文獻(xiàn)1

血漿纖維蛋白原在假體周圍感染的診斷中比

血漿D-二聚體有更好的應(yīng)用價(jià)值：

一項(xiàng)多中心回顧性研究

譯者：張軼超

背景：我們一直在不懈的去尋找快速、準(zhǔn)確的診斷假體周圍感染（PJI）的標(biāo)記物。既往的研究都聚焦于炎癥標(biāo)記物而很少研究與凝集指標(biāo)相關(guān)的標(biāo)記物。本研究的目的是通過多中心回顧性研究來評估血漿纖維蛋白原、D-二聚體和其它血液標(biāo)記物對于假體周圍感染診斷的價(jià)值。

方法：本研究觀察了從2016年1月到2017年12月間的565例全髖、全膝翻修病例，其中有126例出現(xiàn)凝血相關(guān)并發(fā)癥，對這些病例進(jìn)行了分析。選取了439例病例，其中76例PJI病例和363例非PJI病例。PJI的診斷遵循國際共識會議（ICM）對于假體周圍感染的標(biāo)準(zhǔn)。采用受試者操作特征（ROC）曲線對D-二聚體、血漿纖維蛋白原、血沉（ESR）、C-反應(yīng)蛋白（CRP）水平和白細(xì)胞（WBC）計(jì)數(shù)進(jìn)行分析。

結(jié)果：ROC曲線顯示血漿纖維蛋白原具有最大的曲線下面積（AUC），0.852；緊隨其后的是CRP和ESR，分別為0.810和0.808。D-二聚體排在倒數(shù)第二位，為0.657；最后是白細(xì)胞計(jì)數(shù)，為0.590。血漿D-二聚體的最佳閾值是1.25μg/mL，其敏感性、特異性、陽性預(yù)測值（PPV）和陰性預(yù)測值（NPV）分別為0.645、0.650、0.278和0.897。血漿纖維蛋白原的最佳閾值是4.01g/L，其敏感性、特異性、陽性預(yù)測值（PPV）和陰性預(yù)測值（NPV）分別為0.763、0.862、0.537和0.946。

結(jié)論：血漿D-二聚體對于診斷PJI的價(jià)值是有限的，而血漿纖維蛋白原顯示了很好的利用價(jià)值。血漿纖維蛋白原具有很好的敏感性和特異性，與傳統(tǒng)的指標(biāo)（包括CRP、ESR）價(jià)值相當(dāng)。

Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection: A Multicenter Retrospective Study

BACKGROUND: The search for potential markers for a timely and accurate diagnosis of periprosthetic joint infection (PJI) is ongoing. Previous studies have focused on inflammatory markers and have rarely examined coagulation-related indicators. The purpose of this study was to evaluate the values of plasma fibrinogen, D-dimer, and other blood markers for the diagnosis of PJI through a multicenter retrospective study.

METHODS: A total of 565 revision total hip and knee arthroplasty cases were enrolled in this study from January 2016 through December 2017, 126 of which had coagulation-related comorbidities and were analyzed separately. The remaining 439 cases included 76 PJI and 363 non-PJI patients. The definition of PJI was based on the International Consensus Meeting (ICM) on Periprosthetic Infection criteria. The diagnostic values of D-dimer, plasma fibrinogen, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and white blood-cell (WBC) count were analyzed using receiver operating characteristic (ROC) curves.

RESULTS: ROC curves showed that plasma fibrinogen had the highest area under the curve (AUC), 0.852, followed by 2 classical markers, the CRP level and ESR, which had an AUC of 0.810 and 0.808, respectively. D-dimer had an AUC of 0.657, which was the second lowest value and only slightly higher than that of the WBC count, 0.590. The optimal threshold for plasma D-dimer was 1.25 μg/mL, with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.645, 0.650, 0.278, and 0.897, respectively. The optimal threshold for plasma fibrinogen was 4.01 g/L, which showed good sensitivity, specificity, PPV, and NPV, with values of 0.763, 0.862, 0.537, and 0.946, respectively.

CONCLUSIONS: Plasma D-dimer may have a very limited diagnostic value for PJI, while plasma fibrinogen, another coagulation-related indicator, exhibits promising performance. Plasma fibrinogen has good sensitivity and specificity for diagnosing PJI, with values similar to those of classical markers, including CRP level and ESR.

文獻(xiàn)出處：Rui, Li, Hong-Yi, et al. Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection: A Multicenter Retrospective Study.[J]. The Journal of bone and joint surgery. American volume, 2019.

文獻(xiàn)2

髖臼周圍截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良

10年及20年的關(guān)節(jié)生存率

譯者：馬云青

背景：髖臼發(fā)育不良是一種多因素引起的疾病，其特征是髖臼變淺，容易導(dǎo)致髖關(guān)節(jié)骨關(guān)節(jié)炎。 Reinhold Ganz于1984年首次提出伯爾尼髖臼周圍截骨術(shù)(PAO)治療發(fā)育不良的髖關(guān)節(jié)，以期提供更好的股骨頭覆蓋，并延長患者自身髖關(guān)節(jié)壽命。自1987年以來，對430多名患者進(jìn)行了PAO手術(shù)。本研究對這一組患者進(jìn)行了橫斷面回顧性研究，以確定PAO后的10年和20年患者自身關(guān)節(jié)生存情況，以及評估術(shù)后功能和放射學(xué)結(jié)果。

方法：從1987年到2014年，由資深外科醫(yī)生對434例髖臼發(fā)育不良患者進(jìn)行PAO治療。以回顧性方式以病歷和/或郵件/電話問卷的方式獲得了258名患者的302髖的資料。功能包括術(shù)后髖關(guān)節(jié)炎評分和UCLA活動評分。術(shù)前和術(shù)后X線片用于確定外LCE角、前CE角、Tonnis角/骨關(guān)節(jié)炎級和股骨頭至髂恥線的距離。通過Kaplan-Meier分析確定了患者自身髖關(guān)節(jié)的存活率。

結(jié)果：在納入研究的302個(gè)髖關(guān)節(jié)中，248個(gè)髖關(guān)節(jié)至本研究數(shù)據(jù)收集時(shí)仍然存在，54髖接受了全髖關(guān)節(jié)置換術(shù)(THA)。在PAO的整個(gè)隊(duì)列中，患者的平均年齡為32.7歲（13至63歲）。女性患者有215例（83.3%)，男性患者43例(16.8%）。關(guān)節(jié)生存組PAO患者的平均年齡為32.3歲，THA組患者的平均年齡為36.6歲(P<0.01)。在數(shù)據(jù)采集時(shí)，隨訪時(shí)間為2至27年（平均11.2年）。髖關(guān)節(jié)骨關(guān)節(jié)炎的結(jié)果評分和UCLA活動評分報(bào)告了PAO后r仍生存的髖關(guān)節(jié)。通過存活和PAO失敗的X線分析表明術(shù)前和術(shù)后Tonnis角和骨關(guān)節(jié)炎分級是轉(zhuǎn)換為THA的主要預(yù)測因子(P<0.01)。PAO后髖關(guān)節(jié)的存活率在10年時(shí)為86%，在20年時(shí)為60%。髖關(guān)節(jié)生存情況按年齡分類，20歲、30歲、40歲和50歲的10年存活率分別為93.3%、90.1%、81.6%和63.2%。男性和女性患者的生存率沒有顯著差異；然而，男性患者與女性患者相比，15年以后的生存率呈下降趨勢。

結(jié)論：在302個(gè)髖關(guān)節(jié)的隊(duì)列研究中，PAO后患者自身髖關(guān)節(jié)10年和20年生存率分別約為86%和60%。年齡較大的PAO和較高的Tonnis分級是PAO后關(guān)節(jié)生存的反向預(yù)測因素。即使術(shù)后20年，存活的髖關(guān)節(jié)仍有良好的功能。本研究是PAO后最多患者和最長隨訪時(shí)間時(shí)間的生存率研究，本研究的結(jié)果與其他研究一致。

Ten- and 20-year Survivorship of the Hip After Periacetabular Osteotomy for Acetabular Dysplasia

INTRODUCTION: Acetabular dysplasia is a multifactorial condition characterized by a shallow hip socket with predisposition to osteoarthritis of the hip. The Bernese periacetabular osteotomy (PAO), developed by Reinhold Ganz in 1984, reorients the dysplastic hip joint to provide more uniform coverage of the femoral head and to extend the longevity of the native hip. Since 1987, the senior author performed the Bernese PAO on more than 430 patients. We performed a cross-sectional retrospective study on this cohort of patients to determine the 10- and 20-year survivorship after PAO in addition to assessing functional outcomes and radiographic parameters.

METHODS: Four hundred thirty-four patients were treated for acetabular dysplasia with PAO by the senior surgeon from 1987 to 2014. Data were obtained for 302 hips in 258 patients in a retrospective fashion from medical records and/or mail-in/phone questionnaires. Functional outcome data consisted of postoperative Hip Osteoarthritis Outcome Score and University of California-Los Angeles Activity Score. Pre- and postoperative radiographs were used to determine lateral center-edge angle, anterior center-edge angle, T?nnis angle/grade, and head-to-ilioischial line distance. Survivorship of the native hip was determined by Kaplan-Meier analysis.

RESULTS: Of the 302 hips analyzed, 248 were still surviving native hips and 54 had gone on to a total hip arthroplasty (THA) at the time of data acquisition. The average age of patients in the entire cohort at PAO was 32.7 years (range, 13 to 63 years). Of the 258 patients, 215 were female patients (83.3%) and 43 male patients (16.8%). The average age of patients in the surviving group at PAO was 32.3 years, and the average age of patients in the THA group was 36.6 years (P < 0.01). At the time of data acquisition, follow-up ranged from 2 to 27 years (average, 11.2 years). Hip Osteoarthritis Outcome Score and University of California-Los Angeles Activity Score are reported for the surviving native hips after PAO. Radiographic analyses for surviving and failed hips are described, with pre- and postoperative T?nnis grade being statistically significant predictors for conversion to THA (P < 0.01). Survivorship of the native hip was 86% at 10 years and 60% at 20 years in the surviving cohort. Survivorship stratified by age at the time of PAO demonstrated a 10-year survivorship of 93.3%, 90.1%, 81.6%, and 63.2% at ages 20, 30, 40, and 50 years, respectively. No notable difference exists in survivorship between male and female patients; however, male patients had a trend toward lower survivorship compared with female patients at 15 years.

CONCLUSION: The 10- and 20-year survivorship of the native hip after PAO is approximately 86% and 60%, respectively, in our cohort of 302 hips. Older age at the time of PAO and higher T?nnis grade are negative prognostic factors for joint survival after PAO. Surviving hips after PAO have good functional outcomes even up to 20 years after surgery. This survivorship analysis represents one of the largest and longest survival studies of patients after PAO, and our results are consistent with other published studies.

文獻(xiàn)出處：Ziran N, Varcadipane J, Kadri O, Ussef N, Kanim L, Foster A, Matta J. Ten- and 20-year Survivorship of the Hip After Periacetabular Osteotomy for Acetabular Dysplasia. J Am Acad Orthop Surg. 2019 Apr 1;27(7):247-255. doi: 10.5435/JAAOS-D-17-00810.

文獻(xiàn)3

應(yīng)用靜態(tài)型和關(guān)節(jié)型占位器治療

全膝關(guān)節(jié)置換術(shù)后感染的隨機(jī)對照研究

譯者：張薔

背景：目前對于二期感染翻修間應(yīng)用靜態(tài)型還是關(guān)節(jié)型抗生素骨水泥占位器依然沒有定論。本篇多中心隨機(jī)對照研究的目的是比較靜態(tài)型和關(guān)節(jié)型抗生素骨水泥占位器用于全膝關(guān)節(jié)置換術(shù)后感染（根據(jù)MSIS標(biāo)準(zhǔn)）二期翻修的治療效果。

方法：共68例二期翻修病例，隨機(jī)分入靜態(tài)型占位器組（32例）或關(guān)節(jié)型占位器組（36例）。統(tǒng)計(jì)學(xué)效力分析顯示：為了檢測到組間13°以上的活動度差異，我們最少需要28例病例。隨機(jī)化分組后排除6例，6例最終死亡，7例失隨訪。

A.靜態(tài)型占位器；B.關(guān)節(jié)型占位器

結(jié)果：靜態(tài)占位器組的住院時(shí)長比關(guān)節(jié)占位器組多1天（6.1天 vs 5.1天；95%置信區(qū)間[CI]，分別為5.3天-6.9天和4.6天-5.6天；p=0.032），圍術(shù)期未發(fā)現(xiàn)其他差異。在平均3.5年的隨訪（2.0年-6.4年）后，49名患者可再次接受評估。關(guān)節(jié)占位器組平均活動度為113°（95% CI, 108.4°-117.6°），而靜態(tài)占位器組為100.2°（95% CI, 94.2°-106.1°）（p=0.001）。關(guān)節(jié)占位器組（79.4分）的平均KSS評分也高于靜態(tài)占位器組（69.8分）（95% CI, 分別為72.4-86.3和63.6-76.1; p=0.043）。靜態(tài)占位器組在二期手術(shù)時(shí)的切口暴露大于關(guān)節(jié)占位器組（16.7% vs 4.0%；95% CI，分別為0.6%-38.9%和0.5%-26.3%，p=0.189），且再手術(shù)率也高于關(guān)節(jié)組（25% vs 8.0%；95% CI，分別為9.8%-46.7%和1.0%-26%；p=0.138），但并沒有顯著性差異。

結(jié)論：3.5年的隨訪后，關(guān)節(jié)型占位器組的關(guān)節(jié)活動度更佳，KSS評分更高。取出感染假體后靜態(tài)型占位器組的住院時(shí)間更長。在軟組織條件允許同時(shí)骨量充足的情況下，選擇關(guān)節(jié)型占位器顯然效果更佳。

A Randomized Trial of Static and Articulating Spacers for the Treatment of Infection Following Total Knee Arthroplasty

Background: There is no consensus whether the interim antibiotic spacer utilized in the 2-stage exchange arthroplasty should immobilize the joint or allow for motion. The purpose of this multicenter, randomized clinical trial was to compare static and articulating spacers as part of the 2-stage exchange arthroplasty for the treatment of chronic periprosthetic joint infection complicating total knee arthroplasty as defined with use of Musculoskeletal Infection Society criteria.

Methods: Sixty-eight patients undergoing 2-stage exchange arthroplasty were randomized to either a static (32 patients) or an articulating (36 patients) spacer. An a priori power analysis determined that 28 patients per group would be necessary to detect a 13°difference in range of motion between groups. Six patients were excluded after randomization, 6 died, and 7 were lost to follow-up before 2 years.

Results: Patients in the static group had a hospital length of stay that was 1 day greater than the articulating group after stage 1 (6.1 compared with 5.1 days; 95% confidence interval [CI], 5.3 to 6.9 days and 4.6 to 5.6 days, respectively; p = 0.032); no other differences were noted perioperatively. At a mean of 3.5 years (range, 2.0 to 6.4 years), 49 patients were available for evaluation. The mean motion arc was 113.0°(95% CI, 108.4° to 117.6°) in the articulating spacer group, compared with 100.2°(95% CI, 94.2° to 106.1°) in the static spacer group (p = 0.001). The mean Knee Society Score was higher in the articulating spacer cohort (79.4 compared with 69.8 points; 95% CI, 72.4 to 86.3 and 63.6 to 76.1, respectively; p = 0.043). Although not significantly different with the sample size studied, static spacers were associated with a greater need for an extensive exposure at the time of reimplantation (16.7% compared with 4.0%; 95% CI, 0.6% to 38.9% and 0.5% to 26.3%, respectively; p = 0.189) and a higher rate of reoperation (25.0% compared with 8.0%; 95% CI, 9.8% to 46.7% and 1.0% to 26.0%, respectively; p = 0.138).

Conclusions: Articulating spacers provided significantly greater range of motion and higher Knee Society scores at a mean of 3.5 years. Static spacers were associated with a longer hospital stay following removal of the infected implant. When the soft-tissue envelope allows and if there is adequate osseous support, an articulating spacer is associated with improved outcomes.

文獻(xiàn)出處：Nahhas CR, Chalmers PN, Parvizi J, Sporer SM, Berend KR, Moric M, Chen AF, Austin MS, Deirmengian GK, Morris MJ, Della Valle CJ. A Randomized Trial of Static and Articulating Spacers for the Treatment of Infection Following Total Knee Arthroplasty. J Bone Joint Surg Am. 2020 Feb 20. doi: 10.2106/JBJS.19.00915.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

轉(zhuǎn)子間旋轉(zhuǎn)截骨術(shù)后股骨頭壞死區(qū)出現(xiàn)的

進(jìn)行性塌陷導(dǎo)致骨關(guān)節(jié)炎改變——

轉(zhuǎn)子間旋轉(zhuǎn)截骨術(shù)治療股骨頭壞死的中期隨訪

譯者：羅殿中

背景：股骨頭壞死的塌陷往往是漸進(jìn)性的，一旦股骨頭塌陷進(jìn)展，關(guān)節(jié)的破壞則會不可避免的出現(xiàn)。因此，對于股骨頭部分壞死的患者，已有多種截骨術(shù)方案嘗試挽救股骨頭以保持關(guān)節(jié)的正常功能。

方法：我們對接受Sugioka轉(zhuǎn)子間旋轉(zhuǎn)截骨術(shù)的21名患者（25髖）進(jìn)行了平均6.4年隨訪。

結(jié)果：末次隨訪時(shí)20髖（80%）臨床預(yù)后好或非常好，15髖（60%）達(dá)到影像學(xué)上的成功，表現(xiàn)為既沒有新建負(fù)重區(qū)的塌陷，也沒有關(guān)節(jié)間隙的狹窄。10髖（40%）出現(xiàn)了壞死區(qū)進(jìn)行性塌陷，這其中有7髖隨訪期間出現(xiàn)了關(guān)節(jié)間隙的狹窄。16髖（64%）存在骨贅增生，其中股骨頭外側(cè)及前方常見。

結(jié)論：盡管轉(zhuǎn)子間旋轉(zhuǎn)截骨術(shù)可以避免新建負(fù)重區(qū)的塌陷，但是原壞死區(qū)的塌陷可以導(dǎo)致關(guān)節(jié)前方不穩(wěn)定，導(dǎo)致關(guān)節(jié)骨關(guān)節(jié)炎改變。因此，如何避免術(shù)后出壞死區(qū)的塌陷對改善術(shù)后遠(yuǎn)期預(yù)后至關(guān)重要。

一名47歲男性股骨頭壞死患者，術(shù)前股骨頭壞死II期，對其進(jìn)行了90°的前旋截骨。a, b顯示術(shù)后1年時(shí)股骨頭輪廓完整。c, d現(xiàn)術(shù)術(shù)后5年股骨頭壞死區(qū)出現(xiàn)了塌陷，關(guān)節(jié)間隙變窄，股骨頭骨贅增生。

Progressive Collapse of Transposed Necrotic Area After Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head Induces Osteoarthritic Change：Mid-term Results of Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head

Introduction: Osteonecrosis of the femoral head is usually progressive, and once collapse of the femoral head develops, joint destruction almost invariably follows. Therefore, for partial osteonecrosis of the femoral head, various types of osteotomies have been developed in an attempt to save the femoral head and maintain the natural function of the hip joint.

Materials and methods: We reviewed 25 hips in 21 patients for a mean follow-up period of 6.4 years after Sugioka's transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head.

Results: The clinical results were excellent or good in 20 hips (80%), and radiological success was observed in 15 hips (60%) with an absence of both collapse of the newly established weight-bearing area of the femoral head and narrowing of the joint space. Progressive collapse of the transposed necrotic area was noted in 10 hips (40%), and of these 10 hips, narrowing of the joint space was observed in 7 (70%) at follow-up. A significant correlation was demonstrated between progressive collapse of the transposed necrotic area and narrowing of the joint space. Growth of an osteophyte of the femoral head was observed postoperatively in 16 hips (64%), particularly at anterior and lateral sites of the femoral head.

Conclusions: Though collapse of a new weight-bearing area can be prevented, progressive collapse of the transposed necrotic area induces anterior joint instability, giving rise to osteoarthritic change. It is therefore concluded that prevention of the collapse of the transposed necrotic area is important for satisfactory long-term results.

文獻(xiàn)出處：Hisatome T , Yasunaga Y , Takahashi K , et al. Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change[J]. Archives of Orthopaedic & Trauma Surgery, 2004, 124(2):77-81.

文獻(xiàn)2

回顧骨科隨機(jī)對照試驗(yàn)的樣本量和

統(tǒng)計(jì)效能20年前后的變化

譯者：程徽

背景：2001年發(fā)表的一項(xiàng)研究報(bào)告稱，1997年發(fā)表在骨科主要期刊上的隨機(jī)對照試驗(yàn)(RCTs)的樣本量都過小，導(dǎo)致檢測研究效果的統(tǒng)計(jì)效能較低?？茖W(xué)研究方法的基石是統(tǒng)計(jì)，統(tǒng)計(jì)效能低是研究結(jié)果無法重復(fù)的根本原因。本研究的目的是，觀察在過去的20年里骨科研究質(zhì)量的進(jìn)步。

方法：按時(shí)間順序進(jìn)行檢索7種骨科主要期刊2016年和2017年發(fā)表的隨機(jī)對照試驗(yàn)。通過研究中報(bào)道的樣本大小計(jì)算Cohen d值，來檢測小、中、大不同效應(yīng)量后驗(yàn)效能。還計(jì)算了最常用的患者自測療效測量法(PROMs)相關(guān)的效應(yīng)量的檢驗(yàn)銷量。最后，統(tǒng)計(jì)了所有納入研究是否使用了樣本量的估算。

結(jié)果：共有233項(xiàng)研究納入最終分析。所有的陰性研究都沒有納入足夠的樣本(≥0.80)來檢測小的效應(yīng)量。只有15.0%至32.1%的陰性研究有足夠的能力檢測中等的效應(yīng)量。當(dāng)按解剖區(qū)域分類時(shí)，0%至52.6%的的研究有足夠的統(tǒng)計(jì)效能測算出效應(yīng)量的最小重要性差值(MCID)的大小。233項(xiàng)研究中的196項(xiàng)(84%)采用了樣本量估算。然而，46%的使用均值比較的研究中，樣本量的估算無法重復(fù)。

結(jié)論：盡管在過去20年里，骨科隨機(jī)對照試驗(yàn)取得了小小的進(jìn)步，但許多隨機(jī)對照試驗(yàn)的統(tǒng)計(jì)效能仍不盡人意：樣本量仍然太小，不足以檢測出哪些臨床療效真正來自于治療。

Revisiting the Sample Size and Statistical Power of Randomized Controlled Trials in Orthopaedics After 2 Decades

Background: A study published in 2001 reported that sample sizes in the randomized controlled trials (RCTs) published in major orthopaedic journals in 1997 were too small, resulting in low power to detect reasonable effect sizes. Low power is the fundamental reason for the poor reproducibility of research findings and serves to erode a cornerstone of the scientific method. The aim of this study was to ascertain whether improvements have been made in orthopaedic research during the past 2 decades.

Methods: The electronic table of contents from the 2016 and 2017volumes of 7 major orthopaedic journals were searched issue by issue in chronological order to identify possible RCTs. A posteriori (after-the fact)power to detect small, medium, and large effect sizes, defined by the Cohen d value, were calculated from the sample sizes reported in the studies. The power to detect effect sizes associated with the most commonly used patient-reported outcome measures (PROMs) was also calculated. Finally, the use of a priori power analysis in the included studies was assessed.

Results: In total, 233 studies were included in the final analyses. None of the negative studies had sufficient power (≥0.80) to detect a small effect size. Only between 15.0% and 32.1% of the negative studies had adequate power to detect a medium effect size. When categorized by anatomic region, 0% to 52.6% had adequate power to detect an effect size corresponding to the minimal clinically important difference(MCID). An a priori power analysis was employed in 196 (84%) of the 233studies. However, the power analysis could not be replicated in 46% of the studies that used a mean comparison.

Conclusions: Although small improvements in orthopaedic RCTs have occurred during the past 2 decades, many RCTs are still underpowered: the sample sizes are still too small to have adequate power to detect what would be deemed clinically relevant.

文獻(xiàn)3

磁共振測量髖關(guān)節(jié)盂唇寬度與術(shù)中評估的比較

譯者：肖凱

目的：明確關(guān)節(jié)直接造影MRI或普通MRI是否可以準(zhǔn)確測量髖關(guān)節(jié)盂唇的寬度。

方法：選擇2017年12月至2018年6月間連續(xù)就診的接受髖關(guān)節(jié)鏡手術(shù)治療的FAI患者，年齡在18歲至65歲之間。術(shù)前MRI的納入標(biāo)準(zhǔn)包括：系統(tǒng)中存在可用的MRI圖像；有1.5T或3T MRI圖像或3T造影MRI圖像；圖像質(zhì)量正常且沒有盂唇鈣化。根據(jù)時(shí)鐘定位，在術(shù)中對標(biāo)準(zhǔn)化位置的盂唇寬度進(jìn)行測量。使用校準(zhǔn)的探針進(jìn)行測量。盂唇寬度的定義為盂唇自髖臼緣向外側(cè)延伸的距離。MRI測量是由兩名在肌肉骨骼方向的放射科醫(yī)生獨(dú)立進(jìn)行的。測量的點(diǎn)位分別是在冠狀位質(zhì)子密度相測量11:30位置，在斜軸位質(zhì)子密度相測量3:00位置，在矢狀面抑脂相測量1:30位置。外科醫(yī)生與放射科醫(yī)生的測量數(shù)據(jù)均不知情。使用組內(nèi)相關(guān)系數(shù)（ICC），絕對一致性和2隨機(jī)效應(yīng)模型比較術(shù)中和影像學(xué)盂唇寬度測量值的差異。使用相同的ICC模型比較2位放射科醫(yī)生的測量結(jié)果之間的一致性。

結(jié)果：共納入51例患者（30例女性，26例右髖）。通過關(guān)節(jié)鏡測量在3:00、11:30和1:30位置的平均盂唇寬度為5.8 mm（范圍;標(biāo)準(zhǔn)偏差2-8;±1.4），6.3 mm（2-10;±1.5）和6.0 mm（2-9;±1.5），MRI測量結(jié)果分別為6.3 mm（2-10;±1.5），6.7 mm（3-10;±1.4）和6.1 mm（2-9;±1.6）。外科醫(yī)生術(shù)中評估與放射科醫(yī)生MRI測量在3:00、11:30以及1:30之間的ICC一致性為0.82（P <.001），0.78（P <.001），0.84 （P <.001）。放射科醫(yī)生在同一點(diǎn)的ICC一致性為0.88（P <.001），0.93（P <.001）和0.88（P <.001）。

結(jié)論：MRI測量盂唇寬度和關(guān)節(jié)鏡下測量盂唇寬度的結(jié)果存在高度一致性，這表明MRI是測量盂唇寬度的一種準(zhǔn)確方法。不同的MRI方式之間沒有顯著差異。術(shù)前用MRI準(zhǔn)確測量盂唇寬度可能有助于手術(shù)決策。

術(shù)中（A）及冠狀位MRI（D）測量11:30盂唇寬度，術(shù)中（B）及矢狀位MRI（E）測量1:30盂唇寬度，術(shù)中（A）及斜軸位MRI（D）測量3:00盂唇寬度

Measurement of Hip Labral Width Compared With Intraoperative Assessment

Purpose: To determine if magnetic resonance angiography (MRA) and/or magnetic resonance imaging (MRI) could accurately determine the width of the labrum.

Methods: Consecutively enrolled patients between the ages of 18 and 65 indicated for hip arthroscopy for femoroacetabular impingement were included between December 2017 and June 2018. Inclusion criteria for preoperative MRIs included: MRI availability in picture archiving and communication system; performance on a 1.5T or 3T MRI or 3T MRA; and adequate quality and lack of labrum ossification. Intraoperative labral width measurements were taken at standardized locations using an established acetabular 'clockface' paradigm. Measurement was performed using a calibrated probe. The labral width was defined as the distance from the labrum extended laterally from the acetabular rim. MRI measurements were taken by 2 blinded musculoskeletal fellowship-trained radiologists at the same positions. Measurements were made at the 11:30 o'clock position (indirect rectus) on coronal proton density (PD) sequence, at 3 o'clock position (psoas-U) on axial oblique PD sequence, and at 1:30 (a point halfway between the 2) on sagittal fat-suppressed PD. The surgeons were blinded to the radiologists' measurements and vice versa. Intraoperative and radiographic labral width measurements were compared using an intraclass correlation coefficients (ICC), absolute agreement, and 2-way random effects model. The 2 radiologists' measurements were compared for interrater reliability using the same ICC model.

Results: Fifty-one patients were included (30 females, 26 right hips). Average labrum width at the 3:00, 11:30, and 1:30 o'clock positions by arthroscopic measurement were 5.8 mm (range; standard deviation, 2-8; ±1.4), 6.3 mm (2-10; ±1.5) and 6.0 mm (2-9; ±1.5), and by MRI were 6.3 mm (2-10; ±1.5), 6.7 mm (3-10; ±1.4), and 6.1 mm (2-9; ±1.6), respectively. When including all MRI modalities, ICC agreement between intraoperative assessment, and radiologist assessment at the 3:00 o'clock, 11:30, and point halfway between was 0.82 (P < .001), 0.78 (P < .001), 0.84 (P < .001), respectively. Radiologist interrater ICC agreement at the same points was 0.88 (P < .001), 0.93 (P < .001), and 0.88 (P < .001).

Conclusions: Strong agreement was found between radiologic and arthroscopic measurement of labrum width when using MRI, suggesting MRI is an accurate way to measure labral width. There was not a significant difference between different MRI modalities. Accurately measuring labral width preoperatively with MRI may aid in surgical decision making.

文獻(xiàn)出處：Kaplan DJ, Samim M, Burke CJ, Meislin RJ, Youm T.　 Validity of Magnetic Resonance Imaging Measurement of Hip Labral Width Compared With Intraoperative Assessment.　 Arthroscopy. 2020 Mar;36(3):751-758. doi: 10.1016/j.arthro.2019.09.027. Epub 2019 Nov 29.

文獻(xiàn)4

髖關(guān)節(jié)假斜位片準(zhǔn)確度和精確度評估

譯者：任寧濤

目的：旨在評估現(xiàn)存髖關(guān)節(jié)假斜位片準(zhǔn)確度和精確度，并設(shè)計(jì)一種提高髖關(guān)節(jié)假斜位片準(zhǔn)確性和精確性的方法。

方法：設(shè)計(jì)一種髖關(guān)節(jié)假斜位片的成像方法，前后3個(gè)月的髖關(guān)節(jié)假斜位片檢查各采用現(xiàn)存成像方法和新的成像方法。采用Student t檢驗(yàn)和方差分析確定兩組骨盆旋轉(zhuǎn)的均值和方差。通過C臂獲得10個(gè)骨盆的正位和旋轉(zhuǎn)圖像，驗(yàn)證骨盆旋轉(zhuǎn)的計(jì)算方法，測定各假斜位圖像髖關(guān)節(jié)中心距離合AP圖像髖關(guān)節(jié)中心距離的比值（W_P/W）。采用組內(nèi)相關(guān)系數(shù)（ICC）檢驗(yàn)W_P/W與骨盆旋轉(zhuǎn)的關(guān)系。

結(jié)果：平均W_P/W為0.47 (95% CI, 0.45-0.49)?，F(xiàn)存方法組（47.6°；95%CI，45.6-49.5°）和新方法組（60.0°；95%CI，58.7-61.3°）的平均骨盆旋轉(zhuǎn)度有顯著性差異（p<0.0001）。此外，與新方法組（SD=5.7，p=0.0035）相比，現(xiàn)存方法組（SD=7.9°）的測量值分布更廣。

結(jié)論：在臨床中獲得的假斜位片質(zhì)量可能不一致，標(biāo)準(zhǔn)化假斜位片產(chǎn)生更精確的圖像。恰當(dāng)?shù)募傩蔽黄瑧?yīng)在髖關(guān)節(jié)中心之間的距離約為前后（AP）片上相同距離的0.5倍。

圖1 正位片上股骨頭中心距離與假斜位片上股骨頭中心距離之間的幾何關(guān)系。

圖2 股骨頭之間的距離，（a）假斜位，（b）正位，通過這些距離之間的比率計(jì)算旋轉(zhuǎn)程度。

圖3 射線照相足印和假斜位標(biāo)準(zhǔn)體位。受試者先站在第一組足印上進(jìn)行AP位照相，然后旋轉(zhuǎn)至第二組腳印進(jìn)行假斜位照相。

圖4 不同骨盆旋轉(zhuǎn)程度W_P/W比值（虛線95%CI），尸體研究發(fā)現(xiàn)65度斜位時(shí)W_P/W=0.47.

圖5 標(biāo)準(zhǔn)化方法實(shí)施后骨盆旋轉(zhuǎn)的準(zhǔn)確度和精確度出現(xiàn)顯著差異的統(tǒng)計(jì)盒型圖。

表1 研究對象人口統(tǒng)計(jì)學(xué)情況

Assessing precision and accuracy of false-profile hip radiographs

Purpose: The purpose of this study was to assess the accuracy and precision of pelvic rotation in existing false-profile (FP) radiographs and to devise a method to improve accuracy and precision of FP radiographs.

Methods: An imaging protocol was developed to obtain FP radiographs. Pelvic rotation was calculated using the described method for FP images obtained in the 3 months prior to and after implementation of this protocol. Student's t-test and variance ratio tests were used to determine differences in mean and variance of pelvic rotation between the 2 cohorts. Pelvic rotation calculation methodology was validated by using fluoroscopic C-arm to obtain AP and rotated images of 10 osteologic pelvises. The ratio of the distance between hip centres of each rotated image and AP image (W_P/W) was determined. Intraclass coefficient correlation (ICC) was used to verify the relationship between W_P/W and pelvic rotation.

Results: Mean W_P/W was 0.47 (95% CI, 0.45-0.49). There were significant differences in mean pelvic rotation of the pre-protocol group (47.6°; 95% CI, 45.6-49.5°) and the post-protocol group (60.0°; 95% CI, 58.7-61.3°, p < 0.0001). Additionally, there was a significantly wider distribution of measurements in the pre-protocol group (SD = 7.9°) compared to the post-protocol group (SD = 5.7°, p = 0.0035).

Conclusions: The quality of FP radiographs obtained in the clinical setting may be inconsistent. Standardising FP imaging produces more accurate images. Appropriate FP radiographs should have a distance between hip centres that is approximately 0.5 times the same distance found on an anteroposterior (AP) radiograph.

文獻(xiàn)出處：Ryan T Li , Mithun Neral , Heath Gould , Emily Hu , Raymond W Liu , Michael J Salata . Assessing precision and accuracy of false-profile hip radiographs. Hip Int. 2019 Sep 23:1120700019877848. doi: 10.1177/1120700019877848.

文獻(xiàn)5

成人髖關(guān)節(jié)發(fā)育不良的影像學(xué)測量

張利強(qiáng)

髖關(guān)節(jié)發(fā)育不良在成人中是一種常見疾病，從輕微的髖臼發(fā)育不良到髖關(guān)節(jié)發(fā)育不良的復(fù)雜后遺癥。本文介紹了評估成人髖關(guān)節(jié)的最有用的影像學(xué)測量方法。骨盆的前后位片允許測量中心邊緣角（CE角）和臼頂傾斜角（HTE角），這兩個(gè)角度都可以評估髖臼頂?shù)母采w范圍。股骨頸干角（NSA）也在此視圖上測量。骨盆的假側(cè)位片允許測量前垂直中心邊緣角（VCA角），可確定髖臼前部的覆蓋范圍，并檢測早期退行性髖關(guān)節(jié)疾病。當(dāng)考慮手術(shù)時(shí)，計(jì)算機(jī)斷層掃描（CT）有助于利用前髖臼扇形角（AASA）更好地確定前髖臼的覆蓋范圍，而利用后髖臼扇形角（PASA）更好地確定后髖臼的覆蓋范圍。CT也可以測量股骨前傾角。這些測量對髖臼發(fā)育不良的評估和髖關(guān)節(jié)發(fā)育不良的術(shù)前評估特別有用。

CE角為通過兩側(cè)股骨頭中心的連線的垂線和股骨頭中心與髖臼外側(cè)緣的連線的夾角，正常值為大于25°

THE角為雙側(cè)股骨頭中心的連線和髖臼負(fù)重區(qū)內(nèi)外側(cè)緣連線的夾角，正常值為小于10°

髖臼指數(shù)為髖臼深度/髖臼寬度

假斜位片拍攝技術(shù)：足的軸位平行于底板，骨盆與底板成65°

VCA角（前中心邊緣角）：在假斜位片上，通過股骨頭中心與髖臼前緣的連線和股骨頭中心的垂線的夾角，正常值大于25°

CT顯示髖臼的覆蓋，示意圖展示為通過股骨頭中心的水平面，AASA決定前覆蓋，PASA決定后覆蓋，HASA為總覆蓋

股骨頭的髖臼覆蓋率：(A/B) ×100，<75%考慮病理性

22歲女性，A 平片顯示雙側(cè)髖關(guān)節(jié)發(fā)育不良，B CT顯示AASA 和 PASA都減少

Radiographic measurements of dysplastic adult hips

Hip dysplasia is a not uncommon feature in adults and can vary from subtle acetabular dysplasia to complex sequelae of developmental dysplasia of the hip. This review article describes the most useful radiographic measurements used to evaluate the adult hip. The frontal projection of the pelvis permits measurement of the center-edge angle(CE angle) and “horizontal toit externe” angle (HTE angle), both of which assess the superior coverage of the acetabulum. The femoral neck-shaft angle (NSA) is also measured on this view. The false profile radiograph of the pelvis is described. It allows measurement of the vertical-center-anterior angle (VCA angle), which determines the anterior acetabular coverage and detects early degenerative hip joint disease. When surgery is contemplated, computed tomography (CT) is useful to better determine the anterior acetabular coverage by use of the anterior acetabular sector angle (AASA), and the posterior acetabular coverage by use of the posterior acetabular sector angle (PASA). CT also permits measurement of femoral anteversion. These measurements are particularly useful in the evaluation of acetabular dysplasia and for the preoperative assessment of the dysplastic hip.

文獻(xiàn)出處：Delaunay S , Dussault R G , Kaplan P A , et al. Radiographic measurements of dysplastic adult hips[J]. Skeletal Radiology, 1997, 26(2):75-81.

文獻(xiàn)6

股骨頭縮小術(shù)和其他包容手術(shù)可改善股骨頭球形度和

包容性并減輕Legg-Calvé-Perthes病的疼痛

譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）

背景：髖部疾病如Legg-Calvé-Perthes?。↙CPD）在冠狀位可見嚴(yán)重股骨頭畸形而髖臼未受累，并導(dǎo)致關(guān)節(jié)合頁狀外展和撞擊癥。這些罕見畸形不能僅通過切除來解決，因?yàn)榍谐龝＜邦^部血管。股骨頭復(fù)位截骨術(shù)可改善股骨頭形狀，以改善股骨頭球形度、包容性和髖部功能。

問題/目的：在股骨頭嚴(yán)重非球性的髖關(guān)節(jié)中，股骨頭縮小術(shù)是否會導(dǎo)致（1）改善頭部球形度和包容性；（2）緩解疼痛，改善髖關(guān)節(jié)功能；（3）隨后的再次手術(shù)或并發(fā)癥？

方法：在10年時(shí)間里，我們對11例（11髖）嚴(yán)重非球性股骨頭進(jìn)行了股骨頭縮小術(shù)，這些患者術(shù)前診斷為LCPD（10髖）或髖關(guān)節(jié)發(fā)育不良（一側(cè)髖）經(jīng)保守治療而引起的骨骺灌注不平衡。11髖中有5例接受了髖臼包容手術(shù)，包括2例三聯(lián)截骨術(shù)，2例髖臼周圍截骨術(shù)（PAO）和1例Colonna成形術(shù)。平均對患者進(jìn)行了5年（1-10年）的復(fù)查，沒有患者丟失隨訪。股骨頭切開截骨術(shù)時(shí)的患者平均年齡為13歲（范圍7-23歲）。我們獲得了球形指數(shù)（定義為骨盆前后位片上最適合股骨頭關(guān)節(jié)表面繪制的橢圓的短軸與長軸之比）以評估頭形球度。評估包容性是用具有完整Shenton線、擠壓指數(shù)和外側(cè)中心邊緣（LCE）角度的患者比例評估的。評估Merled' Aubigné-Postel得分和運(yùn)動范圍（屈曲、屈曲90°的內(nèi)旋/外旋）以測量疼痛和功能。通過圖表檢查確定并發(fā)癥和再次手術(shù)。

結(jié)果：在最新的隨訪中，股骨頭的球形度（術(shù)前72％，64％-81％對比術(shù)后85％，73％-96％；p = 0.004），擠壓指數(shù)（術(shù)前47％，范圍25％-60％對比術(shù)后20％，范圍3％-58％；p = 0.006）和LCE角（術(shù)前1°，范圍-10°至16°對比術(shù)后26°，范圍4°-40°；p = 0.0064）等都有明顯改善。此外，完整的Shenton線比例（64％對100％；p = 0.087）和Merled' Aubigné-Postel總體得分（術(shù)前14.5，范圍12-16對比術(shù)后15.7，范圍12-18；p = 0.072）在最新隨訪中保持不變。Merled' Aubigné-Postel疼痛評分得到改善（術(shù)前3.5，范圍1-5對比術(shù)后5.0，范圍3-6；p = 0.026）。沒有觀察到運(yùn)動范圍隨病例量的增加而改善（p范圍從0.513到0.778）。除了兩個(gè)髖部的內(nèi)固定物去除外，在平均間隔為2.3年（0.2-7.5年）后，對11髖中的5個(gè)進(jìn)行了后續(xù)手術(shù)，以改善包容性。其中，兩髖行三聯(lián)截骨術(shù)，一髖行三聯(lián) 粗隆間外翻截骨術(shù)，一髖行轉(zhuǎn)子間內(nèi)翻截骨術(shù)，一髖行粗隆間外翻截骨術(shù)。股骨頭未發(fā)生缺血壞死。

結(jié)論：股骨頭縮小術(shù)可以改善股骨頭的球形度。這些髖關(guān)節(jié)經(jīng)常有發(fā)育異常的髖臼，從而改善了頭部的頭部包容性，因此需要最好同時(shí)進(jìn)行額外的髖臼包容性手術(shù)。這可以減輕疼痛，并且股骨頭缺血壞死似乎很少發(fā)生。隨著患者數(shù)量的增加，功能并未改善。因此，未來的研究應(yīng)使用更精確的儀器評估臨床結(jié)果，并包括更長的隨訪時(shí)間以確認(rèn)保髖療效。

圖1. 為了進(jìn)行股骨頭縮小術(shù)，將患者置于側(cè)臥位。髖關(guān)節(jié)通過臀大肌和臀肌之間的間隔（Gibson間隔）進(jìn)行外科脫位以完成粗隆間截骨術(shù)。支持帶軟組織瓣延長確保了股骨頭活動片段的血管供應(yīng)。軟組織瓣通過大轉(zhuǎn)子的后側(cè)骨膜下解剖而形成，包括旋股內(nèi)側(cè)動脈和附著短的外旋肌。通過沿矢狀方向進(jìn)行股骨頭截骨術(shù)去除股骨頭的中央壞死部分。最終，股骨頭的活動部分被固定到穩(wěn)定部分，目的是改善頭部球形度并減小頭部尺寸。

圖2A–B. （A）股骨頭縮小術(shù)可以治療冠狀位股骨頭表面嚴(yán)重的非球性。首先，進(jìn)行了粗隆截骨術(shù)，切除典型的高位大轉(zhuǎn)子的穩(wěn)定部分（相對股骨頸延長）。沿矢狀方向進(jìn)行截骨術(shù)切除股骨頭壞死的中央部分?？梢苿拥墓晒穷^片塊血供通過延伸包括旋股內(nèi)側(cè)動脈的支持帶血管軟組織瓣得以確保。穩(wěn)定部分的股骨頭血供來源于流經(jīng)Weitbrecht韌帶上方的支持帶下動脈和干骺端血流。（B）然后將股骨頭的可移動片塊固定到穩(wěn)定部分，目的是恢復(fù)股骨頭球形并使其適合于髖臼。股骨頸的骨缺損被大轉(zhuǎn)子的穩(wěn)定部分充填。股骨轉(zhuǎn)子片段被固定在較高位置。

圖3A–D. 一名9歲的男性患者（A）由于LCPD而導(dǎo)致股骨頭外側(cè)柱塌陷。（B）病人行股骨頭縮小術(shù)，切除中央壞死區(qū)域以改善股骨頭球形度。另外，大轉(zhuǎn)子進(jìn)行了改良采用轉(zhuǎn)子穩(wěn)定部分的切除和頭頸偏移的改善（股骨頸相對延長）。（C）頭部的包容不足，股骨頭仍處于半脫位狀態(tài)（Shenton線中斷；虛線）。（D）在進(jìn)行了三聯(lián)截骨術(shù)后，經(jīng)過2年的隨訪，獲得了良好的股骨頭球形度。

圖4A–E. （A）一名22歲的女性患者患有LCPD后遺癥。（B）在外展中，由于股骨頭非球形大，導(dǎo)致關(guān)節(jié)鉸鏈外展，而股骨頭不能進(jìn)入髖臼。（C）股骨頭縮小術(shù)后，由于股骨頭尺寸減小和球形度提高，股骨頭能夠進(jìn)入髖臼，從而改善了外展。（D）伴隨的PAO改善了包容度。（E）在5年的隨訪中，頭部和轉(zhuǎn)子的截骨術(shù)均已愈合，并保持了關(guān)節(jié)間隙。

圖5A–B. （A）一名18歲的男性患者，表現(xiàn)為股骨頭中央壞死和半脫位。（B）股骨頭縮小術(shù)和隨后的股骨粗隆間內(nèi)翻截骨術(shù)后，在10年的隨訪中獲得了球形的股骨頭并獲得了良好的臨床效果。

Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease

BACKGROUND: Severe femoral head deformities in the frontal plane such as hips with Legg-Calvé-Perthes disease (LCPD) are not contained by the acetabulum and result in hinged abduction and impingement. These rare deformities cannot be addressed by resection, which would endanger head vascularity. Femoral head reduction osteotomy allows for reshaping of the femoral head with the goal of improving head sphericity, containment, and hip function.

QUESTIONS/PURPOSES: Among hips with severe asphericity of the femoral head, does femoral head reduction osteotomy result in (1) improved head sphericity and containment; (2) pain relief and improved hip function; and (3) subsequent reoperations or complications?

METHODS: Over a 10-year period, we performed femoral head reduction osteotomies in 11 patients (11 hips) with severe head asphericities resulting from LCPD (10 hips) or disturbance of epiphyseal perfusion after conservative treatment of developmental dysplasia (one hip). Five of 11 hips had concomitant acetabular containment surgery including two triple osteotomies, two periacetabular osteotomies (PAOs), and one Colonna procedure. Patients were reviewed at a mean of 5 years (range, 1-10 years), and none was lost to followup. Mean patient age at the time of head reduction osteotomy was 13 years (range, 7-23 years). We obtained the sphericity index (defined as the ratio of the minor to the major axis of the ellipse drawn to best fit the femoral head articular surface on conventional anteroposterior pelvic radiographs) to assess head sphericity. Containment was assessed evaluating the proportion of patients with an intact Shenton's line, the extrusion index, and the lateral center-edge (LCE) angle. Merle d'Aubigné-Postel score and range of motion (flexion, internal/external rotation in 90° of flexion) were assessed to measure pain and function. Complications and reoperations were identified by chart review.

RESULTS: At latest followup, femoral head sphericity (72%; range, 64%-81% preoperatively versus 85%; range, 73%-96% postoperatively; p = 0.004), extrusion index (47%; range, 25%-60% versus 20%; range, 3%-58%; p = 0.006), and LCE angle (1°; range, -10° to 16° versus 26°; range, 4°-40°; p = 0.0064) were improved compared with preoperatively. With the limited number of hips available, the proportion of an intact Shenton's line (64% versus 100%; p = 0.087) and the overall Merle d'Aubigné-Postel score (14.5; range, 12-16 versus 15.7; range, 12-18; p = 0.072) remained unchanged at latest followup. The Merle d'Aubigné-Postel pain subscore improved (3.5; range, 1-5 versus 5.0; range, 3-6; p = 0.026). Range of motion was not observed to have improved with the numbers available (p ranging from 0.513 to 0.778). In addition to hardware removal in two hips, subsequent surgery was performed in five of 11 hips to improve containment after a mean interval of 2.3 years (range, 0.2-7.5 years). Of those, two hips had triple osteotomy, one hip a combined triple and valgus intertrochanteric osteotomy, one hip an intertrochanteric varus osteotomy, and one hip a PAO with a separate valgus intertrochanteric osteotomy. No avascular necrosis of the femoral head occurred.

CONCLUSIONS: Femoral head reduction osteotomy can improve femoral head sphericity. Improved head containment in these hips with an often dysplastic acetabulum requires additional acetabular containment surgery, ideally performed concomitantly. This can result in reduced pain and avascular necrosis seems to be rare. With the number of patients available, function did not improve. Therefore, future studies should use more precise instruments to evaluate clinical outcome and include longer followup to confirm joint preservation.

文獻(xiàn)出處：Siebenrock KA, Anwander H, Zurmühle CA, Tannast M, Slongo T, Steppacher SD. Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 2015 Apr;473(4):1274-83.

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