本期目錄：

1、全膝關(guān)節(jié)置換術(shù)后運(yùn)動(dòng)恐懼癥的患病率及其影響因素

2、MAKO 機(jī)器人輔助髖關(guān)節(jié)置換術(shù)與傳統(tǒng)全髖關(guān)節(jié)置換術(shù)的比較

3、全膝關(guān)節(jié)置換對(duì)線方法對(duì)軟組織平衡以及運(yùn)動(dòng)模式的影響

4、機(jī)器人輔助并未減少全髖關(guān)節(jié)置換術(shù)中的并發(fā)癥

5、當(dāng)股骨頭骨骺出現(xiàn)時(shí)感染后髖脫位處理措施

6、通過比較影像形態(tài)學(xué)分析來評(píng)估印度人群中成人髖關(guān)節(jié)的正常影像形態(tài)

7、髖關(guān)節(jié)撞擊綜合征的三維無創(chuàng)評(píng)估髖關(guān)節(jié)撞擊綜合征的三維無創(chuàng)評(píng)估

8、骨科手術(shù)并發(fā)癥分級(jí)系統(tǒng)的可靠性：保髖截骨手術(shù)隨訪驗(yàn)證

9、機(jī)械力、激素及代謝因素對(duì)血管、血流和骨骼的影響

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)后運(yùn)動(dòng)恐懼癥的患病率及其影響因素：一項(xiàng)系統(tǒng)回顧和薈萃分析

譯者 張軼超

背景：膝關(guān)節(jié)骨關(guān)節(jié)炎是老年人常見的退行性疾病，全膝關(guān)節(jié)置換術(shù)是治療終末期膝關(guān)節(jié)疾病的有效方法。然而，術(shù)后運(yùn)動(dòng)恐懼癥會(huì)阻礙患者的康復(fù)，影響膝關(guān)節(jié)功能的恢復(fù)。對(duì)其相關(guān)影響因素的研究存在差異。

目的：本薈萃分析研究了TKA后運(yùn)動(dòng)恐懼癥的患病率和危險(xiǎn)因素。

方法：檢索了Science、MEDLINE、Pubmed、Cochrane Library、中國知網(wǎng)（CNKI）、Embase、Web of Science等數(shù)據(jù)庫中關(guān)于TKA術(shù)后患者運(yùn)動(dòng)恐懼癥患病率及危險(xiǎn)因素的相關(guān)文獻(xiàn)。排除重復(fù)文獻(xiàn)、低質(zhì)量文獻(xiàn)、觀察指標(biāo)不一致的文獻(xiàn)和沒有全文的文獻(xiàn)。兩名獨(dú)立研究人員使用紐卡斯?fàn)?渥太華量表（NOS）評(píng)估納入文獻(xiàn)的質(zhì)量。數(shù)據(jù)提取后，使用Stata17.0進(jìn)行meta分析。

結(jié)果：本薈萃分析共納入11篇文章，涉及4039個(gè)病例，以評(píng)估TKA術(shù)后運(yùn)動(dòng)恐懼癥的患病率?？偦疾÷蕿?5% （95% CI: 27-44%）。亞組分析顯示，不同年齡、受教育程度、收入和居住地的患病率各不相同，65歲以下以及受教育程度和收入水平較低的人群患病率最高。影響運(yùn)動(dòng)恐懼癥患病率的關(guān)鍵因素包括疼痛（OR=2.313, 95% CI: 1.556-3.07）、低社會(huì)支持（OR=1.681, 95% CI: 1.000-2.361）和消極應(yīng)對(duì)（OR=1.344, 95% CI: 1.165-1.523）。

結(jié)論：TKA術(shù)后運(yùn)動(dòng)恐懼癥發(fā)生率高。不同居住地、不同教育水平、不同月收入的人群中，運(yùn)動(dòng)恐懼癥的患病率存在差異。同時(shí)還受到術(shù)后疼痛、社會(huì)支持低、主動(dòng)性差、消極應(yīng)對(duì)、年齡大、文化程度低等因素的影響。

Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis

Background：Knee osteoarthritis is a common degenerative disease in the elderly, and total knee arthroplasty is an effective treatment for end-stage knee joint diseases. However, kinesiophobia after surgery can impede patients’ rehabilitation and affect the recovery of knee joint function. There are differences in the research on its related influencing factors.

Objectives：This meta-analysis examined the prevalence and risk factors of kinesiophobia after TKA.

Methods：Pubmed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, Web of Science on the prevalence and risk factors of kinesiophobia after TKA was searched in science, MEDLINE and other databases. Duplicate literature, low quality literature, literature with inconsistent observation indicators, and literature without full text were excluded. Two independent researchers used Newcastle-Ottawa Scale (NOS) to evaluate the quality of the

included literature. After data extraction, Meta-analysis was performed using Stata17.0.

Results：A total of 11 articles involving 4039 cases were included in this meta-analysis to assess the prevalence of kinesiophobia after TKA. The overall prevalence was found to be 35% (95% CI: 27-44%). Subgroup analyses revealed varying prevalence rates based on age, education, income, and residence, with the highest prevalence observed in individuals under 65 years and those with lower levels of education and income. Key factors influencing the prevalence of kinesiophobia included pain (OR=2.313, 95% CI: 1.556–3.07), low social support (OR=1.681, 95% CI: 1.000-2.361), and negative coping strategies (OR=1.344, 95% CI: 1.165–1.523).

Conclusion：The prevalence of kinesiophobia after TKA is high. There are differences in the prevalence of kinesiophobia among people with different places of residence, different education levels, and different monthly incomes. At the same time, it is affected by many factors such as postoperative pain, low social support, low selfefficacy, negative coping, old age, and low education level.

文獻(xiàn)出處：Du X, Shao Y, Xue J, Kong J. Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2025 Apr 1;20(1):332. doi: 10.1186/s13018-025-05752-w. PMID: 40170179; PMCID: PMC11959722.

文獻(xiàn)2

MAKO 機(jī)器人輔助髖關(guān)節(jié)置換術(shù)與傳統(tǒng)全髖關(guān)節(jié)置換術(shù)的比較：系統(tǒng)綜述和薈萃分析

譯者 馬云青

研究背景：全髖關(guān)節(jié)置換術(shù)（THA）是治療終末期髖關(guān)節(jié)骨關(guān)節(jié)炎的金標(biāo)準(zhǔn)。為提高手術(shù)可重復(fù)性和安全性，機(jī)器人輔助系統(tǒng)（尤其是MAKO系統(tǒng)）已被引入THA。然而，目前尚缺乏比較MAKO輔助THA（MAKO-THA）與傳統(tǒng)THA C-THA的薈萃分析，且既往綜述常合并多種手術(shù)指征，導(dǎo)致異質(zhì)性較高。

作者對(duì)因單純髖關(guān)節(jié)骨關(guān)節(jié)炎接受THA的患者，進(jìn)行了MAKO機(jī)器人輔助THA與傳統(tǒng)THA的隨機(jī)對(duì)照研究療效的薈萃分析。評(píng)估指標(biāo)包括臨床療效（Harris髖關(guān)節(jié)評(píng)分[HHS]、遺忘關(guān)節(jié)評(píng)分[FJS]和牛津髖關(guān)節(jié)評(píng)分[OHS]）、影像學(xué)參數(shù)（假體定位準(zhǔn)確性）、下肢長度差異、手術(shù)時(shí)長及并發(fā)癥。

研究結(jié)果：共納入20項(xiàng)對(duì)比研究。MAKO輔助THA術(shù)后HHS（MAKO-THA: 89.1, 95%CI: 86.4-91.7；C-THA: 87.0, 95%CI: 83.8-90.1）、FJS（MAKO-THA: 84.7, 95%CI: 79.9-89.6；C-THA: 74.9, 95%CI: 64.0-95.7）和OHS（MAKO-THA: 89.1, 95%CI: 86.4-91.7；C-THA: 87.0, 95%CI: 83.8-90.1）均更高。與傳統(tǒng)C-THA相比，F(xiàn)JS和OHS的改善幅度顯著更大（HHS WMD 2.2 [95%CI: -0.3-4.7], p = 0.09；FJS WMD: 8.7 [95%CI: 2.7-14.8], p = 0.005；OHS WMD: 1.5 [95% CI: 0.1-2.8], p = 0.03）。MAKO-THA分別有94.7%和90.3%的假體在Lewinnek及Callanan安全區(qū)內(nèi)，而傳統(tǒng)THA僅為65.8%和57.1%。MAKO-THA平均手術(shù)時(shí)間較長，術(shù)后下肢長度差異較小，但均無統(tǒng)計(jì)學(xué)顯著性（手術(shù)時(shí)長WMD: 3.5 [95%CI: -2.5-9.5], p = 0.3；下肢長度差異WMD: -0.2 [95%CI: -0.7-0.4], p = 0.6）。兩組并發(fā)癥發(fā)生率均較低且無顯著差異（MAKO-THA: 3.0% [95%CI: 1.2-7.4]；C-THA: 3.5% [95% CI: 1.2-10.1], p = 0.3）。

作者最后得出結(jié)論：MAKO機(jī)器人輔助THA能顯著改善遺忘關(guān)節(jié)評(píng)分、牛津髖關(guān)節(jié)評(píng)分及假體位置精確度的可重復(fù)性，且未增加手術(shù)時(shí)長和并發(fā)癥發(fā)生率。

MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis

Background:Total Hip Arthroplasty (THA) is the gold standard for treating end-stage hip osteoarthritis. Robotic-assisted systems, particularly the MAKO system, have been introduced to enhance reproducibility and safety. However, meta-analyses comparing MAKO-assisted THAs (MAKO-THA) to conventional methods are lacking, and previous reviews often aggregate various indications, introducing heterogeneity.

Methods:A random-effects meta-analysis was conducted on comparative studies between MAKO robotic-arm-assisted and conventional THAs in patients undergoing THA for solely hip osteoarthritis. Clinical outcomes (Harris Hip Scores [HHS], Forgotten Joint Scores [FJS], and Oxford Hip Scores [OHS]), radiographic parameters (implant positioning accuracy), leg-length-discrepancy, surgical duration, and complications were evaluated.

Results:20 comparative studies were included. MAKO-assisted THAs resulted in higher postoperative HHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1), FJS (MAKO-THA: 84.7, 95%CI: 79.9-89.6; C-THA: 74.9, 95%CI: 64.0-95.7), and OHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1). FJS and OHS improvements were significantly greater compared to conventional THA (HHS WMD 2.2 [95%CI: -0.3-4.7, p = 0.09; FJS WMD: 8.7 [95%CI: 2.7-14.8], p = 0.005; OHS WMD: 1.5 [95% CI: 0.1-2.8], p = 0.03). MAKO-THA resulted in 94.7% and 90.3% of implants positioned within Lewinnek-and-Callanan zones, respectively, compared to 65.8% and 57.1% in conventional THA. MAKO-THA had longer mean surgical durations and lower postoperative leg-length discrepancy, but not significantly (Surgical Duration WMD: 3.5 [95%CI: -2.5-9.5], p = 0.3; Leg Length Discrepancy WMD: -0.2 [95%CI: -0.7-0.4], p = 0.6). Complication rates were low and non-significant (MAKO-THA: 3.0% [95%CI: 1.2-7.4]; C-THA: 3.5% [95% CI: 1.2-10.1), p = 0.3).

Conclusion:MAKO robotic-arm-assisted THA significantly improves Forgotten Joint Scores, Oxford Hip Scores and reproducibility in implant positioning without compromising on surgical duration and complication rates.

文獻(xiàn)出處：Loke RWK, Lim YH, Chan YK, Tan BWL. MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2025 May 16;20(1):466. doi: 10.1186/s13018-025-05866-1. PMID: 40380310; PMCID: PMC12083021.

文獻(xiàn)3

全膝關(guān)節(jié)置換對(duì)線方法對(duì)軟組織平衡以及運(yùn)動(dòng)模式的影響

一項(xiàng)對(duì)比運(yùn)動(dòng)對(duì)線與機(jī)械對(duì)線的隨機(jī)對(duì)照試驗(yàn)

譯者 張薔

背景：在最近10年中，多名學(xué)者研發(fā)出多種不同的全膝關(guān)節(jié)置換（TKA）對(duì)線方法，期待膝關(guān)節(jié)假體可以更好的恢復(fù)接近正常的膝關(guān)節(jié)運(yùn)動(dòng)力學(xué)并改善關(guān)節(jié)功能。本研究的目的是計(jì)算并評(píng)估基于嚴(yán)格的運(yùn)動(dòng)對(duì)線（KA）或機(jī)械對(duì)線（MA）手術(shù)技術(shù)的假體軟組織平衡和運(yùn)動(dòng)模式。

方法：共入組109例初次后叉保留型（CR）TKAs手術(shù)病例，并被隨機(jī)分入機(jī)械對(duì)線組或運(yùn)動(dòng)對(duì)線組。我們應(yīng)用墊片內(nèi)置的壓力感受器分別在10°、45°和90°屈曲時(shí)測量內(nèi)、外側(cè)間室壓力和接觸應(yīng)力點(diǎn)變化模式。

結(jié)果：最初截骨完成后，全活動(dòng)范圍內(nèi)膝關(guān)節(jié)內(nèi)、外側(cè)間隙平衡的比例KA對(duì)線法顯著高于MA（KA 61% VS. MA 12%, P<0.001），且各個(gè)屈伸角度內(nèi)均存在顯著性差異。在間隙不平衡的病例中，MA對(duì)線的病例需要進(jìn)行更多的軟組織松解（P=0.008）和對(duì)線調(diào)整（P<0.001）。兩種對(duì)線方法的松解前和松解后假體后滾運(yùn)動(dòng)模式并無顯著性差異（松解前P=0.29，松解后P=0.29）。運(yùn)動(dòng)模式的首要驅(qū)動(dòng)因素并非對(duì)線，而是內(nèi)、外側(cè)間室在45°和90°（45° P<0.001，90° P<0.001）的壓力差異，屈膝時(shí)膝關(guān)節(jié)依從更緊的間室完成后滾。

結(jié)論：在初次CR TKA手術(shù)中，更嚴(yán)格的KA對(duì)線方法可以獲得一個(gè)間隙更為平衡的關(guān)節(jié)，軟組織松解或再截骨顯著減少。原始膝關(guān)節(jié)以內(nèi)側(cè)間室為軸心旋轉(zhuǎn)并引導(dǎo)后滾，為了恢復(fù)這種自然的運(yùn)動(dòng)模式，我們需要在軟組織平衡時(shí)創(chuàng)造一個(gè)非對(duì)稱性的屈曲間隙：伸直時(shí)內(nèi)、外側(cè)間隙平衡，在屈膝的過程中保持內(nèi)側(cè)韌帶張力的同時(shí)允許外側(cè)軟組織松弛度適度增加。本隨機(jī)對(duì)照試驗(yàn)的相關(guān)信息收錄在澳洲/新西蘭臨床試驗(yàn)登記庫中（ACTRN12616001705471）。

Influence of Total Knee Arthroplasty Alignment on Soft-Tissue Balance and Pivot Patterns

A Randomized Controlled Trial of Kinematic Versus Mechanical Alignment

Background: Over the last decade alternative alignment techniques in primary total knee arthroplasty (TKA) have been developed in the hope to allow knee prostheses to better replicate normal knee kinematics and improve clinical outcomes. The purpose of this study was to quantify prosthesis soft-tissue balance and pivot patterns based on a restricted kinematic alignment (KA) or mechanical alignment (MA) surgical technique.

Methods: A total of 109 primary cruciate retaining TKAs were randomized to either a mechanical or KA technique. Medial and lateral compartmental pressures and contact point patterns were quantified at 10, 45, and 90 degrees of flexion using an insert pressure sensor.

Results: A significantly greater proportion of KA knees were balanced through a full range of motion (ROM) after the initial bone resections (61 KA versus 12% MA, P < 0.001) and the differences were significant at all positions of ROM. For the unbalanced prostheses, the MA knees required significantly more soft-tissue releases (P = 0.008) and bone alignment adjustments (P < 0.001). The initial and final rollback pivot patterns were not significantly different between techniques (initial P = 0.29, final P = 0.29). The primary driving factor for the pivot patterns was not alignment, but instead the differential pressure between the medial and lateral compartments at 45 and 90 degrees flexion (45? P < 0.001, 90? P < 0.001), with the knee pivoting on the tighter compartment in flexion.

Conclusions: In primary cruciate retaining TKA a restricted KA technique achieves a balanced prosthesis with significantly fewer soft-tissue releases or bone recuts. The knee’s natural medial pivot pattern can be replicated with a prosthesis by controlling the soft tissue balance to achieve a non-symmetrical flexion gap: equal balance in extension, with medial ligament tension maintained through ROM while allowing increased lateral soft-tissue laxity in flexion. The trial and protocol were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001705471).

文獻(xiàn)4

機(jī)器人輔助并未減少全髖關(guān)節(jié)置換術(shù)中的并發(fā)癥

譯者 沈松坡

目標(biāo)：本研究的目的在于評(píng)估機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)（rTHA）是否在長期隨訪中減少并發(fā)癥。機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)是一種應(yīng)用越來越廣泛的關(guān)節(jié)置換技術(shù)，旨在提高手術(shù)準(zhǔn)確性并減少人為錯(cuò)誤。然而，目前缺乏足夠的臨床證據(jù)支持其在長期并發(fā)癥或手術(shù)結(jié)局方面的優(yōu)勢，盡管如此，其使用率仍持續(xù)上升。本研究比較了接受傳統(tǒng)全髖關(guān)節(jié)置換術(shù)（cTHA）與機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)（rTHA）患者在長期隨訪中的并發(fā)癥發(fā)生率。

資料與方法：研究使用 TriNetX 研究網(wǎng)絡(luò)的數(shù)據(jù)，通過電子病歷篩選出具有至少五年隨訪記錄的患者。第一隊(duì)列為接受傳統(tǒng) THA 的患者，第二隊(duì)列為接受機(jī)器人輔助 THA 的患者。研究對(duì)已知影響臨床結(jié)局的因素進(jìn)行了 1:1 傾向性評(píng)分匹配，以減少混雜因素；并排除與原發(fā) THA 無關(guān)的情況，如病理性骨折或翻修手術(shù)。研究在術(shù)后 1 年、3 年和 5 年分別觀察五類并發(fā)癥的發(fā)生率：假體關(guān)節(jié)感染、脫位、翻修、松動(dòng)以及假體周圍骨折。

結(jié)果：數(shù)據(jù)庫共包含 95,085 名 THA 患者，最終分析納入匹配后每組各 2241 名患者。在 5 年隨訪時(shí)，傳統(tǒng) THA 與機(jī)器人輔助 THA 兩組在全因并發(fā)癥發(fā)生率方面無顯著差異［OR（95% CI），1.073（0.772–1.491）］。在翻修率［OR（95% CI），1.604（0.726–3.543）］與脫位率［OR（95% CI），1.775（0.976–3.228）］方面同樣未觀察到差異。

結(jié)論：盡管已有數(shù)據(jù)表明機(jī)器人輔助技術(shù)可提高手術(shù)精確性并減少操作錯(cuò)誤，但在全髖關(guān)節(jié)置換術(shù)后的五年隨訪期內(nèi)，機(jī)器人輔助并未減少并發(fā)癥發(fā)生率。

關(guān)鍵詞：關(guān)節(jié)成形術(shù)；髖關(guān)節(jié)；機(jī)器人；回顧性；TriNetX。

Robotic-assistance did not reduce complications in total hip arthroplasty

Aims & objectives: Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA.

Materials & methods: Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture.

Results: The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772-1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)].

Conclusion: Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.

Keywords: Arthroplasty; Hip; Retrospective; Robotic; TriNetX.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

當(dāng)股骨頭骨骺出現(xiàn)時(shí)感染后髖脫位處理措施

譯者 羅殿中

兒童延誤或漏診的感染性髖關(guān)節(jié)炎預(yù)后表現(xiàn)多種多樣。當(dāng)股骨頭骨骺出現(xiàn)時(shí)感染后髖脫位當(dāng)前尚無廣為認(rèn)可的分型。本中心在63例感染髖患兒中，有30例出現(xiàn)髖關(guān)節(jié)脫位；本文回顧了18例兒童21髖，在干預(yù)時(shí)股骨頭骨骺（CFE）已經(jīng)顯影。治療后平均隨訪6.3年，最少隨訪2年。

干預(yù)措施包括：閉合復(fù)位±內(nèi)收肌松解、切開復(fù)位±股骨補(bǔ)充截骨、髖臼側(cè)手術(shù)。治療結(jié)果采用Ponseti髖關(guān)節(jié)評(píng)分進(jìn)行臨床評(píng)估、采用改良Severin分級(jí)進(jìn)行影像學(xué)評(píng)估。

結(jié)果：20髖中7髖成功采用閉合復(fù)位（35%），14髖中13髖進(jìn)行了切開復(fù)位。隨訪時(shí)，18髖中9髖臨床療效為良好（50%）；所有患兒隨訪時(shí)平均頸干角為129°、股骨截骨患兒頸干角為124°。有1例出現(xiàn)再脫位，有3例出現(xiàn)半脫位。改良Severin影像學(xué)評(píng)估II型5髖（好）、III型12髖（可）、IV型3髖（差）、VI型1髖（失?。?。

結(jié)論：在股骨頭骨骺出現(xiàn)時(shí)感染后髖脫位是一個(gè)獨(dú)特的群體，MRI檢查有助于治療決策。多數(shù)患兒需要進(jìn)行切開復(fù)位聯(lián)合其它手術(shù)，股骨內(nèi)翻截骨或可導(dǎo)致髖內(nèi)翻。短期療效顯示，手術(shù)干預(yù)可得到一個(gè)穩(wěn)定的、有功能的、可活動(dòng)的髖關(guān)節(jié)。

圖1. 兒童感染髖分型。I型：股骨頭骨骺（CFE）/股骨頸消失，干骺端殘留喙突，關(guān)節(jié)穩(wěn)定；II型：股骨頭骨骺（CFE）/股骨頸消失，不穩(wěn)定；IIIA型：股骨頭骨骺（CFE）存在，不穩(wěn)定，脫位；IIIB型：半脫位，股骨頭骨骺（CFE）存在，不穩(wěn)定；IV型：關(guān)節(jié)不匹配，股骨頭壞死，大頭畸形，骺板損害（短髖、髖內(nèi)翻、髖外翻、大轉(zhuǎn)子高位），穩(wěn)定；V型：股骨頸假關(guān)節(jié)形成，穩(wěn)定或不穩(wěn)定。

圖2. 感染后髖脫位干預(yù)流程。AI，髖臼指數(shù)；ATD，髖臼大轉(zhuǎn)子高度差；CR，閉合復(fù)位；EUA，麻醉下檢查；LR，外移指數(shù)；MRI，核磁共振成像；NSA，頸干角；US，超聲檢查；VDRO，內(nèi)翻去旋轉(zhuǎn)截骨術(shù)。

病例1：

圖3, 病例1，2歲男孩感染后雙髖脫位。

圖4, 病例1，右髖成功閉合復(fù)位。

圖5, 病例1，3歲6個(gè)月時(shí)左髖行切開復(fù)位、內(nèi)翻去旋轉(zhuǎn)截骨、股骨短縮、Dega髖臼截骨。

圖6, 病例1，8歲時(shí)右髖輕度內(nèi)翻、頭臼匹配可；左髖髖臼大轉(zhuǎn)子高度差降低（大轉(zhuǎn)子高位）。

病例2：

圖7, 病例2，1歲女孩雙髖雙膝多部位感染性關(guān)節(jié)炎。

圖8, 病例2，嘗試閉合復(fù)位，左髖復(fù)位失?。蛔篌y切開復(fù)位后1年。

圖9, 病例2，患兒3歲時(shí)。

圖10, 病例2，患兒5歲時(shí)，右髖大頭畸形；左股骨頭骨骺受損扁平。

文獻(xiàn)出處：Johari AN. Residual problems in septic arthritis of the hips in childhood. Thesis submitted for the M.Ch Ortho, University of Liverpool, 1988 in ‘Current Concept: Septic Arthritis in Childhood’ in Trends in Paediatric Orthopaedics, Editor: Mathew Varghese, Macmillan (I) Ltd., pg 25–32, 2002. ISBN 0333 938194.）

文獻(xiàn)2

通過比較影像形態(tài)學(xué)分析來評(píng)估印度人群中成人髖關(guān)節(jié)的正常影像形態(tài)

譯者 任寧濤

目的：分析印度人群正常成人髖關(guān)節(jié)的影像學(xué)形態(tài)學(xué)參數(shù)，并與標(biāo)準(zhǔn)測量值和其他人群進(jìn)行比較，評(píng)估其變化。

方法：對(duì)800人(1600髖)正常骨盆x線片進(jìn)行前瞻性分析。我們計(jì)算了正常成人骨盆X線片上的臼頂傾斜角、髖臼指數(shù)、外側(cè)CE角(LCEA)和頸干角(NSA)、股骨頭球形度、關(guān)節(jié)匹配、髖臼前后傾、髖臼深度和股骨頭外移情況。我們使用RadiAnt DICOM viewer版本4.6.5.18450(64位)進(jìn)行測量。采用SPSS軟件進(jìn)行統(tǒng)計(jì)分析和均值計(jì)算。

結(jié)果：男性髖關(guān)節(jié)978例，女性髖關(guān)節(jié)622例。臼頂傾斜角為1 ~ 9°，平均髖臼指數(shù)為26.5°，LCEA在20 ~ 50之間，頸干角平均為133°。有35例髖關(guān)節(jié)，股骨頭非球形，94.2%髖關(guān)節(jié)匹配好，2.9%髖臼后傾，3.3%股骨頭外移大。

結(jié)論：多數(shù)參數(shù)與標(biāo)準(zhǔn)值相當(dāng)，但是髖臼指數(shù)較低，LCEA和NSA較高，髖臼傾斜角較低。在我們的一般人群中，有一小部分存在股骨頭非球形、關(guān)節(jié)不匹配和股骨頭外移。

A comparative radiographic morphometric analysis to assess the normal radiological morphology of the adult hip in indian population

Objective: Our objective is to analyze the normal radiological morphologic parameters of the adult hip joint of the Indian population and compare it with standard measurements and with other populations to assess the variations.

Methods: A prospective analysis of the normal pelvis X-rays of 800 persons (1600 hips) was done. We have calculated the acetabular inclination, acetabular index, lateral center edge angle (LCEA) and neck-shaft angle (NSA), sphericity of the femoral head, congruity of the joint, version of the acetabulum, depth of acetabulum, and lateralization of the femoral head in normal X-rays of the pelvis in adult persons. We used RadiAnt DICOM viewer version 4.6.5.18450 (64bit) for measurement. Statistical analysis and mean values were calculated using SPSS software.

Results: There were 978 X-rays of the male hip and 622 female. The acetabular inclination varied from 1 to 9. The mean acetabular index was 26.5. The LCEA was between 20 and 50. The mean neck-shaft angle was 133. There were 35, hips with an aspherical head. 94.2% X-rays the hip joint was congruent. There was 2.9% of the retroversion of acetabulum, 3.3% lateralization.

Conclusion: Most of the parameters were comparable to standard values the acetabular index was lower. LCEA and NSA were higher. The acetabular angle was lower. There were femoral head asphericity, joint incongruity, and lateralization of the femoral head in a small proportion of our general population.

文獻(xiàn)出處; Zacharia B, Fawas KM. A comparative radiographic morphometric analysis to assess the normal radiological morphology of the adult hip in indian population. J Clin Orthop Trauma. 2020 Oct 17;15:117-124. doi: 10.1016/j.jcot.2020.10.015. PMID: 33717925; PMCID: PMC7920144.

文獻(xiàn)3

髖關(guān)節(jié)撞擊綜合征的三維無創(chuàng)評(píng)估

譯者 李勇

我們開發(fā)、驗(yàn)證并在臨床初步研究中應(yīng)用了一種基于 CT 的無創(chuàng)三維評(píng)估髖關(guān)節(jié)撞擊綜合征（FAI）的方法——“HipMotion”。該方法可基于解剖結(jié)構(gòu)計(jì)算髖關(guān)節(jié)活動(dòng)度（ROM），精確定位撞擊區(qū)域，并模擬量化手術(shù)操作以治療 FAI。在塑料骨模型中，HipMotion 的精度為 0.7°±3.1°；在尸體標(biāo)本中為 –5.0°±5.6°。除外旋（ICC = 0.48）外，所有測量的信度與可重復(fù)性均極佳（組內(nèi)相關(guān)系數(shù) ICC > 0.87）。研究納入 150 例正常髖關(guān)節(jié)建立正常 ROM 數(shù)據(jù)庫，并與 31 例連續(xù) FAI 患者對(duì)比。FAI 患者屈曲、內(nèi)旋及外展活動(dòng)度均顯著低于正常組（p < 0.001）。現(xiàn)有多部骨科教材普遍高估了正常髖關(guān)節(jié)的屈曲和內(nèi)旋范圍。HipMotion 為深入評(píng)估撞擊髖并精確規(guī)劃手術(shù)干預(yù)量提供了有用工具，是今后采用髖關(guān)節(jié)鏡等微創(chuàng)手段計(jì)算機(jī)輔助治療的基石。

Noninvasive Three-Dimensional Assessment of Femoroacetabular Impingement

ABSTRACT: A CT-based method ("HipMotion") for the noninvasive three-dimensional assessment of femoroacetabular impingement (FAI) was developed, validated, and applied in a clinical pilot study. The method allows for the anatomically based calculation of hip range of motion (ROM), the exact location of the impingement zone, and the simulation of quantified surgical maneuvers for FAI. The accuracy of HipMotion was 0.7 ±3.1° in a plastic bone setup and -5.0 ± 5.6° in a cadaver setup. Reliability and reproducibility were excellent [intraclass correlation coefficient (ICC) > 0.87] for all measures except external rotation (ICC= 0.48). The normal ROM was determined from a cohort of 150 patients and was compared to 31 consecutive hips with FAI. Patients with FAI had a significantly decreased flexion, internal rotation, and abduction in comparison to normal hips (p < 0.001). Normal hip flexion and internal rotation are generally overestimated in a number of orthopedic textbooks. HipMotion is a useful tool for further assessment of impinging hips and for appropriate planning of the necessary amount of surgical intervention, which represents the basis for future computerassisted treatment of FAI with less invasive surgical approaches, such as hip arthroscopy.

文獻(xiàn)出處：Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007 Jan;25(1):122-31. doi: 10.1002/jor.20309. PMID: 17054112.

文獻(xiàn)4

骨科手術(shù)并發(fā)癥分級(jí)系統(tǒng)的可靠性：保髖截骨手術(shù)隨訪驗(yàn)證

譯者 陶可

背景：醫(yī)療質(zhì)量和安全一直受到各專業(yè)機(jī)構(gòu)和政府部門的重視。然而，目前尚無標(biāo)準(zhǔn)化的骨科手術(shù)并發(fā)癥分級(jí)和報(bào)告方法。若缺乏標(biāo)準(zhǔn)化、客觀的并發(fā)癥分級(jí)方案，則對(duì)手術(shù)結(jié)果的結(jié)論是不完整的。普通外科文獻(xiàn)中已有符合上述標(biāo)準(zhǔn)的Clavien-Dindo分級(jí)系統(tǒng)。

問題/目的：我們探討了之前報(bào)道的分級(jí)系統(tǒng)在應(yīng)用于骨科手術(shù)（特別是保髖截骨手術(shù)）后，是否仍具有較高的觀察者內(nèi)和觀察者間可靠性。因此，我們確定了該改良分級(jí)系統(tǒng)應(yīng)用于保髖截骨手術(shù)時(shí)的觀察者間和觀察者內(nèi)可靠性。

方法：我們改良了已驗(yàn)證的Clavien-Dindo并發(fā)癥分級(jí)系統(tǒng)，并測試了其在骨科手術(shù)（特別是保髖截骨手術(shù)）中的可靠性。該系統(tǒng)根據(jù)并發(fā)癥所需的治療方案和潛在的長期并發(fā)癥風(fēng)險(xiǎn)，將并發(fā)癥分為5個(gè)等級(jí)。

本研究基于前瞻性多中心保髖截骨手術(shù)數(shù)據(jù)庫和文獻(xiàn)資料，構(gòu)建了44個(gè)并發(fā)癥情景。來自3個(gè)國家8個(gè)中心的10位髖關(guān)節(jié)手術(shù)醫(yī)師在兩個(gè)不同時(shí)間點(diǎn)對(duì)這些情景進(jìn)行分級(jí)。分別采用Fleiss' κ系數(shù)和Cohen's κ系數(shù)評(píng)估觀察者間和觀察者內(nèi)的一致性。

結(jié)果：觀察者間一致性的總體Fleiss' κ值為0.887（95% CI，0.855-0.891）。加權(quán)κ值分別為：I級(jí)0.925（95% CI，0.894-0.956），II級(jí)0.838（95% CI，0.807-0.869），III級(jí)0.87（95% CI，0.835-0.866），IV級(jí)0.898（95% CI，0.866-0.929）。觀察者內(nèi)信度Cohen's κ值為0.891（95% CI，0.857-0.925）。

結(jié)論：該改良分類系統(tǒng)在應(yīng)用于保髖截骨手術(shù)并發(fā)癥時(shí)，顯示出較高的觀察者間信度和觀察者內(nèi)信度。該分級(jí)方案有助于并發(fā)癥報(bào)告的標(biāo)準(zhǔn)化，并使結(jié)果研究更具可比性。

表 . 并發(fā)癥分級(jí)表（修訂版）

Reliability of a complication classification system for orthopaedic surgery

Background: Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.

Questions/purposes: We asked whether a previously reported classification would show high intraobserver and interobserver reliabilities when modified for orthopaedic surgery specifically looking at hip preservation surgery. We therefore determined the interreader and intrareader reliabilities of the adapted classification scheme as applied to hip preservation surgery.

Methods: We adapted the validated Clavien-Dindo complication classification system and tested its reliability for orthopaedic surgery, specifically hip preservation surgery. There are five grades based on the treatment required t manage the complication and the potential for long-term morbidity. Forty-four complication scenarios were created from a prospective multicenter database of hip preservation procedures and from the literature. Ten readers who perform hip surgery at eight centers in three countries graded the scenarios at two different times. Fleiss' and Cohen's κ statistics were performed for interobserver and intraobserver reliabilities, respectively.

Results: The overall Fleiss' κ value for interobserver reliability was 0.887 (95% CI, 0.855-0.891). The weighted κ was 0.925 (95% CI, 0.894-0.956) for Grade I, 0.838 (95% CI, 0.807-0.869) for Grade II, 0.87 (95% CI, 0.835-0.866) for Grade III, and 0.898 (95% CI, 0.866-0.929) for Grade IV. The Cohen's κ value for intraobserver reliability was 0.891 (95% CI, 0.857-0.925).

Conclusions: The adapted classification system shows high interobserver and intraobserver reliabilities for grading of complications when applied to orthopaedic surgery looking at complications of hip preservation surgery. This grading scheme may facilitate standardization of complication reporting and make outcome studies more comparable.

文獻(xiàn)出處：Ernest L Sink, Michael Leunig, Ira Zaltz, Jennifer Claire Gilbert, John Clohisy; Academic Network for Conservational Hip Outcomes Research Group. Reliability of a complication classification system for orthopaedic surgery. Multicenter Study, Clin Orthop Relat Res. 2012 Aug;470(8):2220-6. doi: 10.1007/s11999-012-2343-2.

文獻(xiàn)5

機(jī)械力、激素及代謝因素對(duì)血管、血流和骨骼的影響

譯者 邱興

骨骼組織具有高度血管化特征，這源于骨骼血管在骨組織及骨髓功能中承擔(dān)的多重作用。例如，血管系統(tǒng)對(duì)骨骼的發(fā)育、維持與修復(fù)至關(guān)重要，負(fù)責(zé)輸送氧氣、營養(yǎng)物質(zhì)、代謝廢物清除、全身性激素以及為骨重塑提供前體細(xì)胞。此外，骨骼血管還是血液和免疫細(xì)胞進(jìn)出骨髓的通道。越來越多的證據(jù)表明，血管系統(tǒng)與骨骼系統(tǒng)在代謝調(diào)控、生理及病理過程中存在密切聯(lián)系。本文綜述了機(jī)械負(fù)荷、甲狀旁腺激素、雌激素、維生素D和降鈣素等被認(rèn)為具有促成骨作用的因子如何對(duì)骨骼血管系統(tǒng)產(chǎn)生顯著影響。事實(shí)上，這些因子在影響骨骼之前會(huì)先作用于骨骼血管。數(shù)據(jù)進(jìn)一步顯示，骨骼血管的舒張能力與骨小梁體積之間存在強(qiáng)關(guān)聯(lián)性，而雌激素狀態(tài)及子宮質(zhì)量與骨小梁體積的關(guān)聯(lián)性較弱。此外，本文重點(diǎn)探討了骨微循環(huán)（特別是血管內(nèi)皮和一氧化氮介導(dǎo)的信號(hào)傳導(dǎo)）在調(diào)節(jié)骨血流量、骨間質(zhì)液流動(dòng)與壓力以及骨細(xì)胞旁分泌信號(hào)傳導(dǎo)中的重要作用。最后，文章還分析了血管內(nèi)皮作為骨骼健康與疾病中介因子的潛在意義。

關(guān)鍵詞：血管生成；骨形成與骨吸收；內(nèi)皮；雌激素；運(yùn)動(dòng)

圖1 骨骼中的缺氧機(jī)制。急性缺氧（數(shù)秒至數(shù)分鐘）會(huì)引發(fā)骨骼動(dòng)脈和小動(dòng)脈的快速血管舒縮反應(yīng)（即血管舒張和/或血管收縮），從而增加血流量并使局部環(huán)境中的氧分壓恢復(fù)正常。慢性缺氧（數(shù)天至數(shù)月）則是由于動(dòng)脈和小動(dòng)脈無法充分增加組織血流量和氧氣供應(yīng)所致。在此情況下，為滿足組織需求將啟動(dòng)血管生成過程。關(guān)于血管系統(tǒng)如何影響骨骼健康，需指出的是：隨著年齡增長和/或疾病發(fā)展，骨骼血管系統(tǒng)功能失調(diào)會(huì)導(dǎo)致小動(dòng)脈舒張與收縮功能失衡，并限制血管生成能力。其結(jié)果是流向骨骼的血流量減少、氧氣輸送能力下降。在此情形下，缺氧的病因應(yīng)歸結(jié)于骨骼血管網(wǎng)絡(luò)的功能障礙，而非骨骼代謝活動(dòng)的增強(qiáng)。

圖A用于幫助讀者識(shí)別示意圖中的各種細(xì)胞結(jié)構(gòu)。為簡化圖示，小動(dòng)脈和小靜脈中的血管平滑肌細(xì)胞未予顯示，因此所描繪的細(xì)胞均為血管內(nèi)皮細(xì)胞。圖B展示了破骨細(xì)胞進(jìn)行骨吸收的過程（1）。在代謝增強(qiáng)過程中，破骨細(xì)胞釋放多種因子（如二氧化碳[CO?]、氫離子[H?]、磷酸鹽[PO?]、ADP、乳酸等），這些因子擴(kuò)散至小動(dòng)脈并引發(fā)代謝性血管舒張（2）。小動(dòng)脈的代謝性血管舒張會(huì)進(jìn)一步引起上游供血?jiǎng)用}和傳導(dǎo)動(dòng)脈的上行性血管舒張（圖示未顯示）。這一過程被稱為傳導(dǎo)性血管舒張，它能確保代謝組織中血流量增加。圖C顯示了血管舒張及隨之增加的血流量（3）如何促進(jìn)毛細(xì)血管（4）向骨間質(zhì)空間（5）的濾過作用和壓力提升。骨間質(zhì)壓力和液體流動(dòng)的增加會(huì)對(duì)骨細(xì)胞產(chǎn)生剪切應(yīng)力（圖D，6）。成骨細(xì)胞在剪切應(yīng)力作用下釋放PGE?和一氧化氮（7），從而增強(qiáng)成骨細(xì)胞活性并抑制破骨細(xì)胞活性，減緩骨吸收并促進(jìn)骨形成。此外，傳導(dǎo)性血管舒張帶來的血流量增加會(huì)增強(qiáng)血管內(nèi)皮細(xì)胞的剪切應(yīng)力（圖E，8）。 consequently，血管內(nèi)皮細(xì)胞釋放的活性因子（如一氧化氮、PGE?、前列環(huán)素[PGI?]）會(huì)擴(kuò)散至骨間質(zhì)空間，刺激成骨細(xì)胞活性并抑制破骨細(xì)胞活性（9）。關(guān)于血管促進(jìn)骨形成的理論此前已由Michael Delp實(shí)驗(yàn)室提出（Colleran等，2000年）。需要說明的是，這些過程并非必須始于破骨細(xì)胞活動(dòng)。例如，誘導(dǎo)骨血管網(wǎng)絡(luò)發(fā)生血管舒張的循環(huán)因子同樣可以啟動(dòng)類似過程。

Mechanical, hormonal and metabolic influences on blood vessels, blood flow and bone

Bone tissue is highly vascularized due to the various roles bone blood vessels play in bone and bone marrow function. For example, the vascular system is critical for bone development, maintenance and repair and provides O2, nutrients, waste elimination, systemic hormones and precursor cells for bone remodeling. Further, bone blood vessels serve as egress and ingress routes for blood and immune cells to and from the bone marrow. It is becoming increasingly clear that the vascular and skeletal systems are intimately linked in metabolic regulation and physiological and pathological processes. This review examines how agents such as mechanical loading, parathyroid hormone, estrogen, vitamin D and calcitonin, all considered anabolic for bone, have tremendous impacts on the bone vasculature. In fact, these agents influence bone blood vessels prior to influencing bone. Further, data reveal strong associations between vasodilator capacity of bone blood vessels and trabecular bone volume, and poor associations between estrogen status and uterine mass and trabecular bone volume. Additionally, this review highlights the importance of the bone microcirculation, particularly the vascular endothelium and NO-mediated signaling, in the regulation of bone blood flow, bone interstitial fluid flow and pressure and the paracrine signaling of bone cells. Finally, the vascular endothelium as a mediator of bone health and disease is considered.

Keywords: angiogenesis; bone formation and resorption; endothelium; estrogen; exercise.

文獻(xiàn)出處：Prisby, Rhonda D. "Mechanical, hormonal and metabolic influences on blood vessels, blood flow and bone." Journal of Endocrinology 235, no. 3 (2017): R77-R100.

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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