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本期目录： 1、临时骨骺阻滞在青少年腕部尺骨撞击综合征中的应用（7例初步报道） 2、Salter骨盆截骨不会导致髋臼后倾 3、改良Woodward手术改善高肩胛症畸形的功能 4、6岁以下严重髋臼发育不良的患儿单纯前路髋臼周围三联截骨术：预防后倾和前方撞击 5、儿童髋关节感染后遗症：长期临床影像学结果研究 6、Legg-Calvé-Perthes病骨盆三联截骨术后髋臼后倾及其对股骨髋臼撞击的影响：15年随访的病例/对照研究？ 7、术前角度测量作为Wassel IV型多指畸形手术的预测因素 8、远端无螺纹螺钉固定骨骼成熟的股骨头骨骺滑移的结果:一项匹配队列研究 9、先天性尺桡骨融合的疗效：系统评价与荟萃分析 10、髋臼深度是髋臼发育的早期预测因素:髋关节发育不良患者行开放复位后的MRI研究 文献1 临时骨骺阻滞在青少年腕部尺骨撞击综合征中的应用（7例初步报道） 译者：肖晟 背景：有尺骨过长的青少年可能会由于尺骨的过长撞击而出现腕部尺骨撞击症状。常见的治疗方法是保守疗法，远端尺骨骨骺永久阻滞术或尺骨截骨短缩术。本文7例青少年尺骨撞击综合征的初步病例报告的目的回顾性研究一种临时可逆性的骨骺阻滞技术的疗效。 方法：这些病例包括四名患者，他们接受了术中定制的骨骺阻滞板固定，以减缓尺骨的生长。所有7例病例均收集了以下参数：诊断、手术年龄、取出阻滞钢板的年龄、尺骨生长板的状态、手术前后的尺骨长度差异以及并发症。尺骨长度的放射性测量按照Gelbermann方法进行。 结果：在7例调查病例（手术平均年龄12.4岁;平均产外年龄14.7岁）中，进行了相关数据统计分析，结果显示，在治疗开始前，平均尺桡骨长度差为+3.9毫米（范围：从+1.9毫米到+6.1毫米）。阻滞后，观察到的平均尺桡骨长度差为+0.1 mm（范围：从3.2毫米到+5.0 mm），对应于平均改善3.8毫米（范围：从0.5毫米到+9.3毫米）。阻滞后尺骨撞击症状明显减轻，显著减少。其中一个病例行了二次尺骨截骨术。 结论：综上所述，尺骨微创临时骨骺阻滞术是一种治疗腕部尺骨撞击综合征有效可行的手术方法，但是也会出现治疗的失败可能需要再次尺骨短缩截骨弥补。 四例定制2.3mm螺钉，1.0mm厚度的钢板 (a) 术前尺桡骨的长度差以及匹配度 (b) 术中植入临时阻滞钢板的影像 (c)术后10天的尺桡骨影像 (d)术后随访最后一次影像尺桡骨远端关节对合良好 Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists Scheider, Philipp; Ganger, Rudolf; Farr, Sebastian Background:Adolescents with ulnar positive variance can develop ulnocarpal symptoms due to ulnocarpal impaction syndrome. Common treatment methods are conservative therapy, distal ulna epiphysiodesis or eventually ulnar shortening osteotomy. The aim of this preliminary case series was to investigate a recently described, new therapeutic approach using a reversible, temporary epiphysiodesis technique, following the principles of guided growth. Methods:Seven cases with the diagnosis of a painful ulnar positive variance, which underwent a temporary epiphysiodesis, were retrospectively evaluated. These cases consisted of four individual patients who received an intraoperatively customized plate fixation to slow down growth. The following parameters were collected: diagnosis, age at surgery, age at explantation, growth plate status at explantation, ulnar variance before and after surgery, complications and any clinical and radiological abnormalities. The radiological measurements of ulnar variance were performed according to the Gelbermann method. Results:The seven investigated cases (average age at surgery 12.4 years; average age at explantation 14.7 years), in which a temporary epiphysiodesis was performed, showed an average ulnar variance of +3.9 mm (range: from +1.9 mm to +6.1 mm) before the start of therapy. After explantation, an average ulnar variance of +0.1 mm (range: from –3.2 mm to +5.0 mm) was observed, which corresponds to an average reduction/improvement of –3.8 mm (range: from –0.5 mm to –9.3 mm). The ulnocarpal wrist complaints were significantly reduced after the intervention. One case needed a secondary ulnar shortening osteotomy. Conclusions:The described method of a temporary, reversible epiphysiodesis is an elegant, less invasive technique to correct the ulnar positive variance without irreversibly closing the growth plate. In case of therapy failure, a secondary ulna shortening osteotomy is still possible. 文献出处：Scheider, Philipp; Ganger, Rudolf; Farr, Sebastian.Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists.J Pediatr Orthop B. 30(6):601-604, November 2021. 文献2 Salter骨盆截骨不会导致髋臼后倾 译者：李欣 背景：在髋关节发育不良（DDH）的儿童，Salter骨盆截骨的目标是手术操作来增加髋臼前方的覆盖和关节稳定。因此，这一过程可能会使髋臼后倾，导致患者出现疼痛，骨关节炎，关节撞击或是需要进一步的手术干预。在本研究中，我们的目标是探讨骨盆截骨术是否会导致术后或随访中出现骨盆后倾。 方法：我们从本机构2009年至2016年的DDH数据库中确定了92名患者，他们接受了一家领先儿童医院的外科专家施行的单侧骨盆截骨术。通过使用计算机断层扫描（CT）用来测量术后髋臼的倾角，对比患侧和与健侧髋关节的髋臼倾角。 结果：术后和健侧髋关节的髋臼倾角的测量结果显示没有发生髋臼后倾。对比健侧和患侧术后髋关节的髋臼倾角，结果有显著性差异（P<0.001）的是与对侧比较，骨盆截骨侧术后髋关节有大角度的髋臼前倾。此外，在随访的影像学中，并没有证据表明当使用先前定义的标记测量时存在骨盆后倾。 结论：这项研究证实Salter骨盆截骨在术后即刻和整个随访中不会导致髋臼后倾。事实上结果表明术侧髋臼比健侧髋关节更加前倾，这一点是以前没有被记录的。此外本研究还展示了一种新的使用CT测量髋臼倾角的方法，此技术可以适应骨盆倾斜，并在不同的个体中有可重复性。 The Salter innominate osteotomy does not lead to acetabular retroversion Airey, Grace; Shelton, James; Dorman, Sara; More Background:In children with developmental dysplasia of the hip (DDH), Salter’s innominate osteotomy aims to surgically manipulate the acetabulum to increase anterior coverage and aid joint support. Consequently, this procedure may retrovert the acetabulum, predisposing patients to pain, osteoarthritis, impingement, or further surgical intervention. In this study, we aim to address whether the innominate osteotomy leads to acetabular retroversion postoperatively or at follow-up. Methods:Ninety-two patients were identified from our institutions DDH database between 2009 and 2016, who underwent a unilateral innominate osteotomy for DDH, performed by expert surgeons in a leading paediatric hospital. A novel technique was utilized to measure acetabular version on postoperative computed tomography (CT) scans, where acetabular version was compared between the pathological and contralateral control hips. Results:Measurement of acetabular version in postoperative and control hips demonstrated no incidence of acetabular retroversion.A significant difference was observed when comparing the acetabular version of control versus post-operative hips ( P < 0.001), where hips postinnominate osteotomy had a larger degree of acetabular anteversion compared to the control hip. Furthermore, on follow-up radiographic imaging, there was no evidence of acetabular retroversion when using previously defined markers. Conclusions: This study confirms that the Salter innominate osteotomy does not lead to acetabular retroversion both immediately post-operatively and throughout follow-up. In fact, it demonstrates that the acetabula are more anteverted than the contralateral control hip, which has not been previously documented. Additionally, this study demonstrates a novel method of measuring acetabular retroversion using CT technology that adjusts for pelvic tilt, which is repeatable among individuals. 文献出处：Airey, Grace; Shelton, James; Dorman, Sara; More.The Salter innominate osteotomy does not lead to acetabular retroversion.J Pediatr OrthopB. 30(6):515-518, November 2021. 文献3 改良Woodward手术改善高肩胛症畸形的功能 译者：方科 背景：改良Woodward手术改善肩部运动和外观。很少有报道对功能结果的客观评估。我们报告了用改良Woodward手术治疗的高肩胛畸形的美容和功能结果。 方法：2006年1月至2014年12月接受改良Woodward手术的12岁及以下儿童被纳入前瞻性研究，关注到Cavendish等级、 Rigault等级和肩部运动的改善。儿科结果数据收集工具(PODCI)和简单肩部测试(SST)评分在最终随访时分配。采用配对T检验和Wilcoxon符号秩检验进行统计分析。 结果：分析了平均随访4.5年(1–8年)的14名患者(1名为双侧)，平均手术年龄为5.7岁(3-12岁)。10名(71%)患者合并有肩椎骨。6例患者有Klippel-Feil综合征，其中1例颈椎半椎体伴前胸壁缺损。Cavendish等级、 Rigault等级显著提高(P < 0.05)。平均肩关节外展和前屈活动分别改善37.3°( P < 0.001)和38.7°( P < 0.001)。平均标准PODCI评分为24.07(报告的标准评分范围从146到53)，SST评分为9.64(报告的评分范围从0到12)。SST评分与肩关节功能呈中度相关。没有相关异常的患者具有更好的外观(P = 0.057)和功能(P = 0.029)改善。 结论：改良的Woodward手术改善了肩部外观，为儿童提供了接近正常的功能结果，且与年龄和性别无关。没有合并其他异常的儿童会有更好的改善。 Modified Woodward’s procedure confers functional improvement in Sprengel’s deformity Ashok, Anand; James, Deeptiman; Gahukamble, Abhay; More Background:Modified Woodward’s procedure improves shoulder movement and cosmesis. There is a paucity of literature reporting objective assessment of functional outcomes. We report cosmetic and functional outcomes in Sprengel’s deformity treated with modified Woodward’s procedure. Methods:Children aged 12 years and under, who underwent Modified Woodward’s procedure from January 2006 to December 2014 were included in the prospective study. Improvement in Cavendish grade, Rigault scale, and shoulder movements was noted. Pediatric outcomes data collection instrument (PODCI) and simple shoulder test (SST) scores were assigned at the final follow-up. Statistical analysis was conducted with paired T -test and Wilcoxon signed-rank tests. Results:Fourteen patients (one bilateral) with a mean follow-up of 4.5 years (1–8 years) were analyzed. The mean age at surgery was 5.7 years (3–12 years). Ten (71%) patients had omovertebral bars. Six patients had Klippel-Feil syndrome including one with cervical hemivertebrae with anterior chest wall deficiency. Cavendish grade and Rigault scale improved significantly ( P < 0.05). Mean shoulder abduction and forward flexion improved by 37.3° ( P < 0.001) and 38.7° ( P < 0.001), respectively. The mean normative PODCI score was 24.07 (reported normative score ranges from −146 to 53) and the SST score was 9.64 (reported score ranges from 0 to 12). SST scores demonstrated a moderate correlation with shoulder function. Patients without associated anomalies had better cosmetic ( P = 0.057) and functional ( P = 0.029) improvement. Conclusions:Modified Woodward’s procedure improved cosmesis and provided near-normal functional outcomes in children irrespective of age and sex. Better improvement was noted in children without anomalies. 文献出处：Ashok, Anand; James, Deeptiman; Gahukamble, Abhay; More.Modified Woodward’s procedure confers functional improvement in Sprengel’s deformity.J Pediatr Orthop B. 30(6):585-592, November 2021. 文献4 6岁以下严重髋臼发育不良的患儿单纯前路髋臼周围三联截骨术：预防后倾和前方撞击 译者：文捷 背景：本研究的目的是在6岁以下严重髋臼发育不良的患儿行髋臼周围三联截骨术时如何获得较好的纠正并避免骨骺过度受压，前方过度纠正以及髋臼后倾。 方法：本研究回顾性分析了24例29髋接受单纯前路髋臼周围三联截骨术的6岁以下的髋关节发育不良的患儿，收集术前，术后以及末次随访的临床检查和影像学检查结果。检查包括CT，对比手术侧和健侧髋关节。 结果：末次随访时的临床检查显示与正常髋关节相比，手术侧的髋关节活动范围无明显差异。所有髋关节分类为Wicart A，所有的活动都可以完成。影像学检查，X片显示术后所有指标均较术前有明显改善，术后与末次随访时无明显差异。CT-2D轴向分析显示无髋臼后倾，前后方的覆盖都很好。CT-3D检查对比了手术侧和正常髋臼的前倾角、前外侧倾角和后外侧倾角，结果提示结果类似。 结论：6岁以下严重髋臼发育不良的患儿可从髋臼周围三联截骨术中获益。截骨接近关节留给术中髋臼的摆动自由度更大，纠正程度也更大。合理的操作改变髋臼的方向可以避免前方的过度纠正和髋臼的后倾，以免出现对应的早期疼痛和关节炎。年龄不应成为选择截骨术式的唯一指标。 Periacetabular triple osteotomy by single anterior approach for children under 6-years-old with severe acetabular deficiency: prevention of retroversion and anterior impingement Najdi, Hassan; Mouarbes, Danny; Karnib, Soha; More Background:The aim of this study was to perform periacetabular triple osteotomy (PATO) in children under 6-years-old with severe acetabular deficiency aiming to obtain important correction and avoid excessive pressure on epiphysis, anterior overcorrection and acetabular retroversion. Methods:This is a retrospective study of 29 PATO using single anterior approach in 24 patients under 6-years-old with dysplasia of the hip. Clinical examination and radiographic evaluation were done pre-op, post-op and at last follow-up. Computed tomography (CT) scan was obtained, comparing operated hip to contro-lateral normal hip. Results:Clinical examination of the operated hip, at the last follow-up, showed a normal range of motion with nonsignificant difference when compared to normal hip. All hips were classified as Wicart A, and all activities were allowed. Radiographically, X-ray revealed improvement of all parameters postoperatively, with nonsignificant change compared to the last follow-up. CT-2D axial analysis demonstrated the absence of acetabular retroversion with good anterior and posterior coverage. CT-3D imaging comparing the anterior acetabular inclination, anterolateral and posterolateral inclination angles of operated hip and normal hip showed comparable results. Conclusions:Patients less than 6 years with severe acetabular deficiency could benefit from PATO. Performing osteotomies close to joint gave important acetabular fragment freedom, allowing an important correction. Appropriate manoeuver of reorientation avoided anterior overcorrection and acetabular retroversion, responsible for early pain and osteoarthritis. Age should not be the only criteria to choose the type of osteotomy. Level of evidence: level IV. 文献出处：Najdi, Hassan; Mouarbes, Danny; Karnib, Soha; More.Periacetabular triple osteotomy by single anterior approach for children under 6-years-old with severe acetabular deficiency: prevention of retroversion and anterior impingement.J Pediatr Orthop B. 30(6):519-526, November 2021. 文献5 儿童髋关节感染后遗症：长期临床影像学结果研究 译者：曾鸣 方法：本回顾性研究报告了18例（23髋）小儿髋关节感染后遗症。患者分为两组：观察组6例（8髋）；干预组共12例（15髋），其中12髋因后遗症接受了手术干预，对侧3髋再次进行连续观察。根据Choi的放射学类型对后遗症髋进行分类。临床评估采用改良的Moon标准。 结果：随访时患者的平均年龄为9.3岁。Choi I型3例（13%）、II型10例（43%）、III型2例（8%）和IV型8例（35%）。Choi放射学类型表现出随时间/干预后改变的倾向。随访时，I型3例（13%）、II型17例（74%）和IV型3例（13%）。在随访结果中，有7名优秀、7名良好和4名一般。观察组以I型、II型为主，干预组以IIIB型、IV型为主。两组的共同发现：相同的Choi放射学类型在临床上表现不同，多个关节受累导致功能恶化，髋臼或股骨近端的晚期改变导致临床功能恶化。 结论：Choi I型或II型感染性髋关节的后遗症可在密切随访监督下观察病情。在某些类型中，干预治疗显著改变了感染后遗症的自然史。 Septic sequelae of hip in children: long-term clinicoradiological outcome study Agarwal, Anil; Rastogi, Prateek Methods:The presented retrospective study is a report of 18 patients (23 hips) with infantile post sepsis hip sequelae. There were two groups of patients. The observation group comprised of 6 patients (8 hips). The intervention group included 12 patients (15 hips) of which 12 hips had been surgically intervened for the sequelae and 3 contralateral hips which were again serially observed. The sequelae hips were classified by Choi’s radiological types. The clinical evaluation was done by modified Moon’s criteria. Results:The average patient age at follow-up was 9.3 years. There were 3 type I (13%), 10 type II (43%), 2 type III (8%), and 8 Choi type IV (35%) at presentation. The Choi radiological type showed propensity to change over time/following intervention. At follow-up, there 3 type I (13%), 17 type II (74%), and 3 type IV (13%) hips. At follow-up, there were seven excellent, seven good, and four fair results. The observation group had mostly type I or II and intervention group IIIB or IV Choi types. Findings common to both groups: same Choi radiological type fared different clinically, multiple joint involvement contributed to deterioration of function and late changes in acetabulum or proximal femur lead to deterioration of clinical function. Conclusions:The sequelae of septic hips likely to be kept under supervised observation were Choi type I or II. In select types, intervention changed the natural history of septic sequelae significantly. 文献出处：Agarwal, Anil; Rastogi, Prateek. Septic sequelae of hip in children: long-term clinicoradiological outcome study.J Pediatr Orthop B. 30(6):563-571, November 2021.. 文献6 Legg-Calvé-Perthes病骨盆三联截骨术后髋臼后倾及其对股骨髋臼撞击的影响：15年随访的病例/对照研究 译者：唐仲文 目的：本研究的目的是对比在两组Legg-Calvé-Perthes病(LCPD)患儿中实施骨盆三联截骨术(TPO)对髋臼倾角的影响。其中一组为术后发生股骨髋臼撞击症(FAI)的患儿，而对照组则没有FAI。 方法：单侧LCPD的患者接受TPO治疗被纳入回顾性分析。双侧LCPD、接受TPO同时联合股骨手术的或影像资料不完整的患儿均被排除。对7名发生FAI患儿(FAI+)和8名不发生FAI患儿(FAI-)进行了评估分析，平均随访14.8年。两组在人口统计学数据、诊断年龄、Herring评分以及BMI方面具有可比性。 我们在CT扫描上测量解剖髋臼倾角、手术髋关节和健康髋关节之间髋臼倾角的差异 (delta)、McKibbin（股骨倾角+髋臼倾角）、Stulberg和 Tönnis评分系统。 结果：两组在Stulberg和Tönnis分数上没有统计学差异。所有手术髋臼均后倾，FAI+：-8.41°（范围，-44° 至 10.5°），FAI-：-3.38°（范围，-37.3° 至 11.5°）（P = 0.61）。平均差异（delta）为 FAI+：23.79°（范围，1.5°-59.5°），FAI-：20.14°（范围，5°-45.3°）（P = 0.68）。FAI+组的所有7名患者都具有病理McKibbin指数（<30°），而对比FAI-组中只有4名（P = 0.03）。 结论:TPO可诱发LCPD患者髋臼后倾。通过静态标记（骨盆前平面）评估得出的髋臼后倾本身并不能解释股骨髋臼撞击（FAI）。 Acetabular retroversion after triple pelvic osteotomy for Legg-Calvé-Perthes disease and its impact on the femoroacetabular impingement: a case/control study at 15 years of follow-up. Jeandel, Clément; Cottalorda, Jérôme; Chammas, Pierre Emmanuel; More Purpose:The objective of this study was to compare the effect of triple pelvic osteotomy (TPO) in Legg-Calvé-Perthes disease (LCPD) on acetabular version in a group of patients who developed a femoroacetabular impingement (FAI) and a control group without FAI. Methods:The objective of this study was to compare the effect of triple pelvic osteotomy (TPO) in Legg-Calvé-Perthes disease (LCPD) on acetabular version in a group of patients who developed a femoroacetabular impingement (FAI) and a control group without FAI. Results:The two groups were not statistically different on the Stulberg and Tönnis scores. All operated hip acetabula were retroverted, FAI+: -8.41° (range, -44 to 10.5), FAI-: -3.38° (range, -37.3 to 11.5) (P = 0.61). The average delta was FAI+: 23.79° (range, 1.5-59.5), FAI-: 20.14° (range, 5-45.3) (P = 0.68). All seven patients of the FAI+ group have pathologic McKibbin index (<30°) versus only four of the FAI- group (P = 0.03). Conclusion:TPO induces acetabular retroversion in patients with LCPD. This retroversion, assessed in a static benchmark (anterior pelvic plane), does not in itself explain the FAI. 文献出处：Jeandel, Clément; Cottalorda, Jérôme; Chammas, Pierre Emmanuel; More.Acetabular retroversion after triple pelvic osteotomy for Legg–Calvé–Perthes disease and its impact on the femoroacetabular impingement: a case/control study at 15 years of follow-up.J Pediatr Orthop B. 30(6):527-534, November 2021. 文献7 术前角度测量作为Wassel IV型多指畸形手术的预测因素 译者：曹舒 背景: 本研究的目的是发现术中需行截骨矫形手术的掌指关节（MCP）的角度，并比较通过单纯软组织重建和（或）矫形截骨术治疗Wassel IV型拇指多指畸形的结果。 方法: 回顾性分析了矫正Wassel IV型拇指多指MCP关节成角畸形的手术选择。术前MCP关节成角畸形及术后最后MCP关节残余畸形均通过拇指正位X片测量。通过受试者特征曲线确定术前MCP成角的分界点，该分界点在单独接受软组织手术的患者中残余畸形更少。 结果: 本研究共有45例患者46例拇指多指畸形(Wassel IV型)。 术前和术后MCP角度平均分别为24.01(0-68°)和14.65(0-39°)。 34个拇指（33例患者）(73.91%)只行了软组织手术，12个拇指(26.09%)需行矫形截骨术。 术前MCP成角的最佳临界点为30°(敏感性96.43%，特异性100%)，且残余畸形不明显。 在MCP成角≤30°时，单独进行软组织重建是矫正成角畸形的有效方法，预测结果为无明显残余畸形(0/27拇指)。 在MCP成角>30°时，由于能使拇指维持在正确的位置和获得足够的软组织平衡，推荐采用截骨矫形术而不是单纯的软组织手术。 明显残余畸形的发生率也有统计学意义[从85.71%(6/7例单独采用软组织手术)下降到30%(3/10例采用矫形截骨术)，P < 0.05]。 结论: 本研究建议使用术前MCP关节成角度数作为Wassel IV型拇指多指手术方式的指导。 Preoperative angulation as a predictor for operations of Wassel type IV polydactyly Luangjarmekorn, Pobe; Virojanawat, Natthawat; Pongpacharaamphon, Podsawee; More Background:The aim of this study was to find the degree of preoperative metacarpophalangeal (MCP) joint angulation that determines the need for corrective osteotomy and to compare the result for Wassel type IV thumb polydactyly operated by soft tissue reconstruction alone or with corrective osteotomy. Methods:The surgical options for correction of the angular deformity of the MCP joint in Wassel type IV thumb polydactyly were retrospectively reviewed. The preoperative angular deformity of the MCP joint and the last postoperative residual deformity at MCP joint were measured from the radiograph of thumb posteroanterior view. The cut-off point of the preoperative MCP angulation that provided less residual deformity in patients who were treated by soft tissue procedures alone was identified from receiver operating characteristic curve. Results:A total of 45 patients with 46 thumb polydactyly (Wassel type IV) were studied. Mean pre and postoperative MCP angulation were 24.01 (range 0–68°) and 14.65 (range 0–39°), respectively. Thirty-four thumbs from 33 patients (73.91%) were operated on by soft tissue procedures alone and 12 thumbs (26.09%) needed corrective osteotomy. The best cut-off point of preoperative MCP angulation that showed less significant residual deformity when treated by soft tissue procedure alone was 30° (96.43% sensitivity and 100% specificity). In MCP angulation ≤30°, soft tissue reconstruction alone was an effective method for correction of angular deformity with predictable outcome of no significant residual deformity (0/27 thumbs). In MCP angulation >30°, corrective osteotomy is recommended over soft tissue procedure alone due to achieve proper thumb position and adequate soft tissue balance. There is also a statistical decrease in significant residual deformity [from 85.71% (6/7 cases, treated by soft tissue procedure alone) to 30% (3/10 cases, treated by corrective osteotomy), P < 0.05]. Conclusions:This study proposes the use of preoperative MCP joint angular deformity as a guide to the type of surgical intervention in Wassel type IV thumb polydactyly. 文献出处：Luangjarmekorn, Pobe; Virojanawat, Natthawat; Pongpacharaamphon, Podsawee; More.Preoperative angulation as a predictor for operations of Wassel type IV polydactyly.J Pediatr Orthop B. 30(6):605-610, November 2021. 文献8 远端无螺纹螺钉固定骨骼成熟的股骨头骨骺滑移的结果:一项匹配队列研究 译者：李博 背景：全球范围内治疗股骨头骨骺滑移最常用的方法是用螺纹螺钉进行原位固定。无螺纹螺钉用于在不妨碍股骨近端残余生长的情况下防止滑移进展。本研究的目的是比较无螺纹螺钉固定和标准螺纹螺钉固定后的生长、重塑和长期预后。 方法：招募年龄、骨骼成熟度、性别和Southwick角相匹配的22例患者（30髋），其中6例患者(9髋)采用无螺纹螺钉，16例患者(21髋)采用标准螺纹螺钉。回顾了患者的基本信息、病史和并发症。回顾了骨骺剩余生长和闭合时间的X线片。计算生长速度。没有凸轮畸形意味着完全重塑。临床评估由优到差，并记录患者报告的结果。 结果：无螺纹螺钉组股骨颈长度(7.6 mm, P = 0.003)、关节到小转子距离(5.3 mm, P = 0.028)、螺钉-离关节面比值(7.439%，P = 0.006)和螺钉-过骨骺比值(8.244%，P = 0.001)显著增加。本组由于持续增长而进行翻修手术的可能性较高(风险比:6.57,P = 0.0008)。骨骺闭合的时间没有显著差异，但无螺纹螺钉固定组的生长速度明显更快。凸轮畸形发生率较低，但无显著性差异。在平均11.2年的随访中，功能和临床结果没有显著差异。 结论：与标准螺纹螺钉相比，无螺纹螺钉允许更大的生长。由于无螺纹螺钉的再手术率较高，且没有任何已证明的好处，因此不推荐使用。 Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study Mills, Henry; Flowers, Mark J.; Agrawal, Yuvraj; More Introduction:The most common treatment for slipped capital femoral epiphysis worldwide is in situ fixation with a threaded screw. Un-threaded screws are designed to prevent slip progression without hindering residual growth of the proximal femur. This study aimed to compare growth, remodelling and long-term outcomes after fixation with un-threaded screws and a matched cohort of patients treated with a standard screw. Methods:Six patients (nine hips) treated with un-threaded screws and 16 patients (21 hips) treated with standard screws matched for age, skeletal maturity, sex and Southwick angle were recruited. Clinical records were reviewed for patient demographics, medical history and complications. Radiographs were reviewed for residual growth and time to physeal closure. Growth velocity was calculated.Absence of cam deformity signified complete remodelling. Clinical assessment was graded from excellent to poor and patient-reported outcomes were recorded. Results:There was significantly more growth recorded in the un-threaded screw group in femoral neck length (7.6 mm, P = 0.003), articulo-lesser trochanter distance (5.3 mm, P = 0.028), pin-joint ratio (7.439%, P = 0.006) and pin-physis ratio (8.244%, P = 0.001). The probability of revision operations due to ongoing growth was higher in this group (risk ratio: 6.57, P = 0.0008). Time to physeal closure was not significantly different, but growth velocity was significantly higher in the un-threaded group. The lower probability of cam deformity was not significant. Functional and clinical results were not significantly different at average 11.2 years’ follow-up. Conclusion:Un-threaded screws allow for significantly more growth than standard threaded screws. The un-threaded screw could not be recommended due to the higher re-operation rates, without any proven benefit. 文献出处：Mills, Henry; Flowers, Mark J.; Agrawal, Yuvraj; More.Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study.J Pediatr Orthop B. 30(6):540-548, November 2021. 文献9 先天性尺桡骨融合的疗效：系统评价与荟萃分析 译者：龚昊立 背景：先天性尺桡骨融合 (CRUS) 是影响肘关节和前臂的最常见的先天性疾病之一，前臂固定在一系列位置，通常从中性旋转到严重旋前。本研究的目的除了对CRUS的所有手术方法进行系统回顾之外，就是找出各种影响因素、结果和并发症之间的相关性。 方法：本综述采用Ovid、MEDLINE和Cochrane图书馆电子文献检索系统综述首选报告项目和meta分析格式进行。评分依据纽卡斯尔-渥太华量表和修正的科尔曼方法论评分。分析人口统计资料、手术方式、结果和并发症。汇集结果数据以确定所有研究的平均值和范围。进行Spearman相关性分析。 结果：共有23篇文章，总体研究质量较差(证据等级 IV级)，符合纳入标准。共374例前臂，平均年龄6.7岁(2.0 ~ 18.8岁)。去旋转手术(91%)比运动保留手术(9%)更常见。平均畸形矫正从64.8°旋前(−75°至110°)改善到平均2.8°旋前(−50°至80°)。总共有17.9%的患者出现并发症。年龄与主要并发症、近端截骨和并发症、双平面截骨与术后复位失效之间存在显著相关性。大多数并发症发生在矫正阈值65-70°以上和7岁及以上的儿童。 结论：手术对于改善先天性尺桡骨融合征患儿的生活质量至关重要。然而，随着在旋转截骨中使用的器械不同，每一种类型的手术都与并发症相关。考虑到纳入研究的固有局限性，在解释这些结果时要谨慎。 Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis Barik, Sitanshu; Farr, Sebastian; Gallone, Giovanni; More Background:Congenital radioulnar synostosis (CRUS) is one of the most common congenital disorders affecting the elbow and forearm, with the forearm being fixed in a range of positions usually varying from neutral rotation to severe pronation. The aim of this study, apart from a systematic review of all surgical procedures described for CRUS, is to derive any correlation between various influencing factors, outcomes and complications. Methods:This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format by an electronic literature search of Ovid , MEDLINE and the Cochrane Library databases. Grading was according to the Newcastle-Ottawa scale and the Modified Coleman Methodology Score. Demographic data, surgical procedures, outcomes and complications were analyzed. Outcome data were pooled to establish means and ranges across all studies. Spearman correlations were performed. Results:A total of 23 articles, showing a poor overall study quality (all Level of Evidence IV), met the inclusion criteria. A total of 374 forearms with a mean age of 6.7 years (2.0–18.8) were analyzed. Derotational surgeries were more commonly performed (91%) than motion-preserving surgeries (9%). The mean deformity improved from 64.8° pronation (−75° to 110°) to a mean of 2.8° pronation (−50° to 80°). In total, 17.9% of patients presented with complications. A significant correlation was noted between age and major complications, proximal osteotomies and complications, and postoperative loss of reduction and double level osteotomies as the primary treatment modality. Most of the complications occurred above the threshold of 65–70° of correction and in children 7 years and above. Conclusion: Surgery is essential to improve the quality of life of children with CRUS. However, each type of surgery is associated with complications, along with the respective hardware being used in rotation osteotomies. Caution is, nevertheless, warranted in interpreting these results in view of the inherent limitations of the included studies. 文献出处：Barik, Sitanshu; Farr, Sebastian; Gallone, Giovanni; More.Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis.J Pediatr Orthop B.30(6):593-600, November 2021. 文献10 髋臼深度是髋臼发育的早期预测因素:髋关节发育不良患者行开放复位后的MRI研究 译者：李范玲 背景：早期预测髋臼未来的发育对决定是否需要额外的髋关节发育不良(DDH)手术非常重要。本研究的目的是利用MRI研究髋臼发育的预测因素。 方法：我们回顾性调查了37例行走年龄后行切开复位的DDH患儿（男9例，女28例）的40个脱位髋和34个正常髋。在随访第5年使用冠状核磁共振T2*加权图像评估的髋臼和盂唇软骨。患儿手术时的平均年龄为22个月，最后一次调查时的平均年龄为19岁。在最终随访时，我们按照Severin分级将患者分为两组，对结果良好组(患髋26，健髋27)和结果不良组(患髋14，健髋7)双侧MRI参数进行比较。通过单因素和多因素logistic回归分析确定髋臼发育的预测因素。 结果：多因素logistic回归分析表明，5岁时盂唇髋臼顶深度和盂唇髋中心距离是患侧切开复位后的预测因素(优势比0.27,P = 0.035;优势比为3.4,P = 0.028，依次)，而骨性髋中心距离是健侧的预测因素(优势比为2.6,P = 0.049)。 结论：健侧髋臼发育可以通过骨评估来预测，而患侧髋臼发育必须使用MRI进行盂唇评估来预测。 Acetabular depth an early predictive factor of acetabular development: MRI study in patients with developmental dysplasia of the hip after open reduction. Tetsunaga Tomonori; Akazawa Hirofumi Background:Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery. Methods:An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers. Results:A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions. Conclusions:There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery. Level of Evidence:Level IV—literature review. 文献出处：Tetsunaga Tomonori; Akazawa Hirofumi.Acetabular depth an early predictive factor of acetabular development: MRI study in patients with developmental dysplasia of the hip after open reduction..J Pediatr Orthop B. 30(6):509-514, November 2021. |
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