本期目錄：1、血友病患者全膝置換術(shù)的圍手術(shù)期效果2、股骨頭壞死磁共振影像：預(yù)測(cè)髖關(guān)節(jié)置換所見(jiàn)3、遺傳因素對(duì)髖關(guān)節(jié)骨關(guān)節(jié)炎比膝關(guān)節(jié)骨關(guān)節(jié)炎的影響更大：基于接受關(guān)節(jié)置換的雙胞胎人群研究4、假體周圍感染高風(fēng)險(xiǎn)患者關(guān)節(jié)置換術(shù)后延長(zhǎng)口服抗生素應(yīng)用時(shí)間的效費(fèi)比研究5、機(jī)器人輔助單髁關(guān)節(jié)置換術(shù)提高假體位置的準(zhǔn)確性：前瞻性隨機(jī)對(duì)照研究6、究比基尼切口與縱向切口用于前入路全髖關(guān)節(jié)置換術(shù)：系統(tǒng)評(píng)價(jià)7、初次全膝關(guān)節(jié)置換術(shù)中內(nèi)側(cè)副韌帶骨撕脫損傷對(duì)療效的影響8、關(guān)于內(nèi)側(cè)UKA的十個(gè)困惑9、有癥狀和無(wú)癥狀人群中臨界髖臼發(fā)育不良的患病率:系統(tǒng)綜述和meta分析10、無(wú)手術(shù)干預(yù)的髖關(guān)節(jié)發(fā)育不良患者骨關(guān)節(jié)炎進(jìn)展的危險(xiǎn)因素11、股骨截骨術(shù)和全髖關(guān)節(jié)置換術(shù)治療股骨頭壞死的患者報(bào)告結(jié)果:一項(xiàng)前瞻性的病例研12、利用解剖影像學(xué)參數(shù)拓寬LCEA在髖關(guān)節(jié)發(fā)育不良分類中的應(yīng)用13、髖關(guān)節(jié)軟骨病變：相關(guān)解剖學(xué)、影像學(xué)檢查和治療方式的最新進(jìn)展14、男性以及競(jìng)技運(yùn)動(dòng)員身份與髖臼后傾患者髖關(guān)節(jié)鏡檢查后更好的預(yù)后相關(guān) 第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)文獻(xiàn)1血友病患者全膝置換術(shù)的圍手術(shù)期效果譯者：張軼超目的：血友病患者會(huì)出現(xiàn)反復(fù)的關(guān)節(jié)積血。逐漸會(huì)導(dǎo)致癥狀型關(guān)節(jié)病，經(jīng)常累及膝關(guān)節(jié)?，F(xiàn)代的治療方法可以延緩關(guān)節(jié)病進(jìn)展到晚期，而全膝關(guān)節(jié)置換（TKA）只用以治療部分晚期關(guān)節(jié)病患者。盡管圍手術(shù)期針對(duì)血液病治療有新的進(jìn)展，但潛在的嚴(yán)重出血依然存在。本研究的目的是測(cè)定血友病患者TKA術(shù)后即時(shí)的失血量和血液學(xué)方面的并發(fā)癥。方法：回顧性的分析了12年間在單一中心做了TKA手術(shù)的A、B型血友病患者。將這些患者與所有作為對(duì)照組的接受TKA手術(shù)的非血友病患者和文獻(xiàn)報(bào)告的接受TKA手術(shù)的非血友病患者的結(jié)果進(jìn)行比較。結(jié)果：有18名患者（A型血友病占72%，B型占28%）的21例TKA手術(shù)被納入研究，平均年齡44歲。術(shù)后24和48小時(shí)平均血紅蛋白下降2.7 g/dl 和3.8 g/dl。與非血友病對(duì)照組比較，兩組間術(shù)后48小時(shí)的血紅蛋白下降數(shù)量無(wú)顯著性差異(P = 0.2644)。沒(méi)有術(shù)后即時(shí)的并發(fā)癥發(fā)生，有2名（9.6%）患者需要輸血。結(jié)論：與非血友病對(duì)照組和文獻(xiàn)報(bào)道的非血友病患者數(shù)據(jù)比較，血友病患者在專業(yè)的三級(jí)轉(zhuǎn)診中心做單側(cè)初次TKA手術(shù)看上去圍手術(shù)期失血量相似。對(duì)于這類復(fù)雜的患者，有經(jīng)驗(yàn)的骨科醫(yī)生和血液科醫(yī)生的介入會(huì)帶來(lái)良好的效果。 Perioperative haematological outcomes following total knee arthroplasty in haemophiliacsPurpose: Patients with haemophilia suffer from recurrent joint haemarthrosis. This can progress to symptomatic arthropathy commonly affecting the knee. While modern coagulation strategies have reduced those proceeding to endstage arthropathy, total knee arthroplasty (TKA) remains the optimal treatment for some patients. Despite innovation in perioperative haematological management, concerns about the potential for excessive haemorrhage still exist. The aim of this study is to quantify immediate postoperative blood loss and haematological complications in haemophiliacs following TKA. Methods: A retrospective study of patients with haemophilia types A or B who underwent a TKA over a 12-year period at a single institution was conducted. These patients were compared to both a non-haemophiliac control group and to published standards in non-haemophiliacs undergoing TKA.Results: Twenty-one TKA procedures in 18 patients (72% haemophilia A, 28% haemophilia B) were suitable for inclusion with a mean age of 44 years. The mean haemoglobin drops at 24 and 48 h postoperatively were 2.7 g/dl and 3.8 g/dl respectively. There was no significant difference in haemoglobin drop at 48 h postoperatively when compared to the non-haemophiliac control group (P ? 0.2644). There were no immediate perioperative complications and two patients (9.6%) required postoperative transfusion. Conclusion: Haemophiliacs undergoing a unilateral primary TKA in a specialised tertiary referral centre appear to have comparable rates of perioperative blood loss when compared to both a non-haemophiliac control group as and published haemostatic standards in non-haemophiliac patients following TKA. Perioperative management with expert orthopaedic and haematological input is recommended to optimise outcomes in this complex patient group. 文獻(xiàn)出處：Mohan K, Broderick JM, Raftery N, McAuley NF, McCarthy T, Hogan N. Perioperative haematological outcomes following total knee arthroplasty in haemophiliacs. J Orthop Surg (Hong Kong). 2021 Sep-Dec;29(3):23094990211033999. doi: 10.1177/23094990211033999. PMID: 34583559. 文獻(xiàn)2股骨頭壞死磁共振影像：預(yù)測(cè)髖關(guān)節(jié)置換所見(jiàn)譯者：羅殿中背景：股骨頭缺血壞死（AVNFH）是一種缺血改變，雖然經(jīng)過(guò)不同方法治療，常導(dǎo)致股骨頭塌陷和髖關(guān)節(jié)置換（THA）。但有關(guān)磁共振成像（MRI）可以預(yù)測(cè)股骨頭壞死進(jìn)展和髖關(guān)節(jié)置換的影像所見(jiàn)，尚不明了。目的：評(píng)估AVNFH的磁共振影像特征，明確可預(yù)測(cè)髖關(guān)節(jié)置換的類型。材料和方法：本研究為回顧性研究，自2015年5月至2017年12月，共15例18髖（男12人，女3人）連續(xù)病例，進(jìn)行了鉆孔減壓聯(lián)合局部骨髓干細(xì)胞的治療。治療后3個(gè)月、術(shù)后1年和/或髖關(guān)節(jié)置換前，進(jìn)行磁共振檢查（1.5T）。隨訪至2018年11月，共有10髖進(jìn)行了髖關(guān)節(jié)置換，未置換組有1例AECO I型患者無(wú)癥狀失訪。觀察置換組與未置換組的骨循環(huán)協(xié)會(huì)分級(jí)（ARCO）與磁共振影像所見(jiàn)，包括AVNFH面積、部位、股骨頸骨髓水腫、軟骨下骨折和關(guān)節(jié)滲液情況。結(jié)果：病情進(jìn)展到髖關(guān)節(jié)置換的患者，股骨頸骨髓水腫更多（90% vs. 0%）、壞死區(qū)附近骨髓水腫更多（100% vs. 43%）、髖臼側(cè)骨髓水腫更多（90% vs.14%），軟骨下骨折更多（70% vs. 0%）、關(guān)節(jié)滲液更多（80% vs. 29%），滑膜炎更多（80% vs. 14.3%），更大的壞死面積、及負(fù)重區(qū)股骨頭外側(cè)柱受累及，也是預(yù)測(cè)髖關(guān)節(jié)置換的因素。結(jié)論：股骨頭缺血壞死（AVNFH）患者中，發(fā)展到髖關(guān)節(jié)置換的患者、較未發(fā)展到髖關(guān)節(jié)置換的患者，在磁共振影像中常存在多種影像特征。
注：未置換組術(shù)后12個(gè)月有1例ARCO I型患者無(wú)癥狀失訪，n=7。 Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplastyBackground: Avascular osteonecrosis of the femoral head (AVNFH) is an ischemic condition which despite different treatments often leads to collapse of the femoral head and to total hip arthroplasty. However, the magnetic resonance imaging findings predisposing to disease progression and total hip arthroplasty are somewhat elusive.Purpose: To evaluate the magnetic resonance imaging findings of AVNFH and to assess the patterns of findings which may predict total hip arthroplasty.Materials and methods: A retrospective study was conducted with a total of 18 diagnosed AVNFH treated with core decompression combined with intraosseous stem cell treatment. After treatment, magnetic resonance imaging follow-ups were done at three-month and one-year follow-up or until total hip arthroplasty. Association Research Circulation Osseous classification and magnetic resonance imaging findings such as the size and the location of the AVNFH, bone marrow edema in femoral neck, effusion and subchondral fracture were evaluated.Results: Hips advancing to total hip arthroplasty have more often bone marrow edema in femoral neck (90% vs. 0%), adjacent to necrotic lesion (100% vs. 43%) and in acetabulum (90% vs. 14%), but also subchondral fractures (70% vs. 0%), effusion (80% vs. 29%), and synovitis (80% vs. 14,3%). The greater size and the lateral weight-bearing location of the necrotic lesion also predicted future total hip arthroplasty.Conclusion: Hips advancing to total hip arthroplasty have often a combination of pathognomonic AVNFH imaging findings compared to hips not advancing to total hip arthroplasty. 文獻(xiàn)出處：V??n?nen M, Tervonen O, Nevalainen MT. Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplasty. Acta Radiol Open. 2021 Apr 27;10(4):20584601211008379. doi: 10.1177/20584601211008379. PMID: 35140984; PMCID: PMC8819766. 文獻(xiàn)3遺傳因素對(duì)髖關(guān)節(jié)骨關(guān)節(jié)炎比膝關(guān)節(jié)骨關(guān)節(jié)炎的影響更大：基于接受關(guān)節(jié)置換的雙胞胎人群研究譯者：馬云青目的:探討和量化遺傳作用與可改變的環(huán)境因素作用對(duì)于已進(jìn)展到需要接受關(guān)節(jié)置換的骨關(guān)節(jié)炎的影響。研究設(shè)計(jì):1915-1960年出生的同性雙胞胎(53.4%女性)的前瞻性隊(duì)列研究，數(shù)據(jù)來(lái)源于2014年以前的挪威關(guān)節(jié)置換術(shù)登記系統(tǒng)數(shù)據(jù)與挪威雙胞胎登記處的國(guó)家身份號(hào)碼相關(guān)聯(lián)。患者自行報(bào)告的教育程度，身高/體重，并計(jì)算體重指數(shù)(BMI)。髖關(guān)節(jié)置換術(shù)的總隨訪時(shí)間為27年(1987-2014,424,914人年)，膝關(guān)節(jié)置換術(shù)為20年(1994-2014,306,207人年)。在髖關(guān)節(jié)和膝關(guān)節(jié)的單獨(dú)分析中估計(jì)了關(guān)節(jié)置換術(shù)的一致性和遺傳因素。結(jié)果:研究人群包括9058對(duì)雙胞胎(n=3803單卵(mz)，n=5226雙卵(dz))?？偟膩?lái)說(shuō)，73%的髖關(guān)節(jié)和45%的膝關(guān)節(jié)置換變異的73%可以用遺傳因素來(lái)解釋。當(dāng)調(diào)整性別，年齡，教育程度和BMI(hr=2.98,95%ci=1.90-4.67，單卵與雙卵雙胞胎相比)時(shí)，遺傳因素與髖關(guān)節(jié)置換術(shù)相關(guān)。當(dāng)調(diào)整受精卵和其他協(xié)變量(hr=1.15,95%ci=1.02-1.29)時(shí)，膝關(guān)節(jié)置換術(shù)在更大程度上于BMI相關(guān)。結(jié)論:髖關(guān)節(jié)置換術(shù)受遺傳因素影響較大，而膝關(guān)節(jié)置換術(shù)在很大程度上取決于較高的體重指數(shù)。與髖關(guān)節(jié)置換術(shù)相比，這項(xiàng)研究表明通過(guò)外界干預(yù)可以減少意患者接受膝關(guān)節(jié)置換術(shù)的概率。 Genetic factors contribute more to hip than knee surgery due to osteoarthritis - a population-based twin registry study of joint arthroplastyObjective: To explore and quantify the relative strengths of the genetic contribution vs the contribution of modifiable environmental factors to severe osteoarthritis (OA) having progressed to total joint arthroplasty.Design: Incident data from the Norwegian Arthroplasty Registry were linked with the Norwegian Twin Registry on the National ID-number in 2014 in a population-based prospective cohort study of same-sex twins born 1915-60 (53.4% females). Education level and height/weight were self-reported and Body Mass Index (BMI) calculated. The total follow-up time was 27 years for hip arthroplasty (1987-2014, 424,914 person-years) and 20 years for knee arthroplasty (1994-2014, 306,207 person-years). We estimated concordances and the genetic contribution to arthroplasty due to OA in separate analyses for the hip and knee joint.Results: The population comprised N = 9058 twin pairs (N = 3803 monozygotic (MZ), N = 5226 dizygotic (DZ)). In total, 73% (95% confidence intervals (CI) = 66-78%) and 45% (95% CI = 30-58%) of the respective variation in hip and knee arthroplasty could be explained by genetic factors. Zygosity (as a proxy for genetic factors) was associated with hip arthroplasty concordance over time when adjusted for sex, age, education and BMI (HR = 2.98, 95% CI = 1.90-4.67 for MZ compared to DZ twins). Knee arthroplasty was to a greater extent dependent on BMI when adjusted for zygosity and the other covariates (HR = 1.15, 95% CI = 1.02-1.29).Conclusion: Hip arthroplasty was strongly influenced by genetic factors whereas knee arthroplasty to a greater extent depended on a high BMI. The study may imply there is a greater potential for preventing progression of knee OA to arthroplasty in comparison with hip OA. 文獻(xiàn)出處：Magnusson K, Scurrah K, Ystrom E, ?rstavik RE, Nilsen T, Steingrímsdóttir óA, Ferreira P, Fenstad AM, Furnes O, Hagen KB. Genetic factors contribute more to hip than knee surgery due to osteoarthritis - a population-based twin registry study of joint arthroplasty. Osteoarthritis Cartilage. 2017 Jun;25(6):878-884. doi: 10.1016/j.joca.2016.12.015. Epub 2016 Dec 13. PMID: 27986619. 文獻(xiàn)4假體周圍感染高風(fēng)險(xiǎn)患者關(guān)節(jié)置換術(shù)后延長(zhǎng)口服抗生素應(yīng)用時(shí)間的效費(fèi)比研究譯者：張薔背景：對(duì)關(guān)節(jié)置換（TJA）術(shù)后感染高風(fēng)險(xiǎn)患者延長(zhǎng)口服抗生素應(yīng)用時(shí)間可以降低假體周圍感染（PJI）發(fā)生率。然而其效費(fèi)比卻并不明確。本研究中，我們應(yīng)用一個(gè)收支平衡的經(jīng)濟(jì)模型研究對(duì)高感染風(fēng)險(xiǎn)的關(guān)節(jié)置換患者延長(zhǎng)口服抗生素應(yīng)用時(shí)間的效費(fèi)比。方法：我們從既往文獻(xiàn)和醫(yī)院采購(gòu)登記信息中收集的數(shù)據(jù)包括高風(fēng)險(xiǎn)患者的假體周圍感染率，治療PJI施行的關(guān)節(jié)翻修術(shù)花費(fèi)以及延長(zhǎng)口服抗生素應(yīng)用的花費(fèi)。我們將這些數(shù)據(jù)錄入一個(gè)收支平衡的經(jīng)濟(jì)模型中來(lái)計(jì)算為有效降低感染率而延長(zhǎng)口服抗生素應(yīng)用的絕對(duì)風(fēng)險(xiǎn)降低值（ARR）。絕對(duì)風(fēng)險(xiǎn)降低值被用來(lái)明確需治療人數(shù)（NNT）。結(jié)果：高感染風(fēng)險(xiǎn)的全膝關(guān)節(jié)置換術(shù)病例術(shù)后延長(zhǎng)口服抗生素頭孢氫氨芐使用時(shí)間可以降低感染風(fēng)險(xiǎn)0.187%（需治療人數(shù)=535），高感染風(fēng)險(xiǎn)的全髖關(guān)節(jié)置換術(shù)病例術(shù)后延長(zhǎng)口服抗生素頭孢氫氨芐使用時(shí)間可以降低感染風(fēng)險(xiǎn)0.151%（需治療人數(shù)=662）。該方法的效費(fèi)比也隨著抗生素品種不同、感染治療花費(fèi)不同和感染率的不同而變化。結(jié)論：對(duì)于高感染風(fēng)險(xiǎn)的關(guān)節(jié)置換病人延長(zhǎng)口服抗生素應(yīng)用時(shí)間可以降低術(shù)后假體周圍感染的風(fēng)險(xiǎn)，效費(fèi)比可觀。然而，目前支持這一觀點(diǎn)的循證學(xué)證據(jù)質(zhì)量有限。此外，其應(yīng)用還可能會(huì)導(dǎo)致未來(lái)產(chǎn)生抗生素耐藥性而變?yōu)樨?fù)價(jià)值，我們?cè)趹?yīng)用時(shí)要充分權(quán)衡其利弊。 The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention after Total Joint Arthroplasty in High-Risk PatientsBackground: Extended oral antibiotic prophylaxis may decrease rates of prosthetic joint infection (PJI)after total joint arthroplasty (TJA) in patients at high risk for infection. However, the cost-effectiveness ofthis practice is not clear. In this study, we used a break-even economic model to determine the costeffectivenessof routine extended oral antibiotic prophylaxis for PJI prevention in high-risk TJA patients.Methods: Baseline PJI rates in high-risk patients, the cost of revision arthroplasty for PJI, and the costs ofextended oral antibiotic prophylaxis regimens were obtained from the literature and institutional purchasingrecords. These variables were incorporated in a break-even economic model to calculate theabsolute risk reduction (ARR) in infection rate necessary for extended oral antibiotic prophylaxis to becost-effective. ARR was used to determine the number needed to treat (NNT).Results: Extended oral antibiotic prophylaxis with Cefadroxil in patients at high risk for PJI was costeffectiveat an ARR in baseline infection rate of 0.187% (NNT = 535) and 0.151% (NNT = 662) for TKAand THA, respectively. Cost-effectiveness was preserved with varying costs of antibiotic regimens, PJItreatment costs, and infection rates.Conclusion: The use of extended oral antibiotic prophylaxis may reduce PJI rates in patients at high riskfor infection following TJA and appears to be cost-effective. However, the current evidence supportingthis practice is limited in quality. The use of extended oral antibiotic prophylaxis should be weighedagainst the possible development of future antimicrobial resistance, which may change the valueproposition. 文獻(xiàn)出處：Lipson S, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Smith EL. The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention After Total Joint Arthroplasty in High-Risk Patients. J Arthroplasty. 2022 Oct;37(10):1961-1966. doi: 10.1016/j.arth.2022.04.025. Epub 2022 Apr 25. PMID: 35472436. 文獻(xiàn)5機(jī)器人輔助單髁關(guān)節(jié)置換術(shù)提高假體位置的準(zhǔn)確性：前瞻性隨機(jī)對(duì)照研究譯者：肖凱背景：據(jù)報(bào)道，與接受全膝關(guān)節(jié)置換術(shù)的患者相比，接受單髁關(guān)節(jié)置換手術(shù)的患者翻修率更高，而假體位置不良是導(dǎo)致內(nèi)植物失敗的一個(gè)因素。機(jī)器人輔助手術(shù)已被認(rèn)為可提高關(guān)節(jié)置換術(shù)中假體植入位置準(zhǔn)確性。這項(xiàng)前瞻性、隨機(jī)、單盲、對(duì)照試驗(yàn)的目的是比較機(jī)器人輔助和傳統(tǒng)手術(shù)在單髁關(guān)節(jié)置換術(shù)中假體位置精確性。方法：將139名患者隨機(jī)分為2組，一組使用MAKO機(jī)器人交互式機(jī)械臂（RIO）系統(tǒng)輔助手術(shù)，另一組使用傳統(tǒng)手術(shù)方式，兩組患者均使用Oxford Phase-3單髁關(guān)節(jié)假體。術(shù)后三個(gè)月進(jìn)行CT掃描，以評(píng)估軸向、冠狀和矢狀位上假體位置的準(zhǔn)確性。結(jié)果：共有120例患者的數(shù)據(jù)可用，其中62例接受了機(jī)器人輔助單髁關(guān)節(jié)置換術(shù)，58例接受了傳統(tǒng)單髁關(guān)節(jié)置換術(shù)。所有測(cè)量的假體位置參數(shù)的觀察者內(nèi)部一致性均為良好。使用機(jī)器人輔助手術(shù)提高了假體定位的準(zhǔn)確性，所有假體參數(shù)的均方根誤差較低，中值誤差顯著降低（p<0.01）。與傳統(tǒng)的單髁關(guān)節(jié)置換，機(jī)器人輔助單髁關(guān)節(jié)置換術(shù)在假體放置在目標(biāo)位置誤差2°以的比例更高，其中股骨假體矢狀位（57%與26%，p=0.0008）、股骨假體冠狀位（70%與28%，p=0.0001）、股骨假體軸位（53%與31%，p=0.0163）、脛骨假體矢狀位置（80%與22%，p=1.0001）和脛骨假體軸位置（48%與19%，p=2.0009）。結(jié)論：與傳統(tǒng)的單髁關(guān)節(jié)置換手術(shù)技術(shù)相比，使用MAKO RIO的機(jī)器人輔助手術(shù)提高了植入物定位的準(zhǔn)確性。 Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled StudyBackground: Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques.Methods: One hundred and thirty-nine patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at three months to assess the accuracy of the axial, coronal, and sagittal component positioning.Results: Data were available for 120 patients, sixty-two who had undergone robotic-assisted unicompartmental knee arthroplasty and fifty-eight who had undergone conventional unicompartmental knee arthroplasty. Intraobserver agreement was good for all measured component parameters. Tith the use of the he accuracy of component positioning was improved wrobotic-assisted surgical procedure, with lower root mean square errors and significantly lower median errors in all component parameters (p < 0.01). The proportion of patients with component implantation within 2° of the target position was significantly greater in the group who underwent robotic-assisted unicompartmental knee arthroplasty compared with the group who underwent conventional unicompartmental knee arthroscopy with regard to the femoral component sagittal position (57% compared with 26%, p = 0.0008), femoral component coronal position (70% compared with 28%, p = 0.0001), femoral component axial position (53% compared with 31%, p = 0.0163), tibial component sagittal position (80% compared with 22%, p = 0.0001), and tibial component axial position (48% compared with 19%, p = 0.0009).Conclusions: Robotic-assisted surgical procedures with the use of the MAKO RIO lead to improved accuracy of implant positioning compared with conventional unicompartmental knee arthroplasty surgical techniques. 文獻(xiàn)出處：Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study. J Bone Joint Surg Am. 2016 Apr 20;98(8):627-35. doi: 10.2106/JBJS.15.00664. PMID: 27098321. 文獻(xiàn)6比基尼切口與縱向切口用于前入路全髖關(guān)節(jié)置換術(shù)：系統(tǒng)評(píng)價(jià)譯者：任寧濤背景：直接前入路全髖關(guān)節(jié)置換術(shù)（DAA THA）傳統(tǒng)上采用縱向切口，但比基尼切口可以改善術(shù)后疤痕外觀和患者滿意度，同時(shí)減少傷口并發(fā)癥。本系統(tǒng)綜述比較了DAATHA比基尼與縱向切口的臨床結(jié)局和手術(shù)并發(fā)癥。方法：對(duì) PubMed、Cochrane 和 EMBASE 進(jìn)行系統(tǒng)評(píng)價(jià)和薈萃分析檢索，以確定 2010 年至 2021 年發(fā)表的比較DAA THA比基尼與縱向切口的原始文章。收集患者人口統(tǒng)計(jì)數(shù)據(jù)和術(shù)后結(jié)局（疤痕外觀、患者滿意度、功能性髖關(guān)節(jié)評(píng)分和并發(fā)癥）并進(jìn)行定性評(píng)估。結(jié)果：共納入8項(xiàng)雙臂研究，可以比較比基尼切口（n = 952）與縱向切口（n = 1361）的臨床結(jié)局。75%（4篇中3篇）的研究比較術(shù)后疤痕外觀和患者滿意度的研究中，報(bào)告了比基尼切口后的改善，而1項(xiàng)研究報(bào)告了兩個(gè)切口結(jié)果相似。股外側(cè)皮神經(jīng)損傷是前路THA后最常報(bào)告的并發(fā)癥，但總體發(fā)生率較低，后期大多數(shù)可恢復(fù)。結(jié)論：比基尼切口與傳統(tǒng)縱向切口具有相似的臨床結(jié)果，但比基尼切口可改善美容和患者滿意度，同時(shí)減少傷口并發(fā)癥。目前的證據(jù)表明，比基尼切口導(dǎo)致股外側(cè)皮神經(jīng)損傷的風(fēng)險(xiǎn)增加，但這需要在進(jìn)一步的前瞻性隨機(jī)研究中得到證實(shí)。 Bikini Incision vs Longitudinal Incision for Anterior Total Hip Arthroplasty A Systematic ReviewBackground: Direct anterior approach total hip arthroplasty (DAA THA) traditionally involves a longitudinal incision, but a bikini incision may improve postoperative scar cosmesis and patient satisfaction while reducing wound complications. This systematic review compares the clinical outcomes and surgical complications in patients undergoing DAA THA via a bikini vs longitudinal incision.Methods: A Preferred Reporting Items for Systematic Review and Meta-Analyses-compliant search of PubMed, Cochrane, and EMBASE was performed to identify original articles comparing patients undergoing DAA THA via a bikini vs longitudinal incision published from 2010 to 2021. Patient demographic data and postoperative outcomes (scar appearance, patient satisfaction, functional hip scores, and complications) were collected and qualitatively evaluated.Results: A total of 8 double-armed studies were included, allowing comparison of clinical outcomes of a bikini incision (n = 952) vs a longitudinal incision (n = 1361). Three out of 4 (75.0%) studies comparing postoperative scar appearance and patient satisfaction reported improvements following bikini incision, while 1 study reported comparable results between incision types. Postoperative hip function was similar between incision types in 3 of 4 (75.0%) studies comparing this outcome. Lateral femoral cutaneous nerve injury was the most frequently reported complication following anterior THA, but rates were low overall, and most injuries resolved.Conclusions: Bikini incision appears to be a safe alternative to the traditional longitudinal incision, with similar functional hip outcomes and potentially improved cosmesis and patient satisfaction while reducing wound complications. Current evidence suggests an elevated risk of lateral femoral cutaneous nerve injury with bikini incision, but this needs to be confirmed in further prospective randomized studies. 文獻(xiàn)出處：Justin Butler , Amy Singleton , Richard Miller, Bradley Morse, Brandon Naylor, Charles DeCook. Bikini Incision vs Longitudinal Incision for Anterior Total Hip Arthroplasty: A Systematic Review. Arthroplast Today . 2022 Jul 31;17:1-8. 文獻(xiàn)7初次全膝關(guān)節(jié)置換術(shù)中內(nèi)側(cè)副韌帶骨撕脫損傷對(duì)療效的影響譯者：沈松坡背景：本研究的目的是(1)尋找術(shù)中應(yīng)用螺釘和墊圈治療內(nèi)側(cè)副韌帶撕脫癥(MCL)的臨床和影像學(xué)結(jié)果，(2)預(yù)測(cè)可能導(dǎo)致初次全膝關(guān)節(jié)置換術(shù)(TKA)中發(fā)生撕脫型MCL損傷的術(shù)前因素。方法：2011年1月至2015年12月，在連續(xù)4916例初次TKA中，有46例(0.8%)發(fā)生術(shù)中MCL撕脫傷。排除后，41個(gè)膝關(guān)節(jié)與未受MCL損傷的對(duì)照組進(jìn)行1:2匹配，并比較各種臨床、放射學(xué)和功能參數(shù)。分析的臨床參數(shù)包括年齡、性別、體重指數(shù)、術(shù)前診斷如骨關(guān)節(jié)炎或類風(fēng)濕性關(guān)節(jié)炎、活動(dòng)范圍、矢狀面畸形和維生素D水平。計(jì)算的放射學(xué)參數(shù)包括冠狀位畸形、脛骨近端內(nèi)翻角、股骨遠(yuǎn)端外翻角、關(guān)節(jié)線一致角、脛骨后傾角、“杯/碟”形態(tài)、有無(wú)膝關(guān)節(jié)半脫位、脛骨外翻和股骨前弓。分析術(shù)前、術(shù)后膝關(guān)節(jié)社會(huì)評(píng)分及膝關(guān)節(jié)社會(huì)功能評(píng)分。如果有并發(fā)癥或翻修，會(huì)在隨訪期間記錄。采用多因素logistic回歸分析預(yù)測(cè)MCL撕脫傷的術(shù)前危險(xiǎn)因素。結(jié)果：平均隨訪58.4±19.3個(gè)月，影像學(xué)和體格檢查均未發(fā)現(xiàn)不穩(wěn)定。與術(shù)前殘疾相比，兩組患者和對(duì)照組在最終隨訪時(shí)的臨床評(píng)分(膝關(guān)節(jié)學(xué)會(huì)評(píng)分和膝關(guān)節(jié)學(xué)會(huì)功能評(píng)分)均有統(tǒng)計(jì)學(xué)意義上的改善(P < .001)。研究組術(shù)前平均冠狀畸形為170.6°±6.96°，對(duì)照組為167.7°±4.3°(P = .021)。研究組術(shù)前脛骨斜度平均為10.5°±4.9°，對(duì)照組為7.91°±4.15° (P = .003)。研究組中有48.8%的膝關(guān)節(jié)出現(xiàn)術(shù)前半脫位(P < .001)， 68.3例膝關(guān)節(jié)呈“杯/碟”形態(tài)(P < .001)。嚴(yán)重內(nèi)翻畸形(優(yōu)勢(shì)比[OR] 1.462, 95%可信區(qū)間[CI] 1.15-1.86)、膝關(guān)節(jié)半脫位(OR 39.78, 95% CI 3.78-418.86)和“杯/碟”形態(tài)(OR 33.11, 95% CI 5.69-192.66)的MCL撕脫損傷幾率較大。結(jié)論：初次TKA術(shù)中MCL骨撕脫傷可以通過(guò)螺釘和墊圈結(jié)構(gòu)成功處理，無(wú)需增加假體約束性。嚴(yán)重內(nèi)翻畸形、膝關(guān)節(jié)半脫位和“杯/碟”形態(tài)的存在往往增加MCL撕脫損傷的機(jī)會(huì)。 Influence of intraoperative medial collateral ligament bony avulsion injury on the outcome of primary total knee arthroplastyBackground: The purpose of this study is (1) to find the clinical and radiological outcome of intraoperative bony avulsion of medial collateral ligament (MCL) treated with screw and washer construct and (2) to predict the preoperative factors which may contribute to the avulsion-type MCL injury during primary total knee arthroplasty (TKA).Methods: Intraoperative MCL avulsion injury occurred in 46 (0.8%) of the 4916 consecutive primary TKA from January 2011 to December 2015. After exclusion, the 41 knees were matched 1:2 with controls without MCL injury and compared for the various clinical, radiological, and functional parameters. The clinical parameters analyzed were age, gender, body mass index, preoperative diagnosis like osteoarthritis or rheumatoid arthritis, range of motion, sagittal deformity, and vitamin D levels. The radiological parameters calculated were coronal deformity, proximal tibial varus angle, distal femur valgus angle, joint line congruence angle, posterior tibial slope, 'cup and saucer' morphology, presence or absence of knee subluxation, tibia vara, and femoral bowing. The preoperative and postoperative Knee Society Score and Knee Society Functional Score were analyzed. Complications or revisions, if any, were noted during the follow-up. Multivariate logistic regression analysis was used to predict the preoperative risk factors for MCL avulsion injury.Results: At a mean follow-up of 58.4 ± 19.3 months, there were no radiological or physical examination findings of instability. Compared to the preoperative disability, there was a statistically significant improvement in clinical scores (Knee Society Score and Knee Society Functional Score) in the final follow-up (P < .001) in both cases and the control group. The mean preoperative coronal deformity was 170.6 ± 6.96 in the study group and 167.7 ± 4.3 in the control group (P = .021). The mean preoperative tibial slope was 10.5 ± 4.9 in the study group and 7.91 ± 4.15 in the control group (P = .003). The preoperative knee subluxation was present in 48.8% knees (P < .001) and 'cup and saucer' morphology in 68.3 knees (P < .001) in the study group. The adjusted odds of MCL avulsion injury were greater for severe varus deformity (odds ratio [OR] 1.462, 95% confidence interval [CI] 1.15-1.86), knee subluxation (OR 39.78, 95% CI 3.78-418.86), and 'cup and saucer' morphology (OR 33.11, 95% CI 5.69-192.66).Conclusion: Intraoperative MCL bony avulsion injury can be managed successfully with screw and washer construct without the need for increased prosthetic constraint in primary TKA. The presence of severe varus deformity, knee subluxation, and 'cup and saucer' morphology tend to have an increased chance of MCL avulsion injury. 文獻(xiàn)出處：Rajkumar N, Soundarrajan D, Dhanasekararaja P, Rajasekaran S. Influence of Intraoperative Medial Collateral Ligament Bony Avulsion Injury on the Outcome of Primary Total Knee Arthroplasty. J Arthroplasty. 2021 Apr;36(4):1284-1294. doi: 10.1016/j.arth.2020.10.051. Epub 2020 Oct 31. PMID: 33229070. 文獻(xiàn)8關(guān)于內(nèi)側(cè)UKA的十個(gè)困惑譯者：張峻全膝關(guān)節(jié)置換術(shù)（TKA）是終末期單間室膝骨關(guān)節(jié)炎的治療方法，而膝關(guān)節(jié)單髁置換術(shù)（UKA）是一種保留骨和韌帶的替代治療方法。盡管UKA是一種成功的手術(shù)方法，UKA的多種優(yōu)勢(shì)與它的自身使用無(wú)關(guān)，很可能與基于對(duì)假體生存能力、患者選擇、理想的墊片設(shè)計(jì)以及先進(jìn)手術(shù)技術(shù)的謹(jǐn)慎使用等方面的考慮有關(guān)。因此，本研究的目的是回顧和總結(jié)有爭(zhēng)議的文獻(xiàn)，并將這些爭(zhēng)議討論作為“UKA的十大困惑”。對(duì)于一個(gè)符合UKA手術(shù)適應(yīng)癥的病人，你在選擇 UKA或TKA的時(shí)候猶豫不決，你還會(huì)傾向選擇UKA嗎？Kozinn和Scott提出的UKA的經(jīng)典理想適應(yīng)癥和非理想適應(yīng)癥在較新的先進(jìn)假體中仍然有效嗎？3.術(shù)前MRI：在考慮患者行UKA前，它是否在決策中發(fā)揮作用？4.假體放置錯(cuò)誤：切口應(yīng)該是最小的還是最佳的？5.墊片設(shè)計(jì)的選擇：移動(dòng)墊片還是固定墊片？6.我們應(yīng)該使用非骨水泥假體而取代骨水泥假體嗎？7.UKA假體的理想力線和最佳位置：共識(shí)是什么？8.前交叉韌帶（ACL）重建與UKA同時(shí)進(jìn)行：是否過(guò)度治療？9.UKA是一種性價(jià)比高的手術(shù)嗎？10.機(jī)器人、計(jì)算機(jī)導(dǎo)航、個(gè)性化器械（PSI）和假體：傳統(tǒng)與技術(shù)輔助的UKA哪個(gè)更佳？ Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKAUnicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as 'Ten Enigmas of UKA.'If you had a dilemma in using UKA or TKA in an UKA-indicated patient, would you choose UKA?2.Are classical ideal and nonideal indications of UKA proposed by Kozinn and Scott still valid with newer advanced prostheses?Preoperative MRI: Do they have a role in the decision-making while considering UKA in a patient?4.Errors in component placement: Should incision be minimal or optimal?5.Choice of bearing design: Mobile or fixed bearing?6.Should we use cementless implants instead of cemented ones?7.Ideal limb alignment and optimal position of UKA prosthesis: What is the consensus?8.Anterior cruciate ligament (ACL) reconstruction simultaneously with UKA: Is it too much?9.Is UKA a cost-effective surgery?10.Robotics, computer navigation, and patient-specific instrumentation and implants: Conventional versus technology-assisted UKA? 文獻(xiàn)出處：Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol. 2020 Sep 2;21(1):15. doi: 10.1186/s10195-020-00551-x. PMID: 32876817; PMCID: PMC7468046. 第二部分：保髖相關(guān)文獻(xiàn)文獻(xiàn)1有癥狀和無(wú)癥狀人群中臨界髖臼發(fā)育不良的患病率:系統(tǒng)綜述和meta分析譯者：程徽 背景:臨界髖臼發(fā)育不良患者是保髖治療中有爭(zhēng)議的患者群體，因?yàn)橐恍┗颊咧饕凶矒粜园Y狀，而另一些患者有不穩(wěn)定性癥狀。臨界發(fā)育不良最常被定義為外側(cè)中心邊緣角(LCEA)為20°至25°。然而，還沒(méi)有文獻(xiàn)清楚描述它的患病率。 目的:(1)通過(guò)對(duì)文獻(xiàn)的系統(tǒng)回顧和薈萃分析，明確臨界髖關(guān)節(jié)發(fā)育不良在一般人群和髖關(guān)節(jié)疼痛的人群中的患病率;(2)描述男女患者之間的差異以及與典型髖關(guān)節(jié)發(fā)育不良患病率的差異。 研究設(shè)計(jì):系統(tǒng)綜述;證據(jù)級(jí)別，3分。 方法:使用搜索詞對(duì)文獻(xiàn)進(jìn)行系統(tǒng)回顧，以獲取臨界發(fā)育不良或不同LCEA患病率的研究。搜索產(chǎn)生了1932個(gè)結(jié)果，其中11篇文章符合納入標(biāo)準(zhǔn)，被納入最后的系統(tǒng)綜述。研究按患者隊(duì)列分組為(1)無(wú)癥狀的一般人群，(2)無(wú)癥狀的目標(biāo)人群(例如，特定運(yùn)動(dòng)項(xiàng)目的運(yùn)動(dòng)員)，和(3)有癥狀的髖關(guān)節(jié)疼痛人群。患病率按受試者或按髖關(guān)節(jié)進(jìn)行統(tǒng)計(jì)。在一項(xiàng)研究中，將臨界發(fā)育不良的發(fā)生率與典型髖關(guān)節(jié)發(fā)育不良(LCEA＜20°)的發(fā)生率進(jìn)行比較。 結(jié)果:總共11項(xiàng)研究納入分析，包括19,648髖(11,754例患者)。在無(wú)癥狀的普通人群中，臨界發(fā)育不良患病率的匯總估計(jì)為總受試者數(shù)的19.8%，占總髖關(guān)節(jié)數(shù)的23.3%(范圍為16.7%-46.0%)。目標(biāo)亞組包括236名運(yùn)動(dòng)員，包括芭蕾、足球、曲棍球、排球、足球和田徑，其患病率在17.8%到51.1%之間。伴有髖關(guān)節(jié)疼痛的組中臨界發(fā)育不良的患病率為12.8%(范圍為12.6%-16.0%)。在無(wú)癥狀的普通人群中，臨界髖關(guān)節(jié)發(fā)育不良的發(fā)生率是典型髖關(guān)節(jié)發(fā)育不良的3.5倍。 結(jié)論:該研究顯示，在無(wú)癥狀的普通人群中，臨界發(fā)育不良的患病率為19.8%至23.3%。此外，在有癥狀的患者中，臨界發(fā)育不良的患病率約12.8%，這些患者的治療決策尚存爭(zhēng)議。 Prevalence of Borderline Acetabular Dysplasia in Symptomatic and Asymptomatic Populations: A Systematic Review and Meta-analysisBACKGROUND: Patients with borderline acetabular dysplasia are a controversial patient population in hip preservation, as some have primarily impingement-based symptoms and others have instability-based symptoms. Borderline dysplasia is most commonly defined as a lateral center-edge angle (LCEA) of 20° to 25°. However, its prevalence has not been well established in the literature. PURPOSE: To (1) define the prevalence of borderline hip dysplasia in the general population as well as in populations presenting with hip pain using a systematic review and meta-analysis of the literature and (2) describe differences between male and female patients as well as differences in prevalence from that of classic acetabular dysplasia. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A systematic review of the literature was performed using search terms to capture borderline dysplasia, or studies reporting prevalence by LCEA. The search yielded 1932 results, of which 11 articles met inclusion criteria and were included in the final systematic review. Studies were grouped by patient cohort as (1) asymptomatic general population, (2) asymptomatic targeted population (eg, athletes in a specific sport), and (3) symptomatic hip pain population. The reporting of prevalence rates by subject or by hip was recorded. In a study, the rates of borderline dysplasia were compared with those of classic acetabular dysplasia (LCEA,<20°). RESULTS: The 11 studies included 19,648 hips (11,754 patients). In the asymptomatic general population, the pooled estimate of the prevalence of borderline dysplasia was 19.8% by subject and 23.3% by hip (range, 16.7%-46.0%). The targeted subpopulation group included 236 athletes with subgroups in ballet, football, hockey, volleyball, soccer, and track and field with prevalence ranging from 17.8% to 51.1%. The prevalence of borderline dysplasia in groups presenting with hip pain was 12.8% (range, 12.6%-16.0%). Borderline acetabular dysplasia was 3.5 times more common than classic acetabular dysplasia in the asymptomatic general population. CONCLUSION: This study demonstrated a prevalence of borderline dysplasia of 19.8% to 23.3% in the asymptomatic general population. Additionally, an estimated prevalence of 12.8% of hips in symptomatic patients highlights the common decision-making challenges in this population. 文獻(xiàn)出處： Freiman S M ,Schwabe M T ,Fowler L , et al. Prevalence of Borderline Acetabular Dysplasia in Symptomatic and Asymptomatic Populations: A Systematic Review and Meta-analysis:[J]. Orthopaedic Journal of Sports Medicine, 2022, 10(2):918-923. 文獻(xiàn)2無(wú)手術(shù)干預(yù)的髖關(guān)節(jié)發(fā)育不良患者骨關(guān)節(jié)炎進(jìn)展的危險(xiǎn)因素譯者：張振東髖關(guān)節(jié)發(fā)育不良（DDH）是髖關(guān)節(jié)疼痛的常見(jiàn)原因，也是髖關(guān)節(jié)骨關(guān)節(jié)炎(OA)和早期全髖關(guān)節(jié)置換術(shù)(THA)的危險(xiǎn)因素。然而目前對(duì)與OA風(fēng)險(xiǎn)增加相關(guān)的具體因素知之甚少。本研究目的是(i)明確DDH髖關(guān)節(jié)骨關(guān)節(jié)炎發(fā)生和全髖關(guān)節(jié)置換術(shù)的總發(fā)生率，(ii)確定與癥狀性髖關(guān)節(jié)骨關(guān)節(jié)炎發(fā)展相關(guān)的影像學(xué)特征和患者特征。使用數(shù)據(jù)庫(kù)確定2000年至2016年期間被診斷為癥狀性髖關(guān)節(jié)發(fā)育不良的所有14-50歲患者。Kaplan-Meier分析用于確定骨關(guān)節(jié)炎的發(fā)生率，定義為髖關(guān)節(jié)x線片T?nnis骨關(guān)節(jié)炎分級(jí)≥1級(jí)。采用單因素和多因素比例風(fēng)險(xiǎn)回歸模型確定OA的危險(xiǎn)因素。在1893例髖關(guān)節(jié)疼痛患者中，159例(144例)髖關(guān)節(jié)發(fā)育不良(52 F:107 M)患者納入研究。其中45例(28%)有嚴(yán)重的髖關(guān)節(jié)發(fā)育不良，外側(cè)中心邊緣角≤18°。發(fā)病時(shí)平均年齡為26.1歲。隨訪時(shí)間8.2±5年。結(jié)果顯示，OA率為20%。11%的患者接受了THA治療。體重指數(shù)>29 (P = 0.03)和年齡增加(P < 0.01)是OA的危險(xiǎn)因素。有癥狀的髖關(guān)節(jié)是骨關(guān)節(jié)炎發(fā)生的顯著危險(xiǎn)因素。因此，體重指數(shù)>29以及出現(xiàn)髖關(guān)節(jié)疼痛時(shí)年齡≥35歲是髖關(guān)節(jié)骨關(guān)節(jié)炎發(fā)生的危險(xiǎn)因素。 Risk factors for long-term hip osteoarthritis in patients with hip dysplasia without surgical interventionHip dysplasia is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and early total hip arthroplasty (THA). Unfortunately, little is known about the specific factors associated with an increased risk of OA. The purpose was (i) to report the overall rate of symptomatic hip OA and THA and (ii) to identify radiographic features and patient characteristics associated with the development of symptomatic hip OA. A geographic database was used to identify all patients aged 14-50 years old diagnosed with symptomatic hip dysplasia between 2000 and 2016. Kaplan-Meier analysis was used to determine the rate of symptomatic hip OA, defined as a T?nnis grade of ≥1 on hip radiograph. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. One hundred and fifty-nine hips (144 patients) with hip dysplasia (52 F:107 M) out of 1893 patients with hip pain were included. Of these, 45 (28%) had severe hip dysplasia with a lateral center-edge angle ≤18°. Mean age at time of presentation was 26.1 (±10.1) years. Mean follow-up time was 8.2 (±5) years. The rate of OA was 20%. THA was performed in 11% of patients. Body mass index >29 (P = 0.03) and increased age (P < 0.01) were risk factors for OA. Patients with symptomatic hip dysplasia are at significant risk of developing hip OA. Body mass index >29 and age ≥35 years at the time of presentation with hip pain were risk factors for hip OA. 文獻(xiàn)出處：Melugin HP, Hale RF, Lee DR, LaPrade MD, Okoroha KR, Sierra RJ, Trousdale RT, Levy BA, Krych AJ. Risk factors for long-term hip osteoarthritis in patients with hip dysplasia without surgical intervention. J Hip Preserv Surg. 2022 Jan 19;9(1):18-21. doi: 10.1093/jhps/hnac007. PMID: 35651707; PMCID: PMC9142191. 文獻(xiàn)3股骨截骨術(shù)和全髖關(guān)節(jié)置換術(shù)治療股骨頭壞死的患者報(bào)告結(jié)果:一項(xiàng)前瞻性的病例研究譯者：李勇摘要背景:患者報(bào)告評(píng)分系統(tǒng)近年來(lái)被應(yīng)用于外科手術(shù)后。本前瞻性研究的目的是評(píng)估患者報(bào)告的股骨截骨術(shù)和全髖關(guān)節(jié)置換術(shù)(THA)治療股骨頭壞死(ONFH)的結(jié)果。方法:42例對(duì)側(cè)髖關(guān)節(jié)無(wú)癥狀的有癥狀的ONFH患者接受經(jīng)轉(zhuǎn)子前旋轉(zhuǎn)截骨術(shù)(ARO)或THA作為初次手術(shù)。在這些患者中，有20名患者在最終隨訪時(shí)(術(shù)后1年多)對(duì)側(cè)髖關(guān)節(jié)仍無(wú)癥狀，被招募參加本研究。ARO治療9例(ARO組)，THA治療11例(THA組)。牛津髖關(guān)節(jié)評(píng)分(OHS)和短髖關(guān)節(jié)評(píng)分(SF-36)均在術(shù)前和最終隨訪時(shí)進(jìn)行評(píng)估。結(jié)果:ARO組和THA組術(shù)前OHS分別為29.1 + 10.9和21.9 + 9.6分，末次隨訪時(shí)OHS分別為38.4 + 9.4和40.3 + 5.1分。ARO組和THA組術(shù)前身體成分總結(jié)評(píng)分分別為30.8 + 12.8分和17.8 + 14.5分，最終隨訪時(shí)分別為44.5 + 10.6分和43.3 + 10.4分。ARO組和THA組的術(shù)前心理成分總結(jié)評(píng)分分別為48.0 + 8.5分和48.6 + 11.3分，在末次隨訪時(shí)均未發(fā)生變化。結(jié)論:本研究的短期患者報(bào)告結(jié)果表明，ARO和THA治療ONFH均可顯著改善術(shù)后髖關(guān)節(jié)功能。 Patient-reported outcomes of femoral osteotomy and totalhip arthroplastyfor osteonecrosis of the femoral head: a prospective caseseries studyBackground: Patient-reported scoring systems have recently been used after surgical procedures. The purpose of this prospective study was to evaluate the patient-reported outcomes of femoral osteotomy and total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). Methods: Forty-two symptomatic ONFH patients with asymptomatic contralateral hip underwent either transtrochanteric anterior rotational osteotomy (ARO) or THA as a primary operation. Of these, 20 patients whose contralateral hips remained asymptomatic at the final follow-up (more than 1 year postoperatively) were recruited to participate in this study. Nine patients were treated with ARO (ARO group) and 11 patients were treated with THA (THA group). Both the Oxford hip score (OHS) and the short form 36 (SF-36) were evaluated preoperatively and at the final follow-up. Results: The preoperative OHS was 29.1 + 10.9 and 21.9 + 9.6 points in the ARO and THA groups, which significantly improved to 38.4 + 9.4 and 40.3 + 5.1 points at the final follow-up, respectively. The preoperative physical component summary score was 30.8 + 12.8 and 17.8 + 14.5 points in the ARO group and THA groups, which significantly improved to 44.5 + 10.6 and 43.3 + 10.4 points at the final follow-up, respectively. The preoperative mental component summary score was 48.0 + 8.5 and 48.6 + 11.3 points in the ARO and THA groups, both of which remained unchanged at the final follow-up. Conclusions: The short-term patient-reported outcomes of this study suggested that both ARO and THA for ONFH resulted in significantly improved postoperative hip joint function. 文獻(xiàn)出處：Kubo Y, Yamamoto T, Motomura G, Karasuyama K, Sonoda K, Iwamoto Y. Patient-reported outcomes of femoral osteotomy and total hip arthroplasty for osteonecrosis of the femoral head: a prospective case series study. Springerplus. 2016 Oct 26;5(1):1880. doi: 10.1186/s40064-016-3576-4. PMID: 27833839; PMCID: PMC5081314. 文獻(xiàn)4利用解剖影像學(xué)參數(shù)拓寬LCEA在髖關(guān)節(jié)發(fā)育不良分類中的應(yīng)用譯者：張利強(qiáng)背景：Wiberg外側(cè)中心邊緣角（LCEA）和T?nnis角（TA）利用一條“水平線”在負(fù)重前后骨盆X線片上測(cè)量髖關(guān)節(jié)。根據(jù)手術(shù)醫(yī)生的偏好，目前使用3種不同的定義方法：（1）平行于X線片底部的線（F），（2）連接髖臼淚滴（AT）下緣的線，或（3）連接坐骨結(jié)節(jié)（IT）的線。必須在初步檢查時(shí)準(zhǔn)確評(píng)估髖關(guān)節(jié)發(fā)育不良的程度，以選擇合適的手術(shù)干預(yù)。目的：評(píng)估X線“水平線”的選擇如何影響LCEA和TA的測(cè)量。第二個(gè)目的是評(píng)估水平線的選擇如何影響正常、臨界發(fā)育不良或發(fā)育不良髖關(guān)節(jié)的分類。研究設(shè)計(jì)：隊(duì)列研究（診斷）證據(jù)水平，3級(jí)方法：于2016年2月至2020年11月接受保髖手術(shù)（140例髖關(guān)節(jié)鏡手術(shù)，46例髖關(guān)節(jié)鏡聯(lián)合髖臼周圍截骨術(shù)）的186名患者的所有術(shù)前負(fù)重前后骨盆X線片上測(cè)量LCEA和TA，每髖分別使用F、AT和IT水平線測(cè)量3次。使用Student t檢驗(yàn)分析LCEA和TA測(cè)量值的差異，并量化不同發(fā)育不良分類組內(nèi)的不一致率。結(jié)果：對(duì)于整個(gè)研究人群，平均LCEAF（23.4°±7.4°）顯著高于LCEAIT（23.1°±7.2°）（95%CI，-0.634至-0.003；P=0.047）和LCEAAT（23.0°±7.1°）值（95%CI，-0.723至-0.139；P=.004）。LCEAIT和LCEAAT之間無(wú)差異（95%CI，-0.305至0.080；P=0.251）。當(dāng)通過(guò)髖關(guān)節(jié)鏡手術(shù)分層時(shí)，平均LCEAF（26.3°±5.6°）顯著大于LCEAAT（25.8° ± 5.3°）（95%CI，-0.845至-0.162；P=0.004）?？傮w而言，在發(fā)育不良分類中與LCEAF相比，LCEAIT和LCEAAT不一致率分別為17.7%和18.3%。整個(gè)研究人群、關(guān)節(jié)鏡手術(shù)組、關(guān)節(jié)鏡聯(lián)合髖臼周圍截骨術(shù)組的平均TAIT、TAAT和TAF之間無(wú)顯著統(tǒng)計(jì)學(xué)差異。結(jié)論：對(duì)于LCEA測(cè)量，AT和IT組之間測(cè)量沒(méi)有統(tǒng)計(jì)學(xué)差異。與F組相比，發(fā)育不良測(cè)量在另2個(gè)分組間更為一致。TA測(cè)量不受參考水平線選擇的影響。 Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip DysplasiaBackground: The lateral center-edge angle of Wiberg (LCEA) and T?nnis angle (TA) rely on a ''horizon’’ that functions as a reference point for measurements of hip dysplasia on weightbearing anteroposterior pelvis radiographs. There are 3 different horizons that are currently utilized depending on surgeon preference: (1) a line parallel to the radiographic floor (F), (2) a line that connects the inferior portions of the acetabular teardrops (ATs), or (3) a line that connects the ischial tuberosities (ITs). It is imperative to accurately assess the degree of hip dysplasia on initial workup to select the appropriate surgical intervention.Purpose: To assess how the choice of a radiographic horizon affects the measurements of the LCEA and TA. The secondary purpose was to assess how the horizon affected the classification of hips as either normal, borderline dysplastic, or dysplastic.Study Design: Cohort study (diagnosis); Level of evidence, 3.Methods: The LCEA and TA were measured on all preoperative weightbearing anteroposterior pelvis radiographs for 186 consecutive patients who underwent hip preservation surgery between February 2016 and November 2020 (140 hip arthroscopic procedures, 46 combined hip arthroscopic procedures with periacetabular osteotomy), 3 times per hip, each time using an F, AT, and IT horizon. The Student t test was used to analyze the differences in the measurements of the LCEA and TA, and discordance rates in the dysplasia classification between horizons were quantified.Results: For the entire study population, the mean LCEAF (23.4° ±7.4°) was significantly greater than the mean LCEAIT (23.1° ± 7.2°) (95% CI, -0.634 to -0.003; P = .047) and mean LCEAAT (23.0° ± 7.1°) (95% CI, -0.723 to -0.139; P = .004). There was no difference between the LCEAIT and LCEAAT (95% CI, -0.305 to 0.080; P = .251). When stratified by hip arthroscopic surgery, the mean LCEAF (26.3° ± 5.6°) was significantly greater than the mean LCEAT (25.8° ± 5.3°) (95% CI, -0.845 to -0.162; P = .004). Overall, there was a 17.7% and 18.3% discordance rate in the dysplasia classification using the LCEAIT and LCEAAT compared with the LCEAF, respectively. There were no statistically significant differences between the mean TAIT, TAAT, and TAF for the entire study population, the arthroscopic surgery group, and the combined arthroscopic surgery and periacetabular osteotomy group.Conclusion: There was no statistical difference between the AT and IT horizons for LCEA measurements. The dysplasia classification was in better agreement between the 2 anatomic horizons compared with the F horizon. The TA was not affected by changes in the horizon. 文獻(xiàn)出處：Megerian MF, Strony JT, Mengers SR, Joseph NM, Salata MJ, Wetzel RJ. Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia. Am J Sports Med. 2022 Nov;50(13):3610-3616. doi: 10.1177/03635465221125784. Epub 2022 Oct 11. PMID: 36220151. 文獻(xiàn)5髖關(guān)節(jié)軟骨病變：相關(guān)解剖學(xué)、影像學(xué)檢查和治療方式的最新進(jìn)展譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）髖關(guān)節(jié)軟骨病變的診斷和治療一直是骨科領(lǐng)域的挑戰(zhàn)。軟骨病變很常見(jiàn)，并且存在幾種分類系統(tǒng)，以根據(jù)嚴(yán)重程度、病變位置、放射學(xué)相關(guān)參數(shù)和可能的治療選擇來(lái)對(duì)其進(jìn)行分類。當(dāng)處理可能患有髖關(guān)節(jié)軟骨病變的患者時(shí)，必須進(jìn)行完整的病史采集、全面的體格檢查和輔助影像學(xué)檢查。應(yīng)對(duì)患者站立、仰臥、俯臥和側(cè)方等全方位進(jìn)行體格檢查。普通X線片是一線（最基本的）拍片檢查方法。然而，除關(guān)節(jié)鏡檢查外，磁共振成像目前是診斷軟骨病變的金標(biāo)準(zhǔn)。多種治療方式可以解決髖關(guān)節(jié)存在的軟骨病變，并繼續(xù)研究報(bào)道新的治療方法。目前，軟骨成形術(shù)、微骨折術(shù)、軟骨移植（自體骨軟骨移植、鑲嵌成形術(shù)、同種異體骨軟骨骨移植術(shù)）和骨生物學(xué)聯(lián)合方式（自體軟骨細(xì)胞植入ACI，自體基質(zhì)誘導(dǎo)的軟骨再生AMIC，PRP）均被用來(lái)成功治療髖關(guān)節(jié)軟骨病變。進(jìn)一步完善研究這些方法和新技術(shù)，以繼續(xù)提高外科醫(yī)生解決髖關(guān)節(jié)中軟骨病變的能力。
圖1.(A, B) Ilizaliturri 的髖臼六分區(qū)法右側(cè)(A)和左側(cè)(B)髖關(guān)節(jié)（1區(qū)：前-下髖臼；2區(qū)：前-上；3區(qū)：中-上；4區(qū)：后-上；5區(qū)：后-下；6區(qū)：髖臼切跡）。 Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalitiesThe diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon's ability to address chondral lesions in the hip joint. 文獻(xiàn)出處：Alison A Dallich, Ehud Rath, Ran Atzmon, Joshua R Radparvar, Andrea Fontana, Zachary Sharfman, Eyal Amar. Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities. Review J Hip Preserv Surg. 2019 Apr 16;6(1):3-15. doi: 10.1093/jhps/hnz002. eCollection 2019 Jan. 文獻(xiàn)6男性以及競(jìng)技運(yùn)動(dòng)員身份與髖臼后傾患者髖關(guān)節(jié)鏡檢查后更好的預(yù)后相關(guān)譯者：王一昕目的：評(píng)估髖臼整體后傾患者的髖關(guān)節(jié)鏡檢查結(jié)果，并確定性別、影像學(xué)測(cè)量結(jié)果、運(yùn)動(dòng)員身份和是否重返賽場(chǎng)與患者報(bào)告結(jié)果（PRO）之間的相關(guān)性。方法：對(duì)接受關(guān)節(jié)鏡下股骨髖臼撞擊（FAI）手術(shù)的髖臼后傾患者進(jìn)行回顧性研究。整體髖臼后傾由3個(gè)標(biāo)準(zhǔn)定義：骨盆前后位片中的交叉征、坐骨棘征和后壁征。用X線測(cè)量外側(cè)中心邊緣角、α角以及前后壁指數(shù)。用三維CT測(cè)量股骨頸前傾角。人口學(xué)統(tǒng)計(jì)包括年齡、性別、運(yùn)動(dòng)員狀態(tài)、重返賽場(chǎng)情況和再次手術(shù)情況。PRO包括改良Harris髖關(guān)節(jié)評(píng)分、髖關(guān)節(jié)結(jié)局評(píng)分（HOS）、髖關(guān)節(jié)殘疾和骨關(guān)節(jié)炎結(jié)局評(píng)分、視覺(jué)模擬量表（VAS）和退伍軍人RAND-12。我們應(yīng)用Spearman相關(guān)性分析確定了圍手術(shù)期PRO的相關(guān)性，用廣義估計(jì)方程確定獨(dú)立的預(yù)測(cè)因子。顯著性設(shè)置為P=0.05。結(jié)果：2013年至2019年，149名患者（65.0%女性）接受了髖關(guān)節(jié)鏡檢查，共160髖出現(xiàn)FAI和髖臼后傾。隨訪平均29.6個(gè)月。除退伍軍人RAND-12中的精神健康量表外，所有的PRO結(jié)果均表現(xiàn)出顯著改善。女性患者大多數(shù)術(shù)后PRO評(píng)分明顯較低，VAS評(píng)分較高（P=0.0002-0.0402）。男性受試者有更高比例達(dá)到改良Harris髖關(guān)節(jié)評(píng)分的最小臨床重要差異（88.00%vs 78.79%）。更小的股骨頸前傾角與更高的HOS ADL評(píng)分、HOS運(yùn)動(dòng)評(píng)分、髖關(guān)節(jié)殘疾和骨關(guān)節(jié)炎結(jié)局評(píng)分和運(yùn)動(dòng)評(píng)分相關(guān)（P=.0077-0.0177）。運(yùn)動(dòng)員報(bào)告的術(shù)前VAS評(píng)分較低，多個(gè)PRO中的圍手術(shù)期評(píng)分較高（P=0.0004-0.0486）。9髖（5.63%）再次手術(shù)。結(jié)論：接受髖關(guān)節(jié)鏡檢查的髖臼整體后傾合并FAI患者的短期隨訪結(jié)果良好。與女性受試者和非運(yùn)動(dòng)員受試者相比，男性受試者與運(yùn)動(dòng)員的結(jié)果更好。除較小的股骨前傾角外，放射學(xué)測(cè)量與結(jié)果無(wú)關(guān)。與非運(yùn)動(dòng)員相比，運(yùn)動(dòng)員的術(shù)前疼痛評(píng)分更低，術(shù)后PRO更高。 Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular RetroversionPurpose: To evaluate outcomes of hip arthroscopy in patients with global acetabular retroversion and to identify correlations between sex, radiographic measurements, athlete status, and return to play with patient-reported outcomes (PROs).Methods: Retrospective study of patients with global acetabular retroversion who underwent arthroscopic femoroacetabular impingement (FAI) surgery was performed. Global acetabular retroversion was defined by 3 criteria: the crossover sign, ischial spine sign, and posterior wall sign on an anteroposterior (AP) pelvic radiograph. Radiographs were used to measure lateral center edge angle, alpha angle, and anterior and posterior wall indices. Femoral version was measured with 3-dimensional computed tomography. Demographics included age, gender, athlete status, return to play, and reoperation. PROs included modified Harris Hip Score, Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score, visual analog scale (VAS), and Veterans RAND-12. Spearman correlation determined correlation with perioperative PROs. Generalized estimating equation determined independent predictors. Significance was set at P = .05.Results: From 2013 to 2019, 149 patients (65.0% female) with 160 hips with FAI and global acetabular retroversion underwent hip arthroscopy. Follow-up averaged 29.6 months. All PROs demonstrated significant improvement with the exception of the Veterans RAND-12 Mental. Female patients scored significantly lower on most postoperative PROs and had greater VAS scores (P = .0002-0.0402). A greater proportion of male subjects met the minimum clinically important difference for the modified Harris Hip Score (88.00% vs 78.79%) Low femoral version correlated with greater HOS ADL, HOS Sport, and Hip Disability and Osteoarthritis Outcome Score Sport scores (P = .0077-0.0177). Athletes reported lower preoperative VAS scores, and higher perioperative scores in multiple PROs (P = .0004-0.0486). Nine hips (5.63%) underwent reoperation.Conclusions: Patients with global acetabular retroversion and FAI undergoing hip arthroscopy report good outcomes at short-term follow-up. Male subjects and athletes had superior outcomes compared to female subjects and nonathletes. Radiographic measurements did not correlate with outcomes with exception of low femoral version. Athletes reported lower preoperative pain scores and greater postoperative PROs than nonathletes. 文獻(xiàn)出處：Olivia C O'Reilly, Molly A Day, Kayla Seiffert, Hollis M Fritts, Qiang An, Robert W Westermann, Christopher M Larson. Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular Retroversion. Arthrosc Sports Med Rehabil. 2022 Aug 31;4(5):e1721-e1729. PMID: 36312706. DOI: 10.1016/j.asmr.2022.06.019
