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本期目录： 1、色素沉着绒毛结节性滑膜炎患者全膝置换术后并发症 2、全髋关节置换术后髋关节旋转中心位置是否会影响外展肌力矩的恢复？ 3、应用氧化锆金属头能否减少全髋关节置换术后的摩擦腐蚀：一项回收组件分析 4、脑瘫患者髋关节放射影像学评估的可靠性 5、机械性髋关节疼痛的诊断流程 6、有症状的临界DDH盂唇损伤概率较高：一项99例患者的前瞻性造影核磁研究 7、股骨外翻截骨联合Chiari骨盆截骨术治疗髋关节骨关节炎的临床结果及预后因素 8、选择性Y型软骨骨骺阻滞术治疗实验性残留髋臼发育不良 第一部分：关节置换及保膝相关文献 文献1 色素沉着绒毛结节性滑膜炎患者 全膝置换术后并发症 译者：张轶超 背景：色素沉着绒毛结节性滑膜炎（PVNS）是一种组织细胞增殖而导致局部破坏的病变，经常发生于膝关节内。关节局部的严重破坏是全膝关节置换（TKA）的指证。本研究的目的是评估膝关节PVNS患者TKA术后发生并发症的危险因素。 方法：收集了从2007年到2016年间在一个国家私人捐赠的保险数据库中的因PVNS行TKA的患者数据。统计了这些病人的急诊就诊，再住院，翻修，僵直，感染和死亡的发生情况，与因骨关节炎（OA）而行TKA手术的患者做对比。 结果：在此期间有453名患者因为PVNS而行TKA手术，匹配获得因OA行TKA手术的1812名作为对照组。两组患者的TKA术后2年的翻修率，急诊就诊，再住院及死亡的发生率没有差异。两组术后1年关节僵直发生率不同（PVNS比OA=6.84%比4.69，优势率1.48，P=0.023）。PVNS组的术后2年感染发生率为3.31%，OA组为1.55%（优势率1.73，P=0.011）。 结论：既往没有PVNS患者行TKA术后的并发症发生率的报道。相对于因OA而行TKA的患者，其术后关节僵直和感染的发生率较高。因此，PVNS患者行TKA后发生并发症的风险更高。 Complications After Total Knee Arthroplasty in Patients With Pigmented Villonodular Synovitis BACKGROUND: Pigmented villonodular synovitis (PVNS) is a locally destructive histiocytic proliferation most commonly occurring in the knee. Extensive local joint destruction can indicate the need for a total knee arthroplasty (TKA). The objective of this study is to evaluate PVNS of the knee as a risk factor for complication after TKA. METHODS: Patients who underwent TKA with a diagnosis of PVNS of the knee from 2007 to 2016 were identified in a national private payer insurance database. Complication rates for emergency room visits, readmission, revision, stiffness, infection, and death were calculated and compared to a control population of patients who received TKA for osteoarthritis (OA). RESULTS: Four hundred fifty-three patients were diagnosed with PVNS of the knee and underwent TKA during the time period and compared with a matched control cohort of 1812 patients who underwent TKA for OA. The rate of revision TKA at 2 years, emergency room visits, readmission, and death did not differ between the PVNS group and the control cohort. The PVNS group had stiffness at 1 year compared to the OA group (6.84% vs 4.69%, odds ratio 1.48, P = .023). The infection rate at 2 years was 3.31% in the PVNS group and 1.55% in the OA group (odds ratio 1.73, P = .011). CONCLUSION: The complication rates for TKA in patients with a diagnosis of PVNS of the knee have not been previously demonstrated. These patients have a higher rate of stiffness and infection when compared to a control cohort, so they may have a more complicated postoperative course. 文献出处：Casp AJ, Browne JA, Durig NE, Werner BC. Complications After Total Knee Arthroplasty in Patients With Pigmented Villonodular Synovitis. J Arthroplasty. 2019 Jan;34(1):36-39. doi: 10.1016/j.arth.2018.08.041. Epub 2018 Sep 6. 文献2 全髋关节置换术后髋关节旋转中心位置 是否会影响外展肌力矩的恢复？ 译者：马云青 背景：在全髋关节置换术（THA）中，如果发生与髋关节发育不良（DDH）相关的畸形，将髋臼杯置于髋臼解剖位置并不总是可能的。到目前为止，髋关节中心对THA术后外展肌力矩的影响还没有明确相关研究。因此，我们进行了一项回顾性研究，评估：（1）THA术后外展肌力矩如何恢复；（2）髋臼杯位置是否影响外展肌力矩的恢复。 假设：高髋关节中心影响髋关节发育不良的THA后外展肌的力矩恢复。 患者和方法：我们评估了100名术后12个月接受单侧初次THA患者。这项研究包括86名女性和14名男性，平均年龄为65.5±9.9岁（范围40至86岁）。所有患者均为DDH导致的继发性骨关节炎患者，其中CroweⅠ:76；CroweⅡ:15、CroweⅢ:9和CroweⅣ：0。所有植入的股骨柄均为生物型固定。用手持带安全带稳定的测力机测量髋外展肌力矩。手术侧的力矩与对侧的力矩之比按力矩比率计算。测量了髋关节水平和垂直的旋转中心（h-cor和v-cor）（相对于泪滴间线）和垂直移动距离（v-shift）（受影响髋部和对侧正常髋部的v-cor差异）。 结果：术后6个月和12个月，外展肌力矩比率分别为95.1%和94.7%。术后6个月外展肌力矩比与V-COR呈显著负相关（r=-0.2436，P=0.0238）。术后6个月，髋关节旋转中心较高（V-shift>15mm）组（比值比=12.7；95%CI:2.11-232.1，P=0.0034）外展肌力矩比恢复明显延迟，术后12个月可完全恢复。 讨论：术后髋关节旋转中心如果位于髋关节解剖中心上方超过15毫米处，会导致THA后外展肌力矩的延迟恢复。 Does hip center location affect the recovery of abductor moment after total hip arthroplasty? BACKGROUND: In total hip arthroplasty (THA), placing the cup in an anatomic position is not always possible in case of deformities related to developmental dysplasia of the hip (DDH). Thus far, the influence of a hip center on the abductor moment after THA has not been clearly elucidated. Therefore, we performed a retrospective study to assess (1) how abductor muscle moment recovers postoperatively in THA and (2) whether acetabular cup position affects the recovery of abductor moment. HYPOTHESIS: A high hip center affects the recovery of abductor moment of a dysplastic hip after THA. PATIENTS AND METHODS: We evaluated 100 patients, who underwent unilateral primary THA, at 12 months postoperatively. The study included 86 women and 14 men, with a mean age of 65.5±9.9 years (range, 40 to 86 years). Patients with secondary osteoarthritis due to DDH were included (Crowe 1: 76; Crowe 2: 15, Crowe 3:9, and Crowe 4: none). A cementless straight stem was implanted in all hips. Hipabductor moment was measured using a belt-stabilized hand-held dynamometer. The ratio of moment of the affected side to that of the contralateral side was calculated as moment ratio. The horizontal and vertical centers of rotation (H-COR and V-COR) (with respect to the inter teardrop line) and vertical shift (V-shift) (difference in V-COR between the affected hip and the contralateral normal hip) were determined. RESULTS: At 6 and 12 months postoperatively, the abductor moment ratios were 95.1 and 94.7%, respectively. Significant negative correlation was observed between the postoperative abductor moment ratio and V-COR at 6 months postoperatively (r=-0.2436, p=0.0238). Significant delay in the recovery of abductor moment ratio was observed in the groups with higher hip center (V-shift>15mm) (odds ratio=12.7; 95% CI: 2.11-232.1, p=0.0034) at 6 months postoperatively, which was fully recovered at 12 months postoperatively. DISCUSSION: Superior placement of a hip center, more than 15mm above the true hip center, delayed the recovery of abductor muscle moment after THA. 文献出处：Fukushi JI, Kawano I, Motomura G, Hamai S, Kawaguchi KI, Nakashima Y. Does hip center location affect the recovery of abductor moment after total hip arthroplasty? Orthop Traumatol Surg Res. 2018 Dec;104(8):1149-1153. doi: 10.1016/j.otsr.2018.06.022. Epub 2018 Oct 3. 文献3 应用氧化锆金属头能否减少全髋关节置换术后 的摩擦腐蚀：一项回收组件分析 译者：张蔷 目的：本篇文章的目的是研究回收的氧化锆金属股骨头(OxZr; 氧化锆, 施乐辉公司, 孟菲斯市, 田纳西州)的磨损和腐蚀情况，并将其与传统钴铬合金金属股骨头对比。 方法：共入组28个髋关节翻修术中取下来的氧化锆金属头，并根据患者基本情况进行匹配选择了另外28个钴铬合金金属头作为对照。氧化锆组初次置换时的平均年龄为56岁（46 to 83），而钴铬合金组的平均年龄为70岁（46 to 92）。根据改良Goldberg评分，我们分别统计了两组的磨损以及腐蚀评分。 结果：氧化锆组的腐蚀评分明显低于钴铬合金组(1.3 (1 to 2.75) vs 2.1 (1 to 4); p < 0.01)。而磨损评分同样明显低于钴铬合金组(1.3 (1 to 2) vs 1.5 (1 to 2.25); p = 0.02)。氧化锆金属头近端磨损明显多于远端磨损。而钴铬合金组的不同部位并无明显差别。氧化锆组内对比发现，股骨头直径越大磨损越多，但差异并无显著性。 氧化锆股骨头锥度 钴铬合金股骨头锥度 结论：与钴铬合金股骨头相比，氧化锆股骨头的回收分析显示磨损与腐蚀较少，而氧化锆这种材料可以有效的减少锥度磨损。 Dooxidized zirconium heads decrease tribocorrosion in total hip arthroplasty Astudy of retrieved components Aims: The aim ofthis study was to evaluate fretting and corrosion in retrieved oxidizedzirconium (OxZr; OXINIUM, Smith & Nephew, Memphis, Tennessee) femoral headsand compare the results with those from a matched cohort of cobalt-chromium(CoCr) femoral heads. Patients and Methods: A total of28 OxZr femoral heads were retrieved during revision total hip arthroplasty(THA) and matched to 28 retrieved CoCr heads according to patient demographics.The mean age at index was 56 years (46 to 83) in the OxZr group and 70 years(46 to 92) in the CoCr group. Fretting and corrosion scores of the female taperof the heads were measured according to the modified Goldberg scoring method. Results: TheOxZr-retrieved femoral heads showed significantly lower mean corrosion scoresthan the CoCr heads (1.3 (1 to 2.75) vs 2.1 (1 to 4); p < 0.01). Meanfretting scores were also significantly lower in the OxZr cohort when comparedwith the CoCr cohort (1.3 (1 to 2) vs 1.5 (1 to 2.25); p = 0.02). OxZr headshad more damage in the proximal region compared with the distal region of thehead. Location had no impact on damage of CoCr heads. A trend towards increasedcorrosion in large heads was seen only in the CoCr heads, although this was notstatistically significant. Conclusion: Retrievalanalysis of OxZr femoral heads showed a decreased amount of fretting andcorrosion compared with CoCr femoral heads. OxZr seems to be effective atreducing taper damage. 文献出处：C. Hampton,L. Weitzler, E. Baral, T. M. Wright, M. P. G. Bostrom. Do oxidized zirconiumheads decrease tribocorrosion in total hip arthroplasty: A study of retrievedcomponents. Cite this article: Bone Joint J 2019; 101-B: 386–389. 第二部分：保髋相关文献 文献1 脑瘫患者髋关节放射影像学评估的可靠性 译者：罗殿中 介绍：脑瘫患儿有髋关节进行性脱位的风险。由于对髋关节移位的监测需要使用特定的影像学参数，进而指导临床决策，因此这些测量的可靠性非常重要，目前应用的测量参数包括Reimer移位百分比（MP）、髋臼指数（AI）、髋臼角（AA）、骨盆倾斜度（PO）。本研究的目的是确定这些影像学测量指标的观察者间及观察者内一致性。本研究参与的医生为参加多中心前瞻性脑瘫患者髋关节预后项目的国际小儿骨科医生。 方法：将25张前后位骨盆X线片以DICOM格式复制到两张光片，将光片发送给外科医生进行数据测量，两张光片的发放时间至少间隔2周。为了减少记忆、任何影响学习的因素、疲劳对测量数据的影响，我们对2张光片内X线片的顺序进行了调整，参与的外科医生接收2张光盘的顺序也为随机。计算组内相关系数（ICC）以评估观察者间和观察者内一致性。同时计算了2次测量数据的平均绝对差异。 结果：MP的测量具有最高的观测者内一致性，其次是PO，AI和AA，ICC（SD;范围）分别为0.95（0.04; 0.84-0.98）; 0.92（0.03; 0.85-0.97）; 0.84（0.05; 0.75-0.92）;和0.82（0.14; 0.51-0.98）。 MP，PO，AI和AA的平均观测者间ICC（SD;范围）分别为0.94（0.05; 0.78-0.99）; 0.90（0.04; 0.76-0.99）; 0.79（0.08; 0.52-0.93）; 0.69（0.23; 0.42-0.98）。观测者2次测量MP，AI，AA和PO之间的绝对差异的平均值（SD; 95％置信区间）分别为4.9％（2.9％; 3.4％-6.4％）; 3. 8°（1.2°; 3.1-4.5°）; 2.6°（1.5°; 1.7-3.5°）; 1.3°（0.3°; 1.29-1.31°）。 结论：MP是一种可重复的测量方法，其观测者内及观测者间一致性良好。但是，应该谨慎对待MP <7％的情况，因为这可能是测量误差导致的。尽管我们发现AI，AA和PO的观测者内及观测者间一致性也较高，但这些测量指标的变化性更大，不适合用作离散结果测量。但是，当这些指标的纵向观察呈现某一趋势时，可以更好地反应出关节的真实变化，进而可以预测预后及指导治疗。 A 骨盆三角软骨未闭合的患者各参数的测量方法；B 骨盆三角软骨闭合的患者各参数的测量方法 Reliability of Radiographic Assessments of the Hip in Cerebral Palsy INTRODUCTION: Children with cerebral palsy are at risk for progressive hip displacement. Since surveillance for hip displacement uses specific radiographic measurements to guide decision making, it is important to establish the reliability of these measurements, which include Reimer's migration percentage (MP), acetabular index or acetabular angle (AI or AA), and pelvic obliquity (PO). The purpose of this study was to determine the intraobserver and interobserver reliability of these radiographic measures among an international group of pediatric orthopaedic surgeons participating in the prospective international multicenter Cerebral Palsy Hip Outcomes Project (CHOP) currently underway to evaluate the outcomes of hip interventions in cerebral palsy. METHODS: Two compact discs (CDs) containing the same 25 anteroposterior pelvis radiographs in Digital Imaging and Communications in Medicine (DICOM) format were provided to participating surgeons at least 2 weeks apart. To reduce the likelihood of recall or any effects of learning or fatigue, the order of the radiographs varied on the 2 CD versions, and participating surgeons received the 2 CDs in random order. The intraclass correlation coefficients (ICCs) were calculated to assess interobserver and intraobserver reliability. Mean absolute differences of hip measurements obtained at 2 time points were also calculated. RESULTS: The MP had the highest reliability followed by PO, AI, and AA with a mean intrarater ICC (SD; range) of 0.95 (0.04; 0.84 to 0.98); 0.92 (0.03; 0.85 to 0.97); 0.84 (0.05; 0.75 to 0.92); and 0.82 (0.14; 0.51 to 0.98); respectively. The mean interrater ICC (SD; range) for MP, PO, AI, and AA were 0.94 (0.05; 0.78 to 0.99); 0.90 (0.04; 0.76 to 0.99); 0.79 (0.08; 0.52 to 0.93); and 0.69 (0.23; 0.42 to 0.98) for MP, PO, AI, and AA, respectively. The mean (SD; 95% confidence interval) for the absolute difference between the 2 measurements for the raters was 4.9% (2.9%; 3.4%-6.4%); 3. 8 degrees (1.2 degrees; 3.1-4.5 degrees); 2.6 degrees (1.5 degrees; 1.7-3.5 degrees); and 1.3 degrees (0.3 degrees; 1.29-1.31 degrees) for MP, AI, AA, and PO, respectively. CONCLUSIONS: MP is a reproducible measure with excellent intrarater and interrater reliability. However, differences in MP of <7% should be treated with caution as these might be a consequence of measurement error. Although we found a high level of intrarater and interrater reliability of the AI, AA, and PO, these measurements are more variable and not ideal for use as discrete outcome measures. Instead, these parameters might be useful for prognostication and decision making when consistent trends are observed longitudinally over time which might be better indications of true change. 文献出处：Shore BJ, Martinkevich P, Riazi M, Baird E, Encisa C, Willoughby K, Narayanan UG. Reliability of Radiographic Assessments of the Hip in Cerebral Palsy. J Pediatr Orthop. 2018 Dec 26. doi: 10.1097/BPO.0000000000001318. 文献2 机械性髋关节疼痛的诊断流程 译者：程徽 背景：随着我们对髋关节疾病理解的不断深入，认识的重点逐渐转向髋关节疾病早期诊断。因此，收集病史、查体和阅片的每一个步骤中分析髋关节疼痛在关节内或关节外，非常重要。 问题/目的：本研究的 目的是回答以下问题：（1）诊断流程化的查体是否能提高非关节炎髋疼诊断的准确程度，从而改进治疗。（2）临床诊断的解剖学分层概念是否提高了诊断准确性？（3）准确应用四层解剖学分层（骨软骨层，静力层，动力层和神经结构层）诊断是否对诊断有利。 方法：对MEDLINE进行了不受限制的计算机检索。不同的术语以各种组合使用。 结果：对非关节炎性髋痛进行流程化的诊断，包括病史，体格检查（特定检查）和影像学检查，有助于理解地关节内和关节外疾病，及其对关节功能的影响。此外，它提高了我们对关节力学异常，如何潜在影响髋关节的理解。这些异常的关节运动学（第一层）可导致软骨和盂唇损伤（第二层），以及对肌肉肌腱（第三层）和髋关节和半骨盆的神经结构（第四层）造成的损伤。层概念是一种确定关于髋关节的哪些结构是髋关节病理学的来源以及如何最好地实施治疗的系统方法。 结论：通过详细和系统的体格检查，诊断成像评估以及机械因素如何导致髋关节广泛的代偿性损伤模式的解释，清楚地了解髋关节疼痛的鉴别诊断可以促进诊断和治疗建议。 An algorithmic approach to mechanical hip pain BACKGROUND:As our understanding of hip pathology evolves,the focus is shifting toward earlier identification of hip pathology.Therefore, it is vitally important to elucidate intra-articular versusextra-articular pathology of hip pain in every step of the patient encounter:history, physical examination, and imaging. QUESTIONS/PURPOSES:The objective was to address the followingresearch questions: (1) Can an algorithmic approach to physical examination ofa painful non-arthritic hip provide a more accurate diagnosis and improvedtreatment plan? (2) Does an anatomical layered concept of clinical diagnosisimprove diagnostic accuracy? (3) What are the diagnostic tools necessary forthe accurate application of a four-layer (osteochondral, inert, contractile,and neuromechanical) diagnosis? METHODS:An unrestricted computerized search of MEDLINEwas conducted. Different terms were used in various combinations. RESULTS:An algorithmic approach to physicalexamination of a painful nonarthritic hip, including history, physicalexamination (specific tests), and advanced imaging allow for betterinterpretation of debilitating intra- and extra-articular disorders and theireffect on core performance. Additionally, it improves our understanding as tohow underlying abnormal joint mechanics may predispose the hip joint and theassociated hemipelvis to asymmetric loads. These abnormal joint kinematics(layer I) can lead to cartilage and labral injury (layer II), as well asresultant injury to the musculotendinous (layer III) and neural structures(layer IV) about the hip joint and the hemipelvis. The layer concept is asystematic means of determining which structures about the hip are the sourceof hip pathology and how to best implement treatment. CONCLUSIONS:A clear understanding of the differentialdiagnosis of hip pain through a detailed and systematic physical examination,diagnostic imaging assessment, and the interpretation of how mechanical factorscan result in such a wide range of compensatory injury patterns about the hipcan facilitate the diagnosis and treatment recommendations. 文献出处：PoultsidesLA1, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J.2012 Oct;8(3):213-24. doi: 10.1007/s11420-012-9304-x. Epub 2012 Sep 21.
有症状的临界DDH盂唇损伤概率较高： 一项99例患者的前瞻性造影核磁研究 译者：肖凯 在DDH及临界DDH患者中均可见到髋关节盂唇病变。髋臼周围截骨术（PAO）治疗DDH的首选方法。但是，一些作者提出应该通过关节镜处理临界DDH患者盂唇的病变。本研究的目的是明确DDH及临界DDH患者盂唇病变的概率，明确外侧CE角是否与盂唇病变相关，明确疼痛与盂唇病变间是否存在相关性。我们检查了99例拟行PAO有症状的患者，共104髋。5名患者因多个关节并发症而被排除在外，4名患者术后2年后失随访。 5名患者术前未完成问卷填写。我们见外侧CE角<20°定义为DDH，将外侧CE角20°-25°定义为临界DDH。对患者进行造影磁共振检查，根据Czerny分型对所有盂唇病变进行分类。应用多元线性回归分析外侧CE角、髋臼指数和术前WOMAC疼痛评分间的关联。统计分析显示DDH组与临界DDH组患者间盂唇病变的发生率没有差异。在整个队列中，99名患者中有86名患者存在盂唇病变。外侧CE角与盂唇病变的严重程度间存在相关性，而髋臼指数与术前疼痛程度与盂唇病变无关。髋臼外侧覆盖降低会增加盂唇的负重，使其易于撕裂。我们建议通过PAO使关节应力进行重新分布，而不是关节镜治疗。疼痛程度与盂唇病变间没有相关性，这提示盂唇病变可能并不能单独解释DDH患者的疼痛。 两组患者造影核磁Czerny分型情况 High frequency of labral pathology in symptomatic borderlinedysplasia: a prospective magnetic resonance arthrography study of 99 patientsLabralpathology is seen in both dysplastic and borderline dysplastic hips.Periacetabular osteotomy (PAO) is the treatment of choice for dysplasia.However, some authors have suggested that borderline dysplastic hips withconcurrent labral pathology should be treated arthroscopically. The purpose ofthis study was to investigate the frequency of labral pathology betweendysplastic and borderline dysplastic hips, whether centre-edge (CE) angle isassociated with labral pathology, and finally if pain and labral pathology areassociated. Ninety-nine symptomatic patients (104 hips) scheduled for PAO wereexamined. Five patients were excluded due to complaints from multiple jointsand four failed to show at 2-year follow-up. Five patients did not fill outquestionnaires preoperatively. Hips were characterized as dysplastic (CE angle<20°) and borderline dysplastic (CE angle 20° ≤ 25°). A magnetic resonancearthrography was performed, and labral pathology was classified according tothe Czerny classification. Association with the CE angle, the acetabular index(AI) and preoperative WOMAC pain score was tested by multiple linearregression. There was no significant difference in frequency of labralpathology when comparing the two groups. Across the cohort, 86 of 99 patientshad labral pathology. The CE angle was associated with increasing severity oflabral pathology, whereas the AI angle and preoperative pain were notassociated with labral pathology. Decreased lateral coverage adversely loadsthe labrum, predisposing it to tears. We advocate reorienting the biomechanical forcesthrough PAO, not arthroscopic treatment. Level of pain was not associated withlabral pathology, suggesting that labral pathology may not alone explain thedysplastic pain complex. 文献出处：Møse FB, Mechlenburg I, Hartig-Andreasen C, Gelineck J, Søballe K, Jakobsen SS. High frequency of labral pathology in symptomaticborderline dysplasia: a prospective magnetic resonance arthrography study of 99patients. J Hip Preserv Surg. 2019 Mar 11;6(1):60-68.doi: 10.1093/jhps/hnz003. eCollection 2019 Jan. 文献4 股骨外翻截骨联合Chiari骨盆截骨术治疗 髋关节骨关节炎的临床结果及预后因素 译者：任宁涛 背景：长期以来，外科医生一直在争论年轻患者的晚期或终末期髋关节骨关节炎是否应该采用全髋关节置换术或截骨术治疗。我们回顾了股骨外翻截骨术联合Chiari骨盆截骨术（VCO）治疗晚期或终末期骨关节炎的中期临床结果，这些骨关节炎与年轻患者严重髋臼发育不良有关，并分析了与全髋关节置换术相关的预后因素。 方法：研究组包括50名患者54个髋关节（5名男性和45名女性；手术时的平均年龄为45.6岁），随访最短时间为10年，平均随访时间为17.6年，采用JOA进行临床评估，使用Kaplan-Meier方法计算从VCO手术开始至接受THA治疗为终点的存活率。我们用Cox比例风险模型定义了预后因素（接受THA治疗）。 结果：平均JOA评分从术前53.0分提高到术后1年77.1分，5年81.6分，10年76.8分。10年、15年和20年的存活率分别为83.3%、59.7%和46.9%，单变量和多变量分析发现臼顶倾斜度数小的术后效果好。 结论：VCO可保留年轻患者严重髋臼发育不良相关的晚期髋关节骨关节炎的关节功能，对臼顶倾斜度数小的患者，VCO术后预后有所改善。 图1 A-D 女性，双侧VCO术后骨盆平片。A 40岁，双侧髋臼发育不良，骨关节炎晚期。B 40岁时接受左髋VCO治疗。 C 1年后再次行右髋VCO治疗。 D 术后复查片（左侧术后24年，右侧术后23年），仍保留有关节间隙。 图2 女性，30岁，右髋VCO自体骨移植。 A 右髋髋臼严重发育不良，骨关节炎晚期。B VCO髋臼缘自体髂嵴骨移植术后片子。 C 术后2年，关节塑形好。 图3 女性，38岁，右髋不稳行VCO。A 严重髋臼发育不良，骨关节炎晚期。 B骨盆动态片可见髋关节内收，使关节外侧间隙变宽，头负重区变平。 C VCO术后片子，骨盆截骨角度高。D 术后2年复查片，髋臼塑形良好。 图4 左图：术前术后影像学参数包括（A）头臼指数（b/a ×100%），（B）Sharp角， （C）臼顶倾斜角。右图：术中影像学参数，（D）骨盆截骨高度（毫米），（E）截骨角度，（F）骨盆内移比例，(d/c × 100%)。 图5 VCO前后髋关节JOA平均分数的条形图。t检验确定P值与术后评分和术前评分之间的差异有关。ADL=日常生活活动，ROM=运动范围。 Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip BACKGROUND: Surgeons have long debated whether advanced or end-stage osteoarthritis of the hip in young patients should be treated with total hip arthroplasty or osteotomy. We reviewed the intermediate-term clinical results of valgus femoral osteotomy combined with Chiari pelvic osteotomy (VCO) for advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip in young patients and analyzed prognostic factors related to conversion to total hip arthroplasty. METHODS: The study group included 54 hips in 50 patients (5 men and 45 women; average age at the time of surgery, 45.6 years). The minimum and average durations of follow-up were 10 and 17.6 years, respectively. The Japanese Orthopaedic Association hip score (JOA score) was used for clinical evaluation. The probability of survival of the VCO from the time of the operation until the end point of conversion to total hip arthroplasty was calculated with use of the Kaplan-Meier method. We defined prognostic factors of outcome (conversion to total hip arthroplasty) with the Cox proportional hazards model. RESULTS: The mean total JOA score increased from 53.0 points preoperatively to 77.1 points at 1 year postoperatively, 81.6 points at 5 years, and 76.8 points at 10 years. The survival rates were 83.3%, 59.7%, and 46.9% at 10, 15, and 20 years, respectively. On univariate and multivariate analyses, patients with a low degree of acetabular roof obliquity had better postoperative results. CONCLUSIONS: VCO is a surgical approach that preserves joint function in young patients with advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip. The postoperative prognosis of VCO was improved in patients with a low degree of acetabular roof obliquity. 文献出处：Uchiyama K, Moriya M, Fukushima K, Yamamoto T, Takahira N, Takaso M.Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip. JB JS Open Access. 2017 Apr 6;2(2):e0006. doi: 10.2106/JBJS.OA.16.00006. eCollection 2017 Jun 26. 文献5 选择性Y型软骨骨骺阻滞术 治疗实验性残留髋臼发育不良 译者：张利强 背景：本研究的目的是评估选择性Y形软骨(TC)髂坐支骨骺阻滞术在实验性髋臼发育不良中的作用。 材料与方法：在3周龄的23只新西兰兔中通过克氏针固定膝关节于伸直位获得髋关节发育不良模型。分为4组：（1）对照组; （2）克氏针保持直至处死; （3）1周后取出克氏针，无骨骺阻滞; （4）1周后取出克氏针并选择性行Y形软骨髂坐支骨骺切除术。在膝关节固定之前，克氏针移除之后和处死之后进行影像学评估。测量了髋臼指数（AI）、Sharp角、ACM角、髋臼底厚度比（AFTR）（左髋/右髋），并且发现存在发育不良、半脱位或脱位。使用CT评估髋臼形状、髋臼扇形角和骨盆旋转。进行股骨近端和髋臼的形态学评分和研究。 结果：在膝关节固定之前或克氏针去除之前，影像学评估各组之间没有差异。第2组的所有病例均显示发育不良，半脱位或髋关节脱位。与组3相比，组4的影像学评估显示较低的AI（P =0.027），Sharp角（P = 0.005），ACM角（0.049）和AFTR（P = 0.017）。第1组和第4组之间在AI（P = 0.08），Sharp角（P = 0.484）和AFTR（P =0.639）之间没有差异。第4组的形态学评分低于第2组和第3组。第4组比第2组（P = 0.008）和第3组（P =0.033）显示更深的髋臼，而与第1组相似（P = 0.364）。 结论：发育不良髋关节行选择性Y型软骨髂坐支骨骺阻滞术使髋臼的影像学测量和髋臼深度正常化，并且改善了先前的关节囊，盂唇和韧带的大体形态。 左髋Y形软骨髂坐支关节外部分的选择性表观解剖（3D-CT和标本）。
A、骨盆前后位片（组3，克氏针拔除无骨骺阻滞）：髋臼指数（AI）31°，Sharp角58°，ACM角77°，髋臼底厚度比1.01，外侧CE角14°。B、骨盆前后位片（第4组，克氏针拔除后行骨骺阻滞）：AI 24°，Sharp角46°，CM角59°，髋臼底厚度比1.11，外侧CE角6°。
圆韧带肥大
髋臼形态。与第2组（克氏针保留至处死）相比，克氏针拔除（第3组，克氏针拔除无骨骺阻滞）组（3）在髋臼的大体方面出现了改善（2）。Y形软骨选择性髂坐支骨骺阻滞术（第4组，去除克氏针随后行骨骺阻滞术）（4）改善了髋臼形态。第1组作为对照组（1） SelectiveEpiphysiodesis of the Triradiate Cartilage for Treatment of ResidualExperimental Acetabular Dysplasia Background: Thepurpose of the study is to evaluate the effect of a selective epiphysiodesis ofthe ilioischial limb of the triradiate cartilage (TC) in an experimentaldysplastic hip. Materials and Methods: A hip dysplasia was obtained in 23 New Zealand rabbits 3weeks old by immobilizing the knee in extension with a K-wire, in 4 groups: (1)control group; (2) K-wire maintained until sacrifice; (3) K-wire removed 1 weeklater without epiphysiodesis; and (4) K-wire removed 1 week later withselective epiphysiodesis of the ilioischial limb of the TC. Radiographicevaluation was performed previous to knee immobilization, after K-wire removaland after sacrifice. Acetabular index (AI), Sharp’s angle, ACM angle,acetabular floor thickness ratio (AFTR) were measured and presence ofdysplasia, subluxation, or dislocation was noted. The acetabular version, theacetabular sector angles, and the pelvis rotation were obtained using CTevaluation. A morphology score was developed and a morphometric study of bothproximal femur and acetabulum was performed. Results: Nodifferences between groups in the radiographic assessment before immobilizationor K-wire removal were found. All cases in group 2 showed dysplasia,subluxation, or dislocation of the hip. The radiographic assessment of group 4,compared with group 3, showed a lower AI (P = 0.027), Sharp’s angle (P =0.005), ACM angle (0.049), and AFTR (P = 0.017). No differences between groups1 and 4 regarding AI (P = 0.08), Sharp’s angle (P = 0.484), and AFTR (P =0.639) were obtained. The morphology score was lower in group 4 than in groups2 and 3. Group 4 showed a deeper acetabulum than group 2 (P = 0.008) and group3 (P = 0.033), while it was similar to group 1 (P = 0.364). Conclusions: Aselective epiphysiodesis of the ilioischial limb of the TC in a dysplastic hipnormalized the radiographic measurements of the acetabulum and the acetabulardeepness, and it improved the previous gross morphology of the capsule, labrum,and ligamentum teres in rabbits. 文献出处：Luis Moraleda, Javier Albinana, et al.Selective epiphysiodesis of the triradiatecartilage for treatment of residual experimental acetabular dysplasia. J Pediatr Orthop 2013;33(8):821-8 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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