本期目录：
1、外侧单间室膝关节置换术的适应证
2、髌骨关节面关节炎是否为单间室膝关节置换术的禁忌证
3、全膝关节置换术后的缝隙腐蚀会降解干骺端袖套
4、水泥固定还是生物固定？一项前瞻性、随机研究比较骨水泥与生物全膝关节置换术的10年随访结果
5、计算机断层扫描与长腿平片在全膝关节置换术中基于 CPAK 的冠状面对线评估对比
6、儿童下肢旋转角度
7、经腹直肌旁入路行髋臼周围截骨术：技术可行性及经验证的手术导航系统控制骨块活动度的尸体研究
8、青少年股骨髋臼撞击征行关节镜治疗后短期深蹲力学分析
9、中国成年人发育性髋关节发育不良患病率
10、影响髋臼周围截骨术后患者满意度的因素
11、步态中调整足步向角可降低膝骨关节炎患者的膝关节内收力矩且不增加髋关节力矩
12、哪些髋臼测量参数最能准确区分患者和对照组
13、形态性髋关节异常的遗传学及其对骨关节炎的影响
第一部分：关节置换及保膝相关文献
No.1
文献1
外侧单间室膝关节置换术的适应证-系统回顾
译者 张轶超
背景：尽管内侧UKA的循证适应征已经确立，但外侧UKA的最佳适应证并没有受到太多的关注。内侧和外侧UKA之间存在明显的解剖、骨关节炎表型、运动学和手术技术差异。这两种手术的适应证可能存在不同。因此，本综述旨在获取已发表的外侧UKA队列研究的适应征和禁忌症，以确定是否存在共识。
方法：于2024年5月，按照系统评价和荟萃分析首选报告项目（PRISMA）指南进行系统评价。纳入了有明确报告外侧UKA适应征的队列研究。搜集了适应征和禁忌症的数据以评估共识。此外，还获得了扩大或评测外侧UKA适应征相关的效果。
结果：纳入38项研究。外侧UKA多用于原发性外侧间室骨关节炎。报道最多的适应征是中度至重度外侧骨关节炎，内侧间室软骨完好，韧带完整，可矫正的外翻畸形，屈曲挛缩< 10-15度。报道最多的禁忌症是炎症性关节炎和严重的髌骨受累。8项研究调查了外侧UKA后不同适应征的效果；提示原发性外侧骨关节炎的预后更好，髌股关节状况对效果无显著影响，年龄和体重方面的影响各家报告不一。
结论：虽然文献表明关于外侧UKA的适应证确实存在一些共识，但没有发现一个强有力的共识，这表明目前还不存在明确的、基于共识的外侧UKA适应证。
Indications for lateral unicompartmental knee arthroplasty – A systematic review
Background: While evidence-based indications are established for medial UKA, the optimal indications for lateral UKA have not received as much attention. There exists significant anatomical, osteoarthritis phenotype, kinematic, and surgical technique differences between medial and lateral UKA. The indications for the two procedures may therefore not be identical. Hence, this review aims to access the indications and contraindications in published cohort studies on lateral UKA, to assess if consensus exists.
Methods: In May 2024, a systematic review was carried out following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies on lateral UKA with a clear report of indications were included. Data on indications and contraindications were extracted to evaluate consensus. Furthermore, outcomes related to expanding or testing indications for lateral UKA were obtained.
Results: 38 studies were included. Lateral UKA was mostly performed for primary lateral osteoarthritis. The most reported indications were moderate to severe lateral osteoarthritis, with full-thickness cartilage in the medial compartment, intact ligaments, a correctable valgus deformity, and a flexion contracture < 10–15 degrees. The most reported contraindications were inflammatory arthritis and severe patellofemoral involvement. Eight studies investigated different indications on outcomes after lateral UKA; suggesting better outcomes for primary lateral osteoarthritis, no significant impact from the state of the patellofemoral joint, and conflicting results regarding age and weight.
Conclusion: While the literature suggests that some agreement does exist regarding indications for lateral UKA, a strong consensus was not found, indicating that well-defined and consensus-based indications for lateral UKA do not yet exist.
文献出处：Ifigenia Bunyoz K, Troelsen A, Gromov K, Alvand A, Bottomley N, Jackson W, Price A. Indications for lateral unicompartmental knee arthroplasty - A systematic review. Knee. 2025 Jan;52:58-68. doi: 10.1016/j.knee.2024.10.012. Epub 2024 Nov 13. PMID: 39541657.
文献2
髌骨关节面关节炎是否为单间室膝关节置换术的禁忌证：当前观点
译者 马云青
内侧单髁膝关节置换术（UKA）在治疗终末期前内侧骨关节炎中的应用日益广泛，部分归因于其相较于全膝关节置换术（TKA）具有恢复更快、功能改善更佳及内科并发症风险更低等优势。然而，尽管UKA取得成功，关于某些患者特征（如年龄、体重指数、前交叉韧带状态以及髌股关节的术前状况）是否适合行此手术仍存争议。作者探讨导致当前争议的历史因素，并围绕术前髌股关节关节炎及前膝痛对内侧UKA假体存活率和临床结局影响的近期证据进行评估。通过研究现有证据支持在严格选择的前内侧骨关节炎患者中，即使存在术前髌股关节退变或前膝痛，施行内侧UKA也是安全有效的。临床决策的重点应从单纯的“是否存在髌股关节炎”转向更精细的评估，特别是关注**外侧髌股关节的病变严重程度（如严重骨缺损、沟槽形成）以及髌骨的轨迹（是否存在外侧半脱位）。这些因素更可能影响预后，被视为需要慎重考虑的相对禁忌症。假体设计（固定或活动平台）的选择可基于外科医生经验和患者具体情况，两者在现有证据下均表现良好。
文献出处：Bertrand TE, Melvin PR, Lombardi AV Jr, Berend KR. Is patella facet arthritis a contraindication to unicompartmental knee arthroplasty: Current concepts. J ISAKOS. 2024 Dec;9(6):100343. doi: 10.1016/j.jisako.2024.100343. Epub 2024 Oct 16. PMID: 39419310.
文献3
全膝关节置换术后的缝隙腐蚀会降解干骺端袖套
译者 张蔷
背景：术者会在膝翻修手术（revision TKA）中应用干骺端袖套来弥补骨缺损并增加稳定性。然而，有一项病例研究记录了假体上出现的腐蚀并发现腐蚀造成的金属释放与局部组织反应的相关性。本研究中，我们调查了干骺端袖套与假体界面的腐蚀情况，并试图解释如下问题：(1)腐蚀的发生率？(2)钴铬钼合金的股骨假体锥度位置是否会出现更多损伤；(3)损伤模式是什么样的？
方法：我们回收并分析了膝翻修术后17个股骨-袖套复合体和15个胫骨-袖套复合体。首先，我们应用Glodberg评分标准来对腐蚀进行分类，并在钴铬钼假体横切面上定量统计腐蚀情况（ΔCmax）。之后，我们应用扫描电子显微镜和X射线能量色散光谱对中-重度腐蚀的假体进行扫描或拍摄。最后，我们应用非参数统计方法分析了胫骨和股骨假体上腐蚀的差异。
带钽金属袖套的钴铬钼合金股骨假体，显示锥度和袖套均存在显著腐蚀情况。
带钽金属袖套的钴铬钼合金胫骨假体，显示锥度和袖套均存在显著腐蚀情况。
结果：我们在82%的股骨锥度和100%的股骨袖套上，以及73%的胫骨平台锥度和86%的胫骨袖套上，发现了腐蚀情况。在横断面切片分析中，我们发现股骨锥度腐蚀明显多于胫骨锥度（P = 0.04）。股骨锥度上最常见的损伤模式为点蚀、蚀刻和氧化物碎片，而钽金属股骨袖套上，我们发现了磨光情况。
结论：我们的发现显示机械性的缝隙腐蚀会促进干骺端假体的降解。如果医生未来遇到应用了干骺端袖套并伴发不明原因疼痛或可疑金属释放的病人，在严格排除其他诊断后，务必考虑测量金属浓度。
Crevice Corrosion Degrades Metaphyseal Sleeves Following Total Knee Arthroplasty
A Retrieval Study
Background: Surgeons use metaphyseal sleeves in revision total knee arthroplasty (TKA) to compensate for bone loss and improve stability. However, a clinical case series documented corrosion on these devices and associated the subsequent metal release with adverse local tissue reactions. In this study, we investigated corrosion at the mixed-alloy, metaphyseal sleeve—implant interface. We asked the following: (1) How common is corrosion? (2) Does more damage occur at the femoral cobalt chrome alloy (CoCrMo) taper? (3) What damage modes occur?
Methods: We analyzed 17 femoral and 15 tibial implant-sleeve components following revision surgery. First, corrosion was classified using the Goldberg score and quantified using the axial corrosion (ΔCmax) on CoCrMo implants. Then, moderately and severely corroded devices were imaged using scanning electron microscopy and energy dispersive X-ray spectroscopy. Differences in corrosion on CoCrMo tibial and femoral implants were assessed using nonparametric statistics.
Results: We observed corrosion on 82% of femoral adapters, 100% of femoral sleeves, 73% of tibial trays, and 86% of tibial sleeves. On CoCrMo femoral adapters, we measured more axial corrosion than on CoCrMo tibial trays (P = 0.04). The predominant damage modes on femoral adapters included pitting, etching, and oxide debris. On titanium alloy femoral sleeves, we documented a burnishing effect, revealing the underlying microstructure.
Conclusions: Our findings indicate that mechanically assisted crevice corrosion promotes metaphyseal implant degradation. Should surgeons encounter patients who have metaphyseal sleeves and unexplained pain or suspected metal release, consider measuring metal concentrations after rigorous rule out of competing diagnoses
文献4
水泥固定还是生物固定？一项前瞻性、随机研究比较骨水泥与生物全膝关节置换术的10年随访结果
译者 丁云鹏
背景：全膝关节置换术（TKA）的最佳固定方式仍存在争议。
方法：本研究纳入100例使用模块化小梁金属胫骨组件的骨水泥与非骨水泥TKA病例进行对比。本次报告涉及91例获得随访数据的病例，其中67例完成至少10年随访（骨水泥组36例[A组]，非骨水泥组31例[B组]）。我们此前已报道过这项前瞻性随机试验的2年和5年结果。术前及术后均记录膝关节协会评分和牛津评分。
结果：两组平均膝关节协会评分（94.4分 vs 89.1分，P=0.21）与牛津评分（44.1分 vs 43.9分，P=0.80）相似。A组在5年随访时有2例翻修，10年随访时新增3例因聚乙烯磨损、骨溶解和松动导致的翻修；B组5年随访时有2例翻修，10年随访时新增2例因聚乙烯磨损、不稳及松弛导致不稳的翻修。总计A组2例、B组1例因假体固定并发症翻修。以任何原因翻修作为终点的假体存活率两组相当（91.5% vs 95.9%，P=0.60），以胫骨托盘翻修作为终点的存活率亦相当（93.7% vs 95.9%，P=0.55）。未发现进行性放射透亮线病例。A组出现5例骨溶解（80%发生在胫骨），B组2例骨溶解（0%发生在胫骨）。
结论：10年随访显示非骨水泥与骨水泥TKA的患者报告结局和假体存活率相当。骨水泥固定存在较高骨溶解和松动率，可能与第三体磨损增加有关。非骨水泥固定展现出作为多数患者理想选择的巨大潜力。本研究计划在15年和20年进行后续更新以获取更长期结果。
To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty
Background: The optimal mode of fixation for total knee arthroplasty (TKA) continues to be a subject of debate.
Methods: There were 100 cases enrolled to compare cemented and cementless TKA using a modular trabecular metal tibia. This is a report on the 91 cases with follow-up information, including 67 cases with a minimum 10-year follow-up: 36 cases in the cemented cohort (A) and 31 cases in the cementless cohort (B). We previously reported the 2- and 5-year results for this prospective, randomized trial. Knee Society Scores and Oxford scores were collected preoperatively and postoperatively.
Results: The mean Knee Society Scores (94.4, 89.1, P = 0.21) and Oxford scores (44.1, 43.9, P = 0.80) were similar in both groups. Group A had two revisions at 5-year follow-up, with three additional revisions for polyethylene wear, osteolysis, and loosening at 10-year follow-up. Group B had two revisions at 5-year follow-up, with two additional revisions for polyethylene wear and instability and instability due to laxity at 10-year follow-up. In total, two group A cases and one group B case were revised for implant fixation complications. Survivorship with any revision as an end point was equivalent between the two cohorts (91.5%, 95.9%, P = 0.60), as was survivorship using tibial tray revision as an end point (93.7%, 95.9%, P = 0.55). No cases demonstrated any progressive radiolucencies. Group A had 5 cases with osteolysis (80% tibial), and Group B had two cases of osteolysis (0% tibial).
Conclusions: Cementless and cemented TKA had equivalent patient-reported outcomes and survivorship at 10-year follow-up. Cemented fixation had a higher rate of osteolysis and loosening, which may be related to increased third-body wear. Cementless fixation shows immense potential as a successful option for many patients. Updates to this study cohort are planned at 15- and 20-year intervals to obtain longer-term outcomes.
文献出处：Nicholas R Olson 1, Nancy L Parks 1, Shaan S Nagda.To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty.J Arthroplasty. 2025 Oct;40(10):2630-2636. doi: 10.1016/j.arth.2025.04.076. Epub 2025 May 7.
文献5
计算机断层扫描与长腿平片在全膝关节置换术中基于 CPAK 的冠状面对线评估对比：一项前瞻性评价
译者 沈松坡
准确评估冠状面对线对于全膝关节置换术（TKA）的规划至关重要 。膝关节冠状面对线（CPAK）分类法将机械对线和关节线倾斜度整合为九种表型，但其可靠性取决于测量精度 。本研究旨在比较通过计算机断层扫描（CT）和长腿站立放射线片获得的 CPAK 分类及冠状面对线参数的准确性和可靠性 。
本项前瞻性对比研究对 100 名因退行性关节炎接受初次 TKA 的患者进行了研究 。每位患者均接受了标准化的长腿站立放射线检查和使用 MAKO 机器人规划软件进行的全肢 CT 扫描 。测量指标包括算术髋-膝-踝（aHKA）角、外侧远端股骨角（LDFA）、内侧近端胫骨角（MPTA）以及关节线倾斜度（JLO） 。CPAK 分类由 aHKA 和 JLO 值确定 。两名独立的观察者记录了所有参数 。研究使用配对 t 检验分析了不同影像模态间的差异，并使用组内相关系数（ICC）和 Cohen's kappa 系数评估了可靠性 。
研究共分析了 100 名患者，其中 86 名患者拥有完整的数据集 。与放射线片相比，CT 在 HKA、LDFA 和 MPTA 测量中持续产生不同的数值（p < 0.001），而 aHKA、JLO 和 CPAK 分类结果则没有显著差异 。两种影像模态均表现出极佳的观察者间可靠性（ICC > 0.88），且在不改变整体 CPAK 表型分类的情况下，CPAK 测量的一致性近乎完美（k = 0.86–0.88） 。
与放射线片相比，基于 CT 的测量为冠状面对线参数提供了更高的精确度和可重复性 。然而，CPAK 分类在不同影像模态之间保持高度一致，验证了其在不同影像技术中的稳健性 。CT 为术前规划提供了精确的数值，特别是在机器人辅助流程或复杂畸形中，而放射线片对于常规表型分析仍然足够 。
关键词： 计算机断层扫描；CPAK 分类；全膝关节置换术；冠状面对线；长腿平片；机器人辅助手术；可靠性
图1 下肢全长片显示各种下肢角度测量
图 2：基于 MAKO 机器人软件的 CT 成像与测量
图 2 A-2C (Fig. 2 A-2C)： 通过 MAKO 机器人规划软件生成的薄层扫描及三维重建图像 。
2A： 展示了股骨在横断面（Transverse）、冠状面（Coronal）和矢状面（Sagittal）的解剖参考点定位 。
2B： 由 MAKO 软件确定的股骨远端解剖标志点（Constitutional landmarks） 。
2C： 由 MAKO 软件确定的胫骨解剖标志点 。
图 2D (Fig. 2D)： 成功上传 CT 扫描数据后，外科医生可在 MAKO 软件中直接获取的自动生成测量值 。
图3 CPAK分型
Computed tomography versus long-leg radiography for CPAK-based coronal alignment assessment in total knee arthroplasty: a prospective evaluation
Abstract
Accurate assessment of coronal alignment is essential for total knee arthroplasty (TKA) planning. The Coronal Plane Alignment of the Knee (CPAK) classification integrates mechanical alignment and joint line obliquity into nine phenotypes, but its reliability depends on measurement accuracy. This study aimed to compare the accuracy and reliability of CPAK classification and coronal alignment parameters obtained from computed tomography (CT) and long-leg standing radiographs. A prospective comparative study was conducted on 100 patients undergoing primary TKA for degenerative arthritis. Each patient underwent standardized long-leg standing radiographs and full-limb CT scans using MAKO robotic planning software. Measurements included the arithmetic hip-knee-ankle (aHKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line obliquity (JLO). CPAK classification was determined from aHKA and JLO values. Two independent observers recorded all parameters. Inter-modality differences were analyzed using paired t-tests, and reliability was assessed using intraclass correlation coefficients (ICC) and Cohen's kappa. A total of 100 patients were analyzed, with complete datasets for 86 patients. CT consistently produced different values for HKA, LDFA, and MPTA compared with radiographs (p < 0.001), while aHKA, JLO and CPAK classifications showed no significant difference. Both modalities demonstrated excellent interobserver reliability (ICC > 0.88) and near-perfect CPAK agreement (κ = 0.86-0.88) measurement without altering overall CPAK phenotype classification. CT-based measurements provide greater precision and reproducibility for coronal alignment parameters compared with radiographs. However, CPAK classification remains largely consistent between modalities, validating its robustness across imaging techniques. CT offers precise value for preoperative planning, particularly in robotic-assisted workflows or complex deformities, while radiographs remain adequate for routine phenotyping. Level II - Prospective comparative study.
Keywords: CPAK classification; Computed tomography; Coronal alignment; Long-leg radiograph; Reliability; Robotic-assisted surgery; Total knee arthroplasty.
第二部分：保髋相关文献
No.2
文献1
儿童下肢旋转角度
译者 任宁涛
我们研究了1000名儿童和成人的正常下肢，以确定下肢旋转的正常值。胎儿在子宫内的位置通过使其股骨向外旋转、胫骨向内旋转来塑造这两块骨头的形态。这些塑造效应通常在婴儿期就会自发地消失，然后遗传决定的个体差异就会显露出来。下肢旋转问题应进行临床评估，并与本研究提供的正常值进行比较。婴儿的外八、幼儿的胫骨内侧扭转和幼儿的股骨内侧扭转是正常发育模式的极端情况。在绝大多数情况下，这些旋转变化都在正常范围内，不需要治疗。
图1 五项测量结果绘制为22个年龄组中每个年龄组正负两个标准差的平均值。实线表示随年龄的平均变化：阴影区域。正常范围：实心圆。不同年龄组的平均测量值：空心圆。同一测量值的正负两个标准差。
图2 男性，不同年龄段髋关节内旋情况
图3 女性，不同年龄段髋关节内旋情况
图4 男性和女性，不同年龄髋关节外旋情况
图5 不同年龄股足角情况
图6 不同年龄跨踝轴（TMA）角度情况
图7 不同年龄股足角和跨踝轴角度比较
Lower-extremity rotational problems in children
We studied 1,000 normal lower extremities of children and adults in order to establish normal values for the rotational profile. The intrauterine position of the fetus molds the femur by rotating it laterally and molds the tibia by rotating it medially. These molding effects usually resolve spontaneously during infancy, and then genetically determined individual differences are unmasked. Rotational problems should be clinically evaluated and the findings compared with the normal values provided by this study. Out-toeing in infants, medial tibial torsion in toddlers, and medial femoral torsion in young children are extremes of a normal developmental pattern. In the vast majority, these rotational variations fall within the broad range of normal and require no treatment.
文献出处：Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47. PMID: 3968103.
文献2
经腹直肌旁入路行髋臼周围截骨术：技术可行性及经验证的手术导航系统控制骨块活动度的尸体研究
译者 李勇
目的： 腹直肌旁入路（pararectus approach）已被证实可有效用于处理髋臼骨折。本研究假设该入路也可作为实施髋臼周围截骨术（PAO）的一种替代入路。
方法： 采用 4 具尸体标本，随机通过腹直肌旁入路或改良 Smith-Petersen（SP）入路实施 PAO。我们评估了该入路的技术可行性与安全性。此外，我们利用手术导航系统监测了骨块的活动度，并对比了两种入路间的活动度差异。通过与经过验证的术前规划软件进行交叉检验，测试了该导航系统的准确性。
结果： 腹直肌旁入路在技术上具有可行性，能够提供充分的术野显露，确保截骨过程安全，并能对风险结构（重要组织）进行极佳的保护。该入路获取的骨块活动度与经 SP 入路获得的结果相当。验证性测量显示，两组间的平均差异小于 1 mm，且无统计学意义。
结论： 实验数据表明，腹直肌旁入路可能是实施 PAO 的一种替代方案。仍需进一步的临床验证以确认这些令人期待的初步结果。
Periacetabular osteotomy through the pararectus approach:technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment
Abstract Purpose The pararectus approach has been validated for managing acetabular fractures. We hypothesised it might be an alternative approach for performing periacetabular osteotomy (PAO). Methods Using four cadaver specimens, we randomly performed PAO through either the pararectus or a modified Smith-Petersen (SP) approach. We assessed technical feasibility and safety. Furthermore, we controlled fragment mobility using a surgical navigation system and compared mobility between approaches. The navigation system's accuracy was tested by cross-examination with validated preoperative planning software. Results The pararectus approach is technically feasible, allowing for adequate exposure, safe osteotomies and excellent control of structures at risk. Fragment mobility is equal to that achieved through the SP approach. Validation of these measurements yielded a mean difference of less <1 mm without statistical significance. Conclusion Experimental data suggests the pararectus approach might be an altemative approach for performing PAO. Clinical validation is necessary to confirm these promising preliminary results.
文献出处：Liu L, Zheng G, Bastian JD, Keel MJ, Nolte LP, Siebenrock KA, Ecker TM. Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment. Int Orthop. 2016 Jul;40(7):1389-96. doi: 10.1007/s00264-015-2892-6. Epub 2015 Jul 11. PMID: 26162984.
文献3
青少年股骨髋臼撞击征行关节镜治疗后短期深蹲力学分析
译者 张利强
背景 股骨髋臼撞击征是由于髋臼覆盖过度或股骨头颈交界处骨凸异常所致，可能导致重复性髋关节屈曲时疼痛或不适。既往研究报道FAI患者与对照组相比在深蹲力学上的适应性改变，但据我们所知，目前很少有研究探讨青少年患者术前至术后的变化。
目的 (1)手术治疗是否能使最大深蹲深度得到可测量的改善？ (2)手术干预是否会改变个体在深蹲过程中的平衡控制策略？ (3)术后在深蹲周期的特定动作里程碑上是否存在运动学变化？ (4)涵盖整个动作的整体深蹲策略是否表现出术后变化？
方法 对2016年2月至2023年7月期间纳入的一项大型前瞻性研究的患者进行回顾性分析，该研究评估了各种髋部手术后的下肢生物力学结果。筛选出60例髋符合特定标准：(1)无神经性或综合征异常；(2)经影像学评估诊断为有症状的特发性FAI；(3)计划由同一位骨科医生进行髋关节镜保髋手术；(4)术前在本实验室进行了运动捕捉测试。其中，排除双侧有症状FAI患者以及曾接受过手术治疗的患者，剩余43例患者。总计，79%(43例中的34例)的患者完成了本研究分析的目标深蹲动作，其中65% (34例中的22例)在术后8至16个月随访时完成了相同的任务。在整个深蹲周期中的四个里程碑关键动作分析矢状面节段角和关节角以及足部前进角即：最大深蹲深度、术前最大深蹲深度、最大骨盆倾斜和最大屈髋。在整个深蹲过程中，绘制骨盆倾斜和屈髋相对于深蹲深度以及彼此之间的关系图，并计算下降与上升曲线之间的面积以量化矢状面运动。
结果 术后最大深蹲深度中位数（范围）增加（术前27 [13至38]对比术后28 [17至40]，中位数差1 [95% CI 1至5]；p = 0.02）。平衡控制策略变化极小，唯一显著差异是术后深蹲时躯干屈曲增加（术前44 [6至65]对比术后47[18至74]，中位数差3 [95% CI 1至13]；p = 0.01）。在最大深蹲深度（术前112 [71至135] 对比 术后117 [78至144]，中位数差5 [95% CI -1至14]；p = 0.02）和最大屈髋位置（术前112 [71至132]对比术后117[78至144]，中位数差5[95% CI -1至14]；p = 0.02）均观察到膝关节屈曲增加。在深蹲过程中的最大深蹲深度、最大骨盆倾斜或最大屈髋位置，骨盆倾斜角、屈髋角和足部前进角均无显示差异。躯干（术前43 [16至66] 对比 术后52 [25至75]，中位数差9 [95% CI 2至16]；p = 0.01）、骨盆（术前24 [13至37] 对比 术后27 [15至44]，中位数差3 [95% CI 1至7]；p = 0.02）、髋关节（术前98 [76至116] 对比 术后103 [89至130]，中位数差5 [95% CI 0至8]；p = 0.046）和膝关节（术前112 [73至141]对比术后124[87至152]，中位数差12 [95% CI 3至15]；p = 0.02）的矢状面活动范围中位数（范围）均增加。
结论 基于这些发现，深蹲检测可作为临床医生在手术治疗前后快速评估患者功能能力的工具。未来研究应探索纵向研究以评估生物力学随时间的变化，并考虑在青少年FAI患者中，标准化的术后康复是否会改变其深蹲模式。
证据等级 III级，治疗性研究。
通过深蹲观察骨盆矢状面运动。
Short-term Squatting Mechanics After Arthroscopic Treatment for Femoroacetabular Impingement in Adolescents
Background Femoroacetabular impingement (FAI) results from overcoverage of the acetabulum or excess bone on the femoral head-neck junction, which may cause pain or discomfort with repetitive hip flexion. Previous studies have reported adaptations in squat mechanics in individuals with FAI compared with controls, but to our knowledge, there has been little research exploring pre- to postoperative deviations in adolescents.
Questions/purposes (1) Does surgical treatment result in measurable improvements in maximum squat depth? (2) Does surgical intervention alter the individual’s balance control strategy during squatting? (3) Are there kinematic changes at specific movement milestones within the squat cycle after surgery? (4) Does the overall squat strategy, encompassing the entire movement, exhibit postoperative changes?
Methods A retrospective analysis was conducted of patients enrolled between February 2016 and July 2023 in a large prospective study evaluating lower extremity biomechanical outcomes after various hip surgeries. Sixty hips were identified meeting specific criteria: (1) absence of neurological or syndromic abnormalities, (2) diagnosis of symptomatic idiopathic FAI through radiographic assessment, (3) scheduled for arthroscopic hip preservation surgery performed by one orthopaedic surgeon, and (4) tested in our motion capture lab before surgery. Of the 60, patients with bilateral symptomatic FAI were excluded as were those who had undergone previous surgical treatment, leaving 43 patients. In all, 79% (34 of 43) of patients completed the target squat that was analyzed in this study, and 65% (22 of 34) of patients completed the same task at their postoperative visit 8 to 16 months after surgery. Sagittal plane segment and joint angles as well as foot progression angle were analyzed across the squat cycle at four key movement milestones: maximum squat depth, preoperative maximum squat depth, maximum pelvic tilt, and maximum hip flexion. Pelvic tilt and hip flexion were plotted versus squat depth and versus each other throughout the squat task with the area between the descent and ascent curves calculated to quantify motion in the sagittal plane.
Results Median (range) maximum squat depth (pre- operative 27 [13 to 38] versus postoperative 28 [17 to 40], median difference 1 [95% CI 1 to 5]; p = 0.02) increased postoperatively. Balance control strategies showed minimal changes, as the only notable difference was increased trunk flexion during the postoperative squat (preoperative 44 [6 to 65] versus postoperative 47 [18 to 74], median difference 3 [95% CI 1 to 13]; p = 0.01). Increased knee flexion was observed at both the maximum squat depth (preoperative 112 [71 to 135] versus postoperative 117 [78 to 144], median difference 5 [95% CI -1 to 14]; p = 0.02) and maximum hip flexion (preoperative 112 [71 to 132] versus postoperative 117 [78 to 144], median difference 5 [95% CI -1 to 14]; p = 0.02) positions. Pelvic tilt, hip flexion, and foot progression angles demonstrated no differences at the maximum squat depth, maximum pelvic tilt, or maximum hip flexion positions during the squat. Median (range) sagittal plane ROM increased for the trunk (pre- operative 43 [16 to 66] versus postoperative 52 [25 to 75], median difference 9 [95% CI 2 to 16]; p = 0.01), pelvis (preoperative 24 [13 to 37] versus postoperative 27 [15 to 44], median difference 3 [95% CI 1 to 7]; p = 0.02), hip (preoperative 98 [76 to 116] versus postoperative 103 [89 to 130], median difference 5 [95% CI 0 to 8]; p = 0.046), and knee (preoperative 112 [73 to 141] versus post- operative 124 [87 to 152], median difference 12 [95% CI 3 to 15]; p = 0.02).
Conclusion Based on these findings, the squat task could be used as a functional tool for clinicians to quickly assess a patient’s abilities before and after surgical treatment. Future research should explore longitudinal studies to assess biomechanical changes over time and to consider whether standardized postoperative rehabilitation in adolescents alters the squat pattern for patients with FAI.
Level of Evidence Level III, therapeutic study.
文献出处：Loewen AM, McGinley J, Ulman S, Johnson B, Morris WZ, Ellis HB. Short-term Squatting Mechanics After Arthroscopic Treatment for Femoroacetabular Impingement in Adolescents. Clin Orthop Relat Res. 2026 Jan 1;484(1):165-174. doi: 10.1097/CORR.0000000000003603. Epub 2025 Jun 25. PMID: 40632063.
文献4
中国成年人发育性髋关节发育不良患病率：一项横断面调查
译者 贾海港
背景： 中国发育性髋关节发育不良（DDH）的患病率尚不清楚。本研究旨在确定中国成年人群中 DDH 的患病率。
方法： 在本研究中，我们对具有全国代表性的中国成年人样本进行了横断面调查。所有参与者都接受了问卷调查、体格检查和 X 线检查。。采用 logistic 回归分析了与发育性髋关节发育不良（DDH）相关的因素。
结果： 我们邀请了 29180 名 18 岁及以上的成年人参与调查，这些受试者是从 18 个初级抽样单元（城市街道和农村乡镇）中随机抽取的。最终有 25767 人完成了调查和体检（10296 名男性和 15471 名女性）。其中 391 人被诊断为发育性髋关节发育不良（DDH），DDH 的总体患病率为 1.52%。基于此，我们估计中国 DDH 患者人数约为 1605 万。DDH 患病率随年龄增加而升高（比值比=1.53 [1.03-2.27]，P=0.036），女性患病率显著高于男性（2.07% vs. 0.75%，P<0.001），农村居民患病率高于城市居民（1.75% vs. 1.29%，P<0.001）。经济发展水平与发育性髋关节发育不良（DDH）的发生存在独立关联。没有证据表明体重指数、教育程度或目前吸烟或饮酒与DDH风险之间存在关联（P > 0.05）。
结论： 发育性髋关节发育不良（DDH）已成为重要的公共卫生问题。应特别关注 DDH 患者。中国应开展 DDH 筛查。
Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey
Background: The prevalence of developmental dysplasia of the hip (DDH) is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults.
Methods: In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression.
Results: We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units (street districts in urban areas and townships in rural areas). The survey and examination were completed in 25,767 people (10,296 men and 15,471 women). DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age (odds ratio = 1.53 [1.03-2.27], P = 0.036), was significantly higher among women than men (2.07% vs. 0.75%, P< 0.001), and was higher among rural residents than urban residents (1.75% vs. 1.29%, P< 0.001). Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education, or current smoking or drinking and risk of DDH (P > 0.05).
Conclusions: DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.
Conclusions:DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.
文献出处：Tian FD, Zhao DW, Wang W, Guo L, Tian SM, Feng A, Yang F, Li DY. Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey. Chin Med J (Engl). 2017 Jun 5;130(11):1261-1268. doi: 10.4103/0366-6999.206357. PMID: 28524823; PMCID: PMC5455033.
文献5
影响髋臼周围截骨术后患者满意度的因素
译者 陶可
背景：髋臼周围截骨术(PAO)旨在治疗髋关节发育不良并预防骨关节炎的进展。既往研究已将人口统计学和影像学变量与术后患者预后相关联，但对患者期望及其与满意度的相关性关注有限。本研究旨在确定PAO术后是否存在此类关联。
方法：本研究采用匿名、去标识化的满意度调查问卷，对2017年4月至2019年4月期间接受PAO手术的患者进行调查。最终纳入分析的患者共40例（26例女性）。患者平均年龄为22.0± 5.1岁。所有患者均接受了至少12个月的术后随访。记录患者的人口统计学特征、诊断和并发症。随后分析X线片，确定术前和术后的外侧中心边缘角（LCEA）和Tönnis角，并进行满意度与X线分析结果的相关性分析。统计分析包括非参数Spearman相关分析和受试者工作特征曲线（ROC曲线）分析。统计学显著性水平设定为p < 0.05。
结果：30例（75%）患者对治疗结果感到满意。患者年龄或性别与术后满意度之间无统计学显著相关性（p > 0.05）。术前平均LCEA为10.9° ± 6.9°，术后为26.0° ± 4.2°，平均变化为15.1° ± 5.6°。术前平均Tönnis角为18.8° ± 3.3°，术后降至11.6° ± 3.2°，平均变化为-7.2° ± 3.2°。观察者间信度较高，术后Tönnis角的相关系数r = 0.782，p < 0.001；术前LCEA的相关系数r = 0.958，p < 0.001。术前LCEA与患者满意度呈正相关（r = 0.351，p = 0.027）。逻辑回归分析显示，术前LCEA每增加1度，术后满意度的几率增加1.13倍（95% CI：1.01至1.27），p = 0.034。
结论：本研究提示，髋臼周围截骨术（PAO）后患者的术后满意度可能与术前患者的人口统计学特征（如LCEA）相关。研究还提示，髋关节发育不良程度较重的患者术后满意度可能低于畸形程度较轻的患者。这些关联值得进一步研究，其结果可能对未来的手术具有预后价值。
Factors Associated with Patient Satisfaction After Periacetabular Osteotomy
Background: The periacetabular osteotomy (PAO) was developed to treat acetabular dysplasia and avoid the progression of osteoarthritis. Prior research has correlated demographic and radiographic variables with postoperative patient outcomes but with limited focus on patient expectations and correlation with satisfaction. The purpose of this study was to determine whether any such associations exist with the PAO.
Methods: An anonymous, de-identified satisfaction survey was applied to patients undergoing a PAO between April 2017 and April 2019. Forty patients (26 females) who underwent PAOs were included in the final analysis. The average age of the cohort was 22.0 ± 5.1 years of age. All patients had a minimum of 12 months of follow-up from the date of surgery. Patient demographics, diagnosis, and complications were recorded. Radiographs were then analyzed to determine pre- and postoperative lateral center edge angle (LCEA) and Tönnis roof angle, and correlations between satisfaction and radiographic analyses were performed. Statistical analysis included non-parametric Spearman's correlation and receiver operator characteristic. Statistical significance was set at p < 0.05.
Results: Thirty (75%) patients were satisfied with their outcome. There were no statistically significant associations between patient age or sex and postoperative satisfaction (p > 0.05). The average LCEA was 10.9° ± 6.9° preoperatively and 26.0° ± 4.2° postoperatively with an average change of 15.1° ± 5.6°. The average Tönnis angle was 18.8° ± 3.3° preoperatively, decreasing to 11.6° ± 3.2° postoperatively with an average change of -7.2° ± 3.2°. Interobserver reliability was high, ranging from r = 0.782, p < 0.001 for postoperative Tönnis angle to r = 0.958, p < 0.001 for preoperative LCEA. Preoperative LCEA correlated positively with satisfaction, r = 0.351, p = 0.027. Logistic regression demonstrated that for every increasing degree of preoperative LCEA, odds of postoperative satisfaction increased by 1.13 (95% CI: 1.01 to 1.27), p = 0.034.
Conclusion: This study suggests that postoperative patient satisfaction after PAO may be associated with preoperative patient demographics such as LCEA. It also suggests that more dysplastic hips may have lower rates of postoperative satisfaction than patients with less severe deformity. These associations warrant further study, which may yield prognostic value for future surgery.
文献出处：David A Bloom, Christina P Herrero, Anna Blaeser, Pablo G Castañeda. Factors Associated with Patient Satisfaction After Periacetabular Osteotomy. Bull Hosp Jt Dis (2013). 2024 Dec;82(4):261-265.
文献6
步态中调整足步向角可降低膝骨关节炎患者的膝关节内收力矩且不增加髋关节力矩
译者 邱兴
膝骨关节炎患者在行走时采用调整后的足步向角，通常可有效降低膝关节内收力矩。然而，目前尚不明确足步向角的改变是否会增加髋关节力矩（髋关节负荷的替代衡量指标），从而加大关节的力学负担。本研究旨在探究改变足步向角对髋关节力矩的影响。膝骨关节炎患者在一台仪器化跑步机上，分别以其基线步态、10°足尖内收步态和10°足尖外展步态进行行走。研究采用肌肉骨骼建模软件包，根据实验数据计算关节力矩。我们从一项规模更大的研究中选取了50名通过调整足步向角成功降低峰值膝关节内收力矩的参与者。在该组中，参与者采用10°足尖内收步态使膝关节内收力矩的第一峰值降低了7.6%，采用10°足尖外展步态使第二峰值降低了11.0%。调整足步向角不仅未增加屈曲力矩和内旋力矩（p > 0.15），还在髋关节接触力达到峰值时，使早期支撑期的髋关节外展力矩得以降低：10°足尖内收步态下降低4.3% ± 1.3%（p = 0.005, d = 0.49），10°足尖外展步态下降低4.6% ± 1.1%（p < 0.001, d = 0.59）。此外，74%的个体在采用调整后的足步向角时，于髋关节接触力峰值时刻的总髋关节力矩有所降低。总而言之，当采用一种能降低膝关节内收力矩的足步向角调整方式时，参与者平均而言并未增加其髋关节负荷的替代衡量指标。
关键词： 步态调整；关节负荷；肌肉骨骼建模；非手术干预；骨关节炎
Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis
People with knee osteoarthritis who adopt a modified foot progression angle (FPA) during gait often benefit from a reduction in the knee adduction moment. It is unknown, however, whether changes in the FPA increase hip moments, a surrogate measure of hip loading, which will increase the mechanical demand on the joint. This study examined how altering the FPA affects hip moments. Individuals with knee osteoarthritis walked on an instrumented treadmill with their baseline gait, 10° toe-in gait, and 10° toe-out gait. A musculoskeletal modeling package was used to compute joint moments from the experimental data. Fifty participants were selected from a larger study who reduced their peak knee adduction moment with a modified FPA. In this group, participants reduced the first peak of the knee adduction moment by 7.6% with 10° toe-in gait and reduced the second peak by 11.0% with 10° toe-out gait. Modifying the FPA reduced the early-stance hip abduction moment, at the time of peak hip contact force, by 4.3% ± 1.3% for 10° toe-in gait (p = 0.005, d = 0.49) and by 4.6% ± 1.1% for 10° toe-out gait (p < 0.001, d = 0.59) without increasing the flexion and internal rotation moments (p > 0.15). Additionally, 74% of individuals reduced their total hip moment at time of peak hip contact force with a modified FPA. In summary, when adopting a FPA modification that reduced the knee adduction moment, participants, on average, did not increase surrogate measures of hip loading.
Keywords: Gait modifications; Joint loading; Musculoskeletal modeling; Non-surgical intervention; Osteoarthritis.
文献出处：Seagers, Kirsten, Scott D. Uhlrich, Julie A. Kolesar, Madeleine Berkson, Janelle M. Kaneda, Gary S. Beaupre, and Scott L. Delp. "Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis." Journal of biomechanics 141 (2022): 111204.
文献7
哪些髋臼测量参数最能准确区分患者和对照组？一项比较研究
译者 陈志强
研究背景：
髋臼形态是影响髋关节生物力学的重要因素。要识别可能与髋关节症状发展相关的髋臼形态特征，同时考虑脊柱盆腔特征，需确定一组45岁以上无骨关节炎症状或体征的髋臼特征。以往的研究利用身体状况不明的患者定义形态阈值以指导管理。
问题/目的：
确定45至60岁、牛津髋部评分（OHS）高且无骨关节炎迹象的男女髋臼形态特征;（2）将这些特征与接受髋关节镜或髋骨周围截骨术（PAO）治疗的有症状髋关节患者进行比较，这些患者针对各种髋关节病理（发育不良、骨盆后倾和髋臼撞击）的情况;以及（3）评估哪些放射或CT参数最准确区分有症状髋关节的患者与无症状患者，从而定义指导治疗的阈值。
方法：
2018年1月至12月期间，我们机构有1358名患者接受了腹部盆腔CT扫描，治疗非骨科疾病。其中，我们认为5%（73%）患者可能符合对照条件，理由是没有重大髋关节炎、外伤或畸形。如果患者OHS不超过43（2% ）、PROMIS低于50（1% ），或Tönnis评分高于1（0.4% ），则排除患者。另外8名患者因数据不足被排除。在随机选择一侧后，每个对照组保留了40个髋关节进行分析（55岁±5岁;女性占48%[19/40]）。在这项比较研究中，该无症状组与接受髋关节镜或PAO治疗的患者组进行了比较。2013年1月至2020年12月期间，共有221名髋关节接受了髋关节保留手术。其中8人因既往盆腔手术被排除，102人因CT扫描不足被排除。一方在接受双侧手术的患者中随机选择，留下48%（221人中的107人）髋关节进行分析（31岁±8岁;女性为54%[58人中107人]）。进行了详细的X光和CT评估（包括分段），以确定髋臼（深度、软骨覆盖率、下角、前倾和倾角）和脊柱骨盆（盆底倾斜和发生率）参数。采用受试者作特征（ROC）分析评估诊断准确性，确定哪些形态参数（及其阈值）最准确区分有症状患者与无症状对照组。
结果：
无症状髋关节的髋臼形态特征为平均深度22±2毫米，关节软骨面积为2619±415平方毫米，覆盖关节面的70%±6%，髋关节平均倾角为48°±6°，解剖学前倾（24°±7°）与功能性（22°±6°）前倾差异极小。有症状髋部的患者髋臼深度通常较小（20 ± 4毫米对比22± 2毫米，平均差3毫米[95%CI1-4];p < 0.001）。髋关节发育不良（67% ± 5% 对 70% ± 6%，平均差6% [95% CI 0%-12%];p = 0.03）或髋臼后倾（67% ± 5% 对 70% ± 6%，平均差6% [95% CI 1%至12%;p = 0.04）相较无症状髋关节的相对软骨面积略小。髋臼倾斜率无差异（48° ± 6° 对 47° ± 7°，平均差0.5° [95% CI -2°- 3°];p = 0.35），但无症状髋部的解剖前倾较高（24° ± 7° 对 19° ± 8°，平均差6° [95% CI 3° -9°];p < 0.001）和功能前倾（22° ± 6° 对 13°± 9°，平均差 9° [95% CI 6° 至 12°];p < 0.001）。无症状时，隐蔽角较高，分别为105°（124° ± 7°对114°±12°，平均差11° [95% CI 3°-17°];p < 0.001）、135°（122° ± 9°对111° ± 12°，平均差10° [95% CI 2°-15°];p < 0.001）和165°（112° ± 9° 对 102° ± 11°，平均差10° [95% CI 2°-14°];p < 0.001）。有症状的髋部骨盆倾斜较低（8° ± 8° 对比 11° ± 5°，平均差为3° [95% CI 1°-5°];p = 0.007）。后壁指数在所有测量参数中具有最高的区分能力，症状髖臼的截断值低于0.9（曲线下面积[AUC] 0.84 [95% CI 0.76-0.91]）（敏感性72%，特异性78%）。CT扫描中用于区分有症状与无症状髋部的诊断有用参数包括髋臼深度小于22毫米（AUC 0.74 [95% CI 0.66-0.83]）和功能性前倾小于19°（AUC 0.79 [95% CI 0.72至0.87]）。区分有症状与无症状髋部最准确的角度为髋关节面钟面的105°（AUC 0.76 [95% CI 0.65-0.88]）、135°（AUC 0.78 [95% CI 0.70-0.86]）和165°（AUC 0.77 [95% CI 0.69至0.85]）。
结论
解剖和功能髋臼前倾角分别为24°和22°，骨盆倾斜度为10°，可增加髋臼开口，并允许更多的无撞击屈曲，同时为负重提供足够的后上覆盖。髋关节前倾角较小或解剖性和功能性前倾角差异较大的髋关节更有可能出现症状。髋臼钟面105°、135°和165°的后壁指数和覆盖角对区分有症状和无症状的髋关节具有很高的区分能力，也说明了充分的后部覆盖的重要性。未来的研究应该证实，在选择保髋手术的患者时，结合这些参数是否可以改善术后结果。
Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study
Background
Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studies have used patients with unknown physical status to define morphological thresholds to guide management.
Questions/purposes
(1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management.
Methods
Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [28]), if they had a PROMIS less than 50 (1% [18]), or their Tönnis score was higher than 1 (0.4% [6]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls.
Results
Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm2, covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface.
Conclusion
An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes.
文献出处：Verhaegen JCF, DeVries Z, Rakhra K, Speirs A, Beaule PE, Grammatopoulos G. Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study. Clin Orthop Relat Res. 2024 Feb 1; 482(2):259-274. doi: 10.1097/CORR.0000000000002768. Epub 2023 Jul 27. PMID: 37498285; PMCID: PMC10776167.
文献8
形态性髋关节异常的遗传学及其对骨关节炎的影响
译者 徐子茵
髋关节形态异常（MHAs）显著影响髋关节的终身预后，导致早发性骨关节炎和功能障碍。髋关节发育异常（DDH）和股骨髋臼撞击症（FAI）是主要病理，分别由股骨头覆盖不足或过多引起。这些异常改变了髋部的生物力学，导致结构损伤、疼痛和关节加速退化。遗传学研究的进展揭示了遗传与机械负荷在塑造髋关节形态中的相互作用。与骨关节炎、DDH和FAI相关的基因包括COL1A1、MMP13和IL-6。与FAI和骨关节炎相关的基因包括ADAMTS4。与DDH和骨关节炎相关的基因包括FRZB、CX3CR1、ASPN、DKK1、PDRG1、GDF5、UQCC1和TGF-β1。形态错乱与症状性骨关节炎之间的联系机制仍未完全明了。结合影像学、生物力学和遗传学的多模态方法可能揭示不同的疾病亚型，实现个性化干预。早期发现MHAs对于预防早发性骨关节炎至关重要。结合先进成像技术，如统计形状建模，可以加深对复杂三维髋关节形态及其骨关节炎进展的理解。未来的研究应探讨其他形态性髋关节疾病的遗传基础，包括颅首股骨骨骺脱位和Legg-Calvé-Perthes病，以完善预防和治疗策略。结合遗传学、影像学和临床洞察的综合方法有望减轻MHAs的终身影响。
Genetics of morphological hip abnormalities and their implications for osteoarthritis: a scoping review
Morphological hip abnormalities (MHAs) significantly influence lifelong prognosis of the hip, contributing to early-onset osteoarthritis and impaired functionality. Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) represent key pathologies, resulting from insufficient or excessive femoral head coverage, respectively. These abnormalities alter hip biomechanics, leading to structural damage, pain, and accelerated joint degeneration. Advances in genetic research have illuminated the interplay between genetics and mechanical loading in shaping hip morphology. Genes associated with osteoarthritis, DDH, and FAI include COL1A1, MMP13, and IL-6. Genes associated with FAI and osteoarthritis include ADAMTS4. Genes associated with DDH and osteoarthritis include FRZB, CX3CR1, ASPN, DKK1, PDRG1, GDF5, UQCC1, and TGF-β1. The mechanisms linking morphological derangements to symptomatic osteoarthritis remain incompletely understood. Multimodal approaches integrating imaging, biomechanics, and genetics may uncover distinct disease subtypes, enabling personalized interventions. Early detection of MHAs is critical in preventing early-onset osteoarthritis. Incorporating advanced imaging techniques, such as statistical shape modelling, can enhance the understanding of complex 3D hip morphologies and their progression to osteoarthritis. Future research should explore the genetic underpinnings of other morphologic hip conditions, including Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes disease, to refine preventive and therapeutic strategies. A comprehensive approach combining genetics, imaging, and clinical insights holds promise for mitigating the lifelong impact of MHAs.
文献出处：Bukowiec LG, Kaji ES, Koch JA, et al. Genetics of morphological hip abnormalities and their implications for osteoarthritis: a scoping review. J Hip Preserv Surg.2025;12(3):202-216. Published 2025 Apr 18. doi:10.1093/jhps/hnaf020
来源：304关节学术
作者：304关节团队
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