1、髕骨電燒去神經(jīng)化對(duì)于未置換髕骨的全膝關(guān)節(jié)置換術(shù)有益嗎

2、相比于BMI，切口部位脂肪厚度是后路全髖關(guān)節(jié)置換術(shù)后切口相關(guān)并發(fā)癥的更佳預(yù)測(cè)指標(biāo)

3、萬(wàn)古霉素在初次全膝關(guān)節(jié)置換術(shù)中的臨床效果

4、采用增強(qiáng)模式的 Mako 機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)中下肢長(zhǎng)度及股骨柄前傾角測(cè)量的準(zhǔn)確性

5、兒童感染髖嚴(yán)重后遺癥的分類(lèi)與外科處理（1981Hunka分類(lèi)法）

6、基于超聲圖像識(shí)別髖關(guān)節(jié)發(fā)育不良的深度學(xué)習(xí)算法

7、運(yùn)動(dòng)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(guān)節(jié)發(fā)育不良（DDH）篩查的風(fēng)險(xiǎn)因素評(píng)估及十年經(jīng)驗(yàn)

10、髖臼周?chē)毓切g(shù)后的中長(zhǎng)期結(jié)果及臨床預(yù)后預(yù)測(cè)因素

11、骨關(guān)節(jié)炎對(duì)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(lèi)性髖關(guān)節(jié)脫位伴關(guān)節(jié)囊及盂唇嵌頓

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

文獻(xiàn)1

髕骨電燒去神經(jīng)化對(duì)于未置換髕骨的全膝關(guān)節(jié)置換術(shù)有益嗎：隨機(jī)對(duì)照試驗(yàn)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(guān)節(jié)置換術(shù)（TKA）后髕骨去神經(jīng)化（PD）和未去神經(jīng)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(jìn)行了系統(tǒng)的電子檢索。僅納入隨機(jī)對(duì)照研究（RCT）。此外，通過(guò)人工檢索方式從綜述文章的參考文獻(xiàn)列表中確定潛在的符合條件的研究。兩名研究人員獨(dú)立進(jìn)行了文獻(xiàn)回顧、數(shù)據(jù)提取和偏倚風(fēng)險(xiǎn)評(píng)估。結(jié)果分析包括膝前痛（AKP）的發(fā)生率、視覺(jué)模擬評(píng)分（VAS）、活動(dòng)范圍（ROM）、美國(guó)膝關(guān)節(jié)學(xué)會(huì)評(píng)分（KSS）、牛津膝關(guān)節(jié)評(píng)分（OKS）、髕骨評(píng)分（PS）、并發(fā)癥和再手術(shù)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(duì)主要和次要效果的總體情況進(jìn)行功效分析。納入了12項(xiàng)研究，涉及1745名患者（1587個(gè)膝關(guān)節(jié)），其中852例做了PD， 893例為NPD。結(jié)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(jì)學(xué)意義。然而，每個(gè)結(jié)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(píng)分無(wú)顯著差異。此外，PD與并發(fā)癥或再手術(shù)的發(fā)生率增加無(wú)關(guān)。在12個(gè)月或更長(zhǎng)時(shí)間內(nèi)，PD被證明是一種有益的干預(yù)措施，可以在不增加并發(fā)癥或再手術(shù)的情況下降低TKA后的AKP。對(duì)于KSS、OKS和PS，通過(guò)PD獲得的最小優(yōu)勢(shì)可能沒(méi)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(xiàn)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(xiàn)2

相比于BMI，切口部位脂肪厚度是后路全髖關(guān)節(jié)置換術(shù)后切口相關(guān)并發(fā)癥的更佳預(yù)測(cè)指標(biāo)

譯者 張薔

背景：體重指數(shù)（BMI）被廣泛用作評(píng)估全髖關(guān)節(jié)置換（THA）術(shù)后并發(fā)癥風(fēng)險(xiǎn)的重要參考指標(biāo)。然而，BMI并無(wú)法顯示患者的脂肪分布情況。既往文獻(xiàn)中，有關(guān)切口部位脂肪厚度（SSFT）對(duì)THA圍術(shù)期并發(fā)癥風(fēng)險(xiǎn)預(yù)測(cè)效果的相關(guān)文章稀少。本篇文章的目的是比較BMI和SSFT對(duì)THA術(shù)后早期并發(fā)癥的預(yù)測(cè)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(jī)器人輔助下后入路THA手術(shù)病例進(jìn)行回顧性研究。所有病例均有CT掃描結(jié)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(jié)果。我們對(duì)所有病例信息進(jìn)行了回顧，重點(diǎn)包括圍術(shù)期變量、早期（術(shù)后90天內(nèi)）術(shù)后并發(fā)癥、再手術(shù)和翻修情況。最后，我們對(duì)收集到的數(shù)據(jù)進(jìn)行了T檢驗(yàn)、二元回歸分析和受試者工作特征曲線(xiàn)分析。

結(jié)果：平均BMI 33.1（范圍，18.9-44.3），平均SSFT 52.4mm（范圍，8-99）。術(shù)后90天內(nèi)，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(guān)；其中7例（4%）進(jìn)行了再手術(shù)。其中4例（2.4%）進(jìn)行了保留假體的清創(chuàng)手術(shù)（DAIR），另外3例（1.8%）進(jìn)行了清創(chuàng)再縫合手術(shù)。單變量分析顯示：SSFT與并發(fā)癥（P < 0.01）、再手術(shù)（P < 0.01）和DAIR（P < 0.01）均存在相關(guān)性， 而B(niǎo)MI只與并發(fā)癥（P = 0.02）存在相關(guān)性，與再手術(shù)（P=0.05）或DAIR（P = 0.27）均不存在相關(guān)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(shù)（P = 0.03，概率比 1.04）的明確預(yù)測(cè)因素，而B(niǎo)MI（兩項(xiàng)P > 0.05）并不是。發(fā)生并發(fā)癥和再手術(shù)的SSFT閾值分別為51.5mm（曲線(xiàn)下面積0.73）和64.5mm（曲線(xiàn)下面積0.81）。

結(jié)論：與BMI相比，SSFT對(duì)THA術(shù)后切口相關(guān)并發(fā)癥的預(yù)測(cè)力更強(qiáng)，且在預(yù)測(cè)術(shù)后早期并發(fā)癥方面，SSFT是更可靠的指標(biāo)。

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(xiàn)3

萬(wàn)古霉素在初次全膝關(guān)節(jié)置換術(shù)中的臨床效果

譯者 丁云鵬

背景：關(guān)節(jié)假體周?chē)腥荆≒JI）仍然是全膝關(guān)節(jié)置換術(shù)（TKA）后令人擔(dān)憂(yōu)的并發(fā)癥。本研究報(bào)告了我們的隊(duì)列PJI發(fā)病率、不良反應(yīng)和并發(fā)癥的最新結(jié)果，并增加了我們?cè)?021年報(bào)道的先前研究的臨床隨訪(fǎng)。

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(nèi)（IO）萬(wàn)古霉素治療的1,923例膝關(guān)節(jié)，隨訪(fǎng)時(shí)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(wàn)古霉素，靜脈注射組止血帶充氣后在脛骨近端給藥500 mg萬(wàn)古霉素。所有患者圍手術(shù)期均接受基于體重劑量的靜脈注射頭孢唑林。2018年國(guó)際共識(shí)會(huì)議標(biāo)準(zhǔn)用于診斷PJI。急性腎損傷（AKI）定義為肌酐升高0.3 mg/dL。

結(jié)果：在隨訪(fǎng)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(shí)，IO組PJI發(fā)生率明顯低于IV組。此外，在隨訪(fǎng)30天（2.3 vs 4.3%, P = 0.023）和90天（2.5 vs 5.4%, P = 0.003）時(shí)，IO組需要口服抗生素的非手術(shù)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(wú)統(tǒng)計(jì)學(xué)意義。在深靜脈血栓、肺栓塞或手術(shù)傷口并發(fā)癥的發(fā)生率方面沒(méi)有差異。

結(jié)論：在初次TKA后90天、1年和2年的隨訪(fǎng)中，骨內(nèi)萬(wàn)古霉素比靜脈萬(wàn)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(fǎng)中，IO萬(wàn)古霉素的其他益處是減少了非手術(shù)性傷口并發(fā)癥，并降低了AKI的發(fā)生率，但沒(méi)有統(tǒng)計(jì)學(xué)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(xiàn)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(xiàn)4

采用增強(qiáng)模式的 Mako 機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)中下肢長(zhǎng)度及股骨柄前傾角測(cè)量的準(zhǔn)確性

譯者 沈松坡

目的

本研究評(píng)估了在采用增強(qiáng)模式的 Mako 機(jī)器人系統(tǒng)進(jìn)行全髖關(guān)節(jié)置換術(shù)（total hip arthroplasty，THA）過(guò)程中，術(shù)中獲得的下肢長(zhǎng)度及股骨前傾角測(cè)量結(jié)果的準(zhǔn)確性。

方法

本研究回顧性分析了 55 個(gè)髖關(guān)節(jié)病例，其中包括 4 名男性和 51 名女性，均經(jīng)前外側(cè)入路使用 Mako 系統(tǒng)行初次全髖關(guān)節(jié)置換術(shù)。比較了 Mako 增強(qiáng)模式術(shù)中顯示的下肢長(zhǎng)度及股骨前傾角測(cè)量值與術(shù)后基于 CT 的測(cè)量結(jié)果。通過(guò)計(jì)算絕對(duì)誤差及其分布情況，以評(píng)估術(shù)中測(cè)量的準(zhǔn)確性。

結(jié)果

術(shù)后下肢長(zhǎng)度不等的平均絕對(duì)誤差為 2.3?±?1.8 mm，股骨柄前傾角的平均絕對(duì)誤差為 2.9?±?2.2°。在 55 個(gè)髖關(guān)節(jié)中，46 例（83.6%）的下肢長(zhǎng)度誤差在 3 mm 以?xún)?nèi)，51 例（92.7%）在 5 mm 以?xún)?nèi)。對(duì)于股骨柄前傾角，48 例（87.3%）在 3° 以?xún)?nèi)，全部 55 例（100%）在 5° 以?xún)?nèi)。由于股骨陣列松動(dòng)或固定螺釘穿入髓腔，10.7% 的病例未能完成 Mako 增強(qiáng)模式的測(cè)量流程。

結(jié)論

Mako 增強(qiáng)模式在術(shù)中下肢長(zhǎng)度及股骨前傾角測(cè)量方面表現(xiàn)出臨床可接受的準(zhǔn)確性，有助于在機(jī)器人輔助全髖關(guān)節(jié)置換術(shù)中實(shí)現(xiàn)更精確的股骨柄植入。

關(guān)鍵詞：髖關(guān)節(jié) · 全髖關(guān)節(jié)置換術(shù) · 機(jī)器人 · Mako · 增強(qiáng)模式

圖1 采用Mako系統(tǒng)的增強(qiáng)模式實(shí)施全髖關(guān)節(jié)置換術(shù)過(guò)程中使用的骨盆與股骨定位架

圖2 采用MAKO系統(tǒng)的增強(qiáng)模式進(jìn)行股骨近端注冊(cè)

圖3 采用MAKO系統(tǒng)的增強(qiáng)模式測(cè)量股骨柄的前傾角

圖 4　Mako 增強(qiáng)模式下的股骨陣列。

（a）采用增強(qiáng)模式的 Mako 系統(tǒng)所使用的股骨陣列；

（b）術(shù)中 X 線(xiàn)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(guān)文獻(xiàn)

文獻(xiàn)1

兒童感染髖嚴(yán)重后遺癥的分類(lèi)與外科處理（1981Hunka分類(lèi)法）

譯者 羅殿中

嬰幼兒和兒童早期感染性髖關(guān)節(jié)炎結(jié)局是災(zāi)難性的，可導(dǎo)致嚴(yán)重骨關(guān)節(jié)后遺癥。文獻(xiàn)中較好討論了感染急性期采用抗生素和早期手術(shù)引流的處理方案；但很少討論其殘余解剖畸形，也沒(méi)有清晰的分類(lèi)方法和治療建議。Hallel和Salvati報(bào)告了24例髖關(guān)節(jié)感染治療結(jié)果。其中10例股骨頭和股骨頸嚴(yán)重破壞，6例采用轉(zhuǎn)子成形手術(shù)；上述病例中僅有3例髖關(guān)節(jié)獲得穩(wěn)定。Weissman和Stetson等各報(bào)告一例采用髖關(guān)節(jié)融合治療的患者。Rigault等宣稱(chēng)在4例患者中采用轉(zhuǎn)子成形術(shù)，其中2例在隨訪(fǎng)時(shí)獲得滿(mǎn)意效果。有關(guān)這方面的信息相對(duì)匱乏，我們對(duì)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(yán)重破壞進(jìn)行回顧性研究，提出了一項(xiàng)兒童感染性髖關(guān)節(jié)炎分類(lèi)系統(tǒng)、及相應(yīng)的建議治療方案。

結(jié)果：2例III型最終轉(zhuǎn)為V型；2例IVA型，3例IVB型；5例為V型（其中2例為III型轉(zhuǎn)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(lèi)型（圖5）。IV型預(yù)后尚可，殘余大轉(zhuǎn)子高位和下肢不等長(zhǎng)；可在適當(dāng)?shù)臅r(shí)機(jī)行大轉(zhuǎn)子下移和下肢均衡手術(shù)；IVB型必要時(shí)可采用髖關(guān)節(jié)穩(wěn)定手術(shù)。V型雖然X線(xiàn)片表現(xiàn)最為嚴(yán)重，如果早期型大轉(zhuǎn)子成形+股骨近端內(nèi)翻手術(shù)，療效尚滿(mǎn)意。

圖1. 兒童感染性髖關(guān)節(jié)炎后遺癥分類(lèi)。I型，股骨頭輕微改變或無(wú)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(guān)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(dá)轉(zhuǎn)子間線(xiàn)，髖關(guān)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(guān)節(jié)脫位。

圖3. 圖2患兒行大轉(zhuǎn)子成形術(shù)后。

圖4. III型感染髖后遺癥，股骨頸假關(guān)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(guān)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(xiàn)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(xiàn)2

基于超聲圖像識(shí)別髖關(guān)節(jié)發(fā)育不良的深度學(xué)習(xí)算法：中國(guó)的一項(xiàng)回顧性、前瞻性、多中心研究

譯者 任寧濤

背景：髖關(guān)節(jié)超聲是診斷疑似嬰兒髖關(guān)節(jié)發(fā)育不良（DDH）的一線(xiàn)工具，但其局限性包括重復(fù)性差和診斷錯(cuò)誤率高。因此本研究旨在利用多中心髖關(guān)節(jié)超聲數(shù)據(jù)，開(kāi)發(fā)并驗(yàn)證一種名為HipSonoNeuNet模型（HSNN）的深度卷積神經(jīng)網(wǎng)絡(luò)算法。

方法：這項(xiàng)多中心橫斷面研究納入22家中國(guó)醫(yī)院（2022年9月至2025年1月）的數(shù)據(jù)，納入了3082名參與者。共收集髖部超聲圖像7286張（動(dòng)態(tài)1429張，靜態(tài)5857張），分為3個(gè)數(shù)據(jù)集。這項(xiàng)研究分三個(gè)階段進(jìn)行。第一階段使用2431名參與者（數(shù)據(jù)集1）訓(xùn)練模型。第二階段比較了500名參與者中不同經(jīng)驗(yàn)的放射科醫(yī)生和模型之間的診斷表現(xiàn)（數(shù)據(jù)集2）。第三階段對(duì)151名參與者（數(shù)據(jù)集3）前瞻性地驗(yàn)證了模型的普遍性。

結(jié)果：在第一階段，HSNN在內(nèi)部測(cè)試數(shù)據(jù)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(píng)分為0.90 （95% CI: 0.87-1.00）。在II期，HSNN的準(zhǔn)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(píng)分為0.58 (95% CI: 0.50-0.66)，與專(zhuān)家（κ = 0.77）高度一致。人工智能輔助提高了所有7名初級(jí)放射科醫(yī)生的診斷表現(xiàn)（準(zhǔn)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(shí)間，增強(qiáng)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(zhuān)家的κ = 0.76）。

圖1 研究設(shè)計(jì)概述。(A)所建立的HSNN框架包含兩個(gè)步驟，一是關(guān)鍵幀（標(biāo)準(zhǔn)平面）檢測(cè)，二是關(guān)鍵幀分類(lèi)；(B) HSNN系統(tǒng)開(kāi)發(fā)和驗(yàn)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(xiàn)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(xiàn)3

運(yùn)動(dòng)員腹股溝疼痛：一種新型診斷方法

譯者 李勇

對(duì)于運(yùn)動(dòng)表現(xiàn)活躍的運(yùn)動(dòng)員來(lái)說(shuō)，腹股溝疼痛的診斷和治療極具挑戰(zhàn)性。鑒別診斷包括關(guān)節(jié)內(nèi)病因、關(guān)節(jié)外病因以及非肌肉骨骼病因。對(duì)這一群體的腹股溝疼痛進(jìn)行詳細(xì)的臨床和影像學(xué)評(píng)估至關(guān)重要，因?yàn)檫@能確定潛在的病理機(jī)制。診斷性髖關(guān)節(jié)阻滯是區(qū)分關(guān)節(jié)內(nèi)與關(guān)節(jié)外病因的有價(jià)值工具。髖關(guān)節(jié)鏡檢查有助于識(shí)別一些難以捉摸的關(guān)節(jié)內(nèi)疾病，這些疾病曾經(jīng)因未被診斷而未得到治療，導(dǎo)致許多運(yùn)動(dòng)員的職業(yè)生涯過(guò)早結(jié)束。本文旨在探討當(dāng)前對(duì)腹股溝疼痛（尤其是年輕個(gè)體）評(píng)估的思考，并建立一個(gè)簡(jiǎn)單的臨床和診斷方案來(lái)應(yīng)對(duì)這一棘手問(wèn)題。

腹股溝疼痛的解剖學(xué)與分類(lèi) (Anatomy & Classification)：解剖結(jié)構(gòu)： 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(nèi)收肌上部等。病因分類(lèi)： 主要分為關(guān)節(jié)內(nèi)病因（髖關(guān)節(jié)球窩內(nèi)的病變）和關(guān)節(jié)外病因（球窩外的病變）。專(zhuān)家估計(jì)60%的關(guān)節(jié)內(nèi)損傷最初被誤診為關(guān)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(guān)節(jié)活動(dòng)時(shí)的彈響可能提示盂唇撕裂（關(guān)節(jié)內(nèi)）；燒灼樣疼痛可能提示神經(jīng)卡壓。 鑒別診斷 (Differential Diagnosis)：關(guān)節(jié)內(nèi)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(guān)節(jié)外病因： 肌肉拉傷/撕裂、應(yīng)力性骨折、恥骨骨炎、運(yùn)動(dòng)疝、彈響綜合征、神經(jīng)卡壓等。

影像學(xué)檢查 (Imaging Studies)：X光片： 基礎(chǔ)檢查，用于觀察骨骼定義和排列（如FAI的“凸輪”畸形）。超聲： 廉價(jià)且快速，適合動(dòng)態(tài)評(píng)估軟組織及排除細(xì)微疝氣。 MRI/MRA： 診斷軟組織、軟骨損傷的金標(biāo)準(zhǔn)，尤其是MRA（磁共振關(guān)節(jié)造影）對(duì)盂唇病理評(píng)估極佳。CT/神經(jīng)傳導(dǎo)研究： CT用于骨骼重建規(guī)劃，神經(jīng)傳導(dǎo)研究用于診斷神經(jīng)卡壓。

關(guān)鍵診斷工具與治療 (Key Diagnostic Tools & Treatment)：診斷性髖關(guān)節(jié)阻滯 (Diagnostic Hip Block)： 在透視引導(dǎo)下進(jìn)行關(guān)節(jié)內(nèi)注射（皮質(zhì)類(lèi)固醇和局麻藥）。陽(yáng)性反應(yīng)（疼痛緩解）是判斷關(guān)節(jié)內(nèi)病變的可靠指標(biāo)（90%可靠性）；若注射無(wú)效，應(yīng)評(píng)估隱匿的關(guān)節(jié)外病因。髖關(guān)節(jié)鏡 (Hip Arthroscopy)： 既是診斷工具也是治療手段。對(duì)于難以確診的關(guān)節(jié)內(nèi)病因極其有效，可處理盂唇撕裂、撞擊等問(wèn)題。

臨床流程圖 (Clinical Algorithm)：首先進(jìn)行腹股溝疼痛的臨床檢查和影像學(xué)檢查。 若確診則治療；若診斷不確定，進(jìn)行診斷性髖關(guān)節(jié)阻滯。若疼痛緩解（提示關(guān)節(jié)內(nèi)病因），建議進(jìn)行髖關(guān)節(jié)鏡檢查。若疼痛持續(xù)（提示關(guān)節(jié)外病因），則進(jìn)一步調(diào)查關(guān)節(jié)外原因。髖關(guān)節(jié)鏡無(wú)法治療或不適用的情況，可考慮截骨術(shù)、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(xiàn)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(xiàn)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(qiáng)

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(qū)動(dòng)，其出現(xiàn)和融合存在年齡與性別差異。本研究量化了SOCs對(duì)青少年髖臼覆蓋、扭轉(zhuǎn)、傾斜及表面積的影響。

方法?：對(duì)540個(gè)無(wú)髖關(guān)節(jié)病變的正常髖關(guān)節(jié)（男性128例，女性142例，年齡8-19歲）進(jìn)行CT掃描，生成三維重建。使用已發(fā)表算法提取髖臼參數(shù)（包括八分位覆蓋角、扭轉(zhuǎn)、傾斜及表面積），并通過(guò)近端股骨成熟指數(shù)（PFMI）評(píng)估骨骼成熟度。采用廣義線(xiàn)性混合模型分析3個(gè)SOCs對(duì)髖臼形態(tài)的貢獻(xiàn)。

結(jié)果?：PFMI與年齡顯著相關(guān)（rs=0.91，p<0.001）。髂骨骨化與上覆蓋增加顯著相關(guān)（p<0.001），坐骨骨化與后覆蓋增加相關(guān)（p<0.001）。上覆蓋與外側(cè)傾斜強(qiáng)相關(guān)（rs=0.837），后覆蓋與前扭轉(zhuǎn)強(qiáng)相關(guān)（rs=0.788）。女性髖臼前扭轉(zhuǎn)（17.7°±6.4° vs 12.2°±6.4°）和外側(cè)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(wú)顯著關(guān)聯(lián)（男性p=0.38，女性p=0.065），前覆蓋與年齡無(wú)相關(guān)性（p=0.115）。

結(jié)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(guān)，而恥骨骨化與前覆蓋無(wú)關(guān)。SOCs的出現(xiàn)和閉合時(shí)間與髖臼形態(tài)的關(guān)鍵發(fā)育變化一致，強(qiáng)調(diào)了其在髖關(guān)節(jié)穩(wěn)定性中的作用。

證據(jù)等級(jí)?：III級(jí)（預(yù)后性研究）。

A 冠狀截面演示三維覆蓋角計(jì)算。B 髖臼分為5個(gè)區(qū)域：后（紅色）、上-后（暗紅色）、上（藍(lán)色）、上-前（淺藍(lán)色）和前（青色）。每個(gè)區(qū)域的覆蓋角為沿髖臼邊緣45°弧度內(nèi)的平均角度。

CT圖像顯示髖臼3個(gè)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(biāo)準(zhǔn)化的3D靶向系統(tǒng)顯示每個(gè)中心的軸位、冠狀面和矢狀面，以評(píng)估多個(gè)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(xiàn)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(xiàn)5

健康兒童人群中發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）篩查的風(fēng)險(xiǎn)因素評(píng)估及十年經(jīng)驗(yàn)

譯者 賈海港

目的： 基于風(fēng)險(xiǎn)的超聲篩查是檢測(cè)髖關(guān)節(jié)發(fā)育不良（DDH）的常用方法。然而，由于數(shù)據(jù)不足以給出明確的建議，不同國(guó)家的風(fēng)險(xiǎn)因素也各不相同。本研究旨在評(píng)估髖關(guān)節(jié)發(fā)育不良（DDH）的風(fēng)險(xiǎn)因素。

方法： 本回顧性病例對(duì)照研究調(diào)查了 2004 年至 2014 年間在土耳其某兒童保健中心接受隨訪(fǎng)的所有兒童的健康記錄，以確定其是否患有發(fā)育性髖關(guān)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(jù) Graf 分級(jí)），這些兒童構(gòu)成病例組。對(duì)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(xiǎn)因素。

結(jié)果： 共對(duì) 9758 名兒童的 19516 個(gè)髖關(guān)節(jié)進(jìn)行了發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的超聲檢查。其中 57 名兒童的 97 個(gè)髖關(guān)節(jié)超聲檢查結(jié)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(xiǎn)因素。病例組中女性患兒的比例也顯著高于男性。髖關(guān)節(jié)外展受限、Ortolani 征陽(yáng)性和 Barlow 征陽(yáng)性是病例組的重要臨床表現(xiàn)。

結(jié)論： 根據(jù)我們的研究結(jié)果，臀位、女性、斜頸和多胎妊娠是該疾病的危險(xiǎn)因素。具有這些危險(xiǎn)因素的嬰兒應(yīng)仔細(xì)檢查是否患有發(fā)育性髖關(guān)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(xiàn)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(xiàn)6

髖臼周?chē)毓切g(shù)后的中長(zhǎng)期結(jié)果及臨床預(yù)后預(yù)測(cè)因素

譯者 陶可

背景：伯爾尼髖臼周?chē)毓切g(shù)是一種常用的保髖（非關(guān)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(guān)節(jié)發(fā)育不良。預(yù)測(cè)哪些髖關(guān)節(jié)能進(jìn)行保髖手術(shù)，哪些髖關(guān)節(jié)在髖臼周?chē)毓切g(shù)后需要髖關(guān)節(jié)置換，是一項(xiàng)重大挑戰(zhàn)。本研究評(píng)估了髖臼周?chē)毓切g(shù)后的中期至長(zhǎng)期結(jié)果，以展示不同程度異常（骨贅）增生和骨關(guān)節(jié)炎患者的臨床結(jié)果?；谶@些結(jié)果，進(jìn)行了失敗概率分析，以預(yù)測(cè)進(jìn)行髖關(guān)節(jié)保髖手術(shù)的可能性，并改善手術(shù)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?chē)毓切g(shù)治療的189個(gè)髖關(guān)節(jié)（共157例患者）中，有31例被排除診斷為發(fā)育性髖關(guān)節(jié)發(fā)育不良，23例未能隨訪(fǎng)。其余135個(gè)髖關(guān)節(jié)（共109名患者）均在平均9年內(nèi)進(jìn)行了回顧性復(fù)查。髖關(guān)節(jié)的評(píng)估采用了西安大略大學(xué)和麥克馬斯特大學(xué)骨關(guān)節(jié)炎指數(shù)的疼痛亞量表，術(shù)后評(píng)估，以及術(shù)前和術(shù)后1年及5年以上拍攝的X線(xiàn)片。截骨失敗被定義為疼痛評(píng)分>或=10，即需要全髖關(guān)節(jié)置換術(shù)。

結(jié)果：102個(gè)髖關(guān)節(jié)（76%）平均保存了9年，西安大略大學(xué)和麥克馬斯特大學(xué)的平均疼痛評(píng)分為2.4分（滿(mǎn)分20分）。33例髖關(guān)節(jié)（24%）符合失敗標(biāo)準(zhǔn)：17例在截骨術(shù)后平均6.1年接受全髖關(guān)節(jié)置換術(shù)，16例術(shù)后疼痛評(píng)分為>或=10。以全髖關(guān)節(jié)置換術(shù)為終點(diǎn)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(gè)髖關(guān)節(jié)出現(xiàn)并發(fā)癥。15個(gè)髖關(guān)節(jié)（11%）因軟骨和/或盂唇病變接受了后續(xù)關(guān)節(jié)鏡手術(shù)，平均發(fā)生在截骨術(shù)后的6.8年。識(shí)別出兩個(gè)獨(dú)立的失敗預(yù)測(cè)因子（定義為全髖關(guān)節(jié)置換術(shù)或高疼痛評(píng)分）：（1）年齡超過(guò)35歲，（2）術(shù)前關(guān)節(jié)吻合關(guān)系差或一般。無(wú)失敗預(yù)測(cè)因素的髖關(guān)節(jié)失敗率為14%，只有一個(gè)預(yù)測(cè)因素（年齡超過(guò)35歲或關(guān)節(jié)吻合關(guān)系差或一般）為36%，同時(shí)具有兩種預(yù)測(cè)因素者為95%。

結(jié)論：伯爾尼髖骨周?chē)毓切g(shù)對(duì)于治療疼痛性髖關(guān)節(jié)發(fā)育不良可能有效，但多達(dá)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(guān)節(jié)吻合關(guān)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(xiàn)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(xiàn)7

骨關(guān)節(jié)炎對(duì)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(guān)節(jié)軟骨深層，其中股骨頸上部區(qū)域承擔(dān)髖關(guān)節(jié)日間承荷的70%以上。這導(dǎo)致股骨頭內(nèi)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(guān)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(guān)節(jié)置換術(shù)中獲取的股骨頭樣本，通過(guò)骨穿透測(cè)量法在8個(gè)預(yù)設(shè)角度以1毫米/秒的穿透速率進(jìn)行分析。其中28例供體因骨關(guān)節(jié)炎接受手術(shù)，其余為髖部骨折的創(chuàng)傷患者。為將測(cè)量結(jié)果與非侵入性數(shù)據(jù)關(guān)聯(lián)，所有樣本在實(shí)驗(yàn)前均接受微計(jì)算機(jī)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(jìn)行比較。

結(jié)果： 實(shí)驗(yàn)顯示骨小梁存在顯著的局部形態(tài)偏差。骨關(guān)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(qiáng)度與其橫截面特征存在顯著相關(guān)性。盡管“性別”對(duì)骨穿透能量的影響具有統(tǒng)計(jì)學(xué)意義，但在將骨穿透能量與二維骨小梁密度關(guān)聯(lián)的回歸模型中，性別未被列為自變量，因其并未提高調(diào)整后R2值。

結(jié)論： 本研究通過(guò)對(duì)比骨關(guān)節(jié)炎與健康樣本，進(jìn)一步揭示了骨關(guān)節(jié)炎患者股骨頭承載能力的變化。結(jié)果表明，股骨頭區(qū)域的軟骨下骨小梁因骨關(guān)節(jié)炎而發(fā)生更明顯的骨重塑和脫礦質(zhì)過(guò)程，這一變化體現(xiàn)在更高的骨穿透測(cè)量值中。

關(guān)鍵詞： 松質(zhì)骨特征；股骨頭；骨關(guān)節(jié)炎；骨穿透測(cè)量。

圖1. 骨穿透測(cè)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(cè)量，垂直于內(nèi)上區(qū)域方向）

圖3. 穿透測(cè)試典型測(cè)量曲線(xiàn)

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(xiàn)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(xiàn)8

非典型性與不可歸類(lèi)性髖關(guān)節(jié)脫位伴關(guān)節(jié)囊及盂唇嵌頓：病例報(bào)告與文獻(xiàn)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(guān)節(jié)脫位的其他類(lèi)型鮮有報(bào)道。我們報(bào)告一例無(wú)法歸類(lèi)的非典型髖關(guān)節(jié)脫位，伴有關(guān)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(jiàn)類(lèi)型髖關(guān)節(jié)脫位。

病例報(bào)告： 患者男，18歲，無(wú)特殊病史，因道路交通事故導(dǎo)致右側(cè)髖關(guān)節(jié)發(fā)生不尋常的移位。首次復(fù)位后，復(fù)查X線(xiàn)片顯示關(guān)節(jié)間隙持續(xù)增寬，強(qiáng)烈提示存在軟組織嵌頓。計(jì)算機(jī)斷層掃描證實(shí)前側(cè)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(jìn)行手術(shù)，術(shù)中發(fā)現(xiàn)前側(cè)關(guān)節(jié)囊及盂唇嵌頓，予以松解并復(fù)位。術(shù)后2年隨訪(fǎng)，患者主訴疼痛，Postel Merle d'Aubigné (PMA)評(píng)分為17分。我們觀察到轉(zhuǎn)子周?chē)锈}化，但股骨頭未見(jiàn)壞死跡象。

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

結(jié)論： 非典型髖關(guān)節(jié)脫位必須謹(jǐn)慎復(fù)位，因其存在較高的軟組織嵌頓風(fēng)險(xiǎn)。復(fù)位后X線(xiàn)片上顯示關(guān)節(jié)間隙增寬應(yīng)引起對(duì)關(guān)節(jié)囊或盂唇嵌頓的懷疑，并需采取手術(shù)策略。

關(guān)鍵詞： 非典型髖關(guān)節(jié)脫位；病例報(bào)告；Hueter入路；關(guān)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(xiàn)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(lái)源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊(duì)

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