本期目錄：
1、無(wú)骨水泥和骨水泥型單間室膝關(guān)節(jié)置換術(shù)脛骨假體周圍骨折的發(fā)生率比較
2、關(guān)節(jié)置換圍術(shù)期老年病科會(huì)診與術(shù)后急診就診減少相關(guān)
3、功能性與機(jī)械性對(duì)線全膝關(guān)節(jié)置換術(shù)結(jié)局比較
4、嬰幼兒切開(kāi)復(fù)位預(yù)期結(jié)果如何
5、胚胎期和胎兒早期骨盆骨骼的軟骨形成
6、計(jì)算機(jī)輔助髖臼周圍截骨術(shù)與傳統(tǒng)截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的療效比較
7、建立一種精準(zhǔn)的術(shù)中替代技術(shù)用于測(cè)量股骨前傾角
8、髖臼周圍截骨術(shù)會(huì)改變骨盆前后傾嗎
9、微創(chuàng)壞死骨沖洗技術(shù)促進(jìn)股骨頭缺血性壞死后的骨愈合：基于幼豬模型的實(shí)驗(yàn)研究
10、髖臼周圍截骨術(shù)后臨界髖關(guān)節(jié)發(fā)育不良患者的結(jié)局和恢復(fù)運(yùn)動(dòng)率
11、關(guān)節(jié)鏡下減壓及盂唇修復(fù)術(shù)治療髖關(guān)節(jié)旁囊腫
第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)
文獻(xiàn)1
無(wú)骨水泥和骨水泥型單間室膝關(guān)節(jié)置換術(shù)脛骨假體周圍骨折的發(fā)生率比較：系統(tǒng)回顧和meta分析
譯者 張軼超
目的：(1)確定骨水泥和非骨水泥型單間室膝關(guān)節(jié)置換（UKA）術(shù)脛骨假體周圍骨折的發(fā)生率和（2）總結(jié)UKA假體周圍骨折的特征和危險(xiǎn)因素。
方法：綜合檢索Pubmed、Cochrane和Embase數(shù)據(jù)庫(kù)。納入所有描述了UKA患者脛骨假體周圍骨折的比例、特征或危險(xiǎn)因素的臨床、實(shí)驗(yàn)室研究或病例報(bào)告研究。評(píng)估骨折發(fā)生率的比例分析僅使用臨床研究的數(shù)據(jù)。評(píng)估和總結(jié)相關(guān)特征和危險(xiǎn)因素的信息。
結(jié)果：共有81項(xiàng)研究被認(rèn)為符合納入條件。根據(jù)41項(xiàng)臨床研究，非骨水泥假體的骨折發(fā)生率為1.24% (95%CI 0.64-2.41)，骨水泥假體（9451例）的骨折發(fā)生率為1.58% （95%CI 1.06-2.36）。
目前文獻(xiàn)中報(bào)道大多數(shù)骨折發(fā)生在手術(shù)中或術(shù)后3個(gè)月內(nèi)（91 / 127例;72%)和非創(chuàng)傷性的(113/95例；84%)。在21張X線片上觀察到6種不同的骨折類型。實(shí)驗(yàn)室研究顯示，過(guò)度壓配（壓配），過(guò)度脛骨截除，后位縱向切割太深和較低的骨密度（BMD）減小了導(dǎo)致脛骨假體周圍骨折所需的力。臨床研究表明，脛骨假體周圍骨折與體重指數(shù)增加和術(shù)后下肢力線角度增加，高齡，骨密度下降，女性，脛骨內(nèi)側(cè)髁過(guò)度突出存在相關(guān)性。
結(jié)論：非骨水泥和骨水泥型UKA脛骨假體周圍骨折發(fā)生率相當(dāng)?shù)?。然而，外科醫(yī)生應(yīng)注意非骨水泥UKA在打入假體時(shí)的過(guò)重打擊操作可能會(huì)帶來(lái)骨折風(fēng)險(xiǎn)，因此需要更加小心那些手術(shù)中可能出現(xiàn)的錯(cuò)誤和有脛骨假體周圍骨折高風(fēng)險(xiǎn)的患者。
Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta?analysis
Purpose：(I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA.
Methods: Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized.
Results: A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64–2.41) for cementless and 1.58% (95%CI 1.06–2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six diferent fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative
alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle.
Conclusion: Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures.
文獻(xiàn)出處：Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):852-874. doi: 10.1007/s00167-021-06449-3. Epub 2021 Feb 2. PMID: 33528591; PMCID: PMC8901491.
文獻(xiàn)2
關(guān)節(jié)置換圍術(shù)期老年病科會(huì)診與術(shù)后急診就診減少相關(guān)
譯者 張薔
背景：既往研究指出老年病科會(huì)診可以給老年髖部骨折的患者帶來(lái)治療獲益，主要表現(xiàn)在改善術(shù)后功能和降低病死率。然而，我們還未深入探究老年病科會(huì)診對(duì)擇期關(guān)節(jié)置換手術(shù)（TJA）的影響。本研究的目的是明確術(shù)前或術(shù)后老年病科參與診治是否與關(guān)節(jié)置換術(shù)后住院時(shí)長(zhǎng)和急診就診（ED）次數(shù)的變化相關(guān)。
方法：本回顧性隊(duì)列研究檢索了某地區(qū)多家醫(yī)院的聯(lián)合數(shù)據(jù)庫(kù)中所有年齡≥65歲的擇期初次關(guān)節(jié)置換手術(shù)病例。記錄的信息包括在TJA術(shù)前90天至TJA術(shù)后90天的時(shí)間范圍內(nèi)有老年病科會(huì)診。我們應(yīng)用了雙變量分析和多元回歸模型來(lái)評(píng)估老年病科會(huì)診與住院時(shí)長(zhǎng)和急診就診次數(shù)變化之間的關(guān)系。
結(jié)果：最終入組了16076例初次TJA病例。其中，9677（60.2%）例為全膝關(guān)節(jié)置換，6087（37.9%）例為全髖關(guān)節(jié)置換，其中1416（8.8%）例曾有老年病科會(huì)診記錄。在置換術(shù)前一周內(nèi)有至少一次老年病科會(huì)診記錄的病例在術(shù)后需要急診就診的概率更低（概率比OR，0.97[95%置信區(qū)間CI，0.68-0.99]）。這種情況在65歲以上病例中更為明顯（OR，0.66[95%]，0.45-0.98）。
結(jié)論：本研究找到了明確證據(jù)支持圍術(shù)期老年病科會(huì)診對(duì)TJA術(shù)后療效的正面影響。術(shù)前會(huì)診與TJA術(shù)后90天內(nèi)急診就診次數(shù)減少有相關(guān)性。因此，擇期TJA手術(shù)圍術(shù)期老年病科參與診治可以提升療效，降低患者的病死率和醫(yī)療支出，并降低術(shù)者和醫(yī)療機(jī)構(gòu)的醫(yī)療成本。
Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits after Total Joint Arthroplasty
Background: Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.
Methods: This retrospective cohort study screened the medical records of patients ≥65 years of age undergoing primary elective TJA in a network of tertiary hospitals. Geriatrician consultations occurring within a period spanning 90 days before to 90 days after TJA were recorded. Bivariate analysis and multivariable regression models were used to assess the relationship between receiving these consultations and changes in the length of stay and ED visits.
Results: A total of 16,076 patients undergoing primary TJA were included. Of these surgical procedures, 9,677 (60.2%) were total knee arthroplasties and 6,087 (37.9%) were total hip arthroplasties; 1,416 (8.8%) of cases had geriatrician visits. Patients had lower odds of requiring postoperative ED visits when they had at least 1 geriatrician appointment within the week preceding an arthroplasty (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.68 to 0.99]; p = 0.005). This effect was most notable for 65-year-old patients (OR, 0.66 [95% CI, 0.45 to 0.98]).
Conclusion: This study reports promising evidence supporting the benefits of perioperative geriatrician visits on TJA outcomes. Preoperative visits were shown to be associated with decreased odds of ED visits after TJA in patients for up to 90 days postoperatively. Thus, geriatrician involvement in elective TJAs has the potential to improve outcomes and reduce morbidity and costs for patients and reduce costs for surgeons and institutions.
文獻(xiàn)3
功能性與機(jī)械性對(duì)線全膝關(guān)節(jié)置換術(shù)結(jié)局比較：基于髖-跟骨X線片的膝關(guān)節(jié)與地面平行性及負(fù)重位分析
譯者 沈松坡
背景： 本研究的目的是比較接受機(jī)械性對(duì)位的傳統(tǒng)全膝關(guān)節(jié)置換術(shù)（MA-CTKA）與接受功能性對(duì)位的機(jī)器人輔助手術(shù)（FA-RTKA）患者的術(shù)后結(jié)局。
方法： 我們回顧性分析了一項(xiàng)前瞻性收集的數(shù)據(jù)庫(kù)，該數(shù)據(jù)庫(kù)包含 2022 年 6 月至 2023 年 5 月期間因膝骨關(guān)節(jié)炎接受初次全膝關(guān)節(jié)置換術(shù)（TKA）的連續(xù)患者。根據(jù)研究期間引入機(jī)器人輔助手術(shù)系統(tǒng)的情況，患者被分為兩組：MA-CTKA 組（n = 50）和 FA-RTKA 組（n = 50）。通過(guò)全長(zhǎng)站立位髖-跟骨 X 線片評(píng)估髖-膝-踝（HKA）角、關(guān)節(jié)線相對(duì)于地面的取向角（JLOA）以及負(fù)重線（WBL）比例，以比較兩組之間傳統(tǒng)機(jī)械軸（MA）和經(jīng)過(guò)膝關(guān)節(jié)的地面機(jī)械軸（GA）。同時(shí)比較兩組的臨床結(jié)局。
結(jié)果： 由于兩組在目標(biāo)對(duì)位策略上的差異，術(shù)后 HKA 角無(wú)顯著差異（FA-RTKA：2.0° vs. MA-CTKA：0.5°，p = 0.001）。FA-RTKA 組術(shù)后 JLOA 更接近平行于地面，而 MA-CTKA 組的關(guān)節(jié)線則向外側(cè)呈向下傾斜（0.6° vs. ?2.7°，p < 0.001）。在 FA-RTKA 組中，GA 經(jīng)過(guò)跟骨時(shí)處于中立位置，而 MA-CTKA 組的 GA 位置更偏向外側(cè)（48.8% vs. 53.8%，p = 0.001）。兩組在臨床結(jié)局方面無(wú)顯著差異，但 FA-RTKA 組表現(xiàn)出更高的“遺忘關(guān)節(jié)評(píng)分”（Forgotten Joint Score）和更大的活動(dòng)度（均 p < 0.05）。
結(jié)論： 與機(jī)械性對(duì)位的 TKA 相比，功能性對(duì)位的 TKA 術(shù)后關(guān)節(jié)線更加平行于地面，且在 GA 方面表現(xiàn)出更中立的負(fù)重對(duì)齊。這些發(fā)現(xiàn)表明，F(xiàn)A-RTKA 可在膝關(guān)節(jié)內(nèi)實(shí)現(xiàn)更均衡的負(fù)荷分布，這可能有助于其優(yōu)越的臨床結(jié)局。
圖1. 采用功能性對(duì)位原則的術(shù)中假體位置。
脛骨假體對(duì)位首先在冠狀面對(duì)準(zhǔn)至 3.0°（內(nèi)翻），以保持原生關(guān)節(jié)線在邊界內(nèi)；隨后，通過(guò)在所有三個(gè)維度上微調(diào)股骨組件對(duì)位來(lái)平衡伸展間隙和屈曲間隙。股骨組件的冠狀面對(duì)位設(shè)定為 ?1.1°（外翻），并相對(duì)于股骨后髁軸外旋 3.9°。符號(hào)表示相同的參考點(diǎn)。
圖2. 髖-跟骨X線片上JLOA的評(píng)估。
(A) 在功能性對(duì)位組中，術(shù)后JLOA與地面平行。
(B) 在機(jī)械性對(duì)位組中，術(shù)后JLOA向外側(cè)呈向下傾斜。
虛線表示地面方向（G）。JLOA定義為脛骨近端關(guān)節(jié)面（實(shí)心紅線）與地面（虛線紅線）之間的夾角。
圖3. 髖-跟骨X線片上功能性對(duì)位全膝關(guān)節(jié)置換術(shù)中膝關(guān)節(jié)的負(fù)重位置評(píng)估。
(A) 地面機(jī)械軸（GA）（實(shí)心紅線）定義為從股骨頭中心延伸至跟骨最低點(diǎn)的連線，其位置相對(duì)于傳統(tǒng)機(jī)械軸（MA）（虛線紅線）更偏向外側(cè)。
(B) 在“真實(shí)”條件下，考慮跟骨因素后，GA 通過(guò)膝關(guān)節(jié)中心。
(C) 相比之下，傳統(tǒng) MA 略微偏內(nèi)側(cè)通過(guò)膝關(guān)節(jié)。
X 線標(biāo)記中的“R”符號(hào)表示“右側(cè)”。
Comparison of Outcomes Between Functionally and Mechanically Aligned Total Knee Arthroplasty: Analysis of Parallelism to the Ground and Weight-Bearing Position of the Knee Using Hip-to-Calcaneus Radiographs
Background: The objective of this study was to compare the outcomes between patients undergoing mechanically aligned conventional total knee arthroplasty (MA-CTKA) and functionally aligned robotic-arm-assisted TKA (FA-RTKA).
Methods: We reviewed a prospectively collected database of consecutive patients who underwent primary total knee arthroplasty (TKA) for knee osteoarthritis between June 2022 and May 2023. Patients were divided into two groups-MA-CTKA (n = 50) and FA-RTKA (n = 50)-based on the introduction of a robotic-arm-assisted system during the study period. The hip-knee-ankle (HKA) angle, joint line orientation angle (JLOA) relative to the floor, and weight-bearing line (WBL) ratio were evaluated using full-length standing hip-to-calcaneus radiographs to compare the conventional mechanical axis (MA) and the ground mechanical axis (GA) passing through the knee joint between the groups. Clinical outcomes were also compared between the two groups.
Results: There were no significant differences in the postoperative HKA angle between the groups, due to discrepancies in the targeted alignment strategies (FA-RTKA: 2.0° vs. MA-CTKA: 0.5°; p = 0.001). The postoperative JLOA in the FA-RTKA group was more parallel to the floor, whereas the MA-CTKA group showed a downward angulation toward the lateral side (0.6° vs. -2.7°; p < 0.001). In the FA-RTKA group, the GA passed through a neutral position when accounting for the calcaneus, while the MA-CTKA group showed a more lateral GA position (48.8% vs. 53.8%; p = 0.001). No significant differences in clinical outcomes were shown between the FA-RTKA and MA-CTKA groups, with the FA-RTKA group demonstrating higher Forgotten Joint Scores and a greater range of motion (all p < 0.05).
Conclusions: Functionally aligned TKA demonstrated improved joint line parallelism to the floor and more neutral weight-bearing alignment in the GA compared to mechanically aligned TKA. These findings indicate a more balanced load distribution across the knee, which may contribute to the superior clinical outcomes observed in the functionally aligned group.
第二部分：保髖相關(guān)文獻(xiàn)
文獻(xiàn)1
嬰幼兒切開(kāi)復(fù)位預(yù)期結(jié)果如何？----一項(xiàng)DDH前瞻性多中心研究
譯者 羅殿中
背景：針對(duì)嬰幼兒發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）切開(kāi)復(fù)位的效果，雖然有少數(shù)單個(gè)中心的研究報(bào)告，罕有前瞻性研究文獻(xiàn)數(shù)據(jù)。本研究為針對(duì)嬰幼兒DDH切開(kāi)復(fù)位（OR）的前瞻性、多中心臨床研究。
方法：該前瞻性研究資料來(lái)自國(guó)際多中心研究小組，針對(duì)所有的嬰幼兒DDH切開(kāi)復(fù)位（OR）；至少隨訪1年；通過(guò)回顧形成共識(shí)，股骨近端生長(zhǎng)干擾（PFGD）采用Salter法；殘余髖臼發(fā)育不良定義為髖臼指數(shù)超過(guò)同年齡分布的90%（單側(cè)十分之一分位）；運(yùn)用統(tǒng)計(jì)學(xué)分析，比較術(shù)前資料、手術(shù)信息，以預(yù)測(cè)再脫位、PFGD、及殘余發(fā)育不良的風(fēng)險(xiǎn)因素。
結(jié)果：本研究共納入195例232髖，切開(kāi)復(fù)位時(shí)平均年齡（中位數(shù)）為19個(gè)月（四分位數(shù)為13至28個(gè)月）；平均隨訪時(shí)間為21個(gè)月（四分位數(shù)為16至32個(gè)月）。再脫位的發(fā)生率為7%（n=16/228）；多數(shù)再脫位發(fā)生在切開(kāi)復(fù)位（OR）術(shù)后1年之內(nèi)（81%，n=13/16）。排除再脫位病例，末次隨訪時(shí)94.5%的髖關(guān)節(jié)表現(xiàn)為IHDI 1型。通過(guò)對(duì)末次隨訪影像的嚴(yán)格分析，在44%（n=101/230）的患髖出現(xiàn)不同程度的PFGD。與正常數(shù)據(jù)庫(kù)對(duì)照，發(fā)現(xiàn)78例（55%）髖關(guān)節(jié)表現(xiàn)為殘余發(fā)育不良。經(jīng)至少2年隨訪，初次手術(shù)進(jìn)行骨盆截骨的患髖近半數(shù)出現(xiàn)殘余發(fā)育不良（39%，n=32/82），而初次手術(shù)未行骨盆截骨的患髖殘余發(fā)育不良發(fā)生率更高（78%，n=46/59）。
結(jié)論：迄今在這項(xiàng)最大規(guī)模的前瞻性、多中心研究中，針對(duì)嬰幼兒DDH切開(kāi)復(fù)位的短期隨訪中，7%出現(xiàn)再脫位，44%出現(xiàn)股骨近端生長(zhǎng)干擾（PFGD），55%出現(xiàn)殘余髖臼發(fā)育不良。不良臨床結(jié)果的發(fā)生率較以前的報(bào)告要高。切開(kāi)復(fù)位同時(shí)行骨盆截骨手術(shù)的髖關(guān)節(jié)殘余發(fā)育不良的發(fā)生率較低。該前瞻性、多中心研究結(jié)果，為患者家長(zhǎng)提供了更多的信息，提高家長(zhǎng)認(rèn)識(shí)、并設(shè)立恰當(dāng)?shù)钠谕怠?/p>
圖 （A）左髖前后位片顯示一個(gè)28個(gè)月男孩，切開(kāi)復(fù)位術(shù)后13個(gè)月，左股骨近端生長(zhǎng)干擾（PFGD）；（B）骨盆前后位片顯示一個(gè)33個(gè)月女孩未行骨盆截骨、右髖切開(kāi)復(fù)位術(shù)后26個(gè)月，殘余髖臼發(fā)育不良（AI=34°）。
A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?
Background:Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population.
Methods:The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter's criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia.
Results:A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59).
Conclusions:In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations.
文獻(xiàn)出處：Kiani SN, Gornitzky AL, Matheney TH, Schaeffer EK, Mulpuri K, Shah HH, Yihua G, Upasani V, Aroojis A, Krishnamoorthy V, Sankar WN; Global Hip Dysplasia Registry. A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction? J Pediatr Orthop. 2023 May-Jun 01;43(5):279-285. doi: 10.1097/BPO.0000000000002383. Epub 2023 Mar 8. PMID: 36882887.
文獻(xiàn)2
胚胎期和胎兒早期骨盆骨骼的軟骨形成
譯者 任寧濤
骨盆骨骼是通過(guò)軟骨內(nèi)骨化形成的。然而，目前尚不清楚正常軟骨是如何在骨化發(fā)生前形成的。此外，骨盆軟骨形成的總體時(shí)間和軟骨形態(tài)尚不清楚。本研究使用相位對(duì)比計(jì)算機(jī)斷層掃描和7T磁共振成像，觀察了25例人類胎兒(冠-臀長(zhǎng)[CRL] = 11.9-75.0 mm)骨盆骨骼的軟骨形成。髂骨、坐骨、恥骨的軟骨中心在卡內(nèi)基期(CS) 18首次同時(shí)出現(xiàn)，位于髖臼周圍，后期呈放射狀生長(zhǎng)。髂嵴在CS20階段形成，而髂體中央部分仍呈軟骨狀。髂骨體在CS22階段形成一個(gè)盤(pán)狀結(jié)構(gòu)。髂骨的生長(zhǎng)速率大于骶骨-尾骨、恥骨和坐骨。在有限的時(shí)間內(nèi)形成連接和關(guān)節(jié)，骶髂關(guān)節(jié)在CS21階段形成。在CS23階段可觀察到恥骨聯(lián)合關(guān)節(jié)、骶髂關(guān)節(jié)連接、髖骨三部分與髖臼Y形連接;在胎兒早期（EF）觀察到坐骨和恥骨分支的連接。此外，在不同的樣本中，骶骨中心的連接程度也不同。大多數(shù)盆腔測(cè)量數(shù)據(jù)顯示與CRL高度相關(guān)。小骨盆入口的橫向徑和前后徑在不同的樣本中存在差異(R2 = 0.11)。恥骨下角也有變化(65 ~ 90°)，與CRL無(wú)關(guān)(R2 = 0.22)。此外，軟骨結(jié)構(gòu)的形成似乎影響骨結(jié)構(gòu)。這項(xiàng)研究為骨盆結(jié)構(gòu)的形態(tài)發(fā)生提供了有價(jià)值的信息。
圖 盆腔環(huán)形成。骨盆骨骼軟骨形成的三維重建視圖。藍(lán)色：股骨; 綠色：恥骨; 淺藍(lán)色：尾骨; 橙色：主動(dòng)脈和髂總動(dòng)脈。紫色：髂骨; 紅色：骶骨; 黃色：坐骨。括號(hào)中的數(shù)字為CRL (mm)。刻度條表示1mm。
Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period
The pelvic skeleton is formed via endochondral ossification. However, it is not known how the normal cartilage is formed before ossification occurs. Furthermore, the overall timeline of cartilage formation and the morphology of the cartilage in the pelvis are unclear. In this study, cartilage formation in the pelvic skeletons of 25 human fetuses (crown-rump length [CRL] = 11.9-75.0 mm) was observed using phase-contrast computed tomography and 7T magnetic resonance imaging. The chondrification center of the ilium, ischium, and pubis first appeared simultaneously at Carnegie stage (CS) 18, was located around the acetabulum, and grew radially in the later stage. The iliac crest formed at CS20 while the iliac body's central part remained chondrified. The iliac body formed a discoid at CS22. The growth rate was greater in the ilium than in the sacrum-coccyx, pubis, and ischium. Connection and articulation formed in a limited period, while the sacroiliac joint formed at CS21. The articulation of the pubic symphysis, connection of the articular column in the sacrum, and Y-shape connection of the three parts of the hip bones to the acetabulum were observed at CS23; the connection of the ischium and pubic ramus was observed at the early-fetal stage. Furthermore, the degree of connection at the center of the sacrum varied among samples. Most of the pelvimetry data showed a high correlation with CRL. The transverse and antero-posterior lengths of the pelvic inlet of the lesser pelvis varied among samples (R2 = 0.11). The subpubic angle also varied (65-90°) and was not correlated with CRL (R2 = 0.22). Moreover, cartilaginous structure formation appeared to influence bone structure. This study provides valuable information regarding the morphogenesis of the pelvic structure.
文獻(xiàn)出處：Okumura M, Ishikawa A, Aoyama T, Yamada S, Uwabe C, Imai H, Matsuda T, Yoneyama A, Takeda T, Takakuwa T. Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period. PLoS One. 2017 Apr 6;12(4):e0173852. doi: 10.1371/journal.pone.0173852. PMID: 28384153; PMCID: PMC5383024
文獻(xiàn)3
計(jì)算機(jī)輔助髖臼周圍截骨術(shù)與傳統(tǒng)截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的療效比較
譯者 李勇
目的 比較計(jì)算機(jī)輔助髖臼周圍截骨術(shù)（PAO）與傳統(tǒng)PAO治療髖關(guān)節(jié)發(fā)育不良（DDH）的療效。
方法 納入91例患者（98髖），每個(gè)DDH病例均采用常規(guī)PAO（術(shù)中x線檢查確定截骨角度和方向）或計(jì)算機(jī)輔助PAO（使用3D導(dǎo)航系統(tǒng)）治療。其中，40髖行常規(guī)PAO， 58髖行計(jì)算機(jī)輔助PAO。
結(jié)果 常規(guī)PAO患者的日本骨科協(xié)會(huì)髖關(guān)節(jié)評(píng)分從術(shù)前70.0分提高到術(shù)后90.7分，計(jì)算機(jī)輔助PAO患者的髖關(guān)節(jié)評(píng)分從術(shù)前74.5分提高到術(shù)后94.2分。在所有計(jì)算機(jī)輔助PAO患者中，術(shù)后頭臼指數(shù)（AHI）和前臼頂傾斜角（VCA）均在放射靶區(qū)內(nèi)。部分常規(guī)PAO患者術(shù)后AHI和VCA角不在靶區(qū)。在平均隨訪5.4年之后，我們對(duì)98例PAO髖關(guān)節(jié)中的5例（5.1%）進(jìn)行了全髖關(guān)節(jié)置換術(shù)（THA）。58例髖關(guān)節(jié)（0%）采用計(jì)算機(jī)輔助PAO，均未進(jìn)行翻修。
結(jié)論 計(jì)算機(jī)輔助PAO可以術(shù)中確認(rèn)截骨部位，實(shí)時(shí)確認(rèn)截骨塊的位置。與傳統(tǒng)PAO相比，計(jì)算機(jī)輔助PAO患者股骨頭前方和外側(cè)有足夠的覆蓋，不需要早期轉(zhuǎn)換為T(mén)HA。結(jié)論計(jì)算機(jī)輔助PAO不僅提高了準(zhǔn)確性和安全性，而且獲得了足夠的前外側(cè)位移，預(yù)防了DDH的進(jìn)展。
Outcomes of Computer-Assisted Peri-Acetabular Osteotomy Compared with Conventional Osteotomy in Hip Dysplasia
This study compared the efficacy of computer-assisted peri-acetabular osteotomy (PAO) with conventional PAO in treating developmental dysplasia of the hip (DDH). Ninety-one patients (98 hips) were enrolled: 40 hips underwent conventional PAO (guided by intraoperative X-ray), and 58 hips underwent computer-assisted PAO (using 3D navigation). Results showed significant improvement in Japanese Orthopaedic Association (JOA) hip scores: from 70.0 preoperatively to 90.7 postoperatively in the conventional group, and from 74.5 to 94.2 in the computer-assisted group. Postoperative acetabular head index (AHI) and vertical center anterior (VCA) angles were within radiographic targets for all computer-assisted PAO cases, while some conventional PAO cases exceeded thresholds. Over a mean follow-up of 5.4 years, 5 of 98 hips (5.1%) required conversion to total hip arthroplasty (THA), all from the conventional group. Computer-assisted PAO enabled real-time visualization of osteotomy sites and fragment positioning, achieving superior anterolateral femoral head coverage and preventing DDH progression.
文獻(xiàn)出處：Imai H, Kamada T, Miyawaki J, Maruishi A, Mashima N, Miura H. Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia. Int Orthop. 2020 Jun;44(6):1055-1061.
文獻(xiàn)4
建立一種精準(zhǔn)的術(shù)中替代技術(shù)用于測(cè)量股骨前傾角
譯者 張利強(qiáng)
背景：在手術(shù)室中準(zhǔn)確評(píng)估股骨前傾角頗具挑戰(zhàn)性。我們?cè)u(píng)估了觀察者是否能通過(guò)改良的C臂技術(shù)可靠且準(zhǔn)確地判斷出股骨頸何時(shí)平行于地面。我們將該技術(shù)與先前報(bào)道的用于術(shù)中測(cè)定股骨前傾角的改良Ogata-Goldsand技術(shù)進(jìn)行了比較。
方法：為評(píng)估觀察者能否判斷出股骨頸何時(shí)與地面水平，我們對(duì)72具尸體股骨近端側(cè)面進(jìn)行拍攝，將股骨旋轉(zhuǎn)以模擬從-20度到+20度、以5度為增量的前傾角變化。這些照片以網(wǎng)格布局排列，并通過(guò)3次隨機(jī)化和盲法驗(yàn)證。5名研究者選擇了他們認(rèn)為最接近中立（0度）股骨前傾角的方位。然后，在手術(shù)室中對(duì)4具完整尸體進(jìn)行了檢查。采用改良C臂技術(shù)與改良Ogata-Goldsand 技術(shù)對(duì)每具全尺寸股骨尸體的股骨前傾角進(jìn)行了評(píng)估，以廣泛認(rèn)可的Kingsley和Olmsted技術(shù)作為標(biāo)準(zhǔn)來(lái)測(cè)量股骨前傾角。
結(jié)果：在確定股骨頸中立位置時(shí)，觀察者能夠準(zhǔn)確地確定0度前傾角，平均偏差為4.4±2.4度。改良C臂技術(shù)測(cè)量值與真實(shí)值的平均偏差為3.2±4.2度。改良的Ogata-Goldsand技術(shù)測(cè)量值與真實(shí)角度的平均偏差為2.3±2.6度。改良的C臂技術(shù)不同觀察者之間的組內(nèi)相關(guān)系數(shù)為0.82，與Kingsley和Olmsted方法作為標(biāo)準(zhǔn)相比為0.81，而改良的Ogata-Goldsand技術(shù)分別為0.72和0.90。
結(jié)論：觀察者能夠準(zhǔn)確地感知股骨頸與虛擬地面平行的情況，這支持將此參數(shù)納入改良C臂技術(shù)。改良C臂技術(shù)與改良Ogata-Goldsand技術(shù)相當(dāng)。
臨床意義：改良C臂技術(shù)相較于改良Ogata-Goldsand技術(shù)相對(duì)簡(jiǎn)單，這使得改良C臂技術(shù)成為術(shù)中測(cè)量股骨前傾角的一個(gè)合理補(bǔ)充選擇。
股骨近端標(biāo)本：九張圖像從-20度到+20度每次增加5度。在實(shí)際研究中，這9張圖像是未標(biāo)記的，并隨機(jī)洗牌以進(jìn)行有效性和可靠性測(cè)試
改良C臂技術(shù)。 A，定義膝關(guān)節(jié)正位片。 B，獲取標(biāo)準(zhǔn)的髖關(guān)節(jié)側(cè)位片，再將C臂推回膝關(guān)節(jié)，通過(guò)旋轉(zhuǎn)C臂獲取膝關(guān)節(jié)正位片與A圖膝關(guān)節(jié)正位片匹配；C，通過(guò)讀取C臂旋轉(zhuǎn)角度獲得前傾角度數(shù)。
改良Ogata-goldsand技術(shù)。 A，C臂位于膝蓋平行的位置，以獲得膝蓋的真實(shí)側(cè)面X射線，于股骨后方放置一不透X線針定義為水平面。 B，側(cè)位X射線。股骨頸和不透X線針之間的角度是β角，。 C，通過(guò)從側(cè)面旋轉(zhuǎn)C-臂90度獲得髖關(guān)節(jié)的前后（AP）X射線。 股骨頸和股骨軸之間的角度是α角。 D，尸體標(biāo)本演示了圖3B中的射線照相方法
Kingsley-Olmsted技術(shù)。股骨髁的后方和大轉(zhuǎn)子后方置于桌子上。 獲得股骨頸從近端到遠(yuǎn)端的軸向圖像，其中股骨頸和桌子表面之間的角度代表股骨前傾角。
Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version
Background: Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version.
Methods: To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from ?20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version.
Results: In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique.
Conclusions: Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique.
Clinical Relevance: The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version.
文獻(xiàn)出處：Yao B, Li D, Cui J, Smith KL, Tyagi V, Kahan JB, Nicholson AD, Smith BG, Liu R, Cooperman DR. Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version. J Pediatr Orthop. 2025 Mar 21. doi: 10.1097/BPO.0000000000002920. Epub ahead of print. PMID: 40126881.
文獻(xiàn)5
髖臼周圍截骨術(shù)會(huì)改變骨盆前后傾嗎
譯者 陶可
髖臼周圍截骨術(shù)(PAO)期間和之后骨盆傾斜(PT)的變化對(duì)于手術(shù)規(guī)劃非常重要。本研究的目的是(i)確定接受PAO治療的患者的PT在整個(gè)治療過(guò)程中如何變化，(ii)測(cè)試哪些因素會(huì)影響PT的變化，以及(iii)評(píng)估PT的變化是否影響所實(shí)現(xiàn)的截骨矯形。
這是一項(xiàng)回顧性、單中心、連續(xù)病例系列研究，納入了111名接受PAO治療的患者，這些患者患有整體(n = 79)、后傾(n = 49)或前傾發(fā)育不良(n = 6)（平均年齡：27.3 ± 7.7歲；85%為女性）。PT是在術(shù)前、術(shù)中、術(shù)后1天、6周和1年通過(guò)仰臥位、前后位骨盆X線片測(cè)定的，使用骶骨-股骨-恥骨(SFP)角，這是一種經(jīng)過(guò)驗(yàn)證的PT替代標(biāo)記。最佳髖臼矯正度取決于外側(cè)中心邊緣角（25°-40°）、髖臼指數(shù)（-5° 至 10°）和交叉征比值（<20%）。
術(shù)前（70.1° ± 4.8°）、1天（71.7° ± 4.3°；P < 0.001）和術(shù)后早期SFP（70.6° ± 4.7°；P = 0.004）之間存在顯著差異。
術(shù)前和術(shù)后1年之間的SPF差異為-0.5° ± 3.1°（P = 0.043），9%的病例差異>5°。
SFP的差異與年齡、性別、體重指數(shù)、發(fā)育不良類型或?qū)崿F(xiàn)最佳髖臼矯正度無(wú)關(guān)（P = 0.1-0.9）。
在術(shù)后早期，PT會(huì)減小，導(dǎo)致髖臼相對(duì)后傾，這種后傾會(huì)逐漸糾正，并通過(guò)每年的隨訪恢復(fù)。PAO期間PT的變化程度不會(huì)對(duì)骨折塊方向產(chǎn)生不利影響。大多數(shù)接受PAO治療的患者PT不會(huì)發(fā)生明顯變化，因此似乎不是一種代償機(jī)制。
圖1 矢狀位骨盆傾斜(PT)的差異；PT減小導(dǎo)致骨盆在矢狀面前旋，減小髖臼傾斜角度（a），而PT增大導(dǎo)致骨盆在矢狀面后旋，增大髖臼傾斜角度（b）。
圖2 隨訪期間不同時(shí)間間隔的骶骨-股骨-恥骨(SFP)角測(cè)量值。
圖3 PAO截骨患者在術(shù)前、術(shù)中和術(shù)后不同時(shí)間點(diǎn)的SFB角。
圖4 術(shù)后1天SFB角變化與術(shù)前值相比大于5°的髖關(guān)節(jié)。
圖5 術(shù)后1年SFB角變化與術(shù)前值相比大于5°的髖關(guān)節(jié)。
Does pelvic tilt change with a peri-acetabular osteotomy?
Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°-40°), acetabular index (-5° to 10°) and cross-over ratio (<20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P < 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was -0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of >5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1-0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.
文獻(xiàn)出處：Jeroen C F Verhaegen, Emin Süha Dedeo?ullar?, Isabel S Horton, Paul E Beaulé, George Grammatopoulos. Does pelvic tilt change with a peri-acetabular osteotomy? J Hip Preserv Surg. 2023 Sep 9;10(3-4):204-213. doi: 10.1093/jhps/hnad029. eCollection 2023 Aug-Dec.
文獻(xiàn)6
微創(chuàng)壞死骨沖洗技術(shù)促進(jìn)股骨頭缺血性壞死后的骨愈合：基于幼豬模型的實(shí)驗(yàn)研究
譯者 邱興
背景： 股骨頭缺血性壞死可致骨髓腔內(nèi)積聚壞死細(xì)胞碎片及炎性因子，引發(fā)慢性炎癥性修復(fù)反應(yīng)。本研究旨在通過(guò)幼豬模型探究沖洗清除壞死細(xì)胞碎片與炎性蛋白對(duì)骨修復(fù)的影響。
方法: 對(duì)12頭幼豬右后肢股骨頸實(shí)施結(jié)扎術(shù)誘導(dǎo)股骨頭壞死。術(shù)后1周，6頭實(shí)驗(yàn)組動(dòng)物接受經(jīng)皮三針骨沖洗術(shù)（單側(cè)股骨頭總沖洗量450 mL）聯(lián)合右后肢免負(fù)重治療（沖洗組），術(shù)中連續(xù)收集沖洗液進(jìn)行分析；另6頭僅接受免負(fù)重治療（免負(fù)重組）。術(shù)后8周通過(guò)影像學(xué)、顯微CT及組織學(xué)評(píng)估骨修復(fù)，并與既往發(fā)表的6例接受多針骨骺鉆孔術(shù)（MED組）聯(lián)合免負(fù)重（未行骨沖洗）的研究數(shù)據(jù)進(jìn)行對(duì)比。
結(jié)果: 缺血誘導(dǎo)1周后，骨沖洗液中檢出壞死細(xì)胞及炎性蛋白。隨著沖洗進(jìn)程，沖洗液內(nèi)蛋白質(zhì)與甘油三酯濃度顯著降低（p < 0.005）。術(shù)后8周，沖洗組骨體積顯著高于MED組及免負(fù)重組（p < 0.0001）。組織學(xué)分析顯示，沖洗組骨形成指標(biāo)較MED組（p = 0.002）和免負(fù)重組（p < 0.0001）顯著提升，且巨噬細(xì)胞數(shù)量明顯減少。
結(jié)論: 經(jīng)皮三針沖洗術(shù)可有效清除壞死股骨頭內(nèi)的細(xì)胞碎片及炎性蛋白，減少破骨細(xì)胞與巨噬細(xì)胞浸潤(rùn)，促進(jìn)缺血性骨壞死后的骨形成。
臨床意義: 本研究首次驗(yàn)證了通過(guò)壞死骨沖洗改善骨愈合的創(chuàng)新理念。該微創(chuàng)技術(shù)為優(yōu)化缺血性骨壞死后的局部微環(huán)境及促進(jìn)骨修復(fù)提供了潛在治療策略。
Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs
Background: Ischemic osteonecrosis of the femoral head produces necrotic cell debris and inflammatory molecules in the marrow space, which elicit a chronic inflammatory repair response. The purpose of this study was to determine the effects of flushing out the necrotic cell debris and inflammatory proteins on bone repair in a piglet model of ischemic osteonecrosis.
Methods: Osteonecrosis of the femoral head of the right hindlimb was induced in 12 piglets by tying a ligature tightly around the femoral neck. One week after the surgery, 6 animals were treated with a percutaneous 3-needle bone washing procedure and non-weight-bearing (NWB) of the right hindlimb (wash group). The total saline solution wash volume was 450 mL per femoral head. Serial wash solutions were collected and analyzed. The remaining 6 animals were treated with NWB only (NWB group). At 8 weeks after the surgery, the femoral heads were assessed using radiography, micro-computed tomography (micro-CT), and histological analysis. In addition, we compared the results for these piglets with our published results for 6 piglets treated with multiple epiphyseal drilling (MED) plus NWB without bone washing (MED group).
Results: Necrotic cells and inflammatory proteins were present in the bone wash solution collected 1 week after ischemia induction. The protein and triglyceride concentrations decreased significantly with subsequent washing (p < 0.005). At 8 weeks after ischemia induction, the wash group had a significantly higher bone volume than the MED or NWB group (p < 0.0001). Histological bone-formation measures were also significantly increased in the wash group compared with the MED group (p = 0.002) or NWB group (p < 0.0001) while macrophage numbers were significantly decreased in the wash group.
Conclusions: The percutaneous 3-needle procedure flushed out cell debris and inflammatory proteins from the necrotic femoral heads, decreased osteoclasts and macrophages, and increased bone formation following induction of ischemic osteonecrosis.
Clinical relevance: We believe that this is the first study to investigate the concept of washing out the necrotic femoral head to improve bone healing. The minimally invasive procedure may be useful to improve the necrotic bone environment and bone repair following ischemic osteonecrosis.
文獻(xiàn)出處：Kim HKW, Park MS, Alves do Monte F, Gokani V, Aruwajoye OO, Ren Y. Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs. J Bone Joint Surg Am. 2021 Jul 7;103(13):1193-1202. doi: 10.2106/JBJS.20.00578. PMID: 33877059.
文獻(xiàn)7
髖臼周圍截骨術(shù)后臨界髖關(guān)節(jié)發(fā)育不良患者的結(jié)局和恢復(fù)運(yùn)動(dòng)率：5 年隨訪的病例系列
譯者 陳志強(qiáng)
背景：臨界髖關(guān)節(jié)發(fā)育不良（BDDH）患者的最佳手術(shù)方法仍存在爭(zhēng)議。髖關(guān)節(jié)鏡檢查和髖臼周圍截骨術(shù)（PAO）都通常用于該患者群體。參加體育運(yùn)動(dòng)的人希望在手術(shù)后恢復(fù)并維持體育活動(dòng)，而這種能力在治療方法的選擇中起著重要作用。據(jù)我們所知，之前沒(méi)有研究評(píng)估過(guò)PAO后BDDH患者的恢復(fù)運(yùn)動(dòng)率和活動(dòng)水平。
目的：根據(jù)加利福尼亞大學(xué)洛杉磯分校（UCLA）的活動(dòng)量表以及患者報(bào)告的結(jié)果指標(biāo)，評(píng)估換著重返運(yùn)動(dòng)場(chǎng)的比率和術(shù)后活動(dòng)水平。同時(shí)從定性和定量?jī)煞矫嬖u(píng)估運(yùn)動(dòng)量的變化以及造成這些變化的根本原因。
方法：我們對(duì)2015年1月至 2017年 6月期間接受PAO 的 52 例 BDDH患者的55個(gè)髖關(guān)節(jié)的前瞻性數(shù)據(jù)進(jìn)行了回顧性分析。記錄恢復(fù)運(yùn)動(dòng)率、UCLA 活動(dòng)評(píng)分、國(guó)際髖關(guān)節(jié)結(jié)果工具-12評(píng)分、主觀髖關(guān)節(jié)評(píng)分、髖關(guān)節(jié)殘疾和骨關(guān)節(jié)炎結(jié)果評(píng)分子評(píng)分、運(yùn)動(dòng)活動(dòng)、體育活動(dòng)的頻率和持續(xù)時(shí)間、術(shù)后變化以及根本原因。
結(jié)果：平均隨訪時(shí)間為 62.8 ± 9.0 個(gè)月。術(shù)前活躍患者的恢復(fù)運(yùn)動(dòng)率為 92.5%。大多數(shù)患者在6個(gè)月（50%）或3至6個(gè)月后（37.5%）恢復(fù)體育活動(dòng)。UCLA活動(dòng)評(píng)分顯著提高（從 5.2 ± 2.4 提高到 7.0 ± 1.8;P < .001）。國(guó)際髖關(guān)節(jié)結(jié)果工具-12 、主觀髖關(guān)節(jié)值評(píng)分、髖關(guān)節(jié)殘疾和骨關(guān)節(jié)炎結(jié)果評(píng)分也顯著提高（全部，P < .001）。PAO 后 34.5% 的病例發(fā)生體育活動(dòng)變化。34.5%的病例在 PAO 后改變了體育活動(dòng)。術(shù)后從事低強(qiáng)度運(yùn)動(dòng)的患者明顯增多。參與高強(qiáng)度運(yùn)動(dòng)的人數(shù)沒(méi)有明顯減少。變化的原因既有與髖關(guān)節(jié)相關(guān)的，也有與髖關(guān)節(jié)無(wú)關(guān)的。從數(shù)量上看，患者的運(yùn)動(dòng)頻率（P = .007）和持續(xù)時(shí)間（P = .007）都有明顯增加。
結(jié)論：PAO 后BDDH患者的恢復(fù)運(yùn)動(dòng)率高達(dá) 92% 以上。大多數(shù)患者在 6 個(gè)月或 3 至 6 個(gè)月后恢復(fù)運(yùn)動(dòng)?？傮w而言，PAO 后活動(dòng)水平和髖關(guān)節(jié)功能有所改善。一些患者在 PAO 后調(diào)整了他們的運(yùn)動(dòng)活動(dòng)。雖然更多的患者參與了低強(qiáng)度運(yùn)動(dòng)，但術(shù)后仍堅(jiān)持參與高強(qiáng)度運(yùn)動(dòng)。這項(xiàng)研究的結(jié)果可能有助于患者和骨科醫(yī)生在BDDH的情況下決定最佳的手術(shù)方法。
Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up
Background:The optimal surgical approach in patients with borderline hip dysplasia (BHD) remains controversial. Both hip arthroscopy and periacetabular osteotomy (PAO) are commonly employed in this patient population. Those who participate in sports want to resume and maintain sports activities after surgery, and the ability to do so plays an important role in the choice of a treatment method. To our knowledge, no previous study has assessed return-to-sports rates and activity levels in patients with BHD after PAO.
Purpose:To assess return-to-sports rates and postoperative activity levels as measured by the University of California, Los Angeles (UCLA), activity scale as well as patient-reported outcome measures. Also to assess changes in sports activity both qualitatively and quantitatively as well as underlying reasons for these changes.
Methods:We conducted a retrospective analysis of prospectively collected data from 55 hips in 52 patients with BHD who underwent PAO between January 2015 and June 2017. Return-to-sports rates, UCLA activity scores, International Hip Outcome Tool–12 scores, Subjective Hip Value scores, Hip disability and Osteoarthritis Outcome Score subscores, sports practiced, frequency and duration of sports activity, and postoperative changes as well as underlying reasons were recorded.
Results:The mean follow-up was 62.8 ± 9.0 months. The return-to-sports rate among preoperatively active patients was 92.5%. Most patients resumed sports activity after 6 months (50%) or after 3 to 6 months (37.5%). The UCLA activity score improved significantly (from 5.2 ± 2.4 to 7.0 ± 1.8; P < .001). The International Hip Outcome Tool-12, Subjective Hip Value, and Hip disability and Osteoarthritis Outcome Score scores also improved significantly (all, P < .001). Changes in sports activity occurred in 34.5% of cases after PAO. Significantly more patients engaged in low-impact sports postoperatively. Participation in high-impact sports did not decrease significantly. Reasons for changes were both hip related and non–hip related. Quantitatively, patients were able to significantly increase both the frequency (P = .007) and duration (P = .007) of sports activity.
Conclusion:The return-to-sports rate in patients with BHD after PAO was high at over 92%. Most patients returned to sports after a period of 6 months or 3 to 6 months. Overall, activity levels and hip function improved after PAO. A number of patients adjusted their sports activity after PAO. Although more patients engaged in low-impact sports, participation in high-impact sports was maintained postoperatively. The results of this study may help both patients and orthopaedic surgeons in deciding on the best surgical procedure in the setting of BHD.
文獻(xiàn)出處：Leopold VJ, Szarek A, Hipfl C, B?rtl S, Perka C, Hardt S. Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up. Am J Sports Med. 2024 Feb;52(2):383-389. doi: 10.1177/03635465231217736.
文獻(xiàn)8
關(guān)節(jié)鏡下減壓及盂唇修復(fù)術(shù)治髖關(guān)節(jié)旁囊腫
譯者 徐子茵
在股骨髖臼撞擊的情況下，盂唇囊腫是有充分證據(jù)的后遺癥。這些囊腫通常與由CAM和/或鉗型骨病變引起的盂唇損傷有關(guān)?；ひ和ㄟ^(guò)盂唇處的撕裂滲出，類似腘窩囊腫，導(dǎo)致囊腫的形成，通常是自限性的。很少有文獻(xiàn)記載的囊腫壓迫附近神經(jīng)血管結(jié)構(gòu)的病例存在。有幾項(xiàng)研究記錄了關(guān)節(jié)鏡下對(duì)這些囊腫的減壓，但沒(méi)有報(bào)道囊腫壓迫股靜脈導(dǎo)致深靜脈血栓形成。我們的病例是，一個(gè)大的前側(cè)囊腫導(dǎo)致壓迫右股靜脈受壓，病人表現(xiàn)為深靜脈血栓形成和髖關(guān)節(jié)疼痛。治療包括關(guān)節(jié)鏡下減壓，然后盂唇修復(fù)和髖關(guān)節(jié)成形術(shù)后，再行介入穿刺抽吸。本病例報(bào)告的目的是記錄這種罕見(jiàn)的表現(xiàn)，并從我們的經(jīng)驗(yàn)中提供學(xué)習(xí)點(diǎn)。
圖1.右側(cè)腹股溝診斷性超聲圖像顯示股總靜脈閉塞性深靜脈血栓形成，鄰近一個(gè)大的低回聲腫塊。
圖2.右腹股溝帶標(biāo)記的橫切面US圖像顯示一個(gè)大的低回聲腫塊，引起股總靜脈與大隱靜脈的連接處的腫塊效應(yīng)。
圖6.右髖關(guān)節(jié)軸向t2加權(quán)MRI顯示盂唇撕裂伴盂唇旁囊腫并壓迫股神經(jīng)血管束。
Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair
In the setting of femoroacetabular impingement of the hip joint, paralabral cysts are well-documented sequelae. These cysts are typically associated with labral tears caused by CAM and/or pincer-type bony lesions. Synovial fluid extravasation through a tear in the labrum, similar to a popliteus cyst, leads to formation of a capsular-based cyst that is usually self-limiting. Few documented cases of these cysts causing compression of nearby neurovascular structures exist. There are several studies documenting arthroscopic decompression of these cysts, but none reporting compression of the femoral vein by a paralabral cyst resulting in deep vein thrombosis. We present the case of a large anterior paralabral cyst causing compression of the right femoral vein in a patient presenting with deep vein thrombosis and hip pain. Treatment consisted of arthroscopic decompression, followed by definitive aspiration by interventional radiology after labral repair and bipolar hip osteoplasty. The purpose of this case report was to document this rare presentation and offer learning points from our experience.
文獻(xiàn)出處：Goodwin TM, White CC, Wetzler A, Cincere BA. Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair. J Am Acad Orthop Surg Glob Res Rev. 2024 Jan 24;8(1):e23.00178. doi: 10.5435/JAAOSGlobal-D-23-00178. PMID: 38265245; PMCID: PMC10807876.
來(lái)源：304關(guān)節(jié)學(xué)術(shù)
作者：304關(guān)節(jié)團(tuán)隊(duì)
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