本期目錄：

1、膝關節和髖關節置換術后持續疼痛的機制和預防策略

2、年輕成年人髖關節周圍骨切除術、髖關節鏡檢查和全髖關節成形術之間的手術指征差異

3、止血帶應用情況與全膝關節置換術后患者自評量表的相關性分析

4、全關節置換術后哪些運動是安全的

5、髖關節發育不良并發股骨骨骺外側生長障礙的髖臼發育情況

6、計算機輔助模式在髖臼周圍截骨術中的應用

7、支具治療發育性髖關節發育不良中停止支具治療的時機

8、髖關節鏡輔助髖臼周圍截骨術

9、術前磁共振成像測量的盂唇大小不能預測初次髖關節鏡手術患者是否需要盂唇重建

第一部分：關節置換及保膝相關文獻

文獻1

膝關節和髖關節置換術后持續疼痛的機制和預防策略

譯者 張軼超

摘要：慢性術后疼痛（CPSP）是全膝關節置換術（TKA）和全髖關節置換術（THA）術后的常見并發癥，可能會降低患者滿意度，增加經濟負擔，并導致長期殘障。明確TKA和THA后CPSP的危險因素是具有挑戰性的，但有針對性的預防治療是至關重要的。最近的薈萃分析和個體研究強調了焦慮狀態升高、抑郁評分、術前疼痛、糖尿病、睡眠障礙和各種其他因素與CPSP風險增加之間存在相關性，并觀察到TKA和THA之間在相關性方面存在差異。雖然CPSP的病因尚不完全清楚，但已經確定了一些因素，如慢性炎癥和術前中樞致敏。其他潛在的機制包括遺傳因素（例如，兒茶酚- o -甲基轉移酶（COMT）和內部鉀校正通道亞科J項6 （KCNJ6）基因）、脂質標志物和心理風險因素（焦慮和抑郁）。在治療和預防方面，以對乙酰氨基酚和非甾體抗炎藥（NSAIDs）等非阿片類鎮痛藥物為重點的多模式藥物鎮痛已經超過硬膜外鎮痛。神經阻滯和局部浸潤麻醉在預防CPSP方面的效果好壞參半。氯胺酮是一種NMDA受體拮抗劑，具有抗痛覺過敏的特性，但其在降低CPSP方面的作用尚不明確。酰胺型局麻藥利多卡因對CPSP可能具有好的作用。選擇性5 -羥色胺再攝取抑制劑（SSRIs）和5 -羥色胺去甲腎上腺素再攝取抑制劑（SNRIs）的結果好壞參半，而加巴噴丁類藥物，如加巴噴丁和普瑞巴林，提供了有希望的數據，但需要進一步的研究，特別是在TKA和THA中，以證明其用于預防CPSP的有效性。

Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review

Abstract: Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA. While the etiology of CPSP is not fully understood, several factors such as chronic inflammation and preoperative central sensitization have been identified.Other potential mechanisms include genetic factors (e.g., catechol-O-methyltransferase (COMT) and potassium inwardly rectifying channel subfamily J member 6 (KCNJ6) genes), lipid markers, and psychological risk factors (anxiety and depression). With regards to therapeutics and prevention, multimodal pharmacological analgesia, emphasizing nonopioid analgesics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has gained prominence over epidural analgesia. Nerve blocks and local infiltrative anesthesia have shown mixed results in preventing CPSP. Ketamine, an Nmethyl-D-aspartate (NMDA)-receptor antagonist, exhibits antihyperalgesic properties, but its efficacy in reducing CPSP is inconclusive. Lidocaine, an amide-type local anesthetic, shows tentative positive effects on CPSP. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have mixed results, while gabapentinoids, like gabapentin and pregabalin, present hopeful data but require further research, especially in the context of TKA and THA, to justify their use for CPSP prevention.

文獻出處：Murphy J, Pak S, Shteynman L, Winkeler I, Jin Z, Kaczocha M, Bergese SD. Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review. Int J Mol Sci. 2024 Apr 26;25(9):4722. doi: 10.3390/ijms25094722. PMID: 38731944; PMCID: PMC11083264.

文獻2

年輕成年人髖關節周圍骨切除術、髖關節鏡檢查和全髖關節成形術之間的手術指征差異

譯者 馬云青

髖部疼痛在年輕人群和老年人群中都比較普遍。在老年患者中，由骨關節炎 (OA) 引起的疼痛最為常見，而在年輕患者中，非退行性疾病是常見的疼痛原因。疼痛可能由髖部發育不良和髖臼撞擊 (FAI) 引起。一些作者推測，髖部活動機制異常可導致高達 80% 的OA發生。因此，在治療年輕髖部疼痛患者時，糾正這些異常顯然至關重要。可以通過骨盆普通站立位X線片測量 CE 角 <25° 來診斷髖關節發育不良。具有顯著癥狀的發育不良或髖臼后傾應接受髖臼周圍截骨術 (PAO)。具有顯著癥狀的 FAI 應通過充分切除撞擊治療，必要時應進行盂唇手術。如果存在導致保髖手術結果不佳的風險因素 (年齡> 45 至 50 歲，OA 存在，關節間距 <3 毫米或關節活動范圍減少), 患者應接受全髖關節置換術 (THA), 而不是 PAO。THA 可以在 PAO 后進行，其結果類似于初次THA。髖關節鏡檢查在 FAI (凸輪和鉗夾) 和 / 或髖臼盂唇撕裂患者上實行。

The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI).Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain.Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis.Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO).FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery.If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO.THA can be performed following PAO with outcomes similar to a primary THA.Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears.

文獻出處：Jakobsen SS, Overgaard S, S?balle K, Ovesen O, Mygind-Klavsen B, Dippmann CA, Jensen MU, Stürup J, Retpen J. The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. EFORT Open Rev. 2018 Jul 11;3(7):408-417. doi: 10.1302/2058-5241.3.170042. PMID: 30233816; PMCID: PMC6129960.

文獻3

止血帶應用情況與全膝關節置換術后患者自評量表的相關性分析

譯者 張薔

背景：在北美，全膝關節置換術（TKA）是最常見的擇期手術之一。近些年，患者優化、手術技術和假體設計方面均有進步，但止血帶的應用仍然是存在爭議的議題，而它和患者的關節功能與術后感受密切相關。

方法：作為PEPPER臨床試驗的一部分，我們入組了5684例初次全膝關節置換病例，其中4866例（85.6%）術中應用止血帶（YT組），818例術中未應用止血帶（NT組）。患者大多數為女性（60.8%），白人（77%），且非西班牙裔或拉丁裔（96.8%）。平均年齡64.6±9.2歲。首要研究指標為術前和術后1月、3月和6月的膝關節損傷與骨關節炎評分（KOOS JR）、患者自評信息-身體狀態評分（PROMIS-PH10）和數字化疼痛評分（NPRS）。次要研究指標為住院時長、出院去處、止疼藥攝入量和術后并發癥情況。最后我們應用多變量分析法評估了止血帶應用情況與TKA術后患者自評量表（PROMs）之間的關系。

結果：在術后1個月時，兩組間患者KOOS JR評分達到最小臨床重要差異（MCID）的比例存在顯著性差異（YT, 55.4%; NT, 47.9%）。而這種差異在術后3個月和6個月時消失。而兩組間患者的PROMIS-PH10評分和NPRS評分在任意時間點達到MCID的比例均無顯著性差異。而兩組間患者任意時間點的KOOS JR評分、PROMIS-PH10評分和NPRS評分均無顯著性差異。而兩組間的阿片類藥物入量、手術時長、住院時長、傷口相關并發癥情況或術后再入院情況均不存在顯著性差異。

結論：與不用止血帶相比，TKA術中應用止血帶的病例在術后1個月KOOS JR評分達到最小臨床重要意義的比例更高。而這種差異在術后3個月和6個月隨訪時消失。在術后1個月、3個月和6個月隨訪時，應用和不應用止血帶的兩組間在阿片類藥物用量、醫療實施情況或并發癥方面均無顯著性差異。多變量分析顯示應用止血帶并不會對PROMs有顯著性影響。由于止血帶的應用與術者偏好相關且會影響術后關節功能，關節外科醫生可以在與患者的術前談話中參考本研究的相關結果。

Association between Tourniquet Use and Patient-Reported Outcomes Following Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. While advancements have been made in patient optimization, surgical technique, and implant design, tourniquet use remains a contentious issue as it relates to patient outcomes and postoperative experience.

Methods: As part of the PEPPER trial, we identified 5,684 patients who underwent primary TKA, of whom 4,866 (85.6%) underwent surgery with a tourniquet (the YT group) and 818 (14.4%) underwent surgery without a tourniquet (the NT group). The cohort was predominantly female (60.8%), White (77%), and of an ethnicity other than Hispanic or Latino (96.8%). The mean age of the patients was 64.6 ± 9.2 years. The primary outcomes were the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH10); and numeric pain rating scale (NPRS), which were captured preoperatively and at 1, 3, and 6 months postoperatively. The secondary outcomes were length of stay, discharge disposition, analgesic consumption, and postoperative complications. Multivariable analysis was performed to assess the associations between tourniquet use and patient-reported outcome measures (PROMs) following TKA.

Results: The percentages of patients achieving the minimal clinically important difference (MCID) for the KOOS JR were significantly different at 1 month only (YT, 55.4%; NT, 47.9%). This difference disappeared at 3 and 6 months. There was no difference between the YT and NT groups in terms of the percentage of patients achieving the MCID for the PROMIS-PH10 or NPRS at any time point. There were no differences between the YT and NT groups at any time point with respect to the KOOS JR, PROMIS-PH10, and NPRS. There were no differences in opioid consumption, operative time, length of stay, wound-related complications, or readmissions postoperatively.

Conclusions: Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon’s preference and how it could influence postoperative function.

文獻4

全關節置換術后哪些運動是安全的？——基于平均5年隨訪期的翻修率分析

譯者 沈松坡

引言：盡管存在疲勞磨損的理論風險，但目前缺乏將術后運動沖擊等級與全髖關節與膝關節置換術（THA 和 TKA）失敗率關聯的實證證據。本研究旨在評估自我報告的體育運動與身體活動的沖擊等級與初次關節置換術后翻修率之間的關系。

方法：我們對2011年6月1日至2022年1月31日期間，在一家城市學術醫療系統接受擇期初次 THA 與 TKA 的患者進行了關于休閑運動參與情況的橫斷面問卷調查。最終共納入1,622例 THA 和 1,388例 TKA 受試者。所有受試者隨訪時間至少為1年（THA 平均 5.3 年；TKA 平均 4.8 年）。根據運動參與及其強度，將患者分為四組：不運動、低沖擊運動、中等沖擊運動與高沖擊運動。通過描述性比較分析各組的翻修率及平均隨訪時間，并使用 Kaplan-Meier 法評估 10 年植入物生存率。

結果：較為年輕且健康狀況較好的 THA 或 TKA 患者更有可能參與中高沖擊運動，且其翻修率并不高于無運動或低沖擊運動者：THA（無運動 2.9%，低沖擊 1.9%，中高沖擊 1.6%）；TKA（分別為 3.0%、1.6%、0.0%）。在分別分析無菌性與感染性翻修時，未發現顯著差異或規律。

結論：在平均 5 年隨訪中，參與中高沖擊運動的年輕健康患者，其翻修率不劣于活動量較少者。這些結果可為臨床醫生在指導關節置換術后患者安全恢復運動活動時提供參考依據。

What Sports Are Safe Following Total Joint Arthroplasty? An Analysis of Revision Rates at a Mean 5-year Follow-Up

Introduction: Despite theoretical risks of fatigue wear, there is little empirical evidence correlating postoperative impact level from physical activity with failure rates following total hip and knee arthroplasty (THA and TKA). This study aimed to assess the relationship between the impact level from self-reported sports and physical activity participation and revision rates following primary arthroplasty.

Methods: A survey was conducted on recreational sports participation among primary elective THA and TKA patients from an urban, academic health system between June 1, 2011 and January 31, 2022. A total of 1,622 THA and 1,388 TKA respondents were included in the study. The survey was administered cross-sectionally at various time points, with a minimum follow-up of at least one year required for inclusion (THA - 5.3 years; TKA - 4.8 years post-operation on average). Patients were divided into four cohorts based on participation and intensity of the sport: no sports, low-impact sports, intermediate-impact sports, and high-impact sports. Descriptive comparisons were made to evaluate revision rates and mean time to follow-up among these groups in THA and TKA patients. The Kaplan-Meier method was utilized to assess 10-year implant survivability.

Results: Healthier and younger patients who underwent THA or TKA were significantly more likely to participate in intermediate- to high-impact sports and were found to have non-inferior revision rates compared to those who engaged in no sports or low-impact sports: THA (2.9 [no sports] versus 1.9 [low-impact] versus 1.6% [intermediate/high impact]), TKA (3.0 versus 1.6 versus 0.0%). When analyzing aseptic versus septic revisions separately, no notable patterns or differences were observed.

Conclusion: At a mean 5-year follow-up, healthier and younger patients who participated in intermediate- and high-impact physical activities had non-inferior revision rates as compared to patients who were less active. These findings offer guidance for clinicians when advising patients on the safe resumption of sports activities following total joint arthroplasty.

第二部分：保髖相關文獻

文獻1

髖關節發育不良并發股骨骨骺外側生長障礙的髖臼發育情況

譯者 任寧濤

背景:股骨頭骨骺外側生長障礙是髖關節發育不良治療過程中最常見的骨骺生長障礙類型。雖然這種類型的骨骺生長障礙被認為可導致髖臼發育不良，但這種生長障礙模式對髖關節發育不良影響的自然史尚不清楚。為了探討這一問題，我們對48名DDH患者治療后發生股骨頭骨骺外側生長障礙的58例髖臼發育情況進行了回顧性研究。

方法:58例髖關節中，36例行閉合復位，22例行切開復位。復位時患者平均年齡為22個月(范圍，3 ~ 97個月)，最近一次隨訪評估時為21歲(范圍，10 ~ 55歲)。隨訪時Severin I級(優)或II級(良)為臨床效果滿意， Severin III級(可)或IV級(差)的被認為是臨床效果不滿意。在連續的影像學上觀察股骨頭的特定變化，在后期隨訪期間，測量髖關節的各種影像學參數，包括股骨骨骺的側傾程度，并在四個時間節點(復位前、復位后兩年、6至8歲和最終隨訪時)對劃分為滿意和不滿意的髖關節進行比較。

結果:平均10歲(4 ~ 14歲)首次出現股骨頭骨骺外側生長發育障礙。在骨骺、骨骺或干骺端中沒有一致的早期變化模式與骨骺外翻傾斜的后期發展有關。末次隨訪時34例髖(59%)滿意，24例髖不滿意。不滿意的髖關節平均在7歲時表現為髖臼發育不良。隨著時間的推移，骨骺板的傾斜逐漸變得更水平甚至倒置; 然而，連續測量的傾斜度并不是Severin分類的顯著預測因子。

結論：股骨頭骨骺外側生長障礙并不一定與髖臼發育不良有關，因為當發育不良確實發生時，通常在確定骨骺生長障礙之前就很明顯了。重要的是監測復位后髖臼的發育，而不是尋找骨骺生長發育的影像學變化，這在幼兒中很難發現。

圖1 25個月大小患兒，右髖高脫位，行內收肌松解閉合復位

圖2 該患者9歲時，股骨近端骨骺外側傾斜，股骨頸上外側可見向外延續的“骨板”。股骨頭部略扁平，髖臼發育不良。

圖3 該患者11歲時，股骨頭嚴重外翻畸形，伴有殘余髖臼發育不良，淚滴形態異常，右髖關節半脫位。

Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis

Background: Lateral growth disturbance of the capital femoral epiphysis is the most common type of physeal arrest complicating the treatment of developmental hip dysplasia. Although this type of physeal damage has been assumed to result in poor acetabular development, the natural history of dysplastic hips affected by this pattern of growth disturbance is still unclear. To investigate this issue, we evaluated acetabular development in a retrospective study of fifty-eight hips in forty-eight patients who had lateral physeal arrest after management of developmental hip dysplasia.

Methods: Of the fifty-eight hips, thirty-six were reduced closed and twenty-two were reduced open. The average age of the patients was twenty-two months (range, three to ninety-seven months) at the time of the reduction and twenty-one years (range, ten to fifty-five years) at the time of the latest follow-up evaluation. Hips rated as Severin class I (an excellent result) or II (a good result) were defined as having a satisfactory result, and those rated as Severin class III (a fair result) or IV (a poor result) were considered to have an unsatisfactory result. Specific femoral head changes were sought in the complete radiographic files on all hips. Various radiographic parameters of hip integrity, including the degree of lateral tilt of the capital femoral epiphysis, were measured over time, and comparisons were made between hips classified as satisfactory and those classified as unsatisfactory at four time-points: before the reduction, at two years after the reduction, at six to eight years of age, and at the time of the final follow-up.

Results: Lateral growth disturbance of the capital femoral epiphysis was first evident by an average of ten years of age (range, four to fourteen years of age). There was no consistent early pattern of changes in the epiphysis, physis, or metaphysis related to later development of valgus tilt of the epiphysis. Thirty-four hips (59 percent) were rated as satisfactory and twenty-four were rated as unsatisfactory at the latest follow-up evaluation. Hips classified as unsatisfactory exhibited poor acetabular development by an average age of seven years. The inclination of the epiphyseal plate became progressively more horizontal or even reversed over time; however, serial measurements of inclination were not significant predictors of Severin classification.

Conclusions: Lateral growth disturbance of the capital femoral epiphysis is not necessarily associated with poor acetabular development, as when dysplasia does occur it is generally evident prior to the identification of the physeal arrest. It is important to monitor acetabular development after reduction rather than search for radiographic changes of physeal arrest, which are difficult to detect in young children.

文獻出處：Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000 Dec;82(12):1692-700. doi: 10.2106/00004623-200012000-00002. PMID: 11130642.

文獻2

計算機輔助模式在髖臼周圍截骨術中的應用

譯者 李勇

計算機輔助模式在髖臼周圍截骨術（PAO）中的作用，以及這些技術的圍手術期和術后結果，目前尚不明確。本系統性綜述旨在評估計算機輔助模式在PAO中的應用技術和治療結果。我們檢索了三個數據庫（PubMed, CINAHL/EBSCOHost 和 Cochrane）中關于PAO計算機輔助模式的臨床研究。排除標準包括小型病例系列（少于10名患者）、非英語研究以及未描述計算機輔助技術的研究。數據提取內容包括所使用的計算機輔助模式、手術技術、患者人口統計學信息、影像學發現、圍手術期結果、患者報告結局（PROs）、并發癥及后續手術情況。共有九項研究符合納入標準，涉及208名患者，平均年齡在26至38歲之間。其中，七項研究使用了術中導航技術，一項研究使用了患者特異性導板，一項研究同時使用了兩種模式。三項研究報告稱，與傳統PAO相比，計算機輔助PAO的術中輻射暴露顯著減少（P < 0.01）。在計算機輔助組與傳統手術組之間，普遍觀察到相似的手術時間和預估失血量（P > 0.05）。接受計算機輔助PAO的患者，其術后平均外側中心邊緣角范圍為27.8°至37.4°，其中六項研究報告其數值與傳統PAO相比無顯著差異（P > 0.05）。在所有六項報告了計算機輔助PAO患者術前和術后數值的研究中，均觀察到患者報告結局得到改善。用于PAO的計算機輔助模式包括對游離髖臼骨塊和手術器械的導航追蹤，以及患者特異性切割導板和旋轉模板。與傳統技術相比，計算機輔助PAO展現出術中輻射暴露減少和相似手術時長的特點，但由于手術技術和外科環境存在異質性，對這些結果應謹慎解讀。

Periacetabular osteotomy with intraoperative computer-assisted modalities: a systematic review

The role of intraoperative computer-assisted modalities for periacetabular osteotomy (PAO), as well as the perioperative and post-operative outcomes for these techniques, remains poorly defined. The purpose of this systematic review was to evaluate the techniques and outcomes of intraoperative computer-assisted modalities for PAO. Three databases (PubMed, CINAHL/EBSCOHost and Cochrane) were searched for clinical studies reporting on computer-assisted modalities for PAO. Exclusion criteria included small case series (<10 patients), non-English language and studies that did not provide a description of the computer-assisted technique. Data extraction included computer-assisted modalities utilized, surgical techniques, demographics, radiographic findings, perioperative outcomes, patient-reported outcomes (PROs), complications and subsequent surgeries. Nine studies met the inclusion criteria, consisting of 208 patients with average ages ranging from 26 to 38 years. Intraoperative navigation was utilized in seven studies, patient-specific guides in one study and both modalities in one study. Three studies reported significantly less intraoperative radiation exposure (P < 0.01) in computer-assisted versus conventional PAOs. Similar surgical times and estimated blood loss (P >0.05) were commonly observed between the computer-assisted and conventional groups. The average post-operative lateral center edge angles in patients undergoing computer-assisted PAOs ranged from 27.8° to 37.4°, with six studies reporting similar values (P > 0.05) compared to conventional PAOs. Improved PROs were observed in all six studies that reported preoperative and post-operative values of patients undergoing computer-assisted PAOs. Computer-assisted modalities for PAO include navigated tracking of the free acetabular fragment and surgical instruments, as well as patient-specific cutting guides and rotating templates. Compared to conventional techniques, decreased intraoperative radiation exposure and similar operative lengths were observed with computer-assisted PAOs, although these results should be interpreted with caution due to heterogeneous operative techniques and surgical settings.

文獻出處：Curley AJ, Bruning RE, Padmanabhan S, Jimenez AE, Laude F, Domb BG. Periacetabular osteotomy with intraoperative computer-assisted modalities: a systematic review. J Hip Preserv Surg. 2023 Apr 20;10(2):104-118. doi: 10.1093/jhps/hnad005. PMID: 37900886; PMCID: PMC10604052.

文獻3

支具治療發育性髖關節發育不良中停止支具治療的時機-是時候確定最佳時機了嗎？

譯者 張利強

目標

對于六個月以下患有髖關節發育不良（DDH）的嬰兒，使用可拆卸支具治療視為治療金標準。然而，在治療“成功”后何時停止使用支具存在很大差異。一些臨床醫生支持立即停止使用支具，而另一些則傾向于逐漸減少支具的使用。本研究旨在探究臨床醫生對逐漸減少支具使用的理解，并確定當前的做法以及不同方法背后的理由，以便為未來隨機對照試驗（RCT）的設計提供信息。

方法

使用Google Forms開發了一份調查問卷，并通過專業網絡、社交媒體和英國兒童骨科手術學會的郵件列表進行分發。該調查針對參與DDH治療的臨床醫生，收集有關人口統計學、治療方案、停止標準和逐漸減少支具使用的信息。對定量和定性數據進行了分析，以確定模式和差異。

結果

共有來自25個國家的139名臨床醫生做出了回應，其中50%來自英國。大多數受訪者（87.8%）遵循支具治療的協議，但在逐漸減少支具使用的定義和實施方面存在很大差異。“脫支具”最常見的定義是隨著時間推移逐漸減少支具佩戴時間（n = 103，74.1%）。總體而言，47.4%的受訪者（n = 65）表示立刻脫掉支具，39.4%（n = 54）會制定一個脫支具的過程，13.1%（n = 18）則視情況而定。在逐漸脫支具組的臨床醫生中，最常見的做法是在數周內逐漸減少每天佩戴的小時數（n = 28，51.9%）。然而，對于即刻脫支具的臨床醫生而言，最常見的做法是僅夜間佩戴（n = 8，44.4%）。脫支具的時間各不相同，不過大多數臨床醫生報告的脫支具周期為2至6周。75.9% （n = 105）的受訪者表示愿意參與未來的RCT研究。

結論

這項調查突顯了發育性髖關節發育不良（DDH）支具治療中停止治療時機存在較大差異，并強調了標準化術語和方案的必要性。這些發現為設計一項隨機對照試驗（RCT）以評估逐漸與立即停止支具治療的效果奠定了基礎，最終將為循證指南的制定提供依據。

The role of weaning in brace treatment for developmental dysplasia of the hip

time to define best practice?

Aims

In infants aged under six months with developmental dysplasia of the hip (DDH), the use of a removable brace is considered the gold-standard treatment. However, considerable variation exists for brace removal after ‘successful’ treatment. Some clinicians support immediate cessation, while others prefer weaning of the brace. This study aimed to explore clinicians’ understanding of weaning, and to identify current practices and the rationale behind different approaches, in order to inform the design of a future randomized controlled trial (RCT).

Methods

A survey was developed using Google Forms and disseminated via professional networks, social media, and the British Society of Children’s Orthopaedic Surgery mailing list. It targeted clinicians involved in DDH care, gathering information on demographics, treatment protocols, criteria for removal, and weaning practices. Quantitative and qualitative data were analyzed to identify patterns and variability.

Results

In total, 139 clinicians from 25 countries responded, with 50% from the UK. Most respondents (87.8%) followed a protocol for brace treatment, with considerable variation in definition and implementation of weaning. ‘Weaning’ was most commonly defined as a gradual reduction in brace wear over time (n = 103, 74.1%). Overall, 47.4% of respondents (n = 65) reported never weaning, 39.4% (n = 54) always wean, and 13.1% (n = 18) varied their approach. Among clinicians who always wean, the most common approach involved gradually reducing the hours per day over several weeks (n = 28, 51.9%). However, for those who sometimes wean, the most frequent practice was night-time only wear (n = 8, 44.4%). Durations of weaning differed, although the majority of clinicians reported weaning periods from two to six weeks. There is broad support for a future RCT, with 75.9% (n = 105) expressing a willingness to participate.

Conclusion

This survey highlights considerable variability in weaning practices for brace treatment in DDH, and underscores the need for standardized terminology and protocols. These findings provide a foundation for designing a RCT to evaluate weaning compared with immediate brace cessation, ultimately informing evidence-based guidelines.

文獻4

髖關節鏡輔助髖臼周圍截骨術

譯者 陶可

在髖臼周圍截骨術(PAO)中，最大限度地減少軟組織剝離并提高重要結構的可視性，對于改善患者預后和減少并發癥至關重要。關節鏡輔助PAO正是為此而引入的。該手術包括：首先進行髖關節鏡檢查，以治療中央間室病變；隨后在X線透視和關節鏡引導下進行小切口Bernese髖臼周圍截骨術；最后進行動態髖關節鏡檢查，以評估髖臼的重新定位和固定情況，并根據需要根據新的髖臼緣位置進行股骨成形術。關節鏡輔助PAO用于以微創方式治療髖關節發育不良或髖臼后傾。

Endoscopy-Assisted Periacetabular Osteotomy

Minimizing soft tissue dissection and improving visualization of vital structures during periacetabular osteotomy (PAO) is of paramount importance to improve patient outcome and minimize complications. The endoscopy-assisted PAO was introduced to accomplish this objective. It involves an initial hip arthroscopy, for treatment of central compartment pathology, followed by a mini-open Bernese periacetabular osteotomy under fluoroscopic and endoscopic guidance, and completed by final dynamic hip arthroscopy to assess acetabular reorientation and fixation and to perform femoroplasty in relation to the new acetabular rim position, if needed. Endoscopy-assisted PAO is used to treat dysplasia or acetabular retroversion in a minimally invasive fashion.

文獻出處：Dean K Matsuda, Hal D Martin, Javad Parvizi. Endoscopy-Assisted Periacetabular Osteotomy. Arthrosc Tech. 2016 Mar 21;5(2):e275-80. doi: 10.1016/j.eats.2016.01.017. eCollection 2016 Apr.

文獻5

術前磁共振成像測量的盂唇大小不能預測初次髖關節鏡手術患者是否需要盂唇重建

譯者 徐子茵

術前影像學測量可能有助于預測哪些髖關節盂唇撕裂患者最終接受修復與初次重建。本研究調查了放射學參數是否：（i） 術前預測盂唇修復與重建，以及 （ii） 與盂唇的 T2 磁共振成像 （MRI） 標測值相關。這項回顧性比較研究包括 14-50 歲的患者，他們在 2 年內在單個機構接受了盂唇修復或重建。既往接受過關節切開或關節鏡手術或術前計算機斷層掃描 （CT） 和 MRI 數據不足的患者被排除在外。在術前 MRI 圖像上的多個位置測量盂唇大小。一位盲法評價員使用三維 CT 分析記錄外側中心緣角 （LCEA） 、髖臼前后傾、ACEA、髖臼覆蓋度、α 角、股骨扭轉和頸干角 （FNSA）。通過對每位患者的最佳矢狀位進行測序分析，獲得盂唇的 T2 MRI 標測值。使用單變量混合線性模型來確定每次放射學測量與修復或重建盂唇決定之間的關聯。共包括 52 例手術。盂唇大小對接受盂唇重建與修復沒有預測作用。接受盂唇重建的可能性與 LCEA （P = .003） 和 臼頂傾斜角 （P = .034） 相關。盂唇 T2 標測值與除 FNSA 和聯合前傾外的所有影像學參數之間存在關聯 （P < .05）。盂唇大小與患者是否接受盂唇重建或修復無關。數據顯示盂唇 T2 信號值與所有放射學參數之間存在關聯。

Labral size measured on preoperative magnetic resonance imaging not predictive of the need for labral reconstruction in patients undergoing primary hip arthroscopy

Preoperative radiographic measurements may help predict which patients with hip labral tears ultimately undergo repair versus primary reconstruction. This study investigated if radiographic parameters: (i) preoperatively predict labral repair versus reconstruction and (ii) correlate with T2 magnetic resonance imaging (MRI) mapping values of the labrum. This retrospective comparative study included patients aged 14-50 years who underwent labral repair or reconstruction at a single institution over a 2-year period. Patients with prior open or arthroscopic hip surgery or who had inadequate preoperative computed tomography (CT) and MRI imaging were excluded. Labral size was measured at multiple positions on preoperative MRI images. A blinded reviewer used three-dimensional CT analysis to record lateral center edge angle (LCEA), acetabular version, Tonnis angle, acetabular coverage, alpha angle, femoral torsion, and neck-shaft angle (FNSA). T2 MRI mapping values of the labrum were obtained via sequencing analyses on each patient's optimal sagittal cut. Univariate mixed linear models were used to identify associations between each radiographic measurement and decision to repair or reconstruct the labrum. Fifty-two operations were included. Labral size had no predictive effect on undergoing labral reconstruction versus repair. Likelihood for undergoing labral reconstruction was associated with LCEA (P = .003) and Tonnis angle (P = .034). There was an association (P < .05) between labral T2 mapping values and all radiographic parameters except for FNSA and combined version. Labral size was not associated with whether patients underwent labral reconstruction or repair. The data showed an association between labrum T2 mapping values and nearly all radiographic parameters.

文獻出處：Peszek, Adam et al. “Labral size measured on preoperative magnetic resonance imaging not predictive of the need for labral reconstruction in patients undergoing primary hip arthroscopy.” Journal of hip preservation surgery vol. 12,1 20-26. 10 Dec. 2024, doi:10.1093/jhps/hnae043

來源：304關節學術

作者：304關節團隊

聲明：本文內容及圖片均為轉載內容，如涉及版權問題請相關權利人及時與我們聯系，我們會立即處理配合采取保護措施，以保障雙方利益。

為什么要投稿？是為了記錄自己的醫學之路！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！讓傳播知識成為一種習慣，是“玖玖骨科”讓你投稿的理由！