第一部分：关节置换相关文献
文献1
股骨外髁滑移截骨：固定膝外翻畸形全膝置换的外侧松解
译者：张轶超
我们治疗了13例固定性膝外翻畸形的病例，采用半限制性假体结合股骨外髁滑移截骨松解外侧副韧带完成了全膝关节置换手术。随访时间1到6.5年，采用KSS评分评估。膝关节评分从术前的32分改善到88分，功能评分从45增加到73分。平均股骨胫骨角被从191°矫正到180°。术后没有出现胫骨股骨或髌骨不稳，大多关节的滑移骨块固定确实。
Lateral femoral sliding osteotomy: Lateral Release In Total Knee Arthroplasty For A Fixed Valgus Deformity
We treated 13patients who had a fixed valgus deformity of the knee with a semiconstrained total knee arthroplasty combined with advancement of the lateral collateral ligament by means of a lateral femoral condylar sliding osteotomy. At follow-up of between one and 6.5 years all patients were assessed using the Knee Society score. The mean knee score improved from 32 to 88 and the functional score from45 to 73. The mean tibiofemoral angle was corrected from 191° to 180°. Therewas no postoperative tibiofemoral or patellar instability and, in most knees,distal transposition of the lateral femoral condyle achieved satisfactory stable alignment.
文献出处：J. Brilhault, S.Lautman, L. Favard, P. Burdin. Lateral femoral sliding osteotomy: lateralrelease in total knee arthroplasty for a fixed valgus deformity. J Bone JointSurg [Br] 2002;84-B:1131-7
文献2
全膝关节置换术中应用止血带会导致总失血量异常增加
译者：马云青
背景：全膝关节置换术中应用止血带是为了减少围手术期失血，但目前术中止血带的应用仍存在安全和有效性的争议。氨甲环酸可以通过抑制凝血块的稳定性而被用来减少围术期失血。由于考虑到以上这些因素，本文主要作者在全膝关节置换术中常规不用止血带，并开始常规使用氨甲环酸。本研究的目的是观察比较围手术期总的失血量，比较单独应用止血带组、应用止血带和氨甲环酸组、单独使用氨甲环酸组的组间差别。
方法：文章对3组共132例患者进行回顾性研究。第一组在全膝关节置换术中仅在骨水泥操作时短时间应用止血带，第二组采用相同的治疗方案，同时使用氨甲环酸，第三组仅使用氨甲氨酸，术中不使用止血带。围手术期出血量的计算采用GROSS方程。
结果：平均失血量最多的是第一组，止血带组总失血量1591.39ml( 95%CI，1064.97至2117.81ml )。第二组同时应用氨甲环酸和止血带，失血量有所下降，为1215.34ml ( 95%CI，1104.93至1325.75mL)，第三组失血量最少，在1007.22ml ( 95%CI，878.781至135.66ml )。
结论：在全膝关节置换术中有限使用止血带的方案反而会导致围手术期失血量的增加。外科医生可以考虑在全膝关节置换术中忽略常规使用止血带。
Use of a Tourniquet in Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss
Background: A tourniquet in total knee arthroplasty has been used in an attempt to decrease perioperative blood loss; however, questions exist regarding safety andefficacy. Tranexamic acid has also been used to decrease blood loss by stabilizing clot formation. Because of the concerns, routine tourniquet use for total knee arthroplasty was discontinued by the senior author and routine tranexamic acid administration was commenced. The purpose of this study was to examine total perioperative blood loss with tourniquet use, with tourniquet useand routine use of tranexamic acid, and with tranexamic acid use alone without tourniquet.
Methods: Aretrospective cohort study of 132 patients in 3 groups was performed. The first group underwent total knee arthroplasty with limited tourniquet use only during cementing, the second group had the same protocol but with tranexamic acid administered, and the third group had tranexamic acid but no tourniquet used. Perioperative blood loss was calculated using the Gross formula.
Results: Themean calculated blood loss was highest in the tourniquet-only group at 1,591.39mL (95% confidence interval[CI], 1(064.97to 2,117.81 mL), decreased in thesecond group using tranexamic acid and tourniquet at l,215.34mL (95% Cl,1,104.93 to 1,325.75 mL), and was lowest in the third group with tranexamic acid and no tourniquet at 1,007.22 mL (95% Cl, 878.78 to 1,135.66 mL).
Conclusions: Use of alimited tourniquet protocol during total knee arthroplasty resulted in aparadoxical increase in blood loss. Surgeons should consider omitting routine tourniquet use in total knee arthroplasty.
文献出处：Timothy Schnettler, MD, Natalie Papillon, MS, and Harold Rees, MD. Use of a Tourniquetin Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss. JBJS Am.2017; 99(16) : 1331-1336
文献3
全膝关节置换后出现膝前痛的决定因素: 系统综述
译者：张蔷
目的：全膝关节置换术后膝前痛现象并不少见，与置换手术直接相关。本篇文章目的是浏览既往相关文献，寻找与初次全膝置换术后出现的膝前痛相关的可变和不可变因素。
方法：于2012年1月在计算机上进行系统性搜索（Cochrane综述数据库，Cochrane对照研究登记中心数据库，MEDLINE，EMBASE和Google学术），用GRADE方法评价文章质量。
结果：共54篇文章符合入组标准。用于评估与膝前痛相关的指标包括患者与关节特异性指标、假体类型、手术技术、髌骨的处理和评价时间。结果发现：膝前痛与某种特定的术前顽固性步态呈弱相关性。改善膝前痛的推荐措施有：应用后旋转中心的股骨假体、切除髌下脂肪垫、髌周去神经化和预防假体联合内旋。髌软骨磨损程度、胫骨假体类型和髌骨置换与膝前痛并无明确相关性。由于文章间存在显著异质性，并综述并未进行荟萃分析。
结论：我们并没有发现存在单一因素可以解释各研究中膝前痛发生率的不同，但引起髌股关节异常负荷可能是膝前痛的发生原因之一。
Determinants of anterior knee pain following total knee replacement: a systematic review
Purpose: Anterior knee pain (AKP) following total knee replacement (TKR) is both prevalent and clinically relevant. The purpose of this study was to systematically review thepeer-reviewed literature, and to identify and assess the different modifiable andnon-modifiable determinants that may be associated with the development of AKP in patients following primary TKR.
Methods: A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Google Scholar) was performed in January 2012. The quality of the studies was assessed using the GRADEapproach.
Results: A total of 54 articles met the inclusion criteria. Variables that have been researched with regard to the prevalence of AKP include patient and knee-specific characteristics,prosthetic design, operative technique, treatment of the patella, and time ofassessment. A weak correlation with AKP was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa's fat pad,patellar rim electrocautery, and preventing combined component internalrotation. The correlation between postsurgical AKP and the degree of patellarcartilage wear, tibial component bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, nometa-analysis was performed.
Conclusions: No single variable is likely to explain the differences in the reported rates of AKP, although variables leading to abnormal patellofemoral joint loading appear to beof special significance.
文献出处：van JonbergenHP, Reuver JM, Mutsaerts EL, Poolman RW. Determinantsof anterior knee pain following total knee replacement: a systematic review. Knee SurgSports Traumatol Arthrosc. 2014 Mar;22(3):478-99.
文献4
比较电话咨询和短信服务对全膝关节置换术后患者膝关节功能、日常生活能力和满意度的影响
译者：程凌燕
研究背景：短信服务和电话咨询对全膝关节置换术（TKR）患者康复影响的比较研究未见报道。
研究目的：本研究的目的是更好的为TKR患者提供出院后电话咨询和短信服务，分析这些服务对他们的膝关节功能，日常生活能力和满意度的不同影响。
研究方法：本研究采用随机对照试验设计。本研究共纳入40例患者（电话咨询组21例，短信服务组19例）。在术前、TKR术后1个月和3个月，分别对电话咨询组和短信服务组患者的膝关节功能、日常生活能力和满意度进行评估。
结果：电话咨询和短信服务对TKR患者的膝关节功能、日常生活能力和满意度具有相同的效果，没有统计学差异。
结论：未来的研究需要确定短信服务的最佳频率和持续时间，以帮助TKR患者。
The Effects of Postdischarge Telephone Counseling and Short Message Service on the Knee Function, Activities of Daily Living, and Life Satisfaction of Patients Undergoing Total Knee Replacement
BACKGROUND: No study comparing short message service (SMS) texts and telephone counseling forpatients undergoing total knee replacement (TKR) has been reported.
PURPOSE: The purposeof the study was to provide postdischarge telephone counseling and SMS texts toTKR patients and to analyze the effects of these services on their kneefunction (KF), activities of daily living (ADL), and life satisfaction (LS).
METHODS: This study used a randomized clinical trial de-sign. This study was conducted with 40patients (counseling group: 21; SMS group: 19). In the telephone counseling groupand the SMS group, KF, ADL, and LS were assessed before surgery and 1 and 3months after TKR.
RESULTS: Telephone counseling and SMS texts have the same effects on KF, ADL, and LS of TKR patients.
CONCLUSION: Future research is needed to determine optimal frequency and duration of post-TKR SMSto support patients who have undergone TKR.
文献出处：Kyung Hye Park. Mi Ryeong Song.TheEffects of Postdischarge Telephone Counseling and Short Message Service on theKnee Function, Activities of Daily Living, and Life Satisfaction of Patients UndergoingTotal Knee Replacemen. Orthop Nurs. 2017 May/Jun;36(3):229-236.
第二部分：保髋相关文献
文献1
儿童股骨颈骨折切开复位内固定可降低股骨头坏死风险
译者：罗殿中
目的：儿童股骨颈骨折虽然罕见，但存在较高的股骨头坏死风险。本研究纳入儿童股骨颈完全移位型骨折患者，旨在对比其切开复位内固定（ORIF）与闭合复位内固定（CRIF）的治疗差异。
方法：本研究获得伦理委员会批准同意。2003年至2012年共计53例接受治疗的股骨颈骨折儿童。纳入标准包括：（1）诊断为完全移位型股骨颈骨折，无皮质连续；（2）年龄4岁至17岁；（3）临床/影像学随访超过1年。我们回顾性分析患者病历及影像学资料，排除了16例非完全移位股骨颈骨折患者、4例年龄不符合纳入标准患者、1例影像学资料不全患者及10例未随访时间不足的患者。最终纳入的22例患者包括6例ORIF及16例CRIF。
结果：结果显示CRIF组股骨头坏死发生率显著高于ORIF组（P=0.051）。此外，与CRIF组相比，ORIF组患者有更好的骨折对位质量（P=0.009）、更高的骨折解剖愈合率（P=.046）及更少的并发症发生率（P=.009）。ORIF组较CRIF组更少发生主要术后并发症（P=0.015）。手术最终影像结果依据Ratliff的优、良、差分级评估，两组间对比无明显差异（P=0.477）。
结论：相比CRIF，ORIF治疗儿童完全移位型股骨颈骨折有着更高质量的复位，且包括股骨头坏死在内的并发症发生率较低。
Open Reduction of Pediatric Femoral NeckFractures Reduces Osteonecrosis Risk
Pediatric femoral neck fractures are rare injuries that are associated with a high riskof osteonecrosis of the femoral head. This study compared pediatric patients with fully displaced femoral neck fractures treated with either open reduction and internal fixation (ORIF) or closed reduction and internal fixation (CRIF). After institutional review board approval was obtained, the authors identified 53 patients who were treated for femoral neck fracture between 2003 and 2012. Inclusion criteria were as follows: (1) diagnosis of a fully displaced femoral neck fracture with no anatomic cortical contact; (2) age of at least 4 years; and (3) clinical/radiographic follow-up of at least 1 year. Medical records and radiographs were retrospectively reviewed. Excluded from the study were 16 patients who had fractures that were not fully displaced, 4 who were outside ofthe eligible age range, 1 who had insufficient radiographs, and 10 who had insufficient follow-up. Of the 22 patients included, 6 were treated with ORIF and 16 were treated with CRIF. Treatment groups were compared with Fisher' sexact test for categorical outcome data and the Wilcoxon rank-sum test for continuous variables. There was a significantly (P=.051) greater occurrence of osteonecrosis after CRIF (50%) than after ORIF (0%). Further, patients who underwent ORIF had a higher (P=.009) quality of reduction, a higher (P=.046) rate of anatomic union, and fewer (P=.009) complications than those who underwent CRIF. Major complications occurred in significantly fewer (P=.015) hips after ORIF than after CRIF. No significant difference (P=.477) was seen between groups, according to the Ratliff assessment of final results. Fully displaced pediatric femoral neck fractures treated with ORIF had a significantly higher quality of reduction, with fewer complications, including osteonecrosis, than those treated with CRIF.
文献出处：Joseph D. stone,MD; Mary K. hill, Ba; Zhaoxing pan, phD; eDuarDo n. novais, MD. Open Reductionof Pediatric Femoral Neck Fractures Reduces Osteonecrosis Risk. Orthopedics.2015; 38(11):e983-e990.
文献2
股髋撞击综合征的手术指征：范围综述
译者：程徽
背景：本综述目的是分析和报告股髋撞击综合征（FAIS）的手术适应证，其中包括开放手术和关节镜手术。
方法：在图书馆检索员协助下，作者检索了Medline、CINAHL和Emabase这三个数据库，找出所有与FAIS手术适应证相关的文章。本研究纳入两类论文：针对FAIS手术治疗疗效（无论是否合并盂唇损伤）的研究论文，和文中阐述了FAIS手术适应证的论文。
结果：在所有纳入的的论文中，92%的论文将影像诊断作为手术适应证。其中，Alpha角是最常见的影像诊断指标，见于68%的论文中。在75%的论文将患者的症状作为手术适应证；70%的论文以特殊体格检查为手术适应证。在30%的论文将关节活动范围受限作为手术适应证。只有12%的研论文中，手术前进行了髋关节腔内注射。44%的论文将保守治疗失败（非手术治疗和理疗师主导下的康复治疗）作为手术适应证。所有纳入到本研究的论文中，只有56%遵循FAIS会议上通过的《Warwick共识》，综合考虑症状、体征和影像学改变三方面内容来确诊FAIS.
结论：对FAIS来说，影像学证据是目前最常见的手术适应证。只有56%的论文综合考虑症状、体征和影像学改变这三方面来诊断FAIS，仅44%的论文将保守治疗失败（18%为物理疗法治疗失败）作为手术治疗的先决条件。
Surgical criteria for femoroacetabularimpingement syndrome: a scoping review
AbstrAct background: The purposeof this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS).
Methods: Alibrarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery was used in this study. Inclusion criteria included studies with the primary purpose of surgery or surgical outcomes for treatment of FAIS with and without labral tear, and reporting criteria for FAIS surgery.
Results: Diagnostic imaging was a criterion for surgery in 92% of the included studies, with alpha angle the most frequently reported (68% of studies) criterion. Reporting of symptoms was a criterion for surgery in 75%, and special tests a criterion in 70% of studies. Range-of-motion limitations were only a required criterion in 30%, only 12% of studies required intra-articular injection and 44% of studies described previously failed treatment (non-surgical or physiotherapist-led rehabilitation) as a criterion for surgery. Only 56% of included studies utilised the combination of symptoms,clinical signs and diagnostic imaging combined for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting.
Conclusion: Diagnostic imaging evidence of FAIS was the most commonly reported criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting, and only 44% of studies had failed non-surgical treatment (and 18% a failed trial of physiotherapy) as a criterion for surgery.
文献出处：Scott Peters, Alisha Laing, Courtney Emerson, Kelsey Mutchler, ThomasJoyce, Kristian Thorborg, Per Hölmich, Michael Reiman. Surgical criteria for femoroacetabular impingement syndrome: a scoping review. Br J Sports Med. 2017Nov;51(22):1605-1610.
文献3
32例髋关节发育不良患者髋臼周围截骨术后1年步态的运动学与动力学研究
译者：肖凯
背景及目的：髋臼周围截骨术是治疗髋关节发育不良的有效方式。我们对接受髋臼周围截骨术的年轻患者术前与术后6-12个月分别进行行走及跑步中的步态分析，比较关节活动度与关节运动模式的变化，同时选择正常人群做对照。
病人及方法：我们通过应用3D运动捕捉系统来收集关节运动学与动力学的数据。本研究共纳入了23例髋关节发育不良患者，年龄18-53岁，术前术后分别进行步态分析，收集步态周期中最大髋关节后伸角度、屈髋力矩峰值。同时，本研究选取32例18-54岁正常人做对照。
结果：与正常人群相比，髋关节发育不良患者行走过程中最大髋关节后伸角度、屈髋力矩峰值的基线值明显减小。行走时屈髋力矩峰值在术后6个月及12个月时较术前增加，跑步时屈髋力矩峰值在术后6个月时较术前增加。术后12个月的跑步屈髋力矩峰值的改善情况并不具有统计学意义。术后12个月的行走最大屈髋角度较术前增加，但并无统计学意义。正常人群间隔12个月测量的最大髋关节后伸角度、屈髋力矩峰值均无统计学差异。
结论：有症状的髋关节发育不良患者在接受髋臼周围截骨术后，行走及跑步的情况均较术前改善，尽管术后12个月还在发生步态的变化。
Joint kinematics and kinetics during walking and running in 32 patients with hip dysplasia 1 yearafter periacetabular osteotomy
BACKGROUND AND PURPOSE: Hip dysplasia can be treated with periacetabular osteotomy(PAO). We compared joint angles and joint moments during walking and running inyoung adults with hip dysplasia prior to and 6 and 12 months after PAO withthose in healthy controls.
PATIENTS AND METHODS: Joint kinematics and kinetics were recorded using a 3-Dmotion capture system. The pre- and postoperative gait characteristicsquantified as the peak hip extension angle and the peak joint moment of hipflexion were compared in 23 patients with hip dysplasia (18-53 years old).Similarly, the gait patterns of the patients were compared with those of 32controls (18-54 years old).
RESULTS: Duringwalking, the peak hip extension angle and the peak hip flexion moment weresignificantly smaller at baseline in the patients than in the healthy controls.The peak hip flexion moment increased 6 and 12 months after PAO relative tobaseline during walking, and 6 months after PAO relative to baseline duringrunning. For running, the improvement did not reach statistical significance at12 months. In addition, the peak hip extension angle during walking increased12 months after PAO, though not statistically significantly. There were nostatistically significant differences in peak hip extension angle and peak hipflexion moment between the patients and the healthy controls after 12 months.
INTERPRETATION: Walkingand running characteristics improved after PAO in patients with symptomatic hipdysplasia, although gait modifications were still present 12 monthspostoperatively.
文献出处：Jacobsen JS, NielsenDB, Sørensen H, et al. Joint kinematics and kinetics during walking and runningin 32 patients with hip dysplasia 1 year after periacetabular osteotomy. Acta Orthop, 2014,85(6):592-599.
文献4
髋臼周围截骨术后参加体育运动是否会导致骨关节炎进展？
译者：张振东
背景：髋臼周围截骨术（Periacetabularosteotomy, PAO）可有效治疗有症状的髋关节发育不良患者，但目前尚不明确PAO术后参加体育运动是否会导致骨关节炎进展。
方法：本研究为病历对照研究，回顾性分析1998年至2011年161例（183髋）因髋关节发育不良接受PAO治疗的患者临床资料。患者术前骨关节炎KL分期为1或2期，手术时年龄为42.0±10.9岁（范围：12-64岁），术后平均随访100月（范围：13-180月）。分别记录患者参加体育运动类型、UCLA评分、手术年龄、体重指数（BMI）、随访时间、既往治疗史、Merle d'Aubigné-Postel评分、牛津髋关节评分、CE角以及骨关节炎KL分期等。通过单因素和多因素分析明确PAO术后关节炎进展至3期或4期的危险因素。
结果：术后参加体育运动的患者数量（89例，55.3%）较术前（50例，31.1%）明显增加。UCLA评分由术前4.7±2.1分显著增加至术后5.5 ± 2.0分。共计16髋骨关节炎KL分期进展至3或4期，其中4例行关节置换。截止术后末次随访，骨关节炎进展与未进展患者相比，术后参加运动比例（11髋[68.8%] vs 89髋[53.3%]，P=0.24）及UCLA评分（5.1 ± 2.0分 vs 5.6 ± 2.0，P=0.30）均无统计学差异。多因素分析显示包括术后体育运动在内的多种因素均与骨关节炎进展无关。
结论：截止中期随访，PAO术后患者参加体育运动并不会导致骨关节炎进展。
Does Participation in Sports Affect Osteoarthritic ProgressionAfter Periacetabular Osteotomy?
BACKGROUND: Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients isunclear.
PURPOSE: Toinvestigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade.
STUDYDESIGN: Case-control study; Level of evidence, 3.
METHODS: The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range,12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO.
RESULTS: The numberof patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwen tconversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. Amultivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4.
CONCLUSION: Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.
文献出处：Hara D,Hamai S, Fukushi JI, Kawaguchi KI, Motomura G, Ikemura S, Komiyama K, NakashimaY. Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy? Am J Sports Med. 2017 Sep;45(11):2468-2475.
文献5
DDH患儿（出生到6月龄）诊断和治疗的最新进展
译者：杨金鑫
目的：目前对DDH流行病学、诊断和治疗方法的理解正在不断加深。本综述着重介绍了出生到6月龄DDH患儿治疗的最新进展。
最新研究结果：DDH的已知易患因素包括家族病史、女性和胎位为臀位。最新的证据表明，胎儿超重是易患因素，而早产可能会降低DDH的发生率。DDH的筛查方法包括对所有新生儿行髋关节物理检查，并对体检异常或存在高危因素的新生儿行影像学检查。六月内患儿的挽具治疗成功率为70%-95%。挽具治疗失败的因素包括:股神经麻痹、用关节不能活动的支具治疗、难复位的髋关节、七周后才开始治疗的患儿、右髋关节脱位、Graf-IV型髋关节脱位、男性患儿。挽具治疗失败后应试用支具治疗，支具治疗失败后应采用闭合复位术。如果闭合复位术仍不能使髋关节达到稳定复位，则需行髋关节切开复位术。没有证据支持骨化中心形成后再行髋关节复位术。
总结：新生儿DDH的发病率是1-7%。所有的新生儿都应该接受DDH的普查，对存在易患因素及初筛异常的新生儿应该接受超声及影像学的再次筛查。DDH越早治疗，效果越好。
Developmental dysplasia of the hip:an update on diagnosis and management from birth to 6 months
PURPOSE OFREVIEW: Our understanding of the epidemiology, diagnosis, and management of developmental dysplasiaof the hip (DDH) is evolving. This review focuses on the most up-to-date literature on DDH in patients from birth to six months of age.
RECENTFINDINGS: Well known risk factors for DDH include family history, female sex, and breech positioning. Recent evidence suggests higher birth weight is a risk, where asprematurity may be protective. Screening includes physical examination of all infant hips and imaging when abnormal findings or risk factors are present. Treatment in the first six months consists of a harness, with 70-95% success. Failure risk factors include femoral nerve palsy, static bracing, irreducible hips, initiation after seven weeks of age, right hip dislocation, Graf-IV hips, and male sex. Rigid bracing may be trialed if reduction with a harness fails and closed reduction is indicated after failed bracing. If the hip is still irreducible, nonconcentric, or unstable, open reduction may be required following closed reduction. Evidence does not support delaying hip reduction until the ossific nucleus is present.
SUMMARY: DDH affects 1-7% of infants. All infants should be examined and selective screening with imaging should be performed for abnormal physical exams or risk factors. Early treatment is associated with optimal outcomes.
文献出处：Swarup I, Penny CL, Dodwell ER. Developmental dysplasia of the hip: an update on diagnosis and management from birth to 6 months. Curr Opin Pediatr. 2018. 30(1): 84-92.
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来源：304关节学术
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