Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.008
Changzhao Li, Jiarong Chen
Anterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients' congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patellofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpatellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreservation or using mobile-bearing rotating-platform.
{"title":"Literature review of the relationship and relative factors between anterior knee pain and patellofemoral joint after total knee arthroplasty","authors":"Changzhao Li, Jiarong Chen","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.008","url":null,"abstract":"Anterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients' congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patellofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpatellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreservation or using mobile-bearing rotating-platform.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1470-1477"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48646718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.009
X. Guan
Cervical spondylotic myelopathy is a common and frequently-occurring disease in Orthopaedics, especially with multi-segmental cervical spondylotic myelopathy. There are several pathogenic factors for cervical spondylotic myelopathy. The clinical symptoms are serious, and the imaging manifestations are complex. Most of them are accompanied by serious neurological damage, which seriously affects the quality of life of patients. Furthermore, some patients have serious cervical spinal cord injury symptoms, which endanger their lives after mild trauma. Therefore, early diagnosis, early treatment and surgery are the most effective methods at present, which could effectively eliminate the factors of spinal cord compression and reconstruct the stability of cervical spine function. However, the choice of surgical approach and decompression fusion has always been the focus of debate. The primary purpose of surgery for cervical spondylotic myelopathy is to completely relieve the compression of spinal cord. According to the imaging characteristics of cervical spondylotic myelopathy, it is the key to the success of the operation to determine the decompression and reconstruction of cervical spondylotic myelopathy. Anterior approach can be adopted in patients with the compression factors located in front of the spinal cord, including disc protrusion, mild osteophyte or local ossification posterior longitudinal ligament, less lesion segments, small compression range, cervical kyphosis or local kyphosis deformity, easy resection of compression and sagittal imbalance correction. Decompression fusion can be selected through intervertebral space, subtotal vertebral body resection and mixed decompression for fusion and fixation. In order to retain the active function of cervical vertebrae, artificial disc replacement and fusion can be selected. For patients with the compression factors located in the posterior part of the spinal cord, including ligamentumflavum hypertrophy or ossification, congenital developmental spinal canal stenosis, there are many factors causing compression in front of the spinal cord. The range is larger, the lesion segment is longer. Thus, it is difficult to resect thoroughly in front of the spinal cord with higher risk of anterior surgery. Although the posterior approach is indirect decompression with the help of posterior spinal cord movement, it plays a good role in improving nerve function with fewer complications and relatively higher safety. There are absolute surgical indications and relative indications for two approaches. Combining anterior and posterior surgery has advantages of complete decompression and strong fixation. However, it has the advantages of great trauma and high risk, so it is necessary to apply it in clinical practice. Moreover, no matter how to choose the approach, we should use perfect imaging data combined with clinical symptoms and signs to clarify the pathological factors of spinal cord com pression, the severity
{"title":"The strategy selection of surgical approach and decompression and fusion for cervical spondylotic myelopathy","authors":"X. Guan","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.009","url":null,"abstract":"Cervical spondylotic myelopathy is a common and frequently-occurring disease in Orthopaedics, especially with multi-segmental cervical spondylotic myelopathy. There are several pathogenic factors for cervical spondylotic myelopathy. The clinical symptoms are serious, and the imaging manifestations are complex. Most of them are accompanied by serious neurological damage, which seriously affects the quality of life of patients. Furthermore, some patients have serious cervical spinal cord injury symptoms, which endanger their lives after mild trauma. Therefore, early diagnosis, early treatment and surgery are the most effective methods at present, which could effectively eliminate the factors of spinal cord compression and reconstruct the stability of cervical spine function. However, the choice of surgical approach and decompression fusion has always been the focus of debate. The primary purpose of surgery for cervical spondylotic myelopathy is to completely relieve the compression of spinal cord. According to the imaging characteristics of cervical spondylotic myelopathy, it is the key to the success of the operation to determine the decompression and reconstruction of cervical spondylotic myelopathy. Anterior approach can be adopted in patients with the compression factors located in front of the spinal cord, including disc protrusion, mild osteophyte or local ossification posterior longitudinal ligament, less lesion segments, small compression range, cervical kyphosis or local kyphosis deformity, easy resection of compression and sagittal imbalance correction. Decompression fusion can be selected through intervertebral space, subtotal vertebral body resection and mixed decompression for fusion and fixation. In order to retain the active function of cervical vertebrae, artificial disc replacement and fusion can be selected. For patients with the compression factors located in the posterior part of the spinal cord, including ligamentumflavum hypertrophy or ossification, congenital developmental spinal canal stenosis, there are many factors causing compression in front of the spinal cord. The range is larger, the lesion segment is longer. Thus, it is difficult to resect thoroughly in front of the spinal cord with higher risk of anterior surgery. Although the posterior approach is indirect decompression with the help of posterior spinal cord movement, it plays a good role in improving nerve function with fewer complications and relatively higher safety. There are absolute surgical indications and relative indications for two approaches. Combining anterior and posterior surgery has advantages of complete decompression and strong fixation. However, it has the advantages of great trauma and high risk, so it is necessary to apply it in clinical practice. Moreover, no matter how to choose the approach, we should use perfect imaging data combined with clinical symptoms and signs to clarify the pathological factors of spinal cord com pression, the severity","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1478-1484"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47500158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.003
Qingyu Zhang, F. Gao, L. Cheng, Wei Sun, Zi-rong Li
Objective To compare the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis. Methods From January 2011 to January 2017, a total of 44 patients with bilateral femoral head necrosis (88 hips) were admitted to the Department of Orthopaedics, China-Japan Friendship Hospital, including 35 males and 9 females with aged 34.9±7.2 years old (ranged from 22-48 years). Core decompression with autologous bone marrow mononuclear cell and impacted bone grafting were conducted to each hip joint for every patient. All patients were followed up for every 3 months at the first year postoperatively and for every 6 months thereafter. The following clinical measurement were recorded, Harris hip score (HHS), visual analogue score (VAS), the anterior-posterior and frog lateral radiographs, and CT. The 5-year survival rate of the hip was calculated with the endpoint event being defined as a need for total hip arthroplasty or other surgical intervention, or a HHS less than 70. Results The postoperative follow-up duration was 50.5±34.2 months in the impacted bone grafting group and 54.0±33.1 months in the core decompression with autologous bone marrow mononuclear cells group. Fifteen hips in the impacted bone grafting group and 13 hips in the core decompression with autologous bone marrow mononuclear cell group failed during the follow-up. The 5-year cumulative survival rates of the hips in two groups were 64.7% and 72.1%, respectively [HR=1.178, 95%CI(0.561, 2.477)]. In the impacted bone grafting group, the 5-year survival rates of the hip joints at the ARCO IIIB+IIIC and IIIA stages were 42.9% and 74.2%, respectively [HR=3.258, 95%CI(1.172, 9.059)]. In the core decompression with autologous bone marrow mononuclear cell group, the 5-year survival rates of hips at the ARCO stage I, II and IIIA stages were 50.0%, 75.3%, and 71.4%, respectively (χ2=0.757, P=0.685). Age, gender, BMI, preoperative HHS and etiology did not affect the effects of core decompression with autologous bone marrow mononuclear cell grafting or impacted bone grafting (P>0.05). The preoperative VAS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 4.80±0.62 and 3.27±1.17, respectively (t=8.625, P<0.001). At the last follow-up, the VAS was reduced to 2.84±1.95 and 2.25±2.08, respectively (t=2.712, P=0.01; t=7.087, P<0.001) with significant difference in postoperative VAS between the two groups (t=2.489, P=0.017). The preoperative HHS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 77.02±5.03 and 82.57±5.71, respectively (t=7.822, P<0.001). At the last follow-up, the HHS increased to 81.57±12.81 and 83.55±12.87, respectively. The difference between the preoperative and postoperative HHS was statistically significant in the impacted b
{"title":"Comparing the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis","authors":"Qingyu Zhang, F. Gao, L. Cheng, Wei Sun, Zi-rong Li","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.003","url":null,"abstract":"Objective \u0000To compare the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis. \u0000 \u0000 \u0000Methods \u0000From January 2011 to January 2017, a total of 44 patients with bilateral femoral head necrosis (88 hips) were admitted to the Department of Orthopaedics, China-Japan Friendship Hospital, including 35 males and 9 females with aged 34.9±7.2 years old (ranged from 22-48 years). Core decompression with autologous bone marrow mononuclear cell and impacted bone grafting were conducted to each hip joint for every patient. All patients were followed up for every 3 months at the first year postoperatively and for every 6 months thereafter. The following clinical measurement were recorded, Harris hip score (HHS), visual analogue score (VAS), the anterior-posterior and frog lateral radiographs, and CT. The 5-year survival rate of the hip was calculated with the endpoint event being defined as a need for total hip arthroplasty or other surgical intervention, or a HHS less than 70. \u0000 \u0000 \u0000Results \u0000The postoperative follow-up duration was 50.5±34.2 months in the impacted bone grafting group and 54.0±33.1 months in the core decompression with autologous bone marrow mononuclear cells group. Fifteen hips in the impacted bone grafting group and 13 hips in the core decompression with autologous bone marrow mononuclear cell group failed during the follow-up. The 5-year cumulative survival rates of the hips in two groups were 64.7% and 72.1%, respectively [HR=1.178, 95%CI(0.561, 2.477)]. In the impacted bone grafting group, the 5-year survival rates of the hip joints at the ARCO IIIB+IIIC and IIIA stages were 42.9% and 74.2%, respectively [HR=3.258, 95%CI(1.172, 9.059)]. In the core decompression with autologous bone marrow mononuclear cell group, the 5-year survival rates of hips at the ARCO stage I, II and IIIA stages were 50.0%, 75.3%, and 71.4%, respectively (χ2=0.757, P=0.685). Age, gender, BMI, preoperative HHS and etiology did not affect the effects of core decompression with autologous bone marrow mononuclear cell grafting or impacted bone grafting (P>0.05). The preoperative VAS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 4.80±0.62 and 3.27±1.17, respectively (t=8.625, P<0.001). At the last follow-up, the VAS was reduced to 2.84±1.95 and 2.25±2.08, respectively (t=2.712, P=0.01; t=7.087, P<0.001) with significant difference in postoperative VAS between the two groups (t=2.489, P=0.017). The preoperative HHS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 77.02±5.03 and 82.57±5.71, respectively (t=7.822, P<0.001). At the last follow-up, the HHS increased to 81.57±12.81 and 83.55±12.87, respectively. The difference between the preoperative and postoperative HHS was statistically significant in the impacted b","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1432-1439"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44355597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.005
Zhang Huadong, Yang Jianping, Zhang Zhongli, Fu Zhe
Objective To investigate the reproducibility of the femoral head perfusion index by enhanced MRI and the predictive value of the Herring lateral pillar classification after the progression of early stage of Perthes disease (X-ray modified Waldenstrom stage Ia, Ib, IIa) to stage IIb. Methods From October 2016 to November 2018, a total of 30 children with early stage of Perthes disease were enrolled, including 29 males and 1 female, aged 7.5±1.0 years (range 6.3 to 9.5 years). All patients were evolved by unilateral with left 24 cases and 6 cases on the right side. There were 1 case in stage Ia, 16 cases in stage Ib and 13 cases in stage IIa. At the initial evaluation, X-ray films and enhanced MRI were performed. Three observers measured the femoral head perfusion index on the enhanced MRI. The ratio of the pixels in the affected ossified nucleus perfusion area to the pixels in the contralateral femoral skull nucleus was recorded. A total of 30 cases were measured with repeated evaluation at intervals of 1 to 2 weeks. The second measurement was independent of the first measurement results. The average of the two measurements was regarded as the final measurement results. At 3 months follow-up, anteroposterior and Lauenstein frog-lateral radiographs were taken. The follow-up duration was end at the stage IIb progression. The Herring lateral pillar of the femoral head was determined on the X-ray films. The differences in the early MRI femoral head perfusion index were compared between the different lateral column types. Results The ICC values of the femoral head perfusion index between the three observers were 0.876. The ICC values measured by the 1/3 perfusion index of the lateral femoral head were 0.729. The ICC values of the femoral head perfusion index measured by the same observer at different times were 0.932. The ICC values measured by the 1/3 perfusion index of the lateral femoral head were 0.805. A total of 30 children were followed to stage IIb at 6.49±5.12 months (range 2.3 to 22.1 months). There were 13 cases of type A and type B and 17 cases of type C. The sputum perfusion index of type A and type B was 59.77%±17.12% (range 25%-85%), and that of group C was 13.47%±10.65% (range 2%-23%). The difference between groups was statistically significant (t=8.563, P=0.000). The 1/3 perfusion index of the lateral femoral head of the A and B groups was 75.62%±15.03% (range 50%-95%), while the C type was 22.24%±12.28% (range 5%-45%) with significant difference (t=10.621, P=0.000). Conclusion The measurement of femoral head perfusion index on enhanced MRI has almost perfect agreement between and within observers across multiple rounds of study. In children with early Perthes disease, enhanced MRI has predictive effect on the Herring lateral pillar classification after progression to stage IIb. Key words: Magnetic resonance imaging; Subtraction technique; Child; Femur head necrosis; Forecasting
{"title":"Significance of enhanced MRI in evaluating the prognosis of early Perthes disease","authors":"Zhang Huadong, Yang Jianping, Zhang Zhongli, Fu Zhe","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.005","url":null,"abstract":"Objective \u0000To investigate the reproducibility of the femoral head perfusion index by enhanced MRI and the predictive value of the Herring lateral pillar classification after the progression of early stage of Perthes disease (X-ray modified Waldenstrom stage Ia, Ib, IIa) to stage IIb. \u0000 \u0000 \u0000Methods \u0000From October 2016 to November 2018, a total of 30 children with early stage of Perthes disease were enrolled, including 29 males and 1 female, aged 7.5±1.0 years (range 6.3 to 9.5 years). All patients were evolved by unilateral with left 24 cases and 6 cases on the right side. There were 1 case in stage Ia, 16 cases in stage Ib and 13 cases in stage IIa. At the initial evaluation, X-ray films and enhanced MRI were performed. Three observers measured the femoral head perfusion index on the enhanced MRI. The ratio of the pixels in the affected ossified nucleus perfusion area to the pixels in the contralateral femoral skull nucleus was recorded. A total of 30 cases were measured with repeated evaluation at intervals of 1 to 2 weeks. The second measurement was independent of the first measurement results. The average of the two measurements was regarded as the final measurement results. At 3 months follow-up, anteroposterior and Lauenstein frog-lateral radiographs were taken. The follow-up duration was end at the stage IIb progression. The Herring lateral pillar of the femoral head was determined on the X-ray films. The differences in the early MRI femoral head perfusion index were compared between the different lateral column types. \u0000 \u0000 \u0000Results \u0000The ICC values of the femoral head perfusion index between the three observers were 0.876. The ICC values measured by the 1/3 perfusion index of the lateral femoral head were 0.729. The ICC values of the femoral head perfusion index measured by the same observer at different times were 0.932. The ICC values measured by the 1/3 perfusion index of the lateral femoral head were 0.805. A total of 30 children were followed to stage IIb at 6.49±5.12 months (range 2.3 to 22.1 months). There were 13 cases of type A and type B and 17 cases of type C. The sputum perfusion index of type A and type B was 59.77%±17.12% (range 25%-85%), and that of group C was 13.47%±10.65% (range 2%-23%). The difference between groups was statistically significant (t=8.563, P=0.000). The 1/3 perfusion index of the lateral femoral head of the A and B groups was 75.62%±15.03% (range 50%-95%), while the C type was 22.24%±12.28% (range 5%-45%) with significant difference (t=10.621, P=0.000). \u0000 \u0000 \u0000Conclusion \u0000The measurement of femoral head perfusion index on enhanced MRI has almost perfect agreement between and within observers across multiple rounds of study. In children with early Perthes disease, enhanced MRI has predictive effect on the Herring lateral pillar classification after progression to stage IIb. \u0000 \u0000 \u0000Key words: \u0000Magnetic resonance imaging; Subtraction technique; Child; Femur head necrosis; Forecasting","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1447-1453"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43901903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.007
Xinluan Wang, L. Zheng, Huijuan Cao, L. Qin
Steroid associated-osteonecrosis (SAON) is non-trauma induced osteonecrosis, which is induced by long-term or high dose of corticosteroid indicated for inflammatory or immune diseases, etc. Subchondral collapse at late stage of SAON usually needs to be treated with joint replacement, while the costs and the prognosis of the surgery are challenge. It is important to perform the fundamental researches on the hip preservation treatments of SAON at early stage, and it is necessary to establish suitable animal models for studying the mechanisms of SAON and evaluating the potential treatments for the SAON. Rabbit SAON model is the most frequently used animal model. It is extensively used in studies on etiology and pathology of SAON. Furthermore, it is possible to evaluate potential drugs for preventing SAON and improving osteogenic repair of mid-stage SAON to prevent joint collapse. Because of bi-pedal, emu has the similar mechanical properties with human. Thus, it can be a suitable animal model for studying preventions and treatments of subchondral collapse of SAON, such as core-decompression with biodegradable materials for bone regeneration. In conclusion, this review updates the current animal SAON models with similar pathology to clinical SAON. These typical models could be used as clinical references for investigating drugs in prevention of early-stage of SAON and biomaterials in hip-preservation surgery for mid-stage of SAON.
{"title":"Animal models and research on preventions and treatments of steroid-associated osteonecrosis of the femoral head","authors":"Xinluan Wang, L. Zheng, Huijuan Cao, L. Qin","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.007","url":null,"abstract":"Steroid associated-osteonecrosis (SAON) is non-trauma induced osteonecrosis, which is induced by long-term or high dose of corticosteroid indicated for inflammatory or immune diseases, etc. Subchondral collapse at late stage of SAON usually needs to be treated with joint replacement, while the costs and the prognosis of the surgery are challenge. It is important to perform the fundamental researches on the hip preservation treatments of SAON at early stage, and it is necessary to establish suitable animal models for studying the mechanisms of SAON and evaluating the potential treatments for the SAON. Rabbit SAON model is the most frequently used animal model. It is extensively used in studies on etiology and pathology of SAON. Furthermore, it is possible to evaluate potential drugs for preventing SAON and improving osteogenic repair of mid-stage SAON to prevent joint collapse. Because of bi-pedal, emu has the similar mechanical properties with human. Thus, it can be a suitable animal model for studying preventions and treatments of subchondral collapse of SAON, such as core-decompression with biodegradable materials for bone regeneration. In conclusion, this review updates the current animal SAON models with similar pathology to clinical SAON. These typical models could be used as clinical references for investigating drugs in prevention of early-stage of SAON and biomaterials in hip-preservation surgery for mid-stage of SAON.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1462-1469"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44331044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.006
Z. Bian, Yuan Guo, Gang Xu, Jie Yang, Jiangli Zhang, X. Lyu, Zheng Yang
Objective To investigate the methods and outcomes of surgical treatment for hip dislocation with cerebral palsy (CP) via soft tissue release, hip reduction and osteotomy. Methods Nineteen CP patients (male: 9, female: 10; total 23 hips) with hip dislocation underwent reconstructive surgery between April 2010 and December 2016. The average age was 12.5±2.4 years. There were 17 diplegic, 1 hemiplegic and 1 quadriplegic patient. Gross motor function classification system distribution were type I in 2 patients, type II in 10 patients, type III in 5 patients, type IV in 2 patients. Combine one-stage surgical procedures included soft tissue release, close or open reduction of hip joint and femoral varus shortening or de-rotational osteotomy and pelvic osteotomy. During the follow-up period, the clinical symptom and radiological parameters including Sharp angle and acetabular index were recorded. Results The average follow-up duration was 2.1 years (1-4.5 years). The radiological parameters were evaluated at one year postoperatively. The migration percentage corrected to 6%±8% from 68%±21% with statistically significant different (t=12.760, P<0.001). The mean Sharp angle was 42°±8.9°, which was statistically significant reduced compared with the pre-operative value 59°±6.1° (t=9.058, P<0.001). In 15 patients with triradiate cartilage open, the acetabular index also improved from 34°±8.7° pre-operatively to 18°±10° with statistical significance (t=5.598, P<0.001). Total of 15 patients had gained hip stability and improved functional status. Hip pain, which happened in 11 patients preoperatively, all had relieved after operation. Four patients had dissatisfied results and re-subluxation happened in 3 hips. All of them had CE angle <20° immediately after operation (average, 17°±2.6°), which was significantly different compared with average CE angle 32°± 8.0° in non-recurrence hips (t=3.143, P=0.005). One patient, who underwent proximal hamstring release, had decline of function status and contralateral hip dislocation. Conclusion Dislocation hips in CP patients can be effectively treated with one stage soft tissue release, hip reduction and femoral and pelvic osteotomy. The selection of osteotomy method is based on the age and pathological changes of patients. Key words: Cerebral palsy; Hip dislocation; Osteotomy
{"title":"One-stage treatment of hip dislocation with cerebral palsy via soft tissue release, hip reduction and osteotomy","authors":"Z. Bian, Yuan Guo, Gang Xu, Jie Yang, Jiangli Zhang, X. Lyu, Zheng Yang","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.006","url":null,"abstract":"Objective \u0000To investigate the methods and outcomes of surgical treatment for hip dislocation with cerebral palsy (CP) via soft tissue release, hip reduction and osteotomy. \u0000 \u0000 \u0000Methods \u0000Nineteen CP patients (male: 9, female: 10; total 23 hips) with hip dislocation underwent reconstructive surgery between April 2010 and December 2016. The average age was 12.5±2.4 years. There were 17 diplegic, 1 hemiplegic and 1 quadriplegic patient. Gross motor function classification system distribution were type I in 2 patients, type II in 10 patients, type III in 5 patients, type IV in 2 patients. Combine one-stage surgical procedures included soft tissue release, close or open reduction of hip joint and femoral varus shortening or de-rotational osteotomy and pelvic osteotomy. During the follow-up period, the clinical symptom and radiological parameters including Sharp angle and acetabular index were recorded. \u0000 \u0000 \u0000Results \u0000The average follow-up duration was 2.1 years (1-4.5 years). The radiological parameters were evaluated at one year postoperatively. The migration percentage corrected to 6%±8% from 68%±21% with statistically significant different (t=12.760, P<0.001). The mean Sharp angle was 42°±8.9°, which was statistically significant reduced compared with the pre-operative value 59°±6.1° (t=9.058, P<0.001). In 15 patients with triradiate cartilage open, the acetabular index also improved from 34°±8.7° pre-operatively to 18°±10° with statistical significance (t=5.598, P<0.001). Total of 15 patients had gained hip stability and improved functional status. Hip pain, which happened in 11 patients preoperatively, all had relieved after operation. Four patients had dissatisfied results and re-subluxation happened in 3 hips. All of them had CE angle <20° immediately after operation (average, 17°±2.6°), which was significantly different compared with average CE angle 32°± 8.0° in non-recurrence hips (t=3.143, P=0.005). One patient, who underwent proximal hamstring release, had decline of function status and contralateral hip dislocation. \u0000 \u0000 \u0000Conclusion \u0000Dislocation hips in CP patients can be effectively treated with one stage soft tissue release, hip reduction and femoral and pelvic osteotomy. The selection of osteotomy method is based on the age and pathological changes of patients. \u0000 \u0000 \u0000Key words: \u0000Cerebral palsy; Hip dislocation; Osteotomy","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1454-1461"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43555541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.001
Dewei Zhao
With the heavily application of steroid in the clinic, the incidence of steroid-induced osteonecrosis of the femoral head is also rapidly increasing. It is generally believed that steroid-induced osteonecrosis of the femoral head is the result of a various of pathological mechanisms. Clinical evidence suggests that the occurrence of osteonecrosis is highly correlated with the daily mean dose and cumulative dose of steroid. Patients don't always have osteonecrosis of the femoral head which may be related to the susceptibility of individual genes to steroid. Steroid-induced osteonecrosis of the femoral head is divided into three stages by pathomorphological, indicating the early, middle and late stage of blood supply changes. With the change of blood supply, the range of osteonecrosis is gradually increasing, and eventually leads to collapses. The earlier the osteonecrosis is found, the more selective the treatments regimen are. The prognosis will be often better with early diagnosis. Regulating the use of steroid can reduce the occurrence of osteonecrosis. Thus, we emphasize that the use of steroid in clinical settings should be cautious and regulated. Digital subtraction angiography can be used to assess early osteonecrosis of the femoral head. According to the assessment of progression of disease, the drug or the corresponding surgical procedure will be selected. Steroid-induced osteonecrosis of the femoral head can achieve good clinical results through early detection and early treatments.
{"title":"Prevention and early treatments of steroid-induced osteonecrosis of the femoral head","authors":"Dewei Zhao","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.001","url":null,"abstract":"With the heavily application of steroid in the clinic, the incidence of steroid-induced osteonecrosis of the femoral head is also rapidly increasing. It is generally believed that steroid-induced osteonecrosis of the femoral head is the result of a various of pathological mechanisms. Clinical evidence suggests that the occurrence of osteonecrosis is highly correlated with the daily mean dose and cumulative dose of steroid. Patients don't always have osteonecrosis of the femoral head which may be related to the susceptibility of individual genes to steroid. Steroid-induced osteonecrosis of the femoral head is divided into three stages by pathomorphological, indicating the early, middle and late stage of blood supply changes. With the change of blood supply, the range of osteonecrosis is gradually increasing, and eventually leads to collapses. The earlier the osteonecrosis is found, the more selective the treatments regimen are. The prognosis will be often better with early diagnosis. Regulating the use of steroid can reduce the occurrence of osteonecrosis. Thus, we emphasize that the use of steroid in clinical settings should be cautious and regulated. Digital subtraction angiography can be used to assess early osteonecrosis of the femoral head. According to the assessment of progression of disease, the drug or the corresponding surgical procedure will be selected. Steroid-induced osteonecrosis of the femoral head can achieve good clinical results through early detection and early treatments.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1421-1423"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41921872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.002
Wei-min Fu, Bao‐yi Liu, Ben-Jie Wang
Objective To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). Methods Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. Results All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. Conclusion The SONFH can be diagnosed early by screening, and is treated by different reserving
{"title":"Preserving hip treatment of steroid-induced osteonecrosis of the femoral head","authors":"Wei-min Fu, Bao‐yi Liu, Ben-Jie Wang","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.002","url":null,"abstract":"Objective \u0000To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. \u0000 \u0000 \u0000Results \u0000All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. \u0000 \u0000 \u0000Conclusion \u0000The SONFH can be diagnosed early by screening, and is treated by different reserving","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1424-1431"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42970178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.22.005
Yonghui Dong, Ang Li, Z. Dai, Shengjie Wang, Wendi Zheng, Weiyu Pan, Yi Jin, Ke Liu, Jiajun Zhao
Objective To establish a mouse model of osteoarthritis (OA) and study the bone microarchitecture and bone metabolism of tibial subchondral bone in early stage of OA. Methods The mouse model of post-traumatic osteoarthritis (PTOA) with anterior cruciate ligament (ACLT) was established by using c57 mice. The Sham operation group served as the control group. All mice were fed with conventional diet. All mice were sacrificed after 4 weeks. The degeneration of knee joint was observed by HE staining and Safranin O-Fast Green staining. The number of osteoclasts was counted by TRAP staining. Micro CT was used to analyze the quantitative parameters of the microstructure of tibia subchondral bone in mice. Serum levels of bone resorption biomarker CTX I and cartilage degeneration marker CTX II were determined. Results After ACLT 4 weeks, the average score of OARSI in ACLT group was 3.2, which was higher than that in Sham group, and the joint degeneration occurred in mice, presenting the pathological characteristics of early OA. Compared with the sham operation phase, the total subchondral bone volume (TV) of ACLT group was 4.72 mm3, increased by 13.6%; the bone trabecular resolution (Tb.Sp) was 0.130 and 0.154 mm, respectively, and the ACLT group also increased by 18.8%; the bone volume/tissue volume (BV/TV) was 0.470 and 0.294, respectively, and the ACLT group decreased by 48.9%; the bone trabecular thickness (Tb.Th) was 0.162 and 0.083 mm groups, ACLT decreased by 37.5%. Trap staining showed that the number of osteoclasts per unit volume in ACLT group was 72, which was significantly higher than that in sham operation group. The CTX I of mice in the sham operated ACLT group and sham operated group were 20.9 ng/ml and 18.29 ng/ml, with an increase of 48.9% in the ACLT group; the CTX II of mice in the ACLT group and sham operated group were 35.5 ng/ml and 28.6 ng/ml, with an increase of 24.1% in the ACLT group. Conclusion ACLT Mouse model can successfully construct early OA, which confirms the early loss of osteochondral bone and the pathological changes of osteoclast activation in OA, and provides a new specific target for the treatment of OA. Key words: Anterior cruciate ligament; Osteoarthritis; Cartilage, articular; Osteoclasts
{"title":"Experimental research on the change of subchondral bone microstructure in early stage of mouse osteoarthritis","authors":"Yonghui Dong, Ang Li, Z. Dai, Shengjie Wang, Wendi Zheng, Weiyu Pan, Yi Jin, Ke Liu, Jiajun Zhao","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.22.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.22.005","url":null,"abstract":"Objective \u0000To establish a mouse model of osteoarthritis (OA) and study the bone microarchitecture and bone metabolism of tibial subchondral bone in early stage of OA. \u0000 \u0000 \u0000Methods \u0000The mouse model of post-traumatic osteoarthritis (PTOA) with anterior cruciate ligament (ACLT) was established by using c57 mice. The Sham operation group served as the control group. All mice were fed with conventional diet. All mice were sacrificed after 4 weeks. The degeneration of knee joint was observed by HE staining and Safranin O-Fast Green staining. The number of osteoclasts was counted by TRAP staining. Micro CT was used to analyze the quantitative parameters of the microstructure of tibia subchondral bone in mice. Serum levels of bone resorption biomarker CTX I and cartilage degeneration marker CTX II were determined. \u0000 \u0000 \u0000Results \u0000After ACLT 4 weeks, the average score of OARSI in ACLT group was 3.2, which was higher than that in Sham group, and the joint degeneration occurred in mice, presenting the pathological characteristics of early OA. Compared with the sham operation phase, the total subchondral bone volume (TV) of ACLT group was 4.72 mm3, increased by 13.6%; the bone trabecular resolution (Tb.Sp) was 0.130 and 0.154 mm, respectively, and the ACLT group also increased by 18.8%; the bone volume/tissue volume (BV/TV) was 0.470 and 0.294, respectively, and the ACLT group decreased by 48.9%; the bone trabecular thickness (Tb.Th) was 0.162 and 0.083 mm groups, ACLT decreased by 37.5%. Trap staining showed that the number of osteoclasts per unit volume in ACLT group was 72, which was significantly higher than that in sham operation group. The CTX I of mice in the sham operated ACLT group and sham operated group were 20.9 ng/ml and 18.29 ng/ml, with an increase of 48.9% in the ACLT group; the CTX II of mice in the ACLT group and sham operated group were 35.5 ng/ml and 28.6 ng/ml, with an increase of 24.1% in the ACLT group. \u0000 \u0000 \u0000Conclusion \u0000ACLT Mouse model can successfully construct early OA, which confirms the early loss of osteochondral bone and the pathological changes of osteoclast activation in OA, and provides a new specific target for the treatment of OA. \u0000 \u0000 \u0000Key words: \u0000Anterior cruciate ligament; Osteoarthritis; Cartilage, articular; Osteoclasts","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1392-1398"},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48523583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.22.007
Shuang Cong, Shaohua Liu, Yaying Sun, Zheci Ding
Femoroacetabular impingement (FAI) is a common cause of hip pain and limited range of motion among young and middle-aged active adults and athletes. The acetabular labral tear and cartilage damage secondary to FAI may increase the risk of hip osteoarthritis. FAI is characterized by pathologic impact between the femoral headneck junction and the acetabular rim secondary to bony deformity. According to the pathological anatomy leading to impingement, the FAI can be divided into the femoral cam-type deformity (Cam), the acetabular over-coverage deformity (Pincer) and a combination of both. In recent years, arthroscopic osteoplasty of the femoral head-neck junction is the main way to treat the Cam deformity; However, there still remain some controversies about how to perform an adequate and effective arthroscopic femoroplasty. Based on this problem, the present article reviewed the preoperative diagnosis, intraoperative evaluation, surgical techniques and postoperative evaluation of Cam-type FAI to explore how to adequately correct Cam deformity under arthroscopy. In the present study, a total of 1928 related articles were obtained by searching PubMed, Web of Science, Cochrane library, China Knowledge Network, Wanfang Full-text Database and Weipu Science and Technology Journal Database. According to the inclusion and exclusion criteria, 43 papers were finally included. After summarizing the above literatures, it was found that anatomical structures such as Cam deformity, femoral neck anteversion, and acetabular coverage can be evaluated preoperatively by X-ray, three-dimensional CT and MRI. X-ray fluoroscopy and arthroscopic dynamic examination are performed during the femoroplasty to locate the Cam deformity and to determine whether the femoral neck offset radio and the spherical structure of femoral head are corrected, at the same time, it is necessary to consider the overall anatomy of the hip joint to achieve an adequate resection of the Cam deformity and restore the normal mobility of the hip joint.
股骨髋臼撞击(FAI)是青壮年和中年活跃的成年人和运动员髋关节疼痛和活动范围受限的常见原因。髋臼唇撕裂和软骨损伤继发于FAI可增加髋骨关节炎的风险。FAI的特点是继发于骨畸形的股骨头颈交界处和髋臼缘之间的病理性冲击。根据导致撞击的病理解剖，FAI可分为股骨凸轮型畸形(Cam)、髋臼过度覆盖畸形(Pincer)以及两者的组合。近年来，关节镜下股骨头颈交界处成形术是治疗Cam畸形的主要方法;然而，如何进行充分有效的关节镜股骨成形术仍存在一些争议。针对这一问题，本文对Cam型FAI的术前诊断、术中评价、手术技术及术后评价进行综述，探讨如何在关节镜下充分矫正Cam畸形。本研究通过检索PubMed、Web of Science、Cochrane图书馆、中国知识网、万方全文库和卫普科技期刊库，共获得相关文献1928篇。根据纳入和排除标准，最终纳入43篇论文。综合以上文献，我们发现术前可通过x线、三维CT及MRI对凸轮畸形、股骨颈前倾、髋臼覆盖等解剖结构进行评估。股骨头成形术中通过x线透视和关节镜下的动态检查定位Cam畸形，确定股骨颈偏置和股骨头球形结构是否得到矫正，同时需要考虑髋关节的整体解剖结构，以达到充分切除Cam畸形，恢复髋关节的正常活动能力。
{"title":"Arthroscopic treatment of Cam-type femoroacetabular impingement","authors":"Shuang Cong, Shaohua Liu, Yaying Sun, Zheci Ding","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.22.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.22.007","url":null,"abstract":"Femoroacetabular impingement (FAI) is a common cause of hip pain and limited range of motion among young and middle-aged active adults and athletes. The acetabular labral tear and cartilage damage secondary to FAI may increase the risk of hip osteoarthritis. FAI is characterized by pathologic impact between the femoral headneck junction and the acetabular rim secondary to bony deformity. According to the pathological anatomy leading to impingement, the FAI can be divided into the femoral cam-type deformity (Cam), the acetabular over-coverage deformity (Pincer) and a combination of both. In recent years, arthroscopic osteoplasty of the femoral head-neck junction is the main way to treat the Cam deformity; However, there still remain some controversies about how to perform an adequate and effective arthroscopic femoroplasty. Based on this problem, the present article reviewed the preoperative diagnosis, intraoperative evaluation, surgical techniques and postoperative evaluation of Cam-type FAI to explore how to adequately correct Cam deformity under arthroscopy. In the present study, a total of 1928 related articles were obtained by searching PubMed, Web of Science, Cochrane library, China Knowledge Network, Wanfang Full-text Database and Weipu Science and Technology Journal Database. According to the inclusion and exclusion criteria, 43 papers were finally included. After summarizing the above literatures, it was found that anatomical structures such as Cam deformity, femoral neck anteversion, and acetabular coverage can be evaluated preoperatively by X-ray, three-dimensional CT and MRI. X-ray fluoroscopy and arthroscopic dynamic examination are performed during the femoroplasty to locate the Cam deformity and to determine whether the femoral neck offset radio and the spherical structure of femoral head are corrected, at the same time, it is necessary to consider the overall anatomy of the hip joint to achieve an adequate resection of the Cam deformity and restore the normal mobility of the hip joint.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1405-1412"},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45505235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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