本期目录：
1、全膝关节置换术后假体周围感染的诊断和治疗的最新进展
2、非骨水泥全膝关节置换术
3、肥胖患者中的机器人辅助 vs 常规（传统）全膝关节置换术
4、幼年髋关节发育不良治疗史的患者成年后的生活质量
5、Dega髋臼成形术治疗发育性髋关节发育不良后髋臼体积和股骨覆盖率的变化
6、股骨的前倾
7、ChatGPT 对髋关节发育不良常见问题的回答可靠性：作为家长信息来源的评估
8、髋臼周围截骨术相关并发症
9、采用数字体积相关法测量人骨关节炎股骨头软骨下骨的异质性应变分布
10、髋关节发育不良患者终末期软骨结构的特异性
11、股骨近端成角畸形患者行全髋关节置换术
第一部分：关节置换及保膝相关文献
文献1
全膝关节置换术后假体周围感染的诊断和治疗的最新进展：第2部分：采用一期还是两期手术技术？
译者 张轶超
全膝关节置换术后假体周围感染（PJI）发生率约2-3%。对于患者和医疗系统来说，这个问题的处理既复杂又昂贵。多种治疗选择包括抗生素治疗，外科治疗和挽救措施。手术治疗被认为是治疗PJI的常规选择，有多种可用的手术技术，包括一期翻修术和两期翻修术等。两期翻修术被认为是治疗PJI的金标准。该方法包括两个手术过程，中间间隔一段时间，第一个过程旨在根除感染，同时植入静态或可活动的间隔物，而第二期旨在移除间隔物并植入新的假体。在间隔期间，通过一些实验室检查和临床体征密切监测患者，以帮助选择进行第二阶段的最佳时间。然而，近年来，一期翻修术因其良好的结果和较少的并发症而受到广泛关注。与两期翻修术相反，一期翻修术只包括一个操作过程，即移除旧的感染假体并植入新的假体。多年来，许多文章对这两种方法进行了比较，但没有就哪一种方法在消除感染和达到更好的结果方面达成一致。关于这两种方法，还有很多问题有待解决，包括哪种间隔器更好、两期之间间隔时间、哪些病例适合做一期翻修术等。我们在此，旨在解决这些问题，寻找出治疗这一并发症的最新进展，并讨论分阶段手术中有争议的话题。
Review of recent advances in the diagnosis and management of periprosthetic joint infection after total knee arthroplasty part 2: single-stage or two-stage surgical technique?
Periprosthetic joint infection (PJI) after total knee arthroplasty is a complication that affects approximately 2–3% of patients. The management of this issue is complicated and expensive for both the patients and the healthcare system. Multiple management options are available including antibiotic suppressive therapy, surgical management, and salvage procedures. Surgical management is considered a popular option for treating PJI, with multiple available surgical techniques, including single-stage revision arthroplasty and two-stage revision arthroplasty among others. Two-stage revision has been considered the gold standard for treating PJI. This method consists of two surgical procedures with a time interval in between, the first procedure aims to eradicate the infection along with implanting either a static or a mobile spacer, while the second intervention aims to remove the spacer and implant a new prothesis. During the interval period the patient is closely monitored through a handful of laboratory tests and clinical signs that help in assessing the optimal time of undertaking the second stage. However, in recent years, the single-stage method has gained much attention for its comparable outcomes and fewer complications. Contrary to the two-stage method, the single-stage approach consists only of one procedure in which the old infected prosthesis is removed and a new one is implanted. Many articles have compared the two methods over the years but have not agreed on a particular approach to be more potent in eliminating infection and providing better outcomes. Plenty of questions are yet to be answered regarding the two methods, including the superior type of spacer, interim period duration, and single-stage revision inclusion criteria. We herein, aim to address these issues, highlighting recent advances in managing this morbid complication and discussing controversial topics in the staged procedures.
文献出处：Suliman J, Warda H, Samaan M. Review of recent advances in the diagnosis and management of periprosthetic joint infection after total knee arthroplasty part 2: single-stage or two-stage surgical technique? J Orthop Surg Res. 2024 Oct 12;19(1):643. doi: 10.1186/s13018-024-05152-6. PMID: 39395987; PMCID: PMC11470652.
文献2
非骨水泥全膝关节置换术：复兴之势——适用人群、时机、地点与方法？
译者 丁云鹏
背景：全膝关节置换术（TKA）是骨科最常见的手术之一，但关于长期耐用性的最佳固定方式（骨水泥固定与非骨水泥骨长入固定）仍存在争议。近期植入材料与技术的改进为非骨水泥TKA提供了可能，使其通过持久稳定的生物性固定、提升手术效率及优化长期疗效（尤其对年轻活跃患者）改变临床实践。
方法：本研讨会评估了非骨水泥TKA的发展历程、近期复苏趋势及适用患者选择标准，并分析了各组件（胫骨、股骨、髌骨）在历史与现代两代产品中的临床结果。此外，还详细介绍了确保手术效果可靠且可重复性的关键技术要点。
结果：历史上骨水泥固定一直是TKA的金标准。但如今非骨水泥固定在美国及全球范围内应用日益广泛，在恰当选择的患者中展现出与骨水泥固定相当或更优的效果。
结论：非骨水泥TKA能实现持久的生物性固定和成功的长期疗效，同时提高手术室效率。该技术可广泛适用于经过合理筛选的患者，术中需精细截骨以确保骨接触面充分，促进生物性固定。
Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How?
Background: Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients.
Methods: This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed.
Results: Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients.
Conclusions: Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation.
文献出处：Zachary A Mosher , Michael P Bolognesi , Arthur L Malkani,Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How?J Arthroplasty. 2024 Sep;39(9S2):S45-S53. doi: 10.1016/j.arth.2024.02.078. Epub 2024 Mar 7.
文献3
肥胖患者中的机器人辅助 vs 常规（传统）全膝关节置换术
译者 沈松坡
目的： 全膝关节置换术（TKA）可有效治疗晚期膝骨关节炎，但肥胖会增加手术复杂性与并发症风险。机器人辅助TKA（RA-TKA）可能通过提高手术精确性来减轻这些挑战。迄今为止，尚无研究在肥胖患者中比较机器人辅助TKA与常规全膝关节置换术。因此，我们旨在进行此类比较。
方法： 按照PRISMA 2020指南进行系统综述与荟萃分析。自数据库建库至2025年7月，对MEDLINE、Scopus与Cochrane Central进行全面检索，以识别随机对照试验（RCT）与观察性研究：随访≥3个月，并报告至少一项结局（包括手术时间、并发症发生率、估计失血量（EBL）、影像学对线、用于关节置换的膝损伤与骨关节炎结局评分（KOOS JR）或西安大略与麦克马斯特大学骨关节炎指数（WOMAC））。
结果： 共纳入5项研究，包含979例肥胖患者。其中561例（57.3%）接受C-TKA。RA-TKA组平均年龄为66.76 ± 2.28岁，平均BMI为33.39 ± 3.49 kg/m²。与C-TKA相比，RA-TKA的手术时间显著更长（MD 12.14分钟；95%CI 7.24至17.05；p < 0.001）。术后髋-膝-踝（HKA）对线显示RA-TKA存在显著差异（MD −0.88°；95%CI −1.76至−0.01；p = 0.05）。相反，其余临床结局未检测到显著差异。
结论： 本荟萃分析表明，与C-TKA相比，RA-TKA需要显著更长的手术时间，而两种技术在其他围手术期与功能结局方面保持可比。
证据等级： II级。
关键词：肥胖、全膝关节置换术、机器人手术、临床结局
Robotic assisted versus conventional total knee arthroplasty in obese patients: A systematic review and meta-analysis
Purpose: Total knee arthroplasty (TKA) effectively treats advanced knee osteoarthritis, but obesity increases surgical complexity and complication risk. Robotic-assisted TKA (RA-TKA) may mitigate these challenges by enhancing surgical precision. To date, no study has compared robotic-assisted TKA with conventional total knee arthroplasty in obese patients. Therefore, we aimed to conduct such a comparison.
Methods: A systematic review and meta-analysis were performed in accordance with PRISMA 2020 guidelines. A comprehensive search of MEDLINE, Scopus, and Cochrane Central was performed from database inception to July 2025, to identify randomized controlled trials (RCTs) and observational studies with ≥3 months of follow-up, reporting at least one outcome of interest including operative time, complications rates, estimated blood loss (EBL), radiological alignment, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: A total of 5 studies comprising 979 obese patients were included. Of these, 561 patients (57.3 %) underwent C-TKA. The mean age in the RA-TKA group was 66.76 ±2.28 years, with a mean BMI of 33.39 ±3.49 kg/m2. Operative time was significantly longer in patients undergoing RA-TKA compared with C-TKA (MD 12.14 min; CI 95 % 7.24 to 17.05; p =< 0.001). Postoperative hip-knee-ankle (HKA) alignment demonstrated significant difference with RA-TKA (MD -0.88◦; CI 95 % − 1.76 to − 0.01; p =0.05). Conversely, no significant differences were detected across the remaining clinical outcomes.
Conclusions: Our meta-analysis demonstrated that RA-TKA required significantly longer operative time compared with C-TKA, while other perioperative and functional outcomes remained comparble between both techniques.
第二部分：保髋相关文献
文献1
幼年髋关节发育不良治疗史的患者成年后的生活质量
译者 张振东
背景：如果治疗不当，髋关节发育不良（DDH）可导致髋关节功能丧失，然而很少有研究关注DDH儿童时期治疗后的长期后果。
方法：本研究对儿童时期接受过髋关节脱位治疗的DDH 患者进行了一项健康相关生活质量调查。研究者向在其机构接受过儿童期髋关节脱位治疗的 287 例DDH 患者发放了调查问卷。使用短表-36调查了患者的人口统计学特征、特定疾病病史以及与健康相关的生活质量。 将患者的身体功能评分（PCS）、心理功能评分（MCS）和社会认知评分（RCS）与日本标准值进行了比较。经排除后，对 68 名患者进行了评估。
结果：患者的 PCS、MCS 和 RCS 总平均值与标准值相当。 PCS 一直保持到 50 岁，但有 10 名例50 岁以上的患者 PCS 显著下降。此外，接受切开复位术的患者的 PCS 明显低于接受保守复位术的患者。在各年龄组和治疗组中，患者的 MCS 和 RCS 与标准值无差异。 PCS、MCS 和 RCS 在双侧、诊断年龄或是否需要额外手术方面也没有差异。
结论：DDH患者的生活质量可在50岁之前一直保持不变，但之后迅速下降，尤其是那些在童年时期就需要进行切开复位的患者。
Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood
Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.
文献出处：Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B. 2025 Jan 1;34(1):38-43.
文献2
Dega髋臼成形术治疗发育性髋关节发育不良后髋臼体积和股骨覆盖率的变化
译者 任宁涛
尽管Dega髋臼成形术已成为一种常用的截骨术，但关于其对髋臼体积和深度的影响仍存在争议。本研究的目的是评估发育性髋关节发育不良（developmental dysplasia of The hip， DDH）患者行改良Dega截骨术后髋臼横平面和髋臼角度的图像。我们对2005年7月至2013年10月期间在我院接受改良Dega截骨手术的DDH患者的骨盆x光片和计算机断层扫描（CT）所获得的形态学指标进行了回顾性研究。使用术前和术后的骨盆 X 光片来测量髋臼指数和髋臼（ACM）角度。术后 CT 扫描用于测量髋臼前倾角（AAA）、髋臼深度和髋臼覆盖深度（总髋臼指数（TAI））。以对侧健侧髋关节作为对照。术后髋臼指数和 ACM 值显示出显著改善，术后 1 年测量值接近正常水平。对 CT 扫描参数（AAA、TAI 及髋臼深度）的比较显示，各组之间的 TAI 和髋臼深度并无显著差异（TAI：P = 0.423；髋臼深度：P = 0.132），而 AAA 的比较则表明发育性髋关节脱位患者的髋关节（17.6°）略优于对侧髋关节（13.3°，P = 0.001）。基于髋臼形态参数的图像集，我们的研究证实了之前的报道，DDH患者行Dega髋臼成形术后髋臼体积增大，股骨头覆盖度明显改善。证据级别：III 级——回顾性比较研究。
Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip
Although Dega's acetabuloplasty has become a commonly used osteotomy, there is still an ongoing debate regarding its impact on the volume and depth of the acetabulum. The purpose of our study was to assess the postoperative images of the transverse acetabular plane and version obtained from developmental dysplasia of the hip (DDH) patients after a modified Dega osteotomy. We performed a retrospective study of the morphologic indices obtained from the pelvic X-rays and computer tomography (CT) scans of patients with DDH, who were operated in our institution between July 2005 and October 2013, using the modified Dega osteotomy. Preoperative and postoperative pelvic X-rays were used to measure the acetabular index and the acetabular (ACM) angle. The postoperative CT scans were used to measure the acetabular anteversion angle (AAA), acetabular depth and depth of acetabular coverage [total acetabular index (TAI)]. The contralateral unaffected hips served as control. The postoperative acetabular indices and ACMs showed a significant improvement, with near-normal values measured 1 year after the surgery. Comparing the CT scan parameters (AAA, TAI and the depth of acetabulum) showed that TAI and the depth of acetabulum were not significantly different between the groups (TAI: P = 0.423; depth of acetabulum: P = 0.132), whereas AAA comparison implied a slight advantage of the DDH hips (17.6° DDH vs. 13.3° contralateral, P = 0.001). On the basis of images set of acetabular morphometric parameters, our study substantiates previous reports on an increase of acetabular volume and a significant improvement of femoral head coverage for patients with DDH who underwent Dega acetabuloplasty. Level of evidence: Level III - retrospective comparative study.
文献出处：Gigi R, Lawniczak D, Kurian B, Madan S, Fernandes J. Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip. J Pediatr Orthop B. 2022 May 1;31(3):247-253. doi: 10.1097/BPB.0000000000000895. PMID: 34285163.
文献3
股骨的前倾
译者 李勇
双平面X线摄影、轴向X线摄影和透视检查是测量股骨前倾角常用的X线摄影方法。这些方法使用的是对前倾角的严格几何定义。近期开发并被广泛应用的计算机断层扫描（CT）测量前倾角的方法，并不符合公认的前倾角定义，且尚未在大样本系列中进行准确性测试。在本研究中，我们在32个股骨标本上测试了这种广泛使用的CT前倾角测量法。结果显示，与直接测量相比，该方法持续低估前倾角平均达 10 度，且可重复性误差在 ±3.6 度以内。因此，我们开发了一种利用计算机断层扫描测量前倾角的新方法。经在相同标本上测试，该方法的精确度达到 ±1 度。本研究从几何学角度论证了为什么当前实行的选择用于定义股骨颈轴线的点的CT方法不符合前倾角的几何定义。本文描述并推荐了一种更准确的定义股骨颈轴线及测量股骨前倾角的方法供临床使用。
图. 如何确定中心点O (Point O)？定义： 在选定的股骨颈基底横截面上（小转子中心上6mm），取股骨干（Femoral Diaphysis）横截面的“质心”（Centroid）。视觉识别： 也就是该横截面上骨性轮廓的几何中心。这个截面通常呈现为股骨干圆润的轮廓，点 O 就是这个圆/椭圆的中心点。
图. 通过股骨颈基底部的截面，我们过去把o点称为H点，通过叠加股骨头中心的位置得到（从另一个截面确定）。请注意，使用提出的方法（方法II）确定的线HO是水平的，并与参考前倾角(R)一致。
Femoral anteversion
Biplane roentgenography, axial roentgenography, and fluoroscopy are the usual roentgenographic methods of measuring femoral anteversion. These methods use a strict geometrical definition of anteversion. The computerized tomography method of measuring anteversion that was developed recently, and is now widely used, does not adhere to the accepted definition of anteversion and has not been tested for accuracy in a large series. In the present study, the widely used computerized-tomography method of measuring anteversion was tested on thirty-two femoral specimens. With that method, anteversion was consistently underestimated by an average of 10 degrees compared with direct measurements and was reproducible only to within ±3.6 degrees. Therefore, a new method of measuring anteversion using computerized tomography was developed. It was shown to be accurate to ±1 degree, as tested on the same specimens. This study demonstrated geometrically why the currently practiced computerized-tomography method of selecting the points that are used to define the axis of the femoral neck is not consistent with geometrical definitions of anteversion. A more accurate method for both defining the axis of the femoral neck and measuring femoral anteversion is described and recommended for clinical use.
文献出处：Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Joint Surg Am. 1987 Oct;69(8):1169-76. PMID: 3667647.
文献4
ChatGPT 对髋关节发育不良常见问题的回答可靠性：作为家长信息来源的评估
译者 贾海港
背景： 人工智能（AI），尤其是基于 AI 的大型语言模型（LLM）如 ChatGPT，正日益改变人们获取信息的方式，为患者理解复杂医疗状况提供了新途径。 当婴儿被诊断为髋关节发育不良（DDH）时，父母面临着生理、情感和后勤等多重挑战，因此对清晰易懂的教育资源需求迫切。本研究旨在评估 ChatGPT 对 DDH 常见问题的回答质量与可靠性。
方法： 本研究评估了人工智能聊天机器人 ChatGPT 4o 对八个关于发育性髋关节发育不良 (DDH) 的常见问题的回复质量，这些问题均来自儿科骨科诊所的真实咨询。每个问题的回复均在一次互动中生成，且使用未接触过医疗信息的 ChatGPT 账户。 由两名独立评估者采用标准化评分体系对回复进行评估，并将其与现有文献、患者教育资源和共识指南进行比较。每个回复均根据其信息准确性和完整性进行分类，并通过描述性统计量化其表现水平。
结果：ChatGPT 4o 能够针对八个家长问题生成结构化回答。回复的评价结果为：12.5%为优秀，25.0%为尚可（只需少量澄清），50.0%为尚可（需要适度澄清），12.5%为不合格（由于信息缺失或不准确）。
结论：ChatGPT 对 DDH 相关问题的回答令人满意，可作为家长获取补充信息的有用资源。然而，由于其在提供详细的诊断和治疗流程方面存在局限性，应将其视为专科医疗咨询的辅助工具，而非替代方案。
关键词： 人工智能；发育性髋关节发育不良；髋关节筛查；婴儿髋关节；大型语言模型。
Reliability of ChatGPT answers to common questions on developmental dysplasia of the hip as an information source for parents
Background: Artificial intelligence (AI), particularly AI-based large language models (LLM) like ChatGPT, is increasingly shaping how information is accessed, offering patients a new source for understanding complex medical conditions. Given the physical, emotional, and logistical challenges that parents are faced when their baby is diagnosed with developmental dysplasia of the hip (DDH), the demand for clear and accessible educational resources is high. This study aimed to evaluate the quality and reliability of ChatGPT's responses to frequently asked questions about DDH.
Methods: This study assessed the quality of responses generated by the AI chatbot ChatGPT 4o to eight frequently asked questions about DDH, derived from real consultations in a pediatric orthopedic clinic Responses were generated during one interaction per question using a ChatGPT account not previously exposed to medical information. Responses were evaluated by two individual readers using a standardized rating system, comparing them to current literature, patient education resources, and consensus guidelines. Each response was categorized by its level of informational accuracy and completeness, and descriptive statistics were calculated to quantify performance.
Results: ChatGPT 4o was able to generate structured responses to all eight parental questions. The responses were rated in 12.5% excellent, 25.0% satisfactory with minimal clarification, 50.0% satisfactory with moderate clarification, and 12.5% unsatisfactory due to missing or inaccurate information.
Conclusion: ChatGPT provided satisfactory answers to questions about DDH and may serve as a useful supplementary information resource for parents. However, due to limitations in presenting detailed diagnostic and treatment pathways, it should be viewed as an adjunct to, not a replacement for, specialist medical consultation.
Keywords: artificial intelligence; developmental dysplasia of the hip; hip screening; infant hip; large language model.
文献出处：Vertesich K, Ortmayr J, Windhager R, Willegger M. Reliability of ChatGPT answers to common questions on developmental dysplasia of the hip as an information source for parents. Front Pediatr. 2025 Dec 15;13:1659812. doi: 10.3389/fped.2025.1659812. PMID: 41473917; PMCID: PMC12745415.
文献5
髋臼周围截骨术相关并发症：一项前瞻性多中心研究
译者 陶可
背景：本前瞻性多中心研究旨在确定并分类由经验丰富的医生实施的髋臼周围截骨术的所有相关并发症。
方法：我们前瞻性分析了7家机构的10名外科医生对205例单侧髋臼周围截骨术患者的围手术期并发症。所有围手术期并发症均在术后平均10周和1年时，采用标准化方法记录，并使用经验证的髋关节保留手术并发症分级方案进行分级。患者平均年龄为25.4岁。其中女性143例，男性62例。最常见的诊断是发育性髋关节发育不良，同期进行的手术最常见的是股骨骨软骨成形术（58%）或髋关节镜检查（20%），后者可能包括盂唇修复或切除。
结果：12例患者（5.9%）出现主要并发症（III级或IV级）。其中7例并发症在术后10周复诊时发现，5例在术后1年复诊时发现。9例并发症需要第二次手术干预，包括髋臼移位的重新修复或植入的内固定螺钉调整（4例）、深部感染切开引流（2例），以及异位骨化切除、对侧腓总神经减压和后柱内固定（各1例）。3例血栓栓塞并发症通过药物治疗。未发生血管损伤、永久性神经麻痹、关节内截骨和/或骨折或髋臼骨坏死。最常见的I级或II级并发症是无症状性异位骨化。
结论：对于经验丰富的髋臼周围截骨术外科医生而言，该手术是安全的，但在度过学习曲线后，仍存在5.9%的III级或IV级并发症风险。大多数并发症都可以顺利解决而不会发生永久性残疾。
Complications associated with the periacetabular osteotomy: a prospective multicenter study
Background: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons.
Methods: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures. The mean patient age was 25.4 years. There were 143 female and sixty-two male patients. The most common diagnosis was developmental acetabular dysplasia, and concomitant procedures most commonly included femoral osteochondroplasty (58%) or hip arthroscopy (20%), which could include labral repair or resection.
Results: Major complications (grade III or IV) occurred in twelve patients (5.9%). Seven complications were evident at the ten-week visit and five at the one-year visit. Nine of the complications required a second surgical intervention, including repair for acetabular migration or implant adjustment (four patients), incision and drainage for a deep infection (two patients), and heterotopic bone resection, contralateral peroneal nerve decompression, and posterior column fixation (one patient each). Three thromboembolic complications were managed medically. There were no vascular injuries, permanent nerve palsies, intra-articular osteotomies and/or fractures, or acetabular osteonecrosis. The most common grade-I or II complication was asymptomatic heterotopic ossification.
Conclusions: For surgeons experienced with the periacetabular osteotomy, it is a safe procedure but is associated with a 5.9% risk of grade-III or IV complications beyond the learning curve. The majority of these complications are resolved without permanent disability.
文献出处：JIra Zaltz, Geneva Baca, Young-Jo Kim, Perry Schoenecker, Robert Trousdale, Rafael Sierra, Daniel Sucato, Ernie Sink, Paul Beaulé, Michael B Millis, David Podeszwa, John C Clohisy. Complications associated with the periacetabular osteotomy: a prospective multicenter study. Clinical Trial, J Bone Joint Surg Am. 2014 Dec 3;96(23):1967-74. doi: 10.2106/JBJS.N.00113.
文献6
采用数字体积相关法测量人骨关节炎股骨头软骨下骨的异质性应变分布
译者 邱兴
骨关节炎是一种慢性疾病，约三分之一的45岁以上人群受其影响。尽管该疾病的病因和发病机制尚未完全明确，但力学因素在骨关节炎的发生与进展中起着重要作用。本研究通过阶梯式压缩结合微CT成像与数字体积相关法，测量并评估了单轴压缩下骨关节炎股骨头内部的全场应变分布。综合分析表明，骨关节炎骨组织的微观结构特征并未影响所采用方法的不确定性水平。研究结果揭示了应变主要集中在承载表面、低骨体积分数区域以及软骨下囊肿区域。骨小梁厚度和连接密度被确定为仅有的两个与表观屈服应变处局部应变大小或超屈服应变骨体积相关的微观结构参数。本研究提出了一种评估重度骨关节炎患者整体股骨头力学特性的新方法。
关键词：髋关节骨关节炎；微CT数字体积相关法；应变；软骨下骨
图1. 样本被包埋于6毫米厚的丙烯酸树脂板中，其中顶板依据股骨头的弧形表面定制成型。包埋后的样本被安置于力学测试夹具中进行加载。该加载夹具包含一个通过加载压板施加压力的加载螺丝、一个测力传感器以及一个线性可变位移传感器，分别用于测量施加的载荷和加载压板的位移。整个系统封装在有机玻璃管内，以确保在整个测试过程中保持可见。
图2. (a) 应用于每个样本的加载方案包括：进行10次循环加载至0.3 kN，并采集两次图像（预加载1和预加载2）；施加1.5 kN载荷并进行“第一次加载后”扫描（后加载1）；将载荷增加至3 kN并进行另一次扫描（后加载2）；最后持续施加载荷直至达到表观失效，并进行最终扫描（后加载3）。每次施加载荷后、扫描前，均设有15分钟的松弛期。(b) 为5个样本记录的载荷-位移曲线。在3 kN载荷阶段之后，曲线呈现的“锯齿状”特征是由于尝试通过加载螺丝施加失效载荷所致。
图3. (a) 从一个骨关节炎样本中提取了多个感兴趣区域（VOIs），以评估具有代表性的总体区域（蓝色）、骨小梁中央区域（绿色）、含囊肿区域（红色）及硬化骨区域（黄色）内数据的不确定性。(b) 展示了四个感兴趣区域在零应变（重复图像）和1%虚拟压缩表观应变（1% VD）条件下的数字体积相关（DVC）应变场。(c-e) 分析结果显示，这四个感兴趣区域之间，以及在节点间距分别为1.01、1.95、2.73和3.90毫米的情况下，所测得的误差标准差（SDER）指标均无明显差异。
Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital
Osteoarthritis (OA) is a chronic disease, affecting approximately one third of people over the age of 45. Whilst the etiology and pathogenesis of the disease are still not well understood, mechanics play an important role in both the initiation and progression of osteoarthritis. In this study, we demonstrate the application of stepwise compression, combined with microCT imaging and digital volume correlation (DVC) to measure and evaluate full-field strain distributions within osteoarthritic femoral heads under uniaxial compression. A comprehensive analysis showed that the microstructural features inherent in OA bone did not affect the level of uncertainties associated with the applied methods. The results illustrate the localization of strains at the loading surface as well as in areas of low bone volume fraction and subchondral cysts. Trabecular thickness and connectivity density were identified as the only microstructural parameters with any association to the magnitude of local strain measured at apparent yield strain or the volume of bone exceeding yield strain. This work demonstrates a novel approach to evaluating the mechanical properties of the whole human femoral head in case of severe OA.
Keywords: hip osteoarthritis; subchondral bone; microCT digital volume correlation; strain
文献出处：Ryan M K , Oliviero S , Costa M C ,et al.Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital Volume Correlation[J].Materials, 2020, 13.DOI:10.3390/ma13204619.
文献7
髋关节发育不良患者终末期软骨结构的特异性
译者 徐子茵
发育性髋关节发育不良（DDH）表现为不同程度的股骨头脱位，严重病例会在髂骨外侧形成一个新的关节面——即新髋臼。尽管传统观点认为这不可能，但在Crowe III级和IV级患者的新髋臼和髋臼处发现了类似于透明软骨的组织，这表明了在没有机械压力的情况下，透明软骨仍具有发育潜力。为了验证这一理论，本研究对从DDH患者获取的髋臼和股骨头软骨进行了苏木精-伊红和甲苯胺蓝染色。并进行了II型和VI型胶原蛋白以及聚集蛋白聚糖的免疫组织化学分析，以及在7.0 T微磁共振成像（MRI）设备上进行了延迟钆增强软骨磁共振成像分析。将DDH患者的结果与对照组进行了比较。研究在DDH患者的新髋臼和髋臼中均发现了透明软骨。组织病理学和MRI分析均证实了该组织的性质。本研究结果证实，在遗传上倾向于形成骨组织且未承受机械应力的解剖区域，也存在透明软骨。这是首次对晚期DDH患者的新髋臼软骨进行了详细表征。
关键词：延迟增强软骨MRI;髋关节发育发育异常;透明软骨;免疫组化;新髋臼;骨关节炎。
Specificities in the Structure of the Cartilage of Patients with Advanced Stages of Developmental Dysplasia of the Hip
Developmental dysplasia of the hip (DDH) presents varying degrees of femoral head dislocation, with severe cases leading to the formation of a new articular surface on the external side of the iliac bone—the neoacetabulum. Despite conventional understanding suggesting otherwise, a tissue resembling hyaline cartilage is found in the neoacetabulum and acetabulum of Crowe III and IV patients, indicating a potential for hyaline cartilage development without mechanical pressure. To test this theory, acetabular and femoral head cartilage obtained from patients with DDH was stained with hematoxylin-eosin and toluidine blue. The immunohistochemical analysis for collagen types II and VI and aggrecan was performed, as well as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) analysis on a 7.0 T micro-MRI machine. The results obtained from DDH patients were compared to those of the control groups. Hyaline cartilage was found in the neoacetabulum and the acetabulum of patients with DDH. The nature of the tissue was confirmed with both the histological and the MRI analyses. The results of this study proved the presence of hyaline cartilage in patients with DDH at anatomical regions genetically predisposed to be bone tissue and at regions that are not subjected to mechanical stress. This is the first time that the neoacetabular cartilage of patients with advanced stages of DDH has been characterized in detail.
Keywords: delayed gadolinium-enhanced MRI of cartilage; developmental dysplasia of the hip; hyaline cartilage; immunohistochemistry; neoacetabulum; osteoarthritis.
文献出处：Duvančić T, Vukasović Barišić A, Čizmić A, Plečko M, Bohaček I, Delimar D. Specificities in the Structure of the Cartilage of Patients with Advanced Stages of Developmental Dysplasia of the Hip. Diagnostics (Basel). 2024 Apr 8;14(7):779. doi: 10.3390/diagnostics14070779. PMID: 38611693; PMCID: PMC11011320.
文献8
股骨近端成角畸形患者行全髋关节置换术
译者 张利强
目的
合并髋关节骨关节炎（OA）的股骨近端成角畸形，会显著增加初次全髋关节置换术（THA）的手术技术难度。本研究旨在明确该类高难度患者行现代标准初次全髋关节置换术后的假体的长期生存率、手术失败的危险因素、术后并发症及临床疗效。
研究方法
本研究调取本院人工关节登记数据库，纳入1997年1月至2017年9月期间，108例股骨近端成角畸形患者接受的119台初次全髋关节置换术病例。其中，102台手术（86%）的股骨畸形由既往股骨截骨术所致，17台手术（14%）的畸形源于发育性或代谢性疾病；62髋（53%）以股骨内翻畸形为主要表现。患者平均年龄44岁（标准差13），平均体质指数29kg/m²（标准差6），女性患者70例（59%）。35 例（30%）使用了带干骺端固定的非骨水泥股骨假体，34 例（29%）使用了带骨干固定的非骨水泥股骨假体，29 例（24%）使用了带干骺端固定套的非骨水泥模块化股骨假体，21 例（18%）使用了骨水泥股骨假体。对 22 例全髋关节置换术（占 18%）同时进行了股骨截骨术。本研究采用Kaplan-Meier生存分析法统计假体生存率，并采用Harris髋关节评分（HHS）评估髋关节功能；患者术后平均随访时长为8年（随访范围2~22年）。
结果
十年内无股骨松动、股骨翻修、全髋关节翻修和再手术的生存率分别为95%、93%、90%和88%。共进行了13次翻修手术，其中3例为无菌性股骨松动，2例为股骨假体骨折，2例为脱位，2例为无菌性髋臼松动，2例为聚乙烯衬垫更换，2例为感染。术前股骨内翻畸形是全髋翻修风险升高的相关危险因素（风险比 HR=12.5，P=0.020）；同期行股骨矫形截骨术的患者，其再次手术的风险显著升高（风险比 HR=3.6，P=0.023）。平均HHS从术前的52分显著提高到十年后的82分（p< 0.001）。
结论
在迄今为止针对髋关节骨关节炎且伴有近端股骨角畸形患者进行初次全髋关节置换术的最大系列研究中，我们发现十年内无任何翻修手术的生存率良好。股骨内翻畸形，尤其是因畸形程度较重或畸形位置特殊、需在置换术中同期行股骨截骨矫形的病例，其后续接受再次手术的概率更高。
Total hip arthroplasty in patients with angular proximal femoral deformities
Aims
An angular proximal femoral deformity, in association with osteoarthritis (OA) of the hip, considerably increases the technical complexity of primary total hip arthroplasty (THA). The aims of this study were to determine the long-term implant survival, the risk factors for failure, complications, and clinical outcomes of contemporary primary THA in this difficult group of patients.
Methods
Our institutional total joint registry was used to identify 119 primary THAs performed
in 108 patients with an angular proximal femoral deformity, between January 1997 and September 2017. The deformity was related to a previous femoral osteotomy in 102 THAs (86%), and developmental or metabolic disorders in 17 THAs (14%). A total of 62 hips (53%) had a predominantly varus deformity. The mean age of the patients was 44 years (SD 13), their mean BMI was 29 kg/m2(SD 6), and 70 (59%) were female. An uncemented femoral component with metaphyseal fixation was used in 35 THAs (30%), an uncemented femoral component with diaphyseal fixation in 34 (29%), an uncemented modular femoral component with a metaphyseal fixation sleeve in 29 (24%), and a cemented femoral component in 21 (18%). Simultaneous corrective femoral osteotomy was performed in 22 THAs (18%). Kaplan-Meier survival and Harris Hip Scores (HHSs) were reported. The mean follow-up was eight years (2 to 22).
Results
The ten-year survival free of femoral loosening, any femoral revision, any revision and any reoperation was 95%, 93%, 90%, and 88%, respectively. A total of 13 revisions were undertaken, for aseptic femoral loosening in three, fracture of the femoral component in two, dislocation in two, aseptic acetabular loosening in two, polyethylene liner exchange in two, and infection in two. A preoperative varus deformity was associated with a higher risk of any revision (hazard ratio (HR) 12.5, p = 0.020), and those with a simultaneous osteotomy had a higher risk of any reoperation (HR 3.6, p = 0.023). The mean HHSs improved significantly from 52 preoperatively to 82 at ten years (p < 0.001).
Conclusion
In the largest series to date of primary THAs in patients with hip OA and an angular proximal femoral deformity, we found a good ten-year survival free from any revision. Varus deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher rate of further surgery.
文献出处：Louis Dagneaux, Matthew P Abdel, Rafael J Sierra, David G Lewallen, Robert T Trousdale, Daniel J Berry; Total hip arthroplasty in patients with angular proximal femoral deformitiesBone Joint J 2025;107-B(6 Supple B):101-108 doi:10.1302/0301-620X.107B6.BJJ-2025-0305.R1
来源：304关节学术
作者：304关节团队
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