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本期目錄：

1、擇期全髖、全膝關(guān)節(jié)置換術(shù)對老年骨科患者體能狀況的影響

2、內(nèi)側(cè)髕股關(guān)節(jié)炎是否影響固定平臺單間室膝關(guān)節(jié)置換術(shù)后的結(jié)果評分和翻修風(fēng)險

3、保留假體清創(chuàng)術(shù)用于治療全膝關(guān)節(jié)置換術(shù)后感染的療效

4、機器人輔助外側(cè)單髁膝關(guān)節(jié)置換術(shù)的優(yōu)異早期療效

5、無癥狀髖關(guān)節(jié)發(fā)育不良是否需要矯正手術(shù)

6、髖臼周圍截骨術(shù)后髖關(guān)節(jié)旋轉(zhuǎn)中心內(nèi)移的評估

7、雙下肢不等長雙側(cè)髖關(guān)節(jié)負(fù)荷情況

8、為何僅關(guān)注髖臼盂唇撕裂-只見樹木不見森林

9、維生素D缺乏對股骨頭骨骺滑脫進(jìn)展的影響

10、髖臼周圍截骨術(shù)中的骨盆后傾：如何避免髖臼后傾和股骨髖臼撞擊

11、股骨頭壞死患者的股骨頭塌陷與髖臼覆蓋之間是否存在關(guān)聯(lián)

12、臨界髖關(guān)節(jié)發(fā)育不良中髖臼覆蓋率的評估：X線是否能準(zhǔn)確評估三維覆蓋

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

文獻(xiàn)1

擇期全髖、全膝關(guān)節(jié)置換術(shù)對老年骨科患者體能狀況的影響

譯者張軼超

背景：骨關(guān)節(jié)炎是老年人的一種常見疾病，導(dǎo)致許多患者身體功能下降，最終需要進(jìn)行髖關(guān)節(jié)或膝關(guān)節(jié)置換術(shù)。該研究的目的是確定髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)對老年骨關(guān)節(jié)炎患者身體機能的影響。

方法：在這項前瞻性研究中，我們使用了由德國聯(lián)邦聯(lián)合委員會（GBA）資助的正在進(jìn)行的特殊骨科老年醫(yī)學(xué)（SOG）試驗的135名參與者的數(shù)據(jù)。采用短體能測試（SPPB）來評估髖膝關(guān)節(jié)置換術(shù)前、術(shù)后3天和7天、術(shù)后4-6周和3個月時的身體功能狀況。統(tǒng)計分析采用Friedman檢驗和后分析檢驗。

結(jié)果：在135名平均年齡為78.5±4.6歲的參與者中，81人接受了全髖關(guān)節(jié)置換術(shù)，54人接受了全膝關(guān)節(jié)置換術(shù)。在所有人群中，關(guān)節(jié)置換術(shù)后3個月SPPB改善的中位數(shù)為2個點（p<0.001）。在髖關(guān)節(jié)置換術(shù)組，術(shù)后3個月SPPB改善的中位數(shù)為2點（p<0.001）。術(shù)后3個月，膝關(guān)節(jié)置換術(shù)組SPPB改善的中位數(shù)為1點（p=0.003）。

結(jié)論：擇期全髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)可使老年骨科骨關(guān)節(jié)炎患者在幾周后的身體機能得到有臨床意義的改善。

The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study

Background：Osteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis.

Methods：In this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4–6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used.

Results：Of the 135 participants with a mean age of 78.5±4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p<0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p<0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p=0.003).

Conclusion：Elective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks.

文獻(xiàn)出處：Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Holzapfel DE, Schwarz T, G?tz J, Pagano S, Scharf M, Michalk K, Grifka J, Meyer M. The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study. BMC Geriatr. 2023 Nov 21;23(1):763. doi: 10.1186/s12877-023-04460-6. PMID: 37990164; PMCID: PMC10664286.

文獻(xiàn)2

內(nèi)側(cè)髕股關(guān)節(jié)炎是否影響固定平臺單間室膝關(guān)節(jié)置換術(shù)后的結(jié)果評分和翻修風(fēng)險？

譯者馬云青

背景：髕股關(guān)節(jié)骨關(guān)節(jié)炎 (OA) 和膝前疼痛有時被認(rèn)為是單間室膝關(guān)節(jié)置換術(shù) (UKA) 的禁忌癥。然而，一些研究已經(jīng)表明，在使用內(nèi)側(cè)活動平臺 UKA 治療有髕股關(guān)節(jié) 的膝關(guān)節(jié)OA患者依然能夠獲得較高的患者報告結(jié)果評分。因為這些研究只評估了活動平臺UKA 的結(jié)果，作者的研究目的是看這一發(fā)現(xiàn)是否也適用于固定平臺內(nèi)側(cè) UKA。
目的：(1) 髕股骨 OA 是否影響UKA 后患者報告的評分？(2) 未經(jīng)治療的內(nèi)側(cè)髕股骨 OA 是否會增加內(nèi)側(cè)固定平臺UKA術(shù)后的翻修率？
方法：在 2008 年至 2015 年間，由一名外科醫(yī)生進(jìn)行了 308 例單一設(shè)計的內(nèi)側(cè)固定平臺UKA手術(shù)。其中80 例 (26%) 至少有中度嚴(yán)重的髕股骨關(guān)節(jié)炎 (ICRS III 或 IV) ，228 例 (74%) 沒有。在此期間，主導(dǎo)刀醫(yī)生沒有將髕股骨關(guān)節(jié)炎作為手術(shù)禁忌?？偟膩碚f，髕股關(guān)節(jié)OA 組中有 13 例 (10%) 在 2 年最低隨訪時失訪，對照組中有 20 例 (11%) 失訪; 所有其他患者均可獲得術(shù)后隨訪資料，納入在這項回顧性研究中。髕股骨關(guān)節(jié)OA 組的平均 (± SD) 隨訪時間為 39 ± 25 個月，對照組為 41 ± 23 個月。有 100 個女性和 120 個男性。患者的平均年齡 ± SD 為 65 ± 10 歲，平均 ± SD BMI 為 29 ± 4.5 kg/m。采用國際軟骨修復(fù)學(xué)會 (ICRS) 分類法評估髕股關(guān)節(jié)的術(shù)中狀態(tài)。主要研究終點是遺忘關(guān)節(jié)評分 (FJS-12) ; 作者還比較了 Lonner髕股關(guān)節(jié)評分 (LPFS) ，Oxford Knee 評分 (OKS) 和 Short-Form 12 (SF-12) 的評分。次要評價終點是股骨或脛骨假體翻修，不管是什么原因，包括通過電話對每個病人進(jìn)行隨訪。
結(jié)果：根據(jù)有效數(shù)據(jù)，髕股關(guān)節(jié) OA 組 UKA 與無髕股關(guān)節(jié) OA 組之間的 FJS-12 評分無差異 (71 ± 29 比 77 ± 26，平均差異 -6; 95% CI，-16-4.5; p = 0.270)。同樣，根據(jù)現(xiàn)有的數(shù)據(jù)，在LPFS、Oxford knee和 SF-12 沒有看到任何差異。髕股關(guān)節(jié) OA 組與無髕股關(guān)節(jié) OA 組之間 4 年全因翻修的生存率無差異 (98% ; 95% CI，85.8-99.7 比 99.5% ; 95% CI，96.0-99.2% ; p = 0.352)。
結(jié)論：在這項單中心研究中，內(nèi)側(cè)骨關(guān)節(jié)炎患者通常受益于內(nèi)側(cè)固定平臺的 UKA，無論是否存在內(nèi)側(cè)髕股關(guān)節(jié)磨損，短期療效評分均為良好至優(yōu)秀。

文獻(xiàn)出處：Berger Y, Ftaita S, Thienpont E. Does Medial Patellofemoral Osteoarthritis Influence Outcome Scores and Risk of Revision After Fixed-bearing Unicompartmental Knee Arthroplasty? Clin Orthop Relat Res. 2019 Sep;477(9):2041-2047. doi: 10.1097/CORR.0000000000000738. PMID: 31140980; PMCID: PMC7000094.

文獻(xiàn)3

保留假體清創(chuàng)術(shù)用于治療全膝關(guān)節(jié)置換術(shù)后感染的療效

譯者張薔

背景：假體周圍感染（PJI）是一項全膝關(guān)節(jié)置換（TKA）術(shù)后嚴(yán)重而具有毀滅性的并發(fā)癥。澳洲國家關(guān)節(jié)登記中心報道清創(chuàng)+抗生素+保留假體（保留假體清創(chuàng)術(shù)，DAIR）的數(shù)量在增加，提示我們需要反復(fù)向患者及家屬強調(diào)對治療決策的結(jié)果要有正確預(yù)期。本研究旨在明確DAIR手術(shù)的結(jié)果，評估初次TKA到DAIR的時間并確定與DAIR失敗相關(guān)的危險因素。

方法：我們選擇國家數(shù)據(jù)庫中自1999年至2021年間的資料進(jìn)行隊列研究。我們最終入組了8642例感染翻修手術(shù)，其中5178例（60%）為初次置換術(shù)后4周內(nèi)施行的DAIR手術(shù)。分析數(shù)據(jù)時，我們選擇Kaplan-Meier估值和Cox比例風(fēng)險模型來評價結(jié)果。

結(jié)果：DAIR術(shù)后，二次翻修的累計百分比（CPR）為術(shù)后一年20%，而在術(shù)后17年增加至36%。初次TKA術(shù)后三個月內(nèi)的早期DAIR手術(shù)后需要再次翻修的比例較低。初次TKA術(shù)后兩周內(nèi)施行DAIR的病人相比初次TKA后三個月施行DAIR的病人需要再次翻修的風(fēng)險概率比為0.74（95%置信區(qū)間：0.62-0.88）。四周后，DAIR術(shù)后翻修率并未進(jìn)一步升高，此后一端時間保持平穩(wěn)。相比于女性，男性病人DAIR失敗的風(fēng)險概率比為1.28（95%CI：1.14-1.43，P < 0.001）。相比年齡≥75歲的病人，年齡＜75歲病人DAIR術(shù)后再翻修的概率比更高。

結(jié)論：本研究結(jié)果提示出患者相關(guān)因素和DAIR手術(shù)時機對未來預(yù)后的重要影響。初次TKA手術(shù)4周以后施行DAIR手術(shù)會顯著增加未來再翻修的風(fēng)險，而盡早施行DAIR介入的老年女性患者通暢結(jié)果更佳。深刻理解這些細(xì)微差別可以優(yōu)化PJI的治療策略，給醫(yī)療決策提供幫助。

Outcomes of Debridement, Antibiotics, and Implant Retention in the Management of Infected Total Knee Arthroplasty-Analysis of 5,178 Cases from the National Australian Registry

Introduction Periprosthetic joint infection (PJI) is a devastating and severe complication of total knee arthroplasty (TKA). The Australian Joint Registry reports an increasing number of debridement, antibiotics, and implant retention (DAIR) procedures, underscoring the need to comprehend outcomes for informed treatment decisions. This study aimed to determine outcome of DAIR procedures, evaluate time since primary TKA, and identify patient-related factors associated with DAIR failure.

Methods We conducted a national registry-based cohort study using data from 1999 to 2021. We included 8,642 revisions for infection, of which 5,178 were DAIR procedures (60%) predominantly performed within four weeks of primary surgery. We assessed outcomes using Kaplan-Meier estimates and Cox proportional hazard models.

Results Post-DAIR, the cumulative percent second revision (CPR) in the DAIR cohort was 20% at year one, increasing to 36% at year 17. Early DAIR procedures had a lower post-DAIR revision rate until three months after primary TKA. A DAIR performed within two weeks after primary TKA compared to three months had a HR [hazard ratio]: 0.74 (95% CI [confidence interval]: 0.62 to 0.88). After four weeks, the post-DAIR revision rate did not deteriorate and was similar for further time periods from the primary. Men had an age-adjusted hazard ratio of 1.28 (95% CI: 1.14 to 1.43, P < 0.001) for DAIR failure compared to women. There was a significantly higher hazard ratio for post-DAIR revision in patients younger than 75 years of age, compared to patients aged ≥ 75 years.

Conclusion These findings underscore the critical influence of patient-related factors and the timing of DAIR treatment on the need for additional surgery. DAIR after four weeks had an increased risk of subsequent revision, and older women undergoing early DAIR interventions had more favorable outcomes. Understanding these nuances aids in optimizing PJI management strategies, offering insights for decision-making.

文獻(xiàn)出處：Kristensen NK, Callary SA, Nelson R, Harries D, Lorimer M, Smith P, Campbell D. Outcomes of Debridement, Antibiotics, and Implant Retention in the Management of Infected Total Knee Arthroplasty: Analysis of 5,178 Cases From the National Australian Registry. J Arthroplasty. 2024 Dec 20:S0883-5403(24)01318-4. doi: 10.1016/j.arth.2024.12.016. Epub ahead of print. PMID: 39710215.

文獻(xiàn)4

機器人輔助外側(cè)單髁膝關(guān)節(jié)置換術(shù)的優(yōu)異早期療效

譯者沈松坡

引言：傳統(tǒng)的外側(cè)單髁膝關(guān)節(jié)置換術(shù)（UKA）在臨床結(jié)果上表現(xiàn)不一，而關(guān)于機器人輔助外側(cè)UKA（RA-UKA）的當(dāng)代研究較為有限。本研究旨在評估RA-UKA的短期存活率、臨床及影像學(xué)結(jié)果。

方法：本研究回顧性分析了2016年至2022年在單一機構(gòu)進(jìn)行的138例RA-UKA手術(shù)。研究對象中，女性占58%，平均BMI為27 kg/m2，平均年齡為62歲，平均隨訪時間為2年。采用Kaplan-Meier分析法評估無全因翻修和再手術(shù)的存活率，并對影像學(xué)參數(shù)進(jìn)行評估，包括假體位置、無菌性松動及骨關(guān)節(jié)炎進(jìn)展情況。

結(jié)果： 1年和2年的無全因翻修存活率均為100%（95%置信區(qū)間[CI]：100%），1年和2年的無全因再手術(shù)存活率分別為97%（95% CI：91-99%）和96%（95% CI：90-98%）。共有6例（4%）患者接受了再手術(shù)，主要原因包括關(guān)節(jié)鏡松解/瘢痕組織切除、滑膜炎及骨贅清理。平均脛股解剖角從術(shù)前的9.7°外翻降低至5.9°。在最終隨訪時，11例（8%）膝關(guān)節(jié)出現(xiàn)影像學(xué)上的骨關(guān)節(jié)炎進(jìn)展。術(shù)后2年，與術(shù)前相比，膝關(guān)節(jié)損傷與骨關(guān)節(jié)炎結(jié)局評分（KOOS JR）從56提高至82（P < 0.0001），視覺模擬疼痛評分（VAS）從53降低至18（P = 0.001）。

結(jié)論：機器人輔助外側(cè)UKA的短期隨訪顯示其具有較高的無全因翻修（100%）和無全因再手術(shù)存活率（96%）?；颊邎蟾娼Y(jié)局指標(biāo)（PROMs）顯著改善，且僅有少數(shù)病例出現(xiàn)骨關(guān)節(jié)炎進(jìn)展。

圖所示：

(A) 右膝的術(shù)前正位X光片，顯示脛股解剖角測量值為6°外翻。

(B) 右膝的術(shù)后正位X光片，顯示脛股解剖角測量值為2°外翻。

(D) 右膝的術(shù)后側(cè)位X光片，顯示脛骨后傾角測量值為5°。

Excellent early outcomes following lateral robotic-assisted unicompartmental knee arthroplasty

Introduction: Lateral unicompartmental knee arthroplasty (UKA) has historically shown mixed results and there is limited contemporary literature on lateral robotic-assisted UKA (RA-UKA) outcomes. This study aimed to evaluate the short-term survivorship, clinical, and radiographic outcomes of lateral RA-UKA.

Methods: A retrospective review identified 138 lateral RA-UKAs performed from 2016 to 2022 at a single institution, with a study population of 58% women, a mean BMI of 27 kg/m2, and a mean age of 62 years. The mean follow-up was two years. Kaplan-Meier analysis assessed survivorship free from all-cause reoperation and revision. A radiographic review evaluated component positioning, aseptic loosening, and osteoarthritis progression.

Results: The one- and two-year survivorship free from all-cause revision was 100% (95% confidence interval [CI]: 100 to 100%). The one- and two-year survivorship free from all-cause reoperation was 97% (95% CI: 91 to 99%) and 96% (95% CI: 90 to 98%), respectively. There were six (4%) reoperations, most commonly for arthroscopic lysis/removal of scar tissue, synovitis, and osteophyte. The mean anatomic tibiofemoral angle decreased from 9.7° to 5.9° valgus. At the latest follow-up, 11 (8%) knees showed radiographic osteoarthritis progression. From preoperatively to two years postoperatively, the mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 56 to 82 (P < 0.0001), and the mean visual analog scale for pain decreased from 53 to 18 (P = 0.001).

Conclusions: Short-term follow-up of contemporary lateral RA-UKA demonstrated high survivorship free from all-cause reoperation (96%) and revision (100%). Patients had significant improvements in PROMs, and a minority had osteoarthritis progression.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

無癥狀髖關(guān)節(jié)發(fā)育不良是否需要矯正手術(shù)？

譯者羅殿中

背景：兒童髖關(guān)節(jié)發(fā)育不良最好在嬰兒或幼兒時期得到非手術(shù)治療，希望髖關(guān)節(jié)得到完全正常發(fā)育。保守治療方法包括Pavlik挽具、支具和早期閉合復(fù)位石膏固定。在一些病例中，理想的效果并未實現(xiàn)，而是殘余髖關(guān)節(jié)發(fā)育不良，通常沒有癥狀。另外一些患者在兒童早期沒有發(fā)現(xiàn)、后來稍晚才發(fā)現(xiàn)髖關(guān)節(jié)發(fā)育不良。還有一些患者在髖關(guān)節(jié)疼痛之前不知道存在髖關(guān)節(jié)問題。也有一些兒童在偶然影像體檢時發(fā)現(xiàn)無癥狀髖關(guān)節(jié)發(fā)育不良。骨科文獻(xiàn)明確建議，對有癥狀的兒童進(jìn)行髖關(guān)節(jié)截骨矯形手術(shù)。針對無癥狀髖關(guān)節(jié)發(fā)育不良的手術(shù)矯正存在爭議。

方法：髖關(guān)節(jié)影像欠佳、但無癥狀的兒童處理意見的確是個問題。針對這些病例，外科醫(yī)生需要引用影像學(xué)髖關(guān)節(jié)對股骨頭覆蓋的正常值、以及自然病程的遠(yuǎn)期結(jié)果，來決定是否需要進(jìn)行髖關(guān)節(jié)截骨的矯正手術(shù)。長期隨訪的研究結(jié)果表明，即便是臨界發(fā)育不良，到中年時期，也會出現(xiàn)明顯的髖關(guān)節(jié)癥狀、和骨關(guān)節(jié)炎。

結(jié)果：許多沒有癥狀的髖關(guān)節(jié)發(fā)不良兒童和青少年，應(yīng)該進(jìn)行髖關(guān)節(jié)矯正手術(shù)。兒童年齡小于8歲，手術(shù)操作更容易，并可取得可預(yù)見的良好效果。

結(jié)論：針對無癥狀的殘余影像上髖關(guān)節(jié)發(fā)育不良兒童，幾乎不可能明確推薦應(yīng)該進(jìn)行髖關(guān)節(jié)截骨矯正手術(shù)。文獻(xiàn)回顧顯示，很大比例的臨界髖關(guān)節(jié)發(fā)育不良，既往未經(jīng)治療，在中年早期會發(fā)生早發(fā)骨關(guān)節(jié)炎。當(dāng)前的資料建議，針對臨界髖關(guān)節(jié)發(fā)育不良，應(yīng)進(jìn)行手術(shù)治療。外科醫(yī)生髖關(guān)節(jié)截骨手術(shù)技術(shù)、和/或便于推薦到相應(yīng)的治療中心，或許是這些決策的流行趨勢。

圖1. A，5歲半女孩，3年前因DDH行閉合復(fù)位石膏固定，左髖前后位片；B，閉合復(fù)位后15年（17歲）左髖前后位片；C，閉合復(fù)位后42年（44歲）左髖前后位片；D，閉合復(fù)位后51年，53歲時獲取的攝片；攝片顯示左髖嚴(yán)重骨關(guān)節(jié)炎，該患者隨后進(jìn)行了全髖關(guān)節(jié)置換手術(shù)。

圖2. A，2歲兒童骨盆前后位片顯示殘余髖關(guān)節(jié)發(fā)育不良，此前曾行Pavlik挽具和外展支具治療；注意明顯中斷的Shenton氏線表明髖關(guān)節(jié)半脫位；B，左髖進(jìn)行了Salter骨盆截骨術(shù)；C，截骨矯正術(shù)后2年，患兒髖關(guān)節(jié)覆蓋充分，Shenton氏線無中斷；遠(yuǎn)期預(yù)后良好。

圖3. A，4歲半女孩骨盆前后位片，在外院判斷為左髖關(guān)節(jié)發(fā)育不良。由于她沒有癥狀，醫(yī)生建議非手術(shù)治療；B，同一孩子9歲10個月時骨盆前后位片。她在進(jìn)行所有的體育運動時，均有嚴(yán)重的左髖關(guān)節(jié)疼痛；C，為明確髖關(guān)節(jié)穩(wěn)定性，進(jìn)行Trendelenburg攝片；患者左腿站立10秒，然后進(jìn)行攝片。攝片確認(rèn)站立位髖關(guān)節(jié)不穩(wěn)；D，10歲時進(jìn)行左髖三聯(lián)截骨術(shù)，術(shù)后一年骨盆前后位片；E，左髖三聯(lián)截骨術(shù)后4年，骨盆前后位片。孩子感覺良好，左髖偶爾有癥狀。片子顯示輕微過度覆蓋。該病例提示，當(dāng)手術(shù)年齡推遲至大于10歲時，很難取得良好效果。

Is there a role for acetabular dysplasia correction in an asymptomatic patient?

Background:Childhood hip dysplasia is best treated in infancy or early childhood with hopes that the acetabulum will be completely normalized by nonoperative treatment methods, which may include Pavlik and brace treatment as well as formal closed reduction and hip spica casting. In many cases, this ideal result cannot be achieved and the child is left with residual dysplasia, which is often not symptomatic. Other patients may present late with hip dysplasia that is not identified in early childhood. Some develop hip pain with no prior known hip problem. Other children have asymptomatic dysplasia that is picked up on an incidental radiograph. The orthopaedic literature is clear regarding the need for corrective hip osteotomies in symptomatic children. Surgery to correct asymptomatic hip dysplasia remains controversial.

Methods:Children who have no symptoms yet have abnormal radiographs present a puzzling circumstance. In these cases, surgeons need to use quoted radiographic normal values for acetabular coverage of the femoral head as well as long-term natural history studies to decide whether to proceed with a corrective acetabular osteotomy. Long-term follow-up studies confirm that even patients with borderline dysplasia are likely to have significant hip symptoms and arthritis by middle age.

Results:Many children and adolescents with asymptomatic residual hip dysplasia should have corrective acetabular procedures performed. Surgery is more easily performed with more predictable results when the child is younger than 8 years.

Conclusions:It is impossible to state with certainty which children with residual radiographic hip dysplasia, but without symptoms, should have a corrective acetabular osteotomy. Review of the literature confirms that many patients have been undertreated in the past, with a high percentage of children with borderline hip dysplasia developing premature arthritis in early to mid-adult life. Current data suggest that surgery should be performed in borderline cases. Skill of the surgeon in performing acetabular osteotomies and/or ease of referral to a treatment center may temper the timing of such decisions.

文獻(xiàn)出處：Wenger DR. Is there a role for acetabular dysplasia correction in an asymptomatic patient? J Pediatr Orthop. 2013 Jul-Aug;33 Suppl 1:S8-12. doi: 10.1097/BPO.0b013e3182771764. PMID: 23764798.

文獻(xiàn)2

髖臼周圍截骨術(shù)后髖關(guān)節(jié)旋轉(zhuǎn)中心內(nèi)移的評估

譯者張振東

背景：髖臼周圍截骨術(shù)(PAO)增加了股骨頭覆蓋，并使髖關(guān)節(jié)中心內(nèi)移，恢復(fù)了正常的關(guān)節(jié)生物力學(xué)。既往研究關(guān)于PAO對旋轉(zhuǎn)中心內(nèi)移程度的測量有較多報道，但并無對相關(guān)測量方法進(jìn)行準(zhǔn)確性驗證。本文作者認(rèn)為截骨術(shù)后髂坐線在股骨頭中心水平可能顯示不清，在股骨頭下三分之一處可以更好地觀察到，因此，文章提出PAO術(shù)后從股骨頭下三分之一處測量內(nèi)移可能更為準(zhǔn)確。

目的：(1)PAO對髖關(guān)節(jié)中心的內(nèi)移程度? (2)哪些影像學(xué)因素(如外側(cè)中心邊緣角[LCEA]和臼頂傾斜角[AI])與內(nèi)移程度相關(guān)? (3)在平片上測量股骨頭中心內(nèi)移(傳統(tǒng)方法)或股骨頭下方1 / 3位置處(本研究提出的替代方法)測量，哪種方法更為準(zhǔn)確? (4)術(shù)中透視與術(shù)后x線片測量髖關(guān)節(jié)內(nèi)移是否相同?

方法：研究對一系列PAO術(shù)后接受低劑量CT的患者進(jìn)行了回顧性研究。本研究的納入標(biāo)準(zhǔn)包括行PAO的有癥狀的髖關(guān)節(jié)發(fā)育不良患者、術(shù)前有CT掃描數(shù)據(jù)、隨訪9個月至5年。2009年2月至2018年7月共有333名接受PAO治療的患者符合這些標(biāo)準(zhǔn)。此外，手術(shù)年齡為16到50歲。排除標(biāo)準(zhǔn)包括既往手術(shù)史、髖關(guān)節(jié)撞擊征(FAI)、妊娠、神經(jīng)肌肉障礙、Perthes病、術(shù)前無CT者。最終39例患者（39髖）納入。87%(34 / 39)為女性患者，13%(5 / 39)為男性患者。手術(shù)時中位年齡為27歲(16 - 49歲)。通過平片測量LCEA和AI。并分別采用傳統(tǒng)的和替代方法來測量髖關(guān)節(jié)內(nèi)移程度。另外通過三維CT髖關(guān)節(jié)重建模型的測量髖關(guān)節(jié)中心真實內(nèi)移程度。同時評估LCEA和AI和內(nèi)移程度之間的相關(guān)性。通過統(tǒng)計分析確定兩種測量方法和CT上的真實內(nèi)移程度之間的相關(guān)性，以及確定術(shù)中透視進(jìn)行測量是否與術(shù)后x線片測量不同。

結(jié)果：通過CT測量評估，PAO實現(xiàn)的髖中心內(nèi)移值為4±3 mm; 46%(39髖)中位0 - 5mm, 36%(14髖)中位5 - 10mm, 5%(2髖)中位大于10mm，13%(5髖)為外移。LCEA不同亞組間的內(nèi)移程度差異很小。AI≥15°(6±3 mm)髖關(guān)節(jié)較AI< 15°(2±3 mm)內(nèi)移更多。替代方法較傳統(tǒng)方法測量內(nèi)移更為準(zhǔn)確。術(shù)中透視與術(shù)后x線片測量的髖關(guān)節(jié)內(nèi)移值沒有差異。

結(jié)論：通過對術(shù)前和術(shù)后CT進(jìn)行測量，該研究表明PAO術(shù)后髖關(guān)節(jié)旋轉(zhuǎn)中心平均內(nèi)移值為4mm，但存在較大的變異性。傳統(tǒng)的在股骨頭中心測量中位的方法可能不準(zhǔn)確; 另一種方法是測量股骨頭下三分之一處的內(nèi)移位置，這可能是評估髖關(guān)節(jié)中心內(nèi)移的更好方法。因此作者建議改用這種方法來獲得最準(zhǔn)確的數(shù)據(jù)，同時應(yīng)注意到與CT測量相比，兩種使用X線測量的方法似乎都低估了PAO術(shù)后真正的內(nèi)移程度。此外，術(shù)中使用透視可以準(zhǔn)確評估髖關(guān)節(jié)中心內(nèi)移。

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

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

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

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

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

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

文獻(xiàn)出處：Fowler LM, Nepple JJ, Devries C, Harris MD, Clohisy JC. Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs. Clin Orthop Relat Res. 2021 May 1;479(5):1040-1049.

文獻(xiàn)3

雙下肢不等長雙側(cè)髖關(guān)節(jié)負(fù)荷情況

譯者任寧濤

目的:雙下肢不等長在健康人群和全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty, THA)后都很常見。關(guān)于THA后下肢長度的研究表明，在恢復(fù)下肢長度方面存在顯著的不一致性。然而，關(guān)于雙下肢不等長時，步態(tài)中髖關(guān)節(jié)負(fù)荷的影響尚不清楚。本研究的目的是采用三維步態(tài)分析來評估步態(tài)中髖關(guān)節(jié)負(fù)荷，模擬下肢長度差異為2cm和4cm。9名沒有任何髖關(guān)節(jié)損傷史的健康受試者參加了研究。

方法:采用標(biāo)準(zhǔn)生物力學(xué)步態(tài)模型，用6個攝像頭和2個力板進(jìn)行3D步態(tài)分析(Vicon, Motion System, Oxford, England)。計算了三種運動自由度下的髖關(guān)節(jié)力矩。采用重復(fù)測量方差分析進(jìn)行統(tǒng)計學(xué)處理。

結(jié)果:短肢外展力矩峰值顯著增加(P < 0.05)，長肢無明顯變化。長肢內(nèi)收力矩在0 ~ 4 cm范圍內(nèi)減小(P < 0.01)，短肢內(nèi)收力矩?zé)o明顯變化。長肢和短肢的髖關(guān)節(jié)內(nèi)旋轉(zhuǎn)力矩都沒有變化。短肢外旋力矩?zé)o變化，長肢0-4 cm外旋力矩明顯減小(P < 0.05)。

結(jié)論:2厘米以上的下肢長度差異會引起長肢和短肢髖關(guān)節(jié)負(fù)荷的生物力學(xué)變化，且短側(cè)的影響更大。從長遠(yuǎn)來看，增加的壓力可能會導(dǎo)致后續(xù)的問題。

Hip joint load in relation to leg length discrepancy

Objective: Leg length discrepancy is common both in healthy subjects and after total hip arthroplasty (THA). Studies that evaluated leg length following THA have demonstrated a notable inconsistency in restoring leg length. The effects concerning joint load during gait is however not well known. The purpose of this study was to use three-dimensional (3D) gait analysis to evaluate joint load during gait with a simulated leg length discrepancy of 2 and 4 cm. Nine healthy subjects without any history of hip injury participated.

Method: A 3D gait analysis (Vicon, Motion System, Oxford, England) was performed with 6 cameras and 2 force palates using a standard biomechanical gait model. Hip joint moments of force were calculated for all three degrees of motion freedom. ANOVA for repeated measurements was used for statistical calculations.

Results: Abduction peak moment was significantly increased at the short side (P < 0.05) but unaffected on the long side. The adduction moment decreased on the long side between 0 and 4 cm (P < 0.01) but was unaffected on the short side. The internal hip rotation moments were unchanged for both the long and the short side. The external rotation moment was unchanged on the short side and decreased between bare foot and 4 cm on the long side (P < 0.05).

Conclusion: A leg length discrepancy of 2 cm or more creates biomechanical changes concerning hip joint load both on the long and the short side and that the effects are larger on the short side. The increased stress may cause problems in the long run.

文獻(xiàn)出處：Wretenberg P, Hugo A, Brostr?m E. Hip joint load in relation to leg length discrepancy. Med Devices (Auckl). 2008 Jul;1:13-8. doi: 10.2147/mder.s3714. Epub 2008 Aug 11. PMID: 22915902; PMCID: PMC3417904.

文獻(xiàn)4

致編輯的信：為何僅關(guān)注髖臼盂唇撕裂？您這是只見樹木不見森林

譯者李勇

摘要：隨著高質(zhì)量影像技術(shù)的發(fā)展，人們對髖關(guān)節(jié)常見形態(tài)和病理的認(rèn)識及其臨床意義日益重視。盡管磁共振成像（MRI）在識別盂唇撕裂方面存在局限性，但許多患者甚至醫(yī)生仍傾向于關(guān)注MRI上顯示的髖臼盂唇撕裂的存在。此外，近期研究表明，髖臼盂唇存在正常變異，且盂唇撕裂在有癥狀的和無癥狀的個體中均具有高發(fā)生率。對于選擇接受盂唇撕裂手術(shù)治療的患者，必須解決潛在病理問題（如股骨髖臼撞擊癥或髖關(guān)節(jié)發(fā)育不良）。若忽視原發(fā)病理，初次手術(shù)后可能形成新的盂唇撕裂。這種綜合治療方式能確保針對盂唇撕裂的根本原因進(jìn)行治療，從而降低復(fù)發(fā)風(fēng)險并改善患者預(yù)后。盡管髖臼盂唇富含神經(jīng)支配（盂唇撕裂可直接引發(fā)患者髖部疼痛），但我們的關(guān)注點不應(yīng)局限于盂唇撕裂本身。僅關(guān)注唇部病理可能使患者陷入治療失敗的困境，因為忽略了導(dǎo)致撕裂的潛在解剖異常。有效治療的關(guān)鍵在于糾正原發(fā)因素，例如修復(fù)股骨髖臼撞擊癥和/或髖關(guān)節(jié)發(fā)育不良。通過矯正這些解剖異常，我們能夠預(yù)防未來唇部損傷，并為患者提供更全面、持久的癥狀緩解。忽視原發(fā)解剖問題可能導(dǎo)致盂唇撕裂復(fù)發(fā)和持續(xù)疼痛，這突顯了采取整體性治療方法的必要性。

Letters to the Editor：Why Do You Focus on the Acetabular Labral Tear? You Can't See the Forest for the Trees

The advent of higher-quality imaging has brought increased attention to the understanding and implications of commonly observed hip morphology and pathology. Many patients and even physicians like to focus on the presence of an acetabular labral tear when one is present on magnetic resonance imaging, despite the limitations of magnetic resonance imaging in identifying labral tears. Furthermore, recent studies have shown normal variations of the acetabular labrum, as well as a high prevalence of labral tears in both symptomatic and asymptomatic individuals. For patients electing to undergo surgical treatment of a labral tear, addressing the underlying pathology is imperative. Ignoring the primary pathology (e.g., femoroacetabular impingement or hip dysplasia) risks the formation of a new labral tear after initial surgical management. This comprehensive approach ensures that the primary cause of the labral tear is treated, thereby reducing the likelihood of recurrence and improving patient outcomes. Although the labrum is highly innervated, making labral tears a direct cause of hip pain in affected patients, we should not be setting our focus on the labral tear itself. Focusing solely on the labral pathology may set up our patients for failure by overlooking the underlying anatomic issues that precipitate these tears. Addressing the root cause, such as correcting femoroacetabular impingement and/or hip dysplasia, is crucial for effective treatment. By correcting these anatomic factors, we can prevent future labral damage and provide more comprehensive and lasting relief for our patients. Ignoring the primary anatomic issues risks recurrent tears and ongoing pain, highlighting the need for a holistic approach to treatment.

文獻(xiàn)出處：Dhillon J, Kraeutler MJ. Why Do You Focus on the Acetabular Labral Tear? You Can't See the Forest for the Trees. Arthroscopy. 2025 Mar;41(3):539-540. doi: 10.1016/j.arthro.2024.10.052. Epub 2024 Nov 13. PMID: 39542409.

文獻(xiàn)5

維生素D缺乏對股骨頭骨骺滑脫進(jìn)展的影響

譯者張利強

目的：股骨頭骨骺滑脫（SCFE）是青少年最常見的髖關(guān)節(jié)疾病之一，常與肥胖有關(guān)。然而，其他因素，如維生素D缺乏，也可能導(dǎo)致SCFE的進(jìn)展。這項研究調(diào)查了維生素D缺乏對大型隊列中SCFE進(jìn)展的影響。

方法：我們利用TriNetX國家數(shù)據(jù)庫查詢記錄鈣二醇水平的兒童患者。隨訪9歲以下有就診記錄并隨后記錄鈣二醇水平的患者，直到SCFE發(fā)生或18歲?；颊叻譃榫S生素D充足（≥30 ng/mL）和缺乏（<30 ng/mL）組。使用多變量邏輯回歸模型進(jìn)行傾向評分匹配，以調(diào)整基線特征，包括年齡，性別，種族和體重指數(shù)百分位數(shù)。使用Fisher精確檢驗和χ2檢驗進(jìn)行顯著性檢驗，以比較隊列之間的SCFE進(jìn)展風(fēng)險，顯著性水平設(shè)定為P＜0.05。

結(jié)果：初步分析后98045名患者符合納入標(biāo)準(zhǔn)。進(jìn)行匹配后維生素D缺乏組和充足組均納入34552名患者，首次就診時平均年齡為8.4歲，女性占50%。維生素D缺乏組和維生素D充足組分別有136例（0.39%）和48例（0.14%）發(fā)生SCFE（P＜0.0001）。維生素D缺乏顯著增加了SCFE進(jìn)展風(fēng)險，相對風(fēng)險為2.8（95%CI:2-3.9；P＜0.0001），風(fēng)險比為1.6（95%CI:1.1-2.2；P＜0.0001）。

結(jié)論：這項研究是迄今為止規(guī)模最大的研究之一，它建立了維生素D缺乏與SCFE進(jìn)展之間的顯著關(guān)聯(lián)。在控制包括體重指數(shù)在內(nèi)的潛在混雜變量后，維生素D缺乏癥患者發(fā)生SCFE的可能性約為2.83倍。研究結(jié)果強調(diào)需要進(jìn)一步研究，以評估補充劑是否可以降低發(fā)生SCFE的風(fēng)險。

Effect of Vitamin D Deficiency on Development of Slipped Capital Femoral Epiphysis

Objective: Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders in adolescents, often linked to obesity. However, other factors, such as vitamin D deficiency, may also contribute to SCFE development. This study investigates the impact of vitamin D deficiency on SCFE development in a large cohort.

Methods: We utilized the TriNetX national database to query pediatric patients with documented calcidiol levels. Patients with a recorded visit below the age of 9 and subsequent documented calcidiol levels were followed until SCFE occurrence or age 18. Patients were categorized into vitamin D adequate ( ≥ 30 ng/mL) and deficient ( < 30 ng/mL) groups. Propensity score matching was performed using a multivariable logistic regression model to adjust for baseline characteristics, including age, sex, race, and body mass index percentile. Significance testing was conducted using the Fisher exact test and χ2 tests to compare SCFE risk between the cohorts, with a significance level set at P < 0.05.

Results: On preliminary analysis, 98,045 patients met the inclusion criteria. After matching, 34,552 individuals in both vitamin D deficient and adequate groups were included, with an average age of 8.4 years at the time of their first visit and 50% females. SCFE occurred in 136 (0.39%) and 48 (0.14%) patients in the vitamin D deficient and adequate groups, respectively (P < 0.0001). Vitamin D deficiency significantly increased SCFE risk, with a relative risk of 2.8 (95% CI: 2-3.9; P < 0.0001) and a hazard ratio of 1.6 (95% CI: 1.1-2.2; P < 0.0001).

Conclusion: This study, one of the largest to date, establishes a significant association between vitamin D deficiency and SCFE development. After controlling for potential confounding variables, including body mass index, individuals with vitamin D defciency were ～2.83 times more likely to develop SCFE. The study findings highlight the need for further research to evaluate whether supplementation could mitigate this risk of developing SCFE.

文獻(xiàn)出處：Torres-Izquierdo B, Galan-Olleros M, Momtaz D, Mittal MM, Gonuguntla R, Tippabhatla A, Hosseinzadeh P. Effect of Vitamin D Deficiency on Development of Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2025 Feb 10. doi: 10.1097/BPO.0000000000002915. Epub ahead of print. PMID: 39927509.

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髖臼周圍截骨術(shù)中的骨盆后傾：如何避免髖臼后傾和股骨髖臼撞擊

譯者陶可

背景：骨盆傾斜直接影響髖臼前后傾。骨盆傾斜的變化可能會影響髖臼周圍截骨術(shù)(PAO)后的髖臼重新定位。

目的：(1)比較髖關(guān)節(jié)發(fā)育不良和后傾、單側(cè)和雙側(cè)PAO以及男性和女性患者的恥骨聯(lián)合高度與骶髂寬度(PS-SI)的比率。(2)通過從術(shù)前到術(shù)中和術(shù)后以及短期和中期隨訪跟蹤PAO后患者的骨盆傾斜（使用PS-SI比率進(jìn)行量化）。

方法：作者進(jìn)行了一項回顧性放射學(xué)研究，評估了124名患有髖關(guān)節(jié)發(fā)育不良的患者（139髖）和46名患有髖臼后傾的患者（57髖）的骨盆傾斜情況，這些患者接受了PAO手術(shù)治療（2005年1月至2019年12月）。如果患者的放射學(xué)數(shù)據(jù)不足、之前或同時進(jìn)行過髖關(guān)節(jié)手術(shù)、創(chuàng)傷后或兒童畸形，或同時存在發(fā)育不良和后傾，則將其排除（90名患者，95髖）。髖關(guān)節(jié)發(fā)育不良定義為外側(cè)中心邊緣角<23°；后傾定義為同時出現(xiàn)后傾指數(shù)30%以及坐骨棘征和后壁征陽性。術(shù)前、PAO期間、術(shù)后以及短期和中期隨訪時均以仰臥位拍攝前后位骨盆X線片（平均值± SD [范圍]；9 ± 3周 [5-23周] 和21 ± 21周[6-125個月]）。計算了5個觀察期（術(shù)前至中期隨訪）不同亞組（發(fā)育不良vs后傾、單側(cè)手術(shù)vs雙側(cè)手術(shù)、男性vs女性）的PS-SI比率，并通過觀察者內(nèi)和觀察者間一致性進(jìn)行了驗證（組內(nèi)相關(guān)系數(shù)分別為 0.984（95% CI，0.976-0.989）和 0.991（95% CI，0.987-0.994））。

結(jié)果：髖關(guān)節(jié)發(fā)育不良和后傾之間的PS-SI比率均不同（P = 0.041 至P < 0.001）。男性髖關(guān)節(jié)發(fā)育不良的PS-SI比值均低于女性髖關(guān)節(jié)發(fā)育不良（P < 0.001 至 P = 0.005）。在髖臼后傾的髖關(guān)節(jié)中，短期和中期隨訪中男性的PS-SI比值低于女性（P = 0.024 和 0.003）。除髖關(guān)節(jié)發(fā)育不良的短期隨訪（P = 0.040）外，單側(cè)和雙側(cè)手術(shù)之間無差異（P = 0.306 至 P = 0.905）。所有亞組的PS-SI比值在術(shù)前、術(shù)中或術(shù)后均下降（P < 0.001 至 P = 0.031）。在短期和中期隨訪中，PS-SI比率與術(shù)中相比有所增加（P < 0.001至P = 0.044），并且所有亞組與術(shù)前無差異（P = 0.370 至 P = 0.795）。

結(jié)論：男性或發(fā)育不良髖關(guān)節(jié)的PS-SI比率較低。在所有亞組中，PS-SI比率在手術(shù)過程中降低，表明骨盆后傾。手術(shù)期間正確的骨盆方向?qū)τ跍?zhǔn)確的髖臼重新定位至關(guān)重要。手術(shù)期間的后傾會導(dǎo)致低估髖臼角度和隨訪中的醫(yī)源性髖臼后傾，而骨盆處于正確且更向前傾斜的方向。PAO術(shù)中不考慮后傾可能會導(dǎo)致股骨髖臼撞擊。

Retrotilt of the Pelvis During Periacetabular Osteotomy: How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement

Background: Pelvic tilt directly influences acetabular version on radiographs. Changes of pelvic tilt potentially affect acetabular reorientation after periacetabular osteotomy (PAO).

Purpose: (1) To compare the ratio of the pubic symphysis height to the sacroiliac width (PS-SI) between hips with dysplasia and acetabular retroversion, uni- and bilateral PAO, and male and female patients. (2) To evaluate pelvic tilt (quantified using the PS-SI ratio) in patients after PAO by tracking it from preoperative to intra- and postoperative and short- and middle-term follow-up.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective and radiographic study was conducted evaluating pelvic tilt in 124 patients (139 hips) with dysplasia and 46 patients (57 hips) with acetabular retroversion who were undergoing PAO (January 2005-December 2019). Patients were excluded if they had insufficient radiographic data, previous or concomitant hip surgery, posttraumatic or pediatric deformities, or combined dysplasia and retroversion (90 patients, 95 hips). Dysplasia was defined as a lateral center-edge angle <23°; retroversion was defined by simultaneous appearance of a retroversion index 30% and positive ischial spine and posterior wall signs. Anteroposterior pelvic radiographs were taken in the supine position preoperatively, during PAO, postoperatively, and at short- and middle-term follow-up (mean ± SD [range]; 9 ± 3 weeks [5-23 weeks] and 21 ± 21 weeks [6-125 months]). The PS-SI ratio was calculated at 5 observation periods (preoperatively to middle-term follow-up) for different subgroups (dysplasia vs retroversion, uni- vs bilateral surgery, male vs female) and validated with intra- and interobserver agreement (intraclass correlation coefficients, 0.984 (95%CI, 0.976-0.989) and 0.991 (95% CI, 0.987-0.994), respectively).

Results: The PS-SI ratio differed between dysplasia and retroversion at all observation periods (P = .041 to P < .001). Male dysplastic hips had a lower PS-SI ratio when compared with female dysplastic hips at all observation periods (P < .001 to P = .005). In hips with acetabular retroversion, the PS-SI ratio was lower in men than women at short- and middle-term follow-up (P = .024 and .003). No difference was found between uni- and bilateral surgery (P = .306 to P = .905) except for short-term follow-up in dysplasia (P = .040). The PS-SI ratio decreased in all subgroups preoperatively to intra- or postoperatively (P < .001 to P = .031). At short- and middle-term follow-up, the PS-SI ratio increased as compared with intraoperatively (P < .001 to P = .044) and did not differ from preoperatively in all subgroups (P = .370 to P = .795).

Conclusion: A lower PS-SI ratio was found for male or dysplastic hips. In all subgroups, the PS-SI ratio decreased during surgery, indicating retrotilt of the pelvis. Correct pelvic orientation during surgery is crucial for accurate acetabular reorientation. Retrotilt during surgery results in underestimation of acetabular version and iatrogenic retroversion of the acetabulum at follow-up, with the pelvis in the correct and more forward-tilted orientation. Not taking into account retrotilt during PAO potentially results in femoroacetabular impingement. Therefore, we changed our intraoperative setting with adjustment of the central beam to compensate for retrotilt of the pelvis.

文獻(xiàn)出處：Nicolas Vuillemin, Malin Kristin Meier, Angela Maria Moosmann, Klaus Arno Siebenrock, Simon Damian Steppacher. Retrotilt of the Pelvis During Periacetabular Osteotomy: How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement. Am J Sports Med. 2023 Apr;51(5):1224-1233. doi: 10.1177/03635465231155201. Epub 2023 Mar 6.

文獻(xiàn)7

股骨頭壞死患者的股骨頭塌陷與髖臼覆蓋之間是否存在關(guān)聯(lián)？

譯者邱興

背景股骨頭壞死（ONFH）的分類系統(tǒng)基于壞死病灶的大小、體積和位置。股骨頭壞死通常（但并非總是）會導(dǎo)致股骨頭塌陷。由于髖臼覆蓋與股骨頭的機械應(yīng)力相關(guān)，它可能與ONFH患者的股骨頭塌陷存在關(guān)聯(lián)。然而，髖臼覆蓋與股骨頭塌陷之間的關(guān)系尚未明確。

問題/目的 (1) ONFH患者的股骨頭塌陷是否與髖臼覆蓋或骨盆入射角（PI）相關(guān)？
(2) ONFH分類系統(tǒng)中已確立的股骨頭塌陷預(yù)測因素是否與髖臼覆蓋相關(guān)？

方法 2008至2018年間，我們評估了218例ONFH患者的343個髖關(guān)節(jié)。排除創(chuàng)傷性病因、塌陷前接受過手術(shù)治療或初次就診時已塌陷的患者后，101個髖關(guān)節(jié)（男性占50%（50例），平均年齡44±15歲）符合納入標(biāo)準(zhǔn)。患者分為兩組：12個月內(nèi)發(fā)生塌陷的塌陷組（35髖）和無塌陷的非塌陷組（66髖）。兩組患者人口學(xué)特征無差異。通過CT測量PI及髖臼覆蓋參數(shù)，包括冠狀面的外側(cè)中心邊緣角（LCEA）、矢狀面的前后中心邊緣角、軸狀面的前后髖臼扇形角，并比較組間差異。分析塌陷相關(guān)參數(shù)的閾值，基于日本骨壞死研究會（JIC）分類和Steinberg分級評估壞死位置和體積與髖臼覆蓋的關(guān)系。

結(jié)果非塌陷組的平均LCEA略高于塌陷組（32°±6° vs. 28°±7°，均差4° [95%置信區(qū)間1.15°~6.46°]，p=0.005），但這一微小差異的臨床意義尚不明確。兩組PI無差異。校正性別、年齡、BMI和病因等混雜因素后，LCEA降低與塌陷風(fēng)險輕度相關(guān)（OR=1.18 [95% CI 1.06~1.33]，p=0.001），但效應(yīng)值較小且臨床意義存疑。LCEA的塌陷閾值為28°（敏感性0.79，特異性0.60，曲線下面積0.73）。LCEA<28°的比例在JIC C1型（OR=6.52 [95% CI 1.64~43.83]，p=0.006）和C2型（OR=9.84 [95% CI 2.34~68.38]，p=0.001）中顯著高于A型和B型。排除病例的髖臼覆蓋參數(shù)與納入病例無差異。

結(jié)論髖臼覆蓋與ONFH患者股骨頭塌陷的關(guān)聯(lián)性微弱。LCEA降低雖與塌陷風(fēng)險輕度相關(guān)，但臨床意義有限。需考慮髖臼覆蓋以外的因素，若結(jié)果被其他研究證實，截骨術(shù)可能無保護(hù)作用。由于本研究患者種族和BMI同質(zhì)性較高，需進(jìn)一步驗證這些因素是否影響塌陷風(fēng)險。

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

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

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

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

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

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

文獻(xiàn)出處：Iwasa M, Ando W, Uemura K, Hamada H, Takao M, Sugano N. Is There an Association Between Femoral Head Collapse and Acetabular Coverage in Patients With Osteonecrosis? Clin Orthop Relat Res. 2023 Jan 1;481(1):51-59. doi: 10.1097/CORR.0000000000002363.

文獻(xiàn)8

臨界髖關(guān)節(jié)發(fā)育不良中髖臼覆蓋率的評估：X線是否能準(zhǔn)確評估三維覆蓋？

譯者徐子茵

簡介：髖臼前覆蓋度的評估通常通過測量前中心邊緣角（ACEA）或前壁指數(shù) （AWI）來完成。這在臨界髖關(guān)節(jié)發(fā)育不良的情況下尤其重要，因為它可能會影響治療決策。

目的：本研究的目的是探討臨界髖關(guān)節(jié)發(fā)育不良中平片影像測量與低劑量 CT 上股骨頭三維覆蓋之間的相關(guān)性。

方法：本研究納入 70 例連續(xù)臨界髖關(guān)節(jié)發(fā)育不良（LCEA 20-25°）的患者。前瞻性進(jìn)行影像學(xué)評估，指標(biāo)包括 AP 骨盆 X 光片上的 LCEA、髖臼傾斜和 AWI，以及假斜位 X 片上的 ACEA。平均 LCEA 為 22.1±1.4°，平均臼頂傾斜角為 10.3±3.3。所有患者均接受低劑量盆腔 CT 評估以進(jìn)行術(shù)前計劃。軸向髖臼覆蓋率是根據(jù) Larson 等人描述的標(biāo)準(zhǔn)化鐘面位置 [在 12：00（橫向）、1：00、2：00、3：00（前部）和 4：00 測量]計算的。統(tǒng)計分析確定了 ACEA 與軸向覆蓋率之間的相關(guān)性。

結(jié)果：組內(nèi)平均 ACEA 為 25.3±5.8° （范圍 10.1-43.9），其中 16% 為 ACEA≤20°，50% 為 ACEA≤25°。平均軸向覆蓋率為 63.5%±1.7 （12：00）、60.7%±2.2 （1：00）、50.8%±3.2 （2：00）、37.0%±3.3 （3：00）和 27.9%±3.1 （4：00）。ACEA 與 12：00 至 4：00 所有位置的覆蓋率相關(guān)性較差（范圍 –0.068-0.173）。AWI 與 3：00 （PCC 0.499）和 4：00 （PCC 0.573）的覆蓋率呈中等相關(guān)性。將髖關(guān)節(jié)與 ACEA 20° 進(jìn)行比較，12：00-4：00 任何位置的平均徑向髖臼覆蓋率均無差異（p=0.18-0.95）。將髖關(guān)節(jié)與 ACEA 25° 進(jìn)行比較，12：00-4：00 任何位置的平均髖臼覆蓋率均無差異（p=0.12-0.71）。從 12：00 到 4：00，覆蓋率正常和不足的亞組之間 AWI 無顯著差異（p=0.09-0.72）。

討論：目前的研究表明，在 12：00 至 4：00 的鐘面位置評估的 ACEA 測量與真正的股骨前頭覆蓋率相關(guān)性差。AWI 顯示 3：00-4：00 覆蓋率的中等相關(guān)性，但未能區(qū)分髖關(guān)節(jié)與正常和不足的覆蓋率。在臨界髖關(guān)節(jié)發(fā)育不良的情況下，應(yīng)通過低劑量 CT 而不是 ACEA 或 AWI 評估前側(cè)和前外側(cè)覆蓋。

ASSESSMENT OF ACETABULAR COVERAGE IN BORDERLINE ACETABULAR DYSPLASIA: ARE PLAIN RADIOGRAPHIC PARAMETERS ACCURATELY ESTIMATES OF THREE-DIMENSIONAL COVERAGE?

Introduction:Assessment of anterior acetabular coverage is commonly done with measurement of the anterior center edge angle (ACEA) or anterior wall index (AWI). This is particularly important in cases of borderline acetabular dysplasia where it may influence treatment decisions. However, the ACEA and AWI has been poorly validated.;

Purpose:The purpose of the current study was to investigate the correlation between plain radiographic measurements and three-dimensional femoral head coverage on low-dose CT in borderline acetabular dysplasia.;

Methods:Seventy consecutive hips with borderline acetabular dysplasia (LCEA 20-25°) were included in the current study. Radiographic evaluation was performed prospectively including LCEA, acetabular inclination, and AWI on AP pelvis radiographs, and ACEA on false profile radiographs. The mean LCEA was 22.1±1.4°, while the mean acetabular inclination was 10.3±3.3. All patients underwent low-dose pelvic CT assessment for preoperative planning. The radial acetabular coverage was calculated according to the standardized clock-face position [measured at 12:00 (lateral), 1:00, 2:00, 3:00 (anterior), and 4:00] as described by Larson et al. Statistical analysis determined the correlation between ACEA and radial coverage.;

Results:The mean ACEA in the group was 25.3±5.8° (range 10.1-43.9), with 16% having ACEA≤20° and 50% having ACEA≤25°. The mean radial coverages were 63.5%±1.7 (12:00), 60.7%±2.2 (1:00), 50.8%±3.2 (2:00), 37.0%±3.3 (3:00), and 27.9%±3.1 (4:00). The ACEA had poor correlation with radial coverage at all positions from 12:00 to 4:00 (range –0.068-0.173). The AWI had moderate correlation with radial coverage at 3:00 (PCC 0.499) and 4:00 (PCC 0.573). Comparing hips with an ACEA 20°, there was no difference between the mean radial acetabular coverage at any position 12:00-4:00 (p=0.18-0.95). Comparing hips with an ACEA 25°, there was no difference between the mean radial acetabular coverage at any position 12:00-4:00 (p=0.12-0.71). No significant difference in AWI was present between subgroups with normal and deficient radial coverage from 12:00 to 4:00 (p=0.09-0.72).;

Discussion:The current study demonstrates poor correlation of the ACEA measurement with true anterior femoral head coverage as evaluated at clock-face positions from 12:00 to 4:00. The AWI demonstrated moderate correlation for 3:00-4:00 coverage but fails to differentiate hips with normal and deficient coverage. In the setting of borderline acetabular dysplasia, anterior and anterolateral femoral coverage should be assessed via low-dose CT rather than ACEA or AWI.

文獻(xiàn)來源：GraesserE ,SchwabeM ,AkersS , et al.ASSESSMENT OF ACETABULAR COVERAGE IN BORDERLINE ACETABULAR DYSPLASIA: ARE PLAIN RADIOGRAPHIC PARAMETERS ACCURATELY ESTIMATES OF THREE-DIMENSIONAL COVERAGE?:[J].Orthopaedic Journal of Sports Medicine,2020,8(4suppl3):2325967120S00207-2325967120S00207.

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊

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