本期目录：
1、后稳定型全膝关节置换术中髌骨软组织平衡的影响
2、全髋关节置换影响脊柱骨盆活动度：一项前瞻性观察
3、术前关节内注射类固醇和透明质酸钠是否会影响后续接受全关节置换的时间
4、重绘髋臼安全区三维形貌图：一项评估髋关节假体稳定性的多变量研究
5、钙卫蛋白横向血流试验: 与排除关节假体周围感染的标准一致
6、CT评估膝关节前内侧骨关节炎的磨损模式
7、髋臼周围截骨术后髋关节中心的内移：验证基于平片的评估
8、年轻股骨颈骨折患者的并发症
9、髋臼周围截骨术后关节囊生物力学特点
10、发育性髋关节发育不良筛查项目的成本分析
11、骨性标志、距离及其相互关系，哪一项可用于髋臼周围截骨术：一项对发育不良髋关节的CT研究
12、创伤后股骨头坏死经股骨大转子旋转截骨术的临床疗效：平均随访12.3年
13、再生疗法提高股骨头缺血坏死的存活率:一项系统回顾和荟萃分析
14、自行居家训练一周后，膝关节强化训练的动作质量下降
第一部分：关节置换及保膝相关文献
文献1
后稳定型全膝关节置换术中髌骨软组织平衡的影响
译者：张轶超
背景：良好的软组织平衡是保证全膝关节置换手术（TKA）成功的必不可少的因素，胫股关节（FT）是否平衡可以通过一个偏心的张力测量器来评估。本研究的目的是观察术中内外侧软组织平衡和髌骨压力间的关系。
方法：本研究纳入了30名因内翻型骨关节炎而接受活动平台后稳定型膝关节假体TKA手术的患者。使用张力测量器在膝关节0°、10°、30°、60°、90°、120°和135°时，安装好股骨假体并将髌骨回位的情况下检测并记录软组织平衡情况，包括关节假体间隙和内外侧韧带是否平衡。等到安装完假体并安装好衬垫后，在各个屈曲角度测量髌骨内外侧的压力。采用单纯回归分析来评估髌骨压力、软组织平衡参数及术后关节屈曲度间的关系。
结果：总的来说随着膝关节的屈曲，内外侧髌骨压力会增大。在屈曲60°、90°和135°时髌骨外侧压力明显高于内侧压力（p<0.05）。在屈曲60°和90°时，髌骨外侧压力与内侧韧带的平衡状态呈负相关（p<0.05）。在屈曲120°和135°时髌骨外侧的压力与术后关节屈曲度呈负相关（p<0.05）。
结论：膝关节软组织平衡影响髌骨压力。特别是在屈曲位外侧松弛的病例会呈现髌骨外侧压力减小，进而术后关节屈曲度大。
图1、膝关节平衡测量器(Ligament Sensor Tensor, DePuy)。将测量器放置在内外侧关节间隙内，在股骨假体试模安装好的情况下给予150Nm的弹性拉力。在髌骨回位的情况下观察偏心臂上的数字来测量内外侧软组织张力。
图2、髌骨压力测量系统。将两个单轴超薄力传感器放置在髌骨假体试模的背面和髌骨截骨面保护片之间，用以测量髌骨内外侧的压力。可以在假体试模都安装完后进行测量。
表1、 髌骨外侧压力与内侧韧带平衡状态间关系。a屈曲60°时两者间呈负相关n (R = −0.423, p = 0.0248)；b屈曲90°时两者间呈负相关(R = −0.404, p = 0.0328)。
表2、 外侧髌骨压力与术后屈曲关节屈曲度间关系。a关节屈曲120°时外侧髌骨压力与术后关节屈曲度间呈负相关(R = –0.474, p = 0.0298)；b关节屈曲135°时外侧髌骨压力与术后关节屈曲度间呈负相关(R = –0.445, p = 0.0434)。
The influence of intraoperative soft tissue balance on patellar pressure in posterior-stabilized total knee arthroplasty
Background: Appropriate soft tissue balance is essential for the success of total knee arthroplasty (TKA), and assessment with an offset-type tensor provides useful information about the femorotibial (FT) joint. The purpose of the study was to investigate the relationship between intraoperative soft tissue balance and patellar pressure at both medial and lateral sides.
Methods: Thirty varus-type osteoarthritis patients who received mobile-bearing posterior-stabilized TKAs were enrolled in the study. Using the tensor, soft tissue balance, including joint component gap and varus ligament balance, was recorded at 0°, 10°, 30°, 60°, 90°, 120°, and 135° with patellofemoral (PF) joint reduction and femoral component placement. Following final prostheses implanted with appropriate insert, the medial and lateral patellar pressures were measured at each flexion angle. A simple regression analysis was performed between each patellar pressure, parameter of soft tissue balance, and postoperative flexion angle.
Results: Both lateral and medial patellar pressures increased with flflexion. The lateral patellar pressure was significantly higher than the medial patellar pressure at 60°, 90°, and 135° of flflexion (p b 0.05). The lateral patellar pressure inversely correlated with the varus ligament balance at 60° and 90° of flflexion (p b 0.05). The lateral patellar pressure at 120° and 135° of flexion inversely correlated with the postoperative flexion angle (p b 0.05).
Conclusion: Soft tissue balance influenced patellar pressure. In particular, a reduced lateral patellar pressure was found at the lateral laxity at flexion, leading to high postoperative flexion angle.
文献出处：Matsumoto T, Shibanuma N, Takayama K, Sasaki H, Ishida K, Matsushita T, Kuroda R, Kurosaka M. The influence of intraoperative soft tissue balance on patellar pressure in posterior-stabilized total knee arthroplasty. Knee. 2016 Jun;23(3):540-4. doi: 10.1016/j.knee.2015.11.020. Epub 2016 Feb 11. PMID: 26875047.
文献2
全髋关节置换影响脊柱骨盆活动度：
一项前瞻性观察
译者：罗殿中
背景：异常的脊柱骨盆活动度被确认是引起全髋关节置换（THA）后关节不稳定的因素之一。对THA术前患者，识别其风险仍然存在挑战。本研究拟解决：（1）评估术前术后脊柱骨盆活动度是否存在不同；（2）明确脊柱骨盆复合体各因素之间的相互作用；（3）明确术前预测脊柱骨盆活动度的指标。
方法：对197例THA患者开展一项前瞻性研究，手术前后分别于站立位和放松坐位拍摄双平面立体摄影。基于2个分类指标，2位独立研究者分析脊柱骨盆活动度（骶骨倾斜角变化ΔSS和骨盆倾斜角变化ΔPT；Δ指从站立位到坐位；Δ<10°为僵硬；10°≤Δ≤30°为正常；Δ>30°为活动度过大）。对接受手术的患者临床特征进行分析、并采用多元回归分析，确认可预测术后脊柱骨盆活动度的指标。
结果：基于ΔPT（术前/术后：18.5°/22.8°；P<0.000）和ΔSS（术前/术后：17.9°/22.4°；P<0.000），THA术后脊柱骨盆活动度明显增加。可观察到由术前僵硬（术前/术后：24%/9.7%）到术后活动度过大（术前/术后：10.2%/22.1%）的比例增加。对接受手术的患者临床特征进行分析，术前PTStanding≥13.0°预测术后脊柱骨盆僵硬的敏感性为90%、特异性为51%；术前SSStanding≥35.2°预测术后脊柱骨盆活动度过大的敏感性为81%、特异性为34%；术前患者年龄、术前PTStanding和术前骨盆倾斜率（PI）均为预测术后脊柱骨盆活动度的独立相关因素（R2=0.24）。
结论：关节置换外科医生应对手术前脊柱骨盆僵硬程度有所注意，THA可影响其活动度。本研究首次提供阈值，根据术前站立位指标可预测术后脊柱骨盆活动度。术前站立侧位摄像可作为筛查骨盆脊柱活动度的工具。
图1. 站立位和坐位腰椎骨盆EOS摄像，图例显示PT和SS。PT定义为：股骨头中心至骶1上终板中点连线，与垂直参考线之间的夹角。SS定义为：骶1上终板与水平线之间的夹角。PT：骨盆倾斜角；SS：骶骨倾斜角。
Total Hip Replacement Influences Spinopelvic Mobility: A Prospective Observational Study
Background: Abnormal spinopelvic mobility is identified as a contributing element of total hip arthroplasty (THA) instability. Preoperative identification of THA patients at risk is still a remaining challenge. We therefore conducted this study to (1) evaluate if preoperative and postoperative spinopelvic mobility differs, (2) determine the interactions between the elements of the spinopelvic complex, and (3) identify preoperative parameters for predicting spinopelvic mobility.
Methods: A prospective observational study assessing 197 THA patients was conducted with biplanar stereoradiography in standing and relaxed sitting positions preoperatively and postoperatively. Two independent investigators determined spinopelvic mobility based on 2 different classifications (Δ sacral slope [SS] and Δ pelvic tilt [PT]; Δ from standing to sitting; Δ < 10° stiff, Δ ≥ 10°-30° normal, Δ > 30° hypermobile). Multiple regression analysis and receiver operating characteristic analysis were used to identify predictors for postoperative spinopelvic mobility.
Results: Spinopelvic mobility significantly increased after THA based on ΔPT (Pre/Post: 18.5°/22.8°; P < .000) and ΔSS (Pre/Post 17.9°/22.4°; P < .000). A distinct shift in the ratio from stiff (Pre/Post: 24%/9.7%) to hypermobile (Pre/Post: 10.2%/22.1%) mobility postoperatively was observed. Receiver operating characteristic analysis predicted postoperative stiffness using preoperative PTStanding ≥ 13.0° with a sensitivity of 90% and a specificity of 51% and hypermobility with preoperative SSStanding ≥ 35.2° with a sensitivity of 81% and a specificity of 34%. Age at surgery, preoperative PTStanding, and pelvic incidence were independent predictors of spinopelvic mobility (R2 = 0.24).
Conclusion: Definition of preoperative stiffness should be interpreted with caution by arthroplasty surgeons as mobility itself is influenced by THA. For the first time thresholds for standing preoperative parameters for predicting postoperative spinopelvic mobility could be provided. For preoperative standing only lateral assessment could serve as a screening tool for spinopelvic mobility.
文献出处：Haffer H, Wang Z, Hu Z, Hipfl C, Perka C, Pumberger M. Total Hip Replacement Influences Spinopelvic Mobility: A Prospective Observational Study. J Arthroplasty. 2022 Feb;37(2):316-324.e2. doi: 10.1016/j.arth.2021.10.029. Epub 2021 Nov 3. PMID: 34742872.
文献3
术前关节内注射类固醇和透明质酸钠
是否会影响后续接受全关节置换的时间
译者：马云青
关节内注射皮质类固醇(CSI)或透明质酸(HAI)可减轻可能需要接受全髋关节（THA）或全膝关节置换术(TKA)患者的骨关节炎症状。然而，它们对全关节置换术(TJA)时间和并发症的影响仍然不确定。文章试图评估 THA/TKA 之前接受过注射的患者的手术延迟时间；(2)接受过注射的患者的比例；(3)注射药物的类型和次数；(4)比较接受注射和未接受注射患者的并发症发生率。
方法：回顾性研究了3340例连续TJA 病例(1770例THA 和1570例TKA)。患者根据术前是否接受关节内注射分为两组。比较第一次临床就诊时的功能和手术相关信息，注射类型和90天内的并发症发生情况，包括关节周围感染。
结果：150/1770 THA 和192/1570 TKA 患者接受了注射(8.5% 对12.2% ，p = 0.0004)。接受TJA注射的患者从到临床就诊到手术的时间明显延长[THA为12.4 ± 11月 vs.7.3 ± 10.7月，p < 0.001; TKA为20.0 ± 17.4月 vs.11.6 ± 15.4月,p < 0.001]。TKA组手术延迟时间明显大于THA 组(8.4个月vs 5.1个月，p < 0.001)。TKA 患者的 接受HAI注射的比例高于THA患者(9%比0.6%，p < 0.0001)。全关节置换术后并发症的总体情况无差异(THA p = 0.19，TKAp = 0.3)。
总结：注射与延迟接受TJA的时间相关，具有统计学差异，但其临床意义是有争议的。手术前至少三个月注射是安全的。如果患者有适当的手术指征并且准备接受全关节置换，不建议关节内注射以推迟手术。
Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability
Background: Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular 'safe zone' to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation.
Methods: Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach.
Results: We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02).
Conclusions: Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters.
文献出处：Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am. 2022 Feb 2;104(3):239-245. doi: 10.2106/JBJS.21.00406. PMID: 34958643.
文献4
重绘髋臼安全区三维形貌图：
一项评估髋关节假体稳定性的多变量研究
译者：张蔷
背景：髋关节脱位是全髋关节置换术后（THA）早期翻修的最常见原因。40多年前，Lewinnek等人提出髋臼“安全区”的概念，期待能够降低脱位风险。虽然这个概念在当时的背景下可谓新颖，但以现在的标准衡量略显局限。本研究的目的是确定全髋关节置换术中髋臼杯安放的最佳位置，以及手术入路对髋臼安全区形貌和脱位风险的影响。
方法：我们选取单一医疗中心2000年至2017年间所有初次全髋关节置换的病例。髋臼杯外展角和前倾角通过高级人工智能神经网络的方法测量分析，应用前首先由两名骨科医生经双盲评分的方法评估其测量效力。我们在随访时采集患者一般信息及脱位情况。最终，我们通过多变量Cox回归分析（包括多维分析）的方法来绘制髋臼安全区的三维形貌图，及其与手术入路的相关性。
结果：我们共入组8081例全髋关节置换患者（9907髋），4166例女性，3915例男性；平均年龄64±13岁，平均随访5±3年（2年-16年），共有316例（3%）THA术后随访时发生过脱位。平均髋臼外展角44°±7°，平均前倾角32°±9°。没有脱位的病例平均前倾角32°±9°（中位数，32°），而最理想的15°前倾角只发生在3%的未脱位病例中（p<0.001）。多变量模型显示脱位率风险最低的病例外展角37°，前倾角27°，而最理想的安全区为27°-47°外展和18°-38°前倾。三维分析显示安全区位置近似，但不同的手术入路（p=0.03）和性别（p=0.02）的安全区形貌有显著性差异。
结论：本研究得出的最佳髋臼杯位置与历史数据有较大差异，比预期更大的前倾角可以降低脱位风险。此外，手术入路和患者性别都对三维安全区形貌有明确影响。我们在未来需要进行更多的研究来评估髋臼杯位置与脊柱骨盆动态平衡和股骨侧指标的关系。
Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability
Background: Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular 'safe zone' to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation.
Methods: Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach.
Results: We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02).
Conclusions: Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters.
文献出处：Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am. 2022 Feb 2;104(3):239-245. doi: 10.2106/JBJS.21.00406. PMID: 34958643.
文献5
钙卫蛋白横向血流试验:
与排除关节假体周围感染的标准一致
译者：沈松坡
引言: 有多种标准用于定义关节假体周围感染(PJI)。本研究的目的是比较钙卫蛋白横向血流床旁检测(POC)试验在全膝关节置换术(TKA)患者诊断感染的诊断准确性，采用三套不同的标准;1) 2013年肌肉骨骼感染学会(MSIS)， 2) 2018年国际共识会议(ICM)， 3) 2019年欧洲骨骼和关节感染学会(EBJIS)提出的标准作为参考标准。
方法: 2018年10月至2020年1月，前瞻性地从TKA翻修患者中收集123例术中滑膜液样本，并使用钙卫蛋白横向血流POC检测。数据由两名对钙蛋白测试结果不知情的独立评论者进行审查和裁决。
结果: 三个标准集有91.8%的一致性。采用2013年MSIS标准，POC检测的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和曲线下面积(AUC)分别为98.1%、95.7%、94.5%、98.5%和0.969。2018年ICM检测POC的敏感性、特异性、PPV、NPV和AUC分别为98.2%、98.5%、98.2%、98.5%和0.984。2019年提出的EBJIS标准POC检测的敏感性、特异性、PPV、NPV和AUC分别为93.2%、100.0%、100.0%、94.2%和0.966。
结论: 钙卫蛋白横向血流POC检测在当前可用的PJI定义中具有极好的敏感性和特异性，应用2018年ICM标准时性能最佳。
Calprotectin Lateral Flow Test: Consistent Across Criteria for Ruling Out Periprosthetic Joint Infection
INTRODUCTION: There are multiple sets of criteria used to define prosthetic joint infection (PJI). The objective of this study was to compare the diagnostic accuracy of the calprotectin lateral flow point of care (POC) test in total knee arthroplasty (TKA) patients to diagnose infection using three different sets of criteria; 1) 2013 Musculoskeletal Infection Society (MSIS), 2) 2018 Intentional Consensus Meeting (ICM), and 3) the 2019 proposed European Bone and Joint Infection Society (EBJIS) criteria as reference standards.
METHODS: From October 2018 to January 2020, 123 intraoperative synovial fluid samples were prospectively collected from revision TKA patients and tested using a calprotectin lateral flow POC assay. Data were reviewed and adjudicated by two independent reviewers blinded to calprotectin test results.
RESULTS: The three criteria sets had 91.8% agreement. Using 2013 MSIS criteria the POC test demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.1%, 95.7%, 94.5%, 98.5%, and 0.969, respectively. The 2018 ICM the POC test demonstrated a sensitivity, specificity, PPV, NPV and AUC of 98.2%, 98.5%, 98.2%, 98.5%, and 0.984, respectively. The 2019 proposed EBJIS criteria the POC test demonstrated a sensitivity, specificity, PPV, NPV and AUC of 93.2%, 100.0%, 100.0%, 94.2%, and 0.966, respectively.
CONCLUSION: The calprotectin lateral flow POC test had excellent sensitivity and specificity across current available PJI definitions, with the best performance observed when applying 2018 ICM criteria.
文献出处：Warren JA, Klika AK, Bowers K, Colon-Franco J, Piuzzi NS, Higuera CA. Calprotectin Lateral Flow Test: Consistent Across Criteria for Ruling Out Periprosthetic Joint Infection. J Arthroplasty. 2022 Feb 3:S0883-5403(22)00099-7. doi: 10.1016/j.arth.2022.01.082. Epub ahead of print. PMID: 35122946.
文献6
CT评估膝关节前内侧骨关节炎的磨损模式
译者：张峻
目的：分析CT在膝关节骨关节炎诊断中的价值，为部分或全膝关节置换术的选择提供依据。
方法：对100例接受膝关节内侧单髁置换术（UKR）（N=50）或全膝关节置换术（TKR）（N=50）的患者进行回顾性研究。一名观察者通过X片、CT和站立位下肢全长X片测量下肢力线和每个间室的膝关节骨关节炎类型。
结果：所有患者均患有内侧股胫关节Kellgren-Lawrence IV级骨关节炎，下肢内翻平均角度（172°（3.5°）HKA角）。区域机械轴分布与HKA有很强的相关性。选择UKR或TKR患者的关节炎类型不同。UKR患者有前内侧骨关节炎和髌骨内侧关节面磨损，而TKR患者有内侧骨关节炎伴弥漫性关节炎，或外侧髌股关节磨损和外侧室中央或后部区域磨损有关。髌骨内侧关节面磨损与更重要的下肢内翻力线有关（Kennedy区0和1）。
结论：CT可以显示在平片或应力位片上看不到的病变，因为中央或后方周围软骨完整。尽管力线内翻，但仍发展为三间室骨关节炎的患者可能除了机械轴因素之外还有其它风险因素，应被视为TKR的适应症。
Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography
Objective: To analyze the value of CT-arthrography imaging in the diagnosis of knee osteoarthritis and to facilitate the selection of partial versus total knee replacement.
Methods: A retrospective study of 100 patients that had either medial unicompartmental knee replacement (UKR) (N=50) or total knee replacement (TKR) (N=50). One observer measured lower limb mechanical alignment and osteoarthritis patterns of the knee in each compartment with radiographs, CT-arthrography and full leg standing radiographs.
Results: All patients had Kellgren-Lawrence grade IV osteoarthritis of the medial femorotibial joint with a mean (SD) varus alignment of the lower limb (172° (3.5°) HKA-angle). Zone mechanical axis distribution showed strong correlation with HKA-axis. Arthritis patterns were different for patients selected for UKR or TKR. UKR patients had anteromedial osteoarthritis and wear of the medial facet of the patella in contrast to TKR patients who had medial osteoarthritis associated with diffuse or lateral patellofemoral wear and wear of the central or posterior zones of the lateral compartment. Medial facet wear of the patella is related to more important varus alignment of the lower limb (Kennedy zone 0 and 1).
Conclusion: CT-arthrography imaging can show lesions that are not visible on plain or stress radiographs because of central or posterior localization with surrounding intact cartilage. Patients who develop tri-compartmental osteoarthritis despite varus alignment have probably other risk factors than their mechanical alignment and should be considered candidates for TKR.
文献出处：Thienpont E, Schwab PE, Omoumi P. Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography. Knee. 2014;21 Suppl 1:S15-9. doi: 10.1016/S0968-0160(14)50004-X. PMID: 25382362.
第二部分：保髋相关文献
文献1
髋臼周围截骨术后髋关节中心的内移：
验证基于平片的评估
译者：程徽
背景：髋臼周围截骨术(periacetabular osteotomy, PAO)通过增加髋臼对股骨头的覆盖，使髋关节中心向内移，恢复正常的关节生物力学。以往的研究报道过PAO所能达到的内移程度，但从未进行过不同成像方式，不同测量方法间内移量的比较。PAO改变了髂坐骨线，在股骨头下三分之一处更容易观察到，因此，在股骨头下三分之一处测量内移可能更准确。
方法：我们对一组在PAO后接受低剂量CT检查的患者，进行了回顾性研究，本研究的纳入标准：行PAO的有症状髋臼发育不良患者，术前有CT，术后随访9个月至5年。从2009年2月到2018年7月，共有333名PAO患者符合这些标准，患者手术时年龄均在16至50岁之间。排除标准包括既往同侧手术史、股骨髋臼撞击(FAI)、怀孕、神经肌肉疾病、Perthes样畸形、无术前CT和无法参与。39例患者的39个髋关节最终纳入研究组；87%(34 / 39)为女性患者，13%(5 / 39髋)为男性患者。手术时的中位年龄为27岁(16 - 49岁)。术前和术后入组时均获取低剂量CT图像；我们还获取了术前和术后的X线片和术中透视图像。在X线平片上评估LCEA和AI。髋关节内移由一名独立的评估者按盲法在所有成像方式上进行评估。在X线平片上，使用传统的和替代的方法测量髋关节内移。由平片上个盆腔旋转量确定X线片是否优良，采用这些优良的X线片进行亚组分析。为了回答我们的第一个问题，我们在三维(3D) CT髋关节重建模型上测量所有髋关节的内移。对于第二个问题，我们计算了Pearson相关系数、单因素方差分析(one-way ANOVA)和Student’t检验，以评估LCEA和AI与内移量之间的相关性。对于第三个问题，我们进行了统计分析，使用Pearson线性回归分析来确定两种影像学方法测量内移和CT上的真正内移之间的相关性，并估计的95%置信区间和标准误。对于我们的第四个问题，我们计算了Pearson相关系数，以确定通过术中透视与X线片，测量内移是否不同。
结果：在我们的研究中，通过CT测量，PAO实现的髋中心内移的真实量为4±3 mm；46%(39髋中的18髋)内移0 ~ 5mm, 36%(14髋)内移在5 ~ 10mm, 5%(2髋)内移大于10mm，13%(5髋)没有内移或有外移。在不同亚组间，LCEA间的 内移差异较小(≤15°为6±3 mm, 15°~ 20°为4±4 mm, 20°~ 25°为2±3 mm [p = 0.04])。臼顶倾斜角≥15°(6±3 mm)的髋关节，比臼顶倾斜角< 15°(2±3 mm; p < 0.001)的内移更多。X线平片上，在股骨头中心测量内移(传统方法)比在股骨头下1 / 3的 (替代方法)测量，与CT标准测量的相关性更差。传统的方法在评估所有的X线片时与CT没有相关性(r = 0.16 [95% CI -0.17 - 0.45]; p = 0.34)；在评估优良X线时也没有相关性（r = 0.26 [95% CI -0.06 ~ 0.53]; p = 0.30)。然而，替代方法在评估所有X线片具有强的相关性(r = 0.71 [95% CI 0.51 - 0.84]; p < 0.001)，在评估良好的X线片时具有非常强的相关性（r = 0.80 [95% CI 0.64 ~ 0.89]; p < 0.001)。在术中透视图像上与术后X线片上测量髋关节内移结果没有差异(r = 0.85; p < 0.001, r = 0.90;只有良好的X线片p < 0.001)。
结论：目前的研究表明，通过术前和术后的CT测量， PAO后旋转中心内移平均4 mm，但个体差异很大。传统的方法测量股骨头中心的内移可能不准确；在股骨头下三分之一处测量髋关节中心内移是一种更好的方法。即使这两种基于X线平片的方法都略低估内移的真实值，为了获得最佳的临床和研究数据，我们仍建议改用这种替代方法。最后，这项研究也为术中透视可以准确评估髋关节中心的内移提供了证据。
Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs
Background: Periacetabular osteotomy (PAO) increases acetabular coverage of the femoral head and medializes the hip's center, restoring normal joint biomechanics. Past studies have reported data regarding the degree of medialization achieved by PAO, but measurement of medialization has never been validated through a comparison of imaging modalities or measurement techniques. The ilioischial line appears to be altered by PAO and may be better visualized at the level of the inferior one-third of the femoral head, thus, an alternative method of measuring medialization that begins at the inferior one-third of the femoral head may be beneficial.
Questions/purposes: (1) What is the true amount and variability of medialization of the hip's center that is achieved with PAO? (2) Which radiographic factors (such as lateral center-edge angle [LCEA] and acetabular inclination [AI]) correlate with the degree of medialization achieved? (3) Does measurement of medialization on plain radiographs at the center of the femoral head (traditional method) or inferior one-third of the femoral head (alternative method) better correlate with true medialization? (4) Are intraoperative fluoroscopy images different than postoperative radiographs for measuring hip medialization?
Methods: We performed a retrospective study using a previously established cohort of patients who underwent low-dose CT after PAO. Inclusion criteria for this study included PAO as indicated for symptomatic acetabular dysplasia, preoperative CT scan, and follow-up between 9 months and 5 years. A total of 333 patients who underwent PAO from February 2009 to July 2018 met these criteria. Additionally, only patients who were between 16 and 50 years old at the time of surgery were included. Exclusion criteria included prior ipsilateral surgery, femoroacetabular impingement (FAI), pregnancy, neuromuscular disorder, Perthes-like deformity, inadequate preoperative CT, and inability to participate. Thirty-nine hips in 39 patients were included in the final study group; 87% (34 of 39) were in female patients and 13% (5 of 39 hips) were in male patients. The median (range) age at the time of surgery was 27 years (16 to 49). Low-dose CT images were obtained preoperatively and at the time of enrollment postoperatively; we also obtained preoperative and postoperative radiographs and intraoperative fluoroscopic images. The LCEA and AI were assessed on plain radiographs. Hip medialization was assessed on all imaging modalities by an independent, blinded assessor. On plain radiographs, the traditional and alternative methods of measuring hip medialization were used. Subgroups of good and fair radiographs, which were determined by the amount of pelvic rotation that was visible, were used for subgroup analyses. To answer our first question, medialization of all hips was assessed via measurements made on three-dimensional (3-D) CT hip reconstruction models. For our second question, Pearson correlation coefficients, one-way ANOVA, and the Student t-test were calculated to assess the correlation between radiographic parameters (such as LCEA and AI) and the amount of medialization achieved. For our third question, statistical analyses were performed that included a linear regression analysis to determine the correlation between the two radiographic methods of measuring medialization and the true medialization on CT using Pearson correlation coefficients, as well as 95% confidence intervals and standard error of the estimate. For our fourth question, Pearson correlation coefficients were calculated to determine whether using intraoperative fluoroscopy to make medialization measurements differs from measurements made on radiographs.
Results: The true amount of medialization of the hip center achieved by PAO in our study as assessed by reference-standard CT measurements was 4 ± 3 mm; 46% (18 of 39 hips) were medialized 0 to 5 mm, 36% (14 hips) were medialized 5 to 10 mm, and 5% (2 hips) were medialized greater than 10 mm. Thirteen percent (5 hips) were lateralized (medialized < 0 mm). There were small differences in medialization between LCEA subgroups (6 ± 3 mm for an LCEA of ≤ 15°, 4 ± 4 mm for an LCEA between 15° and 20°, and 2 ± 3 mm for an LCEA of 20° to 25° [p = 0.04]). Hips with AI ≥ 15° (6 ± 3 mm) achieved greater amounts of medialization than did hips with AI of < 15° (2 ± 3 mm; p < 0.001). Measurement of medialization on plain radiographs at the center of the femoral head (traditional method) had a weaker correlation than using the inferior one-third of the femoral head (alternative method) when compared with CT scan measurements, which were used as the reference standard. The traditional method was not correlated across all radiographs or only good radiographs (r = 0.16 [95% CI -0.17 to 0.45]; p = 0.34 and r = 0.26 [95% CI -0.06 to 0.53]; p = 0.30), whereas the alternative method had strong and very strong correlations when assessed across all radiographs and only good radiographs, respectively (r = 0.71 [95% CI 0.51 to 0.84]; p < 0.001 and r = 0.80 [95% CI 0.64 to 0.89]; p < 0.001). Measurements of hip medialization made on intraoperative fluoroscopic images were not found to be different than measurements made on postoperative radiographs (r = 0.85; p < 0.001 across all hips and r = 0.90; p < 0.001 across only good radiographs).
Conclusion: Using measurements made on preoperative and postoperative CT, the current study demonstrates a mean true medialization achieved by PAO of 4 mm but with substantial variability. The traditional method of measuring medialization at the center of the femoral head may not be accurate; the alternate method of measuring medialization at the lower one-third of the femoral head is a superior way of assessing the hip center's location. We suggest transitioning to using this alternative method to obtain the best clinical and research data, with the realization that both methods using plain radiography appear to underestimate the true amount of medialization achieved with PAO. Lastly, this study provides evidence that the hip center's location and medialization can be accurately assessed intraoperatively using fluoroscopy.
文献出处：Fowler LM, Nepple JJ, Devries C, Harris MD, Clohisy JC. Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs. Clin Orthop Relat Res. 2021 May 1;479(5):1040-1049. doi: 10.1097/CORR.0000000000001572. PMID: 33861214; PMCID: PMC8052006.
文献2
年轻股骨颈骨折患者的并发症
译者：肖凯
背景：60岁或以下人群的股骨颈骨折通常由高能量创伤导致，并且经常伴有骨股颈骨折的移位，因此在治疗上极具挑战。了解疾病的特点是解决该人群治疗争议的重要第一步。本研究的目的是定量汇总年轻股骨颈骨折患者内固定术后重要并发症的发生率。
方法：在生物医学方向图书管理员的指导下，在Medline、Embase、CINAHL、Cochrane数据库中对相关系统综述进行检索。收集了多个并发症数据，包括：再次手术、股骨头坏死、骨折不愈合、感染、内固定失败和畸形愈合。
结果：本荟萃分析包括来自41项研究的1558例骨折患者。单独的股骨颈骨折的术后总的再手术发生率为18.0%。股骨头性坏死的发生率为14.3%，骨折不愈合的发生率为9.3%。当对骨折移位进行分层分析时，移位的骨折更有可能进行再手术并发生股骨头坏死或骨折不愈合。畸形愈合的总发生率为7.1%，内固定失败率为9.7%，手术部位感染率为5.1%。骨股颈骨折合并同侧股骨干骨折患者的总体并发症发生率低于单独的股骨颈颈骨折。
结论：我们的分析结果表明，年轻股骨颈骨折患者的并发症发生率相对较高。近20%的病例在单独股骨颈骨折内固定术后需再次手术，而股骨头坏死和骨折不愈合可能是导致再手术的最常见原因。本研究结果显示需要更加关注该人群的治疗，尽可能改善手术的临床预后。
Complications following young femoral neck fractures
Background: Femoral neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young femoral neck fractures.
Methods: A comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion.
Results: 1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated femoral neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a femoral neck fracture treated in conjunction with an ipsilateral femoral shaft fracture were lower overall than the pooled estimates for isolated neck fractures.
Conclusions: The results of our analysis demonstrate that the incidence of complications experienced by young femoral neck fracture patients is relatively high. Reoperation following internal fixation of isolated femoral neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.
文献出处：Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015 Mar;46(3):484-91. doi: 10.1016/j.injury.2014.10.010. Epub 2014 Oct 31. PMID: 25480307.
文献3
髋臼周围截骨术后关节囊生物力学特点
译者：张振东
髋关节发育不良以股骨头覆盖不足为特征，可导致髋关节不稳定、疼痛和损伤。髋臼周围截骨术(Periacetabular osteotomy, PAO)旨在恢复股骨头的覆盖、重建关节功能，但其对髋关节囊力学特点和关节稳定性的影响尚不清楚。本研究的目的是研究PAO对髋关节发育不良患者关节囊力学和关节活动度的影响。
本研究选择12例发育不良髋关节尸体标本，分别被安装在一个机器测试仪上，并在多个位置进行测试:(1)髋关节完全伸直，(2)中立0°，(3)屈曲30°，(4)屈曲60°，(5)屈曲90°。在每个位置，使用5Nm的扭矩对髋关节进行内旋、外旋、外展、内收。 然后对每例髋关节进行PAO手术以纠正股骨头覆盖，保留关节囊及韧带，并重新进行检测。
结果显示，PAO术后在髋关节屈曲90°时内旋较术前减少(∆IR = -5°; p = 0.003)，在髋关节屈曲60°及90°时外旋均增加(分别为∆ER = +7°; p = 0.001；∆ER = +11°; p = 0.001)。PAO较术前还减少了髋关节伸直位时的外展(∆ABD = -10°; p = 0.002)、中立0°时的外展(∆ABD = -7°; p = 0.001)以及髋关节屈曲30°时的外展(∆ABD = -8°; p = 0.001)，但增加了髋关节中立位0°时的内收(∆ADD = +9°; p = 0.001)、髋关节屈曲30°的内收(∆ADD = +11°; p = 0.002)以及髋关节屈曲60°的内收(∆ADD = +11°; p = 0.003)。
因此，PAO导致髋关节外展和内旋减少，但内收和外旋增加。髋臼骨性结构和关节囊对PAO术后关节的灵活性和稳定性起到平衡作用。
Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia
Background: Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips.
Methods: Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested.
Results: The PAO reduced internal rotation in flexion of 90° (∆IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (∆ER = +7°; p = 0.001) and flexion of 90° (∆ER = +11°; p = 0.001). The PAO also reduced abduction in extension (∆ABD = -10°; p = 0.002), neutral 0° (∆ABD = -7°; p = 0.001), and flexion of 30° (∆ABD = -8°; p = 0.001), but increased adduction in neutral 0° (∆ADD = +9°; p = 0.001), flexion of 30° (∆ADD = +11°; p = 0.002), and flexion of 60° (∆ADD = +11°; p = 0.003).
Conclusions: PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
文献出处：Ng KCG, Bankes MJK, El Daou H, Beaulé PE, Cobb JP, Jeffers JRT. Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia. J Bone Joint Surg Am. 2022 Feb 8. doi: 10.2106/JBJS.21.00405. Epub ahead of print. PMID: 35133990.
文献4
发育性髋关节发育不良筛查项目的成本分析
译者：任宁涛
目的：本研究的目的是评估发育性髋关节发育不良 (DDH) 的筛查成本，以明确国际上各种髋关节筛查项目的成本效益。
方法：通过检查各种 DDH 筛查项目的成本分析研究，包括基于临床检查、选择性超声和通用超声的项目，然后进行 PROSPERO 注册的系统评价。使用叙述性整合进行成本分析。
结果：本综述共纳入了 14 项研究，两项研究发现，临床髋关节筛查在总体成本和有利结果方面都优于完全不筛查。在考虑选择性超声筛查与临床手法筛查时，两项研究发现它更昂贵，一项研究发现它更便宜，三项研究发现两者总体成本相似。使用普遍性髋关节超声筛查时，四项研究发现普遍性髋关节超声筛查比临床手法筛查或选择性超声筛查更便宜，因为降低了晚期检查和手术率。然而，相当数量的研究得出结论，普遍性髋关节超声筛查增加的财务成本大于手术所降低的成本。但没有关于任何长期数据的研究。
结论：缺乏关于DDH筛查成本的信息，现有文献中存在显着的异质性。未来的研究应包括DDH长期并发症的成本分析，包括早发性骨关节炎的社会和心理影响，以及针对性别的超声筛查计划。
Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip
Aims: The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally.
Methods: A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis.
Results: There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging versus clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data.
Conclusion: There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.
文献出处：Philip Harper , Rohit Gangadharan , Daryl Poku , Alexander Aarvold. Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip. Indian J Orthop . 2021 Sep 6;55(6):1402-1409.
文献5
骨性标志、距离及其相互关系，哪一项可用于
髋臼周围截骨术：一项对发育不良髋关节的CT研究
译者：张利强
作为治疗髋关节发育不良的手术技术，伯尔尼髋臼周围截骨术（PAO）仍然存在操作困难和手术步骤不明确，如第一步坐骨截骨的深度、髂骨截骨的起点和髋臼后截骨的宽度，以防止医源性进入关节或后柱骨折。27例发育不良髋关节（CE<25°）随机与27例非发育不良髋关节（CE>25°）匹配。对髋关节的3D CT进行评估，并测量各组坐骨的宽度、髋臼下沟到坐骨棘的距离、从髂前上棘（ASIS）到髋关节或坐骨切迹或坐骨棘的距离、从髋臼最内侧点到后柱或坐骨棘或坐骨切迹的距离，并进行相关分析。发育不良组髋臼下沟至坐骨棘（42±4,44±4，P:0.03）、髂前上棘至髋关节（52±6,60±3，P:0.03）、髋臼最内侧点至后柱（34±2,36±2，P:0.005）的距离（mm）较非发育不良组短。ASIS到坐骨切迹的距离与髋臼下沟到坐骨棘、ASIS到髋关节、髋臼最内侧点到后柱的距离相关。从ASIS到坐骨切迹的距离可用于术中X线引导或盲截骨阶段预测截骨的宽度或深度，防止截骨进入关节或后柱骨折。
图1，坐骨内外侧宽度Iscw为37mm
图2髋臼下沟到坐骨棘的距离为(AceGr-Iscsp)55mm
图3 髂前上棘到髋臼最上缘(ASIS-Joint)的距离为52mm
图4髂前上棘到坐骨切迹最深处(ASIS-Scinotch)距离为96mm
髋臼最深处厚度(Deepw)为4mm
髋臼最内侧点到后柱距离41mm，到坐骨棘50mm，到坐骨切迹55mm
Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips
As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first 'ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42±4, 44±4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34±2, 36±2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.
文献出处：Onur Hapa, Onur Gürsan, Osman Nuri Eroğlu, Hakan Özgül, Efe Kemal Akdoğan, Vadym Zhamilov, Ali Balcı, Hasan Havitçioğlu; Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips.Journal of hip preservation surgery 2021 Jan;8(1):119-124 doi:10.1093/jhps/hnab045
文献6
创伤后股骨头坏死经股骨大转子
旋转截骨术的临床疗效：平均随访12.3年
译者：陶可（北京大学人民医院骨关节科）
简介：本研究检查了应用经股骨转子旋转截骨术(TRO)治疗创伤后股骨头骨坏死(ON)的结果。
患者和方法：我们回顾性分析了股骨转子旋转截骨术时平均年龄为34.8岁（12-61岁）的28名患者（男性，n = 17；女性，n = 11）的28髋。当病变位于股骨头前部时采用经股骨转子向前旋转截骨术（ARO），而对于病变局限于股骨头后部的患者则采用经转子向后旋转截骨术（PRO）。平均随访时间为12.3年（5.0-21.3年）。我们调查了患者的临床和放射学因素，包括年龄、性别、体重指数、术前Harris髋关节评分（HHS）、创伤类型、术前分期和术后完整率（股骨头完整关节面相对于髋臼承重关节面的比率）。我们将患者分为髋关节存活组和中转为全髋关节置换术(THA)组，然后比较两组之间的上述这些因素。
结果：在最后一次随访时，22髋存活，平均HHS为85.8。其余6髋在股骨转子旋转截骨术后平均10.2年接受全髋关节置换术。术前分期与髋关节存活率相关。此外，转换为THA组的术后完整率显着较低。根据接受者操作特征曲线，发现小于33.6%的比率与转换为全髋关节置换术的相关。
结论：用于纠正创伤后股骨头骨坏死的股骨转子旋转截骨术获得了良好的中期结果。转换为全髋关节置换术的可能危险因素是术前股骨头坏死处于晚期和术后完整率低于33.6%。
图 1 术后完整比率表示为完整的股骨头关节面(C-D)与髋臼承重关节面(A-B)的比率，并使用术后前后位X线片确定。A点是通过从B（髋臼边缘）和E（泪滴最低点）的中点到髋臼画一条垂线来确定的。点C和D分别代表股骨头负荷部分的外侧边缘和完整关节面的内侧边缘。
表1 髋关节存活组和中转为THA组单因素分析结果（术前股骨头坏死处于晚期和术后完整率低于33.6%是术后转为髋关节置换的危险因素）
表 2 需要髋关节置换术的患者（6髋）
图2 术后完整率＞33.6%和＜33.6%的Kaplan-Meier生存曲线，95%置信区间。终点是转换为髋关节置换术。
图3 股骨转子旋转截骨术治疗的创伤后股骨头坏死的病例。一名有股骨颈骨折内固定史的38岁男性，尽管没有任何先前的剧烈活动，但仍有右侧髋部疼痛。a内固定术后1.7年获得的右髋正位片显示骨折部位无骨不连的迹象，但有分界的硬化和股骨头塌陷。在他被诊断出患有创伤后股骨头坏死后，进行了股骨转子旋转截骨术。b 股骨转子旋转截骨术后1个月获得的前后位X线片。c 股骨转子旋转截骨术后16.2年获得的前后位X线片。观察到骨赘形成，然而，没有看到塌陷的进展或关节间隙变窄（保髋手术效果很成功）。
Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years
Introduction: This study examined the outcomes of applying transtrochanteric rotational osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON).
Patients and methods: We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12-61 years) at the time of TRO. Transtrochanteric anterior rotational osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior rotational osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0-21.3 years). We investigated the patients' clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups.
Results: At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA.
Conclusions: TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.
文献出处：Kazuhiko Sonoda, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Ryosuke Yamaguchi, Yukihide Iwamoto. Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years. Arch Orthop Trauma Surg. 2015 Sep;135(9):1257-63. doi: 10.1007/s00402-015-2282-y.
文献7
再生疗法提高股骨头缺血坏死的存活率:
一项系统回顾和荟萃分析
译者：李勇
摘要目的:本研究旨在证明再生技术用于治疗股骨头坏死(或股骨头缺血性坏死，AVN)的有效证据，并了解其与单纯核心减压(CD)相比在避免失败和需要全髋关节置换术(THR)方面的好处。方法 根据PRISMA指南对3个医疗电子数据库进行检索。采用kaplan-mayer曲线计算累积生存率的meta分析包括研究报告数量和失败时间。此外，RCT报告的治疗组失败的结果与对照组记录的结果进行了比较，以了解生物疗法与髓芯减压治疗AVN的好处。本系统综述包括48项研究，报告了不同类型的再生技术的结果:骨坏死区间充质干细胞植入、间充质干细胞动脉内浸润、生物活性分子植入或富血小板血浆。总的来说，报告的结果很好，10年随访后的累积生存率为80%，与单纯髓芯减压相比，再生治疗联合使用髓芯减压时的结果更好(89.9% vs70.6%， p<0.0001)。结论 再生疗法治疗AVN具有良好的临床效果。随着时间的推移，与单纯的髓芯减压相比，髓芯减压与再生技术的结合在生存率方面提供了显著的改善。需要进一步的研究来确定最佳的手术方法和最适合的患者从AVN再生治疗中获益。
Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis
Purpose The aim of this study was to document the available evidence on the use of regenerative techniques for the treatment of femoral head osteonecrosis (or avascular necrosis of femoral head, AVN) and to understand their benefit compared to core decompression (CD) alone in avoiding failure and the need for total hip replacement (THR).Methods The search was conducted on three medical electronic databases according to PRISMA guidelines. The studies reporting number and timing of failures were included in a meta-analysis calculating cumulative survivorship with a Kaplan-Mayer curve. Moreover, the results on failures in treatment groups reported in RCT were compared with those documented in control groups, in order to understand the benefit of biological therapies compared to CD for the treatment of AVN. Results Forty-eight studies were included in this systematic review, reporting results of different types of regenerative techniques: mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma. Overall, reported results were good, with a cumulative survivorship of 80% after ten year follow-up, and better results when regenerative treatments were combined to CD compared to CD alone (89.9% vs70.6%, p<0.0001).Conclusion Regenerative therapies offer good clinical results for the treatment of AVN. The combination of CD with regenerative techniques provides a significant improvement in terms of survivorship over time compared with CD alone. Further studies are needed to identify the best procedure and the most suitable patients to benefit from regenerative treatments for AVN.
文献出处：Andriolo, Luca; Merli, Giulia; Tobar, Carlos; Altamura, Sante Alessandro; Kon, Elizaveta; Filardo, Giuseppe (2018). Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. International Orthopaedics, (), –. doi:10.1007/s00264-018-3787-0
文献8
自行居家训练一周后，
膝关节强化训练的动作质量下降
译者：王一昕
背景：用下肢运动学检查，对健康中老年人康复指导后即刻和居家一周后的膝关节运动表现进行对照评价。
方法：这是一项在实验室进行的横断面研究。19名健康志愿者（年龄[y]63.1±8.6，体重[kg]76.3±14.7，身高[m]1.7±0.1）参与了本研究。实验中使用高速视频和反射标记跟踪记录志愿者的4个练习项目的动作。这些练习包括膝关节屈曲、直腿抬高和仰卧位的画“V”动作，以及侧卧位的髋关节外展。所有参与者在训练阶段都接受了语言和触觉的指导，治疗师观察并在必要时纠正练习动作。一周后返回，参与者在没有任何进一步指导的情况下进行了相同的练习。在运动捕捉视频中提取膝关节和髋关节的矢状角和旋转角。采用重复测量t检验比较两次随访观察的动作。
结果：与第一次随访相比，第二次随访时，参与者在直腿抬高和“V-in”训练中表现出更多的膝关节屈曲（均p<0.05）。与第一次相比，参与者在第二次来诊时，“V-out”运动出现了更多的外旋（p<0.05），而“V-in”运动中表现出更多的内旋。
结论：健康中老年人在接受指导后一周，他们的运动表现出现了显著下降。尽管每个参与者都收到了指导性的练习表，但这种下降还是发生了。我们需要探索其他方法，以帮助每个人能够保持正确的康复训练动作。
练。
Quality of knee strengthening exercises performed at home deteriorates after one week
Background: To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later.
Methods: This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and 'V 'in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits.
Results: Participants demonstrated more knee flexion during straight leg raise and 'V in' exercises at the 2nd visit compared to the 1st visit (both p < 0.05). During the 'V out' exercise, they performed more external rotation (p < 0.05) while they showed more internal rotation during the 'V in' exercise at the 2nd visit compared to the 1st visit.
Conclusions: Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
文献出处：Ulrike H Mitchell, Hyunwook Lee, Hayden E Dennis, Matthew K Seeley. Quality of knee strengthening exercises performed at home deteriorates after one week. BMC Musculoskelet Disord. 2022 Feb 19;23(1):164. PMID: 35183152. PMCID: PMC8857831. DOI: 10.1186/s12891-022-05120-3
张洪主任门诊时间：周三上午
膝关节置换:张轶超 13261817537
髋关节置换:马云青 13811705624
保髋疗法:罗殿中 18911358880
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