本期目錄：

1、全膝關(guān)節(jié)置換術(shù)中的非骨水泥固定：目前的證據(jù)和未來(lái)的展望

2、哪些術(shù)前因素與全膝關(guān)節(jié)置換術(shù)后未能達(dá)到可接受的疼痛和功能水平相關(guān)

3、應(yīng)用疊放式錐形補(bǔ)塊處理膝翻修手術(shù)中脛骨側(cè)廣泛骨缺損

4、以基尼指數(shù)量化的收入不平等可作為全膝關(guān)節(jié)置換術(shù)不良結(jié)局的指標(biāo)

5、指甲-髕骨綜合征影像學(xué)表現(xiàn)

6、術(shù)后髖臼壁指數(shù)對(duì)髖關(guān)節(jié)發(fā)育不良患者行髖臼轉(zhuǎn)位截骨術(shù)后患者報(bào)告結(jié)局的影響

7、股骨頭壞死治療的預(yù)后因素

8、髖臼周圍截骨術(shù)治療嚴(yán)重髖關(guān)節(jié)發(fā)育不良-手術(shù)技術(shù)

9、股骨頭軟骨下不全骨折

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

文獻(xiàn)1

全膝關(guān)節(jié)置換術(shù)中的非骨水泥固定：目前的證據(jù)和未來(lái)的展望

譯者 張軼超

介紹：非骨水泥固定在全膝關(guān)節(jié)置換術(shù)（TKA）中扮演著越來(lái)越重要的角色。這篇綜述文章的目的是分析非骨水泥TKA的功能效果和生存率。

材料和方法：對(duì)非骨水泥TKA的預(yù)后和生存率進(jìn)行了全面的文獻(xiàn)檢索。該檢索基于PRISMA 2020指南，使用PubMed、Medline和Embase數(shù)據(jù)庫(kù)。由兩名獨(dú)立觀察員篩選出納入的研究文獻(xiàn)。

結(jié)果：搜索從2010 - 2022年間的文獻(xiàn)，有15項(xiàng)被納入研究。11項(xiàng)研究比較了非水泥TKA和水泥TKA。四項(xiàng)研究?jī)H涉及非骨水泥假體。非骨水泥TKA的生存率和功能結(jié)果至少與骨水泥TKA相當(dāng)。

結(jié)論：隨著制造技術(shù)的進(jìn)步和手術(shù)工具的精確交付，以及機(jī)器人輔助TKA和3D打印植入物的使用，由于更多的生物固定技術(shù)的開(kāi)展，獲得更好的生存率和結(jié)果，可以預(yù)期非骨水泥TKA的使用會(huì)逐漸增加。

Cementless fixation in total knee arthroplasty: current evidence and future perspective

Introduction：Cementless fixation plays an increasing role in total knee arthroplasty (TKA). The objective of this review article is to analyze functional outcomes and survivorship of cementless TKA.

Materials and Methods：A comprehensive literature search for studies reviewing the outcome and survivorship of cementless TKA was conducted. This search was based on the PRISMA 2020 guidelines using PubMed, Medline, and Embase. The included studies were screened by two independent observers.

Results：From 2010 to 2022, fifteen studies were included. Eleven studies compared cementless and cemented TKA. Four studies only covered cementless implants. Survivorship and functional outcomes of cementless TKA are at least comparable to those of cemented implants.

Conclusion：With improvement in manufacturing, and surgical tools for more precise delivery, such as robotic assisted TKA and 3D-printed implants, one can expect increase in usage of cementless TKA, due to a more biological fixation, better survivorship, and outcomes.

文獻(xiàn)出處：Haslhofer DJ, Kraml N, Stadler C, Gotterbarm T, Klotz MC, Klasan A. Cementless fixation in total knee arthroplasty: current evidence and future perspective. Arch Orthop Trauma Surg. 2024 Dec 28;145(1):101. doi: 10.1007/s00402-024-05670-2. PMID: 39731597; PMCID: PMC11682007.

文獻(xiàn)2

哪些術(shù)前因素與全膝關(guān)節(jié)置換術(shù)后未能達(dá)到可接受的疼痛和功能水平相關(guān)？一項(xiàng)國(guó)際多中心研究的發(fā)現(xiàn)

譯者 馬云青

背景：盡管全膝關(guān)節(jié)置換術(shù)（TKA）是治療終末期膝關(guān)節(jié)骨關(guān)節(jié)炎的常見(jiàn)可靠的術(shù)式，但仍有少數(shù)患者無(wú)法獲得滿意的疼痛緩解和功能改善。盡管已有研究試圖找出會(huì)影響臨床結(jié)果不佳的原因，但很少有研究從患者可接受的癥狀狀態(tài)（PASS）這一角度來(lái)探討此問(wèn)題。PASS定義為患者自評(píng)療效指標(biāo)量表上的一個(gè)閾值，高于此閾值表明患者認(rèn)為其當(dāng)前的治療狀態(tài)是可以接受的。

目的： (1) 在TKA術(shù)后1年時(shí)，未達(dá)到疼痛和功能PASS的患者比例是多少？(2) 哪些術(shù)前患者因素與TKA術(shù)后1年未達(dá)到疼痛PASS相關(guān)？(3) 哪些術(shù)前患者因素與TKA術(shù)后1年未達(dá)到功能PASS相關(guān)？

方法：本研究是一項(xiàng)回顧性研究，是對(duì)一項(xiàng)關(guān)于單一TKA系統(tǒng)的前瞻性、國(guó)際性、多中心研究的1年隨訪數(shù)據(jù)進(jìn)行的二次分析。原研究的納入標(biāo)準(zhǔn)為：診斷為原發(fā)骨關(guān)節(jié)炎或創(chuàng)傷后關(guān)節(jié)炎、且能夠進(jìn)行10年隨訪的患者；排除標(biāo)準(zhǔn)為：存在感染、骨髓炎以及既往關(guān)節(jié)置換失敗。在2011年至2014年間，共有449名患者在5個(gè)國(guó)家的10個(gè)中心接受了TKA。在1年時(shí)，13%（58/449）的患者失訪，2%（8/449；缺失1年KOOS數(shù)據(jù)）無(wú)法進(jìn)行分析，剩下85%（383/449）的患者納入本次分析。主要結(jié)局指標(biāo)是未達(dá)到證據(jù)推導(dǎo)出的膝關(guān)節(jié)損傷和骨關(guān)節(jié)炎結(jié)局評(píng)分（KOOS）疼痛分量表及日常生活活動(dòng)（ADL）分量表的PASS閾值。研究構(gòu)建了多變量二元邏輯回歸模型，考慮術(shù)前人口統(tǒng)計(jì)學(xué)、影像學(xué)及患者報(bào)告結(jié)局指標(biāo)數(shù)據(jù)，并采用前向逐步剔除算法來(lái)得到最簡(jiǎn)化的最佳擬合回歸模型。

結(jié)果：在TKA術(shù)后1年，38%（145/383）的患者未達(dá)到KOOS疼痛的PASS，36%（139/383）未達(dá)到KOOS ADL的PASS，29%（110/383）未達(dá)到KOOS疼痛或ADL中任一指標(biāo)的PASS。在控制了性別、年齡、BMI和合并癥評(píng)分等潛在混雜變量后，我們發(fā)現(xiàn)，男性（比值比 2.09；p = 0.01）以及影像學(xué)顯示非嚴(yán)重骨關(guān)節(jié)炎的患者（比值比 2.09；p = 0.01）與未達(dá)到疼痛PASS顯著相關(guān)。在控制了相同的潛在混雜變量后，我們發(fā)現(xiàn)，影像學(xué)顯示非嚴(yán)重骨關(guān)節(jié)炎的患者（比值比 2.09；p = 0.01）也與未達(dá)到功能PASS顯著相關(guān)。

結(jié)論：我們發(fā)現(xiàn)，骨關(guān)節(jié)炎嚴(yán)重程度較輕的患者在TKA術(shù)后1年達(dá)到疼痛和功能PASS的可能性要低得多，并且男性在TKA術(shù)后1年達(dá)到疼痛PASS的可能性也低得多?；谶@些發(fā)現(xiàn)，外科醫(yī)生應(yīng)強(qiáng)烈考慮對(duì)于骨關(guān)節(jié)炎嚴(yán)重程度較輕的患者延遲手術(shù)，并對(duì)男性患者給予額外謹(jǐn)慎。外科醫(yī)生應(yīng)就患者的期望及其獲得有意義的疼痛和功能改善的機(jī)會(huì)向其提供咨詢。未來(lái)的地區(qū)和國(guó)家注冊(cè)研究應(yīng)評(píng)估TKA術(shù)后達(dá)到疼痛和功能PASS患者的真實(shí)比例，并驗(yàn)證本研究中確定的術(shù)前因素在更大型、更多樣化的患者群體中是否仍然顯著。

Which Preoperative Factors are Associated with Not Attaining Acceptable Levels of Pain and Function After TKA? Findings from an International Multicenter Study

Background:Although TKA is a common and proven reliable procedure for treating end-stage knee osteoarthritis, a minority of patients still do not achieve satisfactory levels of pain relief and functional improvement. Even though several studies have attempted to identify patients at risk of having poor clinical outcomes, few have approached this issue by considering the outcome of the patient-acceptable symptom state (PASS), defined as the value on a patient-reported outcome measure scale above which the patient deems their current symptom state acceptable.

Questions/purposes:(1) What is the proportion of patients who do not attain the PASS in pain and function at 1 year after TKA? (2) Which preoperative patient factors are associated with not achieving the PASS in pain at 1 year after TKA? (3) Which preoperative patient factors are associated with not achieving the PASS in function at 1 year after TKA?

Methods:This retrospective study is a secondary analysis of the 1-year follow-up data from a prospective, international, multicenter study of a single TKA system. Inclusion criteria for that study were patients diagnosed with primary osteoarthritis or post-traumatic arthritis and who were able to return for follow-up for 10 years; exclusion criteria were infection, osteomyelitis, and failure of a previous joint replacement. Between 2011 and 2014, 449 patients underwent TKA at 10 centers in five countries. At 1 year, 13% (58 of 449) were lost to follow-up, 2% could not be analyzed (eight of 449; missing 1-year KOOS), leaving 85% (383 of 449) for analysis here. The primary outcomes were not surpassing evidence-derived PASS thresholds in the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain and Activities in Daily Living (ADL) sub-scores. Multivariate binary logistic regressions considering preoperative demographic, radiographic, and patient-reported outcome measure data were constructed using a forward stepwise elimination algorithm to reach the simplest best-fit regression models.

Results:At 1 year after TKA, 38% of the patients (145 of 383) did not reach the PASS in KOOS Pain, 36% (139 of 383) did not reach the PASS in KOOS ADL, and 29% (110 of 383) did not achieve the PASS in either KOOS Pain or ADL. After controlling for potentially confounding variables such as gender, age, BMI, and comorbidity scores, we found that men (odds ratio 2.09; p = 0.01), and patients with less-than-advanced radiographic osteoarthritis (OR 2.09; p = 0.01) were strongly associated with not achieving the PASS in pain. After controlling for the same potentially confounding variables, we found that patients with less-than-advanced radiographic osteoarthritis (OR 2.09; p = 0.01) were also strongly associated with not achieving the PASS in function.

Conclusions:We found that patients with less severe osteoarthritis were much less likely to attain the PASS in pain and function at 1 year after TKA, and that men were much less likely to achieve the PASS in pain at 1 year after TKA. Based on these findings, surgeons should strongly consider delaying surgery in patients who present with less-than-severe osteoarthritis, with increased caution in men. Surgeons should counsel their patients on their expectations and their chances of achieving meaningful levels of pain and functional improvement. Future regional and national registry studies should assess the true proportion of patients attaining PASS in pain and function after TKA and confirm if the preoperative factors identified in this study remain significant in larger, more diverse patient populations.

文獻(xiàn)出處：Connelly JW, Galea VP, Rojanasopondist P, Nielsen CS, Bragdon CR, Kappel A, Huddleston JI 3rd, Malchau H, Troelsen A. Which Preoperative Factors are Associated with Not Attaining Acceptable Levels of Pain and Function After TKA? Findings from an International Multicenter Study. Clin Orthop Relat Res. 2020 May;478(5):1019-1028. doi: 10.1097/CORR.0000000000001162. Erratum in: Clin Orthop Relat Res. 2020 Dec;478(12):2955. doi: 10.1097/CORR.0000000000001565. Erratum in: Clin Orthop Relat Res. 2021 Jul 1;479(7):1641-1643. doi: 10.1097/CORR.0000000000001831. PMID: 32039954; PMCID: PMC7170689.

文獻(xiàn)3

應(yīng)用疊放式錐形補(bǔ)塊處理膝翻修手術(shù)中脛骨側(cè)廣泛骨缺損

譯者 張薔

背景：在處理膝翻修手術(shù)中脛骨近端廣泛骨缺損時(shí)，高孔隙率干骺端錐形補(bǔ)塊涌現(xiàn)為備受青睞的固定選擇。盡管既往關(guān)于疊放式錐形補(bǔ)塊的文獻(xiàn)稀少，這種方法卻逐步流行。本篇文章主要報(bào)道了全膝（TKA）翻修手術(shù)中應(yīng)用疊放式錐形補(bǔ)塊的早期結(jié)果。

方法：我們選擇2010年1月至2022年12月間所有接受疊放式錐形補(bǔ)塊治療的病例，進(jìn)行了一項(xiàng)單中心回顧性觀察研究。收集的資料包括一般資料、手術(shù)信息、影像學(xué)數(shù)據(jù)等。我們應(yīng)用Kaplan-Meier曲線評(píng)估了全因再手術(shù)或脛骨側(cè)翻修的假體生存率，終末點(diǎn)均為影像學(xué)可觀察的假體松動(dòng)。最終，共入組了22例疊放式錐形補(bǔ)塊的病例：其中，15例（68.2%）為男性；平均年齡64.1歲（范圍，42.8-87.8歲），BMI 34.2kg/m2（范圍，20.4-51.9kg/m2），既往手術(shù)中位數(shù)為4臺(tái)（范圍，1-12臺(tái)），平均隨訪時(shí)間為22.6個(gè)月（范圍，6.8-79.1個(gè)月）。

評(píng)估骨缺損的方法：在距離腓骨頭近端15mm的位置畫一條垂直于脛骨軸線的水平線標(biāo)記原始關(guān)節(jié)線，內(nèi)外側(cè)平臺(tái)皮質(zhì)骨向關(guān)節(jié)線做垂線，估算骨缺損。

77歲老年男性，既往應(yīng)用鉸鏈膝的二期膝翻修病史（A），因假體周圍感染行再翻修手術(shù)，一期應(yīng)用含有抗生素的靜態(tài)間隔器（B），二期手術(shù)時(shí)可見(jiàn)AORI 3型的脛骨側(cè)廣泛非包容性骨缺損，分別應(yīng)用遠(yuǎn)端3D打印的多孔鈦金屬錐形補(bǔ)塊和近端高孔隙率鉭金屬錐形補(bǔ)塊疊放的技術(shù)處理骨缺損，術(shù)后1年隨訪時(shí)顯示假體結(jié)構(gòu)穩(wěn)定（C）。

結(jié)果：有20例應(yīng)用了兩塊疊放的錐形補(bǔ)塊，而另外2例應(yīng)用了三塊疊放的錐形補(bǔ)塊。應(yīng)用疊放式錐形補(bǔ)塊的適應(yīng)證包括：假體周圍感染（n = 11），無(wú)菌性松動(dòng)（n = 9），脛骨側(cè)疼痛（n = 1）和假體周圍骨折（n = 1）。在術(shù)后中位數(shù)2.9個(gè)月后（范圍，0.4-37.3個(gè)月），5例病例接受了再手術(shù)，原因包括：伸膝裝置失效（n = 2），股骨假體松動(dòng)（n = 1），淺表傷口開(kāi)裂（n = 1）和術(shù)后血腫（n = 1）。在術(shù)后3年隨訪時(shí)，未出現(xiàn)因脛骨側(cè)假體松動(dòng)而翻修的病例（有一例在術(shù)后15個(gè)月隨訪時(shí)片子顯示松動(dòng)跡象，但最終未接受翻修治療）。

結(jié)論：在全膝翻修手術(shù)中遇到廣泛干骺端骨缺損時(shí)，疊放式錐形補(bǔ)塊是一種安全有效的治療選擇。

Stacked Cone Constructs for the Treatment of Extensive Tibial Bone Loss in Revision Total Knee Arthroplasty-A Series of 22 Patients

Background: Highly porous metaphyseal cones have emerged as a promising fixation strategy to address extensive proximal tibial bone loss in the multiply revised knee. Despite a paucity of literature regarding stacked cone constructs, they have gained popularity. This study reports on the early outcomes of stacked tibial cone constructs that are used during revision total knee arthroplasty (TKA).

Methods: A single-institution retrospective observational study was performed to identify patients who had been treated with a stacked cone construct during revision TKA between January 2010 and December 2022. Demographic, operative, clinical, and radiographic data were collected and assessed. Kaplan-Meier estimates were used to assess survival with all-cause reoperation, tibial-sided revision, and radiographic loosening as end points. In total, 22 stacked cone constructs were identified: 15 (68.2%) of the patients were men; the demographics included a mean age of 64.1 years (range, 42.8 to 87.8 years), a body mass index of 34.2 kg/m2 (range, 20.4 to 51.9 kg/m2), a median of 4 prior surgeries (range, 1 to 12 prior surgeries), and a mean follow-up of 22.6 months (range, 6.8 to 79.1 months).

Results: Twenty patients received 2-cone constructs, and 2 patients received 3-cone constructs. Patients received the stacked cone constructs during revision TKA for the following indications: periprosthetic joint infection (n = 11), aseptic loosening (n = 9), tibial stem pain (n = 1), and periprosthetic fracture (n = 1). At a median time of 2.9 months (range, 0.4 to 37.3 months), 5 patients underwent reoperation for the following indications: extensor mechanism failure (n = 2), femoral component loosening (n = 1), superficial wound dehiscence (n = 1), and postoperative hematoma (n = 1). At the 3-year follow-up, no patients had undergone revision for tibial component loosening (1 patient had radiographic evidence of loosening at the 15-month follow-up but did not undergo revision).

Conclusions: Stacked cone constructs are a viable option during revision TKA when extensive metaphyseal bone loss is encountered.

文獻(xiàn)4

以基尼指數(shù)量化的收入不平等可作為全膝關(guān)節(jié)置換術(shù)不良結(jié)局的指標(biāo)

譯者 沈松坡

背景：全膝關(guān)節(jié)置換術(shù)（TKA）術(shù)后結(jié)局可能因非醫(yī)療因素（包括健康的社會(huì)決定因素，SDOH）而有所差異。雖然區(qū)域貧困指數(shù)（ADI）和社會(huì)脆弱性指數(shù)（SVI）等復(fù)合指標(biāo)已將社區(qū)劣勢(shì)與不良結(jié)局聯(lián)系起來(lái)，但收入不平等在骨科領(lǐng)域中的作用尚未得到充分研究。基尼指數(shù)（GI）作為衡量收入差距的指標(biāo)，可能為評(píng)估社會(huì)經(jīng)濟(jì)因素對(duì)手術(shù)結(jié)果的影響提供一種更聚焦的方法。本研究旨在探討患者所處地區(qū)的GI是否與TKA術(shù)后短期并發(fā)癥相關(guān)。

方法：利用大型全國(guó)數(shù)據(jù)庫(kù)，通過(guò)國(guó)際疾病分類第10版（ICD-10）代碼篩選2017年至2021年接受原發(fā)性TKA的成年人。根據(jù)GI將患者分為低（<0.40）、中（0.40–0.49）和高（≥0.50）三組。結(jié)局指標(biāo)包括術(shù)后一年內(nèi)的翻修率、機(jī)械性并發(fā)癥和感染性并發(fā)癥。采用傾向評(píng)分匹配以控制人口學(xué)差異。

結(jié)果：高GI組患者的全因翻修率顯著高于中GI組，術(shù)后90天（0.9% vs 0.6%，比值比OR=1.42，P=0.01）及一年（1.5% vs 1.1%，OR=1.46，P<0.01）。高GI組脫位率亦較高，術(shù)后90天（2.6% vs 1.7%，OR=1.54，P<0.001）及一年（3.3% vs 2.1%，OR=1.58，P<0.001）。低GI組的翻修率及機(jī)械性并發(fā)癥與中GI組無(wú)顯著差異。感染率在各GI組間無(wú)差別。

結(jié)論：GI高于全國(guó)平均水平的患者TKA并發(fā)癥風(fēng)險(xiǎn)更高，而GI低于平均水平者無(wú)顯著差異。社區(qū)收入不平等程度可能是影響骨科結(jié)局的重要社會(huì)決定因素。

Income Inequality Quantified by the Gini Index Is an Indicator for Adverse Total Knee Arthroplasty Outcomes

Background: Postoperative outcomes following total knee arthroplasty (TKA) may vary due to non-medical factors, including social determinants of health (SDOH). While composite indices such as the Area Deprivation Index and Social Vulnerability Index link community disadvantage to adverse outcomes, the role of income inequality is underexplored in orthopaedics. The Gini Index (GI), a measure of income disparity, may provide a focused approach to assess socioeconomic influence on surgical outcomes. This study investigates whether a patient's GI is associated with short-term complications after TKA.

Methods: A large national database was queried to identify adults who underwent primary TKA from 2017 to 2021 via International Procedural Code - 10th Edition (ICD-10) codes. Patients were categorized by GI into low (< 0.40), average (0.40 to 0.49), and high (≥ 0.50) groups. Outcomes included revision rates, mechanical complications, and infectious complications within one year postoperatively. Propensity score matching was performed to control for demographic differences.

Results: Patients in the high-GI cohort had significantly increased rates of all-cause revision at 90 days (0.9 versus 0.6%, odds ratio (OR) 1.42, P = 0.01) and one year (1.5 versus 1.1%, OR 1.46, P < 0.01) compared to the average-GI group. Dislocation rates were also elevated at 90 days (2.6 versus 1.7%, OR 1.54, P < 0.001) and one year (3.3 versus 2.1%, OR 1.58, P < 0.001 in the high-GI group. There were no differences observed in revisions or mechanical complications in the low-GI group. Infection rates were similar across all GI categories.

Conclusion: Patients assigned a GI index greater than the national average demonstrated a higher risk for TKA complications, while there were no differences in patients who had a GI lower than the national average. The degree of income inequality in a community may be an influential SDOH driving variance in orthopaedic outcomes.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

指甲-髕骨綜合征影像學(xué)表現(xiàn)

譯者 任寧濤

指甲-髕骨綜合征（NPS）是一種罕見(jiàn)的常染色體顯性遺傳病，發(fā)病率1/50,000，NPS 是 LMX1B突變的結(jié)果。NPS典型的特征是指甲發(fā)育不全或發(fā)育不全、髕骨發(fā)育不良或發(fā)育不全、肘部發(fā)育不良和髂骨犄角。髂骨犄角被認(rèn)為是特有的，與發(fā)育不全或發(fā)育不良的髕骨與指甲異常相結(jié)合是診斷此病的主要特征。早在70年前，Captain Fong就報(bào)道了髂骨犄角，髂骨犄角是該綜合征的特征，但并非在所有情況下都會(huì)出現(xiàn)。大多數(shù)情況下都存在肘關(guān)節(jié)發(fā)育不良，并且可以表現(xiàn)出該綜合征的典型特征。除了骨骼和關(guān)節(jié)異常外，NPS 患者的肌肉質(zhì)量低，體型偏瘦，他們通常很難在中年之前增加體重。在此，我們展示了一名患有指甲-髕骨綜合征的女性的肘部、膝蓋和骨盆的影像學(xué)表現(xiàn)。

圖1 髂骨犄角

圖2 雙髕骨發(fā)育不良

圖3 肘關(guān)節(jié)發(fā)育不良，橈骨小頭后脫位

Radiographic findings in the nail-patella syndrome

Nail-patella syndrome is a rare disorder characterized classically by the tetrad of nail hypoplasia or aplasia, aplastic or hypoplastic patellae, elbow dysplasia, and the presence of iliac horns. Iliac horns are considered pathognomonic, and the presence of hypoplastic or aplastic patellae in conjunction with nail abnormalities is a cardinal feature of diagnosis. Elbow dysplasia is present in most cases and can exhibit features typical of the syndrome. Herein we present the radiographic findings of the elbows, knees, and pelvis of a woman with nail-patella syndrome.

文獻(xiàn)出處：James A West , Thomas H Louis. Radiographic findings in the nail-patella syndrome. Proc (Bayl Univ Med Cent) . 2015 Jul;28(3):334-6.

文獻(xiàn)2

術(shù)后髖臼壁指數(shù)對(duì)髖關(guān)節(jié)發(fā)育不良患者行髖臼轉(zhuǎn)位截骨術(shù)后患者報(bào)告結(jié)局的影響

譯者 李勇

引言： 本研究旨在確定術(shù)前變量和三維髖臼矯正對(duì)髖臼轉(zhuǎn)位截骨術(shù)（TOA）（一種球形髖臼周圍截骨術(shù)）后患者報(bào)告結(jié)局（PROMs）的影響。

方法： 我們回顧性分析了1998年至2019年間接受TOA治療的442例（582髖）髖關(guān)節(jié)發(fā)育不良患者，他們均完成了有效的問(wèn)卷調(diào)查，包括疼痛和滿意度的視覺(jué)模擬評(píng)分（VAS）以及髖關(guān)節(jié)殘疾和骨關(guān)節(jié)炎結(jié)果評(píng)分（HOOS）。中位隨訪時(shí)間為12年。我們分析了患者報(bào)告結(jié)局與術(shù)前變量及術(shù)后髖臼覆蓋率（外側(cè)中心邊緣角、前壁指數(shù)和后壁指數(shù)）之間的關(guān)聯(lián)。

結(jié)果： 年齡較大與HOOS-ADL（日常生活活動(dòng)）呈負(fù)相關(guān)（r = -0.26, P < 0.001），與HOOS-運(yùn)動(dòng)/娛樂(lè)呈負(fù)相關(guān)（r = -0.25, P < 0.001）。男性患者報(bào)告的HOOS-QOL（生活質(zhì)量）中位數(shù)低于女性患者（P = 0.038）。T?nnis分級(jí)為0級(jí)的患者，其滿意度-VAS中位數(shù)高于2級(jí)患者（P = 0.031），且其HOOS-ADL、運(yùn)動(dòng)/娛樂(lè)和QOL子量表的中位數(shù)均高于1級(jí)或2級(jí)患者。對(duì)于術(shù)后前壁指數(shù)，（前壁）缺陷組的VAS-疼痛評(píng)分較高（P = 0.045），而HOOS-疼痛評(píng)分較低（P = 0.047）。對(duì)于術(shù)后后壁指數(shù)，（后壁）過(guò)度組的HOOS-疼痛評(píng)分低于正常組（P = 0.029）。

結(jié)論： 即使在TOA術(shù)后保留的髖關(guān)節(jié)中，髖臼的矢狀面矯正也會(huì)影響術(shù)后疼痛，而年齡、性別和T?nnis分級(jí)則會(huì)影響患者滿意度、功能能力和生活質(zhì)量。這些見(jiàn)解對(duì)于優(yōu)化手術(shù)適應(yīng)證和髖臼重新定向策略，以及改善術(shù)后患者體驗(yàn)具有重要意義。

Impact of Postoperative Acetabular Wall Index on Patient-Reported Outcomes After Transposition Osteotomy of the Acetabulum in Patients With Hip Dysplasia

Introduction: This study aimed to determine the effect of preoperative variables and three-dimensional acetabular correction on patient-reported outcome measures after transposition osteotomy of the acetabulum (TOA), a spherical periacetabular osteotomy.

Methods: We retrospectively reviewed 442 patients (582 hips) with hip dysplasia who underwent TOA between 1998 and 2019 and completed validated questionnaires, including the visual analog scale (VAS) for pain and satisfaction and the Hip disability and Osteoarthritis Outcome Score (HOOS). The median follow-up was 12 years. Associations between patient-reported outcome measures and preoperative variables and postoperative acetabular coverage (lateral center-edge angle, anterior wall index, and posterior wall index) were analyzed.

Results: Older age was negatively correlated with HOOS-ADL (r = -0.26, P < 0.001) and HOOS-sports/recreation (r = -0.25, P < 0.001). Male patients reported lower median HOOS-QOL than female patients (P = 0.038). Patients with T?nnis grade 0 had higher median satisfaction-VAS than those with grade 2 (P = 0.031), and higher median HOOS-ADL, sports/recreation, and QOL subscales than those with grade 1 or 2. For postoperative anterior wall index, the deficient group had higher VAS-pain (P = 0.045) and lower HOOS-pain (P = 0.047) than the normal group. For postoperative posterior wall index, the excessive group had lower HOOS-pain than the normal group (P = 0.029).

Conclusion: Even in preserved hips after TOA, sagittal plane acetabular correction influenced postoperative pain, whereas age, sex, and T?nnis grade affected satisfaction, functional capacity, and QOL. These insights have implications for refining surgical indications and acetabular reorientation strategies, improving postoperative patient experience.

文獻(xiàn)出處：Tanaka, Shiori MD; Fujii, Masanori MD, PhD; Kawano, Shunsuke MD, PhD; Ueno, Masaya MD, PhD; Nagamine, Satomi MD, PhD; Mawatari, Masaaki MD, PhD. Impact of Postoperative Acetabular Wall Index on Patient-Reported Outcomes After Transposition Osteotomy of the Acetabulum in Patients With Hip Dysplasia. JAAOS: Global Research and Reviews 9(10):e25.00154, October 2025. | DOI: 10.5435/JAAOSGlobal-D-25-00154

文獻(xiàn)3

股骨頭壞死治療的預(yù)后因素：一項(xiàng)系統(tǒng)綜述

譯者 張利強(qiáng)

背景：多種保髖技術(shù)描述用于治療股骨頭壞死（ONFH）。本系統(tǒng)綜述旨在確定與治療失敗及轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)（THA）相關(guān)的治療股骨頭壞死預(yù)后因素。

材料與方法：本研究遵循PRISMA指南。于2021年11月進(jìn)行文獻(xiàn)檢索。獲取所有比較兩種或兩種以上股骨頭壞死治療方法的臨床試驗(yàn)。通過(guò)多元分析來(lái)探究基線特征與手術(shù)結(jié)果之間的關(guān)聯(lián)。采用皮爾遜積矩相關(guān)系數(shù)（r）進(jìn)行多元線性回歸分析。

結(jié)果：共檢索到88篇文章（6112例手術(shù)）。女性患者與轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)的時(shí)間延長(zhǎng)（P = 0.03）和全髖關(guān)節(jié)置換率降低（P = 0.03）相關(guān)。治療前癥狀持續(xù)時(shí)間越長(zhǎng)，治療失敗時(shí)間越短（P = 0.03）。治療前的視覺(jué)模擬評(píng)分（VAS）升高與失敗間隔縮短（P = 0.03）和全髖關(guān)節(jié)置換術(shù)（THA）間隔時(shí)間縮短（P = 0.04）相關(guān)。治療前髖關(guān)節(jié)功能降低與全髖關(guān)節(jié)置換術(shù)率升高（P = 0.02）和失敗率升高（P = 0.005）相關(guān)?；颊吣挲g、體重指數(shù)（BMI）、病因、術(shù)后完全負(fù)重時(shí)間以及患側(cè)均未顯示出與手術(shù)結(jié)果有統(tǒng)計(jì)學(xué)顯著關(guān)聯(lián)的證據(jù)。

結(jié)論：男性、治療前癥狀持續(xù)時(shí)間較長(zhǎng)、VAS評(píng)分較高以及HHS評(píng)分較低均為股骨頭壞死治療的不良預(yù)后因素。

Prognostic factors in the management of osteonecrosis of the femoral head: A systematic review

Background: Several hip preserving techniques have been described for the management of osteonecrosis of the femoral head (ONFH). This systematic review identified prognostic factors in the treatment of ONFH that are associated with treatment failure and conversion to total hip arthroplasty (THA).

Material and methods: This study followed the PRISMA guidelines. The literature search was conducted in November 2021. All clinical trials comparing two or more treatments for femoral head osteonecrosis were accessed. A multivariate analysis was performed to investigate the association between baseline characteristics and the surgical outcome. A multiple linear model regression analysis through the Pearson Product-Moment Correlation Coefficient (r) was used.

Results: Data from 88 articles (6112 procedures) were retrieved. Female gender was associated with increased time to THA (P = 0.03) and reduced rate of THA (P = 0.03). Longer symptom duration before treatment was associated with shorter time to failure (P = 0.03). Increased pre-treatment VAS was associated with reduced time to failure (P = 0.03) and time to THA (P = 0.04). Reduced pre-treatment hip function was associated with increased rate of THA (P = 0.02) and failure (P = 0.005). Patient age and BMI, aetiology, time from surgery to full weight bearing and the side did not show evidence of a statistically significant association with the surgical outcome.

Conclusion: Male gender, longer symptom duration before treatment, higher VAS scores, and lower HHS scores were negative prognostic factors after treatment for osteonecrosis of the femoral head.

文獻(xiàn)出處：Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Prognostic factors in the management of osteonecrosis of the femoral head: A systematic review. Surgeon. 2023 Apr;21(2):85-98. doi: 10.1016/j.surge.2021.12.004. Epub 2022 Jan 4. PMID: 34991986.

文獻(xiàn)4

髖臼周圍截骨術(shù)治療嚴(yán)重髖關(guān)節(jié)發(fā)育不良-手術(shù)技術(shù)

譯者 陶可

背景：嚴(yán)重髖關(guān)節(jié)發(fā)育不良伴股骨頭半脫位或繼發(fā)性髖臼（解剖結(jié)構(gòu)異常）的最佳治療方法仍存在爭(zhēng)議。本研究的目的是分析手術(shù)矯正的程度和使用伯爾尼髖臼周圍截骨術(shù)治療青少年和年輕成人患者的嚴(yán)重髖關(guān)節(jié)發(fā)育不良所獲得的早期臨床結(jié)果。

方法：平均年齡為17.6歲（范圍，13.0至31.8歲）的13名患者（16髖）被歸類為嚴(yán)重髖關(guān)節(jié)發(fā)育不良（根據(jù)Severin分類為IV型或V型）。8髖存在半脫位，8髖存在繼發(fā)髖臼（解剖結(jié)構(gòu)異常）。術(shù)前，所有患者均出現(xiàn)髖關(guān)節(jié)疼痛，且X線片上的髖關(guān)節(jié)（股骨頭與髖臼）形合度完全一致，可考慮進(jìn)行截骨術(shù)。所有16髖均接受了伯爾尼髖臼周圍截骨術(shù)，其中6個(gè)髖關(guān)節(jié)同時(shí)接受了股骨近端截骨術(shù)。術(shù)后，髖關(guān)節(jié)進(jìn)行放射學(xué)評(píng)估，以評(píng)估畸形的矯正、截骨部位的愈合和骨關(guān)節(jié)炎的進(jìn)展。術(shù)后采用Harris髖關(guān)節(jié)評(píng)分測(cè)量臨床結(jié)果和髖關(guān)節(jié)功能，平均隨訪4.2年。

結(jié)果：術(shù)前和隨訪X線片比較顯示W(wǎng)iberg外側(cè)中心邊緣角平均改善44.6度（從-20.5度到24.1度），假斜位片上的前方中心邊緣角平均改善51.0度（從-25.4度到25.6度），及髖臼頂傾斜角平均改善25.9度（從37.3度到11.4度）。髖關(guān)節(jié)中心向內(nèi)側(cè)平均平移10毫米（范圍，0至31毫米）。所有髂骨截骨部位均愈合。平均Harris髖關(guān)節(jié)評(píng)分從術(shù)前的73.4分提高到最近一次隨訪時(shí)的91.3分。13例患者中有11例（16髖中的14例）對(duì)手術(shù)結(jié)果表示滿意，14髖臨床效果良好或優(yōu)良。主要并發(fā)癥包括一名患者的髖臼固定丟失，這需要額外的手術(shù)治療；另一名患者的髖臼過(guò)度矯正和相關(guān)的坐骨骨不連。在最近一次隨訪時(shí)，兩名患者的臨床結(jié)果都很好。沒(méi)有嚴(yán)重的神經(jīng)血管損傷或關(guān)節(jié)內(nèi)骨折。

結(jié)論：髖臼周圍截骨術(shù)是一種有效的手術(shù)矯正青少年和年輕成人嚴(yán)重髖關(guān)節(jié)發(fā)育不良的技術(shù)。本系列早期臨床效果非常好，平均術(shù)后4.2年；兩大并發(fā)癥并沒(méi)有影響良好的臨床效果。

圖1-A 患者仰臥位于可透射線的手術(shù)臺(tái)上。在受影響的髖關(guān)節(jié)下方放置一個(gè)小凸起襯墊，并將足部固定在手術(shù)臺(tái)上。放置神經(jīng)監(jiān)測(cè)導(dǎo)線以進(jìn)行持續(xù)的周圍神經(jīng)監(jiān)測(cè)。

圖1-B 演示了改良Smith-Petersen入路的髖關(guān)節(jié)切口。ASIS = 髂前上棘。

圖2-A 圖 2-A改良的Smith-Petersen方法的示意圖。

圖2-B和 2-C 改良的Smith-Petersen方法的示意圖。

圖3-A 髖臼下坐骨切口。使用Metzenbaum剪刀（長(zhǎng)彎組織剪）在髖關(guān)節(jié)前囊上方和腰大肌腱下方形成一個(gè)平面。

圖3-B 該平面向下，再向后進(jìn)入前坐骨（坐骨體，髖臼下溝），進(jìn)行第一次截骨。

圖3-C和 3-D 截骨的位置可以通過(guò)前后（圖3-C）和45°髂骨斜位（圖3-D）透視圖來(lái)確認(rèn)。

圖3-E 注意因?yàn)榭拷巧窠?jīng)，而不要過(guò)度伸展切口的后外側(cè)。

圖4-A、4-B和 4-C 恥骨上支截骨術(shù)。圖4-A將窄、鈍、彎曲的牽開(kāi)器前后放置，然后用尖頭Homan牽開(kāi)器暴露恥骨上支。

圖4-B和4-C大部分截骨切口是用小擺鋸（圖4-B）完成的，深層皮質(zhì)切開(kāi)采用半英寸（1.27厘米）帶角度的骨刀完成（圖4-B和4-C)。

圖5-A 髂骨截骨術(shù)從髂前上棘直接朝向坐骨切跡進(jìn)行，并在骨盆邊緣上外側(cè)約1cm處停止。高速磨鉆用于為髂骨切口而制作目標(biāo)打孔。

5-B和5-C 使用擺鋸進(jìn)行截骨術(shù)。ASIS =髂前上棘。

圖6-A 后柱切口與髂骨切口成120°角。圖6-B可以通過(guò)45°髂骨斜透視評(píng)估該切口的方向。

圖6-C 使用45°角骨刀完成截骨。

圖7-A至7-E 嚴(yán)重髖關(guān)節(jié)發(fā)育不良的髖臼周圍切口和髖臼復(fù)位的假骨模型。重要的是要注意，這個(gè)假骨模型中描述的復(fù)位是指矯正嚴(yán)重髖臼發(fā)育不良所需的積極復(fù)位的類型。具體而言，由于需要大量重新定位，髂骨間隙可能缺乏髖臼碎片和髂骨之間的骨與骨接觸（圖7-C）。此外，模型中明顯過(guò)度的前方矯正（圖7-E）不會(huì)出現(xiàn)在髖臼前方嚴(yán)重不足的髖關(guān)節(jié)。圖7-A、7-B和7-C重新定位的目標(biāo)是增加股骨頭前外側(cè)的覆蓋范圍，保持或獲得髖臼前傾，并在需要時(shí)向內(nèi)側(cè)平移髖關(guān)節(jié)（旋轉(zhuǎn)）中心。我們通過(guò)：(1)內(nèi)旋（外側(cè)覆蓋和前傾）、（2）前傾或伸展（前覆蓋）和（3）內(nèi)側(cè)平移（關(guān)節(jié)中心的內(nèi)側(cè)化）進(jìn)行髖臼復(fù)位。圖7-B和7-C展示了髖臼周圍的切口。圖7-D和7-E截骨部位通常用四枚螺釘固定，將切除的突出的髂前上棘移植入髂骨間隙。

圖8 髖臼截骨骨塊暫時(shí)用克氏針固定，最終用4.5毫米螺釘從髂嵴插入截開(kāi)的髖臼（骨塊）。

9-A、9-B和9-C股骨頭頸交界處的股骨成形術(shù)。圖9-A髖臼周圍截骨術(shù)后中度髖關(guān)節(jié)發(fā)育不良的術(shù)中蛙式位片，顯示在前外側(cè)頭頸交界處存在非球形股骨頭（箭頭）。

圖9-B 這種畸形與關(guān)節(jié)切開(kāi)術(shù)中觀察到的屈曲100°時(shí)的股骨髖臼前方撞擊有關(guān)。

圖9C 進(jìn)行頭頸部交界處的骨成形術(shù)，以實(shí)現(xiàn)髖關(guān)節(jié)在運(yùn)動(dòng)范圍內(nèi)無(wú)撞擊。

圖10 髖關(guān)節(jié)重建后檢查被動(dòng)髖關(guān)節(jié)屈曲運(yùn)動(dòng)，以確保髖關(guān)節(jié)屈曲至少為90°（最好>100°）。

圖11-A至11-D 一名患有嚴(yán)重髖臼發(fā)育不良的16歲男孩的髖關(guān)節(jié)X線片。圖11-A和11-B前后位（圖11-A）和假斜位（圖11-B）X線片顯示嚴(yán)重的髖關(guān)節(jié)發(fā)育不良。該患者采用髖臼周圍截骨術(shù)和股骨近端內(nèi)翻截骨術(shù)聯(lián)合治療。

圖11-C和11-D 術(shù)后3年拍攝X線片，顯示重建后實(shí)現(xiàn)了廣泛的重新定向、最小的骨盆變形和完全的骨愈合。該患者的臨床效果極佳。

Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique

Background: The optimal treatment of severe acetabular dysplasia with subluxation of the femoral head or the presence of a secondary acetabulum remains controversial. The purpose of this study was to analyze the extent of surgical correction and the early clinical results obtained with the Bernese periacetabular osteotomy for the treatment of severely dysplastic hips in adolescent and young adult patients.

Methods: Sixteen hips in thirteen patients with an average age of 17.6 years (range, 13.0 to 31.8 years) were classified as having severe acetabular dysplasia (Group IV or V according to the Severin classification). Eight hips were classified as subluxated, and eight had a secondary acetabulum. Preoperatively, all patients had hip pain and sufficient hip joint congruency on radiographs to be considered candidates for the osteotomy. All sixteen hips underwent a Bernese periacetabular osteotomy, and six of them underwent a concomitant proximal femoral osteotomy. Postoperatively, the hips were assessed radiographically to evaluate correction of deformity, healing of the osteotomy site, and progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 4.2 years postoperatively.

Results: Comparison of preoperative and follow-up radiographs demonstrated an average improvement of 44.6 degrees (from -20.5 degrees to 24.1 degrees) in the lateral center-edge angle of Wiberg, an average improvement of 51.0 degrees (from -25.4 degrees to 25.6 degrees) in the anterior center-edge angle of Lequesne and de Seze, and an average improvement of 25.9 degrees (from 37.3 degrees to 11.4 degrees) in acetabular roof obliquity. The hip center was translated medially an average of 10 mm (range, 0 to 31 mm). All iliac osteotomy sites healed. The average Harris hip score improved from 73.4 points preoperatively to 91.3 points at the time of the latest follow-up. Eleven of the thirteen patients (fourteen of the sixteen hips) were satisfied with the result of the surgery, and fourteen hips had a good or excellent clinical result. Major complications included loss of acetabular fixation, which required an additional surgical procedure, in one patient and overcorrection of the acetabulum and an associated ischial nonunion in another patient. Both patients had a good clinical result at the time of the latest follow-up. There were no major neurovascular injuries or intra-articular fractures.

Conclusions: The periacetabular osteotomy is an effective technique for surgical correction of a severely dysplastic acetabulum in adolescents and young adults. In this series, the early clinical results were very good at an average of 4.2 years postoperatively; the two major complications did not compromise the good clinical results.

文獻(xiàn)出處：John C Clohisy, Susan E Barrett, J Eric Gordon, Eliana D Delgado, Perry L Schoenecker. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique. Review J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:65-83.

文獻(xiàn)5

股骨頭軟骨下不全骨折

譯者 邱興

股骨頭軟骨下不全骨折（SIF）是近期（2012）提出的一個(gè)概念，需與骨壞死相鑒別。臨床上，SIF常見(jiàn)于患有骨質(zhì)疏松的老年女性或腎移植術(shù)后患者。早期影像學(xué)改變不明顯，但部分病例可出現(xiàn)軟骨下塌陷（新月征）。在T1加權(quán)磁共振圖像上，低信號(hào)帶是其特征性影像表現(xiàn)之一，組織學(xué)上對(duì)應(yīng)骨折線及相關(guān)的骨折修復(fù)組織。因此，低信號(hào)帶的形態(tài)通常呈不規(guī)則、不連續(xù)且凸向關(guān)節(jié)面的特點(diǎn)。SIF的預(yù)后尚未明確，部分病例通過(guò)保守治療癥狀可緩解，而另一些病例則出現(xiàn)快速塌陷進(jìn)展，如快速進(jìn)展性髖關(guān)節(jié)病。

關(guān)鍵詞：股骨頭；骨壞死；骨質(zhì)疏松；軟骨下不全骨折

圖1、一名68歲女性患者，患有右股骨頭軟骨下不全骨折。（A）于發(fā)病8周后拍攝的X線片顯示股骨頭外側(cè)部分出現(xiàn)軟骨下塌陷，并可見(jiàn)關(guān)節(jié)間隙狹窄。（B）在側(cè)位視圖中，可清晰觀察到新月征（箭頭所示）。該病例的最終組織病理學(xué)診斷為軟骨下不全骨折。

圖2、68歲女性，右股骨頭軟骨下不全骨折。（A）發(fā)病后4周拍攝的X光片顯示股骨頭未見(jiàn)明顯異常。（B、C）發(fā)病后4周進(jìn)行MRI，存在彌漫性骨髓水腫模式，T1加權(quán)像呈低信號(hào)強(qiáng)度（B），T2加權(quán)像呈高信號(hào)強(qiáng)度（C）。同時(shí)可見(jiàn)一條與關(guān)節(jié)面平行的極低信號(hào)強(qiáng)度帶（箭頭所示）。（D）切除的股骨頭截面顯示，關(guān)節(jié)面正下方可見(jiàn)一條發(fā)白的線（箭頭所示）。（E）標(biāo)本X光片顯示一條骨硬化線（箭頭所示），該硬化線由沿骨折線形成的骨痂構(gòu)成（箭頭所示）。（F）線性硬化區(qū)域的組織學(xué)檢查顯示，原有的骨小梁骨折，伴有骨折骨痂形成，并且骨髓腔內(nèi)有肉芽組織。未見(jiàn)既往存在的骨壞死證據(jù)（蘇木精-伊紅染色，×100）。

圖3、軟骨下不全骨折（A）與骨壞死（B）的帶狀影像比較。在軟骨下不全骨折中，該帶狀影像對(duì)應(yīng)于骨折線，因此通常形態(tài)不規(guī)則、不連續(xù)、呈凸形且與軟骨表面平行。相比之下，骨壞死中的帶狀影像對(duì)應(yīng)于壞死區(qū)域周圍形成的修復(fù)組織，其形態(tài)往往光滑、邊界清晰且呈凹形。

Subchondral insufficiency fractures of the femoral head

A subchondral insufficiency fracture (SIF) of the femoral head is a recently proposed concept, which needs to be differentiated from osteonecrosis. Clinically, SIF has generally been observed in the osteoporotic elderly women or renal transplant recipients. Radiographical changes are not obvious in its early phase, however, some cases undergo subchondral collapse (crescent sign). On the T1-weighted magnetic resonance images, a low intensity band is one of the characteristic imaging appearances, which corresponds histologically to the fracture line and associated fracture repair tissue. Therefore, the shape of the low intensity band generally tends to be irregular, disconnected, and convex to the articular surface. The prognosis of SIF is not clearly established. Some cases show resolution of the symptoms by the conservative treatments, while other cases show rapid progression of the collapse such as rapidly progressive arthrosis of the hip.

Keywords: Femoral head; Osteonecrosis; Osteoporosis; Subchondral insufficiency fracture.

文獻(xiàn)出處：Yamamoto, Takuaki. "Subchondral insufficiency fractures of the femoral head." Clinics in orthopedic Surgery 4, no. 3 (2012): 173.

來(lái)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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