本期目錄：

1、機(jī)器人外骨骼和全膝關(guān)節(jié)置換術(shù)：膝關(guān)節(jié)康復(fù)和替代的未來

2、初次全膝關(guān)節(jié)置換術(shù)后行關(guān)節(jié)鏡下粘連松解手術(shù)對(duì)假體周圍感染和翻修概率的影響

3、日本患者的運(yùn)動(dòng)學(xué)對(duì)線技術(shù)全膝關(guān)節(jié)置換在術(shù)后2年顯示出顯著改善

4、Chiari骨盆截骨后全髖關(guān)節(jié)置換----301例髖關(guān)節(jié)發(fā)育不良回顧性研究

5、影像學(xué)及患者因素與髖關(guān)節(jié)發(fā)育不良骨關(guān)節(jié)炎的相關(guān)性

6、疼痛性臨界髖關(guān)節(jié)發(fā)育不良：有什么新進(jìn)展

7、穩(wěn)定型股骨頭骨骺滑脫（SCFE）的治療有多緊急

8、髖臼周圍截骨術(shù)后(PAO)髖關(guān)節(jié)的生存率

9、股骨去旋轉(zhuǎn)截骨術(shù)位置及其對(duì)髖關(guān)節(jié)發(fā)育不良患者關(guān)節(jié)反作用力的影響

10、無癥狀的女性壘球投手髖關(guān)節(jié)形態(tài)和軟骨成分發(fā)生改變

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)器人外骨骼和全膝關(guān)節(jié)置換術(shù)：膝關(guān)節(jié)康復(fù)和替代的未來-薈萃分析

譯者 張軼超

目的：外骨骼可以在TKA術(shù)后康復(fù)中發(fā)揮關(guān)鍵作用，加速恢復(fù)，改善活動(dòng)能力，降低進(jìn)一步損傷的風(fēng)險(xiǎn)。本薈萃分析評(píng)估了外骨骼在全膝關(guān)節(jié)置換術(shù)（TKR）后康復(fù)中的有效性。

設(shè)計(jì)：在PubMed、OVID Medline、Cochrane Collaboration Library和Embase（時(shí)間段：數(shù)據(jù)庫建立到2023年3月）上進(jìn)行全面的檢索。隨機(jī)對(duì)照試驗(yàn)納入了接受TKR的患者，研究了機(jī)器人輔助康復(fù)對(duì)身體功能和疼痛的影響。因此納入了8項(xiàng)研究（302例患者）。

結(jié)果：與常規(guī)康復(fù)相比，外骨骼顯著改善了患者的主動(dòng)活動(dòng)度（ROM） （SMD: 10.98, 95%可信區(qū)間（CI）： 7.81 ~ 14.16, P < 0.001）、被動(dòng)ROM （SMD: 4.11, 95% CI: 1.02 ~ 7.20, P = 0.009）、特種外科醫(yī)院評(píng)分（SMD: 7.78, 95% CI: 5.87 ~ 9.68, P < 0.00001）和住院時(shí)間（SMD: - 3.19, 95% CI: - 4 ~ - 2.38, P < 0.001）。主動(dòng)和被動(dòng)ROM的改善表明外骨骼有助于TKR術(shù)后膝關(guān)節(jié)功能和靈活性的恢復(fù)，而特種外科醫(yī)院評(píng)分的改善支持將外骨骼應(yīng)用在TKR康復(fù)中。縮短住院時(shí)間是一項(xiàng)重要的發(fā)現(xiàn)，可能會(huì)降低醫(yī)療成本并改善手術(shù)效果。

結(jié)論：盡管納入的研究數(shù)量有限，但我們的研究結(jié)果表明外骨骼可以提高TKR后的康復(fù)結(jié)果并改善生活質(zhì)量。機(jī)器人輔助康復(fù)可能在TKR后有效。進(jìn)一步的研究應(yīng)該會(huì)證實(shí)這些發(fā)現(xiàn)。

Robotic exoskeletons and total knee arthroplasty The future of knee rehabilitation and replacement – A meta-analysis

Objective: Exoskeletons can play a crucial role in post-TKA rehabilitation by accelerating recovery, improving mobility, and reducing further injury risk. This meta-analysis evaluated the effectiveness of exoskeletons in post-total knee replacement (TKR) rehabilitation.

Design: Comprehensive searches were conducted on PubMed, OVID Medline, Cochrane Collaboration Library, and Embase (period: database inception to March 2023). Randomized controlled trials enrolling patients who underwent TKR and studies examining the effect of robot-assisted rehabilitation on physical function and pain outcomes were eligible for inclusion. Eight studies (302 patients) were thus included.

Results: Exoskeletons significantly improved active range of motion (ROM) (SMD: 10.98, 95% confidence interval (CI): 7.81– 14.16, P < .001), passive ROM (SMD: 4.11, 95% CI: 1.02–7.20, P = .009), Hospital for Special Surgery scores (SMD: 7.78, 95% CI: 5.87–9.68, P < .00001), and hospital stay length (SMD: ?3.19, 95% CI: ?4 to ?2.38, P < .00001) compared with conventional rehabilitation. Active and passive ROM improvements suggest that exoskeletons aid knee function restoration and mobility post-TKR, whereas Hospital for Special Surgery score improvements support exoskeleton use in TKR rehabilitation. A shorter hospital stay was an important finding which could potentially reduce healthcare costs and improve outcomes.

Conclusion: Despite the inclusion of a limited number of studies, our findings suggest that exoskeletons can enhance post-TKR rehabilitation outcomes and improve quality of life. Robot-assisted rehabilitation may be effective following TKR. Further research should confirm these findings.

文獻(xiàn)出處：Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement - A meta-analysis. Medicine (Baltimore). 2024 Apr 26;103(17):e37876. doi: 10.1097/MD.0000000000037876. PMID: 38669435; PMCID: PMC11049723.

文獻(xiàn)2

初次全膝關(guān)節(jié)置換術(shù)后行關(guān)節(jié)鏡下粘連松解手術(shù)對(duì)假體周圍感染和翻修概率的影響

譯者 張薔

背景：關(guān)節(jié)纖維化是導(dǎo)致全膝關(guān)節(jié)置換（TKA）術(shù)后效果不佳的一種嚴(yán)重并發(fā)癥，關(guān)節(jié)鏡下粘連松解（LOA）可以改善活動(dòng)度并緩解疼痛。然而，文獻(xiàn)中關(guān)于LOA后假體周圍感染（PJI）和需要翻修（rTKA）的概率分析十分有限。本研究中，我們旨在比較TKA術(shù)后行關(guān)節(jié)鏡下粘連松解和TKA術(shù)后未行關(guān)節(jié)鏡下粘連松解的病例間假體周圍感染和翻修情況。

方法：我們在PearlDiver數(shù)據(jù)庫中搜索自2016年至2021年間的初次TKA手術(shù)病例，并應(yīng)用ICD-10（國際疾病分類目錄，第十版）和CPT（當(dāng)前醫(yī)療服務(wù)）編碼集來找出接受關(guān)節(jié)鏡下粘連松解以治療關(guān)節(jié)纖維化的病例。我們比較了施行LOA組和未施行LOA組的PJI和rTKA概率。同時(shí)，我們還應(yīng)用了多變量分析和Cox回歸分析的方法，在匹配了年齡、性別、Charlson合并癥指數(shù)、吸煙情況和BMI>30kg/m2等基本信息后，比較了LOA組和未LOA組的PJI和翻修概率。

結(jié)果：共入選了383143例病例，其中703例接受了關(guān)節(jié)鏡下粘連松解。施行LOA的病例總體PJI（2.7% vs. 1.3%; p = 0.001）和全因翻修率（9.8% vs. 1.8%; p < 0.001）均高于未施行LOA的病例。初次TKA術(shù)后1年內(nèi)，施行LOA的病例PJI（概率比OR，2.00；p < 0.014）、無菌性松動(dòng)翻修（OR, 3.31; p = 0.002）和全因翻修（OR, 5.32; p < 0.001）的概率明顯高于對(duì)照組。而兩組間的術(shù)后1年時(shí)PJI相關(guān)翻修率卻沒有顯著性差異（OR, 1.71; p = 0.193）。時(shí)間事件分析顯示：施行LOA組的PJI（p = 0.003）和全因翻修（p = 0.001）風(fēng)險(xiǎn)均顯著高于對(duì)照組，但PJI相關(guān)翻修（p = 0.322）或無菌性松動(dòng)翻修（p = 0.111）風(fēng)險(xiǎn)卻沒有顯著性差異。

結(jié)論：初次TKA術(shù)后施行關(guān)節(jié)鏡下粘連松解與術(shù)后假體周圍感染和后續(xù)翻修手術(shù)風(fēng)險(xiǎn)增加相關(guān)。術(shù)者在向患者強(qiáng)調(diào)早期康復(fù)和改善風(fēng)險(xiǎn)指標(biāo)的重要性時(shí)可以把本研究結(jié)果加入考量。

Rates of Periprosthetic Joint Infection and Revision Increase after Arthroscopic Lysis of Adhesions Subsequent to Primary TKA

Background: Arthrofibrosis is a debilitating complication of total knee arthroplasty (TKA) and may benefit from arthroscopic lysis of adhesions (LOA) to improve range of motion and decrease pain. However, the rates of periprosthetic joint infection (PJI) and of the need for future revision TKA (rTKA) have only been studied in a limited capacity in the literature. In this study, we aimed to compare PJI and revision outcomes in patients who had undergone TKA between those who subsequently underwent arthroscopic LOA and those who did not undergo arthroscopic LOA.

Methods: The PearlDiver database was utilized to identify patients who had undergone primary TKA between 2016 and 2021. ICD-10 (International Classification of Diseases, Tenth Revision) and CPT (Current Procedural Terminology) codes were then used to identify patients who underwent LOA for arthrofibrosis. The rates of PJI and rTKA were compared between patients who did and did not undergo LOA. Multivariable logistic and Cox regressions, controlling for age, sex, Charlson Co morbidity Index, tobacco use, and a body mass index of >30kg/m2, were performed to compare the rates of PJI and revision between the LOA and no-LOA groups.

Results: A total of 383,143 patients were identified, of whom 703 had undergone arthroscopic LOA. Patients who underwent LOA had higher overall rates of PJI (2.7% versus 1.3%; p = 0.001) and all-cause revision (9.8% versus 1.8%; p < 0.001) than those who did not. Patients who underwent LOA had significantly higher odds of PJI (odds ratio [OR], 2.00; p < 0.014), aseptic loosening-related revision (OR, 3.31; p = 0.002), and all-cause revision (OR, 5.32; p < 0.001) within 1 year after the initial TKA. There was no significant difference in 1-year PJI-related revisions between the groups (OR, 1.71; p = 0.193). In a time-to-event analysis, patients undergoing LOA had significantly higher risks of PJI (p = 0.003) and all-cause revision (p = 0.001) but not PJI-related revision (p = 0.322) or aseptic loosening-related revision (p = 0.111).

Conclusions: Arthroscopic LOA after primary TKA was associated with higher rates of PJI and subsequent revision surgery. Surgeons should consider the results of these studies when counseling patients on the importance of early rehabilitation and improving modifiable risk factors after TKA.

文獻(xiàn)3

日本患者的運(yùn)動(dòng)學(xué)對(duì)線技術(shù)全膝關(guān)節(jié)置換在術(shù)后2年顯示出顯著改善

譯者 沈松坡

目的： 本研究旨在評(píng)估在日本患者中應(yīng)用非限制性運(yùn)動(dòng)學(xué)對(duì)對(duì)線技術(shù)進(jìn)行全膝關(guān)節(jié)置換術(shù)（TKA）后2年的術(shù)后效果，并了解該技術(shù)的潛在益處。

方法： 本研究回顧性分析了2019年至2021年間，207例因膝骨關(guān)節(jié)炎接受運(yùn)動(dòng)學(xué)對(duì)線TKA的患者，最終納入符合標(biāo)準(zhǔn)的164例膝關(guān)節(jié)（女患者130膝，男患者34膝）。平均年齡為74.5±8.0歲，平均體重指數(shù)為26.4±4.1 kg/m2。術(shù)前與術(shù)后均進(jìn)行了X線影像測量，術(shù)前、術(shù)后1年及術(shù)后2年進(jìn)行了臨床評(píng)估（包括膝關(guān)節(jié)伸屈角度、肌力、步態(tài)及Knee Society評(píng)分的患者滿意度與功能評(píng)分）。影像學(xué)參數(shù)使用配對(duì)t檢驗(yàn)分析，臨床數(shù)據(jù)使用單因素方差分析及Tukey–Kramer多重比較法，顯著性水平設(shè)定為p<0.05。

結(jié)果： 手術(shù)后，膝關(guān)節(jié)伸展與屈曲角度以及肌力均有統(tǒng)計(jì)學(xué)顯著改善（p<0.01）。術(shù)后2年，89.6%的患者可獨(dú)立室內(nèi)行走，58.9%可單步上下樓梯。Knee Society評(píng)分在滿意度與功能方面較術(shù)前顯著提高（p<0.01），且并發(fā)癥較少，無需翻修手術(shù)。

結(jié)論： 在日本患者中，TKA中采用的運(yùn)動(dòng)學(xué)對(duì)線技術(shù)在術(shù)后2年內(nèi)展現(xiàn)出顯著改善和良好結(jié)果。盡管不同族群間在骨關(guān)節(jié)炎前的下肢對(duì)線特征存在差異，但該技術(shù)通過模擬個(gè)體化對(duì)線方式，獲得了良好的術(shù)后效果。

Kinematic alignment in Japanese patients shows significant improvement 2 years after total knee replacement surgery

Purpose: This study aimed to evaluate the 2-year post-operative results of the unrestricted kinematic alignment technique in total knee arthroplasty (TKA) among Japanese patients and understand the potential benefits of this technique.

Methods: In total, 207 patients who underwent kinematic alignment in TKA for knee osteoarthritis between 2019 and 2021 were retrospectively reviewed. After applying the exclusion criteria, 164 knees remained for analysis (130 and 34 knees from female and male patients, respectively). The average age and body mass index were 74.5 ± 8.0 years and 26.4 ± 4.1 kg/m2, respectively. Radiographic measurements were conducted preoperatively and post-operatively, while clinical evaluations-including knee extension, flexion angles, muscle strength, gait patterns and Knee Society scores (patient satisfaction and function)-were performed preoperatively, 1 year post-operatively and 2 years post-operatively. Statistical analysis was used to determine interobserver reliability and compare the preoperative and post-operative values. Radiographic evaluations were analyzed using a paired Student's t test, while clinical evaluations were analyzed using one-way ANOVA followed by a Tukey-Kramer multiple comparison test. Statistical significance was set at p < 0.05.

Results: After surgery, statistically significant improvements were observed in both knee extension and flexion angles, as well as muscle strength (p < 0.01). Two years after surgery, the rates of independent indoor walking and stair climbing were 89.6% and 58.9%, respectively. Additionally, the Knee Society Scores (patient satisfaction and function) significantly improved compared with the preoperative status (p < 0.01). Complications were minimal; revision surgery was not required.

Conclusion: In Japanese patients, kinematic alignment in TKA demonstrated significant improvements and promising outcomes over 2 years. Although alignment characteristics prior to arthritis may vary due to ethnic differences, this method-designed to replicate patient-specific alignments-is considered to have achieved favourable outcomes by tailoring to individual alignments. Further research comparing kinematic alignment with conventional alignment techniques could provide more valuable insights.

Level of evidence: Level III.

Keywords: Japanese patients; cinical evaluations; kinematic alignment; radiographic measurements; total knee arthroplasty; two‐year outcomes.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

Chiari骨盆截骨后全髖關(guān)節(jié)置換----301例髖關(guān)節(jié)發(fā)育不良回顧性研究

譯者 羅殿中

背景：骨盆截骨術(shù)后是否對(duì)全髖關(guān)節(jié)置換（THA）帶來負(fù)面影響，存在爭議。本研究擬對(duì)Chiari骨盆內(nèi)移截骨（CPO）術(shù)后THA患者進(jìn)行隨訪，評(píng)估假體生存率和患者報(bào)告結(jié)果（PROs）。

方法：搜集到301例患者曾行CPO、接受THA治療的數(shù)據(jù)，通過臨床和影像隨訪、并進(jìn)行電話問卷調(diào)查。針對(duì)假體分層分析計(jì)算Kaplan-Meier生存曲線。

結(jié)果：在1536例連續(xù)CPO病例中，405例504髖CPO得到隨訪，平均隨訪36±8年（22至54年）；截止末次隨訪時(shí)，301髖（60%）接受了THA。以髖關(guān)節(jié)翻修為終點(diǎn)，THA假體在術(shù)后10年、20年和25年假體生存率分別為93%、76%、68%?？傮w翻修率為12%?；颊唧y關(guān)節(jié)翻修年齡為57.9±10歲（33.2至78.5歲）。最常見的翻修原因?yàn)闊o菌性松動(dòng)。

結(jié)論：該回顧性研究支持這一假說，即以前的CPO并不影響終末期進(jìn)行THA的治療效果。THA術(shù)后10年假體生存率為93%，與其它病因的初次髖關(guān)節(jié)置換相當(dāng)。

圖.（A-E）男性患者，1939年出生，1956年右髖結(jié)核保守治療7年后進(jìn)行髖關(guān)節(jié)融合術(shù)，1979年因左髖發(fā)育不良、半脫位，采用Chiari骨盆內(nèi)移手術(shù)治療。1992年行右側(cè)THA，1995年（CPO術(shù)后16年）左側(cè)THA；2017年末次隨訪時(shí)（左髖THA術(shù)后22年），患者滿意度為良好（2級(jí)）；Trendelenburg試驗(yàn)陽性，幾乎無疼痛，活動(dòng)度良好。

Total Hip Arthroplasty after Previous Chiari Pelvic Osteotomy-A Retrospective Study of 301 Dysplastic Hips

Background:Controversy exists whether previous pelvic osteotomies have negative effects on total hip arthroplasty (THA). This study evaluates the implant survival and patient-reported outcomes of THA after previous Chiari pelvic osteotomy (CPO).

Methods:Data on 301 THAs after CPO were collected through clinical and radiological follow-up examinations and telephone interviews. The Kaplan-Meier survivorship analysis depicts implant survival.

Results:Of this consecutive series of 1536 CPOs, follow-up was completed in 405 patients with 504 CPOs after a mean time of 36 years (±8; range, 22-54 years). At follow-up, 301 hips (60%) had already undergone THA. The overall survival of THA with revision as an end point after 10, 20, and 25 years was 93%, 76%, and 68%, respectively. The revision rate was 12%. The average period between THA and revision surgery was 9.6 years (±6.1; 4 months-25.4 years). The patient's age at revision was 57.9 years (±10; 33.2-78.5 years). Aseptic loosening was the most common of the known reasons for revision surgery.

Conclusion:This retrospective study supports the hypothesis that prior CPO does not compromise the prerequisites for successful THA at a later stage. Survival rates of the implanted prosthesis are comparable to primary implanted hips, as overall survival was 93% after 10 years.

文獻(xiàn)出處：Schneider E, Stamm T, Schinhan M, Peloschek P, Windhager R, Chiari C. Total Hip Arthroplasty after Previous Chiari Pelvic Osteotomy-A Retrospective Study of 301 Dysplastic Hips. J Arthroplasty. 2020 Dec;35(12):3638-3643. doi: 10.1016/j.arth.2020.06.047. Epub 2020 Jun 20. PMID: 32674940

文獻(xiàn)2

影像學(xué)及患者因素與髖關(guān)節(jié)發(fā)育不良骨關(guān)節(jié)炎的相關(guān)性

譯者 任寧濤

背景 髖關(guān)節(jié)發(fā)育不良可導(dǎo)致關(guān)節(jié)軟骨的異常應(yīng)力，引起骨關(guān)節(jié)炎的發(fā)生，本研究旨在利用軟骨延遲增強(qiáng)磁共振成像(dGEMRIC) 指數(shù)作為疾病的標(biāo)志，研究與發(fā)育不良髖關(guān)節(jié)骨關(guān)節(jié)炎早期發(fā)病相關(guān)的解剖學(xué)和人口統(tǒng)計(jì)學(xué)因素。

方法 納入74名患者，96例有癥狀性髖關(guān)節(jié)，均行標(biāo)準(zhǔn)放射學(xué)檢查和dGEMRIC掃描，在標(biāo)準(zhǔn)的骨盆前后位上測量外側(cè)CE角、臼頂傾斜角和Shenton線的連續(xù)性，在假斜位上測量前CE角來評(píng)估前覆蓋情況。在MRI造影時(shí)出現(xiàn)盂唇每個(gè)層面都可見到造影劑時(shí)診斷為盂唇撕裂，骨關(guān)節(jié)炎定義為 dGEMRIC 值 <390 ms（正常髖關(guān)節(jié)的 dGEMRIC 數(shù)值低于 dGEMRIC 數(shù)值的兩個(gè)標(biāo)準(zhǔn)偏差）。

結(jié)果 該隊(duì)列的平均 dGEMRIC 指數(shù)（和標(biāo)準(zhǔn)偏差）（473 +/- 104 ms）顯著低于形態(tài)正常的髖關(guān)節(jié)（570 +/- 90 ms）。在單變量分析中發(fā)現(xiàn)前CE角、關(guān)節(jié)間隙寬度和盂唇撕裂與否都與骨關(guān)節(jié)炎有關(guān)。第二個(gè)模型去除了前CE角，因?yàn)橥鈧?cè)CE角和前CE角高度相關(guān)，并且外側(cè)CE角在臨床測量上更常見，該模型將年齡、外側(cè)CE角和盂唇撕裂與否確定為與骨關(guān)節(jié)炎相關(guān)的重要獨(dú)立因素。

結(jié)論 正如之前對(duì)髖關(guān)節(jié)的研究所證明的那樣，這項(xiàng)研究表明，骨關(guān)節(jié)炎與年齡增長和發(fā)育不良的嚴(yán)重程度有關(guān)，外側(cè)CE角和前CE角都證明了這一點(diǎn)。此外，我們將盂唇撕裂確定為骨關(guān)節(jié)炎的危險(xiǎn)因素。

Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia

Background: Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. The purpose of this study was to investigate the anatomic and demographic factors associated with the early onset of osteoarthritis in dysplastic hips by utilizing the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index as a marker of the disease.

Methods: Ninety-six symptomatic dysplastic hips in seventy-four patients were assessed with standard radiographs and a dGEMRIC scan. The lateral center-edge angle of Wiberg, the acetabular index of T?nnis, and the break in the Shenton line were measured on a standing anteroposterior radiograph. Anterior undercoverage was assessed by measuring the anterior center-edge angle on a Lequesne false-profile view. A labral tear was considered to be present when contrast agent was seen through the entire thickness of the labrum on magnetic resonance arthrography. Osteoarthritis was defined as a dGEMRIC value of <390 msec (two standard deviations below the dGEMRIC index in normal hips).

Results: The mean dGEMRIC index (and standard deviation) for this cohort (473 +/- 104 msec) was significantly lower than that of a morphologically normal hip (570 +/- 90 msec). The anterior center-edge angle, the joint space width, and the presence of a labral tear were all found to be associated with osteoarthritis in the univariate analysis. Multivariate analysis identified age, the anterior center-edge angle, and the presence of a labral tear as independent factors associated with osteoarthritis. A second model was fitted with omission of the anterior center-edge angle because the lateral and anterior center-edge angles were highly correlated and the lateral center-edge angle is a more common clinical measure. This model identified age, the lateral center-edge angle, and the presence of a labral tear as significant independent factors associated with osteoarthritis.

Conclusions: As has been demonstrated in previous studies of the hip, this investigation showed osteoarthritis to be associated with increasing age and the severity of dysplasia, as demonstrated both by the Wiberg lateral center-edge angle and the Lequesne anterior center-edge angle. Additionally, we identified a labral tear as being a risk factor for osteoarthritis.

文獻(xiàn)出處：Rebecca H Jessel , David Zurakowski, Christoph Zilkens, Deborah Burstein, Martha L Gray, Young-Jo Kim. Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia. J Bone Joint Surg Am. 2009 May;91(5):1120-9.

文獻(xiàn)3

疼痛性臨界髖關(guān)節(jié)發(fā)育不良：有什么新進(jìn)展？

譯者 李勇

髖關(guān)節(jié)發(fā)育不良（DDH）是一種復(fù)雜的靜態(tài)和動(dòng)態(tài)疾病，可導(dǎo)致慢性關(guān)節(jié)不穩(wěn)定和骨關(guān)節(jié)炎。臨界髖關(guān)節(jié)發(fā)育不良是指髖臼形態(tài)和覆蓋范圍略有異常，但未達(dá)到發(fā)育不良的程度；盡管如此，這些變化仍可能導(dǎo)致機(jī)械功能障礙和髖關(guān)節(jié)不穩(wěn)。在保髖領(lǐng)域，診斷和治療仍然是備受爭議的話題，并且缺乏可指導(dǎo)準(zhǔn)確診斷和治療決策的對(duì)比文獻(xiàn)。傳統(tǒng)上，臨界DDH的診斷依賴于骨盆前后位X光片評(píng)估，特別是外側(cè)中心邊緣角（LCEA），其正常值范圍為20°至25°，根據(jù)一些較新的研究，則為18°至25°。手術(shù)治療的決策涉及是采用單純的髖關(guān)節(jié)鏡檢查還是髖臼周圍截骨術(shù)，考慮到在臨界DDH患者中，難以確定是否存在潛在的機(jī)械性診斷（不穩(wěn)與股骨髖臼撞擊癥）。因此，有效的手術(shù)決策需要評(píng)估額外的骨骼解剖特征、關(guān)節(jié)不穩(wěn)以及患者的個(gè)體特征。

Painful Borderline Acetabular Dysplasia: What’s New?

Developmental dysplasia of the hip (DDH) is a complex static and dynamic disease that leads to chronic joint instability and osteoarthritis. Borderline acetabular dysplasia refers to cases in which acetabular morphology and coverage are slightly abnormal but do not fall within the dysplastic range; nevertheless, these changes can cause mechanical dysfunction and hip instability. Diagnosis and treatment remain controversial topics in hip preservation, and there is a lack of comparative literature to guide accurate diagnosis and treatment decisions. Traditionally, the diagnosis of borderline DDH has relied on anteroposterior pelvic radiographic assessment, particularly the lateral center-edge angle (LCEA), with normal values ranging from 20° to 25°, or 18° to 25° according to some newer studies. The decision for surgical treatment involves whether to use isolated hip arthroscopy or periacetabular osteotomy, considering that in patients with borderline DDH, it is difficult to determine whether there is an underlying mechanical diagnosis (instability versus femoroacetabular impingement). Therefore, effective surgical decision-making requires the assessment of additional skeletal anatomical features, joint instability, and individual patient characteristics.

文獻(xiàn)出處：Monari R, Pessiquelli FLF, Machado EG. Painful Borderline Acetabular Dysplasia: What's New? Rev Bras Ortop (Sao Paulo). 2025 Apr 2;60(1):1-8. doi: 10.1055/s-0044-1790212. PMID: 40177532; PMCID: PMC11964716.

文獻(xiàn)4

穩(wěn)定型股骨頭骨骺滑脫（SCFE）的治療有多緊急？一項(xiàng)多中心回顧性研究：穩(wěn)定型股骨頭骨骺滑脫患者手術(shù)時(shí)機(jī)與并發(fā)癥的關(guān)系

譯者 張利強(qiáng)

背景：穩(wěn)定型股骨頭骺板滑脫（SCFE）通常被視為亞急性狀態(tài)，需要住院進(jìn)行原位螺釘固定（ISF），這可能會(huì)增加醫(yī)療成本/負(fù)擔(dān)。不穩(wěn)定型SCFE患者中25%至50%會(huì)出現(xiàn)股骨頭缺血性壞死（AVN），但在穩(wěn)定型SCFE患者中較為少見。對(duì)于初診為穩(wěn)定型SCFE的患者，目前尚不清楚診斷與手術(shù)時(shí)機(jī)之間的關(guān)系對(duì)滑脫進(jìn)展或并發(fā)癥有何影響。

方法：本回顧性觀察研究納入了2000年至2020年期間在4個(gè)中心接受ISF治療的初診為穩(wěn)定型SCFE的18歲以下患者。初診為Loder不穩(wěn)定型SCFE的患者被排除在外。時(shí)間數(shù)據(jù)包括：（1）癥狀出現(xiàn)至診斷的時(shí)間；（2）癥狀出現(xiàn)至手術(shù)團(tuán)隊(duì)評(píng)估的時(shí)間；（3）癥狀出現(xiàn)至手術(shù)的時(shí)間；（4）診斷至手術(shù)團(tuán)隊(duì)評(píng)估的時(shí)間；（5）手術(shù)團(tuán)隊(duì)評(píng)估至手術(shù)的時(shí)間；（6）診斷至手術(shù)的時(shí)間?；貧w分析探討時(shí)間與滑脫進(jìn)展至不穩(wěn)定狀態(tài)、后續(xù)手術(shù)以及并發(fā)癥（根據(jù)改良的Clavien-Dindo-Sink 系統(tǒng)分級(jí)）之間的關(guān)系。

結(jié)果：共納入298例患者362個(gè)穩(wěn)定型股骨頭骨骺滑脫（SCFE）。從癥狀出現(xiàn)到診斷的平均時(shí)間為134天，從診斷到骨科團(tuán)隊(duì)評(píng)估為3.2天，從骨科團(tuán)隊(duì)評(píng)估到手術(shù)為2.1天。平均隨訪時(shí)間為2.4年。18%的髖關(guān)節(jié)出現(xiàn)并發(fā)癥。有2例最初診斷為穩(wěn)定型SCFE的患者進(jìn)展為不穩(wěn)定型SCFE，他們在診斷后、骨科評(píng)估前跌倒；其中1例繼而出現(xiàn)股骨頭缺血性壞死（AVN）。癥狀出現(xiàn)、診斷、骨科團(tuán)隊(duì)評(píng)估以及手術(shù)之間的時(shí)間間隔與并發(fā)癥的發(fā)生率或嚴(yán)重程度以及后續(xù)手術(shù)無關(guān)。

結(jié)論：穩(wěn)定型SCFE手術(shù)治療的緊迫性似乎不影響中期結(jié)果。如果穩(wěn)定型SCFE的手術(shù)治療不緊急進(jìn)行，關(guān)鍵在于避免負(fù)重和跌倒，以減少進(jìn)展為不穩(wěn)定型SCFE的風(fēng)險(xiǎn)。

證據(jù)級(jí)別：III級(jí)，治療性。

關(guān)鍵詞：骨骺固定術(shù)、髖關(guān)節(jié)、原位固定、小兒骨科、股骨頭骨骺滑脫、時(shí)機(jī)

How Urgent Are Stable SCFEs? A Multisite Retrospective Study of Surgical Timing and Complications Among Patients With Stable Slipped Capital Femoral Epiphysis

Background: Stable slipped capital femoral epiphysis (SCFE) is often considered semi-urgent, prompting admission for in situ screw fixation (ISF), which may increase the cost/burden of care. Avascular necrosis (AVN) affects 25% to 50% of patients with unstable SCFE, yet it is uncommon after stable SCFE. Among patients presenting with stable SCFE, little is known about the relationship between diagnosis and surgical timing with regard to slip progression or complications.

Methods: This retrospective observational study included all patients younger than 18 years with stable SCFE at initial diagnosis treated with ISF between 2000 and 2020 at 4 centers. Patients with Loder unstable SCFE at the time of initial SCFE diagnosis were excluded. Timing data included time from (1) symptom onset to diagnosis, (2) symptom onset to surgical team evaluation, (3) symptom onset to surgery, (4) diagnosis to surgical team evaluation, (5) surgical team evaluation to surgery, and (6) diagnosis to surgery. Regression analyses explored relationships between timing and slip progression to unstable, subsequent procedures, and complications as graded by the modified Clavien-Dindo-Sink system.

Results: A total of 298 patients with 362 stable SCFEs were included. The mean time from symptom onset to diagnosis was 134 days, from diagnosis to surgical team evaluation was 3.2 days, and from surgical team evaluation to surgery was 2.1 days. The mean follow-up was 2.4 years. Eighteen percent of hips were affected by a complication. Two patients initially diagnosed with stable SCFE progressed to unstable SCFE, having experienced falls after diagnosis and before orthopaedic evaluation; one of these went on to develop AVN. Time elapsed between symptom onset, diagnosis, surgical team evaluation, and surgery was not associated with the incidence or severity of complications or subsequent procedure.

Conclusions: The urgency of surgical treatment of stable SCFE does not appear to affect mid-term outcomes. If surgical management of stable SCFE is not performed urgently, it is critical to avoid weight bearing and falls to reduce progression to an unstable SCFE. Level of Evidence:

Level III, therapeutic.

Key Words: epiphysiodesis, hip, in situ fixation, pediatric orthopaedics, SCFE slipped capital femoral epiphysis, timing

文獻(xiàn)出處：White AB, Keil LG, Bardsley H, Selberg C, Mansour A, Brooks AC, Manickam R, Mayassi HA, Zhao L, Uchtman M, Whitlock P, Stone J. How Urgent Are Stable SCFEs? A Multisite Retrospective Study of Surgical Timing and Complications Among Patients With Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2025 May 1. doi: 10.1097/BPO.0000000000002997. Epub ahead of print. PMID: 40314216.

文獻(xiàn)5

髖臼周圍截骨術(shù)后(PAO)髖關(guān)節(jié)的生存率：一項(xiàng)薈萃分析

譯者 陶可

背景：髖臼周圍截骨術(shù)(PAO)已成為一種用于矯正發(fā)育性病理形態(tài)髖臼的常用手術(shù)。自1988年Reinhold Ganz首次描述以來，全球許多機(jī)構(gòu)已采用該手術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良(DDH)，并隨后報(bào)告了其結(jié)果。本研究旨在對(duì)髖關(guān)節(jié)發(fā)育不良患者接受髖臼周圍截骨術(shù)(PAO)后長期生存的可能性進(jìn)行薈萃分析。

方法：使用Medline、Cochrane和“Web of Science”數(shù)據(jù)庫進(jìn)行系統(tǒng)性文獻(xiàn)綜述，以檢索報(bào)告發(fā)育性髖關(guān)節(jié)脫位(DDH)患者接受髖臼周圍截骨術(shù)(PAO)生存率估計(jì)值的文獻(xiàn)。納入分析的研究必須包含年齡小于40歲、骨關(guān)節(jié)炎分級(jí)小于T?nnis III級(jí)且無任何神經(jīng)肌肉發(fā)育不良的患者隊(duì)列。對(duì)隊(duì)列重疊進(jìn)行了校正。質(zhì)量評(píng)估包括根據(jù)牛津中心LOE標(biāo)準(zhǔn)和“非隨機(jī)研究方法學(xué)指數(shù)(MINORS)”進(jìn)行的證據(jù)水平評(píng)估(LOE)。數(shù)據(jù)提取后，采用隨機(jī)效應(yīng)薈萃分析模型，提供5年、10年、15年和20年生存率的加權(quán)平均估計(jì)值。

結(jié)果：9篇相關(guān)文章納入了9家機(jī)構(gòu)接受PAO治療的2268例發(fā)育不良髖關(guān)節(jié)患者。納入研究中，5項(xiàng)研究為III級(jí)證據(jù)，4項(xiàng)為IV級(jí)證據(jù)。3項(xiàng)研究的MINORS評(píng)分為11分，4項(xiàng)研究為12分，2項(xiàng)研究為13分。PAO術(shù)后5年生存率為96.1%（95% CI，94.9-97.3），10年生存率為91.3%（95% CI，87.7-94.8），15年生存率為85.0%（95% CI，78.9-91.1），20年生存率為67.6%（95% CI，53.9-81.3）。

結(jié)論：本研究結(jié)果基于全球證據(jù)，為PAO術(shù)后髖關(guān)節(jié)發(fā)育不良的髖關(guān)節(jié)生存率提供了具有代表性的評(píng)估。這應(yīng)該為臨床醫(yī)生和患者提供了對(duì)此類手術(shù)后預(yù)后預(yù)期的充分證據(jù)。

圖 對(duì)5篇報(bào)道PAO后5年生存率的文獻(xiàn)進(jìn)行Meta分析，結(jié)果顯示異質(zhì)性較低（τ2 0.0，I2 0.0%）。加權(quán)5年生存率估計(jì)值為96.1%（95% CI，94.9-97.3）。

圖 對(duì)9篇報(bào)道PAO后10年生存率的文獻(xiàn)進(jìn)行Meta分析，結(jié)果顯示異質(zhì)性較高（τ2 17.9，I2 78.4%）。加權(quán)10年生存率估計(jì)值為91.3%（95% CI，87.7-94.8）。

圖 對(duì)6篇報(bào)道PAO后15年生存率的文獻(xiàn)進(jìn)行Meta分析，結(jié)果顯示異質(zhì)性較高（τ2 39.0，I2 78.1%）。加權(quán)15年生存率估計(jì)為85.0%（95% CI，78.9-91.1）。

圖 兩篇報(bào)告20年生存率的文獻(xiàn)的加權(quán)估計(jì)值。20年生存率估計(jì)為67.6%（95% CI，53.9-81.3）。

圖 加權(quán)生存率估計(jì)值及各時(shí)間間隔置信區(qū)間的圖示。

Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis

Background: Periacetabular osteotomy (PAO) has become a popular procedure for re-orientation of the acetabulum in patients with a developmental pathomorphology. Since its first description by Reinhold Ganz in 1988, many institutions worldwide have adopted the procedure for the treatment of developmental hip dysplasia (DDH) and have subsequently reported their results. The aim of this study was to provide a meta-analysis of the likelihood of long-term survival of a dysplastic hip after PAO.

Methods: A systematic literature review was conducted using Medline, Cochrane and "Web of Science" databases to identify articles reporting survival estimates for PAO in patients with DDH. To be included in the analysis, studies had to include patient cohorts aged <40 years, with Osteoarthritis grade < T?nnis III and no form of neuromuscular dysplasia. Adjustment for cohort overlap was performed. Quality assessment included level of evidence (LOE) according to the oxford center for LOE criteria and the "Methodological index for non-randomized studies (MINORS)". After data extraction, a random-effects meta-analytical model was applied to provide weighted mean estimates of survival at 5 years, 10 years, 15 years and 20 years.

Results: Nine relevant articles included 2268 dysplastic hips that underwent PAO in 9 institutions. Of the included studies, 5 presented level III evidence and 4 presented level IV evidence. The MINORS score was 11 for 3 studies, 12 for 4 studies and 13 for 2 studies. The 5-year survival after PAO was 96.1% (95% CI, 94.9-97.3), the 10-year survival was 91.3% (95% CI, 87.7-94.8), 15-year survival 85.0% (95% CI, 78.9-91.1), 20-year survival 67.6% (95% CI, 53.9-81.3).

Conclusions: The results provide a representative survival estimate of a dysplastic hip after PAO based on global evidence. This should provide clinicians and patients with an adequate reflection of prognostic expectations after this kind of surgery.

文獻(xiàn)出處：Sufian S Ahmad, Gregor M Giebel, Carsten Perka, Sebastian Meller, Matthias Pumberger, Sebastian Hardt, Ulrich St?ckle, Christian Konrads. Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Meta-Analysis, Hip Int. 2023 Mar;33(2):306-312. doi: 10.1177/11207000211048425. Epub 2021 Sep 27.

文獻(xiàn)6

股骨去旋轉(zhuǎn)截骨術(shù)位置及其對(duì)髖關(guān)節(jié)發(fā)育不良患者關(guān)節(jié)反作用力的影響

譯者 邱興

股骨扭轉(zhuǎn)（Femoral version, FV）畸形常見于發(fā)育性髖關(guān)節(jié)發(fā)育不良（developmental dysplasia of the hip, DDH）患者，異常關(guān)節(jié)負(fù)荷可能導(dǎo)致軟骨損傷。股骨去旋轉(zhuǎn)截骨術(shù)（derotational femoral osteotomy, DFO）可矯正FV畸形。然而，關(guān)于DFO術(shù)中股骨截骨位置的選擇尚未達(dá)成共識(shí)，且其對(duì)關(guān)節(jié)負(fù)荷的影響尚不明確。本研究旨在比較兩種常見DFO截骨位置對(duì)DDH患者肌力和髖關(guān)節(jié)反作用力（joint reaction forces, JRFs）的影響?；诨颊咛禺愋约∪夤趋滥Ｐ?，對(duì)9例伴有FV異常的DDH患者進(jìn)行DFO手術(shù)模擬。分別在小轉(zhuǎn)子近端和遠(yuǎn)端進(jìn)行股骨截骨模擬，并將FV矯正至理想值15°。對(duì)比兩種截骨位置在步態(tài)早期和晚期支撐相中的JRF變化。結(jié)果顯示，近端與遠(yuǎn)端DFO對(duì)JRFs的影響總體相似，但股骨前傾患者晚期支撐相內(nèi)側(cè)JRF分量存在統(tǒng)計(jì)學(xué)顯著差異（p=0.01）。五個(gè)髖關(guān)節(jié)肌群的肌力變化在截骨位置間差異顯著，但變化幅度較小。股骨后傾患者的JRF變化趨勢與前傾患者相反，后傾矯正后前后向和上方向JRF增加。DFO矯正后，DDH患者的上方向和內(nèi)側(cè)JRF仍高于對(duì)照組。明確DFO截骨位置對(duì)肌肉源性髖關(guān)節(jié)力的影響，有助于外科醫(yī)生制定合理決策并可能實(shí)現(xiàn)DDH患者FV畸形手術(shù)矯正的標(biāo)準(zhǔn)化。
關(guān)鍵詞：去旋轉(zhuǎn)截骨術(shù)；發(fā)育性髖關(guān)節(jié)發(fā)育不良；股骨扭轉(zhuǎn)；關(guān)節(jié)反作用力

圖. 股骨去旋轉(zhuǎn)截骨術(shù)（DFO）模擬示意圖

通過在股骨近端（小轉(zhuǎn)子近端）和遠(yuǎn)端（小轉(zhuǎn)子遠(yuǎn)端）制作橫向截骨，并將股骨從前傾角（FV）的原始角度旋轉(zhuǎn)至理想化的15°來模擬DFO操作。肌肉附著點(diǎn)以標(biāo)記點(diǎn)的形式顯示于股骨表面（右圖示前側(cè)，左圖示后側(cè)）。顏色標(biāo)注：綠色＝臀肌群，藍(lán)色＝髂腰肌，紅色＝閉孔肌群，黃色＝孖肌和梨狀肌，灰色＝股方肌，橙色＝大收肌近端。

Derotational femoral osteotomy locations and their influence on joint reaction forces in dysplastic hips

Femoral version (FV) deformities are common in patients with developmental dysplasia of the hip (DDH) and may contribute to cartilage damage due to abnormal joint loading. Derotational femoral osteotomy (DFO) surgery corrects FV deformities. However there is little consensus about the femoral transection location for DFO, and its influence on joint loads is unknown. The purpose of this study was to compare the effects of two common DFO locations on muscle forces and hip joint reaction forces (JRFs) in patients with DDH. DFO was simulated in nine patients with DDH and abnormal FV using patient-specific musculoskeletal models. Femoral transection for DFO was separately simulated proximal and distal to the lesser trochanter and FV values were corrected to an idealized 15°. JRFs during early and late stance of gait were compared between the two simulated transection locations. Most changes to JRFs were similar between proximal and distal DFO, however, statistically significant differences were found for the medial JRF component during late stance among patients with femoral anteversion (p = 0.01). Force changes from five hip muscles were significantly different between DFO locations, however, changes were minimal. Most changes after DFO in patients with femoral retroversion were opposite of those with femoral anteversion, with anteroposterior and superior JRFs increasing after retroversion correction. After DFO correction, superior and medial JRFs in DDH patients remained elevated compared to controls. Understanding the influence of DFO location on muscle-generated hip forces can help surgeons justify decisions and potentially standardize surgical correction of FV deformities in patients with DDH.

Keywords: derotational osteotomy; developmental dysplasia of the hip; femoral version; joint reaction forces.

文獻(xiàn)出處： Shepherd M C , Clohisy J C , Harris N M D .Derotational femoral osteotomy locations and their influence on joint reaction forces in dysplastic hips[J].Journal of orthopaedic research, 2023, 41(11):2474-2483.DOI:10.1002/jor.25559.

文獻(xiàn)7

無癥狀的女性壘球投手髖關(guān)節(jié)形態(tài)和軟骨成分發(fā)生改變

譯者 徐子茵

目前鮮有研究探討女性運(yùn)動(dòng)員的髖關(guān)節(jié)形態(tài)與軟骨成分，或評(píng)估諸如壘球投球等重復(fù)性不對(duì)稱負(fù)荷對(duì)其產(chǎn)生的影響。這項(xiàng)橫斷面研究通過計(jì)算機(jī)斷層掃描評(píng)估了大學(xué)水平壘球投手組（"Pitch1"，n=25）與越野跑運(yùn)動(dòng)員組（"Run"，n=13）的雙側(cè)骨性髖關(guān)節(jié)形態(tài)，并利用磁共振成像檢測了第二組投手（"Pitch2"，n=10）與非運(yùn)動(dòng)員對(duì)照組（"Con"，n=4）的軟骨弛豫時(shí)間。

研究發(fā)現(xiàn)：Pitch1組的最大α角較Run組大52%（p<0.001），且至少一側(cè)髖關(guān)節(jié)出現(xiàn)α角≥60°的幾率是Run組的21.3倍（95%CI 2.4-192.0）；Pitch2組驅(qū)動(dòng)側(cè)下肢（即投擲臂同側(cè)）和踏步側(cè)股骨上端軟骨的T2弛豫時(shí)間均長于Con組（所有p<0.02）；其驅(qū)動(dòng)側(cè)股骨上端軟骨的T1ρ和T2弛豫時(shí)間亦較踏步側(cè)更長（所有p≤0.03）。

研究表明，無癥狀壘球投手與越野跑運(yùn)動(dòng)員相比存在髖關(guān)節(jié)骨性形態(tài)改變，與非運(yùn)動(dòng)員對(duì)照組相比則表現(xiàn)出軟骨成分差異，同時(shí)其軟骨成分具有不對(duì)稱性特征。未來需擴(kuò)大樣本量進(jìn)一步研究，并深入探討這些改變在癥狀發(fā)展及骨關(guān)節(jié)炎形成方面可能產(chǎn)生的長期影響。

Asymptomatic female softball pitchers have altered hip morphology and cartilage composition

Few studies have explored hip morphology and cartilage composition in female athletes or the impact of asymmetric repetitive loading, such as occurs during softball pitching. The current cross-sectional study assessed bilateral bony hip morphology on computed tomography imaging in collegiatelevel softball pitchers (‘Pitch1’, n = 25) and cross-country runners (‘Run’, n = 13). Magnetic resonance imaging was used to assess cartilage relaxation times in a second cohort of pitchers (‘Pitch2’, n = 10) and non-athletic controls (‘Con’, n = 4). Pitch1 had 52% greater maximum alpha angle than Run (p < 0.001) and were 21.3 (95% CI 2.4 to 192.0) times more likely to have an alpha angle ≥ 60° within at least one hip. Pitch2 had longer T2 relaxation times in the superior femoral cartilage of the drive leg (same side as the throwing arm) and stride leg than Con (all p < 0.02). The drive leg in Pitch2 had longer T1ρ and T2 relaxation times in the superior femoral cartilage compared to the stride leg (all p ≤ 0.03). Asymptomatic softball pitchers exhibit altered bony hip morphology and cartilage composition compared to cross-country runners and non-athletic controls, respectively. They also exhibit asymmetry in cartilage composition. Further studies with larger sample sizes are warranted and any potential long-term consequences of the changes in terms of symptom and osteoarthritis development requires investigation.

文獻(xiàn)出處：Warden, Stuart J et al. “Asymptomatic female softball pitchers have altered hip morphology and cartilage composition.” Scientific reports vol. 15,1 3262. 25 Jan. 2025, doi:10.1038/s41598-025-87839-2

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊(duì)

聲明：本文內(nèi)容及圖片均為轉(zhuǎn)載內(nèi)容，如涉及版權(quán)問題請相關(guān)權(quán)利人及時(shí)與我們聯(lián)系，我們會(huì)立即處理配合采取保護(hù)措施，以保障雙方利益。

為什么要投稿？是為了記錄自己的醫(yī)學(xué)之路！是為了與更多的骨科同道交流分享！是為了讓更多的人看到而受益！讓傳播知識(shí)成為一種習(xí)慣，是“玖玖骨科”讓你投稿的理由！