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关节置换相关文献 文献1 大于75岁内侧间室骨关节炎患者单髁置换和全膝置换的比较：再手术，翻修和并发症发生率 译者：张轶超 背景：既往的研究对比了老年人做单髁置换术（UKA）和全膝关节置换术（TKA）之间的效果，而这些研究大多是以关节疾病的种类和病人的情况作为比较分组的依据。我们的研究对象是大于75岁的单纯内侧间室骨关节炎患者，着重观察其术后短期恢复情况，并发症情况，再手术率及假体中期生存率。 方法：回顾了从2002年到2012年在我院完成的所有大于等于75岁的UKA和TKA患者。所有做了TKA的患者都由一位不知情的第三方医生对其术前X光片进行阅读，确定这些患者由于是内侧间室骨关节炎而适合行UKA手术。至少随访2年，屈曲挛缩超过10°及类风湿性关节炎除外。最终得到观察的有120例UKA（106名患者）和188例TKA（170名患者）。记录术后的恢复情况，并发症，各种原因的再手术情况及假体生存率。 结果：UKA患者的手术时间明显短，住院时间短，术中出血少，术后输血少，拥有更好的术后活动度，出院时活动水平更高。2名UKA患者及2名TKA患者需要进行翻修。两者术后膝关节协会评分没有明显差异。5年生存率两者间没有差异。 结论：相对TKA手术，由于UKA手术本身创伤小，所以对于大于75岁的老年人来说恢复更快，而并发症发生率和中期生存率没有差别。对于老年有适应证的患者，UKA是一个好的选择。 Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial CompartmentArthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and ComplicationRates BACKGROUND: Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperationrates, and implant survivorship at midterm follow-up. METHODS:A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritisconsidered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship. RESULTS: UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates. CONCLUSION: Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA. 文献出处：Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial CompartmentArthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and ComplicationRates. J Arthroplasty. 2017 Jun;32(6):1792-1797. 文献2 年龄对全髋关节或膝关节置换术后假体翻修风险的影响:基于大宗人群的队列研究 译者：马云青 背景：全髋和全膝关节置换是治疗髋关节和膝关节终末期骨关节炎的有效方法，并表现出明显的临床症状改善。但是，以人口为基础的终生假体翻修风险至今仍不能提供给患者加以参考，对于年轻患者来说这同样也是一个关于如何选择手术最佳年龄的问题。 方法：对所有在临床实践研究数据中接受过全髋关节置换术或全膝关节置换术的患者进行假体的生存分析。这些数据是根据国家统计局的全因死亡率数据进行分析的，并基于在患者接受初次手术的年龄增加时所形成的终身假体翻修风险。 结果：1991年1月1日至2011年8月10日期间，共63158名患者接受了全髋关节置换术，54276名患者接受了全膝关节置换术，并对这些患者进行了最长达20年的随访。在全髋关节置换术中，10年假体生存率为95·6% (95% CI 95·3-95·9)，20年生存率为85·0%(83·2-86·6)。全膝关节置换术10年假体生存率为96·1%(95·8-96·4)，20年存活率为89·7%(87·5 - 91·5)。70岁以上接受全髋关节置换术或全膝关节置换术的患者需要进行翻修手术的终生风险约为5%，性别间无差异。然而，对于年龄在70岁以下的患者，年龄较轻的患者终生假体翻修风险增加，50岁出头的男性高达35% (95% CI 30·9-39·1)，男性和女性患者之间存在较大差异(同年龄组的女性低15%)。60岁以下患者的中位翻修时间为4·4年。 说明：本研究应用新的方法对年轻的患者手术的重要性和髋膝关节置换术后的翻修风险进行了探讨并提出了新的见解。我们的证据对越来越多的年轻患者接受全髋关节置换术和全膝关节置换术的趋势提出了挑战，这些数据应该作为医患术前谈话决策过程的一部分提供给患者。 The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study Background: Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on besttiming for surgery. Methods: We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. Findings: We identified 63158 patients who had undergone total hip replacement and 54276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Interpretation: Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. 文献出处：Lee E Bayliss, David Culliford, A Paul Monk, Sion Glyn-Jones, Daniel Prieto-Alhambra, Andrew Judge, Cyrus Cooper, Andrew J Carr, Nigel K Arden, David J Beard, Andrew J Price. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017 Apr 8;389(10077):1424-1430. 文献3 经皮肤皱褶“比基尼”切口行直接前入路全髋关节置换术：一组964例2-4年随访对照性研究 译者：张蔷 目的：髋关节直接前方入路的常规纵行切口并不顺应皮肤线条，可导致伤口愈合障碍及欠佳的外观。本篇研究对比了直接前入路全髋关节置换术常规纵行切口与改良“比基尼”切口在瘢痕满意度、髋关节功能与影像学结果方面的差异。 方法：共964例患者（51%为女性；59%为纵行切口，41%为比基尼切口）完成的术后2-4年的随访问卷，包括Oxford髋关节评分（OHS）、北卡罗莱纳大学“4P”瘢痕评分（UNC4P）和两项评价瘢痕外观以及麻木症状的评分。同时评价指标还包括假体位置，异位骨化（HO）概率和翻修概率。 常规纵行切口与改良比基尼切口 切开后术野 纵形切口随访时瘢痕与比基尼切口随访时瘢痕 结果：两组间Oxford髋关节评分相似（p = 0.41）。比基尼切口组的平均UNC4P瘢痕评分稍好（p = 0.01），对切口瘢痕满意的患者比例也明显更高（p < 0.001）。纵行切口组患者报告切口麻木的比例更高（14.5%="" vs7.5%,="" p="">< 0.001）。髋臼假体外展角，股骨柄位置以及异位骨化概率在组间并无显著性差异。两组间翻修率无明显差异，纵行切口组为2.3%，比基尼切口组为1.5%（p=""> 结论：我们发现：使用短斜形“比基尼”皮肤皱褶切口进行直接前入路全髋关节置换是安全有效的，并不会影响假体的安放或增加股外侧皮神经损伤导致感觉异常的几率。尽管该切口瘢痕满意率较高，但其长度较短，术者应在熟悉常规纵行切口后再考虑使用比基尼切口。 保髋相关文献 文献1 股骨头外侧柱保留与股骨头坏死塌陷之间的关系 译者：罗殿中 对于股骨头坏死患者，一般很难预测股骨头是否会塌陷以及何时发生塌陷。本研究通过分析早期股骨头坏死患者核磁影像学资料，明确股骨头外侧柱保留与股骨头坏死塌陷之间的关系。于股骨头中冠状位断面上将股骨头分为3柱：外侧、中间及内侧柱（图1）。依据股骨头坏死位置，将股骨头坏死分为3型：I，坏死区位于内侧及中间柱，外侧柱未受累；II，坏死区累及部分外侧住；III，坏死区累及全部外侧柱（图2）。本研究中一组患者为ARCO分期1期，共87例（127髋），保守治疗并随访3-8年，随访6.2年；另一组亦为ARCO分期1期患者，包括42例（72髋），接受打压植骨术治疗，术后随访5-9年，平均7.1年。两组患者均可见外侧柱保留越多，塌陷发生率也越低。因此该研究证实了外侧柱的保留与股骨头塌陷与否相关，强调了外侧柱在股骨头坏死中的重要作用。 图1 股骨头中冠状位切面可见3柱：外侧住（L）占30%，中间柱（C）占40%，内侧柱（M）占30% 图2 A 坏死区仅累及内侧柱；B 坏死区累及内侧柱及中间柱；C 坏死区累及3柱，但外侧住部分保留；D坏死区累及全部外侧住及部分中间柱；E 坏死区累及全部3柱 图3 A MRI显示股骨头坏死区未累及外侧住，7年后CT可见未发生股骨头塌陷（B）；CMRI显示外侧住部分保留，4年后未发生股骨头塌陷（D）；E III型股骨头坏死，坏死区累及整个外侧柱，2年后可见股骨头塌陷（F） 图4 A 术前，右侧I型、左侧II型股骨头坏死；B 打压植骨术后7年，CT见股骨头无塌陷，髋关节功能正常；C术前，双髋III型股骨头坏死；D 打压植骨术后5年，右侧股骨头轮廓正常，左侧股骨头塌陷 Relationship between preservation of the lateral pillar and collapse of the femoral head inpatients with osteonecrosis It is difficult to predict if and when the femoral head will collapse and whether the collapse can be minimized. This study examined the final outcome of early-stage osteonecrosis of the femoral head (ONFH) using magnetic resonance imaging to verify the relationshipbetween preservation of the lateral pillar and collapse of the femoral head. A midcoronal section of the femoral head was divided into 3 pillars (medial, central, and lateral) on a T1-weighted image. According to the site of necrosis on the lateral pillar, the necrosis was divided into 3 types: I, the necrosis occupies the central and medial pillars, and the lateral pillar is preserved; II, the necrosis partially occupies the lateral pillar; and III, the necrosis totally occupies the lateral pillar. One group of 87 patients (127 hips) with Association for Research on Osseous Circulation (ARCO) stage I ONFH underwent nonoperative treatment and were followed for 3 to 8 years (average, 6.2 years). Another group of 42 patients (72 hips) with ARCO stage I ONFH underwent debridement and impacted bone graft and were followed for 5 to 9 years (average, 7.1 years). In both groups, the more preserved the lateral pillar, the less collapseoccurred. The authors concluded that whether ONFH progressed to collapse is determined by preservation of the lateral pillar. Thelateral pillar is the keystone for maintaining the sphere of the femoral head and its preservation. 文献出处：Sun W, Li ZR, Wang BL, Liu BL, Zhang QD, Guo WS. Relationship Between Preservation of the Lateral Pillar and Collapse of the Femoral Head in Patients With Osteonecrosis. Orthopedics. 2014 Jan;37(1):e24-8. 文献2 髋关节撞击综合征患者有哪些非手术治疗方式？（本文为对文献的概况总结） 译者：程徽 背景：在运动医学和骨科领域中，对患髋臼盂唇撞击综合征(FAI)病人最适宜的治疗方式有很多争议。最近的Warwick共识会议提出了三种针对FAI主要的治疗方式：保守治疗，物理治疗为主的康复治疗，和手术治疗[1]。目前大多数研究都致力于探索手术对于FAI的疗效，而非手术治疗策略的研究却不多[2]。 髋关节手术适应证：近日，Warwick共识会通过了关于FAI的指导诊断标准[1]。这些标准包括了症状、临床体征和影像学发现。但FAI的手术适应证还比较模糊[3]。一般认为髋关节损伤程度较重，存在早期关节软骨损伤，及严重的形态学异常的患者更适合选择手术治疗，非手术治疗失败是最重要的手术指征。（表1，实线）[4]然而，目前尚无成形的非手术治疗的具体措施。FAI患者非手术治疗应该包含各种保守治疗，包括：教育、活动运动方式的改变，理法为主的康复训练，以及在必要的情况下口服镇痛药[1]。在现有的研究中，较少文献明确将非手术治疗的失败作为髋关节手术治疗的指征 [3]。对已经达到手术指征的患者，是否必须尝试非手术治疗还不明确。此外，在上述非手术治疗失败作为手术指征的研究中，非手术治疗的具体手段缺乏具体的描述[3]。 手术与非手术治疗的对比：目前已有随机对照试验比较FAI的手术治疗和非手术治疗 [1]。这些研究中，采用非手术治疗方案作为对照组来评估髋关节手术治疗的疗效。这些研究中仅包括了存在FAI手术适应证的，愿意接受随机对照试验的患者。基于已有的证据，FAI的非手术治疗和手术治疗看起来应序贯进行而不是平行进行。事实上，患者应该已经尝试过非手术治疗，并且非手术治疗已经失败了后才可以认为患者应进行手术治疗[4]。此外，对于没有尝试非手术治疗的患者，如果他们首先进行了一系列高质量及有效的康复训练，可能症状就会缓解，不一定需要髋关节手术治疗。 非手术治疗方案：目前，针对FAI的非手术治疗并没有成形的方案。哪些患者能够最大限度的受益于非手术治疗方案也没有答案（目前尚无level 1的证据）。到目前为止，只有一套程序化的非手术治疗方案（例如，个体化髋关节疗法） [5]。这个方案包括了保守治疗和一个基于功能训练的髋关节康复计划，这套计划基于已有的专题文献和经验较丰富的物理治疗师的共识。然而，这个旨在减轻FAI患者的症状，并提高髋关节功能的治疗方案的疗效还尚未被证实。此外，通过主动锻炼对治疗FAI综合征理论上也很合理，这些主动锻炼包括：髋关节和下肢肌力训练，核心肌肉稳定及姿势平衡训练[6]。这种锻炼起到治疗效果的机理，可能是通过主动神经肌肉训练，提高髋关节髋臼盂唇动态稳定，来降低作用于髋关节的机械载荷，最终达到减轻症状的目的。相反的，对于单独应用于髋关节的一些被动治疗手段也会对FAI治疗有作用就很难解释，如手法治疗（按摩，活动和牵拉），也许这些方法可能改善髋关节生物力学以减轻症状。 展望：在不远的将来，科研人员和临床医生应该整研究成果来探索非手术治疗手段治疗FAI患者的有效性。除了需要探索FAI非手术治疗方案，还需要探索哪些患者可能从这些方案中最大获益，哪些患者适合进行手术治疗。更广泛的理解FAI非手术治疗效果，可以提出更明确的手术适应证， FAI的诊断治疗决策提供支持。对于不适合保守治疗的患者，可以不进行保守治疗直接手术（表1，虚线）。因此，在将来应该设计良好的随机对照实验来比较各种以物疗为主的康复治疗方案的有效性，其中包括有不同的治疗元素（例如：主动运动训练与被动运动训练比较）。找出最有效的FAI保守治疗手段。 1 Griffin DR,Dickenson EJ, O’Donnell J, et al. The Warwick Agreementon femoroacetabular impingement syndrome (FAI syndrome): an internationalconsensus statement. Br J Sports Med 2016;50:1169–76. 2 Kemp JL, Beasley I. 2016 internationalconsensus on femoroacetabular impingement syndrome: the Warwick Agreement-whydoes it matter? Br J Sports Med 2016;50:1162–3. 3 Peters S, Laing A, Emerson C, et al.Surgical criteria for femoroacetabular impingement syndrome: a scoping review.Br J Sports Med 2017 (Epub ahead of print: 20 Feb 2017). 4 Khan M, Bedi A, Fu F, et al. Newperspectives on femoroacetabular impingement syndrome. Nat Rev Rheumatol2016;12:303–10. 5 Wall PD, Dickenson EJ, Robinson D, et al.Personalised Hip Therapy: development of a non-operative protocol to treatfemoroacetabular impingement syndrome in the FASHIoN randomised controlledtrial. Br J Sports Med 2016;50:1217–23. 6 Casartelli NC, Maffiuletti NA, Bizzini M, etal. The management of symptomatic femoroacetabular impingement: what is therationale for non-surgical treatment? Br J Sports Med 2016;50:511–2. 文献出处：Casartelli NC, Bizzini M, Kemp J, Naal FD, Leunig M, Maffiuletti NA. What treatment options exist for patients with femoroacetabular impingement syndrome but without surgical indication? Br J Sports Med. 2018 May;52(9):552-553. 文献3 双侧髋关节撞击症患者接受双髋同期关节镜手术：术后1年随访 译者：肖凯 目的：与双侧髋关节撞击症分期手术相比，评估在单次麻醉同时进行双侧髋关节镜后是否能获得同样的恢复速度及同样的功能。 方法：我们选取了3组患者：第1组患者双髋同期手术治疗；第二组患者双髋分期手术治疗；第三组患者只进行单髋治疗。评估指标包括麻醉及手术时间、住院时间、疼痛VAS评分（术后1/3/7/30天）、术后镇痛药物应用情况、患者恢复日常运动功能所需要的时间（骑车、开车、办公室工作、健身运动、跑步等）。术后6个月及12个月对患者进行非关节炎髋关节评分及西安大略省和麦克马斯特大学骨关节炎指数评分。 结果：本项研究纳入了76名患者（122髋），其中男性42例，女性34例，平均年龄为33岁（14-50岁），平均BMI为24（18-35）。第1组包括26名患者（52髋，16名男性和10名女性患者）。第2组包括20名患者（40髋，13名男性和7名女性患者），两次手术时间平均间隔14.56周。第3组包括33名患者（30髋，13名男性和17名女性患者）。3组患者之间术前情况未发现差异。第1组的手术和麻醉时间明显长于第2组和第3组。3组患者术后疼痛VAS评分、镇痛药物应用情况及住院时间没有显着差异。第1组在患者术后需要更长的时间才能够骑自行车（第1组为14.7天，第2组为7.8天，第3组为8.5天; P <0.05）。我们发现3组患者之间在能够开车、进行办公室工作及达到正常步态的时间没有差异。与术前相比，每组患者在术后6个月和12个月时的西安大略省和麦克马斯特大学骨关节炎指数及非关节炎髋关节评分均有显着改善（p><> 结果：双髋同时进行髋关节镜手术并不会导致更高的并发症、更严重的术后疼痛、更多的镇痛药物应用及其他负面效果。相比单侧手术，双髋同期手术并不会明显延长术后康复时间，并且患者只需要1次康复过程。 Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateralfemoroacetabular impingement: 1-year outcomes PURPOSE: The purpose of this study was to investigate whether, in patients with bilateral symptomatic femoroacetabular impingement, bilateral surgery under 1 anesthetic is safe and efficacious and allows a rapid return of function compared with staged procedures. METHODS: Three groups were evaluated: in group 1 both hips were treated simultaneously, in group 2 both hips were treated in a staged fashion, and in group 3 a single hip was addressed. The outcome measures were anesthesia and surgical times; time in the hospital; visual analog scale score for pain on postoperative days 1, 3, 7, and 30; analgesic use; and time until the patient could bike, drive, perform office work, perform gym activities, run, and return to play. Midterm evaluation was performed with the Non-Arthritic Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at 6 and 12 months postoperatively. RESULTS: We enrolled 76 patients (122 hips) in this study. There were 42 male and 34 female patients. The mean age was 33 years (range, 14 to 50 years), and the mean body mass index was 24 (range, 18 to 35). Group 1 comprised 26 patients (52 hips, 16 male and 10 female patients). Group 2 comprised 20 patients (40 hips, 13 male and 7 female patients), with a mean time between surgeries of 14.56 weeks. Group 3 comprised 33 patients (30 hips, 13 male and 17 female patients). No preoperative differences were found between the groups. The surgical and anesthesia times in group 1 were significantly longer than those in groups 2 and 3. We found no significant differences in postoperative visual analog scale scores, analgesic use, or length of hospital stay. Group 1 required more time before patients were able to ride a stationary bicycle (14.7 days in group 1, 7.8 days in group 2, and 8.5 days in group 3; P < .05).="" we="" found="" no="" differences="" between="" the="" groups="" regarding="" when="" patients="" returned="" to="" driving,="" performing="" office="" work,="" or="" reporting="" a="" normal="" gait.="" each="" group="" had="" significant="" improvements="" in="" the="" western="" ontario="" and="" mcmaster="" universities="" osteoarthritis="" index="" and="" non-arthritic="" hip="" score="" at="" 6="" and="" 12="" months="" compared="" with="" preoperatively="" (p="">< .05).="" no="" significant="" differences="" in="" outcome="" scores="" were="" found="" in="" the="" 3="" groups="" before="" surgery="" and="" at="" 6="" or="" 12="" months="" after=""> CONCLUSIONS: Simultaneous femoroacetabular impingement surgery does not lead to higher rates of complications, postoperative pain, analgesic use, or side effects. The return to daily activities is similar to a single-hip procedure with the advantage of a single rehabilitation. 文献出处：Mei-DanO, McConkey MO, Knudsen JS, Brick MJ. Bilateral hip arthroscopy under the sameanesthetic for patients with symptomatic bilateral femoroacetabularimpingement: 1-year outcomes. Arthroscopy. 2014. 30(1): 47-54. 文献4 英国对于股骨头坏死治疗方法的选择现状 译者：张振东 股骨头坏死的治疗目前仍存争议，对于其治疗方法的选择偏好在英国尚无相关报道。该研究的目的为通过调查英国髋关节外科医生，明确股骨头坏死的治疗方法选择现状。研究方法为基于网络的调查，分别通过邮件发送给英国髋关节协会（British Hip Society，BHS）352位成员，进行问卷调查。问卷10个项目中包含16个特定的股骨头坏死病例。共计115为BHS成员完成调查。结果显示，对于有症状的未塌陷股骨头坏死病例，打压植骨为最常被选择的手术干预方式；而对于已发生股骨头塌陷的股骨头坏死病例，多数医生选择关节置换手术。不同的手术方式选择比例在24至48岁患者中无显著差异，年轻患者多选择保髋手术而年龄相对大者多选择关节置换手术。对于一例48岁股骨头坏死患者，即使是处于股骨头坏死早期，多数医生仍会更倾向选择关节置换手术治疗。调查显示打压植骨及关节置换在英国是最常见的治疗选择，但也存在其他各种治疗方法，同一类型的病例会有不同的选择，说明英国对于股骨头坏死的治疗，尚未达到共识。因此本研究建议应进行前瞻性的随机对照试验明确不同程度股骨头坏死的最佳治疗策略，以便达成治疗共识。此外，对于股骨头坏死分期的选择，大部分（89.1%）医生使用Ficat and Arlet分期系统来指导治疗方法的选择，57%的医生也会选择塌陷前期及已塌陷期进行分型，少数医生选择其他的分期方法：Steinberg(14%)，Gardeniers (ARCO，12%)，Ohzono (7%)以及Kerbou (3%)。 图1 有轻度症状及中度症状的股骨头坏死患者（塌陷前期），选择手术干预者所占的比例 图2 不同时期股骨头坏死选择关节置换治疗的比例 Current practice of BHS members in the treatment of osteonecrosis of the femoral head inadults INTRODUCTION: The management of osteonecrosis (ON) of the femoral head remains controversial. It is unclear the extent to which non-arthroplasty procedures are used and there has been no previous report of the trends in operative management of ON in the UK. Our objective is to report current trends in management of ON of the femoral head amongst specialist hip surgeons in the UK. METHODS: A single-stage internet-based survey was e-mailed to 352 eligible members of the British Hip Society (BHS). This consisted of 10 question stems including 16 hypothetical clinical scenarios with imaging. RESULTS:115 active Consultant members of the BHS completed the survey. For symptomatic pre-collapse ON we found core decompression (CD) was the most common operative intervention and for post-collapse ON we found that total hip arthroplasty (THA) was the most common operative intervention. We found no difference in the rate of operative intervention between 24 and 48-year-old patients at any stage of ON but joint preserving procedures were more often selected for the younger patient and arthroplasty for the older patient. Surgeons were more likely to offer arthroplasty to a 48-year-old patient at an earlier stage of disease. CONCLUSIONS: Our respondents would offer different operative interventions dependent on stage of ON and patient age. Core decompression (CD) and arthroplasty were common but variation in treatment options offered suggests a lack of consensus amongst UK hip surgeons. We suggest that further research such as a prospective RCT is needed to gain consensus on management of this condition. 文献出处：Colaço HB, Davidson JA, Davenport D, Norris MC, Bankes MJK, Shah Z. Current practice of BHS members in the treatment of osteonecrosis of the femoral head in adults. Hip Int. 2018 Jan;28(1):90-95. |
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