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本期目录： 1、用于诊断慢性假体周围感染的实验室检查可以预测二期翻修术的效果 2、初次髋关节置换术中股骨球头的使用情况 3、人工关节置换术后血糖值波动升高与负性反应增多相关 4、带血管蒂骨移植治疗非创伤性股骨头坏死：5-11年随访 5、治疗股髋撞击手术中行软骨游离瓣下钻孔降低全髋关节置换的风险——超过5年随访 6、髋关节镜下髂前下棘成形不会影响术后的肌肉力量 7、髋关节反复后脱位的手术治疗 第一部分：关节置换相关文献 文献1 用于诊断慢性假体周围感染的实验室检查可以预测二期翻修术的效果 译者：张轶超 背景：尽管二期翻修术对于治疗慢性假体周围感染（PJI）是个非常有效的方法，但是成功率却有很大差别。本研究的目的是检验诊断慢性假体周围感染的指标是否也能被用于预测二期翻修的失败风险。 方法：我们收集了来自于4个单位的205名由于全膝或髋置换术后假体周围感染行二期翻修手术的患者。通过医学记录收集了他们的一般情况，手术情况和实验室检查。实验室检查值包括血沉（ESR），血清C反应蛋白（CRP），关节液白细胞计数和中性粒细胞百分比，关节液和/或组织培养，以及革兰氏染色。对于因感染复发而再次行翻修手术的病例被认为是二期翻修手术失败。比较两组间的一般情况，手术情况和实验室检查指标。通过受试者工作特征曲线（ROC）来确定有意义的实验室指标的阈值。 结果：总体看二期翻修的失败率为27.3%。感染复发的病例的术前血沉(p=0.035)、关节液白细胞计数(p=0.008)及中性粒细胞百分比(p=0.041)都明显高于二期翻修成功的病例。ROC曲线分析结果显示关节液白细胞计数的阈值为>60,000个/μL ，关节液中性粒细胞百分比>92%，血沉>99mm/小时。二期翻修失败的病例术前关节液白细胞计数比成功的病例增高2.5倍，关节液中性粒细胞百分比高2倍，血沉高1.8倍。 结论：我们的结果证明了二期翻修失败的病例术前的关节液白细胞计数>60,000个/μL ，关节液中性粒细胞百分比>92%，血沉>99mm/小时。实验室指标比成功的高1.8到2.5倍。这个数据可以给临床提供术前预测二期翻修手术失败风险。 Laboratory Tests for Diagnosis of Chronic Periprosthetic Joint Infection Can Help Predict Outcomes of Two-Stage Exchange BACKGROUND: Although 2-stage exchange arthroplasty is the most effective treatment among available strategies for managing chronic periprosthetic joint infection (PJI), rates of its success vary greatly. The purpose of our study was to examine whether objective measurements collected at the time of the diagnosis of PJI could be used to identify patients at risk of failure of 2-stage exchange. METHODS: We identified 205 patients across 4 institutions who underwent 2-stage exchange arthroplasty for the treatment of PJI following total hip or total knee arthroplasty. Demographic, surgical, and laboratory data were obtained for each patient from their medical chart. Laboratory values included serum erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) level, synovial fluid white blood-cell (WBC) count and neutrophil percentage, synovial fluid and/or tissue culture, and Gram stain. Patients who underwent revision surgery for recurrent infection were considered to have failed the 2-stage procedure. Demographic, surgical, and laboratory variables were compared between the 2 groups. Receiver operating characteristic (ROC) curves were constructed to determine threshold cutoffs for significant laboratory values. Risk ratios and 95% confidence intervals were calculated. RESULTS: Overall, 2-stage exchange was unsuccessful for 27.3% of the patients. Preoperative serum ESR (p = 0.035) and synovial fluid WBC count (p = 0.008) and neutrophil percentage (p = 0.041) were greater in patients with recurrent infection. ROC curve analysis revealed a threshold of >60,000 cells/μL for synovial fluid WBC count, >92% for synovial fluid WBC neutrophil percentage, and >99 mm/hr for serum ESR. Failure of 2-stage exchange was 2.5 times more likely for patients with an elevated preoperative synovial fluid WBC count, 2.0 times more likely for those with an elevated preoperative synovial fluid WBC neutrophil percentage, and 1.8 times more likely for those with an elevated preoperative serum ESR. CONCLUSIONS: Our results demonstrated that a greater number of patients in whom 2-stage exchange arthroplasty ultimately failed had a preoperative synovial fluid WBC count of >60,000 cells/μL, a synovial fluid WBC neutrophil percentage of >92%, or a serum ESR of >99 mm/hr. Patients with elevated laboratory values had 1.8 to 2.5 times the risk of treatment failure. These data can serve as a clinical guideline to identify patients most at risk for failure of 2-stage exchange. 文献出处：Dwyer MK, Damsgaard C, Wadibia J, et al. Laboratory Tests for Diagnosis of Chronic Periprosthetic Joint Infection Can Help Predict Outcomes of Two-Stage Exchange. J Bone Joint Surg Am. 2018 Jun 20;100(12):1009-1015. 文献2 初次髋关节置换术中股骨球头的使用情况 译者：马云青 1. 过去10年中，大直径球头在全髋关节置换术(THA)中的使用有所增加；参考几个较大的关节置换术登记处的报告，32 mm和36 mm是最常用的股骨头大小。 2. 使用大直径球头是增加髋关节稳定性和减少髋关节使用寿命（减少聚乙烯厚度）间的一种平衡。 3. 通过文献回顾（主要集中在过去5年），确定了在THA中使用更大的球头的好处和并发症。我们发现，当使用>36 mm的球头时，髋关节活动范围或髋关节功能没有明显提高。 4. 36 mm或更大直径球头因脱位而导致翻修的风险明显低于28 mm或更小的球头，甚至是32 mm球头。 5. 金属对交联聚乙烯(MoXLPE)THA中大于32mm球头比32 mm或更小球头的容积摩擦和摩擦扭矩更高。而在陶瓷对交联聚乙烯(CoXLPE)THA中并没有这种现象。 6. 32mm球头MoXLPE摩擦界面的THA长期假体生存率比较大和较小的球头都高。 7. 如果使用MoXLPE界面，我们建议使用32mm的球头。在使用较大球头的髋关节病例上，使用陶瓷头更安全。 不同国家地区髋关节假体股骨头直径分布 不同国家地区髋关节假体摩擦界面选择分布 Head size in primary total hip arthroplasty 1．The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries. 2．The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship. 3．We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA. 4．We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used. 5．The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm. 6．Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE). 7. Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones. We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer. 文献出处：Tsikandylakis G, Mohaddes M, Cnudde P, Eskelinen A, Kärrholm J, Rolfson O. Head size in primary total hip arthroplasty. EFORT Open Rev. 2018 May 21;3(5):225-231. doi: 10.1302/2058-5241.3.170061. eCollection 2018 May. 文献3 人工关节置换术后血糖值波动升高与负性反应增多相关 译者：张蔷 背景：既往研究显示：住院期间，非骨科手术后患者住院时间延长、死亡率升高与血糖值波动升高相关。本研究的目的是调查人工关节置换术后患者血糖值波动与术后并发症的相关性。 方法：2001年至2017年间，单一医疗中心共21487例全膝、全髋置换术病例入组。入组标准为术后每天至少测2次血糖值或总共测3次以上血糖值。血糖值波动水平通过变异系数表示。负性反应包括住院时间延长、90天死亡率、再手术率、假体周围感染和手术切口感染。假体周围感染的诊断通过肌骨感染协会标准（MSIS）确定。 结果：最终组里包括2360例全髋置换患者和2698例全膝置换患者，其中1007人有糖尿病。血糖值波动升高与住院时间延长、90天死亡率升高、假体周围感染和手术切口感染率升高相关。分析显示：血糖值变异系数每增高10%，住院时间延长6.1% (95% confidence interval[CI], 5.1% to 7.2%; p < 0.001)，死亡率升高26% (odds ratio[OR] = 1.26, 95% CI = 0.98 to 1.61; p = 0.07)，假体周围感染和手术切口感染风险分别增高20% (OR = 1.20, 95% CI = 1.02 to 1.41; p = 0.03)和14% (OR = 1.14, 95% CI = 1.00 to 1.31; p = 0.06)。手术时间、年龄、BMI、Elixhauser合并症指数、糖尿病诊断、住院期间应用胰岛素或激素和住院期间平均血糖水平并不影响本研究相关性。 结论：术后血糖值波动升高与假体周围感染和手术切口感染率升高相关，并可以作为全髋、全膝置换术后死亡率的预测因素。因此，我们应尽力控制术后早期患者血糖值波动。在未来，相关研究的重点应放在对血糖值波动较大的患者进行持续血糖监测等方面。
Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty Background: Increased glucose variability during hospitalization has been associated with a longer length of stay in the hospital and a higher mortality rate following non-orthopedic surgical procedures. Our aim was to investigate the association between glucose variability and postoperative complications following total joint arthroplasty. Methods: We analyzed data on 21,487 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single center from 2001 to 2017. Patients with a minimum of 2 postoperative glucose values per day or > 3 values overall were included in the study. Glucose variability was assessed using a coefficient of variation. Adverse outcomes included an increased length of stay in the hospital, 90-day mortality, reoperations, periprosthetic joint infection, and surgical site infection. Periprosthetic joint infection was defined using the Musculoskeletal Infection Society criteria. Results: The final cohort included 2,360 patients who had undergone THA and 2,698 who had undergone TKA; 1,007 (19.9%) had diabetes. Higher glycemic variability was associated with an increased length of stay, 90-day mortality, periprosthetic joint infection, and surgical site infection. Adjusted analysis indicated that for every 10-percentage-point increase in the coefficient of variation, the length of stay increased by 6.1% (95% confidence interval [CI], 5.1% to 7.2%; p < 0.001), the risk of mortality increased by 26% (odds ratio [OR] = 1.26, 95% CI = 0.98 to 1.61; p = 0.07), and the risks of periprosthetic joint infection and surgical site infection increased by 20% (OR = 1.20, 95% CI = 1.02 to 1.41; p = 0.03) and 14% (OR = 1.14, 95% CI = 1.00 to 1.31; p = 0.06), respectively. These associations were independent of the year of surgery, age, body mass index, Elixhauser comorbidity index, diagnosis of diabetes, in-hospital use of insulin or steroids, and mean glucose values during hospitalization. Conclusions: Higher glucose variability in the postoperative period is associated with increased rates of surgical site and Periprosthetic joint infections and may be a useful predictor of the risk of mortality following THA and TKA. Efforts should be made to control the glucose variability in the early postoperative period, and future studies should examine the role of continuous glucose monitoring in a subset of patients with high glucose fluctuations. 文献出处：Noam Shohat, Camilo Restrepo, Arash Allierezaie, et al. Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty. J Bone Joint Surg Am. 2018; 100:1110-7 第二部分：保髋相关文献 文献1 带血管蒂骨移植治疗非创伤性股骨头坏死：5-11年随访 译者：罗殿中 我们研究了26例（31髋）股骨头坏死患者，其中非创伤性股骨头坏死20例，激素性股骨头坏死6例，所有患者均通过带血管蒂髂骨移植术治疗。所有患者平均手术年龄为38.3岁。性别组成：女性3例，男性23例。术后平均随访时间为8年。患者Harris评分由术前平均62分提高到末次随访时平均83分。1例患者因术后股骨头塌陷行人工关节置换术。末次随访时，19髋（63%）临床预后被评定为好/非常好，4髋评定为一般，7髋评定为较差。末次随访时，术前股骨头坏死Inoue及Ono分期II期27髋中的15髋（56%）术后出现了股骨头进行性塌陷。在激素性股骨头坏死患者中，3位女患者4髋中的2髋术后临床效果较差。此研究中接受带血管蒂骨移植患者的临床预后仅轻微优于接受髓芯减压术的文献报道，并不优于那些接受骨减压结合单纯打压植骨（用不带血管的骨支撑软骨下骨）的患者。我们的结论是：带血管蒂骨移植术适用于某些早期未发生股骨头塌陷的非创伤性股骨头坏死患者。 A．髂骨取骨，保留旋髂浅动脉及静脉，有8髋应用了旋髂深动脉及静脉；B. 做足够大的骨隧道，植入髂骨骨块，血管蒂与股动静脉吻合 35岁男性患者不同时期右髋关节冠状位MRI A. 术前 B. 术后6个月 C. 术后18个月 28岁男性酒精性双侧股骨头坏死 A. 术前骨盆A-P位X线片，左髋日本股骨头坏死研究学会分型I-C型，Inoue及Ono分期II期，右髋关节无症状 B.双髋术前蛙式位 C. 左髋术后11年进展为III-A型，右髋术后9年进展为III-B型 D. 末次随访时双髋蛙式位 Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head：A 5- to 11-year follow-up We investigated the results of 31 hips in 26 patients with nontraumatic (n = 20) and steroid-induced (n = 6) avascular necrosis of the femoral head (ANFH) treated with vascularized iliac pedicle bone graft (PBG). The average age at operation was 38.3 years. Three were women and 23 men. The average follow-up was 8.0 years. The Harris hip score prior to operation and at latest follow-up improved from 62 to 83; one hip collapsed and was revised with a bipolar endoprosthesis. At the final follow-up, 19 hips (63%) were clinically rated as good to excellent, 4 fair, and 7 poor. At the final follow-up, 15 of 27 hips (56%) of stage II before operation showed progressive collapse after bone grafting. In steroid-induced ANFH, in three women, 2 of 4 hips showed poor results. These results are only slightly better than those of core decompression and no better than those obtained after decompression and simple nonvascularized grafts to provide support for the subchondral bone. We concluded that vascularized PBG is sometimes indicated for ANFH in an early stage before collapse of the femoral head. 文献出处：Hasegawa Y, Iwata H, Torii S, Iwase T, Kawamoto K, Iwasada S. Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head. A 5- to 11-year follow-up. Arch Orthop Trauma Surg. 1997;116(5):251-8. 文献2 治疗股髋撞击手术中行软骨游离瓣下钻孔降低全髋关节置换的风险——超过5年随访 译者：程徽 介绍：股髋撞击（FAI）手术中，如何很好的处理髋臼软骨瓣目前尚不明确。我们希望明确软骨下钻孔是否可以改善临床和影像学结果，以及是否存在可以预测手术失败的因素。 方法：在2000年1月至2007年12月期间，使用髋关节外科脱位技术治疗了79例有症状的FAI伴有髋臼游离软骨瓣的患者。除外既往髋关节病史和创伤史，本研究纳入62例患者（80髋）。43例患者/ 51髋（对照组）中，软骨瓣仅仅进行了轻微的修整。在28例患者/ 29髋（研究组）中，术中同时进行软骨瓣下钻孔。失访4例（5髋，6％）。平均随访时间为9年（5-13年）。两组患者在人口统计学数据，放射学参数或随访情况方面无显著差异。使用Merle d'Aubigné评分，改良Harris髋关节评分，和加州大学洛杉矶分校活动评分评估临床结果；使用Tönnis分级评价骨关节炎进展情况。 结果：在随访中，对照组的7例患者（8髋，16％）最终接受终行全髋关节置换术（THA），而钻孔治疗组没有患者进行置换（p = 0.005）。在未行置换的髋关节中，两组间临床评分和Tönnis分级的进展没有差异。过大的髋臼覆盖率，年龄和体重指数，是导致关节置换的单变量预测因素。没有钻孔，也是导致关节置换的独立预测因素（风险比58.07，p = 0.009）。 结论：在手术治疗FAI中，髋臼软骨瓣下的钻孔可以降低后期行关节置换的概率。 Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up INTRODUCTION: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. METHODS: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5-13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d'Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. RESULTS: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group (p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). CONCLUSION: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA. 文献出处：Haefeli PC, Tannast M, Beck M, Siebenrock KA, Büchler L. Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up. Hip Int. 2018 Jun 1:1120700018781807. 文献3 髋关节镜下髂前下棘成形不会影响术后的肌肉力量 译者：肖凯 目的：本研究的目的是评估髋关节镜下髂前下棘（AIIS）成形术后是否会影响伸膝肌肉及屈髋肌肉力量；比较进行或不进行髂前下棘成形术的FAI患者术后的功能情况。 方法：本研究纳入60例接受髋关节镜手术治疗的FAI患者，根据患者髂前下棘形态不同分为两组。其中31例（FAI组）单纯进行关节镜下FAI处理，不进行髂前下棘成形，髂前下棘分型：I型5例，II型26例，III型0例。另外29例（AIIS组）除了进行关节镜下FAI处理，同时进行髂前下棘成形，髂前下棘分型：I型5例，II型24例，III型0例。术前及术后6个月对伸膝肌肉力量及屈髋肌肉力量进行测试。术前及术后6个月要求患者完成自我评分量表，包括改良Harris髋关节评分、非骨关节炎髋关节评分、iHOT-12评分。 结果：两组患者间术前及术后6个月的伸膝肌肉力量间均无明显差异。AIIS组患者术后屈髋肌肉力量较术前明显提高（p <0.05），而FAI组术后肌肉力量较术前无明显改善。两组患者术前及术后改良Harris髋关节评分及非骨关节炎髋关节评分均无明显差异。但是，AIIS组患者术后iHOT评分较FAI组高（p <0.01）。AIIS组患者再手术率明显低于FAI组（p <0.05）。 左、中、右分别为术前、初次术后、翻修术后髋关节CT三位重建影像，初次手术未处理髂前下棘，翻修术后，髂前下棘突出部分明显变小 结论：髂前下棘成形术作为关节镜下治疗FAI的一部分，可以降低再手术的概率，并且不会影响伸膝肌肉及屈髋肌肉力量。相比FAI组，AIIS组患者手术预后更好。对于FAI患者，同时进行髂前下棘成形术可以改善术后患者自我评分结果，并且不影响屈髋及伸膝肌肉力量。 Arthroscopic anterior inferior iliac spine decompression does not alter postoperative muscle strength PURPOSE: The purpose of this study was to assess the additional effect of anterior inferior iliac spine (AIIS) decompression on knee extensor and hip flexor strength and compare functional outcomes after arthroscopic FAI correction with and without AIIS decompression. METHODS: Sixty patients who underwent arthroscopic FAI correction surgery were divided into two groups matched for AIIS morphology: 31 patients who underwent arthroscopic FAI surgery only (without AIIS decompression) (FAI group) (AIIS Type I; n = 5, Type II; n = 26, Type III; n = 0) and 29 patients who underwent arthroscopic FAI surgery with AIIS decompression (AIIS group) (AIIS Type I; n = 5, Type II; n = 24, Type III; n = 0). Knee extensor and hip flexor strength were evaluated preoperatively and at 6 months after surgery. Patient-reported outcome (PRO) scores using the modified Harris hip score (MHHS), the nonarthritic hip score (NAHS) and iHOT-12 were obtained preoperatively and at 6 months after surgery. RESULTS: In the AIIS group, there was no significant difference between knee extensor strength pre- and postoperatively (n.s.). In the AIIS group, hip flexor strength was significantly improved postoperatively compared to preoperative measures (p < 0.05). In the FAI group, there were no significant improvements regarding muscle strength (n.s.). While there were no significant differences of preoperative and postoperative MHHS and NAHS between both groups (MHHS; n.s., NAHS; n.s.), the mean postoperative iHOT-12 in the FAI group was inferior to that in the AIIS group. (p < 0.01). The revision surgery rate for the AIIS group was significantly lower compared with that in the FAI group (p < 0.05). CONCLUSION: Anterior inferior iliac spine decompression, as a part of an arthroscopic FAI corrective procedure, had a lower revision surgery rate and did not compromise knee extensor and hip flexor strength, and it improved clinical outcomes comparable to FAI correction without AIIS decompression. AIIS decompression for FAI correction improved postoperative PRO scores without altering the muscle strength of hipflexor and knee extensor. 文献出处：Tateishi S, Onishi Y, Suzuki H, et al. Arthroscopic anterior inferior iliac spine decompression does not alter postoperative muscle strength. Knee Surg Sports Traumatol Arthrosc. 2018 Jun 28. 文献4 髋关节反复后脱位的手术治疗 译者：张振东 阿基米德曾经说过“给我一个支点，就可以撬动整个地球”，同样对于髋关节稳定性来讲，如果股骨近端与骨盆间存在支点，也可导致髋关节后脱位。对于无既往手术史的髋关节反复发生脱位，曾经被认为与严重系统性疾病或神经肌肉疾病有关，而忽视了髋关节结构本身的问题（图1）。而近年来研究表明这类髋关节脱位与髋关节撞击征和/或髋关节后倾相关。髋臼前壁高凸、股骨颈凸轮畸形及股骨颈前倾角小或后倾，均可以提供一个可以使髋关节后脱位的支点。 图1 男性，29岁，反复髋关节后脱位，有癫痫病史，但其每一次髋关节脱位均与癫痫无关 髋关节反复后脱位在临床上较为罕见，且对其治疗的长期报道更是少见，因此对于其治疗缺乏相关临床建议，Carlson BC等人总结了两个中心（美国Mayo Clinic以及瑞士SchulthessClinic）共计9例髋关节反复后脱位的患者治疗特点，对其手术疗效及影像学结果进行随访，结果报道于最新一期的JBJSAm杂志上。 该研究回顾性分析了9例接受保髋手术治疗的反复性髋关节后脱位的患者，术前患者脱位次数平均为3.2次（范围：1-7次）。使用骨盆X线测量评估髋臼及股骨近端形态，影像学测量是否存在髋关节撞击有助于选择合适的手术方式。手术方式包括股骨畸形纠正伴或不伴髋臼周围截骨术（图2）。 图2 反复髋关节后脱位患者的髋关节侧位（A）及正位（B）x线片，可见右侧髋臼后倾，后壁征（ ）、交叉征（ ），右侧股骨颈alpha角60度，存在凸轮畸形。C、D示髋臼周围截骨术纠正髋臼前倾角并结合股骨头颈部骨软骨成形术 结果显示，9例患者平均随访时间为73.8月（范围：10-192月），截至末次随访未出现一例髋关节再次脱位情况。因此对于反复髋关节脱位的患者，需明确是否存在解剖学异常造成的股骨近端与髋臼间的支点，据此可选择合适的手术治疗以避免再次脱位。
附 反复性髋关节后脱位的诊治原则 Modern Surgical Treatment of Recurrent Posterior Dislocation of the Native Hip BACKGROUND: Redislocation of the native hip is rare. An anterior fulcrum between the proximal part of the femur and the pelvis must be present for a posterior dislocation to occur. The purpose of this study is to describe the cases of 9 patients with posterior redislocation or recurrent subluxation of the native hip that was treated with hip preservation surgery. METHODS: We retrospectively identified the cases of 9 patients, from 2 institutions, who had undergone hip preservation surgery for the management of posterior redislocation or recurrent subluxation of the native hip after a dislocation. The mean number of dislocations prior to surgery was 3.2 (range, 1 to 7). Pelvic radiographs were used to classify the acetabular morphology, sufficiency of acetabular containment, and structural anatomy of the proximal part of the femur. Radiographic identification of impinging structures was used to guide surgical treatment, which involved either femoral correction alone or the combination of femoral correction and an anteverting periacetabular osteotomy. RESULTS: At a mean follow-up of 73.8 months (range, 10 to 192 months), there had been no subsequent episodes of dislocation or subluxation in any of the hips treated with correction of the anatomic pivot point. An algorithmic approach is presented. CONCLUSIONS: In patients who have episodes of redislocation or recurrent subluxation of the native hip, the identification of anatomic abnormalities that create a fulcrum between the proximal part of the femur and the pelvis is critical for making appropriate treatment decisions. 文献出处：Carlson BC, Desy NM, Johnson JD, Trousdale RT, Leunig M, Ganz R, Sierra RJ. Modern Surgical Treatment of Recurrent Posterior Dislocation of the Native Hip. J Bone Joint Surg Am. 2018 Jun 20;100(12):1056-1063. 张洪主任好大夫网站zhanghongmd.haodf.com 张洪主任门诊时间：周三上午 关节外科护士站：01066867304 转848810（请在14:00-18:00拨入） 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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