本期目录：

1、全膝关节置换术后使用低温加压装置促进恢复的作用

2、激素替代疗法不能消除全关节置换术后关节并发症的危险因素

3、胫骨平台无菌性松动与骨水泥厚度相关

4、全膝关节置换术的翻修原因分析

5、全髋关节置换术后股骨前倾变化如何影响股骨旋转和前偏心距

6、欧亚健康中年人群下肢扭转显著不同

7、Perthes病患者大转子阻滞术术后的影像学结果

8、骨关节炎综述

9、儿童Legg-Calve-Perthes病行股骨近端内翻截骨术后生活质量的长期改善

10、前倾髋臼周围截骨术治疗有症状的髋臼后倾

11、髋关节发育不良中髋臼覆盖特征的性别差异

第一部分：关节置换及保膝相关文献

文献1

全膝关节置换术后使用低温加压装置促进恢复的作用：一项随机对照试验

译者 张轶超

目的：本研究旨在探讨低温加压Game Ready™（GR）与常规护理方案（UC）对全膝关节置换术后早期康复的有效性。

方法：本研究前瞻性地随机选择72例全膝关节置换术患者，进行为期2周（从术后第0天开始）的GR治疗（n=36, 63.9%的女性）或冰敷UC静态加压（n=36, 45.7%的女性）治疗。术后第1、2、14天和6周记录膝关节屈伸活动度（ROM）、视觉模拟疼痛量表和肢体围度。记录了药物使用情况和住院时间。患者报告的结果评测（PROMs）包括膝关节损伤和骨关节炎疗效评分和患者满意度问卷。采用线性混合模型进行统计分析，采用Satterthwaite法进行方差表分析，并采用双尾t检验。

结果：对于任何结果间都不存在显著的以时间分组的相互影响。在2周时GR组有19%失去随访，而UC组有8%。与UC组相比，GR组在第1天（p=0.048）和第14天（p=0.007）在膝关节伸直度数上表现出明显更好的结果。在疼痛、关节屈曲角度、肢体围度、阿片类药物使用或PROMs方面没有观察到组间差异。总体而言，疼痛程度越高导致阿片类药物摄入量增加（p=0.002），老年患者使用阿片类药物明显更少（p<0.001），男性报告的疼痛明显少于女性（p=0.048）。两种方案均未观察到不良反应。

结论：尽管在最初的两周干预期内，与UC相比，使用GR的患者具有更好的膝关节伸直度数，但这种影响可能是偶然的。在干预期间或结束后，两组之间没有观察到更多方面的显著差异。

图. GRPro® 2.1 系统，用于膝关节术后康复。

The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial

Purpose：The study sought to investigate the efectiveness of a cryocompression Game Ready™ (GR) versus usual care protocol (UC) on early post-operative recovery following total knee arthroplasty.

Methods：This study prospectively randomised 72 total knee arthroplasties to a 2-week (from day 0) intervention of GR treatment (n=36, 63.9% females) or UC of ice with static compression (n=36, 45.7% females). Knee fexion and extension range of motion (ROM), a visual analogue pain scale and limb circumference were documented at day 1, 2 and 14, as well as 6 weeks post-surgery. Medication usage and length of hospital stay were documented. Patient-reported outcome measures (PROMs) included the Knee Injury and Osteoarthritis Outcome Score and a Patient Satisfaction Questionnaire. Statistical analysis using linear mixed modelling and analysis of variance table with Satterthwaite's method were used along with two-tailed t-tests.

Results：There were no signifcant group-by-time interactions regarding any of the outcomes. The GR group had 19% lost to follow-up at 2 weeks, while the UC group had 8%. The GR group demonstrated signifcantly better knee extension ROM at day 1 (p=0.048) and day 14 (p=0.007) compared with the UC group. There were no group diferences (n.s.) observed in pain, fexion ROM, limb circumference, opioid use or PROMs. Overall, higher pain levels resulted in increased opioid intake (p=0.002), older patients used signifcantly less opioids (p<0.001) and males reported signifcantly less pain than females (p=0.048). No adverse efects were observed due to either protocol.

Conclusion：Despite patients gaining signifcantly more knee extension during the initial two-week intervention period when using GR compared to UC, this efect was likely due to chance. No further signifcant diferences were observed between the groups during or after cession of the intervention.

文献出处：Marinova M, Sundaram A, Holtham K, Ebert JR, Wysocki D, Meyerkort D, Radic R. The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4422-4429. doi: 10.1007/s00167-023-07455-3. Epub 2023 Jul 18. PMID: 37464101; PMCID: PMC10471706.

文献2

激素替代疗法不能消除全关节置换术后关节并发症的危险因素

译者 马云青

摘要：年龄增长会导致睾丸激素和雌激素的减少，这与骨密度的降低有关。激素替代疗法及其对关节成形术结果的影响尚不清楚。本研究旨在分析睾酮替代疗法 (TRT) 和雌激素替代疗法 (ERT) 对全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 的内科和关节置换术后疗效的影响。使用 PearlDiver 数据库进行回顾性队列研究。围手术期接受 TRT 或 ERT 的患者与对照组相匹配。询问 90 天内科并发症和 2 年关节并发症的发生率。与对照组相比，接受 TRT 的患者在 THA 后 2 年内翻修，假体周围感染和合并关节并发症的风险增加，败血症和无菌性翻修以及 TKA 后无菌性松动的发生率增加。接受 ERT 治疗的患者在全髋关节置换术后 2 年内无菌性松动和合并关节并发症的发生率增加，全因翻修和合并关节并发症的发生率增加。接受 TRT 治疗的患者显示出更高的翻修率和 PJI 发生率。接受围手术期 ERT 治疗的患者翻修率和关节感染的风险明显增加。

Hormone Replacement Therapy Does Not Eliminate Risk Factors for Joint Complications following Total Joint Arthroplasty: A Matched Cohort Study

Aging causes a reduction in testosterone and estrogen, which is linked to diminished bone mineral density. Hormone replacement therapy and its effect on the outcome of joint arthroplasties is unclear. The purpose of this study was to analyze the impact of testosterone replacement therapy (TRT) and estrogen replacement therapy (ERT) on the medical and joint outcomes of total hip (THA) and total knee arthroplasties (TKA). A retrospective cohort study was conducted using the PearlDiver database. Patients who received TRT or ERT perioperatively were matched to controls. Rates of 90-day medical complications and 2-year joint complications were queried. Patients who received TRT had an increased risk of revision, periprosthetic joint infection, and pooled joint complications within 2 years following a THA and increased rates of septic and aseptic revisions, and aseptic loosening after TKA compared to the control cohort. Patients receiving ERT had increased rates of aseptic loosening and pooled joint complications within 2 years following THA and increased rates of all-cause revisions and pooled joint complications after TKA. Patients who received TRT demonstrated significantly higher rates of revision rates and PJI. Patients who received perioperative ERT were significantly more likely to have increased risks of revision rates and joint infections.

文献出处：Collins LK, Cole MW, Waters TL, Iloanya M, Massey PA, Sherman WF. Hormone Replacement Therapy Does Not Eliminate Risk Factors for Joint Complications following Total Joint Arthroplasty: A Matched Cohort Study. Pathophysiology. 2023 Apr 4;30(2):123-135. doi: 10.3390/pathophysiology30020011. PMID: 37092525; PMCID: PMC10123744.

文献3

胫骨平台无菌性松动与骨水泥厚度相关

译者 张蔷

背景：全膝关节置换（TKA）的骨水泥技术对于达成牢固固定和假体长期生存至关重要。胫骨-假体界面的骨水泥厚度可能与胫骨侧无菌性松动相关。然而，迄今为止，没有一篇文章明确证实骨水泥厚度与胫骨侧无菌性松动率的直接相关性。

方法：我们回顾性选择了某医疗中心2013年-2021年间共28327例至少包含两年随访结果的骨水泥型初次全膝关节置换手术病例。共有115例因胫骨侧无菌性松动接受了翻修手术。其中23例因松动相关原因而假体召回的病例被排除后，剩余92例胫骨侧无菌性松动病例，我们按照2:1的比例匹配了没有胫骨侧松动的对照组。最终，我们挑选两位独立观察员在术后平片上沿骨-假体界面的10个不同位点分别测量骨水泥厚度，并应用独立t检验分析了所有采集的测量数据。

正位和侧位上各5个不同位置的骨水泥厚度测量点

结果：使用A假体（施乐辉Legion，n=75）并出现胫骨侧无菌性松动病例的骨水泥厚度在10个位点均显著低于对照组。使用B假体（史赛克Triathlon，n=17）并出现胫骨侧无菌性松动病例的骨水泥厚度也在所有位点均低于对照组，但只在背托内、龙骨内、龙骨外、龙骨前和背托后这几个位点存在显著性差异。

结论：在两种广泛应用的全膝关节假体上我们发现，与未出现松动的对照组相比，存在胫骨侧无菌性松动病例的骨-假体界面骨水泥厚度明显更薄。我们在未来需要进行更多研究来确定最佳的龙骨设计以及最薄的可接受骨水泥厚度，以避免可能出现的假体松动情况。

Aseptic Tibial Loosening is Associated with Thickness of the Cement

A Radiographic Case-Control Study

Background: The cementation technique is crucial for achieving adequate fixation and optimal survivorship in total knee arthroplasty (TKA). The thickness of the cement at the tibial bone implant surface may be related to aseptic tibial loosening. However, to date, no studies have demonstrated a direct association between cement thickness and rates of aseptic tibial loosening.

Methods: We performed a retrospective review to identify 28,327 primary cemented TKAs with at least two years of follow-up at an academic health system from 2013 to 2021. A total of 115 cases underwent revision surgery for aseptic tibial loosening. Cases where the implant was recalled specifically for loosening (n = 23) were excluded. The remaining 92 aseptic tibial loosening cases were 2:1 propensity score matched and implant-matched to control patients who did not have tibial loosening. There were two independent reviewers who then measured the thickness of the cement interface in ten locations along the bone-implant interface from initial postoperative radiographs. The averages of the reviewers’ measurements were calculated and then compared using independent t-tests.

Results: Aseptic tibial loosening cases involving implant A tibial baseplate (n = 75) had significantly thinner cement interfaces than matched controls at all ten locations measured. Aseptic loosening cases involving implant B (n = 17) also displayed a thinner cement interface than matched controls in all locations, but this result was only statistically significant at the medial baseplate, medial keel, lateral keel, anterior keel, and posterior baseplate.

Conclusion: In two widely used TKA systems, tibial aseptic loosening was associated with significantly thinner cement interfaces when compared to propensity-matched controls in two different implant types. Further prospective studies are needed to identify the optimal keel preparation and design as well as minimal cement interface thickness to avoid implant loosening.

文献4

全膝关节置换术的翻修原因分析

译者 沈松坡

背景：在许多国家，全膝关节翻修术（TKA）的数量正在增加。本研究旨在前瞻性评估导致TKA翻修的原因，并将这些原因与以前发布的数据进行比较。

方法：本研究前瞻性纳入了2010至2015年间进行TKA翻修术的患者。翻修原因通过患者的所有可用记录信息进行分类，包括术前诊断、术中发现以及假体周围组织分析的结果。根据以往的研究，患者分为早期翻修（2年内）和晚期翻修（2年以上）。此外，还包括已经进行过TKA翻修术的再次翻修病例。

结果：我们评估了312名患者，他们共进行了402次TKA翻修，其中89.6%的患者是由于转诊到我们的中心进行翻修手术。在289名患者（71.9%）中，这是首次进行的翻修手术。首次翻修手术中，大多数为晚期翻修（73.7%）。113名患者（28.1%）已经进行过一次或多次翻修手术。总体而言，翻修最常见的原因是感染（36.1%），其次是无菌性松动（21.9%）和假体周围骨折（13.7%）。

结论：在专业的关节置换中心，假体周围关节感染（PJI）是最常见的TKA翻修和再翻修的原因。这与基于人口的登记数据相反，并且对这些中心的成本和成功率具有重要影响。

Analysis of Total Knee Arthroplasty revision causes

Background: The number of revision Total Knee Arthroplasty (TKA) is rising in many countries. The aim of this study was the prospective assessment of the underlying causes leading to revision TKA in a tertiary care hospital and the comparison of those reasons with previously published data.

Methods: In this study patients who had revision TKA between 2010 and 2015 were prospectively included. Revision causes were categorized using all available information from patients' records including preoperative diagnostics, intraoperative findings as well as the results of the periprosthetic tissue analysis. According to previous studies patients were divided into early (up to 2 years) and late revision (more than 2 years). Additional also re-revisions after already performed revision TKA were included.

Results: We assessed 312 patients who underwent 402 revision TKA, 89.6% of them were referred to our center for revision surgery. In 289 patients (71.9%) this was the first revision surgery after primary TKA. Among the first revisions the majority was late revisions (73.7%). One hundred thirteen patients (28.1%) had already had one or more revision surgeries before. Overall, the most frequent reason for revision was infection (36.1%) followed by aseptic loosening (21.9%) and periprosthetic fracture (13.7%).

Conclusions: In a specialized arthroplasty center periprosthetic joint infection (PJI) was the most common reason for revision and re-revision TKA. This is in contrast to population-based registry data and has consequences on costs as well as on success rates in such centers.

文献5

全髋关节置换术后股骨前倾变化如何影响股骨旋转和前偏心距

译者 邱兴

背景：股骨前倾角变化对全髋关节置换术（THA）后股骨旋转及前偏心距影响尚未得到充分研究。因此，本研究探讨了THA术前术后股骨前倾角、前偏心距与股骨旋转之间关系。

方法：995例接受分阶段行双侧初次THA患者，在每次THA术前均按照标准化方案接受仰卧位计算机断层扫描（CT）用于手术规划。分别在首次手术髋关节的术前（首次CT）和术后（第二次CT）测量以下参数：股骨解剖前倾角（定义为股骨颈或假体颈轴与后髁轴之间的夹角）、股骨旋转（定义为后髁轴相对于CT冠状面的角度）以及股骨前偏心距（定义为股骨头中心到包含股骨内侧髁、外侧髁和梨状窝和梨状窝的股骨平面的最短距离）。两次CT扫描的平均间隔时间为11个月（范围2-44个月）。使用线性回归（β=斜率）和Pearson相关系数（r）描述变量间关联，并通过t分布检验相关性。

结果：术前（β=0.565，r=0.914，P<0.001）和术后（β=0.671，r=0.958，P<0.001），股骨前倾角均与前偏心距显著相关；术前（β=0.623，r=0.575，P<0.001）和术后（β=0.459，r=0.517，P<0.001），股骨前倾角亦与股骨旋转显著相关。前倾角从术前到术后的增加会导致前偏心距增加（β=0.621，r=0.908，P<0.001）和股骨内旋（IR）增加（β=0.241，r=0.273，P<0.001）。前倾角增加>20°的患者（平均增加26°，范围20-40.5°，n=71），其股骨内旋平均增加9.6±9.8°。

结论：增加股骨前倾角会增大前偏心距并增加股骨内旋，平均每增加4°前倾角，内旋约增加1°。外科医生在THA规划时应充分重视调整前倾角对术后效果的影响。

图1. (A) 股骨前倾角的测量方法：术前（左图）与术后（右图）均通过连接股骨头中心与股骨颈中心的轴线（头颈轴线）与后髁轴之间的夹角进行测量。(B) 股骨旋转角的测量方法：术前（左图）与术后（右图）将CT扫描冠状面与后髁轴之间的夹角投影至（CT）横断面上进行测量。

图2：股骨前偏距（Anterior femoral offset）定义为股骨头中心至股骨内侧髁、外侧髁及梨状窝确定的股骨平面的距离。当股骨头中心位于股骨平面后方时，前侧偏移为负值。图示：(A) 术前侧位观，(B) 术前轴位观，(C) 术后轴位观。

图3.示意图展示股骨前倾角变化引起的肌肉张力平衡调节机制假设。左图：自然髋关节术前状态，前部与后部肌肉张力平衡；中图：术后股骨前倾角增加导致大转子后移，内旋肌群张力增加而外旋肌群松弛；右图：继发性股骨内旋随后发生以恢复肌肉平衡。

How Do Changes in Femoral Anteversion Impact Femoral Rotation and Anterior Offset After Total Hip Arthroplasty?

Background: The impact of femoral anteversion changes on femoral rotation and anterior offset following total hip arthroplasty (THA) has not been well studied. This study therefore investigated the relationship among femoral anteversion, anterior offset, and femoral rotation before and after THA.

Methods: There were 995 patients who had staged primary bilateral THAs who received a preoperative supine computerized axial tomography (CT) scan, following a standardized protocol, for surgical planning prior to each THA. The following measurements were performed for the first operative hip preoperatively and postoperatively on the first and second CT scans, respectively: femoral anatomic anteversion, defined as the angle between the native femoral neck or stem neck axis and the posterior condylar axis; femoral rotation, defined as the angle of the posterior condylar axis relative to the coronal plane of the CT; and femoral anterior offset, defined as the shortest distance between the femoral head center and a femoral plane containing the epicondyles and the piriformis fossa. The mean time between imagings was 11 months (range, 2 to 44). Associations are described using linear regression (β = slope) and Pearson correlation (r) coefficients. A t distribution was used for testing correlation.

Results: Femoral anteversion correlated with femoral anterior offset preoperatively (β = 0.565, r = 0.914, P < 0.001) and postoperatively (β = 0.671, r = 0.958, P < 0.001), and with femoral rotation preoperatively (β = 0.623, r = 0.575, P < 0.001) and postoperatively (β = 0.459, r = 0.517, P < 0.001). Increasing anteversion from preoperatively to postoperatively increased anterior offset (β = 0.621, r = 0.908, P < 0.001) and femoral internal rotation (IR) (β = 0.241, r = 0.273, P < 0.001). Patients who had >20° increase in anteversion (mean increase 26°, range 20 to 40.5°, n = 71) had a mean increase in femoral IR of 9.6 ± 9.8°.

Conclusions: Increasing femoral anteversion increases anterior offset and IR of the femur, with approximately a 1° increase in IR for every 4° increase in anteversion on average. Surgeons should appreciate the implications of changing anteversion during THA planning.

Keywords: femoral anteversion; femoral offset; femoral rotation; hip biomechanics; prosthetic alignment.

文献出处：Dennis D A , Bryman J A , Smith G H ,et al. How Do Changes in Femoral Anteversion Impact Femoral Rotation and Anterior Offset After Total Hip Arthroplasty? The Journal of Arthroplasty[2025-02-16].DOI:10.1016/j.arth.2024.07.027.

第二部分：保髋相关文献

文献1

欧亚健康中年人群下肢扭转显著不同

译者 罗殿中

目的：目前缺乏一种可靠的测量下肢扭转力线的方法。已经发表的文献中，下肢扭转的正常值也缺乏一致性。采用3D-CT对健康人进行测量，并针对不同人口学指标确定其股骨颈扭转角（FNV）和胫骨扭转角（TT）。本研究的目的：1）确定下肢扭转力线的正常值；2）明确正常人群下肢扭转畸形个体自身、与个体间的差异。假定情况是：股骨颈扭转角（FNV）和胫骨扭转角（TT）受性别、年龄、种族等个体特征影响，而左右侧别差别不大。

方法：191例成人健康个体采用3D-CT检查后，自动检测其下肢扭转相关骨性标志。股骨颈扭转角（FNV）是指股骨颈轴线与股骨后髁连线之间的夹角；胫骨扭转角（TT）是指胫骨平台轴线与踝关节轴线之间的夹角。对于胫骨平台轴线有两种测量方法：一是胫骨平台内髁和外髁最突出点的连线（方法1，TT1），二是胫骨平台内髁和外髁后缘连线（方法2，TT2）；对于踝关节轴线，定义为内踝和外踝之间的连线。上述参考线均为自动测量。并对每个个体的性别、年龄、种族、和BMI进行记录。P<0.05视为存在显著统计学差异。

结果：整体结果来看，平均FNV为15.3±9.5°，平均TT为31.6±6.3°。女性髋关节较男性前倾角更大。高加索人髋关节前倾角较亚洲人更小，但胫骨外旋角更大。年龄和BMI对下肢扭转解剖指标没有影响。值得注意的是同一个体左右侧下肢力线存在差异，FNV平均相差6.3°（绝对差值AD），不对称比例为47%（As%）；TT1的AD为3°，As%为12%；TT2的AD为4.9°，As%为9%（P=0.008）。

结论：该研究发现下肢扭转指标患者与患者之间、同一患者左右腿之间的差异很大。对健康人群股骨扭转角和胫骨外旋角的正常值理解，可帮助外科医生对病理性FNV和TT的确定，对下肢扭转畸形的矫正同样有帮助。

图1. 股骨前倾/扭转角测量。采用此前标记的内外髁最后面骨性标志，后髁连线作为后髁轴线（PCA），PCA与股骨颈轴线投射在轴位面上，期间的夹角为股骨扭转角（FNV）。

图2. 胫骨扭转角测量。胫骨近端轴线有两种测量方法，TT1是胫骨内外侧平台最外侧点之间的连线，TT2是胫骨内外侧平台后侧缘之间的连线。踝关节轴线为内外踝之间的连线。期间的夹角为胫骨扭转角（TT）。

表1. 下肢扭转力线与性别，P值采用Student t检验

CI，confident interval,置信区间；SD，standard deviation, 标准差；n.s. 没有显著差异

表2. 下肢扭转力线与种族，P值采用Student t检验

CI，confident interval,置信区间；SD，standard deviation, 标准差

Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion

Purpose:There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals' lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.

Methods:Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.

Results:Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).

Conclusion:The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.

文献出处：Mathon P, Micicoi G, Seil R, Kacaoglu B, Cerciello S, Ahmad F, LiArno S, Teitge R, Ollivier M. Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion. Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1083-1089. doi: 10.1007/s00167-020-06096-0. Epub 2020 Jun 16. PMID: 32548676.

文献2

Perthes病患者大转子阻滞术术后的影像学结果

译者 任宁涛

目的：Legg-Calvé-Perthes病常导致大转子高位，对髋关节的生物力学产生负面影响。本研究的目的是评估大转子的生长和大转子阻滞术的放射学效果。

方法：回顾性分析46名单侧Legg-Calvé-Perthes患儿的临床资料，其中男33例，平均年龄(8±1.3)岁，行股骨大转子骨骺固定及局部骨骺融合术。通过术前和术后的骨盆x线片(平均随访3.5年)，确定大转子高度、关节大转子距离和关节中心大转子距离，并与未受影响侧进行比较。建立大转子高度、关节大转子距离和关节中心大转子距离随时间的生理发育参考值。

结果:以大转子高度衡量，大转子阻滞术使大转子生长降低29%，但仅在<8岁组有统计学意义(p = 0.02)。回归分析显示，大转子生长抑制率为0.92 mm/年。在随访期间，患侧和健侧关节大转子距离和关节中心大转子距离趋同:患侧髋关节大转子距离增加(术前:11.2±7 mm，发育成熟:18.5±10 mm;P < 0.01)，而健侧无变化(术前:19.3±5 mm，发育成熟:18±6 mm;P = 0.69)。患侧髋中心转子距离保持不变(术前:(-7.9)±7 mm，发育成熟(-7.8)±9 mm;P = 0.13)。在健侧，关节中心大转子距离变为负值(术前:0.9±6mm，发育成熟:(-6.5)±5mm;P < 0.001)。以关节大转子距离和中心大转子距离测量，31.8%的患者获得最佳结果。

结论：大转子阻滞术对抑制大转子的生长有积极的影响，从而对髋关节的解剖有积极的影响。进一步的研究必须证明这些积极的影响是否也会导致生物力学和功能上的好处。

图1 大转子高度（TH）：大转子尖和大转子最底部两个平行线之间的距离，两个平行线垂直于股骨干轴线。关节大转子距离（ATD）：大转子尖和股骨头最顶部两个平行线之间的距离，两个平行线垂直于股骨干轴线。关节中心大转子距离(CTD)：大转子尖和股骨头中心两个之间的距离，垂直于股骨干轴线。

图2 男，11岁，因LCPD行Salter截骨治疗，后行大转子阻滞术。

Radiographic outcome after greater trochanteric epiphysiodesis in patients with Perthes disease

Purpose: Legg-Calvé-Perthes disease often leads to greater trochanteric overgrowth, which negatively affects the biomechanics of the hip joint. This study aimed to evaluate the physiologic growth of the greater trochanter and the effectiveness of greater trochanteric epiphysiodesis radiographically.

Methods: Retrospectively, 46 children (33 male, average age at greater trochanteric epiphysiodesis 8 ± 1.3 years) with unilateral Legg-Calvé-Perthes disease undergoing greater trochanteric epiphysiodesis with screws and curettage of the epiphysis were included. On radiographs of the pelvis pre- and postoperatively (mean follow-up 3.5 years), trochanteric height, articulotrochanteric distance, and center-trochanter distance were determined and compared to the unaffected side. Reference values for the physiological development of trochanteric height, articulotrochanteric distance, and center-trochanter distance over time were established.

Results: Greater trochanteric epiphysiodesis reduced trochanteric growth by 29% measured by trochanteric height, but only statistically significant in the group "<8 years" (p = 0.02). Regression analysis revealed inhibition of trochanteric growth of 0.92 mm/year. Both articulotrochanteric distance and center-trochanter distance of the affected and unaffected side converged during the follow-up period: articulotrochanteric distance of the affected hip increased (preop: 11.2 ± 7 mm, maturity: 18.5 ± 10 mm; p < 0.01) compared to no change on the unaffected side (preop: 19.3 ± 5 mm, maturity: 18 ± 6 mm; p = 0.69). Center-trochanter distance of the affected hip stayed unchanged (preop: (-7.9) ± 7 mm, maturity: (-7.8) ± 9 mm; p = 0.13). On the unaffected side, center-trochanter distance became negative (preop: 0.9 ± 6 mm, maturity: (-6.5) ± 5 mm; p < 0.001). Measured by articulotrochanteric distance and center-trochanter distance, 31.8% achieved an optimal result.

Conclusion: Greater trochanteric epiphysiodesis has a positive effect on greater trochanter growth and therefore on hip anatomy. Further studies must show whether these positive effects also result in biomechanical and functional benefits.

文献出处：Osterholt AC, Bittersohl B, Westhoff B. Radiographic outcome after greater trochanteric epiphysiodesis in patients with Perthes disease. J Child Orthop. 2024 Feb 4;18(2):153-161. doi: 10.1177/18632521241228700. PMID: 38567042; PMCID: PMC10984151.

文献3

骨关节炎综述

译者 李勇

骨关节炎是一种具有异质性的全身关节疾病，其引发的疼痛是导致功能障碍和过早丧失劳动能力的主要原因。肥胖和关节损伤作为首要风险因素已获学界公认且具有可干预性。目前研究正通过深入解析包括炎症反应、代谢异常及创伤后修复在内的复杂致病机制，以及疼痛的病理生理学基础，为靶向治疗策略的制定提供理论依据。

在临床管理层面，现阶段主要采用生活方式干预措施（如自我管理方案、健康教育、体能锻炼和体重控制）来缓解疼痛和改善关节功能障碍。然而，全球范围内疾病负担居高不下的重要诱因，在于患者对现有有效治疗方案的依从性不足。对于核心治疗效果欠佳且症状持续影响生活质量的患者群体，关节置换术可作为备选治疗方案。

这种疾病所造成的负担对受影响的个人的生活质量造成重大影响。对社会而言，这种疾病是保健费用增加和就业不足的主要驱动因素。本综述基于最新循证医学证据，系统阐述该领域研究进展并剖析现存学术争议。

nature reviews：Osteoarthritis

Osteoarthritis is a heterogeneous whole-joint disease that can cause pain and is a leading cause of disability and premature work loss. The predominant disease risk factors-obesity and joint injury-are well recognized and modifiable. A greater understanding of the complex mechanisms, including inflammatory, metabolic and post-traumatic processes, that can lead to disease and of the pathophysiology of pain is helping to delineate mechanistic targets.

Currently, management is primarily focused on alleviating the main symptoms of pain and obstructed function through lifestyle interventions such as self-management programmes, education, physical activity, exercise and weight management. However, lack of adherence to known effective osteoarthritis therapeutic strategies also contributes to the high global disease burden. For those who have persistent symptoms that are compromising quality of life and have not responded adequately to core treatments, joint replacement is an option to consider.

The burden imparted by the disease causes a substantiald impact on individuals affected in terms of quality of life. For society, this disease is a substantial driver of increased health-care costs and underemployment. This Primer highlights advances and controversies in osteoarthritis, drawing key insights from the current evidence base.

文献出处：Tang S, Zhang C, Oo WM, Fu K, Risberg MA, Bierma-Zeinstra SM, Neogi T, Atukorala I, Malfait AM, Ding C, Hunter DJ. Osteoarthritis. Nat Rev Dis Primers. 2025 Feb 13;11(1):10. doi: 10.1038/s41572-025-00594-6. PMID: 39948092.

文献4

儿童Legg-Calve-Perthes病行股骨近端内翻截骨术后生活质量的长期改善

译者 张利强

背景：股骨近端内翻截骨术（PFVO）常用于改善Legg-Calve-Perthes病（LCPD）患者的股骨头包容性并减少畸形。目前关于PFVO术后对患者生活质量的影响知之甚少。本研究的目的是确定PFVO术后患者报告的身体、心理和社会健康指标的长期变化。

方法：本研究对前瞻性收集的20例接受PFVO治疗的单侧LCPD患者的患者报告结局测量信息系统（PROMIS）数据进行了回顾性分析。我们在术前及术后大约1、3、8、12和18个月收集了七项PROMIS指标（行动能力、焦虑、疲劳、抑郁症状、疼痛干扰、愤怒和同伴关系）。使用重复测量方差分析和Tukey调整的多重配对比较，对不同时间点的PROMIS评分进行了比较。使用Spearman相关性分析了术前和术后心理健康评分之间的关系。

结果：PFVO手术时的平均年龄为8.2±1.6岁。平均随访时间为17.0±2.1个月。行动能力评分在术前与术后12个月（P=0.0031）和18个月（P<0.0001）之间有显著改善。焦虑评分在术前与术后18个月之间有显著改善（P=0.0014）。疼痛干扰评分在术前与术后12个月和18个月之间有显著降低（P<0.0001）。同伴关系在术后1个月至18个月之间有显著改善（P=0.0355）。个体间也存在差异表现为一些患者的抑郁症状和焦虑评分较高。术前和术后的焦虑及抑郁症状评分之间存在中度相关性。

结论：PFVO术后，PROMIS的行动能力、焦虑、疼痛干扰和同伴关系评分均有显著改善。虽然每次随访时的平均焦虑、抑郁症状、同伴关系和愤怒评分均在正常范围内，但观察到个体间存在差异，部分患者的焦虑和抑郁症状评分较高。这些新的长期PROMIS数据将更好地为患者及其家庭提供关于PFVO术后生活质量和恢复经历的信息。

Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus Osteotomy

Background: Proximal femoral varus osteotomy (PFVO) is commonly performed to improve femoral head containment and decrease deformity in Legg-Calve-Perthes disease (LCPD). Little is known about how PFVO impacts the quality of life after surgery. The purpose of this study was to determine the longitudinal changes to patient-reported physical, mental, and social health measures after PFVO.

Methods: This is a retrospective review of prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) data from 20 patients with unilateral LCPD treated with a PFVO. We collected seven PROMIS measures (mobility, anxiety, fatigue, depressive symptoms, pain interference, anger, and peer relationships) before and approximately 1, 3, 8, 12, and 18 months after surgery. We compared PROMIS scores across different time points using repeated measures ANOVA and multiple pairwise comparisons with Tukey adjustment. The relationship between presurgery and postsurgery mental health scores was analyzed using a Spearman correlation.

Results: The mean age at PFVO was 8.2 ± 1.6 years. The mean length of follow-up was 17.0 ± 2.1 months. There was a significant improvement in the mobility score between preoperation and 12 months (P= 0.0031) and 18 months postoperation (P< 0.0001). Anxiety scores significantly improved from preoperation and 18 months postoperation (P= 0.0014). A significant reduction in the pain interference score between preoperation and 12 and 18 months postoperation (P<0.0001) was observed. Peer relationships significantly improved from one month postoperatively to 18 months postoperation (P=0.0355). Individual variations were also observed with some patients having elevated depressive symptoms and anxiety scores. Moderate correlations between preoperative and postoperative anxiety and depressive symptoms scores were observed.

Conclusions: PROMIS mobility, anxiety, pain interference, and peer relationship scores improved significantly after PFVO. While the mean anxiety, depressive symptoms, peer relationships, and anger scores were in normal ranges at each visit, individual variations with elevated anxiety and depressive symptom scores were observed. This new longitudinal PROMIS data will better inform patients and families about the quality of life and recovery experience after PFVO.

文献出处：Angel A Valencia, Dang-Huy Do, Chan-Hee Jo, Harry K W Kim; Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus OsteotomyJournal of pediatric orthopedics 2025 Jan 15; doi:10.1097/BPO.0000000000002896

文献5

前倾髋臼周围截骨术治疗有症状的髋臼后倾：10年随访的结果

译者 陶可

背景：髋臼后倾与钳夹型股骨髋臼撞击有关，可导致髋骨关节炎。我们报告了先前描述的一组患者10年后的结果，这些患者接受了矫正性髋臼周围截骨术治疗有症状的髋臼后倾。

方法：在术前以及术后2年和10年评估临床和放射学参数。对22名患者（29髋）进行了Kaplan-Meier生存率分析，平均随访期（和标准差）为11 ± 1年（范围：9至12年）。此外，还进行了单变量Cox回归分析，以转为全髋关节置换术为主要终点，以骨关节炎进展、根据Merle d'Aubigné评分为一般或较差的结果或需要进行翻修手术为次要终点。

结果：平均Merle d'Aubigné评分从术前的14 ± 1.4分（范围：12至17分）显着提高到10年时的16.9 ± 0.9分（范围：15至18分）（p < 0.001）。与术前相比，髋关节屈曲(p = 0.003)、内旋(p = 0.003)和内收(p = 0.002)也有显著改善。10年内平均Tönnis骨关节炎评分无显著增加(p = 0.06)。以转为全髋关节置换术为主要终点的累计10年生存率为100%。达到次要终点之一的累计10年生存率为71% (95%置信区间，54%至88%)。预后不良的预测因素是股骨偏心距调整不足和髋臼前倾过度矫正导致前倾过度。

结论：前倾髋臼周围截骨术治疗髋臼后倾可获得良好的长期效果，平均10年内保留原生髋关节。过度矫正导致髋关节过度前倾和忽略股骨头颈连接处随之产生的偏心距，会导致不良后果。

图 1-A、1-B和1-C 一名患有髋臼后倾的16岁女性患者。图1-A术前前后位X线片显示交叉征阳性、后壁征阳性和坐骨棘征阳性。图1-B前倾髋臼周围截骨术后拍摄的X线片。图1-C 10年后随访，Merle d’Aubign'e 评分为18分（优秀），无骨关节炎证据。

图2-A至2-D 一名患有有症状的髋臼后倾的18岁女性患者。图2-A术前X线片。图2-B前倾髋臼周围截骨术后拍摄的X线片。图2-C术后4年，患者报告髋后部疼痛。当时拍摄的X线片显示髋臼后壁相对突出，并出现双轮廓（箭头），这是后撞击的征象。图2-D X线片显示患者随后接受髋关节脱位后壁修整并在一年后取出部分螺钉后的最终结果。

Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years

Background: Acetabular retroversion is associated with pincer-type femoroacetabular impingement and can lead to hip osteoarthritis. We report the ten-year results of a previously described patient cohort that had corrective periacetabular osteotomy for the treatment of symptomatic acetabular retroversion.

Methods: Clinical and radiographic parameters were assessed preoperatively and at two and ten years postoperatively. A Kaplan-Meier survivorship analysis of the twenty-two patients (twenty-nine hips) with a mean follow-up (and standard deviation) of 11 ± 1 years (range, nine to twelve years) was performed. In addition, a univariate Cox regression analysis was done with conversion to total hip arthroplasty as the primary end point and progression of the osteoarthritis, a fair or poor result according to the Merle d'Aubigné score, or the need for revision surgery as the secondary end points.

Results: The mean Merle d'Aubigné score improved significantly from 14 ± 1.4 points (range, 12 to 17 points) preoperatively to 16.9 ± 0.9 points (range, 15 to 18 points) at ten years (p < 0.001). There were also significant improvements with regard to hip flexion (p = 0.003), internal rotation (p = 0.003), and adduction (p = 0.002) compared with the preoperative status. No significant increase of the mean Tönnis osteoarthritis score was seen at ten years (p = 0.06). The cumulative ten-year survivorship, with conversion to a total hip arthroplasty as the primary end point, was 100%. The cumulative ten-year survivorship in achievement of one of the secondary end points was 71% (95% confidence interval, 54% to 88%). Predictors for poor outcome were the lack of femoral offset creation and overcorrection of the acetabular version resulting in excessive anteversion.

Conclusions: Anteverting periacetabular osteotomy for acetabular retroversion leads to favorable long-term results with preservation of the native hip at a mean of ten years. Overcorrection resulting in excessive anteversion of the hip and omitting concomitant offset creation of the femoral head-neck junction are associated with an unfavorable outcome.

文献出处：Klaus A Siebenrock, Claudio Schaller, Moritz Tannast, Marius Keel, Lorenz Büchler. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am. 2014 Nov 5;96(21):1785-92. doi: 10.2106/JBJS.M.00842.

文献6

髋关节发育不良中髋臼覆盖特征的性别差异

译者 陈志强

背景：进行偏心髋臼旋转截骨术（ERAO）是为了预防由发育性髋关节发育不良 （DDH） 引起的骨关节炎。为了获得足够的髋臼覆盖，了解 DDH 中髋臼覆盖的特征是必要的。然而，DDH 男性髋臼覆盖的特征仍不清楚。我们认为女性和男性之间髋臼覆盖率的差异可能与不同性别骨盆形态的差异有关。

问题/目的：(1) 女性和男性 DDH 患者的髋臼覆盖率有何不同？(2) DDH 女性和男性的髂骨和坐骨的旋转有何不同？(3) DDH女性和男性的髂骨和坐骨的旋转在不同高度位置上与髋臼覆盖率之间的关系？

方法：2016年至2023年间，我院共有114名患者（138个髋关节）接受了ERAO。我们排除了Tönnis 2级或以上、LCEA为25º或以上以及骨盆或股骨畸形的患者，最终纳入了100名患者（122个髋关节）。女性患者（98 个髋关节）的年龄中位数（范围）为 40 岁（10 -58 岁），男性患者（24 个髋关节）的年龄中位数（范围）为 31 岁（14 -53 岁）。我们使用了所有患者的术前骨盆正位片和CT 数据。通过骨盆正位X光片评估了交叉征、后壁征和骨盆宽度指数。我们在两个不同的高度评估了髂骨在轴向平面的旋转情况，特别是在通过髂前上棘的平面处，以及在 CT 数据中通过耻骨联合和坐骨棘的平面处。此外，我们还评估了髋臼前后扇形角。我们还比较了每位患者中女性和男性的骨盆骨测量值和髋臼覆盖测量值的相关变量。我们分别评估了女性和男性骨盆形态测量值与髋臼覆盖率之间的相关性，然后将结果进行比较，以确定是否存在性别差异。对于连续变量，我们采用了 t 检验；对于分类变量，我们采用了Fisher精确检验。P值小于0.05被认为具有统计学意义。

结果：在评估骨盆正位X光片时，髋臼后倾的指标--交叉征在性别间没有差异，而后壁征（女性 46% [98 例中的 45 例] 髋关节与男性 75% [24 例中的 18 例] 髋关节，OR 3. 50[95%置信区间 (CI) 1.20 至 11.71]；P = 0.01）和骨盆宽度指数小于 56%（女性为 1%[98 例中的 1 例]，男性为 17%[24 例中的 4 例]，OR 18.71 [95% CI 1.74 至 958.90]；P = 0.005）的发生率男性高于女性。髂骨旋转参数没有差异，但男性的坐骨外旋更多（女性为 30° ± 2°，男性为 24° ± 1°；p < 0.001）。在髋臼覆盖方面，女性和男性的髋臼前扇形角没有差异。相反，男性的髋臼后扇形角值小于女性（85° ± 9° 对 91° ± 7°；p = 0.002）。在女性中，髂骨旋转与髋臼扇形角之间存在相关性（髋臼前扇形角：r = -0.35 [95% CI -0.05 to 0.16]；p < 0.001，髋臼后扇形角：r = 0.42 [95% CI 0.24 to 0.57]；p < 0.001）。同样，髋臼旋转也与两个髋臼扇形角相关（髋臼前扇形角：r = -0.34 [95% CI -0.51 to -0.15]；p < 0.001；髋臼后扇形角：r = 0.45 [95% CI 0.27 to 0.59]；p < 0.001）。因此，在女性中，我们观察到坐骨外旋和骶骨内旋与髋臼前部覆盖增加和后部覆盖减少相关。相反，虽然男性的髋臼覆盖率与髂骨旋转有相关性（髋臼前扇形角：r = -0.55 [95% CI -0.78 to -0.18]；p = 0.006；髋臼后扇形角：r = 0.74 [95% CI 0.48 to 0.88]；p < 0.001），但与坐骨旋转没有相关性。

结论：在男性中，髋臼后倾比女性更常见，这归因于他们的髋臼后覆盖率降低。在女性中，髋臼后覆盖率的增加与坐骨的外旋角相关，而在男性中，坐骨旋转与髋臼后覆盖之间没有相关性。在通过ERAO治疗男性 DDH 时，必须调整截骨块以防止髋臼后部覆盖不足。未来的研究可能需要研究不同下肢位置下男性和女性髋臼覆盖率的差异，并考虑截骨块旋转的方向。

临床相关性：研究结果表明，患有 DDH 的男性比女性更频繁地表现出髋臼后倾，这归因于在男性中观察到的髋臼后覆盖率低。男性髋臼后部覆盖率较小可能与性别之间坐骨形态的差异有关。在男性 DDH 患者的ERAO中，充分旋转的髋臼骨块可能有助于补偿髋臼后侧覆盖不足。

What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia?

Background:Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes.

Questions/purposes:(1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?

Methods:Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.

Results:In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation.

Conclusion:In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation.

Clinical relevance:Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.

来源：304关节学术

作者：304关节团队

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