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本期目录：
1、全膝关节置换术后远程康复的疗效和安全性
2、单髁置换术后胫骨假体内翻放置会降低术后骨折的潜在风险
3、双动关节界面在全髋翻修手术中的应用：金/陶对聚乙烯与限制性界面的比较
4、骨显像能反映单髁膝关节置换术后骨关节炎的进展吗？
5、髋臼周围截骨术后截骨端不愈合导致的骨盆不稳定的外科治疗
6、髋关节的感觉神经支配与相关疼痛
7、先天性髋关节脱位的盂唇畸形分类
8、组织工程骨再生治疗负重区中重度股骨头坏死
9、体质指数与儿童和青少年的股骨前倾角、步态中的髋关节旋转以及髋关节被动运动范围有关
10、髋关节发育不良并不罕见，但经常被忽视：一项基于 1,870 名成人放射线检查的横断面研究
11、接受髋臼周围截骨术(PAO)治疗髋关节发育不良的成人的疼痛、功能和生活质量受到的影响：系统综述和荟萃分析
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第一部分：关节置换及保膝相关文献
文献1
全膝关节置换术后远程康复的疗效和安全性：系统综述
译者 张轶超
背景：评估全膝关节置换术（TKA）患者远程康复的有效性和安全性的研究越来越多。然而，研究质量和结果参差不齐，系统评价有限。我们的目的是综合系统综述和荟萃分析来评估TKA术后患者远程康复的效果。
材料和方法：从8个数据库中检索出从数据库建立至2022年12月18日关于TKA远程康复的有效性和安全性的系统综述和meta分析。采用系统综述和荟萃分析首选报告项目（PRISMA）、评估系统综述2的测量工具（AMSTAR 2）、系统综述偏倚风险（ROBIS）及GRADE系统对结果、方法、偏倚和证据质量进行评价。
结果：对13项系统综述和荟萃分析进行了分析。AMSTAR 2在7项研究中显示较低的方法学质量，在6项研究中显示极低的方法学质量。其中在关键条目中，有4篇综述在项目2进行评审系统评估前就已在网站注册。关于条目4，有4篇综述没有提供详尽的搜索策略。对于条目7，没有一篇综述提供排除某一条款的理由清单。对于条目9，关于是否使用了合适的工具来评估每个纳入研究的偏倚风险，一篇综述被评价为“部分是”，一篇综述仅包括RCTs，其余的被评价为“是”。对于条目11，一篇综述没有明确指出使用的统计学方法，三篇综述没有进行荟萃分析。对于条目13，四篇综述在解释或讨论研究结果时考虑了偏倚风险。对于条目15，有7篇综述没有评价发表偏倚。13篇综述的PRISMA评分从17.5到26.0不等。PRISMA显示69.2%没有方案注册，38.5%没有提供其他得确定性材料和证据，23.1%没有提供确定性评估，30.8%没有报告研究偏倚。根据ROBIS量表，在所有的综述中不同的领域具有不同的风险。
结论：远程康复对TKA术后行走能力、膝关节伸直和患者花费都有积极影响。在生活质量、患者满意度和WOMAC评分方面，远程康复与常规康复效果相似。由于研究质量较低，这些结论应谨慎解读，未来需要高质量的研究。
The efficacy and safety of telerehabilitation for patients following total knee arthroplasty: a overviews of systematic reviews
Background: Studies evaluating the efectiveness and safety of telerehabilitation in patients undergoing total knee arthroplasty (TKA) have increased. However, the study quality and results difer, systematic reviews are limited. We aimed to synthesise systematic reviews and meta-analyses to assess the efects of telerehabilitation in patients post-TKA.
Materials and methods: Systematic reviews and meta-analyses regarding the efectiveness and safety of TKA telerehabilitation were retrieved from eight databases from establishment to 18 December 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic Reviews (ROBIS) and GRADE system were used to evaluate results, methods, bias and evidence quality.
Results: Thirteen systematic reviews and meta-analyses were analysed. The AMSTAR 2 showed low methodological quality in seven studies and very low quality in six. Among the key items, item 2 had been registered on website before systematic review in four reviews. Concerning item 4, did not provide a comprehensive search strategy in 4 reviews. For item 7, none of the reviews provided a list of reasons for excluding an article. For item 9, regarding whether appropriate tools were used to assess the risk of bias of each included study, one review was assessed as‘partially yes’, one review only included RCTs, and the remainder were assessed as‘yes’. For item 11, one review did not specify the statistical methods used, and three reviews did not conduct a meta-analysis. For item 13, four reviews considered the risk of bias when interpreting or discussing the study results. For item 15, seven reviews did not evaluate publication bias. The PRISMA scores of the 13 reviews ranged from 17.5 to 26.0. The PRISMA indicated that 69.2% had no protocol registration, 38.5% did not provide other materials and evidence certainty, 23.1% did not provide certainty assessment, 30.8% did not report study bias. According to the ROBIS scale, diferrent domains have diferrent risks in all the reviews.
Conclusion: Telerehabilitation positively afects walking ability, knee extension and patient costs post-TKA surgery. Regarding the quality of life, patient satisfaction and the WOMAC, telerehabilitation had similar efects to conventional rehabilitation. Owing to the low quality of the studies, these conclusions should be interpreted cautiously, high-quality studies are needed in the future.
文献出处：Pang D, Sun A, Wang F, Lu J, Guo Y, Ding W. The efficacy and safety of telerehabilitation for patients following total knee arthroplasty: a overviews of systematic reviews. Biomed Eng Online. 2023 Oct 8;22(1):97. doi: 10.1186/s12938-023-01158-z. PMID: 37807054; PMCID: PMC10560426.
文献2
单髁置换术后胫骨假体内翻放置会降低术后骨折的潜在风险
译者 马云青
胫骨假体龙骨与胫骨皮质距离(KCD) ，特别是与胫后皮质的距离短，是胫骨骨折的潜在危险因素，特别是牛津移动平台单间室膝关节置换术(OUKA)术后平台骨折。本研究目的是评价胫骨假体在冠状面和胫骨近端位置成角关系，在这项研究中包括了51名初次择期单髁置换的患者。术前和术后均进行 KCD测量，测量使用的三维模拟软件进行垂直于胫骨轴线(中立)的评估 ，3 ° 外翻，3 ° 内翻，和6 ° 内翻。测量是否存在突出的内侧胫骨髁的胫骨粗隆线，胫骨粗隆线包括内侧胫骨粗隆起平行于胫骨轴，通过胫骨皮质以外。在所有假体测量线中，胫骨内侧突出的患者的后侧 KCD 明显缩短。内侧突出的患者后侧 KCD 显著高当胫骨假体置于内翻3 ° 时(4.6 ± 1.5 mm，P = 0.003,(P < 0.001 vs 3 ° 外翻)和6 ° 内翻时(5.0 ± 1.4 mm，P < 0.001 vs 中性，P < 0.001 vs 3 ° 外翻)较中立位(3.5 ± 1.9 mm)或3 ° 外翻(2.8 ± 1.8 mm)。这说明内翻放置假体可能会降低术后骨折的风险，即使在膝内侧胫骨平台出现假体突出时。外翻植入胫骨假体会缩短 KCD，因此应尽可能避免出现类似情况。
文献出处：Kamenaga T, Hiranaka T, Suda Y, Fujishiro T, Okamoto K, Kuroda R, Matsumoto T. Varus placement of the tibial component reduces the potential risk of fracture with adequate bony coverage in the Oxford unicompartmental knee arthroplasty. Sci Rep. 2024 Jan 13;14(1):1274. doi: 10.1038/s41598-023-48659-4. PMID: 38218913; PMCID: PMC10787735.
文献3
双动关节界面在全髋翻修手术中的应用：金/陶对聚乙烯与限制性界面的比较
译者 张蔷
背景：近期逐步流行的双动髋臼复合体（DMCs）使术者在全髋翻修术（rTHA）中可以更好的选择股骨头尺寸。我们试图评估应用DMC的全髋翻修手术相比于其他关节界面选择的再翻修和脱位风险。
方法：我们应用美国医保系统的关节置换登记库数据进行了一项队列研究。选择范围是2002年至2022年所有先接受初次THA手术再施行松动翻修手术的成年病人。治疗组分为三组，分别为全髋翻修时应用DMC的、应用限制性内衬的或应用金/陶对高交联聚乙烯（XLPE）的。疗效重点观察松动再翻修和脱位。我们应用多变量Cox回归分析的方法在配平患者因素、术中因素和术者因素后评估了松动再翻修和脱位的风险。
结果：最终入组DMC组375例，限制性内衬组268例，<36mm金/陶对XLPE组995例和≥36mm金/陶对XLPE组2087例。DMC在翻修手术中的应用比例从2011年的1.0%提升至2022年的21.6%。配平分析后我们发现：相比于DMC组，限制性内衬组(风险比[HR] = 2.43, 95% 置信区间[CI] = 1.29 - 4.59)、<36mm金/陶对XLPE组(HR = 2.05, 95% CI = 1.13 - 3.75)和≥36mm金/陶对XLPE组(HR = 2.03, 95% CI = 1.19 - 3.48)的再翻修风险明显更高。相比于DMC组，两个XLPE组(<36mm: HR = 2.04, 95% CI = 1.33 - 3.14; ≥36mm: HR = 2.46, 95% CI = 1.69 - 3.57)的脱位风险均显著更高；而限制性内衬组的脱位风险虽然也高于DMC组，却并未体现显著性差异。
结论：在本组基于美国数据库的大型队列研究中，应用DMCs的全髋翻修病例再翻修和脱位风险均最低。DMC组的两项风险均显著低于金/陶对XLPE组，再翻修风险显著低于限制性内衬组，脱位风险也低于限制性内衬组却没有显著性差异。
Dual-Mobility Articulations in Revision Total Hip Arthroplasty：A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations
Background: The increased availability of dual-mobility acetabular constructs (DMCs) provides surgeons with a newer option to increase the effective femoral head size in revision total hip arthroplasty (rTHA). We sought to evaluate risks of re-revision and prosthetic dislocation following rTHA involving a DMC compared with other articulations.
Methods: A cohort study was conducted using data from a U.S. integrated health-care system’s Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders.
Methods: A cohort study was conducted using data from a U.S. integrated health-care system’s Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders.
Conclusions: In a large U.S.-based cohort, rTHAs using DMCs had the lowest re-revision risk and dislocation risk. Both outcomes were significantly lower than those using a unipolar femoral head on XLPE, re-revision risk was significantly lower than using a constrained liner, and dislocation risk trended toward a lower risk than using a constrained liner.
文献4
骨显像能反映单髁膝关节置换术后骨关节炎的进展吗？
译者 沈松坡
背景：据报道，骨闪烁成像（BS）是原发性膝关节OA中骨关节炎（OA）进展的有效预测指标。然而，之前没有研究探讨单髁膝关节置换术（UKA）后保留间室BS和OA进展之间的关系。因此，我们评估了在UKA患者中OA是否会进展到其他间室，以及BS摄取增加是否与UKA后其他间室的OA进展有关。
方法：共纳入41例UKA术后至少5年的膝关节BS患者。通过使用Kellgren-Lawrence分级系统（K-L分级）和国际骨关节炎研究协会（OARSI）图谱评分对每位患者的骨关节炎严重程度进行分级和比较，来评估其他间室骨关节炎的放射学进展。UKA后，分析各保留间室BS摄取与骨性关节炎进展的相关性。还进行了相关分析，以评估BS摄取与OA进展等级之间的关系。
结果：在UKA术后98.5±26.0个月的随访中，对侧胫股间室和髌股间室的OA均有显著进展（p < 0.001）。在对侧和髌股间室中，BS摄取与影像学上的OA进展之间没有相关性，BS摄取与影像学上的OA进展等级之间也没有相关性。
结论：UKA后，OA在保留的对侧胫股和髌股间室进展至少5年的随访期。因此，BS对评估这些间室骨关节炎的进展是无效的。
Can bone scintigraphy reflect the progression of osteoarthritis after unicompartmental knee arthroplasty?
Background: Bone scintigraphy (BS) has been reported to be a useful predictor of osteoarthritis (OA) progression in primary knee OA. However, no previous studies have explored the relationship between BS and OA progression in the retained compartments after unicompartmental knee arthroplasty (UKA). Thus, we evaluated whether OA progresses to other compartments in patients who undergo UKA and if increased uptake on BS is associated with OA progression in other compartments after UKA.
Methods: A total of 41 patients with knee BS at least five years after UKA were included. Radiographic OA progression in other compartments was assessed by grading and comparing OA severity in each patient using the Kellgren-Lawrence grading system (K-L grade) and Osteoarthritis Research Society International (OARSI) atlas score. After UKA, the correlation between BS uptake and radiographic OA progression was analyzed in each retained compartment. A correlation analysis was also performed to evaluate the association between BS uptake and OA progression grades.
Results: A significant progression of OA was observed in both contralateral tibiofemoral and patellofemoral compartments after UKA at 98.5 ± 26.0 months of follow-up (all p<0.001). No correlation was found between BS uptake and radiographic OA progression nor between BS uptake and radiographic OA progression grade in the contralateral and patellofemoral compartments.
Conclusions: Following UKA, OA progresses in the retained contralateral tibiofemoral and patellofemoral compartments over a minimum five-year follow-up period. Thus, BS is ineffective in assessing the progression of OA in these compartments.
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第二部分：保髋相关文献
文献1
髋臼周围截骨术后截骨端不愈合导致的骨盆不稳定的外科治疗
译者 肖凯
引言：髋臼周围截骨术（PAO）是一种针对骨骼成熟且无骨关节炎的症状性髋关节发育不良患者的治疗方法。关于截骨端不愈合和相关应力性骨折的报道较少。应力性骨折和截骨端不愈合会导致持续的髋部疼痛和骨盆不稳定。本研究的目的是报告我们在处理PAO术后截骨端不愈合合并持续性疼痛的经验。
患者和方法：2015年至2018年间，共有8名患者因PAO术后截骨端不愈合且出现症状而就诊。患者在术后平均48.1（15-82）个月均接受了耻骨上支不愈合的切开复位内固定术联合同侧髂骨取骨植骨术。记录了人口统计学数据和围手术期相关数据。术后随访至放射学证实骨愈合为止，平均随访时间9.9个月。
结果：所有患者均为女性，平均年龄为31.8（18-41）岁。在7/8（87.5%）的患者中成功采用了改良的Stoppa入路。1名患者因旋转矫正角度大而应用了髂腹股沟入路。所有患者的耻骨上支均愈合，且机械性症状得到改善。5/8（62.5%）的患者间接地达到后柱或耻骨下支应力性骨折的愈合。2/8（25%）的患者尽管骨盆稳定性恢复，但仍存在关节疼痛进展。1名患者因股静脉损伤而进行术中输血。患者中未见其他并发症。
结论：据我们所知，这是迄今为止最大样本的PAO截骨端不愈合手术管理的研究。通过不愈合的耻骨上支进行复位、植骨和固定，可以满意地解决由于不愈合和应力性骨折导致的骨盆不稳定。改良的Stoppa入路在适用于大多数病例，且能够提供充分的暴露，同时尽量减少对软组织的损伤。我们应预见PAO术后的骨盆解剖结构改变，进而降低附近神经血管结构的风险。
Surgical management of chronic pelvic instability following periacetabular osteotomy nonunion
Introduction: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia in skeletally mature individuals without arthritis. Pelvic nonunion and associated stress fractures are under-reported. Nonunited stress fractures can cause continued buttock pain and pelvic instability. The aim of this study is to report on our experience managing patients with ongoing pain following nonunion of PAO.
Patients and methods: 8 patients presented to a tertiary referral pelvic service with symptomatic PAO nonunion between 2015-2018. All patients underwent open reduction internal fixation of the superior pubic ramus nonunion, with ipsilateral iliac autograft, at an average of 48.1 (15-82) months following initial osteotomy. Demographic and perioperative data were recorded. Follow-up was on average to 9.9 months, once union was confirmed radiographically.
Results: All patients were female and average age was 31.8 (18-41) years. In 7/8 (87.5%) patients a modified Stoppa approach was successfully utilised. 1 patient required an ilioinguinal approach due to the amount of rotational correction. All patients went on to union at the superior pubic ramus and reported improvement in mechanical symptoms. 5/8 (62.5%) patients were noted to develop union of the posterior column or inferior pubic ramus stress fracture indirectly. 2/8 (25%) patients developed progression of intra-articular pain, despite restoration of pelvic stability. 1 patient required intraoperative transfusion due to femoral vein injury. There were no other complications seen in this series.
Conclusions: To our knowledge, this is the largest case series of surgically managed PAO nonunion. Pelvic instability resulting from nonunion and stress fracture can be satisfactorily addressed by mobilising, grafting and plating the nonunion at the superior pubic ramus. The modified Stoppa approach is suitable in most cases, allowing excellent exposure whilst minimising the insult to soft tissues. The altered anatomy of the pelvis following PAO should be anticipated to reduce the risk to nearby neurovascular structures.
文献2
髋关节的感觉神经支配与相关疼痛：文献系统回顾
译者 张振东
研究目的：本文献综述旨在就支配髋关节的神经分支的解剖特征及其关节囊内感觉受体的分布达成共识。
方法：检索查询了五个电子数据库，搜索范围包括 1945 年 1 月至 2019 年 6 月间发表的文章。共查阅了 21 篇详细描述髋关节囊（13 篇）及其关节分支（8 篇）周围感觉受体的原创文章。
结果：发现前关节囊上部和盂唇是痛觉神经支配最密集的区域。与痛觉感受器的分布类似运动神经感受器的密度也是前部高于后部。研究发现，髋关节囊神经支配始终涉及股神经和闭孔神经（分支至前关节囊）以及股神经（分支至后关节囊）。股神经、闭孔神经和臀上神经均有关节分支至髋关节囊中神经感受器最丰富的区域。
结论：股神经、闭孔神经和股神经均有分支至髋关节囊前方及后方。前方关节囊（主要为股神经和闭孔神经分支）以及上方盂唇似乎是髋关节的主要疼痛位点，因为它们的痛觉感受器和运动感受器密度分布较高。
Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature
Objectives: The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule.
Methods: Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed.
Results: The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule.
Conclusions: The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors.
文献出处：Laumonerie P, Dalmas Y, Tibbo ME, Robert S, Durant T, Caste T, Vialla T, Tiercelin J, Gracia G, Chaynes P. Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature. Pain Med. 2021 May 21;22(5):1149-1157. doi: 10.1093/pm/pnab061. PMID: 33565587.
文献3
先天性髋关节脱位的盂唇畸形分类
译者 任宁涛
作者对先天性髋关节脱位的盂唇畸形进行了自己的分类，研究对象是 1970 年至 1985 年间在布拉格查理大学综合医学院第一矫形外科诊所接受手术的一组患者，在此期间，他们对70名儿童的78个髋关节进行了手术，其中8例是双侧手术，该组包括17名男孩和53名女孩，手术对象为右髋关节30个，左髋关节48个。儿童的年龄范围为5至23个月，手术时儿童的平均年龄为9.3个月，采用Ludloff 手术进行切开复位。根据尸体研究，作者发现盂唇是髋臼的很大一部分，髋臼的背侧盂唇明显更大，因此股骨头似乎完全被韧性的盂唇所包裹，单纯髋臼似乎覆盖超过一半的股骨头。髋臼的背侧和上部大部分由易变形的纤维结构所形成，由于髋臼的软骨模型在背侧和近侧是平坦的，因此对股骨头施加后上的压力可导致其脱位。这种易变形的结构在某些条件下会因股骨头部压力而发生变形，以至于在脱位开始的第一阶段，它总是外翻，而在第二阶段，外翻滑动持续存在，或者股骨头越过关节缘，然后关节缘因复位力而内翻。作者在其著作中介绍了其分类，根据手术结果，他们根据形状的差异将盂唇分为四类：I型：规则环形（外翻）的盂唇——符合正常解剖形状，没有明显变形，不妨碍复位。II 型：内翻薄的盂唇——与正常盂唇相比，其形状扁平，通常内翻于髋臼，有弹性的，其可能妨碍复位，其相对容易外翻。III 型：内翻的固定性盂唇——内翻范围相当大，与软骨“坚固”贴附，减小了髋臼的容量，复位通常较困难。
Classification of deformities of the glenoid labrum in congenital hip dislocation
The authors have developed their own classification of the deformities of labrum glenoidale in congenital hip dislocation. Open reposition was performed by the Ludloff procedure. The basic material for their work was the group of patients operated on at I. Orthopaedic Clinic of the Faculty of General Medicine of Charles University in Prague in the years 1970-1985. In the course of this period they operated on 78 hip joints in 70 children, out of which 8 operations were bilateral, the group comprised 17 boys and 53 girls, operation was performed on 30 right hip joints and 48 left ones. The age of children ranged from 5 to 23 months. The average age of children in time of operation was 9.3 months. On the basis of the cadaver material the authors have found out that glenoidale represents an extensive part of acetabulum. Labrum glenoidale is considerably more sizable in the dorsal parts of acetabulum so that the head seems to be completely enveloped by ligamentary limbus and the acetabulum seems to form at least half of the ball-shaped surface. In the dorsal and upper parts the acetabulum is from great part formed by a fibrous structure which is easily deformed. The pressure applied to the head dorsally can result in its dislocation just because the cartilaginous model of acetabulum is flat in its dorsal and proximal parts. This easily deformable structure is under certain conditions deformed by pressure of the head in such a way that in the first phase in the course of the onset of the dislocation it is always everted and in the second phase the evertion lither persists or the head shifts over the margin of the limbus and the limbus is then inverted by reposition force. The authors present in their work the classification of the limbus. Proceeding from operation findings they divide limbi into four groups according to differences in their shape: Type I: regularly annular (everted) limbus--it corresponds to a normal anatomic shape, it is not pronouncedly deformed and does not present an impediment to reduction. Type II: inverted gracilis limbus--it is exaggerated in comparison to the normal one, usually it is inverted in the acetabulum, it is never rigid but elastic. Together with the structure of capsule it can be an impediment to reduction. It can be relatively easily everted. Type III: inverted callous limbus--it is sizable, rigid, reducing by its position the capacity of the acetabulum. The reduction is usually difficult.
文献出处：Sosna A, Popelka S Jr. Klasifikace deformací labrum glenoidale u vrozené luxace kycelního kloubu [Classification of deformities of the glenoid labrum in congenital hip dislocation]. Acta Chir Orthop Traumatol Cech. 1989 Oct;56(5):446-56. Czech. PMID: 2631494.
文献4
组织工程骨再生治疗负重区中重度股骨头坏死：一项观察性研究
译者 李勇
背景： 干细胞疗法治疗股骨头坏死（ONFH）取得了良好的疗效。 然而，股骨头坏死患者在负重部分的病变面积较大，预后不良，仍是一个亟待解决的难题。 我们的目的是评估组织工程骨再生对这种具有挑战性的情况下保留股骨头的效果。
方法 对2002年3月至2004年3月期间接受骨髓间充质干细胞（BMdMSCs）体外扩增的成骨细胞和偏磷酸盐钙（CMP）作为支架的7例（9髋）ONFH患者进行了回顾性研究。 中位年龄为27.0岁（四分位数间距[IOR]，23.0-34.0岁），中位随访期为20.0年（IOR，11.0-20.0年）。 干细胞培养和扩增后，我们进行了核心减压术，并植入了BMdMSC，中位数为10.1 x10'（IQR，9.9-10.9 x10'）。 为了评估放射学结果，我们在术前和随访期间评估了ARCO分期、日本调查委员会（JIC）分类和改良Kerboul联合坏死角（mKCNA）。 临床结果通过视觉模拟量表（VAS）和哈里斯髋关节评分（HHS）进行评估。
结果： 5 个髋关节的 ONFH 术前分期为 ARCO 2，4 个髋关节的 ONFH 术前分期为 ARCO 3a。 3 个 ARCO 2 期的髋关节和 4 个 ARCO 3a 期的髋关节维持了 ARCO 分期。 ARCO 2 中有 2 个出现放射学进展的髋关节接受了全髋关节置换术。 根据 mKCNA，2 个髋关节显示中度病变，7 个髋关节显示大面积病变。 4个髋关节坏死病灶的大小减小（2个为ARCO 2型，2个为ARCO 3a型）。 所有髋关节的JIC分类均无明显变化（C1型：3个髋关节，C2型：6个髋关节）（P= 0.655）。 在临床上，术前和最后一次随访之间的 VAS 和 HHS 没有明显变化（分别为 p=0.072 和 p=0.635）。
结论 利用 BMdMSC 和 CMP 在体外扩增的成骨细胞进行组织工程技术，对于治疗主要位于负重区的中大型ONFH塌陷前期和早期塌陷期，显示出良好的效果。
Tissue-Engineered Bone Regeneration for Medium-to-Large Osteonecrosis of the Femoral Head in the Weight-Bearing Portion: An Observational Study
Background: Stem cell therapy for the treatment of osteonecrosis of the femoral head (ONFH) showed promising outcomes. However, ONFH with a large lesion in the weight-bearing portion is a poor prognostic factor and still challenging issue to be solved. We aimed to evaluate the effect of tissue-engineered bone regeneration for this challenging condition to preserve the femoral head. Methods: A total of 7 patients (9 hips) with ONFH who received osteoblasts expanded ex vivo from bone marrow-derived mesenchymal stem cells (BMdMSCs) and calcium metaphosphate (CMP) as scaffolds from March 2002 to March 2004 were retrospectively reviewed. The median age was 27.0 years (interquartile range [IOR], 23.0-34.0 years), and the median follow-up period was20.0 years (IOR, 11.0-20.0 years). After culture and expansion of stem cells, we performed core decompression with BMdMSC implantation at a median number of 10.1 x10' (IQR, 9.9-10.9 x10'). To evaluate radiographic outcomes, the Association Research Circulation Osseous (ARCO) classifications, the Japanese Investigation Committee (JIC) classification, and modified Kerboul combined necrotic angle (mKCNA) were evaluated preoperatively and during follow-up. Clinical outcomes were evaluated by a visual analog scale (VAS) and Harris Hip Score (HHS). Results: The preoperative stage of ONFH was ARCO 2 in 5 hips and ARCO 3a in 4 hips. The ARCO staging was maintained in 3 hips of ARCO 2 and 4 hips of ARCO 3a. Two hips of ARCO 2 with radiographic progression underwent total hip arthroplasty. According to mKCNA, 2 hips showed medium lesions, and 7 hips showed large lesions. The size of necrotic lesion was decreased in 4 hips (2 were ARCO 2 and 2 were ARCO 3a). There were no significant changes in JIC classification in all hips (type C1: 3 hips and type C2: 6 hips) (p= 0.655). Clinically, there were no significant changes in the VAS and HHS between preoperative and last followup (p =0.072 and p = 0.635, respectively). Conclusions: Tissue engineering technique using osteoblasts expanded ex vivo from BMdMSC and CMP showed promising outcomes for the treatment of pre-collapsed and early-collapsed stage ONFH with medium-to-large size, mainly located in weightbearing areas.
文献出处：Park EK, Shim BJ, Kim SY, Baek SH, Kim SY. Tissue-Engineered Bone Regeneration for Medium-to-Large Osteonecrosis of the Femoral Head in the Weight-Bearing Portion: An Observational Study. Clin Orthop Surg. 2024 Oct;16(5):702-710. doi: 10.4055/cios23344. Epub 2024 Sep 13. PMID: 39364109; PMCID: PMC11444941.
文献5
体质指数与儿童和青少年的股骨前倾角、步态中的髋关节旋转以及髋关节被动运动范围有关
译者 张利强
背景：超重和肥胖是全球主要的健康问题，通常与骨科问题、骨骼排列异常和步态生物力学改变有关。然而，横向上骨骼和生物力学的适应性仍然没有得到充分的探索。因此，本研究旨在调查体质指数（BMI）与描述儿童和青少年下肢扭转、髋关节旋转性和横断面步态特征变量之间的关系。
方法：回顾性分析122名儿童和青少年在步态站立阶段的髋臼和股骨前倾角、胫骨扭转（通过计算机断层扫描测量）、髋关节和膝关节旋转以及足前进角（通过3D步态分析测量），以及被动髋关节旋转活动范围（在临床检查中评估为髋关节旋转的中点）。计算了所有变量与logit转换的BMI百分位数之间的相关性。
结果：在站立阶段，BMI百分位数与髋关节旋转（r=-0.68，P<0.001）、髋关节被动旋转中点（r=-0.51，P<0.001）和股骨前倾角（r=-0.50，P<0.001）之间存在中度相关性。观察到髋臼前倾角（r=-0.36，P<0.001）、站立阶段膝关节旋转（r=0.34，P<0.001）和站立阶段足推进角（r=0.31，P<0.001）之间存在微小相关性。胫骨扭转与BMI百分位数的关系不显著，可以忽略不计（r=-0.26，P=0.004）。
结论：在步态站立阶段，BMI百分位数与髋关节外旋和髋关节被动外旋转呈正相关，与股骨前倾角呈负相关。这些发现表明，体重异常与静态和动态生物力学改变有关。因此，在儿童和青少年的骨科评估和治疗计划中应考虑体重管理。
Body Mass Index is Related to Femoral Anteversion, Hip Rotation During Gait, and Passive Hip Range of Motion in Children and Adolescents
Background: Overweight and obesity are major global health issues, often linked to orthopaedic problems, skeletal malalignments, and altered gait biomechanics. However, skeletal and biomechanical adaptions in the transverse plane remain underexplored. Therefore, this study aimed to investigate the relationship between body mass index (BMI) and variables describing lower extremity torsional profiles, hip rotation mobility, and transverse plane gait characteristics in children and adolescents.
Methods: Acetabular and femoral anteversion, tibial torsion (measured through computed tomography), hip and knee rotation, and foot progression angles during the stance phase of gait (measured by 3D gait analysis), as well as passive hip rotation range of motion (evaluated as the midpoint of hip rotation in clinical examination), were retrospectively analyzed in 122 children and adolescents. Correlations between all variables and logit-transformed BMI percentiles were calculated.
Results: Moderate correlations were found between BMI percentile and hip rotation during the stance phase (r = -0.68, P< 0.001), the passive midpoint of hip rotation (r = -0.51, P< 0.001), and femoral anteversion (r = -0.50, P< 0.001). Small correlations were observed for acetabular anteversion (r = -0.36, P< 0.001), knee rotation during stance phase (r = 0.34, P< 0.001), and foot progression angle during stance phase (r = 0.31, P< 0.001). Tibial torsion showed a nonsignificant negligible relationship with BMI percentile (r = -0.26, P= 0.004).
Conclusion: BMI percentile was positively correlated with external hip rotation during the stance phase of gait and passive external hip rotation, and negatively correlated with femoral anteversion. These findings suggest abnormal body weight is associated with static and dynamic biomechanical alterations. Therefore, weight management should be considered in orthopaedic assessments and treatment planning for children and adolescents.
文献出处：Dobler F, Engler L, Lengnick H, Cip J, Alexander N. Body Mass Index is Related to Femoral Anteversion, Hip Rotation During Gait, and Passive Hip Range of Motion in Children and Adolescents. J Pediatr Orthop. 2024 Oct 31. doi: 10.1097/BPO.0000000000002862. Epub ahead of print. PMID: 39482988.
文献6
髋关节发育不良并不罕见，但经常被忽视：一项基于 1,870 名成人放射线检查的横断面研究
译者 贾海港
背景和目的：成人髋关节发育不良是一种髋臼不足以覆盖股骨头的畸形。文献中很少描述其患病率。我们调查了马尔默（瑞典）的发病率，并评估了放射学报告中是否记录了这种情况。
对象和方法： 对 2007-2008 年间在马尔默市为 20-70 岁、拥有瑞典个人身份号码的受检者进行的骨盆 X 线片进行了评估。1870张数字X线片符合分析条件。对外侧中心边缘角（LCEA）和髋臼指数角（AIA）进行了测量。LCEA≤20°定义为髋关节发育不良。观察者内部测量的组内相关系数 (ICC) 从 0.87（AIA，95% CI 0.78-0.93）到 0.98（LCEA，CI 0.97-0.99）不等。
结果：髋关节发育不良（LCEA ≤ 20°）的发病率为 5.2% (CI 4.3-6.3)，(98/1,870)。在髋关节发育不良发病率或平均LCEA方面，男女之间没有明显的统计学差异。男性（4.1 SD 5.5）的平均髋关节内径比女性（3.2 SD 5.4）高 0.9°（CI 0.3-1.3）。放射科医生报告 98 例中有 7 例患有髋关节发育不良。
解读：马尔默（瑞典）的髋关节发育不良患病率与哥本哈根（丹麦）和卑尔根（挪威）之前报告的数据相似。我们的研究结果表明，髋关节发育不良经常被放射科医生忽视，这可能会影响对患者的治疗。
AI=髋臼指数角（文中称为AIA）；CE = 中心边缘角（文中称为 LCEA）
Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults
Background and purpose - Hip dysplasia in adults is a deformity in which the acetabulum inadequately covers the femoral head. The prevalence is sparingly described in the literature. We investigated the prevalence in Malmö (Sweden) and assessed whether the condition was recognized in the radiology reports.Subjects and methods - All pelvic radiographs performed in Malmö during 2007-2008 on subjects aged 20-70 years with a Swedish personal identity number were assessed. 1,870 digital radiographs were eligible for analysis. The lateral center-edge angle (LCEA) and acetabular index angle (AIA) were measured. Hip dysplasia was defined as an LCEA ≤ 20°. Intraclass correlation coefficients (ICC) for intra-observer measurements ranged from 0.87 (AIA, 95% CI 0.78-0.93) to 0.98 (LCEA, CI 0.97-0.99).
Results - The prevalence of hip dysplasia (LCEA ≤ 20°) was 5.2% (CI 4.3-6.3), (98/1,870). There was no statistically significant difference between the sexes for either prevalence of hip dysplasia or mean LCEA. The mean AIA was 0.9° (CI 0.3-1.3) higher in men (4.1 SD 5.5) compared with women (3.2 SD 5.4). The radiologists had reported hip dysplasia in 7 of the 98
cases.Interpretation - The prevalence of hip dysplasia in Malmö (Sweden) is similar to previously reported data from Copenhagen (Denmark) and Bergen (Norway). Our results indicate that hip dysplasia is often overlooked by radiologists, which may influence patient treatment.
文献出处：Leide R, Bohman A, Wenger D, Overgaard S, Tiderius CJ, Rogmark C. Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults. Acta Orthop. 2021 Oct;92(5):575-580. doi: 10.1080/17453674.2021.1936918. Epub 2021 Jul 9. PMID: 34238106; PMCID: PMC8519544.
文献7
接受髋臼周围截骨术(PAO)治疗髋关节发育不良的成人的疼痛、功能和生活质量受到的影响：系统综述和荟萃分析
译者 陶可
背景：髋关节发育不良是成年人的一种常见疾病，髋关节疼痛可导致髋关节退化。髋臼周围截骨术(PAO)是治疗髋关节发育不良的常见手术。这种手术对疼痛、功能和生活质量(QOL)的影响尚未得到系统分析。
目的：对于髋关节发育不良的成人：(1)评估接受PAO的患者和健康对照者的疼痛、功能和生活质量的差异；(2)评估PAO前后疼痛、功能和生活质量的变化；(3)评估接受PAO的轻度和重度发育不良患者的疼痛、功能和生活质量的差异；(4)评估原发性PAO患者和之前接受过髋关节镜检查的患者在疼痛、功能和生活质量方面的差异。
方法：在5个不同的数据库中执行了全面、可重复的搜索策略。我们纳入了评估因髋关节发育不良而接受PAO的成年人的疼痛、功能和生活质量的研究，使用针对髋关节的患者报告结果测量。
结果：从筛选的5017个标题和摘要中，纳入了62项研究。荟萃分析显示，与健康参与者相比，PAO患者在PAO前后的结果均较差。具体来说，疼痛（标准化平均差异[SMD] 95%置信区间[CI]）：-4.05；-4.78至-3.32）、功能（-2.81；-3.89至-1.74）和生活质量（-4.10；-4.43 至 -3.77）在术前明显更差。荟萃分析发现患者在PAO后得到了改善。疼痛从术前到术后1年（标准化配对差异[SPD] 1.35；95% CI，1.02-1.67）和术后2年（1.35；1.16-1.54）均有所改善。就功能而言，1年（1.22；1.09-1.35）和2年（1.06；0.9-1.22）的日常生活活动评分以及1年（1.36；1.22-1.5）和2年（1.3；1.1-1.5）的生活质量均有所改善。接受PAO的轻度和重度发育不良患者之间没有差异。
结论：在接受PAO手术之前，与健康参与者相比，患有髋关节发育不良的成年人的疼痛、功能和生活质量水平较差。这些水平在PAO之后有所改善，但没有达到与健康参与者相同的水平。
Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis.
Background: Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed.
Purpose: In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy.
Methods: A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures.
Results: From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia.
Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants.
文献出处：Michael Jm O'Brien, Adam I Semciw, Inger Mechlenburg, Lisa Cu Tønning, Chris Jw Stewart, Joanne L Kemp. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis. Meta-Analysis, Hip Int. 2024 Jan;34(1):96-114. doi: 10.1177/11207000231179610. Epub 2023 Jun 12.
来源：304关节学术
作者：304关节团队
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