本期目錄：
1、全膝關節(jié)置換術中使用高型合度聚乙烯墊片而犧牲后交叉韌帶的影響
2、股骨遠端去旋轉(zhuǎn)截骨可有效治療髕骨不穩(wěn)定
3、全髖關節(jié)置換術治療年輕髖關節(jié)股骨頭壞死的療效觀察
4、CroweIV型先髖全髖關節(jié)置換術中指導髖臼杯安放的幾何形態(tài)學研究
5、髖關節(jié)鏡術中透視與標準X線片的比較：一項尸體研究
6、髖關節(jié)發(fā)育不良患者進行漸進性抗阻訓練：可行性研究
7、有關青少年Chiari骨盆內(nèi)移截骨結果的文獻綜述
8、髖關節(jié)鏡下盂唇修復與關節(jié)囊重疊縫合治療臨界髖關節(jié)發(fā)育不良：最少5年的患者隨訪結果
9、對股骨頭骨骺滑脫的理解和治療方法的全新理解
第一部分：關節(jié)置換及保膝相關文獻
文獻1
全膝關節(jié)置換術中使用高型合度聚乙烯墊片而犧牲后交叉韌帶的影響
譯者：張軼超
背景：關于在全膝置換術（TKA）中使用保留后交叉韌帶（PCL）假體與不保留PCL假體哪種更好一直都有爭論。我們想確定在TKA中使用高型合度墊片保留PCL和不保留PCL在關節(jié)活動度（ROM）方面是否存在差異。
方法：我們選擇一個醫(yī)療中心審查委員會所認可的從2013年11月到2016年1月的回顧性研究資料，這些連續(xù)性病例都是接受了使用相同高型合度假體的TKA手術，由同一名醫(yī)生完成。所有病人根據(jù)術中PCL保持完好和被切斷而分為兩組。記錄病人的年齡，BMI，術中PCL狀態(tài)（松弛的，保持完好的或切斷的）及術前術后膝關節(jié)ROM。
結果：各組間平均年齡（60.5歲對60.6歲）和BMI（33.3對32.6）相似。術后脛骨后傾兩組間存在差異（PCL切斷組5.5°，PCL保留組6.6°，P=0.028）；其它的力線和活動度兩組相似。
結論：結果顯示使用高型合度界面設計可以很好的保留PCL，沒有證據(jù)顯示會影響術后的ROM，而PCL切斷的患者也不會出現(xiàn)關節(jié)不穩(wěn)。
The Effect of Sacrificing the Posterior Cruciate Ligament in Total Knee Arthroplasties That Use a Highly Congruent Polyethylene Component
BACKGROUND: There is continued debate regarding retention versus sacrificing of the posterior cruciate ligament (PCL) in total kneearthroplasty (TKA). We sought to determine if there was a difference in range of motion (ROM) after TKA between patients with PCL sacrifice versus PCL retention when using a highly congruent polyethylene insert.
METHODS: We conducted an Institutional Review Board approved retrospective study of consecutive patients receiving TKA using the same implant with a highly congruent polyethylene component implanted by one surgeon from November 2013 to January 2016. Patients were placed in 2 groups based on whether the PCL was intact or released at the time of surgery. Patient charts were reviewed for age, body mass index, PCL status at surgery (incompetent, kept intact, or released), and preoperative/postoperative knee ROM.
RESULTS: Both groups were similar in average age (60.5 vs 60.6, respectively) and body mass index (33.3 vs 32.6, respectively). Postoperative tibial slope (5.5° PCL release, 6.6° PCL retained, P = .028) was the only alignment variable reaching significance; all other alignment and motion variables were similar.
CONCLUSION: Results indicate that the PCL can be successfully retained with the use of a congruent bearing design, with no evident limitation in postoperative ROM or loss of stability due to the bearing in comparison to patients who undergo PCL release.
文獻出處：Stronach BM, Adams JC, Jones LC, Farrell SM, Hydrick JM. The Effect of Sacrificing the Posterior Cruciate Ligament in Total Knee Arthroplasties That Use a Highly Congruent Polyethylene Component. J Arthroplasty. 2019 Feb;34(2):286-289. doi: 10.1016/j.arth.2018.10.006. Epub 2018 Oct 13.
文獻2
股骨遠端去旋轉(zhuǎn)截骨可有效治療髕骨不穩(wěn)定
譯者：羅殿中
目的：股骨前傾角的增加可影響髕股關節(jié)的生物力學特點，本研究通過回顧性分析股骨遠端去旋轉(zhuǎn)截骨治療髕股關節(jié)不穩(wěn)的病例，評估其臨床療效。
方法：本研究納入2007年至2016年所有接受股骨遠端去旋轉(zhuǎn)截骨術（圖1）的髕股關節(jié)不穩(wěn)的患者，排除標準包括：骨骺未閉、創(chuàng)傷后畸形以及隨訪時間小于12月者。依據(jù)核磁等影像學檢查評估是否存在軟骨損傷及股骨滑車發(fā)育不良，并測量脛骨結節(jié)至股骨滑車溝間距及下肢力線情況。此外還于術前術后分別評估患者VAS疼痛評分、WOMAC評分、主觀IKDC評分、Lysholm評分及Tegner活動度評分等。
圖1 左圖為股骨遠端截骨術后X線片。黑色箭頭所示為截骨線，固定方式為股骨遠端外側(cè)鎖定碳板。白色箭頭及★所示為內(nèi)側(cè)髕股韌帶重建部位（示意圖見右）。
結果：222例股骨截骨的患者中，共42例（44膝）符合納入標準。術前股骨前傾角平均為31°（標準差±9°），平均外翻角度為1°（標準差±3°）。除股骨去旋轉(zhuǎn)截骨外，還聯(lián)合使用的術式包括：內(nèi)側(cè)髕股韌帶重建64%（28例）、髕股關節(jié)成型18%（8例）、股骨滑車節(jié)成型14%（6例）以及脛骨結節(jié)移位14%（6例）。平均隨訪時間為44月（標準差±27，范圍：12-88月），失訪5例。VAS疼痛評分由術前4±3改善至2±2分，WOMAC評分由術前80±14改善至88±16分（圖2），Lysholm評分由術前46±21改善至71±24分，IKDC評分由術前54±13改善至65±17分。隨訪期間無髕骨再脫位發(fā)生。
結論：聯(lián)合使用股骨遠端去旋轉(zhuǎn)截骨術治療由股骨扭轉(zhuǎn)畸形所致的髕骨不穩(wěn)，可顯著緩解疼痛、改善膝關節(jié)功能，有著較好的短期隨訪結果。
Derotational osteotomy at the distal femur is effective to treat patients with patellar instability
Abstract Purpose Increased femoral antetorsion influences patellofemoral joint kinematics. The aim of this study was to retrospectively evaluate the clinical outcome after derotational osteotomies and combined procedures in patients with patellofemoral instability.
Methods All patients with derotational osteotomies and combined procedures in patients with patellofemoral instability and increased femoral antetorsion performed between 2007 and 2016 were retrospectively analyzed. Exclusion criteria were open growth plates, posttraumatic deformities, and a follow-up period less than 12 months. Simple radiography and magnetic resonance imaging to evaluate cartilage lesions, trochlear dysplasia, tubercle distance, and osseous malalignment as frontal axis and torsion were performed on every patient. Patients were evaluated pre- and postoperatively using the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the subjective IKDC evaluation form, the Lysholm score, and the Tegner activity score.
Results Out of 222 femoral osteotomies, a total of 42 patients (44 knees) met the inclusion criteria. Mean preoperative femoral antetorsion of 31° (SD ± 9°) and mean valgus malalignment of 1° (SD ± 3°) were observed. An intended derotation of 12° (SD ± 5°) was set overall. The additional procedures included correction of valgus in 50% (n = 22), MPFL reconstruction in 64% (n = 28), patellofemoral arthroplasty in 18% (n = 8), trochleoplasty in 14% (n = 6), tibial tubercle transfer in 14% (n = 6). During the mean follow-up period of 44 months (SD ± 27, range 12–88), a total of five patients were lost to follow-up, resulting in a follow-up rate of 89% (n = 39). A significant pain relief from VAS 4 (SD ± 3) to VAS 2 (SD ± 2) (p = 0.006) as well as improved scores, WOMAC: from 80 (SD ± 14) to 88 (SD ± 16) (p = 0.007), Lysholm: from 46 (SD ± 21) to 71 (SD ± 24) (p < 0.001), IKDC: from 54 (SD ± 13) to 65 (SD ± 17) (p < 0.001), were observed postoperatively. During the follow-up period, no patellar re-dislocation was observed.
Conclusion Combined derotational osteotomy is a suitable treatment for patellar instability due to torsional malformity, as it leads to a significant reduction of pain, and a significant increase of knee function with good-to- excellent results in the short-term follow-up.
文獻出處：Imhoff FB, Cotic M, Liska F, Dyrna FGE, Beitzel K, Imhoff AB, Herbst E. Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):652-658. doi: 10.1007/s00167-018-5212-z. Epub 2018 Oct 13.
文獻3
全髖關節(jié)置換術治療年輕髖關節(jié)股骨頭壞死的療效觀察
譯者：馬云青
背景：髖關節(jié)股骨頭壞死是一種典型的臨床、影像學和病理學明確的疾病，通常影響年輕患者。本研究評估35歲或更年輕的股骨頭壞死患者的長期假體生存率和初次全髖關節(jié)置換術(THA)后的患者的療效。
方法：通過單一醫(yī)學中心的臨床資料進行一項回顧性研究，并進行了前瞻性隨訪。對年輕股骨頭壞死接受THA治療的患者進行回顧性分析，并進行隨訪調(diào)查，以確定種假體生存時間和患者報告的臨床結果。采用Kaplan-Meier生存分析評估假體生存，采用髖關節(jié)功能障礙和骨關節(jié)炎結局評分(HOOS)描述患者臨床療效。
結果：該研究納入135名患者(204例THAs)，平均隨訪時間為14年。本組10年假體存活率為86%，20年假體存活率為66%。男性患者(p = 0.02)和25歲以上患者(p = 0.03)的假體生存時間更長。隨訪中疼痛，日常癥狀和ADLs的平均HOOS評分為87分，運動評分為77分。翻修THA患者的所有HOOS評分均較低，手術時年齡大于25歲的患者HOOS- pain和HOOS-sport評分較低(p<0.05)。
結論：年輕的股骨頭壞死患者有良好的假體生存率和長期預后療效。在預測年輕股骨頭壞死患者THA術后種植體存活和預后功能時，應考慮患者因素和假體自身特征。
Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip
BACKGROUND: Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosisaged 35 or younger.
METHODS: A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.
RESULTS: The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05).
CONCLUSIONS: Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.
文獻出處：Swarup I, Shields M, Mayer EN, Hendow CJ, Burket JC, Figgie MP. Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip. Hip Int. 2017 May 12;27(3):286-292. doi: 10.5301/hipint.5000457. Epub 2017 Jan 31.
文獻4
CroweIV型先髖全髖關節(jié)置換術中指導髖臼杯安放的幾何形態(tài)學研究
譯者：張薔
目的：我們借助幾何形態(tài)學分析方法，使用患者的CT數(shù)據(jù)分析并獲得Crowe IV型先髖的全髖關節(jié)置換術中髖臼杯中心的理想安放位置，并分析該方法的可靠性。
方法：我們回顧性分析入組了52例Crowe IV型髖關節(jié)（42名患者，7男，35女；平均年齡68.5歲（32-82歲）），50例相對正常髖關節(jié)（50名患者，8男，42女；平均年齡60.7歲（34-86歲））的全髖關節(jié)置換手術病例。在這一基于CT數(shù)據(jù)的模擬研究中，我們將髖臼杯安放在真臼位置上，外展角40°，前傾角20°。我們使用廣義對齊算法（GPA）這一幾何形態(tài)學方法分析髖臼形態(tài)以及髖臼杯中心的安放位置。
三角形狀的真臼，髖臼杯中心在后壁的中上三分之一附近（藍點位置）
結果：Crowe IV型先髖的髖臼通常呈現(xiàn)獨特的三角形，而髖臼杯中心的理想安放位置在髖臼后壁的上方。在曲線分析中，前兩個扭曲點分別可以覆蓋34.2%和18.4%的變量，而相對正常組可以覆蓋28.6%和18.0%的變量。我們以后壁的中上三分之一作為髖臼杯中心的參照點，髖臼杯的中心距參照點的平均距離為5.6mm。
黑色箭頭指示真臼位置，藍色箭頭指示髖臼杯中心點
結論：Crowe IV型先髖的髖臼是獨特的三角形，而在安放髖臼杯時后壁的中上三分之一是一個十分重要的骨性標志物。
Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty
Aims: We analyzedthe acetabular morphology of Crowe type IV hips using CT data to identify alandmark for the ideal placement of the center of the acetabular component, asassessed by morphometric geometrical analysis, and its reliability.
Patients and Methods: A total of 52 Crowe IV hips (42 patients; seven male, 35 female; mean age 68.5 years (32to 82)) and 50 normal hips (50 patients; eight male, 42 female; mean age 60.7years (34 to 86)) undergoing total hip arthroplasty were retrospectively identified. In this CT-based simulation study, the acetabular component waspositioned at the true acetabulum with a radiological inclination of 40° andanteversion of 20°. Acetabular shape and the position of the center of theacetabular component were analyzed by morphometric geometrical analysis usingthe generalized Procrustes analysis.
Results: Theacetabular shapes of Crowe IV hips were distinctively triangular; the idealposition of the center of the acetabular component was superior on theposterior bony wall. The first and second relative warps explained 34.2% and18.4% of the variance, respectively, compared with that of 28.6% and 18.0% innormal hips. We defined the landmark as one-third the distance from top on theposterior bony wall in Crowe IV hips. The average distance from the center ofthe acetabular component was 5.6 mm.
Conclusion: Crowe IVhips are distinctively triangular; the point one-third from the top on theposterior bony wall was a useful landmark for placing the acetabular component.
文獻出處：J.Yoshitani, T. Kabata, Y. Kajino, T. Ueno, K. Ueoka, T. Nakamura, H. Tsuchiya. Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty. Cite thisarticle: Bone Joint J 2019; 101-B: 189–197.
第二部分：保髖相關文獻
文獻1
髖關節(jié)鏡術中透視與標準X線片的比較：一項尸體研究
譯者：程徽
目的：比較術中透視和標準的前后位骨盆X光片上測量的的髖臼形態(tài)的指標。
投照中心對圖像的影響
方法：使用以髖關節(jié)為中心的透視和標準前后位骨盆X射線片對10個干燥的人骨盆標本（20髖）進行成像。評估每個髖關節(jié)的髖臼形態(tài)和覆蓋范圍，指標包括側(cè)中心邊緣（LCE）角，髖臼指數(shù)（AI），前覆蓋率，后覆蓋率和交叉征。
結果：平均LCE角度（透視36.5°±8.3° vs 平片36.1°±7.9°，P =0.59），髖臼指數(shù)（0.6°±8.6° vs 0.2°±7.1°，P =0.61），ACM角（44.0°±2.6° vs44.1°±3.8°，P = 0.89），Sharp角（31.8°±5.7° vs 32.4°±3.9°，P =0.44），外側(cè)覆蓋率（80.9％±6.4％ vs 80.7％±7.5％，P =0.83）之間無統(tǒng)計學差異。相反，與平片X射線照相相比，前覆蓋率（30.7％±8.5％ vs 33.3％±8.2％，P <0.0001）顯著下降，后覆蓋率（54.1％±6.9％vs 49.1％±7.8％，P <0.0001）顯著增加。透視檢查漏診了30％的交叉征，并且低估了后傾指數(shù)（9％±16％，v 13％±16％，P =0.016）。
結論：通過以髖部為中心的透視檢查確定的LCE角度和AI的值，與標準前后平片獲得的值沒有差異。然而，與標準化骨盆前后位片相比，在透視觀察中髖臼看起來更加前傾，前覆蓋率顯著降低，后覆蓋率顯著增加。
臨床相關性：該研究顯示了透視可以可靠的反映LCE和AI角度，但在髖臼前后傾方面，透視和標準骨盆前后位片存在顯著差異。
IntraoperativeEvaluation of Acetabular Morphology in Hip Arthroscopy Comparing StandardRadiography Versus Fluoroscopy: A Cadaver Study
PURPOSE: To compare quantitative measurements of acetabular morphology obtained usingintraoperative fluoroscopy, to standardized anteroposterior (AP) pelvisradiographs.
METHODS: Ten dried human pelvis specimens (20 hips) were imaged using hip-centeredfluoroscopy and standardized AP pelvis radiographs. Each hip was evaluated foracetabular version and coverage, including lateral center edge (LCE) angle,acetabular index (AI), total anterior and posterior coverage, and crossoversign.
RESULTS: No statistically significant differences existed between the mean LCE angle(fluoroscopy 36.5° ± 8.3° v plain films 36.1° ± 7.9°, P = .59), acetabular index (0.6° ± 8.6° v 0.2° ± 7.1°, P = .61), ACM angle (44.0° ± 2.6° v 44.1° ±3.8°, P = .89), Sharp's angle (31.8° ± 5.7° v 32.4° ± 3.9°, P = .44), and thetotal femoral coverage (80.9% ± 6.4% v 80.7% ± 7.5%, P = .83). Conversely,total anterior coverage (30.7% ± 8.5% v 33.3% ± 8.2%, P < .0001) appearedsignificantly decreased and the total posterior coverage (54.1% ± 6.9% v 49.1%± 7.8%, P < .0001) appeared significantly increased in fluoroscopy comparedwith plain film radiographs. Fluoroscopy also failed to identify the presenceof a crossover sign in 30% and underestimated the retroversion index (9% ± 16%,v 13% ± 16%, P = .016).
CONCLUSIONS: The values for the LCE angle and AI determined by hip-centered fluoroscopy didnot differ from those obtained by standardized AP plain film radiography.However, fluoroscopy leads to a more anteverted projection of the acetabulumwith significantly decreased total anterior coverage, significantly increasedtotal posterior coverage, and underestimated signs of retroversion compared with standardized AP pelvis radiography.
CLINICALRELEVANCE: This study shows reliable LCE and AI angles but significantdifferences in the projected anteversion of the acetabulum between standardizedAP pelvis radiography and hip-centered fluoroscopy.
文獻出處：Büchler L, Schwab JM, Whitlock PW, Beck M, Tannast M. Arthroscopy. Intraoperative Evaluation of Acetabular Morphology in Hip Arthroscopy ComparingStandard Radiography Versus Fluoroscopy: A Cadaver Study.2016 Jun;32(6):1030-7.doi: 10.1016/j.arthro.2015.12.048. Epub 2016 Mar 15.
文獻2
髖關節(jié)發(fā)育不良患者進行漸進性抗阻訓練：可行性研究
譯者：肖凱
目的：明確有癥狀的髖關節(jié)發(fā)育不良患者在接受髖臼周圍截骨術治療前進行漸進性抗阻訓練是否可行。次要目標是調(diào)查患者自我評分結果、髖關節(jié)功能及和髖部肌肉力量改善情況。
設計：可行性研究。
患者和方法：17名患者（中位年齡28歲，范圍22-40歲）在指導下進行了為期8周（20次）的漸進性抗阻訓練。記錄了患者訓練依從性、中途退出訓練情況和不良事件的發(fā)生率。記錄疼痛VAS評分?；颊咄瓿审y關節(jié)和腹股溝結果評分（Hip andGroin Outcome Score），進行2次跳躍測試，并通過等速測力法評估髖部峰值扭矩。
結果：患者訓練依從性為90.3±9％。不良事件發(fā)生很少且輕微，一名患者中途退出，在訓練期間患者報告了可接受的疼痛水平。6個患者自我評分量表中有4個得分改善（p<0.05），站立跳躍距離提高了12.2％（95％置信區(qū)間[1.3,23.0]），反向運動跳躍提高了25.1％（95％置信區(qū)間 [1.3,48.8]）?；紓?cè)等速髖關節(jié)屈曲峰值扭矩改善16.5%（95％置信區(qū)間[4.6,28.6]），健側(cè)等長髖關節(jié)屈曲改善10.9%（95％置信區(qū)間 [0.3,21.6]）。
結論：對于髖關節(jié)發(fā)育不良患者，在進行髖臼周圍截骨術前指導進行抗阻訓練是可行的。此干預可改善疼痛水平，提高患者自我評分量表結果，改善髖關節(jié)功能表現(xiàn)和髖關節(jié)屈曲肌肉力量。
Progressive resistance training in patients with hip dysplasia: A feasibility study
OBJECTIVES: To examine whether progressive resistance training is feasible in patients with symptomatic hip dysplasia scheduled for periacetabular osteotomy. A secondary objective was to investigate patient-reported outcomes, functional performance and hip muscle strength.
DESIGN: Feasibility study.
PATIENTS AND METHODS: Seventeen patients (median age 28 years, range 22-40 years) performed 8 weeks (20 sessions) of supervised sessions of progressive resistance training. Training-adherence, number of dropouts and adverse events, and visual analogue scale scores on pain were registered. Patients completed the Hip and Groin Outcome Score, performed 2 hop-tests, and hip peak torque was assessed by isokinetic dynamometry.
RESULTS: Training-adherence was 90.3±9%. Few and minor adverse events were observed, one patient dropped out and acceptable pain levels were reported during the intervention. Scores on 4 out of 6 subscales on patient-reported outcome improved (p?<0.05), as did standing distance jump (12.2%, 95% confidence interval (CI) [1.3, 23.0]), countermovement jump (25.1%, 95% CI [1.3, 48.8]). Isokinetic concentric hipflexion peak torque showed significant improvements (16.6%, 95% CI [4.6, 28.6]) on the affected side while isometric hip flexion (10.9%, 95% CI [0.3, 21.6]) improved on the non-affected side.
CONCLUSION: Supervised progressive resistance training is feasible in patients with hip dysplasia. The intervention may improve pain levels, patient-reported outcomes, functional performance and hip flexion muscle strength.
文獻出處：Mortensen L, Schultz J, Elsner A, Jakobsen SS, S?balle K, Jacobsen JS, Kierkegaard S, Dalgas U, Mechlenburg I. Progressive resistance training in patients with hip dysplasia: A feasibility study. J Rehabil Med. 2018 Aug 22;50(8):751-758. doi: 10.2340/16501977-2371.
文獻3
有關青少年Chiari骨盆內(nèi)移截骨結果的文獻綜述
譯者：任寧濤
目的：Chiari骨盆內(nèi)移截骨是利用髂骨骨松質(zhì)包容股骨頭和負重的一種手術技術，是最有爭議的髖關節(jié)截骨方式。本研究旨在研究兒童行Chiari骨盆內(nèi)移截骨中期隨訪結果。
方法：從1995年到2004年，共進行了20例Chiari骨盆內(nèi)移截骨術（18個患者），其中包含15名男性，3名女性，手術時平均年齡為12.6歲，平均隨訪時間為54個月。采用 Chiari描述的手術方法，選擇髂股入路，不使用牽引床，如股骨頭前側(cè)或前外側(cè)覆蓋小，則進行局部植骨造蓋。
結果：截骨角度平均為12度，距離髖臼平均為3.2mm，平均內(nèi)移程度為42%。從臨床療效和影像學觀察，20例Chiari骨盆內(nèi)移截骨中11例效果為優(yōu)，8例為良，1例為可。T- Test檢驗發(fā)現(xiàn)髖關節(jié)影像學參數(shù)（Sharp角、CE角和股骨頭覆蓋率）均有改善。25%的病例出現(xiàn)骨移植物的吸收。
結論：10歲以下的Chiari骨盆內(nèi)移截骨術的適應癥非常罕見。由于移植物吸收率高，當有髖關節(jié)前側(cè)或前外側(cè)覆蓋不良時，不首選Chiari骨盆內(nèi)移截骨。
圖1 Chiari骨盆內(nèi)移截骨影像學參數(shù)，Chiari截骨角度（a），參考線（平行于雙側(cè)淚滴連線）與截骨線之間的角度；內(nèi)移=A/B × 100。
圖2 男孩，9.5歲，LCPD，8歲時行股骨近端內(nèi)翻截骨術，術后18個月后行Chiari骨盆內(nèi)移截骨和骨移植術（A-C），Chiari術后9年隨訪發(fā)現(xiàn)骨移植物吸收，股骨頭覆蓋不良。
The results of Chiari pelvicosteotomy in adolescents with a brief literature review
PURPOSE: Chiari medialdisplacement osteotomy is a procedure that uses the cancellous boneof the ilium to contain the femoral head and bear weight. It is the most contraversial osteotomy ofthe hip joint. This study was therefore conducted to determine the results ofthis osteotomy with mid-term follow-up in children.
METHODS: From 1995 to 2004,20 Chiari pelvic osteotomies (in 18 patients) were performed.There were 15 male and 3 female patients. The average age at operation was 12.6years and the mean follow-up was 54 months. The operative technique was asdescribed by Chiari. An iliofemoral approach was used without utilizing atraction table. If there was anterior or anterolateral uncoverage of thefemoral head, bone graft augmentation was performed.
RESULTS: The angle of the osteotomy averaged12 degrees , with the distance from the acetabulum averaging 3.2 mm. Theaverage displacement was 42%. Of the 20 Chiari osteotomies, 11 werecategorized as excellent, 8 as good and one as fair in terms of clinical andradiological results. Student's t test statistics showed improvements inall radiologic parameters of the hip joint (Sharp angle, center-edge angle andcoverage of the femoral head). Graft resorption was observed in 25% of thepatients.
CONCLUSION: There are very rareindications of Chiari osteotomy in patients younger than 10years. Because of the high rate of graft resorption, Chiari osteotomy shouldbe the last treatment option when there is anterior or anterolateral uncoverageof the hip joint.
文獻出處：Karami M, Fitoussi F, IlharrebordeB, Penne?ot GF, Mazda K, Bensahel H.Theresults of Chiari pelvic osteotomy in adolescents with a brief literaturereview. J Child Orthop. 2008Feb;2(1):63-8. doi: 10.1007/s11832-007-0071-z. Epub 2008 Jan 3.
文獻4
髖關節(jié)鏡下盂唇修復與關節(jié)囊重疊縫合治療臨界髖關節(jié)發(fā)育不良：最少5年的患者隨訪結果
譯者：張利強
背景：發(fā)育性髖關節(jié)發(fā)育不良（DDH）的關節(jié)鏡治療一直存在爭議，已被證明效果參差不齊。而對強調(diào)盂唇和關節(jié)囊作為次要穩(wěn)定結構的臨界DDH患者的研究表明，接受關節(jié)鏡治療的患者，其病人回饋結果（PROs）都有改善。
目的/假設：本研究旨在評估在最少5年的隨訪中，臨界DDH患者行髖關節(jié)鏡下盂唇修復與關節(jié)囊重疊縫合是否具有長久的、積極的結果。假設仔細選擇患者，結果將是良好的。
方法：對40歲以下髖關節(jié)內(nèi)病變行關節(jié)鏡手術治療患者的資料進行前瞻性收集和回顧性分析。入選標準包括外側(cè)中心邊緣角（LCEA）在18°到25°之間，并行盂唇修復與關節(jié)囊重疊縫合，最少5年隨訪。排除標準為嚴重發(fā)育不良（LCEA18°）、Tonnis分級≥2、兒童期既往髖關節(jié)疾病或髖關節(jié)手術。于術后3月及每年分別收集包括改良Harris評分（mHHS）、NAHS評分、HOS-SSS評分和VAS評分的PRO s分數(shù)。并記錄術后并發(fā)癥和翻修情況。
結果：25髖（24例）符合入選標準。21髖（19例，84%）得到隨訪。平均手術年齡為22.9歲。平均術前LCEA和Tonnis角分別為21.7°（范圍，18°至24°）和6.9°（范圍，-1°至16°）。平均隨訪時間為68.8個月。mHHS平均值從70.3增加到85.9（p<0.0001），NAHS平均值從68.3增加到87.3（p<0.0001），HOS-SSS平均值從52.1增加到70.8（p=0.0002）。VAS評分平均值從5.6分改善到1.8分（P<0.0001）。4例髖關節(jié)（19%）需要二次關節(jié)鏡檢查，所有這些患者在最后的隨訪中PRO s評分都提高了。沒有患者需要行全髖關節(jié)置換術。
結論：雖然髖臼周圍截骨術仍是治療真正的髖臼發(fā)育不良的標準方法，但中期隨訪結構顯示髖關節(jié)鏡檢查可為處理臨界DDH的關節(jié)內(nèi)病變提供一種安全、長久的方法。這些手術應由具有豐富關節(jié)鏡技術專業(yè)知識的外科醫(yī)生執(zhí)行，采用嚴格的患者選擇標準并重點行盂唇修復與關節(jié)囊重疊縫合。
圖1。關節(jié)囊移位/折疊。（a）髖關節(jié)關節(jié)鏡手術結束時關節(jié)鏡下關節(jié)囊折疊的目的是使股骨側(cè)關節(jié)囊向近端移位。（b）近端的縫線偏向前外側(cè)，遠端的縫線偏向內(nèi)下方，實現(xiàn)錯位縫合（c）打結縫線會將內(nèi)下方關節(jié)囊拉向前外側(cè)
圖2。關節(jié)鏡下關節(jié)囊折疊/移位術中視圖。（a）縫合線斜向穿過關節(jié)囊切開部位的股骨側(cè)。（b）縫合處系緊，以產(chǎn)生近端關節(jié)囊移位。髖關節(jié)保持外展，以確保不發(fā)生關節(jié)囊的分離。
Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes
Background: The arthroscopic management of hip dysplasia has been controversial and has historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown improvement in patient-reported outcomes (PROs).
Purpose/Hypothesis: The purpose was to assess whether the results of hip arthroscopic surgery with labral preservation and concurrent capsular plication in patients with borderline hip dysplasia have lasting, positive outcomes at a minimum 5-year follow-up. It was hypothesized that with careful patient selection, outcomes would be favorable.
Methods: Data were prospectively collected and retrospectively reviewed for patients aged<40 years who underwent hip arthroscopic surgery for intra-articular abnormalities. Inclusion criteria included lateral center-edge angle (LCEA) between 18° and 25°, concurrent capsular plication and labral preservation, and minimum 5-year follow-up. Exclusion criteria were severe dysplasia (LCEA18°), To?nnis grade2, pre-existing childhood hip conditions, or prior hip surgery. PRO scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) and the visual analog scale (VAS) score for pain were collected preoperatively, at 3 months, and annually thereafter. Complications and revisions were recorded.
Results: Twenty-five hips (24 patients) met the inclusion criteria. Twenty-one hips (19 patients, 84%) were available for follow-up. The mean age at surgery was 22.9 years. The mean preoperative LCEA and To?nnis angle were 21.7° (range, 18° to 24°) and 6.9° (range, -1° to 16°), respectively. The mean follow-up was 68.8 months. The mean mHHS increased from 70.3 to 85.9 (P < .0001), the mean NAHS from 68.3 to 87.3 (P<.0001), and the mean HOS-SSS from 52.1 to 70.8 (P = .0002). The mean VAS score improved from 5.6 to 1.8 (P<.0001). Four hips (19%) required secondary arthroscopic procedures, all of which resulted in improved PRO scores at latest follow-up. No patient required conversion to total hip arthroplasty.
Conclusion: While periacetabular osteotomy remains the standard for treating true acetabular dysplasia, hip arthroscopy may provide a safe and durable means of managing intra-articular abnormalities in the setting of borderline acetabular dysplasia at midterm follow-up. These procedures should be performed by surgeons with expertise in advanced arthroscopic techniques, using strict patient selection criteria, with emphasis on labral preservation and capsular plication.
文獻出處：Benjamin G. Domb , Edwin O. Chaharbakhshi, et al. Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes. Am J Sports Med 2018;46(2):305-313
文獻5
對股骨頭骨骺滑脫的理解和治療方法的全新理解
譯者：陶可（北京大學人民醫(yī)院骨關節(jié)科）
綜述目的：回顧性調(diào)研股骨頭骨骺滑脫（SCFE），重點關注其病因?qū)W的研究新進展以及手術固定方法的演變。
最新發(fā)現(xiàn)：青春期骨骺結節(jié)及其大小對于理解SCFE的發(fā)病機制至關重要。在慢性穩(wěn)定性SCFE中，骨骺圍繞結節(jié)旋轉(zhuǎn)從而保護錄了外側(cè)骨骺血管免于破壞；在急性不穩(wěn)定性SCFE中，結節(jié)發(fā)生位移，增加了股骨頭壞死的風險，也就是常說的股骨頭缺血性壞死（AVN）。術中穩(wěn)定性表明基于移動的穩(wěn)定和不穩(wěn)定來判斷的SCFE可能是不準確的。對于穩(wěn)定性SCFE，原位固定仍然是緩解遲發(fā)的癥狀性股骨髖臼撞擊（FAI）伴發(fā)輕度滑脫的最常用治療方法。采用糾正力線的截骨術治療中重度穩(wěn)定性滑脫可減少股骨畸形，并可獲得更好的預后。然而，它具有更高的并發(fā)癥風險，包括AVN和軟骨碎裂溶解。我們對SCFE病因的探索正不斷深入。中度至重度SCFE手術治療的最佳技術仍存在爭議，并且因治療的中心而有所差異。需要對這些患者進行控制良好的研究，以了解這一難題的最佳治療策略。此外，提高對SCFE的認識對于早期識別和治療早期畸形以及避免嚴重的SCFE畸形至關重要，這也與長期預后較差有關。
Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis
PURPOSE OF REVIEW: To review slipped capital femoral epiphysis (SCFE), with afocus on new insights into its etiology and evolving methods of operativefixation.
RECENT FINDINGS: The epiphyseal tubercle and its size during adolescence areparamount to understanding the mechanism of SCFE. In chronic stable SCFE, theepiphysis rotates about the tubercle protecting the lateral epiphyseal vesselsfrom disruption. In an acute unstable SCFE, the tubercle displaces, increasingthe risk of osteonecrosis, also known as avascular necrosis (AVN).Intraoperative stability suggests that stable and unstable SCFE based onambulation may be inaccurate. For stable SCFE, in situ pinning remains the mostaccepted treatment for mild slips with delayed symptomatic femoroacetabularimpingement (FAI) management. Treatment of moderate to severe stable slips withrealignment osteotomy leads to less femoral deformity and potentially betteroutcomes. However, it has a higher risk of complications, including AVN andchondrolysis. Our knowledge of the etiology for SCFE is evolving. The optimaltechnique for operative treatment of moderate to severe SCFE is controversialand varies by center. Well-controlled studies of these patients are needed tounderstand the best treatment for this difficult problem. Furthermore,increasing the awareness about SCFE is paramount to allow for early recognitionand treatment of deformity at its early stages and avoiding severe SCFEdeformity which has been associated with worse long-term outcomes.
文獻出處：Wylie JD, Novais EN.Evolving Understanding of and Treatment Approaches to Slipped Capital FemoralEpiphysis. Curr Rev Musculoskelet Med. 2019 Mar 12. doi:10.1007/s12178-019-09547-5. [Epub ahead of print].
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