本期目錄：

1、外側(cè)單間室膝關(guān)節(jié)置換術(shù)的適應(yīng)證

2、髕骨關(guān)節(jié)面關(guān)節(jié)炎是否為單間室膝關(guān)節(jié)置換術(shù)的禁忌證

3、全膝關(guān)節(jié)置換術(shù)后的縫隙腐蝕會降解干骺端袖套

4、水泥固定還是生物固定？一項前瞻性、隨機研究比較骨水泥與生物全膝關(guān)節(jié)置換術(shù)的10年隨訪結(jié)果

5、計算機斷層掃描與長腿平片在全膝關(guān)節(jié)置換術(shù)中基于 CPAK 的冠狀面對線評估對比

6、兒童下肢旋轉(zhuǎn)角度

7、經(jīng)腹直肌旁入路行髖臼周圍截骨術(shù)：技術(shù)可行性及經(jīng)驗證的手術(shù)導航系統(tǒng)控制骨塊活動度的尸體研究

8、青少年股骨髖臼撞擊征行關(guān)節(jié)鏡治療后短期深蹲力學分析

9、中國成年人發(fā)育性髖關(guān)節(jié)發(fā)育不良患病率

10、影響髖臼周圍截骨術(shù)后患者滿意度的因素

11、步態(tài)中調(diào)整足步向角可降低膝骨關(guān)節(jié)炎患者的膝關(guān)節(jié)內(nèi)收力矩且不增加髖關(guān)節(jié)力矩

12、哪些髖臼測量參數(shù)最能準確區(qū)分患者和對照組

13、形態(tài)性髖關(guān)節(jié)異常的遺傳學及其對骨關(guān)節(jié)炎的影響

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻

No.1

文獻1

外側(cè)單間室膝關(guān)節(jié)置換術(shù)的適應(yīng)證-系統(tǒng)回顧

譯者 張軼超

背景：盡管內(nèi)側(cè)UKA的循證適應(yīng)征已經(jīng)確立，但外側(cè)UKA的最佳適應(yīng)證并沒有受到太多的關(guān)注。內(nèi)側(cè)和外側(cè)UKA之間存在明顯的解剖、骨關(guān)節(jié)炎表型、運動學和手術(shù)技術(shù)差異。這兩種手術(shù)的適應(yīng)證可能存在不同。因此，本綜述旨在獲取已發(fā)表的外側(cè)UKA隊列研究的適應(yīng)征和禁忌癥，以確定是否存在共識。

方法：于2024年5月，按照系統(tǒng)評價和薈萃分析首選報告項目（PRISMA）指南進行系統(tǒng)評價。納入了有明確報告外側(cè)UKA適應(yīng)征的隊列研究。搜集了適應(yīng)征和禁忌癥的數(shù)據(jù)以評估共識。此外，還獲得了擴大或評測外側(cè)UKA適應(yīng)征相關(guān)的效果。

結(jié)果：納入38項研究。外側(cè)UKA多用于原發(fā)性外側(cè)間室骨關(guān)節(jié)炎。報道最多的適應(yīng)征是中度至重度外側(cè)骨關(guān)節(jié)炎，內(nèi)側(cè)間室軟骨完好，韌帶完整，可矯正的外翻畸形，屈曲攣縮< 10-15度。報道最多的禁忌癥是炎癥性關(guān)節(jié)炎和嚴重的髕骨受累。8項研究調(diào)查了外側(cè)UKA后不同適應(yīng)征的效果；提示原發(fā)性外側(cè)骨關(guān)節(jié)炎的預(yù)后更好，髕股關(guān)節(jié)狀況對效果無顯著影響，年齡和體重方面的影響各家報告不一。

結(jié)論：雖然文獻表明關(guān)于外側(cè)UKA的適應(yīng)證確實存在一些共識，但沒有發(fā)現(xiàn)一個強有力的共識，這表明目前還不存在明確的、基于共識的外側(cè)UKA適應(yīng)證。

Indications for lateral unicompartmental knee arthroplasty – A systematic review

Background: While evidence-based indications are established for medial UKA, the optimal indications for lateral UKA have not received as much attention. There exists significant anatomical, osteoarthritis phenotype, kinematic, and surgical technique differences between medial and lateral UKA. The indications for the two procedures may therefore not be identical. Hence, this review aims to access the indications and contraindications in published cohort studies on lateral UKA, to assess if consensus exists.

Methods: In May 2024, a systematic review was carried out following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies on lateral UKA with a clear report of indications were included. Data on indications and contraindications were extracted to evaluate consensus. Furthermore, outcomes related to expanding or testing indications for lateral UKA were obtained.

Results: 38 studies were included. Lateral UKA was mostly performed for primary lateral osteoarthritis. The most reported indications were moderate to severe lateral osteoarthritis, with full-thickness cartilage in the medial compartment, intact ligaments, a correctable valgus deformity, and a flexion contracture < 10–15 degrees. The most reported contraindications were inflammatory arthritis and severe patellofemoral involvement. Eight studies investigated different indications on outcomes after lateral UKA; suggesting better outcomes for primary lateral osteoarthritis, no significant impact from the state of the patellofemoral joint, and conflicting results regarding age and weight.

Conclusion: While the literature suggests that some agreement does exist regarding indications for lateral UKA, a strong consensus was not found, indicating that well-defined and consensus-based indications for lateral UKA do not yet exist.

文獻出處：Ifigenia Bunyoz K, Troelsen A, Gromov K, Alvand A, Bottomley N, Jackson W, Price A. Indications for lateral unicompartmental knee arthroplasty - A systematic review. Knee. 2025 Jan;52:58-68. doi: 10.1016/j.knee.2024.10.012. Epub 2024 Nov 13. PMID: 39541657.

文獻2

髕骨關(guān)節(jié)面關(guān)節(jié)炎是否為單間室膝關(guān)節(jié)置換術(shù)的禁忌證：當前觀點

譯者 馬云青

內(nèi)側(cè)單髁膝關(guān)節(jié)置換術(shù)（UKA）在治療終末期前內(nèi)側(cè)骨關(guān)節(jié)炎中的應(yīng)用日益廣泛，部分歸因于其相較于全膝關(guān)節(jié)置換術(shù)（TKA）具有恢復(fù)更快、功能改善更佳及內(nèi)科并發(fā)癥風險更低等優(yōu)勢。然而，盡管UKA取得成功，關(guān)于某些患者特征（如年齡、體重指數(shù)、前交叉韌帶狀態(tài)以及髕股關(guān)節(jié)的術(shù)前狀況）是否適合行此手術(shù)仍存爭議。作者探討導致當前爭議的歷史因素，并圍繞術(shù)前髕股關(guān)節(jié)關(guān)節(jié)炎及前膝痛對內(nèi)側(cè)UKA假體存活率和臨床結(jié)局影響的近期證據(jù)進行評估。通過研究現(xiàn)有證據(jù)支持在嚴格選擇的前內(nèi)側(cè)骨關(guān)節(jié)炎患者中，即使存在術(shù)前髕股關(guān)節(jié)退變或前膝痛，施行內(nèi)側(cè)UKA也是安全有效的。臨床決策的重點應(yīng)從單純的“是否存在髕股關(guān)節(jié)炎”轉(zhuǎn)向更精細的評估，特別是關(guān)注**外側(cè)髕股關(guān)節(jié)的病變嚴重程度（如嚴重骨缺損、溝槽形成）以及髕骨的軌跡（是否存在外側(cè)半脫位）。這些因素更可能影響預(yù)后，被視為需要慎重考慮的相對禁忌癥。假體設(shè)計（固定或活動平臺）的選擇可基于外科醫(yī)生經(jīng)驗和患者具體情況，兩者在現(xiàn)有證據(jù)下均表現(xiàn)良好。

文獻出處：Bertrand TE, Melvin PR, Lombardi AV Jr, Berend KR. Is patella facet arthritis a contraindication to unicompartmental knee arthroplasty: Current concepts. J ISAKOS. 2024 Dec;9(6):100343. doi: 10.1016/j.jisako.2024.100343. Epub 2024 Oct 16. PMID: 39419310.

文獻3

全膝關(guān)節(jié)置換術(shù)后的縫隙腐蝕會降解干骺端袖套

譯者 張薔

背景：術(shù)者會在膝翻修手術(shù)（revision TKA）中應(yīng)用干骺端袖套來彌補骨缺損并增加穩(wěn)定性。然而，有一項病例研究記錄了假體上出現(xiàn)的腐蝕并發(fā)現(xiàn)腐蝕造成的金屬釋放與局部組織反應(yīng)的相關(guān)性。本研究中，我們調(diào)查了干骺端袖套與假體界面的腐蝕情況，并試圖解釋如下問題：(1)腐蝕的發(fā)生率？(2)鈷鉻鉬合金的股骨假體錐度位置是否會出現(xiàn)更多損傷；(3)損傷模式是什么樣的？

方法：我們回收并分析了膝翻修術(shù)后17個股骨-袖套復(fù)合體和15個脛骨-袖套復(fù)合體。首先，我們應(yīng)用Glodberg評分標準來對腐蝕進行分類，并在鈷鉻鉬假體橫切面上定量統(tǒng)計腐蝕情況（ΔCmax）。之后，我們應(yīng)用掃描電子顯微鏡和X射線能量色散光譜對中-重度腐蝕的假體進行掃描或拍攝。最后，我們應(yīng)用非參數(shù)統(tǒng)計方法分析了脛骨和股骨假體上腐蝕的差異。

帶鉭金屬袖套的鈷鉻鉬合金股骨假體，顯示錐度和袖套均存在顯著腐蝕情況。

帶鉭金屬袖套的鈷鉻鉬合金脛骨假體，顯示錐度和袖套均存在顯著腐蝕情況。

結(jié)果：我們在82%的股骨錐度和100%的股骨袖套上，以及73%的脛骨平臺錐度和86%的脛骨袖套上，發(fā)現(xiàn)了腐蝕情況。在橫斷面切片分析中，我們發(fā)現(xiàn)股骨錐度腐蝕明顯多于脛骨錐度（P = 0.04）。股骨錐度上最常見的損傷模式為點蝕、蝕刻和氧化物碎片，而鉭金屬股骨袖套上，我們發(fā)現(xiàn)了磨光情況。

結(jié)論：我們的發(fā)現(xiàn)顯示機械性的縫隙腐蝕會促進干骺端假體的降解。如果醫(yī)生未來遇到應(yīng)用了干骺端袖套并伴發(fā)不明原因疼痛或可疑金屬釋放的病人，在嚴格排除其他診斷后，務(wù)必考慮測量金屬濃度。

Crevice Corrosion Degrades Metaphyseal Sleeves Following Total Knee Arthroplasty

A Retrieval Study

Background: Surgeons use metaphyseal sleeves in revision total knee arthroplasty (TKA) to compensate for bone loss and improve stability. However, a clinical case series documented corrosion on these devices and associated the subsequent metal release with adverse local tissue reactions. In this study, we investigated corrosion at the mixed-alloy, metaphyseal sleeve—implant interface. We asked the following: (1) How common is corrosion? (2) Does more damage occur at the femoral cobalt chrome alloy (CoCrMo) taper? (3) What damage modes occur?

Methods: We analyzed 17 femoral and 15 tibial implant-sleeve components following revision surgery. First, corrosion was classified using the Goldberg score and quantified using the axial corrosion (ΔCmax) on CoCrMo implants. Then, moderately and severely corroded devices were imaged using scanning electron microscopy and energy dispersive X-ray spectroscopy. Differences in corrosion on CoCrMo tibial and femoral implants were assessed using nonparametric statistics.

Results: We observed corrosion on 82% of femoral adapters, 100% of femoral sleeves, 73% of tibial trays, and 86% of tibial sleeves. On CoCrMo femoral adapters, we measured more axial corrosion than on CoCrMo tibial trays (P = 0.04). The predominant damage modes on femoral adapters included pitting, etching, and oxide debris. On titanium alloy femoral sleeves, we documented a burnishing effect, revealing the underlying microstructure.

Conclusions: Our findings indicate that mechanically assisted crevice corrosion promotes metaphyseal implant degradation. Should surgeons encounter patients who have metaphyseal sleeves and unexplained pain or suspected metal release, consider measuring metal concentrations after rigorous rule out of competing diagnoses

文獻4

水泥固定還是生物固定？一項前瞻性、隨機研究比較骨水泥與生物全膝關(guān)節(jié)置換術(shù)的10年隨訪結(jié)果

譯者 丁云鵬

背景：全膝關(guān)節(jié)置換術(shù)（TKA）的最佳固定方式仍存在爭議。

方法：本研究納入100例使用模塊化小梁金屬脛骨組件的骨水泥與非骨水泥TKA病例進行對比。本次報告涉及91例獲得隨訪數(shù)據(jù)的病例，其中67例完成至少10年隨訪（骨水泥組36例[A組]，非骨水泥組31例[B組]）。我們此前已報道過這項前瞻性隨機試驗的2年和5年結(jié)果。術(shù)前及術(shù)后均記錄膝關(guān)節(jié)協(xié)會評分和牛津評分。

結(jié)果：兩組平均膝關(guān)節(jié)協(xié)會評分（94.4分 vs 89.1分，P=0.21）與牛津評分（44.1分 vs 43.9分，P=0.80）相似。A組在5年隨訪時有2例翻修，10年隨訪時新增3例因聚乙烯磨損、骨溶解和松動導致的翻修；B組5年隨訪時有2例翻修，10年隨訪時新增2例因聚乙烯磨損、不穩(wěn)及松弛導致不穩(wěn)的翻修?？傆婣組2例、B組1例因假體固定并發(fā)癥翻修。以任何原因翻修作為終點的假體存活率兩組相當（91.5% vs 95.9%，P=0.60），以脛骨托盤翻修作為終點的存活率亦相當（93.7% vs 95.9%，P=0.55）。未發(fā)現(xiàn)進行性放射透亮線病例。A組出現(xiàn)5例骨溶解（80%發(fā)生在脛骨），B組2例骨溶解（0%發(fā)生在脛骨）。

結(jié)論：10年隨訪顯示非骨水泥與骨水泥TKA的患者報告結(jié)局和假體存活率相當。骨水泥固定存在較高骨溶解和松動率，可能與第三體磨損增加有關(guān)。非骨水泥固定展現(xiàn)出作為多數(shù)患者理想選擇的巨大潛力。本研究計劃在15年和20年進行后續(xù)更新以獲取更長期結(jié)果。

To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty

Background: The optimal mode of fixation for total knee arthroplasty (TKA) continues to be a subject of debate.

Methods: There were 100 cases enrolled to compare cemented and cementless TKA using a modular trabecular metal tibia. This is a report on the 91 cases with follow-up information, including 67 cases with a minimum 10-year follow-up: 36 cases in the cemented cohort (A) and 31 cases in the cementless cohort (B). We previously reported the 2- and 5-year results for this prospective, randomized trial. Knee Society Scores and Oxford scores were collected preoperatively and postoperatively.

Results: The mean Knee Society Scores (94.4, 89.1, P = 0.21) and Oxford scores (44.1, 43.9, P = 0.80) were similar in both groups. Group A had two revisions at 5-year follow-up, with three additional revisions for polyethylene wear, osteolysis, and loosening at 10-year follow-up. Group B had two revisions at 5-year follow-up, with two additional revisions for polyethylene wear and instability and instability due to laxity at 10-year follow-up. In total, two group A cases and one group B case were revised for implant fixation complications. Survivorship with any revision as an end point was equivalent between the two cohorts (91.5%, 95.9%, P = 0.60), as was survivorship using tibial tray revision as an end point (93.7%, 95.9%, P = 0.55). No cases demonstrated any progressive radiolucencies. Group A had 5 cases with osteolysis (80% tibial), and Group B had two cases of osteolysis (0% tibial).

Conclusions: Cementless and cemented TKA had equivalent patient-reported outcomes and survivorship at 10-year follow-up. Cemented fixation had a higher rate of osteolysis and loosening, which may be related to increased third-body wear. Cementless fixation shows immense potential as a successful option for many patients. Updates to this study cohort are planned at 15- and 20-year intervals to obtain longer-term outcomes.

文獻出處：Nicholas R Olson 1, Nancy L Parks 1, Shaan S Nagda.To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty.J Arthroplasty. 2025 Oct;40(10):2630-2636. doi: 10.1016/j.arth.2025.04.076. Epub 2025 May 7.

文獻5

計算機斷層掃描與長腿平片在全膝關(guān)節(jié)置換術(shù)中基于 CPAK 的冠狀面對線評估對比：一項前瞻性評價

譯者 沈松坡

準確評估冠狀面對線對于全膝關(guān)節(jié)置換術(shù)（TKA）的規(guī)劃至關(guān)重要 。膝關(guān)節(jié)冠狀面對線（CPAK）分類法將機械對線和關(guān)節(jié)線傾斜度整合為九種表型，但其可靠性取決于測量精度 。本研究旨在比較通過計算機斷層掃描（CT）和長腿站立放射線片獲得的 CPAK 分類及冠狀面對線參數(shù)的準確性和可靠性 。

本項前瞻性對比研究對 100 名因退行性關(guān)節(jié)炎接受初次 TKA 的患者進行了研究 。每位患者均接受了標準化的長腿站立放射線檢查和使用 MAKO 機器人規(guī)劃軟件進行的全肢 CT 掃描 。測量指標包括算術(shù)髖-膝-踝（aHKA）角、外側(cè)遠端股骨角（LDFA）、內(nèi)側(cè)近端脛骨角（MPTA）以及關(guān)節(jié)線傾斜度（JLO） 。CPAK 分類由 aHKA 和 JLO 值確定 。兩名獨立的觀察者記錄了所有參數(shù) 。研究使用配對 t 檢驗分析了不同影像模態(tài)間的差異，并使用組內(nèi)相關(guān)系數(shù)（ICC）和 Cohen's kappa 系數(shù)評估了可靠性 。

研究共分析了 100 名患者，其中 86 名患者擁有完整的數(shù)據(jù)集 。與放射線片相比，CT 在 HKA、LDFA 和 MPTA 測量中持續(xù)產(chǎn)生不同的數(shù)值（p < 0.001），而 aHKA、JLO 和 CPAK 分類結(jié)果則沒有顯著差異 。兩種影像模態(tài)均表現(xiàn)出極佳的觀察者間可靠性（ICC > 0.88），且在不改變整體 CPAK 表型分類的情況下，CPAK 測量的一致性近乎完美（k = 0.86–0.88） 。

與放射線片相比，基于 CT 的測量為冠狀面對線參數(shù)提供了更高的精確度和可重復(fù)性 。然而，CPAK 分類在不同影像模態(tài)之間保持高度一致，驗證了其在不同影像技術(shù)中的穩(wěn)健性 。CT 為術(shù)前規(guī)劃提供了精確的數(shù)值，特別是在機器人輔助流程或復(fù)雜畸形中，而放射線片對于常規(guī)表型分析仍然足夠 。

關(guān)鍵詞： 計算機斷層掃描；CPAK 分類；全膝關(guān)節(jié)置換術(shù)；冠狀面對線；長腿平片；機器人輔助手術(shù)；可靠性

圖1 下肢全長片顯示各種下肢角度測量

圖 2：基于 MAKO 機器人軟件的 CT 成像與測量

圖 2 A-2C (Fig. 2 A-2C)： 通過 MAKO 機器人規(guī)劃軟件生成的薄層掃描及三維重建圖像 。

2A： 展示了股骨在橫斷面（Transverse）、冠狀面（Coronal）和矢狀面（Sagittal）的解剖參考點定位 。

2B： 由 MAKO 軟件確定的股骨遠端解剖標志點（Constitutional landmarks） 。

2C： 由 MAKO 軟件確定的脛骨解剖標志點 。

圖 2D (Fig. 2D)： 成功上傳 CT 掃描數(shù)據(jù)后，外科醫(yī)生可在 MAKO 軟件中直接獲取的自動生成測量值 。

圖3 CPAK分型

Computed tomography versus long-leg radiography for CPAK-based coronal alignment assessment in total knee arthroplasty: a prospective evaluation

Abstract

Accurate assessment of coronal alignment is essential for total knee arthroplasty (TKA) planning. The Coronal Plane Alignment of the Knee (CPAK) classification integrates mechanical alignment and joint line obliquity into nine phenotypes, but its reliability depends on measurement accuracy. This study aimed to compare the accuracy and reliability of CPAK classification and coronal alignment parameters obtained from computed tomography (CT) and long-leg standing radiographs. A prospective comparative study was conducted on 100 patients undergoing primary TKA for degenerative arthritis. Each patient underwent standardized long-leg standing radiographs and full-limb CT scans using MAKO robotic planning software. Measurements included the arithmetic hip-knee-ankle (aHKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line obliquity (JLO). CPAK classification was determined from aHKA and JLO values. Two independent observers recorded all parameters. Inter-modality differences were analyzed using paired t-tests, and reliability was assessed using intraclass correlation coefficients (ICC) and Cohen's kappa. A total of 100 patients were analyzed, with complete datasets for 86 patients. CT consistently produced different values for HKA, LDFA, and MPTA compared with radiographs (p < 0.001), while aHKA, JLO and CPAK classifications showed no significant difference. Both modalities demonstrated excellent interobserver reliability (ICC > 0.88) and near-perfect CPAK agreement (κ = 0.86-0.88) measurement without altering overall CPAK phenotype classification. CT-based measurements provide greater precision and reproducibility for coronal alignment parameters compared with radiographs. However, CPAK classification remains largely consistent between modalities, validating its robustness across imaging techniques. CT offers precise value for preoperative planning, particularly in robotic-assisted workflows or complex deformities, while radiographs remain adequate for routine phenotyping. Level II - Prospective comparative study.

Keywords: CPAK classification; Computed tomography; Coronal alignment; Long-leg radiograph; Reliability; Robotic-assisted surgery; Total knee arthroplasty.

第二部分：保髖相關(guān)文獻

No.2

文獻1

兒童下肢旋轉(zhuǎn)角度

譯者 任寧濤

我們研究了1000名兒童和成人的正常下肢，以確定下肢旋轉(zhuǎn)的正常值。胎兒在子宮內(nèi)的位置通過使其股骨向外旋轉(zhuǎn)、脛骨向內(nèi)旋轉(zhuǎn)來塑造這兩塊骨頭的形態(tài)。這些塑造效應(yīng)通常在嬰兒期就會自發(fā)地消失，然后遺傳決定的個體差異就會顯露出來。下肢旋轉(zhuǎn)問題應(yīng)進行臨床評估，并與本研究提供的正常值進行比較。嬰兒的外八、幼兒的脛骨內(nèi)側(cè)扭轉(zhuǎn)和幼兒的股骨內(nèi)側(cè)扭轉(zhuǎn)是正常發(fā)育模式的極端情況。在絕大多數(shù)情況下，這些旋轉(zhuǎn)變化都在正常范圍內(nèi)，不需要治療。

圖1 五項測量結(jié)果繪制為22個年齡組中每個年齡組正負兩個標準差的平均值。實線表示隨年齡的平均變化：陰影區(qū)域。正常范圍：實心圓。不同年齡組的平均測量值：空心圓。同一測量值的正負兩個標準差。

圖2 男性，不同年齡段髖關(guān)節(jié)內(nèi)旋情況

圖3 女性，不同年齡段髖關(guān)節(jié)內(nèi)旋情況

圖4 男性和女性，不同年齡髖關(guān)節(jié)外旋情況

圖5 不同年齡股足角情況

圖6 不同年齡跨踝軸（TMA）角度情況

圖7 不同年齡股足角和跨踝軸角度比較

Lower-extremity rotational problems in children

We studied 1,000 normal lower extremities of children and adults in order to establish normal values for the rotational profile. The intrauterine position of the fetus molds the femur by rotating it laterally and molds the tibia by rotating it medially. These molding effects usually resolve spontaneously during infancy, and then genetically determined individual differences are unmasked. Rotational problems should be clinically evaluated and the findings compared with the normal values provided by this study. Out-toeing in infants, medial tibial torsion in toddlers, and medial femoral torsion in young children are extremes of a normal developmental pattern. In the vast majority, these rotational variations fall within the broad range of normal and require no treatment.

文獻出處：Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47. PMID: 3968103.

文獻2

經(jīng)腹直肌旁入路行髖臼周圍截骨術(shù)：技術(shù)可行性及經(jīng)驗證的手術(shù)導航系統(tǒng)控制骨塊活動度的尸體研究

譯者 李勇

目的： 腹直肌旁入路（pararectus approach）已被證實可有效用于處理髖臼骨折。本研究假設(shè)該入路也可作為實施髖臼周圍截骨術(shù)（PAO）的一種替代入路。

方法： 采用 4 具尸體標本，隨機通過腹直肌旁入路或改良 Smith-Petersen（SP）入路實施 PAO。我們評估了該入路的技術(shù)可行性與安全性。此外，我們利用手術(shù)導航系統(tǒng)監(jiān)測了骨塊的活動度，并對比了兩種入路間的活動度差異。通過與經(jīng)過驗證的術(shù)前規(guī)劃軟件進行交叉檢驗，測試了該導航系統(tǒng)的準確性。

結(jié)果： 腹直肌旁入路在技術(shù)上具有可行性，能夠提供充分的術(shù)野顯露，確保截骨過程安全，并能對風險結(jié)構(gòu)（重要組織）進行極佳的保護。該入路獲取的骨塊活動度與經(jīng) SP 入路獲得的結(jié)果相當。驗證性測量顯示，兩組間的平均差異小于 1 mm，且無統(tǒng)計學意義。

結(jié)論： 實驗數(shù)據(jù)表明，腹直肌旁入路可能是實施 PAO 的一種替代方案。仍需進一步的臨床驗證以確認這些令人期待的初步結(jié)果。

Periacetabular osteotomy through the pararectus approach:technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment

Abstract Purpose The pararectus approach has been validated for managing acetabular fractures. We hypothesised it might be an alternative approach for performing periacetabular osteotomy (PAO). Methods Using four cadaver specimens, we randomly performed PAO through either the pararectus or a modified Smith-Petersen (SP) approach. We assessed technical feasibility and safety. Furthermore, we controlled fragment mobility using a surgical navigation system and compared mobility between approaches. The navigation system's accuracy was tested by cross-examination with validated preoperative planning software. Results The pararectus approach is technically feasible, allowing for adequate exposure, safe osteotomies and excellent control of structures at risk. Fragment mobility is equal to that achieved through the SP approach. Validation of these measurements yielded a mean difference of less <1 mm without statistical significance. Conclusion Experimental data suggests the pararectus approach might be an altemative approach for performing PAO. Clinical validation is necessary to confirm these promising preliminary results.

文獻出處：Liu L, Zheng G, Bastian JD, Keel MJ, Nolte LP, Siebenrock KA, Ecker TM. Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment. Int Orthop. 2016 Jul;40(7):1389-96. doi: 10.1007/s00264-015-2892-6. Epub 2015 Jul 11. PMID: 26162984.

文獻3

青少年股骨髖臼撞擊征行關(guān)節(jié)鏡治療后短期深蹲力學分析

譯者 張利強

背景 股骨髖臼撞擊征是由于髖臼覆蓋過度或股骨頭頸交界處骨凸異常所致，可能導致重復(fù)性髖關(guān)節(jié)屈曲時疼痛或不適。既往研究報道FAI患者與對照組相比在深蹲力學上的適應(yīng)性改變，但據(jù)我們所知，目前很少有研究探討青少年患者術(shù)前至術(shù)后的變化。

目的 (1)手術(shù)治療是否能使最大深蹲深度得到可測量的改善？ (2)手術(shù)干預(yù)是否會改變個體在深蹲過程中的平衡控制策略？ (3)術(shù)后在深蹲周期的特定動作里程碑上是否存在運動學變化？ (4)涵蓋整個動作的整體深蹲策略是否表現(xiàn)出術(shù)后變化？

方法 對2016年2月至2023年7月期間納入的一項大型前瞻性研究的患者進行回顧性分析，該研究評估了各種髖部手術(shù)后的下肢生物力學結(jié)果。篩選出60例髖符合特定標準：(1)無神經(jīng)性或綜合征異常；(2)經(jīng)影像學評估診斷為有癥狀的特發(fā)性FAI；(3)計劃由同一位骨科醫(yī)生進行髖關(guān)節(jié)鏡保髖手術(shù)；(4)術(shù)前在本實驗室進行了運動捕捉測試。其中，排除雙側(cè)有癥狀FAI患者以及曾接受過手術(shù)治療的患者，剩余43例患者?？傆嫞?9%(43例中的34例)的患者完成了本研究分析的目標深蹲動作，其中65% (34例中的22例)在術(shù)后8至16個月隨訪時完成了相同的任務(wù)。在整個深蹲周期中的四個里程碑關(guān)鍵動作分析矢狀面節(jié)段角和關(guān)節(jié)角以及足部前進角即：最大深蹲深度、術(shù)前最大深蹲深度、最大骨盆傾斜和最大屈髖。在整個深蹲過程中，繪制骨盆傾斜和屈髖相對于深蹲深度以及彼此之間的關(guān)系圖，并計算下降與上升曲線之間的面積以量化矢狀面運動。

結(jié)果 術(shù)后最大深蹲深度中位數(shù)（范圍）增加（術(shù)前27 [13至38]對比術(shù)后28 [17至40]，中位數(shù)差1 [95% CI 1至5]；p = 0.02）。平衡控制策略變化極小，唯一顯著差異是術(shù)后深蹲時軀干屈曲增加（術(shù)前44 [6至65]對比術(shù)后47[18至74]，中位數(shù)差3 [95% CI 1至13]；p = 0.01）。在最大深蹲深度（術(shù)前112 [71至135] 對比 術(shù)后117 [78至144]，中位數(shù)差5 [95% CI -1至14]；p = 0.02）和最大屈髖位置（術(shù)前112 [71至132]對比術(shù)后117[78至144]，中位數(shù)差5[95% CI -1至14]；p = 0.02）均觀察到膝關(guān)節(jié)屈曲增加。在深蹲過程中的最大深蹲深度、最大骨盆傾斜或最大屈髖位置，骨盆傾斜角、屈髖角和足部前進角均無顯示差異。軀干（術(shù)前43 [16至66] 對比 術(shù)后52 [25至75]，中位數(shù)差9 [95% CI 2至16]；p = 0.01）、骨盆（術(shù)前24 [13至37] 對比 術(shù)后27 [15至44]，中位數(shù)差3 [95% CI 1至7]；p = 0.02）、髖關(guān)節(jié)（術(shù)前98 [76至116] 對比 術(shù)后103 [89至130]，中位數(shù)差5 [95% CI 0至8]；p = 0.046）和膝關(guān)節(jié)（術(shù)前112 [73至141]對比術(shù)后124[87至152]，中位數(shù)差12 [95% CI 3至15]；p = 0.02）的矢狀面活動范圍中位數(shù)（范圍）均增加。

結(jié)論 基于這些發(fā)現(xiàn)，深蹲檢測可作為臨床醫(yī)生在手術(shù)治療前后快速評估患者功能能力的工具。未來研究應(yīng)探索縱向研究以評估生物力學隨時間的變化，并考慮在青少年FAI患者中，標準化的術(shù)后康復(fù)是否會改變其深蹲模式。

證據(jù)等級 III級，治療性研究。

通過深蹲觀察骨盆矢狀面運動。

Short-term Squatting Mechanics After Arthroscopic Treatment for Femoroacetabular Impingement in Adolescents

Background Femoroacetabular impingement (FAI) results from overcoverage of the acetabulum or excess bone on the femoral head-neck junction, which may cause pain or discomfort with repetitive hip flexion. Previous studies have reported adaptations in squat mechanics in individuals with FAI compared with controls, but to our knowledge, there has been little research exploring pre- to postoperative deviations in adolescents.

Questions/purposes (1) Does surgical treatment result in measurable improvements in maximum squat depth? (2) Does surgical intervention alter the individual’s balance control strategy during squatting? (3) Are there kinematic changes at specific movement milestones within the squat cycle after surgery? (4) Does the overall squat strategy, encompassing the entire movement, exhibit postoperative changes?

Methods A retrospective analysis was conducted of patients enrolled between February 2016 and July 2023 in a large prospective study evaluating lower extremity biomechanical outcomes after various hip surgeries. Sixty hips were identified meeting specific criteria: (1) absence of neurological or syndromic abnormalities, (2) diagnosis of symptomatic idiopathic FAI through radiographic assessment, (3) scheduled for arthroscopic hip preservation surgery performed by one orthopaedic surgeon, and (4) tested in our motion capture lab before surgery. Of the 60, patients with bilateral symptomatic FAI were excluded as were those who had undergone previous surgical treatment, leaving 43 patients. In all, 79% (34 of 43) of patients completed the target squat that was analyzed in this study, and 65% (22 of 34) of patients completed the same task at their postoperative visit 8 to 16 months after surgery. Sagittal plane segment and joint angles as well as foot progression angle were analyzed across the squat cycle at four key movement milestones: maximum squat depth, preoperative maximum squat depth, maximum pelvic tilt, and maximum hip flexion. Pelvic tilt and hip flexion were plotted versus squat depth and versus each other throughout the squat task with the area between the descent and ascent curves calculated to quantify motion in the sagittal plane.

Results Median (range) maximum squat depth (pre- operative 27 [13 to 38] versus postoperative 28 [17 to 40], median difference 1 [95% CI 1 to 5]; p = 0.02) increased postoperatively. Balance control strategies showed minimal changes, as the only notable difference was increased trunk flexion during the postoperative squat (preoperative 44 [6 to 65] versus postoperative 47 [18 to 74], median difference 3 [95% CI 1 to 13]; p = 0.01). Increased knee flexion was observed at both the maximum squat depth (preoperative 112 [71 to 135] versus postoperative 117 [78 to 144], median difference 5 [95% CI -1 to 14]; p = 0.02) and maximum hip flexion (preoperative 112 [71 to 132] versus postoperative 117 [78 to 144], median difference 5 [95% CI -1 to 14]; p = 0.02) positions. Pelvic tilt, hip flexion, and foot progression angles demonstrated no differences at the maximum squat depth, maximum pelvic tilt, or maximum hip flexion positions during the squat. Median (range) sagittal plane ROM increased for the trunk (pre- operative 43 [16 to 66] versus postoperative 52 [25 to 75], median difference 9 [95% CI 2 to 16]; p = 0.01), pelvis (preoperative 24 [13 to 37] versus postoperative 27 [15 to 44], median difference 3 [95% CI 1 to 7]; p = 0.02), hip (preoperative 98 [76 to 116] versus postoperative 103 [89 to 130], median difference 5 [95% CI 0 to 8]; p = 0.046), and knee (preoperative 112 [73 to 141] versus post- operative 124 [87 to 152], median difference 12 [95% CI 3 to 15]; p = 0.02).

Conclusion Based on these findings, the squat task could be used as a functional tool for clinicians to quickly assess a patient’s abilities before and after surgical treatment. Future research should explore longitudinal studies to assess biomechanical changes over time and to consider whether standardized postoperative rehabilitation in adolescents alters the squat pattern for patients with FAI.

Level of Evidence Level III, therapeutic study.

文獻出處：Loewen AM, McGinley J, Ulman S, Johnson B, Morris WZ, Ellis HB. Short-term Squatting Mechanics After Arthroscopic Treatment for Femoroacetabular Impingement in Adolescents. Clin Orthop Relat Res. 2026 Jan 1;484(1):165-174. doi: 10.1097/CORR.0000000000003603. Epub 2025 Jun 25. PMID: 40632063.

文獻4

中國成年人發(fā)育性髖關(guān)節(jié)發(fā)育不良患病率：一項橫斷面調(diào)查

譯者 賈海港

背景： 中國發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的患病率尚不清楚。本研究旨在確定中國成年人群中 DDH 的患病率。

方法： 在本研究中，我們對具有全國代表性的中國成年人樣本進行了橫斷面調(diào)查。所有參與者都接受了問卷調(diào)查、體格檢查和 X 線檢查。。采用 logistic 回歸分析了與發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）相關(guān)的因素。

結(jié)果： 我們邀請了 29180 名 18 歲及以上的成年人參與調(diào)查，這些受試者是從 18 個初級抽樣單元（城市街道和農(nóng)村鄉(xiāng)鎮(zhèn)）中隨機抽取的。最終有 25767 人完成了調(diào)查和體檢（10296 名男性和 15471 名女性）。其中 391 人被診斷為發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH），DDH 的總體患病率為 1.52%?；诖耍覀児烙嬛袊?DDH 患者人數(shù)約為 1605 萬。DDH 患病率隨年齡增加而升高（比值比=1.53 [1.03-2.27]，P=0.036），女性患病率顯著高于男性（2.07% vs. 0.75%，P<0.001），農(nóng)村居民患病率高于城市居民（1.75% vs. 1.29%，P<0.001）。經(jīng)濟發(fā)展水平與發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的發(fā)生存在獨立關(guān)聯(lián)。沒有證據(jù)表明體重指數(shù)、教育程度或目前吸煙或飲酒與DDH風險之間存在關(guān)聯(lián)（P > 0.05）。

結(jié)論： 發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）已成為重要的公共衛(wèi)生問題。應(yīng)特別關(guān)注 DDH 患者。中國應(yīng)開展 DDH 篩查。

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey

Background: The prevalence of developmental dysplasia of the hip (DDH) is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults.

Methods: In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression.

Results: We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units (street districts in urban areas and townships in rural areas). The survey and examination were completed in 25,767 people (10,296 men and 15,471 women). DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age (odds ratio = 1.53 [1.03-2.27], P = 0.036), was significantly higher among women than men (2.07% vs. 0.75%, P< 0.001), and was higher among rural residents than urban residents (1.75% vs. 1.29%, P< 0.001). Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education, or current smoking or drinking and risk of DDH (P > 0.05).

Conclusions: DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.

Conclusions:DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.

文獻出處：Tian FD, Zhao DW, Wang W, Guo L, Tian SM, Feng A, Yang F, Li DY. Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey. Chin Med J (Engl). 2017 Jun 5;130(11):1261-1268. doi: 10.4103/0366-6999.206357. PMID: 28524823; PMCID: PMC5455033.

文獻5

影響髖臼周圍截骨術(shù)后患者滿意度的因素

譯者 陶可

背景：髖臼周圍截骨術(shù)(PAO)旨在治療髖關(guān)節(jié)發(fā)育不良并預(yù)防骨關(guān)節(jié)炎的進展。既往研究已將人口統(tǒng)計學和影像學變量與術(shù)后患者預(yù)后相關(guān)聯(lián)，但對患者期望及其與滿意度的相關(guān)性關(guān)注有限。本研究旨在確定PAO術(shù)后是否存在此類關(guān)聯(lián)。

方法：本研究采用匿名、去標識化的滿意度調(diào)查問卷，對2017年4月至2019年4月期間接受PAO手術(shù)的患者進行調(diào)查。最終納入分析的患者共40例（26例女性）?；颊咂骄挲g為22.0± 5.1歲。所有患者均接受了至少12個月的術(shù)后隨訪。記錄患者的人口統(tǒng)計學特征、診斷和并發(fā)癥。隨后分析X線片，確定術(shù)前和術(shù)后的外側(cè)中心邊緣角（LCEA）和T?nnis角，并進行滿意度與X線分析結(jié)果的相關(guān)性分析。統(tǒng)計分析包括非參數(shù)Spearman相關(guān)分析和受試者工作特征曲線（ROC曲線）分析。統(tǒng)計學顯著性水平設(shè)定為p < 0.05。

結(jié)果：30例（75%）患者對治療結(jié)果感到滿意?；颊吣挲g或性別與術(shù)后滿意度之間無統(tǒng)計學顯著相關(guān)性（p > 0.05）。術(shù)前平均LCEA為10.9° ± 6.9°，術(shù)后為26.0° ± 4.2°，平均變化為15.1° ± 5.6°。術(shù)前平均T?nnis角為18.8° ± 3.3°，術(shù)后降至11.6° ± 3.2°，平均變化為-7.2° ± 3.2°。觀察者間信度較高，術(shù)后T?nnis角的相關(guān)系數(shù)r = 0.782，p < 0.001；術(shù)前LCEA的相關(guān)系數(shù)r = 0.958，p < 0.001。術(shù)前LCEA與患者滿意度呈正相關(guān)（r = 0.351，p = 0.027）。邏輯回歸分析顯示，術(shù)前LCEA每增加1度，術(shù)后滿意度的幾率增加1.13倍（95% CI：1.01至1.27），p = 0.034。

結(jié)論：本研究提示，髖臼周圍截骨術(shù)（PAO）后患者的術(shù)后滿意度可能與術(shù)前患者的人口統(tǒng)計學特征（如LCEA）相關(guān)。研究還提示，髖關(guān)節(jié)發(fā)育不良程度較重的患者術(shù)后滿意度可能低于畸形程度較輕的患者。這些關(guān)聯(lián)值得進一步研究，其結(jié)果可能對未來的手術(shù)具有預(yù)后價值。

Factors Associated with Patient Satisfaction After Periacetabular Osteotomy

Background: The periacetabular osteotomy (PAO) was developed to treat acetabular dysplasia and avoid the progression of osteoarthritis. Prior research has correlated demographic and radiographic variables with postoperative patient outcomes but with limited focus on patient expectations and correlation with satisfaction. The purpose of this study was to determine whether any such associations exist with the PAO.

Methods: An anonymous, de-identified satisfaction survey was applied to patients undergoing a PAO between April 2017 and April 2019. Forty patients (26 females) who underwent PAOs were included in the final analysis. The average age of the cohort was 22.0 ± 5.1 years of age. All patients had a minimum of 12 months of follow-up from the date of surgery. Patient demographics, diagnosis, and complications were recorded. Radiographs were then analyzed to determine pre- and postoperative lateral center edge angle (LCEA) and T?nnis roof angle, and correlations between satisfaction and radiographic analyses were performed. Statistical analysis included non-parametric Spearman's correlation and receiver operator characteristic. Statistical significance was set at p < 0.05.

Results: Thirty (75%) patients were satisfied with their outcome. There were no statistically significant associations between patient age or sex and postoperative satisfaction (p > 0.05). The average LCEA was 10.9° ± 6.9° preoperatively and 26.0° ± 4.2° postoperatively with an average change of 15.1° ± 5.6°. The average T?nnis angle was 18.8° ± 3.3° preoperatively, decreasing to 11.6° ± 3.2° postoperatively with an average change of -7.2° ± 3.2°. Interobserver reliability was high, ranging from r = 0.782, p < 0.001 for postoperative T?nnis angle to r = 0.958, p < 0.001 for preoperative LCEA. Preoperative LCEA correlated positively with satisfaction, r = 0.351, p = 0.027. Logistic regression demonstrated that for every increasing degree of preoperative LCEA, odds of postoperative satisfaction increased by 1.13 (95% CI: 1.01 to 1.27), p = 0.034.

Conclusion: This study suggests that postoperative patient satisfaction after PAO may be associated with preoperative patient demographics such as LCEA. It also suggests that more dysplastic hips may have lower rates of postoperative satisfaction than patients with less severe deformity. These associations warrant further study, which may yield prognostic value for future surgery.

文獻出處：David A Bloom, Christina P Herrero, Anna Blaeser, Pablo G Casta?eda. Factors Associated with Patient Satisfaction After Periacetabular Osteotomy. Bull Hosp Jt Dis (2013). 2024 Dec;82(4):261-265.

文獻6

步態(tài)中調(diào)整足步向角可降低膝骨關(guān)節(jié)炎患者的膝關(guān)節(jié)內(nèi)收力矩且不增加髖關(guān)節(jié)力矩

譯者 邱興

膝骨關(guān)節(jié)炎患者在行走時采用調(diào)整后的足步向角，通?？捎行Ы档拖リP(guān)節(jié)內(nèi)收力矩。然而，目前尚不明確足步向角的改變是否會增加髖關(guān)節(jié)力矩（髖關(guān)節(jié)負荷的替代衡量指標），從而加大關(guān)節(jié)的力學負擔。本研究旨在探究改變足步向角對髖關(guān)節(jié)力矩的影響。膝骨關(guān)節(jié)炎患者在一臺儀器化跑步機上，分別以其基線步態(tài)、10°足尖內(nèi)收步態(tài)和10°足尖外展步態(tài)進行行走。研究采用肌肉骨骼建模軟件包，根據(jù)實驗數(shù)據(jù)計算關(guān)節(jié)力矩。我們從一項規(guī)模更大的研究中選取了50名通過調(diào)整足步向角成功降低峰值膝關(guān)節(jié)內(nèi)收力矩的參與者。在該組中，參與者采用10°足尖內(nèi)收步態(tài)使膝關(guān)節(jié)內(nèi)收力矩的第一峰值降低了7.6%，采用10°足尖外展步態(tài)使第二峰值降低了11.0%。調(diào)整足步向角不僅未增加屈曲力矩和內(nèi)旋力矩（p > 0.15），還在髖關(guān)節(jié)接觸力達到峰值時，使早期支撐期的髖關(guān)節(jié)外展力矩得以降低：10°足尖內(nèi)收步態(tài)下降低4.3% ± 1.3%（p = 0.005, d = 0.49），10°足尖外展步態(tài)下降低4.6% ± 1.1%（p < 0.001, d = 0.59）。此外，74%的個體在采用調(diào)整后的足步向角時，于髖關(guān)節(jié)接觸力峰值時刻的總髖關(guān)節(jié)力矩有所降低?？偠灾?，當采用一種能降低膝關(guān)節(jié)內(nèi)收力矩的足步向角調(diào)整方式時，參與者平均而言并未增加其髖關(guān)節(jié)負荷的替代衡量指標。

關(guān)鍵詞： 步態(tài)調(diào)整；關(guān)節(jié)負荷；肌肉骨骼建模；非手術(shù)干預(yù)；骨關(guān)節(jié)炎

Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis

People with knee osteoarthritis who adopt a modified foot progression angle (FPA) during gait often benefit from a reduction in the knee adduction moment. It is unknown, however, whether changes in the FPA increase hip moments, a surrogate measure of hip loading, which will increase the mechanical demand on the joint. This study examined how altering the FPA affects hip moments. Individuals with knee osteoarthritis walked on an instrumented treadmill with their baseline gait, 10° toe-in gait, and 10° toe-out gait. A musculoskeletal modeling package was used to compute joint moments from the experimental data. Fifty participants were selected from a larger study who reduced their peak knee adduction moment with a modified FPA. In this group, participants reduced the first peak of the knee adduction moment by 7.6% with 10° toe-in gait and reduced the second peak by 11.0% with 10° toe-out gait. Modifying the FPA reduced the early-stance hip abduction moment, at the time of peak hip contact force, by 4.3% ± 1.3% for 10° toe-in gait (p = 0.005, d = 0.49) and by 4.6% ± 1.1% for 10° toe-out gait (p < 0.001, d = 0.59) without increasing the flexion and internal rotation moments (p > 0.15). Additionally, 74% of individuals reduced their total hip moment at time of peak hip contact force with a modified FPA. In summary, when adopting a FPA modification that reduced the knee adduction moment, participants, on average, did not increase surrogate measures of hip loading.

Keywords: Gait modifications; Joint loading; Musculoskeletal modeling; Non-surgical intervention; Osteoarthritis.

文獻出處：Seagers, Kirsten, Scott D. Uhlrich, Julie A. Kolesar, Madeleine Berkson, Janelle M. Kaneda, Gary S. Beaupre, and Scott L. Delp. "Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis." Journal of biomechanics 141 (2022): 111204.

文獻7

哪些髖臼測量參數(shù)最能準確區(qū)分患者和對照組？一項比較研究

譯者 陳志強

研究背景：

髖臼形態(tài)是影響髖關(guān)節(jié)生物力學的重要因素。要識別可能與髖關(guān)節(jié)癥狀發(fā)展相關(guān)的髖臼形態(tài)特征，同時考慮脊柱盆腔特征，需確定一組45歲以上無骨關(guān)節(jié)炎癥狀或體征的髖臼特征。以往的研究利用身體狀況不明的患者定義形態(tài)閾值以指導管理。

問題/目的：

確定45至60歲、牛津髖部評分（OHS）高且無骨關(guān)節(jié)炎跡象的男女髖臼形態(tài)特征;（2）將這些特征與接受髖關(guān)節(jié)鏡或髖骨周圍截骨術(shù)（PAO）治療的有癥狀髖關(guān)節(jié)患者進行比較，這些患者針對各種髖關(guān)節(jié)病理（發(fā)育不良、骨盆后傾和髖臼撞擊）的情況;以及（3）評估哪些放射或CT參數(shù)最準確區(qū)分有癥狀髖關(guān)節(jié)的患者與無癥狀患者，從而定義指導治療的閾值。

方法：

2018年1月至12月期間，我們機構(gòu)有1358名患者接受了腹部盆腔CT掃描，治療非骨科疾病。其中，我們認為5%（73%）患者可能符合對照條件，理由是沒有重大髖關(guān)節(jié)炎、外傷或畸形。如果患者OHS不超過43（2% ）、PROMIS低于50（1% ），或T?nnis評分高于1（0.4% ），則排除患者。另外8名患者因數(shù)據(jù)不足被排除。在隨機選擇一側(cè)后，每個對照組保留了40個髖關(guān)節(jié)進行分析（55歲±5歲;女性占48%[19/40]）。在這項比較研究中，該無癥狀組與接受髖關(guān)節(jié)鏡或PAO治療的患者組進行了比較。2013年1月至2020年12月期間，共有221名髖關(guān)節(jié)接受了髖關(guān)節(jié)保留手術(shù)。其中8人因既往盆腔手術(shù)被排除，102人因CT掃描不足被排除。一方在接受雙側(cè)手術(shù)的患者中隨機選擇，留下48%（221人中的107人）髖關(guān)節(jié)進行分析（31歲±8歲;女性為54%[58人中107人]）。進行了詳細的X光和CT評估（包括分段），以確定髖臼（深度、軟骨覆蓋率、下角、前傾和傾角）和脊柱骨盆（盆底傾斜和發(fā)生率）參數(shù)。采用受試者作特征（ROC）分析評估診斷準確性，確定哪些形態(tài)參數(shù)（及其閾值）最準確區(qū)分有癥狀患者與無癥狀對照組。

結(jié)果：

無癥狀髖關(guān)節(jié)的髖臼形態(tài)特征為平均深度22±2毫米，關(guān)節(jié)軟骨面積為2619±415平方毫米，覆蓋關(guān)節(jié)面的70%±6%，髖關(guān)節(jié)平均傾角為48°±6°，解剖學前傾（24°±7°）與功能性（22°±6°）前傾差異極小。有癥狀髖部的患者髖臼深度通常較?。?0 ± 4毫米對比22± 2毫米，平均差3毫米[95%CI1-4];p < 0.001）。髖關(guān)節(jié)發(fā)育不良（67% ± 5% 對 70% ± 6%，平均差6% [95% CI 0%-12%];p = 0.03）或髖臼后傾（67% ± 5% 對 70% ± 6%，平均差6% [95% CI 1%至12%;p = 0.04）相較無癥狀髖關(guān)節(jié)的相對軟骨面積略小。髖臼傾斜率無差異（48° ± 6° 對 47° ± 7°，平均差0.5° [95% CI -2°- 3°];p = 0.35），但無癥狀髖部的解剖前傾較高（24° ± 7° 對 19° ± 8°，平均差6° [95% CI 3° -9°];p < 0.001）和功能前傾（22° ± 6° 對 13°± 9°，平均差 9° [95% CI 6° 至 12°];p < 0.001）。無癥狀時，隱蔽角較高，分別為105°（124° ± 7°對114°±12°，平均差11° [95% CI 3°-17°];p < 0.001）、135°（122° ± 9°對111° ± 12°，平均差10° [95% CI 2°-15°];p < 0.001）和165°（112° ± 9° 對 102° ± 11°，平均差10° [95% CI 2°-14°];p < 0.001）。有癥狀的髖部骨盆傾斜較低（8° ± 8° 對比 11° ± 5°，平均差為3° [95% CI 1°-5°];p = 0.007）。后壁指數(shù)在所有測量參數(shù)中具有最高的區(qū)分能力，癥狀髖臼的截斷值低于0.9（曲線下面積[AUC] 0.84 [95% CI 0.76-0.91]）（敏感性72%，特異性78%）。CT掃描中用于區(qū)分有癥狀與無癥狀髖部的診斷有用參數(shù)包括髖臼深度小于22毫米（AUC 0.74 [95% CI 0.66-0.83]）和功能性前傾小于19°（AUC 0.79 [95% CI 0.72至0.87]）。區(qū)分有癥狀與無癥狀髖部最準確的角度為髖關(guān)節(jié)面鐘面的105°（AUC 0.76 [95% CI 0.65-0.88]）、135°（AUC 0.78 [95% CI 0.70-0.86]）和165°（AUC 0.77 [95% CI 0.69至0.85]）。

結(jié)論

解剖和功能髖臼前傾角分別為24°和22°，骨盆傾斜度為10°，可增加髖臼開口，并允許更多的無撞擊屈曲，同時為負重提供足夠的后上覆蓋。髖關(guān)節(jié)前傾角較小或解剖性和功能性前傾角差異較大的髖關(guān)節(jié)更有可能出現(xiàn)癥狀。髖臼鐘面105°、135°和165°的后壁指數(shù)和覆蓋角對區(qū)分有癥狀和無癥狀的髖關(guān)節(jié)具有很高的區(qū)分能力，也說明了充分的后部覆蓋的重要性。未來的研究應(yīng)該證實，在選擇保髖手術(shù)的患者時，結(jié)合這些參數(shù)是否可以改善術(shù)后結(jié)果。

Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Background

Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studies have used patients with unknown physical status to define morphological thresholds to guide management.

Questions/purposes

(1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management.

Methods

Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [28]), if they had a PROMIS less than 50 (1% [18]), or their T?nnis score was higher than 1 (0.4% [6]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls.

Results

Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm2, covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface.

Conclusion

An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes.

文獻出處：Verhaegen JCF, DeVries Z, Rakhra K, Speirs A, Beaule PE, Grammatopoulos G. Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study. Clin Orthop Relat Res. 2024 Feb 1; 482(2):259-274. doi: 10.1097/CORR.0000000000002768. Epub 2023 Jul 27. PMID: 37498285; PMCID: PMC10776167.

文獻8

形態(tài)性髖關(guān)節(jié)異常的遺傳學及其對骨關(guān)節(jié)炎的影響

譯者 徐子茵

髖關(guān)節(jié)形態(tài)異常（MHAs）顯著影響髖關(guān)節(jié)的終身預(yù)后，導致早發(fā)性骨關(guān)節(jié)炎和功能障礙。髖關(guān)節(jié)發(fā)育異常（DDH）和股骨髖臼撞擊癥（FAI）是主要病理，分別由股骨頭覆蓋不足或過多引起。這些異常改變了髖部的生物力學，導致結(jié)構(gòu)損傷、疼痛和關(guān)節(jié)加速退化。遺傳學研究的進展揭示了遺傳與機械負荷在塑造髖關(guān)節(jié)形態(tài)中的相互作用。與骨關(guān)節(jié)炎、DDH和FAI相關(guān)的基因包括COL1A1、MMP13和IL-6。與FAI和骨關(guān)節(jié)炎相關(guān)的基因包括ADAMTS4。與DDH和骨關(guān)節(jié)炎相關(guān)的基因包括FRZB、CX3CR1、ASPN、DKK1、PDRG1、GDF5、UQCC1和TGF-β1。形態(tài)錯亂與癥狀性骨關(guān)節(jié)炎之間的聯(lián)系機制仍未完全明了。結(jié)合影像學、生物力學和遺傳學的多模態(tài)方法可能揭示不同的疾病亞型，實現(xiàn)個性化干預(yù)。早期發(fā)現(xiàn)MHAs對于預(yù)防早發(fā)性骨關(guān)節(jié)炎至關(guān)重要。結(jié)合先進成像技術(shù)，如統(tǒng)計形狀建模，可以加深對復(fù)雜三維髖關(guān)節(jié)形態(tài)及其骨關(guān)節(jié)炎進展的理解。未來的研究應(yīng)探討其他形態(tài)性髖關(guān)節(jié)疾病的遺傳基礎(chǔ)，包括顱首股骨骨骺脫位和Legg-Calvé-Perthes病，以完善預(yù)防和治療策略。結(jié)合遺傳學、影像學和臨床洞察的綜合方法有望減輕MHAs的終身影響。

Genetics of morphological hip abnormalities and their implications for osteoarthritis: a scoping review

Morphological hip abnormalities (MHAs) significantly influence lifelong prognosis of the hip, contributing to early-onset osteoarthritis and impaired functionality. Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) represent key pathologies, resulting from insufficient or excessive femoral head coverage, respectively. These abnormalities alter hip biomechanics, leading to structural damage, pain, and accelerated joint degeneration. Advances in genetic research have illuminated the interplay between genetics and mechanical loading in shaping hip morphology. Genes associated with osteoarthritis, DDH, and FAI include COL1A1, MMP13, and IL-6. Genes associated with FAI and osteoarthritis include ADAMTS4. Genes associated with DDH and osteoarthritis include FRZB, CX3CR1, ASPN, DKK1, PDRG1, GDF5, UQCC1, and TGF-β1. The mechanisms linking morphological derangements to symptomatic osteoarthritis remain incompletely understood. Multimodal approaches integrating imaging, biomechanics, and genetics may uncover distinct disease subtypes, enabling personalized interventions. Early detection of MHAs is critical in preventing early-onset osteoarthritis. Incorporating advanced imaging techniques, such as statistical shape modelling, can enhance the understanding of complex 3D hip morphologies and their progression to osteoarthritis. Future research should explore the genetic underpinnings of other morphologic hip conditions, including Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes disease, to refine preventive and therapeutic strategies. A comprehensive approach combining genetics, imaging, and clinical insights holds promise for mitigating the lifelong impact of MHAs.

文獻出處：Bukowiec LG, Kaji ES, Koch JA, et al. Genetics of morphological hip abnormalities and their implications for osteoarthritis: a scoping review. J Hip Preserv Surg.2025;12(3):202-216. Published 2025 Apr 18. doi:10.1093/jhps/hnaf020

來源：304關(guān)節(jié)學術(shù)

作者：304關(guān)節(jié)團隊

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