本期目录：
1、全膝关节置换术中使用高型合度聚乙烯垫片而牺牲后交叉韧带的影响
2、股骨远端去旋转截骨可有效治疗髌骨不稳定
3、全髋关节置换术治疗年轻髋关节股骨头坏死的疗效观察
4、CroweIV型先髋全髋关节置换术中指导髋臼杯安放的几何形态学研究
5、髋关节镜术中透视与标准X线片的比较：一项尸体研究
6、髋关节发育不良患者进行渐进性抗阻训练：可行性研究
7、有关青少年Chiari骨盆内移截骨结果的文献综述
8、髋关节镜下盂唇修复与关节囊重叠缝合治疗临界髋关节发育不良：最少5年的患者随访结果
9、对股骨头骨骺滑脱的理解和治疗方法的全新理解
第一部分：关节置换及保膝相关文献
文献1
全膝关节置换术中使用高型合度聚乙烯垫片而牺牲后交叉韧带的影响
译者：张轶超
背景：关于在全膝置换术（TKA）中使用保留后交叉韧带（PCL）假体与不保留PCL假体哪种更好一直都有争论。我们想确定在TKA中使用高型合度垫片保留PCL和不保留PCL在关节活动度（ROM）方面是否存在差异。
方法：我们选择一个医疗中心审查委员会所认可的从2013年11月到2016年1月的回顾性研究资料，这些连续性病例都是接受了使用相同高型合度假体的TKA手术，由同一名医生完成。所有病人根据术中PCL保持完好和被切断而分为两组。记录病人的年龄，BMI，术中PCL状态（松弛的，保持完好的或切断的）及术前术后膝关节ROM。
结果：各组间平均年龄（60.5岁对60.6岁）和BMI（33.3对32.6）相似。术后胫骨后倾两组间存在差异（PCL切断组5.5°，PCL保留组6.6°，P=0.028）；其它的力线和活动度两组相似。
结论：结果显示使用高型合度界面设计可以很好的保留PCL，没有证据显示会影响术后的ROM，而PCL切断的患者也不会出现关节不稳。
The Effect of Sacrificing the Posterior Cruciate Ligament in Total Knee Arthroplasties That Use a Highly Congruent Polyethylene Component
BACKGROUND: There is continued debate regarding retention versus sacrificing of the posterior cruciate ligament (PCL) in total kneearthroplasty (TKA). We sought to determine if there was a difference in range of motion (ROM) after TKA between patients with PCL sacrifice versus PCL retention when using a highly congruent polyethylene insert.
METHODS: We conducted an Institutional Review Board approved retrospective study of consecutive patients receiving TKA using the same implant with a highly congruent polyethylene component implanted by one surgeon from November 2013 to January 2016. Patients were placed in 2 groups based on whether the PCL was intact or released at the time of surgery. Patient charts were reviewed for age, body mass index, PCL status at surgery (incompetent, kept intact, or released), and preoperative/postoperative knee ROM.
RESULTS: Both groups were similar in average age (60.5 vs 60.6, respectively) and body mass index (33.3 vs 32.6, respectively). Postoperative tibial slope (5.5° PCL release, 6.6° PCL retained, P = .028) was the only alignment variable reaching significance; all other alignment and motion variables were similar.
CONCLUSION: Results indicate that the PCL can be successfully retained with the use of a congruent bearing design, with no evident limitation in postoperative ROM or loss of stability due to the bearing in comparison to patients who undergo PCL release.
文献出处：Stronach BM, Adams JC, Jones LC, Farrell SM, Hydrick JM. The Effect of Sacrificing the Posterior Cruciate Ligament in Total Knee Arthroplasties That Use a Highly Congruent Polyethylene Component. J Arthroplasty. 2019 Feb;34(2):286-289. doi: 10.1016/j.arth.2018.10.006. Epub 2018 Oct 13.
文献2
股骨远端去旋转截骨可有效治疗髌骨不稳定
译者：罗殿中
目的：股骨前倾角的增加可影响髌股关节的生物力学特点，本研究通过回顾性分析股骨远端去旋转截骨治疗髌股关节不稳的病例，评估其临床疗效。
方法：本研究纳入2007年至2016年所有接受股骨远端去旋转截骨术（图1）的髌股关节不稳的患者，排除标准包括：骨骺未闭、创伤后畸形以及随访时间小于12月者。依据核磁等影像学检查评估是否存在软骨损伤及股骨滑车发育不良，并测量胫骨结节至股骨滑车沟间距及下肢力线情况。此外还于术前术后分别评估患者VAS疼痛评分、WOMAC评分、主观IKDC评分、Lysholm评分及Tegner活动度评分等。
图1 左图为股骨远端截骨术后X线片。黑色箭头所示为截骨线，固定方式为股骨远端外侧锁定碳板。白色箭头及★所示为内侧髌股韧带重建部位（示意图见右）。
结果：222例股骨截骨的患者中，共42例（44膝）符合纳入标准。术前股骨前倾角平均为31°（标准差±9°），平均外翻角度为1°（标准差±3°）。除股骨去旋转截骨外，还联合使用的术式包括：内侧髌股韧带重建64%（28例）、髌股关节成型18%（8例）、股骨滑车节成型14%（6例）以及胫骨结节移位14%（6例）。平均随访时间为44月（标准差±27，范围：12-88月），失访5例。VAS疼痛评分由术前4±3改善至2±2分，WOMAC评分由术前80±14改善至88±16分（图2），Lysholm评分由术前46±21改善至71±24分，IKDC评分由术前54±13改善至65±17分。随访期间无髌骨再脱位发生。
结论：联合使用股骨远端去旋转截骨术治疗由股骨扭转畸形所致的髌骨不稳，可显著缓解疼痛、改善膝关节功能，有着较好的短期随访结果。
Derotational osteotomy at the distal femur is effective to treat patients with patellar instability
Abstract Purpose Increased femoral antetorsion influences patellofemoral joint kinematics. The aim of this study was to retrospectively evaluate the clinical outcome after derotational osteotomies and combined procedures in patients with patellofemoral instability.
Methods All patients with derotational osteotomies and combined procedures in patients with patellofemoral instability and increased femoral antetorsion performed between 2007 and 2016 were retrospectively analyzed. Exclusion criteria were open growth plates, posttraumatic deformities, and a follow-up period less than 12 months. Simple radiography and magnetic resonance imaging to evaluate cartilage lesions, trochlear dysplasia, tubercle distance, and osseous malalignment as frontal axis and torsion were performed on every patient. Patients were evaluated pre- and postoperatively using the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the subjective IKDC evaluation form, the Lysholm score, and the Tegner activity score.
Results Out of 222 femoral osteotomies, a total of 42 patients (44 knees) met the inclusion criteria. Mean preoperative femoral antetorsion of 31° (SD ± 9°) and mean valgus malalignment of 1° (SD ± 3°) were observed. An intended derotation of 12° (SD ± 5°) was set overall. The additional procedures included correction of valgus in 50% (n = 22), MPFL reconstruction in 64% (n = 28), patellofemoral arthroplasty in 18% (n = 8), trochleoplasty in 14% (n = 6), tibial tubercle transfer in 14% (n = 6). During the mean follow-up period of 44 months (SD ± 27, range 12–88), a total of five patients were lost to follow-up, resulting in a follow-up rate of 89% (n = 39). A significant pain relief from VAS 4 (SD ± 3) to VAS 2 (SD ± 2) (p = 0.006) as well as improved scores, WOMAC: from 80 (SD ± 14) to 88 (SD ± 16) (p = 0.007), Lysholm: from 46 (SD ± 21) to 71 (SD ± 24) (p < 0.001), IKDC: from 54 (SD ± 13) to 65 (SD ± 17) (p < 0.001), were observed postoperatively. During the follow-up period, no patellar re-dislocation was observed.
Conclusion Combined derotational osteotomy is a suitable treatment for patellar instability due to torsional malformity, as it leads to a significant reduction of pain, and a significant increase of knee function with good-to- excellent results in the short-term follow-up.
文献出处：Imhoff FB, Cotic M, Liska F, Dyrna FGE, Beitzel K, Imhoff AB, Herbst E. Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):652-658. doi: 10.1007/s00167-018-5212-z. Epub 2018 Oct 13.
文献3
全髋关节置换术治疗年轻髋关节股骨头坏死的疗效观察
译者：马云青
背景：髋关节股骨头坏死是一种典型的临床、影像学和病理学明确的疾病，通常影响年轻患者。本研究评估35岁或更年轻的股骨头坏死患者的长期假体生存率和初次全髋关节置换术(THA)后的患者的疗效。
方法：通过单一医学中心的临床资料进行一项回顾性研究，并进行了前瞻性随访。对年轻股骨头坏死接受THA治疗的患者进行回顾性分析，并进行随访调查，以确定种假体生存时间和患者报告的临床结果。采用Kaplan-Meier生存分析评估假体生存，采用髋关节功能障碍和骨关节炎结局评分(HOOS)描述患者临床疗效。
结果：该研究纳入135名患者(204例THAs)，平均随访时间为14年。本组10年假体存活率为86%，20年假体存活率为66%。男性患者(p = 0.02)和25岁以上患者(p = 0.03)的假体生存时间更长。随访中疼痛，日常症状和ADLs的平均HOOS评分为87分，运动评分为77分。翻修THA患者的所有HOOS评分均较低，手术时年龄大于25岁的患者HOOS- pain和HOOS-sport评分较低(p<0.05)。
结论：年轻的股骨头坏死患者有良好的假体生存率和长期预后疗效。在预测年轻股骨头坏死患者THA术后种植体存活和预后功能时，应考虑患者因素和假体自身特征。
Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip
BACKGROUND: Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosisaged 35 or younger.
METHODS: A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.
RESULTS: The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05).
CONCLUSIONS: Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.
文献出处：Swarup I, Shields M, Mayer EN, Hendow CJ, Burket JC, Figgie MP. Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip. Hip Int. 2017 May 12;27(3):286-292. doi: 10.5301/hipint.5000457. Epub 2017 Jan 31.
文献4
CroweIV型先髋全髋关节置换术中指导髋臼杯安放的几何形态学研究
译者：张蔷
目的：我们借助几何形态学分析方法，使用患者的CT数据分析并获得Crowe IV型先髋的全髋关节置换术中髋臼杯中心的理想安放位置，并分析该方法的可靠性。
方法：我们回顾性分析入组了52例Crowe IV型髋关节（42名患者，7男，35女；平均年龄68.5岁（32-82岁）），50例相对正常髋关节（50名患者，8男，42女；平均年龄60.7岁（34-86岁））的全髋关节置换手术病例。在这一基于CT数据的模拟研究中，我们将髋臼杯安放在真臼位置上，外展角40°，前倾角20°。我们使用广义对齐算法（GPA）这一几何形态学方法分析髋臼形态以及髋臼杯中心的安放位置。
三角形状的真臼，髋臼杯中心在后壁的中上三分之一附近（蓝点位置）
结果：Crowe IV型先髋的髋臼通常呈现独特的三角形，而髋臼杯中心的理想安放位置在髋臼后壁的上方。在曲线分析中，前两个扭曲点分别可以覆盖34.2%和18.4%的变量，而相对正常组可以覆盖28.6%和18.0%的变量。我们以后壁的中上三分之一作为髋臼杯中心的参照点，髋臼杯的中心距参照点的平均距离为5.6mm。
黑色箭头指示真臼位置，蓝色箭头指示髋臼杯中心点
结论：Crowe IV型先髋的髋臼是独特的三角形，而在安放髋臼杯时后壁的中上三分之一是一个十分重要的骨性标志物。
Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty
Aims: We analyzedthe acetabular morphology of Crowe type IV hips using CT data to identify alandmark for the ideal placement of the center of the acetabular component, asassessed by morphometric geometrical analysis, and its reliability.
Patients and Methods: A total of 52 Crowe IV hips (42 patients; seven male, 35 female; mean age 68.5 years (32to 82)) and 50 normal hips (50 patients; eight male, 42 female; mean age 60.7years (34 to 86)) undergoing total hip arthroplasty were retrospectively identified. In this CT-based simulation study, the acetabular component waspositioned at the true acetabulum with a radiological inclination of 40° andanteversion of 20°. Acetabular shape and the position of the center of theacetabular component were analyzed by morphometric geometrical analysis usingthe generalized Procrustes analysis.
Results: Theacetabular shapes of Crowe IV hips were distinctively triangular; the idealposition of the center of the acetabular component was superior on theposterior bony wall. The first and second relative warps explained 34.2% and18.4% of the variance, respectively, compared with that of 28.6% and 18.0% innormal hips. We defined the landmark as one-third the distance from top on theposterior bony wall in Crowe IV hips. The average distance from the center ofthe acetabular component was 5.6 mm.
Conclusion: Crowe IVhips are distinctively triangular; the point one-third from the top on theposterior bony wall was a useful landmark for placing the acetabular component.
文献出处：J.Yoshitani, T. Kabata, Y. Kajino, T. Ueno, K. Ueoka, T. Nakamura, H. Tsuchiya. Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty. Cite thisarticle: Bone Joint J 2019; 101-B: 189–197.
第二部分：保髋相关文献
文献1
髋关节镜术中透视与标准X线片的比较：一项尸体研究
译者：程徽
目的：比较术中透视和标准的前后位骨盆X光片上测量的的髋臼形态的指标。
投照中心对图像的影响
方法：使用以髋关节为中心的透视和标准前后位骨盆X射线片对10个干燥的人骨盆标本（20髋）进行成像。评估每个髋关节的髋臼形态和覆盖范围，指标包括侧中心边缘（LCE）角，髋臼指数（AI），前覆盖率，后覆盖率和交叉征。
结果：平均LCE角度（透视36.5°±8.3° vs 平片36.1°±7.9°，P =0.59），髋臼指数（0.6°±8.6° vs 0.2°±7.1°，P =0.61），ACM角（44.0°±2.6° vs44.1°±3.8°，P = 0.89），Sharp角（31.8°±5.7° vs 32.4°±3.9°，P =0.44），外侧覆盖率（80.9％±6.4％ vs 80.7％±7.5％，P =0.83）之间无统计学差异。相反，与平片X射线照相相比，前覆盖率（30.7％±8.5％ vs 33.3％±8.2％，P <0.0001）显着下降，后覆盖率（54.1％±6.9％vs 49.1％±7.8％，P <0.0001）显着增加。透视检查漏诊了30％的交叉征，并且低估了后倾指数（9％±16％，v 13％±16％，P =0.016）。
结论：通过以髋部为中心的透视检查确定的LCE角度和AI的值，与标准前后平片获得的值没有差异。然而，与标准化骨盆前后位片相比，在透视观察中髋臼看起来更加前倾，前覆盖率显着降低，后覆盖率显着增加。
临床相关性：该研究显示了透视可以可靠的反映LCE和AI角度，但在髋臼前后倾方面，透视和标准骨盆前后位片存在显着差异。
IntraoperativeEvaluation of Acetabular Morphology in Hip Arthroscopy Comparing StandardRadiography Versus Fluoroscopy: A Cadaver Study
PURPOSE: To compare quantitative measurements of acetabular morphology obtained usingintraoperative fluoroscopy, to standardized anteroposterior (AP) pelvisradiographs.
METHODS: Ten dried human pelvis specimens (20 hips) were imaged using hip-centeredfluoroscopy and standardized AP pelvis radiographs. Each hip was evaluated foracetabular version and coverage, including lateral center edge (LCE) angle,acetabular index (AI), total anterior and posterior coverage, and crossoversign.
RESULTS: No statistically significant differences existed between the mean LCE angle(fluoroscopy 36.5° ± 8.3° v plain films 36.1° ± 7.9°, P = .59), acetabular index (0.6° ± 8.6° v 0.2° ± 7.1°, P = .61), ACM angle (44.0° ± 2.6° v 44.1° ±3.8°, P = .89), Sharp's angle (31.8° ± 5.7° v 32.4° ± 3.9°, P = .44), and thetotal femoral coverage (80.9% ± 6.4% v 80.7% ± 7.5%, P = .83). Conversely,total anterior coverage (30.7% ± 8.5% v 33.3% ± 8.2%, P < .0001) appearedsignificantly decreased and the total posterior coverage (54.1% ± 6.9% v 49.1%± 7.8%, P < .0001) appeared significantly increased in fluoroscopy comparedwith plain film radiographs. Fluoroscopy also failed to identify the presenceof a crossover sign in 30% and underestimated the retroversion index (9% ± 16%,v 13% ± 16%, P = .016).
CONCLUSIONS: The values for the LCE angle and AI determined by hip-centered fluoroscopy didnot differ from those obtained by standardized AP plain film radiography.However, fluoroscopy leads to a more anteverted projection of the acetabulumwith significantly decreased total anterior coverage, significantly increasedtotal posterior coverage, and underestimated signs of retroversion compared with standardized AP pelvis radiography.
CLINICALRELEVANCE: This study shows reliable LCE and AI angles but significantdifferences in the projected anteversion of the acetabulum between standardizedAP pelvis radiography and hip-centered fluoroscopy.
文献出处：Büchler L, Schwab JM, Whitlock PW, Beck M, Tannast M. Arthroscopy. Intraoperative Evaluation of Acetabular Morphology in Hip Arthroscopy ComparingStandard Radiography Versus Fluoroscopy: A Cadaver Study.2016 Jun;32(6):1030-7.doi: 10.1016/j.arthro.2015.12.048. Epub 2016 Mar 15.
文献2
髋关节发育不良患者进行渐进性抗阻训练：可行性研究
译者：肖凯
目的：明确有症状的髋关节发育不良患者在接受髋臼周围截骨术治疗前进行渐进性抗阻训练是否可行。次要目标是调查患者自我评分结果、髋关节功能及和髋部肌肉力量改善情况。
设计：可行性研究。
患者和方法：17名患者（中位年龄28岁，范围22-40岁）在指导下进行了为期8周（20次）的渐进性抗阻训练。记录了患者训练依从性、中途退出训练情况和不良事件的发生率。记录疼痛VAS评分。患者完成髋关节和腹股沟结果评分（Hip andGroin Outcome Score），进行2次跳跃测试，并通过等速测力法评估髋部峰值扭矩。
结果：患者训练依从性为90.3±9％。不良事件发生很少且轻微，一名患者中途退出，在训练期间患者报告了可接受的疼痛水平。6个患者自我评分量表中有4个得分改善（p<0.05），站立跳跃距离提高了12.2％（95％置信区间[1.3,23.0]），反向运动跳跃提高了25.1％（95％置信区间 [1.3,48.8]）。患侧等速髋关节屈曲峰值扭矩改善16.5%（95％置信区间[4.6,28.6]），健侧等长髋关节屈曲改善10.9%（95％置信区间 [0.3,21.6]）。
结论：对于髋关节发育不良患者，在进行髋臼周围截骨术前指导进行抗阻训练是可行的。此干预可改善疼痛水平，提高患者自我评分量表结果，改善髋关节功能表现和髋关节屈曲肌肉力量。
Progressive resistance training in patients with hip dysplasia: A feasibility study
OBJECTIVES: To examine whether progressive resistance training is feasible in patients with symptomatic hip dysplasia scheduled for periacetabular osteotomy. A secondary objective was to investigate patient-reported outcomes, functional performance and hip muscle strength.
DESIGN: Feasibility study.
PATIENTS AND METHODS: Seventeen patients (median age 28 years, range 22-40 years) performed 8 weeks (20 sessions) of supervised sessions of progressive resistance training. Training-adherence, number of dropouts and adverse events, and visual analogue scale scores on pain were registered. Patients completed the Hip and Groin Outcome Score, performed 2 hop-tests, and hip peak torque was assessed by isokinetic dynamometry.
RESULTS: Training-adherence was 90.3±9%. Few and minor adverse events were observed, one patient dropped out and acceptable pain levels were reported during the intervention. Scores on 4 out of 6 subscales on patient-reported outcome improved (p <0.05), as did standing distance jump (12.2%, 95% confidence interval (CI) [1.3, 23.0]), countermovement jump (25.1%, 95% CI [1.3, 48.8]). Isokinetic concentric hipflexion peak torque showed significant improvements (16.6%, 95% CI [4.6, 28.6]) on the affected side while isometric hip flexion (10.9%, 95% CI [0.3, 21.6]) improved on the non-affected side.
CONCLUSION: Supervised progressive resistance training is feasible in patients with hip dysplasia. The intervention may improve pain levels, patient-reported outcomes, functional performance and hip flexion muscle strength.
文献出处：Mortensen L, Schultz J, Elsner A, Jakobsen SS, Søballe K, Jacobsen JS, Kierkegaard S, Dalgas U, Mechlenburg I. Progressive resistance training in patients with hip dysplasia: A feasibility study. J Rehabil Med. 2018 Aug 22;50(8):751-758. doi: 10.2340/16501977-2371.
文献3
有关青少年Chiari骨盆内移截骨结果的文献综述
译者：任宁涛
目的：Chiari骨盆内移截骨是利用髂骨骨松质包容股骨头和负重的一种手术技术，是最有争议的髋关节截骨方式。本研究旨在研究儿童行Chiari骨盆内移截骨中期随访结果。
方法：从1995年到2004年，共进行了20例Chiari骨盆内移截骨术（18个患者），其中包含15名男性，3名女性，手术时平均年龄为12.6岁，平均随访时间为54个月。采用 Chiari描述的手术方法，选择髂股入路，不使用牵引床，如股骨头前侧或前外侧覆盖小，则进行局部植骨造盖。
结果：截骨角度平均为12度，距离髋臼平均为3.2mm，平均内移程度为42%。从临床疗效和影像学观察，20例Chiari骨盆内移截骨中11例效果为优，8例为良，1例为可。T- Test检验发现髋关节影像学参数（Sharp角、CE角和股骨头覆盖率）均有改善。25%的病例出现骨移植物的吸收。
结论：10岁以下的Chiari骨盆内移截骨术的适应症非常罕见。由于移植物吸收率高，当有髋关节前侧或前外侧覆盖不良时，不首选Chiari骨盆内移截骨。
图1 Chiari骨盆内移截骨影像学参数，Chiari截骨角度（a），参考线（平行于双侧泪滴连线）与截骨线之间的角度；内移=A/B × 100。
图2 男孩，9.5岁，LCPD，8岁时行股骨近端内翻截骨术，术后18个月后行Chiari骨盆内移截骨和骨移植术（A-C），Chiari术后9年随访发现骨移植物吸收，股骨头覆盖不良。
The results of Chiari pelvicosteotomy in adolescents with a brief literature review
PURPOSE: Chiari medialdisplacement osteotomy is a procedure that uses the cancellous boneof the ilium to contain the femoral head and bear weight. It is the most contraversial osteotomy ofthe hip joint. This study was therefore conducted to determine the results ofthis osteotomy with mid-term follow-up in children.
METHODS: From 1995 to 2004,20 Chiari pelvic osteotomies (in 18 patients) were performed.There were 15 male and 3 female patients. The average age at operation was 12.6years and the mean follow-up was 54 months. The operative technique was asdescribed by Chiari. An iliofemoral approach was used without utilizing atraction table. If there was anterior or anterolateral uncoverage of thefemoral head, bone graft augmentation was performed.
RESULTS: The angle of the osteotomy averaged12 degrees , with the distance from the acetabulum averaging 3.2 mm. Theaverage displacement was 42%. Of the 20 Chiari osteotomies, 11 werecategorized as excellent, 8 as good and one as fair in terms of clinical andradiological results. Student's t test statistics showed improvements inall radiologic parameters of the hip joint (Sharp angle, center-edge angle andcoverage of the femoral head). Graft resorption was observed in 25% of thepatients.
CONCLUSION: There are very rareindications of Chiari osteotomy in patients younger than 10years. Because of the high rate of graft resorption, Chiari osteotomy shouldbe the last treatment option when there is anterior or anterolateral uncoverageof the hip joint.
文献出处：Karami M, Fitoussi F, IlharrebordeB, Penneçot GF, Mazda K, Bensahel H.Theresults of Chiari pelvic osteotomy in adolescents with a brief literaturereview. J Child Orthop. 2008Feb;2(1):63-8. doi: 10.1007/s11832-007-0071-z. Epub 2008 Jan 3.
文献4
髋关节镜下盂唇修复与关节囊重叠缝合治疗临界髋关节发育不良：最少5年的患者随访结果
译者：张利强
背景：发育性髋关节发育不良（DDH）的关节镜治疗一直存在争议，已被证明效果参差不齐。而对强调盂唇和关节囊作为次要稳定结构的临界DDH患者的研究表明，接受关节镜治疗的患者，其病人回馈结果（PROs）都有改善。
目的/假设：本研究旨在评估在最少5年的随访中，临界DDH患者行髋关节镜下盂唇修复与关节囊重叠缝合是否具有长久的、积极的结果。假设仔细选择患者，结果将是良好的。
方法：对40岁以下髋关节内病变行关节镜手术治疗患者的资料进行前瞻性收集和回顾性分析。入选标准包括外侧中心边缘角（LCEA）在18°到25°之间，并行盂唇修复与关节囊重叠缝合，最少5年随访。排除标准为严重发育不良（LCEA18°）、Tonnis分级≥2、儿童期既往髋关节疾病或髋关节手术。于术后3月及每年分别收集包括改良Harris评分（mHHS）、NAHS评分、HOS-SSS评分和VAS评分的PRO s分数。并记录术后并发症和翻修情况。
结果：25髋（24例）符合入选标准。21髋（19例，84%）得到随访。平均手术年龄为22.9岁。平均术前LCEA和Tonnis角分别为21.7°（范围，18°至24°）和6.9°（范围，-1°至16°）。平均随访时间为68.8个月。mHHS平均值从70.3增加到85.9（p<0.0001），NAHS平均值从68.3增加到87.3（p<0.0001），HOS-SSS平均值从52.1增加到70.8（p=0.0002）。VAS评分平均值从5.6分改善到1.8分（P<0.0001）。4例髋关节（19%）需要二次关节镜检查，所有这些患者在最后的随访中PRO s评分都提高了。没有患者需要行全髋关节置换术。
结论：虽然髋臼周围截骨术仍是治疗真正的髋臼发育不良的标准方法，但中期随访结构显示髋关节镜检查可为处理临界DDH的关节内病变提供一种安全、长久的方法。这些手术应由具有丰富关节镜技术专业知识的外科医生执行，采用严格的患者选择标准并重点行盂唇修复与关节囊重叠缝合。
图1。关节囊移位/折叠。（a）髋关节关节镜手术结束时关节镜下关节囊折叠的目的是使股骨侧关节囊向近端移位。（b）近端的缝线偏向前外侧，远端的缝线偏向内下方，实现错位缝合（c）打结缝线会将内下方关节囊拉向前外侧
图2。关节镜下关节囊折叠/移位术中视图。（a）缝合线斜向穿过关节囊切开部位的股骨侧。（b）缝合处系紧，以产生近端关节囊移位。髋关节保持外展，以确保不发生关节囊的分离。
Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes
Background: The arthroscopic management of hip dysplasia has been controversial and has historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown improvement in patient-reported outcomes (PROs).
Purpose/Hypothesis: The purpose was to assess whether the results of hip arthroscopic surgery with labral preservation and concurrent capsular plication in patients with borderline hip dysplasia have lasting, positive outcomes at a minimum 5-year follow-up. It was hypothesized that with careful patient selection, outcomes would be favorable.
Methods: Data were prospectively collected and retrospectively reviewed for patients aged<40 years who underwent hip arthroscopic surgery for intra-articular abnormalities. Inclusion criteria included lateral center-edge angle (LCEA) between 18° and 25°, concurrent capsular plication and labral preservation, and minimum 5-year follow-up. Exclusion criteria were severe dysplasia (LCEA18°), Tönnis grade2, pre-existing childhood hip conditions, or prior hip surgery. PRO scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) and the visual analog scale (VAS) score for pain were collected preoperatively, at 3 months, and annually thereafter. Complications and revisions were recorded.
Results: Twenty-five hips (24 patients) met the inclusion criteria. Twenty-one hips (19 patients, 84%) were available for follow-up. The mean age at surgery was 22.9 years. The mean preoperative LCEA and Tönnis angle were 21.7° (range, 18° to 24°) and 6.9° (range, -1° to 16°), respectively. The mean follow-up was 68.8 months. The mean mHHS increased from 70.3 to 85.9 (P < .0001), the mean NAHS from 68.3 to 87.3 (P<.0001), and the mean HOS-SSS from 52.1 to 70.8 (P = .0002). The mean VAS score improved from 5.6 to 1.8 (P<.0001). Four hips (19%) required secondary arthroscopic procedures, all of which resulted in improved PRO scores at latest follow-up. No patient required conversion to total hip arthroplasty.
Conclusion: While periacetabular osteotomy remains the standard for treating true acetabular dysplasia, hip arthroscopy may provide a safe and durable means of managing intra-articular abnormalities in the setting of borderline acetabular dysplasia at midterm follow-up. These procedures should be performed by surgeons with expertise in advanced arthroscopic techniques, using strict patient selection criteria, with emphasis on labral preservation and capsular plication.
文献出处：Benjamin G. Domb , Edwin O. Chaharbakhshi, et al. Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes. Am J Sports Med 2018;46(2):305-313
文献5
对股骨头骨骺滑脱的理解和治疗方法的全新理解
译者：陶可（北京大学人民医院骨关节科）
综述目的：回顾性调研股骨头骨骺滑脱（SCFE），重点关注其病因学的研究新进展以及手术固定方法的演变。
最新发现：青春期骨骺结节及其大小对于理解SCFE的发病机制至关重要。在慢性稳定性SCFE中，骨骺围绕结节旋转从而保护录了外侧骨骺血管免于破坏；在急性不稳定性SCFE中，结节发生位移，增加了股骨头坏死的风险，也就是常说的股骨头缺血性坏死（AVN）。术中稳定性表明基于移动的稳定和不稳定来判断的SCFE可能是不准确的。对于稳定性SCFE，原位固定仍然是缓解迟发的症状性股骨髋臼撞击（FAI）伴发轻度滑脱的最常用治疗方法。采用纠正力线的截骨术治疗中重度稳定性滑脱可减少股骨畸形，并可获得更好的预后。然而，它具有更高的并发症风险，包括AVN和软骨碎裂溶解。我们对SCFE病因的探索正不断深入。中度至重度SCFE手术治疗的最佳技术仍存在争议，并且因治疗的中心而有所差异。需要对这些患者进行控制良好的研究，以了解这一难题的最佳治疗策略。此外，提高对SCFE的认识对于早期识别和治疗早期畸形以及避免严重的SCFE畸形至关重要，这也与长期预后较差有关。
Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis
PURPOSE OF REVIEW: To review slipped capital femoral epiphysis (SCFE), with afocus on new insights into its etiology and evolving methods of operativefixation.
RECENT FINDINGS: The epiphyseal tubercle and its size during adolescence areparamount to understanding the mechanism of SCFE. In chronic stable SCFE, theepiphysis rotates about the tubercle protecting the lateral epiphyseal vesselsfrom disruption. In an acute unstable SCFE, the tubercle displaces, increasingthe risk of osteonecrosis, also known as avascular necrosis (AVN).Intraoperative stability suggests that stable and unstable SCFE based onambulation may be inaccurate. For stable SCFE, in situ pinning remains the mostaccepted treatment for mild slips with delayed symptomatic femoroacetabularimpingement (FAI) management. Treatment of moderate to severe stable slips withrealignment osteotomy leads to less femoral deformity and potentially betteroutcomes. However, it has a higher risk of complications, including AVN andchondrolysis. Our knowledge of the etiology for SCFE is evolving. The optimaltechnique for operative treatment of moderate to severe SCFE is controversialand varies by center. Well-controlled studies of these patients are needed tounderstand the best treatment for this difficult problem. Furthermore,increasing the awareness about SCFE is paramount to allow for early recognitionand treatment of deformity at its early stages and avoiding severe SCFEdeformity which has been associated with worse long-term outcomes.
文献出处：Wylie JD, Novais EN.Evolving Understanding of and Treatment Approaches to Slipped Capital FemoralEpiphysis. Curr Rev Musculoskelet Med. 2019 Mar 12. doi:10.1007/s12178-019-09547-5. [Epub ahead of print].
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