本期目錄：
1、后穩(wěn)定型全膝關(guān)節(jié)置換術(shù)中髕骨軟組織平衡的影響
2、全髖關(guān)節(jié)置換影響脊柱骨盆活動度：一項前瞻性觀察
3、術(shù)前關(guān)節(jié)內(nèi)注射類固醇和透明質(zhì)酸鈉是否會影響后續(xù)接受全關(guān)節(jié)置換的時間
4、重繪髖臼安全區(qū)三維形貌圖：一項評估髖關(guān)節(jié)假體穩(wěn)定性的多變量研究
5、鈣衛(wèi)蛋白橫向血流試驗: 與排除關(guān)節(jié)假體周圍感染的標(biāo)準(zhǔn)一致
6、CT評估膝關(guān)節(jié)前內(nèi)側(cè)骨關(guān)節(jié)炎的磨損模式
7、髖臼周圍截骨術(shù)后髖關(guān)節(jié)中心的內(nèi)移：驗證基于平片的評估
8、年輕股骨頸骨折患者的并發(fā)癥
9、髖臼周圍截骨術(shù)后關(guān)節(jié)囊生物力學(xué)特點
10、發(fā)育性髖關(guān)節(jié)發(fā)育不良篩查項目的成本分析
11、骨性標(biāo)志、距離及其相互關(guān)系，哪一項可用于髖臼周圍截骨術(shù)：一項對發(fā)育不良髖關(guān)節(jié)的CT研究
12、創(chuàng)傷后股骨頭壞死經(jīng)股骨大轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)的臨床療效：平均隨訪12.3年
13、再生療法提高股骨頭缺血壞死的存活率:一項系統(tǒng)回顧和薈萃分析
14、自行居家訓(xùn)練一周后，膝關(guān)節(jié)強化訓(xùn)練的動作質(zhì)量下降
第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻
文獻1
后穩(wěn)定型全膝關(guān)節(jié)置換術(shù)中髕骨軟組織平衡的影響
譯者：張軼超
背景：良好的軟組織平衡是保證全膝關(guān)節(jié)置換手術(shù)（TKA）成功的必不可少的因素，脛股關(guān)節(jié)（FT）是否平衡可以通過一個偏心的張力測量器來評估。本研究的目的是觀察術(shù)中內(nèi)外側(cè)軟組織平衡和髕骨壓力間的關(guān)系。
方法：本研究納入了30名因內(nèi)翻型骨關(guān)節(jié)炎而接受活動平臺后穩(wěn)定型膝關(guān)節(jié)假體TKA手術(shù)的患者。使用張力測量器在膝關(guān)節(jié)0°、10°、30°、60°、90°、120°和135°時，安裝好股骨假體并將髕骨回位的情況下檢測并記錄軟組織平衡情況，包括關(guān)節(jié)假體間隙和內(nèi)外側(cè)韌帶是否平衡。等到安裝完假體并安裝好襯墊后，在各個屈曲角度測量髕骨內(nèi)外側(cè)的壓力。采用單純回歸分析來評估髕骨壓力、軟組織平衡參數(shù)及術(shù)后關(guān)節(jié)屈曲度間的關(guān)系。
結(jié)果：總的來說隨著膝關(guān)節(jié)的屈曲，內(nèi)外側(cè)髕骨壓力會增大。在屈曲60°、90°和135°時髕骨外側(cè)壓力明顯高于內(nèi)側(cè)壓力（p<0.05）。在屈曲60°和90°時，髕骨外側(cè)壓力與內(nèi)側(cè)韌帶的平衡狀態(tài)呈負相關(guān)（p<0.05）。在屈曲120°和135°時髕骨外側(cè)的壓力與術(shù)后關(guān)節(jié)屈曲度呈負相關(guān)（p<0.05）。
結(jié)論：膝關(guān)節(jié)軟組織平衡影響髕骨壓力。特別是在屈曲位外側(cè)松弛的病例會呈現(xiàn)髕骨外側(cè)壓力減小，進而術(shù)后關(guān)節(jié)屈曲度大。
圖1、膝關(guān)節(jié)平衡測量器(Ligament Sensor Tensor, DePuy)。將測量器放置在內(nèi)外側(cè)關(guān)節(jié)間隙內(nèi)，在股骨假體試模安裝好的情況下給予150Nm的彈性拉力。在髕骨回位的情況下觀察偏心臂上的數(shù)字來測量內(nèi)外側(cè)軟組織張力。
圖2、髕骨壓力測量系統(tǒng)。將兩個單軸超薄力傳感器放置在髕骨假體試模的背面和髕骨截骨面保護片之間，用以測量髕骨內(nèi)外側(cè)的壓力。可以在假體試模都安裝完后進行測量。
表1、 髕骨外側(cè)壓力與內(nèi)側(cè)韌帶平衡狀態(tài)間關(guān)系。a屈曲60°時兩者間呈負相關(guān)n (R = ?0.423, p = 0.0248)；b屈曲90°時兩者間呈負相關(guān)(R = ?0.404, p = 0.0328)。
表2、 外側(cè)髕骨壓力與術(shù)后屈曲關(guān)節(jié)屈曲度間關(guān)系。a關(guān)節(jié)屈曲120°時外側(cè)髕骨壓力與術(shù)后關(guān)節(jié)屈曲度間呈負相關(guān)(R = –0.474, p = 0.0298)；b關(guān)節(jié)屈曲135°時外側(cè)髕骨壓力與術(shù)后關(guān)節(jié)屈曲度間呈負相關(guān)(R = –0.445, p = 0.0434)。
The influence of intraoperative soft tissue balance on patellar pressure in posterior-stabilized total knee arthroplasty
Background: Appropriate soft tissue balance is essential for the success of total knee arthroplasty (TKA), and assessment with an offset-type tensor provides useful information about the femorotibial (FT) joint. The purpose of the study was to investigate the relationship between intraoperative soft tissue balance and patellar pressure at both medial and lateral sides.
Methods: Thirty varus-type osteoarthritis patients who received mobile-bearing posterior-stabilized TKAs were enrolled in the study. Using the tensor, soft tissue balance, including joint component gap and varus ligament balance, was recorded at 0°, 10°, 30°, 60°, 90°, 120°, and 135° with patellofemoral (PF) joint reduction and femoral component placement. Following final prostheses implanted with appropriate insert, the medial and lateral patellar pressures were measured at each flexion angle. A simple regression analysis was performed between each patellar pressure, parameter of soft tissue balance, and postoperative flexion angle.
Results: Both lateral and medial patellar pressures increased with flflexion. The lateral patellar pressure was significantly higher than the medial patellar pressure at 60°, 90°, and 135° of flflexion (p b 0.05). The lateral patellar pressure inversely correlated with the varus ligament balance at 60° and 90° of flflexion (p b 0.05). The lateral patellar pressure at 120° and 135° of flexion inversely correlated with the postoperative flexion angle (p b 0.05).
Conclusion: Soft tissue balance influenced patellar pressure. In particular, a reduced lateral patellar pressure was found at the lateral laxity at flexion, leading to high postoperative flexion angle.
文獻出處：Matsumoto T, Shibanuma N, Takayama K, Sasaki H, Ishida K, Matsushita T, Kuroda R, Kurosaka M. The influence of intraoperative soft tissue balance on patellar pressure in posterior-stabilized total knee arthroplasty. Knee. 2016 Jun;23(3):540-4. doi: 10.1016/j.knee.2015.11.020. Epub 2016 Feb 11. PMID: 26875047.
文獻2
全髖關(guān)節(jié)置換影響脊柱骨盆活動度：
一項前瞻性觀察
譯者：羅殿中
背景：異常的脊柱骨盆活動度被確認(rèn)是引起全髖關(guān)節(jié)置換（THA）后關(guān)節(jié)不穩(wěn)定的因素之一。對THA術(shù)前患者，識別其風(fēng)險仍然存在挑戰(zhàn)。本研究擬解決：（1）評估術(shù)前術(shù)后脊柱骨盆活動度是否存在不同；（2）明確脊柱骨盆復(fù)合體各因素之間的相互作用；（3）明確術(shù)前預(yù)測脊柱骨盆活動度的指標(biāo)。
方法：對197例THA患者開展一項前瞻性研究，手術(shù)前后分別于站立位和放松坐位拍攝雙平面立體攝影?；?/span>2個分類指標(biāo)，2位獨立研究者分析脊柱骨盆活動度（骶骨傾斜角變化ΔSS和骨盆傾斜角變化ΔPT；Δ指從站立位到坐位；Δ<10°為僵硬；10°≤Δ≤30°為正常；Δ>30°為活動度過大）。對接受手術(shù)的患者臨床特征進行分析、并采用多元回歸分析，確認(rèn)可預(yù)測術(shù)后脊柱骨盆活動度的指標(biāo)。
結(jié)果：基于ΔPT（術(shù)前/術(shù)后：18.5°/22.8°；P<0.000）和ΔSS（術(shù)前/術(shù)后：17.9°/22.4°；P<0.000），THA術(shù)后脊柱骨盆活動度明顯增加?？捎^察到由術(shù)前僵硬（術(shù)前/術(shù)后：24%/9.7%）到術(shù)后活動度過大（術(shù)前/術(shù)后：10.2%/22.1%）的比例增加。對接受手術(shù)的患者臨床特征進行分析，術(shù)前PTStanding≥13.0°預(yù)測術(shù)后脊柱骨盆僵硬的敏感性為90%、特異性為51%；術(shù)前SSStanding≥35.2°預(yù)測術(shù)后脊柱骨盆活動度過大的敏感性為81%、特異性為34%；術(shù)前患者年齡、術(shù)前PTStanding和術(shù)前骨盆傾斜率（PI）均為預(yù)測術(shù)后脊柱骨盆活動度的獨立相關(guān)因素（R2=0.24）。
結(jié)論：關(guān)節(jié)置換外科醫(yī)生應(yīng)對手術(shù)前脊柱骨盆僵硬程度有所注意，THA可影響其活動度。本研究首次提供閾值，根據(jù)術(shù)前站立位指標(biāo)可預(yù)測術(shù)后脊柱骨盆活動度。術(shù)前站立側(cè)位攝像可作為篩查骨盆脊柱活動度的工具。
圖1. 站立位和坐位腰椎骨盆EOS攝像，圖例顯示PT和SS。PT定義為：股骨頭中心至骶1上終板中點連線，與垂直參考線之間的夾角。SS定義為：骶1上終板與水平線之間的夾角。PT：骨盆傾斜角；SS：骶骨傾斜角。
Total Hip Replacement Influences Spinopelvic Mobility: A Prospective Observational Study
Background: Abnormal spinopelvic mobility is identified as a contributing element of total hip arthroplasty (THA) instability. Preoperative identification of THA patients at risk is still a remaining challenge. We therefore conducted this study to (1) evaluate if preoperative and postoperative spinopelvic mobility differs, (2) determine the interactions between the elements of the spinopelvic complex, and (3) identify preoperative parameters for predicting spinopelvic mobility.
Methods: A prospective observational study assessing 197 THA patients was conducted with biplanar stereoradiography in standing and relaxed sitting positions preoperatively and postoperatively. Two independent investigators determined spinopelvic mobility based on 2 different classifications (Δ sacral slope [SS] and Δ pelvic tilt [PT]; Δ from standing to sitting; Δ < 10° stiff, Δ ≥ 10°-30° normal, Δ > 30° hypermobile). Multiple regression analysis and receiver operating characteristic analysis were used to identify predictors for postoperative spinopelvic mobility.
Results: Spinopelvic mobility significantly increased after THA based on ΔPT (Pre/Post: 18.5°/22.8°; P < .000) and ΔSS (Pre/Post 17.9°/22.4°; P < .000). A distinct shift in the ratio from stiff (Pre/Post: 24%/9.7%) to hypermobile (Pre/Post: 10.2%/22.1%) mobility postoperatively was observed. Receiver operating characteristic analysis predicted postoperative stiffness using preoperative PTStanding ≥ 13.0° with a sensitivity of 90% and a specificity of 51% and hypermobility with preoperative SSStanding ≥ 35.2° with a sensitivity of 81% and a specificity of 34%. Age at surgery, preoperative PTStanding, and pelvic incidence were independent predictors of spinopelvic mobility (R2 = 0.24).
Conclusion: Definition of preoperative stiffness should be interpreted with caution by arthroplasty surgeons as mobility itself is influenced by THA. For the first time thresholds for standing preoperative parameters for predicting postoperative spinopelvic mobility could be provided. For preoperative standing only lateral assessment could serve as a screening tool for spinopelvic mobility.
文獻出處：Haffer H, Wang Z, Hu Z, Hipfl C, Perka C, Pumberger M. Total Hip Replacement Influences Spinopelvic Mobility: A Prospective Observational Study. J Arthroplasty. 2022 Feb;37(2):316-324.e2. doi: 10.1016/j.arth.2021.10.029. Epub 2021 Nov 3. PMID: 34742872.
文獻3
術(shù)前關(guān)節(jié)內(nèi)注射類固醇和透明質(zhì)酸鈉
是否會影響后續(xù)接受全關(guān)節(jié)置換的時間
譯者：馬云青
關(guān)節(jié)內(nèi)注射皮質(zhì)類固醇(CSI)或透明質(zhì)酸(HAI)可減輕可能需要接受全髖關(guān)節(jié)（THA）或全膝關(guān)節(jié)置換術(shù)(TKA)患者的骨關(guān)節(jié)炎癥狀。然而，它們對全關(guān)節(jié)置換術(shù)(TJA)時間和并發(fā)癥的影響仍然不確定。文章試圖評估 THA/TKA 之前接受過注射的患者的手術(shù)延遲時間；(2)接受過注射的患者的比例；(3)注射藥物的類型和次數(shù)；(4)比較接受注射和未接受注射患者的并發(fā)癥發(fā)生率。
方法：回顧性研究了3340例連續(xù)TJA 病例(1770例THA 和1570例TKA)。患者根據(jù)術(shù)前是否接受關(guān)節(jié)內(nèi)注射分為兩組。比較第一次臨床就診時的功能和手術(shù)相關(guān)信息，注射類型和90天內(nèi)的并發(fā)癥發(fā)生情況，包括關(guān)節(jié)周圍感染。
結(jié)果：150/1770 THA 和192/1570 TKA 患者接受了注射(8.5% 對12.2% ，p = 0.0004)。接受TJA注射的患者從到臨床就診到手術(shù)的時間明顯延長[THA為12.4 ± 11月 vs.7.3 ± 10.7月，p < 0.001; TKA為20.0 ± 17.4月 vs.11.6 ± 15.4月,p < 0.001]。TKA組手術(shù)延遲時間明顯大于THA 組(8.4個月vs 5.1個月，p < 0.001)。TKA 患者的 接受HAI注射的比例高于THA患者(9%比0.6%，p < 0.0001)。全關(guān)節(jié)置換術(shù)后并發(fā)癥的總體情況無差異(THA p = 0.19，TKAp = 0.3)。
總結(jié)：注射與延遲接受TJA的時間相關(guān)，具有統(tǒng)計學(xué)差異，但其臨床意義是有爭議的。手術(shù)前至少三個月注射是安全的。如果患者有適當(dāng)?shù)氖中g(shù)指征并且準(zhǔn)備接受全關(guān)節(jié)置換，不建議關(guān)節(jié)內(nèi)注射以推遲手術(shù)。
Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability
Background: Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular 'safe zone' to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation.
Methods: Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach.
Results: We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02).
Conclusions: Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters.
文獻出處：Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am. 2022 Feb 2;104(3):239-245. doi: 10.2106/JBJS.21.00406. PMID: 34958643.
文獻4
重繪髖臼安全區(qū)三維形貌圖：
一項評估髖關(guān)節(jié)假體穩(wěn)定性的多變量研究
譯者：張薔
背景：髖關(guān)節(jié)脫位是全髖關(guān)節(jié)置換術(shù)后（THA）早期翻修的最常見原因。40多年前，Lewinnek等人提出髖臼“安全區(qū)”的概念，期待能夠降低脫位風(fēng)險。雖然這個概念在當(dāng)時的背景下可謂新穎，但以現(xiàn)在的標(biāo)準(zhǔn)衡量略顯局限。本研究的目的是確定全髖關(guān)節(jié)置換術(shù)中髖臼杯安放的最佳位置，以及手術(shù)入路對髖臼安全區(qū)形貌和脫位風(fēng)險的影響。
方法：我們選取單一醫(yī)療中心2000年至2017年間所有初次全髖關(guān)節(jié)置換的病例。髖臼杯外展角和前傾角通過高級人工智能神經(jīng)網(wǎng)絡(luò)的方法測量分析，應(yīng)用前首先由兩名骨科醫(yī)生經(jīng)雙盲評分的方法評估其測量效力。我們在隨訪時采集患者一般信息及脫位情況。最終，我們通過多變量Cox回歸分析（包括多維分析）的方法來繪制髖臼安全區(qū)的三維形貌圖，及其與手術(shù)入路的相關(guān)性。
結(jié)果：我們共入組8081例全髖關(guān)節(jié)置換患者（9907髖），4166例女性，3915例男性；平均年齡64±13歲，平均隨訪5±3年（2年-16年），共有316例（3%）THA術(shù)后隨訪時發(fā)生過脫位。平均髖臼外展角44°±7°，平均前傾角32°±9°。沒有脫位的病例平均前傾角32°±9°（中位數(shù)，32°），而最理想的15°前傾角只發(fā)生在3%的未脫位病例中（p<0.001）。多變量模型顯示脫位率風(fēng)險最低的病例外展角37°，前傾角27°，而最理想的安全區(qū)為27°-47°外展和18°-38°前傾。三維分析顯示安全區(qū)位置近似，但不同的手術(shù)入路（p=0.03）和性別（p=0.02）的安全區(qū)形貌有顯著性差異。
結(jié)論：本研究得出的最佳髖臼杯位置與歷史數(shù)據(jù)有較大差異，比預(yù)期更大的前傾角可以降低脫位風(fēng)險。此外，手術(shù)入路和患者性別都對三維安全區(qū)形貌有明確影響。我們在未來需要進行更多的研究來評估髖臼杯位置與脊柱骨盆動態(tài)平衡和股骨側(cè)指標(biāo)的關(guān)系。
Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability
Background: Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular 'safe zone' to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation.
Methods: Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach.
Results: We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02).
Conclusions: Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters.
文獻出處：Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am. 2022 Feb 2;104(3):239-245. doi: 10.2106/JBJS.21.00406. PMID: 34958643.
文獻5
鈣衛(wèi)蛋白橫向血流試驗:
與排除關(guān)節(jié)假體周圍感染的標(biāo)準(zhǔn)一致
譯者：沈松坡
引言: 有多種標(biāo)準(zhǔn)用于定義關(guān)節(jié)假體周圍感染(PJI)。本研究的目的是比較鈣衛(wèi)蛋白橫向血流床旁檢測(POC)試驗在全膝關(guān)節(jié)置換術(shù)(TKA)患者診斷感染的診斷準(zhǔn)確性，采用三套不同的標(biāo)準(zhǔn);1) 2013年肌肉骨骼感染學(xué)會(MSIS)， 2) 2018年國際共識會議(ICM)， 3) 2019年歐洲骨骼和關(guān)節(jié)感染學(xué)會(EBJIS)提出的標(biāo)準(zhǔn)作為參考標(biāo)準(zhǔn)。
方法: 2018年10月至2020年1月，前瞻性地從TKA翻修患者中收集123例術(shù)中滑膜液樣本，并使用鈣衛(wèi)蛋白橫向血流POC檢測。數(shù)據(jù)由兩名對鈣蛋白測試結(jié)果不知情的獨立評論者進行審查和裁決。
結(jié)果: 三個標(biāo)準(zhǔn)集有91.8%的一致性。采用2013年MSIS標(biāo)準(zhǔn)，POC檢測的敏感性、特異性、陽性預(yù)測值(PPV)、陰性預(yù)測值(NPV)和曲線下面積(AUC)分別為98.1%、95.7%、94.5%、98.5%和0.969。2018年ICM檢測POC的敏感性、特異性、PPV、NPV和AUC分別為98.2%、98.5%、98.2%、98.5%和0.984。2019年提出的EBJIS標(biāo)準(zhǔn)POC檢測的敏感性、特異性、PPV、NPV和AUC分別為93.2%、100.0%、100.0%、94.2%和0.966。
結(jié)論: 鈣衛(wèi)蛋白橫向血流POC檢測在當(dāng)前可用的PJI定義中具有極好的敏感性和特異性，應(yīng)用2018年ICM標(biāo)準(zhǔn)時性能最佳。
Calprotectin Lateral Flow Test: Consistent Across Criteria for Ruling Out Periprosthetic Joint Infection
INTRODUCTION: There are multiple sets of criteria used to define prosthetic joint infection (PJI). The objective of this study was to compare the diagnostic accuracy of the calprotectin lateral flow point of care (POC) test in total knee arthroplasty (TKA) patients to diagnose infection using three different sets of criteria; 1) 2013 Musculoskeletal Infection Society (MSIS), 2) 2018 Intentional Consensus Meeting (ICM), and 3) the 2019 proposed European Bone and Joint Infection Society (EBJIS) criteria as reference standards.
METHODS: From October 2018 to January 2020, 123 intraoperative synovial fluid samples were prospectively collected from revision TKA patients and tested using a calprotectin lateral flow POC assay. Data were reviewed and adjudicated by two independent reviewers blinded to calprotectin test results.
RESULTS: The three criteria sets had 91.8% agreement. Using 2013 MSIS criteria the POC test demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.1%, 95.7%, 94.5%, 98.5%, and 0.969, respectively. The 2018 ICM the POC test demonstrated a sensitivity, specificity, PPV, NPV and AUC of 98.2%, 98.5%, 98.2%, 98.5%, and 0.984, respectively. The 2019 proposed EBJIS criteria the POC test demonstrated a sensitivity, specificity, PPV, NPV and AUC of 93.2%, 100.0%, 100.0%, 94.2%, and 0.966, respectively.
CONCLUSION: The calprotectin lateral flow POC test had excellent sensitivity and specificity across current available PJI definitions, with the best performance observed when applying 2018 ICM criteria.
文獻出處：Warren JA, Klika AK, Bowers K, Colon-Franco J, Piuzzi NS, Higuera CA. Calprotectin Lateral Flow Test: Consistent Across Criteria for Ruling Out Periprosthetic Joint Infection. J Arthroplasty. 2022 Feb 3:S0883-5403(22)00099-7. doi: 10.1016/j.arth.2022.01.082. Epub ahead of print. PMID: 35122946.
文獻6
CT評估膝關(guān)節(jié)前內(nèi)側(cè)骨關(guān)節(jié)炎的磨損模式
譯者：張峻
目的：分析CT在膝關(guān)節(jié)骨關(guān)節(jié)炎診斷中的價值，為部分或全膝關(guān)節(jié)置換術(shù)的選擇提供依據(jù)。
方法：對100例接受膝關(guān)節(jié)內(nèi)側(cè)單髁置換術(shù)（UKR）（N=50）或全膝關(guān)節(jié)置換術(shù)（TKR）（N=50）的患者進行回顧性研究。一名觀察者通過X片、CT和站立位下肢全長X片測量下肢力線和每個間室的膝關(guān)節(jié)骨關(guān)節(jié)炎類型。
結(jié)果：所有患者均患有內(nèi)側(cè)股脛關(guān)節(jié)Kellgren-Lawrence IV級骨關(guān)節(jié)炎，下肢內(nèi)翻平均角度（172°（3.5°）HKA角）。區(qū)域機械軸分布與HKA有很強的相關(guān)性。選擇UKR或TKR患者的關(guān)節(jié)炎類型不同。UKR患者有前內(nèi)側(cè)骨關(guān)節(jié)炎和髕骨內(nèi)側(cè)關(guān)節(jié)面磨損，而TKR患者有內(nèi)側(cè)骨關(guān)節(jié)炎伴彌漫性關(guān)節(jié)炎，或外側(cè)髕股關(guān)節(jié)磨損和外側(cè)室中央或后部區(qū)域磨損有關(guān)。髕骨內(nèi)側(cè)關(guān)節(jié)面磨損與更重要的下肢內(nèi)翻力線有關(guān)（Kennedy區(qū)0和1）。
結(jié)論：CT可以顯示在平片或應(yīng)力位片上看不到的病變，因為中央或后方周圍軟骨完整。盡管力線內(nèi)翻，但仍發(fā)展為三間室骨關(guān)節(jié)炎的患者可能除了機械軸因素之外還有其它風(fēng)險因素，應(yīng)被視為TKR的適應(yīng)癥。
Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography
Objective: To analyze the value of CT-arthrography imaging in the diagnosis of knee osteoarthritis and to facilitate the selection of partial versus total knee replacement.
Methods: A retrospective study of 100 patients that had either medial unicompartmental knee replacement (UKR) (N=50) or total knee replacement (TKR) (N=50). One observer measured lower limb mechanical alignment and osteoarthritis patterns of the knee in each compartment with radiographs, CT-arthrography and full leg standing radiographs.
Results: All patients had Kellgren-Lawrence grade IV osteoarthritis of the medial femorotibial joint with a mean (SD) varus alignment of the lower limb (172° (3.5°) HKA-angle). Zone mechanical axis distribution showed strong correlation with HKA-axis. Arthritis patterns were different for patients selected for UKR or TKR. UKR patients had anteromedial osteoarthritis and wear of the medial facet of the patella in contrast to TKR patients who had medial osteoarthritis associated with diffuse or lateral patellofemoral wear and wear of the central or posterior zones of the lateral compartment. Medial facet wear of the patella is related to more important varus alignment of the lower limb (Kennedy zone 0 and 1).
Conclusion: CT-arthrography imaging can show lesions that are not visible on plain or stress radiographs because of central or posterior localization with surrounding intact cartilage. Patients who develop tri-compartmental osteoarthritis despite varus alignment have probably other risk factors than their mechanical alignment and should be considered candidates for TKR.
文獻出處：Thienpont E, Schwab PE, Omoumi P. Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography. Knee. 2014;21 Suppl 1:S15-9. doi: 10.1016/S0968-0160(14)50004-X. PMID: 25382362.
第二部分：保髖相關(guān)文獻
文獻1
髖臼周圍截骨術(shù)后髖關(guān)節(jié)中心的內(nèi)移：
驗證基于平片的評估
譯者：程徽
背景：髖臼周圍截骨術(shù)(periacetabular osteotomy, PAO)通過增加髖臼對股骨頭的覆蓋，使髖關(guān)節(jié)中心向內(nèi)移，恢復(fù)正常的關(guān)節(jié)生物力學(xué)。以往的研究報道過PAO所能達到的內(nèi)移程度，但從未進行過不同成像方式，不同測量方法間內(nèi)移量的比較。PAO改變了髂坐骨線，在股骨頭下三分之一處更容易觀察到，因此，在股骨頭下三分之一處測量內(nèi)移可能更準(zhǔn)確。
方法：我們對一組在PAO后接受低劑量CT檢查的患者，進行了回顧性研究，本研究的納入標(biāo)準(zhǔn)：行PAO的有癥狀髖臼發(fā)育不良患者，術(shù)前有CT，術(shù)后隨訪9個月至5年。從2009年2月到2018年7月，共有333名PAO患者符合這些標(biāo)準(zhǔn)，患者手術(shù)時年齡均在16至50歲之間。排除標(biāo)準(zhǔn)包括既往同側(cè)手術(shù)史、股骨髖臼撞擊(FAI)、懷孕、神經(jīng)肌肉疾病、Perthes樣畸形、無術(shù)前CT和無法參與。39例患者的39個髖關(guān)節(jié)最終納入研究組；87%(34 / 39)為女性患者，13%(5 / 39髖)為男性患者。手術(shù)時的中位年齡為27歲(16 - 49歲)。術(shù)前和術(shù)后入組時均獲取低劑量CT圖像；我們還獲取了術(shù)前和術(shù)后的X線片和術(shù)中透視圖像。在X線平片上評估LCEA和AI。髖關(guān)節(jié)內(nèi)移由一名獨立的評估者按盲法在所有成像方式上進行評估。在X線平片上，使用傳統(tǒng)的和替代的方法測量髖關(guān)節(jié)內(nèi)移。由平片上個盆腔旋轉(zhuǎn)量確定X線片是否優(yōu)良，采用這些優(yōu)良的X線片進行亞組分析。為了回答我們的第一個問題，我們在三維(3D) CT髖關(guān)節(jié)重建模型上測量所有髖關(guān)節(jié)的內(nèi)移。對于第二個問題，我們計算了Pearson相關(guān)系數(shù)、單因素方差分析(one-way ANOVA)和Student’t檢驗，以評估LCEA和AI與內(nèi)移量之間的相關(guān)性。對于第三個問題，我們進行了統(tǒng)計分析，使用Pearson線性回歸分析來確定兩種影像學(xué)方法測量內(nèi)移和CT上的真正內(nèi)移之間的相關(guān)性，并估計的95%置信區(qū)間和標(biāo)準(zhǔn)誤。對于我們的第四個問題，我們計算了Pearson相關(guān)系數(shù)，以確定通過術(shù)中透視與X線片，測量內(nèi)移是否不同。
結(jié)果：在我們的研究中，通過CT測量，PAO實現(xiàn)的髖中心內(nèi)移的真實量為4±3 mm；46%(39髖中的18髖)內(nèi)移0 ~ 5mm, 36%(14髖)內(nèi)移在5 ~ 10mm, 5%(2髖)內(nèi)移大于10mm，13%(5髖)沒有內(nèi)移或有外移。在不同亞組間，LCEA間的 內(nèi)移差異較小(≤15°為6±3 mm, 15°~ 20°為4±4 mm, 20°~ 25°為2±3 mm [p = 0.04])。臼頂傾斜角≥15°(6±3 mm)的髖關(guān)節(jié)，比臼頂傾斜角< 15°(2±3 mm; p < 0.001)的內(nèi)移更多。X線平片上，在股骨頭中心測量內(nèi)移(傳統(tǒng)方法)比在股骨頭下1 / 3的 (替代方法)測量，與CT標(biāo)準(zhǔn)測量的相關(guān)性更差。傳統(tǒng)的方法在評估所有的X線片時與CT沒有相關(guān)性(r = 0.16 [95% CI -0.17 - 0.45]; p = 0.34)；在評估優(yōu)良X線時也沒有相關(guān)性（r = 0.26 [95% CI -0.06 ~ 0.53]; p = 0.30)。然而，替代方法在評估所有X線片具有強的相關(guān)性(r = 0.71 [95% CI 0.51 - 0.84]; p < 0.001)，在評估良好的X線片時具有非常強的相關(guān)性（r = 0.80 [95% CI 0.64 ~ 0.89]; p < 0.001)。在術(shù)中透視圖像上與術(shù)后X線片上測量髖關(guān)節(jié)內(nèi)移結(jié)果沒有差異(r = 0.85; p < 0.001, r = 0.90;只有良好的X線片p < 0.001)。
結(jié)論：目前的研究表明，通過術(shù)前和術(shù)后的CT測量， PAO后旋轉(zhuǎn)中心內(nèi)移平均4 mm，但個體差異很大。傳統(tǒng)的方法測量股骨頭中心的內(nèi)移可能不準(zhǔn)確；在股骨頭下三分之一處測量髖關(guān)節(jié)中心內(nèi)移是一種更好的方法。即使這兩種基于X線平片的方法都略低估內(nèi)移的真實值，為了獲得最佳的臨床和研究數(shù)據(jù)，我們?nèi)越ㄗh改用這種替代方法。最后，這項研究也為術(shù)中透視可以準(zhǔn)確評估髖關(guān)節(jié)中心的內(nèi)移提供了證據(jù)。
Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs
Background: Periacetabular osteotomy (PAO) increases acetabular coverage of the femoral head and medializes the hip's center, restoring normal joint biomechanics. Past studies have reported data regarding the degree of medialization achieved by PAO, but measurement of medialization has never been validated through a comparison of imaging modalities or measurement techniques. The ilioischial line appears to be altered by PAO and may be better visualized at the level of the inferior one-third of the femoral head, thus, an alternative method of measuring medialization that begins at the inferior one-third of the femoral head may be beneficial.
Questions/purposes: (1) What is the true amount and variability of medialization of the hip's center that is achieved with PAO? (2) Which radiographic factors (such as lateral center-edge angle [LCEA] and acetabular inclination [AI]) correlate with the degree of medialization achieved? (3) Does measurement of medialization on plain radiographs at the center of the femoral head (traditional method) or inferior one-third of the femoral head (alternative method) better correlate with true medialization? (4) Are intraoperative fluoroscopy images different than postoperative radiographs for measuring hip medialization?
Methods: We performed a retrospective study using a previously established cohort of patients who underwent low-dose CT after PAO. Inclusion criteria for this study included PAO as indicated for symptomatic acetabular dysplasia, preoperative CT scan, and follow-up between 9 months and 5 years. A total of 333 patients who underwent PAO from February 2009 to July 2018 met these criteria. Additionally, only patients who were between 16 and 50 years old at the time of surgery were included. Exclusion criteria included prior ipsilateral surgery, femoroacetabular impingement (FAI), pregnancy, neuromuscular disorder, Perthes-like deformity, inadequate preoperative CT, and inability to participate. Thirty-nine hips in 39 patients were included in the final study group; 87% (34 of 39) were in female patients and 13% (5 of 39 hips) were in male patients. The median (range) age at the time of surgery was 27 years (16 to 49). Low-dose CT images were obtained preoperatively and at the time of enrollment postoperatively; we also obtained preoperative and postoperative radiographs and intraoperative fluoroscopic images. The LCEA and AI were assessed on plain radiographs. Hip medialization was assessed on all imaging modalities by an independent, blinded assessor. On plain radiographs, the traditional and alternative methods of measuring hip medialization were used. Subgroups of good and fair radiographs, which were determined by the amount of pelvic rotation that was visible, were used for subgroup analyses. To answer our first question, medialization of all hips was assessed via measurements made on three-dimensional (3-D) CT hip reconstruction models. For our second question, Pearson correlation coefficients, one-way ANOVA, and the Student t-test were calculated to assess the correlation between radiographic parameters (such as LCEA and AI) and the amount of medialization achieved. For our third question, statistical analyses were performed that included a linear regression analysis to determine the correlation between the two radiographic methods of measuring medialization and the true medialization on CT using Pearson correlation coefficients, as well as 95% confidence intervals and standard error of the estimate. For our fourth question, Pearson correlation coefficients were calculated to determine whether using intraoperative fluoroscopy to make medialization measurements differs from measurements made on radiographs.
Results: The true amount of medialization of the hip center achieved by PAO in our study as assessed by reference-standard CT measurements was 4 ± 3 mm; 46% (18 of 39 hips) were medialized 0 to 5 mm, 36% (14 hips) were medialized 5 to 10 mm, and 5% (2 hips) were medialized greater than 10 mm. Thirteen percent (5 hips) were lateralized (medialized < 0 mm). There were small differences in medialization between LCEA subgroups (6 ± 3 mm for an LCEA of ≤ 15°, 4 ± 4 mm for an LCEA between 15° and 20°, and 2 ± 3 mm for an LCEA of 20° to 25° [p = 0.04]). Hips with AI ≥ 15° (6 ± 3 mm) achieved greater amounts of medialization than did hips with AI of < 15° (2 ± 3 mm; p < 0.001). Measurement of medialization on plain radiographs at the center of the femoral head (traditional method) had a weaker correlation than using the inferior one-third of the femoral head (alternative method) when compared with CT scan measurements, which were used as the reference standard. The traditional method was not correlated across all radiographs or only good radiographs (r = 0.16 [95% CI -0.17 to 0.45]; p = 0.34 and r = 0.26 [95% CI -0.06 to 0.53]; p = 0.30), whereas the alternative method had strong and very strong correlations when assessed across all radiographs and only good radiographs, respectively (r = 0.71 [95% CI 0.51 to 0.84]; p < 0.001 and r = 0.80 [95% CI 0.64 to 0.89]; p < 0.001). Measurements of hip medialization made on intraoperative fluoroscopic images were not found to be different than measurements made on postoperative radiographs (r = 0.85; p < 0.001 across all hips and r = 0.90; p < 0.001 across only good radiographs).
Conclusion: Using measurements made on preoperative and postoperative CT, the current study demonstrates a mean true medialization achieved by PAO of 4 mm but with substantial variability. The traditional method of measuring medialization at the center of the femoral head may not be accurate; the alternate method of measuring medialization at the lower one-third of the femoral head is a superior way of assessing the hip center's location. We suggest transitioning to using this alternative method to obtain the best clinical and research data, with the realization that both methods using plain radiography appear to underestimate the true amount of medialization achieved with PAO. Lastly, this study provides evidence that the hip center's location and medialization can be accurately assessed intraoperatively using fluoroscopy.
文獻出處：Fowler LM, Nepple JJ, Devries C, Harris MD, Clohisy JC. Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs. Clin Orthop Relat Res. 2021 May 1;479(5):1040-1049. doi: 10.1097/CORR.0000000000001572. PMID: 33861214; PMCID: PMC8052006.
文獻2
年輕股骨頸骨折患者的并發(fā)癥
譯者：肖凱
背景：60歲或以下人群的股骨頸骨折通常由高能量創(chuàng)傷導(dǎo)致，并且經(jīng)常伴有骨股頸骨折的移位，因此在治療上極具挑戰(zhàn)。了解疾病的特點是解決該人群治療爭議的重要第一步。本研究的目的是定量匯總年輕股骨頸骨折患者內(nèi)固定術(shù)后重要并發(fā)癥的發(fā)生率。
方法：在生物醫(yī)學(xué)方向圖書管理員的指導(dǎo)下，在Medline、Embase、CINAHL、Cochrane數(shù)據(jù)庫中對相關(guān)系統(tǒng)綜述進行檢索。收集了多個并發(fā)癥數(shù)據(jù)，包括：再次手術(shù)、股骨頭壞死、骨折不愈合、感染、內(nèi)固定失敗和畸形愈合。
結(jié)果：本薈萃分析包括來自41項研究的1558例骨折患者。單獨的股骨頸骨折的術(shù)后總的再手術(shù)發(fā)生率為18.0%。股骨頭性壞死的發(fā)生率為14.3%，骨折不愈合的發(fā)生率為9.3%。當(dāng)對骨折移位進行分層分析時，移位的骨折更有可能進行再手術(shù)并發(fā)生股骨頭壞死或骨折不愈合?；斡系目偘l(fā)生率為7.1%，內(nèi)固定失敗率為9.7%，手術(shù)部位感染率為5.1%。骨股頸骨折合并同側(cè)股骨干骨折患者的總體并發(fā)癥發(fā)生率低于單獨的股骨頸頸骨折。
結(jié)論：我們的分析結(jié)果表明，年輕股骨頸骨折患者的并發(fā)癥發(fā)生率相對較高。近20%的病例在單獨股骨頸骨折內(nèi)固定術(shù)后需再次手術(shù)，而股骨頭壞死和骨折不愈合可能是導(dǎo)致再手術(shù)的最常見原因。本研究結(jié)果顯示需要更加關(guān)注該人群的治療，盡可能改善手術(shù)的臨床預(yù)后。
Complications following young femoral neck fractures
Background: Femoral neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young femoral neck fractures.
Methods: A comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion.
Results: 1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated femoral neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a femoral neck fracture treated in conjunction with an ipsilateral femoral shaft fracture were lower overall than the pooled estimates for isolated neck fractures.
Conclusions: The results of our analysis demonstrate that the incidence of complications experienced by young femoral neck fracture patients is relatively high. Reoperation following internal fixation of isolated femoral neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.
文獻出處：Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015 Mar;46(3):484-91. doi: 10.1016/j.injury.2014.10.010. Epub 2014 Oct 31. PMID: 25480307.
文獻3
髖臼周圍截骨術(shù)后關(guān)節(jié)囊生物力學(xué)特點
譯者：張振東
髖關(guān)節(jié)發(fā)育不良以股骨頭覆蓋不足為特征，可導(dǎo)致髖關(guān)節(jié)不穩(wěn)定、疼痛和損傷。髖臼周圍截骨術(shù)(Periacetabular osteotomy, PAO)旨在恢復(fù)股骨頭的覆蓋、重建關(guān)節(jié)功能，但其對髖關(guān)節(jié)囊力學(xué)特點和關(guān)節(jié)穩(wěn)定性的影響尚不清楚。本研究的目的是研究PAO對髖關(guān)節(jié)發(fā)育不良患者關(guān)節(jié)囊力學(xué)和關(guān)節(jié)活動度的影響。
本研究選擇12例發(fā)育不良髖關(guān)節(jié)尸體標(biāo)本，分別被安裝在一個機器測試儀上，并在多個位置進行測試:(1)髖關(guān)節(jié)完全伸直，(2)中立0°，(3)屈曲30°，(4)屈曲60°，(5)屈曲90°。在每個位置，使用5Nm的扭矩對髖關(guān)節(jié)進行內(nèi)旋、外旋、外展、內(nèi)收。 然后對每例髖關(guān)節(jié)進行PAO手術(shù)以糾正股骨頭覆蓋，保留關(guān)節(jié)囊及韌帶，并重新進行檢測。
結(jié)果顯示，PAO術(shù)后在髖關(guān)節(jié)屈曲90°時內(nèi)旋較術(shù)前減少(?IR = -5°; p = 0.003)，在髖關(guān)節(jié)屈曲60°及90°時外旋均增加(分別為?ER = +7°; p = 0.001；?ER = +11°; p = 0.001)。PAO較術(shù)前還減少了髖關(guān)節(jié)伸直位時的外展(?ABD = -10°; p = 0.002)、中立0°時的外展(?ABD = -7°; p = 0.001)以及髖關(guān)節(jié)屈曲30°時的外展(?ABD = -8°; p = 0.001)，但增加了髖關(guān)節(jié)中立位0°時的內(nèi)收(?ADD = +9°; p = 0.001)、髖關(guān)節(jié)屈曲30°的內(nèi)收(?ADD = +11°; p = 0.002)以及髖關(guān)節(jié)屈曲60°的內(nèi)收(?ADD = +11°; p = 0.003)。
因此，PAO導(dǎo)致髖關(guān)節(jié)外展和內(nèi)旋減少，但內(nèi)收和外旋增加。髖臼骨性結(jié)構(gòu)和關(guān)節(jié)囊對PAO術(shù)后關(guān)節(jié)的靈活性和穩(wěn)定性起到平衡作用。
Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia
Background: Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips.
Methods: Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested.
Results: The PAO reduced internal rotation in flexion of 90° (?IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (?ER = +7°; p = 0.001) and flexion of 90° (?ER = +11°; p = 0.001). The PAO also reduced abduction in extension (?ABD = -10°; p = 0.002), neutral 0° (?ABD = -7°; p = 0.001), and flexion of 30° (?ABD = -8°; p = 0.001), but increased adduction in neutral 0° (?ADD = +9°; p = 0.001), flexion of 30° (?ADD = +11°; p = 0.002), and flexion of 60° (?ADD = +11°; p = 0.003).
Conclusions: PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
文獻出處：Ng KCG, Bankes MJK, El Daou H, Beaulé PE, Cobb JP, Jeffers JRT. Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia. J Bone Joint Surg Am. 2022 Feb 8. doi: 10.2106/JBJS.21.00405. Epub ahead of print. PMID: 35133990.
文獻4
發(fā)育性髖關(guān)節(jié)發(fā)育不良篩查項目的成本分析
譯者：任寧濤
目的：本研究的目的是評估發(fā)育性髖關(guān)節(jié)發(fā)育不良 (DDH) 的篩查成本，以明確國際上各種髖關(guān)節(jié)篩查項目的成本效益。
方法：通過檢查各種 DDH 篩查項目的成本分析研究，包括基于臨床檢查、選擇性超聲和通用超聲的項目，然后進行 PROSPERO 注冊的系統(tǒng)評價。使用敘述性整合進行成本分析。
結(jié)果：本綜述共納入了 14 項研究，兩項研究發(fā)現(xiàn)，臨床髖關(guān)節(jié)篩查在總體成本和有利結(jié)果方面都優(yōu)于完全不篩查。在考慮選擇性超聲篩查與臨床手法篩查時，兩項研究發(fā)現(xiàn)它更昂貴，一項研究發(fā)現(xiàn)它更便宜，三項研究發(fā)現(xiàn)兩者總體成本相似。使用普遍性髖關(guān)節(jié)超聲篩查時，四項研究發(fā)現(xiàn)普遍性髖關(guān)節(jié)超聲篩查比臨床手法篩查或選擇性超聲篩查更便宜，因為降低了晚期檢查和手術(shù)率。然而，相當(dāng)數(shù)量的研究得出結(jié)論，普遍性髖關(guān)節(jié)超聲篩查增加的財務(wù)成本大于手術(shù)所降低的成本。但沒有關(guān)于任何長期數(shù)據(jù)的研究。
結(jié)論：缺乏關(guān)于DDH篩查成本的信息，現(xiàn)有文獻中存在顯著的異質(zhì)性。未來的研究應(yīng)包括DDH長期并發(fā)癥的成本分析，包括早發(fā)性骨關(guān)節(jié)炎的社會和心理影響，以及針對性別的超聲篩查計劃。
Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip
Aims: The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally.
Methods: A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis.
Results: There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging versus clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data.
Conclusion: There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.
文獻出處：Philip Harper , Rohit Gangadharan , Daryl Poku , Alexander Aarvold. Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip. Indian J Orthop . 2021 Sep 6;55(6):1402-1409.
文獻5
骨性標(biāo)志、距離及其相互關(guān)系，哪一項可用于
髖臼周圍截骨術(shù)：一項對發(fā)育不良髖關(guān)節(jié)的CT研究
譯者：張利強
作為治療髖關(guān)節(jié)發(fā)育不良的手術(shù)技術(shù)，伯爾尼髖臼周圍截骨術(shù)（PAO）仍然存在操作困難和手術(shù)步驟不明確，如第一步坐骨截骨的深度、髂骨截骨的起點和髖臼后截骨的寬度，以防止醫(yī)源性進入關(guān)節(jié)或后柱骨折。27例發(fā)育不良髖關(guān)節(jié)（CE<25°）隨機與27例非發(fā)育不良髖關(guān)節(jié)（CE>25°）匹配。對髖關(guān)節(jié)的3D CT進行評估，并測量各組坐骨的寬度、髖臼下溝到坐骨棘的距離、從髂前上棘（ASIS）到髖關(guān)節(jié)或坐骨切跡或坐骨棘的距離、從髖臼最內(nèi)側(cè)點到后柱或坐骨棘或坐骨切跡的距離，并進行相關(guān)分析。發(fā)育不良組髖臼下溝至坐骨棘（42±4,44±4，P:0.03）、髂前上棘至髖關(guān)節(jié)（52±6,60±3，P:0.03）、髖臼最內(nèi)側(cè)點至后柱（34±2,36±2，P:0.005）的距離（mm）較非發(fā)育不良組短。ASIS到坐骨切跡的距離與髖臼下溝到坐骨棘、ASIS到髖關(guān)節(jié)、髖臼最內(nèi)側(cè)點到后柱的距離相關(guān)。從ASIS到坐骨切跡的距離可用于術(shù)中X線引導(dǎo)或盲截骨階段預(yù)測截骨的寬度或深度，防止截骨進入關(guān)節(jié)或后柱骨折。
圖1，坐骨內(nèi)外側(cè)寬度Iscw為37mm
圖2髖臼下溝到坐骨棘的距離為(AceGr-Iscsp)55mm
圖3 髂前上棘到髖臼最上緣(ASIS-Joint)的距離為52mm
圖4髂前上棘到坐骨切跡最深處(ASIS-Scinotch)距離為96mm
髖臼最深處厚度(Deepw)為4mm
髖臼最內(nèi)側(cè)點到后柱距離41mm，到坐骨棘50mm，到坐骨切跡55mm
Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips
As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first 'ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42±4, 44±4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34±2, 36±2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.
文獻出處：Onur Hapa, Onur Gürsan, Osman Nuri Ero?lu, Hakan ?zgül, Efe Kemal Akdo?an, Vadym Zhamilov, Ali Balc?, Hasan Havit?io?lu; Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips.Journal of hip preservation surgery 2021 Jan;8(1):119-124 doi:10.1093/jhps/hnab045
文獻6
創(chuàng)傷后股骨頭壞死經(jīng)股骨大轉(zhuǎn)子
旋轉(zhuǎn)截骨術(shù)的臨床療效：平均隨訪12.3年
譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）
簡介：本研究檢查了應(yīng)用經(jīng)股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)(TRO)治療創(chuàng)傷后股骨頭骨壞死(ON)的結(jié)果。
患者和方法：我們回顧性分析了股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)時平均年齡為34.8歲（12-61歲）的28名患者（男性，n = 17；女性，n = 11）的28髖。當(dāng)病變位于股骨頭前部時采用經(jīng)股骨轉(zhuǎn)子向前旋轉(zhuǎn)截骨術(shù)（ARO），而對于病變局限于股骨頭后部的患者則采用經(jīng)轉(zhuǎn)子向后旋轉(zhuǎn)截骨術(shù)（PRO）。平均隨訪時間為12.3年（5.0-21.3年）。我們調(diào)查了患者的臨床和放射學(xué)因素，包括年齡、性別、體重指數(shù)、術(shù)前Harris髖關(guān)節(jié)評分（HHS）、創(chuàng)傷類型、術(shù)前分期和術(shù)后完整率（股骨頭完整關(guān)節(jié)面相對于髖臼承重關(guān)節(jié)面的比率）。我們將患者分為髖關(guān)節(jié)存活組和中轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)(THA)組，然后比較兩組之間的上述這些因素。
結(jié)果：在最后一次隨訪時，22髖存活，平均HHS為85.8。其余6髖在股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)后平均10.2年接受全髖關(guān)節(jié)置換術(shù)。術(shù)前分期與髖關(guān)節(jié)存活率相關(guān)。此外，轉(zhuǎn)換為THA組的術(shù)后完整率顯著較低。根據(jù)接受者操作特征曲線，發(fā)現(xiàn)小于33.6%的比率與轉(zhuǎn)換為全髖關(guān)節(jié)置換術(shù)的相關(guān)。
結(jié)論：用于糾正創(chuàng)傷后股骨頭骨壞死的股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)獲得了良好的中期結(jié)果。轉(zhuǎn)換為全髖關(guān)節(jié)置換術(shù)的可能危險因素是術(shù)前股骨頭壞死處于晚期和術(shù)后完整率低于33.6%。
圖 1 術(shù)后完整比率表示為完整的股骨頭關(guān)節(jié)面(C-D)與髖臼承重關(guān)節(jié)面(A-B)的比率，并使用術(shù)后前后位X線片確定。A點是通過從B（髖臼邊緣）和E（淚滴最低點）的中點到髖臼畫一條垂線來確定的。點C和D分別代表股骨頭負荷部分的外側(cè)邊緣和完整關(guān)節(jié)面的內(nèi)側(cè)邊緣。
表1 髖關(guān)節(jié)存活組和中轉(zhuǎn)為THA組單因素分析結(jié)果（術(shù)前股骨頭壞死處于晚期和術(shù)后完整率低于33.6%是術(shù)后轉(zhuǎn)為髖關(guān)節(jié)置換的危險因素）
表 2 需要髖關(guān)節(jié)置換術(shù)的患者（6髖）
圖2 術(shù)后完整率＞33.6%和＜33.6%的Kaplan-Meier生存曲線，95%置信區(qū)間。終點是轉(zhuǎn)換為髖關(guān)節(jié)置換術(shù)。
圖3 股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)治療的創(chuàng)傷后股骨頭壞死的病例。一名有股骨頸骨折內(nèi)固定史的38歲男性，盡管沒有任何先前的劇烈活動，但仍有右側(cè)髖部疼痛。a內(nèi)固定術(shù)后1.7年獲得的右髖正位片顯示骨折部位無骨不連的跡象，但有分界的硬化和股骨頭塌陷。在他被診斷出患有創(chuàng)傷后股骨頭壞死后，進行了股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)。b 股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)后1個月獲得的前后位X線片。c 股骨轉(zhuǎn)子旋轉(zhuǎn)截骨術(shù)后16.2年獲得的前后位X線片。觀察到骨贅形成，然而，沒有看到塌陷的進展或關(guān)節(jié)間隙變窄（保髖手術(shù)效果很成功）。
Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years
Introduction: This study examined the outcomes of applying transtrochanteric rotational osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON).
Patients and methods: We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12-61 years) at the time of TRO. Transtrochanteric anterior rotational osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior rotational osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0-21.3 years). We investigated the patients' clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups.
Results: At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA.
Conclusions: TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.
文獻出處：Kazuhiko Sonoda, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Ryosuke Yamaguchi, Yukihide Iwamoto. Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years. Arch Orthop Trauma Surg. 2015 Sep;135(9):1257-63. doi: 10.1007/s00402-015-2282-y.
文獻7
再生療法提高股骨頭缺血壞死的存活率:
一項系統(tǒng)回顧和薈萃分析
譯者：李勇
摘要目的:本研究旨在證明再生技術(shù)用于治療股骨頭壞死(或股骨頭缺血性壞死，AVN)的有效證據(jù)，并了解其與單純核心減壓(CD)相比在避免失敗和需要全髖關(guān)節(jié)置換術(shù)(THR)方面的好處。方法 根據(jù)PRISMA指南對3個醫(yī)療電子數(shù)據(jù)庫進行檢索。采用kaplan-mayer曲線計算累積生存率的meta分析包括研究報告數(shù)量和失敗時間。此外，RCT報告的治療組失敗的結(jié)果與對照組記錄的結(jié)果進行了比較，以了解生物療法與髓芯減壓治療AVN的好處。本系統(tǒng)綜述包括48項研究，報告了不同類型的再生技術(shù)的結(jié)果:骨壞死區(qū)間充質(zhì)干細胞植入、間充質(zhì)干細胞動脈內(nèi)浸潤、生物活性分子植入或富血小板血漿?？偟膩碚f，報告的結(jié)果很好，10年隨訪后的累積生存率為80%，與單純髓芯減壓相比，再生治療聯(lián)合使用髓芯減壓時的結(jié)果更好(89.9% vs70.6%， p<0.0001)。結(jié)論 再生療法治療AVN具有良好的臨床效果。隨著時間的推移，與單純的髓芯減壓相比，髓芯減壓與再生技術(shù)的結(jié)合在生存率方面提供了顯著的改善。需要進一步的研究來確定最佳的手術(shù)方法和最適合的患者從AVN再生治療中獲益。
Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis
Purpose The aim of this study was to document the available evidence on the use of regenerative techniques for the treatment of femoral head osteonecrosis (or avascular necrosis of femoral head, AVN) and to understand their benefit compared to core decompression (CD) alone in avoiding failure and the need for total hip replacement (THR).Methods The search was conducted on three medical electronic databases according to PRISMA guidelines. The studies reporting number and timing of failures were included in a meta-analysis calculating cumulative survivorship with a Kaplan-Mayer curve. Moreover, the results on failures in treatment groups reported in RCT were compared with those documented in control groups, in order to understand the benefit of biological therapies compared to CD for the treatment of AVN. Results Forty-eight studies were included in this systematic review, reporting results of different types of regenerative techniques: mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma. Overall, reported results were good, with a cumulative survivorship of 80% after ten year follow-up, and better results when regenerative treatments were combined to CD compared to CD alone (89.9% vs70.6%, p<0.0001).Conclusion Regenerative therapies offer good clinical results for the treatment of AVN. The combination of CD with regenerative techniques provides a significant improvement in terms of survivorship over time compared with CD alone. Further studies are needed to identify the best procedure and the most suitable patients to benefit from regenerative treatments for AVN.
文獻出處：Andriolo, Luca; Merli, Giulia; Tobar, Carlos; Altamura, Sante Alessandro; Kon, Elizaveta; Filardo, Giuseppe (2018). Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. International Orthopaedics, (), –. doi:10.1007/s00264-018-3787-0
文獻8
自行居家訓(xùn)練一周后，
膝關(guān)節(jié)強化訓(xùn)練的動作質(zhì)量下降
譯者：王一昕
背景：用下肢運動學(xué)檢查，對健康中老年人康復(fù)指導(dǎo)后即刻和居家一周后的膝關(guān)節(jié)運動表現(xiàn)進行對照評價。
方法：這是一項在實驗室進行的橫斷面研究。19名健康志愿者（年齡[y]63.1±8.6，體重[kg]76.3±14.7，身高[m]1.7±0.1）參與了本研究。實驗中使用高速視頻和反射標(biāo)記跟蹤記錄志愿者的4個練習(xí)項目的動作。這些練習(xí)包括膝關(guān)節(jié)屈曲、直腿抬高和仰臥位的畫“V”動作，以及側(cè)臥位的髖關(guān)節(jié)外展。所有參與者在訓(xùn)練階段都接受了語言和觸覺的指導(dǎo)，治療師觀察并在必要時糾正練習(xí)動作。一周后返回，參與者在沒有任何進一步指導(dǎo)的情況下進行了相同的練習(xí)。在運動捕捉視頻中提取膝關(guān)節(jié)和髖關(guān)節(jié)的矢狀角和旋轉(zhuǎn)角。采用重復(fù)測量t檢驗比較兩次隨訪觀察的動作。
結(jié)果：與第一次隨訪相比，第二次隨訪時，參與者在直腿抬高和“V-in”訓(xùn)練中表現(xiàn)出更多的膝關(guān)節(jié)屈曲（均p<0.05）。與第一次相比，參與者在第二次來診時，“V-out”運動出現(xiàn)了更多的外旋（p<0.05），而“V-in”運動中表現(xiàn)出更多的內(nèi)旋。
結(jié)論：健康中老年人在接受指導(dǎo)后一周，他們的運動表現(xiàn)出現(xiàn)了顯著下降。盡管每個參與者都收到了指導(dǎo)性的練習(xí)表，但這種下降還是發(fā)生了。我們需要探索其他方法，以幫助每個人能夠保持正確的康復(fù)訓(xùn)練動作。
練。
Quality of knee strengthening exercises performed at home deteriorates after one week
Background: To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later.
Methods: This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and 'V 'in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits.
Results: Participants demonstrated more knee flexion during straight leg raise and 'V in' exercises at the 2nd visit compared to the 1st visit (both p < 0.05). During the 'V out' exercise, they performed more external rotation (p < 0.05) while they showed more internal rotation during the 'V in' exercise at the 2nd visit compared to the 1st visit.
Conclusions: Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
文獻出處：Ulrike H Mitchell, Hyunwook Lee, Hayden E Dennis, Matthew K Seeley. Quality of knee strengthening exercises performed at home deteriorates after one week. BMC Musculoskelet Disord. 2022 Feb 19;23(1):164. PMID: 35183152. PMCID: PMC8857831. DOI: 10.1186/s12891-022-05120-3
張洪主任門診時間：周三上午
膝關(guān)節(jié)置換:張軼超 13261817537
髖關(guān)節(jié)置換:馬云青 13811705624
保髖療法:羅殿中 18911358880
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