本期目录：
1、全膝置换术后股骨骨密度的变化：一项系统性回顾和Meta分析
2、全髋关节置换术患者矢状位脊柱畸形的发生率
3、比较全髋和半髋关节置换手术治疗股骨颈骨折的并发症和支出：一项匹配的大样本量对照研究
4、骶髂关节融合：手术入路及近期报道的预后
5、运动活跃患者接受髋臼周围截骨术后中期随访时可维持正常运动水平
6、股骨不同节段对股骨整体扭转的影响
7、髋关节微不稳定：病因、诊断和治疗
8、胫骨近端骨折和股骨头骨骺向上滑脱：有关联吗？
第一部分：关节置换及保膝相关文献
文献1
全膝置换术后股骨骨密度的变化：
一项系统性回顾和Meta分析
译者：张轶超
背景：全膝关节置换术（TKA）后的骨丢失可能会导致假体周围骨折进而增加了治疗费用（发病率，经济等），手术固定的难度也较大。本Meta分析量化了初次TKA术后股骨远端骨密度（BMD）的改变。
方法：由2个独立分析师系统的对6个数据库的数据进行了系统性回顾。研究了报告膝关节置换术后骨密度的文献并符合入选/排除标准。提取出数据并使用综合Meta分析软件对其进行分析。
结果：有14项研究被纳入研究。BMD在术后3,6,12和24个月时平均下降0.09 [0.05, 0.13]，0.14[0.08, 0.20],0.16[0.10, 0.23]和0.16[0.12, 0.20]g/cm2，相当于BMD丢失了9.3%，13.2%，15.8%和15.4%。各个研究间存在较高的异质性(最高I2> 90%)。
结论：总之，TKA术后6个月内BMD下降得较快达15%，并且持续到24个月。因此就很好理解了，围手术期骨的状况会影响BMD的丢失以及假体周围骨折的风险。
Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis
BACKGROUND: Bone loss after total knee arthroplasty (TKA) may lead to periprosthetic fractures that are associated with significant costs (morbidity, economic, etc.) and pose a challenge to operative fixation. This meta-analysis quantifies the change in bone mineral density (BMD) of the distal femur after primary TKA.
METHODS: A systematic review of six databases was performed by two independent reviewers. Studies that reported bone density after knee arthroplasty were identified and inclusion/exclusion criteria was applied. Data were extracted and analyzed using the Comprehensive Meta-Analysis Software.
RESULTS: Fourteen studies were included in the analysis. The average decrease in BMD was 0.09 [0.05, 0.13], 0.14 [0.08, 0.20], 0.16 [0.10, 0.23], and 0.16 [0.12, 0.20] g/cm2 at 3, 6, 12, and 24 months, respectively, corresponding to a 9.3%, 13.2%, 15.8%, and 15.4% BMD loss. A high degree of heterogeneity existed between the studies (I2 > 90% at most time points).
CONCLUSION: In summary, there is a rapid and significant 15% decrease in BMD in the first 6 months after TKA that is sustained to 24 months. Better understanding regarding how perioperative optimization of bone health may affect BMD loss and the incidence of periprosthetic fracture is essential.
文献出处：Prince JM, Bernatz JT, Binkley N, Abdel MP, Anderson PA. Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis. Arch Osteoporos. 2019 Feb 23;14(1):23. doi: 10.1007/s11657-019-0572-7.
文献2
全髋关节置换术患者矢状位脊柱畸形的发生率
译者：马云青
背景：矢状位脊柱排列与全髋关节置换术(THA)之间的重要关系越来越受到人们的重视。既往的研究表明，矢状位脊柱畸形(SSD)与THA不稳定有着显著的关系。本研究旨在确定术前THA患者中SSD的患病率。
方法：对术前对多中心数据库的患者进行分析，对所有站立位X线片进行测量，测量参数包括骨盆前平面倾斜度(APPt)、脊柱斜度(SPT)和腰椎前凸角(LL)，骨盆入射角(PI)由计算机断层扫描(CT)测量。PI-LL>10°定义为失衡，平衡为-10°~10°的PI-LL，PI-LL<-10°为过度前凸。
结果：共分析1088例(平均64岁，女性占48%)。59%(n=644)患者力线平衡，16%(n=174)PI-LL>10°，4%(n=46)PI-LL>20°(严重平背畸形)。过度前凸的发生率为25%，共270例。严重平背畸形患者较其余患者年龄更大 (69.5y vs 64.0y vs 60.8y，P<0.001)。平背畸形组较其余患者的SPT(24.7°vs 15.4°vs 7.0°)、APPt(-7.1°vs-2.0°vs 2.5°)和PI(64.1°vs 56.8°vs 49.0°)均有显着性差异(P<0.001)。
结论：在接受THA手术的患者中，只有59%的患者有正常排列的腰椎角度。SSD平背的发生率为16%(4%为4%)，其中25%为单纯性前凸。腰椎平背（僵直）与年龄增加、骨盆后倾、PI增大有关。脊柱畸形在这类人群中的患病率相对较高，这就加强了在术前规划和风险分析中考虑髋脊柱力线畸形的重要性。
Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty
BACKGROUND: The important relationship between sagittal spinal alignment and total hip arthroplasty (THA) is becoming well recognized. Prior research has shown a significant relationship between sagittal spinal deformity (SSD) and THA instability. This study aims at determining the prevalence of SSD among preoperative THA patients.
METHODS: A multicenter database of preoperative THA patients was analyzed. Radiographic parameters measured from standing radiographs included anterior pelvic plane tilt, spinopelvic tilt, and lumbar lordosis (LL); pelvic incidence (PI) was measured from computed tomography scans. Lumbar flatback was defined as PI-LL mismatch >10°, balanced as PI-LL of -10° to 10°, and hyperlordosis as PI-LL <-10°.
RESULTS: A total of 1088 patients were analyzed (mean, 64 years; 48% female). And 59% (n = 644) of patients had balanced alignment, 16% (n = 174) had a PI-LL > 10°, and 4% (n = 46) had a PI-LL > 20° (severe flatback deformity). The prevalence of hyperlordosis was 25% (n = 270). Flatback patients tended to be older than balanced and hyperlordotic patients (69.5 vs 64.0 vs 60.8 years, P < .001). Spinopelvic tilt was more posterior in flatback compared to balanced and hyperlordotic patients (24.7° vs 15.4° vs 7.0°) as was anterior pelvic plane tilt (-7.1° vs -2.0° vs 2.5°) and PI (64.1° vs 56.8° vs 49.0°), all P < .001.
CONCLUSION: Only 59% of patients undergoing THA have normally aligned lumbar spines. Flatback SSD was observed in 16% (4% with severe flatback deformity) and there was a 25% prevalence of hyperlordosis. Lumbar flatback was associated with increasing age, posterior pelvic tilt, and larger PI. The relatively high prevalence of spinal deformity in this population reinforces the importance of considering spinopelvic alignment in THA planning and risk stratification.
文献出处：Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ3 Vigdorchik JM. Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty. J Arthroplasty. 2019 Aug 10. pii: S0883-5403(19)30751-X. doi: 10.1016/j.arth.2019.08.020.
文献3
比较全髋和半髋关节置换手术治疗
股骨颈骨折的并发症和支出：
一项匹配的大样本量对照研究
译者：张蔷
背景：在世界范围内，高龄人群的股骨颈移位骨折发生率逐年攀升，而对于选择全髋关节置换还是半髋关节置换治疗的争议仍为解决。尽管全髋关节置换手术可以获得更佳的功能，但伴随而来的是更昂贵的支出和更高的并发症率。我们的研究目的是比较对老年人群股骨颈移位骨折应用全髋关节置换手术或半髋关节置换手术的并发症率和医疗支出。
方法：本研究纳入了自2004年4月1日至2014年3月31日老年人群（60岁及以上）因股骨颈骨折接受全髋关节置换或半髋关节置换手术的患者，并根据患者基本信息、合并症等进行了组间匹配。我们排除了长期居住于医疗康复机构的患者。最终，我们比较了两组间的医疗及手术并发症率，以及围手术期和术后一年的医疗支出。医疗并发症包括术后90天内的急性心梗、深静脉血栓、肺栓塞、肠梗阻、肺炎、肾衰竭，手术并发症包括术后1年内的脱位、感染、翻修手术。支出包括入院手术的全部费用，和术后一年的支出，与术前一年的正常值比较。
结果：初始入组29121名患者，有2713名（9.3%）患者接受了全髋关节置换手术，匹配后分别入组了2689例全髋关节置换术患者和2689例半髋关节置换术患者，与半髋组相比，全髋置换组的患者术后脱位的风险更高（1.7% VS. 1.0%；p = 0.02），而翻修的风险更低（0.2% VS. 1.8%; p < 0.0001）。此外，置换术后一年的总医疗支出大约为2700加元，全髋置换组更低（p < 0.001）。
结论：对股骨颈移位骨折的老年人群来说，相比于半髋关节置换手术，接受全髋关节置换手术的翻修率更低，手术及术后一年的医疗支出更低。
Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study
Background: Although the prevalence of displaced femoral neck fractures in the elderly population is increasing worldwide, there remains controversy as to whether these injuries should be managed with hemiarthroplasty or total hip arthroplasty. Although total hip arthroplasties result in better function, they are more expensive and may have higher complication rates. Our objective was to compare the complication rates and health-care costs between hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the elderly population.
Methods: A population-based, retrospective cohort study was performed on adults (≥60 years of age) undergoing either hemiarthroplasty or total hip arthroplasty for hip fracture between April 1, 2004, and March 31, 2014. We excluded patients who resided in long-term care facilities prior to the injury and those who were discharged to these facilities after the surgical procedure. Patients who underwent a hemiarthroplasty and those who underwent a total hip arthroplasty were matched using a propensity score encompassing patient demographic characteristics, patient comorbidities, and provider factors. After matching, we compared the rates of medical and surgical complications, as well as the perioperative and postoperative health-care costs in the year following the surgical procedure. The primary outcome was the occurrence of a medical complication (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, ileus, pneumonia, renal failure) within 90 days or a surgical complication (dislocation, infection, revision surgical procedure) within 1 year. Additionally, we examined the change in health-care costs in the year following the surgical procedure, including costs associated with the index admission, relative to the year before the surgical procedure.
Results: Among 29121 eligible patients, 2, 713 (9.3%) underwent a total hip arthroplasty. After successfully matching 2,689 patients who underwent a total hip arthroplasty with those who underwent a hemiarthroplasty, the patients who underwent a total hip arthroplasty were at an increased risk for dislocation (1.7% compared with 1.0%; p = 0.02), but were at a decreased risk for revision (0.2% compared with 1.8%; p < 0.0001), relative to patients who underwent a hemiarthroplasty. Furthermore, the overall increase in the annual health-care expenditure in the year following the surgical procedure was approximately $2,700 in Canadian dollars lower in patients who underwent a total hip arthroplasty (p < 0.001).
Conclusions: Among elderly patients with displaced femoral neck fractures, total hip arthroplasty was associated with lower rates of revision surgical procedures and reduced health-care costs during the index admission and in the year following the surgical procedure, relative to hemiarthroplasty.
文献出处：Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study. J Bone Joint Surg Am. 2019 Apr 3;101(7):572-579. doi: 10.2106/JBJS.18.00539.
第二部分：保髋相关文献
文献1
骶髂关节融合：
手术入路及近期报道的预后
译者：罗殿中
很大一部分下腰部疼痛及臀部疼痛是由骶髂关节引起的。骶髂关节疼痛的非手术治疗主要包括核心肌肉及骨盆相关肌肉的柔韧性及肌力锻炼、口服及注射药物治疗、射频消融。对于不能通过综合的非手术治疗改善症状的患者，骶髂关节融合术不失为一种良好的选择，此手术总体效果良好且患者满意度较高。与传统的开放式手术相比，微创手术的并发症发生率更低，术后康复更快。迄今为止，大多数有关微创骶髂关节融合的已发表临床研究都是由公司赞助的，并且主要使用一种固定系统（骨长入三角形钛棒）。现有的研究种包括两项比较微创骶髂关节融合术与非手术治疗预后比较循证等级1级的随机对照试验，其结果显示手术治疗效果更好。
临床试验结果汇总 LOE：循证等级；CM：保守治疗；S：手术
Sacroiliac Joint Fusion: Approaches and Recent Outcomes
The sacroiliac joint may be a primary source of pain in patients complaining of low back and/or buttock pain. Nonsurgical treatment of sacroiliac joint pain typically includes structured core and pelvic muscle flexibility and strengthening; pharmaceutical management through oral and injectable medication; and ablation procedures. For patients who do not improve with comprehensive, nonoperative treatment, surgical fusion of the sacroiliac joint is an option with overall good reported outcomes and high patient satisfaction. Minimally invasive surgery (MIS) approaches have been shown to have lower morbidity and earlier recovery than traditional open approaches. To date, the majority of published clinical studies on MIS sacroiliac joint fusion are industry-sponsored and predominantly using one system (ingrowth triangular titanium rods). These include two level 1 randomized controlled trials comparing MIS sacroiliac joint fusion to nonoperative management, with results favoring surgery.
文献出处：Yson SC, Sembrano JN, Polly DW Jr. Sacroiliac Joint Fusion: Approaches and Recent Outcomes. PM R. 2019 Aug;11 Suppl 1:S114-S117. doi: 10.1002/pmrj.12198. Epub 2019 Jul 22.
文献2
运动活跃患者接受髋臼周围截骨术后
中期随访时可维持正常运动水平
译者：肖凯
背景：对于接受髋臼周围截骨术（PAO）的运动活跃患者，术后恢复并维持其高水平的运动能力非常重要。
目的：评估运动活跃且有症状的髋关节发育不良患者接受PAO治疗后中期随访时运动水平的情况。
研究设计：病例队列研究；循证4级别。
方法：本研究回顾性分析了自2006年6月至2013年8月期间纳入前瞻性纵行保髋数据库的接受接PAO治疗的有症状髋关节发育不良患者。所有患者术前加利福尼亚大学洛杉矶分校评分（UCLA）得分≥7且术后随访至少5年。通过UCLA评分、改良Harris评分（mHHS）以及西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评估患者的功能情况。维持较高活动水平的评定标准为末次随访时UCLA评分≥7。测量患者相关放射影像学参数。统计显着性定义为P值<0.05。
结果：本研究总纳入66髋（58名患者）。平均年龄为25.3岁（范围为14-47岁），平均体重指数为23.9 kg / m2（范围为19-32 kg / m2），72％为女性患者。术后平均随访时间为6.8年（范围5-11年）。有67％的患者的末次随访时UCLA评分≥7。患者术后功能评分较术前明显改善，其中mHHS由67±17提高到88±14（P <.001），WOMAC由73±20提高到89±15（P <.001）。在末次随访中，外侧CE角、前CE角和臼顶倾斜角均得到了显着改善（P <.001）。只有4名患者（7％）因为髋关节疼痛而被评定为运动能力受限。没有患者接受全髋关节置换术。
结论：大多数（67%）运动活跃患者在接受PAO后中期随访时可以恢复到术前或更高的运动水平。
Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy
BACKGROUND: For active patients undergoing periacetabular osteotomy (PAO), returning to and maintaining a high level of activity postoperatively is a priority.
PURPOSE: To evaluate the maintenance of activity levels at midterm follow-up in active patients treated with PAO for symptomatic acetabular dysplasia.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Patients who underwent PAO for symptomatic acetabular dysplasia between June 2006 and August 2013 were identified by a retrospective review of our prospective longitudinal institutional Hip Preservation Database. All patients with a preoperative University of California, Los Angeles (UCLA) score of ≥7 and a potential minimum 5 years of follow-up were included in the study. Functional outcome measures were the UCLA score, modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The maintenance of high activity levels was defined as a UCLA score of ≥7 at final follow-up. Radiographic parameters were measured. Statistical significance was defined as a P value <.05.
RESULTS: A total of 66 hips (58 patients) were included. The mean age was 25.3 years (range, 14-47 years), the mean body mass index was 23.9 kg/m2 (range, 19-32 kg/m2), and 72% were female. The mean follow-up was 6.8 years (range, 5-11 years). There were 67% of patients who maintained a UCLA score of ≥7. Patient-reported outcomes improved postoperatively from preoperatively for the mHHS (88 ± 14 vs 67 ± 17, respectively; P < .001) and WOMAC (89 ± 15 vs 73 ± 20, respectively; P < .001). The lateral center-edge angle, anterior center-edge angle, and acetabular inclination were significantly improved at final follow-up (P < .001). Only 4 patients (7%) cited postoperative activity limitations as being caused by hip pain. There were no conversions to total hip arthroplasty.
CONCLUSION: The majority (67%) of active patients returned to preoperative or higher activity levels after PAO at midterm follow-up.
文献出处：Okoroafor UC, Pascual-Garrido C, Schwabe MT, Nepple JJ, Schoenecker PL, Clohisy JC. Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy. Am J Sports Med. 2019 Nov 5:363546519881421. doi: 10.1177/0363546519881421.
文献3
股骨不同节段对股骨整体扭转的影响
译者：任宁涛
背景：股骨扭转是髋膝关节疾病的关键参数，假设股骨扭转只取决于股骨颈，但此假设未经证实。
目的：此研究旨在对患者组（股骨扭转大或小）和健康组的股骨不同节段的扭转进行测量比较，我们假设健康组和患者组股骨不同节段扭转不一样。
研究设计：横断面研究；证据水平3级。
方法：纳入MRI检查有髌骨不稳和股骨扭转 ≥25°的患者（11个患者，16个股骨），股骨扭转≤0°（14个患者，22个股骨）， 对照组选择30个健康志愿者（60个股骨）。选择4条线进行股骨扭转的评估，第一条线为股骨头中心和股骨颈中心的连线（FN），第二条线为小转子顶点和股骨中心的连线（LT），第三条线为腓肠肌附着点正上方股骨远端后方相切的线（DF），第四条线为股骨后髁的切线（PCs）。三名观测者进行测量，均进行2次的测量。
结果：在高扭转组、低扭转组和对照组中，所有股骨不同节段显示出明显的不同扭转角，不同节段的扭转均可影响股骨整体扭转。在高扭转组，由于股骨干外旋小，颈部扭转角（FN和LT夹角）和股骨干扭转角（LT和PCs夹角）比值增大，低扭转组，由于股骨干内旋小外旋大，两者比值变小。
结论：通过重复测量进行颈部扭转角（FN和LT夹角），股骨中部扭转角（LT和DF夹角）和股骨远端扭转角（DF和PCs夹角）的差异比较，我们发现三个水平的扭转可影响股骨整体扭转，在高扭转和髌骨不稳的患者中会有不用的模式。
图1 4个不同水平面及4条连线，a 股骨颈（股骨头和股骨颈-小转子） b 小转子中点（小转子-股骨远端） c 股骨远端（股骨远端-后髁） d 股骨总扭转（股骨头和颈-后髁），A 左髋MRI，层厚增加，直至可显示出整个头和颈，白线通过股骨头和颈的中心 B 小转子水平，白线通过股骨中点和小转子中心 C 腓肠肌附着点水平，白线与股骨远端后部相切 D 后髁切线
表1 股骨不同节段扭转角度
图2 三组内不同节段对股骨整体扭转的影响
图3 三组股骨颈扭转与股骨干扭转的相关性（R）
图4 三组扭转分布情况，与对照组相比，高扭转组内旋略增加，外旋明显减少，低扭转组内外旋也有相似的变化。
表2 不同测量观察者间和观察者内可靠性
The Contribution of Different Femur Segments to Overall Femoral Torsion
BACKGROUND: Femoral torsion is a critical parameter in hip and knee disorders. The unproven assumption is that the femoral neck exclusively contributes to the overall torsion of the femur.
PURPOSE/HYPOTHESIS: The aim of this study was to measure femoral torsion at different levels in patients with abnormally high or low femoral torsion and to compare the results with healthy volunteers. Our hypothesis was that the pattern of torsion distribution among the different femoral levels varies between patients with abnormal torsion and healthy volunteers.
STUDY DESIGN: Cross-sectional study; Level of evidence, 3.
METHODS: Magnetic resonance images of patients with a history of patellar instability and torsion of the femur ≥25° (11 patients, 16 femurs) and ≤0° (14 patients, 22 femurs) were analyzed. Our controls were 30 healthy volunteers (60 femurs). To assess femoral torsion, 4 lines were drawn: a first line through the center of the femoral head and neck, a second line through the center of the femur at the top of the lesser trochanter, a third line tangent to the posterior aspect of the distal femur just above the attachment of the gastrocnemius, and a fourth line tangent to the posterior condyles. Three investigators performed the measurements; 1 performed the measurements twice.
RESULTS: All femur segments showed significantly different torsion among the high-torsion, low-torsion, and control groups. Regarding the pattern of torsion distribution, on average, all levels contributed to the torsion. The ratio between the average neck and shaft torsion shifted toward a higher value in the high-torsion group, mostly because of a lack of external torsion in the shaft, and toward a lower value in the low-torsion group, owing to both a lack of internal torsion of the neck and increased external torsion in the shaft.
CONCLUSION: We established a difference between neck, mid, and distal femoral torsion with reproducible measurements. Our data suggest that all 3 levels of the femur contribute to the total femoral torsion, with a different pattern among patients with high torsion and patellar instability.
文献出处：Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP. The Contribution of Different Femur Segments to Overall Femoral Torsion. Am J Sports Med. 2016 Jul;44(7):1796-800. doi: 10.1177/0363546516639945. Epub 2016 Apr 22.
文献4
髋关节微不稳定：病因、诊断和治疗
译者：张利强
症状性髋关节微不稳定现在被认为是年轻患者疼痛和活动受限的潜在原因。髋关节微不稳定的原因包括潜在的骨或软组织异常和髋关节囊的医源性损伤；然而，许多患者缺乏明确的潜在病因。治疗通常从各种非手术治疗开始，特别是康复和物理治疗。手术治疗应着重于根本原因的治疗以及任何相关的关节内改变。在许多情况下，当不考虑骨结构不良时可行关节镜下关节囊折叠缝合。在这篇文章中，我们将回顾症状性髋关节微不稳定，重点包括相关的解剖、病因、诊断和各种治疗选择。
股骨近端3条韧带螺旋环绕髋关节。B、髂股韧带；C、坐股韧带；D、耻股韧带
滚动实验（Log roll）。检查时病人处于仰卧位，检查者内旋患者患腿，然后让腿自动外旋。此患者仰卧位时，她的右腿的休息姿势比左腿更明显地向外旋转，这与她的髂股韧带松弛一致。
前恐惧测试，也称为过伸外旋试验（Anterior apprehension test）。患者被安排在检查床的边缘抱膝屈髋，而另一侧髋关节允许过伸到检查床的边缘。然后，检查者外旋患者髋关节。髋关节前方疼痛考虑前盂唇撕裂和/或髋关节前不稳定。后髋关节疼痛可能与后髋关节撞击有关。
后恐惧实验（Posterior apprehension test）。患者仰卧位，检查者将患者髋关节屈曲至90°，内收内旋，然后对膝关节施加向后的压力引起髋关节后方疼痛或不稳定感为阳性。
俯卧外旋试验（Prone external rotation test）。病人俯卧位，患髋最大限度地外旋，在大转子上施加向前的压力，以使股骨头向前平移。患者在这个位置出现症状为阳性。
外展后伸外旋试验（Abduction-extension-external rotation test）。患者侧卧位，患肢位于上方，外展30°及外旋，于后方大转子上施加一向前的力，同时髋关节由屈曲10°到完全伸直，出现症状为阳性表示髋关节前方不稳定。
右髋疼痛的女排运动员的前后位X片，有右髋脱位病史。小圆圈在股骨头的中心，髋臼后壁位于股骨头中心的内侧，这被称为后壁征。显示后壁覆盖不足。黑色线条勾勒出坐骨棘，箭头指向突出的坐骨棘。这表明患者有髋臼后倾，这是她后壁覆盖不足的原因。
MR关节造影冠状位片显示关节囊缺损（箭头）。患者因髋关节不稳有症状行关节镜。
人为牵引（利用自身体重，但没有使用骨折牵引床）下患者的术中透视图，结果显示股骨头被牵出几毫米，这与髋关节不稳定表现相一致。这个患者给与关节囊折叠缝合和盂唇修补后，症状完全消失。
和上图同样的病人，尽管用腰穿针去除关节内负压力，去除牵引力后，她的股骨头仍然脱位，同样与髋关节不稳定相一致。
关节镜下关节囊折叠术：（A）前外侧部关节囊切除术在“裸区”（无韧带附着）进行，直到看见股骨头为止。（B）用缝线闭合装置将三到五条缝线穿过部分切除的关节囊处。（C）缝合线系在关节囊切开处。
Microinstability of the hip—it does exist: etiology, diagnosis and treatment
Symptomatic hip microinstability is now recognized as a potential cause of pain and disability in young patients. Causes of hip microinstability include underlying bony or soft tissue abnormalities and iatrogenic injuries of the hip capsule; however, many patients lack a clear underlying etiology. Treatment usually begins with an extensive course of non-operative management with an emphasis on activity modification and physical therapy. Surgical intervention should focus on treatment of the underlying cause as well as any associated intra-articular pathology. In many cases, arthroscopic suture plication can be considered when bony deficiency is not the cause. In this article, we will review the spectrum of symptomatic hip microinstability with a focus on the relevant anatomy, etiology, diagnosis and various treatment options.
文献出处：Kalisvaart M M , Safran M R . Microinstability of the hip--it does exist: etiology, diagnosis and treatment[J]. Journal of Hip Preservation Surgery, 2015, 2(2):123-135.
文献5
胫骨近端骨折和股骨头骨骺向上滑脱：
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译者：陶可（北京大学人民医院骨关节科）
胫骨近端骨折和股骨头骨骺向上滑脱（SUFE）具有共同的危险因素，但它们之间的关系尚不清楚。在这两种情况下，患者通常都是肥胖的。据我们所知，文献中只有两份先前的报告描述了三名患者发生胫腓骨近端骨折和SUFE的情况。我们报告了一名儿童，该儿童在3岁时接受了双侧胫腓骨治疗，随后在13岁时出现了SUFE。结论：胫骨和SUFE具有共同的危险因素，提示相似的致病性，甚至在组织学上相似。在极少数情况下，它可以同时发生，但目前尚无法证明真正的关联。
（a，b）3岁时胫骨斜位截骨术后3个月双膝的临床照片和X射线照片。
（a，b）6岁时的大体照片和X线片显示膝关节正常对齐。
13岁时的临床照片。这个孩子肥胖，左下肢向外旋转。
前后位和蛙式位X线片显示股骨头向左上轻度滑脱。
左股骨近端骨骺单个原位空心螺钉固定术后立即进行X线片检查。
Tibia vara and slipped upper femoral epiphysis: is there an association?
Tibia vara and slipped upper femoral epiphysis (SUFE) share a common risk factor, but their relationship is unclear. In both conditions, the patients are usually obese. To the best of our knowledge, there have been only two previous reports in the literature that have described the occurrence of tibia vara and SUFE in three patients. We report a child who was treated for bilateral tibia vara at the age of 3 years and subsequently developed a SUFE at the age of 13 years. Conclusion: Tibia vara and SUFE share common risk factors, suggest similar pathogenicity and even resemble one another histologically. In rare situations, it can occur concurrently but no true association can be proven at present.
文献出处：Jamil K, Abdul Rashid AH, Ibrahim S. Tibia vara and slipped upper femoral epiphysis: is there an association? J Pediatr Orthop B. 2015 Jan;24(1):46-49.
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