图 核磁共振显示胫骨近端BME的冠状、矢状和横断面影像。Subchondral Bone Marrow Edema Had Greater Effect on Postoperative Pain After Medial Unicompartmental Knee Arthroplasty Than Total Knee ArthroplastyBackground: Although the relationship between pain and bone marrow edema (BME) in the osteoarthritic knee has been established, little is known about the effect of preoperative BME on postoperative outcomes after knee arthroplasty or if the inflfluence of BME on postoperative outcomes differs between medial unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The purpose of this study was to compare pain, patient satisfaction, and revision rates between medial UKA and TKA patients with and without magnetic resonance imaging evidence of BME in the proximal tibia.Methods: We identifified 71 patients (72 knees) from our prospective outcomes database with magnetic resonance images taken before undergoing either medial UKA or TKA and recorded the absence or presence of tibial BME. We then compared preoperative and postoperative Knee Society pain scores, patient satisfaction, and revisions between groups of UKA and TKA patients with or without preoperative tibial BME.Results: Pain scores for UKA patients with BME were worse both before and after surgery, whereas TKA patients with BME demonstrated greater postoperative improvements in pain scores when compared to TKA patients without BME. Similarly, signifificantly fewer UKA patients with BME were satisfified with their procedure than those without BME (8/11, 73% vs 17/17, 100%; P = .05), but BME did not affect patient satisfaction after TKA.Conclusion: Preoperative BME did not inflfluence TKA outcomes; however, pain scores for UKA patients with BME were worse both before and after surgery and fewer UKA patients with preoperative tibial BME were satisfified with their surgery.文献出处：Jacobs CA, Christensen CP, Karthikeyan T. Subchondral Bone Marrow Edema Had Greater Effect on Postoperative Pain After Medial Unicompartmental Knee Arthroplasty Than Total Knee Arthroplasty. J Arthroplasty. 2016 Feb;31(2):491-4. doi: 10.1016/j.arth.2015.09.023. Epub 2015 Sep 26. PMID: 26474951.文献2全髋关节置换术中理想下肢长度矫正方法译者：马云青目的：全髋关节置换术后双下肢不等长（LLD）是患者术后常见的不满原因。此研究的目的是确定一种最佳下肢长度差目标值。方法：回顾性分析132例患者的影像学不等长(R-LLD)、患者自身感觉不等长(P-LLD)，以及患者术后是否对下肢不等长有不适感。结果：所有患者的不等长不适感发生率为9.1%(12/132例)，其中10例因腿长过长而感到不适。当R-LLD在7mm以内时，发病率为6.8%(8/118例)，与R-LLD在2mm以内时的发病率7.8%(5/64例)相当。另一方面，当R-LLD为8mm或8mm以上时，发生率为57.1%(4/7例)。结论：研究结果表明，7mm可能是一个合理的双下肢不等长阈值，控制双下肢长度差在阈值以内可以减少患者不适感。然而，即使只有很少或根本没有LLD，一些患者仍然会感到不适。作者认为这是因为在此种情况下，患者手术前R-LLD和P-LLD本身存在差异。如果患者在手术前患侧髋关节有骨盆偏斜，并且存在腰椎向对侧髋关节侧凸，此时理想的长度可能比影像学双下肢等长短一点，因为这些患者可能感觉到腿的长度比放射片显示的要长。Optimizing leg length correction in total hip arthroplastyPurpose: Residual feeling of leg length discrepancy (LLD) is a common cause of patient dissatisfaction following total hip arthroplasty (THA). The purpose of this study is to propose a method for determining an optimal leg length correction goal in THA.Methods: We conducted a retrospective study of 132 patients to examine the radiographic LLD (R-LLD), perceived LLD (P-LLD), and whether or not the patient has an uncomfortable feeling about the leg length after THA.Results: The residual discomfort rate in all patients was 9.1% (12/132 patients), and ten of these 12 patients felt uncomfortable due to a longer leg length. When R-LLD was within 7 mm, the rate was 6.8% (8/118 patients), which is nearly equal to the rate of 7.8% (5/64 patients) in cases in which R-LLD was within 2 mm. On the other hand, when R-LLD was 8 mm or more, the rate was 57.1% (4/7 patients).Conclusions: The results of our study show that 7 mm may be a reasonable threshold for reducing the residual discomfort. However, even with little or no R-LLD, some patients will continue to experience discomfort. We think that this is because of pre-operative differences between R-LLD and P-LLD in such cases. If the patient has a pelvic declination on the affected hip side and a lumbar scoliosis angle that is convex toward the affected hip side before surgery, the ideal length may be a little shorter than the radiographic isometry, since such patients are likely to feel a longer leg length than that shown radiographically.文献出处：Fujita K, Kabata T, Kajino Y, Tsuchiya H. Optimizing leg length correction in total hip arthroplasty. Int Orthop. 2020 Mar;44(3):437-443. doi: 10.1007/s00264-019-04411-0. Epub 2019 Oct 9. PMID: 31595310.文献3曾有膝关节感染性关节炎病史的患者接受初次全膝关节置换手术的疗效分析：一项病例对照研究译者：张蔷背景：膝关节感染会对关节造成不可逆的损伤，从而增加未来接受膝关节置换（TKA）的概率。本篇文章的目的是评估曾有膝关节感染性关节炎病史的患者接受初次全膝关节置换手术后中期随访时的假体周围感染（PJI）率，无菌性翻修率以及再手术率，并与单纯因骨关节炎而接受手术的病例进行比较。方法：我们从单一医疗中心回顾性选择1971年至2016年间共215例有既往膝关节感染性关节炎病史的初次全膝关节置换病例。另外，我们按1:1匹配的条件下选择了另外一组单纯膝关节骨关节炎的患者，组间年龄、性别、BMI及手术时间可比。平均年龄63岁，平均BMI 30kg/m2，平均随访时间9年。
既往感染性关节炎病史，现需膝关节置换病例的术前正侧位片结果：感染性关节炎组10年除外PJI的假体生存率为90%，而骨关节炎组为99%（HR=6.1; p<0.01< span=''>）。10年除外无菌性翻修的假体生存率分别为83%和93%（HR=2.5; p<0.01< span=''>）。而10年除外任何再手术的假体生存率分别为61%和84%（HR=2.9; p<0.01< span=''>）。此外，感染性关节炎到TKA的间隔时间越长，后续继发感染的相对风险越低。术前和术后2年的KSS评分组间近似（p=0.16和p=0.19）。结论：有既往膝关节感染性关节炎病史的患者接受初次全膝关节置换手术后出现假体周围感染的概率是单纯因骨关节炎而接受置换手术患者的6.1倍，10年随访时累积概率为9%。亚组分析显示感染性关节炎和初次置换间隔时间在5-7年以内的病例出现感染的概率显著高于间隔时间更长的病例。此外，感染性关节炎组除外无菌性翻修、任意翻修或任意再手术的10年假体生存率也显著低于对照组。Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee: A Case-Control StudyBackground: Septic arthritis of the native knee often results in irreversible joint damage leading to the need for total knee arthroplasty (TKA). The purpose of the present study was to examine the intermediate-term risk of periprosthetic joint infection (PJI), aseptic revision, and reoperation following primary TKA in patients with a history of septic arthritis of the native knee as compared with primary TKA performed for the treatment of osteoarthritis.Methods: We retrospectively identified 215 primary TKAs performed from 1971 to 2016 at a single institution in patients with a history of septic arthritis of the native knee. Each case was matched 1:1 based on age, sex, body mass index (BMI), and surgical year to a TKA for osteoarthritis. The mean age and BMI were 63years and 30kg/m2, respectively. The meanduration of follow-up was 9 years.Results: Survivorships free of PJI at 10 years were 90% and 99% for the septic arthritis and osteoarthritis groups, respectively (hazard ratio [HR] = 6.1; p<0.01).< span=''> Ten-year survivorships free of any aseptic revisions were 83% and 93% (HR = 2.5; p<0.01), and survivorships free of any reoperation were 61% and 84% (HR = 2.9; p<0.01) for the septic arthritis and osteoarthritis groups, respectively. In addition, as time from the diagnosis of native knee septic arthritis to TKA increased, the relative risk of subsequent infection decreased. Preoperative and 2-year postoperative Knee Society scores were similar between the groups (p=0.16 and p=0.19, respectively).Conclusions: There was a 6.1-fold increased risk of PJI in patients undergoing TKA with a history of native knee septicarthritis when compared with controls undergoing TKA for the treatment of osteoarthritis, with a cumulative incidence of 9% at 10 years. Subgroup analysis of the septic arthritis cohort revealed a higher risk of any infection in patients who underwent TKA within the first 5 to 7 years after the diagnosis of septic arthritis as compared with those with a greater duration. Moreover, the 10-year rates of survival free of aseptic revision, any revision, and any reoperation were significantly worse in the native knee septic arthritis cohort.文献出处：Jacob W. Bettencourt, BS, Cody C. Wyles, MD, Kristin M. Fruth, BS, Douglas R. Osmon, MD, Arlen D. Hanssen, MD, Daniel J. Berry, MD, and Matthew P. Abdel, MD. Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee: A Case-Control Study. J Bone Joint Surg Am. 2021;00:1-8 d http://dx.doi.org/10.2106/JBJS.20.01678文献4层状双氢氧化物改性骨水泥通过多种成骨信号通路促进骨整合译者：沈松坡聚甲基丙烯酸甲酯(PMMA)骨水泥已广泛应用于骨科手术，包括全髋关节/膝关节置换术、椎体压缩性骨折治疗和骨缺损修复。然而，PMMA骨水泥与骨之间界面的无菌性松动往往导致失败。因此，开发能促进骨生长的改性PMMA骨水泥是降低无菌性松动发生率的关键。本研究合成了具有良好骨结合性能的镁-铝层状双氢氧化物(LDH)微片改性PMMA (PMMA&LDH)骨水泥。PMMA&LDH的最大聚合反应温度比PMMA和PMMA& COL -I(矿化胶原I改性PMMA)的最大聚合反应温度分别降低了7.0和11.8℃。与PMMA相比，PMMA& LDH的力学性能略有下降，有利于缓解应力屏蔽性骨溶解，间接促进骨融合。PMMA& LDH在体内的优越成骨能力已被证明，与PMMA & COL-I和PMMA组相比，PMMA&LDH在术后2个月促进骨生长增加了2.17倍和18.34倍。此外，转录组测序揭示了4种关键成骨通路: p38 MAPK、ERK/MAPK、FGF和TGF-β， IPA、qPCR和Western blot进一步证实了这4种通路。因此，LDH改性的PMMA骨水泥是一种很有前途的生物材料，可以促进骨生长，并在相关的骨科手术中有潜在的应用前景。Layered Double Hydroxide Modified Bone Cement Promoting Osseointegration via Multiple Osteogenic Signal PathwaysPoly(methyl methacrylate) (PMMA) bone cement has been widely used in orthopedic surgeries including total hip/knee replacement, vertebral compression fracture treatment, and bone defect filling. However, aseptic loosening of the interface between PMMA bone cement and bone often leads to failure. Hence, the development of modified PMMA that facilitates the growth of bone into the modified PMMA bone cement is key to reducing the incidence of aseptic loosening. In this study, MgAl-layered double hydroxide (LDH) microsheets modified PMMA (PMMA&LDH) bone cement with superior osseointegration performance has been synthesized. The maximum polymerization reaction temperature of PMMA&LDH decreased by 7.0 and 11.8 °C, respectively, compared with that of PMMA and PMMA&COL-I (mineralized collagen I modified PMMA). The mechanical performance of PMMA&LDH decreased slightly in comparison with PMMA, which is beneficial to alleviate stress-shielding osteolysis, and indirectly promote osseointegration. The superior osteogenic ability of PMMA&LDH has been demonstrated in vivo, which boosts bone growth by 2.17- and 18.34-fold increments compared to the PMMA&COL-I and PMMA groups at 2 months, postoperatively. Moreover, transcriptome sequencing revealed four key osteogenic pathways: p38 MAPK, ERK/MAPK, FGF, and TGF-β, which were further confirmed by IPA, qPCR, and Western blot assays. Hence, LDH-modified PMMA bone cement is a promising biomaterial to enhance bone growth with potential applications in relevant orthopedic surgeries.文献出处：Wang Y, Shen S, Hu T, Williams GR, Bian Y, Feng B, Liang R, Weng X. Layered Double Hydroxide Modified Bone Cement Promoting Osseointegration via Multiple Osteogenic Signal Pathways. ACS Nano. 2021 Jun 22;15(6):9732-9745. doi: 10.1021/acsnano.1c00461. Epub 2021 Jun 4. PMID: 34086438.文献5髋关节骨关节炎病人脊柱骨盆力线：一项与腰痛病人的影像学对比研究译者：张峻目的：研究髋关节骨关节炎（HOA）和腰痛（LBP）病人的脊柱骨盆力线，同时明确两组病人力线特征及差异。背景资料摘要：髋脊柱综合征，最早由Offerski和MacNab描述，是治疗腰痛和下肢疼痛的重要病理学依据。然而，尽管它是一个众所周知的疾病，充分研究和评估髋脊柱综合征病人脊柱骨盆力线的论文很少。方法：对150例HOA病人和150例LBP病人进行全脊柱正位和侧位的矢状位和冠状位脊柱骨盆力线检查。本研究中测量的参数为侧位片上的腰椎前凸角（LL）、骶骨倾斜角（SS）、C7矢状铅锤线的移位、骨盆入射角（PI）和骨盆倾斜角（PT）。在前后位（AP）片上，测量腰椎侧弯、骨盆倾斜、下肢不等长、冠状位C7铅垂线移位和Sharp角。比较两组的各项指标。在HOA病人中，还分析了Sharp角与其它参数之间的关系，以阐明矢状位和冠状位脊柱骨盆对无髋臼发育不良的HOA的可能影响。结果：LBP组LL、SS、PI、PO明显低于HOA组，两组间LS无显著性差异。在HOA病人中PI明显更高，并且与PT、SS和LL密切相关（随着PI的增加，PT、SS和LL也增加）。HOA病人的Sharp角也明显增大，且与年龄、LL和SS密切相关（即，随着Sharp角的增大，LL和SS也随之增大）；然而，髋部病人的年龄有所下降。结论：这些发现提示年轻人中PI较高的个体在以后的生活中可能发展为HOA，即使不存在腰椎后凸和髋臼发育不良导致的髋臼前覆盖不足。我们期望将会有更多的关于髋脊柱综合征病人的脊柱骨盆力线研究问世。Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back painObjectives: To investigate the spinopelvic alignment in patients with osteoarthosis of the hip (HOA) and those with low back pain (LBP) and to determine the characteristics and differences in both groups.Summary of background data: Hip-spine syndrome, first described by Offierski and MacNab, is quite an important pathology when treating patients with pain in their low back and lower extremities. However, despite it being a well-known entity, few papers have adequately investigated and assessed the spinopelvic alignment in patients with hip-spine syndrome.Methods: Sagittal and coronal spinopelvic alignments were investigated in 150 patients with HOA and 150 with LBP using radiographs of the whole spine in both anteroposterior and lateral views. Parameters measured in this study were lumbar lordosis (LL), sacral slope (SS), the shift of the sagittal C7 plumb line, pelvic incidence (PI), and pelvic tilt (PT) on the lateral radiographs. On the anteroposterior (AP) films, lumbar scoliosis, pelvic obliquity, leg length discrepancy, the shift of the coronal C7 plumb line, and Sharp angle were measured. These parameters were compared between the two groups. In patients with HOA, the relationships between Sharp angle and other parameters were also analyzed to clarify the possible influence of sagittal and coronal spinopelvic alignments on HOA without acetabular dysplasia.Results: LL, SS, PI, and PO were found to be less in patients with LBP compared with those with HOA, and there was no significant difference in LS between the two groups. PI was significantly greater in HOA patients and strongly correlated to PT, SS, and LL (i.e., as the PI increased so did the PT, SS, and LL). Sharp angles were also significantly greater in HOA patients and strongly correlated to age, LL and SS (i.e., as Sharp angles increased so did LL and SS); however, age decreased in the hip patients.Conclusions: These findings suggest that higher PI in the younger individual may contribute to the development of HOA in later life without both lumbar kyphosis and acetabular dysplasia because of the anterior uncovering of the acetabulum. More investigation will be expected to analyze the spinopelvic alignment in patients with hip spine syndrome.文献出处：Yoshimoto H, Sato S, Masuda T, Kanno T, Shundo M, Hyakumachi T, Yanagibashi Y. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005 Jul 15;30(14):1650-7. doi: 10.1097/01.brs.0000169446.69758.fa. PMID: 16025036.第二部分：保髋相关文献文献1对日本多发骨软骨瘤病外显子1和外显子2大范围突变分析译者：罗殿中背景：多发骨软骨瘤病（MO）是常染色体异常引起的骨骼异常，其特征是多发骨软骨瘤形成，外显子1（EXT1）和外显子2（EXT2）突变是引起多发骨软骨瘤病（MO）的主要致病因素。本研究中，我们对日本多发骨软骨瘤病（MO）的基因背景和突变类型进行了研究。结果：我们对71个家庭中112例MO患者进行了研究。从外周血白细胞中获取基因组DNA，通过PCR扩增，直接确定EXT1和EXT2外显子、及外显子/内含子连接区。47个家庭中52例MO患者突变来自EXT1或EXT2；其中42.3%（22例/52患者中）的突变是新发生突变。29个家庭（40.8%）突变发生于EXT1，15个家庭（21.1%）突变发生于EXT2。值得主意的是3个家庭（4.2%）EXT1和EXT2均发生突变。24个家庭（33.8%）EXT1和EXT2均未发生突变。基于对这些突变类型的认识，59.6%为非活跃突变；38.5%为错误/错配突变。结论：我们发现在日本MO家庭中，EXT1突变占多数，较EXT2突变多。另外我们发现在这一组日本MO病例中，22例为新发生的EXT1或EXT2突变。本研究表明，MO的基因型是多样的。Large-scale mutational analysis in the EXT1 and EXT2 genes for Japanese patients with multiple osteochondromasBackground: Multiple osteochondroma (MO) is an autosomal dominant skeletal disorder characterized by the formation of multiple osteochondromas, and exostosin-1 (EXT1) and exostosin-2 (EXT2) are major causative genes in MO. In this study, we evaluated the genetic backgrounds and mutational patterns in Japanese families with MO.Results: We evaluated 112 patients in 71 families with MO. Genomic DNA was isolated from peripheral blood leucocytes. The exons and exon/intron junctions of EXT1 and EXT2 were directly sequenced after PCR amplification. Fifty-two mutations in 47 families with MO in either EXT1 or EXT2, and 42.3% (22/52) of mutations were novel mutations. Twenty-nine families (40.8%) had mutations in EXT1, and 15 families (21.1%) had mutations in EXT2. Interestingly, three families (4.2%) had mutations in both EXT1 and EXT2. Twenty-four families (33.8%) did not exhibit mutations in either EXT1 or EXT2. With regard to the types of mutations identified, 59.6% of mutations were inactivating mutations, and 38.5% of mutations were missense mutations.Conclusions: We found that the prevalence of EXT1 mutations was greater than that of EXT2 mutations in Japanese MO families. Additionally, we identified 22 novel EXT1 and EXT2 mutations in this Japanese MO cohort. This study represents the variety of genotype in MO.文献出处：Ishimaru D, Gotoh M, Takayama S, Kosaki R, Matsumoto Y, Narimatsu H, Sato T, Kimata K, Akiyama H, Shimizu K, Matsumoto K. Large-scale mutational analysis in the EXT1 and EXT2 genes for Japanese patients with multiple osteochondromas. BMC Genet. 2016 Mar 9;17:52. doi: 10.1186/s12863-016-0359-4. PMID: 26961984; PMCID: PMC4784393.文献2170例无症状髋关节各种髋臼角度的CT参考值及变异度译者：程徽背景：髋臼角的参考值目前尚不明确。目的：明确髋臼CE角、臼顶倾斜角、髋臼前扇形角、髋臼后扇形角和髋臼前倾角的参考值及变异度，并探讨这些数值是否存在性别差异。材料和方法：回顾性研究，我们招募了96名志愿者，其中女性52名，男性44名(平均年龄63±12岁)。志愿者均于2013年在奥尔胡斯大学医院因为淋巴瘤而进行CT检查。我们对所有志愿者CT检查之后进行牛津髋关节评分。志愿者中11人被排除，包括表示有髋关节问题8人，数据缺失3人。。由经验丰富的放射科医生在CT图像上测量双髋的角度。用均数±标准差报告左右髋关节各种角度，并用双样本t检验对女性和男性进行比较。
图1 在髋关节CT上测量髋臼角度 A.在股骨头的正中冠状面，以两股骨头中点连线为基准测量右髋的臼顶倾斜角和左髋的外侧CE角 B. 在股骨头的正中水平面以两股骨头中点连线为基准测量前扇形角 C.后扇形角 和 D.髋臼前倾角结果：所有髋关节左右两侧平均CE角分别为34±6，35±5；平均臼顶倾斜角分别为3±6，1±5；平均髋臼前扇形角分别为 58±7，60±9；平均髋臼后扇形角分别为94±7，95±7；平均髋臼前倾角分别为18±5，18±5。与男性相比，女性的髋臼前扇形角较小，而髋臼后扇形角和髋臼前倾角较大。结论：我们发现不同人的髋臼各种角度存在相当大的差异。髋臼前后扇形角和髋臼前倾角存在性别差异。明确正常参考值对诊断髋关节疾患价值很大。Reference values and variation of acetabular angles measured by computed tomography in 170 asymptomatic hipsBackground: We have little knowledge of reference values for acetabular angles.Purpose: The purpose of this study was to report values and variation for the center-edge (CE), the acetabular-index (AI), the anterior-sector (AASA), the posterior-sector (PASA), and the acetabular-anteversion angle (AcAV) and to investigate gender differences.Material and Methods: Retrospectively, we recruited 96 individuals, 52 women (mean age¼6312 years) who hadundergone computed tomography (CT) as part of examination for lymphomas in 2013 at Aarhus University Hospital. After CT, the participants completed the Oxford Hip Score. Eight individuals indicated hip problems and three had missing data; those 11 were excluded from the material. The acetabular angles for both hips were measured on CT images by an experienced radiologist. The acetabular angles are reported for right and left hip as meanSD degrees and compared women and men with a two-sample t-test.Results: The CE angle [right;left] averaged [346;355]. The AI angle averaged [36;15]. The AASA averaged [587;609]. The PASA averaged [947;957]. The AcAV averaged [185;185]. The AASA was lower whereas the PASA and the ACAV were higher for women compared to men.Conclusion: We found considerable variation in the values for acetabular angles. There were gender differences in the sector angles and for the AcAV. Knowledge of reference values is important when we attempt to diagnose the pathological hip conditions.文献出处：Mechlenburg I, Stilling M, Rømer L, de Bruijne M, Søballe K, de Raedt S. Reference values and variation of acetabular angles measured by computed tomography in 170 asymptomatic hips. Acta Radiol. 2019 Jul;60(7):895-901. doi: 10.1177/0284185119831688. Epub 2019 Feb 28. PMID: 30818980.文献3临界髋关节发育不良的髋关节镜翻修术：术后至少2年随访的结果，并与匹配的非发育不良对照组进行亚组分析译者：肖凯背景：临界髋关节发育不良患者的髋关节镜手术仍存在争议。更有争议的是如何进行这些髋关节手术失败的后续治疗。目前文献中关于关节镜翻修术后预后的研究很少。目的：(1) 报告接受髋关节镜翻修术的临界发育不良患者术后最少2年的患者自我评分(PRO)，以及 (2) 比较与无发育不良对照组的PRO差异。方法：前瞻性收集了2009年8月至2017年11月间的数据。纳入标准是髋关节镜翻修术，进行了关节囊紧缩缝合，有基线和术后最短2年的的PRO，包括改良Harris评分（mHHS）、非关节炎髋关节评分（NAHS)、髋关节预后评分-运动分量表 (HOS-SSS) 和疼痛VAS评分。排除了Tönnis等级>1或既往髋关节疾病患者。设立了两个组：临界发育不良组（外侧中心边缘角 [LCEA]，18°-25°）和没有发育不良的对照组（LCEA，25°-40°）。根据性别、年龄、体重指数和随访时间按1:3的比例进匹配对照组。结果：在研究期间，共有21例（22髋）临界发育不良患者行髋关节镜翻修术，且进行了至少2年的随访。该组中的患者报告所有PRO与基线相比都有显着改善，有70%的达到了mHHS最小临床重要差异 (MCID)。21个临界发育不良髋关节共匹配了63个对照髋关节。研究组和对照组的平均LCEA分别为22.6 ± 1.7和32.0 ± 5.0。两组患者的所有PRO改善程度类似。mHHS和VAS达到MCID的比例相似；然而，对照组的HOS-SSS和NAHS达到 MCID的比例更高（分别为 P = .042 和 P = .025）。对照组中转换为髋关节置换术的比例为 7.9% (n = 5)，而临界发育不良组为23.8% (n = 5) (P = .052)。对照组再次行髋关节镜翻修术率为11.1% (n = 7)，临界发育不良组为19.0% (n = 4) (P = .350)。结论：髋关节镜翻修术后至少2年的随访中，临界发育不良患者的所有PRO均获得显着改善。此外，预后、患者满意度、mHHS和VAS达到MCID的比例以及二次手术的比例与对照组相似。然而，临界发育不良患者翻修术有是否需要应当行更高级的手术，还需要对患者进行综合评估后决定。Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control GroupBackground: Hip arthroscopy in patients with borderline dysplasia continues to be surrounded by controversy. Even more controversial is the management of the failed hip arthroscopy in this population. There is a paucity of studies in contemporary literature regarding outcomes after arthroscopic revision surgery.Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores in patients with borderline dysplasia who underwent revision hip arthroscopy and (2) to compare these PRO scores with those of a propensity-matched control group without dysplasia who underwent revision hip arthroscopy.Methods: Data were prospectively collected between August 2009 and November 2017. Inclusion criteria were revision arthroscopic surgery, capsular plication, and baseline and minimum 2-year follow-up for the following PROs: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or previous hip conditions were excluded. Two groups were created: a study group with borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and a control group without dysplasia (LCEA, 25°-40°). Groups were propensity-matched in a 1:3 ratio for sex, age, body mass index, and follow-up time.Results: A total of 22 revision borderline dysplastic hips (21 patients) had a minimum 2-year follow-up during the study period. Patients in this group reported significant improvements for all PROs from baseline and achieved the minimal clinically important difference (MCID) for the mHHS at a rate of 70%. Moreover, 21 borderline dysplastic hips (21 patients) were matched to 63 control hips (63 patients). Mean LCEA for the study and control groups was 22.6 ± 1.7 and 32.0 ± 5.0, respectively. Both groups reported similar improvement in all PROs. The rate for achieving the MCID for the mHHS and VAS was similar between groups; however, the control group had higher rates of meeting the MCID for the HOS-SSS and NAHS (P = .042 and P = .025, respectively). The rates of conversion to hip arthroplasty were 7.9% (n = 5) in the control group and 23.8% (n = 5) in the borderline dysplasia propensity-matched group (P = .052). The rate of re-revision arthroscopy was 11.1% (n = 7) in the control group and 19.0% (n = 4) on the borderline dysplasia group (P = .350).Conclusion: After revision hip arthroscopy, significant improvement was obtained for all PROs in patients with borderline dysplasia at a minimum 2-year follow-up. Moreover, outcomes, patient satisfaction, the rate for achieving the MCID for the mHHS and VAS, and the rate for secondary surgery were similar to those of a propensity-matched control group without dysplasia. Nevertheless, there was a nonsignificant trend toward higher secondary procedures in the study group; therefore, arthroscopic revision surgery in the borderline patients should be approached with measured prognosis.文献出处：Maldonado DR, Kyin C, Shapira J, Rosinsky PJ, Meghpara MB, Yelton MJ, Lall AC, Domb BG. Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group. Am J Sports Med. 2021 Jan;49(1):66-75. doi: 10.1177/0363546520969878. Epub 2020 Nov 20. PMID: 33216619.文献4先天性生长激素缺乏与髋关节发育不良及儿童股骨头缺血性坏死相关译者：张振东生长激素缺乏症(Growth hormone deficiency，GHD)临床上通常使用重组人生长激素(rhGH)治疗，而这很少被认为与髋关节疾患相关。本文作者分析了接受rhGH治疗的先天性生长激素缺乏症患者并伴有髋关节发育不良或儿童股骨头缺血性坏死（Legg-Calve-Perthes，LCPD)患者的临床资料，以确定髋关节疾患是与生长激素缺乏症相关还是与接受rhGH治疗相关。本研究对1992-2018年期间患有先天性生长激素缺乏症和髋关节疾病的儿童和青少年患者进行了回顾性分析。收集所有患者的医疗数据，包括人口统计学资料、临床和影像学数据，并记录髋关节疾病表现出的症状出现时间与生长激素缺乏症开始治疗时间的先后关系。结果显示，13例髋关节疾病患者中10例为髋关节发育不良，3例为儿童股骨头缺血性坏死。50%的病例在接受rhGH治疗开始前诊断出髋关节发育不良。 这些患者均为双侧髋关节发育不良。有1例患者在开始rhGH治疗前被诊断为儿童股骨头缺血性坏死，但病情没有进展。 另两例患者中，儿童股骨头缺血性坏死在rhGH开始后被诊断出来，其中一例患者还表现出病情的进展，但rhGH治疗没有因此停止，因为LCPD似乎与接受rhGH治疗无关。因此，本研究提示髋关节发育不良可能是生长激素缺乏症潜在的一种表现。 此外，rhGH治疗不一定是LCPD发生的原因。Congenital growth hormone deficiency associated with hip dysplasia and Legg-Calve-Perthes diseaseObjective: Growth hormone deficiency (GHD) is usually treated with recombinant human GH (rhGH), and this has been rarely associated with hip disorders. We analysed the clinical data of patients with congenital GHD receiving rhGH who had associated hip dysplasia or Legg-Calve-Perthes disease (LCPD), with a view to determining whether the hip dysplasia was associated with the underlying disease or with rhGH treatment.Design: We performed a retrospective analysis of paediatric and adolescent patients seen between 1992-2018 with congenital GHD and hip disorders. Data were collected through a review of the patients' medical records and included demographics, clinical and imaging data, and the time frame between the onset of the symptoms related to the hip disorders and the onset of GH treatment.Results: Of the 13 patients with hip disorders, hip dysplasia was present in ten patients and LCPD in three. Hip dysplasia was diagnosed before rhGH was initiated in 50% of cases. These patients had bilateral hip dysplasia and isolated GHD. LCPD was diagnosed in one patient before rhGH was commenced and did not progress. In two patients, LCPD was diagnosed after rhGH was started and did temporarily progress in one of them, but rhGH was not discontinued because LCPD did not seem to be related to rhGH treatment.Conclusions: This study suggests that hip dysplasia could be a manifestation of an underlying GHD. Additionally, rhGH treatment may not necessarily be causative of LCPD.文献出处：Lamback EB, Chiarini S, Roposch A, Dattani MT. Congenital growth hormone deficiency associated with hip dysplasia and Legg-Calve-Perthes disease. Clin Endocrinol (Oxf). 2021 Apr;94(4):590-597. doi: 10.1111/cen.14365. Epub 2020 Nov 20. PMID: 33147364.文献5DDH患儿发病率是否与季节相关译者：任宁涛背景：据推测，DDH在冬季出生的婴儿中更为常见。本研究的目的是确定作者所在医院的DDH 发病率是否存在任何季节相关性，并使用严格的数学拟合将我们的结果与文献中的结果进行比较/对比。方法：纳入了 1993 年至 2012 年在作者医院接受治疗的所有DDH患儿。记录出生月份并使用余弦分析分析时间变化。并对来自文献的类似数据进行分析。结果：共有424名儿童（363名女孩，61名男孩）。从文献中又添加了22,936 名儿童，共计23,360 名。 Pearson卡方检验表明，我院424名儿童以及综合北半球和南半球的文献在出生月份的分布不均匀。对 424 名儿童的余弦分析显示，3 月中旬和10月中旬出现双峰。在整个 23,360 名儿童中，2,205 名（9.4 %）患儿的发病情况没有观察到季节性规律，16,425名（70.3 %）有一个冬季高峰，1,280 名（5.5 %）有一个夏季高峰，3,450 名在春季和秋季出现双高峰 (14.8%)。结论：本研究部分支持紧身衣/寒冷温度是DDH病因的一个因素的假设，紧身衣/襁褓会增加DDH的风险。 然而，约20% 的DDH患儿表现出非冬季高峰。单一的夏季和双春/秋季高峰，以及那些没有注意到季节性规律的情况，反驳了避寒冬季服装假说。也许这些季节性规律的不同模式代表了 DDH 遗传因素与外部因素（温度和衣服）和内部因素（代谢）相互作用的异质性。因此需要进一步的研究以了解 DDH 发病率与季节相关性中的不同模式。Seasonal variation in children with developmental dysplasia of the hipBackground: It has been postulated that developmental dysplasia of the hip (DDH) is more frequent in infants born in the winter months. It was the purpose of this study to ascertain if there was any seasonal variation in DDH at the author's institution and compare/contrast our results with those in the literature using rigorous mathematical fitting.Methods: All children with DDH treated at the author's institution from 1993 to 2012 were identified. The month of birth was recorded and temporal variation was analyzed using cosinor analysis. Similar data from the literature was analyzed.Results: There were 424 children (363 girls, 61 boys). An additional 22,936 children were added from the literature for a total of 23,360. Pearson's Chi-square test demonstrated a non-uniform distribution in the month of birth for both our 424 children as well as the combined literature series in both the Northern and Southern hemispheres. Cosinor analysis of the 424 children demonstrated double peaks in mid-March and mid-October. For the entire 23,360 children, no seasonal variation was observed in 2,205 (9.4 %), a single winter peak in 16,425 (70.3 %), a single summer peak in 1,280 (5.5 %), and double peaks in the spring and autumn in 3,450 (14.8 %).Conclusions: This study partly supports the hypothesis of tight clothing/cold temperature as one factor in the etiology of DDH with the tighter clothing/swaddling increasing the risk of DDH. However ~20 % of the DDH births demonstrated a non-winter peak. The single summer and double spring/autumn peaks, as well as in those series where no seasonal variation was noted, refutes the cold winter clothing hypothesis. Perhaps these different patterns in seasonal variation represent the heterogeneity of the genetic factors in DDH interacting with external factors (temperature and clothing) and internal factors (metabolic). Further study will be required to understand these different patterns in DDH seasonal variation.文献出处：Randall T Loder, Cody Shafer. Seasonal variation in children with developmental dysplasia of the hip. J Child Orthop. 2014 Feb;8(1):11-22.文献6髋臼骨性边缘内移能否作为治疗发育性髋关节发育不良的预后因素？译者：张利强目的：探讨髋臼骨性边缘内移（ARM）是否可以作为Graf Ⅲ、Ⅳ型DDH治疗选择和治疗时间的新指标。方法：在2015年至2019年间，12300名婴儿接受Graf髋关节超声检查（US），其中26名婴儿（9名为双侧病变，因此共35例髋关节）为III型和IV型DDH，并可获得随访数据。记录初始诊断时的患儿年龄、测量ARM、治疗持续时间、治疗结果。为了确定ARM的范围，测量与髂骨翼相切的直线与髋臼边缘之间的距离。结果：预后不良者，右侧髋臼边缘内移6～8.5mm，左侧4～9mm。双侧或单侧、侧别、性别对预后无显著影响（P>0.05）。初次诊断时的年龄和ARM对治疗成功率有显著影响（分别为P=0.04和P=0.00）。在预测预后方面，ARM比年龄更为成功（AUC=0.95 比 AUC=0.68）。当这两个变量一起评估时，预测预后的成功率显著提高（AUC=0.98）。结论：测量ARM对决定Graf Ⅲ、Ⅳ型DDH的治疗方法和治疗时长有重要意义。它可以单独作为预后因素，也可以与治疗开始时间联合应用。当这两个因素同时应用时，预后价值显著增加。关键词：发育性髋关节发育不良；发育不良指标；Graf’s分类法；髋关节超声
Graf III型髋关节的ARM为4.5毫米。Graf Ⅳ型髋关节ARM为7毫米。Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip?Objectives: To investigate if acetabular rim medialization (ARM) can be used as a new parameter in determining the treatment choice and duration in Graf type III and IV hips.Methods: Among the 12,300 infants who underwent hip ultrasound (US) according to Graf’s method between 2015 and 2019, 26 infants (9 had bilateral pathology hence 35 hips) with type III and IV hips, whose follow-up data could be obtained were included in the study. Age of the infants at the initial diagnosis, ARM measurement, the duration of harness treatment, and the treatment results were noted. To determine the extent of ARM, distance between a line that is drawn tangential to the iliac wing and acetabular rim was measured.Results: In cases with poor prognosis, ARM measurement was 6 to 8.5 mm on the right hip and 4 to 9 mm on the left hip. Bilaterality or unilaterality, left or right pathology, and gender did not have a significant effect on the prognosis (P >.05). Age at the initial diagnosis and ARM had significant effects on treatment success (P = .04, P = .00, respectively). In predicting the prognosis, ARM was found to be more successful than age (AUC = 0.95 versus AUC = 0.68). When these two variables were evaluated together, the success in predicting the prognosis significantly increased (AUC = 0.98).Conclusions: ARM measurement may have an important role in determining the treatment method and duration in Graf type III and IV hips. It can be used as a prognostic factor alone or in combination with treatment initiation time. When the two factors are combined, prognostic value significantly increases.文献出处：Koşar PN, Ergün E, Gökharman D. Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip? J Ultrasound Med. 2021 May 19. doi: 10.1002/jum.15745. Epub ahead of print. PMID: 34008885.文献7在髋关节MR成像期间注射局麻药以区分关节内和关节外病变译者：陶可（北京大学人民医院骨关节科）目的：确定在髋关节MR关节造影成像（MRA）期间注射局麻药的应用价值，以区分髋关节疼痛患者是关节内或关节外病变。材料和方法：这项回顾性研究已获得IRB批准且符合HIPAA。我们连续纳入了 75 名被转诊接受MRA的成年患者（46名女性，平均年龄38 ± 13 岁）。所有患者在注射前立即接受了重点髋关节检查，包括主动屈曲、被动屈曲和内旋和外旋被动屈曲。在透视引导下关节内注射混合局麻药的造影剂后进行麻醉 MRA。注射后，重复髋关节检查，并记录疼痛反应。回顾临床记录，包括对皮质类固醇注射的反应、物理治疗记录和手术报告，以验证关节内或关节外病变是髋关节疼痛的来源（金标准）。计算了用于区分关节内和关节外病变的麻醉 MRA 的阳性 (PPV) 和阴性预测值 (NPP)。结果：在MRI上，41例患者仅有关节内病变，5例患者仅有关节外病变，而29例患者同时具有关节内和关节外病变。 43 名患者在注射局麻药后疼痛减轻，32 名患者疼痛没有减轻。麻醉 MRA 检测关节内病变的 PPV 为 91%，NPV 为 67%。结论：麻醉 MRA 可作为辅助手段来确定髋部疼痛的起源。阳性反应表明关节内病理，这有助于在 MRI 上关节内和关节外病变均明显的模棱两可的情况下定位疼痛来源。
图 5 一名 53 岁女性左髋关节疼痛的假阳性麻醉 MR 关节成像。带有脂肪抑制的斜轴位 T1 加权图像（a）显示前方盂唇撕裂（箭头）。具有脂肪抑制的冠状位 T2 加权图像（b）臀中肌腱病/部分撕裂（箭头）。患者在麻醉 MR 关节造影后疼痛缓解（疼痛从 2 减少到 0）。在临床检查中，疼痛位于大转子上方，并在物理治疗后有所改善。Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathologyPurpose: To determine the value of anesthetic injection during hip MR arthrography (anesthetic MRA) to differentiate between intra- and extra-articular pathology in patients with hip pain.Materials and methods: This retrospective study was IRB-approved and HIPAA-compliant. We included 75 consecutive adult patients (46 women, mean age 38 ± 13 years) who were referred for MRA. All patients underwent a focused hip examination including active flexion, passive flexion, and passive flexion with internal and external rotation, immediately prior to injection. Anesthetic MRA was performed following fluoroscopically guided intra-articular injection of contrast mixed with anesthetic. Following the injection, the hip examination was repeated, and the pain response was recorded. Clinical records, including response to corticosteroid injections, physical therapy notes, and operative reports were reviewed for verification of intra- and extra-articular pathology as the source of hip pain (gold standard). The positive (PPV) and negative predictive values (NPP) of anesthetic MRA to differentiate between intra- and extra-articular pathology were calculated.Results: On MRI, 41 patients had only intra-articular and 5 patients only extra-articular pathology, while 29 patients had both, intra- and extra-articular pathology. Forty-three patients had pain relief and 32 patients had no pain relief after anesthetic injection. PPV of anesthetic MRA to detect intra-articular pathology was 91% and NPV was 67%.Conclusion: Anesthetic MRA can be used as an adjunct to define the origin of hip pain. A positive response suggests intra-articular pathology which can be helpful to localize the source of pain in equivocal cases where both intra- and extra-articular pathology are evident on MRI.文献出处：Arvin B Kheterpal, Katherine M Bunnell, Jad S Husseini, Connie Y Chang, Scott D Martin, Adam C Zoga, Miriam A Bredella. Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol. 2020 Apr;49(4):555-561.doi: 10.1007/s00256-019-03323-9. Epub 2019 Oct 23.文献8模拟康复训练对髋关节发育不良患者单腿深蹲时髋关节负荷的影响译者：孙维康复治疗为发育性髋关节发育不良（DDH）患者解决了可改变的因素，以减轻症状并预防或延缓骨关节炎的进展，但其对关节力学的影响仍然未知。我们的目标是确定使用肌肉骨骼模型和概率分析模拟的康复治疗（肌肉力量和运动训练）如何改变DDH患者在单腿深蹲期间的髋关节反作用力（JRF）。在四名DDH患者中，通过在0和32.6%之间增加最大等长收缩值来模拟髋外展肌强化，通过相对于基线在0到10度之间减小髋内收角度来模拟运动训练。通过2,000次蒙特卡罗模拟来分别模拟力量训练和运动训练，从中计算99%的置信区间和敏感度。我们的试验结果表明，旨在减少髋关节内收的模拟运动训练对髋关节JRF的影响远大于力量强化训练，如最终JRF的99%置信区间所示（分别为0.88±0.55 xBW和0.31±0.12 xBW）。相对于基线来说，运动训练使髋关节内收减少10度，从而使JRF减少了0.78±0.65 xBW，同时加强了17.6%的外展肌肌力，使最终的JRF增加了0.18±0.06xBW。据我们所知，这些结果首次提供了有关康复治疗对DDH患者髋关节力学影响的证据，并可用于指导更有针对性的干预措施。Effect of simulated rehabilitation on hip joint loading during single limb squat in patients with hip dysplasiaRehabilitation for patients with developmental dysplasia of the hip (DDH) addresses modifiable factors in an effort to reduce symptoms and prevent or delay the development of osteoarthritis, yet its effect on joint mechanics remains unknown. Our objective was to establish how rehabilitation (muscle strength- ening and movement training), simulated with a musculoskeletal model and probabilistic analyses, alters hip joint reaction forces (JRF) in patients with DDH during a single limb squat. In four patients with DDH, hip abductor strengthening was simulated by increasing the maximum isometric force value between 0 and 32.6% and movement training was simulated by decreasing the hip adduction angle between 0 and 10_ relative to baseline. 2,000 Monte Carlo simulations were performed separately to simulate strength- ening and movement training, from which 99% confidence bounds and sensitivity factors were calculated. Our results indicated that simulated movement training aimed at decreasing hip adduction had a sub- stantially larger influence on hip JRF than strengthening, as indicated by 99% confidence bounds of the resultant JRF (0.88 ± 0.55 xBW vs. 0.31 ± 0.12 xBW, respectively). Relative to baseline, movement training that resulted in a 10_ decrease in hip adduction decreased the resultant JRF by 0.78 ± 0.65 xBW, while strengthening the abductors by 17.6% increased resultant JRF by 0.18 ± 0.06 xBW. To our knowledge, these results are the first to provide evidence pertaining to the effect of rehabilitation on joint mechanics in patients with DDH and can be used to inform more targeted interventions.文献出处：Gaffney BMM, Harris-Hayes M, Clohisy JC, Harris MD. Effect of simulated rehabilitation on hip joint loading during single limb squat in patients with hip dysplasia. J Biomech. 2021 Feb 12;116:110183. doi: 10.1016/j.jbiomech.2020.110183. Epub 2021 Jan 7. PMID: 33422726; PMCID: PMC7938363.文献9成人髋关节发育不良患者的影像学表现与患者报告的结果之间的相关关系:一项医院横断面研究译者：李勇前言:本研究旨在阐明在一个医院相关的横断面分析中，髋关节发育不良(DDH)患者的个体影像学参数和特征与患者报告的结果测量指标(PROMs)之间的关系。方法:本横断面研究纳入108例日本DDH患者(女性，n =88;男性，n =20，平均年龄43.4岁)。记录在前后位片测量的CE角、Sharp角、ARO、ADR、AHI、交叉征、手枪柄畸形、股骨头颈比，在Lauenstein位上测量α角。我们也记录了两种窗位上骨囊肿和骨赘。我们采用日本骨科协会髋关节疾病评估量表(HEQ)对PROMs进行评估。比较有无囊肿、骨赘患者与有无凸轮、钳形畸形患者的PROMs。采用线性回归分析评估特定PROMs与影像学特征之间的关系，采用多种自变量的多元回归分析评估PROMs与影像学特征之间的独立相关性。结果：骨囊肿形成患者的HEQ量表的运动和精神评分明显低于未形成者。HEQ分量表值并不因有无骨赘、凸轮畸形或钳形畸形而不同。线性回归分析发现CE角与JHEQ量表运动得分相关。为了确定与HEQ各分量表得分独立相关的影像学特征，我们将年龄、体重指数、性别和受累髋关节(双侧或单侧)数量作为自变量进行了多元回归分析。CE角与HEQ运动评分独立相关。结论:CE角与HEQ运动评分独立相关。The relationship between radiographic findings and patient-reported outcomes in adult hip dysplasia patients: A hospital cross-sectional studyIntroduction: This study aimed to clarify the relationship of individual radiographic parameters and features with the patient-reported outcome measurements (PROMs) of patients with developmental dysplasia of the hip (DDH) in a hospital-referred cross-sectional analysis.Methods: This cross-sectional study included 108 Japanese DDH patients (female, n =88; male, n=20 mean age, 43.4 years). We recorded the CE angle, angle of Sharp, ARO, ADR, AHI, crossover sign, pistol grip deformity, and femoral head-neck ratio, which were measured on the AP view, and the α-angle which was measured on the Lauenstein view. We also recorded cyst formation and osteophytes on either view. We used the Japanese Orthopaedic Association hip disease evaluation questionnaire (HEQ) to assess the PROMs. The PROMs of patients with and without cysts or osteophytes and those of patients with or without cam or pincer deformity were compared. The relationships between specific PROMs and radiographic features were evaluated with a linear regression analysis and independent associations between PROMs and radiographic features were assessed with a multiple regression analysis using various independent variables.Results: The JHEQ movement and mental values in patients with cyst formation were significantly lower in comparison to those in patients without cyst formation. The HEQ subscale values did not differ according to the presence or absence of osteophytes, cam deformity or pincer deformity. The CE angle was found to be associated with the HEQ movement score in the linear regression analysis. To identify radiographic features that were independently associated with each of the JHEQ subscale scores, we performed a multiple regression analysis with age, body mass index, sex and the number of affected hip joints (bilateral or unilateral) included as independent variables. The CE angle was found to be independently associated with HEQ movement.Conclusion: The CE angle was independently associated with the HEQ movement value.文献出处：Takegami, Yasuhiko; Seki, Taisuke; Osawa, Yusuke; Kusano, Taiki; Ishiguro, Naoki (2019). The relationship between radiographic findings and patient-reported outcomes in adult hip dysplasia patients: A hospital cross-sectional study. Journal of Orthopaedic Science, (), S0949265819302817–. doi:10.1016/j.jos.2019.09.007张洪主任门诊时间：周三上午膝关节置换:张轶超 13261817537髋关节置换:马云青 13811705624保髋疗法:罗殿中 18911358880
