本期目录：
1、全膝置换术后满意度预测模型的有效性验证
2、矢状位脊柱力线对全髋关节置换术患者后盆腔活动的影响
3、下肢不等长对全髋关节置换术后临床疗效的影响：一项前瞻性临床研究
4、占位器植入二期置换治疗髋关节严重化脓性关节炎
5、临界髋关节发育不良:哪些是异常?如何判断？
6、计算机辅助手术预防髋臼周围截骨术的并发症
7、髋臼截骨术后的并发症和结局-手术入路的影响
8、大龄儿童DDH一期联合手术治疗时是否需要术前牵引
9、利用有限元分析优化Ganz髋臼周围截骨术中髋臼的位置
10、股骨头骨骺滑脱（SCFE）：临床特点、诊断和分类标准
第一部分：关节置换及保膝相关文献
文献1
全膝置换术后满意度预测模型的有效性验证
译者：张轶超
背景：全膝关节置换手术（TKA）的数量在不断增加，作为一种配套治疗模式，术后患者感觉不适会增加额外的护理而增加医疗成本。本研究的目的是找到并测试一种TKA术后预测患者满意度的模型的有效性。
方法：我们入选了从2014年1月到2016年1月总共有484名性初次TKA的患者。根据回顾性的资料将这些患者分为4个程度：低风险（>96.5），轻度风险（75-96.4），中等风险（60-74.9）和高风险（<60）。而这个术后满意度的新的调查表包括11个方面内容。采用二进制逻辑分析及多元线性回归模型来明确这个调查表是否为满意度预测指标。做出一个预测曲线来找到术后患者不满意的最低阈值。
结果：平均年龄66.3±9.2岁（31.7-100.1岁），平均体重指数为34.2±8.2 kg/m2（16.2-68.4）。96.5的调查评分意味着97.5%的敏感度和95.7%的满意度准确率。具有较高调查评分的患者术后满意的几率很大（优势比1.03,95%可信区间1.01-1.06，P=0.003）。随着风险层级的增高则满意度下降（低风险95.7%，轻度风险93.8%，中等风险86.4%，高风险80.4%；P=0.007）。评分与并发症没有明显的相关性(r=-0.43,P=0.32)。
结论：这个新的膝关节调查表对于预测初次TKA术后患者满意度具有97.5%的敏感性和95.7%的准确率。
Internal Validation of a Predictive Model for Satisfaction After Primary Total Knee Arthroplasty
BACKGROUND: As the number of total knee arthroplasty (TKA) procedures continues to rise in the context of bundled payment models, patients dissatisfied postoperatively that require additional care will impose additional cost to the healthcare system. The purpose of this study is to internally validate a predictive model for postoperative patient satisfaction after TKA.
METHODS: In total, 484 consecutive primary TKA patients between January 2014 and January 2016 were included. Patients were stratified into 4 risk tiers based on scores of a retrospectively applied, 11-component novel knee survey for postoperative satisfaction: low risk (>96.5), mild risk (75-96.4), moderate risk (60-74.9), and high risk (<60). Binary logistic and multivariate linear regression models were constructed to determine whether the survey was predictive of satisfaction. A receiver operator curve was constructed to determine a threshold score below which patients were likely to experience postoperative dissatisfaction.
RESULTS: The mean (±standard deviation) age was 66.3 ± 9.2 years (range 31.7-100.1) and mean body mass index was 34.2 ± 8.2 kg/m2 (range 16.2-68.4). A knee survey score of 96.5 conferred a 97.5% sensitivity and 95.7% negative predictive value for satisfaction. Patients with higher knee survey scores had greater odds (odds ratio 1.03, 95% confidence interval 1.01-1.06, P = .003) of postoperative satisfaction. Increasing risk tier was significantly associated with decreased satisfaction (low risk 95.7%, mild risk 93.8%, moderate risk 86.4%, and high risk 80.4%; P = .007). The knee survey was not significantly correlated with complications (r = -0.43, P = .32).
CONCLUSION: This novel knee survey conferred a 97.5% sensitivity and 95.7% negative predictive value in identifying at-risk patients for postoperative dissatisfaction after primary TKA.
文献出处：Kunze KN, Akram F, Fuller BC, Zabawa L, Sporer SM, Levine BR. Internal Validation of a Predictive Model for Satisfaction After Primary Total Knee Arthroplasty. J Arthroplasty. 2019 Apr;34(4):663-670. doi: 10.1016/j.arth.2018.12.020. Epub 2018 Dec 19.
文献2
矢状位脊柱力线对全髋关节置换术
患者后盆腔活动的影响
译者：马云青
背景：最近的研究表明，全髋关节置换术(THA)后盆腔活动减少的患者从站立到坐位的脱位率较高。本研究评价脊柱矢状位畸形中的骨盆入射-腰椎前凸角(PI-LL)所定义的矢状位脊柱畸形对盆腔倾斜(PT)在体位变化时的影响。
方法：对1100例多中心术前THA患者的数据进行分析。在仰卧位、站立、坐姿和抬腿体位的患者的X线片上测量前盆平面倾斜度(APPt)、脊髓盆倾斜度(SPT)和腰椎前凸角(LL)，计算机体层摄影(CT)测量PI。将患者按PI-LL分为3组(<-10°，-10°to 10°，>10°)并与PI的倾向相匹配。腰椎平背畸形的定义为PI-LL>10°，过度前凸：PI-LL<-10°，采用方差分析和T图基(tukey)事后检验法，对PI-LL各组体位间的变化和SPT/APPt进行比较。皮尔逊相关分析检测之间的相关性。
结果：在倾向评分匹配后，共288例患者(平均65岁，49%女性)纳入研究，SPT和APPt在不同的PI-LL类别间在从站立到坐姿、仰卧、抬腿等间的差异均有显着性(均P<.001)。在严重前凸畸形患者中与平背畸形患者有较少SPT和APPt。从站立到坐位(R= 0.294)、仰卧(R= 0.292)和抬腿(R=0.207)的PI-LL值越大SPT越大，P<0.001。从站立到坐位的LL变化较小，与SPT增加有关(R=0.372，P<0.001)。
结论：THA患者术后SPT/APPT的改变与矢状位测量值有关。腰椎过度前凸的患者与平背型患者相比更倾向于使用脊柱，而脊柱僵直的患者更有可能通过改变PT来完成体位变化。增加对腰椎僵直患者的关注可有助于减少THA后假体脱位的发生率。
Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates
BACKGROUND: Recent research has demonstrated that patients with reduced pelvic mobility from standing to sitting have higher rates of dislocation after total hip arthroplasty (THA). This study evaluates the effect of sagittal spinal deformity, defined by pelvic incidence-lumbar lordosis mismatch (PI-LL), on postural changes in pelvic tilt (PT).
METHODS: A multicenter database of 1100 preoperative THA patients was queried. Anterior-pelvic-plane tilt (APPt), spinopelvic tilt (SPT), and LL were measured from radiographs of patients in supine, standing, flexed-seated, and stepping-up postures; PI was measured from computed tomography. Patients were separated into 3 groups based on PI-LL (<-10°, -10° to 10°, >10°) and propensity-score matched by PI. Lumbar flatback-deformity was defined as PI-LL > 10°, hyperlordosis: PI-LL < -10°. SPT/APPt, including changes between each posture were compared across PI-LL groups using analysis of variance, with post-hoc Tukey tests. Pearson correlations were reported when testing associations between SPT/APPt change and PI-LL.
RESULTS: After propensity-score matching, 288 patients were analyzed (mean 65 y; 49% F). SPT and APPt change differed across all PI-LL categories from standing to seated, supine, and stepping-up with less SPT/APPt recruitment among hyperlordotic vs flatback patients (all P < .001). Greater PI-LL correlated with greater SPT recruitment from standing to seated (R = 0.294), supine (R = 0.292), and stepping-up (R = 0.207) (all P < .001). Smaller LL changes from standing to seated were associated with greater SPT recruitment (R = 0.372, P < .001).
CONCLUSIONS: Postural changes in SPT/APPt are associated with spinopelvic measures in THA candidates. Hyperlordotic patients tend to utilize their spines more compared with flatback patients who were more likely to recruit PT. Increased focus on patients with lumbar flatback and hyperlordosis may help in reducing prosthetic dislocation prevalence following THA.
文献出处：Buckland AJ, Fernandez L, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM. Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates. J Arthroplasty. 2019 Nov;34(11):2663-2668. doi: 10.1016/j.arth.2019.06.036. Epub 2019 Jun 22.
文献3
下肢不等长对全髋关节置换术后临床疗效的影响：
一项前瞻性临床研究
译者：张蔷
全髋关节置换术后下肢不等长对早期临床疗效的影响仍未明确。我们进行了一项前瞻性的临床研究，包含94名全髋关节置换手术患者，分别在术前和术后一年评价双下肢长度差异，进而与影像学测量进行比较，此外，我们还评估了肢体长度差异对步行、跛行、疼痛及患者满意度的影响。术后平均肢体长度差异为0.05cm（-1.5-1.5，标准差0.5）。临床测量与影像学测量的结果相关性较差（术前ω=0.36，术后ω=0.186）。与双下肢等长相比，术侧下肢稍短的患者出现跛行的可能性更高（p<0.05），而术侧下肢稍长的患者出现疼痛的可能性更高（p<0.05）。下肢长度差异对行走能力、Harris评分和患者满意度只有极小的影响。绝大多数的病人术后双下肢几乎等长，但越明显的长度差异越会对患者造成跛行或疼痛等不同的影响。因此，我们建议术者加强术前教育，提前告知患者可能出现的肢体长度差异及其导致的相应症状。
肢体长度临床测量：增加高度垫块直到骨盆彻底水平
Influence of leg length discrepancy on clinical results after total hip arthroplasty: A prospective clinical trial
The effect of leg length differences on early clinical outcome after total hip arthroplasty remains uncertain. We performed a prospective study on 94 patients who were evaluated preoperatively and one year after surgery for clinical leg length differences, which were then compared with radiological measurements. The effect of leg length differences on walking ability, limp, pain and patient satisfaction was studied. The mean clinical leg length difference after operation was 0.05 cm (-1.5 to 1.5, SD 0.5). Clinical and radiological measurements correlated poorly (ω=0.36 pre- and ω=0.186 postoperatively). Patients with a shorter operated leg on clinical assessment were more prone to limping (p<0.05), and patients with a longer leg had more pain compared to patients with equal leg lengths (p<0.05). Walking ability, Harris Hip Score and patient satisfaction were only marginally affected by leg length differences. Virtually equal leg length was achieved for most patients but small differences had a negative influence in relation to limping and pain. Patients should be counselled pre-operatively about possible leg length differences and associated symptoms.
文献出处：Christian Plaass, Martin Clauss, Peter E. Ochsner, Thomas Ilchmann. Influence of leg length discrepancy on clinical results after total hip arthroplasty: A prospective clinical trial. Hip Int 2011; 21 ( 04 ): 441 – 449.
第二部分：保髋相关文献
文献1
占位器植入二期置换治疗髋关节严重化脓性关节炎
译者：罗殿中
介绍：髋关节严重化脓性关节炎的最佳治疗方案目前仍存在争议。本回顾性研究的目的是报道使用抗生素骨水泥占位器治疗髋关节严重化脓性关节炎的经验。
材料和方法：本研究纳入了22例连续就诊患者（男11例，女11例，平均年龄59.7岁），均接受了两阶段治疗方案及抗生素骨水泥占位器植入术。通过回顾患者的病历收集下述信息：合并症/易感因素、感染原因、病原体微生物、脓肿存在情况、占位器植入时间、占位器在体内放置时间、关节型占位器、注入骨水泥、系统性抗生素治疗、植入假体的时间、内植物类型、并发症、感染控制率。
结果：最常见的致病微生物是金黄色葡萄球菌（73％）。占位器在体内的平均放置时间为88天。在各治疗阶段，有23％的病例观察到了占位器相关的特异性并发症，在50％的病例观察到了非占位器特异性发症。第一阶段治疗后的死亡率为18％。有16髋接受了假体植入。在平均随访44.8（12-120）个月时，初次感染控制率（第一次占位器植入后）为87％（13/15），二期治疗感染控制率（在第二次占位器植入后）为100％。
结论：占位器植入二期治疗可有效控制感染，但也导致两阶段治疗间的高死亡率。
INTRODUCTION: The ideal treatment of the destructive septic arthritis of the hip joint remains controversial. The aim of the present retrospective study was to report on our experience about the use of antibiotic-loaded cement spacers in the treatment of destructive bacterial coxitis.
MATERIALS AND METHODS: 22 consecutive patients (11 male, 11 female, mean age 59.7 years) have been treated with a two-stage protocol and implantation of an antibiotic-loaded cement spacer. All patients' records have been retrospectively evaluated with regard to comorbidities/predisposing factors, infection cause, causative pathogen organism, presence of a psoas abscess, surgical time of spacer implantation, duration of spacer implantation, spacer articulation, impregnation of bone cement, systemic antibiotic therapy, surgical time of prosthesis implantation, implant type, complications, and infection control rate.
RESULTS: The most common identified organism was Staphylococcus aureus (73 %). The mean duration of spacer implantation was 88 days. Spacer-specific complications were observed in 23 % of the cases and spacer non-specific ones in 50 % between stages. The mortality rate after the first stage was 18 %. Prosthesis implantation was performed in 16 cases. At a mean follow-up of 44.8 (12-120) months, the primary infection control rate (after one spacer implantation) was 87 % (13/15) and the secondary infection control rate (after two spacer implantations) 100 %.
CONCLUSIONS: Two-stage treatment and spacer implantation is associated with a high rate of infection control but also with a high mortality rate between stages.
文献出处：Anagnostakos K, Duchow L, Koch K. Two-stage protocol and spacer implantation in the treatment of destructive septic arthritis of the hip joint. Arch Orthop Trauma Surg. 2016 Jul;136(7):899-906. doi: 10.1007/s00402-016-2455-3. Epub 2016 Apr 21.
文献2
临界髋关节发育不良:哪些是异常?如何判断？
译者：程徽
临界髋臼发育不良是指髋臼形状和覆盖状态的轻度亚正常模式，可能使儿童易发生髋关节功能障碍和不稳定。通常来说，LCE角在18-24°的儿童可以认为是处于临界发育不良的状态中。一些影像学指标处于边缘状态的儿童，其髋关节力学状态和功能情况可能都正常，而另一些可以通过髋关节矫形手术治疗。尽管临界发育不良的影像学表现可能提示不稳定，但最终的诊断则不仅仅依赖影像学检查，病史和体格检查也非常重要。具有影像学临界髋关节发育不良的儿童可通过MR横断成像进行进一步观察，评估不稳定的继发改变，包括：髋臼缘的损伤，或盂唇变性和肥大。CT也有助于了解三维髋臼形态，并进行术前评估和规划。通常，小儿放射科医生首先通过X线片发现边界或轻度发育不良。这一复杂患者群体需要多学科综合治疗，小儿放射科医师做出有效的提示并提供适当的建议，是其中种重要的一部分。
The borderline dysplastic hip: when and how is it abnormal?
Borderline acetabular dysplasia refers to mildly sub-normal patterns of acetabular shape and coverage that might predispose children to mechanical dysfunction and instability. Borderline dysplasia generally includes children with a lateral center edge angle (CEA) of 18–24°. Some children with borderline radiographic measurements have normal joint mechanics and function while others benefit from acetabular reorienting surgery. Although radiographic findings of borderline dysplasia might suggest instability, the ultimate diagnosis is based on history and physical exam in addition to imaging. Children with borderline acetabular dysplasia sometimes benefit from other cross-sectional imaging studies such as MR imaging to evaluate for secondary evidence of instability, including damage along the acetabular rim, or labral degeneration and hypertrophy. CT is also helpful for depiction of 3-D acetabular morphology for preoperative assessment and planning. Pediatric radiologists are often the first to identify borderline or mild dysplasia on radiographs. It is imperative that pediatric radiologists serve as effective consultants and offer appropriate recommendations as part of a cohesive multidisciplinary approach to this complex patient population.
文献出处：Bixby SD, Millis MB. The borderline dysplastic hip: when and how is it abnormal?. Pediatric radiology. 2019 Nov 1;49(12):1669-77.
文献3
计算机辅助手术预防髋臼周围截骨术的并发症
译者：程徽
目的：本研究的目的是评估一个导航系统在髋臼周围弧形截骨术(CPO)中的准确性。
方法：髋关节发育不良患者47例(53髋)纳入本研究，部分患者进行导航下CPO手术，部分进行传统无导航CPO受术。术后进行临床和影像学评估，将导航组和非导航组进行比较。
图1 导航示意图。(a)术前计划(b)开始手术前确认截骨面(c)矫形完成后确认髋臼外缘
结果：导航组和非导航组的临床结果无显著差异。此外，导航组和非导航组术后髋臼骨块矫形情况也无差异。导航组与非导航组相比，手术截骨线与术前计划的截骨线吻合度更高 (p < 0.05)。导航组并发症发生率降低(p < 0.001)。
结论：导航能显著提高截骨位置的准确性。因此，在CPO手术中使用导航可以减少并发症。
Computer-assisted surgery prevents complications during peri-acetabular osteotomy
PURPOSE: The aim of the study is to evaluate the accuracy of a navigation system during curved peri-acetabular osteotomy (CPO).
METHODS: Forty-seven patients (53 hips) with hip dysplasia were enrolled and underwent CPO with or without navigation during surgery. Clinical and radiographical evaluations were performed and compared between the navigation group and non-navigation group, post-operatively.
RESULTS: The clinical outcomes were not significantly different between the navigation and non-navigation groups. Furthermore, post-operative reorientation of the acetabular fragment was similar between the navigation and non-navigation groups. However, the discrepancy between the pre-operative planning line and post-operative osteotomy line was significantly improved in the navigation group compared with that in the non-navigation group (p < 0.05). Further, the complication rate was significantly improved in the navigation group (p < 0.001).
CONCLUSION: The accuracy of the osteotomy's position was significantly improved by using navigation. Therefore, the use of navigation during periacetabular osteotomy can avoid complications.
文献出处：Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Shibanuma N, Ishida K, Nishida K, Kuroda R. Computer-assisted surgery prevents complications during peri-acetabular osteotomy. International orthopaedics. 2018 Nov 1;42(11):2555-61.
文献4
髋臼截骨术后的并发症和结局：
手术入路的影响
译者：肖凯
背景：伯尔尼髋臼截骨术（PAO）由Ganz教授发明，通过将髋臼进行旋转，改善股骨头臼的对合关系，临床上用于治疗骨骼成熟的髋关节发育不良患者。通过改良的Smith-Petersen入路（髂股入路）PAO进行了众多改良，可以降低手术并发症发生率，降低手术失败风险。
目标：本综述的目的是报告与手术方法相关的并发症发生率、功能和影像学预后。
方法：对NICE医疗保健数据库建立初至2018年5月的数据行了高级搜索。我们纳入了报道PAO并发症的研究。通过从病例队列中提取相关数据，以明确并发症的发生率、与手术入路的关系以及并发症的时间趋势。
结果：本综述共纳入了40篇研究，包含4070例髋关节，平均年龄为29岁，平均随访时间为52.8个月。结果指标显示82％的预后优良。髂腹股沟入路及双切口入路发生股外侧皮神经及坐骨神经损伤的概率更高。微创改良Smith-Petersen入路（MSP）、微创经皮和经粗隆入路与任何重大伤口并发症均无相关性。影像学指标改善程度：髋臼倾斜角平均改善17.90（范围4.5-40），前CE角矫正25.40（范围10-51），外侧CE角矫正23.30（范围15-44.6）和股骨头内移6mm （范围3.2-10）。
结论：与Clohisy等人先前的综述相比，本综述的并发症发生率似乎较低（7％ VS 6-37％）。微创经皮穿入路/ 微创S-P入路和股骨转子间入路可降低并发症发生率。本综述认为微创入路可以减少神经损伤和伤口并发症的发生率。
Complications and outcome after periacetabular osteotomy - influence of surgical approach
BACKGROUND: Bernese periacetabular osteotomy (PAO) was introduced by Ganz as a novel surgical technique for hip dysplasia with a congruent hip to reorient the acetabulum in skeletally mature patients. The PAO through a modified Smith-Petersen (Iliofemoral) approach, has been subject to many modifications in order to avoid complications and to minimise risks for failure.
AIM: The aim of this review was to report on the complication rates, functional and radiological outcomes in relation to surgical approaches.
METHODS: A search of NICE healthcare database advanced search, was conducted from the year of inception to May 2018. We included studies that reported complications of PAO. Data extracted from case series was analysed to detect the incidence of complications, relation to surgical approach and temporal trend of complications.
RESULTS: 40 studies including 4070 hips with a mean age of 29 years and a mean follow-up of 52.8 month, were analysed. Outcome measures demonstrated good to excellent outcome in 82%. Higher rates of LFCN and sciatic nerve injuries were found to be associated with the ilioinguinal and the 2-incision approach. Minimally invasive (MIS) modified Smith-Petersen (MSP), minimally invasive trans-sartorial and trans-trochanteric approaches were not reported to be associated with any major wound complications. Radiological correction achieved with a mean improvement in acetabular inclination of 17.90 (range 4.5-40), anterior centre-edge correction 25.40 (range 10-51), lateral centre-edge correction 23.30 (range 15-44.6) and medial translation of 6 mm (range 3.2-10).
CONCLUSIONS: The complication rates seem to be lower in this current review (7%) as compared to the previous review performed by Clohisy et al. (6-37%). The MIS trans-sartorial/MIS MSP and intertrochanteric approaches are associated with an even reduced complications rates. This review enables favouring the minimally invasive approaches with regard to reducing nerve injury and wound complications.
文献出处：Ali M, Malviya A. Complications and outcome after periacetabular osteotomy - influence of surgical approach. Hip Int. 2019 Sep 16:1120700019871195. doi: 10.1177/1120700019871195.
文献5
大龄儿童DDH一期联合手术治疗时
是否需要术前牵引
译者：任宁涛
目的：比较大龄儿童DDH一期联合手术时术前行和未行牵引的治疗效果。
方法：回顾性分析9名DDH手术患儿12个髋关节行术前牵引（组1），12名DDH患儿16个髋关节未行术前牵引（组2），手术方式包括切开复位、Salter截骨和股骨短缩内翻去旋转截骨。患儿平均手术年龄为5.8岁，平均随访年龄为5.9年。
结果：终末随访时，尽管两组影像学评估没有明显差别，但是组1临床效果较组2差。
结论：一期联合手术未行术前牵引在大龄儿童DDH治疗中是有效的，并发症低，影像学评估无差别。
表1 两组患儿临床数据
One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children
PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH).
METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years.
RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups.
CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.
文献出处：Tezeren G, Tukenmez M, Bulut O, Cekin T, Percin S. One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children. J Orthop Surg (Hong Kong). 2006 Dec;14(3):259-64.
文献6
利用有限元分析
优化Ganz髋臼周围截骨术中髋臼的位置
译者：张利强
髋臼周围截骨术（PAO）是一种纠正发育性髋关节发育不良（DDH）髋臼位置的手术方法。它通过改变髋臼的位置以增加股骨头的覆盖率，并将软骨表面的接触压力分散开。PAO的成功与否很大程度上取决于外科医生的经验。利用DDH患者的CT数据，我们建立了三维有限元模型来研究PAO术中纠正髋臼的最佳位置。利用虚拟PAO模拟术中髋臼旋转从原始中心边缘（CE）角开始并逐渐增加的情况。分析股骨和髋臼软骨的接触面积、接触压力和Von Mises应力。对4例髋关节发育不良患者的5个髋关节进行了建模。通过虚拟PAO发现软骨的接触面积、接触压力和Von Mises应力均随CE角的变化而变化。髋臼的最佳位置为可以达到最大限度的接触面积，同时最小化髋臼和股骨软骨的接触压力和Von Mises应力。髋臼的最佳位置取决于患者自身，并不总是对应于“正常”的CE角。我们首次证明了PAO手术中髋臼和股骨软骨与矫正角度、接触面积和接触压力之间的相互关系。
中心边缘角
五例模型的图示
利用弹性元件模拟韧带的模型CE10
受力和边界条件。（a）髋关节接触力，（b）荷载和（c）边界条件。
在Abaqus软件上模拟PAO手术过程，（a）失状面显示髋臼周围截骨线，（b）冠状面显示截骨线，（c）旋转髋臼增加外侧CE角，（d）将髋臼与骨盆再次融合
CE10骨盆髋臼软骨的压力分布
Optimization of the Position of the Acetabulum in a Ganz Periacetabular Osteotomy by Finite Element Analysis
Periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in developmental dysplasia of the hip (DDH). It changes the position of the acetabulum to increase femoral head coverage and distribute the contact pressure over the cartilage surface. The success of PAO depends significantly on the surgeon’s experience. Using computed tomography data from patients with DDH, we developed a 3D finite element (FE) model to investigate the optimal position of the acetabulum following PAO. A virtual PAO was performed with the acetabulum rotated in increments from the original center edge (CE) angle. Contact area, contact pressure, and Von Mises stress in the femoral and pelvic cartilage were analyzed. Five dysplastic hips from four patients were modeled. Contact area, contact pressure, and Von Mises stress in the cartilage all varied according to the change of CE angle through virtual PAO. An optimal position could be achieved for the acetabulum that maximizes the contact area while minimizing the contact pressure and von Mises stress in the pelvic and femoral cartilage. The optimal position of the acetabulum was patient dependent and did not always correspond to what would be considered a ‘‘normal’’ CE angle. We demonstrated for the first time the interrelation of correction angle, contact area, and contact pressure between the pelvic and femoral cartilage in PAO surgery.
文献出处：Zou Z , Chávez-Arreola, Arturo, Mandal P , et al. Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis[J]. Journal of Orthopaedic Research, 2013, 31(3):472-479.
文献7
股骨头骨骺滑脱（SCFE）：
临床特点、诊断和分类标准
译者：陶可（北京大学人民医院骨关节科）
目的：本文旨在通过综述股骨头骨骺滑脱（SCFE）诊断、病理生物力学理解及基于机械力学分类的进展，以提高SCFE治疗效果。
方法：在我们大样本中心，对SCFE的临床经验进行回顾性分析，与其他临床专家进行讨论，并进行文献综述，从而阐明当前的研究趋势。
结果：SCFE仍然是一个重要的临床问题，后期诊断仍很常见。对股骨髋臼撞击无处不在的更好理解指导了当前的分类和治疗方案。
结论：SCFE是一个重要的临床问题，在儿童和成年期都有较高的髋关节功能受损发生率。在尽早进行临床诊断、现代影像检查以及对受累髋关节进行机械分类和进行最佳治疗，有望改善预后。
图1. 一名12岁女孩，右膝疼痛和跛行6个月。右膝X线片和MRI均正常。膝关节物理疗法无助于疼痛缓解。腹股沟疼痛始于3个星期前。患者开始使用拐杖。她能够扶拐杖行走。第1次髋部X线照片即显示严重的双侧SCFE。经检查，她可以将双腿抬离桌子，但右髋关节疼痛。（a和b）前后位片和Lauenstein侧位片。（c和d）改良Dunn截骨术中，尽管后部骨量丰富，并且术前能够扶拐杖，但右侧股骨头非常不稳定。（e，f和g）术后一年，Dunn截骨术，左髋原位螺钉内固定（ISP）。腹股沟疼痛仅发生在左髋。（h和i）右髋Dunn截骨术后5年，左髋关节前关节囊成形术和股骨颈成形术后3年。双髋均无症状。
图2. 一名27岁的女性在原位内固定16年后获得稳定的SCFE。她痛苦的在坐位上持续了4年。髋关节可屈曲至90度。屈曲位时内旋仅至中立位。在X线片上，滑移角约为25°。滑脱畸形为轻度，但股骨干骺端较大且突出。（a和b）AP和Lauenstein侧位X线片。（c）外科脱位和股骨颈成形术时发现严重的髋臼前缘损伤。（d）股骨干骺端突出。
SCFE: Clinical Aspects, Diagnosis, and Classification
Purpose: This article seeks to improve treatment outcomes in slipped capital femoral epiphysis (SCFE) by outlining advances in diagnosis, understanding of pathomechanics, and mechanically-based classification.
Methods: Review of clinical experience with SCFE at our high-volume centre, interaction with other clinical experts, and literature review has allowed a current perspective to be articulated.
Results: SCFE remains an important clinical problem, with late diagnosis still frequent. Improved understanding of the ubiquity of femoroacetabular impingement has guided current classification and treatment protocols.
Conclusion: SCFE is an important clinical problem, with high historical rates of impaired hip function both in childhood and adulthood. Great opportunities exist for improved outcomes following earliest possible clinical diagnosis, modern imaging, and mechanically-based classification of involved hips to allow optimal treatment.
文献出处： M B Millis. SCFE: Clinical Aspects, Diagnosis, and Classification. J Child Orthop, 11 (2), 93-98 Apr 2017.
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