JBJS|保留股骨颈的全髋关节置换术

2022-06-13 青年君zhang 骨科青年

国外学者采用一种新型的髋关节假体,无需将股骨柄插入髓腔,保留了股骨颈部分。

髋关节置换是终末期骨关节炎、老龄股骨颈骨折最常用也是最有效的治疗方法,传统股骨颈假体需插入股骨干髓腔,导致大量骨质丢失。
对于老龄患者,预期寿命较关节假体寿命短,翻修比例较低,但对于年轻患者行关节置换,由于关节假体本身使用年限因素,无菌性松动等,后期二期翻修的比例较高。因此,尽可能保留年轻患者的骨质,是利于二期翻修的关键
国外学者采用一种新型的髋关节假体,无需将股骨柄插入髓腔,保留了股骨颈部分
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该假体柄为梯形结构,具有较好的旋转稳定性。

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骨关节炎行全髋关节置换术后影像片


研究人员对假体周围骨质进行骨密度测定,ROI 1为大粗隆部,ROI 2为外侧壁,ROI 3为股骨干部,ROI 4为内侧皮质与股骨矩部。

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在术后6周,股骨假体平均下沉0.38mm,术后6月至12月,股骨假体内翻0.93°。2年随访过程中,ROI 1部和2部出现明显的骨质丢失,4部的骨密度显著增高。同时作者发现,骨密度越好,假体下沉越轻微。


对这种保留股骨颈的假体,也有研究人员采用了圆柱形的股骨柄假体,也取得了比较好的临床疗效。建议对于年轻患者,可考虑,以降低二次翻修难度。

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    2022-09-16 yxch48
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    2022-06-15 qingrejiedu

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根据2020年美国风湿病学院(ACR)虚拟会议上公布的一项研究显示,与使用直接口服抗凝剂相比,使用华法林与膝或髋关节置换风险的显著更高有关,且这种风险随着使用时间的延长而增加。

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临床医生要考虑对患有脑病或心肌病的关节置换患者进行尿钴水平筛查,因为钴中毒可能是一种可治愈的疾病。

Ann Rheum Dis:引入生物性DMARDs后类风湿性关节炎髋关节和膝关节置换的发生率

在1996年与GPC相比,RA患者中THR和TKR的发生率分别高3倍和14倍。

J Rheumatol:食用乳制品与骨关节炎全髋关节置换术发生率的关系

男性中,乳制品消费增加与OA全髋关节置换风险增加相关,女性中无显著相关性

A&R:血浆中的CRTAC1蛋白与骨关节炎相关并预测将来是否需要关节置换:冰岛的大规模蛋白质组学扫描

该研究将血浆中的CRTAC1鉴定为一种新的OA候选生物标志物,它既与OA的发生有关,又可预测关节置换的进展。