本期目录：
1、关节置换手术中超清洁手术室对于预防深部感染的作用
2、螺钉固定和半髋关节置换治疗老年非移位股骨颈骨折患者哪个更有效
3、翻修时应用骨水泥将限制性内衬粘在牢固固定髋臼杯中的长期随访研究
4、股骨去旋转截骨术对股骨冠状面力线的影响
5、双侧髋臼周围截骨术是否能减小代偿性骨盆前倾？
6、髋关节镜术后的术后康复：最佳方案的寻找
7、Salter或Chiari治疗史对DDH患者行THA效果的影响
8、髋臼盂唇-软骨复合体的胚胎学
第一部分：关节置换及保膝相关文献
文献1
关节置换手术中超清洁手术室对于预防深部感染的作用
译者：张轶超
深部感染被认为是全髋关节置换术后早期最严重的并发症。传统手术室中的空气传播污染被认为是导致深部感染的主要因素。随着手术室设备的不断改进，空气传播污染的问题被大大减少。有多篇文章深入研究了空气传播污染与深部感染率间的关系。
由英国医学研究委员会（MRC）进行的一项试验研究显示：手术中使用超清洁手术室（UCA）会明显减少深部感染的发生率。而应用身体除菌系统则可以进一步降低深部感染发生率。MRC研究还包含了一项详尽的微生物学研究，明确了空气传播污染与深部感染发生率之间的关系。
近期的观察性研究显示：在现代医疗中，感染的发生率有逐渐加重的趋势。从登记系统的观察结果来看，层流手术室的应用是否能够有效预防感染依然存在争议。
登记系统提供的关于超清洁手术室有效性的相关证据十分有限。尽管近些年手术科室的医疗实践出现了一些变化，MRC得出的研究结果依然有效，而超清洁手术室的应用在深部感染预防方面依然在扮演重要角色。
有证据显示如果UCA手术室没有得到正确应用，那么手术室内的微生物学检测指标会出现更多不良结果。目前应用的UCA手术室也有其局限性，我们还需要进一步研究将其升级并改良其微生物学结果。
The effectiveness of ultra-clean air operating theatres in the prevention of deep infection in jointarthroplasty surgery
Deep infection was identified as a serious complication in the earliest days of total hip arthroplasty. It was identified that airborne contamination in conventional operating theatres was the major contributing factor. As progress was made in improving the engineering of operating theatres, airborne contamination was reduced. Detailed studies were carried out relating airborne contamination to deep infectionrates. In a trial conducted by the United Kingdom Medical Research Council (MRC), it was found that the use of ultra-clean air (UCA) operating theatres was associated with a significant reduction in deep infection rates. Deep infection rates were further reduced by the use of a body exhaust system. The MRC trial also included a detailed microbiology study, which confirmed the relationship between airborne contamination and deep infection rates. Recent observational evidence from joint registries has shown that in contemporary practice, infection rates remain a problem, and may be getting worse. Registry observations have also called into question the value of 'laminar flow' operating theatres. Observational evidence from joint registries provides very limited evidence on the efficacy of UCA operating theatres. Although there have been some changes in surgical practice in recent years, the conclusions of the MRC trial remain valid, and the use of UCA is essential in preventing deep infection. There is evidence that if UCA operating theatres are not used correctly, they may have poor microbiological performance. Current UCA operating theatres have limitations, and further research is required to update them and improve their microbiological performance in contemporary practice.
文献出处：Thomas AM, Simmons MJ. The effectiveness of ultra-clean air operating theatres in the prevention of deep infection in jointarthroplasty surgery.
Cite this article: Bone Joint J 2018;100-B:1264-9.
文献2
螺钉固定和半髋关节置换治疗
老年非移位股骨颈骨折患者哪个更有效
译者：马云青
背景：老年股骨颈移位骨折患者行髋关节置换术，其功能可能优于内固定术。我们假设在髋部功能、活动度、疼痛、生活质量以及老年股骨颈骨折患者再次手术的风险方面，半关节置换术优于螺钉固定。
方法：在一项多中心随机对照试验（RCT）中，来自挪威的、年龄≥70岁的非移位（外翻崁插或真正非移位）股骨颈骨折患者被分配到螺钉固定组或半关节置换组中。评估人员不了解治疗类型，以Harris髋关节评分（HHS）作为主要评价结果，并根据定时“坐起”测试评估活动性、数字评分量表评估的疼痛，以及在3、12和24个月时用Euroqol-5 Dimension-3水平（Eq-5d）评估的生活质量来评估髋关节术后功能。包括再次手术，用意向治疗分析进行评估。
结果：2012年2月6日至2015年2月6日期间，111名患者进行螺钉固定，108名患者进行半髋关节置换。随访时，螺钉固定组与半关节置换术组的髋关节功能无显著性差异，24个月HHS（标准差）分别为74±19和76±17，调整后的平均差为-2（95%置信区间[CI]=6-3，P=0.499）。半关节成形术组的患者比螺钉固定组的患者更灵活（24个月TUG=16.6±9.5 vs 20.4±12.8秒；调整后的平均差=6.2秒[95%CI=1.9至10.5秒]；P=0.004）。此外，螺钉固定是主要再手术的危险因素，110例接受螺钉固定的患者中有20%（22例）进行了翻修，而108例接受半关节置换的患者中有5%（5例）（RRR=3.3[95%CI=0.7-10.0]；NNH=6.5；P=0.002）。接受内固定治疗的患者24个月死亡率为36%（40/111），接受半关节成形术的患者24个月死亡率为26%（28/108）（RRR=0.4[95%CI=-0.1-1.1]；P=0.11）。其中有两名患者失访。
结论：在这项多中心随机对照试验中，经HHS评价，半关节置换术在重建髋关节功能方面并不优于螺钉固定。然而，半关节成形术提高了活动能力，减少了再手术的风险。研究结果表明，某些老年股骨颈骨折患者使用最新一代半关节成形术而非螺钉固定可能会受益。
Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in ElderlyPatients: A Multicenter Randomized Controlled Trial
BACKGROUND: Elderly patients with a displaced femoral neck fracture treated with hip arthroplasty may have better function than those treated with internal fixation. We hypothesized that hemiarthroplasty would be superior to screw fixation with regard to hip function, mobility, pain, quality of life, and the risk of a reoperation in elderly patients with a nondisplaced femoral neck fracture.
METHODS: In a multicenter randomized controlled trial (RCT), Norwegian patients ≥70 years of age with a nondisplaced (valgus impacted or truly nondisplaced) femoral neck fracture were allocated to screw fixation or hemiarthroplasty. Assessors blinded to the type of treatment evaluated hip function with the Harris hip score (HHS) as the primary outcome as well as on the basis of mobility assessed with the timed 'Up & Go' (TUG) test, pain as assessed on a numerical rating scale, and quality of life as assessed with the EuroQol-5 Dimension-3 Level (EQ-5D) at 3, 12, and 24 months postsurgery. Results, including reoperations, were assessed with intention-to-treat analysis.
RESULTS: Between February 6, 2012, and February 6, 2015, 111 patients were allocated to screw fixation and 108, to hemiarthroplasty. At the time of follow-up, there was no significant difference in hip function between the screw fixation and hemiarthroplasty groups, with a 24-month HHS (and standard deviation) of 74 ± 19 and 76 ± 17, respectively, and an adjusted mean difference of -2 (95% confidence interval [CI] = -6 to 3; p = 0.499). Patients allocated to hemiarthroplasty were more mobile than those allocated to screw fixation (24-month TUG = 16.6 ± 9.5 versus 20.4 ± 12.8 seconds; adjusted mean difference = 6.2 seconds [95% CI = 1.9 to 10.5 seconds]; p = 0.004). Furthermore, screw fixation was a risk factor for a major reoperation, which was performed in 20% (22) of 110 patients who underwent screw fixationversus 5% (5) of 108 who underwent hemiarthroplasty (relative risk reduction [RRR] = 3.3 [95% CI = 0.7 to 10.0]; number needed to harm [NNH] = 6.5; p = 0.002). The 24-month mortality rate was 36% (40 of 111) for patients allocated to internal fixation and 26% (28 of 108) for those allocated to hemiarthroplasty (RRR = 0.4 [95% CI = -0.1 to 1.1]; p = 0.11). Two patients were lost to follow-up.
CONCLUSIONS: In this multicenter RCT, hemiarthroplasty was not found to be superior to screw fixation in reestablishing hip function as measured by the HHS (the primary outcome). However, hemiarthroplasty led to improved mobility and fewer major reoperations. The findings suggest that certain elderly patients with a nondisplaced femoral neck fracture may benefit from being treated with a latest-generation hemiarthroplasty rather than screw fixation.
文献出处：Dolatowski FC, Frihagen F, Bartels S, Opland V, Šaltytė Benth J, Talsnes O, Hoelsbrekken SE, Utvåg SE. Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in ElderlyPatients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2019 Jan 16;101(2):136-144. doi: 10.2106/JBJS.18.00316.
文献3
翻修时应用骨水泥将限制性内衬粘
在牢固固定髋臼杯中的长期随访研究
译者：张蔷
背景：髋关节翻修手术中，当发现髋臼杯牢固固定，安放角度良好时，将限制性内衬用骨水泥粘入髋臼杯是治疗不稳定的一种可靠方法。然而，仍然有医生顾虑这种方法会出现远期机械性失效和不稳定复发的情况。本篇研究的目的是为了评估翻修中用骨水泥将限制性内衬粘入牢固固定的髋臼杯这种方法的长期生存率、并发症和影像学结果。
方法：我们选取了1998至2006年间共125例将同一种设计的限制性内衬用骨水泥粘入骨长入牢靠的髋臼杯中的髋翻修病例。翻修时平均年龄70岁，平均随访时间为7年。分析的数据包括生存率，脱位风险以及临床和影像学结果。
限制性内衬可能的失效界面
一例内衬-骨水泥界面失效的病例
结果：统计因不稳定而翻修的病例后，5年生存率为86%，10年生存率为81%。统计因无菌性松动而翻修的病例后，5年生存率为78%，10年生存率为65%，最常见的失效机制为限制性内衬与髋臼杯分离。统计因任何原因而翻修的病例后，5年生存率为76%，10年生存率为60%。最常见的并发症为不稳定和假体周围感染，在7年时的累计发生率分别为18%和11%。髋关节Harris评分并没有显著改善。髋臼杯安放角度并不影响假体生存率或脱位风险。
全因生存率
结论：用骨水泥将限制性内衬粘入牢固固定的髋臼杯这种翻修方法拥有令人满意的长期结果，10年随访时80%的病人没有发生不稳定。统计髋臼松动的10年生存率较差（65%），主要源于限制性内衬与髋臼杯分离。
Long-Term Outcomes of Constrained Liners Cemented into Retained, Well-Fixed Acetabular Components
Background: Cementation of a constrained liner is a viable option for treating instability after total hip arthroplasty (THA) when the acetabular component is well fixed and well aligned. However, concerns regarding long-term mechanical failure and recurrent instability remain. The aim of this study was to evaluate the long-term survivorship, complications, and clinical and radiographic outcomes of constrained polyethylene liners cemented into well-fixed acetabular components at the time of revision THA.
Methods: We identified 125 cases in which a constrained liner of 1 design was cemented into a retained, osseo-integrated acetabular component during revision THA between 1998 and 2006. The mean patient age at revision was 70 years. Mean follow-up was 7 years. Survivorship data, risk of instability, and clinical and radiographic outcomes were analyzed.
Results: Survivorship free from revision for instability was 86% at 5 years and 81% at 10 years. Survivorship free from aseptic acetabular component revision was 78% at 5 years and 65% at 10 years, with the most common failure mechanism being dissociation of the constrained liner from the acetabular component. Survivorship free from revision for any reason was 76% at 5 years and 60% at 10 years. The most common complications were instability and periprosthetic joint infection, with cumulative incidences at 7 years of 18% and 11%, respectively. Harris hip scores did not significantly improve. Cup position did not affect implant survivorship or risk of dislocation.
Conclusions: Cementing a constrained liner into a retained acetabular shell at the time of revision THA has durable long-term results, with 8 in 10 patients free from instability at 10 years. Aseptic acetabular survivorship was worse (65%) at 10 years, primarily due to dissociation of the constrained liner from the acetabular component.
文献出处：Brown TS1, Tibbo ME1, Arsoy D1, Lewallen DG1, Hanssen AD1, Trousdale RT1, Abdel MP1. Long-Term Outcomes of Constrained Liners Cemented into Retained, Well-Fixed AcetabularComponents. J Bone Joint Surg Am. 2019 Apr 3;101(7):620-627. doi: 10.2106/JBJS.18.00607.
第二部分：保髋相关文献
文献1
股骨去旋转截骨术对股骨冠状面力线的影响
译者：罗殿中
目的：股骨旋转截骨术是纠正异常股骨扭转畸形的首选方法。股骨旋转截骨术对股骨冠状面力线的影响尚不明确。因此，本研究的目的是评估股骨去旋截骨术对股骨近端、中段和远端冠状面力线的影响。
方法：使用人尸体股骨（右侧）的CT数据创建的3D计算机模型，进而明确股骨的解剖轴旋转对冠状面力线的影响。在5个不同的股骨前弓角度下，分别于股骨近端、中段和远端行10°、20°、30°的虚拟外旋截骨术。通过机械外侧股骨角明确冠状面股骨力线变化。
结果：股骨近端去旋转截骨术会导致远端机械外侧股骨角（mLDFA）增加0.8°-2.6°（10°去旋转）、1.6°-5.1°（20°去旋转）、2.3-7.9°（30°去旋转），这表明股骨内翻角度增加。股骨髁上去旋转截骨术导致mLDFA变化-0.1°-1.7°（10°去旋转）、-0.2至-3.7°（20°去旋转）、-0.7至-6.9°（30°去旋转），这表明股骨外翻角度增加。这种效果随着去旋转角度的增加及虚拟股骨前弓角的增加而增加。股骨中段去旋转截骨术对股骨冠状面力线影响最小。
结论：这项三维计算机模型研究阐述了股骨旋转截骨术与股骨冠状面力线之间的关系。股骨近端去旋转截骨术会导致股骨内翻增加，而股骨远端去旋转截骨术导致股骨外翻增加。股骨旋转截骨术在临床应用中会面临无意识改变股骨冠状面力线的风险。
a 股骨计算机模型的正面与侧面观，LM1-3分别代表股骨头中心、股骨外侧髁远端及股骨内侧髁远端，VO1-3代表3个虚拟股骨截骨线（mechanical axis: 机械轴；mLDFA：远端机械外侧股骨角；ACA：股骨前弓角） b 于股骨近端进行去旋转截骨术后的股骨模型
a 一股骨前倾角增大患者髌骨向内侧移位，由于患者股骨远端外旋，股骨远端为斜位伴外翻；b 患者在外旋下肢后显示的真正股骨正位，图中的黄色及绿色方框对应c图及d图中的区域；c 股骨近端虚拟截骨术后，股骨颈偏心距增加，mLDFA增加；d 股骨远端虚拟截骨术后，股骨颈偏心距增加，mLDFA减小，股骨外翻角度增加
The effects of femoral external derotational osteotomy on frontal plane alignment
PURPOSE: Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of externalderotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment.
METHODS: The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle.
RESULTS: Proximal derotational osteotomies resulted in an increased mechanical lateral distal femoral angle (mLDFA) of 0.8°-2.6° for 10°, of 1.6°-5.1° for 20° and of 2.3-7.9° for 30° derotational osteotomy, indicating an increased varus angulation. Supracondylar derotationalosteotomy resulted in a decreased mLDFA of -0.1° to -1.7° for 10°, of -0.2 to -3.7° for 20° and of -0.7 to -6.9° for 30° derotational osteotomy, indicating an increased valgus angulation. The effect increased with the amount of torsional correction and virtually increased antecurvatum angles. Mid-shaft torsional osteotomies had the smallest effect on frontal plane alignment.
CONCLUSION: This three-dimensional computer model study demonstrates the relationship between femoral torsional osteotomies and frontal plane alignment. Proximal external derotational osteotomies tend to result in an increased varus angulation, whilst distal externalderotational osteotomies tend to result in an increased valgus angulation. As a clinical consequence, torsional osteotomies have an increased risk of unintentional implications on frontal plane alignment.
文献出处：Nelitz M, Wehner T, Steiner M, Dürselen L, Lippacher S. The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2740-6. doi: 10.1007/s00167-013-2618-5. Epub 2013 Jul 26.
文献2
双侧髋臼周围截骨术是否能减小代偿性骨盆前倾？
译者：程徽
背景：理论上讲，腰椎、骨盆倾斜和髋关节三者之间存在动力学相关性，在髋关节发育不良的患中，这种相关性需要进一步证实。一些报告称患者不自觉的通过增加骨盆前倾代偿髋臼覆盖的不足。目前尚不清楚这种骨盆前倾在术后是否能恢复。
问题/目的：（1）双侧髋臼周围截骨术（PAO）后大于6个月随访时患者的骨盆前倾是否比术前减小？（2）在骨骼模型上，替代指标耻骨联合-骶髂关节（PS-SI）指数是否骨盆倾斜相关？（3）PS-SI指数能否表现出较高的评估者间可靠性？
图1 使用合成骨测量每个角度的PS-SI指数和骨盆前倾
方法：我们调取了一名外科医生的手术记录，该外科医生为保髋疗效研究学术网络（ANCHOR）的成员。该医生2007年至2016年期间对113例患者进行了第二侧PAO手术。其中，70例（62％）在第二次PAO后6个月内失访或没有足够的影像学检查无法纳入研究，另有3例（3％）因预先指定原因被排除，余下的40例（35％）进行评估回顾性研究。术前和末次随访的前后位骨盆X线片用于测量Tönnis角，前壁指数，后壁指数，外侧CE角，耻骨联合 - 骶尾交界距离和PS-SI指数。患者末次随访在第二次PAO后16±6个月进行呢。我们选择随访6个月以上的患者，是因为在这个时间点大多数患者已达到其最大临床改善不再受肌肉功能障碍的限制。统计分析使用组内相关系数（ICC）进行评估者间可靠性，使用配对t检验评估术前和术后测量值的变化。另外，PS-SI指数和骨盆前倾相关性的数学模型使用物理合成骨创建。合成骨固定于支架上，每增加5°前倾摄AP骨盆X射线片，测量PS-SI指数，并进行回归分析以评估趋势。
图2 PS-SI指数：骶髂关节到耻骨联合的距离
结果：在合成骨试验证实，骨盆前倾和PS-SI指数之间存在线性关系（PS-SI指数= 5.0° 3.6°倾斜，R =0.99）。通过PS-SI指数测量，40名患者中的37名（93％）骨盆倾斜减少。术后末次随访中X线片与术前X线片比较PS-SI指数下降（97±14 mm vs. 89±13mm，方差8±9 mm; 95％置信区间-11至-5；范围从前倾17°变化为后倾24°，p <0.001）。术前PS-SI指数（ICC = 0.986）和术后（ICC = 0.988）的观测者间可靠性都是极好的。
结论：我们发现双侧PAO后骨盆前倾减少。这一发现表明髋臼的矫形会影响骨盆倾斜。在临床实践中，髋臼发育不良患者的代偿性骨盆前倾是可逆的。通过测量骨盆入口的高度计算PS-SI指数来评估骨盆的倾斜程度，是一种可靠的方法。进一步的研究应当关注骨盆倾斜相关影像学指标与腰痛等并发症的关系。
Does Compensatory Anterior Pelvic Tilt Decrease AfterBilateral Periacetabular Osteotomy?
BACKGROUND:The kinetic link among the lumbar spine,pelvic tilt, and the hip has been hypothesized, but this relationship requiresfurther study in acetabular dysplasia. Anecdotal reports suggest that patientsmay compensate for acetabular dysplasia with an involuntary increase inanterior pelvic tilt; it is not known if this relationship is affected byacetabular reorientation.
QUESTIONS/PURPOSES:(1) Does compensatory pelvic tilt decrease onpreoperatively obtained standing AP pelvis radiographs compared with thoseobtained at a minimum of 6 months after bilateral periacetabular osteotomy(PAO)? (2) Does a modified surrogate measurement of pelvic tilt, the pubicsymphysis to sacroiliac (PS-SI) index, correlate with a physical syntheticbones model in which pelvic tilt can be directly measured? (3) Can the PS-SIindex demonstrate high interrater reliability?
METHODS:We assessed the surgical records of onesurgeon, who participates in the longitudinally maintained Academic Network ofConservational Hip Outcomes Research (ANCHOR) registry, for patients who hadundergone the second side of a staged bilateral PAO between 2007 and 2016;there were 113 such patients. Of those, 70 (62%) were lost to followup within 6months of the second PAO or did not have adequate imaging studies, and anotherthree (3%) were excluded for prespecified reasons, leaving 40 (35%) forevaluation in this retrospective study. Standing preoperative and most recentpostoperative AP pelvis radiographs were used to measure the Tönnis angle,anterior wall index, posterior wall index, lateral center-edge angle, pubissymphysis-to-sacrococcygeal junction distance, and the PS-SI index. The mostrecent radiographs were obtained at a mean of 16 ± 6 months after the secondPAO. We chose 6 months as the minimum because at this time point, the majorityof patients have reached their maximum clinical improvement and are no longerlimited by postoperative muscle dysfunction. Statistical analysis was performedusing the intraclass correlation coefficient (ICC) for interrater reliabilityand paired t-tests for assessing change in measurements from pre- to postoperative.Additionally, a model was created using a physical synthetic bones model inwhich pelvic tilt could be directly measured. This model was secured throughbilateral acetabuli on a mount and rotated through 5° increases in pelvic tilt.AP pelvis radiographs were obtained at each point, the PS-SI index wasmeasured, and a regression analysis performed to evaluate for trend.
RESULTS:Overall, 37 of 40 patients (93%) had a decrease in pelvic tilt, as measured bythe PS-SI index. The mean amount of pelvic tilt as measured by the PS-SI indexdecreased after surgery when comparing the preoperative with latest radiographson this parameter (97 ± 14 mm versus 89 ± 13 mm, mean difference 8 ± 9 mm; 95%confidence interval, -11 to -5; range 17 increase to 24 decrease, p <0.001). A linear relationship between pelvic tilt and PS-SI index (PS-SI index= 5.0° 3.6° tilt, R = 0.99) was identified in the synthetic bones validationmodel. Finally, the interrater reliability was found to be excellent for thePS-SI index preoperatively (ICC = 0.986) and postoperatively (ICC = 0.988).
CONCLUSIONS:We found a modest reduction in anterior pelvic tilt after bilateral PAO. Thisfinding suggests that acetabular reorientation affects pelvic position. Inclinical practice, patients with acetabular dysplasia may compensate withdynamic and reversible changes in pelvic tilt. The PS-SI index is areproducible tool to measure the height of the pelvic inlet as an assessment ofpelvic tilt. In the future, clinical studies should evaluate the clinicalimplications of these radiographic findings, including the assessment of backpain, which although multifactorial may be influenced by pelvic tilt.
文献出处：DaleyE, Nahm N, Koueiter D, Zaltz I. Does Compensatory Anterior Pelvic Tilt DecreaseAfter Bilateral Periacetabular Osteotomy? Clin Orthop Relat Res. 2019May;477(5):1168-1175. doi: 10.1097/CORR.0000000000000560.
文献3
髋关节镜术后的术后康复：最佳方案的寻找
译者：肖凯
背景：目前髋关节镜手术越来越多地用于治疗有顽固性髋关节疼痛的活跃人群。髋关节镜现用于处理的病症包括盂唇病变、股髋撞击症、关节囊松弛、韧带撕裂和关节内游离体。虽然髋关节镜检查及手术相关的文献越来越多，但专门针对术后康复疗效的研究较少。迄今为止，还没有评价术后康复有效性的系统综述。
目的：评估髋关节关节镜术后康复的现有方案。
证据搜集：2014年1月，根据系统综述及meta分析的首选报告项目（PRISMA）指南，我们在PubMed、CINAHL、SPORTDiscus、ProQuest和Google Scholar数据库进行了文献检索。
证据综合：共有6项研究符合纳入标准，这些研究为病例系列研究或病例报告（4级证据），描述了4期或5期的术后康复计划。现有证据支持术后一段时间限制负重和关节活动；然而，术后不同阶段的具体干预措施是可变的，没有对照试验证明哪种是最佳的方案。
结论：该综述发现髋关节镜术后康复的相关研究缺乏。现有研究为描述某一康复方案效果的研究，缺乏对照，因此无法确定最优的康复方案。从现有的研究中可以推测，术后4至5阶段的康复，结合术后初期免负重及限制活动，有助于改善关节功能、提高患者满意度和恢复竞技运动水平。临床医生可能会将此类计划视为术后康复指南，但应根据手术的具体操作和手术医生指南制定个性化康复治疗方案。未来的研究应侧重于对照试验，进一步确定最佳的康复措施。
Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence
CONTEXT: Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.
OBJECTIVE: To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.
EVIDENCE ACQUISITION: A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.
EVIDENCE SYNTHESIS: Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.
CONCLUSION: This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.
文献出处：Cheatham SW, Enseki KR, Kolber MJ. Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence. J Sport Rehabil. 2015 Nov;24(4):413-8. doi: 10.1123/JSR.2014-0208a.
文献4
Salter或Chiari治疗史对DDH患者行THA效果的影响
译者：任宁涛
背景：DDH骨盆截骨手术史对THA临床效果的影响仍存在争议。
目的：我们对DDH行THA治疗的患者进行了回顾性图表和放射学检查分析，以获得围手术期并发症、髋臼和股骨翻修、Harris髋关节评分和生存率的结果，并对此进行比较。此类患者之前曾有或无髋关节骨盆截骨手术史。
方法：我们对87例DDH继发骨关节炎患者（共行103例髋关节行初次THAs）进行至少3年的随访，其中有52例髋关节曾行骨盆截骨（Salter 40例，Chiari 9例，Salter和Chiari 3例），51例髋关节没有手术治疗史（对照组）。
结果：与对照组相比，骨盆截骨组术中股骨或髋臼骨折或脱位的发生率未见增高。骨盆截骨术组的整体翻修率为28.8%，而对照组为19.6%。Harris髋关节评分（范围20-87）没有降低，术后8年的总生存率骨盆截骨术组（83.3%）和对照组（88.4%）之间的任何时候都没有差异。
结论：DDH患者行THA治疗时，既往骨盆截骨手术史未导致围手术期并发症发生率增加、翻修率增加、Harris髋关节评分降低或生存率缩短。
Effect of prior Salteror Chiari osteotomy on THA with developmental hip dysplasia
BACKGROUND: Controversy exists regarding the outcome of THA afterprior pelvic osteotomy.
QUESTIONS/PURPOSES: We conducted a retrospective chart and radiographicreview to obtain outcome measures for perioperative complications, acetabularand femoral component revisions, Harris hip score, and survivorship andcompared these outcomes for patients presenting with developmental dysplasia ofthe hip treated surgically using THA with and withoutprior pelvic osteotomy.
PATIENTS AND METHODS: We performed 103 primary THAs in 87 patients withosteoarthritis secondary to developmental dysplasia of the hip with a minimum3-year followup. Previous pelvic osteotomy was performed in 52hips (Salter, 40; Chiari, nine; Salter and Chiari, three), and 51hips had no previous surgery (control group).
RESULTS: The pelvic osteotomy group did not have higher rates offemoral or acetabular intraoperative fracture or dislocation compared with thecontrol group. The overall revision rate was 28.8% inthe pelvic osteotomy group compared with 19.6% in the controlgroup. The revision rate for aseptic loosening was 23.1% inthe pelvic osteotomy group compared with 17.6% in the controlgroup. Harris hip scores (range, 20-87) were not compromised, and overallsurvivorship rates 8 years postoperatively were not different at any timebetween the pelvicosteotomy (83.3%) and control (88.4%) groups.
CONCLUSIONS: Prior pelvic osteotomy did not lead to ahigher perioperative complication rate, higher revision rate, compromisedHarris hip score, or shortened survivorship in eventual THA in developmentaldysplasia of the hip.
文献出处:Tokunaga K, Aslam N, Zdero R, Schemitsch EH, Waddell JP. Effect of prior Salteror Chiari osteotomy on THA with developmental hip dysplasia.Clin Orthop Relat Res. 2011 Jan;469(1):237-43. doi:10.1007/s11999-010-1375-8. Epub 2010 May 11.
文献5
髋臼盂唇-软骨复合体的胚胎学
译者：张利强
髋臼盂唇-软骨复合体的损伤和修复是治疗年轻人髋关节疼痛和预防髋关节退行性关节炎的临床关注领域。关于为什么大部分髋臼盂唇撕裂位于前上方有不同的理论。我们研究了11例胎龄从妊娠8周到足月的胎儿髋臼盂唇-软骨复合体的产前发育情况。
在妊娠所有阶段，前髋臼盂唇软骨复合体和后髋臼盂唇软骨复合体一直存在差异。前盂唇与髋臼软骨有一定的边缘连接并包括突向关节内部分。后盂唇与髋臼软骨相连并延续。前盂唇软骨移行区界限清晰，后盂唇软骨移行区则变得逐渐平缓且互相融合。前盂唇的胶原纤维排列平行于盂唇软骨连接处，但在后盂唇，它们垂直于连接处排列。
我们认为，胶原纤维在盂唇前部边缘附着和平行于盂唇软骨方向连接的特点可能使其比盂唇后部锚定于髋臼软骨中的胶原纤维更容易受到损伤。前方盂唇内翻不应视为病理特征。
足月胎儿髋关节的显微照片（A，髋臼; B，股骨头; C，前盂唇; D，前盂唇的关节内部分; E，后盂唇（注意没有关节内部分）; F，髋臼-盂唇过渡区）。
a）妊娠19.5至20周的前髋臼盂唇-软骨复合体的显微照片，显示盂唇的关节内部分和与软骨表面缺乏连续性（A，髋臼; B，前盂唇; C，前盂唇关节内部分; D，髋臼-盂唇过渡区; E，关节间隙）
b）同一标本的后髋臼盂唇-软骨复合体，显示盂唇和关节软骨之间的交错过渡区（A，髋臼） ; B，后盂唇; C，髋臼-盂唇过渡区; D，关节间隙）。
a）前髋臼盂唇-软骨复合体的显微照片，显示在软骨髋臼和盂唇交界处的急剧，突然的过渡区（A，髋臼; B，前盂唇; C，髋臼- 盂唇过渡区） b）同一标本中的后髋臼盂唇-软骨复合体显示逐渐和交错的过渡区（A，髋臼; B，后盂唇; C，髋臼-盂唇过渡区）
a）妊娠19至20.5周的前髋臼盂唇-软骨复合体的显微照片，显示平行于盂唇-软骨交界处的胶原纤维（A，髋臼; B，前盂唇; C，髋臼- 盂唇过渡区） b）同一标本中的后髋臼-软骨复合体，显示在盂唇-软骨交界处垂直/交叉的胶原纤维（A，髋臼；B，后盂唇; C，髋臼-盂唇过渡区；D，关节间隙；E，股骨头）
a）前髋臼盂唇-软骨复合体的显微照片显示平行于盂唇-软骨交界处的胶原纤维（A，髋臼; B，前盂唇; C，髋臼-盂唇过渡区） b）同一标本中的后髋臼盂唇-软骨复合体显示在盂唇-软骨交界处垂直/相互交错的胶原纤维（A，髋臼; B，盂唇; C，髋臼- 盂唇过渡区）。
Embryology of the acetabular labral-chondral complex
Damage to and repair of the acetabular labral-chondral complex are areas of clinical interest in the treatment of young adults with pain in the hip and in the prevention of degenerative arthritis of the hip. There are varying theories as to why most acetabular tears are located anterosuperiorly. We have studied the prenatal development of the human acetabular labral-chondral complex in 11 fetal hips, aged from eight weeks of gestation to term.
There were consistent differences between the anterior and posterior acetabular labral- chondral complex throughout all ages of gestation. The anterior labrum had a somewhat marginal attachment to the acetabular cartilage with an intra-articular projection. The posterior labrum was attached and continuous with the acetabular cartilage. Anteriorly, the labral-chondral transition zone was sharp and abrupt, but posteriorly it was gradual and interdigitated. The collagen fibres of the anterior labrum were arranged parallel to the labral- chondral junction, but at the posterior labrum they were aligned perpendicular to the junction.
We believe that in the anterior labrum the marginal attachment and the orientation of the collagen fibres parallel to the labral-chondral junction may render it more prone to damage than the posterior labrum in which the collagen fibres are anchored in the acetabular cartilage. The anterior intra-articular projection of the labrum should not be considered to be a pathological feature.
文献出处：M Cashin, H Uhthoff. et al. Embryology of the acetabular labral-chondral complex. J Bone Joint Surg . Br if(2014):3.309 2008;90(8):1019-24 doi:10.1302/0301-620X.90B8.20161
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