1、髕骨電燒去神經化對于未置換髕骨的全膝關節(jié)置換術有益嗎

2、相比于BMI，切口部位脂肪厚度是后路全髖關節(jié)置換術后切口相關并發(fā)癥的更佳預測指標

3、萬古霉素在初次全膝關節(jié)置換術中的臨床效果

4、采用增強模式的 Mako 機器人輔助全髖關節(jié)置換術中下肢長度及股骨柄前傾角測量的準確性

5、兒童感染髖嚴重后遺癥的分類與外科處理（1981Hunka分類法）

6、基于超聲圖像識別髖關節(jié)發(fā)育不良的深度學習算法

7、運動員腹股溝疼痛：一種新型診斷方法

8、基于二次骨化中心發(fā)育的正常髖臼三維形態(tài)變化量化研究

9、健康兒童人群中發(fā)育性髖關節(jié)發(fā)育不良（DDH）篩查的風險因素評估及十年經驗

10、髖臼周圍截骨術后的中長期結果及臨床預后預測因素

11、骨關節(jié)炎對股骨頭軟骨下骨小梁區(qū)域解剖變異的影響

12、非典型性與不可歸類性髖關節(jié)脫位伴關節(jié)囊及盂唇嵌頓

第一部分：關節(jié)置換及保膝相關文獻

文獻1

髕骨電燒去神經化對于未置換髕骨的全膝關節(jié)置換術有益嗎：隨機對照試驗的薈萃分析

譯者 張軼超

為了研究未髕骨表面置換的初次全膝關節(jié)置換術（TKA）后髕骨去神經化（PD）和未去神經化（NPD）的影響，本研究遵循Cochrane協(xié)議的建議，于2023年11月使用PubMed、Embase、Web of Science、Cochrane和Scopus進行了系統(tǒng)的電子檢索。僅納入隨機對照研究（RCT）。此外，通過人工檢索方式從綜述文章的參考文獻列表中確定潛在的符合條件的研究。兩名研究人員獨立進行了文獻回顧、數據提取和偏倚風險評估。結果分析包括膝前痛（AKP）的發(fā)生率、視覺模擬評分（VAS）、活動范圍（ROM）、美國膝關節(jié)學會評分（KSS）、牛津膝關節(jié)評分（OKS）、髕骨評分（PS）、并發(fā)癥和再手術情況。Meta分析采用RevMan 5.3軟件。為了提高研究的可信度，采用TSA v0.9軟件對主要和次要效果的總體情況進行功效分析。納入了12項研究，涉及1745名患者（1587個膝關節(jié)），其中852例做了PD， 893例為NPD。結果顯示PD組與NPD組相比，AKP發(fā)生率有顯著降低。PD和NPD在KSS、OKS和PS方面的差異具有統(tǒng)計學意義。然而，每個結果的95%置信區(qū)間上限低于最小臨床主要差異（MCID）。兩組的VAS和ROM評分無顯著差異。此外，PD與并發(fā)癥或再手術的發(fā)生率增加無關。在12個月或更長時間內，PD被證明是一種有益的干預措施，可以在不增加并發(fā)癥或再手術的情況下降低TKA后的AKP。對于KSS、OKS和PS，通過PD獲得的最小優(yōu)勢可能沒有臨床意義。

Does Patellar Denervation with Electrocautery Benefits for Total Knee Arthroplasty without Patellar Resurfacing: A Meta-analysis of Randomized Controlled Trails

To investigate the effects of patellar denervation (PD) and non-patellar denervation (NPD) after primary total knee arthroplasty (TKA) without patellar resurfacing, this study conducted systematic electronic searches in November 2023 using PubMed, Embase, Web of Science, Cochrane, and Scopus, adhering to Cochrane Collaboration recommendations. Only randomized controlled trials (RCTs) were included. Additionally, a manual search was performed to identify potentially eligible studies from the reference lists of review articles. Two researchers independently conducted literature reviews, data extraction, and risk of bias assessments. The outcome analysis encompassed the incidence of anterior knee pain (AKP), visual analogue scale (VAS), range of motion (ROM), American Knee Society Score (KSS), Oxford Knee Score (OKS), patellar score (PS), complications, and reoperations. Meta-analysis was executed using RevMan 5.3 software. To enhance the credibility of the study, TSA v0.9 software was utilized to perform power analysis on the overall efficacy of primary and secondary outcomes. Twelve studies involving 1745 patients (1587 knees) were included, with 852 undergoing PD and 893 undergoing NPD. Results indicated a superior reduction in AKP incidence in the PD group compared to the NPD group. Statistically significant differences were observed between PD and NPD in KSS, OKS, and PS. However, the upper limit of the 95% confidence interval for each outcome fell below the minimal clinically important difference (MCID). No significant differences were found in VAS and ROM between PD and NPD. Additionally, PD was not associated with an increased incidence of complications or reoperations. Within 12 months and beyond, PD was proven to be a beneficial intervention in reducing AKP following TKA without patellar resurfacing, achieved without an increase in complications or reoperations. Regarding KSS, OKS, and PS, the minimal advantage achievable through PD may not be clinically significant.

文獻出處：Zhou X, Jiang Y, Chen D, Chen T, Tian Z. Does Patellar Denervation with Electrocautery Benefits for Total Knee Arthroplasty without Patellar Resurfacing: A Meta-analysis of Randomized Controlled Trails. Orthop Surg. 2024 Aug;16(8):1832-1848.

文獻2

相比于BMI，切口部位脂肪厚度是后路全髖關節(jié)置換術后切口相關并發(fā)癥的更佳預測指標

譯者 張薔

背景：體重指數（BMI）被廣泛用作評估全髖關節(jié)置換（THA）術后并發(fā)癥風險的重要參考指標。然而，BMI并無法顯示患者的脂肪分布情況。既往文獻中，有關切口部位脂肪厚度（SSFT）對THA圍術期并發(fā)癥風險預測效果的相關文章稀少。本篇文章的目的是比較BMI和SSFT對THA術后早期并發(fā)癥的預測效果。

方法：我們選擇了某地區(qū)醫(yī)療中心2022年5月至2024年5月共167例連續(xù)的機器人輔助下后入路THA手術病例進行回顧性研究。所有病例均有CT掃描結果。在CT橫斷位平掃中，選擇股骨臀肌粗隆層面自皮膚至髂脛束的水平距離作為SSFT結果。我們對所有病例信息進行了回顧，重點包括圍術期變量、早期（術后90天內）術后并發(fā)癥、再手術和翻修情況。最后，我們對收集到的數據進行了T檢驗、二元回歸分析和受試者工作特征曲線分析。

結果：平均BMI 33.1（范圍，18.9-44.3），平均SSFT 52.4mm（范圍，8-99）。術后90天內，我們共發(fā)現(xiàn)15例（9%）并發(fā)癥，均為傷口延遲愈合或感染相關；其中7例（4%）進行了再手術。其中4例（2.4%）進行了保留假體的清創(chuàng)手術（DAIR），另外3例（1.8%）進行了清創(chuàng)再縫合手術。單變量分析顯示：SSFT與并發(fā)癥（P < 0.01）、再手術（P < 0.01）和DAIR（P < 0.01）均存在相關性， 而BMI只與并發(fā)癥（P = 0.02）存在相關性，與再手術（P=0.05）或DAIR（P = 0.27）均不存在相關性。雙元回歸分析顯示：SSFT是并發(fā)癥（P = 0.03，概率比 1.04）和再手術（P = 0.03，概率比 1.04）的明確預測因素，而BMI（兩項P > 0.05）并不是。發(fā)生并發(fā)癥和再手術的SSFT閾值分別為51.5mm（曲線下面積0.73）和64.5mm（曲線下面積0.81）。

結論：與BMI相比，SSFT對THA術后切口相關并發(fā)癥的預測力更強，且在預測術后早期并發(fā)癥方面，SSFT是更可靠的指標。

Surgical Site Fat Thickness Is More Predictive of Postoperative Wound Complications than Body Mass Index Following Posterior Approach Total Hip Arthroplasty

Background: Body mass index (BMI) is widely utilized to counsel patients on complication risk following total hip arthroplasty (THA). However, BMI is unable to account for fat distribution. The existing literature is sparse regarding the effect of surgical site fat thickness (SSFT) on perioperative risk in THA. The purpose of the study was to compare BMI and SSFT with acute postoperative complications following THA.

Methods: A retrospective review of 167 consecutive, posterior approach, robotic-arm-assisted THAs between May 2022 and May 2024 at a tertiary academic institution was performed. Computed tomography scans were available for all cases. On the axial computed tomography, SSFT from the iliotibial band to skin at the level of the vastus ridge was measured in mm. A chart review was performed for perioperative variables and acute (within 90 days postoperatively) surgical complications, reoperations, and revisions. T-tests, bivariate regression, and receiver operating characteristic curve analyses were performed.

Results: Mean BMI was 33.1 (range, 18.9 to 44.3), and mean SSFT was 52.4 mm (range, 8 to 99). Within 90 days, there were 15 (9%) complications, all of which were wound- or infection-related; seven (4.2%) were managed with reoperation. Of these, four (2.4%) underwent debridement, antibiotics, and implant retention (DAIR), and three (1.8%) had superficial incision and drainage. With univariate analysis, SSFT was associated with complications (P < 0.01), reoperations (P < 0.01), and DAIR (P = 0.03). Body mass index (BMI) was associated with complications (P = 0.02), but was not associated with reoperations (P = 0.05) or DAIR (P = 0.27). With bivariate regression, SSFT was predictive of complications (P = 0.03, odds ratio 1.04) and reoperations (P = 0.04, odds ratio 1.05), while BMI was not (P > 0.05 for both). Threshold values for complications and reoperations were SSFT of 51.5 mm area under the curve, 0.73) and 64.5 mm (area under the curve, 0.81), respectively.

Conclusions: Compared to BMI, SSFT was more predictive of postoperative wound complications following THA and may be a more reliable measure to counsel patients on early postoperative complication risk.

文獻3

萬古霉素在初次全膝關節(jié)置換術中的臨床效果

譯者 丁云鵬

背景：關節(jié)假體周圍感染（PJI）仍然是全膝關節(jié)置換術（TKA）后令人擔憂的并發(fā)癥。本研究報告了我們的隊列PJI發(fā)病率、不良反應和并發(fā)癥的最新結果，并增加了我們在2021年報道的先前研究的臨床隨訪。

方法：回顧性分析2016年5月至2023年5月期間接受靜脈（IV）或骨內（IO）萬古霉素治療的1,923例膝關節(jié)，隨訪時間至少為90天（平均913±611天）。IV組564例，IO組1359例。靜脈注射組在切口前按體重給藥萬古霉素，靜脈注射組止血帶充氣后在脛骨近端給藥500 mg萬古霉素。所有患者圍手術期均接受基于體重劑量的靜脈注射頭孢唑林。2018年國際共識會議標準用于診斷PJI。急性腎損傷（AKI）定義為肌酐升高0.3 mg/dL。

結果：在隨訪90天（0.5 vs 1.6%, P = 0.018）、1年（0.7 vs 1.8%, P = 0.048）和2年（0.9 vs 2.4%, P = 0.032）時，IO組PJI發(fā)生率明顯低于IV組。此外，在隨訪30天（2.3 vs 4.3%, P = 0.023）和90天（2.5 vs 5.4%, P = 0.003）時，IO組需要口服抗生素的非手術傷口并發(fā)癥發(fā)生率較低。IO組AKI發(fā)生率較低（1.6 vs 3.2%, P = 0.078），但差異無統(tǒng)計學意義。在深靜脈血栓、肺栓塞或手術傷口并發(fā)癥的發(fā)生率方面沒有差異。

結論：在初次TKA后90天、1年和2年的隨訪中，骨內萬古霉素比靜脈萬古霉素表現(xiàn)出更好的臨床效果，PJI的發(fā)生率降低。在90天的隨訪中，IO萬古霉素的其他益處是減少了非手術性傷口并發(fā)癥，并降低了AKI的發(fā)生率，但沒有統(tǒng)計學意義。

Superior Clinical Results With Intraosseous Vancomycin in Primary Total Knee Arthroplasty

Background: Periprosthetic joint infection (PJI) remains a feared complication after total knee arthroplasty (TKA). This study reports updated outcomes of the incidence of PJI, adverse reactions, and complications of our cohort with increased clinical follow-up of our previous study reported in 2021.

Methods: A retrospective review of 1,923 knees that received either intravenous (IV) or intraosseous (IO) vancomycin during primary TKA between May 2016 and May 2023 with a minimum 90-day follow-up (mean 913 ± 611 days). There were 564 cases in the IV group and 1,359 in the IO group. The IV group received a weight-based dose of vancomycin before incision, and the IO group received 500 mg of vancomycin in the proximal tibia after tourniquet inflation. All patients received a weight-based dose of IV cefazolin perioperatively. The 2018 International Consensus Meeting criteria were used to diagnose PJI. Acute kidney injury (AKI) was defined as a creatinine increase of 0.3 mg/dL.

Results: The IO group demonstrated a significantly lower incidence of PJI compared to the IV group at 90-day (0.5 versus 1.6%, P = 0.018), 1-year (0.7 versus 1.8%, P = 0.048), and 2-year (0.9 versus 2.4%, P = 0.032) follow-up. Additionally, there was a lower incidence of nonoperative wound complications requiring oral antibiotics in the IO group at 30-day (2.3 versus 4.3%, P = 0.023) and at 90-day (2.5 versus 5.4%, P = 0.003) follow-up. There was a lower incidence of AKI in the IO group (1.6 versus 3.2%, P = 0.078), but this did not reach statistical significance. There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, or operative wound complications.

Conclusions: Intraosseous vancomycin demonstrated superior clinical outcomes over IV vancomycin with a reduced incidence of PJI at 90-day, 1- and 2-year follow-up after primary TKA. Additional benefits of IO vancomycin were a reduction in nonoperative wound complications through 90-day follow-up and a nonstatistically significant reduction in the incidence of AKI.

文獻出處Kwan J Park , Austin E Wininger , Thomas C Sullivan，Superior Clinical Results With Intraosseous Vancomycin in Primary Total Knee Arthroplasty.J Arthroplasty. 2025Oct;40(10):2650-2654. doi: 10.1016/j.arth.2025.04.074. Epub 2025 May 5.

文獻4

采用增強模式的 Mako 機器人輔助全髖關節(jié)置換術中下肢長度及股骨柄前傾角測量的準確性

譯者 沈松坡

目的

本研究評估了在采用增強模式的 Mako 機器人系統(tǒng)進行全髖關節(jié)置換術（total hip arthroplasty，THA）過程中，術中獲得的下肢長度及股骨前傾角測量結果的準確性。

方法

本研究回顧性分析了 55 個髖關節(jié)病例，其中包括 4 名男性和 51 名女性，均經前外側入路使用 Mako 系統(tǒng)行初次全髖關節(jié)置換術。比較了 Mako 增強模式術中顯示的下肢長度及股骨前傾角測量值與術后基于 CT 的測量結果。通過計算絕對誤差及其分布情況，以評估術中測量的準確性。

結果

術后下肢長度不等的平均絕對誤差為 2.3?±?1.8 mm，股骨柄前傾角的平均絕對誤差為 2.9?±?2.2°。在 55 個髖關節(jié)中，46 例（83.6%）的下肢長度誤差在 3 mm 以內，51 例（92.7%）在 5 mm 以內。對于股骨柄前傾角，48 例（87.3%）在 3° 以內，全部 55 例（100%）在 5° 以內。由于股骨陣列松動或固定螺釘穿入髓腔，10.7% 的病例未能完成 Mako 增強模式的測量流程。

結論

Mako 增強模式在術中下肢長度及股骨前傾角測量方面表現(xiàn)出臨床可接受的準確性，有助于在機器人輔助全髖關節(jié)置換術中實現(xiàn)更精確的股骨柄植入。

關鍵詞：髖關節(jié) · 全髖關節(jié)置換術 · 機器人 · Mako · 增強模式

圖1 采用Mako系統(tǒng)的增強模式實施全髖關節(jié)置換術過程中使用的骨盆與股骨定位架

圖2 采用MAKO系統(tǒng)的增強模式進行股骨近端注冊

圖3 采用MAKO系統(tǒng)的增強模式測量股骨柄的前傾角

圖 4　Mako 增強模式下的股骨陣列。

（a）采用增強模式的 Mako 系統(tǒng)所使用的股骨陣列；

（b）術中 X 線影像，顯示用于固定股骨陣列的螺釘；

（c）螺釘穿入股骨髓腔。

Accuracy of intraoperative leg length and stem version measurements in robotic?assisted total hip arthroplasty using the Mako system with enhanced mode

Purpose This study evaluated the accuracy of intraoperative leg length and femoral anteversion measurements obtained during total hip arthroplasty (THA) using the Mako robotic system with enhanced mode.

Methods A total of 55 hips in four men and 51 women who underwent primary THA with the Mako system via an anterolateral approach were retrospectively evaluated. Intraoperative measurements of leg length and femoral anteversion displayed by the Mako enhanced mode were compared with postoperative CT-based measurements. Absolute errors and their distributions were calculated to assess the accuracy of intraoperative assessments.

Results The mean absolute error was 2.3 ± 1.8 mm for postoperative leg length discrepancy and 2.9 ± 2.2° for stem anteversion. Of the 55 hips, 46 (83.6%) showed leg length errors within 3 mm and 51 (92.7%) within 5 mm. For stem anteversion, 48 hips (87.3%) were within 3° and all 55 hips (100%) were within 5°. Mako enhanced mode could not be completed in 10.7% of cases because of femoral array loosening or screw penetration into the medullary canal.

Conclusion Mako enhanced mode demonstrated clinically acceptable accuracy for intraoperative measurement of leg length and femoral anteversion, contributing to precise femoral stem implantation in robotic-assisted THA.

第二部分：保髖相關文獻

文獻1

兒童感染髖嚴重后遺癥的分類與外科處理（1981Hunka分類法）

譯者 羅殿中

嬰幼兒和兒童早期感染性髖關節(jié)炎結局是災難性的，可導致嚴重骨關節(jié)后遺癥。文獻中較好討論了感染急性期采用抗生素和早期手術引流的處理方案；但很少討論其殘余解剖畸形，也沒有清晰的分類方法和治療建議。Hallel和Salvati報告了24例髖關節(jié)感染治療結果。其中10例股骨頭和股骨頸嚴重破壞，6例采用轉子成形手術；上述病例中僅有3例髖關節(jié)獲得穩(wěn)定。Weissman和Stetson等各報告一例采用髖關節(jié)融合治療的患者。Rigault等宣稱在4例患者中采用轉子成形術，其中2例在隨訪時獲得滿意效果。有關這方面的信息相對匱乏，我們對蒙特利爾兒童醫(yī)院（MCH）3例、和蒙特利爾Shriner兒童殘障醫(yī)院（MSH）7例股骨近端嚴重破壞進行回顧性研究，提出了一項兒童感染性髖關節(jié)炎分類系統(tǒng)、及相應的建議治療方案。

結果：2例III型最終轉為V型；2例IVA型，3例IVB型；5例為V型（其中2例為III型轉歸）。I型和II型不在本文討論之列。III型處理非常困難，骨移植效果不佳，骨移植僅限于股骨頭增大的類型（圖5）。IV型預后尚可，殘余大轉子高位和下肢不等長；可在適當的時機行大轉子下移和下肢均衡手術；IVB型必要時可采用髖關節(jié)穩(wěn)定手術。V型雖然X線片表現(xiàn)最為嚴重，如果早期型大轉子成形+股骨近端內翻手術，療效尚滿意。

圖1. 兒童感染性髖關節(jié)炎后遺癥分類。I型，股骨頭輕微改變或無變化；IIA型，股骨頭畸形但骺板不受累及；IIB型，股骨頭畸形且骺板早閉；III型，股骨頸假關節(jié)；IVA型，股骨干骺端完全破壞，但殘余股骨頸穩(wěn)定；IVB型，股骨干骺端完全破壞，但殘余股骨頸不穩(wěn)定穩(wěn)定；V型，股骨頭頸完全破壞直達轉子間線，髖關節(jié)脫位。

圖2. V型感染髖后遺癥，股骨頭和股骨頸消失，髖關節(jié)脫位。

圖3. 圖2患兒行大轉子成形術后。

圖4. III型感染髖后遺癥，股骨頸假關節(jié)形成，股骨頭壞死、變小。

圖5. III型感染髖后遺癥，股骨頸假關節(jié)，股骨頭增大在位。

Classification and surgical management of the severe sequelae of septic hips in children

The treatment of the acute state of septic arthritis of the hip in children has been clearly outlined in the current literature. The treatment of residual anatomic deformity is less well understood; no classification or comprehensive treatment program has been documented. The following classification of the sequelae of septic hips in children is based on the presence or absence of a capital femoral epiphysis and hip stability. This classification defines the case material and outlines the anatomic problem requiring solution. Of ten patients with severe destruction of the femoral head followed for an average period of 11.2 years, there were eight satisfactory and two unsatisfactory results. Both unsatisfactory results were Type III hips with pseudarthrosis of the neck. Both had an average of five surgical procedures, compared with 2.2 procedures for patients with satisfactory results. The complications were leg-length discrepancy, hip instability, and scoliosis.

文獻出處：Hunka L, Said SE, MacKenzie DA, Rogala EJ, Cruess RL. Classification and surgical management of the severe sequelae of septic hips in children. Clin Orthop Relat Res. 1982 Nov-Dec;(171):30-6. PMID: 7140082.

文獻2

基于超聲圖像識別髖關節(jié)發(fā)育不良的深度學習算法：中國的一項回顧性、前瞻性、多中心研究

譯者 任寧濤

背景：髖關節(jié)超聲是診斷疑似嬰兒髖關節(jié)發(fā)育不良（DDH）的一線工具，但其局限性包括重復性差和診斷錯誤率高。因此本研究旨在利用多中心髖關節(jié)超聲數據，開發(fā)并驗證一種名為HipSonoNeuNet模型（HSNN）的深度卷積神經網絡算法。

方法：這項多中心橫斷面研究納入22家中國醫(yī)院（2022年9月至2025年1月）的數據，納入了3082名參與者。共收集髖部超聲圖像7286張（動態(tài)1429張，靜態(tài)5857張），分為3個數據集。這項研究分三個階段進行。第一階段使用2431名參與者（數據集1）訓練模型。第二階段比較了500名參與者中不同經驗的放射科醫(yī)生和模型之間的診斷表現(xiàn)（數據集2）。第三階段對151名參與者（數據集3）前瞻性地驗證了模型的普遍性。

結果：在第一階段，HSNN在內部測試數據集上的AUC為0.99 (95% CI: 0.99-1.00)，靈敏度為1.00 (95% CI: 0.99-1.00)，特異性為0.91 (95% CI: 0.88-1.00)， F1評分為0.90 （95% CI: 0.87-1.00）。在II期，HSNN的準確率為0.94 (95% CI: 0.88-1.00)， AUC為0.99 (95% CI: 0.99-1.00)，靈敏度為1.00 (95% CI: 0.99-1.00)，特異性為0.94 (95% CI: 0.87-1.00)， F1評分為0.58 (95% CI: 0.50-0.66)，與專家（κ = 0.77）高度一致。人工智能輔助提高了所有7名初級放射科醫(yī)生的診斷表現(xiàn)（準確率從0.90提高到0.93，AUC從0.80提高到0.95，靈敏度從0.69提高到0.97），并縮短了檢查時間，增強了觀察者之間的一致性。在第三階段，模型保持了穩(wěn)健的性能（精度= 0.92,AUC = 0.99，靈敏度= 1.00，與專家的κ = 0.76）。

圖1 研究設計概述。(A)所建立的HSNN框架包含兩個步驟，一是關鍵幀（標準平面）檢測，二是關鍵幀分類；(B) HSNN系統(tǒng)開發(fā)和驗證的示意圖概述。

Deep learning algorithms for identifying developmental retrospective prospective multicenter study in ChinaDeep learning algorithms for identifying developmental retrospective prospective multicenter study in China

Background: Hip ultrasound is the first-line tool to identify developmental dysplasia of the hip (DDH) among suspected infants, yet it has limitations including poor reproducibility and high diagnostic error rates. This study aims to develop and validate a deep convolutional neural network algorithm, named HipSonoNeuNet model (HSNN), using multicenter hip ultrasound data.

Methods: This multicenter cross-sectional study combined data from 22 Chinese hospitals (September 2022-January 2025), enrolling 3082 participants. A total of 7286 hip ultrasound images (1429 dynamic, 5857 static) were collected and were divided into three datasets. The study was conducted in three phases. Phase I trained the models using 2431 participants (Dataset 1). Phase II compared diagnostic performance between radiologists of varied experience and the model across 500 participants (Dataset 2). Phase III prospectively validated the model's generalizability with 151 participants (Dataset 3).

Findings: In Phase I, the HSNN yielded AUC of 0.99 (95% CI: 0.99-1.00), sensitivity of 1.00 (95% CI: 0.99-1.00), specificity of 0.91 (95% CI: 0.88-1.00), F1 score of 0.90 (95% CI: 0.87-1.00) on internal test dataset. In Phase II, the HSNN achieved an accuracy of 0.94 (95% CI: 0.88-1.00), AUC of 0.99 (95% CI: 0.99-1.00), sensitivity of 1.00 (95% CI: 0.99-1.00), specificity of 0.94 (95% CI: 0.87-1.00), F1 score of 0.58 (95% CI: 0.50-0.66), and strong agreement with expert (κ = 0.77). AI assistance improved all 7 junior radiologists' diagnostic performance (accuracy from 0.90 to 0.93, AUC from 0.80 to 0.95, sensitivity from 0.69 to 0.97) and reduced examination time with enhanced interobserver agreement. In Phase III, the model maintained robust performance (accuracy = 0.92, AUC = 0.99, sensitivity = 1.00, κ with experts = 0.76).

文獻出處：Xu N, Han T, Huang B, Fan W, Chen X, Zhu M, Miao L, Huang Y, Zhu Z, Tong L, Chen L, Liu J, Lin S, Nie L, Liu C, Gao J, Zhan X, Lin L, Meng M, Xu S, Wang Y, Peng H, Hu X, Cao Z, Zhang Z, Kong D, Feng T, Ni D, Yang X, Zhou L. Deep learning algorithms for identifying developmental dysplasia of the hip based on sonographic images: a retrospective, prospective, multicenter study in China. EClinicalMedicine. 2025 Oct 9;89:103552. doi: 10.1016/j.eclinm.2025.103552. PMID: 41140452; PMCID: PMC12547208.

文獻3

運動員腹股溝疼痛：一種新型診斷方法

譯者 李勇

對于運動表現(xiàn)活躍的運動員來說，腹股溝疼痛的診斷和治療極具挑戰(zhàn)性。鑒別診斷包括關節(jié)內病因、關節(jié)外病因以及非肌肉骨骼病因。對這一群體的腹股溝疼痛進行詳細的臨床和影像學評估至關重要，因為這能確定潛在的病理機制。診斷性髖關節(jié)阻滯是區(qū)分關節(jié)內與關節(jié)外病因的有價值工具。髖關節(jié)鏡檢查有助于識別一些難以捉摸的關節(jié)內疾病，這些疾病曾經因未被診斷而未得到治療，導致許多運動員的職業(yè)生涯過早結束。本文旨在探討當前對腹股溝疼痛（尤其是年輕個體）評估的思考，并建立一個簡單的臨床和診斷方案來應對這一棘手問題。

腹股溝疼痛的解剖學與分類 (Anatomy & Classification)：解剖結構： 涉及腹部與腿部交界處，包括腹直肌下部、腹股溝區(qū)、恥骨聯(lián)合、大腿內收肌上部等。病因分類： 主要分為關節(jié)內病因（髖關節(jié)球窩內的病變）和關節(jié)外病因（球窩外的病變）。專家估計60%的關節(jié)內損傷最初被誤診為關節(jié)外損傷。非骨骼肌肉病因： 需排除婦科、泌尿科、腫瘤等引起的牽涉痛。

診斷方法 (Approach to Diagnosis)：病史與體檢： 是縮窄診斷范圍的第一步。例如，髖關節(jié)活動時的彈響可能提示盂唇撕裂（關節(jié)內）；燒灼樣疼痛可能提示神經卡壓。 鑒別診斷 (Differential Diagnosis)：關節(jié)內病因： 股骨髖臼撞擊綜合征 (FAI)、軟骨盂唇損傷、圓韌帶損傷、游離體等。關節(jié)外病因： 肌肉拉傷/撕裂、應力性骨折、恥骨骨炎、運動疝、彈響綜合征、神經卡壓等。

影像學檢查 (Imaging Studies)：X光片： 基礎檢查，用于觀察骨骼定義和排列（如FAI的“凸輪”畸形）。超聲： 廉價且快速，適合動態(tài)評估軟組織及排除細微疝氣。 MRI/MRA： 診斷軟組織、軟骨損傷的金標準，尤其是MRA（磁共振關節(jié)造影）對盂唇病理評估極佳。CT/神經傳導研究： CT用于骨骼重建規(guī)劃，神經傳導研究用于診斷神經卡壓。

關鍵診斷工具與治療 (Key Diagnostic Tools & Treatment)：診斷性髖關節(jié)阻滯 (Diagnostic Hip Block)： 在透視引導下進行關節(jié)內注射（皮質類固醇和局麻藥）。陽性反應（疼痛緩解）是判斷關節(jié)內病變的可靠指標（90%可靠性）；若注射無效，應評估隱匿的關節(jié)外病因。髖關節(jié)鏡 (Hip Arthroscopy)： 既是診斷工具也是治療手段。對于難以確診的關節(jié)內病因極其有效，可處理盂唇撕裂、撞擊等問題。

臨床流程圖 (Clinical Algorithm)：首先進行腹股溝疼痛的臨床檢查和影像學檢查。 若確診則治療；若診斷不確定，進行診斷性髖關節(jié)阻滯。若疼痛緩解（提示關節(jié)內病因），建議進行髖關節(jié)鏡檢查。若疼痛持續(xù)（提示關節(jié)外病因），則進一步調查關節(jié)外原因。髖關節(jié)鏡無法治療或不適用的情況，可考慮截骨術、表面置換或全髖置換等。

Groin pain in athletes: a novel diagnostic approach

Abstract：Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.

文獻出處：Shetty VD, Shetty NS, Shetty AP. Groin pain in athletes: a novel diagnostic approach. SICOT J. 2015 Jul 7;1:16. doi: 10.1051/sicotj/2015017. PMID: 27163072; PMCID: PMC4849255.

文獻4

基于二次骨化中心發(fā)育的正常髖臼三維形態(tài)變化量化研究

譯者 張利強

背景?：髖臼發(fā)育由Y形軟骨（TRC）和恥骨、坐骨、髂骨的二次骨化中心（SOCs）驅動，其出現(xiàn)和融合存在年齡與性別差異。本研究量化了SOCs對青少年髖臼覆蓋、扭轉、傾斜及表面積的影響。

方法?：對540個無髖關節(jié)病變的正常髖關節(jié)（男性128例，女性142例，年齡8-19歲）進行CT掃描，生成三維重建。使用已發(fā)表算法提取髖臼參數（包括八分位覆蓋角、扭轉、傾斜及表面積），并通過近端股骨成熟指數（PFMI）評估骨骼成熟度。采用廣義線性混合模型分析3個SOCs對髖臼形態(tài)的貢獻。

結果?：PFMI與年齡顯著相關（rs=0.91，p<0.001）。髂骨骨化與上覆蓋增加顯著相關（p<0.001），坐骨骨化與后覆蓋增加相關（p<0.001）。上覆蓋與外側傾斜強相關（rs=0.837），后覆蓋與前扭轉強相關（rs=0.788）。女性髖臼前扭轉（17.7°±6.4° vs 12.2°±6.4°）和外側傾斜（38.5°±4.7° vs 36.6°±5.7°）更大，男性髖臼表面積更大（31.9±6.4 vs 28.8±4.2 cm2，p<0.001）。恥骨骨化與前覆蓋無顯著關聯(lián)（男性p=0.38，女性p=0.065），前覆蓋與年齡無相關性（p=0.115）。

結論?：髂骨和坐骨骨化分別與青少年髖臼上覆蓋和后覆蓋增加相關，而恥骨骨化與前覆蓋無關。SOCs的出現(xiàn)和閉合時間與髖臼形態(tài)的關鍵發(fā)育變化一致，強調了其在髖關節(jié)穩(wěn)定性中的作用。

證據等級?：III級（預后性研究）。

A 冠狀截面演示三維覆蓋角計算。B 髖臼分為5個區(qū)域：后（紅色）、上-后（暗紅色）、上（藍色）、上-前（淺藍色）和前（青色）。每個區(qū)域的覆蓋角為沿髖臼邊緣45°弧度內的平均角度。

CT圖像顯示髖臼3個繼發(fā)性骨化中心（soc）的外觀和閉合：恥骨（前）、髂骨（上）和坐骨（后）。使用標準化的3D靶向系統(tǒng)顯示每個中心的軸位、冠狀面和矢狀面，以評估多個解剖視圖的骨化情況。

Quantifying Changes in 3D Acetabular Morphology in Normal Hips Based on the Development of Secondary Ossification Centers

Background: Acetabular development in pediatric hips is driven by growth from the triradiate cartilage (TRC) and secondary ossification centers (SOCs) of the os pubis, os ischium, and os ilium. These SOCs appear and fuse at different ages, with sex-specific differences affecting their morphology. This study quantifies the impact of SOCs on acetabular coverage, version, tilt, and surface area during adolescence.

Methods: Three-dimensional (3D) surface reconstructions of 540 normal hips (in 128 male and 142 female patients) aged 8 to 19 years with no hip pathology were generated from computed tomography (CT) scans. Acetabular parameters, including coverage angles in predefined octants, version, tilt, and surface area, were extracted with use of a previously published algorithm. The Proximal Femur Maturity Index (PFMI) was used to assess skeletal maturity. Contributions to acetabular morphology from the 3 SOCs were analyzed using generalized linear mixed models. Significance was defined as p < 0.05.

Results: PFMI grades strongly correlated with chronological age (rs = 0.91; p < 0.001). Os ilium ossification was significantly associated with increased superior coverage (p < 0.001), and os ischium ossification was associated with increased posterior coverage (p < 0.001). Superior coverage demonstrated a strong correlation with lateral tilt (rs = 0.837; p < 0.001), and posterior coverage was strongly correlated with anteversion (rs = 0.788; p < 0.001). Female patients exhibited greater acetabular anteversion (17.7 ° ± 6.4 ° versus 12.2 ° ± 6.4 °; p < 0.001) and lateral tilt (38.5 ° ± 4.7 ° versus 36.6 ° ± 5.7 °; p < 0.001), whereas male patients demonstrated larger acetabular surface area (31.9 ± 6.4 versus 28.8 ± 4.2 cm 2 ; p < 0.001). We did not find a significant association between os pubis ossification and increased anterior coverage in male (p = 0.38) or female (p = 0.065) patients, nor did we find a correlation between anterior coverage and age (p = 0.115).

Conclusions: Os ilium and os ischium ossification were associated with increased superior and posterior acetabular coverage, respectively, during adolescence. In contrast, os pubis ossification was not associated with changes in anterior coverage. The timing of SOC appearance and closure aligns with key developmental changes in acetabular morphology, reinforcing the role of SOCs in determining hip stability.

Level of Evidence: Prognostic Level III.

文獻出處：Grewal RS, Keil LG, Bomar JD, Ryan J, Beasley BVL, Farnsworth CL, Schmitz MR, Upasani VV. Quantifying Changes in 3D Acetabular Morphology in Normal Hips Based on the Development of Secondary Ossification Centers. J Bone Joint Surg Am. 2025 Nov 5;107(21):2365-2370. doi: 10.2106/JBJS.25.00428. Epub 2025 Sep 12. PMID: 40939009.

文獻5

健康兒童人群中發(fā)育性髖關節(jié)發(fā)育不良（DDH）篩查的風險因素評估及十年經驗

譯者 賈海港

目的： 基于風險的超聲篩查是檢測髖關節(jié)發(fā)育不良（DDH）的常用方法。然而，由于數據不足以給出明確的建議，不同國家的風險因素也各不相同。本研究旨在評估髖關節(jié)發(fā)育不良（DDH）的風險因素。

方法： 本回顧性病例對照研究調查了 2004 年至 2014 年間在土耳其某兒童保健中心接受隨訪的所有兒童的健康記錄，以確定其是否患有發(fā)育性髖關節(jié)發(fā)育不良（DDH）。在 9758 名兒童中，57 名兒童被發(fā)現(xiàn)存在超聲檢查異常（根據 Graf 分級），這些兒童構成病例組。對照組選取了 228 名與病例組兒童出生月份相匹配的健康兒童。比較了兩組的危險因素。

結果： 共對 9758 名兒童的 19516 個髖關節(jié)進行了發(fā)育性髖關節(jié)發(fā)育不良（DDH）的超聲檢查。其中 57 名兒童的 97 個髖關節(jié)超聲檢查結果異常。兩組比較發(fā)現(xiàn)，臀位、多胎妊娠和斜頸是 DDH 的危險因素。病例組中女性患兒的比例也顯著高于男性。髖關節(jié)外展受限、Ortolani 征陽性和 Barlow 征陽性是病例組的重要臨床表現(xiàn)。

結論： 根據我們的研究結果，臀位、女性、斜頸和多胎妊娠是該疾病的危險因素。具有這些危險因素的嬰兒應仔細檢查是否患有發(fā)育性髖關節(jié)發(fā)育不良（DDH）。

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Aim: Risk based screening for developmental dysplasia of the hip (DDH) with ultrasound is common. However, risk factors vary from one country to the other since data are insufficient to give clear recommendations. We aimed to evaluate the risk factors for developmental dysplasia of the hip (DDH).

Methods: In this retrospective case-control study, the health records of all children, who were followed up between 2004 and 2014 at a well-child unit, were investigated for the diagnosis of DDH in Turkey. Of 9758 children, 57 children were found to have abnormal ultrasonographic findings (according to Graf classification) and these constituted the case group. As the control group, healthy 228 children who matched the case children in birth months were selected. Two groups were compared for the risk factors.

Results: A total of 19516 hips of 9758 children were examined for DDH. 97 hips of 57 children were found to have abnormal ultrasonographic findings. When the two groups were compared, breech presentation, multiple pregnancy, and torticollis were identified as risk factors. The female sex was also found to have a significantly high prevalence among the children in the case group. Limited hip abduction, positive Ortolani, and Barlow signs were important clinical findings in the case group.

Conclusion: According to our findings, breech presentation, female sex, torticollis, and multiple pregnancy were found to be the risk factors of this disorder. Infants with these risk factors should be investigated carefully for DDH.

文獻出處：Kural B, Devecio?lu Karap?nar E, Y?lmazba? P, Eren T, G?k?ay G. Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population. Biomed Res Int. 2019 Aug 4;2019:7213681. doi: 10.1155/2019/7213681. PMID: 31467908; PMCID: PMC6699317

文獻6

髖臼周圍截骨術后的中長期結果及臨床預后預測因素

譯者 陶可

背景：伯爾尼髖臼周圍截骨術是一種常用的保髖（非關節(jié)置換）的選擇，用于治療有癥狀的年輕患者發(fā)育性髖關節(jié)發(fā)育不良。預測哪些髖關節(jié)能進行保髖手術，哪些髖關節(jié)在髖臼周圍截骨術后需要髖關節(jié)置換，是一項重大挑戰(zhàn)。本研究評估了髖臼周圍截骨術后的中期至長期結果，以展示不同程度異常（骨贅）增生和骨關節(jié)炎患者的臨床結果。基于這些結果，進行了失敗概率分析，以預測進行髖關節(jié)保髖手術的可能性，并改善手術決策。

方法：在1991年5月至1998年9月期間，單一外科醫(yī)生接受髖臼周圍截骨術治療的189個髖關節(jié)（共157例患者）中，有31例被排除診斷為發(fā)育性髖關節(jié)發(fā)育不良，23例未能隨訪。其余135個髖關節(jié)（共109名患者）均在平均9年內進行了回顧性復查。髖關節(jié)的評估采用了西安大略大學和麥克馬斯特大學骨關節(jié)炎指數的疼痛亞量表，術后評估，以及術前和術后1年及5年以上拍攝的X線片。截骨失敗被定義為疼痛評分>或=10，即需要全髖關節(jié)置換術。

結果：102個髖關節(jié)（76%）平均保存了9年，西安大略大學和麥克馬斯特大學的平均疼痛評分為2.4分（滿分20分）。33例髖關節(jié)（24%）符合失敗標準：17例在截骨術后平均6.1年接受全髖關節(jié)置換術，16例術后疼痛評分為>或=10。以全髖關節(jié)置換術為終點的Kaplan-Meier分析顯示，5年存活率為96%（95%置信區(qū)間，93%至99%），10年存活率為84%（95%置信區(qū)間，77%至90%）。20個髖關節(jié)出現(xiàn)并發(fā)癥。15個髖關節(jié)（11%）因軟骨和/或盂唇病變接受了后續(xù)關節(jié)鏡手術，平均發(fā)生在截骨術后的6.8年。識別出兩個獨立的失敗預測因子（定義為全髖關節(jié)置換術或高疼痛評分）：（1）年齡超過35歲，（2）術前關節(jié)吻合關系差或一般。無失敗預測因素的髖關節(jié)失敗率為14%，只有一個預測因素（年齡超過35歲或關節(jié)吻合關系差或一般）為36%，同時具有兩種預測因素者為95%。

結論：伯爾尼髖骨周圍截骨術對于治療疼痛性髖關節(jié)發(fā)育不良可能有效，但多達15%的病例可能出現(xiàn)并發(fā)癥。理想的病例是年齡在35歲以下且髖關節(jié)吻合關系良好或極佳的患者。

Intermediate to long- term results following the Bernese periacetabular osteotomy and predictors of clinical outcome

Background: The Bernese periacetabular osteotomy is a commonly used non-arthroplasty option to treat developmental hip dysplasia in symptomatic younger patients. Predicting which hips will remain preserved and which hips will go on to require arthroplasty following periacetabular osteotomy is a major challenge. In the present study, we assessed the intermediate to long-term results following periacetabular osteotomy to demonstrate the clinical outcomes for patients with varying amounts of dysplasia and arthritis. From these results, a probability-of-failure analysis was conducted to predict the likelihood of hip preservation and to improve surgical decision-making.

Methods: Of the 189 hips (in 157 patients) that were treated with periacetabular osteotomy by a single surgeon from May 1991 to September 1998, thirty-one had diagnoses other than developmental hip dysplasia and twenty-three were lost to follow-up. The remaining 135 hips (in 109 patients) were retrospectively reviewed at an average of nine years. Hips were evaluated with use of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index postoperatively as well as with radiographs that were made preoperatively and at one and more than five years postoperatively. Osteotomy failure was defined as a pain score of ?10 or the need for total hip arthroplasty.

Results: One hundred and two hips (76%) remained preserved at an average of nine years, with an average Western Ontario and McMaster Universities pain score of 2.4 of 20. Thirty-three hips (24%) met the failure criteria: seventeen underwent arthroplasty at an average of 6.1 years after the osteotomy, and sixteen had a postoperative pain score of 10. Kaplan-Meier analysis with arthroplasty as the end point revealed a survival rate of 96% (95% confidence interval, 93% to 99%) at five years and 84% (95% confidence interval, 77% to 90%) at ten years. Complications occurred in twenty hips. Fifteen hips (11%) were treated with a subsequent arthroscopy because of chondral and/or labral lesions at an average of 6.8 years after the osteotomy. Two independent predictors of failure (defined as arthroplasty or a high pain score) were identified: (1) an age of more than thirty-five years and (2) poor or fair preoperative joint congruency. The probability of failure requiring arthroplasty was 14% for hips with no predictors of failure, 36% for those with one predictor (either an age of more than thirty-five years or poor or fair joint congruency), and 95% for those with both predictors.

Conclusions: The Bernese periacetabular osteotomy can be effective for the treatment of painful hip dysplasia, but complications may be expected in as many as 15% of cases. The ideal candidate is the patient who is less than thirty-five years of age and who has good or excellent hip joint congruency.

文獻出處：Matheney Travis, YJ Kim, Zurakowski David, Matero Catherine, Millis Michael. Intermediate to long- term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am, 2009; 91:2113-2123.

文獻7

骨關節(jié)炎對股骨頭軟骨下骨小梁區(qū)域解剖變異的影響

譯者 邱興

背景： 軟骨下骨小梁位于關節(jié)軟骨深層，其中股骨頸上部區(qū)域承擔髖關節(jié)日間承荷的70%以上。這導致股骨頭內軟骨下骨小梁存在顯著的局部解剖差異。本研究旨在探討骨關節(jié)炎是否影響這些局部形態(tài)特征。

方法： 研究收集了60例髖關節(jié)置換術中獲取的股骨頭樣本，通過骨穿透測量法在8個預設角度以1毫米/秒的穿透速率進行分析。其中28例供體因骨關節(jié)炎接受手術，其余為髖部骨折的創(chuàng)傷患者。為將測量結果與非侵入性數據關聯(lián)，所有樣本在實驗前均接受微計算機斷層掃描（μCT）檢查。分析垂直于穿刺路徑的橫截面積，并將其與記錄的骨穿透能量偏差進行比較。

結果： 實驗顯示骨小梁存在顯著的局部形態(tài)偏差。骨關節(jié)炎樣本中的偏差更為明顯，且整體需要更高的骨穿透能量。研究發(fā)現(xiàn)，骨的方向性強度與其橫截面特征存在顯著相關性。盡管“性別”對骨穿透能量的影響具有統(tǒng)計學意義，但在將骨穿透能量與二維骨小梁密度關聯(lián)的回歸模型中，性別未被列為自變量，因其并未提高調整后R2值。

結論： 本研究通過對比骨關節(jié)炎與健康樣本，進一步揭示了骨關節(jié)炎患者股骨頭承載能力的變化。結果表明，股骨頭區(qū)域的軟骨下骨小梁因骨關節(jié)炎而發(fā)生更明顯的骨重塑和脫礦質過程，這一變化體現(xiàn)在更高的骨穿透測量值中。

關鍵詞： 松質骨特征；股骨頭；骨關節(jié)炎；骨穿透測量。

圖1. 骨穿透測量針及其施力方向示意圖

圖2. 股骨頭軟骨下骨橫截面積（于股骨頭表面以下7 mm處測量，垂直于內上區(qū)域方向）

圖3. 穿透測試典型測量曲線

The effect of osteoarthritis on the regional anatomical variation of subchondral trabecular bone in the femoral head

Background: The subchondral trabecular bone is located deep inside the articular cartilage, with the subcapital region carrying up to 70% of the diurnal loads occurring in the hip joint. This leads to severe regional anatomical variations of subchondral trabecular bone in the femoral head and the purpose of this study was to examine whether osteoarthritis affects these topographic characteristics.

Methods: 60 femoral heads were harvested during hip replacement and studied by osteopenetration at 8 pre-defined angles, at a penetration rate of 1mm/s. Twenty-eight of the donors underwent surgery due to osteoarthritis, whereas the remaining were trauma patients with hip fractures. To correlate these measurements to non-invasive data, all specimens were scanned by micro Computed Tomography (μCT) prior to experimentation. A cross-sectional area, perpendicular to the needle penetration pathway, was analyzed and the deviations compared to the recorded osteopenetration energy.

Findings: The experiments revealed significant topographical deviations in the trabeculae. These were more pronounced in the osteoarthritic samples which also required overall higher osteopenetration energy. A notable dependency of the directional bone strength to its cross-sectional characteristics was observed. Although the effect of "gender" on osteopenetration energy was proven to be significant, gender was not considered an independent variable in a regression model correlating osteopenetration energy to 2D trabecular bone density as this did not improve the value of the adjusted R(2).

Interpretation: The investigation provided refined insight into femoral head load-bearing capacity of patients suffering from osteoarthritis, as a comparison of osteoarthritic to healthy samples illustrated that subchondral trabecular bone in the femoral head region is subjected to increased remodeling and demineralization, reflected in higher osteopenetration values.

Keywords: Cancellous bone characteristics; Femoral head; Osteoarthritis; Osteopenetration.

文獻出處：Tsouknidas, A., K. Anagnostidis, S. Panagiotidou, and N. Michailidis. "The effect of osteoarthritis on the regional anatomical variation of subchondral trabecular bone in the femoral head." Clinical Biomechanics 30, no. 5 (2015): 418-423.

文獻8

非典型性與不可歸類性髖關節(jié)脫位伴關節(jié)囊及盂唇嵌頓：病例報告與文獻回顧

譯者 徐子茵

引言與重要性： 除前脫位、后脫位或中心性脫位外，髖關節(jié)脫位的其他類型鮮有報道。我們報告一例無法歸類的非典型髖關節(jié)脫位，伴有關節(jié)囊和盂唇的嵌頓。本文旨在描述一種伴有軟組織嵌頓的罕見類型髖關節(jié)脫位。

病例報告： 患者男，18歲，無特殊病史，因道路交通事故導致右側髖關節(jié)發(fā)生不尋常的移位。首次復位后，復查X線片顯示關節(jié)間隙持續(xù)增寬，強烈提示存在軟組織嵌頓。計算機斷層掃描證實前側區(qū)域有軟組織嵌頓于股骨頭與髖臼之間。傷后兩周，采用Hueter入路進行手術，術中發(fā)現(xiàn)前側關節(jié)囊及盂唇嵌頓，予以松解并復位。術后2年隨訪，患者主訴疼痛，Postel Merle d'Aubigné (PMA)評分為17分。我們觀察到轉子周圍有鈣化，但股骨頭未見壞死跡象。

臨床討論： 髖關節(jié)脫位主要類型為后脫位和前脫位。不屬于這些類型的脫位形式少有文獻綜述。后者通常需手術治療，以清除嵌頓物（如軟組織或骨塊）。然而，手術入路的選擇取決于脫位類型。

結論： 非典型髖關節(jié)脫位必須謹慎復位，因其存在較高的軟組織嵌頓風險。復位后X線片上顯示關節(jié)間隙增寬應引起對關節(jié)囊或盂唇嵌頓的懷疑，并需采取手術策略。

關鍵詞： 非典型髖關節(jié)脫位；病例報告；Hueter入路；關節(jié)囊和盂唇嵌頓

Atypical and unclassifiable hip dislocation with capsule and labrum incarceration: a case report and review of the literature

Introduction and importance: Hip dislocations excluding the anterior, posterior or central variety have rarely been published. We report an atypical and unclassifiable dislocation of the hip joint with incarceration of the capsule and labrum. The aim of the presentation was to describe an uncommon type of hip dislocation with entrapment of the soft tissue.

Case presentation: 18-year-old patient, with no specific pathological history, was involved in a road traffic accident causing an unusual right hip joint displacement. After the first reduction, the control X-rays showed persistent enlargement of the joint line, strongly suggesting soft-tissue impingement. Computed tomography confirmed soft tissue entrapment in the anterior area between the head and the acetabulum. An Hueter approach carried out two weeks after the injury, revealed incarceration of the capsule and anterior labrum; which was released and repositioned. At 2-year follow-up, the patient complained of the pain and the Postel Merle d'Aubigné (PMA) score was 17. We observed the peritrochanteric calcifications but without signs of osteonecrosis femoral head.

Clinical discussion: Posterior and anterior hip dislocations are the main types. Forms excluding these types have rarely been reviewed. The last ones are usually surgical treatments, which help remove the obstacle, such as soft tissue or a bone fragment. However, the choice of approach depends on the displacement.

Conclusion: Atypical dislocation of the hip must be carefully reduced, due to the high risk of soft-tissue incarceration. An enlarged joint line on a control X-rays should lead to suspicion of a capsule or labrum interposition and a surgical strategy is required.

Keywords: Atypical hip dislocation; Case report; Hueter approach; Incarceration of the capsule and labrum.

文獻出處：Zengui FZP, Ellah MR, Bouhelo-Pam KBP, Bilongo-Bouyou ASW, Mvili NSNG, Monka M. Atypical and unclassifiable hip dislocation with capsule and labrum incarceration: a case report and review of the literature. Int J Surg Case Rep.

來源：304關節(jié)學術

作者：304關節(jié)團隊

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