文献1

血清D二聚体检测可以作为关节假体周围感染和二次翻修手术时机的潜在方法

译者：马云青

背景：尽管存在可用的系统检测方法，假体周围感染的检测仍然是一种挑战。D二聚体检测已经被广泛的应用于纤溶活性的检查，在感染状态下这种纤溶活性同样存在。我们可以预见到患有假体周围感染的病人会有较高的d二聚体水平，同样d二聚体高水平的等待二期翻修的患者可能存在持续性感染。

方法：作为前瞻性研究共纳入245名初次关节置换和翻修的患者，包括：初次关节置换23例，无菌性失败需要翻修的86例，假体周围感染的57例，二期翻修的29例，关节以外其他部位感染的50例。假体周围感染的诊断标准参考骨骼肌肉感染协会的标准。术前检测所有患者的D二聚体水平，ESR和CRP。

结果：假体周围感染患者的D二聚体中位数较无菌性失败患者的明显升高，差异有统计学意义。参考约登指数，850ng/ml可以作为D二聚体诊断是否有假体周围感染的理想阈值。血清D二聚体优于ESR和CRP对假体周围感染的诊断。灵敏度为89%特意度93%，而ESR为73和78CRP为79和80，两者联合的灵敏度为84%特意度为47%。

结论：很显然D二聚体是一种很好的假体周围感染的检测标志，同时可以预测最佳的二次翻修时机。

Serum D-Dimer Test Is Promising forthe Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation

Background: Despite the availability of abattery of tests, the diagnosisof periprosthetic joint infection (PJI)continues to be challenging. SerumD-dimer assessment is a widely available testthat detects fibrinolyticactivities that occurduring infection. We hypothesized that patients with PJImay have a high levelof circulating D-dimer and that the presence of a highlevel of serum D-dimermay be a sign of persistent infection in patientsawaiting reimplantation.

Methods: This prospective study wasinitiated to enroll patients undergoingprimary and revision arthroplasty. Ourcohort consisted of 245 patients undergoingprimary arthroplasty (n=23),revision for aseptic failure (n=86), revision for PJI(n= 57), or reimplantation(n = 29) or who had infection in a site other than ajoint (n = 50). PJI was defined using the MusculoskeletalInfectionSociety criteria.In all patients, serum D-dimer level,erythrocytesedimentation rate(ESR), andC-reactive protein (CRP) level were measuredpreoperatively.

Results: The median D-dimer level wassignificantly higher (p < 0.0001)forthe patients with PJI (1,110 ng/mL [range, 243 to 8,487 ng/mL]) than forthepatients with aseptic failure (299 ng/mL [range, 106 to 2,571 ng/mL). UsingtheYouden index, 850 ng/mL was determined as the optimal threshold value forserumD-dimer for the diagnosis of PJI. Serum D-dimer outperformed both ESR andserumCRP, with a sensitivity of 89% and a specificity of 93%. ESR and CRP had asensitivity of 73% and 79%andaspecificity of 78% and 80%, respectively.Thesensitivity and specificity of ESR and CRP combined was84% (95% confidence interval [CI], 76% to 90%)and47% (95% CI, 36% to 58%), respectively. Conclusions: Itappears that serum D-dimer is a promising markerfor the diagnosis of PJI. Thistest may also have a great utility fordetermining the optimal timing ofreimplantation.

文献出处：

ShahiA, Kheir MM, Tarabichi M, Hosseinzadeh HRS, TanTL, Parvizi J. Serum D-Dimer Test Is Promising for the Diagnosis ofPeriprosthetic Joint Infection and Timing of Reimplantation.  JBone Joint Surg Am. 2017 Sep 6;99(17):1419-1427.

文献2

全膝关节置换术中使用股骨外侧髁滑移截骨治疗固定膝外翻畸形的技术要点

译者：张蔷

背景：外翻膝的全膝关节置换术中，我们有多种方法可以重建下肢力线并平衡软组织其中之一就是股股外侧髁滑移截骨。

方法：用回顾性研究的方法收录了2007年至2016年间共10例外翻膝患者（12膝），3男7女，在全膝关节置换术中均应用了股骨外侧髁滑移截骨，7例PS假体、3例限制性PS假体和2例髁限制性假体，平均年龄68岁（48-89），平均随访34.7个月（4-109）。记录的数据包括术前及术后的KSS评分，膝关节稳定性，活动度及下肢力线。

结果：术后平均屈曲活动度125°（95°-145°），术前平均股胫角16.4°外翻（12°-26°），术后平均股胫角5.5°外翻（4°-7°）。术前平均KSS主观评分、满意度评分、期待评分和功能活动评分分别为71分、20分、11分和30分，术后分别为88分、34分、13分和64分。有1例术后深静脉血栓和1例暂时性的腓总神经麻痹。

结论：在外翻膝的全膝关节置换术中，股骨外侧髁滑移截骨是重建下肢机械力线的有效方法。

Lateral Femoral EpicondylarOsteotomy for Correction ofFixed Valgus Deformity in Total Knee Arthroplasty: ATechnical Note

Background: Multiple surgical techniquesexist to restore limbalignment and to balance soft tissues in valgus kneesduring total kneearthroplasty (TKA). One technique is to perform a lateralfemoral epicondylarosteotomy.

Methods: A retrospective analysis wasperformed on all patientswith a fixed valgus deformity that was corrected witha lateral femoralepicondylar osteotomy during TKA. Preoperative andpostoperative Knee SocietyKnee Scores, knee stability, range of motion, andradiographic alignment wererecorded.

Results: Ten patients (3 male and 7 female)underwent 12 TKAs by asingle surgeon using a lateral femoral epicondylarosteotomy to correct a fixedvalgus deformity. Implants used included 7posterior stabilized, 3 constrainedposterior stabilized, and 2 constrainedcondylar knees. Average age was 68years (range 48-89) and average follow-up was34.7 months (4-109). Averagepostoperative range of motion was 125° of flexion(range 95° -145° ). Themeanradiographic preoperative and postoperative anatomic tibiofemoral angleswere16.4° of valgus (range 12°-26° ) and 5.5° of valgus(range 4° -7° ), respectively.Themean preoperative knee society objective, satisfaction, expectation,andfunctional activity scores were 71, 20, 11, and 30, respectively. Themeanpostoperative knee society objective, satisfaction, expectation, andfunctionalactivity scores were 88, 34, 13, and 64, respectively. There was1post-operative deep vein thrombosis and 1 temporary peroneal nerve palsy.

Conclusion: Lateral femoral epicondylarosteotomy is a usefultechnique to restore mechanical alignment in fixed valgusdeformities in TKA.

文献出处：

Conjeski JM,Scuderi GR. Lateral FemoralEpicondylar Osteotomy for Correction of Fixed ValgusDeformity in Total KneeArthroplasty: A Technical Note. J Arthroplasty. 2017 Sep19.pii:S0883-5403(17)30802-1.

文献3

髋关节圆韧带实验：诊断圆韧带损伤的新检查法

译者：程徽

背景：圆韧带损伤是髋关节病人，关节镜手术中常见的病理变化。圆韧带损伤在术前很难诊断。圆韧带损伤没有特征性的病史、体格检查和影像学变化。

目的：报告评估圆韧带损伤的新体格检查方法：圆韧带实验。

方法：本实验包括因各种原因进行关节镜手术的75名患者。每一名患者都由两名独立的检查者进行体格检查。圆韧带实验保持髋关节屈曲70°，最大外展后内收30°，内旋或外旋髋关节至终点，出现疼痛即为圆韧带征阳性。然后进行髋关节镜检查，印证关节内的异常。对于每条圆韧带都在关节镜手术中进行照相，第三名检查者独立判断是否存在与圆韧带损伤。临床查体结果和关节镜结论相比较，得出敏感性、特异性、阳性预测值和阴性预测值。此外，关节内病灶与圆韧带损伤比较，观察之间知否有相关性。

结果： 在150次检查中，阳性率是55%。敏感性和特异性性分别是90%和85%。阳性预测值是84%，阴性预测值是91%。圆韧带损伤、钳夹撞击灶和需要外科处理的盂唇损伤都与圆韧带式样有正相关。观察者组间一致性是0.80（Kappa值）。

结论：圆韧带实验室评估圆韧带损伤的有效的方法，具有较好的观察者间一致性。除了圆韧带撕裂，钳夹撞击灶和需要外科处理的盂唇损伤也与圆韧带实验有一定的相关性。

The ligamentum teres test: a noveland effectivetest in diagnosing tears of the ligamentum teres

BACKGROUND: A ligamentum teres (LT)injuryis a common finding at the time of hip arthroscopic surgery in patientswithchronic groin and hip pain; however, LT tears have been difficult toidentifybefore surgery. There have been no unique features identified onhistory assessment,physical examination, or imaging that reliably identifyinjuries of the LTpreoperatively.

PURPOSE: To report a new clinicalexaminationto assess the presence of an LT tear: the LT test.

METHODS: The study consisted of75patients undergoing hip arthroscopic surgery for multiple lesions. Eachpatientwas evaluated by 2 independent examiners using the LT test, leading toa totalof 150 tests being performed. The LT test isconducted with the hip flexed at 70° and 30° short of full abduction; the hipis then internally and externallyrotated to its limits of motion. Pain oneither internal or external rotation isconsistent with a positive LT testresult. Hip arthroscopic surgery was thenperformed and allintra-articular abnormalities noted. Arthroscopic images weretaken of each LTand examined by a third independent examiner who determined thepresence orabsence of a tear. Clinical examination findings were compared withthearthroscopic findings to determine the sensitivity, specificity, andpositiveand negative predictive values. In addition, the presence ofintra-articularpathological lesions was compared with the test results todetermine if therewas a correlation between the presence of an intra-articularpathologicalabnormality and a positive LT test result.

RESULTS: Of the 150 examinationsperformed,the test result was positive 55% of the time (77 examinations). Thesensitivityand specificity of the test were 90% and 85%, respectively. Thepositive predictivevalue was 84%, and the negative predictive value was 91%.The presence of an LTtear, pincer lesion, and labral tear that required repairwas associated with apositive LT test result. The κ coefficient forinterobserver reliability was .80.

CONCLUSION: The LT test is aneffectiveway of assessing the presence of LT tears with moderate to highinterobserverreliability. In addition to an LT tear, the presence of a pincerlesion orlabral tear requiring repair are also associated with a positive LTtest result.

文献出处：

O'Donnell J1,Economopoulos K, SinghP, Bates D, Pritchard M. The ligamentum teres test: anovel and effective testin diagnosing tears of the ligamentum teres. Am JSports Med. 2014Jan;42(1):138-43.

文献4

健康及肥胖儿童中膝外翻与扁平足发病情况的观察

译者：肖凯

目的：明确儿童肥胖与膝外翻、扁平足之间的关系，并进一步提出临床治疗策略。

方法：本研究共纳入1364例3-7岁儿童。我们收集了所有研究对象的身高体重指数（BMI），并对胖瘦程度进行了分类（正常、超重、肥胖）。膝关节的力线的评估通过测量站立位髁间距。纵向足弓的高度通过Clarke’s 角进行评估。

结果：超重和肥胖的发生比例随着年龄的增长而升高。我们观察到，随着生长发育，最典型的特点是髁间距的缩小及足纵弓长度的增加。超重的儿童更容易发生膝外翻。身高体重指数、髁间距及Clarke’s角之间存在明显的相关性（P<0.05）。

结论：超重或肥胖的儿童更容易发生膝外翻及扁平足。

Genu Valgum and FlatFeet inChildren With Healthy and Excessive Body Weight

Purpose: To examinethe relationshipbetween obesity, genu valgum, and flat feet in children, and find practicalimplications for therapeutic interventions.

Methods: A total of1364 children aged3–7 years took partin the research. Their body mass indexwas calculated and their weight statusdescribed. Participants’ knee alignmentwas assessed bymeasuring the intermalleolar distance in the standing positionwith the knees incontact. The height of the longitudinal arch of each foot wasmeasured usingClarke’s angle.

Results: Theprevalence of overweight andobesity increased with age. Reduction ofintermalleolar distance and increasedlongitudinal arch of the foot,characteristic of typical growth and development,were observed. Genu valgumwas more common in children who were overweight.Significant correlations among body massindex, intermalleolardistance, and Clarke’s angle (P < .05) were alsodiscovered.

Conclusion: Children who areoverweight ordemonstrate obesity are more likely to develop genu valgum and flat feet.

文献出处：

Jankowicz-SzymanskaA,Mikolajczyk E. Genu Valgum and Flat Feet in Children With Healthy andExcessiveBody Weight[J]. Pediatr Phys Ther, 2016,28(2):200-206.

文献5

Romosozumab联合阿伦磷酸钠对绝经后女性骨质疏松患者的骨折预防作用

译者：张振东

背景：Romosozumab是一种靶向单抗药物，可结合并抑制骨硬化蛋白活性的单克隆抗体，具有增加骨形成、减少骨吸收的作用。

方法：研究纳入4093例绝经后骨质疏松伴脆性骨折的女性患者，随机双盲分为两组，1组给予皮下注射Romosozumab 210mg，1次/月，另一组给予阿伦磷酸钠口服，70mg，1次/周，两组均持续治疗12月。随后两组患者均给予阿伦磷酸钠（70mg，1次/周）治疗。主要研究终点为24月内新发脊柱骨折，次要研究终点为非脊柱骨折和髋关节骨折。同时还观察治疗期间严重心血管疾病、下颌骨骨坏死以及非典型股骨骨折的发生情况。

结果：随访24月内，Romosozumab联合阿伦磷酸钠组新发脊柱骨折发生率为6.2%（127/2046），低于单独使用阿伦磷酸钠组（11.6%，243/2047）（P<0.001）。非脊柱骨折在两组间发生率分别为8.7%（178/2046）、10.6%（217/2047）（P=0.04）。髋关节骨折在两组间发生率分别为2.0%（41/2046）、3.2%（66/2047）（P=0.02）。总体不良反应及严重不良反应在两组见发生率无明显差异。治疗开始1年内，严重心血管不良反应在Romosozumab组发生率高于阿伦磷酸钠组，分别为2.5%、1.9%。治疗开始后第二年服用阿伦磷酸钠期间，两组各发生1例下颌骨骨坏死，非典型股骨骨折分别有2例、4例。

结论：对于有高风险骨折的绝经后骨质疏松女性，相比单独使用阿伦磷酸钠，Romosozumab治疗12月后再行阿伦磷酸钠口服，可显著减低骨折风险。

Romosozumab or Alendronate forFracture Prevention  in Women with Osteoporosis

BACKGROUND: Romosozumab is a monoclonalantibody that binds to andinhibits sclerostin, increases bone formation, anddecreases bone resorption.

METHODS: We enrolled 4093 postmenopausalwomen with osteoporosisand a fragility fracture and randomly assigned them in a1:1 ratio to receivemonthly subcutaneous romosozumab (210 mg) or weekly oralalendronate (70 mg) ina blinded fashion for 12 months, followed by openlabel alendronatein bothgroups. The primary end points were the cumulative incidence of newvertebralfracture at 24 months and the cumulative incidence of clinicalfracture (nonvertebraland symptomatic vertebral fracture) at the time of theprimary analysis (afterclinical fractures had been confirmed in ≥330 patients).Secondary end pointsincluded the incidences of nonvertebral and hip fracture atthe time of theprimary analysis. Serious cardiovascular adverse events,osteonecrosis of thejaw, and atypical femoral fractures were adjudicated.

RESULTS: Over a period of 24 months, a 48%lower risk of newvertebral fractures was observed in theromosozumab-to-alendronate group (6.2%[127 of 2046 patients]) than in thealendronateto-alendronate group (11.9% [243of 2047 patients]) (P<0.001).Clinical fractures occurred in 198 of 2046patients (9.7%) in theromosozumab-to-alendronate group versus 266 of 2047patients (13.0%) in thealendronate-to-alendronate group, representing a 27%lower risk with romosozumab(P<0.001). The risk of nonvertebral fractureswas lower by 19% in theromosozumab-to-alendronate group than in thealendronate-to-alendronate group(178 of 2046 patients [8.7%] vs. 217 of 2047patients [10.6%]; P = 0.04), andthe risk of hip fracture was lower by 38% (41of 2046 patients [2.0%] vs. 66 of2047 patients [3.2%]; P = 0.02). Overalladverse events and serious adverseevents were balanced between the two groups.During year 1, positivelyadjudicated serious cardiovascular adverse eventswere observed more often withromosozumab than with alendronate (50 of 2040patients [2.5%] vs. 38 of 2014patients [1.9%]). During the open-labelalendronate period, adjudicated eventsof osteonecrosis of the jaw (1 eventeach in the romosozumab-to-alendronate andalendronate-to-alendronate groups)and atypical femoral fracture (2 events and 4events, respectively) wereobserved.

CONCLUSIONS: In postmenopausal women withosteoporosis who were athigh risk for fracture, romosozumab treatment for 12months followed byalendronate resulted in a significantly lower risk offracture than alendronatealone.

文献出处：

Saag KG, PetersenJ,Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, MeisnerPD,Grauer A. Romosozumab or Alendronate for Fracture Prevention in WomenwithOsteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-1427.

文献6

DDH流行病学回顾:我们需要新的策略吗?

译者：杨金鑫

背景：尽管髋关节发育不良(DDH)是儿骨医生所熟知的，它的病因仍不清楚，尽管有大量的研究，但其结果仍然是不充分和令人困惑的。DDH的确切发病率及其与已知危险因素的相关性在伊朗的新生儿中尚不清楚。就DDH的发病率和相关危险因素，我们做了为期一年的研究并报道如下。

方法：从2013年3月到2014年3月，在阿訇霍梅尼医院对1073名健康新生儿进行髋关节超声检查。采用Graf分类标准进行分类。阳性病例再次进行DDH已知危险因素的检查

结果：与DDH有显著相关性的：臀先露(P=0.000)，先天性斜颈(P=0.004)，距骨内收(P=0.024)。

结论：在被研究的新生儿中，DDH的发病率显著增高，建议对当前DDH的筛查方法进行重新评价。在受过训练的儿科医生和其他卫生专业人员的帮助下，需要改进筛查方案。

DDH Epidemiology Revisited: Do WeNeed New Strategies?

Background: Althoughthe developmental dysplasiaof the hip (DDH) is well known to pediatricorthopedists, its etiology has stillremained unknown and despite dedication ofa vast majority of research, theresults are still inadequate and confusing.The exact incidence of DDH and itsrelationship with known risk factors in Iranis still unknown. Here we representthe results of one year study on theincidence and related conditions of DDH.

Methods: Sonographywas performed on the hipjoints of 1073 full term healthy newborns at ImamKhomeini Hospital from March2013 to March 2014. The results were classifiedaccording to Graf’s classification.Pathologic hips were cross checked by theknown risk factors for DDH.

Results: Asignificant correlation was foundbetween DDH and breech presentation (P=0.000),torticollis (P=0.004),metatarsus adductus (P=0.024).

Conclusion: Theincidence of DDH issignificantly high in the studied group of neonates,suggesting reevaluation ofcurrent approach to DDH. The screening protocols needto be improved with thehelp of trained pediatricians and other healthprofessions.

文献出处：

Vafaee AR,BaghdadiT, Baghdadi A, Jamnani RK. DDH Epidemiology Revisited: Do We NeedNewStrategies? Arch Bone Jt Surg. 2017 Nov;5(6):440-442.