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本期目錄：

1、抗阻運動訓(xùn)練可以改善膝關(guān)節(jié)置換術(shù)患者術(shù)后康復(fù)效果

2、應(yīng)用維生素C預(yù)防全膝關(guān)節(jié)置換術(shù)后復(fù)雜性局部疼痛綜合征復(fù)發(fā)

3、機(jī)器人全膝關(guān)節(jié)置換術(shù)的真實世界療效

4、幼年髖脫位治療的患者成年后的生活質(zhì)量

5、兒童創(chuàng)傷性三角軟骨損傷的回顧性分析

6、日間骨盆截骨術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良的長期經(jīng)驗

7、髖臼周圍截骨術(shù)治療嚴(yán)重髖關(guān)節(jié)發(fā)育不良

8、髖臼周圍截骨術(shù)后髖關(guān)節(jié)中心內(nèi)移的評估：X光平片驗證

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)

文獻(xiàn)1

抗阻運動訓(xùn)練可以改善膝關(guān)節(jié)置換術(shù)患者術(shù)后康復(fù)效果

譯者 張軼超

膝關(guān)節(jié)骨關(guān)節(jié)炎與肌肉力量、肌肉量和身體功能的缺陷有關(guān)。盡管采用了包括體能/功能訓(xùn)練這些標(biāo)準(zhǔn)化的康復(fù)計劃，肌肉相關(guān)的缺陷在全膝關(guān)節(jié)置換術(shù)（TKA）后依然會急劇加重，并在手術(shù)后持續(xù)很長時間�？棺柽\動訓(xùn)練（RET）已被證明是一種非常有效的辦法，可以改善健康人群和病人與肌肉相關(guān)的手術(shù)效果。然而，在TKA后的傳統(tǒng)康復(fù)計劃中，RET的使用是非常有限的。在這篇敘述性綜述中，我們提供了一種最新的觀點，即在TKA后恢復(fù)期（長達(dá)1年）將RET加入標(biāo)準(zhǔn)康復(fù)（SR）中，與單獨進(jìn)行SR相比，是否會導(dǎo)致肌肉相關(guān)效果的更大改善�？偟膩碚f，研究結(jié)果清楚地表明，與SR相比，基于RET的康復(fù)可以在更大程度上改善肌肉力量和肌肉量。此外，與SR相比，依賴股四頭肌力量和平衡的身體功能測量（例如，爬樓梯，站椅子等）也似乎從基于RET的計劃中獲益更多，特別是在身體功能水平較低的患者中。但重要的是，為了使RET達(dá)到最佳效果，它應(yīng)該以最大肌力的70%-80%進(jìn)行訓(xùn)練，每次練習(xí)3 - 4組，每周至少3次，持續(xù)8周�；谶@一敘述性回顧，我們建議將這種高強(qiáng)度的漸進(jìn)式RET納入TKA術(shù)后康復(fù)的標(biāo)準(zhǔn)方案中。

Resistance exercise training to improve post‐operative rehabilitation in knee arthroplasty patients: A narrative review

Knee osteoarthritis is associated with deficits in muscle strength, muscle mass, and physical functioning. These muscle‐related deficits are acutely exacerbated following total knee arthroplasty (TKA) and persist long after surgery, despite the application of standardized rehabilitation programs that include physical/functional training. Resistance exercise training (RET) has been shown to be a highly effective strategy to improve muscle‐related outcomes in healthy as well as clinical populations. However, the use of RET in traditional rehabilitation programs after TKA is limited. In this narrative review, we provide an updated view on whether adding RET to the standard rehabilitation (SR) in the recovery period (up to 1 year) after TKA leads to greater improvements in muscle‐related outcomes when compared to SR alone. Overall, research findings clearly indicate that both muscle strength and muscle mass can be improved to a greater extent with RET‐based rehabilitation compared to SR. Additionally, measures of physical functioning that rely on quadriceps strength and balance (e.g., stair climbing, chair standing, etc.) also appear to benefit more from a RET‐based program compared to SR, especially in patients with low levels of physical functioning. Importantly though, for RET to be optimally effective, it should be performed at 70%–80% of the one‐repetition maximum, with 3–4 sets per exercise, with a minimum of 3 times per week for 8 weeks. Based upon this narrative review, we recommend that such high‐intensity progressive RET should be incorporated into standard programs during rehabilitation after TKA.

文獻(xiàn)出處：Monsegue AP, Emans P, van Loon LJC, Verdijk LB. Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: A narrative review. Eur J Sport Sci. 2024 Jul;24(7):938-949. doi: 10.1002/ejsc.12114. Epub 2024 May 12. PMID: 38956794; PMCID: PMC11235919.

文獻(xiàn)2

應(yīng)用維生素C預(yù)防全膝關(guān)節(jié)置換術(shù)后復(fù)雜性局部疼痛綜合征復(fù)發(fā)

譯者 張薔

背景：有多項研究調(diào)查了復(fù)雜性局部疼痛綜合征（CRPS）的風(fēng)險以及應(yīng)用維生素C預(yù)防的相關(guān)情況。然而，目前缺少相關(guān)文獻(xiàn)探究全膝關(guān)節(jié)置換（TKA）術(shù)后應(yīng)用維生素C預(yù)防CRPS發(fā)作或復(fù)發(fā)的有效性。

方法：本回顧性單中心觀察性隊列研究選擇2017年1月至2021年12月的病例資料，并應(yīng)用傾向性評分匹配方法。最初，我們?nèi)虢M了1088例TKA病例，其中49例既往曾有CRPS發(fā)作的病史。排除50例不符合入組標(biāo)準(zhǔn)的病例，最終包含467例（45%）接受了維生素C預(yù)防治療（1g Qd * 40天）的病例和571例（55%）未接受維生素C預(yù)防治療的病例。在性別、年齡、BMI、糖尿病及高血壓情況、吸煙飲酒情況、止血帶應(yīng)用情況、焦慮與抑郁情況經(jīng)1:1匹配后，維生素C預(yù)防組和未預(yù)防組各包含480例病例。共960例中有28例曾有CRPS發(fā)作史。

結(jié)果：在經(jīng)過傾向性評分匹配后的病例組中，6.9%（33例）的維生素C預(yù)防組病例術(shù)后出現(xiàn)CRPS發(fā)作，而未預(yù)防組的病例為11.0%（53例）（概率比OR=0.59[95%置信區(qū)間(CI), 0.37 - 0.9], p = 0.024）。而曾有CRPS發(fā)作史會顯著增加術(shù)后復(fù)發(fā)的概率（發(fā)作史32% VS. 無發(fā)作史8%；OR=5.4 [95% CI, 2.57 - 11.4], p < 0.001）。在28例曾有CRPS發(fā)作史的病例中，應(yīng)用維生素C預(yù)防治療會將術(shù)后發(fā)作概率降至19%（21例中4例），而未應(yīng)用維生素C預(yù)防治療的病例發(fā)作概率為71%（7例中5例）（OR=0.09 [95% CI, 0.01 - 0.64], p = 0.02）。多變量回歸分析后，維生素C預(yù)防也與TKA術(shù)后CRPS低復(fù)發(fā)率獨立相關(guān)（OR=0.53 [95% CI, 0.3 - 0.86], p = 0.011）。

結(jié)論：應(yīng)用維生素C預(yù)防可以減少TKA術(shù)后CRPS發(fā)作。此外，本研究還發(fā)現(xiàn)維生素C預(yù)防可以降低術(shù)前曾有CRPS發(fā)作史病例TKA術(shù)后CRPS復(fù)發(fā)的概率。

Prophylaxis against Complex Regional Pain Syndrome Recurrence with Vitamin C in Total Knee Arthroplasty-A Propensity Score-Matched Analysis of 960 Cases

Background: Several studies have investigated the risk of complex regional pain syndrome (CRPS) and its prevention with vitamin C. However, evidence regarding the effectiveness of vitamin C for prevention of CRPS development or recurrence after total knee arthroplasty (TKA) is lacking.

Methods: This retrospective single-center observational cohort study, which utilized propensity-score matching (PSM), was conducted from January 2017 to December 2021. It initially included 1,088 TKAs, 49 of which were in patients who had a previous CRPS. After exclusion of 50 TKAs, the study included 467 TKAs (45%) in patients who received vitamin C prophylaxis (1 g daily for 40 days) after surgery and 571 (55%) in patients who did not. After 1:1 matching on the basis of sex, age, body mass index, presence of diabetes mellitus and hypertension, use of tobacco and alcohol, anesthesia modality, tourniquet use, and anxiety and depression, the vitamin C group and the no-vitamin C group comprised 480 patients each. Twenty-eight of these 960 patients had a history of CRPS.

Results: In the PSM population, 6.9% (33) of the 480 patients who received vitamin C prophylaxis after TKA developed CRPS compared with 11.0% (53) of the 480 who did not receive vitamin C (odds ratio [OR] = 0.59 [95% confidence interval (CI), 0.37 to 0.9], p = 0.024). The rate of CRPS was significantly higher in patients with a history of CRPS (32% versus 8% for patients with no previous CRPS; OR = 5.4 [95% CI, 2.57 to 11.4], p < 0.001). In the 28 patients with a history of CRPS, vitamin C prophylaxis reduced the rate of CRPS recurrence after TKA to 19% (4 of 21) compared with 71% (5 of 7) in the patients not treated with vitamin C (OR = 0.09 [95% CI, 0.01 to 0.64], p = 0.02). In multivariable regression of the matched patients, vitamin C was also found to be independently associated with a lower rate of CRPS recurrence after TKA (OR = 0.53 [95% CI, 0.3 to 0.86], p = 0.011).

Conclusions: Vitamin C prophylaxis may be appropriate for preventing CRPS after TKA. Furthermore, the study highlights the beneficial role of vitamin C in reducing the rate of CRPS recurrence in patients with a history of CRPS who are undergoing TKA.

文獻(xiàn)3

機(jī)器人全膝關(guān)節(jié)置換術(shù)的真實世界療效：一家非學(xué)術(shù)中心的五年經(jīng)驗

譯者 沈松坡

背景：機(jī)器人輔助手術(shù)系統(tǒng)已改變了全膝關(guān)節(jié)置換術(shù)（TKA），其宣稱可提高精度并改善術(shù)中一致性，然而來自非學(xué)術(shù)中心的真實世界數(shù)據(jù)仍然有限。

目的：本研究評估了一種半自主、基于CT的機(jī)械臂輔助TKA在德國一家三級非教學(xué)醫(yī)院中五年的臨床應(yīng)用情況，重點關(guān)注術(shù)前規(guī)劃精度、間隙平衡及術(shù)中結(jié)果。

方法： 我們回顧性分析了2020年至2025年間接受MAKO輔助TKA的全部患者（n=457），手術(shù)均由三名骨科醫(yī)生采用標(biāo)準(zhǔn)化股內(nèi)側(cè)肌下入路完成。評估內(nèi)容包括術(shù)前畸形、術(shù)中對線、假體尺寸及間隙平衡。當(dāng)有必要時術(shù)中調(diào)整手術(shù)計劃。通過斜率分析比較術(shù)前計劃與術(shù)后實施值，以評估執(zhí)行一致性。

結(jié)果：患者中位年齡為67.0歲（四分位距：60.0–75.0）；84.1%為內(nèi)翻（7.0°，IQR: 4.0°–10.0°），13.2%為外翻（3.0°，IQR: 1.5°–5.8°），2.7%為中立對線。80.4%存在屈曲攣縮（6.0°，IQR: 3.0°–10.0°），12.7%出現(xiàn)反屈（2.0°，IQR: 1.5°–5.0°）。即使在術(shù)中計劃調(diào)整情況下，規(guī)劃與執(zhí)行的一致性仍然較高。各對線參數(shù)的斜率值分別為：脛骨旋轉(zhuǎn)1.0、股骨矢狀角0.8、脛骨矢狀角0.9、冠狀后髁角0.9、股骨假體尺寸1.0、脛骨假體尺寸1.0。超過95%的病例中計劃值與最終值的偏差≤3.0°。骨切除一致性表現(xiàn)為中等相關(guān)性，斜率介于0.8（股骨內(nèi)側(cè)后切，單位mm）到0.5（脛骨外側(cè)切，單位mm）之間。術(shù)中各階段間隙平衡均改善，內(nèi)外側(cè)伸屈間隙的變異性下降（均p<0.05）。功能重建顯示伸展、屈曲及畸形顯著改善（均p<0.001）。

結(jié)論： 半自主、基于CT的機(jī)械臂輔助TKA在非學(xué)術(shù)中心得以成功實施，顯示出可接受的術(shù)中及功能重建結(jié)果，支持其在非學(xué)術(shù)機(jī)構(gòu)中應(yīng)用的可行性。

關(guān)鍵詞：機(jī)器人輔助TKA；真實世界數(shù)據(jù)；術(shù)中對線；間隙平衡；非學(xué)術(shù)醫(yī)院

Real-World Outcomes of Robotic Total Knee Arthroplasty: Five Years' Experience in a Non-Academic Center

Background: Robotic-assisted systems have transformed total knee arthroplasty (TKA), promising improved accuracy and intraoperative consistency, yet real-world data from non-academic centers remain limited.

Objective: This study evaluates five-year clinical integration of a semi-autonomous, CT-based, robotic-arm-assisted TKA at a tertiary non-teaching hospital in Germany, focusing on planning accuracy, gap balancing, and intraoperative outcomes. Methods: We retrospectively analyzed all patients (n = 457) who underwent MAKO-assisted TKA from 2020 to 2025, performed by three orthopedic surgeons using a standardized subvastus approach. We assessed preoperative deformities, intraoperative alignment, implant sizing, and gap balancing. Surgical plans were adapted intraoperatively when indicated. Pre- vs. post-implantation values were compared using slopes to evaluate execution consistency.

Results: Median patient age was 67.0 years (IQR: 60.0-75.0), with varus in 84.1% (7.0°, IQR: 4.0°-10.0°), valgus in 13.2% (3.0°, IQR: 1.5°-5.8°), and neutral alignment in 2.7%. Flexion contracture occurred in 80.4% (6.0°, IQR: 3.0-10.0%), hyperextension in 12.7% (2.0°, IQR: 1.5°-5.0°). Planning-to-execution consistency was high, even with plan adaptations. Slope values for alignment parameters were: tibial rotation in degrees (slope value: 1.0), femoral sagittal angle in degrees (0.8), tibial sagittal angle in degrees (0.9), coronal posterior condylar angle in degrees (0.9), femoral component size (1.0), tibial component size (1.0). Over 95% of cases showed ≤3.0° deviation between planned and final values. Bone resection concordance showed moderate agreement, with slopes from 0.8 (posterior medial femoral cut in mm) to 0.5 (lateral tibial cut in mm). Gap balancing improved at all stages, with reduced variability in medial/lateral extension and flexion gaps (all p < 0.05). Functional reconstruction showed significant improvements in extension, flexion, and deformities (all p < 0.001).

Conclusions: Semi-autonomous, CT-based, robotic-arm-assisted TKA was successfully implemented in this non-academic setting, demonstrating acceptable intraoperative and functional reconstruction outcomes, supporting the feasibility of robotic-assisted surgery outside academic centers.

Keywords: gap balancing; intraoperative alignment; non-academic hospital; real-world data; robotic-assisted TKA.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

幼年髖脫位治療的患者成年后的生活質(zhì)量

譯者 張振東

髖關(guān)節(jié)發(fā)育不良（DDH）如不及時干預(yù)可導(dǎo)致髖關(guān)節(jié)功能過早喪失；然而很少有研究關(guān)注DDH兒童時期治療后的長期結(jié)果。

本研究對兒童時期接受過髖關(guān)節(jié)脫位治療的患者進(jìn)行了一項健康相關(guān)生活質(zhì)量調(diào)查。研究者向在其機(jī)構(gòu)接受過兒童期髖關(guān)節(jié)脫位治療的 287 名DDH 患者發(fā)放了調(diào)查問卷。調(diào)查患者的人口統(tǒng)計學(xué)特征、特定疾病病史以及與健康相關(guān)的生活質(zhì)量。將患者的身體功能評分（PCS）、心理功能評分（MCS）和社會認(rèn)知評分（RCS）與標(biāo)準(zhǔn)值進(jìn)行了比較。最終納入68 名患者進(jìn)行了評估。

結(jié)果顯示，患者的 PCS、MCS 和 RCS 總平均值與標(biāo)準(zhǔn)值相當(dāng)。PCS 一直保持到 50 歲，但有 10 名 50 歲以上的患者 PCS 顯著下降。此外，接受切開復(fù)位術(shù)的患者的 PCS 明顯低于接受保守復(fù)位術(shù)的患者。在各年齡組和治療組中，患者的 MCS 和 RCS 與標(biāo)準(zhǔn)值無差異。 此外，PCS、MCS 和 RCS 在雙側(cè)、診斷年齡或是否需要額外手術(shù)方面也沒有差異。DDH患者的身體生活質(zhì)量在50歲之前一直保持不變，但之后迅速下降，尤其是那些在童年時期就需要進(jìn)行切開復(fù)位的患者。

Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood

Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.

文獻(xiàn)出處：Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B. 2025 Jan 1;34(1):38-43. doi: 10.1097/BPB.0000000000001173. Epub 2024 Feb 26. PMID: 38451811.

文獻(xiàn)2

兒童創(chuàng)傷性三角軟骨損傷的回顧性分析

譯者 任寧濤

背景:總結(jié)分析兒童外傷后三角軟骨損傷(TCI)的流行病學(xué)特點、治療方法及相應(yīng)療效，為早期診斷和改進(jìn)治療提供理論依據(jù)。

方法:采用Bucholz分型對TCI損傷進(jìn)行分型，隨訪時采用Harris髖關(guān)節(jié)評分及影像學(xué)檢查評價最終療效。最后，通過查閱文獻(xiàn)中的病例并結(jié)合我院的患者進(jìn)行綜合分析。

結(jié)果:本院共收治三角軟骨損傷15例(18髖)。I型損傷1例，II型損傷9例，IV型損傷2例，V型損傷1例，VI型損傷5例。隨訪完整的12例患者中，8例在三角軟骨內(nèi)或周圍發(fā)現(xiàn)骨橋，5例出現(xiàn)早期三角軟骨融合，3例髖關(guān)節(jié)發(fā)育不良，4例股骨頭半脫位，HHS優(yōu)8例，良4例。

結(jié)論:TCI損傷的早期診斷仍是一個難題。保守治療通常是首選。髖臼骨折累及三角軟骨的整體預(yù)后較差。三角軟骨骨橋的形成通常預(yù)示著過早閉合的可能性，這可能導(dǎo)致創(chuàng)傷后髖臼發(fā)育不良和股骨頭半脫位的嚴(yán)重并發(fā)癥。

Retrospective analysis of traumatic triradiate cartilage injury in children

Background: To summarize and analyze the epidemiological characteristics, treatment and corresponding curative effect of triradiate cartilage injury(TCI) in children after trauma, to provide a theoretical basis for early diagnosis and improvement of treatment.

Methods: The TCI was classified according to Bucholz classification, and the final curative effect was evaluated with Harris Hip Score and imaging examination during follow-up. Finally, a comprehensive analysis was made by reviewing the cases in the literature combined with the patients in our hospital.

Results: A total of 15 cases (18 hips) of triradiate cartilage injuries were collected in our hospital. There was 1 hip with type I injury, nine hips with type II injury, two hips with type IV injury, one hip with type V injury and five hips with type VI injury. Among the 12 cases with complete follow-up, the bone bridge was found in or around the triradiate cartilage in 8 cases, early fusion of triradiate cartilage occurred in 5 patients, 3 cases had hip dysplasia, 4 cases had a subluxation of the femoral head, and HHS was excellent in 8 cases and good in 4 cases.

Conclusion: The early diagnosis of TCI is still a difficult problem. Conservative treatment is often the first choice. The overall prognosis of acetabular fractures involving triradiate cartilage is poor. The formation of the bone bridge in triradiate cartilage usually indicates the possibility of premature closure, which may lead to severe complications of post-traumatic acetabular dysplasia and subluxation of the femoral head.

文獻(xiàn)出處：Dong Y, Wang J, Qin J, Nan G, Su Y, He B, Cai W, Chen K, Gu K, Liang X, Yan G, Wang Z. Retrospective analysis of traumatic triradiate cartilage injury in children. BMC Musculoskelet Disord. 2021 Aug 10;22(1):674. doi: 10.1186/s12891-021-04565-2. PMID: 34376165; PMCID: PMC8356404.

文獻(xiàn)3

日間骨盆截骨術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良的長期經(jīng)驗

譯者 李勇

目的 發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的發(fā)病率為每1000名活產(chǎn)兒6.73例，每年導(dǎo)致大量的骨科轉(zhuǎn)診。這種高需求推動了在兒科骨科環(huán)境中優(yōu)化服務(wù)效率的動力。這里，我們描述了我們在一項創(chuàng)新的日間骨盆截骨術(shù)項目中獲得的長期經(jīng)驗。我們還描述了在執(zhí)行日間骨盆截骨術(shù)時可能預(yù)見的任何潛在并發(fā)癥。

方法 這是一項非隨機(jī)前瞻性隊列研究，旨在比較2017年1月至2023年11月期間進(jìn)行的傳統(tǒng)住院骨盆截骨術(shù)與日間截骨術(shù)。所有手術(shù)均在一家城市三級國家轉(zhuǎn)診中心進(jìn)行，由四名對DDH具有特別專業(yè)興趣的兒科骨科醫(yī)生執(zhí)刀。

結(jié)果 總共進(jìn)行了164例Salter和Pemberton截骨術(shù)，其中115例符合日間手術(shù)標(biāo)準(zhǔn)。根據(jù)HSE的“�？瞥杀緢蟾妗焙汀澳甓葓蟾媾c財務(wù)報表”，接受住院截骨術(shù)患者的總出院花費為6619歐元，而每位日間手術(shù)患者的花費為2670歐元。對于這110例日間手術(shù)，治療花費總計為293,700歐元；因此，醫(yī)院通過執(zhí)行這110例日間手術(shù)總共節(jié)省了434,390歐元。這相當(dāng)于每例日間手術(shù)節(jié)省了3949歐元。

結(jié)論 7年期的回顧表明，針對DDH的日間骨盆截骨術(shù)仍然是一項安全且具有成本效益的舉措，它顯著減少了對住院病床資源的需求。

A long-term experience of day-case pelvic osteotomy for developmental dysplasia of the hip

Objective Developmental hip dysplasia has an incidence of 6.73 per 1000 live births and leads to a significant number of orthopaedic referrals annually. This high demand has encouraged the drive to optimize the efficiency of service provision in the paediatric orthopaedic setting. Here we describe our long-term experience with a novel day-case pelvic osteotomy initiative. We also describe any potential complications one can expect when performing day-case pelvic osteotomies.

Methods This was a non-randomized prospective cohort study conducted to compare conventional in-patient pelvic osteotomies with day-case osteotomies performed between January 2017 and November 2023. All surgeries took place at an urban tertiary national referral centre by four paediatric orthopaedic surgeons with a specialist interest in DDH.

Results 164 Salter and Pemberton osteotomies were performed of which 115 met the day-case criteria. Based on the HSE ‘Specialty Costing Report’ and ‘Annual Report and Financial Statements’, the total discharge cost for patients undergoing an in-patient osteotomy was �6619 in contrast to �2670 per day-case patient. For the 110 day-cases, the cost to treat amounted to �293,700; hence, there was a total saving of �434,390 made by the hospital for the 110 day-cases performed. This amounts to �3949 saved for every day-case.

Conclusion Review at 7 years has demonstrated that day-case pelvic osteotomy surgery for DDH remains a safe and cost-effective initiative that significantly reduces the demand on in-patient hospital bed resources.

文獻(xiàn)出處：Moore DM, Howells C, Gallagher O, Moore DP, O'Toole P. A long-term experience of day-case pelvic osteotomy for developmental dysplasia of the hip. Ir J Med Sci. 2025 Jun;194(3):963-967. doi: 10.1007/s11845-025-03963-y. Epub 2025 May 9. PMID: 40343576; PMCID: PMC12276099.

文獻(xiàn)4

髖臼周圍截骨術(shù)治療嚴(yán)重髖關(guān)節(jié)發(fā)育不良

譯者 陶可

背景：對于伴有股骨頭半脫位或繼發(fā)性髖臼(病變)的嚴(yán)重髖關(guān)節(jié)發(fā)育不良，最佳治療方案仍存在爭議。本研究旨在分析伯爾尼髖臼周圍截骨術(shù)治療青少年及青年重度髖關(guān)節(jié)發(fā)育不良的矯正程度及早期臨床療效。

方法：納入13例患者共16個髖關(guān)節(jié)，平均年齡17.6歲（范圍13.0～31.8歲），均被診斷為重度髖關(guān)節(jié)發(fā)育不良（根據(jù)Severin分型為IV或V組）。其中8個髖關(guān)節(jié)為半脫位，8個髖關(guān)節(jié)為繼發(fā)性髖臼(病變)。術(shù)前，所有患者均存在髖關(guān)節(jié)疼痛，且X線片顯示髖關(guān)節(jié)匹配度良好，符合截骨術(shù)指征。所有16個髖關(guān)節(jié)均行伯爾尼髖臼周圍截骨術(shù)，其中6個髖關(guān)節(jié)同時行股骨近端截骨術(shù)。術(shù)后，對髖關(guān)節(jié)進(jìn)行X線檢查，以評估畸形矯正情況、截骨部位愈合情況以及骨關(guān)節(jié)炎進(jìn)展情況。術(shù)后平均4.2年，采用Harris髖關(guān)節(jié)評分評估臨床結(jié)果和髖關(guān)節(jié)功能。

結(jié)果：術(shù)前和隨訪X線片對比顯示，Wiberg外側(cè)中心邊緣角平均改善44.6度（由-20.5度改善至24.1度），Lequesne和de Seze前方中心邊緣角平均改善51.0度（由-25.4度改善至25.6度），髖臼頂傾斜度平均改善25.9度（由37.3度改善至11.4度）。髖關(guān)節(jié)中心平均向內(nèi)側(cè)移位10 mm（范圍0至31 mm）。所有髂骨截骨部位均已愈合。術(shù)前平均Harris髖關(guān)節(jié)評分73.4分提高至末次隨訪時的91.3分。13例患者中有11例（16個髖關(guān)節(jié)中的14個）對術(shù)后效果滿意，14個髖關(guān)節(jié)的臨床效果良好或優(yōu)異。主要并發(fā)癥包括1例患者出現(xiàn)髖臼固定失敗，需再次手術(shù)；另1例患者出現(xiàn)髖臼過度矯正及相關(guān)坐骨不愈合。兩例患者在末次隨訪時均獲得良好的臨床效果。未發(fā)生重大神經(jīng)血管損傷或關(guān)節(jié)內(nèi)骨折。

結(jié)論：髖臼周圍截骨術(shù)是治療青少年及青年嚴(yán)重髖臼發(fā)育不良的有效手術(shù)方法。本組病例術(shù)后平均4.2年的早期臨床效果良好；兩例主要并發(fā)癥并未影響良好的臨床效果。

圖1-A和1-B 病例6，一名16歲男孩，患有嚴(yán)重的髖關(guān)節(jié)發(fā)育不良，前后位（圖1-A）和假斜位（圖1-B）X線片均顯示了這一情況。該患者接受了髖臼周圍截骨術(shù)聯(lián)合股骨近端內(nèi)翻截骨術(shù)治療。

Periacetabular osteotomy for the treatment of severe acetabular dysplasia

Background: The optimal treatment of severe acetabular dysplasia with subluxation of the femoral head or the presence of a secondary acetabulum remains controversial. The purpose of this study was to analyze the extent of surgical correction and the early clinical results obtained with the Bernese periacetabular osteotomy for the treatment of severely dysplastic hips in adolescent and young adult patients.

Methods: Sixteen hips in thirteen patients with an average age of 17.6 years (range, 13.0 to 31.8 years) were classified as having severe acetabular dysplasia (Group IV or V according to the Severin classification). Eight hips were classified as subluxated, and eight had a secondary acetabulum. Preoperatively, all patients had hip pain and sufficient hip joint congruency on radiographs to be considered candidates for the osteotomy. All sixteen hips underwent a Bernese periacetabular osteotomy, and six of them underwent a concomitant proximal femoral osteotomy. Postoperatively, the hips were assessed radiographically to evaluate correction of deformity, healing of the osteotomy site, and progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 4.2 years postoperatively.

Results: Comparison of preoperative and follow-up radiographs demonstrated an average improvement of 44.6 degrees (from -20.5 degrees to 24.1 degrees ) in the lateral center-edge angle of Wiberg, an average improvement of 51.0 degrees (from -25.4 degrees to 25.6 degrees ) in the anterior center-edge angle of Lequesne and de Seze, and an average improvement of 25.9 degrees (from 37.3 degrees to 11.4 degrees ) in acetabular roof obliquity. The hip center was translated medially an average of 10 mm (range, 0 to 31 mm). All iliac osteotomy sites healed. The average Harris hip score improved from 73.4 points preoperatively to 91.3 points at the time of the latest follow-up. Eleven of the thirteen patients (fourteen of the sixteen hips) were satisfied with the result of the surgery, and fourteen hips had a good or excellent clinical result. Major complications included loss of acetabular fixation, which required an additional surgical procedure, in one patient and overcorrection of the acetabulum and an associated ischial nonunion in another patient. Both patients had a good clinical result at the time of the latest follow-up. There were no major neurovascular injuries or intra-articular fractures.

Conclusions: The periacetabular osteotomy is an effective technique for surgical correction of a severely dysplastic acetabulum in adolescents and young adults. In this series, the early clinical results were very good at an average of 4.2 years postoperatively; the two major complications did not compromise the good clinical results.

文獻(xiàn)出處：John C Clohisy, Susan E Barrett, J Eric Gordon, Eliana D Delgado, Perry L Schoenecker. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005 Feb;87(2):254-9. doi: 10.2106/JBJS.D.02093.

文獻(xiàn)5

髖臼周圍截骨術(shù)后髖關(guān)節(jié)中心內(nèi)移的評估：X光平片驗證

譯者 邱興

背景： 髖臼周圍截骨術(shù)通過增加股骨頭的髖臼覆蓋并使髖關(guān)節(jié)中心內(nèi)移，以恢復(fù)正常關(guān)節(jié)生物力學(xué)。既往研究雖已報道PAO所能實現(xiàn)的內(nèi)移程度，但內(nèi)移的測量從未通過對不同影像學(xué)模式或測量技術(shù)的比較得到驗證。由于坐骨棘線可能因PAO而發(fā)生改變，且在股骨頭下1/3水平顯示更佳，因此，采用從股骨頭下1/3處開始測量的新方法可能更有優(yōu)勢。

研究問題/目的： (1) PAO實現(xiàn)的髖關(guān)節(jié)中心真實內(nèi)移量及其變異性是多少？(2) 哪些影像學(xué)參數(shù)（如外側(cè)中心邊緣角和髖臼傾斜角）與實現(xiàn)的內(nèi)移程度相關(guān)？(3) 在X光平片上，于股骨頭中心（傳統(tǒng)方法）還是股骨頭下1/3處（新方法）測量內(nèi)移，哪個與真實內(nèi)移相關(guān)性更好？(4) 術(shù)中透視圖像與術(shù)后X光片在測量髖關(guān)節(jié)內(nèi)移方面是否存在差異？

方法： 我們利用一個既往建立的、在PAO術(shù)后接受了低劑量CT檢查的患者隊列進(jìn)行了一項回顧性研究。本研究納入標(biāo)準(zhǔn)包括：因有癥狀的髖臼發(fā)育不良而接受PAO、有術(shù)前CT掃描、以及術(shù)后隨訪時間在9個月至5年之間。2009年2月至2018年7月期間接受PAO的333名患者符合這些標(biāo)準(zhǔn)。此外，僅納入手術(shù)時年齡在16至50歲之間的患者。排除標(biāo)準(zhǔn)包括：既往同側(cè)手術(shù)史、股骨髖臼撞擊征、妊娠、神經(jīng)肌肉疾病、Perthes樣畸形、術(shù)前CT不充分以及無法參與研究。最終研究組納入39名患者的39個髖關(guān)節(jié)；其中87%為女性患者，13%為男性患者。手術(shù)時的中位年齡為27歲（范圍16至49歲）。獲取了術(shù)前和術(shù)后入組時的低劑量CT圖像；我們還獲取了術(shù)前和術(shù)后X光片以及術(shù)中透視圖像。在X光平片上評估LCEA和AI。由一名獨立的、不知分組情況的評估者通過所有影像學(xué)模式評估髖關(guān)節(jié)內(nèi)移。在X光平片上，采用了測量髖關(guān)節(jié)內(nèi)移的傳統(tǒng)方法和新方法。根據(jù)可見的骨盆旋轉(zhuǎn)程度，劃分出優(yōu)質(zhì)和合格X光片亞組進(jìn)行亞組分析。為回答第一個問題，通過三維CT髖關(guān)節(jié)重建模型的測量來評估所有髖關(guān)節(jié)的內(nèi)移。為回答第二個問題，計算了Pearson相關(guān)系數(shù)、單因素方差分析和Student t檢驗，以評估影像學(xué)參數(shù)（如LCEA和AI）與實現(xiàn)的內(nèi)移量之間的相關(guān)性。為回答第三個問題，進(jìn)行了統(tǒng)計分析，包括線性回歸分析，以使用Pearson相關(guān)系數(shù)、95%置信區(qū)間和估計標(biāo)準(zhǔn)誤，來確定兩種測量內(nèi)移的X線方法與CT所示真實內(nèi)移之間的相關(guān)性。為回答第四個問題，計算了Pearson相關(guān)系數(shù)以確定使用術(shù)中透視測量內(nèi)移是否與X光片上的測量結(jié)果不同。

結(jié)果： 在本研究中，通過參考標(biāo)準(zhǔn)CT測量評估，PAO實現(xiàn)的髖關(guān)節(jié)中心真實內(nèi)移量為4 ± 3毫米；46%的髖關(guān)節(jié)內(nèi)移了0至5毫米，36%內(nèi)移了5至10毫米，5%內(nèi)移超過10毫米。13%的髖關(guān)節(jié)發(fā)生了外側(cè)移位（內(nèi)移< 0毫米）。不同LCEA亞組之間的內(nèi)移量存在微小差異（LCEA ≤ 15°者為6 ± 3毫米，LCEA在15°至20°之間者為4 ± 4毫米，LCEA在20°至25°之間者為2 ± 3毫米）。AI ≥ 15°的髖關(guān)節(jié)實現(xiàn)的內(nèi)移量大于AI < 15°的髖關(guān)節(jié)。與作為參考標(biāo)準(zhǔn)的CT掃描測量結(jié)果相比，在X光平片上于股骨頭中心測量內(nèi)移（傳統(tǒng)方法）的相關(guān)性弱于在股骨頭下1/3處測量（新方法）。傳統(tǒng)方法在所有X光片或僅在優(yōu)質(zhì)X光片中均未顯示出相關(guān)性，而新方法在所有X光片和僅在優(yōu)質(zhì)X光片中評估時，分別呈現(xiàn)出強(qiáng)相關(guān)和極強(qiáng)相關(guān)。術(shù)中透視圖像上的髖關(guān)節(jié)內(nèi)移測量結(jié)果與術(shù)后X光片上的測量結(jié)果未發(fā)現(xiàn)差異。

結(jié)論： 通過術(shù)前和術(shù)后CT測量，本研究顯示PAO實現(xiàn)的平均真實內(nèi)移量為4毫米，但變異性很大。在股骨頭中心測量內(nèi)移的傳統(tǒng)方法可能不準(zhǔn)確；在股骨頭下1/3處測量內(nèi)移的新方法是評估髖關(guān)節(jié)中心位置的更優(yōu)方法。我們建議轉(zhuǎn)而使用這種新方法以獲得最佳的臨床和研究數(shù)據(jù)，但要認(rèn)識到兩種基于X光平片的方法似乎都低估了PAO實現(xiàn)的真實內(nèi)移量。最后，本研究提供證據(jù)表明，髖關(guān)節(jié)中心的位置和內(nèi)移可以在術(shù)中通過透視進(jìn)行準(zhǔn)確評估。

圖1、 A-B 采用骨盆前后位X光片測量髖關(guān)節(jié)位置。(A) 在這張術(shù)前X光片中，線1代表從股骨頭中心起始的傳統(tǒng)測量方法，線2代表從股骨頭直徑下三分之一處起始并延伸至坐骨棘線的替代測量方法。(B) 在這張術(shù)后X光片中，坐骨棘線在股骨頭中部水平不可見，但在采用從股骨頭直徑下三分之一處起始的測量方法時清晰可見且易于測量。

圖2 、基于CT掃描的內(nèi)移測量方法圖示：將股骨頭中心與一條代表中線的垂直參考線相連進(jìn)行測量。

圖3 、替代性內(nèi)移測量的起始點定于股骨頭內(nèi)側(cè)緣，具體位置在股骨頭垂直徑的下三分之一分界點。

圖4、A-B 如(A)術(shù)前與(B)術(shù)后X光片所示，該髖關(guān)節(jié)經(jīng)PAO術(shù)后實現(xiàn)內(nèi)移。采用X光平片的替代測量法（自股骨頭直徑下三分之一處起始進(jìn)行測量）測得該髖關(guān)節(jié)內(nèi)移量為9毫米，而通過參考標(biāo)準(zhǔn)CT測量法測得的內(nèi)移量為8毫米。

Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs

Background: Periacetabular osteotomy (PAO) increases acetabular coverage of the femoral head and medializes the hip's center, restoring normal joint biomechanics. Past studies have reported data regarding the degree of medialization achieved by PAO, but measurement of medialization has never been validated through a comparison of imaging modalities or measurement techniques. The ilioischial line appears to be altered by PAO and may be better visualized at the level of the inferior one-third of the femoral head, thus, an alternative method of measuring medialization that begins at the inferior one-third of the femoral head may be beneficial.

Questions/purposes: (1) What is the true amount and variability of medialization of the hip's center that is achieved with PAO? (2) Which radiographic factors (such as lateral center-edge angle [LCEA] and acetabular inclination [AI]) correlate with the degree of medialization achieved? (3) Does measurement of medialization on plain radiographs at the center of the femoral head (traditional method) or inferior one-third of the femoral head (alternative method) better correlate with true medialization? (4) Are intraoperative fluoroscopy images different than postoperative radiographs for measuring hip medialization?

Methods: We performed a retrospective study using a previously established cohort of patients who underwent low-dose CT after PAO. Inclusion criteria for this study included PAO as indicated for symptomatic acetabular dysplasia, preoperative CT scan, and follow-up between 9 months and 5 years. A total of 333 patients who underwent PAO from February 2009 to July 2018 met these criteria. Additionally, only patients who were between 16 and 50 years old at the time of surgery were included. Exclusion criteria included prior ipsilateral surgery, femoroacetabular impingement (FAI), pregnancy, neuromuscular disorder, Perthes-like deformity, inadequate preoperative CT, and inability to participate. Thirty-nine hips in 39 patients were included in the final study group; 87% (34 of 39) were in female patients and 13% (5 of 39 hips) were in male patients. The median (range) age at the time of surgery was 27 years (16 to 49). Low-dose CT images were obtained preoperatively and at the time of enrollment postoperatively; we also obtained preoperative and postoperative radiographs and intraoperative fluoroscopic images. The LCEA and AI were assessed on plain radiographs. Hip medialization was assessed on all imaging modalities by an independent, blinded assessor. On plain radiographs, the traditional and alternative methods of measuring hip medialization were used. Subgroups of good and fair radiographs, which were determined by the amount of pelvic rotation that was visible, were used for subgroup analyses. To answer our first question, medialization of all hips was assessed via measurements made on three-dimensional (3-D) CT hip reconstruction models. For our second question, Pearson correlation coefficients, one-way ANOVA, and the Student t-test were calculated to assess the correlation between radiographic parameters (such as LCEA and AI) and the amount of medialization achieved. For our third question, statistical analyses were performed that included a linear regression analysis to determine the correlation between the two radiographic methods of measuring medialization and the true medialization on CT using Pearson correlation coefficients, as well as 95% confidence intervals and standard error of the estimate. For our fourth question, Pearson correlation coefficients were calculated to determine whether using intraoperative fluoroscopy to make medialization measurements differs from measurements made on radiographs.

Results: The true amount of medialization of the hip center achieved by PAO in our study as assessed by reference-standard CT measurements was 4 ± 3 mm; 46% (18 of 39 hips) were medialized 0 to 5 mm, 36% (14 hips) were medialized 5 to 10 mm, and 5% (2 hips) were medialized greater than 10 mm. Thirteen percent (5 hips) were lateralized (medialized < 0 mm). There were small differences in medialization between LCEA subgroups (6 ± 3 mm for an LCEA of ≤ 15°, 4 ± 4 mm for an LCEA between 15° and 20°, and 2 ± 3 mm for an LCEA of 20° to 25° [p = 0.04]). Hips with AI ≥ 15° (6 ± 3 mm) achieved greater amounts of medialization than did hips with AI of < 15° (2 ± 3 mm; p < 0.001). Measurement of medialization on plain radiographs at the center of the femoral head (traditional method) had a weaker correlation than using the inferior one-third of the femoral head (alternative method) when compared with CT scan measurements, which were used as the reference standard. The traditional method was not correlated across all radiographs or only good radiographs (r = 0.16 [95% CI -0.17 to 0.45]; p = 0.34 and r = 0.26 [95% CI -0.06 to 0.53]; p = 0.30), whereas the alternative method had strong and very strong correlations when assessed across all radiographs and only good radiographs, respectively (r = 0.71 [95% CI 0.51 to 0.84]; p < 0.001 and r = 0.80 [95% CI 0.64 to 0.89]; p < 0.001). Measurements of hip medialization made on intraoperative fluoroscopic images were not found to be different than measurements made on postoperative radiographs (r = 0.85; p < 0.001 across all hips and r = 0.90; p < 0.001 across only good radiographs).

Conclusion: Using measurements made on preoperative and postoperative CT, the current study demonstrates a mean true medialization achieved by PAO of 4 mm but with substantial variability. The traditional method of measuring medialization at the center of the femoral head may not be accurate; the alternate method of measuring medialization at the lower one-third of the femoral head is a superior way of assessing the hip center's location. We suggest transitioning to using this alternative method to obtain the best clinical and research data, with the realization that both methods using plain radiography appear to underestimate the true amount of medialization achieved with PAO. Lastly, this study provides evidence that the hip center's location and medialization can be accurately assessed intraoperatively using fluoroscopy.

文獻(xiàn)出處：Fowler, Lucas M., Jeffrey J. Nepple, Clarabelle Devries, Michael D. Harris, and John C. Clohisy. "Medialization of the hip’s center with periacetabular osteotomy: validation of assessment with plain radiographs." Clinical Orthopaedics and Related Research? 479, no. 5 (2021): 1040-1049.

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊

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