本期目錄：

1、機(jī)器人輔助全膝關(guān)節(jié)置換術(shù)的趨勢和流行病學(xué)：減少并發(fā)癥和縮短住院時(shí)間

2、國際共識(shí)研討會(huì)對(duì)膝關(guān)節(jié)翻修術(shù)中骨缺損的處理

3、應(yīng)用高交聯(lián)聚乙烯和傳統(tǒng)聚乙烯墊片的同期雙側(cè)后交叉韌帶保留型（CR）全膝關(guān)節(jié)置換病例的比較研究

4、擇期全關(guān)節(jié)置換術(shù)中加速康復(fù)外科（ERAS）路徑

5、DDH幼年治療后的患者成年后的生活質(zhì)量

6、兒童創(chuàng)傷性三角軟骨損傷的回顧性分析

7、骨盆再定位截骨術(shù)前髖臼三維形態(tài)分析方法

8、髖關(guān)節(jié)不同姿勢對(duì)坐骨神經(jīng)位置的影響

9、外側(cè)柱是支撐塌陷前股骨頭壞死的關(guān)鍵：基于傾向評(píng)分匹配隊(duì)列的有限元模型分析

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)

文獻(xiàn)1

機(jī)器人輔助全膝關(guān)節(jié)置換術(shù)的趨勢和流行病學(xué)：減少并發(fā)癥和縮短住院時(shí)間

譯者 張軼超

介紹：本研究對(duì)機(jī)器人輔助全膝關(guān)節(jié)置換術(shù)（RA - TKA）與傳統(tǒng)全膝關(guān)節(jié)置換術(shù)（C - TKA）的即時(shí)術(shù)后結(jié)果和影響進(jìn)行了深入分析，特別是在死亡率、并發(fā)癥、住院時(shí)間和費(fèi)用方面，研究數(shù)據(jù)來自全國范圍內(nèi)的綜合數(shù)據(jù)集。

方法：全國住院患者樣本（NIS）數(shù)據(jù)庫是美國最大的包括各種付款人住院醫(yī)療保健數(shù)據(jù)庫，從中找出從2016年至2019年期間接受RA - TKA或C - TKA的所有患者。共有527,376例，相當(dāng)于2,638,679名接受擇期TKA的患者，其中88,415例為RA - TKA。為了減輕兩組之間基線特征的潛在差異和選擇偏差，采用傾向評(píng)分匹配分析來進(jìn)一步平衡和完善我們的數(shù)據(jù)集，結(jié)果176,830名患者均勻分布在兩組之間。對(duì)一般情況、即時(shí)術(shù)后并發(fā)癥和經(jīng)濟(jì)數(shù)據(jù)（包括付款人類別、住院時(shí)間和總費(fèi)用）進(jìn)行分析。

結(jié)果：RA - TKA有明顯的變化，從2016年最初的0.70%到2019年顯著的7.30%。與C - TKA組（66.7±SD年）相比，接受RA - TKA的患者略年輕（66.2±SD年）。RA - TKA組和C - TKA組住院時(shí)間分別為1.89天和2.29天。收費(fèi)指標(biāo)顯示RA - TKA的收費(fèi)略高。RA - TKA組術(shù)后并發(fā)癥較少，如失血、貧血、急性腎損傷、靜脈血栓栓塞、肺栓塞、肺炎和手術(shù)傷口并發(fā)癥。即使按照傾向評(píng)分匹配，這些結(jié)論仍然是一致的，具有統(tǒng)計(jì)學(xué)意義。

結(jié)論：與C - TKA相比，RA - TKA在美國的使用在過去幾年中有了顯著的增長，并且顯著減少了術(shù)后并發(fā)癥和住院時(shí)間，為TKA患者提供了更安全的手術(shù)治療。對(duì)RA - TKA短期和長期結(jié)果的進(jìn)一步研究將提高對(duì)該技術(shù)全部潛力的理解。

Trends and epidemiology in robotic‐assisted total knee arthroplasty: Reduced complications and shorter hospital stays

Introduction: This study provides an in‐depth analysis of the immediate postoperative outcomes and implications or robotic‐assisted total knee arthroplasty (RA‐TKA) compared with conventional TKA (C‐TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set.

Methods: The Nationwide Inpatient Sample (NIS) database, the largest all‐payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA‐TKA or C‐TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA‐TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score‐matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post‐operative complications, and economic data, including payor class, length of stay and total charges.

Results: There was a marked shift towards RA‐TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA‐TKA were slightly younger (66.2 ± SD years), compared to the C‐TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA‐TKA and C‐TKA, respectively. Charges metrics revealed slightly higher charges for RA‐TKA. Less postoperative complications were found in the RA‐TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound

complication. Even following the propensity score matching, these findings remained consistent and statistically significant.

Conclusions: RA‐TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post‐operative complications and length of hospital stay compared to C‐TKA, offering safer surgical management for TKA patients. Further studies on the short‐ and long‐term outcomes of RA‐TKA would improve the understanding of the full potential of this technology.

文獻(xiàn)出處：Maman D, Laver L, Becker R, Takrori LA, Mahamid A, Finkel B, Gan-Or H, Yonai Y, Berkovich Y. Trends and epidemiology in robotic-assisted total knee arthroplasty: Reduced complications and shorter hospital stays. Knee Surg Sports Traumatol Arthrosc. 2024 Dec;32(12):3281-3288. doi: 10.1002/ksa.12353. Epub 2024 Jul 17. PMID: 39016343; PMCID: PMC11605021.

文獻(xiàn)2

國際共識(shí)研討會(huì)對(duì)膝關(guān)節(jié)翻修術(shù)中骨缺損的處理

譯者 馬云青

在膝關(guān)節(jié)翻修術(shù)（rTKA）中，對(duì)全膝置換（TKA）術(shù)后嚴(yán)重骨缺損的評(píng)估、分型與治療，仍是復(fù)雜且存在爭議的課題。盡管已有新證據(jù)與新技術(shù)用于指導(dǎo)翻修膝嚴(yán)重骨缺損的診療策略，但目前仍缺乏一份能系統(tǒng)整合這些新型外科技術(shù)的文獻(xiàn)。因此，有必要對(duì)翻修全膝關(guān)節(jié)置換術(shù)中嚴(yán)重骨缺損的治療進(jìn)行全面綜述。

美國特種外科醫(yī)院（HSS）復(fù)雜關(guān)節(jié)重建中心，以翻修髖、膝關(guān)節(jié)置換的臨床與研究為核心，于2022年6月24日主辦了翻修TKA骨缺損處理共識(shí)研討會(huì)。會(huì)議邀請(qǐng)了42位國際專家并分為若干小組，每組圍繞以下4大主題中的一項(xiàng)展開討論：

1. 術(shù)前評(píng)估與影像學(xué)檢查、預(yù)期骨缺損、分型系統(tǒng)及假體隨訪監(jiān)測

2. 翻修全膝關(guān)節(jié)置換術(shù)中嚴(yán)重骨缺損情況下如何實(shí)現(xiàn)可靠固定

3. 嚴(yán)重骨缺損病例中髕骨骨缺損與伸膝裝置的處理

4. 復(fù)雜模塊化置換系統(tǒng)的應(yīng)用：鉸鏈?zhǔn)郊袤w、股骨遠(yuǎn)端置換與脛骨近端置換

在充分文獻(xiàn)復(fù)習(xí)與互動(dòng)討論基礎(chǔ)上，各小組盡可能形成共識(shí)意見。文章對(duì)上述4個(gè)領(lǐng)域、各組共識(shí)及未來研究方向進(jìn)行綜述。

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.

文獻(xiàn)出處：Sculco PK, Flevas DA, Jerabek SA, Jiranek WA, Bostrom MP, Haddad FS, Fehring TK, Gonzalez Della Valle A, Berry DJ, Brenneis M, Bornes TD, Rojas Marcos CE, Wright TM, Sculco TP. Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium. HSS J. 2024 May;20(2):141-181. doi: 10.1177/15563316231202750. Epub 2024 Jan 25. PMID: 39281983; PMCID: PMC11393633.

文獻(xiàn)3

應(yīng)用高交聯(lián)聚乙烯和傳統(tǒng)聚乙烯墊片的同期雙側(cè)后交叉韌帶保留型（CR）全膝關(guān)節(jié)置換病例的比較研究

譯者 張薔

背景：目前文獻(xiàn)中并無相關(guān)文章比較高交聯(lián)聚乙烯（HXLPE）和傳統(tǒng)聚乙烯（CP）對(duì)CR全膝關(guān)節(jié)置換（TKAs）術(shù)后翻修率的影響。本文章的目的是比較應(yīng)用HXLPE和CP的CR TKAs病例長期隨訪的臨床療效、平片和計(jì)算機(jī)掃描（CT）結(jié)果，以及骨溶解發(fā)生率、翻修率和假體生存率。

方法：本研究納入了410例連續(xù)的單一麻醉下同期雙側(cè)TKAs韓國患者（平均年齡，62.6±8歲）。其中164例男性和246例女性。每例均為一側(cè)應(yīng)用HXLPE墊片的CR高屈曲全膝假體（NexGen CR-Flex TKA; Zimmer Biomet），另一側(cè)應(yīng)用CP墊片的CR高屈曲NexGen TKA假體。平均隨訪時(shí)間為17.5年（范圍15年-19年）。

結(jié)果：在末次隨訪時(shí)，兩組間的膝關(guān)節(jié)協(xié)會(huì)評(píng)分（KSS，94分 vs. 93分），WOMAC評(píng)分（19.2分 vs. 19.2分），活動(dòng)度（125° vs. 126°），平片和CT結(jié)果，或翻修率（2.0% vs. 2.2%）均無顯著性差異。兩組內(nèi)均未出現(xiàn)骨溶解病例。如果以翻修或無菌性松動(dòng)作為終末點(diǎn)，在17.5年的預(yù)測假體生存率分別為：HXLPE組 98.0%（95%置信區(qū)間, 92% - 100%），CP組 97.8%（95%置信區(qū)間, 92% - 100%）。

結(jié)論：本長期隨訪（最低15年隨訪）研究顯示應(yīng)用HXLPE墊片和CP墊片的CR高屈曲全膝關(guān)節(jié)置換病例均獲得了優(yōu)異的臨床療效和假體生存率。然而，在本組病例中，我們并未發(fā)現(xiàn)高交聯(lián)聚乙烯墊片相對(duì)傳統(tǒng)墊片的優(yōu)勢。

Comparison?of?Highly?Cross-Linked?and Conventional?Polyethylene?During Simultaneous?Bilateral?Cruciate-Retaining Total?Knee?Arthroplasties

Results at a Minimum Follow-up of 15 Years

Background: There have been no long-term studies comparing the revision rates of a highly cross-linked polyethylene (HXLPE) bearing with those of a conventional polyethylene (CP) bearing among cruciate-retaining (CR) total knee arthroplasties (TKAs). The aim of the current long-term study was to compare CR TKAs with HXLPE and CP bearings in terms of clinical, radiographic, and computed tomographic (CT) scan results; prevalence of osteolysis; revision rate; and implant survivorship.

Methods: This study enrolled a consecutive series of 410 Korean patients (mean age, 62.6±8 years) who underwent simultaneous bilateral TKAs during the same anesthetic session. This study included 164 men and 246 women. Each patient underwent a posterior CR high-flexion TKA (NexGen CR-Flex TKA; Zimmer Biomet) with an HXLPE bearing on 1 side and a NexGen CR-Flex TKA with a CP bearing on the opposite side. The mean follow-up period was 17.5 years (range, 15 to 19 years).

Results: At the latest follow-up, there were no significant differences between the HXLPE and CP groups with regard to the Knee Society score (94 compared with 93 points), Western Ontario and McMaster Universities Osteoarthritis Index (19.2 points for both groups), range of motion (125° compared with 126°), radiographic and CT results, or revision rate (2.0% compared with 2.2%). No knee showed osteolysis in either group. The estimated survival rate at 17.5 years, using revision or aseptic loosening as the end point, was 98.0% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with an HXLPE bearing and 97.8% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with a CP bearing.

Conclusions: The findings of this long-term study (minimum follow-up of 15 years) indicate that CR-Flex TKAs with HXLPE and CP bearings both yielded excellent clinical outcomes and implant survivorship. However, no significant clinical advantage was observed for HXLPE over CP bearings in this patient population.

文獻(xiàn)出處：Kim YH, Park JW, Jang YS, Kim EJ. Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties: Results at a Minimum Follow-up of 15 Years. J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00621. Epub ahead of print. PMID: 41460951.

文獻(xiàn)4

擇期全關(guān)節(jié)置換術(shù)中加速康復(fù)外科（ERAS）路徑

譯者 沈松坡

加速康復(fù)外科（ERAS）方案在全髖關(guān)節(jié)和全膝關(guān)節(jié)置換術(shù)中的應(yīng)用日益增多，旨在改善結(jié)局、減少并發(fā)癥并縮短住院時(shí)間。這涉及一種從術(shù)前到術(shù)后的多學(xué)科、循證醫(yī)學(xué)方法。本文綜述了ERAS在擇期全髖關(guān)節(jié)置換術(shù)（THA）和全膝關(guān)節(jié)置換術(shù)（TKA）中實(shí)施的當(dāng)前文獻(xiàn)，重點(diǎn)關(guān)注住院時(shí)間（LOS）、阿片類藥物使用、并發(fā)癥/再入院等臨床結(jié)局，以及麻醉標(biāo)準(zhǔn)化、使用阿片節(jié)約型鎮(zhèn)痛藥物、早期活動(dòng)和患者滿意度等其他關(guān)鍵組成部分。

我們檢索了 PubMed、Embase 和 Google Scholar 數(shù)據(jù)庫（最后檢索時(shí)間為2025年5月），以尋找評(píng)估ERAS方案在擇期THA和TKA中應(yīng)用的研究。在無地域限制的前提下，納入了2000年至2025年間以英文發(fā)表的相關(guān)文章，包括臨床試驗(yàn)、觀察性研究、病例系列、病例報(bào)告和綜述文章。關(guān)鍵詞包括“enhanced recovery after surgery”“ERAS”“fast-track”“rapid recovery”“total joint arthroplasty”“total knee replacement”“total hip replacement”以及“outcomes”。文章的選擇基于與主題的相關(guān)性，并強(qiáng)調(diào)臨床結(jié)局。鑒于本綜述為敘述性綜述，未進(jìn)行正式的定量綜合分析。

納入的文獻(xiàn)（涵蓋多項(xiàng)研究中約294,000例患者）一致表明，ERAS路徑可在不增加再入院率或并發(fā)癥發(fā)生率的情況下，將LOS顯著縮短1至3天。多模式、阿片節(jié)約型鎮(zhèn)痛方案可帶來更優(yōu)的疼痛控制并減少阿片暴露，從而促進(jìn)早期活動(dòng)并減少不良反應(yīng)。功能恢復(fù)得到加速，許多ERAS患者可在術(shù)后數(shù)小時(shí)內(nèi)下地行走?；颊邎?bào)告結(jié)局和滿意度較高，且早期生活質(zhì)量改善較為常見。從衛(wèi)生系統(tǒng)角度看，ERAS的實(shí)施可帶來顯著的成本節(jié)約，這主要?dú)w因于更短的住院時(shí)間和更少的術(shù)后并發(fā)癥。ERAS的發(fā)展也促進(jìn)了在適當(dāng)篩選患者中門診關(guān)節(jié)置換術(shù)（當(dāng)日出院）的增長。

全關(guān)節(jié)置換術(shù)（TJA）中的ERAS代表了圍手術(shù)期照護(hù)模式的范式轉(zhuǎn)變，融合了安全性、效率和以患者為中心的康復(fù)。其實(shí)施可改善臨床結(jié)局并提升醫(yī)療價(jià)值，支持其繼續(xù)推廣，并作為髖、膝關(guān)節(jié)置換術(shù)全球照護(hù)標(biāo)準(zhǔn)加以采用。

Enhanced Recovery After Surgery (ERAS) Pathways in Elective Total Joint Arthroplasty

Enhanced recovery after surgery (ERAS) protocols are increasingly used in total hip and knee arthroplasty to improve outcomes, reduce complications, and shorten hospital stays. This involves a multidisciplinary, evidence-based approach covering the preoperative to postoperative period. This review explores the current literature on ERAS implementation in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA), focusing on clinical outcomes such as length of stay (LOS), opioid use, complications/readmissions, and other key components such as anesthetic standardization, use of opioid-sparing analgesia agents, early mobilization, and patient satisfaction. We performed a literature search of PubMed, Embase, and Google Scholar databases (last searched May 2025) for studies evaluating the use of ERAS protocols in elective THA and TKA. Relevant articles, including clinical trials, observational studies, case series, case reports, and review articles, were identified without geographic restrictions, limited to English-language publications from 2000 to 2025. Key search terms included "enhanced recovery after surgery," "ERAS," "fast-track," "rapid recovery," "total joint arthroplasty," "total knee replacement," "total hip replacement," and "outcomes." The selection of articles was based on relevance to the topic, emphasizing clinical outcomes. No formal quantitative synthesis was performed, given the narrative scope. The included literature (spanning approximately 294,000 patients across multiple studies) consistently demonstrates that ERAS pathways significantly reduce LOS by one to three days without increasing readmission or complication rates. Multimodal, opioid-sparing analgesia regimens lead to superior pain control and reduced opioid exposure, enhancing early mobilization and minimizing adverse effects. Functional recovery is accelerated, with many ERAS patients ambulating within hours of surgery. Patient-reported outcomes and satisfaction are high, and early quality-of-life improvements are commonly observed. ERAS implementation results in substantial cost savings from a systems perspective, largely due to shorter inpatient stays and fewer postoperative complications. The evolution of ERAS has also facilitated the growth of outpatient (same-day discharge) arthroplasty in appropriately selected patients. ERAS in total joint arthroplasty (TJA) represents a paradigm shift in perioperative care, combining safety, efficiency, and patient-centred recovery. Its implementation leads to improved clinical outcomes and enhanced healthcare value, supporting its continued expansion and adoption as a global standard of care in hip and knee arthroplasty.

文獻(xiàn)出處：Ishaku Z, Koshy DI, Adamu Bala M. Enhanced Recovery After Surgery (ERAS) Pathways in Elective Total Joint Arthroplasty. Cureus. 2025 Sep 2;17(9):e91481. doi: 10.7759/cureus.91481. PMID: 40917910; PMCID: PMC12412062

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

DDH幼年治療后的患者成年后的生活質(zhì)量

譯者 張振東

髖關(guān)節(jié)發(fā)育不良（DDH）如果治療不當(dāng)可導(dǎo)致髖關(guān)節(jié)功能過早喪失，然而很少有研究關(guān)注DDH幼年治療后的長期臨床隨訪結(jié)果。

本研究對(duì)兒童時(shí)期接受過髖關(guān)節(jié)脫位治療的DDH 患者進(jìn)行了一項(xiàng)健康相關(guān)生活質(zhì)量調(diào)查。 研究者向在其機(jī)構(gòu)接受過兒童期髖關(guān)節(jié)脫位治療的 287 名DDH 患者發(fā)放了調(diào)查問卷。使用SF-36調(diào)查了患者的人口統(tǒng)計(jì)學(xué)特征、特定疾病病史以及與健康相關(guān)的生活質(zhì)量。將患者的身體功能評(píng)分（PCS）、心理功能評(píng)分（MCS）和社會(huì)認(rèn)知評(píng)分（RCS）與日本標(biāo)準(zhǔn)值進(jìn)行了比較。 最終納入 68 例患者進(jìn)行了評(píng)估。

結(jié)果顯示：患者的 PCS、MCS 和 RCS 總平均值與標(biāo)準(zhǔn)值相當(dāng)。PCS可一直保持到 50 歲，但有 10 例50 歲以上的患者 PCS 顯著下降。接受切開復(fù)位術(shù)的患者的 PCS 明顯低于接受保守復(fù)位術(shù)的患者。在各年齡組和治療組中，患者的 MCS 和 RCS 與標(biāo)準(zhǔn)值無差異。 此外，PCS、MCS 和 RCS 在雙側(cè)、診斷年齡或是否需要額外手術(shù)方面也沒有差異。

DDH患者的身體生活質(zhì)量在50歲之前一直保持不變，但之后迅速下降，尤其是那些在幼年時(shí)期就需要進(jìn)行切開復(fù)位的患者。

Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood

Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.

文獻(xiàn)出處：Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B. 2025 Jan 1;34(1):38-43.

文獻(xiàn)2

兒童創(chuàng)傷性三角軟骨損傷的回顧性分析

譯者 任寧濤

背景:總結(jié)分析兒童外傷后三角軟骨損傷(TCI)的流行病學(xué)特點(diǎn)、治療方法及相應(yīng)療效，為早期診斷和改進(jìn)治療提供理論依據(jù)。

方法:采用Bucholz分型對(duì)TCI損傷進(jìn)行分型，隨訪時(shí)采用Harris髖關(guān)節(jié)評(píng)分及影像學(xué)檢查評(píng)價(jià)最終療效。最后，通過查閱文獻(xiàn)中的病例并結(jié)合我院的患者進(jìn)行綜合分析。

結(jié)果:本院共收治三角軟骨損傷15例(18髖)。I型損傷1例，II型損傷9例，IV型損傷2例，V型損傷1例，VI型損傷5例。隨訪完整的12例患者中，8例在三角軟骨內(nèi)或周圍發(fā)現(xiàn)骨橋，5例出現(xiàn)早期三角軟骨融合，3例髖關(guān)節(jié)發(fā)育不良，4例股骨頭半脫位，HHS優(yōu)8例，良4例。

結(jié)論:TCI損傷的早期診斷仍是一個(gè)難題。保守治療通常是首選。髖臼骨折累及三角軟骨的整體預(yù)后較差。三角軟骨骨橋的形成通常預(yù)示著過早閉合的可能性，這可能導(dǎo)致創(chuàng)傷后髖臼發(fā)育不良和股骨頭半脫位的嚴(yán)重并發(fā)癥。

Retrospective analysis of traumatic triradiate cartilage injury in children

Background: To summarize and analyze the epidemiological characteristics, treatment and corresponding curative effect of triradiate cartilage injury(TCI) in children after trauma, to provide a theoretical basis for early diagnosis and improvement of treatment.

Methods: The TCI was classified according to Bucholz classification, and the final curative effect was evaluated with Harris Hip Score and imaging examination during follow-up. Finally, a comprehensive analysis was made by reviewing the cases in the literature combined with the patients in our hospital.

Results: A total of 15 cases (18 hips) of triradiate cartilage injuries were collected in our hospital. There was 1 hip with type I injury, nine hips with type II injury, two hips with type IV injury, one hip with type V injury and five hips with type VI injury. Among the 12 cases with complete follow-up, the bone bridge was found in or around the triradiate cartilage in 8 cases, early fusion of triradiate cartilage occurred in 5 patients, 3 cases had hip dysplasia, 4 cases had a subluxation of the femoral head, and HHS was excellent in 8 cases and good in 4 cases.

Conclusion: The early diagnosis of TCI is still a difficult problem. Conservative treatment is often the first choice. The overall prognosis of acetabular fractures involving triradiate cartilage is poor. The formation of the bone bridge in triradiate cartilage usually indicates the possibility of premature closure, which may lead to severe complications of post-traumatic acetabular dysplasia and subluxation of the femoral head.

文獻(xiàn)出處：Dong Y, Wang J, Qin J, Nan G, Su Y, He B, Cai W, Chen K, Gu K, Liang X, Yan G, Wang Z. Retrospective analysis of traumatic triradiate cartilage injury in children. BMC Musculoskelet Disord. 2021 Aug 10;22(1):674. doi: 10.1186/s12891-021-04565-2. PMID: 34376165; PMCID: PMC8356404.

文獻(xiàn)3

骨盆再定位截骨術(shù)前髖臼三維形態(tài)分析方法：范圍綜述

譯者 李勇

背景： 髖臼周圍截骨術(shù)是治療髖臼發(fā)育不良的金標(biāo)準(zhǔn)。髖臼發(fā)育不良的巨大變異性要求通過三維重建和計(jì)算機(jī)輔助手術(shù)進(jìn)行個(gè)性化的術(shù)前規(guī)劃。為了規(guī)劃通過骨盆截骨術(shù)移動(dòng)髖臼骨塊，需要定義一個(gè)參考平面和一種描述髖臼三維方向的方法。

方法： 在PubMed上進(jìn)行了一項(xiàng)范圍綜述，檢索那些在三維參考系中描述原生髖關(guān)節(jié)髖臼形態(tài)的 articles。從3815篇報(bào)告中篩選出98篇 articles 納入分析。研究確定了三種可重復(fù)的參考平面：骨盆前平面、步態(tài)分析中使用的標(biāo)準(zhǔn)化與術(shù)語委員會(huì)平面以及骶骨基底平面。用于髖臼三維分析的不同方法被分為四組：整體方向、三平面測量、分割和股骨頭表面覆蓋率。

結(jié)論： 研究發(fā)現(xiàn)有兩種方法適用于再定位截骨術(shù)：通過向量法的整體方向法和三平面法。整體方向法依賴于從髖臼緣、髖臼面或連續(xù)平面創(chuàng)建向量。通過將整體髖臼向量標(biāo)準(zhǔn)化至一個(gè)理想向量，可以通過一次對(duì)齊操作來矯正髖臼發(fā)育不良。三平面法基于在股骨頭中心進(jìn)行角度測量，涉及通過考慮軸面、冠狀面和矢狀面來矯正異常。盡管其他兩種方法不直接適用于再定位，但它們有助于篩選患者以及驗(yàn)證規(guī)劃和術(shù)后結(jié)果。

Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review

? Periacetabular osteotomy is the gold standard treatment for acetabular dysplasia. The great variability of acetabular dysplasia requires a personalized preoperative planning improved by 3D reconstruction and computer-assisted surgery. To plan the displacement of the acetabular fragment by a pelvic osteotomy, it is necessary to define a reference plane and a method to characterize 3D acetabular orientation.
? A scoping review was performed on PubMed to search for articles with a method to characterize the acetabulum of native hips in a 3D reference frame. Ninety-eight articles out of 3815 reports were included. Three reproducible reference planes were identified: the anterior pelvic plane, the Standardization and Terminology Committee plane used in gait analysis, and the sacral base plane. The different methods for 3D analysis of the acetabulum were divided in four groups: global orientation, triplanar measurements, segmentation, and surface coverage of the femoral head.
? Two methods were found appropriate for reorientation osteotomies: the global orientation by a vector method and the triplanar method. The global orientation method relies on the creation of a vector from the acetabular rim, from the acetabular surface or from successive planes. Normalization of the global acetabular vector would correct acetabular dysplasia by a single alignment maneuver on an ideal vector. The triplanar method, based on angle measurements at the center of the femoral head, would involve correction of anomalies by considering axial, frontal, and sagittal planes. Although not directly fit for reorientation, the two others would help to candidate patients and verify both planning and postoperative result.

文獻(xiàn)出處：du Cluzel de Remaurin X, Khouri N, Georges S, Gajny L, Vergari C, Badina A. Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review. EFORT Open Rev. 2024 Aug 1;9(8):762-772. doi: 10.1530/EOR-22-0126. PMID: 39087510; PMCID: PMC11370718.

文獻(xiàn)4

髖關(guān)節(jié)不同姿勢對(duì)坐骨神經(jīng)位置的影響：一項(xiàng)MRI研究

譯者 陶可

背景：在考慮進(jìn)行髖關(guān)節(jié)手術(shù)（特別是骨盆三聯(lián)截骨術(shù)或髖臼周圍截骨術(shù)中的坐骨截骨術(shù)）時(shí)，必須重視坐骨神經(jīng)位置的變化，以確定最安全的下肢位置。由于坐骨神經(jīng)靠近截骨部位，因此在這些手術(shù)過程中可能會(huì)受到損傷，導(dǎo)致嚴(yán)重的功能障礙。本研究首次通過實(shí)驗(yàn)證實(shí)了髖關(guān)節(jié)位置對(duì)坐骨神經(jīng)位置的影響。

方法：我們研究了改變髖關(guān)節(jié)位置如何使坐骨神經(jīng)靠近或遠(yuǎn)離髖臼下溝（進(jìn)行骨盆三聯(lián)截骨術(shù)或髖臼周圍截骨術(shù)時(shí)，坐骨截骨的理想起始點(diǎn)位于髖臼下方）。我們對(duì)11名健康兒童（5名男孩和6名女孩，年齡7至17歲，均無髖關(guān)節(jié)手術(shù)史）進(jìn)行了左髖關(guān)節(jié)磁共振成像掃描，掃描體位分別為：中立位/仰臥位、屈髖30至45度、屈髖/外展/外旋30至45度。在磁共振圖像上測量了坐骨神經(jīng)與髖臼下溝之間的距離。計(jì)算了每位受試者在屈曲位和屈曲/外展/外旋位下，以中立位為基準(zhǔn)的距離比值。

結(jié)果：髖關(guān)節(jié)屈曲但不外展時(shí)，坐骨神經(jīng)向坐骨截骨部位移動(dòng)（平均屈曲/中立位比值為0.79，P<0.01）。然而，當(dāng)髖關(guān)節(jié)屈曲30°至45°，并外展和外旋時(shí)，坐骨神經(jīng)則遠(yuǎn)離截骨部位（平均屈髖/外展/外旋/中立位比值為1.34），這意味著神經(jīng)到髖臼下溝的距離顯著增加（P<0.01）。中立位時(shí)平均距離為14.8 mm（11至20 mm），屈曲位時(shí)為11.8 mm（9至16 mm），屈髖/外展/外旋位時(shí)為20.0 mm（9至30 mm）。

結(jié)論：在進(jìn)行骨盆三聯(lián)截骨術(shù)或髖臼周圍截骨術(shù)時(shí)，進(jìn)行坐骨截骨術(shù)最安全的髖/下肢位置可能是屈髖、外展和外旋位。在此位置，可以通過內(nèi)側(cè)或前側(cè)入路進(jìn)行截骨術(shù)，使坐骨神經(jīng)遠(yuǎn)離截骨部位。

圖1. 左側(cè)髖關(guān)節(jié)磁共振成像掃描在三種不同體位下進(jìn)行：中立/仰臥位、屈髖30至45度、以及屈髖/外展/外旋30至45度。

圖2. 軸位T1加權(quán)磁共振成像掃描示例及坐骨神經(jīng)至髖臼下溝的距離測量：中立位11至20毫米（平均14.8毫米），屈髖位9至16毫米（平均11.8毫米），屈髖/外展/外旋9至30毫米（平均20.0毫米）。

圖3. 髖關(guān)節(jié)屈曲但不外展時(shí)，坐骨神經(jīng)向坐骨截骨部位移動(dòng)。平均屈髖/中立位比值為0.79 (P<0.01)。然而，在髖關(guān)節(jié)屈曲/外展/外旋30至45度時(shí)，坐骨神經(jīng)會(huì)顯著遠(yuǎn)離截骨部位（平均比值為1.34，P<0.01）。

圖4. 示例：一名體型偏瘦的男孩，其坐骨神經(jīng)周圍脂肪組織極少，在髖關(guān)節(jié)中立位和屈髖/外展/外旋位（Flex/Abd/ER）時(shí)，坐骨神經(jīng)的位置變化極小。

The effect of hip position upon the location of the sciatic nerve: an MRI Study

Background: Allowance for the positional changes of the sciatic nerve is important when considering the safest position of the leg to perform hip operations, specifically the ischial osteotomy during a pelvic triple or periacetabular osteotomy. As for its proximity to the osteotomy site the sciatic nerve can be injured during these operations with the consequence of severe functional impairment. This is the first in-vivo study that demonstrates the effect of hip position upon the location of the sciatic nerve.

Methods: We determined how altering the position of the hip moves the nerve toward or away from the infracotyloid groove, the desired starting point of the ischial osteotomy site just inferior to the acetabulum when performing a pelvic triple or periacetabular osteotomy. Magnetic resonance imaging scans of the left hip in 3 different positions (neutral/supine, 30 to 45 degrees flexion, 30 to 45 degrees flexion/abduction/external rotation) were performed in 11 healthy children (5 boys and 6 girls, age 7 to 17 y) without prior hip surgery. The distance between the sciatic nerve and the infracotyloid groove was measured on the magnetic resonance images. Distance ratios based on the neutral position were calculated for flexion and flexion/abduction/external rotation for each of the participants.

Results: The sciatic nerve moves toward the ischium osteotomy site in hip flexion without abduction (mean flexion: neutral ratio 0.79, P<0.01). However the nerve moves away from the osteotomy site when the hip is 30 to 45 degrees flexed, abducted, and externally rotated (mean flexion/abduction/external rotation: neutral ratio 1.34), meaning the distance from nerve to infracotyloid groove increases significantly (P<0.01). The mean distances were 14.8 mm (11 to 20 mm) in neutral, 11.8 mm (9 to 16 mm) in flexion, and 20.0 mm (9 to 30 mm) in flexion/abduction/external rotation.

Conclusions: The likely safest position of the hip/leg to perform the ischium osteotomy as part of a pelvic triple or periacetabular osteotomy is in flexion, abduction, and external rotation. In this position the osteotomy can be performed via a medial or anterior approach with the nerve the furthest away from the osteotomy site.

文獻(xiàn)出處：Oliver Birke, Piers D Mitchell, Ella Onikul, David G Little. The effect of hip position upon the location of the sciatic nerve: an MRI Study. J Pediatr Orthop. 2011 Mar;31(2):165-9. doi: 10.1097/BPO.0b013e31820a1345.

文獻(xiàn)5

外側(cè)柱是支撐塌陷前股骨頭壞死的關(guān)鍵：基于傾向評(píng)分匹配隊(duì)列的有限元模型分析

譯者 邱興

背景： 本研究設(shè)計(jì)為一項(xiàng)隊(duì)列研究，采用傾向評(píng)分匹配法，根據(jù)年齡、性別和體重指數(shù)進(jìn)行匹配，對(duì)塌陷組和非塌陷組髖關(guān)節(jié)塌陷前的CT圖像進(jìn)行有限元模型分析。通過有限元分析，可獲得髖關(guān)節(jié)周圍整體的應(yīng)力分布圖形結(jié)果，直觀地展示應(yīng)力集中或分散的簡單印象。

方法： 回顧性分析了32例國際骨循環(huán)研究會(huì)ARCO 2期或3期股骨頭壞死患者的髖關(guān)節(jié)，這些患者接受了超過一年的隨訪。將16例隨訪期間無進(jìn)行性塌陷的髖關(guān)節(jié)設(shè)為研究組，然后采用傾向評(píng)分匹配法，選取了16例因塌陷進(jìn)展而需行關(guān)節(jié)置換術(shù)的髖關(guān)節(jié)作為對(duì)照組。使用Mechanical Finder軟件為每位患者建立有限元模型，然后在髂嵴頂部1000平方毫米區(qū)域施加4500牛的載荷，分析模型在屈服應(yīng)力方面的等效值。

結(jié)果： 兩組的年齡、性別和體重指數(shù)無顯著差異，但塌陷組中病灶位于外側(cè)的比例（p = 0.015）顯著更高，且病灶尺寸（p = 0.015）顯著更大。非塌陷髖關(guān)節(jié)主要表現(xiàn)為應(yīng)力分散至內(nèi)側(cè)柱和外側(cè)柱，而塌陷髖關(guān)節(jié)則表現(xiàn)為應(yīng)力集中于外側(cè)柱和原發(fā)性壓力骨小梁（p = 0.001）。

結(jié)論： 通過有限元模型分析，外側(cè)柱和原發(fā)性壓力骨小梁區(qū)域的應(yīng)力集中可用于高概率地預(yù)測股骨頭壞死的未來塌陷。研究結(jié)果提供了簡單直觀且對(duì)臨床醫(yī)生有重要參考價(jià)值的信息。因此，尤其對(duì)于年輕患者，通過保髖手術(shù)支撐外側(cè)柱可能是防止進(jìn)一步塌陷的關(guān)鍵。

Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts

Background: This study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion.

Methods: A total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm2 area at the top of iliac crest to analyze the models in terms of equivalents for yield stress.

Results: Age, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001).

Conclusion: Through FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.

Keywords: Femoral head collapse; Finite element analysis; Lateral pillar; Osteonecrosis of the femoral head; Propensity-matched score.

文獻(xiàn)出處：Bahk JH, Jo WL, Kim SC, Kwon SY, Lim YW. Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts. J Orthop Surg Res. 2021 Dec 20;16(1):728. doi: 10.1186/s13018-021-02875-8. PMID: 34930357; PMCID: PMC8686362.

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊(duì)

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