40, 28) to 20 mA at 120 kV. Scan parameters were 16 x 1.5 mm collimation. Reconstructions of axial and coronal images were used for evaluation of cortex, trabeculum, image quality, image noise, acetabulum and iliosacral (ISJ) joints. After data were blinded, evaluation of images was done by three radiologists according to 5-point Likert scale. Accuracy of the observers in sorting films according to dose reduction was determined with kappa coefficient. Mean values of image evaluation were determined. Pronounced deterioration of image quality for all criteria was observed between 80 and 28 mA. Adequate image quality was obtained at 40 mA [effective dose (E): 2.2 mSv, CTDI{sub w}: 2.8 mGy] for criterion detailed definition of acetabulum and ISJ and at 80 mA (E: 4.4 mSv, CTDI{sub w}: 5.6 mGy) for remaining criteria. Moderate agreement was observed between the three observers (kappa coefficient: 0.31). All observers were excellent in arranging images according to decreasing dose. Using 16-row MDCT image quality of pelvis is acceptable at 80 mA and 120 kV. This translates into a dose reduction of 33% of average value of the nationwide survey of the German Roentgen Society (1999) for this type of examination. (orig.)

  15. A comparative study of "plasmacup" and "porous-coated" acetabular components: survival after 10 to 12 years of follow-up

    José Ricardo Negreiros Vicente


    Full Text Available OBJECTIVES: Our primary aim was to compare the long-term survivorship rates and the rates of successful osseointegration between two different types of uncemented acetabular components. INTRODUCTION: Two types of alloys have primarily been used for the manufacture of the uncemented acetabular components: titanium-based and cobalt-based alloys. A titanium-based alloy appears to be more effective with regard to interface stress transfer to the host bone because of its lower elastic modulus relative to a cobalt-based alloy. This supposed mechanical advantage of a titanium-based alloy component motivated this comparative study. METHODS: Two uncemented acetabular components, a porous-coated acetabulum and a Plasmacup®, were compared with a focus on long-term prosthesis survivorship and the development of acetabular osseointegration. Five radiographic signs of osseointegration were evaluated at the last follow-up appointment: (1 absence of radiolucent lines, (2 presence of a superolateral buttress, (3 medial stress-shielding, (4 radial trabeculae, and (5 an inferomedial buttress. We considered the presence of any three of these radiographic signs, in the absence of acetabular dislocation or symptoms, to be indicative of successful acetabular osseointegration. RESULTS: Among 70 patients implanted with the porous-coated acetabulum, 80% achieved osseointegration over a mean follow-up time of 11.9 years versus 75.3% of the 73 patients who received a Plasmacup insert over a mean of 10.7 years. Prosthesis survivorship rates were not different between the two groups. Revision surgery due to mild or severe acetabular osteolysis, polyethylene wear, and aseptic loosening occurred in eight patients (11.4% with a PCA versus nine (12.3% with a Plasmacup. CONCLUSIONS: We conclude that, during the first ten years after surgery, there is no significant difference between these two types of uncemented cups with regard to either prosthesis survivorship or successful

  16. Increasing thickness and fibrosis of the cartilage in acetabular dysplasia: a rabbit model research

    LI Tian-you; MA Rui-xue


    Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-seven 1-month-old New Zealand rabbits underwent cast immobilization of the left hind limb in knee extension. Serial acetabular dysplasia models were established by assessment of the acetabular index and Sharp's angle on radiographs. The thickness of the acetabular cartilage was measured under a microscope, and fibrosis was observed. Ultrastructural changes were investigated with scanning electron microscopy and transmission electron microscopy. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 were measured by real-time fluorescence quantitative polymerase chain reaction.Results In an immature group of rabbits, the acetabular index of the treated hip increased with animal growth. The cartilage on the brim of the left acetabulum was significantly thicker than that on the right side. The collagen fibrils on the surface of the cartilage became gross, and the chondrocytes in the enlargement layer underwent necrosis. In a mature group of rabbits, the left Sharp's angle increased in the rabbits with 6-week casting. The cartilage on the brim of the left acetabulum underwent fibrosis. The chondrocytes were weakly stained, and the number of lysosomes was much larger than normal. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 in the cartilage differed significantly at different ages.Conclusions Increasing thickness followed by fibrosis may be the order of pathological cartilage changes in acetabular dysplasia, with changes in ultrastructure and collagen expression contributing to the process.

  17. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Werner, Clement M.L. [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland); University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Copeland, Carol E.; Stromberg, Jeff; Turen, Clifford H. [University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Ruckstuhl, Thomas; Bouaicha, Samy [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland)


    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (<20 ) or the AI (>12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  18. Comparative pelvic development of the axolotl (Ambystoma mexicanum) and the Australian lungfish (Neoceratodus forsteri): conservation and innovation across the fish-tetrapod transition.

    Boisvert, Catherine Anne; Joss, Jean Mp; Ahlberg, Per E


    The fish-tetrapod transition was one of the major events in vertebrate evolution and was enabled by many morphological changes. Although the transformation of paired fish fins into tetrapod limbs has been a major topic of study in recent years, both from paleontological and comparative developmental perspectives, the interest has focused almost exclusively on the distal part of the appendage and in particular the origin of digits. Relatively little attention has been paid to the transformation of the pelvic girdle from a small unipartite structure to a large tripartite weight-bearing structure, allowing tetrapods to rely mostly on their hindlimbs for locomotion. In order to understand how the ischium and the ilium evolved and how the acetabulum was reoriented during this transition, growth series of the Australian lungfish Neoceratodus forsteri and the Mexican axolotl Ambystoma mexicanum were cleared and stained for cartilage and bone and immunostained for skeletal muscles. In order to understand the myological developmental data, hypotheses about the homologies of pelvic muscles in adults of Latimeria, Neoceratodus and Necturus were formulated based on descriptions from the literature of the coelacanth (Latimeria), the Australian Lungfish (Neoceratodus) and a salamander (Necturus). In the axolotl and the lungfish, the chondrification of the pelvic girdle starts at the acetabula and progresses anteriorly in the lungfish and anteriorly and posteriorly in the salamander. The ilium develops by extending dorsally to meet and connect to the sacral rib in the axolotl. Homologous muscles develop in the same order with the hypaxial musculature developing first, followed by the deep, then the superficial pelvic musculature. Development of the pelvic endoskeleton and musculature is very similar in Neoceratodus and Ambystoma. If the acetabulum is seen as being a fixed landmark, the evolution of the ischium only required pubic pre-chondrogenic cells to migrate posteriorly. It

  19. Uma nova espécie de Dadayius Fukui, 1929 (Digenea: Cladorchiidae parasita do trato intestinal de Metynnis maculatus (Kner, 1858 (Characidae da planície de inundação do alto rio Paraná, Brasil - DOI: 10.4025/actascibiolsci.v25i2.2044 A new species of Dadayius Fukui, 1929 (Digenea: Cladorchiidae, parasite of the intestinal tract of Metynnis maculates (Kner, 1858 (Characidae from the Upper Paraná River floodplain, Brazil - DOI: 10.4025/actascibiolsci.v25i2.2044

    Ricardo Massoto Takemoto


    Full Text Available Uma nova espécie de Cladorchiidae (Trematoda, Digenea foi encontrada no trato intestinal do peixe de água-doce “pacu peva”, Metynnis maculatus (Kner, 1858 na planície de inundação do Alto Rio Paraná, Brasil. A nova espécie foi classificada no gênero Dadayius Fukui, 1929 por apresentar testículos não lobados e acetábulo ventro-terminal com um “entalhe” postero-mediano na margem interior, características do gênero que possui apenas duas espécies conhecidas. Algumas características que diferem a espécie nova de D. marenzelleri (Daday, 1907 e D. pacuensis Thatcher, 1996 são cecos não alcançando o acetábulo, vitelária de extensão limitada e não atingindo o nível do testículo posterior e a presença de dois tamanhos diferentes de ovos em dois estágios de maturação diferentes.A new species of Cladorchiidae (Trematoda, Digenea was found in the intestinal tract of freshwater fish “pacu peva”, Metynnis maculates (Kner, 1858 from the Upper Paraná River floodplain, southern Brazil. The new species was classified in the genus Dadayius Fukui, 1929 by having non-lobate testis and a ventro-terminal acetabulum with postero median notch on rim, characters of the genus wich has only two previously known species. Some characters that differ the new species from D. marenzelleri (Daday, 1907 and D. pacuensis Thatcher, 1996 are: ceca not reaching acetabulum, vitellaria of limited extension, not reaching the level of posterior testis and the presence of two different egg sizes in two different maturity stages.

  20. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Espandar R


    Full Text Available Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS, Harris hip score (HHS, force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.Results : The mean HHS was 82.5 (55-95. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

  1. Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study.

    Elmadağ, Mehmet; Uzer, Gökçer; Yıldız, Fatih; Ceylan, Hasan H; Acar, Mehmet A


    The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. After the osteotomy, the mean CE angle was improved from 19.8° to 25.2°, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  2. Lecithostaphylus tylosuri sp. nov. (Digenea, Zoogonidae) from the digestive tract of the needlefish Tylosurus acus imperialis (Teleostei, Belonidae).

    Manel, Châari; Hela, Derbel; Lassâd, Neifar


    Lecithostaphylus tylosuri sp. nov. (Digenea, Zoogonidae) specimen were collected from the digestive tract of Tylosurus acus imperialis (Teleostei, Belonidae) caught off the eastern coast of Tunisia. L. tylosuri is very similar to its closest relatives, L. retroflexus and L. nitens. It can be easily distinguished from L. retroflexus (Molin, 1859) in having a more extensive vitellarium, with follicles reaching from the posterior margin of the acetabulum and extending beyond the posterior margin of the testes and a coiled seminal vesicle. L. tylosuri differs from L. nitens as illustrated by Linton 1898, in having a longer cirrus pouch (0.7 mm vs 0.36 mm, respectively) overlapping the anterior edge of the ventral sucker and a submarginal genital pore (submedian in L. nitens). It's also different from L. nitens as described by Manter 1947 in the vitelline disposition and in having the greater sucker ratio (1: 1.3-2.1 vs 1: 1.3-1.6, respectively). L. tylosuri differs from L. nitens as reported by Machida and Kuramochi 2000 by the absence of variations in the vitellarium disposition in all specimens. L. tylosuri is more similar to L. nitens from group A (considered synonym of L. ahaaha Yamaguti, 1970 = L. nitens by Bray 1987) by having vitelline follicles extending beyond the testes. L. tylosuri can be distinguished from L. ahaaha by its pedunculate rather than prominent acetabulum and its larger body size (4.10-7.85 mm long and 0.75-1.2 mm large vs 2.1-6 mm long and 0.45-1.1 mm large, respectively). The prevalence of L. tylosuri sp. nov. was negatively correlated with host length (decreasing with host size increasing). Host sex does not seem to affect infection parameters.

  3. [Bernese periacetabular osteotomy. : Indications, technique and results 30 years after the first description].

    Lerch, T D; Steppacher, S D; Liechti, E F; Siebenrock, K A; Tannast, M


    The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80-90 %. For the very first 75 patients, the cumulative 20-year survivorship was 60 %. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30 %. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.

  4. Rationales for the Bernese approaches in acetabular surgery.

    Keel, M J B; Ecker, T M; Siebenrock, K-A; Bastian, J D


    To present two new approaches to acetabular surgery that were established in Berne, and which aim at enhanced visualization and anatomical reconstruction of acetabular fractures. The trochanteric flip osteotomy allows for surgical hip dislocation, and was introduced as a posterior approach for acetabular fracture management involving the posterior column and wall. For acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach is described. Full exposure of the hip joint, as provided by the trochanteric flip osteotomy, facilitates anatomical reduction of acetabular or femoral head fractures and safe positioning of the anterior column screw in transverse or T-shaped fractures. Additionally, the approach enables osteochondral transplantation as a salvage procedure for severe chondral femoral head damage and osteoplasty of an associated inadequate offset at the femoral head-neck junction. The Pararectus approach allows anatomical restoration with minimal access morbidity, and combines advantages of the ilioinguinal and modified Stoppa approaches. Utilization of the trochanteric flip osteotomy eases visualization of the superior aspect of the acetabulum, and enables the evaluation and treatment of chondral lesions of the femoral head or acetabulum and labral tears. Displaced fractures of the anterior column with a medialized quadrilateral plate can be addressed successfully through the Pararectus approach, in which surgical access is associated with minimal morbidity. However, long-term results following the two presented Bernese approaches are needed to confirm that in the treatment of complex acetabular fractures the rate of poor results in almost one-third of all cases (as currently yielded using traditional approaches) might be reduced by the utilization of the presented novel approaches.

  5. Hyaline cartilage thickness in radiographically normal cadaveric hips: comparison of spiral CT arthrographic and macroscopic measurements.

    Wyler, Annabelle; Bousson, Valérie; Bergot, Catherine; Polivka, Marc; Leveque, Eric; Vicaut, Eric; Laredo, Jean-Denis


    To assess spiral multidetector computed tomographic (CT) arthrography for the depiction of cartilage thickness in hips without cartilage loss, with evaluation of anatomic slices as the reference standard. Permission to perform imaging studies in cadaveric specimens of individuals who had willed their bodies to science was obtained from the institutional review board. Two independent observers measured the femoral and acetabular hyaline cartilage thickness of 12 radiographically normal cadaveric hips (from six women and five men; age range at death, 52-98 years; mean, 76.5 years) on spiral multidetector CT arthrographic reformations and on coronal anatomic slices. Regions of cartilage loss at gross or histologic examination were excluded. CT arthrographic and anatomic measurements in the coronal plane were compared by using Bland-Altman representation and a paired t test. Differences between mean cartilage thicknesses at the points of measurement were tested by means of analysis of variance. Interobserver and intraobserver reproducibilities were determined. At CT arthrography, mean cartilage thickness ranged from 0.32 to 2.53 mm on the femoral head and from 0.95 to 3.13 mm on the acetabulum. Observers underestimated cartilage thickness in the coronal plane by 0.30 mm +/- 0.52 (mean +/- standard error) at CT arthrography (P cartilage thicknesses at the different measurement points was significant for coronal spiral multidetector CT arthrography and anatomic measurement of the femoral head and acetabulum and for sagittal and transverse CT arthrography of the femoral head (P cartilage thickness from the periphery to the center of the joint ("gradients") were found by means of spiral multidetector CT arthrography and anatomic measurement. Spiral multidetector CT arthrography depicts cartilage thickness gradients in radiographically normal cadaveric hips. (c) RSNA, 2007.

  6. Association of a single nucleotide polymorphism in growth differentiate factor 5 with congenital dysplasia of the hip: a case-control study.

    Dai, Jin; Shi, Dongquan; Zhu, Pengsheng; Qin, Jianghui; Ni, Haijian; Xu, Yong; Yao, Chen; Zhu, Lunqing; Zhu, Hongtao; Zhao, Baocheng; Wei, Jia; Liu, Baorui; Ikegawa, Shiro; Jiang, Qing; Ding, Yitao


    Congenital dysplasia of the hip is an abnormal seating of the femoral head in the acetabulum, mainly caused by shallow acetabulum and lax joint capsule. Genetic factors play a considerable role in the pathogenesis of congenital dysplasia of the hip. The gene growth differentiate factor 5 (GDF5) has been implicated in skeletal development and joint morphogenesis in humans and mice. A functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of GDF5 (rs143383) was reported to be associated with osteoarthritis susceptibility. As a key regulator in morphogenesis of skeletal components and soft tissues in and around the joints, GDF5 may be involved in the aetiology and pathogenesis of congenital dysplasia of the hip. Our objective is to evaluate if the GDF5 SNP is associated with congenital dysplasia of the hip in people of Han Chinese origin. The GDF5 SNP was genotyped in 338 children with congenital dysplasia of the hip and 622 control subjects. The SNP was significantly associated with congenital dysplasia of the hip (p = 0.0037; odds ration (OR) = 1.40; 95% confidence interval (CI) = 1.11 to 1.75). A significant difference was detected in female samples when stratified by gender (p = 0.0053; OR = 1.46; 95% CI = 1.21 to 1.91), and in hip dislocation when stratified by severity (p = 0.0078; OR = 1.43; 95% CI = 1.11 to 1.85). Our results indicate that GDF5 is important in the aetiology of congenital dysplasia of the hip. To the authors' knowledge this is the first time that a definite association with the congenital dysplasia of the hip susceptibility has been detected.

  7. Cyclic compressive stress-induced scinderin regulates progress of developmental dysplasia of the hip.

    Wang, Cheng-Long; Wang, Hui; Xiao, Fei; Wang, Chuan-Dong; Hu, Guo-Li; Zhu, Jun-Feng; Shen, Chao; Zuo, Bin; Cui, Yi-Min; Li, De; Yuan-Gao; Zhang, Xiao-Ling; Chen, Xiao-Dong


    Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder characterized by a mismatch between acetabulum and femoral head. Mechanical force plays an important role during the occurrence and development of abnormities in acetabulum and femoral head. In this study, we established a mechanical force model named cyclic compressive stress (Ccs). To analyze the effect of Ccs on DDH, we detected special genes in chondrocytes and osteoblasts. Results showed that Ccs downregulated chondrogenesis of ADTC5 in a concentration-dependent manner. Moreover, the mRNA level of Scinderin (Scin) considerably increased. We established lentivirus-SCIN(GV144-SCIN) to transfect hBMSCs, which were treated with different Ccs levels (0.25 Hz*5 cm, 0.5 Hz*5 cm, and 1 Hz*10 cm); the result showed that overexpression of Scin upregulated osteogenesis and osteoclastogenesis. By contrast, expression of chondrocyte-specific genes, including ACAN, COL-2A, and Sox9, decreased. Further molecular investigation demonstrated that Scin promoted osteogenesis and osteoclastogenesis through activation of the p-Smad1/5/8, NF-κB, and MAPK P38 signaling pathways, as well as stimulated the expression of key osteoclast transcriptional factors NFATc1 and c-Fos. Moreover, Scin-induced osteogenesis outweighed osteoclastogenesis in defective femur in vivo. The results of the analysis of Micro-CT confirmed these findings. Overall, Ccs influenced the development of DDH by promoting osteogenesis and cartilage degradation. In addition, Scin played a vital role in the development of DDH.

  8. Association of a single nucleotide polymorphism in growth differentiate factor 5 with congenital dysplasia of the hip: a case-control study

    Dai, Jin; Shi, Dongquan; Zhu, Pengsheng; Qin, Jianghui; Ni, Haijian; Xu, Yong; Yao, Chen; Zhu, Lunqing; Zhu, Hongtao; Zhao, Baocheng; Wei, Jia; Liu, Baorui; Ikegawa, Shiro; Jiang, Qing; Ding, Yitao


    Introduction Congenital dysplasia of the hip is an abnormal seating of the femoral head in the acetabulum, mainly caused by shallow acetabulum and lax joint capsule. Genetic factors play a considerable role in the pathogenesis of congenital dysplasia of the hip. The gene growth differentiate factor 5 (GDF5) has been implicated in skeletal development and joint morphogenesis in humans and mice. A functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of GDF5 (rs143383) was reported to be associated with osteoarthritis susceptibility. As a key regulator in morphogenesis of skeletal components and soft tissues in and around the joints, GDF5 may be involved in the aetiology and pathogenesis of congenital dysplasia of the hip. Our objective is to evaluate if the GDF5 SNP is associated with congenital dysplasia of the hip in people of Han Chinese origin. Methods The GDF5 SNP was genotyped in 338 children with congenital dysplasia of the hip and 622 control subjects. Results The SNP was significantly associated with congenital dysplasia of the hip (p = 0.0037; odds ration (OR) = 1.40; 95% confidence interval (CI) = 1.11 to 1.75). A significant difference was detected in female samples when stratified by gender (p = 0.0053; OR = 1.46; 95% CI = 1.21 to 1.91), and in hip dislocation when stratified by severity (p = 0.0078; OR = 1.43; 95% CI = 1.11 to 1.85). Conclusions Our results indicate that GDF5 is important in the aetiology of congenital dysplasia of the hip. To the authors' knowledge this is the first time that a definite association with the congenital dysplasia of the hip susceptibility has been detected. PMID:18947434

  9. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip.

    Greber, Eric M; Pelt, Christopher E; Gililland, Jeremy M; Anderson, Mike B; Erickson, Jill A; Peters, Christopher L


    Developmental dysplasia of the hip (DDH) is a recognized cause of secondary arthritis, which may eventually lead to total hip arthroplasty (THA). An understanding of the common acetabular and femoral morphologic abnormalities will aid the surgeon in preparing for the complexity of the surgical case. We present the challenges associated with acetabular and femoral morphologies that may be present in the dysplastic hip and discuss surgical options to consider when performing THA. In addition, common complications associated with this population are reviewed. The complexity of THA in the DDH patient is due to a broad range of pathomorphologic changes of the acetabulum and femur, as well as the diverse and often younger age of these patients. As such, THA in the DDH patient may offer a typical primary hip arthroplasty or be a highly complex reconstruction. It is important to be familiar with all the subtleties associated with DDH in the THA population. The surgeon must be prepared for bone deficiency when reconstructing the acetabulum and should place the component low and medial (at the anatomic hip center), and avoid oversizing the acetabular component. Femoral dysplasia is also complex and variable, and the surgeon must be prepared for different stem choices that allow for decoupling of the metaphyseal stem fit from the implanted stem version. In Crowe III and IV dysplasia, femoral derotation/shortening osteotomy may be required. Many complications associated with THA in the DDH patient may be mitigated with careful planning and surgical technique. Performed correctly, THA can yield excellent results in this complex patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Computerized tomography in evaluation of decreased acetabular and femoral anteversion; Besonderheiten bei der Bestimmung der Hueftpfannenanteversion und Schenkelhalsantetorsion durch Computertomographie

    Toennis, D.; Skamel, H.J. [Institut fuer Strahlendiagnostik, Klinikum Dortmund GmbH (Germany)


    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.) [German] Fuer die Computertomographie hat sich eine neue Aufgabe ergeben. Es hat sich gezeigt, dass verringerte Pfannenanteversion und Schenkelhalsantetorsion haeufige Ursachen von Hueftschmerz und -arthrose sind, v. a. wenn beide gegen 0 gehen. Da operative Massnahmen vor Eintreten der Arthrose ergriffen werden sollten, sind genaue Messwerte erforderlich. Die Untersuchung sollte in Bauchlage durchgefuehrt werden, um eine einheitliche und weitgehend normale Beckenkippung zu gewaehrleisten. Die Schenkelhalstorsion wird zwischen der Kniegelenk- und der Schenkelhalsachse gemessen. Zur Festlegung der Sagittalebene legt man am besten eine Mittellinie zwischen die Beckenschaufeln. Die Messung der Pfannenanteversion sollte in der Schnitthoehe erfolgen, wo die Bewegungseinschraenkung der Innenrotation auftritt. (orig.)

  11. Percutaneous acetabuloplasty for metastatic acetabular lesions

    Logroscino Giandomenico


    Full Text Available Abstract Background Osteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective. Methods We report a retrospective study in 25 such patients (30 acetabuli who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC, Eastern Cooperative Oncology Group (ECOG. The results obtained were analysed using the χ2 Test and Fisher's exact test. Significance was sent at P Results Marked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition. Complete pain relief was achieved in 15 of our 25 (59% of patients, and pain reduction was achieved in the remaining 10 (41% patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12% between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences. Conclusion Percutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

  12. Fixation of total hip components in rheumatoid arthritis and arthrosis. A radiographic, roentgen stereophotogrammetric, densitometric and histomorphometric study

    Oensten, I.


    The radiographic survival of the Charnley prosthesis was studied in two retrospective, matched-pair cohorts of rheumatoid arthritis (RA) and arthrosis (OA) patients. In RA, the 7-year radiographic socket survival improved from 87% to 96% after the introduction of flanged sockets, bone transplants in cases of acetabular protrusion and the rejection of the pilot hole technique. In OA the 10-year radiographic socket survival was 95%. In both groups the 7-year radiographic stem survival improved from 80% to 96% following the introduction of the new cementing technique. Migration of the Charnley prosthesis in the first two years was evaluated by roentgen stereophotogrammetric analysis (RSA) in RA and OA patients, and related to the histomorphometric characteristics of trabecular bone in the acetabulum and the femur. In RA, sockets migrated six times more in the proximal direction as compared with OA; there was no difference in migration in other directions. Stem fixation was equally secure in RA and OA. RA cases had more osteoid in both the femur and the acetabulum, but the amount of osteoid was not correlated with the degree of migration. The bone mineral content (BMC) of RA and OA hips was assessed by dual photone roentgen absorptiometry prior to hip replacement. Patients with RA had 20% less BMC than those with OA but there were no signs of a relative peri-acetabular deficit. In two randomized trials of 81 OA patients, migration of the uncemented, Harris-Galante type I socket was evaluated by RSA and compared with Charnley sockets. After a minimum follow-up of 2 years, no difference in migration between the two socket designs was found. 98 refs, 18 figs, 2 tabs.

  13. Renal Metastasis and Dual (18F-Fluorodeoxyglucose and 131I) Avid Skeletal Metastasis in a Patient with Papillary Thyroid Cancer

    Kulkarni, Prashanth; Rekha, Pobbi Setty Radhakrishna Gupta; Prabhu, Meghana; Venkataramarao, Sunil Hejjaji; Raju, Nalini; Chandrasekhar, Naveen Hedne; Kannan, Subramanian


    Differentiated thyroid carcinoma (DTC) though usually behaves in an indolent manner, can have unusual metastatic presentation. Initial presentation of metastatic disease has been reported in 1–12% of DTC being less frequent in papillary (~2%) than in follicular (~10%) thyroid carcinoma. Renal metastasis from DTC is very rare. To our knowledge, only about 30 cases have been reported in the English literature to date. To make clinicians aware that management of such high-risk thyroid cancer frequently requires novel multimodality imaging and therapeutic techniques. A 72-year-old female is described who presented with abdominal pain and bilateral lower limbs swelling. Initial contrast enhanced computed tomography (CT) scan of abdomen showed a well-encapsulated mass in the upper pole of right kidney favoring a renal cell carcinoma. Postright sided radical nephrectomy, histopathology, and immunohistochemistry reports suggested metastatic deposits from thyroid malignancy. 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT demonstrated hypermetabolic nodule in the left lobe of thyroid and a lytic lesion involving left acetabulum suggestive of skeletal metastasis. Subsequently, ultrasound-guided fine needle aspiration cytology of the thyroid nodules in bilateral lobes confirmed thyroid malignancy (Bethesda 6/6). Total thyroidectomy revealed papillary thyroid cancer (PTC) (follicular variant-PTC [FV-PTC]). After surgery, 131I-whole body scan showed iodine avid lytic lesion in the left acetabulum. The present case is a rare scenario of a renal metastasis as the presenting feature of an FV-PTC. Dual avidity in metastatic thyroid cancers (iodine and FDG) is rare and based on the degree of dedifferentiation of the DTC. PMID:28242987

  14. 髋臼发育不良髋关节置换前髋臼侧的三维测量%Three-dimensional measurement of acetabular side before arthroplasty for acetabular dysplasia

    许杰; 马若凡; 李登; 蔡志清; 李亮平


    BACKGROUND:The anatomical strucure of acetabulum is smal and shal ow in adult acetabular dysplasia patients. The large amount of cal us and scar tissues in the acetabulum make it difficult to identify and instal the acetabular cup during arthroplasty. The comprehensive understanding of the acetabulum before arthroplasty is the premise for selecting the appropriate acetabular prosthesis and making the acetabular reconstruction program. OBJECTIVE:To evaluate the application value of three-dimensional reconstruction technique in choosing the size of acetabular cup before total hip arthroplasty for acetabular dysplasia. METHODS:Spiral CT was carried out in the 11 acetabular dysplasia patients who waiting for total hip arthroplasty. The acetabulum was multi-planar reconstructed, and the size of the acetabular cup was determined through digitized acetabular cup template implantation, and then the mathching degree assessment was performed to compare with the actual size. RESULTS AND CONCLUSION:Spiral CT could clearly show the acetabular morphology, and the 71.4%of the acetabular size chosen in the three-dimensional preoperative plan was the same as actual one, the intraclass correlation coefficient was 0.888. The agreement was much higher than that of two-dimensional preoperative plan based on X-ray plain film. For the patients with acetabular dysplasia, the acetabulum became saml er and shal ower, and there were various extents of bone defects in the superior-lateral acetabulum. Three-dimensional multi-planar reconstruction can effectively evaluate the acetabular morphology, and three-dimensional preoperative plan can provide useful information for the choice of implant.%背景:成人髋臼发育不良髋臼小而浅,臼内有大量骨痂和瘢痕组织等都为人工髋关节置换术中真臼的辨认、臼杯的准确安装带来极大困难,关节置换前对髋臼的全面认识是选择合适的髋臼假体和制定个性化髋臼重建方案的前提。目

  15. Management of early-stage hip dislocation after hemipelvic endoprosthesis reconstruction:14 cases of reportc%人工半骨盆置换患者术后早期髋关节脱位14例报告

    李大森; 郭卫; 杨荣利; 唐顺; 汤小东; 燕太强


    Objective It is challenging to resect the pelvic malignancy involving the acetabulum and reconstruct it with hemipelvic endoprosthesis. The postoperative hip dislocation rate is relatively high. The aim of this study is to outline key technical considerations in dealing with early-stage hip dislocation after pelvic tumor resection and hemipelvic endoprosthesis reconstruction. Methods 169 cases who had pelvic tumor resection and hemipelvic endoprosthesis reconstruction between July 2003 and December 2011 were reviewed. After tumor resection, artificial total hip with anti-dislocation mechanism was used, and periacetabular muscular tension was carefully rebuilt. Postoperative rehabilitation was supervised by a specialized nursing team. Early-stage dislocation was defined as the dislocation occurred within 6 months postoperatively. Open reduction was considered only when closed reduction under subarachnoid anesthesia failed. A normal acetabulum abduction angle was defined between 30 and 55 degrees. The chi-square test was used to detect group differences ( dislocation group and non-group dislocation ) of acetabulum abduction angle. Results 14 patients had early-stage dislocation. The midterm time between dislocation and operation was 16 days ( range;0-94 days ). Successful close reduction was accomplished in 5 patients and the other 9 patients had to undergo open reduction. No hemipelvic prosthesis loosening or sciatic nerve injury was observed during reduction. Second hip dislocation happened in 2 cases after close reduction. No case had an acetabulum abduction angel less than 30 degree. 5 of the dislocated hip had an acetabulum abduction angle more than 55 degrees, while 50 of the non-dislocation group had that an acetabulum abduction angle ( Fisher’s Exact Test, P=0.773 ). Conclusions Despite all the techniques we applied, hip dislocation rate is high after periacetabular tumor resection and hemipelvic prosthesis reconstruction. This is partly due to the

  16. 经皮髋臼成形术穿刺部位的解剖学研究%Anatomic study on the puncture point of the percutaneous acetabular reconstruction

    蒋昆利; 梁清福; 王俊江; 田征


    目的:从解剖学角度探讨经皮髋臼成形术治疗髋臼转移瘤患者手术入路的最佳穿刺点、深度。方法选用30具经防腐固定处理的成人去肌肉骨盆髋关节标本和2具完整成人尸体标本。以髋臼中点为 O 点,过髂前上棘和 O 点做1条直线,再做1条过 O 点且垂直于该直线的直线,2条直线分别与髋臼边缘交于 A、B 点,并把髋臼分为4个象限。∠AOB 的角平分线与髋臼边缘交于 C 点。设髋臼顶点为0时,测量大转子顶点所在水平面与 A、B、C 各点所在水平面的垂直距离及 A、B、C 3点在髋臼边缘外10 mm 相对应 A’、B’、C’3点处的髋臼后壁厚度。根据测量的数据得出最佳穿刺点和深度,对2具完整尸体标本行髋臼穿刺操作并灌注骨水泥验证。结果A’点位于大转子顶点上方31.6~38.4 mm,男性平均34.9 mm,女性平均34.2 mm;B’点位于与 A’点相同距离的10~11点钟位置;C’点位于转子顶点上方33.8~42.5 mm,男性平均距离36.7 mm,女性35.5 mm 的0点钟位置。A’、B’、C’对应的体表投影点即为穿刺部位。其穿刺深度分别为6.7~8.4、17.7~20.4、14.7~17.9 mm,平均深度约分别为7.5、18.5、16.5 mm。经验证髋臼成形术最佳进针点结果成立。结论A’、B’、C’3点的体表投影点均可为行髋臼成形术的穿刺点,3个穿刺点可以较短距离到达髋臼后上象限区的肿瘤。%Objective To discuss the optimal puncture point and depth of percutaneous acetabulum forming operation for treatment of acetabular tumor on the basis of anatomical angle.Methods 30 adult pelvis and hip specimens without muscle fixed with formol and 2 complete cadavers were anatomized and measured. Set the central of acetabulum as point O,from the point O,let a vertical line intersected line which went through the point of spina iliaca anterior superior and the point O

  17. Establishment of classified pelvic and acetabular fractures and their significance%骨盆髋臼骨折三维数字化分型系统的建立及其意义

    王会祥; 汪方; 王秋根; 林艳萍; 陈豪; 陶星光


    目的 建立骨盆、髋臼骨折三维数字化分型系统,评价其对骨科临床及教学的指导意义.方法 将一名健康男性志愿者CT扫描所得数据转换成DICOM格式并导入Mimics10.01软件中进行处理,分别重建骨盆、髋臼模型,同时模拟出国际内固定研究学会(A0)分型中各型骨盆、髋臼骨折,对各骨折块予以不同颜色渲染,并将完成制作的骨折三维模型以标准三维图形(STL)文件格式保存.利用视觉化图像工具库(VTK)及跨平台C+ +图形用户界面应用程序开发框架(Qt)等软件开发工具,完成骨盆、髋臼骨折三维数字化分型软件开发.10名骨科医生及20名医学生分别将三维数字化骨盆、髋臼骨折AO分型图谱和传统的二维分型图谱与患者影像学资料进行对比,并给予初步评价.结果 骨盆、髋臼骨折三维数字化分型软件可实现对骨折三维模型的旋转及放缩等操作,从任意角度观察骨折模型.9名骨科医生及18名医学生评价提示,三维数字化骨折分型系统与传统的二维平面分型系统相比,利于对骨盆、髋臼骨折AO分型的理解和判断.结论 骨盆、髋臼骨折三维数字化分型系统具有逼真、直观、立体、动态等特点,对于骨科临床及医学教学具有积极意义.%Objective To establish three-dimensional (3D) digital classification models of pelvic and acetabular fractures and evaluate its significance in orthopaedic clinical and teaching work. Methods Pelvic of a healthy male volunteer was scanned with CT, and the resulting data in DICOM format was imported to Mimics10. 01 software to reconstruct the model of the pelvis and acetabulum respectively. Based on the standards of AO/ASIF classification of pelvic and acetabular fractures, various types of fractures were simulated. The fracture fragments were displayed with different colors. The completed fracture models were saved in STL format. By use of VTK and Qt softwares, the software

  18. Evaluation of Bernese periacetabular osteotomy: prospective studies examining projected load-bearing area, bone density, cartilage thickness and migration.

    Mechlenburg, Inger


    The typical dysplastic hip joint is characterised by maldirection of the acetabulum and femoral neck, insufficient coverage of the femoral head focally and globally and erosions of the limbus acetabuli (1). An unknown number of persons with hip dysplasia will suffer from pain in hip or groin, decreased hip function and development of osteoarthritis at a young age. The Bernese periacetabular osteotomy is performed to prevent osteoarthritis in patients with hip dysplasia and has been carried out at Aarhus University Hospital, Denmark since 1996 with more than 500 osteotomies performed. Throughout the years, research and quality improvement of the treatment has taken place and this PhD thesis is part of that process. The aims of this PhD thesis were to evaluate outcome aspects after periacetabular osteotomy in terms of I) estimating the projected loadbearing surface before and after periacetabular osteotomy, II) estimating bone density changes in the acetabulum after periacetabular osteotomy, III) developing a technique to precisely and efficiently estimate the thickness of the articular cartilage in the hip joint and IV) examining the stability of the re-orientated acetabulum after periacetabular osteotomy. In study I, we applied a stereologic method based on 3D computed tomography (CT) to estimate the projected loadbearing surface in six normal hip joints and in six dysplastic hips. The dysplastic hips were CT scanned before and after periacetabular osteotomy. We found that the average area of the projected loadbearing surface of the femoral head preoperatively was 7.4 (range 6.5-8.4) cm2 and postoperatively 11 (9.8-14.3) cm2. The area of the projected loadbearing surface was increased significantly with a mean of 49% (34-70%) postoperatively and thus comparable with the load-bearing surface in the normal control group. Double measurements were performed and the error variance of the mean was estimated to be 1.6%. The effect of overprojection, on the projected

  19. 发育性髋脱位早期髋臼软骨细胞凋亡与Caspase-3、Bcl-2表达的相关性研究

    丁良甲; 王炳海; 刘莹丽; 韦宜山


    Objective To investigate the corelation of the apoptosis and the expression of Caspase-3 and Bcl-2 of the acetabulum chondrocytes in the early stage of development dislocation of the hip. Methods Thirty two rabbits of 4 weeks old with no restriction on the gender were used in the experiment.The hip was flexured and the left back knee was extended and then fixed with a plaster cast as DDH model group and the right side without fixation as the control group. The apoptosis was detected by TUNEL,and the expression of Caspase-3,Bcl-2 was determined by immunohistochemistry in the acetabulum chondrocytes of 24 successful models. The correlation of apoptosis and the expression of Caspase-3,Bcl-2 was analyzed by the Spearman rank correlation. Results TUNEL Results showed that the apoptosis rate of acetabulum chondrocytes in DDH model group(45.23±10.42)was higher than that in the control group(8.04±4.35,P<0.050)before 8 weeks. However,after 8 weeks the apoptosis in DDH model group did not change obviously. Immunohistochemical results showed that the expression of caspase-3 and bcl-2 in DDH model group was higher than it in the control group(56.73±7.85vs61.45±5.47 and 56.73±7.85 vs. 52.32±7.99,respectively;P<0.05). The caspase-3 expression and the apoptosis rate in acetabulum chondrocytes was negatively correlated(r=-0.896,P<0.05),while bcl-2 expression and the apoptosis rate was positively correlated(r=-0.896,P<0.05). Conclusion Caspase-3 and bcl-2 may play a role in acetabulum dysplasia and cartilage degeneration.%目的:探讨发育性髋关节脱位(development dislocation of the hip,DDH)早期髋臼软骨细胞凋亡与Caspase-3、Bcl-2表达的相关性。方法选取32只4周龄新西兰大白兔,采用兔后肢屈髋伸膝位管型石膏固定制作DDH动物模型。对24只成功模型兔采用TUNEL法检测髋臼软骨细胞凋亡情况;免疫组化法检测软骨细胞中Caspase-3和Bcl-2的表达。Spearman等级相关分

  20. Periacetabular rotational osteotomy through the medial wall of ilium for the treatment of acetabu-lar dysplasia%经髂骨内侧壁髋臼周围旋转截骨治疗髋臼发育不良

    薛源; 冯香; 高化富; 张印峰


    Objective To investigate the effect of periacetabular rotational osteotomy through the medial wall of ilium on acetabular dysplasia. Methods Thirty-six patients with acetabular dysplasia were operated with periacetabular rotational osteotomy through medial wall of ilium. Firstly,the dissec-tion was performed in the subperiosteal plane of the medial ilium via the ilioinguinal incision to expose the medial wall of the bottom of acetabulum. Secondly,without dissecting the internal iliac vasculoneural sheaths,osteotome was used to complete the osteotomy around the acetabulum within 1. 5 cm. The supe-rior portion was greater sciatic notch and the inferior portion was pecten pubis and body of ischium. In or-der to isolate the acetabulum,the two layer cortical bone was cut through and without damaging the later-al periosteum. Thirdly,with the help of biofix rods,the acetabulum was rotated anterolaterally and inferi-orly to correct the Sharp angle to 35° and to restore the coverage rate of femoral head to 75% . Two stein-mann pins were used to put pressure on the medial wall of the bottom of acetabulum through anterior su-perior spine. Postoperatively,none of the operated patients was immobilized. Results Thirty-one of the total 36 patients had 7 to 82 months(average 22 months)of follow up. According to Mckay criteria,the effect was excellent in 21 cases and good in 8 cases. Conclusions Periacetabular rotational osteotomy through the medial wall of ilium for the treatment of acetabular dysplasia is an effective,simple method. It has the advantages of little influence on the stability of pelvis,reliable fixation without external fixa-tion,and can avoide the risk of complications. This method can not only alleviate the patients’pain in the injured hip,but also avoid or delay the development of osteoarthritis.%目的:探讨经髂骨内侧壁髋臼周围旋转截骨术治疗髋臼发育不良的疗效。方法应用经髂骨内侧壁髋臼周围旋转截骨术

  1. Acetabular lateral reconstruction after total hip arthroplasty:understanding and application of core technology%人工髋关节翻修髋臼侧重建:对技术核心的认识及应用

    张文贤; 范有福; 王小燕; 吕江宏


    BACKGROUND:After the initial hip replacement, aseptic or infective loosening and subsidence of the prosthesis, acetabular wear, pain, osteolysis and other factors may lead to the loss of prosthesis stability and loss of joint function, which are the common cause of hip arthroplasty. Among the hip arthroplasty, acetabular lateral reconstruction is essential and largely determines the success or failure of revision surgery. OBJECTIVE:To explore the present situation of reconstructing acetabulum after total hip arthroplasty. METHODS:A computer-based online search of PubMed database ( between January 1998 and March 2014, and CNKI database ( from January 2003 to March 2014 was undertaken for the articles about reconstructing acetabulum after total hip arthroplasty. The key words were“artificial joint, reconstruction, acetabular lateral reconstruction, current situation”in Chinese and“reconstructed acetabulum, total hip arthroplasty”in English. Article about hip reconstruction, acetabyular reconstruction, bone defect reconstruction, prosthesis choice and reconstruction, and soft tissue balance were also selected. Repetitive researches were excluded. RESULTS AND CONCLUSION:According to inclusion criteria, 26 articles were involved in this study. A perfect acetabular revision should achieve the fol owing goals:stabilize acetabular prosthesis after acetabular revision;recover hip rotation center and biomechanical properties;repair acetabular bone defects and increase hip bone. Adequate preparation before surgery is an important prerequisite for the success of surgery and good results, aseptic and septic loosening or subsidence of the prosthesis, as wel as acetabular wear and tear are common causes of hip revision. Intraoperative reconstruction of acetabular anteversion and camber angles, acetabular rotation center reconstruction, reconstruction of acetabular bone defects, selection of reconstruction of

  2. Surgical hip dislocation approach for treatment of Pipkin type Ⅳ fractures%髋关节外科脱位入路治疗Pipkin Ⅳ型骨折

    刘世学; 杨晓东; 夏广; 谷城; 王宏波; 李涛; 黄伟奇; 麦奇光; 樊仕才


    目的 探讨髋关节外科脱位入路(Ganz入路)治疗PipkinⅣ型骨折(股骨头骨折合并髋臼骨折)的临床疗效. 方法 回顾性分析2010年6月至2014年12月采用Ganz入路治疗的5例Pipkin Ⅳ型骨折患者资料,男3例,女2例;年龄为21 ~ 57岁,平均38.2岁.股骨头骨折按照Pipkin分型:Ⅰ型2例,Ⅱ型3例;髋臼骨折按Letournel-Judet分型:后壁骨折1例,后壁加后柱骨折2例,后壁加横形骨折2例.所有患者均在伤后8h内复位并行股骨髁上牵引,于伤后5~12d行手术治疗.手术采用Ganz入路,大转子截骨后转子翻向前方,关节囊做一个“Z”字形切开,股骨头后脱位处理股骨头骨折及髋臼顶骨折,复位股骨头后处理髋臼骨折. 结果 术后X线片及CT三维重建均显示股骨头、髋臼骨折复位良好.5例患者术后获平均18个月(6 ~ 36个月)随访.X线片及CT三维重建明确骨折获愈合.磁共振成像明确1例患者发生Ⅰb~Ⅱb期(国际骨循环学会分期)股骨头缺血性坏死,无明显症状;另1例患者发生Ⅲb期股骨头缺血性坏死,行人工全髋关节置换术.1例患者发生异位骨化.无感染、内固定物断裂、髋臼及股骨大转子不愈合等并发症发生.根据Thompson-Epstein评价系统评价髋关节功能:优3例,良1例,可1例.结论 Ganz入路既能保护股骨头残存血管,又能充分显露髋臼和股骨头,是治疗PipkinⅣ型骨折较理想的入路.%Objective To investigate clinical efficacy of surgical hip dislocation approach (Ganz approach) used in the treatment of Pipkin type Ⅳ fracture (combined fracture of femoral head and acetabulum).Methods We retrospectively reviewed 5 patients who had been treated for Pipkin type Ⅳ fracture through surgical hip dislocation approach between June 2010 and December 2014.They were 3 men and 2 women,with an average age of 38.2 years (from 21 to 57 years).According to Pipkin classification,the fractures of femoral head were type Ⅰ (2 cases

  3. Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

    Wang, Cheng-Wei; Wu, Kuan-Wen; Wang, Ting-Ming; Huang, Shier-Chieg; Kuo, Ken N


    The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered. The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty. Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured vertical-center-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup. In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95% CI, 0.70, 1.17], Pemberton

  4. 全髋关节置换中C臂X射线机移位测量髋臼前倾角及外展角%C-arm X-ray machine displacement measurement of acetabular anteversion angle and abduction angle during total hip arthroplasty

    陈军; 伏鹏; 王旭刚; 张军; 高明; 黄河; 王守刚


    BACKGROUND:In total hip arthroplasty, the accurate placement of the acetabulum is needed to guarantee the survival rate of the prosthesis and improve the prognosis. In order to ensure the accurate placement of the acetabulum, the accurate measurement of the abduction angle and the anteversion angle of the acetabulum is needed. OBJECTIVE:To investigate the application value of C-arm X-ray displacement measurement of acetabular anteversion angle and abduction angle in total hip arthroplasty. METHODS:Total y 63 cases undergoing total hip arthroplasty were divided into two groups according to their wil . Patients in the control group (n=30) were implanted with traditional acetabular prosthesis locator. Patients in the observation group (n=33) were implanted with acetabular prosthesis after C-arm X-ray displacement measurement. Acetabular anteversion angle, abduction angle and pelvic inclination were measured before, during and after arthroplasty. Acetabular anteversion angle and abduction angle were measured in both groups after arthroplasty. Pain score and hip function Harris score were recorded in both groups at different time points. RESULTS AND CONCLUSION:(1) No significant difference in acetabular anteversion angle, abduction angle and pelvic inclination was detected before, during and after arthroplasty (al P>0.05). (2) No significant difference in abduction angle was determined between the two groups after arthroplasty (P>0.05), but acetabular anteversion angle was significantly smal er in the observation group than in the control group (P0.05);②置换后2组的髋臼外展角差异无显著性意义(P>0.05),但观察组的髋臼前倾角显著小于对照组(P<0.05);③置换后7 d,观察组的目测类比评分低于对照组(P<0.05);④与置换前比较,2组置换后的Harris评分均显著提高(P<0.05);观察组置换后3,12个月的Harris评分均高于对照组(P<0.05);⑤结果提示,全髋关节置换术中利用C臂X射线机进

  5. 单切口配合经皮拉力螺钉与前后联合入路治疗髋臼双柱骨折的比较

    唐慧斌; 闵继康


    目的:比较两种手术方式治疗髋臼双柱骨折的疗效分析。方法将2008年3月至2014年7月髋臼双柱骨折的患者24例分为甲组(11例)和乙组(13例)。甲组采用单切口配合经皮拉力螺钉治疗,乙组采用前后联合入路。比较两组的手术操作时间、术中出血量、骨折复位matta分级。结果甲组和乙组平均手术时间分别为(106.83±15.29)min、(189.21±11.61)min,术中出血量分别为(642.56±224.85)ml、(938.86±142.56)ml,差异均有统计学意义(P0.05)。结论单切口配合经皮拉力螺钉和前后联合入路均可以较好的复位和固定髋臼双柱骨折,前者可以明显缩短手术时间,减少术中出血量,是一种良好可行的手术方式。%Objecetive To compare therapeutic effects of two surgical approach in the treatment of fracture of acetabulum double column. Methods From March 2008 to July 2014,24 patients with fracture of acetabulum double column were included in the study. The 24 patients were divided in two groups:group A,treated with single incision with lag screw(11 cases),group B,treated with combined anterior and posterior approach(13 cases). Operation time,intraoperative blood loss and the fracture matta grading were compared in the two groups. Results Statistically significant differences were found in operation time(106.83±15.29 min vs. 189.21±11.61min),intraoperative blood loss(642.56±224.85 vs. 938.86±142.56 ml)in group A and group B(P<0.05). According to Matta’s criteria,group A was 90.9% excellent,good rate of 92.8% in Group B. Hip function reference improved merled Aubigne standards,A was 87.5% excellent,good rate of 84% in Group B,and there was no statistically significant difference in the two groups. Conclusions Both surgical approach can reduction and fixation acetabulum double column fractures,the single incision with lag screw can shorten the operation time,reduce intraoperative blood loss.

  6. 正常步态下髋臼底接触面积与压力分布的三维有限元分析%Three-dimensional finite analysis of hip contact area and contact pressure during normal walking

    汪光晔; 张春才; 许硕贵


    BACKGROUND: Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation.OBJECTIVE: To explore the hip joint contact area and pressure distribution during different trait phases, which is important in predicting joint degeneration mechanism.METHODS: CT scanning and computer image processing system were used to establish the model to simulate the situation of acetabulum for 32 phases during the trait. A finite element solves was used to calculate stress and contact area. RESULTS AND CONCLUSION: Stress distribution within the acetabular cartilage was obtained and regions with elevated stress at 32 phases were located. The stress distributions of 32 phases were significantly different. The stress demonstrated the bimodal shape of a pronounced phush-off often seen in trial gait cycle (4.2 MPa). The regions of elevated stress and contact area of acetabulum both occurred during stance phases of a gait cycle. Persistent stress-transfer located on medial roof, while on anterior and posterior horn there is always no stress-transfer. The elevated stress located roof during stance phases and medial acetabular cartilage during swing-phases respectively. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, the renions of elevated stress and contact area of acetabulum are important, which provide an insight into the factors contribution to the arthritis.%背景:认识髋关节的正常压力分布特点,将有助于进一步了解正常髋关节的力学机制与异常载荷下关节软骨的病理学行为.目的:运用三维有限元的方法,分析正常步态过程中头臼间接触面积和应力分布情况.方法:应用CT扫描技术和计算机图像处理系统,建立髋臼的

  7. 人体骨盆生物力学三维光弹性的实验研究%A experimental study on the biomechanics of the human pelvis by t he three-dim ensional photoelastics

    郭磊; 范广宇; 高鹏飞; 董本涵


    目的 研究人体正常骨盆和髋臼发育不良骨盆的生物力学特征。方法 依据光弹性力学原理,应用光敏材料E-51环氧树脂制作人体骨盆三维光弹模型共4套,模型加载,应力冻结,测量分析骨盆的应力分布及形态改变。结果 人体双腿站立时,正常及髋臼发育不良骨盆环的应力集中在I7、I8、S4、A1、A2等处;髋臼发育不良时髋臼内壁应力异常集中于髋臼上缘,A1∶A4 =6∶1。负重后正常骨盆髋臼外口呈“椭圆形”改变。结论 人体骨盆应力分布复杂;人体双腿站立负重时髋臼可发生形态改变;髋臼发育不良时髋臼应力分布不均导致髋关节骨关节炎的发生。%Objective To investigate the biomechanic characteristic of normal human pelvis and pelvis with development displasia of h ip (DDH) by the three-dimensional photoelastics. Methods Four photoelastic models of human pelvis were made by using light-sensat ory material with hypersensitivity E-51 epoxy resin. The weight was put on mode l and performed froze stress, and the distribution of model stress and morphorlog ical change were observed. Results The stresses of human pelvic ring were concentrated on the parts, such as I7, I8, S4, A1, A2 . In DDH, stresses within acetabulum were concentrated on the parts of upper mar gin of acetabulum,such as A1∶A4=6∶1. In the loading pelvis, acetabular ou tlet became ellipse in shape. Conclusion Under standing condtion of double legs, stresses of human pelvic ring were complicated. In the loading pelvis, morphological changes of acetabulum occurred. In DDH, the abnorm al concentration of stresses within pelvis leads to the development of osteoarth ritis.

  8. Assessment of a New Axis of Radiation in Hip Joint Radiographies

    "A. Esmaeelzadeh


    Full Text Available Introduction & Background: The harmful effects of x-rays on sensitive cells such as those of sex gonads are a well-established fact. Therefore, special care should be taken in hip radiographies to protect the gonads. According to the most recent references, to locate the head of femur and its joint in hip radiographies, a line should be drawn from the ASIS to symphysis pubis. To locate the head of the joint, we had to move 2.5cm inferior and laterally from the middle of the men-tioned line. The outer end of this new line indicates the position of the femur head. However, due to the lack of accurate instruments in wards and the variety of diseases and also to avoid repetitive hip radiogra-phies, we decided to apply an experimental method. Patients & Methods: In this study, hip radiographies with FFD=100 were done for 50 patients of both sex with different ages. In all instances the distances be-tween symphysis pubis and the greater trocanter, the base of the lesser trocanter, and upper edge of acetabulum, and symphysis pubis and the center of femur, were measured on the radiographs by means of a standard ruler. The findings were then statisti-cally analyzed. The radiography apparatus was Phil-lips 500MA model D7. Results: In this study, it was shown that in 27 cases, the distance between symphysis pubis and the center of the head of femur was equal to the distance be-tween the base of the lesser trocanter and the upper edge of acetabulum. There was also a difference of 0.5, 1, and 2.5 centimeters in 14, 10, and 3 cases re-spectively. Conclusion: These findings were statistically signifi-cant and new. This is notable with regard to the ease of locating the hip joint in small radiographs. In addi-tion it has the advantage of a small degree of gonadal protection.

  9. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist.

    Telleria, Jessica J M; Lindsey, Derek P; Giori, Nicholas J; Safran, Marc R


    To examine and describe the normal anatomic intra-articular locations of the hip capsular ligaments in the central and peripheral compartments of the hip joint. Eight paired fresh-frozen human cadaveric hips (mean age, 73.3 years) were carefully dissected free of soft tissue to expose the hip capsule. Needles were placed through the capsule along the macroscopic borders of the hip capsular ligaments. Arthroscopy was performed on each hip, and the relations of the needles, and thus the ligaments, to the arthroscopic portals and other soft-tissue and osseous landmarks in the hip were recorded by use of a clock-face reference system. The iliofemoral ligament (ILFL) ran from 12:45 to 3 o'clock. The ILFL was pierced by the anterolateral and anterior portals just within its lateral and medial borders, respectively. The pubofemoral ligament was located from the 3:30 to the 5:30 clock position; the lateral border was at the psoas-U perimeter, and the medial border was at the junction of the anteroinferior acetabulum and the cotyloid fossa. The ischiofemoral ligament (ISFL) ran from the 7:45 to the 10:30 clock position. The posterolateral portal pierced the ISFL just inside its superior/lateral border, and the inferior/lateral border was located at the posteroinferior acetabulum. In the peripheral compartment the lateral ILFL and superior/lateral ISFL borders were in proximity to the lateral synovial fold. The medial ILFL and lateral pubofemoral ligament borders were closely approximated to the medial synovial fold. The hip capsular ligaments have distinct and consistent arthroscopic locations within the hip joint and are associated with clearly identifiable landmarks in the central and peripheral compartments. The standard hip arthroscopy portals are closely related to the borders of the hip capsular ligaments. These findings will help orthopaedic surgeons know which structures are being addressed during arthroscopic surgery and may help in the development of future hip

  10. Monitoring of Containment in Perthes' Disease: Can Ultrasonography be Helpful?

    Stuecker, Markus H F; Meiss, A Ludwig


    Background. Prevention of loss of containment has become an accepted principle in the treatment of Perthes' disease. The pre-requisite is early recognition. It is based on evaluation of plain radiographs and more recently, on the study of Magnetic Resonance (MR) images which allow discrimination of early cartilaginous changes. Ultrasonography (US) allows visualisation of the lateral cartilaginous portion of the femoral head and the acetabular rim including the labrum and measurement of femoral head protrusion/lateralisation. The purpose of this paper is to highlight its potential for monitoring of containment . Materials and methods. We present typical MR and US images to demonstrate the anatomic landmarks of the normal hip joint and to define the parameters of protrusion in Perthes' disease. We selected three illustrative cases that had undergone routine imaging of both hip joints by MR imaging and ultrasound for evaluation of containment. Radiographs of the hips were also available. In radiographs we assessed the coverage of the femoral head, i.e. containment, by the well established Acetabulum-Head Index (AHI) and in MR imaging by the Cartilaginous Acetabulum-Head Index (CAHI). In US we assessed the uncoverage, i. e. protrusion, by the Lateral Cartilage Distance (LCD). Changes in the important morphological MR containment features were also noted. Results. There was a significant increase in the LCD in all Perthes hips (6.2, 7.4, 11.6 mm) when compared to the unaffected side (5.2, 5.1, 4.1 mm) and also when compared to the published mean normal value (5.4 +/- 0.9 mm). Correspondingly, the CAHI values were significantly decreased (75, 69, 67% versus 87, 79, 81%), also in comparison to the published limits (77, 75, and 73% respectively). As for the AHI only the value of 71 % in the third case represented a definite decrease below published normal limits (86 and 80.7% respectively). In the 1st case we diagnosed adequate containment, in the 2nd containment at risk

  11. Biomechanical Study of Acetabunlum Transverse and Posterior Wall Fractures Treated by Internal Fixation with Locking Reconstruction Plate%锁定重建接骨板治疗髋臼横行伴后壁骨折的生物力学研究

    付久洋; 吴啸波


    Objective To evaluate the stability of 3 different internal fixation methods for transverse and posterior wall fractures of the acetabulum. Methods Seighteen acetabula of 9 whole pelvises were divided into 3 groups randomly. Models of transverse and posterior wall fracturesof acetabulum were established and then fixed with one of following three internal fixation methods:(Group A)posterior column locking reconstruction plate group,(Group B)posterior column common reconstruction plate withposterior wall 2 lag screwsgroup ,(Group C)anterior column lag screw and posterior column common reconstruction plate with posterior wall2 lag screws group. biomechanical tests are conducted in a single leg stance tomeasurethe maximal loads in the three groups and the displacements of the posterior wall fractures when the stress were loaded to 2 200 N on the three groups. Results The maximal loads in Groups A,B,C were as follows:(2243. 74 ± 116. 36)N,(2769. 05 ± 131. 42) N,(2832. 87 ± 137. 93)N. When the stress was loaded to 2 200 N on the three groups,the displacements of the posterior wall fractures were as follows:(2. 15 ± 0. 26)mm,(0. 45 ± 0. 05)mm,(0. 53 ± 0. 07)mm. We found there was no significant difference between the Group B and the Group C(P > 0. 05). There was significant difference between Groups B,C and Groups A,(P 0.05)。B、C 两组数据与 A 组比较,差异均有统计学意义(P <0.05,P <0.01)。结论锁定重建接骨板固定髋臼横行伴后壁骨折固定可靠,能够满足患者早期功能锻炼的要求,具有较大临床应用价值。

  12. [Retrospective analysis on total hip arthroplasty for the treatment of developmental dysplasia of the hip in 29 adults].

    Cao, Yin-Sheng; Lu, Min; Yao, Gong-He; Li, Wei-Ning; Zhu, Fu-Ping; Zhang, Bo


    To study the results of the total hip arthroplasty (THA) in the treatment of developmental dysplasia of the hip (DDH) with severe osteoarthritis in adults. From March 2004 to February 2011, 29 patients (32 hips) with DDH were treated by THA with an cementless cup. There were 11 males and 18 females,with an average age of 52.6 years (ranging from 37 to 73 years). Unilateral DDH occurred in 26 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 18 hips in 17 patients of type I ,7 hips in 6 patients of type II, 4 hips in 3 patients of type III, 3 hips in 3 patients of type IV. Except for 3 patients with bilateral DDH, the other patients' ill lower limbs were 1 to 6 cm shorter than the healthy lower ones. All the patients were followed up,and the duration ranged from 8 months to 5.3 years(averaged 3.7 years) without infection, dislocation, and sciatic nerves injury after the operation. One patient with proximal femoral fracture, intraoperation used wire binding, after 4 years of follow-up, fracture healed without evidence of prosthesis loosening. All grafts and subtrochanteric osteotomy healing were achieved. In 21 patients, the pain was completely relieved and the function of the hip joints was good. Five patients still had mild limping, but reduced significantly than preoperation. In 3 patients, the ill lower limbs were more than 1 cm shorter than the healthy lower ones and the other patients' ill lower limbs were less than 1 cm shorter than the healthy lower ones. Two patients' lower limbs were lengthened 4 to 5 cm. The Harris scores were 43.6 +/- 7.1 preoperatively and 86.7 +/- 5.3 postoperatively (P < 0.05). THA with deepening the medial wall of the acetabulum at the true acetabulum, according to different characteristics of Crowe classification, using different operation program, cementless cup in adult could obtain favorable results.

  13. Numerical Investigations of Interactions between the Knee-Thigh-Hip Complex with Vehicle Interior Structures.

    Kim, Yong Sun; Choi, Hyeong Ho; Cho, Young Nam; Park, Yong Jae; Lee, Jong B; Yang, King H; King, Albert I


    Although biomechanical studies on the knee-thigh-hip (KTH) complex have been extensive, interactions between the KTH and various vehicular interior design parameters in frontal automotive crashes for newer models have not been reported in the open literature to the best of our knowledge. A 3D finite element (FE) model of a 50(th) percentile male KTH complex, which includes explicit representations of the iliac wing, acetabulum, pubic rami, sacrum, articular cartilage, femoral head, femoral neck, femoral condyles, patella, and patella tendon, has been developed to simulate injuries such as fracture of the patella, femoral neck, acetabulum, and pubic rami of the KTH complex. Model results compared favorably against regional component test data including a three-point bending test of the femur, axial loading of the isolated knee-patella, axial loading of the KTH complex, axial loading of the femoral head, and lateral loading of the isolated pelvis. The model was further integrated into a Wayne State University upper torso model and validated against data obtained from whole body sled tests. The model was validated against these experimental data over a range of impact speeds, impactor masses and boundary conditions. Using Design Of Experiment (DOE) methods based on Taguchi's approach and the developed FE model of the whole body, including the KTH complex, eight vehicular interior design parameters, namely the load limiter force, seat belt elongation, pretensioner inlet amount, knee-knee bolster distance, knee bolster angle, knee bolster stiffness, toe board angle and impact speed, each with either two or three design levels, were simulated to predict their respective effects on the potential of KTH injury in frontal impacts. Simulation results proposed best design levels for vehicular interior design parameters to reduce the injury potential of the KTH complex due to frontal automotive crashes. This study is limited by the fact that prediction of bony fracture was

  14. Application of uncemented Zweymüller hip prosthesis in adult patients with hip osteoarthritis secondary to developmental dysplasia

    XU Yong-sheng; WANG Yan; LU Long; WEI Bao-gang


    Background Developmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated ‘high-riding' hip.It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48% of patients requiring total hip arthroplasty (THA) for coxarthrosis.The aim of this study was to evaluate efficiency and safety of THA using Zweymüller hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip (DDH) in adults.Methods From January 2000 to February 2008,35 patients (40 hips) with developmental dysplasia of the hip were included.Five were male and 30 were female,with ages ranging from 26 to 65 years and an average age of 45 years.According to Hartofilakidis classification,there were type Ⅰ in 5 hips,type Ⅱ in 20 hips,type Ⅲ in 15 hips.All the patients were performed the THA using the Zweymüller hip implant.The preoperative average Harris score was 44.The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients.The patients mainly suffered from pain and claudication.Clinical and radiological results were analyzed.The Harris score was used for outcome measurement.Results Thirty five patients (40 hips) were followed and the mean follow-up period was 46 months (ranged from 24 months to 96 months).The latest follow-up average Harris score was 88.9 (97.1% of good rate).All the patients were pain-free and there was no sign of infection,aseptic loosening and subsidence.Conclusions In summary,THA using Zweymüller hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults.The key techniques for the total hip replacement are as follows:good preoperative plan,firmly placing the acetabular component in the true acetabulum,proper preparation of proximal femur,suitable femoral component choosing and improving the techniques of the bone graft.

  15. Sertl shelf arthroplasty (BOP procedure) in the treatment of canine hip dysplasia.

    Jensen, D J; Sertl, G O


    The BOP/Sertl shelf arthroplasty procedure is not difficult or lengthy. It uses minimal metallic fixation. It is quite physiological with minimal morbidity because there is no change in the bony anatomic pelvis except to create an extension of the lateral rim of the acetabulum. The animal is able to walk the day after surgery. The procedure can be performed bilaterally the same day, thus creating good bony stability and decreasing stretching of the joint capsule, which in turn prevents further subluxation and pain in the hip joint. The aim of this procedure is to return the animal to a satisfactory lifestyle through an effective but less complicated surgical procedure as compared to other available options. This procedure is straightforward and can be done by a surgeon who is familiar with orthopedic surgical techniques and has been trained in this procedure. To date, more than 150 veterinarians have had hands-on training to perform this operation. We are not claiming that this procedure is a cure for CHD; rather, it is a procedure that dramatically slows down the progress of this malady and allows the dog to lead a more normal lifestyle and avoids euthanasia. After 51 months, our study of 200 hips has had a success rate of 99% on the animals available for follow-up as evidenced by returning those animals to a satisfactory lifestyle with stable hips.

  16. [Response of a finite element model of the pelvis to different side impact loads].

    Ruan, Shijie; Zheng, Huijing; Li, Haiyan; Zhao, Wei


    The pelvis is one of the most likely affected areas of the human body in case of side impact, especially while people suffer from motor vehicle crashes. With the investigation of pelvis injury on side impact, the injury biomechanical behavior of pelvis can be found, and the data can help design the vehicle security devices to keep the safety of the occupants. In this study, a finite element (FE) model of an isolated human pelvis was used to study the pelvic dynamic response under different side impact conditions. Fracture threshold was established by applying lateral loads of 1000, 2000, 3000, 4000 and 5000 N, respectively, to the articular surface of the right acetabulum. It was observed that the smaller the lateral loads were, the smaller the von Mises stress and the displacement in the direction of impact were. It was also found that the failure threshold load was near 3000 N, based on the fact that the peak stress would not exceed the average compressive strength of the cortical bone. It could well be concluded that with better design of car-door and hip-pad so that the side impact force was brought down to 3000 N or lower, the pelvis would not be injured.

  17. Mazabraud 综合征一例%Mazabraud syndrome:1 case report

    陆国强; 李自强


    Objective To investigate clinicopathological characteristics of Mazabraud syndrome by reviewing the data of the ifrst case of the Mazabraud syndrome in China with literature review. Methods We have analyzed the clinical data of a case of hospitalized Mazabraud syndrome patient to clearly diagnose with pathological examination. Result The patient was a 70-year-old male hospitalized for a lump in the left hip for more than half a month. The X-ray iflms of the pelvis, bilateral hip joints and bilateral upper femurs showed soap bubble-like appearance, which are typical ifndings of osteoifbrous dysplasia. The CT scan of whole pelvis showed soap-bubble-like appearance of bilateral ilium, patial sacrum, acetabulum, pubis and ischium. There was a 3-cm-diameter cystic mass in left gluteus max imus muscle, of which CT value was 2 - 7 Hu. Postoperative histopathological examination showed loose arrangement of fusiform ifbrous tissue and immature ifbrous bone, as well as irregular arrangement, English alphabet-shaped tenuity bone trabecula, which was surrounded by a few lfat osteoblasts. This was amyxoma in the left gluteus max imus. Under microscope, the tumor showed clear boundary without capsule. There were much mucus-like substance and few cells. Cells were small, star-shaped and had no speciifcity.Conclusions Mazabraud syndrome is a rare disease, which is deifned as ifbrous dysplasia associated wish intramuscular myxoma. Development of Mazabraud syndrome may be related to the Gsa gene mutation. Pathology plays an important role in diagnosis of Mazabraud syndrome.

  18. Disease severity classification using quantitative magnetic resonance imaging data of cartilage in femoroacetabular impingement.

    Henn, Lisa L; Hughes, John; Iisakka, Eleena; Ellermann, Jutta; Mortazavi, Shabnam; Ziegler, Connor; Nissi, Mikko J; Morgan, Patrick


    Femoroacetabular impingement (FAI) is a condition in which subtle deformities of the femoral head and acetabulum (hip socket) result in pathological abutment during hip motion. FAI is a common cause of hip pain and can lead to acetabular cartilage damage and osteoarthritis. For some patients with FAI, surgical intervention is indicated, and it can improve quality of life and potentially delay the onset of osteoarthritis. For other patients, however, surgery is contraindicated because significant cartilage damage has already occurred. Unfortunately, current imaging modalities (X-rays and conventional MRI) are subjective and lack the sensitivity to distinguish these two groups reliably. In this paper, we describe the pairing of T2* mapping data (an investigational, objective MRI sequence) and a spatial proportional odds model for surgically obtained ordinal outcomes (Beck's scale of cartilage damage). Each hip in the study is assigned its own spatial dependence parameter, and a Dirichlet process prior distribution permits clustering of said parameters. Using the fitted model, we produce a six-color, patient-specific predictive map of the entire acetabular cartilage. Such maps will facilitate patient education and clinical decision making. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Hip replacement in femoral head osteonecrosis: current concepts.

    Scaglione, Michelangelo; Fabbri, Luca; Celli, Fabio; Casella, Francesco; Guido, Giulio


    Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient's factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.

  20. Pigmented Villonodular Synovitis Causing Osteonecrosis of the Femoral Head: A Case Report

    Tomohiro Mimura


    Full Text Available We report a case of a 27-year-old man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. According to our review of the English-language literature, no detailed report of osteonecrosis of the femoral head complicated with pigmented villonodular synovitis has been published. Preoperative X-ray images showed joint narrowing and severe multiple bone erosions at the acetabulum and femoral neck. Magnetic resonance imaging revealed a low-intensity band attributable to osteonecrosis of the femoral head and massive diffuse pigmented villonodular synovitis lesions. Comparison of a three-dimensional computed tomographic image of this patient with an angiographic image of a normal individual demonstrated proximity of the pigmented villonodular synovitis-induced bone erosions to the medial and lateral femoral circumflex arteries and retinacular arteries, suggesting likely the compromise of the latter by the former. We propose that the massive pigmented villonodular synovitis may have contributed to the pathogenesis of osteonecrosis of the femoral head in this patient. We performed open synovectomy and total hip arthroplasty. No operative complications occurred, and no recurrence of the pigmented villonodular synovitis was detected for 3 years after the operation.

  1. Regional material properties of the human hip joint capsule ligaments.

    Hewitt, J; Guilak, F; Glisson, R; Vail, T P


    The hip joint capsule functions to constrain translation between the femur and acetabulum while allowing rotational and planar movements. Despite the crucial role it plays in the pathogenesis of hip instability, little is known about its biomechanical properties. The goal of this study was to determine the regional material properties of the iliofemoral and ischiofemoral ligaments of the capsule. Ten human cadaveric specimens of each ligament were tested to failure in tension. The stress at failure, strain at failure, strain energy density at failure, toe- and linear-region elastic moduli, and the Poisson's ratio were measured for each ligament. The strain to failure was greatest in the ischiofemoral ligament, while no significant difference was noted in failure stress by region or ligament. The Young's moduli of elasticity ranged from 76.1 to 285.8 MPa among the different ligaments, and were generally consistent with properties previously reported for the shoulder capsule. The elastic moduli and strain energy density at failure differed by region. No significant differences in Poisson's ratio were found by region or ligament. The average Poisson's ratio was approximately 1.4, consistent with anisotropic behavior of ligamentous tissues. Understanding the material properties of the hip capsule may help the orthopaedic surgeon better understand normal ligament function, and thereby choose a surgical approach or strategy of repair. Furthermore, knowledge of the normal mechanical function of the hip capsule ligaments could assist in the evaluation of the success of a repair.

  2. Secondary capsular laxity of the hip.

    Blakey, Caroline M; Field, Michael H; Singh, Parminder J; Tayar, Rene; Field, Richard E


    We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury. Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation. In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60º) and the appearance of laxity despite full external rotation. Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.

  3. Differentiating subluxation from developmental dislocation of the hip.

    Tavares, Joao O


    The radiological and clinical picture of a developmental hip dislocation and a severe subluxation are identical. According to Leveuf and Wiberg the diagnosis can only be made by arthrography. The differential diagnosis is critical, as treatment differs dependent on the diagnosis. In this study, the diagnosis of subluxation was based on a plain radiograph of the pelvis. A radiograph of the pelvis with the hips abducted at least 45° and internally rotated (AIR view) was used to differentiate these two entities. In subluxations, the femoral head will relocate into the acetabulum with perfect or near perfect reconstitution of the Shenton's line. It will fail to do so in true dislocations. Five patients, mean age 14.6 months (range 9 to 20 months), presented with delayed diagnosis of hip dysplasia. The examination revealed minimal or no limitation of hip abduction, a leg length discrepancy, and a Trendelenburg gait in the three walking age girls. The radiograph suggested a hip dislocation. The diagnosis of hip subluxation was based on the relocation of the femoral head with the abduction/internal rotation radiograph. All were successfully treated with an Ilfeld abduction splint. None had examination with general anesthesia, arthrograms, traction or immobilization in spica cast. Avoiding over diagnosis of hip dislocation in cases of subluxation is important. This is necessary to prevent overtreatment and to accurately assess the results of treatment. The abduction/internal rotation view may achieve this goal while avoiding diagnostic and therapeutic procedures, such as arthrograms, cast immobilization and surgery.

  4. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Halil Ceylan


    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  5. [Early diagnosis of hip dysplasia. Crippling disease for life. Consensus of the Mexican College of Orthopedics and Traumatology].

    Cymet-Ramírez, J; Alvarez-Martínez, M M; García-Pinto, G; Frías-Austria, R; Meza-Vernis, A; Rosales-Muñoz, M E; Isunza-Ramírez, A; Isunza-Alonso, O D; Brito-Ramírez, J A; Anaya-García, M; Lizalde-Yañez, A


    The developmental dysplasia of the hip (DDH), where the spectrum of deformity varies from a slight mismatch in the articular surfaces between the ilium and femur, which will bring a premature wear of the joint, until the situation more serious when the femoral head is out of the acetabulum, causing a host of disorders side as curvature of the spine, significant shortening of the limb deformities in the knee and the contralateral hip, as well as causing pain and loss of joint mobility mentioned. All this makes the spectrum of abnormalities in a person being disabled with a social and economic burden for the family and society. "Preventing" a clinical entity such as developmental dysplasia of the hip does not mean to anticipate the presentation, because children continue to be born with this problem, but to have a program for early detection and early treatment and thus prevent the occurrence. The goal of this study was to provide the medical community that timely tool for prevention. When diagnosed and treated in a timely and favorable prognosis qualified for motor function and quality of life.

  6. Preparation and Evaluation of Acetabularia-Modified Carbon Paste Electrode in Anodic Stripping Voltammetry of Copper and Lead Ions

    Muhammad Raziq Rahimi Kooh


    Full Text Available Seaweed is well known about for potential in chelating heavy metals. In this study, carbon paste electrodes were fabricated with siphonous seaweed Acetabularia acetabulum as the modifiers to sense lead (II and copper (II by square-wave anodic stripping voltammetry. Various scan rates and deposition potentials were measured to obtain the optimal peak current for Pb(II and Cu(II. Optimum conditions of Acetabularia-CPE for sensing Pb(II were at the scan rate of 75 mV/s and deposition potential of −800 mV, while for Cu(II sensing were at 100 mV/s and −300 mV, respectively. The electrodes were characterized by the duration of accumulation time, preconcentration over a range of standards, supporting electrolyte, and standard solutions of various pH values. Interference studies were carried out. Both Zn(II and Cu(II were found to interfere with Pb(II sensing, whereas only Zn(II causes interference with Cu(II sensing. The electrode was found to have good regeneration ability via electrochemical cleaning. Preliminary testing of complex samples such as NPK fertilisers, black soil, and sea salt samples was included.

  7. Irreducible traumatic posterior hip dislocation with entrapment and a buttonhole effect

    André-Pierre Uzel; Ricardo Bertino; Guy Daculsi; George Yves Laflamme


    The authors reported the case of a 27-year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment.Initial X-rays showed only a small acetabular fragment.After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed,the patient was treated by immediate open reduction through a posterolateral approach.Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule,clogging the acetabulum.The femoral head crossed over the torn capsule with a buttonhole effect.These elements were relieved,the bone fragment was fixed with a 2 mm screw and the capsule was repaired.At the 10-year follow-up,the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis.The authors propose a literature review of this uncommon lesion.

  8. Congenital insensitivity to pain with anhidrosis (CIPA): the spectrum of radiological findings

    Schulman, H.; Tsodikow, V.; Hertzanu, Y. [Dept. of Radiology, Soroka University Medical Centre, Beer-Sheva (Israel); Einhorn, M.; Levy, Y.; Shorer, Z. [Dept. of Pediatrics, Soroka University Medical Centre, Beer-Sheva (Israel)


    Background: Congenital insensitivity to pain with anhidrosis (CIPA) is an exceedingly rare, hereditary, sensory autonomic neuropathy (HSAN). Aim: To evaluate the various skeletal manifestations and cranial CT features in children affected by CIPA. Materials and methods: In the semidesert area of the Negev, the Bedouin tribes constitute a closed society where consanguineous marriages are the custom. This has resulted in a group of 20 children being affected by this rare autosomal recessive HSAN. The skeletal surveys and CT scans of these 20 Bedouin patients, 12 girls and 8 boys, ages ranging between 1 month and 8 years, were retrospectively analysed. Cranial CT scans were performed in ten children because of neonatal hypotonia and psychomotor retardation. The skeletal findings were classified as follows: fractures, joint deformities, joint dislocations, osteomyelitis, avascular necrosis and acro-osteolysis. Results: All 20 patients had fractures of the extremities and acro-osteolysis of the fingers. Six had joint deformities. Three children had recurrent hip joint dislocations and another three had avascular necrosis. Ten patients presented with osteomyelitis of the limbs, acetabulum and scapula. The cranial CT scans disclosed mild brain volume loss with some ventriculomegaly. Conclusions: CIPA is a severe autosomal recessive condition that leads to self-mutilation early in life and to fractures, osteomyelitis and limb amputation in older children. Mental retardation is common. Death from hyperpyrexia occurs in almost 20 % of patients in the first 3 years of life. (orig.)

  9. Driven Around the Bend: Novel Use of a Curved Steerable Needle

    Murphy, Darra T., E-mail:; Korzan, Jeffrey R.; Ouellette, Hugue A.; Liu, David M. [Vancouver General Hospital, Department of Radiology (Canada); Clarkson, Paul W. [Vancouver General Hospital, Department of Orthopedic Surgery (Canada); Munk, Peter L. [Vancouver General Hospital, Department of Radiology (Canada)


    This technical note describes the novel use of a curved, steerable needle to access symptomatic osseous lesions in the pelvis and sacrum for palliative percutaneous treatment that would otherwise be difficult to treat using conventional straight needles. Seven patients with lytic bone lesions were treated. One patient had multiple myeloma; the remaining had metastatic disease: breast carcinoma (n = 2), colorectal carcinoma (n = 1), renal cell carcinoma (n = 1), squamous cell carcinoma (n = 1), and leiomyosarcoma (n = 1). Five of the seven patients had lesions in the posterior acetabulum, and the two other patients had lesions in the sacrum. Four of the seven patients received radiofrequency ablation followed by cementoplasty; three patients received cementation alone. We used a novel needle designed for vertebroplasty, which has an articulating tip allowing it to be guided into lytic bone lesions located in difficult-to-access regions of the pelvis and sacrum. All patients were successfully treated with cementoplasty either with or without thermal ablation. No serious adverse events were reported. The needle was difficult to withdraw in two patients. Steerable curved needles can be successfully used to treat lytic osseous metastases with cementoplasty when lesions are located in sites that may be difficult to reach using conventional straight needles.

  10. [Salter innominate osteotomy for the treatment of developmental dysplasia of the hip: 37 years of follow-up].

    Atik, O Şahap; Daldal, İsmail


    In this article, we report the radiological and clinical status at postoperative 37th year of a 39-year-old male patient who was treated with bilateral Salter innominate osteotomy due to bilateral developmental dysplasia of the hip when he was two years old. The patient expressed that he had no complaint including pain or limitation in range of motion in both hip joints for 37 years. Pain started six months ago in right hip joint. Patient used cortisone for 12 months with a diagnosis of Henoch-Schönlein purpura five years ago. Radiologic imaging revealed findings of bilateral Salter innominate osteotomy and avascular osteonecrosis on the right femoral head. Kirschner wires which were used during operations 37 years ago remained buried in pelvic bone. Bilateral development of acetabulum and femoral head was very good. Anteroposterior and lateral radiographs of right hip joint revealed degenerative osteoarthritis secondary to avascular osteonecrosis on the right femoral head. Except for the last six months, patient has been living without pain or limitation in range of motion for postoperative 37 years.

  11. Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

    Vukašinović Zoran


    Full Text Available Legg-Calvé-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies. Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush, should be treated by Chiari pelvic osteotomy.

  12. Value of 3-D CT in classifying acetabular fractures during orthopedic residency training.

    Garrett, Jeffrey; Halvorson, Jason; Carroll, Eben; Webb, Lawrence X


    The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.

  13. Osteometric sex estimation from the os coxa in a Thai population.

    Mahakkanukrauh, Pasuk; Ruengdit, Sittiporn; Tun, Saw Myint; Case, D Troy; Sinthubua, Apichat


    The coxal bone shows a very high degree of sexual dimorphism both morphologically and metrically. However, despite a number of recent studies on sex estimation from the skeleton in Thailand, no osteometric methods of sexing the Thai os coxa have been proposed. Therefore, the aim of this study was to develop a standard sex estimation method for a Thai population by examining the efficacy of six coxal bone measurements and eight indices obtained from 200 Thai skeletons. Independent samples t-tests revealed statistically significant differences between males and females for all but one of the measurements. The equation with the highest correct allocation accuracy was based on four measurements (pubis length, ischium length, total height and acetabulum diameter) and had a predicted and cross-validated accuracy of 96.9% and a tested accuracy of 97.5% on a holdout sample of 40 individuals. The single variable equation with the highest correct allocation accuracy of 94.4% and a tested accuracy of 97.5% was for the ischiopubic index, which is calculated from ischium length and pubis length. Percentage accuracies in predicting sex from these equations were higher than many previous studies, suggesting high levels of sexual dimorphism in the Thai os coxa.

  14. The anatomy and function of the gluteus minimus muscle.

    Beck, M; Sledge, J B; Gautier, E; Dora, C F; Ganz, R


    In order to investigate the functional anatomy of gluteus minimus we dissected 16 hips in fresh cadavers. The muscle originates from the external aspect of the ilium, between the anterior and inferior gluteal lines, and also at the sciatic notch from the inside of the pelvis where it protects the superior gluteal nerve and artery. It inserts anterosuperiorly into the capsule of the hip and continues to its main insertion on the greater trochanter. Based on these anatomical findings, a model was developed using plastic bones. A study of its mechanics showed that gluteus minimus acts as a flexor, an abductor and an internal or external rotator, depending on the position of the femur and which part of the muscle is active. It follows that one of its functions is to stabilise the head of the femur in the acetabulum by tightening the capsule and applying pressure on the head. Careful preservation or reattachment of the tendon of gluteus minimus during surgery on the hip is strongly recommended.

  15. Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses

    Rubello, D. [Dept. of Nuclear Medicine, General Hospital of Castelfranco Veneto (Italy); Borsato, N. [Dept. of Nuclear Medicine, General Hospital of Castelfranco Veneto (Italy); Chierichetti, F. [Dept. of Nuclear Medicine, General Hospital of Castelfranco Veneto (Italy); Zanco, P. [Dept. of Nuclear Medicine, General Hospital of Castelfranco Veneto (Italy); Ferlin, G. [Dept. of Nuclear Medicine, General Hospital of Castelfranco Veneto (Italy)


    The three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses (UHPs) has not previously been elucidated. We evaluated 28 patients with complicated UHPs who had undergone total hip arthroplasty a very long time previously (range 3-20 years, mean 8.4). All the patients were surgically reviewed: 26 UHPs were found to be loosened and two infected. Nine asymptomatic UHPs were taken as controls. The dynamic phase was invariably negative in both loosened and asymptomatic UHPs while markedly positive in the infected ones. The blood pool phase was positive to various degrees in 16 of the 26 loosened UHPs as well as in the infected UHPs, but was invariably negative in painless replacements. In the bone phase, areas of significantly (discrete to marked) increased uptake were observed in all the loosened prostheses as well as in two-thirds of the asymptomatic ones. However, the regions of the lesser trochanter and/or tip and/or shaft were involved exclusively in the case of the loosened UHPs, and diffuse periprosthetic uptake was found only with loosened or infected implants. Areas of slight methylene diphosphonate (MDP) uptake were found at every periprosthetic site and areas of discrete to marked MDP uptake were commonly found in the acetabulum and/or the greater trochanter with both loosened and painless prostheses and are thus considered to be nonspecific findings. (orig.)

  16. Application of three-dimensional computed tomography in total hip arthroplasty of adult developmental dysplasia of hip%3DCT技术在成人髋臼发育不良全髋关节置换术中的应用

    徐永胜; 魏宝刚; 吕龙; 马秉贤


    , male 5, female 20, aged 21 - 63 years old, mean age 47.9 years old. All of patients underwent pre—operative digital radiography (DR) and 3DCT reconstruction, and measured some parameters to obtain relevant data, then performed THA accorded guideline of the data. All the patients underwent pelvic DR after operation, the horizontal distance and vertical distance from femoral head center to ideal rotation center between contralateral and ipsilateral at pre-operation and post-operation were compared, and recovery level of rotation center in ipsilaieral hip were evaluated. Results The CT showed that anteroposterior diameter of acetabulum became smaller, posterior thickness of acetabulum became thicker and depth of acetabulum was shallower, and there were statistically significant differences in morphological parameters of femur and acetabulum between 2 groups(P 0.05). The mean horizontal distance in pre-operation was 20.15 mm (16 — 38 mm), and mean horizontal distance in post-operation was 2.95 mm (- 2.0 - 9.3 mm). The lateral side of idea center of rotation was positive numeric, and the difference between pre -operation and post -operation were statistically significant (t = 6.74, P < 0.01). The mean vertical distance in pre-operation was 23.58 mm (18 - 42 mm), and mean vertical distance in post-operation was 3.25 mm(- 6.0 - 13.4 mm). The upper side of idea center of rotation as positive numeric, and the difference between pre-operation and post-operation were statistically significant(t=4.53, P< 0.01). Conclusion It is demonstrated that 3DCT reconstruction could provide preferred design for DDH patients with THA, including the customization of acetabular prosthetic, the position of acetabular bone graft and reconstruction, and acetabular component placement angle. The 3DCT plays an important role in recovery of concentric reduction, restoration of anatomical structure and hip joint function.

  17. Massive acetabular bone loss: Limits of trabecular metal cages

    Villanueva-Martínez Manuel


    Full Text Available Massive acetabular bone loss (more than 50% of the acetabular area can result in insufficient native bone for stable fixation and long-term bone ingrowth of conventional porous cups. The development of trabecular metal cages with osteoconductive properties may allow a more biological and versatile approach that will help restore bone loss, thus reducing the frequency of implant failure in the short-to-medium term. We report a case of massive bone loss affecting the dome of the acetabulum and the ilium, which was treated with a trabecular metal cage and particulate allograft. Although the trabecular metal components had no intrinsic stability, they did enhance osseointegration and incorporation of a non-impacted particulate graft, thus preventing failure of the reconstruction. The minimum 50% contact area between the native bone and the cup required for osseointegration with the use of porous cups may not hold for new trabecular metal cups, thus reducing the need for antiprotrusio cages. The osteoconductive properties of trabecular metal enhanced allograft incorportation and iliac bone rebuilding without the need to fill the defect with multiple wedges nor protect the reconstruction with an antiprotrusio cage.

  18. Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients

    Richard Prazeres Canella


    Full Text Available OBJECTIVE: To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI, using computed tomography (CT. METHODS: We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third, femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient. RESULTS: There were inverse correlations between the following angles: (1 acetabular coverage versus alpha angle (p = 0.019; (2 acetabular version (supraequatorial versus alpha angle (p = 0.049. For patients with femoral anteversion lower than 15 degrees: (1 acetabular version (supraequatorial versus alpha angle (p = 0.026; (2 acetabular version (middle third versus alpha angle (p = 0.02. For patients with acetabular version (supraequatorial lower than 10 degrees: (1 acetabular version (supraequatorial versus alpha angle (p = 0.004; (2 acetabular version (middle third versus alpha angle (p = 0.009. CONCLUSION: There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases.

  19. Large aneurysmal bone cyst of iliac bone in a female child: a case report

    Kumar Pawan


    Full Text Available Abstract Background Symptomatic aneurysmal bone cysts in pediatric age group with an expansile lesion in ilium is a rare occurrence. Case An 11-year-old female presented with a swelling over her right iliac region and numbness along the medial aspect of thigh. Clinicoradiological diagnosis was aneurysmal bone cyst confirmed on fine needle aspiration cytology. Excision curettage (wide margin excision of the soft tissue tumor and intralesional curettage in the region of acetabulum of the tumor was performed in view of proximity to acetabular roof and endangered hip stability. Result At follow up of 18 months, the child has full painless range of movements in the hip joint with no recurrence. Conclusions Pelvic aneurysmal bone cysts are distinctly rare in pediatric age. The lesion was associated with an atypical symptom of numbness along the femoral nerve distribution. Hip stability and range of movements were major concern in this patient. Although many treatment options are described, surgical excision still remains the mainstay. In our case, we performed excision curettage, with good outcome.

  20. Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma

    Their, Micael E.A.; Bensch, Frank V.; Koskinen, Seppo K. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Handolin, Lauri [Toeoeloe Trauma Center, Department of Orthopaedics and Traumatology, Helsinki (Finland); Kiuru, Martti J. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Research Institut of Military Medicine, Helsinki (Finland)


    The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16-91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not. (orig.)

  1. Imaging findings of femoroacetabular impingement syndrome

    Beall, Douglas P.; Sweet, Clifford F.; Martin, Hal D.; Lastine, Craig L.; Grayson, David E.; Ly, Justin Q.; Fish, Jon R. [University of Oklahoma Health Sciences Center, Department of Radiologal Sciences, Oklahoma City (United States)


    Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement - cam impingement and pincer impingement - are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms. (orig.)

  2. Validation of a standardized mapping system of the hip joint for radial MRA sequencing

    Klenke, Frank M.; Hoffmann, Daniel B.; Cross, Brian J.; Siebenrock, Klaus A. [Bern University Hospital, Department of Orthopedic Surgery, Inselspital, Bern (Switzerland)


    Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform. (orig.)

  3. 髋关节撞击综合征诊断与治疗的研究进展%Advances in the research of the diagnosis and treatment of femoroacetabular impingement

    熊元; 赵振国; 邹亮; 鲍同柱


    The etiology of femoroacetabular impingement ( FAI ) is abnormal stresses acting on the proximal femur and the acetabulum resulting from abnormally structural relationship between them caused by various factors. FAI plays an important role in inducing early hip osteoarthritis, and the main manifestation is chronic hip pain. Early diagnosis and early treatment help to improve the quality of life of patients and delay the incidence of arthritis. The common X-ray can provide an important reference for the diagnosis and classiifcation of FAI, and the CT scan can provide multi-faceted and multi-dimensional images for hip joint diseases. The sensitivity and speciifcity of MRI are better for the cartilage damages and soft tissue injuries. Therefore, the diagnosis of this disease is not difficult when the clinical symptoms, signs and imaging are combined together. Conservative treatment of FAI is ineffective, and while better therapeutic effects can be achieved with early open surgery or arthroscopic surgery according to the disease conditions. Because FAI has not been found and studied until recent decades, many doctors still do not know it and often misdiagnose it. The key words included “the femur”, “the acetabulum”, “impingement”, “imaging”, “open surgery” and “arthroscope” in this article.

  4. Acetabular retroversion as a rare cause of chronic hip pain: recognition of the ''figure-eight'' sign

    Banks, Kevin P. [Brooke Army Medical Center, Department of Radiology, Fort Sam Houston, TX (United States); Grayson, David E. [Wilford Hall Medical Center, Department of Radiology, Lackland Air Force Base, TX (United States)


    While well-recognized in the orthopedic literature as a cause of chronic hip pain, acetabular retroversion has not been specifically described in the radiologic literature. Acetabular retroversion represents a particular form of hip dysplasia characterized by abnormal posterolateral orientation of the acetabulum. This pathophysiology predisposes the individual to subsequent anterior impingement of the femoral neck upon the anterior acetabular margin and fibrous labrum. Without treatment, cases may progress to damage of the anterior labrum and cartilage, with eventual early onset of osteoarthritic disease. This impinging condition has been described as occurring in isolation or as part of a complex dysplasia. We describe two cases of acetabular retroversion diagnosed by conventional radiographic evaluation of the pelvis, one in isolation and one occurring in the setting of a larger congenital syndrome. These cases illustrate the utility of the ''figure-eight'' sign in identifying abnormalities of acetabular version and thus assisting clinicians in properly identifying these individuals so that appropriate therapy may be instituted. (orig.)

  5. Total hip arthroplasty

    Slavković Nemanja


    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  6. Importance of Herrings classification in predicting the outcome of aseptic necrosis of the femoral head

    Žarko Dašić


    Full Text Available Aim To highlight the importance of values of the Herring’s classification in the treatment planning of Legg-Calve-Perthes disease (LCPD. Method The charts of 14 patients in a period of 4 years (2004-2008 were retrospectively reviewed. Inclusion criteria was unilateral LCPD and contralateral healthy hip. The patients were divided into three Herring groups according to radiographic images (A, B and C. For all patients the acetabulum/head index (AHI was determined. Results The youngest patient was 4.9 years and the oldest 9.11 years; male patients were dominant (male:female 11:3. The right hip side was more affected comparing to the left one (8:6. The distribution of patients in Herring groups was three in the Group A, six in the Group B and five patients in the Group C. The AHI index was lowest in the group C. Patients in the group C were treated surgically. Conclusion Herrings classification predicts patients with extensive changes and suggests what kind of treatment should be applied.

  7. Developmental dysplasia of the hip

    Shahryar Noordin


    Full Text Available Developmental dysplasia of the hip (DDH is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with limping, joint pain, and/or osteoarthritis. Repeated, careful examination of all infants from birth and throughout the first year of life until the child begins walking is important to prevent late cases. Provocative testing includes the Barlow and Ortolani maneuvers. Other signs, such as shorting of the femur with hips and knees flexed (Galeazzi sign, asymmetry of the thigh or gluteal folds, and discrepancy of leg lengths are potential clues. Treatment depends on age at presentation and outcomes are much better when the child is treated early, particularly during the first six months of life.

  8. Functional and radiographic evaluation and quality of life analysis after cementless total hip arthroplasty with ceramic bearings: minimum of 5 years follow-up

    Rafael Borghi Mortat


    Full Text Available Objective: The aim of the study is to analyze and correlate functional and radiographic results and quality of life in patients undergoing cementless total hip arthroplasty with ceramic surface, performed at Hospital Servidor Publico de Sao Paulo from 2001 to 2006. Methods: We retrospectively analyzed 35 hips treated with cementless total hip arthroplasty with ceramic surfaces with a minimum follow-up of 5 years. Functional evaluation was based on the Harris Hip Score (HHS. Radiographic evaluation was based on the method proposed by Charles Engh for evaluation of femoral osseointegration and on DeLee and Charnley zones for acetabulum. Quality of life was assessed by SF-36 questionnaire. Results: The HHS presented excellent and good results in 91% of patients postoperatively (mean of 93.14 points HHS. As for radiographic evaluation, we found excellent results in 100% of evaluated hips (proven osseointegration. SF-36 scores were not compared to the control group for the following components: pain, vitality, mental health and social aspects. The difference between HHS pre and postoperatively had a statistically significant correlation with physical functioning of the SF-36. Conclusion: Total hip arthroplasty with ceramic surface is a treatment that enables functional improvement of the hip and increases quality of life of patients to levels close to those of people without joint diseases.

  9. Morfologia externa de espécimes adultos de Paratanaisia bragai (Santos, 1934 (Digenea: Eucotylidae External morphology of the adults specimens of Paratanaisia bragai (Santos, 1934(Diginea; Eucotylidae

    Solange V.P.B. Brandolini


    Full Text Available Espécimes adultos de Paratanaisia bragai foram coletados de ductos renais de Columba livia infectados naturalmente, fixados em glutaraldeído 2,5% e processados para microscopia eletrônica de varredura. Foram identificados dois tipos distintos de escamas, escamas bífidas e simples, dispostas em fileiras transversais no tegumento das faces dorsal e ventral do corpo. Também mostrando em detalhes a ventosa oral subterminal, bem desenvolvida e acetábulo de tamanho reduzido, localizado no terço médio do corpo, circundado por pequenas protuberâncias e quatro papilas dispostas regularmente na sua margem.Adult specimens of Paratanaisia bragai collected from renal ducts of Columba livia naturally infected, were fixed in glutaraldehyde 2.5% and processed for scanning electron microscopy. Two distinct types of scales had been identified, bifid and simple scales, disposed in transversal rows, on the tegument of dorsal and ventral face of the body. Also show in details the oral sucker subterminal, well developed and acetabulum of size reduced, located in third medium of the body, surrounded for small protuberance and four papillae on its edge.

  10. Ipsilateral Traumatic Posterior Hip Dislocation, Posterior Wall and Transverse Acetabular Fracture with Trochanteric Fracture in an adult: Report of First Case

    Skand Sinha


    Full Text Available Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. Keywords: Hip dislocation; acetabular fractures; intertrochanteric fracture; operative treatment.

  11. 髋臼骨折的治疗%Diagnosis and management of acetabular fracture



    @@ 解剖复位、有效内固定和早期功能锻练早已成为移位关节骨折的治疗原则.然而这一原则能否适用于髋臼骨折(Acetabulum fracture,下称AC)曾有争论.反对者认为AC的X线表现与疗效并不密切相关,只复位股骨头,不解剖复位骨折,仍可取得满意疗效.相反,某些切开解剖复位者,因手术创伤导致的患病率增加,功能并不满意.60年代始,Judet系统研究AC后认为,缺乏统一合理的分类是导致手术和非手术疗效缺乏可比性的关键,鉴此提出了AC的Judet分类.此后,Letournel又对此作了简化和完善,使其更为合理.最近20年的研究则证实,AC的复位质量与临床疗效密切相关,关节骨折的治疗原则同样适用于移位AC.

  12. An evaluation of merits of total hip arthroplasty done for traumatic and non-traumatic displaced fracture neck of femur

    Vipul Agarwal


    Results: On clinical and functional evaluation, patients scored 84% excellent/good in non-traumatic group whereas 68% excellent/good score in traumatic group. 12% and 16% patients scored poor in non-traumatic group and in traumatic group respectively. In non-traumatic group, following complications were observed. Dislocation rate of 4% (one hip, 4% incidence of aseptic acetabular loosening (one hip, and 16% incidence of heterotrophic ossification (four hips. In traumatic group, we observed 2 (8% dislocations, 4 (16% heterotopic ossifications. Loosening of acetabulum and subsidence were observed in two (8% patients. Conclusions: There are higher chances of dislocation among patients undergoing total hip replacement for a traumatic indications as compared to their non-traumatic indications. Chances of dislocation can be curtailed by keeping known factors in mind along with careful patient selection, adherence to postoperative protocol and use of a lateral approach with large head in high risk patients. [Int J Res Med Sci 2016; 4(5.000: 1632-1635

  13. Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

    Scheinfeld, Meir H; Dym, Akiva A; Spektor, Michael; Avery, Laura L; Dym, R Joshua; Amanatullah, Derek F


    Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

  14. A report of bilateral hip dislocations (left rear, right front) caused by trauma combined with unilateral fracture of the femoral head in 1 case%双侧髋关节创伤性左后右前脱位并单侧股骨头骨折一例

    刘丙立; 张宏斌; 张立峰


    @@ 髋关节脱位在所有关节脱位中所占比例较低,外伤性髋关节脱位约占所有关节脱位的2%~5%[1-2], 双侧髋关节同时脱位约占所有髋关节脱位的1%﹪~2%﹪,其中一前一后脱位约占40%[3].%Objective To analyze the mechanism and treatment of asymmetric bilateral dislocations of the hip. Methods I male patient of asymmetry bilateral hip dislocations caused by crushing injury from the agricultural vehicle was accompanied with the fractures of left acetabulum and femoral head. The dislocations were treated with manipulative reduction, and the fracture of the left femoral head was treated with open reduction and internal fixation. Results The function of bilateral hip recovered to the normal in the 2 years' follow-up. HARR.1S score: left 95, right 100. Conclusions Asymmetric hip dislocations are rare to see, careful check and proper treatment can insure a satisfactory effect.

  15. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    Shuichi Miyamoto


    Full Text Available Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.

  16. Ultrasound-guided central venous catheterization in prone position

    Sofi Khalid


    Full Text Available Central venous catheterization (CVC is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV, which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.

  17. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M


    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p fractures toward improving clinical prognoses.

  18. Radiology of postnatal skeletal development. Pt. 12

    Ogden, J.A.


    The development of the second cervical vertebra is complex. The dens (odontoid process) develops two primary ossification centers that usually coalesce within three months following birth. These centers are separated from the primary ossification center of the vertebral centrum by a cartilaginous region - the dentocentral synchondrosis. This synchondrosis is a slow growing, bipolar physis similar to the triradiate cartilage of the acetabulum. It contributes to the overall heights of both the dens as well as the vertebral body. Anatomically the dentocentral synchondrosis is below the level of the C1-C2 articulations. This cartilaginous structure is continuous throughout the vertebral body with similar cartilage in both the facet regions as well as the neurocentral synchondroses. These various cartilaginous continuities progressively close - first, the connections to the facet regions, next the neurocentral synchondroses, and finally the dentocentral synchondrosis. Remnants of the incompletely closed dentocentral synchondrosis must be distinguished from a fracture, which usually propagates along this structure as a physeal injury in infants and children. The cartilaginous epiphysis at the tip of the dens may be transverse or may form a cleft ('V') shape. At eight to ten years, a secondary ossification center - the ossiculum terminale - develops in this proximal dens epiphysis. Fusion of the ossiculum terminale with the rest of the dens occurs between ten and thirteen years.

  19. 髋臼骨折并发症的研究进展%The Evolution of Research on the Complication of Acetabular Fracture

    季良全; 彭吾训


    Acetabular fracture is a kind of high-energy traumatic fracture.With the development of modern transportation and industry,it has dramatical y increased and experienced an increasingly complex trend.The anatomical structure of acetabulum is intricate and the anatomical reduction is of greater dif iculty than general.Furthermore,Acetabular fracture belongs to intra-articular fracture and often gives rise to complication,making it more intricately complex.The thesis reviews the research literatures in this filed of study.%髋臼骨折是一种高能量创伤骨折,随着现代交通及工业的发展而日渐增多,并呈现出复杂程度增加的趋势。髋臼解剖结构复杂,解剖复位难度较一般骨折大,且髋臼骨折属关节内骨折,由此导致的并发症较为复杂。本文就相关文献予以综述。

  20. Cementoplasty for managing painful bone metastases outside the spine

    Sun, Gang; Jin, Peng; Liu, Xun-wei; Li, Min; Li, Li [Jinan Military General Hospital, Department of Medical Imaging, Jinan, Shandong Province (China)


    To illustrate the effect of treatment with cementoplasty in patients with painful bone metastases in the extraspinal region. A retrospective study was conducted to review 51 consecutive patients who underwent cementoplasty under CT or fluoroscopic guidance, a total of 65 lesions involving the ilium, ischium, pubis, acetabulum, humeral, femur and tibia. In 5 patients with a high risk of impending fracture in long bones based on Mirels' scoring system, an innovative technique using a cement-filled catheter was applied. The clinical effects were evaluated using the visual analogue scale (VAS) preoperatively and postoperatively. All patients were treated successfully with a satisfying resolution of painful symptoms at 3 months' follow-up. Cement leakage was found in 8 lesions without any symptoms. VAS scores decreased from 8.19 ± 1.1 preoperatively to 4.94 ± 1.6 at 3 days, 3.41 ± 2.1 at 1 month and 3.02 ± 1.9 at 3 months postoperatively. There was a significant difference between the mean preoperative baseline score and the mean score at all of the postoperative follow-up points (P < 0.01). Cementoplasty is an effective technique for treating painful bone metastases in extraspinal regions, which is a valuable, minimally invasive, method that allows reduction of pain and improvement of patients' quality of life. (orig.)