Objective To evaluate efficiency and safety of total hip replacement (THR) in the treatment of developmental dysplasia of the hip (DDH) in adult.Method From Jane 2005 to January 2011,a total of 30 patients (30 hips) of DDH underwent THR.The preoperative average Harris score 52.8 points (25 to 58 points).Results Follow-up period of 8 months to 5 years,the average time of 2.9 years.The postoperative average Harris score 88.9 points (75 to 96 points),good rate of 86.7％ (26/30),All the patiients were no femoral nerve palsy,,no infection,aseptic loosening and prosthesis subsidence and other complications.The ostoperative acetabular bone were healed.Conclusion THR is a good treatment method for DDH in adult,especially in patients with dislocation of the femoral head high.The key techniques for the THR are as follow so good preoperative plan.

Objective To investigate the risk factors related to failure of proximal femoral nail anti-rotation(PFNA)internal fixation for intertrochanteric fracture of femur.Methods A retrospective research was done on 249 cases with intertrochanteric fracture of femur after PFNA internal fixation.The failure ratios related to sex,fat,fracture pattern,osteoporosis,replace condition in operation and tip-apex distance(TAD)were calculated.And the risk factors related to failure of PFNA were statistically analysed.Results Two hundred and forty-three cases were followed up ranged from 10 months to 3 years after operation.Plain AP and lateral radiographs were obtained at each follow-up patient,13 of 243 cases resulted in failing by PFNA internal fixation.The failure ratios in PFNA internal fixation with fat,unstable fracture,TAD≥25 mm and bad replace condition in operation were 8.5％(12/141),7.8％(12/153),18.5 ％(5/27)and 26.1％(6/23),respectively,which were higher than those in PFNA internal fixation with nonobese,stable fracture,TAD ＜ 25 mm and good replace condition in operation[1.0％(1/102),1.1％(1/90),3.7％(8/216)and 3.2％(7/220),respectively](P＜0.05 or ＜0.01).Conclusions Fat,unstable fracture,TAD≥25 mm and bad replace condition in operation are the relatively independent risk factors related to failure of PFNA internal fixation for intertrochanteric fracture of femur.Furthermore,it will prevent and reduce the ratio of complications to avoid these risk factors when PFNA internal fixation is selected for treatment intertrochanteric fracture of femur.

Objective To explore the effect of the proximal femoral nail antirotation(PFNa) for the treatment of femoral intertrochanteric fracture.Methods 272 consecutive patients with femoral intertrochanteric fracture were treated with PFNa.Results The mean operative time was 55min(range 35 ～95)min.The mean blood loss was 85ml (range:20 ～200)ml.The mean follow-up was 15.6months( range:6 ～36)monthsand achieved bone healing with an average time of 14.5weeks.According to the Harris criterion for evaluation.Conclusion PFNa was more comfortable for human's biomechanism and more favorable for the healing of the fracture as well as the recovery of the hip function.It had the advantage of simple manipulation,fewer trauma,strong fixation,anti-rotation,less osclerotin.PFNa was an ideal treatment for intertrochanteric fracture,specially the unstable intertrochanteric fracture and senile osteoporosis.

Objective:To discuss the causes and solutions for failed anterior ring fixation for unstable pelvic fractures.Methods:A retrospective analysis was conducted of the 84 patients who had been admitted to Department of Orthopedics and Joint Surgery, Jiangmen Central Hospital for unstable pelvic fractures from January 2009 to March 2019. They were 56 males and 28 females, aged from 19 to 64 years (mean, 42.5 years). By the Tile classification, 22 cases were type B1, 16 type B2, 10 type B3, 22 type C1, 6 type C2 and 8 type C3. Simple anterior ring fixation was performed for 21 cases and combined anterior and posterior ring fixation for 63 ones. The Matta's criteria were applied for the evaluation of fracture reduction. The cases of failed anterior ring fixation and their solutions were recorded and analyzed.Results:All patients were followed up for 6 to 36 months (average, 13.5 months). Failed anterior ring fixation was observed in 7 cases (8.3%) at 3 to 75 days after operation (average, 29.1 days). The failure was attributed to improper operation timing and unstable anterior ring fixation in 2 cases, mere unstable anterior ring fixation in one, wrong choice of anterior ring fixators and improper rehabilitation in 2 cases, poor intraoperative reduction in one and unstable posterior ring fixation in one. In the 2 failed cases that had been treated by external fixators, one underwent revision and the other conservative treatment. In the 5 cases that had been treated by plating, 4 underwent revision and one conservative treatment. By the Majeed criteria, the pelvic function was evaluated at the final follow-up as excellent in 2, good in 2 and fair in one in the 5 cases of revision who obtained follow-up from 11 to 24 months(average, 17.2 months) after revision; malunion was observed in the 2 cases of conservative treatment.Conclusions:Failed anterior ring fixation for unstable pelvic fracture may be caused by improper operation timing, wrong choice of anterior ring fixators, intraoperative malreduction, unstable pelvic ring fixation and improper rehabilitation. The key solution to failed anterior ring fixation is to find the specific causes. Plate revision may lead to fine therapeutic efficacy.

Objective: To investigate the clinical effect of preoperative computed tomography (CT) measurement of acetabulum femoral neck combined anteversion in primary total hip arthroplasty (THA). Methods: From March 2016 to may 2018, 48 patients (90 hips) with developmental dysplasia of the hip (DDH) who were treated with THA in the orthopaedic department of Jiangmen Central Hospital were measured by X-ray and spiral CT three-dimensional reconstruction technology before operation, and the best combined anteversion angle of acetabulum was determined before implementing THA, which was CT group; the remaining 42 patients were not measured by CT before operation, which was X-ray group. The difference of acetabulum cup anteversion angle, acetabulum femoral neck combined anteversion angle and preoperation angle were evaluated by three-dimensional computed tomography (3D-CT) in CT group. Results: There was no significant difference in operative time, intraoperative blood loss, time of getting out of bed and length of lower limbs between the two groups (P>0.05). In CT group, the acetabulum cup anteversion and acetabulum femoral neck anteversion were close to the pre-operative angle at 2 and 3 months postoperatively (P>0.05). The Harris hip score of CT group was significantly higher than that of X-ray group at 2 and 3 months after operation, and the incidence of deep vein thrombosis was 6.25%, significantly lower than that of X-ray group (21.43%) (P<0.05). The incidence of dislocation, infection and periprosthetic fracture was slightly lower than that of X-ray group, but the difference was not statistically significant (P>0.05). Conclusions For DDH patients who received THA for the first time, preoperative CT measurement of acetabulum femoral neck combined with anteversion is conducive to the formulation of the best combined anteversion adjustment scheme, which can obtain the maximum initial stability, improve the surgical effect and reduce the occurrence of dislocation of prosthesis.