本期目录：
1、阿司匹林与低分子肝素预防膝关节和髋关节置换术后静脉血栓栓塞的疗效
2、髌骨周围去神经术能否为不置换髌骨的同期双侧全膝关节置换术的患者减轻膝部疼痛并改善患者疗效
3、全膝关节置换术后假体周围感染会增加病死率
4、机器人辅助手术全髋关节置换术后髂骨嵴不全骨折：两例病例报告
5、患者对保髋手术的期望程度
6、髋臼周围截骨术（PAO）患者在婴儿时期接受髋关节发育不良（DDH）治疗和未治疗的髋关节形态学比较
7、股骨髋臼撞击症的开放手术治疗
8、挪威全国母亲、父亲和儿童队列研究中髋关节发育不良的流行病学
9、保髋截骨手术并发症
10、股骨头塌陷与髋臼覆盖在股骨头坏死患者中的关联性研究
11、股骨和髋臼联合前倾与性别有关，在髋关节发育不良和髋臼后倾的患者中有所不同
12、人类髋臼盂唇形态的组织病理学分析
第一部分：关节置换及保膝相关文献
文献1
阿司匹林与低分子肝素预防膝关节和髋关节置换术后静脉血栓栓塞的疗效：随机对照试验的系统回顾和荟萃分析
译者 张轶超
目的：本研究的目的是评估阿司匹林与低分子肝素（LMWH）在预防髋关节和膝关节置换术后静脉血栓栓塞（VTE）的疗效。
方法：检索PubMed/Medline、Embase、Cochrane Library和谷歌学术数据库，从建立到2024年6月，检索研究阿司匹林与低分子肝素在髋关节和膝关节置换术患者中治疗VTE疗效的原始试验。以是否出现静脉血栓栓塞为主要指标。次要指标包括小出血和大出血事件，以及90天内的术后死亡率。本综述按照系统回顾首选报告项目和Meta分析指南的要求来进行。
结果：共纳入7项随机对照试验，12134名受试者。阿司匹林组和低分子肝素组的平均年龄分别为66.6（57.6-69.0）岁和66.8（57.9-68.9）岁。阿司匹林组和低分子肝素组间的静脉血栓栓塞风险无统计学差异（优势比[OR]: 0.95； 95%可信区间[CI]: 0.48-1.89; p: 0.877）。基于特定VTE实体（肺栓塞[PE]或深静脉血栓）的亚组分析显示，服用阿司匹林的患者发生PE的风险明显高于低分子肝素组（OR: 1.79; 95% CI: 1.11-2.89; p: 0.017）。两组的轻微出血（OR: 0.64; 95% CI: 0.40-1.04; p: 0.072）和大出血（OR: 0.77; 95% CI: 0.40-1.47; p: 0.424）发生率无差异。此外，对全膝关节置换术组的亚组分析显示，阿司匹林组比低分子肝素组更容易发生静脉血栓栓塞（OR: 1.55; 95% CI: 1.21-1.98; p < 0.001）。
结论：本研究表明，骨关节炎髋关节或膝关节置换术后服用阿司匹林的患者发生PE的风险明显高于低分子肝素。特别是在接受膝关节置换术的患者中，阿司匹林与静脉血栓栓塞的总体风险显著升高有关。这可能表明阿司匹林与低分子肝素相比在预防静脉血栓栓塞方面的疗效较差。
The efficacy of aspirin versus low‐molecular‐weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta‐analysis of randomized controlled trials
Purpose: The purpose of this study was to assess the efficacy of aspirin versus low‐molecular‐weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty.
Methods: PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.
Results: A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6–69.0) years and 66.8 (57.9–68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48–1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11–2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40–1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40–1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21–1.98; p < 0.001).
Conclusion: This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures.
文献出处：Salman LA, Altahtamouni SB, Khatkar H, Al-Ani A, Hameed S, Alvand A. The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1605-1616. doi: 10.1002/ksa.12456. Epub 2024 Sep 3. PMID: 39228215; PMCID: PMC12022833.
文献2
髌骨周围去神经术能否为不置换髌骨的同期双侧全膝关节置换术的患者减轻膝部疼痛并改善患者疗效？
译者 马云青
全膝关节置换术后膝前痛的发生率为4%至49%，可能是导致患者对手术不满意的一个原因。为减少膝前痛的发生，有学者提出采用电灼法进行髌骨去神经化。然而，关于此方法的有效性，研究结果存在分歧。
作者评估了接受双侧同期TKA且未进行髌骨置换的患者，旨在探讨：(1) 与未行髌骨周围电灼相比，髌骨周围环形电灼是否能减少术后膝前痛？(2) 与未行电灼相比，髌骨周围环形电灼是否能基于患者报告结果而获得更好的功能结局？(3) 电灼组与未电灼组在并发症发生率上是否存在差异？
通过前瞻性、准随机研究纳入了78名患者，每位患者自身作为对照。在同期双侧TKA中，右侧膝关节进行髌骨周围电灼。有5名患者在术后2年最低随访期前失访。所有TKA均由同一位外科医生使用同类型假体完成，所有髌骨均切除骨赘且未进行表面置换。髌骨电灼深度为2-3毫米，距离髌骨边缘约5毫米环形进行。测量了术前股胫角和骨关节炎程度。使用前髁比值评估髌股关节的恢复情况。在术前、术后1个月和术后2年评估临床结局。术前，两组在放射学骨关节炎严重程度、基线疼痛和膝关节评分方面均无差异。两组的平均股胫角也具有可比性。术前和术后的前髁比值在两组间也无差异。
在2年随访时，两组平均Kujala评分无差异。平均VAS疼痛评分在电灼膝和未电灼膝之间无差异。平均活动度在两组间无差异。在症状、疼痛、日常活动、体育运动、生活质量以及牛津膝关节评分方面，两组间均无差异。并发症不常见，且两组间无差异。
作者得出结论：对于接受未置换髌骨、同期双侧初次TKA且至少随访2年的患者，与未行髌骨周围电灼相比，环髌骨周围电灼在膝前痛、功能结局和并发症发生率方面均未带来差异。不建议在接受TKA且未行髌骨置换的患者中常规进行环形电灼。
Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA?
Background:Anterior knee pain, which has a prevalence of 4% to 49% after TKA, may be a cause of patient dissatisfaction after TKA. To limit the occurrence of anterior knee pain, patellar denervation with electrocautery has been proposed. However, studies have disagreed as to the efficacy of this procedure.Questions/purposes We evaluated patients undergoing bilateral, simultaneous TKA procedures without patellar resurfacing to ask: (1) Does circumferential patellar cauterization decrease anterior knee pain (Kujala score) postoperatively compared with non-cauterization of the patella? (2) Does circumferential patellar cauterization result in better functional outcomes based on patient report (VAS score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score) than non-cauterization of the patella? (3) Is there any difference in the complication rate (infection, patellar maltracking, fracture, venous thromboembolism, or reoperation rate) between cauterized patellae and non-cauterized patellae?
Methods:Seventy-eight patients (156 knees) were included in this prospective, quasi-randomized study, with each patient serving as his or her own control. Patellar cauterization was always performed on the right knee during simultaneous, bilateral TKA. Five patients (6%) were lost to follow-up before the 2-year minimum follow-up interval. A single surgeon performed all TKAs using the same type of implant, and osteophyte excision was performed in all patellae, which were left unresurfaced. Patellar cauterization was performed at 2 mm to 3 mm deep and approximately 5 mm circumferentially away from the patellar rim. The preoperative femorotibial angle and degree of osteoarthritis (according to the Kellgren-Lawrence grading system) were measured. Restoration of the patellofemoral joint was assessed using the anterior condylar ratio. Clinical outcomes, consisting of clinician-reported outcomes (ROM and Kujala score) and patient-reported outcomes (VAS pain score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score), were evaluated preoperatively and at 1 month and 2 years postoperatively. Preoperatively, the radiologic severity of osteoarthritis, based on the Kellgren-Lawrence classification, was not different between the two groups, nor were the baseline pain and knee scores. The mean femorotibial angle of the two groups was also comparable: 189° ± 4.9° and 191° ± 6.3° preoperatively (p = 0.051) and 177° ± 2.9° and 178° ± 2.1° postoperatively (p = 0.751) for cauterized and non-cauterized knees, respectively. The preoperative (0.3 ± 0.06 versus 0.3 ± 0.07; p = 0.744) and postoperative (0.3 ± 0.06 versus 0.2 ± 0.07; p = 0.192) anterior condylar ratios were also not different between the cauterized and non-cauterized groups.
Results:At the 2-year follow-up interval, no difference was observed in the mean Kujala score (82 ± 2.9 and 83 ± 2.6 for cauterized and non-cauterized knees, respectively; mean difference 0.3; 95% confidence interval, -0.599 to 1.202; p = 0.509). The mean VAS pain score was 3 ± 0.9 in the cauterized knee and 3 ± 0.7 in the non-cauterized knee (p = 0.920). The mean ROM was 123° ± 10.8° in the cauterized knee and 123° ± 10.2° in the non-cauterized knee (p = 0.783). There was no difference between cauterized and non-cauterized patellae in the mean Knee Injury and Osteoarthritis Outcome Score for symptoms (86 ± 4.5 versus 86 ± 3.9; p = 0.884), pain (86 ± 3.8 versus 86 ± 3.6; p = 0.905), activities (83 ± 3.2 versus 83 ± 2.8; p = 0.967), sports (42 ± 11.3 versus 43 ± 11.4; p = 0.942), and quality of life (83 ± 4.9 versus 83 ± 4.7; p = 0.916), as well as in the Oxford knee score (40 ± 2.1 versus 41 ± 1.9; p = 0.771). Complications were uncommon and there were no differences between the groups (one deep venous thromboembolism in the cauterized group and two in the control group; odds ratio 0.49, 95% CI, 0.04-5.56; p = 0.57).
Conclusions:Patellar cauterization results in no difference in anterior knee pain, functional outcomes, and complication rates compared with non-cauterization of the patella in patients who undergo non-resurfaced, simultaneous, bilateral, primary TKA with a minimum of 2 years of follow-up. We do not recommend circumferential patellar cauterization in non-resurfaced patellae in patients who undergo TKA.
文献出处：Budhiparama NC, Hidayat H, Novito K, Utomo DN, Lumban-Gaol I, Nelissen RGHH. Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA? Clin Orthop Relat Res. 2020 Sep;478(9):2020-2033. doi: 10.1097/CORR.0000000000001035. PMID: 32023234; PMCID: PMC7431264.
文献3
全膝关节置换术后假体周围感染会增加病死率
一项全国范围的包含916例的队列研究
译者 张蔷
背景：全膝关节置换（TKA）术后出现的假体周围感染（PJI）是一种有增加患者病死率潜在风险的严重并发症。我们通过一组全国范围内验证的队列研究来对比PJI翻修和无菌性翻修的病死率。
方法：我们的数据选自丹麦膝关节置换登记库和丹麦微生物学登记库。我们选择了2010年1月1日至2023年11月9日间所有PJI翻修的病例并与相同时间区间内的无菌性翻修病例作对比。随访截止时间为2024年4月4日。病死率通过Kaplan-Meier曲线来计算。风险概率比通过治疗加权逆概率法得出并比较PJI和无菌性翻修的病死率。加权中的其他因素还包括年龄、性别、体重、Charlson合并症指数以及婚姻状态。估算值通过95%置信区间计算。最终入组了916例PJI翻修病例和4129例无菌性翻修病例。PJI翻修组的平均随访时间为7.0年而无菌性翻修组的平均随访时间为7.3年。PJI翻修组的病例比无菌性翻修组的病例年龄更大，男性比例更高，更为肥胖且合并症更多。
结果：PJI翻修组的粗略病死率为5.7人/100人-年，无菌性翻修组的粗略病死率为2.4人/100人-年。匹配后的Kaplan-Meier 10年累计病死率为PJI翻修组36%和无菌性翻修组24%。Cox比例风险分析显示PJI相关的病死率风险概率比为1.48（CI: 1.26 - 1.74, P < 0.001）。
结论：与无菌性翻修相比，全膝关节置换术后假体周围感染翻修与更高的病死率显著相关。
Increased Mortality Following Periprosthetic Joint Infection After Total Knee Arthroplasty
A Microbiologically Verified Nationwide Cohort of 916 Cases
Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication with potential implications for patient mortality. We assessed mortality associated with PJI revisions compared to major aseptic revisions using a microbiologically verified, population-based, nationwide cohort.
Methods: We used data from the Danish Knee Arthroplasty Register and the Danish Microbiology Database. We included patients who underwent PJI revisions between January 1, 2010, and November 9, 2023, and compared them with patients undergoing major aseptic revisions in the same period. The follow-up period was until April 4, 2024. Mortality was calculated using the Kaplan-Meier method. The inverse probability of treatment weighting method was utilized to calculate adjusted hazard ratios with 95% confidence intervals (CIs) comparing PJI and aseptic revisions in terms of mortality. Confounders included in the weighting were age, sex, weight, Charlson Comorbidity Index, and marital status. Estimates were reported with 95% CIs. We identified 916 PJI revisions and 4,129 major aseptic revisions following primary TKA. The mean follow-up time was 7.0 years for PJI revisions and 7.3 years for aseptic revisions. Patients undergoing PJI revisions had a higher proportion of men, older age, greater prevalence of obesity, and higher comorbidity compared to those who had aseptic revisions.
Results: The PJI revisions had a crude mortality rate of 5.7 deaths per 100 person-year, and major aseptic revisions had a crude mortality rate of 2.4 deaths per 100 person-year. The adjusted Kaplan-Meier 10-year cumulative mortality was 36% for PJI and 24% for aseptic revisions. Cox proportional hazards analysis demonstrated an adjusted hazard ratio of 1.48 (CI: 1.26 to 1.74, P < 0.001), for PJI-associated mortality.
Conclusions: A PJI following TKA was associated with a significantly higher mortality risk compared to major aseptic revisions.
文献4
机器人辅助手术全髋关节置换术后髂骨嵴不全骨折：两例病例报告
译者 沈松坡
在机器人辅助手术全髋关节置换术（THA）过程中插入骨针后发生髂骨嵴不全骨折的风险尚不明确，因为关于此类并发症的报道极少。在此，我们报告了两例使用 Mako 系统（Stryker Orthopaedics，美国新泽西 Mahwah）进行机器人辅助手术 THA 后出现对侧髂骨嵴不全骨折的病例。两名患者均采用前外侧仰卧入路行左侧 THA，并在右侧髂骨嵴插入三枚螺纹骨针（直径 4.0 mm）用于固定骨盆阵列。在病例一中，三枚骨针均获得了双皮质固定。在病例二中，一枚骨针表现为对髂骨外侧皮质的长距离跨皮质固定，另一枚插入软组织，第三枚为单皮质固定。术后，两名患者均无疼痛及影像学骨折证据而出院；然而在术后约四周于无外伤情况下出现对侧髂骨疼痛。通过普通 X 线证实髂骨嵴骨针插入部位的不全骨折。在采用 T 形手杖步行且无负重限制的保守治疗下，两病例均于三至六个月内观察到骨愈合。这些病例提示，双皮质或跨皮质方式固定的髂骨嵴骨针均可能导致髂骨的骨量不足性骨折。本报告强调需要提高对机器人辅助手术 THA 中与骨针插入相关的不全骨折的认识。
关键词：髂骨翼；不全骨折；MAKO；机器人辅助手术；应力骨折；全髋关节置换
图1 病例一术前与术后 X 线片。A：术前骨盆 X 线，诊断为左侧股骨头坏死；B：术后一周的 X 线片；C：术后四周的 X 线显示右侧髂骨嵴应力性骨折；D：来自 C 图的右侧髂骨放大图。白色箭头指示髂骨嵴骨折线。E：术后三个月的 X 线显示髂骨嵴骨折轻度移位并已骨愈合。
图 2：病例一术后 3D 图像。A：术后一周的骨盆 3D 图像。黄色箭头指示髂骨嵴处的骨针孔。B：术后四周的骨盆 3D 图像。C：术后一周的骨盆侧位图像。黄色箭头指示髂骨外侧皮质上的骨针孔。D：术后一周的骨盆侧位图像，覆盖了由蓝线标示的骨针插入点位置；E：术后四周的骨盆侧位图像。骨折线穿过髂骨外侧皮质的三枚骨针孔。
图 3：病例二术前与术后 X 线片。A：术前骨盆 X 线显示左侧髋关节骨关节炎；B：术后 1 周 X 线片；C：术后三个月的 X 线显示右侧髂骨嵴应力性骨折；D：来自 C 图的右侧髂骨放大图。白色箭头指示髂骨嵴骨折线。E：术后六个月的 X 线显示髂骨嵴骨折无移位且已骨愈合。
图 4：病例二术后 3D 与 CT 图像。A：术后一周的骨盆 3D 图像。黄色箭头指示两枚骨针的插入部位。B：术后六个月的骨盆 3D 图像显示髂骨内侧皮质骨层已骨愈合且无移位。C：术后一周在远端骨针孔水平的骨盆轴位 CT 显示穿过髂骨外侧皮质的长距离跨皮质固定。D：术后一周骨盆 3D 侧位图像显示髂骨外侧皮质未见骨针孔。E：术后一周的骨盆侧位图像，上覆蓝线显示骨针插入位置。F：术后六个月的骨盆侧位图像。骨折线沿跨皮质固定线路延伸。G：术后六周在远端骨针孔水平的骨盆轴位 CT 显示髂骨已骨愈合。
图 5：上方的骨针代表用于 CT 导航的骨针，下方的骨针代表用于 Mako 的骨针。用于 Mako 的骨针比用于 CT 导航的骨针具有更长的螺纹部分以及更大的螺纹间距。
Insufficiency Fractures of the Iliac Crest Following Robot-Assisted Total Hip Arthroplasty: A Report of Two Cases
The risk of insufficiency fractures at the iliac crest following pin insertion during robot-assisted total hip arthroplasty (THA) is unknown, as there have been very few reports on this complication. Here, we report two cases of insufficiency fractures of the contralateral iliac crest following robot-assisted THA using the Mako system (Stryker Orthopaedics, Mahwah, NJ, USA). Both patients underwent left THA using the anterolateral supine approach, and three threaded bone pins (4.0 mm diameter) were inserted into the right iliac crest for pelvic array fixation. In case one, all three pins achieved bicortical fixation. In case two, one pin demonstrated long transcortical fixation with the outer cortex of the ilium, another was inserted into soft tissue, and the third pin was fixed monocortically. Postoperatively, both patients were discharged without pain or radiographic evidence of fracture; however, contralateral iliac pain developed approximately four weeks postoperatively without trauma. Insufficiency fractures of the iliac crest at the pin insertion sites were confirmed by plain radiography. Bone union was observed within three to six months of conservative treatment in both cases, with T-cane ambulation and no weight-bearing restrictions. These cases suggest that both bicortical and transcortical pin fixation to the iliac crest may cause insufficiency fractures of the iliac bone. This report highlights the need for increasing awareness of insufficiency fractures associated with pin insertion in robot-assisted THA.
Keywords: iliac crest; insufficiency fractures; mako; robot-assisted surgery; stress-fracture; total hip arthroplasty
第二部分：保髋相关文献
文献1
患者对保髋手术的期望程度
译者 张振东
目的：本研究对大样本保髋手术尚的患者期望值进行调查，以确定其对手术期望值的分布情况，并明确不同人口统计学资料或临床特征患者期望程度的差异。
方法：连续纳入年龄≥18岁且母语为英语的患者，并排除既往髋关节手术史或骨关节炎分级Tönnis≥2的患者。 患者共完成了21个项目的调查，确定了每个项目的单项期望值及总体期望值，以及国际髋关节结局工具评分( International Hip Outcome Tool，iHOT)。 通过多变量回归方法进行统计学分析。并分别对患者不同受教育程度、专业、从事竞技活动以及平时体育水平进行亚组分析。
结果：共纳入患者320例，平均年龄32岁; 髋关节撞击征270例(89%)，症状<6个月72例(24%)，平均iHOT评分41分。 所有21个调查项目均完成选择的有120例患者(40%)，选择18 ~ 20个项目的有112例(37%)，选择数目≤17个的有70例(23%)。 在多变量分析中，年龄年轻(比值比[OR] = 1.3; P = .02)、症状<6个月(OR = 1.3; P = .03)以及iHOT评分较差(OR = 2.5; P = .0001)与保髋期望值高相关。另外，平均期望值总分为80分(范围31-100分)，同样，在多变量分析中，年龄年轻(P = .05)、症状<6个月(P = .01)和iHOT评分低(P = .03)与期望值得分高相关。大学生学历或职业运动员选择所期望的调查条目更多(P = .01)，更期望术后有可能提高运动成绩(OR = 7.5; P = .001)，实现运动潜能突破(OR = 3.7; P = .002)，并期望未来可选择更苛刻的运动(OR = 2.7; P = . 01)。
结论：患者对当前和未来身体功能和心理健康状况的改善均有较高期望，尤其是对于较年轻、症状持续时间较短或者髋关节功能状态较差的患者。了解不同患者的期望可以更好的指导术前教育，使患者对术后恢复和远期预后提供更客观的预期。
Patients' Expectations of Hip Preservation Surgery
Purpose: To administer the Hip Preservation Surgery Expectations Survey to a large sample of patients to ascertain the prevalence of their preoperative expectations and to assess expectations in terms of demographic and clinical characteristics.
Methods: Consecutive patients were enrolled if they were ≥18 years old/spoke English and excluded if they had prior hip surgery/degenerative changes Tönnis ≥2. Patients completed the 21-item survey addressing the amount of improvement expected for each item (number of items and an overall score were determined) and the International Hip Outcome Tool (iHOT; hip score determined). Analyses included multivariable regression with survey score and number of expectations as dependent variables. Subanalyses considered collegiate/professional, competitive, and recreational sports level.
Results: Three hundred two patients participated, with a mean age of 32; 270 (89%) had cam impingement, 72 (24%) had symptoms <6 months, and mean iHOT score was 41. One hundred twenty patients (40%) selected all 21 survey items, 112 (37%) selected 18 to 20, and 70 (23%) selected ≤17 items. In multivariable analysis, younger age (odds ratio [OR] = 1.3; P = .02), symptoms <6 months (OR = 1.3; P = .03), and worse iHOT score (OR = 2.5; P = .0001) were associated with selecting more items. The mean survey score was 80 (range, 31-100). In multivariable analysis, younger age (P = .05), symptoms <6 months (P = .01), and worse iHOT score (P = .03) were associated with greater survey scores. Collegiate/professional athletes selected more items (P = .01) and were more likely to select improvement in sports performance (OR = 7.5; P = .001), achievement of athletic potential (OR = 3.7; P = .002), and maintaining options for more demanding future activities (OR = 2.7; P = .01).
Conclusions: Patients had multiple expectations for marked improvement in current and future physical function and psychological well-being. Younger patients, shorter symptom duration, and worse hip-specific functional status were associated with greater expectations. Understanding patients' expectations can guide preoperative education regarding realistic expectations for recovery and long-term outcome.
Clinical relevance: Patients' preoperative expectations vary according to demographic and clinical characteristics as measured in a survey study.
文献出处：Mancuso CA, Wentzel CH, Kersten SM, Kelly BT. Patients' Expectations of Hip Preservation Surgery: A Survey Study. Arthroscopy. 2019 Jun;35(6):1809-1816.
文献2
髋臼周围截骨术（PAO）患者在婴儿时期接受髋关节发育不良（DDH）治疗和未治疗的髋关节形态学比较
译者 任宁涛
背景：婴儿时期成功治疗的发育性髋关节发育不良（DDH）患者在骨骼成熟时出现症状性髋臼发育不良，行髋臼周围截骨（PAO）治疗。本研究的目的是比较既往DDH治疗后伴有晚期髋臼发育不良的PAO患者与无DDH治疗史的PAO患者的股骨和髋臼形态变化。
方法：回顾性分析2011年至2021年期间接受PAO手术的患者。纳入既往使用Pavlik挽具、外展支具、闭合复位加spica石膏固定或切开复位加spica石膏固定治疗的婴儿DDH患者。既往做过髋骨手术的患者被排除在外。记录每个髋关节的术前X线测量，包括外侧CE角、前CE角和股骨-骨骺髋臼顶指数。计算机断层扫描测量包括冠状CE角、矢状CE角、Tönnis角、髋臼1、2、3点钟前倾、股骨颈干角、股骨扭转角和α角。无DDH诊断或治疗史的PAO为对照组，与婴幼儿DDH治疗组根据冠状CE角、年龄、性别按2:1比例匹配。
结果：18例患者21髋既往接受婴儿DDH治疗（13例为Pavlik挽具，3例外展支具，1例闭合复位，1例切开复位）。对照组为42例患者42髋既往未接受DDH治疗的患者。有过DDH治疗的患者与未有过DDH治疗的患者在记录的各项指标中，包括股骨扭转角（P=0.494）、髋臼1点钟前倾（P=0.820）、2点钟前倾（P=0.584）、3点钟前倾（P=0.137）、颈干角（P=0.612）、外侧CE角（P=0.433）、股骨-髋臼顶指数（P=0.144）、α角（P=0.156），差异均无统计学意义。
结论：经过DDH治疗后持续存在症状性髋臼发育不良的PAO患者，与骨骼成熟后出现髋臼发育不良且没有DDH治疗史的患者，其股骨和髋臼形态相似。
Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment
Background: A subset of patients successfully treated for developmental dysplasia of the hip (DDH) as infants have symptomatic acetabular dysplasia at skeletal maturity leading to periacetabular osteotomy (PAO). The purpose of this study was to compare femoral and acetabular morphology in PAO patients with late acetabular dysplasia after previous treatment for DDH with PAO patients who do not have a history of DDH treatment.
Methods: A single surgeon's patients who underwent PAO between 2011 and 2021 were retrospectively reviewed. Patients previously treated for infantile DDH with a Pavlik harness, abduction brace, closed reduction and spica casting, or open reduction and spica casting were included. Patients with previous bony hip surgery were excluded. Preoperative radiographic measurements of each hip were recorded including lateral center edge angle, anterior center edge angle, and Femoro-Epiphyseal Acetabular Roof index. Computed tomography measurements included the coronal center edge angle, sagittal center edge angle, Tönnis angle, acetabular anteversion at 1, 2, and 3 o'clock, femoral neck-shaft angle, femoral version, and alpha angle. Control PAO cases without a history of DDH diagnosis or treatment were matched with the infantile DDH treatment group in a 2:1 ratio based on coronal center edge angle, age, and sex.
Results: There were 21 hips in 18 patients previously treated for infantile DDH (13 patients Pavlik harness, 3 abduction brace, 1 closed reduction, and 1 open reduction). The control PAO cohort was 42 hips in 42 patients who did not have previous DDH treatment. There was no statistically significant difference in any of the recorded measurements between patients previously treated for DDH and those without previous treatment including femoral version (P=0.494), anteversion at 1 o'clock (P=0.820), anteversion at 2 o'clock (P=0.584), anteversion at 3 o'clock (P=0.137), neck-shaft angle (P=0.612), lateral center edge angle (P=0.433), Femoro-Epiphyseal Acetabular Roof index (P=0.144), and alpha angle (P=0.156).
Conclusions: Femoral and acetabular morphology is similar between PAO patients with persistent symptomatic acetabular dysplasia following DDH treatment and patients presenting after skeletal maturity with acetabular dysplasia and no previous history of DDH treatment.
文献出处：Ellsworth BK, Bram JT, Sink EL. Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment. J Pediatr Orthop. 2022 Jul 1;42(6):e565-e569. doi: 10.1097/BPO.0000000000002137. Epub 2022 Mar 10. PMID: 35667051.
文献3
股骨髋臼撞击症的开放手术治疗
译者 李勇
目的：消除股骨髋臼撞击症的关节内撞击。使髋关节恢复无痛且活动范围正常。
适应证：任何类型的股骨髋臼撞击症（凸轮型/钳夹型）以及任何部位（前/后）。
禁忌证：绝对禁忌：晚期髋关节骨关节炎、髋关节周围局部感染。相对禁忌：髋臼后倾过度伴髋臼后壁缺损。
手术技术：侧卧位。在大转子正上方做直切口。进入吉布森间隙。进行“二腹肌式”大转子截骨术，保护旋股内侧动脉。打开梨状肌与臀小肌之间的间隙。做 Z 形关节囊切开术。脱位股骨头。分离髋臼盂唇。修整过长的髋臼缘。重新固定髋臼盂唇。形成足够的股骨头颈偏心距。缝合关节囊。重新固定转子。
术后管理：住院期间，使用持续被动活动机对髋关节进行强化活动，最大屈曲角度为 90 度。术后 6 周内禁止主动外展和被动内收超过身体中线，最大负重 10 至 15 千克。随后进行首次临床和影像学随访。在完全负重前需预防深静脉血栓形成。
结果：短期和中期结果显示，95%的患者术后临床评分（Merle d'Aubigné 评分）有所改善，具体取决于手术时个体关节退变情况。91%的病例取得了良好至优秀的结果。5 年累计生存率为 91%（终点为全髋关节置换术或 Merle d'Aubigné 评分差）。长期结果尚未得出。
Open Therapy of Femoroacetabular Impingement
Objective: Elimination of an intraarticular femoroacetabular impingement conflict. Creation of a painfree, normal range of motion of the hip. Indications: Femoroacetabular impingement of any type (cam/pincer) and any localization (anterior/posterior). Contraindications: Absolute: advanced hip osteoarthritis, local infections around the hip. Relative: excessive acetabular retroversion with deficiency of the posterior wall. Surgical technique: Lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Detachment of the labrum. Trimming of the excessive acetabular rim. Refixation of the labrum. Creation of a sufficient femoral head-neck offset. Suture of the capsule. Refixation of the trochanter. Postoperative management: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline. Maximum weight bearing 10-15 kg for 6 weeks. Subsequently, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis until full weight bearing. Results: Short- and mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné Score) in 95% of all patients, depending on the individual degenerative joint alterations at the time of surgery. Good to excellent results were obtained in 91% of all cases. Cumulative 5-year survival was 91% (endpoint total hip arthroplasty or poor Merle d'Aubigné Score). Long-term results are not available yet.
文献出处：Tannast M, Siebenrock KA. Die offene Therapie des femoroazetabulären Impingements [Open therapy of femoroacetabular impingement]. Oper Orthop Traumatol. 2010 Mar;22(1):3-16. German. doi: 10.1007/s00064-010-3001-7. PMID: 20349166.
文献4
挪威全国母亲、父亲和儿童队列研究中髋关节发育不良的流行病学
译者 贾海港
目的：髋关节发育不良（DDH）是一种先天性疾病，其风险因素包括臀位分娩、女性性别及家族遗传倾向。尽管其中若干危险因素已被纳入国家筛查计划，但 DDH 的延迟诊断仍时有发生。本研究的目的是调查这些及其他危险因素的患病率，以便改进现行筛查方案。。
方法：本研究采用了挪威母亲、父亲和儿童队列研究（MoBa）及挪威医疗出生登记处（MBRN）的数据。我们使用了描述性统计和逻辑回归分析。患有脑瘫、综合征性疾病或发育迟缓的儿童被排除在研究之外。
结果：共纳入 107,194 名儿童，家长通过问卷报告了子女是否被诊断为或接受过髋关节发育不良（DDH）治疗。 MoBa 研究中共有 3,460 名儿童（3.2%）被诊断为 DDH，其中 1,453 名（1.4%）接受过 DDH 治疗。具有统计学意义的风险因素包括女性、臀位分娩及马蹄内翻足，而多胎妊娠和母体糖尿病则是 DDH 的保护性因素。剖宫产分娩并未增加 DDH 的患病率。
结论：我们证实了先前提出的风险因素（如臀位分娩和女婴性别），而多胎妊娠和剖宫产等其他变量则未被证实为风险因素。然而，回归分析表明存在其他影响髋关节发育不良（DDH）患病率的因素。这些因素可能涉及环境与遗传双重影响，凸显了深化 DDH 研究以优化现有筛查方案的必要性。
The epidemiology of hip dysplasia in the nationwide Norwegian Mother, Father, and Child Cohort Study
Aims: Developmental dysplasia of the hip (DDH) is a congenital disorder with several assumed risk factors, including breech presentation, female sex, and familial predisposition. Although several of these risk factors are included in national screening programmes, delayed diagnoses of DDH still occur. The aim of this study was to examine the prevalence of these and other risk factors in order to improve the current screening programmes.
Methods: This study used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). We used descriptive statistics and logistic regression analyses. Children with cerebral palsy, syndromic disorders, or developmental delay were excluded from the study.
Results: A total of 107,194 children were included, with parents reporting using questionnaires if their child had a diagnosis of, or treatment for, DDH. A total of 3,460 children (3.2%) in MoBa had a diagnosis of DDH, with 1,453 (1.4%) being treated for DDH. Statistically significant risk factors included female sex, breech presentation, and pes equinovarus, whereas plural births and maternal diabetes were protective factors for DDH. Having a Caesarean section did not increase the prevalence of DDH.
Conclusion: We were able to confirm previously proposed risk factors such as breech presentation and female sex, whereas other variables such as plural births and Caesarean section were not found to be risk factors. However, regression analysis suggested that there are additional factors which affect the prevalence of DDH. These could be both environmental and genetic factors, highlighting the need for further research on DDH to improve the current screening programmes.
文献出处：Jacobsen KK, Kristiansen H, Gundersen T, Lie SA, Rosendahl K, Laborie LB. The epidemiology of hip dysplasia in the nationwide Norwegian Mother, Father, and Child Cohort Study. Bone Joint J. 2025 Jul 1;107-B(7):761-768.
文献5
保髋截骨手术并发症
译者 陶可
术前病理形态学评估对于手术计划至关重要，包括以X线片为基础的影像学检查，以及磁共振成像（MRI）和基于病例的辅助影像学检查（例如三维CT、外展位片）。髋关节镜手术（HAS）技术取得了巨大的进步，应用范围大幅扩大，适应症也日益广泛。髋关节镜术后翻修手术最常见的适应症是髋臼盂唇撕裂和残余股骨髋臼撞击综合征（FAI）。目前，对于临界发育性髋关节发育不良的治疗仍存在争议。了解个体髋关节的根本问题并区分髋关节不稳（发育不良）和股骨髋臼撞击综合征（FAI）至关重要，因为对于髋关节不稳，合适的治疗方法是髋臼周围截骨术（PAO），而对于FAI，则应进行髋关节镜下撞击手术。对于髋关节发育不良的治疗，PAO联合凸轮切除术的生存率高于单纯PAO。此外，外科医生面临的挑战是如何平衡过度矫正和矫正不足。应评估股骨扭转异常，并将股骨旋转截骨术的评估纳入治疗方案。
图1 一位34岁患者在另一家医疗机构接受髋关节镜下髋臼缘修整和盂唇修复术后出现髋关节疼痛。(A)骨盆正位片显示关节间隙正常，无明显畸形。(B)髋关节CT扫描显示钻孔，并怀疑锚钉位于关节内。(C)患者随后接受了髋关节脱位手术，证实了锚钉位于关节内，并导致髋臼软骨损伤。
图2 (A)一位27岁职业足球运动员，术前骨盆正位片显示其患有髋臼撞击综合征，接受了髋关节镜下髋臼撞击切除术。(B)患者重返赛场10个月后，出现髋关节疼痛复发。相应的X线片未见明显病变。（C）髋关节冠状位液体敏感磁共振图像显示骨髓水肿明显，并可见硬化线，提示应力性骨折。（D）采用空心螺钉固定应力性骨折。
图3 （A）一位26岁女性患者，患有临界髋关节发育不良，在两次髋关节镜手术（包括髋臼偏移矫正和盂唇清理）后仍持续存在髋关节疼痛。骨盆正位片显示髋臼覆盖不足，外侧中心边缘角（LCE）为18°。（B）行磁共振关节造影以评估关节内病变。矢状位图像显示盂唇发育不良，伴有实质撕裂（箭头所示）。造影剂在髋臼后下部积聚（箭头所示），导致股骨头向前移位，提示髋关节不稳定。（C）髋臼周围截骨术后6个月的骨盆正位片显示髋臼外侧覆盖改善，LCE为27°。
图4 （A、B）一位33岁患者，髋臼覆盖正常，轻度凸轮畸形，前上方部分髋臼盂唇撕裂（箭头所示），接受了髋关节镜下凸轮切除和髋臼唇修复术。（C）患者术后持续疼痛，多次磁共振关节造影显示前关节囊广泛缺损（箭头所示）。随后安排患者进行髋关节囊重建术。
图5 一位24岁患者，因混合型股骨髋臼撞击行髋关节外科脱位后持续疼痛。磁共振关节造影显示关节囊与股骨颈之间存在粘连（箭头所示）。患者接受了髋关节镜粘连松解术。
图6 (A)一位39岁髋关节发育不良患者（外侧中心边缘角（LCE）为15°），关节间隙保持良好。(B)髋臼周围截骨术后6周，LCE为28°。(C)术后6个月，骨盆正位片显示截骨处不愈合，耻骨下支应力性骨折。(D)经髂腹股沟入路行皮质骨剥脱和骨再固成术。
图7 （A、B）一名41岁男性患者，既往有Legg-Calvé-Perthes病史，此次就诊主诉为髋关节疼痛。骨盆正位片和三维计算机断层扫描（3D CT）重建显示髋关节发育不良，表现为髂前下棘（AIIS，白色实线）明显下倾，以及股骨颈短缩和大头（股骨头偏大）。髋臼前壁（AW）以红色显示，髋臼后壁（PW）以蓝色显示。（C、D）患者随后接受了髋臼周围截骨术和髋关节外科脱位手术，并进行了股骨头相对延长和偏心距矫正。术后6个月，患者仍存在持续性疼痛和活动受限。术后X线片（C）和三维重建CT（D）显示髋臼后倾角增大（交叉征阳性）和髂前下棘（AIIS）突出（白色实线），导致关节内和关节外撞击。（E）经髂腹股沟入路减压突出的AIIS并修整边缘后的术后影像。
图8 （A、B）一名14岁男孩，主诉髋关节疼痛和不稳定的中度股骨头骨骺滑脱（B图中Southwick角为43°）。（C、D）磁共振成像显示股骨颈关节积液和骨髓水肿，但未见股骨头坏死征象。（E）术后6周骨盆正位片。改良邓恩手术后。(F)术后4个月，患者疼痛加剧，X线片显示股骨头扁平，提示股骨头缺血性坏死。
Complications of hip preserving surgery
Preoperative evaluation of the pathomorphology is crucial for surgical planning, including radiographs as the basic modality and magnetic resonance imaging (MRI) and case-based additional imaging (e.g. 3D-CT, abduction views).Hip arthroscopy (HAS) has undergone tremendous technical advances, an immense increase in use and the indications are getting wider. The most common indications for revision arthroscopy are labral tears and residual femoroacetabular impingement (FAI).Treatment of borderline developmental dysplastic hip is currently a subject of controversy. It is paramount to understand the underlining problem of the individual hip and distinguish instability (dysplasia) from FAI, as the appropriate treatment for unstable hips is periacetabular osteotomy (PAO) and for FAI arthroscopic impingement surgery. PAO with a concomitant cam resection is associated with a higher survival rate compared to PAO alone for the treatment of hip dysplasia. Further, the challenge for the surgeon is the balance between over- and undercorrection. Femoral torsion abnormalities should be evaluated and evaluation of femoral rotational osteotomy for these patients should be incorporated to the treatment plan.
文献出处：Markus S Hanke, Till D Lerch, Florian Schmaranzer, Malin K Meier, Simon D Steppacher, Klaus A Siebenrock. Complications of hip preserving surgery. Review EFORT Open Rev. 2021 Jun 28;6(6):472-486. doi: 10.1302/2058-5241.6.210019.
文献6
股骨头塌陷与髋臼覆盖在股骨头坏死患者中的关联性研究
译者 邱兴
背景： 股骨头坏死（ONFH）的分型系统通常基于坏死病灶的大小、体积和位置。ONFH 常导致股骨头塌陷，但并非总是如此。由于髋臼覆盖与股骨头所受的机械应力相关，因此它也可能与 ONFH 患者的股骨头塌陷有关。然而，髋臼覆盖与这些患者股骨头塌陷之间的关联尚未明确。
研究问题/目的： （1）在 ONFH 患者中，股骨头塌陷是否与髋臼覆盖或骨盆入射角（PI）相关？（2）ONFH 分型系统中已确立的股骨头塌陷预测因素是否与髋臼覆盖相关？
方法： 在 2008 年至 2018 年期间，我们评估了 218 名 ONFH 患者的 343 个髋关节。我们考虑了所有 ONFH 患者，但排除了创伤性病因、塌陷前有手术治疗史或初次就诊时已发生塌陷的患者。最终，101 个 ONFH 髋关节（男性占 50% [50例]，平均年龄 44 ± 15 岁）符合我们的纳入标准。这些患者随后被分为两组：12 个月内发生股骨头塌陷组（塌陷组，35 髋）和未发生股骨头塌陷组（未塌陷组，66 髋）。两组患者在人口统计学资料方面无差异。我们使用 CT 图像测量 PI 和三个平面的髋臼覆盖度：冠状面的外侧中心边缘角（LCEA）、矢状面的前/后中心边缘角以及轴状面的前/后髋臼扇形角；此外，还比较了组间这些参数的差异。针对存在差异的参数，探讨了其预测股骨头塌陷的临界值。分别采用日本骨坏死研究委员会（JIC）分型和 Steinberg 分级来评估坏死部位和大小。我们检验了这些参数与分型之间的关系。
结果： 未塌陷组的平均 LCEA 略大于塌陷组（32° ± 6° 对比 28° ± 7°；平均差值为 4° [95% CI 1.15° 至 6.46°]；p = 0.005）；这一微小差异的临床重要性尚不确定。两组的 PI 无差异。在考虑了性别、年龄、BMI 和病因等混杂因素，以及髋臼覆盖参数和 PI 后，我们发现较低的 LCEA 与增加的塌陷风险独立相关，尽管效应量较小且其重要性存疑（OR 1.18 [95% CI 1.06 至 1.33]；p = 0.001）。LCEA 预测股骨头塌陷的临界值为 28°（敏感性 = 0.79，特异性 = 0.60，曲线下面积 = 0.73）。JIC C1 型（OR 6.52 [95% CI 1.64 至 43.83]；p = 0.006）和 C2 型（OR 9.84 [95% CI 2.34 至 68.38]；p = 0.001）患者中 LCEA 小于 28° 的比例高于 A 型和 B 型患者。被排除患者的髋臼覆盖数据与纳入分析的患者数据无差异。
结论： 我们的研究结果表明，髋臼覆盖与 ONFH 患者发生塌陷的可能性之间似乎关联甚微（如果存在的话）。我们发现较低的 LCEA 与较高的塌陷风险之间存在微弱的关联，但其效应量可能不具备临床重要性。需要考虑髋臼覆盖以外的因素，并且如果我们的发现得到其他研究者证实，则截骨术不太可能起到保护作用。由于本研究中的患者在种族和 BMI 方面较为同质，这些因素需要进一步研究以确定它们是否与 ONFH 的股骨头塌陷相关。
证据等级： III 级，预后性研究。
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.
Level of evidence: Level III, prognostic study.
文献出处：Iwasa, Makoto, Wataru Ando, Keisuke Uemura, Hidetoshi Hamada, Masaki Takao, and Nobuhiko Sugano. "Is there an association between femoral head collapse and acetabular coverage in patients with osteonecrosis?." Clinical Orthopaedics and Related Research® 481, no. 1 (2023): 51-59.
文献7
股骨和髋臼联合前倾与性别有关，在髋关节发育不良和髋臼后倾的患者中有所不同
译者 陈志强
目的：在发育性髋关节发育不良(DDH)患者中，股骨和髋臼前倾角(AV)及其组合的异常频率尚不清楚。本研究旨在探讨先天性髋关节脱位(DDH)和髋臼后倾(AR)患者的股骨前倾(FV)、增加的FV和股骨后倾的比例以及联合倾斜度(CV、FV+AV)。
患者和方法：对78例(90个髋关节)有症状的DDH患者和65例(77个髋关节)因AR引起的髋臼撞击(FAI)患者(77个髋关节，经AP片诊断)进行了IRB批准的回顾性观察研究。比较CT/MRI测量的FV(Murphy法)和AV。分析FV增加(Fv＞25◦)、FV严重增加(FV＞35◦)和FV极度增大(Fv＞45◦)、FV后倾(Fv＜10◦)和CV(McKibbin指数/COTAV指数)的频率。
结果：DDH患者的平均FV和CV(25±11◦和47±18◦)显著高于AR(16±11◦和28±13◦)(p＜0.001)。女性患者平均FV(27±16◦)和AR(19±12◦)显著高于男性患者(18±13◦)和AR(13±8◦)(P<0.001)。在DDH患者中，FVv＞25◦的频率为47%，FV＞35◦的频率为23%。与 DDH 患者 (17%) 相比，AR 患者 (31%) 的股骨后倾比例 (FV < 10) 显着较高 (p < 0.001)。 18% 的 DDH 患者 AV > 25° 且 FV > 25°。在 AR 患者中，12% 的 FV < 10°且 AV < 10。
结论：DDH和AR患者的FV和CV具有显着的性别相关差异。 对于 DDH 患者，FV 严重增加 > 35° (23%) 的频率相当高，但 17% 的患者表现出 FV 降低，这可能会影响治疗 不同的组合强调了在保髋手术（髋臼周围截骨术和股骨去旋截骨术）和髋关节镜检查之前进行患者特异性评估的重要性。
Combined femoral and acetabular version is sex-related and differs between patients with hip dysplasia and acetabular retroversion
Aims: Frequency of abnormal femoral and acetabular version (AV) and combinations are unclear in patients with developmental dysplasia of the hip (DDH). This study aimed to investigate femoral version (FV), the proportion of increased FV and femoral retroversion, and combined-version (CV, FV+AV) in DDH patients and acetabularretroversion (AR).
Patients and methods: A retrospective IRB-approved observational study was performed with 78 symptomatic DDH patients (90 hips) and 65 patients with femoroacetabular-impingement (FAI) due to AR (77 hips, diagnosis on AP radiographs). CT/MRI-based measurement of FV (Murphy method) and central AV were compared. Frequency of increased FV(FV > 25◦), severely increased FV (FV > 35◦) and excessive FV (FV > 45◦) and of decreased FV (FV < 10◦) and CV (McKibbin-index/COTAV-index) was analysed.
Results: Mean FV and CV was significantly (p < 0.001) increased of DDH patients (mean ± SD of 25 ± 11◦ and 47 ± 18◦) compared to AR (16 ± 11◦ and 28 ± 13◦). Mean FV of female DDH patients (27 ± 16◦) and AR (19 ± 12◦) was significantly (p < 0.001) increased compared to male DDH patients (18 ± 13◦) and AR (13 ± 8◦). Frequency of increased FV (>25◦) was 47% and of severely increased FV (>35◦) was 23% for DDH patients. Proportion of femoral retroversion (FV < 10◦) was significantly (p < 0.001) higher in patients AR (31%) compared to DDH patients (17%). 18% of DDH patients had AV > 25◦ combined with FV > 25◦. Of patients with AR, 12% had FV < 10◦ combined with AV < 10◦.
Conclusion: Patients with DDH and AR have remarkable sex-related differences of FV and CV. Frequency of severely increased FV > 35◦ (23%) is considerable for patients with DDH, but 17% exhibited decreased FV, that could influence management. The different combinations underline the importance of patient-specific evaluation before open hip preservation surgery (periacetabular osteotomy and femoral derotation osteotomy) and hiparthroscopy.
文献出处：Meier, Malin K. et al. European Journal of Radiology, Volume 158, 110634
文献8
人类髋臼盂唇形态的组织病理学分析
译者 徐子茵
软组织对机械负荷的结构和功能适应控制了其承受伤害的能力，并影响其愈合能力。与膝半月板类似，髋臼盂唇在机械载荷分布上表现出不同区域，形成具有独特结构和功能特性的区域。然而对盂唇退行性变化的严重程度和分布的影响知之甚少。本研究旨在评估盂唇匹配对组织病理特征严重程度和分布的影响。从9具尸体中提取了人体组织，共计16个半骨盆（10名男性和6名女性），平均年龄为80岁（年龄范围66-99岁）。每个髋关节被划分为8个不同的区域，形成128个区域分段。载玻片使用赤木精和嗜氨酸（H&E）和Safranin-O（Saf O）染色，并结合了对伊信（F-Eosin）的荧光扫描。采用改良膝关节半月板分级标准评估了髋臼盂的组织病理特征。这些特征在髋关节解剖象限的整体范围内以及内外区域进行了评估。对盂唇的整体分析显示，髋关节的上象限、前象限、下象限和后象限的组织病理特征分布相似。相反，在128个盂唇节段中，成对区域评估显示退行性特征的严重程度显著增加（p < 0.05），这些特征主要集中在靠近关节面的内侧盂唇区。这些退行性变化包括基质蛋白聚糖含量、细胞结构、胶原蛋白组织以及盂唇关节表面（的变化。内侧髖臼盂唇纤维的致密程度增加、血管穿透极少以及显著的退行性变化，意味着该区域易受伤，愈合能力可能有限。这些不同分区框架的划分凸显了唇唇对其机械环境的功能适应。与以往全球分析相比，对唇的区域分析提供了对组织病理特征分布动态更为详细的视角，更精确地理解了可能解释区域特异性易受损伤和退化的解剖因素。
Histopathologic Analysis of the Morpho-Functional Zones of the Human Acetabular Labrum
The structural and functional adaptation of soft tissues to mechanical load controls their ability to withstand injury and influences their capacity for healing. Similar to the knee meniscus, the acetabular labrum exhibits zonal differences in mechanical load distribution, resulting in distinct regions with unique structural and functional properties. However, little is known about the effect of these zonal adaptations on the severity and distribution of labral degenerative changes. This study aims to assess the impact of labral zonal adaptations on the severity and distribution of histopathologic features. Human tissue was obtained from 9 embalmed cadavers, comprising a total of 16 hemipelves (10 males and 6 females) with an average age of 80 years (age range 66-99). Each hip was divided into 8 distinct regions, resulting in 128 regional segments. Slides were stained using Hematoxylin and Eosin (H&E) and Safranin-O (Saf O), with the incorporation of fluorescent scanning of eosin (F-Eosin). Labral histopathologic features were assessed using established modified grading criteria for the knee meniscus. These features were evaluated both globally across the anatomical quadrants of the hip joint and zonally across the inner and outer zones. The global analysis of the labrum revealed a similar distribution of histopathologic features across the superior, anterior, inferior, and posterior quadrants of the hip joint. Conversely, across 128 labral segments, pairwise zonal assessments revealed a significant increase (p < 0.05) in the severity of degenerative features, which were predominantly concentrated in the inner labral zone near the articular surface. These degenerative changes encompassed alterations in matrix proteoglycan content, cellularity, collagen organization, and labral articular surface, including the lamellar layer. The increased compactness of labral fibers in the inner zone, minimal vascular penetration, and significant degenerative changes imply that it is a vulnerable area for injury with a potentially limited capacity for healing. The delineation of these distinct zonal frameworks highlights the labrum's functional adaptation to its mechanical environment. The zonal analysis of the labrum provided a considerably more detailed perspective on the distribution dynamics of histopathologic features compared to previous global analyses, offering a more precise understanding of the anatomical factors that may explain zone-specific vulnerability to injury and degeneration.
文献出处：Alomiery AA, Hall AC, Gillingwater TH, Alsolami A, Alashkham A. Histopathologic Analysis of the Morpho-Functional Zones of the Human Acetabular Labrum. Clin Anat. Published online September 12, 2025. doi:10.1002/ca.70031
来源：304关节学术
作者：304关节团队
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