本期目录：
1、机器人辅助全膝关节置换术的趋势和流行病学：减少并发症和缩短住院时间
2、国际共识研讨会对膝关节翻修术中骨缺损的处理
3、应用高交联聚乙烯和传统聚乙烯垫片的同期双侧后交叉韧带保留型（CR）全膝关节置换病例的比较研究
4、择期全关节置换术中加速康复外科（ERAS）路径
5、DDH幼年治疗后的患者成年后的生活质量
6、儿童创伤性三角软骨损伤的回顾性分析
7、骨盆再定位截骨术前髋臼三维形态分析方法
8、髋关节不同姿势对坐骨神经位置的影响
9、外侧柱是支撑塌陷前股骨头坏死的关键：基于倾向评分匹配队列的有限元模型分析
第一部分：关节置换及保膝相关文献
文献1
机器人辅助全膝关节置换术的趋势和流行病学：减少并发症和缩短住院时间
译者 张轶超
介绍：本研究对机器人辅助全膝关节置换术（RA - TKA）与传统全膝关节置换术（C - TKA）的即时术后结果和影响进行了深入分析，特别是在死亡率、并发症、住院时间和费用方面，研究数据来自全国范围内的综合数据集。
方法：全国住院患者样本（NIS）数据库是美国最大的包括各种付款人住院医疗保健数据库，从中找出从2016年至2019年期间接受RA - TKA或C - TKA的所有患者。共有527,376例，相当于2,638,679名接受择期TKA的患者，其中88,415例为RA - TKA。为了减轻两组之间基线特征的潜在差异和选择偏差，采用倾向评分匹配分析来进一步平衡和完善我们的数据集，结果176,830名患者均匀分布在两组之间。对一般情况、即时术后并发症和经济数据（包括付款人类别、住院时间和总费用）进行分析。
结果：RA - TKA有明显的变化，从2016年最初的0.70%到2019年显著的7.30%。与C - TKA组（66.7±SD年）相比，接受RA - TKA的患者略年轻（66.2±SD年）。RA - TKA组和C - TKA组住院时间分别为1.89天和2.29天。收费指标显示RA - TKA的收费略高。RA - TKA组术后并发症较少，如失血、贫血、急性肾损伤、静脉血栓栓塞、肺栓塞、肺炎和手术伤口并发症。即使按照倾向评分匹配，这些结论仍然是一致的，具有统计学意义。
结论：与C - TKA相比，RA - TKA在美国的使用在过去几年中有了显著的增长，并且显著减少了术后并发症和住院时间，为TKA患者提供了更安全的手术治疗。对RA - TKA短期和长期结果的进一步研究将提高对该技术全部潜力的理解。
Trends and epidemiology in robotic‐assisted total knee arthroplasty: Reduced complications and shorter hospital stays
Introduction: This study provides an in‐depth analysis of the immediate postoperative outcomes and implications or robotic‐assisted total knee arthroplasty (RA‐TKA) compared with conventional TKA (C‐TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set.
Methods: The Nationwide Inpatient Sample (NIS) database, the largest all‐payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA‐TKA or C‐TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA‐TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score‐matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post‐operative complications, and economic data, including payor class, length of stay and total charges.
Results: There was a marked shift towards RA‐TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA‐TKA were slightly younger (66.2 ± SD years), compared to the C‐TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA‐TKA and C‐TKA, respectively. Charges metrics revealed slightly higher charges for RA‐TKA. Less postoperative complications were found in the RA‐TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound
complication. Even following the propensity score matching, these findings remained consistent and statistically significant.
Conclusions: RA‐TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post‐operative complications and length of hospital stay compared to C‐TKA, offering safer surgical management for TKA patients. Further studies on the short‐ and long‐term outcomes of RA‐TKA would improve the understanding of the full potential of this technology.
文献出处：Maman D, Laver L, Becker R, Takrori LA, Mahamid A, Finkel B, Gan-Or H, Yonai Y, Berkovich Y. Trends and epidemiology in robotic-assisted total knee arthroplasty: Reduced complications and shorter hospital stays. Knee Surg Sports Traumatol Arthrosc. 2024 Dec;32(12):3281-3288. doi: 10.1002/ksa.12353. Epub 2024 Jul 17. PMID: 39016343; PMCID: PMC11605021.
文献2
国际共识研讨会对膝关节翻修术中骨缺损的处理
译者 马云青
在膝关节翻修术（rTKA）中，对全膝置换（TKA）术后严重骨缺损的评估、分型与治疗，仍是复杂且存在争议的课题。尽管已有新证据与新技术用于指导翻修膝严重骨缺损的诊疗策略，但目前仍缺乏一份能系统整合这些新型外科技术的文献。因此，有必要对翻修全膝关节置换术中严重骨缺损的治疗进行全面综述。
美国特种外科医院（HSS）复杂关节重建中心，以翻修髋、膝关节置换的临床与研究为核心，于2022年6月24日主办了翻修TKA骨缺损处理共识研讨会。会议邀请了42位国际专家并分为若干小组，每组围绕以下4大主题中的一项展开讨论：
1. 术前评估与影像学检查、预期骨缺损、分型系统及假体随访监测
2. 翻修全膝关节置换术中严重骨缺损情况下如何实现可靠固定
3. 严重骨缺损病例中髌骨骨缺损与伸膝装置的处理
4. 复杂模块化置换系统的应用：铰链式假体、股骨远端置换与胫骨近端置换
在充分文献复习与互动讨论基础上，各小组尽可能形成共识意见。文章对上述4个领域、各组共识及未来研究方向进行综述。
Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium
The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.
文献出处：Sculco PK, Flevas DA, Jerabek SA, Jiranek WA, Bostrom MP, Haddad FS, Fehring TK, Gonzalez Della Valle A, Berry DJ, Brenneis M, Bornes TD, Rojas Marcos CE, Wright TM, Sculco TP. Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium. HSS J. 2024 May;20(2):141-181. doi: 10.1177/15563316231202750. Epub 2024 Jan 25. PMID: 39281983; PMCID: PMC11393633.
文献3
应用高交联聚乙烯和传统聚乙烯垫片的同期双侧后交叉韧带保留型（CR）全膝关节置换病例的比较研究
译者 张蔷
背景：目前文献中并无相关文章比较高交联聚乙烯（HXLPE）和传统聚乙烯（CP）对CR全膝关节置换（TKAs）术后翻修率的影响。本文章的目的是比较应用HXLPE和CP的CR TKAs病例长期随访的临床疗效、平片和计算机扫描（CT）结果，以及骨溶解发生率、翻修率和假体生存率。
方法：本研究纳入了410例连续的单一麻醉下同期双侧TKAs韩国患者（平均年龄，62.6±8岁）。其中164例男性和246例女性。每例均为一侧应用HXLPE垫片的CR高屈曲全膝假体（NexGen CR-Flex TKA; Zimmer Biomet），另一侧应用CP垫片的CR高屈曲NexGen TKA假体。平均随访时间为17.5年（范围15年-19年）。
结果：在末次随访时，两组间的膝关节协会评分（KSS，94分 vs. 93分），WOMAC评分（19.2分 vs. 19.2分），活动度（125° vs. 126°），平片和CT结果，或翻修率（2.0% vs. 2.2%）均无显著性差异。两组内均未出现骨溶解病例。如果以翻修或无菌性松动作为终末点，在17.5年的预测假体生存率分别为：HXLPE组 98.0%（95%置信区间, 92% - 100%），CP组 97.8%（95%置信区间, 92% - 100%）。
结论：本长期随访（最低15年随访）研究显示应用HXLPE垫片和CP垫片的CR高屈曲全膝关节置换病例均获得了优异的临床疗效和假体生存率。然而，在本组病例中，我们并未发现高交联聚乙烯垫片相对传统垫片的优势。
Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties
Results at a Minimum Follow-up of 15 Years
Background: There have been no long-term studies comparing the revision rates of a highly cross-linked polyethylene (HXLPE) bearing with those of a conventional polyethylene (CP) bearing among cruciate-retaining (CR) total knee arthroplasties (TKAs). The aim of the current long-term study was to compare CR TKAs with HXLPE and CP bearings in terms of clinical, radiographic, and computed tomographic (CT) scan results; prevalence of osteolysis; revision rate; and implant survivorship.
Methods: This study enrolled a consecutive series of 410 Korean patients (mean age, 62.6±8 years) who underwent simultaneous bilateral TKAs during the same anesthetic session. This study included 164 men and 246 women. Each patient underwent a posterior CR high-flexion TKA (NexGen CR-Flex TKA; Zimmer Biomet) with an HXLPE bearing on 1 side and a NexGen CR-Flex TKA with a CP bearing on the opposite side. The mean follow-up period was 17.5 years (range, 15 to 19 years).
Results: At the latest follow-up, there were no significant differences between the HXLPE and CP groups with regard to the Knee Society score (94 compared with 93 points), Western Ontario and McMaster Universities Osteoarthritis Index (19.2 points for both groups), range of motion (125° compared with 126°), radiographic and CT results, or revision rate (2.0% compared with 2.2%). No knee showed osteolysis in either group. The estimated survival rate at 17.5 years, using revision or aseptic loosening as the end point, was 98.0% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with an HXLPE bearing and 97.8% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with a CP bearing.
Conclusions: The findings of this long-term study (minimum follow-up of 15 years) indicate that CR-Flex TKAs with HXLPE and CP bearings both yielded excellent clinical outcomes and implant survivorship. However, no significant clinical advantage was observed for HXLPE over CP bearings in this patient population.
文献出处：Kim YH, Park JW, Jang YS, Kim EJ. Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties: Results at a Minimum Follow-up of 15 Years. J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00621. Epub ahead of print. PMID: 41460951.
文献4
择期全关节置换术中加速康复外科（ERAS）路径
译者 沈松坡
加速康复外科（ERAS）方案在全髋关节和全膝关节置换术中的应用日益增多，旨在改善结局、减少并发症并缩短住院时间。这涉及一种从术前到术后的多学科、循证医学方法。本文综述了ERAS在择期全髋关节置换术（THA）和全膝关节置换术（TKA）中实施的当前文献，重点关注住院时间（LOS）、阿片类药物使用、并发症/再入院等临床结局，以及麻醉标准化、使用阿片节约型镇痛药物、早期活动和患者满意度等其他关键组成部分。
我们检索了 PubMed、Embase 和 Google Scholar 数据库（最后检索时间为2025年5月），以寻找评估ERAS方案在择期THA和TKA中应用的研究。在无地域限制的前提下，纳入了2000年至2025年间以英文发表的相关文章，包括临床试验、观察性研究、病例系列、病例报告和综述文章。关键词包括“enhanced recovery after surgery”“ERAS”“fast-track”“rapid recovery”“total joint arthroplasty”“total knee replacement”“total hip replacement”以及“outcomes”。文章的选择基于与主题的相关性，并强调临床结局。鉴于本综述为叙述性综述，未进行正式的定量综合分析。
纳入的文献（涵盖多项研究中约294,000例患者）一致表明，ERAS路径可在不增加再入院率或并发症发生率的情况下，将LOS显著缩短1至3天。多模式、阿片节约型镇痛方案可带来更优的疼痛控制并减少阿片暴露，从而促进早期活动并减少不良反应。功能恢复得到加速，许多ERAS患者可在术后数小时内下地行走。患者报告结局和满意度较高，且早期生活质量改善较为常见。从卫生系统角度看，ERAS的实施可带来显著的成本节约，这主要归因于更短的住院时间和更少的术后并发症。ERAS的发展也促进了在适当筛选患者中门诊关节置换术（当日出院）的增长。
全关节置换术（TJA）中的ERAS代表了围手术期照护模式的范式转变，融合了安全性、效率和以患者为中心的康复。其实施可改善临床结局并提升医疗价值，支持其继续推广，并作为髋、膝关节置换术全球照护标准加以采用。
Enhanced Recovery After Surgery (ERAS) Pathways in Elective Total Joint Arthroplasty
Enhanced recovery after surgery (ERAS) protocols are increasingly used in total hip and knee arthroplasty to improve outcomes, reduce complications, and shorten hospital stays. This involves a multidisciplinary, evidence-based approach covering the preoperative to postoperative period. This review explores the current literature on ERAS implementation in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA), focusing on clinical outcomes such as length of stay (LOS), opioid use, complications/readmissions, and other key components such as anesthetic standardization, use of opioid-sparing analgesia agents, early mobilization, and patient satisfaction. We performed a literature search of PubMed, Embase, and Google Scholar databases (last searched May 2025) for studies evaluating the use of ERAS protocols in elective THA and TKA. Relevant articles, including clinical trials, observational studies, case series, case reports, and review articles, were identified without geographic restrictions, limited to English-language publications from 2000 to 2025. Key search terms included "enhanced recovery after surgery," "ERAS," "fast-track," "rapid recovery," "total joint arthroplasty," "total knee replacement," "total hip replacement," and "outcomes." The selection of articles was based on relevance to the topic, emphasizing clinical outcomes. No formal quantitative synthesis was performed, given the narrative scope. The included literature (spanning approximately 294,000 patients across multiple studies) consistently demonstrates that ERAS pathways significantly reduce LOS by one to three days without increasing readmission or complication rates. Multimodal, opioid-sparing analgesia regimens lead to superior pain control and reduced opioid exposure, enhancing early mobilization and minimizing adverse effects. Functional recovery is accelerated, with many ERAS patients ambulating within hours of surgery. Patient-reported outcomes and satisfaction are high, and early quality-of-life improvements are commonly observed. ERAS implementation results in substantial cost savings from a systems perspective, largely due to shorter inpatient stays and fewer postoperative complications. The evolution of ERAS has also facilitated the growth of outpatient (same-day discharge) arthroplasty in appropriately selected patients. ERAS in total joint arthroplasty (TJA) represents a paradigm shift in perioperative care, combining safety, efficiency, and patient-centred recovery. Its implementation leads to improved clinical outcomes and enhanced healthcare value, supporting its continued expansion and adoption as a global standard of care in hip and knee arthroplasty.
文献出处：Ishaku Z, Koshy DI, Adamu Bala M. Enhanced Recovery After Surgery (ERAS) Pathways in Elective Total Joint Arthroplasty. Cureus. 2025 Sep 2;17(9):e91481. doi: 10.7759/cureus.91481. PMID: 40917910; PMCID: PMC12412062
第二部分：保髋相关文献
文献1
DDH幼年治疗后的患者成年后的生活质量
译者 张振东
髋关节发育不良（DDH）如果治疗不当可导致髋关节功能过早丧失，然而很少有研究关注DDH幼年治疗后的长期临床随访结果。
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 名DDH 患者发放了调查问卷。使用SF-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。 最终纳入 68 例患者进行了评估。
结果显示：患者的 PCS、MCS 和 RCS 总平均值与标准值相当。PCS可一直保持到 50 岁，但有 10 例50 岁以上的患者 PCS 显著下降。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。 此外，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。
DDH患者的身体生活质量在50岁之前一直保持不变，但之后迅速下降，尤其是那些在幼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
儿童创伤性三角软骨损伤的回顾性分析
译者 任宁涛
背景:总结分析儿童外伤后三角软骨损伤(TCI)的流行病学特点、治疗方法及相应疗效，为早期诊断和改进治疗提供理论依据。
方法:采用Bucholz分型对TCI损伤进行分型，随访时采用Harris髋关节评分及影像学检查评价最终疗效。最后，通过查阅文献中的病例并结合我院的患者进行综合分析。
结果:本院共收治三角软骨损伤15例(18髋)。I型损伤1例，II型损伤9例，IV型损伤2例，V型损伤1例，VI型损伤5例。随访完整的12例患者中，8例在三角软骨内或周围发现骨桥，5例出现早期三角软骨融合，3例髋关节发育不良，4例股骨头半脱位，HHS优8例，良4例。
结论:TCI损伤的早期诊断仍是一个难题。保守治疗通常是首选。髋臼骨折累及三角软骨的整体预后较差。三角软骨骨桥的形成通常预示着过早闭合的可能性，这可能导致创伤后髋臼发育不良和股骨头半脱位的严重并发症。
Retrospective analysis of traumatic triradiate cartilage injury in children
Background: To summarize and analyze the epidemiological characteristics, treatment and corresponding curative effect of triradiate cartilage injury(TCI) in children after trauma, to provide a theoretical basis for early diagnosis and improvement of treatment.
Methods: The TCI was classified according to Bucholz classification, and the final curative effect was evaluated with Harris Hip Score and imaging examination during follow-up. Finally, a comprehensive analysis was made by reviewing the cases in the literature combined with the patients in our hospital.
Results: A total of 15 cases (18 hips) of triradiate cartilage injuries were collected in our hospital. There was 1 hip with type I injury, nine hips with type II injury, two hips with type IV injury, one hip with type V injury and five hips with type VI injury. Among the 12 cases with complete follow-up, the bone bridge was found in or around the triradiate cartilage in 8 cases, early fusion of triradiate cartilage occurred in 5 patients, 3 cases had hip dysplasia, 4 cases had a subluxation of the femoral head, and HHS was excellent in 8 cases and good in 4 cases.
Conclusion: The early diagnosis of TCI is still a difficult problem. Conservative treatment is often the first choice. The overall prognosis of acetabular fractures involving triradiate cartilage is poor. The formation of the bone bridge in triradiate cartilage usually indicates the possibility of premature closure, which may lead to severe complications of post-traumatic acetabular dysplasia and subluxation of the femoral head.
文献出处：Dong Y, Wang J, Qin J, Nan G, Su Y, He B, Cai W, Chen K, Gu K, Liang X, Yan G, Wang Z. Retrospective analysis of traumatic triradiate cartilage injury in children. BMC Musculoskelet Disord. 2021 Aug 10;22(1):674. doi: 10.1186/s12891-021-04565-2. PMID: 34376165; PMCID: PMC8356404.
文献3
骨盆再定位截骨术前髋臼三维形态分析方法：范围综述
译者 李勇
背景： 髋臼周围截骨术是治疗髋臼发育不良的金标准。髋臼发育不良的巨大变异性要求通过三维重建和计算机辅助手术进行个性化的术前规划。为了规划通过骨盆截骨术移动髋臼骨块，需要定义一个参考平面和一种描述髋臼三维方向的方法。
方法： 在PubMed上进行了一项范围综述，检索那些在三维参考系中描述原生髋关节髋臼形态的 articles。从3815篇报告中筛选出98篇 articles 纳入分析。研究确定了三种可重复的参考平面：骨盆前平面、步态分析中使用的标准化与术语委员会平面以及骶骨基底平面。用于髋臼三维分析的不同方法被分为四组：整体方向、三平面测量、分割和股骨头表面覆盖率。
结论： 研究发现有两种方法适用于再定位截骨术：通过向量法的整体方向法和三平面法。整体方向法依赖于从髋臼缘、髋臼面或连续平面创建向量。通过将整体髋臼向量标准化至一个理想向量，可以通过一次对齐操作来矫正髋臼发育不良。三平面法基于在股骨头中心进行角度测量，涉及通过考虑轴面、冠状面和矢状面来矫正异常。尽管其他两种方法不直接适用于再定位，但它们有助于筛选患者以及验证规划和术后结果。
Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review
• Periacetabular osteotomy is the gold standard treatment for acetabular dysplasia. The great variability of acetabular dysplasia requires a personalized preoperative planning improved by 3D reconstruction and computer-assisted surgery. To plan the displacement of the acetabular fragment by a pelvic osteotomy, it is necessary to define a reference plane and a method to characterize 3D acetabular orientation.
• A scoping review was performed on PubMed to search for articles with a method to characterize the acetabulum of native hips in a 3D reference frame. Ninety-eight articles out of 3815 reports were included. Three reproducible reference planes were identified: the anterior pelvic plane, the Standardization and Terminology Committee plane used in gait analysis, and the sacral base plane. The different methods for 3D analysis of the acetabulum were divided in four groups: global orientation, triplanar measurements, segmentation, and surface coverage of the femoral head.
• Two methods were found appropriate for reorientation osteotomies: the global orientation by a vector method and the triplanar method. The global orientation method relies on the creation of a vector from the acetabular rim, from the acetabular surface or from successive planes. Normalization of the global acetabular vector would correct acetabular dysplasia by a single alignment maneuver on an ideal vector. The triplanar method, based on angle measurements at the center of the femoral head, would involve correction of anomalies by considering axial, frontal, and sagittal planes. Although not directly fit for reorientation, the two others would help to candidate patients and verify both planning and postoperative result.
文献出处：du Cluzel de Remaurin X, Khouri N, Georges S, Gajny L, Vergari C, Badina A. Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review. EFORT Open Rev. 2024 Aug 1;9(8):762-772. doi: 10.1530/EOR-22-0126. PMID: 39087510; PMCID: PMC11370718.
文献4
髋关节不同姿势对坐骨神经位置的影响：一项MRI研究
译者 陶可
背景：在考虑进行髋关节手术（特别是骨盆三联截骨术或髋臼周围截骨术中的坐骨截骨术）时，必须重视坐骨神经位置的变化，以确定最安全的下肢位置。由于坐骨神经靠近截骨部位，因此在这些手术过程中可能会受到损伤，导致严重的功能障碍。本研究首次通过实验证实了髋关节位置对坐骨神经位置的影响。
方法：我们研究了改变髋关节位置如何使坐骨神经靠近或远离髋臼下沟（进行骨盆三联截骨术或髋臼周围截骨术时，坐骨截骨的理想起始点位于髋臼下方）。我们对11名健康儿童（5名男孩和6名女孩，年龄7至17岁，均无髋关节手术史）进行了左髋关节磁共振成像扫描，扫描体位分别为：中立位/仰卧位、屈髋30至45度、屈髋/外展/外旋30至45度。在磁共振图像上测量了坐骨神经与髋臼下沟之间的距离。计算了每位受试者在屈曲位和屈曲/外展/外旋位下，以中立位为基准的距离比值。
结果：髋关节屈曲但不外展时，坐骨神经向坐骨截骨部位移动（平均屈曲/中立位比值为0.79，P<0.01）。然而，当髋关节屈曲30°至45°，并外展和外旋时，坐骨神经则远离截骨部位（平均屈髋/外展/外旋/中立位比值为1.34），这意味着神经到髋臼下沟的距离显著增加（P<0.01）。中立位时平均距离为14.8 mm（11至20 mm），屈曲位时为11.8 mm（9至16 mm），屈髋/外展/外旋位时为20.0 mm（9至30 mm）。
结论：在进行骨盆三联截骨术或髋臼周围截骨术时，进行坐骨截骨术最安全的髋/下肢位置可能是屈髋、外展和外旋位。在此位置，可以通过内侧或前侧入路进行截骨术，使坐骨神经远离截骨部位。
图1. 左侧髋关节磁共振成像扫描在三种不同体位下进行：中立/仰卧位、屈髋30至45度、以及屈髋/外展/外旋30至45度。
图2. 轴位T1加权磁共振成像扫描示例及坐骨神经至髋臼下沟的距离测量：中立位11至20毫米（平均14.8毫米），屈髋位9至16毫米（平均11.8毫米），屈髋/外展/外旋9至30毫米（平均20.0毫米）。
图3. 髋关节屈曲但不外展时，坐骨神经向坐骨截骨部位移动。平均屈髋/中立位比值为0.79 (P<0.01)。然而，在髋关节屈曲/外展/外旋30至45度时，坐骨神经会显著远离截骨部位（平均比值为1.34，P<0.01）。
图4. 示例：一名体型偏瘦的男孩，其坐骨神经周围脂肪组织极少，在髋关节中立位和屈髋/外展/外旋位（Flex/Abd/ER）时，坐骨神经的位置变化极小。
The effect of hip position upon the location of the sciatic nerve: an MRI Study
Background: Allowance for the positional changes of the sciatic nerve is important when considering the safest position of the leg to perform hip operations, specifically the ischial osteotomy during a pelvic triple or periacetabular osteotomy. As for its proximity to the osteotomy site the sciatic nerve can be injured during these operations with the consequence of severe functional impairment. This is the first in-vivo study that demonstrates the effect of hip position upon the location of the sciatic nerve.
Methods: We determined how altering the position of the hip moves the nerve toward or away from the infracotyloid groove, the desired starting point of the ischial osteotomy site just inferior to the acetabulum when performing a pelvic triple or periacetabular osteotomy. Magnetic resonance imaging scans of the left hip in 3 different positions (neutral/supine, 30 to 45 degrees flexion, 30 to 45 degrees flexion/abduction/external rotation) were performed in 11 healthy children (5 boys and 6 girls, age 7 to 17 y) without prior hip surgery. The distance between the sciatic nerve and the infracotyloid groove was measured on the magnetic resonance images. Distance ratios based on the neutral position were calculated for flexion and flexion/abduction/external rotation for each of the participants.
Results: The sciatic nerve moves toward the ischium osteotomy site in hip flexion without abduction (mean flexion: neutral ratio 0.79, P<0.01). However the nerve moves away from the osteotomy site when the hip is 30 to 45 degrees flexed, abducted, and externally rotated (mean flexion/abduction/external rotation: neutral ratio 1.34), meaning the distance from nerve to infracotyloid groove increases significantly (P<0.01). The mean distances were 14.8 mm (11 to 20 mm) in neutral, 11.8 mm (9 to 16 mm) in flexion, and 20.0 mm (9 to 30 mm) in flexion/abduction/external rotation.
Conclusions: The likely safest position of the hip/leg to perform the ischium osteotomy as part of a pelvic triple or periacetabular osteotomy is in flexion, abduction, and external rotation. In this position the osteotomy can be performed via a medial or anterior approach with the nerve the furthest away from the osteotomy site.
文献出处：Oliver Birke, Piers D Mitchell, Ella Onikul, David G Little. The effect of hip position upon the location of the sciatic nerve: an MRI Study. J Pediatr Orthop. 2011 Mar;31(2):165-9. doi: 10.1097/BPO.0b013e31820a1345.
文献5
外侧柱是支撑塌陷前股骨头坏死的关键：基于倾向评分匹配队列的有限元模型分析
译者 邱兴
背景： 本研究设计为一项队列研究，采用倾向评分匹配法，根据年龄、性别和体重指数进行匹配，对塌陷组和非塌陷组髋关节塌陷前的CT图像进行有限元模型分析。通过有限元分析，可获得髋关节周围整体的应力分布图形结果，直观地展示应力集中或分散的简单印象。
方法： 回顾性分析了32例国际骨循环研究会ARCO 2期或3期股骨头坏死患者的髋关节，这些患者接受了超过一年的随访。将16例随访期间无进行性塌陷的髋关节设为研究组，然后采用倾向评分匹配法，选取了16例因塌陷进展而需行关节置换术的髋关节作为对照组。使用Mechanical Finder软件为每位患者建立有限元模型，然后在髂嵴顶部1000平方毫米区域施加4500牛的载荷，分析模型在屈服应力方面的等效值。
结果： 两组的年龄、性别和体重指数无显著差异，但塌陷组中病灶位于外侧的比例（p = 0.015）显著更高，且病灶尺寸（p = 0.015）显著更大。非塌陷髋关节主要表现为应力分散至内侧柱和外侧柱，而塌陷髋关节则表现为应力集中于外侧柱和原发性压力骨小梁（p = 0.001）。
结论： 通过有限元模型分析，外侧柱和原发性压力骨小梁区域的应力集中可用于高概率地预测股骨头坏死的未来塌陷。研究结果提供了简单直观且对临床医生有重要参考价值的信息。因此，尤其对于年轻患者，通过保髋手术支撑外侧柱可能是防止进一步塌陷的关键。
Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts
Background: This study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion.
Methods: A total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm2 area at the top of iliac crest to analyze the models in terms of equivalents for yield stress.
Results: Age, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001).
Conclusion: Through FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.
Keywords: Femoral head collapse; Finite element analysis; Lateral pillar; Osteonecrosis of the femoral head; Propensity-matched score.
文献出处：Bahk JH, Jo WL, Kim SC, Kwon SY, Lim YW. Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts. J Orthop Surg Res. 2021 Dec 20;16(1):728. doi: 10.1186/s13018-021-02875-8. PMID: 34930357; PMCID: PMC8686362.
来源：304关节学术
作者：304关节团队
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