 本期目录：  1、全膝关节置换术会影响骨盆运动吗? 2、全髋关节置换中陶瓷部件破损的概率是多少？1997年至2017年挪威关节成形术登记系统的统计结果 3、全膝关节置换患者KOOS评分获得最小临床差异和患者可接受状态的诊断学阈值分析 4、股骨粗隆间骨折固定失败后全髋关节置换术 5、膝骨关节炎患者中大腿肌肉力量影响因素 6、人工智能阅读骨盆片可靠吗？ 7、闭合复位、截骨术和腓骨移植术可有效治疗儿童感染后股骨颈假关节 8、股骨或Salter截骨术能否改善LCPD的股骨头球形形态? 9、较大的髋臼盂唇与髋关节发育不良、关节形合度差和临床症状有关 10、Graf髋关节超声检查：学生、检查者和审查者的操作说明 11、LCPD特发性儿童股骨头坏死：内翻去旋转截骨术（VDRO）的短期随访结果  第一部分：关节置换及保膝相关文献 ▷  文献1 全膝关节置换术会影响骨盆运动吗? 译者 张轶超 目的：脊柱-骨盆-下肢任何部位的病理性改变都可能损害整体的姿势平衡，导致其他部位的代偿性改变。本研究的目的是比较患有膝关节骨关节炎的患者与接受全膝关节置换术的患者和健康对照者的骨盆运动状况。 方法：本研究于2021年4月至2022年2月在Cankiri州立医院矫形外科和创伤科诊所进行。这项研究包括84名参与者。其中，2018 - 2020年间行全膝关节置换术的患者31名作为全膝关节置换术组，膝关节骨性关节炎患者28名作为膝关节骨性关节炎组。在对照组中，有25名健康人。排除标准包括任何类型的神经系统疾病，不能独立行走100米，或有下肢手术史者。使用无线三轴加速度计评估骨盆运动(即倾斜、旋转和不正)和步态参数(即步态速度、节奏和步幅长度)。 结果：与膝关节骨性关节炎组相比，全膝关节置换术组和对照组骨盆前倾最小值减小，前倾最大值减小，骨盆倾斜范围减小。与对照组相比，膝关节骨性关节炎组和全膝关节置换术组的步态速度和步幅均显著降低。 结论：在本研究中，发现全膝关节置换术会影响骨盆运动。人们认为全膝关节置换术改变了这些变量，可能是由于通过手术纠正了冠状面和矢状面的力线。 Does total knee arthroplasty affect pelvic movements? A prospective comparative study OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., “gait velocity,” “cadence,” and “stride length”) were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery. 文献出处：Polat EA, Polat Y, Karatay GM, Esmer M, Kafa N, Guzel NA. Does total knee arthroplasty affect pelvic movements? A prospective comparative study. Rev Assoc Med Bras (1992). 2023 Sep 18;69(9):e20221231. doi: 10.1590/1806-9282.20221231. PMID: 37729355; PMCID: PMC10508946. ▷ 文献2 全髋关节置换中陶瓷部件破损的概率是多少？ 1997年至2017年挪威关节成形术 登记系统的统计结果 译者 马云青 背景: THA 中的陶瓷界面已经被用来减少磨损，最近，由于金属离子的不利影响，陶瓷界面也被用来替换金属对金属摩擦界面。陶瓷界面的潜在缺点是其易脆性和陶瓷破损的风险，这可能导致翻修手术。然而，对于断裂陶瓷界面的翻修比例还没有得到充分的研究。 (1)在聚乙烯陶瓷(CoP)和陶瓷陶瓷(CoC) THAs 中，陶瓷假体破裂的翻修比例是多少? 氧化铝陶瓷和氧化铝基复合陶瓷(AMC)之间有什么区别？ (2)与这种陶瓷破损的并发症的相关的危险因素有哪些？ (3)接受陶瓷假体破损翻修的患者在后续翻修的程度有多大，原因是什么？ What Is the Frequency of Fracture of Ceramic Components in THA? Results from the Norwegian Arthroplasty Register from 1997 to 2017 Background:Ceramic bearings in THA have been used to reduce wear and, more recently, to avoid metals in the bearing because of the risk of metal ions adverse effects. Potential disadvantages to ceramic bearings are their brittleness and the ceramic fracture risk, which may lead to revision surgery. The frequency of revision for a fracture ceramic bearing, however, has not been thoroughly studied. Questions/purposes:(1) What is the frequency of revision for a fractured ceramic bearing in ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) THAs, and is there any difference between alumina ceramics and alumina matrix composites (AMC)? (2) What are the factors associated with this complication? (3) To what extent did the patients who underwent revision for a fractured ceramic bearing undergo subsequent revisions, and for what reason? Methods:The Norwegian Arthroplasty Register has collected data on hip arthroplasty since 1987 and has a completeness of reporting of 97.3% for primary THAs and 93.3% for revision. From 1997 to 2017, 146,171 primary THAs were registered in the Norwegian Arthroplasty Register. Of these, 31,479 had a CoP articulation and 5790 had a CoC articulation. Two manufacturers produced ceramic heads; one produced 25,678 alumina heads and the other made 2465 alumina heads. All 7901 AMC heads were made by the same manufacturer. Patients who underwent CoP THA were a median (range) of 63 years old (11 to 98) and CoC THA were a median (range) 61 years old (17 to 95); 38% (11,833 of 31,479) of the patients who underwent CoP THA and 41% (2379 of 5790) of the patients who underwent CoC THA were males. Femoral heads made of alumina (n = 28,143), zirconia (n = 1225), and AMC (n = 7901) ceramics were used. To assess revision frequency, we identified patients who underwent revision because of fracture of a ceramic head and/or liner, and calculated the Kaplan-Meier survivorship free of revision for fracture in CoC and CoP articulations. Alumina ceramics and AMC were compared. In terms of factors potentially associated with revision, patient factors (age, sex, and diagnosis), type of articulation (CoP or CoC), femoral head size, and femoral head/neck length were evaluated with Cox regression models to evaluate any association with ceramic fracture and a Poisson regression to compare alumina and AMC head fractures. To evaluate subsequent revisions, hips that were revised for ceramic fracture were evaluated for any further revisions; Kaplan-Meier survivorship free of further revisions was calculated, and revision causes were identified. Results:Survivorship free from revision for ceramic fracture was 99.9% (95% CI 99.9 to 99.9) for CoP bearings, and 99.8% (95% CI 99.6 to 100) for CoC bearings at 10 years, with 7467 and 1884 hips at risk in the two groups, respectively. The hazard ratio for ceramic head fracture was 3.6 (95% CI 1.7 to 7.6) for CoC compared with CoP. The risk of fracture was greater for alumina ceramics than for AMC heads (adjusted HR 14.1 [95% CI 4.2 to 47.0]; p < 0.001). Factors that were associated with revision for fracture of a ceramic head were male sex (HR 5.2 [95% CI 2.6 to 10.4]; p < 0.001), a CoC articulation compared with CoP (HR 3.6 [95% CI 1.7 to 7.6]; p = 0.001), a 28-mm femoral head compared with a 32-mm head (HR 2.7 [95% CI 1.1 to 6.4]; p = 0.02), and short head/neck length compared with a medium head/neck length (HR 2.5 [95% CI 1.1 to 5.3]; p = 0.03). Five of 50 patients undergoing revision for ceramic fracture underwent further revisions, resulting in a 5-year survivorship free from re-revision of 86% (95% CI 74.4 to 98.0). The reasons for re-revision were infection (n = 2), another ceramic head fracture (n = 2), and cup loosening (n = 1). Conclusions:Fracture of a ceramic THA bearing is rare and seems to affect about one in 1000 patients who receive such a bearing. To minimize the risk of this complication, surgeons should avoid small femoral heads (< 32 mm) and the shortest head/neck lengths. Surgeons should also know that the risk is increased in CoC articulations and in males. Bearings made of AMC appear to be at lower risk than those made from alumina ceramics. However, the long-term clinical wear performance of AMC bearings has not been extensively studied and should be studied further. 文献出处：What Is the Frequency of Fracture of Ceramic Components in THA? Results from the Norwegian Arthroplasty Register from 1997 to 2017. Clin Orthop Relat Res (2020) 478:1254-1261 ▷ 文献3 全膝关节置换患者KOOS评分获得最小临床差异 和患者可接受状态的诊断学阈值分析 译者 张蔷 背景：文献显示各种患者自评量表需要获得最小临床差异（MCID）和患者可接受状态（PASS）的阈值有很大不同。本篇研究的目的是确定因骨关节炎（OA）而施行初次全膝关节置换手术（TKA）的患者膝关节损伤与骨关节炎（KOOS）评分疼痛亚表、功能短表（PS）和关节置换亚表（JR）所能获得的最小可监测变化（MDC）、MCID和PASS的阈值。 方法：本前瞻性研究共入组了6778例初次全膝关节置换患者。最终，共有5316例患者在1年随访时完成了KOOS疼痛亚表，共有5018例患者在1年随访时完成了KOOS功能短表，共有4033例患者在1年随访时完成了KOOS关节置换亚表。共5186例患者术前诊断为骨关节炎，本组平均年龄67岁，59.9%为男性，80.4%为白人。我们通过基于分布的方法估算诊断性的MDCs和MCIDs值，另外通过基于术后一年随访时的满意度问题来估算PASS值。 结果：OA组患者KOOS疼痛亚表评分MCID阈值为7.9分，功能短表评分MCID阈值为8.0而关节置换亚表评分MCID阈值为6.7。大多数患者（疼痛亚表，95%；功能短表，88%；关节置换亚表，94%）均达到了各个评分的MCID阈值。KOOS疼痛亚表的MDC 80%-95%置信区间为9.1-14.0，KOOS功能短表的MDC 80%-95%置信区间为9.2-14.1，KOOS关节置换亚表的MDC 80%-95%置信区间为7.7-11.8。OA组患者疼痛评分的PASS阈值为77.7（73%的患者均能达到），功能短表的PASS阈值为70.3（68%的患者均能达到），而关节置换亚表的PASS阈值为70.7（70%的患者均能达到）。 结论：本研究为OA患者的KOOS疼痛评分、功能短表评分和关节置换评分提供了有临床价值的MCID、MDC和PASS阈值。这些确定的诊断阈值可以作为未来术后临床改进的标尺。未来有关TKA的疗效评价研究应合理运用这些诊断OA的阈值。若能做到这一点，我们就能以患者为中心，真正准确的评估手术的成功与改良。 Diagnosis-Specific Thresholds of the Minimal Clinically Important Difference and Patient Acceptable Symptom State for KOOS after Total Knee Arthroplasty Background: Literature-reported minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for patient-reported outcome measures demonstrate marked variability. The purpose of this study was to determine the minimal detectable change (MDC), MCID, and PASS thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subdomain, Physical Function Short Form (PS), and Joint Replacement (JR) among patients with osteoarthritis (OA) who underwent primary total knee arthroplasty (TKA). Methods: A prospective cohort of 6,778 patients who underwent primary TKA was analyzed. Overall, 1-year follow-up was completed by 5,316 patients for the KOOS Pain, 5,018 patients for the KOOS PS, and 4,033 patients for the KOOS JR. A total of 5,186 patients had an OA diagnosis; this group had an average age of 67.0 years and was 59.9% female and 80.4% White. Diagnosis-specific MDCs and MCIDs were estimated with use of a distribution-based approach. PASS values were estimated with use of an anchor-based approach, which corresponded to a response to a satisfaction question at 1 year postoperatively. Results: The MCID thresholds for the OA group were 7.9 for the KOOS Pain, 8.0 for the KOOS PS, and 6.7 for the KOOS JR. A high percentage of patients achieved the MCID threshold for each outcome measure (KOOS Pain, 95%; KOOS PS, 88%; and KOOS JR, 94%). The MDC 80% to 95% confidence intervals ranged from 9.1 to 14.0 for the KOOS Pain, 9.2 to 14.1 for the KOOS PS, and 7.7 to 11.8 for the KOOS JR. The PASS thresholds for the OA group were 77.7 for the KOOS Pain (achieved by 73% of patients), 70.3 for the KOOS PS (achieved by 68% of patients), and 70.7 for the KOOS JR (achieved by 70% of patients). Conclusions: The present study provided useful MCID, MDC, and PASS thresholds for the KOOS Pain, PS, and JR for patients with OA. The diagnosis-specific metrics established herein can serve as benchmarks for clinically meaningful postoperative improvement. Future research and quality assessments should utilize these OA-specific thresholds when evaluating outcomes following TKA. Doing so will enable more accurate determinations of operative success and improvements in patient-centered care. 文献出处：Emara AK, Pasqualini I, Klika AK, Orr MN, Rullán PJ, Piuzzi NS; Cleveland Clinic Arthroplasty Group. Diagnosis-Specific Thresholds of the Minimal Clinically Important Difference and Patient Acceptable Symptom State for KOOS After Total Knee Arthroplasty. J Bone Joint Surg Am. 2024 Feb 21. doi: 10.2106/JBJS.23.00027. Epub ahead of print. PMID: 38381811. ▷ 文献4 股骨粗隆间骨折固定失败后全髋关节置换术 译者 丁云鹏 背景：粗隆间骨折是老年患者常见的骨折。全髋关节置换术（THA）被认为是一种在固定失败后恢复髋关节功能的挽救性手术，但由于一些临床潜在问题，该手术仍存在一些争议。 方法：回顾性分析2013年9月至2016年10月接受THA治疗的18例老年股骨粗隆间骨折固定失败患者（平均年龄70.3岁）。内固定治疗包括5名接受了股骨近端抗旋转钉治疗的患者，7名接受了锁定股骨近端钢板治疗的患者和6名接受了动力髋螺钉治疗的患者。所有患者均使用生物髋臼假体和全涂层长柄股骨假体进行THA治疗，必要时使用钢丝或钢板固定大粗隆。患者治疗前后的Harris评分、SF-36健康问卷评分和数字放射学（DR）用于关节假体的初始稳定性和生存评估。 结果：15名患者完成了19至54个月的随访期（平均26.2个月；1名患者死于肺栓塞，1名患者在手术后1年死于肺心病，1名因个人原因退出）。没有关节感染、假体周围骨折或脱位。平均Harris评分显著增加，从手术前的32.68±12.04分增加到治疗后24个月的91.08±5.9分。SF-36评分显著升高。 结论：THA抢救治疗老年股骨粗隆间骨折内固定失败，可明显减轻髋关节疼痛，恢复关节功能，早期临床疗效满意。 Total hip arthroplasty for intertrochanteric fracture fxation failure Background: Intertrochanteric fracture is a common fracture sufered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fxation failure, which remains somewhat controversial due to some clinical potential issues. Methods: 18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fxation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fxation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fxed using wire or steel when necessary. Patients’ Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation. Results: 15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased signifcantly, from 32.68±12.04 points before surgery to 91.08±5.9 points at 24 months posttreatment. SF-36 scores were signifcantly increased. Conclusion: THA as salvage treatment for failed internal fxation of intertrochanteric femoral fractures in elderly patients signifcantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory. 文献出处：Liyun Liu , Yongqiang Sun , Linlin Wang ，Total hip arthroplasty for intertrochanteric fracture fxation failure. Eur J Med Res 2019 Dec 27;24(1):39. doi: 10.1186/s40001-019-0398-1. ▷ 文献5 膝骨关节炎患者中大腿肌肉力量影响因素 译者 张峻 目的：在膝关节或髋关节骨关节炎患者中，肌肉无力是常见的，并且与临床结果密切相关。到目前为止，还没有关于膝关节和髋关节骨关节炎肌肉力量相关因素的明确综述。本文的目的是提供关于这一人群中与大腿肌肉力量相关因素的最新知识概述。 设计：截止2017年4月22日，对MEDLINE数据库进行了系统搜索。包括描述膝关节或髋关节骨关节炎患者各因素与肌肉力量之间关系的研究。 结果：共有65项研究符合纳入标准。在膝骨关节炎的研究中，一致发现4个因素与较低的肌肉力量有关。由于髋关节骨关节炎的研究数量较少，因此无法得出相关结论。 结论：膝骨关节炎病人中，较低的肌肉质量，缺乏运动，更加严重的关节退变和严重的疼痛和大腿肌肉力量下降有关。未来膝骨关节炎的研究应该关注肌肉力量的潜在决定因素，如肌肉量、肌肉活力、营养和维生素以及炎症。在髋关节骨关节炎中，需要对所有潜在的决定因素进行更多的研究。 Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review Objective: Muscle weakness is common and strongly related to clinical outcome in patients with knee or hip osteoarthritis. To date, there is no clear overview of the information on factors associated with muscle strength in knee and hip osteoarthritis. The aim of this paper is to provide an overview of current knowledge on factors associated with upper leg muscle strength in this population. Design: The framework of a scoping review was chosen. MEDLINE database was searched systematically up to 22 April 2017. Studies that described a relationship between a factor and muscle strength in knee or hip osteoarthritis were included. Results: A total of 65 studies met the inclusion criteria. In studies of knee osteoarthritis, 4 factors were consistently found to be associated with lower muscle strength. Due to the low number of studies on hip osteoarthritis no conclusions could be drawn on associations. Conclusion: Lower muscle quality, physical inactivity, more severe joint degeneration, and higher pain are reported to be associated with lower strength in the upper leg muscles in knee osteoarthritis. Future research into knee osteoarthritis should focus on other potential determinants of muscle strength, such as muscle quantity, muscle activation, nutrition and vitamins, and inflammation. In hip osteoarthritis, more research is needed into all potential determinants. 文献出处：de Zwart AH, Dekker J, Lems W, Roorda LD, van der Esch M, van der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. J Rehabil Med. 2018 Feb 13;50(2):140-150. doi: 10.2340/16501977-2284. PMID: 29186637. 第二部分：保髋相关文献  ▷ 文献1 人工智能阅读骨盆片可靠吗？ 译者 罗殿中 目的：虽然骨盆三维成像方面是骨盆评估的里程碑式的进步，但有报告认为，由于对骨盆标志点选择的主观变化，导致观察者间和观察者内的巨大差异。人工智能（AI）增强软件系统的应用---通过提供标准化测量方法，可大大提高骨盆影像测量的可重复性。本研究的目的是采用一种新研制的评估骨盆影像的AI流程、来明确该软件的可靠性和一致性。 方法：280名患者300例骨盆影像资料纳入评估，涵盖不同程度的髋臼包容、和骨关节炎程度（Tonnis 0至3级）。比较人工测量和AI测量输出结果的可靠性和一致性，包含外侧中心边缘角（LCE）、颈干角、髋臼指数（臼顶倾斜角）、和股骨头外移指数。 结果：AI输出结果可靠性为94.3%（283/300），组内相关系数（ICC）自臼顶倾斜角的0.73至LCE角的0.80。人工测量与AI测量输出结果存在一致性，以测量的标准误为指标（SEM），一致性较好的是包容正常组（LCE-SEM：3.4°）、和无骨关节炎组（LCE-SEM：3.3°）；一致性较差的是包容不良组（LCE-SEM：5.2°）和严重骨关节炎组（LCE-SEM：5.1°）。 结论：在对骨盆影像进行评估时，AI增强的应用是对人工测量的可靠补充。对于正常髋臼覆盖和轻度骨关节炎征象患者，测量结果准确可靠；而对于髋臼发育不良和重度骨关节炎患者，需要进一步提高评估效果。 图. AI软件评估骨盆片输出示例。 图. 正常髋臼覆盖、覆盖不足、和过度覆盖中正确的骨性标志示例。 图. 错误骨性标志示例。左图显示股骨轴线识别错误；中图显示眉弓外缘设置在骨赘上；右图显示旋转中心和股骨颈中点识别错误。 文献出处：Can an artifcial intelligence powered software reliably assess pelvic radiographs? International Orthopaedics (2023) 47:945–953. ▷ 文献2 闭合复位、截骨术和腓骨移植术 可有效治疗儿童感染后股骨颈假关节 译者 张振东 背景：如果急性髋关节化脓性关节炎延误治疗，可能会出现严重的后遗症。这可能表现为短髋畸形、髋内翻或髋外翻畸形。股骨颈假性关节是一种罕见的并发症，目前仅有少数研究可用于指导治疗。 问题/目的：在一系列急性化脓性关节炎后股骨颈假性关节患者中，我们希望确定：（1）是否可以通过各种手术方法实现股骨颈骨愈合；(2) 这些患者是否符合 Hunka 和 Choi 提出的标准，即髋关节稳定、屈曲≥ 70°且无固定的内收或外展挛缩畸形、固定的屈曲畸形不超过 20°、疼痛缓解以及术后恢复日常生活活动；以及 (3) 观察到的任何与治疗相关的并发症。 方法：研究查阅了Lady Hardinge医学院及附属医院骨科门诊部诊断为髋关节化脓性关节炎后遗症患者的病历。2003年至2014年间，共有54名髋关节化脓后遗症患儿（61髋）接受了各种髋关节重建手术。其中，16 例患者（30%）被诊断为股骨颈假性关节，并被纳入本研究。所有确诊患者均接受了手术治疗。在这组患者中，中位年龄为 48 个月（18-96 个月）。初次感染的发病年龄为 0.3 个月至 84 个月（中位数为 8 个月）。这16例患者共接受了24次手术，以实现假关节部位的骨性连接。大多数患者手术方案为近端截骨、腓骨移植和外翻截骨术。对于股骨颈较短并伴有假性关节的患者，采用了联合腓骨移植的截骨术。所有患者的假关节部位均未显露。中位随访时间为 6 年（3-12 年）。没有患者在 3 年前失去随访。所有患者都按照 Choi 的标准进行了临床评估。此外，还询问了患者父母的日常活动和疼痛情况。其他相关并发症也被详细记录。 结果：16 例患者中有 15 例在 6 至 24 个月内（中位数为 9 个月）实现了假关节部位的骨性愈合。10例患者只接受了一次手术就实现了骨性愈合，4例患者接受了两次手术，另外2例患者接受了三次手术。15例患者达到了Hunka 和 Choi 提出的标准，1例患者未能达到。并发症包括深部感染和缺血性坏死等并发症。 结论：髋关节化脓后股骨颈假性关节的手术重建非常困难，但许多患者有可能获得成功。应尽一切努力实现假关节修复。一旦修复成功，临床功能和髋关节稳定性都会得到改善。在早期随访中，许多患者都有足够的活动度，疼痛轻微，跛行可以接受，并且可以在没有支撑的情况下进行室内和室外活动。长期效果尚不清楚，治疗儿童髋关节感染疾病后遗症是一项挑战。 Closed Reduction, Osteotomy, and Fibular Graft Are Effective in Treating Pediatric Femoral Neck Pseudarthrosis After Infection Background: When treatment of acute septic arthritis of the hip is delayed, severe sequelae can occur. This may take the form of coxa breva, vara, or valga. Pseudoarthrosis of the femoral neck is a rare complication with only a few studies to guide treatment. Question/purposes: In a small series of patients with pseudarthrosis of the femoral neck after acute septic arthritis, we wanted to determine (1) whether femoral neck union can be achieved using a variety of surgical approaches; (2) whether these patients satisfied criteria outlined by Hunka and Choi, defined as a stable hip, a flexion arc ≥ 70° and no fixed adduction or abduction contractures, fixed flexion deformity not more than 20°, pain relief, and restoration of activities of daily living after surgery; and (3) any treatment-related complications if observed. Methods: We reviewed the charts of patients who had presented to the orthopaedics outpatient department at Lady Hardinge Medical College and Associated Hospitals with the diagnosis sequelae of septic arthritis of the hip. Between 2003 and 2014, a total of 54 pediatric patients (61 hips) with sequelae of a septic hip had undergone various hip reconstructive procedures. Of these, 16 patients (30%) were diagnosed with pseudarthrosis of the femoral neck and were included in this study. All patients with this diagnosis were treated surgically. In this group, the median age at first contact with our treating team was 48 months (range, 18-96 months). The age of onset of the initial infection was 0.3 months to 84 months (median, 8 months). These 16 patients underwent a total of 24 surgical procedures to achieve union at the pseudoarthrosis site. We performed close reduction, fibula graft, and valgus osteotomy in most of the patients. Wagner's double intertrochantric osteotomy with a fibula graft was done in patients in whom there was a short femoral neck along with pseudoarthrosis. In all patients, the pseudarthrosis site was not exposed. Median followup was 6 years (range, 3-12 years). No patient was lost to followup before 3 years. Union was defined when there was complete radiologic healing at the pseudoarthrosis site. All the patients were clinically evaluated as per Choi's criteria. Parents were also asked about daily activities and pain. Other related complications were also recorded. Results: Fifteen of 16 patients achieved union at the pseudarthrosis site within 6 to 24 months (median, 9 months). Ten patients underwent a single procedure to achieve union, whereas four patients underwent two surgical procedures and two patients underwent three procedures. Fifteen patients achieved Choi's criteria and one patient could not achieve this. While attempting this reconstruction, complications occurred in the form of deep infection and avascular necrosis. Conclusions: Surgical reconstruction of pseudarthrosis of the femoral neck after pyarthrosis of the hip is difficult, but a successful result may be possible in many patients. Every effort should be made to achieve pseudarthrosis repair while the femoral head remains viable on radiographs. Once union is achieved, clinical function and hip stability improve. At early followup, many patients have adequate ROM with minimal pain, an acceptable limp, and are able to do indoor and outdoor activities without support. Long-term results are unknown, and we caution that treating the sequelae of childhood hip disease is challenging. 文献出处：Kanojia RK, Gupta S, Kumar A, Reddy BK. Closed Reduction, Osteotomy, and Fibular Graft Are Effective in Treating Pediatric Femoral Neck Pseudarthrosis After Infection. Clin Orthop Relat Res. 2018 Jul;476(7):1479-1490. doi: 10.1097/01.blo.0000533616.93007.46. PMID: 29698303; PMCID: PMC6437561. ▷ 文献3 股骨或Salter截骨术能否改善LCPD的 股骨头球形形态?一个荟萃分析 译者 任宁涛 背景: 最近，两项前瞻性多中心观察性研究的作者建议通过手术来改善大龄儿童LCPD的股骨头球形度，而大型回顾性观察性研究提示手术并不能改善大龄儿童的股骨头球形度。因此，Legg-Calvé-Perthes疾病(LCPD)的治疗仍存在争议。 问题/目的: 通过荟萃分析，与非手术方式相比，股骨内翻截骨术(FVO)或Salter截骨术(SIO)在LCPD疾病过程结束时是否能获得更好的影像学上股骨头球形度。 方法:系统检索相关文献，包括LCPD、手术治疗和非手术治疗。在160篇摘要中，回顾了57篇全文研究，并选择14篇文章进行荟萃分析。采用亚组分析评估年龄和疾病分期对预后的影响。计算手术后与非手术治疗后股骨头球形度的比值，以衡量每个研究的效应大小，并计算合并效应值比值比 (OR)。 结果: 与非手术治疗的患者相比，手术可使股骨头球形度改善(OR, 1.29; 95% CI, 1.05-1.60)。在小于6岁的儿童中，手术没有改变股骨头球形度(OR, 1.02; 95% CI, 0.45-2.36);6岁及以上儿童手术治疗比非手术治疗更有可能获得更好的股骨头球形度(OR, 2.05; 95% CI, 1.28-3.26)。 结论:荟萃分析结果提示在碎裂期或碎裂期之前年龄大于6岁的LCPD患者应考虑FVO或SIO。 Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis Background: Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial. Questions/purposes: Using a meta-analysis we asked whether femoral varus osteotomy (FVO) or Salter innominate osteotomy (SIO) resulted in better radiographic head sphericity at the end of the disease process as compared with nonsurgical modalities. Methods: We systematically searched the literature using the key concepts LCPD, operative treatment, and nonoperative treatment. Of 160 abstracts, 57 full-text studies were reviewed and 14 papers chosen for meta-analysis. Subgroup analyses were performed to assess the impact of age and stage of disease. The odds of a spherical head after operative compared with nonoperative treatment were calculated to measure effect size for each study and a pooled odds ratio (OR) calculated. Results: Head sphericity improved (OR, 1.29; 95% CI, 1.05-1.60) by FVO or SIO as compared with patients treated nonoperatively. In children younger than 6 years, it did not alter femoral head sphericity (OR, 1.02; 95% CI, 0.45-2.36); children 6 years of age and older were more likely to have better femoral head sphericity from surgical treatment than nonoperative treatment (OR, 2.05; 95% CI, 1.28-3.26). Conclusions: The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered. 文献出处：Saran N, Varghese R, Mulpuri K. Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis. Clin Orthop Relat Res. 2012 Sep;470(9):2383-93. doi: 10.1007/s11999-012-2326-3. PMID: 22467420; PMCID: PMC3830109. ▷ 文献4 较大的髋臼盂唇与髋关节发育不良、关节形合度差和临床症状有关 译者 李勇 目的:探讨盂唇部长度与髋臼形态及临床症状的关系。方法:回顾性纳入2015年1月至2018年12月在我院髋关节门诊就诊的患者。我们的样本包括接受以下一种或多种诊断的患者:髋关节盂唇撕裂、股骨髋臼撞击(FAI)和髋关节发育不良。排除骨关节炎和/或骨坏死患者。测量双侧盂唇长度为在中央冠状面t1加权磁共振成像扫描水平交叉参考轴向面(3- 9点钟位置)，从髋臼边缘到盂唇边缘的距离。平片评价髋臼外侧中心边缘角(LCEA)和髋臼顶倾斜度(ARO)。LCEA为25°或更小被定义为髋关节发育不良，而LCEA为30°或更大、LCEA大于40°或髋臼倾角小于0°的阳性交叉征象被定义为钳型FAI。α角大于50°或头颈偏移小于8mm被认为是凸轮失稳。使用日本骨科协会疼痛量表评估双侧髋关节症状的严重程度，其中得分为满分(即满分)的髋关节被定义为无症状，而得分为所有其他分数的髋关节被认为有症状。我们使用简单的线性回归来检验盂唇长度与LCEA和ARO的相关性。根据患者髋关节症状状态，使用Mann-Whitney U测试比较盂唇长度。结果:本研究纳入102例患者，其中双侧症状14例，单侧症状88例。盂唇长与LCEA (r=-0.612, P<.001)和ARO (r=0.635, P<.001)呈显著正相关。此外，有症状髋关节患者的盂唇(9.5±3.0 mm)明显大于无症状髋关节患者(7.9±2.1 mm, P = 0.004)。结论:髋臼盂唇长度在发育不良，关节形合度差和有症状的髋关节较正常关节相比明显更大。 Larger Acetabular Labrum Is Associated With Hip Dysplasia, Joint Incongruence, and Clinical Symptoms Purpose: To evaluate the association of labral length with acetabular morphology and clinical symptoms. Methods: Patients treated at our hip joint clinic between January 2015 and December 2018 were retrospectively enrolled in the study. Our sample included patients who received a diagnosis of one or more of the following: hip labral tear, femoroacetabular impingement (FAI), and developmental dysplasia of the hip. Patients with osteoarthritis and/or osteonecrosis were excluded. Bilateral labral length was measured as the distance from the acetabular rim to the edge of the labrum at the level of the central coronal Tl-weighted magnetic resonance imaging scan cross-referenced to the axial plane (3- to 9o'clock position). The lateral center-edge angle (LCEA) and acetabular roof obliquity (ARO) were evaluated with plain radiographs. An LCEA of 25° or less was defined as developmental dysplasia of the hip, whereas a positive crossover sign in the presence of an LCEA of 30° or greater, an LCEA greater than 40°, or acetabular inclination lower 0° was defined as pincer FAI. An alpha angle greater than 50° or head-neck offset lower 8 mm was considered cam FAL. The severity of hip symptoms was evaluated bilaterally using the Japanese Orthopaedic Association pain scale, on which hips scoring full points (i.e., a perfect score) were defined as asymptomatic whereas hips with all other scores were considered symptomatic. We used simple linear regression to examine the correlations of labral length with the LCEA and ARO. Labral length was also compared according to patient hip symptom status using the Mann-Whitney U test. Results: The study included 102 patients (14 with bilateral symptoms and 88 with unilateral symptoms). Labral length was strongly correlated with the LCEA (r=-0.612, P<.001) and ARO (r=0.635, P<.001). Additionally, patients with symptomatic hips had significantly larger labra (9.5 ± 3.0 mm) than those with asymptomatic hips (7.9 ± 2.1 mm, P = .004). Conclusions: Acetabular labral length is significantly greater in dysplastic, irregularly congruent, symptomatic hips. Level of Evidence: Level IV, retrospective cross-sectional study. 文献出处：Kamenaga T, Hashimoto S, Hayashi S, Takayama K, Niikura T, Kuroda R, Matsumoto T. Larger Acetabular Labrum Is Associated With Hip Dysplasia, Joint Incongruence, and Clinical Symptoms. Arthroscopy. 2020 Sep;36(9):2446-2453. doi: 10.1016/j.arthro.2020.05.023. Epub 2020 May 24. PMID: 32461021. ▷ 文献5 Graf髋关节超声检查： 学生、检查者和审查者的操作说明 译者 张利强 自1980年Reinhard Graf教授的工作发表以来，Graf技术已成为许多欧洲和非欧洲国家筛查发育性髋关节发育不良（DDH）的金标准。尽管它有可靠的文献证据支持，但也有人批评它的可靠性和可重复性，质疑诊断过程的几个方面。然而，根据最近的文献，人们对发表数据的质量和可靠性感到担忧，在许多情况下，这些数据可能是基于不正确的扫描，因此得出的任何结论都必须受到质疑。本综述的目的是说明Graf技术的最重要方面，澄清潜在的混淆来源，并指出超声检查或报告过程中最常见的错误。此外，这篇综述可以作为审稿人和编辑的指南，有助于加强对这一主题出版物的质量控制。 关键词：发育性髋关节发育不良；超声；Graf 强烈建议每次扫描时使用检查支架（用于正确固定婴儿）和探头支架（用于固定和定位传感器）。 图像的投影应始终处于正确的冠状位置（与a.p.位髋关节X射线对右髋进行成像相同）。 如果图像旋转/镜像在技术上不可行，强烈建议使用外部显示器 髋关节应至少占据图像的三分之二，在头端延伸至近端软骨膜上方几毫米，尾侧清晰地显示软骨骨边界。 在每次髋关节扫描中识别某些解剖标志至关重要。（COB：软骨骨边界，FH：股骨头，SF：滑膜皱襞，JC：关节囊，L：盂唇，C：软骨，BR：骨顶，cc：凹度，cv：凸度，TP：转折点）。 盂唇：(a) 始终与股骨头接触，(b) 位于关节囊内侧，恰好位于股骨头外侧的位置，(c) 位于“软骨膜间隙”的远端，并且(d)位于髋臼（骨顶）透明软骨的外侧。（IFL：坐股韧带，L：盂唇，HC：透明软骨 ，FH：股骨头，PG：软骨膜间隙，如箭头所示）。 从髂骨的内侧和远端开始扫描非常重要，并沿着骨性髋臼的轮廓到近端和外侧。（TP：转折点，虚线和箭头显示了扫描的正确方向，即从内侧到外侧）。 倾斜误差的类型和特征性超声检查结果 Hip sonography according to Graf: practical notes for the student, the examiner and the reviewer Since the publication of Professor Reinhard Graf’s work in 1980, Graf’s technique has become the gold standard for screening Developmental Dysplasia of the Hip (DDH) in many European and non-European countries. Despite the fact that it is supported by robust literature evidence, there is criticism about its reliability and reproducibility, questioning several aspects of the diagnostic procedure. There is, however, concern, based on recent literature, about the quality and reliability of the published data, which may, in many cases, be based on inadequate scans, and therefore any conclusions drawn have to be questioned. The aim of this review is to demonstrate the most important aspects of Graf’s technique, to clarify the potential sources of confusion and to flag up the most common errors and mistakes made, either during the ultrasound examination, or during the reporting procedure. Furthermore, this review can be used as a guide for reviewers and editors and should help to enhance the quality control of publications on this subject. Keywords: Developmental Dysplasia Hip; Ultrasound; Graf 文献出处：Chlapoutakis K, Maizen C, Placzek S, O'Beirne J, Dubs B, Casini C, Tzatzairis T. Hip sonography according to Graf: practical notes for the student, the examiner and the reviewer. Med Ultrason. 2023 Dec 27;25(4):453-465. doi: 10.11152/mu-4194. Epub 2023 Sep 10. PMID: 37778029. ▷ 文献6 LCPD特发性儿童股骨头坏死： 内翻去旋转截骨术（VDRO）的短期随访结果 译者 陶可 背景：未经治疗的Perthes病可在40岁时导致髋关节骨关节炎。对于6岁以下的儿童，治疗为保守治疗，6-9岁年龄组可手术治疗。晚发性Perthes年龄超过9岁或以上的病例，因病程侵袭性强且预后不佳而令人担心。然而，文献并未就保守治疗和手术治疗达成共识。本研究评估了8岁或以上晚发性Perthes病的内翻去旋转截骨术(VDRO)的临床和放射学结果。 材料和方法：本研究纳入了15名儿童（13名男性和2名女性），平均年龄为9.4岁，属于改良Elizabethtown分类IB、IIA、IIB期，2008年至2014年间接受开放楔形内翻去旋转截骨术(VDRO)治疗。7名患者(46.67%)就诊时年龄>10岁。所有患者均存在外展和内旋受限。8名患者（53.33%）出现髋部疼痛，12名患者（80%）出现跛行。诊断和矫正手术之间的平均时间为3周。 结果：使用股骨头指数（CI）和骨骺比值（EQ，注：EQ是受累股骨头的骨骺指数与未受累股骨头的骨骺指数之比。骨骺指数是通过骨骺的最大高度除以其宽度来计算的。）以及放射学上的股骨头关节面转子距离、运动范围和Harris髋关节评分来评估临床结果。所有测量均在随访3年后通过术前和术后X线检查进行，并与对侧正常髋关节进行比较。经过平均3.4年的随访期后，我们注意到术前和术后值之间存在统计学上的显着差异。我们注意到，所有（100%）IB、IIA阶段的儿童和50% IIB阶段的儿童都取得了令人满意的成绩。所有患者术后CI均发生显着变化（P = 0.000）。内翻去旋转截骨术(VDRO) 3年后的最终EQ为0.606，具有显着性（P = 0.0000）。 结论：基于令人鼓舞的短期放射学和临床结果，内翻去旋转截骨术(VDRO)可被视为IB、IIA、IIB期晚期Perthes病的治疗方法。 图1 X线（右）髋关节前后位片，“D”为股骨头的最大直径，“s”为从D中部到股骨头表面的最小半径。 图2 (a) 术前骨盆前后位X线片显示IB期Perthes病，(b)术后即刻X线片前后位图和，(c)显示VDRO（varus derotation osteotomy, 内翻去旋转截骨术）和原位钢板的侧位图，(d) 术后3年的前后位放射学结果，(e)侧位图显示髋关节覆盖良好。 图3 X线右髋关节前后视图显示(a)就诊时的IIA期Perthes病，(b)术后即刻X线片前后视图，(c)显示VDRO（varus derotation osteotomy, 内翻去旋转截骨术），和原位植入物的侧位图，(d) 3年后的最终放射学结果，(e)侧位图显示髋部包含覆盖良好。 图4 Perthes病晚期表现的自然病程：(a) X线（左）髋关节前后视图显示IB期Perthes病，(b)出现IIB期8个月后，(c) X线骨盆双髋关节前后视图，和（d）蛙式位显示15个月时Perthes病晚期表现的自然病程，骨骺完全破坏。 Short Term Outcome of Varus Derotation Osteotomy in Late Presenting Perthes Disease Background: Untreated Perthes disease can lead to osteoarthritis by the fourth decade. The treatment is conservative for children <6 years, operative within the age group of 6-9 years. Late onset Perthes, older than 9 years or more, are notorious with the aggressive course with poor outcome. However, literature do not come to a consensus between conservative and operative management. This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) in Perthes disease presenting late with age 8 years or more. Materials and methods: 15 children (13 males and 2 females) with the mean age of 9.4 years belonging to modified Elizabethtown classification Stage IB, IIA, IIB treated with open wedge VDRO between 2008 and 2014 were included in this study. Seven patients (46.67%) were of >10 years of age at presentation. All patients had limitation of abduction and internal rotation. Eight patients (53.33%) had pain at the hip and 12 patients (80%) had limp. Mean time between diagnosis and corrective surgery was 3 weeks. Results: The evaluation was done using caput index (CI) and epiphyseal quotient (EQ) and articulotrochanteric distance radiologically, range of motion and Harris Hip Score for clinical outcome. All the measurements were carried out on pre- and postoperative X-rays after 3 years followup and compared with the contralateral normal hip. After a mean followup period of 3.4 years, we noted the statistically significant difference between pre- and postoperative values. We noted that all (100%) children in Stage IB, IIA and 50% children in Stage IIB achieved satisfactory results. There was a significant change (P = 0.000) in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.606 and was significant (P = 0.0000). Conclusion: In our opinion, based on the encouraging short term radiological and clinical outcomes, VDRO may be regarded as a treatment procedure for late presenting Perthes disease in stage IB, IIA, IIB. 文献出处：Narendra Joshi, Soumya Shrikanta Mohapatra, Mahaveer Prasad Goyal, Shiv Kumar Goyal, Rakesh Kumar, Mukesh Saini. Short Term Outcome of Varus Derotation Osteotomy in Late Presenting Perthes Disease. Indian J Orthop. 2018 Mar-Apr;52(2):133-139. doi: 10.4103/ortho.IJOrtho_196_16 来源：整理自304关节学术 |
|
|
