结果：未带延长杆的胫骨假体仅显示出有更大的内翻（差异的中位数为0.14°，P < 0.05），但这么小的度数没有临床意义。应力分布无差异。骨密度仅对前后位倾斜有影响［ρ=－0.72（p＜0.01）］。
Tibial component with and without stem extension in a trabecular metal cone construct
PURPOSE: The purpose of this study was to investigate stability and strain distribution of a tibial plateau reconstruction with a trabecularmetal cone while the tibial component is implanted with and without a stem, and whether prosthetic stability was influenced by bone mineral density. Trabecular metal cones are designed to fill up major bone defects in total knee arthroplasty. Tibial components can be implanted in combination with a stem, but it is unclear whether this is necessary after reconstruction with a trabecular metal cone. Implanting a stem can give extra stability, but may have negative side effects.
METHODS: Tibial revision arthroplasties with trabecular metal cones were performed after reconstruction of a 2B bone defect according to the Anderson Orthopedic Research Institute classification. Components were implanted in seven pairs of cadaveric tibiae; one tibia of each pair was implanted with stem and the other without. All specimens were loaded to one bodyweight alternating between the medial and lateral tibial component. Implant-bone micro-motions, bone strains, bone mineral density and correlations were measured and/or calculated.
RESULTS: Tibial components without a stem showed only more varus tilt [difference in median 0.14° (P < 0.05)], but this was not considered clinically relevant. Strain distribution did not differ. Bone mineral density only had an effect on the anterior/posterior tilt [ρ: -0.72 (P < 0.01)].
CONCLUSION: Tibial components, with or without a stem, which are implanted after reconstruction of major bone defects using trabecularmetal cones produce very similar biomechanical conditions in terms of stability and strain distribution. If in vivo studies confirm that a stemextension is not mandatory, orthopaedic surgeons can decide not to implant a stem.
文献出处：Meijer MF, Boerboom AL, Stevens M, et al. Tibial component with and without stem extension in a trabecular metal cone construct. Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3644-3652.
实验设计：25位没有骨关节炎病史和膝关节外伤史的志愿者作为受试对象 。在测试前和测试后分别应用超声对受试者股骨内侧髁软骨的厚度进行测量，测试分三种不同的情况，每种情况测试 30分钟：1）以自己习惯的行走速度步行， 2）以自己习惯的速度跑步， 3）坐在治疗床上（作为对照）。软骨变形程度的评价依据测试前后软骨厚度改变的百分比计算。最后比较三种不同情况下软骨变形情况。
结果：三组受试者间软骨厚度的基础值无差异 (F1,24=0.18,p=0.68)。测试后三组间的软骨变形情况存在差异 (F1,24=47.54，p<0.001)。步行组 (%D=-6.7，t24=6.90，p<0.001，d=-1.92) 和跑步组 (%D=-8.9，t24=8.14，p<0.001，d=-1.85)与坐姿组（对照组）(%D=+3.4) 比较软骨变形明显。而步行组和跑步组间比较无差异 (t24=1.10，p=0.28，d=0.33)。超声测量股骨内侧髁软骨厚度在一次测试时的可信度和准确度 (ICC2，k=0.966，SEM=0.07mm)，在之后的 7至 16天多次测为 (ICC2，k=0.964，SEM=0.08mm) 和 (ICC2，k=0.919，SEM=0.11mm)。
Ultrasonographic Assessment of Medial Femoral Cartilage Deformation Acutely Following Walking and Running Matthew
Objective: To determine the magnitude of medial femoral cartilage deformation using ultrasonography (US) following walking and running in healthy individuals.
Design: Twenty-five healthy participants with no history of osteoarthritis or knee injury volunteered for this study. Medial femoral cartilage thickness was assessed using US before and after three separate 30-minute loading conditions: 1) walking at a self-selected speed, 2) running at a self-selected speed, and 3) sitting on a treatment table (i.e. control). Cartilage deformation was calculated as the percent change score from pre to post loading in each loading condition. The magnitude of cartilage deformation was compared between the three loading conditions.
Results: There was no difference in baseline cartilage thickness between the three sessions (F1,24 =0.18, p=0.68). Cartilage deformation was different between the loading conditions (F1,24 =47.54, p<0.001). The walking (%Δ=-6.7, t24 =6.90, p<0.001, d=-1.92) and running (%Δ=-8.9, t24 =8.14, p<0.001, d=-1.85) conditions resulted in greater cartilage deformation when compared to the control condition (%Δ=+3.4). There was no difference in cartilage deformation between the running and walking conditions (t24 =1.10, p=0.28, d=0.33). US measured medial femoral cartilage thickness demonstrated reliability and precision within a single session (ICC2,k =0.966, SEM=0.07mm) and between additional sessions separated by seven (ICC2,k =0.964, SEM=0.08mm) and sixteen days (ICC2,k =0.919, SEM=0.11mm).
Conclusions: US demonstrated to be a reliable and sensitive imaging modality at quantifying medial femoral cartilage deformation in healthy individuals. Both walking and running conditions created greater cartilage deformation when compared to the control conditions, but no difference was observed between the walking and running conditions.
Coronal bowing of the femur and tibia in Chinese its incidence and effects on total knee arthroplasty planning
Purposes: To study the incidence of femoral or tibial bowing in the coronal plane in a Chinese population, and how it affects the accuracy of bone cuts for total knee replacement when an intramedullary alignment system is used.
Methods: Standing radiographs of the entire lower limb of each patient with end-stage primary osteoarthritis of the knee were analyzed. All radiographs were digitized and the extent of bowing in the coronal plane measured. A bowing was marked if an angulation was more than 2 degrees. The projected error of cutting was then calculated.
Results: Of 93 lower limbs, 58 (62%) of the femurs had marked bowing in the coronal plane; 41 (44%) had a mean lateral bowing of 5.3 (standard deviation [SD], 3.2) degrees; 17 (18%) had a mean medial bowing of 4.4 (SD, 1.9) degrees. Marked tibial bowing in the coronal plane was less common (30 tibias, 32%). If a cutting error of more than 2 degrees was considered unacceptable, significantly more unacceptable cuts would ensue in the groups with marked bowing (p=0.003 for femurs and p<0.001 for tibia, respectively).
Conclusion: The incidence of femoral or tibial bowing in the coronal plane was high in a Chinese population with end-stage osteoarthritis of the knee. This phenomenon may increase bone cut errors in total knee replacement if an intramedullary alignment system is used and the extent of bowing is not recognized.
文献出处：WP Yau, KY Chiu, WM Tang, TP Ng. Coronal bowing of the femur and tibia in Chinese its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong). 2007 Apr;15(1):32-6.
Arthrotomy and open reduction of the displaced fracture of the femoral neck in children
The objective of the study was to examine the efficacy of limited arthrotomy coupled with open reduction and internal fixation to minimize potential complications of vascular disruption of the capital femoral physis and femoral epiphysis. It was a patient outcome study. Skeletally immature patients with femoral neck fractures were treated according to a protocol in which all patients underwent limited arthrotomy with decompression of the intercapsular hematoma, open reduction and internal fixation. Radiographic and magnetic resonance imaging studies were carried out on patients to assess whether avascular necrosis developed in the postoperative period. Patients were followed for a mean length of 2 years 8 months, with a range of 2 years to 5.5 years. Twelve patients had good results and one had fair results using Ratliff criteria. No patient developed avascular necrosis (ischemic necrosis), coxa vara, nonunion or premature epiphyseal closure. This study supports the hypothesis that limited decompression of the intracapsular hematoma in children with femoral neck fractures may be a factor in obviating the subsequent appearance of ischemic disruption of the epiphysis and physis.
文献出处：Song KS, Kim YS, Sohn SW, Ogden JA. Arthrotomy and open reduction of the displaced fracture of the femoral neck in children. J Pediatr Orthop B. 2001 Jul;10(3):205-10.
Positive effects on bone mineralisation and muscular fitness after 10 months of intense school-based physical training for children aged 8-10 years: the FIT FIRST randomised controlled trial
OBJECTIVES: We investigated whether musculoskeletal fitness of school children aged 8-10 years was affected by frequent intense PE sessions.
DESIGN AND PARTICIPANTS: 295 Danish school children aged 8-10 years were cluster randomised to a small-sided ball game group (SSG) (n=96, four schools, five classes), a circuit strength training group (CST) (n=83, four schools, four classes) or a control group (CON, n=116, two schools, five classes).
INTERVENTION: SSG or CST was performed 3×40 min/week over 10 months. Whole-body dual-energy X-ray absorptiometry (DXA) scans were used to determine areal bone mineral density (aBMD), bone mineral content (BMC) and lean body mass (LBM). Flamingo balance, standing long jump and 20-m sprint tests were used to determine muscular fitness.
RESULTS: Analysis of baseline-to-10 months change scores showed between-group differences in favour of the interventions in whole-body aBMD (SSG vs CON: 8 mg/cm2, 95% CI 3 to 13; CST vs CON: 7 mg/cm2, 95% CI 2 to 13, p<0.05) and leg BMC (SSG vs CON: 11 g, 95% CI 4 to 18; CST vs CON: 11 g, 95% CI 3 to 18, p<0.05). SSG had higher change scores in leg aBMD compared with CON and CST (SSG vs CON: 19 mg/cm2, 95% CI 11 to 39, p<0.05; SSG vs CST: 12 mg/cm2, 95% CI 3 to 21, p<0.05), and CST had higher change scores in whole-body BMC compared with CON (CST vs CON: 25 g, 95% CI 10 to 39, p<0.05). Both training types resulted in higher change scores in postural balance (SSG vs CON: 2.4 fewer falls/min, 95% CI 0.3 to 4.5, CST vs CON: 3.6 fewer falls/min, 95% CI 1.3 to 5.9, p<0.05) and jump length (SSG vs CON: 10%, 95% CI 5 to 16%; CST vs CON: 9%, 95% CI 3 to 15%, p<0.05). No between-group differences were observed for sprint performance or LBM (p>0.05).
CONCLUSIONS: In conclusion, 3×40 min/week with SSG or CST over a full school year improves bone mineralisation and several aspects of muscular fitness of children aged 8-10 years, suggesting that well-organised intense physical education classes can contribute positively to develop musculoskeletal health in young children.
文献出处：Larsen MN, Nielsen CM, Helge EW, et. Positive effects on bone mineralisation and muscular fitness after 10 months of intense school-based physical training for children aged 8-10 years: the FIT FIRST randomised controlled trial. Br J Sports Med.2018 Feb;52(4):254-260.
接受髋臼周围截骨术（PAO）的发育性髋关节发育不良（DDH）患者通常合并盂唇撕裂。对于MRI上显示盂唇全层撕裂的DDH患者，单纯PAO与PAO联合关节切开或关节镜哪种才是最佳的手术方案？这是本研究着重探讨的问题。本研究共纳入两组患者，单纯PAO组（47髋）与PAO合并关节切开或关节镜组（PAO-A）（60髋）。两组病例均有平均随访28个月的髋关节发育不良骨关节炎结果评分（HOOS）、改良Harris评分（mHHS）、VAS评分及临床与影像学资料。我们对两组病例的再手术率及术后并发症发生率进行比较。单纯PAO组患者年龄较PAO-A组年轻（25.2±9.7 VS 31.3±8.3）。单纯PAO组的髋臼畸形相对更重：外侧CE角（7.6°±9.63° VS 10.8°±6.85°）、前CE角（4°±12.92° VA 10.8°±9.92°）。单纯PAO组术前的mHHS评分（65.2±15.3 versus 57.8±14.8）及HOOS评分（66.3±17.5 VS 55.8±20.1）相对更高。两组患者的末次随访结果无明显差异：mHHS评分（86.8±12.4 VS 83.3±17.2）、HOOS评分（86.5±13.3 VS 82.5±16.8）、VAS评分（2.5±2.8 VS 2.5±3.1）。两组患者间再手术率无明显差异（6.4% VS11.6%, P=0.51）。单纯PAO组整体的术后并发症发生率低于PAO-A组（26% VS 68%），但是主要并发症的发生率是相当的。基于我们的数据，我们还不能十分确切地说单纯PAO适用于所有合并盂唇损伤的DDH患者，至少关节切开或关节镜手术在某些病例中是有意义的。
Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required?
Patients with developmental dysplasia of the hip (DDH) who undergo periacetabular osteotomy (PAO) often have labral tears. The objective of this retrospective study was to compare PAO alone with PAO combined with arthrotomy or arthroscopy in DDH patients who had a full-thickness labral tear on magnetic resonance imaging. In total, 47 hips in the PAO group (PAO) were compared with 60 hips in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) with respect to Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS), clinical and radiographic outcomes at a median of 29 months. Reoperation rate and complications were compared between two groups of treatment. The PAO group was younger than the PAO-A group (25.2 ± 9.7 versus 31.3 ± 8.3). The PAO group was more likely to have worse dysplasia: lateral center edge angle (7.6°±9.63° versus 10.8°±6.85°) and anterior center edge angle (4°±12.92° versus 10.8°±9.92°). The PAO group had a higher preoperative mHHS (65.2 ± 15.3 versus 57.8 ± 14.8) and HOOS (66.3 ± 17.5 versus 55.8 ± 20.1). There were no significant differences in final functional outcome scores across treatment groups: mHHS (PAO; 86.8 ± 12.4 versus PAO-A, 83.3 ± 17.2), HOOS (86.5 ± 13.3 versus 82.5 ± 16.8) and VAS (2.5 ± 2.8 versus 2.5 ± 3.1). There was no difference in reoperation rate between two groups (6.4% versus 11.6%, P = 0.51). The overall complication rate was lower in the PAO group (26% versus 68%), but major complications were comparable. On the basis of our data, we were not able to conclusively demonstrate a clear benefit for the routine treatment of all labral tears; however, arthrotomy or arthroscopy may play a role in some conditions.
文献出处：Thanacharoenpanich S, Boyle MJ, Murphy RF, et al. Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required? J Hip Preserv Surg. 2018 Jan 11;5(1):23-33.
Capsular augmentation in Colonna arthroplasty for the management of chronic hip dislocation
Colonna capsular arthroplasty represents an option for the management of chronic hip dislocation in young patients with dysplasia. In the appropriate patient, modern capsular arthroplasty procedures may provide an opportunity for hip preservation in patients with preserved femoral head cartilage and not appropriate for total hip arthroplasty. Here, we review our experience with surgical dislocation of the hip and capsular arthroplasty in a 27-year-old female with congenital hip dysplasia and chronic superior hip dislocation. Due to inadequate native capsular tissue, a decellularized dermal allograft was used for interposition and capsular arthroplasty augmentation. The femoral head with preserved articular cartilage was reduced into the enlarged native acetabulum using a parachute technique to hold the allograft in position. Post-operatively, the patient was placed in a hip abduction brace and made non-weight bearing for six weeks. A conservative physical therapy protocol was implemented to allow gradual increase in weight bearing and range of motion over the first 12 weeks post-operatively.
文献出处：Sloan M, Kamath AF. Capsular augmentation in Colonna arthroplasty for the management of chronic hip dislocation. J Hip Preserv Surg. 2018 Jan 11;5(1):34-38.
Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors
PURPOSE: Different timing and approaches to screening for developmental dysplasia of the hip (DDH) are used in the orthopaedic community. Thus ultrasonographic screening programs and reports based on clinical examinations produced differing incidence rates of DDH. Furthermore different risk factors and a change of incidence of DDH in the last decades were discussed. The purpose of this study was the evaluation of incidence and risk factors of the very early DDH in a modern cohort based on a universal ultrasound screening program.
METHODS: We analysed the results of the screening program performed at our institution: 5,356 consecutive hips of newborns were screened ultrasonographically and clinically according to the system published by R. Graf within the first two postnatal weeks . A set of risk factors was analysed by univariate and multiple linear regression models.
RESULTS: Sonographic signs of developmental dysplasia of the hip were found in 0.24 % of the newborns. A significant negative influence of the risk factors birth weight, family history of DDH and female gender on the α-angle was found. Early or pre-term delivery showed a protective potential for DDH.
CONCLUSIONS: Our data show a very low incidence of DDH in the first two postnatal weeks. Despite the significance of the risk factors analysed, it has to be considered that these factors only showed low impact on the risk of early DDH. In conclusion we favour universal ultrasound screening for DDH at the age of six to eight weeks.
文献出处：Kolb A1, Schweiger N2, Mailath-Pokorn y M, et al. Low incidence of early developmental dysplasia of the hip in universal ultrasonographicscreening of newborns: analysis and evaluation of risk factors. Int Orthop. 2016 Jan;40(1):123-7.