本期目录：
1、固定平台内侧单髁膝关节置换术：在前交叉韧带功能不全膝关节中的新适应证
2、非骨水泥固定在全膝关节置换术中的应用：目前的证据和未来的展望
3、全髋关节置换术中手术入路与强化技术使用的当前趋势
4、儿童感染性髋关节炎后遗症：一种改良分型和病例报告
5、盂唇内翻是DDH患儿Pavlik挽具治疗失败的预测因素
6、骨盆形态在旋转和倾斜度上存在差异：发育性髋关节发育不良与髋臼后倾的对比研究
7、巴基斯坦髋关节发育不良的流行病学研究
8、髋臼周围截骨术治疗青少年髋关节发育不良的并发症
9、有症状的发育性髋关节发育不良患者从仰卧位到站立位的骨盆后倾
第一部分：关节置换及保膝相关文献
文献1
固定平台内侧单髁膝关节置换术：在前交叉韧带功能不全膝关节中的新适应证
译者 马云青
前交叉韧带功能不全合并骨关节炎的膝关节是一种具有挑战性的疾病类型，其治疗需要审慎考量，达到恢复关节功能并帮助患者重返活动。随着技术与手术方法的进步，单髁关节置换术的适应症已扩展至经过严格筛选的前交叉韧带功能不全患者。深入理解此类膝关节的病理特征，有助于临床医生制定决策以恢复膝关节功能。
对于前交叉韧带功能不全合并单间室骨关节炎的膝关节，患者主诉常涉及前后向不稳定。在处理前交叉韧带功能不全的膝关节时，相比活动平台单髁置换术（后者可能存在偏心负荷增加和聚乙烯磨损等问题），采用固定平台单髁假体可以更好地恢复关节运动学，并避免早期结果中的相关担忧。谨慎且有选择地清理髁间窝骨赘，对于维持单髁置换术后的膝关节稳定性至关重要。
证据表明，在前交叉韧带功能不全的膝关节进行单髁置换时，将胫骨后倾角控制在4至7度之间是最佳的，这有助于维持膝关节稳定性并促进屈膝活动。
Fixed-bearing medial unicompartmental knee arthroplasty: New indications in the anterior cruciate ligament-deficient knee
The anterior cruciate ligament (ACL)-deficient osteoarthritic knee presents a challenging disease entity, which requires careful thought to restore function and enable return to activities. Advancements in technology and surgical techniques have expanded indications for unicompartmental knee arthroplasty (UKA), to inlcude ACL-deficiency in appropriately-selected patients. An improved understanding of the ACL-deficient osteoarthritic knee can aid in clinical and surgeon decision-making to restore knee function. This review will discuss current practice guidelines for the ACL-deficient knee with single-compartment osteoarthritis, including pathoanatomy,indications,contraindications,technical considerations, and clinical outcomes.
文献出处：Plancher KD, Braun GE, Petterson SC. Fixed-bearing medial unicompartmental knee arthroplasty: New indications in the anterior cruciate ligament-deficient knee. J ISAKOS. 2024 Dec;9(6):100337. doi: 10.1016/j.jisako.2024.100337. Epub 2024 Oct 12. PMID: 39401701.
文献2
非骨水泥固定在全膝关节置换术中的应用：目前的证据和未来的展望
译者 丁云鹏
非骨水泥固定在全膝关节置换术（TKA）中扮演着越来越重要的角色。这篇综述文章的目的是分析非骨水泥TKA的功能结局和生存率。
材料和方法：对非骨水泥TKA的预后和生存率进行了全面的文献检索。该检索基于PRISMA 2020指南，使用PubMed、Medline和Embase。纳入的研究由两名独立观察员筛选。
结果：2010 - 2022年共纳入15项研究。11项研究比较了非水泥TKA和水泥TKA。四项研究仅涉及非骨水泥假体。非骨水泥TKA的生存和功能结果至少与骨水泥假体相当。
结论：随着制造技术的进步和更精确的手术工具的使用，如机器人辅助TKA和3D打印假体，由于更多的生物固定，更好的存活率和疗效，可以预期非骨水泥TKA的使用会增加。
Cementless fixation in total knee arthroplasty: current evidence and future perspective
Introduction: Cementless fixation plays an increasing role in total knee arthroplasty (TKA). The objective of this review article is to analyze functional outcomes and survivorship of cementless TKA.
Materials and methods: A comprehensive literature search for studies reviewing the outcome and survivorship of cementless TKA was conducted. This search was based on the PRISMA 2020 guidelines using PubMed, Medline, and Embase. The included studies were screened by two independent observers.
Results: From 2010 to 2022, fifteen studies were included. Eleven studies compared cementless and cemented TKA. Four studies only covered cementless implants. Survivorship and functional outcomes of cementless TKA are at least comparable to those of cemented implants.
Conclusion: With improvement in manufacturing, and surgical tools for more precise delivery, such as robotic assisted TKA and 3D-printed implants, one can expect increase in usage of cementless TKA, due to a more biological fixation, better survivorship, and outcomes.
文献出处：David J Haslhofer , Nikolaus Kraml ， Christian Stadler ，Cementless fixation in total knee arthroplasty: current evidence and future perspective.Arch Orthop Trauma Surg. 2024 Dec 28;145(1):101.
文献3
全髋关节置换术中手术入路与强化技术使用的当前趋势：利用美国骨科医师协会口试与再认证数据，对早期职业与更有经验的外科医生进行比较
译者 沈松坡
背景： 全髋关节置换术（THA）一直是医学中最成功的手术之一，但其优选入路及强化技术的使用正在不断发展。本研究旨在明确早期职业外科医生与更有经验外科医生在当前 THA 实践中的（手术入路以及强化技术使用）情况。本研究的第二个目标是识别 6 个月时患者报告结局测量信息系统（PROMIS）的疼痛干扰或功能评分以及早期并发症的差异。
方法： 在 2022 年和 2023 年，共有 35,068 例 THA 由参加美国骨科医师协会（ABOS）第二部分口试的考生（14,993 例）以及作为再认证过程的一部分由已获得认证的医师（20,075 例）提交。患者平均年龄为 66 岁，54% 为女性。第二部分考生组中，有 2,019 名患者获得了基线和 6 个月的 PROMIS 疼痛干扰与功能问卷。所有患者的术后并发症均由考生或再认证医师报告。
结果： 第二部分考生选择的手术入路为：直接前方（DA）69%，后方 26%，直接外侧 2%，其他 2%。再认证医师的手术入路为：DA 43%，后方 43%，直接外侧 6%，其他 7%。机器人或导航的使用率分别为 18% 和 15%。所有组的 PROMIS 功能均有等量改善。第二部分考生报告的显著手术并发症高于再认证考生（8.4% vs 2.7%，P < 0.001），其中骨折是最常见的并发症（第二部分：2.3%；再认证：0.6%）。
结论： 第二部分考生比再认证考生更可能选择 DA 入路。第二部分考生报告的术后并发症率更高。然而，基于手术入路，在外科医生报告的并发症或骨折率中并无差异。机器人与导航的总体使用率低于 20%。所有 THA 组的 PROMs 均有等量改善。
关键词：全髋关节置换；手术入路；机器人或导航；手术并发症；结局
Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data
Background: Total hip arthroplasty (THA) has been among the most successful procedures in medicine, but the preferred approach and use of enhancing technologies are evolving. This study was conducted to define current THA practice (surgical approach and use of enhancing technologies) among early-career and more experienced surgeons. A secondary goal of this study was to identify differences in 6-month Patient-Reported Outcome Measurement Information System (PROMIS) pain interference or function scores and early complications.
Methods: In 2022 and 2023, 35,068 THAs were submitted to the American Board of Orthopaedic Surgery by candidates for the part II oral certification examination (14,993) and by Diplomates as part of the recertification process (20,075). The average patient age was 66 years, and 54% of patients were women. Baseline and 6-month PROMIS pain interference and function surveys were obtained from 2,019 patients in the Part II group. Postoperative complications were reported by the candidates or diplomates for all patients.
Results: Part II candidate surgical approach was direct anterior (DA) (69%), posterior (26%), direct lateral (2%), and other (2%). For recertification candidates, the surgical approach was DA (43%), posterior (43%), direct lateral (6%), and other (7%). Robotics or navigation was utilized in 18 and 15%, respectively. There were equivalent improvements in the PROMIS function in all groups. The surgeon-reported significant surgical complications were higher in part II candidates (8.4%) than in candidates undergoing recertification (2.7%, P < 0.001), with bone fracture the most common in each group (part II: 2.3%; recertification at 0.6%).
Conclusions: The part II candidates are more likely to utilize the DA approach compared to recertification candidates. The Part II candidates report higher rates of postoperative complications. However, there was no difference in the rate of surgeon-reported surgical complications or fractures based on surgical approach. Robotics and navigation are utilized in less than 20% of THA cases. The PROMs improved equally in all THA groups.
Keywords: outcomes; robotics or navigation; surgical approach; surgical complications; total hip arthroplasty.
文献出处：Nelson CL, Harrast JJ, Jacobs JJ, Martin DF, Garvin KL. Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data. J Arthroplasty. 2025 Aug;40(8S1):S96-S100. doi: 10.1016/j.arth.2025.02.069. Epub 2025 Mar 4. PMID: 40049563.
第二部分：保髋相关文献
文献1
儿童感染性髋关节炎后遗症：一种改良分型和病例报告
译者 罗殿中
背景：现有的儿童感染性髋关节炎（SAH）的分类系统非常复杂。本文介绍一种新的分类方法—西安红会医院儿童骨科分类（HHPO），该分类设计增强了对于该疾病的治疗方案、和预后评估。
方法：本文对18例儿童感染性髋关节炎（SAH）进行回顾性研究，通过骨盆片评估股骨头颈的完整性、及其与髋臼的空间对合关系。基于这些评估内容，形成了HHPO分类系统。6位观察者分别独立对每一例进行HHPO和Choi分类。针对这两种分类方法，比较观察者之间、2周重复观察者内可靠性。
结果：HHPO的分类结果如下：IA型5髋、IB型6髋、ID型2髋、IIA型3髋、IIB型2髋。HHPO分类方法较Choi分类方法具有更高的观察者间和观察者内一致性。临床来说，治疗后5髋严重疼痛，2髋偶尔疼痛，11髋无疼痛。大部分髋关节（88.9%）活动度满意；72.2%在影像上稳定。感染发生越早、治疗效果月严重。
结论：HHPO儿童感染性髋关节炎分类系统简单、可重复性强，在本组病例中展示出治疗儿童SAH后遗症时的潜在作用。
表1, 感染性髋关节炎后遗症红会医院分型（HHPO）
图1. a-j 病例2，12岁女孩，肺部感染后继发左侧SAH。经过2次关节切开引流、静脉用万古霉素、口服利奈唑胺，感染得到控制。但急性期治疗期间，感染由局部扩散至多个部位（左侧胫骨远端、左股骨、左髂骨）（a-d）。一年后，患者最终形成ID型髋感染后遗症、并下肢不等长（LLD）（e-h）。此后对她进行大转子下移（GTA）+股骨截骨延长术（i和j），改善了髋关节功能和步态。
图2. a-g 病例13，4-6岁情况，她因新生儿感染致右髋SAH，外院静脉用万古霉素控制良好后出院，右髋未行切开和引流，口服头孢甲肟一月。4岁时发现右髋疼痛、活动受限、步态异常。检查发现为ID型髋感染后遗症和下肢不等长（LLD）短缩16.4mm（a-e）。最后，在本中心行大转子下移（GTE）、股骨近端去旋转截骨+Salter骨盆截骨术，术后右髋疼痛消失，关节功能和步态改善（f和g）。
图3, a-j 病例3，两岁前左髋SAH，当前7-8岁。当时静脉使用抗生素、关节切开引流控制感染，证明有效。他左髋遗留半脱位（a），行股骨近端内翻截骨（b）。股骨愈合取出内固定（c），密切观察随访至7岁（d-g）。此时，患儿跛行，影像证实左髋股骨颈前倾角显著增大，髋臼包容不良，髋臼外缘吸收。患儿再次行股骨近端去旋转截骨+Salter骨盆截骨（h）。术后患儿髋关节稳定，肢体短缩<2cm，代偿性脊柱侧弯。截骨愈合取出内固定后，髋关节功能好、步态正常（i和j）。
图4, a-g 病例4，7-8岁女孩，3-4岁时发现左髋SAH。当时外院行抗生素治疗、关节切开引流。一年前她左髋疼痛跛行，骨盆片显示，左髋关节半脱位、股骨头部分消失（IIA型）（a）。对她采用Pemberton骨盆截骨+股骨大转子下移+股骨去旋转截骨术治疗（b）。术后截骨愈合，髋关节稳定，髋臼包容好，无下肢不等长（LLD）等其它并发症。术后一年髋关节功能良好（c-e），内固定取出后影像（f和g）
图5, a-h 病例11，9-10岁男孩，2岁前左髋SAH，5岁时左髋跛行。影像显示左髋关节脱位，左股骨颈吸收，股骨头残留，为IIB型（a）。保守治疗并随访，无明显改善（b-d），并出现左髋疼痛。最终，该患儿行股骨近端外翻截骨+Chiari骨盆內移截骨术（e-g）。近期随访显示，截骨愈合，髋关节稳定，髋关节功能好，但遗留下肢不等长3cm。
图6, a-i 病例11，12-13岁男孩，患儿1-2岁出现左髋SAH，导致左髋关节脱位，髋臼发育不良，股骨头股骨颈大部分消失（a）。对他行骨赘切除改善臀中肌步态，下肢延长，髋关节稳定手术（b-d）。但内固定取出后在密切随访时，发现左髋脱位复发。特别是内固定取出后，左髋脱位，肢体短缩小于2cm（e-i）。随后决定行髋臼截骨，采用股骨大转子重建股骨头，并稳定髋关节。但当患肢穿增高鞋、髋关节功能可、几乎无疼痛、对日常生活无影响。另外患儿父母对髋关节重建手术缺乏信心，故患者未行手术，继续观察随访。
The sequelae of septic hip arthritis in children: a revised classification and case review
Background:Existing classification systems for sequelae of pediatric septic arthritis of the hip (SAH) are notably complex. This study introduces a simplified radiographic classification-the Xi'an Honghui Hospital Paediatric Orthopaedic Classification (HHPO classification)-designed to enhance accuracy in treatment planning and prognostic evaluation.
Methods:A retrospective analysis was conducted involving 18 pediatric patients with SAH. Pelvic radiographs were evaluated to assess the structural integrity of the femoral head and neck and their spatial relationship with the acetabulum. Based on these assessments, the HHPO classification was developed. Six independent observers classified each case using both the HHPO and Choi systems. Interobserver reliability and two-week intraobserver consistency were assessed and compared between the two classifications.
Results:The distribution according to the HHPO classification was as follows: Type IA (n=5), Type IB (n=6), Type ID (n=2), Type IIA (n=3), and Type IIB (n=2). The HHPO system demonstrated significantly higher inter- and intraobserver agreement compared to the Choi classification. Clinically, severe hip pain was reported in 5 patients, occasional pain in 2, and no pain in 11. The majority of hips (88.9%) exhibited satisfactory range of motion, and 72.2% were radiologically stable. Earlier onset of infection was associated with more severe sequelae.
Conclusion:The HHPO classification is simpler, more reproducible, and demonstrates potential clinical utility for managing pediatric SAH sequelae in this cohort.
文献出处：Qi B, Lu Q, Wang X, Jie Q, Su F, Liu C, Yang Y. The sequelae of septic hip arthritis in children: a revised classification and case review. Ann Med. 2025 Dec;57(1):2553878. doi: 10.1080/07853890.2025.2553878. Epub 2025 Sep 5. PMID: 40908846; PMCID: PMC12416003.
文献2
盂唇内翻是DDH患儿Pavlik挽具治疗失败的预测因素
译者 任宁涛
介绍
据报道，Pavlik挽具治疗髋关节发育不良(DDH)的失败率高达55%。本研究的目的是探讨髋臼盂唇内翻对Pavlik挽具治疗DDH疗效的影响。
方法
回顾性分析2004 - 2016年某三级儿科医院DDH患儿，纳入采用Pavlik挽具进行治疗并随访时间不短于12个月的DDH患儿。统计纳入患儿的人口学信息、治疗和随访结果，比较盂唇内翻和无盂唇内翻患儿的预后。
结果
共纳入156名患儿，229例髋关节发育不良。开始治疗的平均年龄为1.9±1.4个月，平均随访时间为37.7±23.0个月。46%(73/156)的患儿诊断为双侧DDH。总共有37%(75/229)髋关节Pavlik挽具治疗失败。进一步治疗中，91%(68/75)的髋关节为硬性外展支具，5%(4/75)的髋关节为闭合复位，4%(3/75)的髋关节为切开复位。10%(22/229)的患儿存在髋关节盂唇内翻。内翻盂唇组Pavlik挽具治疗失败的发生率为91%(20/22)，而对照组为27% (55/207)(P<0.001)。盂唇内翻组86%(15/22)需要闭合或切开复位，对照组3% (7/207)(P<0.001)。盂唇内翻组的缺血性坏死发生率为18%(4/22)，对照组为0.4% (1/207)(P<0.001)。
结论
在接受Pavlik挽具治疗的DDH患儿中，髋臼盂唇内翻的存在是治疗失败的有力预测因素。与没有内翻盂唇的髋关节相比，有内翻盂唇的髋关节需要闭合或切开复位和发生缺血性坏死的风险也明显更高。
图1 生后1周女性患儿，髋关节超声检查可见双侧DDH，B图箭头处可见左髋内翻盂唇，采用Pavlik挽具治疗6周，右髋治疗效果良好，左髋因盂唇内翻接受了进一步的硬性支具的治疗，最终采用闭合复位石膏外固定治疗。
An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia
Introduction: The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH.
Methods: A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum.
Results: A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9±1.4 months and mean follow-up was 37.7±23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001).
Conclusions: In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum.
文献出处Lin AJ, Siddiqui AA, Lai LM, Goldstein RY. An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia. J Pediatr Orthop. 2021 Sep 1;41(8):479-482. doi: 10.1097/BPO.0000000000001916. PMID: 34267151.
文献3
骨盆形态在旋转和倾斜度上存在差异：发育性髋关节发育不良与髋臼后倾的对比研究
译者 李勇
背景：发育性髋关节发育不良（DDH）和髋臼后倾是两种不同的髋臼形态病理改变。两者均与骨盆形态的变化相关。在髋臼的直接X线评估困难或不可行时，或者在DDH与后倾混合存在的病例中，额外的间接骨盆测量参数将有助于识别主要潜在的结构异常。
问题/目的：我们探究：通过骨盆宽度指数、髂前下棘征（AIIS征）、髂坐骨角和闭孔指数来测量，DDH和髋臼后倾在旋转和冠状面倾斜度上有何不同？以及每个变量在检测髋臼后倾方面的预测价值如何？
方法：我们回顾性分析了51例发育不良髋和51例后倾髋的骨盆前后位X光片。发育不良的诊断基于外侧中心边缘角小于20°且髋臼指数大于14°。后倾的诊断基于外侧中心边缘角大于25°并同时存在交叉征/坐骨棘征/后壁征。我们计算了用于诊断髋臼后倾的每个变量的敏感性、特异性和受试者工作特征曲线下面积。
结果：我们发现，在髋臼后倾中，骨盆宽度指数较低，AIIS征的出现率较高，髂坐骨角较高，闭孔指数较低。整个髋骨在DDH中呈内旋，而在后倾中呈外旋。ROC曲线下面积分别为：0.969（骨盆宽度指数）、0.776（AIIS征）、0.971（髂坐骨角）和0.925（闭孔指数）。
结论：骨盆形态与髋臼的病理形态相关。我们的测量指标（除AIIS征外）是髋臼后倾的间接指标。数据表明，当髋臼缘显示不清且后倾不明显时，可以使用这些指标。
图 1A-D 这些图表说明了如何（A）计算骨盆宽度指数（a/b），（B）确定髂前上棘征，（C）确定髂坐骨角，以及（D）计算闭孔指数（c/d）
Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion
Background: Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality.
Questions/purposes: We asked: How does DDH and retroversion differ with respect to rotation and coronal obliquity as measured by the pelvic width index, anterior inferior iliac spine (AIIS) sign, ilioischial angle, and obturator index? And what is the predictive value of each variable in detecting acetabular retroversion?
Methods: We reviewed AP pelvis radiographs for 51 dysplastic and 51 retroverted hips. Dysplasia was diagnosed based on a lateral center-edge angle of less than 20° and an acetabular index of greater than 14°. Retroversion was diagnosed based on a lateral center-edge angle of greater than 25° and concomitant presence of the crossover/ischial spine/posterior wall signs. We calculated sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for each variable used to diagnose acetabular retroversion.
Results: We found a lower pelvic width index, higher prevalence of the AIIS sign, higher ilioischial angle, and lower obturator index in acetabular retroversion. The entire innominate bone is internally rotated in DDH and externally rotated in retroversion. The areas under the ROC curve were 0.969 (pelvic width index), 0.776 (AIIS sign), 0.971 (ilioischial angle), and 0.925 (obturator index).
Conclusions: Pelvic morphology is associated with acetabular pathomorphology. Our measurements, except the AIIS sign, are indirect indicators of acetabular retroversion. The data suggest they can be used when the acetabular rim is not clearly visible and retroversion is not obvious.
文献出处：Tannast M, Pfannebecker P, Schwab JM, Albers CE, Siebenrock KA, Büchler L. Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion. Clin Orthop Relat Res. 2012 Dec;470(12):3297-305. doi: 10.1007/s11999-012-2473-6. PMID: 22798136; PMCID: PMC3492631.
文献4
巴基斯坦髋关节发育不良的流行病学研究：基于巴基斯坦儿科骨科登记系统（PORP）的见解
译者 贾海港
目的：本研究旨在确定巴基斯坦髋关节发育不良的患病率、风险因素及地理分布情况，评估各种治疗方法的累积疗效，并提出建议以建立巴基斯坦的预防策略和最佳治疗实践。
方法：本多中心回顾性研究分析了巴基斯坦 PORP 注册中心发育性髋关节发育不良（DDH）部分的临床数据。由第 1、3-11 作者上传，涵盖过去三十年间的治疗病例。 评估参数涵盖 25 个变量，包括患者基本人口统计学特征、地域性发病率、DDH 特征及相关危险因素。此外，还分析了不同年龄组和不同严重程度的 DDH 患者的治疗方法和累积疗效
结果：本研究纳入 755 例患者，共 1107 个受累髋关节，年龄从出生 1 天到 8 岁以上不等。其中 86.25%的患者在 18 个月后确诊，11.7%确诊时年龄超过 8 岁。在 104 例新生儿中，23%接受了新生儿筛查。 男女比例为 3:1。21%的患者有发育性髋关节发育不良（DDH）家族史，24%的患者来自偏远农村地区。46.6%的患者为双侧 DDH。48.43%的患者髋臼指数明显钝化（≥3-45°）。髋臼指数（AI）与年龄呈显著正相关（p=0.001）。88%的单侧正常髋关节 AI≥30°，11%的单侧髋关节 AI 为中度发育不良（30°-45°）。 129 例患者接受了非手术治疗，至少三年随访后成功率为 83.72%。Pavlik 吊带的失败率为 25%。626 例患者接受了开放复位手术，至少一年随访后成功率为 70.42%。保守治疗和手术治疗的失败病例大多发生在双侧病例的单侧。10 年随访期间的远期并发症包括股骨颈偏短、髋臼过大和残余髋臼发育不良。
结论：本研究利用 PORP 登记数据，识别了发育性髋关节发育不良（DDH）的人口统计学特征、风险因素和治疗结果。研究强调了建立肌肉骨骼筛查方案的必要性，以便尽早诊断 DDH，防止因治疗延误而导致的残疾，并促进 DDH 管理的最佳实践。
关键词： 并发症；DDH；DDH 预后；人口统计学特征；发育性髋关节发育不良；危险因素；地域分布。
Epidemiology of Developmental Dysplasia of Hip in Pakistan: Insights from the Paediatric Orthopaedic Registry Pakistan (PORP)
Objective:This study aims to determine prevalence, risk factors and geographic distribution of Developmental Dysplasia of the Hip in Pakistan and to assess the cumulative outcomes of various treatments used and propose recommendations to establish preventive strategies and best treatment practices in Pakistan.
Methods:This multicentric retrospective study was conducted with analysis of data from DDH section of PORP registry of Pakistan. The data was uploaded by 1,3-11 authors, which were treated during last three decades. The evaluation parameters included 25 variables of basic demographics of patients, geographic prevalence, characteristics of DDH and related risk factors. The data was also analyzed to know methods of treatment used and cumulative outcomes in various age groups and severity of dysplasia.
Results:The study included 755 patients with 1,107 affected hips, aged one day to over eight years. Of these, 86.25% were diagnosed after 18 months, 11.7% were over eight years. Among 104 neonates, 23% had neonatal screening. The female-to-male ratio was 3:1. 21% had history of DDH in family, and 24% were from remote rural areas. 46.6% had bilateral DDH. 48.43% patients had significantly obtuse acetabular index >45°. The acetabular index (AI) found highly associated with age bilaterally (p=0.001). 88% of normal unilateral hips had AI <30°, and 11% have moderate dysplasia of 30°-45°. 129 patients were treated non-operatively with 83.72% success rate at minimum three years follow-up. The failure rate of Pavlik harness was 25%. Six hundred twenty six (626) patients underwent open reduction with 70.42% success rate at minimum one year follow-up. Most failures in conservative and operative treatment were on one side of bilateral cases. Late complications over 10 years follow-up was short femoral neck offset, coxa magna and residual acetabular dysplasia.
Conclusion:This study leverages PORP registry data to identify DDH demographics, risk factors, and treatment outcomes. It highlights the need for establishment of MSK screening protocols, to diagnose DDH at earliest, to prevent development of disability of late treatment and enhance best practices in DDH management.
Keywords:Complications; DDH; DDH Outcomes; Demographics; Developmental Dysplasia Hips; Risk factors; Topographic Distribution.
文献出处：Bhatti A, Soomro MH, Chinoy MA, Zaman AU, Baloch MA, Ali P, Khan MA, Nadeem U, Zafir MB, Jamil M, Peracha A, Pirwani MA, Ahmed Z. Epidemiology of Developmental Dysplasia of Hip in Pakistan: Insights from the Paediatric Orthopaedic Registry Pakistan (PORP). Pak J Med Sci. 2025 Mar;41(3):668-675. doi: 10.12669/pjms.41.3.10922. PMID: 40103867; PMCID: PMC11911762.
文献5
髋臼周围截骨术治疗青少年髋关节发育不良的并发症
译者 陶可
背景：髋臼周围截骨术是一种有效的髋臼重新定位手术，可使髋臼恢复正常位置，从而改善成人髋关节发育不良患者的股骨头解剖覆盖和髋关节内移。然而，该手术难度较高，目前尚无研究专门分析青少年患者接受此手术的并发症及其相关因素。
方法：本研究回顾性分析了一系列接受伯尔尼髋臼周围截骨术治疗髋关节发育不良的青少年患者的临床和影像学资料。
结果：共对76例患者进行了83次截骨术，患者平均年龄（及标准差）为15.6±2.4岁。影像学检查显示，从术前到术后2年随访评估，外侧中心边缘角（-0.14°至35.5°）、前方中心边缘角（-5.13°至31.3°）和股骨头外移指数（38.4%至7.7%）均有显著改善（所有指标p<0.0001）。共发生3例主要并发症，包括：一例既往行髋臼成形术的患者出现动脉出血过多，需行栓塞治疗；一例伴有严重髋关节发育不良和半脱位的患者出现髋臼骨坏死；以及一例患有夏科-马里-图斯病（Charcot-Marie-Tooth disease）的患者在行髋臼周围和股骨联合截骨术后出现股骨头坏死。18例髋关节（22%）出现轻微并发症，包括耻骨上支截骨不愈合（5例）、浅表缝线脓肿（4例）和暂时性股外侧皮神经麻痹（4例）。9例髋关节（11%）因螺钉刺激症状而需手术取出螺钉，其中2例需要第二次手术以复位髋臼截骨块。除发育性髋关节发育不良外的其他潜在诊断会增加轻微并发症的发生率（p = 0.0017）外，手术时间延长、出血量增加以及近端股骨截骨则更易导致严重并发症。
结论：髋臼周围截骨术作为保髋手术，能够非常有效地矫正青少年患者的髋关节发育不良，并能改善影像学结果且并发症发生率低。虽然除发育性髋关节发育不良外的其他潜在诊断会增加轻微并发症的发生率，但未发现其他预测因素。然而，手术时间越长，同时进行股骨内翻截骨术，发生严重并发症的可能性就越大。
Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents
Background: The Bernese (Ganz) periacetabular osteotomy is an effective surgical procedure to reorient the acetabulum, allowing restoration of anatomic femoral head coverage and medial translation of the hip in adults with hip dysplasia. However, it is a challenging surgical procedure, and we know of no study that has specifically analyzed the complications and associated factors seen with this procedure in adolescent patients.
Methods: A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted.
Results: Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 +/- 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (-0.14 degrees to 35.5 degrees), the ventral center-edge angle (-5.13 degrees to 31.3 degrees), and the femoral head extrusion index (38.4% to 7.7%) (p < 0.0001 for all). There were three major complications, including excessive arterial bleeding requiring embolization in a patient with a prior acetabuloplasty, osteonecrosis of the acetabular fragment in a patient with severe dysplasia and subluxation of the hip, and osteonecrosis of the femoral head following combined periacetabular and femoral osteotomies in a patient with Charcot-Marie-Tooth disease. Eighteen hips (22%) had minor complications, including nonunion of the superior pubic ramus osteotomy (five hips), a superficial stitch abscess (four), and transient lateral femoral cutaneous nerve palsy (four). Nine hips (11%) underwent removal of symptomatic screws, and two required a second operation to reposition the acetabular fragment. An underlying diagnosis other than developmental dysplasia increased the prevalence of minor complications (p = 0.0017), while a major complication was more likely with longer surgery time, greater blood loss, and proximal femoral osteotomy.
Conclusions: The Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.
文献出处：Dinesh Thawrani, Daniel J Sucato, David A Podeszwa, Adriana DeLaRocha. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am. 2010 Jul 21;92(8):1707-14. doi: 10.2106/JBJS.I.00829.
文献6
有症状的发育性髋关节发育不良患者从仰卧位到站立位的骨盆后倾
译者 邱兴
骨盆矢状面倾斜度显著影响发育性髋关节发育不良患者的髋臼对股骨头的覆盖程度，但目前尚无研究量化DDH患者在仰卧位和站立位时的PSI。此外，关于髋臼周围截骨术后PSI如何变化也知之甚少。本研究旨在量化DDH患者术前及术后仰卧位与站立位的PSI。
我们分析了25例接受髋臼周围截骨术的DDH患者。采用X光片与计算机断层扫描图像的配准技术，测量了术前及术后2年时仰卧位和站立位的PSI。同时，量化了从仰卧位变为站立位时PSI变化超过10°的患者比例。
术前，从仰卧位到站立位，骨盆平均向后倾斜8.2 ± 5.0°。其中9例（36%）患者出现超过10°的骨盆后倾。髋臼周围截骨术后2年，体位性PSI变化为平均向后倾斜7.1 ± 3.9°。比较术前与术后的PSI值发现，站立位PSI无显著差异（p = 0.20）。同样，从仰卧位到站立位的PSI变化量也无显著差异（p = 0.26）。
结论：在有症状的DDH患者中，术前即存在站立位时的骨盆后倾，且该现象在髋臼周围截骨术后2年依然存在。这种PSI的体位性变化似乎并未影响髋臼周围截骨术的手术效果。然而，在进行术前规划时，外科医生应认识到，部分DDH患者的髋臼前倾角或髋臼前侧覆盖度在仰卧位和站立位之间存在差异。
关键词： 2D-3D配准；发育性髋关节发育不良；骨盆矢状面倾斜度；髋臼周围截骨术；术后分析。
图1. 仰卧位与站立位骨盆矢状面倾斜度的定义。(A) 仰卧位PSI 定义为骨盆前平面（白色线）与平行于地面的直线（黑色线）之间的夹角。(B) 站立位PSI 定义为骨盆前平面（白色线）与垂直于地面的直线（黑色线）之间的夹角。(C) 仰卧位（青色）与站立位（黄色）骨盆位置的比较。 为清晰起见，将两种体位的垂直轴与耻骨结节位置进行了匹配。PSI值设定为：骨盆前旋为正，后旋为负。
图2 应用放射性立体测量分析评估二维-三维（2D-3D）配准的准确性。(A) 固定于定制倾斜平台上的干燥骨骼，分别展示其水平与倾斜位置。(B) 干燥骨骼在水平及倾斜位置（带有性腺防护罩）拍摄的前后位X光片。(C) 水平与倾斜位置的2D-3D配准结果（此处显示为根据计算机断层扫描图像生成并与X光片配准的表面模型）。
Posterior Pelvic Tilt From Supine to Standing in Patients With Symptomatic Developmental Dysplasia of the Hip
Pelvic sagittal inclination (PSI) significantly affects the femoral head coverage by the acetabulum in patients with developmental dysplasia of the hip (DDH), while no reports have quantified PSI in DDH patients in the supine and standing positions. Furthermore, little is known about how PSI changes after periacetabular osteotomies. Herein, PSI in the supine and standing positions was quantified in DDH patients preoperatively and postoperatively. Twenty-five patients with DDH who had undergone periacetabular osteotomies were analyzed. The preoperative PSI and the PSI 2 years after surgery were measured in the supine and standing positions using the image registration technique between radiographs and computed tomographic images. The percentage of patients who showed PSI changes of more than 10° from the supine to the standing position was quantified. PSI changed 8.2 ± 5.0° posteriorly from the supine to the standing position during the preoperative period. Posterior pelvic tilt of more than 10° was found in nine cases (36%). Two years after periacetabular osteotomies, the postural PSI change was 7.1 ± 3.9° posteriorly. When the preoperative and postoperative PSI values were compared, PSI in the standing position did not differ (p = 0.20). Similarly, the amount of PSI change from the supine to standing position was not significantly different (p = 0.26). In conclusion, posterior pelvic tilt in the standing position was found preoperatively in symptomatic DDH patients, and it remained for 2 years after periacetabular osteotomies. This postural change in PSI does not seem to influence the outcome of periacetabular osteotomy. However, during preoperative planning, surgeons should recognize that acetabular anteversion or anterior acetabular coverage differs between the supine and standing positions in some patients with DDH.
Keywords: 2D-3D registration; developmental dysplasia of the hip (DDH); pelvic sagittal inclination; periacetabular osteotomy; postoperative analysis.
文献出处：Tani, Tetsuro, Masaki Takao, Keisuke Uemura, Yoshito Otake, Hidetoshi Hamada, Wataru Ando, Yoshinobu Sato, and Nobuhiko Sugano. "Posterior pelvic tilt from supine to standing in patients with symptomatic developmental dysplasia of the hip." Journal of Orthopaedic Research® 38, no. 3 (2020): 578-587.
来源：304关节学术
作者：304关节团队
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