本期目录：
1、John N. Insall奖：全膝关节置换术中的功能对线与机械对线
2、全髋关节置换术后神经损伤的处置
3、原发性化脓性膝关节炎行二期翻修时，Hofmann关节型间隔器与预制骨水泥间隔器的比较研究
4、影像学及患者因素与髋关节发育不良骨关节炎的相关性
5、伯尔尼髋臼周围截骨术（PAO）中降低神经损伤风险的推荐措施
6、髋臼周围截骨术（PAO）治疗多发骨骺发育不良髋关节骨关节炎的疗效
7、发育性髋关节发育不良中髋臼覆盖特征的性别差异有哪些
8、髋臼周围截骨术中的增强标志物追踪技术
第一部分：关节置换及保膝相关文献
文献1
John N. Insall奖：全膝关节置换术中的功能对线与机械对线：一项随机对照研究
译者 张轶超
背景：全膝关节置换术中的机械对线（MA）被认为是金标准；然而，一些患者表示术后不满意。功能对线（FA）是一种潜在的替代方法，它将运动学对线（KA）原则与预先截骨的骨平衡结合在一起。使用FA的目的是通过恢复自然关节线和优化软组织平衡来改善手术效果。然而，两者比较的证据是有限的。
方法：这项前瞻性、随机对照研究比较了MA （n=121）和FA （n=123）在机器人辅助全膝关节置换术中的应用。对于MA，假体垂直于肢体机械轴放置，通过软组织松解以达到平衡。对于FA，设定假体的位置与原始膝关节解剖结构相似，并在截骨前调整软组织平衡。将关节遗忘评分（FJS）作为评价结果的依据。结果采用混合模型方差分析进行比较。
结果：在2年的随访中，平均FJS具有可比性（MA: 64.4±30.1,FA: 70.1±25.6,P=0.10）。MA患者比FA患者术中进行了更多的软组织松解（65%比16%，P < 0.001）。与MA患者相比，FA患者有更高的膝关节损伤和骨关节炎预后（KOOS）症状评分（86.6±12.9比82.5±14.0,P = 0.01）和KOOS-生活质量评分（76.1±20.3比70.7±22.7,P= 0.03）。更多的FA患者“会推荐”该手术方法（94%对82%，P < 0.01）。对于术前膝关节冠状面对线为I型的患者，FA的FJS（71.3±24.8比56.8±31.6,P=0.02）和KOOS -生活质量评分（76.4±21.7比64.2±19.2,P=0.02）高于MA。在患者报告的结果（牛津膝关节评分、KOOS、EuroQol-5维度、疼痛视觉模拟量表）、临床结果（住院时间、功能物理测试）、再手术或假体生存率（FA: 1 vs MA: 0翻修）方面未见其他差异。
结论：虽然与机械对线相比，FA需要进行更少的软组织松解，但在2年时的患者报告和临床结果相似。根据患者的术前对线情况，采用FA可以改善特定亚组患者的预后。
The John N. Insall Award: Functional Versus Mechanical Alignment in Total Knee Arthroplasty: A Randomized Controlled Trial
Background: Mechanical alignment (MA) in total knee arthroplasty is regarded as a gold standard; however, some patients report dissatisfaction postsurgery. Functional alignment (FA) is a potential alternative, integrating kinematic alignment (KA) principles with preresection bone balancing within defined boundaries. The use of FA aims to improve outcomes by restoring native joint lines and optimizing soft-tissue balance. However, comparative evidence is limited.
Methods: This prospective, randomized controlled trial compared MA (n ¼ 121) and FA (n ¼ 123) in robotic-assisted total knee arthroplasty. For MA, components were positioned perpendicular to the limb mechanical axis, with soft-tissue releases to achieve balance. For FA, initial virtual component positioning was used to match native knee anatomy, with adjustments for soft-tissue balance before bone cuts. The primary outcome was the forgotten joint score (FJS). Outcomes were compared with a mixedmodel analysis of variance.
Results: At the 2-year follow-up, the mean FJS was comparable (MA: 64.4 ± 30.1 versus FA: 70.1 ± 25.6, P ¼ 0.10). The MA cases had more soft-tissue releases than FA (65 versus 16%, P < 0.001). Compared to MA patients, FA patients had higher Knee Injury and Osteoarthritis Outcome (KOOS) Symptoms (86.6 ± 12.9 versus 82.5 ± 14.0, P ¼ 0.01) and KOOS-Quality of Life scores (76.1 ± 20.3 versus 70.7 ± 22.7, P ¼ 0.03). More FA patients “would recommend” the procedure (94 versus 82%, P < 0.01). For patients who had preoperative Coronal Plane Alignment of the Knee Type I, FA had higher FJS (71.3 ± 24.8 versus 56.8 ± 31.6, P ¼ 0.02) and KOOS-Quality of Life (76.4 ± 21.7 versus 64.2 ± 19.2, P ¼ 0.02) than MA. No other differences were seen in patient-reported outcomes (Oxford Knee Score, KOOS, EuroQol-5 Dimensions, Pain Visual Analog Scale), clinical outcomes (length of stay, functional physio tests), reoperations, or implant survivorship (FA: 1 versus MA: 0 revisions).
Conclusions: While FA required fewer soft-tissue releases compared to mechanical alignment, at 2 years patient-reported and clinical outcomes were similar. The use of FA may provide improved outcomes for a specific subgroup of patients based on their preoperative alignment.
文献出处：Young SW, Tay ML, Kawaguchi K, van Rooyen R, Walker ML, Farrington WJ, Bayan A. The John N. Insall Award: Functional Versus Mechanical Alignment in Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty. 2025 Jul;40(7S1):S20-S30.e2. doi: 10.1016/j.arth.2025.02.065. Epub 2025 Feb 27. PMID: 40023458.
文献2
全髋关节置换术后神经损伤的处置
译者 张蔷
⑴ 神经损伤依然是全髋关节置换术后神经结扎的最常见原因。⑵ 全髋关节置换术后神经损伤的主要危险因素包括先前存在的脊柱病变、翻修术、复杂的髋关节解剖变异、女性、术者经验不足以及肢体过度延长。⑶ 术后可进行骨盆CT平扫以评估假体植入位置并寻找潜在的压迫性血肿，我们还可进行带去金属伪影序列的核磁共振检查以评估受损神经的结构性变化。⑷ 我们可以应用肌电图和其他神经传导检查来评估神经损伤的程度和等级。这些检查在术中神经损伤患者术后3-6周无任何恢复进度时最为有用。⑸ 保守治疗的重点是辅助性理疗、足踝矫正器以及神经病理性疼痛的镇痛治疗。⑹ 全髋关节置换术后股神经损伤的预后要优于坐骨神经损伤的预后。⑺ 初次全髋关节置换术后神经损伤的发病率在0.08%-3.7%，而全髋翻修术后神经损伤的发生率在0%-8%。
图示：坐骨神经围绕梨状肌走行的六种不同解剖变异
The Management of Neurological Injuries Following Total Hip Arthroplasty
Neurological injury remains the most common reason for ligation following total hip arthroplasty.
The main risk factors for neurological injury following total hip arthroplasty are preexisting spinal pathology, revision surgery, complex hip anatomy, female sex, surgeon inexperience, and excessive limb lengthening.
Postoperative pelvic computed tomographic scans may be used to assess component positioning and identify any compressive hematomas. Magnetic resonance imaging with a metal artifact reduction protocol may be used to evaluate architectural changes in the affected nerve.
Electromyography and nerve conducion stuies may help to asess the level and grade of the nerve injury. These tests are most useful when performed in patients who show no signs of neurological improvement 3 to6 weeks after surgery.
The mainstay of nonoperative management is supportive care with physical therapy, an ankle-foot orthosis, and neuropathic pain treatment.
The prognosis for a femoral nerve injury is generally more favorable than that for a sciatic nerve injury following total hip arthroplasty.
The reported rate of neurological injury ranges from 0.08% to 3.7% following primary total hip arthroplasty (THA) and from 0% to 8% following revision THA.
文献出处：Kayani B, Stammers JG, Donaldson J, Newman S, Jayadev C, Miles J, Skinner JA, Fox M. The Management of Neurological Injuries Following Total Hip Arthroplasty. J Bone Joint Surg Am. 2026 Feb 4;108(3):181-192. doi: 10.2106/JBJS.25.00389. Epub 2025 Dec 26. PMID: 41452940.
文献3
原发性化脓性膝关节炎行二期翻修时，Hofmann关节型间隔器与预制骨水泥间隔器的比较研究
译者 沈松坡
目的： 原发性膝关节化脓性关节炎（septic arthritis，SA）是一种严重且患病率日益升高的疾病，尤其常见于老年及合并多种基础疾病的患者。当其合并终末期退行性关节病变时，通常采用植入载抗生素关节型间隔器的二期全膝关节置换术（total knee arthroplasty，TKA）。然而，直接比较不同间隔器设计的证据仍然有限。本研究旨在比较两种二期治疗策略的临床和功能结局：预制骨水泥关节型间隔器与Hofmann型金属-聚乙烯关节型间隔器。
方法： 我们回顾性分析了2022年6月至2024年12月在一家三级转诊中心接受治疗的15例连续患者。纳入标准为：原发性膝关节化脓性关节炎合并终末期关节炎，计划接受二期TKA治疗，且随访时间至少12个月。7例患者接受Hofmann间隔器治疗，8例患者接受预制骨水泥间隔器治疗。主要终点为感染性失败，定义为复发性感染并需要外科干预；次要终点包括间隔期及再植入术后的功能结局〔膝关节协会评分（Knee Society Score，KSS）、牛津膝关节评分（Oxford Knee Score，OKS）、遗忘关节评分（Forgotten Joint Score，FJS）〕、疼痛〔视觉模拟评分（Visual Analog Scale，VAS）〕以及关节活动度（range of motion，ROM）。
结果： 平均随访时间为24.2个月。两组感染清除效果相当，仅骨水泥间隔器组发生1例再感染（6.7%）（p=1）。在间隔期，Hofmann组的KSS、OKS、FJS、VAS及ROM均显著优于骨水泥间隔器组（p=0.001）。再植入术后，Hofmann组的功能结局仍显著更优，表现为更大的ROM以及更高的患者报告结局评分。Hofmann组有2例患者因功能满意而选择保留间隔器。
结论： 两种策略均可实现有效的感染控制。然而，Hofmann关节型间隔器在不影响感染清除效果的前提下，可获得更优的功能恢复，支持其在原发性化脓性膝关节炎合并严重退行性变的特定患者中应用。
关键词：
化脓性膝关节炎；二期全膝关节翻修术；关节型间隔器；Hofmann间隔器；骨水泥间隔器
图 （a）Hofmann间隔器的股骨侧组件；（b）Hofmann间隔器的胫骨侧组件；（c）术中植入情况。
Hofmann articulating spacer vs preformed cement spacer two stage revision in native septic knee arthritis: a comparative study
Purpose: Septic arthritis (SA) of the native knee is a severe and increasingly prevalent condition, particularly among elderly and comorbid patients. When associated with end-stage degenerative joint disease, a two-stage total knee arthroplasty (TKA) with an antibiotic-loaded articulating spacer is commonly adopted. However, evidence directly comparing different spacer designs is limited. The aim of this study was to compare the clinical and functional outcomes of two two-stage strategies: a preformed cement articulating spacer and a Hofmann-type metal-on-polyethylene articulating spacer.
Methods: We retrospectively reviewed 15 consecutive patients treated between June 2022 and December 2024 at a tertiary referralcentre. Inclusion criteria were native knee SA with end-stage arthritis managed with planned two-stage TKA and minimum 12-month follow-up. Seven patients received a Hofmann spacer and eight a preformed cement spacer. The primary endpoint was septic failure, defined as recurrent infection requiring surgical intervention; secondary endpoints included functional outcomes (Knee Society Score [KSS], Oxford Knee Score [OKS], Forgotten Joint Score [FJS]), pain (VAS), and range of motion (ROM) during the interstage period and after reimplantation.
Results: Mean follow-up was 24.2 months. Infection eradication was comparable between groups, with one reinfection (6.7%) occurring in the cement spacer group (p = 1). During the interstage period, the Hofmann group demonstrated significantly superior KSS, OKS, FJS, VAS, and ROM (p = 0.001). After reimplantation, functional outcomes remained significantly better in the Hofmann group, with greater ROM and higher patient-reported scores. Two patients in the Hofmann group elected spacer retention due to satisfactory function.
Conclusion: Both strategies achieved effective infection control. However, the Hofmann articulating spacer provided superior functional recovery without compromising septic eradication, supporting its use in selected patients with native septic knee arthritis and advanced degeneration.
Keywords: Articulating spacer; Cement spacer; Hofmann spacer; Septic knee arthritis; Two-stage total knee arthroplasty.
第二部分：保髋相关文献
影像学及患者因素与髋关节发育不良骨关节炎的相关性
译者 任宁涛
背景
髋关节发育不良可导致关节软骨的异常应力，引起骨关节炎的发生，本研究旨在利用软骨延迟增强磁共振成像(dGEMRIC) 指数作为疾病的标志，研究与发育不良髋关节骨关节炎早期发病相关的解剖学和人口统计学因素。
方法
纳入74名患者，96例有症状性髋关节，均行标准放射学检查和dGEMRIC扫描，在标准的骨盆前后位上测量外侧CE角、臼顶倾斜角和Shenton线的连续性，在假斜位上测量前CE角来评估前覆盖情况。在MRI造影时出现盂唇每个层面都可见到造影剂时诊断为盂唇撕裂，骨关节炎定义为 dGEMRIC 值 <390 ms（正常髋关节的 dGEMRIC 数值低于 dGEMRIC 数值的两个标准偏差）。
结果
该队列的平均 dGEMRIC 指数（和标准偏差）（473 +/- 104 ms）显着低于形态正常的髋关节（570 +/- 90 ms）。在单变量分析中发现前CE角、关节间隙宽度和盂唇撕裂与否都与骨关节炎有关。第二个模型去除了前CE角，因为外侧CE角和前CE角高度相关，并且外侧CE角在临床测量上更常见，该模型将年龄、外侧CE角和盂唇撕裂与否确定为与骨关节炎相关的重要独立因素。
结论
正如之前对髋关节的研究所证明的那样，这项研究表明，骨关节炎与年龄增长和发育不良的严重程度有关，外侧CE角和前CE角都证明了这一点。此外，我们将盂唇撕裂确定为骨关节炎的危险因素。
Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia
Background: Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. The purpose of this study was to investigate the anatomic and demographic factors associated with the early onset of osteoarthritis in dysplastic hips by utilizing the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index as a marker of the disease.
Methods: Ninety-six symptomatic dysplastic hips in seventy-four patients were assessed with standard radiographs and a dGEMRIC scan. The lateral center-edge angle of Wiberg, the acetabular index of Tönnis, and the break in the Shenton line were measured on a standing anteroposterior radiograph. Anterior undercoverage was assessed by measuring the anterior center-edge angle on a Lequesne false-profile view. A labral tear was considered to be present when contrast agent was seen through the entire thickness of the labrum on magnetic resonance arthrography. Osteoarthritis was defined as a dGEMRIC value of <390 msec (two standard deviations below the dGEMRIC index in normal hips).
Results: The mean dGEMRIC index (and standard deviation) for this cohort (473 +/- 104 msec) was significantly lower than that of a morphologically normal hip (570 +/- 90 msec). The anterior center-edge angle, the joint space width, and the presence of a labral tear were all found to be associated with osteoarthritis in the univariate analysis. Multivariate analysis identified age, the anterior center-edge angle, and the presence of a labral tear as independent factors associated with osteoarthritis. A second model was fitted with omission of the anterior center-edge angle because the lateral and anterior center-edge angles were highly correlated and the lateral center-edge angle is a more common clinical measure. This model identified age, the lateral center-edge angle, and the presence of a labral tear as significant independent factors associated with osteoarthritis.
Conclusions: As has been demonstrated in previous studies of the hip, this investigation showed osteoarthritis to be associated with increasing age and the severity of dysplasia, as demonstrated both by the Wiberg lateral center-edge angle and the Lequesne anterior center-edge angle. Additionally, we identified a labral tear as being a risk factor for osteoarthritis.
文献出处：Rebecca H Jessel , David Zurakowski, Christoph Zilkens, Deborah Burstein, Martha L Gray, Young-Jo Kim. Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia. J Bone Joint Surg Am . 2009 May;91(5):1120-9.
文献2
伯尔尼髋臼周围截骨术（PAO）中降低神经损伤风险的推荐措施
译者 李勇
伯尔尼髋臼周围截骨术（PAO）是一种广泛应用的手术，用于重新定向因发育性髋关节发育不良、髋臼后倾、髋臼内陷或某些创伤性畸形所导致的发育不良髋臼。在手术过程中，股外侧皮神经（LFCN）以及闭孔神经、股神经和坐骨神经都可能受损。三大主要神经中任何一条的损伤对患者而言都是一次灾难性事件，随之而来的是一段充满不确定性的时期——既期待神经功能恢复，又恐惧终身残疾。手术经验是降低神经损伤发生率的关键因素，而术中透视和神经监测的价值仍有待证实。尽管已知例如复杂的截骨术中坐骨切迹会使坐骨神经处于风险之中，但在具体情况下导致神经损伤的操作往往并不明确。现有文献多局限于发病率的报告，缺乏分析性信息。
通过尸体解剖，我们观察了手术不同步骤对邻近神经可能产生的影响，本文展示了如何通过牵开器放置来保护神经，以及如何通过下肢体位摆放实现神经松弛——这是避免机械性损伤的重要手段。股外侧皮神经的频繁损伤完全与手术入路有关，而坐骨神经损伤主要源于坐骨截骨步骤，股神经损伤则几乎仅在髋臼骨块矫正时出现。作者将所展示的措施应用了9年，期间约800例髋臼周围截骨术中总共发生2例股神经损伤和2例坐骨神经损伤——神经损伤率为0.5%。其中3例髋的神经损伤在6至9个月内恢复，1例患者在撰写时仍有永久性足下垂，需佩戴支具。
Recommendations to Reduce Risk of Nerve Injury During Bernese Periacetabular Osteotomy (PAO)
The Bernese periacetabular osteotomy (PAO) is a widely used procedure to reorient a dysplastic acetabulum resulting from developmental dysplasia of the hip, retroversion, protrusio, or some deformities with a traumatic etiology. Throughout the execution, the lateral femoral cutaneous nerve (LFCN) as well as the obturator, femoral, and sciatic nerves can be injured. Injury to 1 of the 3 major nerves is a devastating event for the patient followed by an ill-defined period of hope for nerve recovery and fear of lifelong disability. Surgical experience is an essential factor in reducing the prevalence of nerve injury, whereas proof of the value of intraoperative fluoroscopy and nerve monitoring still must be established. Although it is known that, for example, the ischial cuts of the complex osteotomy place the sciatic nerve at risk, the action causing the nerve injury is rarely clear in the individual situation. The literature has been mostly limited to reports of incidence and offers little analytic information.
Through the use of cadaveric dissections, we visualized the possible impacts of the different steps of the procedure on the nerves in their anatomic vicinity, and the present report demonstrates how nerves can be protected with retractor positioning and how lower-limb positioning can lead to nerve relaxation, an important means to avoid mechanical injury. While the frequent injuries of the LFCN are exclusively related to the approach, sciatic nerve injuries are mainly the result of the ischial osteotomy steps and femoral nerve injuries are seen nearly exclusively with the correction of the acetabular fragment. The authors implemented the demonstrated measures for 9 years, during which approximately 800 periacetabular osteotomies resulted in a total of 2 femoral and 2 sciatic nerve lesions—or a nerve injury rate of 0.5%. The nerves injuries resolved within 6 to 9 months in 3 hips, and 1 patient had a definitive foot drop requiring a splint at the time of writing.
文献出处：Kalhor M, Collado D, Leunig M, Rego P, Ganz R. Recommendations to Reduce Risk of Nerve Injury During Bernese Periacetabular Osteotomy (PAO). JBJS Essent Surg Tech. 2017 Nov 22;7(4):e34. doi: 10.2106/JBJS.ST.17.00017. PMID: 30233969; PMCID: PMC6132992.
文献3
髋臼周围截骨术（PAO）治疗多发骨骺发育不良髋关节骨关节炎的疗效
译者 陶可
背景：多发性骨骺发育不良（MED）是一种罕见的先天性骨骼发育不良（性疾病）。MED患者在30至40岁会出现继发性髋关节骨关节炎。目前，对于预防MED继发的进行性髋关节关节炎尚无共识。髋臼周围截骨术（PAO）是一种保髋手术，旨在重塑髋臼并扩大股骨头覆盖范围。然而，目前尚无关于该手术对MED髋关节疗效的文献报道。
患者与方法：作者分析了6例MED髋关节接受伯尔尼PAO术后的初步结果。手术时平均年龄为14.3岁（范围：11.4至17.2岁）。为了研究时间效率，我们分析了术前和术后1年的影像结果。采用Harris髋关节评分（HHS）评估术前和术后的髋关节功能。
结果：平均随访时间为1.7年。平均外侧中心边缘角从3.8°增加到47.1°（p=0.02），前侧中心边缘角从7.3°增加到35.1°（p=0.02），髋臼指数从27.8°降低到14.6°（p=0.04）股骨头覆盖率从66.8%增加到100%（p=0.02）。术后前后位骨盆X线片显示所有术前中断的沈通氏线均得到纠正。平均HHS从67.3分提高到86.7分（p=0.05）。
结论：PAO是治疗MED患者髋关节病变的可行方法。它能有效重塑髋臼和股骨形态。在本研究中，初步结果表明该手术不仅改善了影像学结果，还改善了髋关节功能。
图 骨盆前后位X线片上PAO截骨术前与术后结果的比较
The favorable outcome of Bernese periacetabular osteotomy for the hip osteoarthritis in multiple epiphyseal dysplasia
Background: Multiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as the third to the fourth decade. Currently, there is no consensus on the prevention of the progressive hip osteoarthritis secondary to MED. The Bernese periacetabular osteotomy (PAO) is a joint-preserving surgery to reshape acetabulum and extend femoral head coverage. However, there is no documentary evidence for the effect of the procedure on MED hips.
Patients and methods: We analyzed the preliminary outcomes following the Bernese PAO in 6 MED hips. The average age at the time of surgery was 14.3 years (range from 11.4 to 17.2 years). For our study interest of time efficiency, radiographic parameters were analyzed preoperatively and 1 year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery.
Results: The mean follow-up time was 1.7 years. The mean lateral center-edge angle increased from 3.8° to 47.1° (p = 0.02), anterior center-edge angle increased from 7.3° to 35.1° (p = 0.02), and acetabulum index decreased from 27.8° to 14.6° (p = 0.04). The femoral head coverage ratio increased from 66.8% to 100% (p = 0.02). The post-operative anteroposterior pelvic radiograph demonstrated all preoperative broken Shenton lines were reversed. The mean HHS improved from 67.3 to 86.7 (p = 0.05).
Conclusion: Bernese PAO is a feasible treatment for hip disorders in MED patients. It reshapes acetabular and femoral morphology efficiently. In our study, the preliminary results showed the procedure not only improved radiographic outcomes but also hip function.
文献出处：Yao-Yuan Chang, Chia-Che Lee, Sheng-Chieh Lin, Ken N Kuo, Jia-Feng Chang, Kuan-Wen Wu, Ting-Ming Wang. The favorable outcome of Bernese periacetabular osteotomy for the hip osteoarthritis in multiple epiphyseal dysplasia.Orphanet J Rare Dis. 2023 Oct 30;18(1):340. doi: 10.1186/s13023-023-02920-1.
文献4
发育性髋关节发育不良中髋臼覆盖特征的性别差异有哪些？
译者 邱兴
背景： 偏心旋转髋臼截骨术用于预防发育性髋关节发育不良（DDH）所致的骨关节炎。为了获得充分的髋臼覆盖，了解DDH中髋臼覆盖的特征是必要的。然而，男性DDH患者髋臼覆盖的特点尚不明确。我们认为，男性和女性在髋臼覆盖上的差异可能与两性之间骨盆形态的差异有关。
问题/目的： (1) 男性和女性DDH患者在髋臼覆盖方面有何差异？(2) 男性和女性DDH患者在髂骨和坐骨的旋转方面有何差异？(3) 在DDH女性和男性患者中，不同高度的髂骨和坐骨旋转与髋臼覆盖之间存在何种关系？
方法： 在2016年至2023年间，我院有114例患者（138髋）接受了偏心旋转髋臼截骨术。我们排除了Tönnis分级为2级或以上、外侧中心边缘角≥25°以及存在骨盆或股骨畸形的患者，最终纳入100例患者（122髋）。女性患者（98髋）的中位年龄（范围）为40岁（10至58岁），男性患者（24髋）为31岁（14至53岁）。我们使用了所有患者的术前骨盆正位X线片和CT数据。在正位X线片上评估了交叉征、后壁征和骨盆宽度指数。在CT数据中，于两个不同高度（具体为通过髂前上棘的层面和通过耻骨联合及坐骨棘的层面）评估了无名骨在轴面上的旋转。此外，我们还评估了前、后髋臼扇形角。比较了男女患者各自的无名骨测量变量和髋臼覆盖测量变量之间的差异。分别评估女性和男性中骨盆形态测量值与髋臼覆盖之间的相关性，随后比较结果以识别任何性别特异性差异。对于连续变量，采用Student t检验；对于二分类变量，采用Fisher精确检验。p值<0.05被认为具有统计学显著性。
结果： 在正位X线片评估中，髋臼后倾的指标之一——交叉征，在性别之间没有差异；而后壁征（女性46% [45/98髋] 对比男性75% [18/24髋]，OR 3.50 [95%置信区间(CI) 1.20至11.71]；p=0.01）以及骨盆宽度指数<56%（女性1% [1/98] 对比男性17% [4/24]，OR 18.71 [95% CI 1.74至958.90]；p=0.005）在男性中比女性中更常见。髂骨旋转参数没有差异，但男性坐骨表现出更大的外旋（女性30°±2° 对比男性24°±1°；p<0.001）。关于髋臼覆盖，前髋臼扇形角在男女之间没有观察到差异。相比之下，男性的后髋臼扇形角值小于女性（85°±9° 对比 91°±7°；p=0.002）。在女性中，观察到髂骨旋转与髋臼扇形角之间存在相关性（前髋臼扇形角：r = -0.35 [95% CI -0.05至0.16]；p<0.001；后髋臼扇形角：r = 0.42 [95% CI 0.24至0.57]；p<0.001）。同样，坐骨旋转与两个髋臼扇形角也显示出相关性（前髋臼扇形角：r = -0.34 [95% CI -0.51至-0.15]；p<0.001；后髋臼扇形角：r = 0.45 [95% CI 0.27至0.59]；p<0.001）。因此，在女性中，我们观察到髂骨外旋和坐骨内旋与前髋臼覆盖增加及后髋臼覆盖减少相关。相比之下，虽然男性髋臼覆盖显示与髂骨旋转相关（前髋臼扇形角：r = -0.55 [95% CI -0.78至-0.18]；p=0.006；后髋臼扇形角：r = 0.74 [95% CI 0.48至0.88]；p<0.001），但未观察到与坐骨旋转的相关性。
结论： 在男性中，髋臼后倾比女性更常见，这归因于男性后髋臼覆盖减少。在女性中，后髋臼覆盖的增加与坐骨的外旋角度相关，而在男性中，未发现坐骨旋转与后髋臼覆盖之间存在相关性。在通过偏心旋转髋臼截骨术治疗男性DDH时，调整骨块以防止后髋臼覆盖不足至关重要。未来的研究可能需要探讨男性和女性在不同肢体位置下髋臼覆盖的差异，并考虑骨块旋转的方向。
临床相关性： 我们的研究结果表明，患有DDH的男性比女性更常表现出髋臼后倾，这归因于男性中观察到的后髋臼覆盖减少。男性后髋臼覆盖较小可能与性别间的坐骨形态差异有关。在为患有DDH的男性进行偏心旋转髋臼截骨术时，充分旋转髋臼骨块可能有助于补偿后髋臼覆盖的不足。
What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia?
Background: Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes.
Questions/purposes: (1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?
Methods: Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.
Results: In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation.
Conclusion: In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation.
Clinical relevance: Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.
文献出处：Funahashi, H., Osawa, Y., Takegami, Y., Iida, H., Ozawa, Y., Ido, H., & Imagama, S. (2024). What are the sex-based differences of acetabular coverage features in hip dysplasia?. Clinical Orthopaedics and Related Research®, 482(11), 1971-1983.
文献5
髋臼周围截骨术中的增强标志物追踪技术
译者 徐子茵
目的 开发一种基于混合增强标志物的导航系统，用于髋臼周围截骨术（peri-acetabular osteotomy，PAO）中髋臼重新定向的导航。
方法 该系统由固定于患者骨盆上的追踪单元、固定于髋臼骨块上的增强标志物，以及用于完成全部计算和可视化的主机计算机组成。增强标志物包括一个面向追踪单元的外部平面 标志物，以及一个用于测量其方向的内部惯性测量单元（inertial measurement unit，IMU）。IMU 输出的方向信息被传输至主机计算机。追踪单元将增强标志物的实时视频流传输至主机计算机，在主机计算机中检测平面标志物并估计其位姿。基于 Kalman 滤波的传感器融合方法将标志物追踪结果与 IMU 输出进行结合。研究者通过塑料骨模型实验和尸体实验对该系统进行了验证。每次实验中，均将该系统测得的髋臼倾斜角和前倾角与既往开发的基于光学追踪的导航系统测量结果进行比较。
结果 在尸体实验中，髋臼倾斜角和前倾角的平均绝对差异分别为 1.34°（±1.50°）和 1.21°（±1.07°）。在塑料骨模型实验中，髋臼倾斜角和前倾角的平均绝对差异分别为 1.63°（±1.48°）和 1.55°（±1.49°）。在两项验证实验中，均观察到非常强的相关性。
结论 本研究成功证明了该系统在 PAO 术中测量髋臼方向可行性。
Augmented marker tracking for peri-acetabular osteotomy surgery
Objective To develop a hybrid augmented marker-based navigation system for acetabular reorientation during peri-acetabular osteotomy (PAO).
Methods The system consists of a tracking unit attached to the patient’s pelvis, augmented marker attached to the acetabular fragment and a host computer to do all the computations and visualization. The augmented marker is comprised of an external planar Aruco marker facing toward the tracking unit and an internal inertial measurement unit (IMU) to measure its orientation. The orientation output from the IMU is sent to the host computer. The tracking unit streams a live video of the augmented marker to the host computer, where the planar marker is detected and its pose is estimated. A Kalman filter-based sensor fusion combines the output from marker tracking and the IMU. We validated the proposed system using a plastic bone study and a cadaver study. Every time, we compared the inclination and anteversion values measured by the proposed system to those from a previously developed optical tracking-based navigation system.
Results Mean absolute differences for inclination and anteversion were 1.34 (± 1.50) and 1.21 (± 1.07)°, respectively, for the cadaver study. Mean absolute differences were 1.63 (± 1.48) and 1.55 (± 1.49)° for inclination and anteversion for the plastic bone study. In both validation studies, very strong correlations were observed.
Conclusion We successfully demonstrated the feasibility of our system to measure the acetabular orientation during PAO.
Keywords Computer-assisted surgery · Navigation · PAO surgery
文献出处：Pflugi S, Vasireddy R, Lerch T, Ecker TM, Tannast M, Boemke N, Siebenrock K, Zheng G. Augmented marker tracking for peri-acetabular osteotomy surgery. Int J Comput Assist Radiol Surg. 2018 Feb;13(2):291-304. doi: 10.1007/s11548-017-1690-6. Epub 2017 Nov 29. PMID: 29188423.
来源：304关节学术
作者：304关节团队
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