本期目錄：

1、阿司匹林與低分子肝素預(yù)防膝關(guān)節(jié)和髖關(guān)節(jié)置換術(shù)后靜脈血栓栓塞的療效

2、髕骨周圍去神經(jīng)術(shù)能否為不置換髕骨的同期雙側(cè)全膝關(guān)節(jié)置換術(shù)的患者減輕膝部疼痛并改善患者療效

3、全膝關(guān)節(jié)置換術(shù)后假體周圍感染會增加病死率

4、機器人輔助手術(shù)全髖關(guān)節(jié)置換術(shù)后髂骨嵴不全骨折：兩例病例報告

5、患者對保髖手術(shù)的期望程度

6、髖臼周圍截骨術(shù)（PAO）患者在嬰兒時期接受髖關(guān)節(jié)發(fā)育不良（DDH）治療和未治療的髖關(guān)節(jié)形態(tài)學(xué)比較

7、股骨髖臼撞擊癥的開放手術(shù)治療

8、挪威全國母親、父親和兒童隊列研究中髖關(guān)節(jié)發(fā)育不良的流行病學(xué)

9、保髖截骨手術(shù)并發(fā)癥

10、股骨頭塌陷與髖臼覆蓋在股骨頭壞死患者中的關(guān)聯(lián)性研究

11、股骨和髖臼聯(lián)合前傾與性別有關(guān)，在髖關(guān)節(jié)發(fā)育不良和髖臼后傾的患者中有所不同

12、人類髖臼盂唇形態(tài)的組織病理學(xué)分析

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻

文獻1

阿司匹林與低分子肝素預(yù)防膝關(guān)節(jié)和髖關(guān)節(jié)置換術(shù)后靜脈血栓栓塞的療效：隨機對照試驗的系統(tǒng)回顧和薈萃分析

譯者 張軼超

目的：本研究的目的是評估阿司匹林與低分子肝素（LMWH）在預(yù)防髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)后靜脈血栓栓塞（VTE）的療效。

方法：檢索PubMed/Medline、Embase、Cochrane Library和谷歌學(xué)術(shù)數(shù)據(jù)庫，從建立到2024年6月，檢索研究阿司匹林與低分子肝素在髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)患者中治療VTE療效的原始試驗。以是否出現(xiàn)靜脈血栓栓塞為主要指標(biāo)。次要指標(biāo)包括小出血和大出血事件，以及90天內(nèi)的術(shù)后死亡率。本綜述按照系統(tǒng)回顧首選報告項目和Meta分析指南的要求來進行。

結(jié)果：共納入7項隨機對照試驗，12134名受試者。阿司匹林組和低分子肝素組的平均年齡分別為66.6（57.6-69.0）歲和66.8（57.9-68.9）歲。阿司匹林組和低分子肝素組間的靜脈血栓栓塞風(fēng)險無統(tǒng)計學(xué)差異（優(yōu)勢比[OR]: 0.95； 95%可信區(qū)間[CI]: 0.48-1.89; p: 0.877）�；谔囟╒TE實體（肺栓塞[PE]或深靜脈血栓）的亞組分析顯示，服用阿司匹林的患者發(fā)生PE的風(fēng)險明顯高于低分子肝素組（OR: 1.79; 95% CI: 1.11-2.89; p: 0.017）。兩組的輕微出血（OR: 0.64; 95% CI: 0.40-1.04; p: 0.072）和大出血（OR: 0.77; 95% CI: 0.40-1.47; p: 0.424）發(fā)生率無差異。此外，對全膝關(guān)節(jié)置換術(shù)組的亞組分析顯示，阿司匹林組比低分子肝素組更容易發(fā)生靜脈血栓栓塞（OR: 1.55; 95% CI: 1.21-1.98; p < 0.001）。

結(jié)論：本研究表明，骨關(guān)節(jié)炎髖關(guān)節(jié)或膝關(guān)節(jié)置換術(shù)后服用阿司匹林的患者發(fā)生PE的風(fēng)險明顯高于低分子肝素。特別是在接受膝關(guān)節(jié)置換術(shù)的患者中，阿司匹林與靜脈血栓栓塞的總體風(fēng)險顯著升高有關(guān)。這可能表明阿司匹林與低分子肝素相比在預(yù)防靜脈血栓栓塞方面的療效較差。

The efficacy of aspirin versus low‐molecular‐weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta‐analysis of randomized controlled trials

Purpose: The purpose of this study was to assess the efficacy of aspirin versus low‐molecular‐weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty.

Methods: PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.

Results: A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6–69.0) years and 66.8 (57.9–68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48–1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11–2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40–1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40–1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21–1.98; p < 0.001).

Conclusion: This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures.

文獻出處：Salman LA, Altahtamouni SB, Khatkar H, Al-Ani A, Hameed S, Alvand A. The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1605-1616. doi: 10.1002/ksa.12456. Epub 2024 Sep 3. PMID: 39228215; PMCID: PMC12022833.

文獻2

髕骨周圍去神經(jīng)術(shù)能否為不置換髕骨的同期雙側(cè)全膝關(guān)節(jié)置換術(shù)的患者減輕膝部疼痛并改善患者療效？

譯者 馬云青

全膝關(guān)節(jié)置換術(shù)后膝前痛的發(fā)生率為4%至49%，可能是導(dǎo)致患者對手術(shù)不滿意的一個原因。為減少膝前痛的發(fā)生，有學(xué)者提出采用電灼法進行髕骨去神經(jīng)化。然而，關(guān)于此方法的有效性，研究結(jié)果存在分歧。

作者評估了接受雙側(cè)同期TKA且未進行髕骨置換的患者，旨在探討：(1) 與未行髕骨周圍電灼相比，髕骨周圍環(huán)形電灼是否能減少術(shù)后膝前痛？(2) 與未行電灼相比，髕骨周圍環(huán)形電灼是否能基于患者報告結(jié)果而獲得更好的功能結(jié)局？(3) 電灼組與未電灼組在并發(fā)癥發(fā)生率上是否存在差異？

通過前瞻性、準(zhǔn)隨機研究納入了78名患者，每位患者自身作為對照。在同期雙側(cè)TKA中，右側(cè)膝關(guān)節(jié)進行髕骨周圍電灼。有5名患者在術(shù)后2年最低隨訪期前失訪。所有TKA均由同一位外科醫(yī)生使用同類型假體完成，所有髕骨均切除骨贅且未進行表面置換。髕骨電灼深度為2-3毫米，距離髕骨邊緣約5毫米環(huán)形進行。測量了術(shù)前股脛角和骨關(guān)節(jié)炎程度。使用前髁比值評估髕股關(guān)節(jié)的恢復(fù)情況。在術(shù)前、術(shù)后1個月和術(shù)后2年評估臨床結(jié)局。術(shù)前，兩組在放射學(xué)骨關(guān)節(jié)炎嚴(yán)重程度、基線疼痛和膝關(guān)節(jié)評分方面均無差異。兩組的平均股脛角也具有可比性。術(shù)前和術(shù)后的前髁比值在兩組間也無差異。

在2年隨訪時，兩組平均Kujala評分無差異。平均VAS疼痛評分在電灼膝和未電灼膝之間無差異。平均活動度在兩組間無差異。在癥狀、疼痛、日�；顒�、體育運動、生活質(zhì)量以及牛津膝關(guān)節(jié)評分方面，兩組間均無差異。并發(fā)癥不常見，且兩組間無差異。

作者得出結(jié)論：對于接受未置換髕骨、同期雙側(cè)初次TKA且至少隨訪2年的患者，與未行髕骨周圍電灼相比，環(huán)髕骨周圍電灼在膝前痛、功能結(jié)局和并發(fā)癥發(fā)生率方面均未帶來差異。不建議在接受TKA且未行髕骨置換的患者中常規(guī)進行環(huán)形電灼。

Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA?

Background:Anterior knee pain, which has a prevalence of 4% to 49% after TKA, may be a cause of patient dissatisfaction after TKA. To limit the occurrence of anterior knee pain, patellar denervation with electrocautery has been proposed. However, studies have disagreed as to the efficacy of this procedure.Questions/purposes We evaluated patients undergoing bilateral, simultaneous TKA procedures without patellar resurfacing to ask: (1) Does circumferential patellar cauterization decrease anterior knee pain (Kujala score) postoperatively compared with non-cauterization of the patella? (2) Does circumferential patellar cauterization result in better functional outcomes based on patient report (VAS score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score) than non-cauterization of the patella? (3) Is there any difference in the complication rate (infection, patellar maltracking, fracture, venous thromboembolism, or reoperation rate) between cauterized patellae and non-cauterized patellae?

Methods:Seventy-eight patients (156 knees) were included in this prospective, quasi-randomized study, with each patient serving as his or her own control. Patellar cauterization was always performed on the right knee during simultaneous, bilateral TKA. Five patients (6%) were lost to follow-up before the 2-year minimum follow-up interval. A single surgeon performed all TKAs using the same type of implant, and osteophyte excision was performed in all patellae, which were left unresurfaced. Patellar cauterization was performed at 2 mm to 3 mm deep and approximately 5 mm circumferentially away from the patellar rim. The preoperative femorotibial angle and degree of osteoarthritis (according to the Kellgren-Lawrence grading system) were measured. Restoration of the patellofemoral joint was assessed using the anterior condylar ratio. Clinical outcomes, consisting of clinician-reported outcomes (ROM and Kujala score) and patient-reported outcomes (VAS pain score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score), were evaluated preoperatively and at 1 month and 2 years postoperatively. Preoperatively, the radiologic severity of osteoarthritis, based on the Kellgren-Lawrence classification, was not different between the two groups, nor were the baseline pain and knee scores. The mean femorotibial angle of the two groups was also comparable: 189° ± 4.9° and 191° ± 6.3° preoperatively (p = 0.051) and 177° ± 2.9° and 178° ± 2.1° postoperatively (p = 0.751) for cauterized and non-cauterized knees, respectively. The preoperative (0.3 ± 0.06 versus 0.3 ± 0.07; p = 0.744) and postoperative (0.3 ± 0.06 versus 0.2 ± 0.07; p = 0.192) anterior condylar ratios were also not different between the cauterized and non-cauterized groups.

Results:At the 2-year follow-up interval, no difference was observed in the mean Kujala score (82 ± 2.9 and 83 ± 2.6 for cauterized and non-cauterized knees, respectively; mean difference 0.3; 95% confidence interval, -0.599 to 1.202; p = 0.509). The mean VAS pain score was 3 ± 0.9 in the cauterized knee and 3 ± 0.7 in the non-cauterized knee (p = 0.920). The mean ROM was 123° ± 10.8° in the cauterized knee and 123° ± 10.2° in the non-cauterized knee (p = 0.783). There was no difference between cauterized and non-cauterized patellae in the mean Knee Injury and Osteoarthritis Outcome Score for symptoms (86 ± 4.5 versus 86 ± 3.9; p = 0.884), pain (86 ± 3.8 versus 86 ± 3.6; p = 0.905), activities (83 ± 3.2 versus 83 ± 2.8; p = 0.967), sports (42 ± 11.3 versus 43 ± 11.4; p = 0.942), and quality of life (83 ± 4.9 versus 83 ± 4.7; p = 0.916), as well as in the Oxford knee score (40 ± 2.1 versus 41 ± 1.9; p = 0.771). Complications were uncommon and there were no differences between the groups (one deep venous thromboembolism in the cauterized group and two in the control group; odds ratio 0.49, 95% CI, 0.04-5.56; p = 0.57).

Conclusions:Patellar cauterization results in no difference in anterior knee pain, functional outcomes, and complication rates compared with non-cauterization of the patella in patients who undergo non-resurfaced, simultaneous, bilateral, primary TKA with a minimum of 2 years of follow-up. We do not recommend circumferential patellar cauterization in non-resurfaced patellae in patients who undergo TKA.

文獻出處：Budhiparama NC, Hidayat H, Novito K, Utomo DN, Lumban-Gaol I, Nelissen RGHH. Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA? Clin Orthop Relat Res. 2020 Sep;478(9):2020-2033. doi: 10.1097/CORR.0000000000001035. PMID: 32023234; PMCID: PMC7431264.

文獻3

全膝關(guān)節(jié)置換術(shù)后假體周圍感染會增加病死率

一項全國范圍的包含916例的隊列研究

譯者 張薔

背景：全膝關(guān)節(jié)置換（TKA）術(shù)后出現(xiàn)的假體周圍感染（PJI）是一種有增加患者病死率潛在風(fēng)險的嚴(yán)重并發(fā)癥。我們通過一組全國范圍內(nèi)驗證的隊列研究來對比PJI翻修和無菌性翻修的病死率。

方法：我們的數(shù)據(jù)選自丹麥膝關(guān)節(jié)置換登記庫和丹麥微生物學(xué)登記庫。我們選擇了2010年1月1日至2023年11月9日間所有PJI翻修的病例并與相同時間區(qū)間內(nèi)的無菌性翻修病例作對比。隨訪截止時間為2024年4月4日。病死率通過Kaplan-Meier曲線來計算。風(fēng)險概率比通過治療加權(quán)逆概率法得出并比較PJI和無菌性翻修的病死率。加權(quán)中的其他因素還包括年齡、性別、體重、Charlson合并癥指數(shù)以及婚姻狀態(tài)。估算值通過95%置信區(qū)間計算。最終入組了916例PJI翻修病例和4129例無菌性翻修病例。PJI翻修組的平均隨訪時間為7.0年而無菌性翻修組的平均隨訪時間為7.3年。PJI翻修組的病例比無菌性翻修組的病例年齡更大，男性比例更高，更為肥胖且合并癥更多。

結(jié)果：PJI翻修組的粗略病死率為5.7人/100人-年，無菌性翻修組的粗略病死率為2.4人/100人-年。匹配后的Kaplan-Meier 10年累計病死率為PJI翻修組36%和無菌性翻修組24%。Cox比例風(fēng)險分析顯示PJI相關(guān)的病死率風(fēng)險概率比為1.48（CI: 1.26 - 1.74, P < 0.001）。

結(jié)論：與無菌性翻修相比，全膝關(guān)節(jié)置換術(shù)后假體周圍感染翻修與更高的病死率顯著相關(guān)。

Increased Mortality Following Periprosthetic Joint Infection After Total Knee Arthroplasty

A Microbiologically Verified Nationwide Cohort of 916 Cases

Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication with potential implications for patient mortality. We assessed mortality associated with PJI revisions compared to major aseptic revisions using a microbiologically verified, population-based, nationwide cohort.

Methods: We used data from the Danish Knee Arthroplasty Register and the Danish Microbiology Database. We included patients who underwent PJI revisions between January 1, 2010, and November 9, 2023, and compared them with patients undergoing major aseptic revisions in the same period. The follow-up period was until April 4, 2024. Mortality was calculated using the Kaplan-Meier method. The inverse probability of treatment weighting method was utilized to calculate adjusted hazard ratios with 95% confidence intervals (CIs) comparing PJI and aseptic revisions in terms of mortality. Confounders included in the weighting were age, sex, weight, Charlson Comorbidity Index, and marital status. Estimates were reported with 95% CIs. We identified 916 PJI revisions and 4,129 major aseptic revisions following primary TKA. The mean follow-up time was 7.0 years for PJI revisions and 7.3 years for aseptic revisions. Patients undergoing PJI revisions had a higher proportion of men, older age, greater prevalence of obesity, and higher comorbidity compared to those who had aseptic revisions.

Results: The PJI revisions had a crude mortality rate of 5.7 deaths per 100 person-year, and major aseptic revisions had a crude mortality rate of 2.4 deaths per 100 person-year. The adjusted Kaplan-Meier 10-year cumulative mortality was 36% for PJI and 24% for aseptic revisions. Cox proportional hazards analysis demonstrated an adjusted hazard ratio of 1.48 (CI: 1.26 to 1.74, P < 0.001), for PJI-associated mortality.

Conclusions: A PJI following TKA was associated with a significantly higher mortality risk compared to major aseptic revisions.

文獻4

機器人輔助手術(shù)全髖關(guān)節(jié)置換術(shù)后髂骨嵴不全骨折：兩例病例報告

譯者 沈松坡

在機器人輔助手術(shù)全髖關(guān)節(jié)置換術(shù)（THA）過程中插入骨針后發(fā)生髂骨嵴不全骨折的風(fēng)險尚不明確，因為關(guān)于此類并發(fā)癥的報道極少。在此，我們報告了兩例使用 Mako 系統(tǒng)（Stryker Orthopaedics，美國新澤西 Mahwah）進行機器人輔助手術(shù) THA 后出現(xiàn)對側(cè)髂骨嵴不全骨折的病例。兩名患者均采用前外側(cè)仰臥入路行左側(cè) THA，并在右側(cè)髂骨嵴插入三枚螺紋骨針（直徑 4.0 mm）用于固定骨盆陣列。在病例一中，三枚骨針均獲得了雙皮質(zhì)固定。在病例二中，一枚骨針表現(xiàn)為對髂骨外側(cè)皮質(zhì)的長距離跨皮質(zhì)固定，另一枚插入軟組織，第三枚為單皮質(zhì)固定。術(shù)后，兩名患者均無疼痛及影像學(xué)骨折證據(jù)而出院；然而在術(shù)后約四周于無外傷情況下出現(xiàn)對側(cè)髂骨疼痛。通過普通 X 線證實髂骨嵴骨針插入部位的不全骨折。在采用 T 形手杖步行且無負重限制的保守治療下，兩病例均于三至六個月內(nèi)觀察到骨愈合。這些病例提示，雙皮質(zhì)或跨皮質(zhì)方式固定的髂骨嵴骨針均可能導(dǎo)致髂骨的骨量不足性骨折。本報告強調(diào)需要提高對機器人輔助手術(shù) THA 中與骨針插入相關(guān)的不全骨折的認識。

關(guān)鍵詞：髂骨翼；不全骨折；MAKO；機器人輔助手術(shù)；應(yīng)力骨折；全髖關(guān)節(jié)置換

圖1 病例一術(shù)前與術(shù)后 X 線片。A：術(shù)前骨盆 X 線，診斷為左側(cè)股骨頭壞死；B：術(shù)后一周的 X 線片；C：術(shù)后四周的 X 線顯示右側(cè)髂骨嵴應(yīng)力性骨折；D：來自 C 圖的右側(cè)髂骨放大圖。白色箭頭指示髂骨嵴骨折線。E：術(shù)后三個月的 X 線顯示髂骨嵴骨折輕度移位并已骨愈合。

圖 2：病例一術(shù)后 3D 圖像。A：術(shù)后一周的骨盆 3D 圖像。黃色箭頭指示髂骨嵴處的骨針孔。B：術(shù)后四周的骨盆 3D 圖像。C：術(shù)后一周的骨盆側(cè)位圖像。黃色箭頭指示髂骨外側(cè)皮質(zhì)上的骨針孔。D：術(shù)后一周的骨盆側(cè)位圖像，覆蓋了由藍線標(biāo)示的骨針插入點位置；E：術(shù)后四周的骨盆側(cè)位圖像。骨折線穿過髂骨外側(cè)皮質(zhì)的三枚骨針孔。

圖 3：病例二術(shù)前與術(shù)后 X 線片。A：術(shù)前骨盆 X 線顯示左側(cè)髖關(guān)節(jié)骨關(guān)節(jié)炎；B：術(shù)后 1 周 X 線片；C：術(shù)后三個月的 X 線顯示右側(cè)髂骨嵴應(yīng)力性骨折；D：來自 C 圖的右側(cè)髂骨放大圖。白色箭頭指示髂骨嵴骨折線。E：術(shù)后六個月的 X 線顯示髂骨嵴骨折無移位且已骨愈合。

圖 4：病例二術(shù)后 3D 與 CT 圖像。A：術(shù)后一周的骨盆 3D 圖像。黃色箭頭指示兩枚骨針的插入部位。B：術(shù)后六個月的骨盆 3D 圖像顯示髂骨內(nèi)側(cè)皮質(zhì)骨層已骨愈合且無移位。C：術(shù)后一周在遠端骨針孔水平的骨盆軸位 CT 顯示穿過髂骨外側(cè)皮質(zhì)的長距離跨皮質(zhì)固定。D：術(shù)后一周骨盆 3D 側(cè)位圖像顯示髂骨外側(cè)皮質(zhì)未見骨針孔。E：術(shù)后一周的骨盆側(cè)位圖像，上覆藍線顯示骨針插入位置。F：術(shù)后六個月的骨盆側(cè)位圖像。骨折線沿跨皮質(zhì)固定線路延伸。G：術(shù)后六周在遠端骨針孔水平的骨盆軸位 CT 顯示髂骨已骨愈合。

圖 5：上方的骨針代表用于 CT 導(dǎo)航的骨針，下方的骨針代表用于 Mako 的骨針。用于 Mako 的骨針比用于 CT 導(dǎo)航的骨針具有更長的螺紋部分以及更大的螺紋間距。

Insufficiency Fractures of the Iliac Crest Following Robot-Assisted Total Hip Arthroplasty: A Report of Two Cases

The risk of insufficiency fractures at the iliac crest following pin insertion during robot-assisted total hip arthroplasty (THA) is unknown, as there have been very few reports on this complication. Here, we report two cases of insufficiency fractures of the contralateral iliac crest following robot-assisted THA using the Mako system (Stryker Orthopaedics, Mahwah, NJ, USA). Both patients underwent left THA using the anterolateral supine approach, and three threaded bone pins (4.0 mm diameter) were inserted into the right iliac crest for pelvic array fixation. In case one, all three pins achieved bicortical fixation. In case two, one pin demonstrated long transcortical fixation with the outer cortex of the ilium, another was inserted into soft tissue, and the third pin was fixed monocortically. Postoperatively, both patients were discharged without pain or radiographic evidence of fracture; however, contralateral iliac pain developed approximately four weeks postoperatively without trauma. Insufficiency fractures of the iliac crest at the pin insertion sites were confirmed by plain radiography. Bone union was observed within three to six months of conservative treatment in both cases, with T-cane ambulation and no weight-bearing restrictions. These cases suggest that both bicortical and transcortical pin fixation to the iliac crest may cause insufficiency fractures of the iliac bone. This report highlights the need for increasing awareness of insufficiency fractures associated with pin insertion in robot-assisted THA.

Keywords: iliac crest; insufficiency fractures; mako; robot-assisted surgery; stress-fracture; total hip arthroplasty

第二部分：保髖相關(guān)文獻

文獻1

患者對保髖手術(shù)的期望程度

譯者 張振東

目的：本研究對大樣本保髖手術(shù)尚的患者期望值進行調(diào)查，以確定其對手術(shù)期望值的分布情況，并明確不同人口統(tǒng)計學(xué)資料或臨床特征患者期望程度的差異。

方法：連續(xù)納入年齡≥18歲且母語為英語的患者，并排除既往髖關(guān)節(jié)手術(shù)史或骨關(guān)節(jié)炎分級T?nnis≥2的患者。 患者共完成了21個項目的調(diào)查，確定了每個項目的單項期望值及總體期望值，以及國際髖關(guān)節(jié)結(jié)局工具評分( International Hip Outcome Tool，iHOT)。 通過多變量回歸方法進行統(tǒng)計學(xué)分析。并分別對患者不同受教育程度、專業(yè)、從事競技活動以及平時體育水平進行亞組分析。

結(jié)果：共納入患者320例，平均年齡32歲; 髖關(guān)節(jié)撞擊征270例(89%)，癥狀<6個月72例(24%)，平均iHOT評分41分。 所有21個調(diào)查項目均完成選擇的有120例患者(40%)，選擇18 ~ 20個項目的有112例(37%)，選擇數(shù)目≤17個的有70例(23%)。 在多變量分析中，年齡年輕(比值比[OR] = 1.3; P = .02)、癥狀<6個月(OR = 1.3; P = .03)以及iHOT評分較差(OR = 2.5; P = .0001)與保髖期望值高相關(guān)。另外，平均期望值總分為80分(范圍31-100分)，同樣，在多變量分析中，年齡年輕(P = .05)、癥狀<6個月(P = .01)和iHOT評分低(P = .03)與期望值得分高相關(guān)。大學(xué)生學(xué)歷或職業(yè)運動員選擇所期望的調(diào)查條目更多(P = .01)，更期望術(shù)后有可能提高運動成績(OR = 7.5; P = .001)，實現(xiàn)運動潛能突破(OR = 3.7; P = .002)，并期望未來可選擇更苛刻的運動(OR = 2.7; P = . 01)。

結(jié)論：患者對當(dāng)前和未來身體功能和心理健康狀況的改善均有較高期望，尤其是對于較年輕、癥狀持續(xù)時間較短或者髖關(guān)節(jié)功能狀態(tài)較差的患者。了解不同患者的期望可以更好的指導(dǎo)術(shù)前教育，使患者對術(shù)后恢復(fù)和遠期預(yù)后提供更客觀的預(yù)期。

Patients' Expectations of Hip Preservation Surgery

Purpose: To administer the Hip Preservation Surgery Expectations Survey to a large sample of patients to ascertain the prevalence of their preoperative expectations and to assess expectations in terms of demographic and clinical characteristics.

Methods: Consecutive patients were enrolled if they were ≥18 years old/spoke English and excluded if they had prior hip surgery/degenerative changes T?nnis ≥2. Patients completed the 21-item survey addressing the amount of improvement expected for each item (number of items and an overall score were determined) and the International Hip Outcome Tool (iHOT; hip score determined). Analyses included multivariable regression with survey score and number of expectations as dependent variables. Subanalyses considered collegiate/professional, competitive, and recreational sports level.

Results: Three hundred two patients participated, with a mean age of 32; 270 (89%) had cam impingement, 72 (24%) had symptoms <6 months, and mean iHOT score was 41. One hundred twenty patients (40%) selected all 21 survey items, 112 (37%) selected 18 to 20, and 70 (23%) selected ≤17 items. In multivariable analysis, younger age (odds ratio [OR] = 1.3; P = .02), symptoms <6 months (OR = 1.3; P = .03), and worse iHOT score (OR = 2.5; P = .0001) were associated with selecting more items. The mean survey score was 80 (range, 31-100). In multivariable analysis, younger age (P = .05), symptoms <6 months (P = .01), and worse iHOT score (P = .03) were associated with greater survey scores. Collegiate/professional athletes selected more items (P = .01) and were more likely to select improvement in sports performance (OR = 7.5; P = .001), achievement of athletic potential (OR = 3.7; P = .002), and maintaining options for more demanding future activities (OR = 2.7; P = .01).

Conclusions: Patients had multiple expectations for marked improvement in current and future physical function and psychological well-being. Younger patients, shorter symptom duration, and worse hip-specific functional status were associated with greater expectations. Understanding patients' expectations can guide preoperative education regarding realistic expectations for recovery and long-term outcome.

Clinical relevance: Patients' preoperative expectations vary according to demographic and clinical characteristics as measured in a survey study.

文獻出處：Mancuso CA, Wentzel CH, Kersten SM, Kelly BT. Patients' Expectations of Hip Preservation Surgery: A Survey Study. Arthroscopy. 2019 Jun;35(6):1809-1816.

文獻2

髖臼周圍截骨術(shù)（PAO）患者在嬰兒時期接受髖關(guān)節(jié)發(fā)育不良（DDH）治療和未治療的髖關(guān)節(jié)形態(tài)學(xué)比較

譯者 任寧濤

背景：嬰兒時期成功治療的發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）患者在骨骼成熟時出現(xiàn)癥狀性髖臼發(fā)育不良，行髖臼周圍截骨（PAO）治療。本研究的目的是比較既往DDH治療后伴有晚期髖臼發(fā)育不良的PAO患者與無DDH治療史的PAO患者的股骨和髖臼形態(tài)變化。

方法：回顧性分析2011年至2021年期間接受PAO手術(shù)的患者。納入既往使用Pavlik挽具、外展支具、閉合復(fù)位加spica石膏固定或切開復(fù)位加spica石膏固定治療的嬰兒DDH患者。既往做過髖骨手術(shù)的患者被排除在外。記錄每個髖關(guān)節(jié)的術(shù)前X線測量，包括外側(cè)CE角、前CE角和股骨-骨骺髖臼頂指數(shù)。計算機斷層掃描測量包括冠狀CE角、矢狀CE角、T?nnis角、髖臼1、2、3點鐘前傾、股骨頸干角、股骨扭轉(zhuǎn)角和α角。無DDH診斷或治療史的PAO為對照組，與嬰幼兒DDH治療組根據(jù)冠狀CE角、年齡、性別按2:1比例匹配。

結(jié)果：18例患者21髖既往接受嬰兒DDH治療（13例為Pavlik挽具，3例外展支具，1例閉合復(fù)位，1例切開復(fù)位）。對照組為42例患者42髖既往未接受DDH治療的患者。有過DDH治療的患者與未有過DDH治療的患者在記錄的各項指標(biāo)中，包括股骨扭轉(zhuǎn)角（P=0.494）、髖臼1點鐘前傾（P=0.820）、2點鐘前傾（P=0.584）、3點鐘前傾（P=0.137）、頸干角（P=0.612）、外側(cè)CE角（P=0.433）、股骨-髖臼頂指數(shù)（P=0.144）、α角（P=0.156），差異均無統(tǒng)計學(xué)意義。

結(jié)論：經(jīng)過DDH治療后持續(xù)存在癥狀性髖臼發(fā)育不良的PAO患者，與骨骼成熟后出現(xiàn)髖臼發(fā)育不良且沒有DDH治療史的患者，其股骨和髖臼形態(tài)相似。

Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment

Background: A subset of patients successfully treated for developmental dysplasia of the hip (DDH) as infants have symptomatic acetabular dysplasia at skeletal maturity leading to periacetabular osteotomy (PAO). The purpose of this study was to compare femoral and acetabular morphology in PAO patients with late acetabular dysplasia after previous treatment for DDH with PAO patients who do not have a history of DDH treatment.

Methods: A single surgeon's patients who underwent PAO between 2011 and 2021 were retrospectively reviewed. Patients previously treated for infantile DDH with a Pavlik harness, abduction brace, closed reduction and spica casting, or open reduction and spica casting were included. Patients with previous bony hip surgery were excluded. Preoperative radiographic measurements of each hip were recorded including lateral center edge angle, anterior center edge angle, and Femoro-Epiphyseal Acetabular Roof index. Computed tomography measurements included the coronal center edge angle, sagittal center edge angle, T?nnis angle, acetabular anteversion at 1, 2, and 3 o'clock, femoral neck-shaft angle, femoral version, and alpha angle. Control PAO cases without a history of DDH diagnosis or treatment were matched with the infantile DDH treatment group in a 2:1 ratio based on coronal center edge angle, age, and sex.

Results: There were 21 hips in 18 patients previously treated for infantile DDH (13 patients Pavlik harness, 3 abduction brace, 1 closed reduction, and 1 open reduction). The control PAO cohort was 42 hips in 42 patients who did not have previous DDH treatment. There was no statistically significant difference in any of the recorded measurements between patients previously treated for DDH and those without previous treatment including femoral version (P=0.494), anteversion at 1 o'clock (P=0.820), anteversion at 2 o'clock (P=0.584), anteversion at 3 o'clock (P=0.137), neck-shaft angle (P=0.612), lateral center edge angle (P=0.433), Femoro-Epiphyseal Acetabular Roof index (P=0.144), and alpha angle (P=0.156).

Conclusions: Femoral and acetabular morphology is similar between PAO patients with persistent symptomatic acetabular dysplasia following DDH treatment and patients presenting after skeletal maturity with acetabular dysplasia and no previous history of DDH treatment.

文獻出處：Ellsworth BK, Bram JT, Sink EL. Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment. J Pediatr Orthop. 2022 Jul 1;42(6):e565-e569. doi: 10.1097/BPO.0000000000002137. Epub 2022 Mar 10. PMID: 35667051.

文獻3

股骨髖臼撞擊癥的開放手術(shù)治療

譯者 李勇

目的：消除股骨髖臼撞擊癥的關(guān)節(jié)內(nèi)撞擊。使髖關(guān)節(jié)恢復(fù)無痛且活動范圍正常。

適應(yīng)證：任何類型的股骨髖臼撞擊癥（凸輪型/鉗夾型）以及任何部位（前/后）。

禁忌證：絕對禁忌：晚期髖關(guān)節(jié)骨關(guān)節(jié)炎、髖關(guān)節(jié)周圍局部感染。相對禁忌：髖臼后傾過度伴髖臼后壁缺損。

手術(shù)技術(shù)：側(cè)臥位。在大轉(zhuǎn)子正上方做直切口。進入吉布森間隙。進行“二腹肌式”大轉(zhuǎn)子截骨術(shù)，保護旋股內(nèi)側(cè)動脈。打開梨狀肌與臀小肌之間的間隙。做 Z 形關(guān)節(jié)囊切開術(shù)。脫位股骨頭。分離髖臼盂唇。修整過長的髖臼緣。重新固定髖臼盂唇。形成足夠的股骨頭頸偏心距�？p合關(guān)節(jié)囊。重新固定轉(zhuǎn)子。

術(shù)后管理：住院期間，使用持續(xù)被動活動機對髖關(guān)節(jié)進行強化活動，最大屈曲角度為 90 度。術(shù)后 6 周內(nèi)禁止主動外展和被動內(nèi)收超過身體中線，最大負重 10 至 15 千克。隨后進行首次臨床和影像學(xué)隨訪。在完全負重前需預(yù)防深靜脈血栓形成。

結(jié)果：短期和中期結(jié)果顯示，95%的患者術(shù)后臨床評分（Merle d'Aubigné 評分）有所改善，具體取決于手術(shù)時個體關(guān)節(jié)退變情況。91%的病例取得了良好至優(yōu)秀的結(jié)果。5 年累計生存率為 91%（終點為全髖關(guān)節(jié)置換術(shù)或 Merle d'Aubigné 評分差）。長期結(jié)果尚未得出。

Open Therapy of Femoroacetabular Impingement

Objective: Elimination of an intraarticular femoroacetabular impingement conflict. Creation of a painfree, normal range of motion of the hip. Indications: Femoroacetabular impingement of any type (cam/pincer) and any localization (anterior/posterior). Contraindications: Absolute: advanced hip osteoarthritis, local infections around the hip. Relative: excessive acetabular retroversion with deficiency of the posterior wall. Surgical technique: Lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Detachment of the labrum. Trimming of the excessive acetabular rim. Refixation of the labrum. Creation of a sufficient femoral head-neck offset. Suture of the capsule. Refixation of the trochanter. Postoperative management: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline. Maximum weight bearing 10-15 kg for 6 weeks. Subsequently, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis until full weight bearing. Results: Short- and mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné Score) in 95% of all patients, depending on the individual degenerative joint alterations at the time of surgery. Good to excellent results were obtained in 91% of all cases. Cumulative 5-year survival was 91% (endpoint total hip arthroplasty or poor Merle d'Aubigné Score). Long-term results are not available yet.

文獻出處：Tannast M, Siebenrock KA. Die offene Therapie des femoroazetabul?ren Impingements [Open therapy of femoroacetabular impingement]. Oper Orthop Traumatol. 2010 Mar;22(1):3-16. German. doi: 10.1007/s00064-010-3001-7. PMID: 20349166.

文獻4

挪威全國母親、父親和兒童隊列研究中髖關(guān)節(jié)發(fā)育不良的流行病學(xué)

譯者 賈海港

目的：髖關(guān)節(jié)發(fā)育不良（DDH）是一種先天性疾病，其風(fēng)險因素包括臀位分娩、女性性別及家族遺傳傾向。盡管其中若干危險因素已被納入國家篩查計劃，但 DDH 的延遲診斷仍時有發(fā)生。本研究的目的是調(diào)查這些及其他危險因素的患病率，以便改進現(xiàn)行篩查方案。。

方法：本研究采用了挪威母親、父親和兒童隊列研究（MoBa）及挪威醫(yī)療出生登記處（MBRN）的數(shù)據(jù)。我們使用了描述性統(tǒng)計和邏輯回歸分析�；加心X癱、綜合征性疾病或發(fā)育遲緩的兒童被排除在研究之外。

結(jié)果：共納入 107,194 名兒童，家長通過問卷報告了子女是否被診斷為或接受過髖關(guān)節(jié)發(fā)育不良（DDH）治療。 MoBa 研究中共有 3,460 名兒童（3.2%）被診斷為 DDH，其中 1,453 名（1.4%）接受過 DDH 治療。具有統(tǒng)計學(xué)意義的風(fēng)險因素包括女性、臀位分娩及馬蹄內(nèi)翻足，而多胎妊娠和母體糖尿病則是 DDH 的保護性因素。剖宮產(chǎn)分娩并未增加 DDH 的患病率。

結(jié)論：我們證實了先前提出的風(fēng)險因素（如臀位分娩和女嬰性別），而多胎妊娠和剖宮產(chǎn)等其他變量則未被證實為風(fēng)險因素。然而，回歸分析表明存在其他影響髖關(guān)節(jié)發(fā)育不良（DDH）患病率的因素。這些因素可能涉及環(huán)境與遺傳雙重影響，凸顯了深化 DDH 研究以優(yōu)化現(xiàn)有篩查方案的必要性。

The epidemiology of hip dysplasia in the nationwide Norwegian Mother, Father, and Child Cohort Study

Aims: Developmental dysplasia of the hip (DDH) is a congenital disorder with several assumed risk factors, including breech presentation, female sex, and familial predisposition. Although several of these risk factors are included in national screening programmes, delayed diagnoses of DDH still occur. The aim of this study was to examine the prevalence of these and other risk factors in order to improve the current screening programmes.

Methods: This study used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). We used descriptive statistics and logistic regression analyses. Children with cerebral palsy, syndromic disorders, or developmental delay were excluded from the study.

Results: A total of 107,194 children were included, with parents reporting using questionnaires if their child had a diagnosis of, or treatment for, DDH. A total of 3,460 children (3.2%) in MoBa had a diagnosis of DDH, with 1,453 (1.4%) being treated for DDH. Statistically significant risk factors included female sex, breech presentation, and pes equinovarus, whereas plural births and maternal diabetes were protective factors for DDH. Having a Caesarean section did not increase the prevalence of DDH.

Conclusion: We were able to confirm previously proposed risk factors such as breech presentation and female sex, whereas other variables such as plural births and Caesarean section were not found to be risk factors. However, regression analysis suggested that there are additional factors which affect the prevalence of DDH. These could be both environmental and genetic factors, highlighting the need for further research on DDH to improve the current screening programmes.

文獻出處：Jacobsen KK, Kristiansen H, Gundersen T, Lie SA, Rosendahl K, Laborie LB. The epidemiology of hip dysplasia in the nationwide Norwegian Mother, Father, and Child Cohort Study. Bone Joint J. 2025 Jul 1;107-B(7):761-768.

文獻5

保髖截骨手術(shù)并發(fā)癥

譯者 陶可

術(shù)前病理形態(tài)學(xué)評估對于手術(shù)計劃至關(guān)重要，包括以X線片為基礎(chǔ)的影像學(xué)檢查，以及磁共振成像（MRI）和基于病例的輔助影像學(xué)檢查（例如三維CT、外展位片）。髖關(guān)節(jié)鏡手術(shù)（HAS）技術(shù)取得了巨大的進步，應(yīng)用范圍大幅擴大，適應(yīng)癥也日益廣泛。髖關(guān)節(jié)鏡術(shù)后翻修手術(shù)最常見的適應(yīng)癥是髖臼盂唇撕裂和殘余股骨髖臼撞擊綜合征（FAI）。目前，對于臨界發(fā)育性髖關(guān)節(jié)發(fā)育不良的治療仍存在爭議。了解個體髖關(guān)節(jié)的根本問題并區(qū)分髖關(guān)節(jié)不穩(wěn)（發(fā)育不良）和股骨髖臼撞擊綜合征（FAI）至關(guān)重要，因為對于髖關(guān)節(jié)不穩(wěn)，合適的治療方法是髖臼周圍截骨術(shù)（PAO），而對于FAI，則應(yīng)進行髖關(guān)節(jié)鏡下撞擊手術(shù)。對于髖關(guān)節(jié)發(fā)育不良的治療，PAO聯(lián)合凸輪切除術(shù)的生存率高于單純PAO。此外，外科醫(yī)生面臨的挑戰(zhàn)是如何平衡過度矯正和矯正不足。應(yīng)評估股骨扭轉(zhuǎn)異常，并將股骨旋轉(zhuǎn)截骨術(shù)的評估納入治療方案。

圖1 一位34歲患者在另一家醫(yī)療機構(gòu)接受髖關(guān)節(jié)鏡下髖臼緣修整和盂唇修復(fù)術(shù)后出現(xiàn)髖關(guān)節(jié)疼痛。(A)骨盆正位片顯示關(guān)節(jié)間隙正常，無明顯畸形。(B)髖關(guān)節(jié)CT掃描顯示鉆孔，并懷疑錨釘位于關(guān)節(jié)內(nèi)。(C)患者隨后接受了髖關(guān)節(jié)脫位手術(shù)，證實了錨釘位于關(guān)節(jié)內(nèi)，并導(dǎo)致髖臼軟骨損傷。

圖2 (A)一位27歲職業(yè)足球運動員，術(shù)前骨盆正位片顯示其患有髖臼撞擊綜合征，接受了髖關(guān)節(jié)鏡下髖臼撞擊切除術(shù)。(B)患者重返賽場10個月后，出現(xiàn)髖關(guān)節(jié)疼痛復(fù)發(fā)。相應(yīng)的X線片未見明顯病變。（C）髖關(guān)節(jié)冠狀位液體敏感磁共振圖像顯示骨髓水腫明顯，并可見硬化線，提示應(yīng)力性骨折。（D）采用空心螺釘固定應(yīng)力性骨折。

圖3 （A）一位26歲女性患者，患有臨界髖關(guān)節(jié)發(fā)育不良，在兩次髖關(guān)節(jié)鏡手術(shù)（包括髖臼偏移矯正和盂唇清理）后仍持續(xù)存在髖關(guān)節(jié)疼痛。骨盆正位片顯示髖臼覆蓋不足，外側(cè)中心邊緣角（LCE）為18°。（B）行磁共振關(guān)節(jié)造影以評估關(guān)節(jié)內(nèi)病變。矢狀位圖像顯示盂唇發(fā)育不良，伴有實質(zhì)撕裂（箭頭所示）。造影劑在髖臼后下部積聚（箭頭所示），導(dǎo)致股骨頭向前移位，提示髖關(guān)節(jié)不穩(wěn)定。（C）髖臼周圍截骨術(shù)后6個月的骨盆正位片顯示髖臼外側(cè)覆蓋改善，LCE為27°。

圖4 （A、B）一位33歲患者，髖臼覆蓋正常，輕度凸輪畸形，前上方部分髖臼盂唇撕裂（箭頭所示），接受了髖關(guān)節(jié)鏡下凸輪切除和髖臼唇修復(fù)術(shù)。（C）患者術(shù)后持續(xù)疼痛，多次磁共振關(guān)節(jié)造影顯示前關(guān)節(jié)囊廣泛缺損（箭頭所示）。隨后安排患者進行髖關(guān)節(jié)囊重建術(shù)。

圖5 一位24歲患者，因混合型股骨髖臼撞擊行髖關(guān)節(jié)外科脫位后持續(xù)疼痛。磁共振關(guān)節(jié)造影顯示關(guān)節(jié)囊與股骨頸之間存在粘連（箭頭所示）。患者接受了髖關(guān)節(jié)鏡粘連松解術(shù)。

圖6 (A)一位39歲髖關(guān)節(jié)發(fā)育不良患者（外側(cè)中心邊緣角（LCE）為15°），關(guān)節(jié)間隙保持良好。(B)髖臼周圍截骨術(shù)后6周，LCE為28°。(C)術(shù)后6個月，骨盆正位片顯示截骨處不愈合，恥骨下支應(yīng)力性骨折。(D)經(jīng)髂腹股溝入路行皮質(zhì)骨剝脫和骨再固成術(shù)。

圖7 （A、B）一名41歲男性患者，既往有Legg-Calvé-Perthes病史，此次就診主訴為髖關(guān)節(jié)疼痛。骨盆正位片和三維計算機斷層掃描（3D CT）重建顯示髖關(guān)節(jié)發(fā)育不良，表現(xiàn)為髂前下棘（AIIS，白色實線）明顯下傾，以及股骨頸短縮和大頭（股骨頭偏大）。髖臼前壁（AW）以紅色顯示，髖臼后壁（PW）以藍色顯示。（C、D）患者隨后接受了髖臼周圍截骨術(shù)和髖關(guān)節(jié)外科脫位手術(shù)，并進行了股骨頭相對延長和偏心距矯正。術(shù)后6個月，患者仍存在持續(xù)性疼痛和活動受限。術(shù)后X線片（C）和三維重建CT（D）顯示髖臼后傾角增大（交叉征陽性）和髂前下棘（AIIS）突出（白色實線），導(dǎo)致關(guān)節(jié)內(nèi)和關(guān)節(jié)外撞擊。（E）經(jīng)髂腹股溝入路減壓突出的AIIS并修整邊緣后的術(shù)后影像。

圖8 （A、B）一名14歲男孩，主訴髖關(guān)節(jié)疼痛和不穩(wěn)定的中度股骨頭骨骺滑脫（B圖中Southwick角為43°）。（C、D）磁共振成像顯示股骨頸關(guān)節(jié)積液和骨髓水腫，但未見股骨頭壞死征象。（E）術(shù)后6周骨盆正位片。改良鄧恩手術(shù)后。(F)術(shù)后4個月，患者疼痛加劇，X線片顯示股骨頭扁平，提示股骨頭缺血性壞死。

Complications of hip preserving surgery

Preoperative evaluation of the pathomorphology is crucial for surgical planning, including radiographs as the basic modality and magnetic resonance imaging (MRI) and case-based additional imaging (e.g. 3D-CT, abduction views).Hip arthroscopy (HAS) has undergone tremendous technical advances, an immense increase in use and the indications are getting wider. The most common indications for revision arthroscopy are labral tears and residual femoroacetabular impingement (FAI).Treatment of borderline developmental dysplastic hip is currently a subject of controversy. It is paramount to understand the underlining problem of the individual hip and distinguish instability (dysplasia) from FAI, as the appropriate treatment for unstable hips is periacetabular osteotomy (PAO) and for FAI arthroscopic impingement surgery. PAO with a concomitant cam resection is associated with a higher survival rate compared to PAO alone for the treatment of hip dysplasia. Further, the challenge for the surgeon is the balance between over- and undercorrection. Femoral torsion abnormalities should be evaluated and evaluation of femoral rotational osteotomy for these patients should be incorporated to the treatment plan.

文獻出處：Markus S Hanke, Till D Lerch, Florian Schmaranzer, Malin K Meier, Simon D Steppacher, Klaus A Siebenrock. Complications of hip preserving surgery. Review EFORT Open Rev. 2021 Jun 28;6(6):472-486. doi: 10.1302/2058-5241.6.210019.

文獻6

股骨頭塌陷與髖臼覆蓋在股骨頭壞死患者中的關(guān)聯(lián)性研究

譯者 邱興

背景： 股骨頭壞死（ONFH）的分型系統(tǒng)通常基于壞死病灶的大小、體積和位置。ONFH 常導(dǎo)致股骨頭塌陷，但并非總是如此。由于髖臼覆蓋與股骨頭所受的機械應(yīng)力相關(guān)，因此它也可能與 ONFH 患者的股骨頭塌陷有關(guān)。然而，髖臼覆蓋與這些患者股骨頭塌陷之間的關(guān)聯(lián)尚未明確。

研究問題/目的： （1）在 ONFH 患者中，股骨頭塌陷是否與髖臼覆蓋或骨盆入射角（PI）相關(guān)？（2）ONFH 分型系統(tǒng)中已確立的股骨頭塌陷預(yù)測因素是否與髖臼覆蓋相關(guān)？

方法： 在 2008 年至 2018 年期間，我們評估了 218 名 ONFH 患者的 343 個髖關(guān)節(jié)。我們考慮了所有 ONFH 患者，但排除了創(chuàng)傷性病因、塌陷前有手術(shù)治療史或初次就診時已發(fā)生塌陷的患者。最終，101 個 ONFH 髖關(guān)節(jié)（男性占 50% [50例]，平均年齡 44 ± 15 歲）符合我們的納入標(biāo)準(zhǔn)。這些患者隨后被分為兩組：12 個月內(nèi)發(fā)生股骨頭塌陷組（塌陷組，35 髖）和未發(fā)生股骨頭塌陷組（未塌陷組，66 髖）。兩組患者在人口統(tǒng)計學(xué)資料方面無差異。我們使用 CT 圖像測量 PI 和三個平面的髖臼覆蓋度：冠狀面的外側(cè)中心邊緣角（LCEA）、矢狀面的前/后中心邊緣角以及軸狀面的前/后髖臼扇形角；此外，還比較了組間這些參數(shù)的差異。針對存在差異的參數(shù)，探討了其預(yù)測股骨頭塌陷的臨界值。分別采用日本骨壞死研究委員會（JIC）分型和 Steinberg 分級來評估壞死部位和大小。我們檢驗了這些參數(shù)與分型之間的關(guān)系。

結(jié)果： 未塌陷組的平均 LCEA 略大于塌陷組（32° ± 6° 對比 28° ± 7°；平均差值為 4° [95% CI 1.15° 至 6.46°]；p = 0.005）；這一微小差異的臨床重要性尚不確定。兩組的 PI 無差異。在考慮了性別、年齡、BMI 和病因等混雜因素，以及髖臼覆蓋參數(shù)和 PI 后，我們發(fā)現(xiàn)較低的 LCEA 與增加的塌陷風(fēng)險獨立相關(guān)，盡管效應(yīng)量較小且其重要性存疑（OR 1.18 [95% CI 1.06 至 1.33]；p = 0.001）。LCEA 預(yù)測股骨頭塌陷的臨界值為 28°（敏感性 = 0.79，特異性 = 0.60，曲線下面積 = 0.73）。JIC C1 型（OR 6.52 [95% CI 1.64 至 43.83]；p = 0.006）和 C2 型（OR 9.84 [95% CI 2.34 至 68.38]；p = 0.001）患者中 LCEA 小于 28° 的比例高于 A 型和 B 型患者。被排除患者的髖臼覆蓋數(shù)據(jù)與納入分析的患者數(shù)據(jù)無差異。

結(jié)論： 我們的研究結(jié)果表明，髖臼覆蓋與 ONFH 患者發(fā)生塌陷的可能性之間似乎關(guān)聯(lián)甚微（如果存在的話）。我們發(fā)現(xiàn)較低的 LCEA 與較高的塌陷風(fēng)險之間存在微弱的關(guān)聯(lián)，但其效應(yīng)量可能不具備臨床重要性。需要考慮髖臼覆蓋以外的因素，并且如果我們的發(fā)現(xiàn)得到其他研究者證實，則截骨術(shù)不太可能起到保護作用。由于本研究中的患者在種族和 BMI 方面較為同質(zhì)，這些因素需要進一步研究以確定它們是否與 ONFH 的股骨頭塌陷相關(guān)。

證據(jù)等級： III 級，預(yù)后性研究。

Is There an Association Between Femoral Head Collapse and Acetabular Coverage in Patients With Osteonecrosis?

Background: Osteonecrosis of the femoral head (ONFH) classification systems are based on the size, volume, and location of necrotic lesions. Often-but not always-ONFH results in femoral head collapse. Because acetabular coverage is associated with mechanical stress on the femoral head, it might also be associated with femoral head collapse in patients with ONFH. However, the association between acetabular coverage and femoral head collapse in these patients has not been established.

Questions/purposes: (1) Is femoral head collapse associated with acetabular coverage or pelvic incidence (PI) in patients with ONFH? (2) Are established predictors of femoral head collapse in ONFH classification systems associated with acetabular coverage?

Methods: Between 2008 and 2018, we evaluated 343 hips in 218 patients with ONFH. We considered all patients with ONFH except for those with a traumatic etiology, a history of surgical treatment before collapse, or those with collapse at initial presentation as potentially eligible for this study. Of those, 101 hips with ONFH (50% [50] were in males with a mean age of 44 ± 15 years) met our inclusion criteria. These patients were subsequently divided into two groups: those with femoral head collapse within 12 months (collapse group, 35 hips) and those without femoral head collapse (noncollapse group, 66 hips). No differences in patient demographics were observed between the two groups. CT images were used to measure the PI and acetabular coverage in three planes: the lateral center-edge angle (LCEA) in the coronal plane, the anterior and posterior center-edge angle in the sagittal plane, and the anterior and posterior acetabular sector angle in the axial plane; in addition, the difference between these parameters was investigated between the groups. The thresholds for femoral head collapse in the parameters that showed differences were investigated. Necrotic location and size were evaluated using the Japanese Investigation Committee (JIC) classification and the Steinberg grade classification, respectively. We examined the relationship between these parameters and classifications.

Results: The mean LCEA was slightly greater in the noncollapse group than in the collapse group (32° ± 6° versus 28° ± 7°; mean difference 4° [95% CI 1.15° to 6.46°]; p = 0.005); the clinical importance of this small difference is uncertain. There were no differences in PI between the two groups. After accounting for sex, age, BMI, and etiology as confounding factors, as well as acetabular coverage parameters and PI, we found a lower LCEA to be independently associated with increased odds of collapse, although the effect size is small and of questionable importance (OR 1.18 [95% CI 1.06 to 1.33]; p = 0.001). The threshold of LCEA for femoral head collapse was 28° (sensitivity = 0.79, specificity = 0.60, area under the curve = 0.73). The percentage of patients with an LCEA less than 28° was larger in JIC Type C1 (OR 6.52 [95% CI 1.64 to 43.83]; p = 0.006) and C2 (OR 9.84 [95% CI 2.34 to 68.38]; p = 0.001) than in patients with both Type A and Type B. The acetabular coverage data for the excluded patients did not differ from those of the patients included in the analysis.

Conclusion: Our findings suggest that acetabular coverage appears to have little, if any, association with the likelihood of collapse in patients with ONFH. We found a small association between a lower LCEA and a higher odds of collapse, but the effect size may not be clinically important. Factors other than acetabular coverage need to be considered, and if our findings are verified by other investigators, osteotomy is unlikely to have a protective role. As the patients in our study were fairly homogeneous in terms of ethnicity and BMI, these factors need to be further investigated to determine whether they are associated with femoral head collapse in ONFH.

Level of evidence: Level III, prognostic study.

文獻出處：Iwasa, Makoto, Wataru Ando, Keisuke Uemura, Hidetoshi Hamada, Masaki Takao, and Nobuhiko Sugano. "Is there an association between femoral head collapse and acetabular coverage in patients with osteonecrosis?." Clinical Orthopaedics and Related Research? 481, no. 1 (2023): 51-59.

文獻7

股骨和髖臼聯(lián)合前傾與性別有關(guān)，在髖關(guān)節(jié)發(fā)育不良和髖臼后傾的患者中有所不同

譯者 陳志強

目的：在發(fā)育性髖關(guān)節(jié)發(fā)育不良(DDH)患者中，股骨和髖臼前傾角(AV)及其組合的異常頻率尚不清楚。本研究旨在探討先天性髖關(guān)節(jié)脫位(DDH)和髖臼后傾(AR)患者的股骨前傾(FV)、增加的FV和股骨后傾的比例以及聯(lián)合傾斜度(CV、FV+AV)。

患者和方法：對78例(90個髖關(guān)節(jié))有癥狀的DDH患者和65例(77個髖關(guān)節(jié))因AR引起的髖臼撞擊(FAI)患者(77個髖關(guān)節(jié)，經(jīng)AP片診斷)進行了IRB批準(zhǔn)的回顧性觀察研究。比較CT/MRI測量的FV(Murphy法)和AV。分析FV增加(Fv＞25?)、FV嚴(yán)重增加(FV＞35?)和FV極度增大(Fv＞45?)、FV后傾(Fv＜10?)和CV(McKibbin指數(shù)/COTAV指數(shù))的頻率。

結(jié)果：DDH患者的平均FV和CV(25±11?和47±18?)顯著高于AR(16±11?和28±13?)(p＜0.001)。女性患者平均FV(27±16?)和AR(19±12?)顯著高于男性患者(18±13?)和AR(13±8?)(P<0.001)。在DDH患者中，F(xiàn)Vv＞25?的頻率為47%，F(xiàn)V＞35?的頻率為23%。與 DDH 患者 (17%) 相比，AR 患者 (31%) 的股骨后傾比例 (FV < 10) 顯著較高 (p < 0.001)。 18% 的 DDH 患者 AV > 25° 且 FV > 25°。在 AR 患者中，12% 的 FV < 10°且 AV < 10。

結(jié)論：DDH和AR患者的FV和CV具有顯著的性別相關(guān)差異。 對于 DDH 患者，F(xiàn)V 嚴(yán)重增加 > 35° (23%) 的頻率相當(dāng)高，但 17% 的患者表現(xiàn)出 FV 降低，這可能會影響治療 不同的組合強調(diào)了在保髖手術(shù)（髖臼周圍截骨術(shù)和股骨去旋截骨術(shù)）和髖關(guān)節(jié)鏡檢查之前進行患者特異性評估的重要性。

Combined femoral and acetabular version is sex-related and differs between patients with hip dysplasia and acetabular retroversion

Aims: Frequency of abnormal femoral and acetabular version (AV) and combinations are unclear in patients with developmental dysplasia of the hip (DDH). This study aimed to investigate femoral version (FV), the proportion of increased FV and femoral retroversion, and combined-version (CV, FV+AV) in DDH patients and acetabularretroversion (AR).

Patients and methods: A retrospective IRB-approved observational study was performed with 78 symptomatic DDH patients (90 hips) and 65 patients with femoroacetabular-impingement (FAI) due to AR (77 hips, diagnosis on AP radiographs). CT/MRI-based measurement of FV (Murphy method) and central AV were compared. Frequency of increased FV(FV > 25?), severely increased FV (FV > 35?) and excessive FV (FV > 45?) and of decreased FV (FV < 10?) and CV (McKibbin-index/COTAV-index) was analysed.

Results: Mean FV and CV was significantly (p < 0.001) increased of DDH patients (mean ± SD of 25 ± 11? and 47 ± 18?) compared to AR (16 ± 11? and 28 ± 13?). Mean FV of female DDH patients (27 ± 16?) and AR (19 ± 12?) was significantly (p < 0.001) increased compared to male DDH patients (18 ± 13?) and AR (13 ± 8?). Frequency of increased FV (>25?) was 47% and of severely increased FV (>35?) was 23% for DDH patients. Proportion of femoral retroversion (FV < 10?) was significantly (p < 0.001) higher in patients AR (31%) compared to DDH patients (17%). 18% of DDH patients had AV > 25? combined with FV > 25?. Of patients with AR, 12% had FV < 10? combined with AV < 10?.

Conclusion: Patients with DDH and AR have remarkable sex-related differences of FV and CV. Frequency of severely increased FV > 35? (23%) is considerable for patients with DDH, but 17% exhibited decreased FV, that could influence management. The different combinations underline the importance of patient-specific evaluation before open hip preservation surgery (periacetabular osteotomy and femoral derotation osteotomy) and hiparthroscopy.

文獻出處：Meier, Malin K. et al. European Journal of Radiology, Volume 158, 110634

文獻8

人類髖臼盂唇形態(tài)的組織病理學(xué)分析

譯者 徐子茵

軟組織對機械負荷的結(jié)構(gòu)和功能適應(yīng)控制了其承受傷害的能力，并影響其愈合能力。與膝半月板類似，髖臼盂唇在機械載荷分布上表現(xiàn)出不同區(qū)域，形成具有獨特結(jié)構(gòu)和功能特性的區(qū)域。然而對盂唇退行性變化的嚴(yán)重程度和分布的影響知之甚少。本研究旨在評估盂唇匹配對組織病理特征嚴(yán)重程度和分布的影響。從9具尸體中提取了人體組織，共計16個半骨盆（10名男性和6名女性），平均年齡為80歲（年齡范圍66-99歲）。每個髖關(guān)節(jié)被劃分為8個不同的區(qū)域，形成128個區(qū)域分段。載玻片使用赤木精和嗜氨酸（H&E）和Safranin-O（Saf O）染色，并結(jié)合了對伊信（F-Eosin）的熒光掃描。采用改良膝關(guān)節(jié)半月板分級標(biāo)準(zhǔn)評估了髖臼盂的組織病理特征。這些特征在髖關(guān)節(jié)解剖象限的整體范圍內(nèi)以及內(nèi)外區(qū)域進行了評估。對盂唇的整體分析顯示，髖關(guān)節(jié)的上象限、前象限、下象限和后象限的組織病理特征分布相似。相反，在128個盂唇節(jié)段中，成對區(qū)域評估顯示退行性特征的嚴(yán)重程度顯著增加（p < 0.05），這些特征主要集中在靠近關(guān)節(jié)面的內(nèi)側(cè)盂唇區(qū)。這些退行性變化包括基質(zhì)蛋白聚糖含量、細胞結(jié)構(gòu)、膠原蛋白組織以及盂唇關(guān)節(jié)表面（的變化。內(nèi)側(cè)髖臼盂唇纖維的致密程度增加、血管穿透極少以及顯著的退行性變化，意味著該區(qū)域易受傷，愈合能力可能有限。這些不同分區(qū)框架的劃分凸顯了唇唇對其機械環(huán)境的功能適應(yīng)。與以往全球分析相比，對唇的區(qū)域分析提供了對組織病理特征分布動態(tài)更為詳細的視角，更精確地理解了可能解釋區(qū)域特異性易受損傷和退化的解剖因素。

Histopathologic Analysis of the Morpho-Functional Zones of the Human Acetabular Labrum

The structural and functional adaptation of soft tissues to mechanical load controls their ability to withstand injury and influences their capacity for healing. Similar to the knee meniscus, the acetabular labrum exhibits zonal differences in mechanical load distribution, resulting in distinct regions with unique structural and functional properties. However, little is known about the effect of these zonal adaptations on the severity and distribution of labral degenerative changes. This study aims to assess the impact of labral zonal adaptations on the severity and distribution of histopathologic features. Human tissue was obtained from 9 embalmed cadavers, comprising a total of 16 hemipelves (10 males and 6 females) with an average age of 80 years (age range 66-99). Each hip was divided into 8 distinct regions, resulting in 128 regional segments. Slides were stained using Hematoxylin and Eosin (H&E) and Safranin-O (Saf O), with the incorporation of fluorescent scanning of eosin (F-Eosin). Labral histopathologic features were assessed using established modified grading criteria for the knee meniscus. These features were evaluated both globally across the anatomical quadrants of the hip joint and zonally across the inner and outer zones. The global analysis of the labrum revealed a similar distribution of histopathologic features across the superior, anterior, inferior, and posterior quadrants of the hip joint. Conversely, across 128 labral segments, pairwise zonal assessments revealed a significant increase (p < 0.05) in the severity of degenerative features, which were predominantly concentrated in the inner labral zone near the articular surface. These degenerative changes encompassed alterations in matrix proteoglycan content, cellularity, collagen organization, and labral articular surface, including the lamellar layer. The increased compactness of labral fibers in the inner zone, minimal vascular penetration, and significant degenerative changes imply that it is a vulnerable area for injury with a potentially limited capacity for healing. The delineation of these distinct zonal frameworks highlights the labrum's functional adaptation to its mechanical environment. The zonal analysis of the labrum provided a considerably more detailed perspective on the distribution dynamics of histopathologic features compared to previous global analyses, offering a more precise understanding of the anatomical factors that may explain zone-specific vulnerability to injury and degeneration.

文獻出處：Alomiery AA, Hall AC, Gillingwater TH, Alsolami A, Alashkham A. Histopathologic Analysis of the Morpho-Functional Zones of the Human Acetabular Labrum. Clin Anat. Published online September 12, 2025. doi:10.1002/ca.70031

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團隊

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