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本期目录：
1、普瑞巴林治疗全髋和全膝关节置换术后疼痛的有效性和安全性
2、结核性髋关节髋臼内陷：全髋关节置换术中利用自体股骨头植骨的临床疗效
3、全髋关节置换术后30天内早期股骨侧假体周围骨折患者高企的并发症率和再骨折率
4、全膝关节置换术后髌骨运动学与接触力的预测：一项关于股四头肌力线不良的模拟研究
5、基于“步态-肌肉-骨骼系统-有限元”个性化建模方法的步态周期内髋关节接触应力变化
6、40岁以上髋关节发育不良患者接受髋臼周围截骨术治疗的系统综述
7、预测髋臼周围截骨术后早期重返运动
第一部分：
关节置换及保膝相关文献
文献1
普瑞巴林治疗全髋和全膝关节置换术后疼痛的有效性和安全性：一项系统综述和荟萃分析
译者 张轶超
介绍：关节置换术后常见的骨关节炎和术后神经性疼痛突显了疼痛管理的必要性。许多患者发展为慢性神经性疼痛，需要有针对性的干预。普瑞巴林缓解疼痛的有效性研究结果相互矛盾，需要进一步探索以确定其治疗价值。本研究旨在评估普瑞巴林在术后疼痛管理中的有效性和安全性，分析结论不一致的文献，并加强对其临床应用的理解。
方法：本研究遵循系统评价和荟萃分析指南的首选报告项目。在四个主要数据库中进行了系统搜索，以选择相应文献。使用Review Manager 5.4.1进行统计分析，根据异质性采用固定或随机效应模型（I2）。根据给予普瑞巴林的类型、时间和剂量进行亚组分析。
结果：普瑞巴林在术后24小时（MD -0.62, 95%CI -1.02至-0.23）、48小时（MD -0.53, 95%CI -0.90至-0.15）和72小时（MD -0.59, 95%CI -1.05至-0.12）可以显著减轻运动性疼痛。阿片类药物的消耗量在24小时（SMD - 0.50, 95%CI -0.80至-0.20）、48小时（SMD - 0.76, 95%CI -1.34至-0.19）和72小时（SMD - 1.33, 95%CI -2.16至-0.49）时也显著降低。虽然在24和48小时的活动范围没有显著改善，但普瑞巴林与72小时时的活动范围显著增加相关（SMD 1.11, 95%CI 0.12, 2.09）。全膝关节置换术（TKA）后服用普瑞巴林，恶心（OR 0.30, 95%CI 0.09 ~ 0.99）和呕吐（OR 0.17, 95%CI 0.04 ~ 0.65）发生率显著降低。此外，普瑞巴林会使得TKA （OR 2.27, 95%CI， 1.13至4.56）和全髋关节置换术（THA）（OR 2.54, 95%CI 1.11至5.79）术后的镇静增强，TKA/THA患者24小时可能会出现视觉模糊（OR 4.68, 95%CI 1.37至15.99;n=95; I2=34）。无其它不良事件。术前提前超过24小时给予普瑞巴林可以在术后72小时时获得最大程度的疼痛减轻和阿片类药物使用量最少。
结论：普瑞巴林可以明显的减轻全关节置换术后的疼痛和阿片类药物的使用量，同时增加了第3天的活动能力，具有可接受的耐受性和安全性。
Efficacy and safety of pregabalin for postoperative pain after total hip and knee arthroplasty: a systematic review and metaanalysis
Introduction：The prevalence of osteoarthritis and postoperative neuropathic pain after arthroplasty highlights the necessity for improved pain management. Many patients develop chronic neuropathic pain, necessitating targeted interventions. Research on pregabalin’s effectiveness in pain relief has yielded conflicting findings, necessitating further exploration to determine its therapeutic value. This study sought to assess pregabalin’s efficacy and safety in postoperative pain management, reconcile inconsistent literature, and enhance understanding of its clinical use.
Methods：This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted across four major databases to select clinical trials. Statistical analysis was performed using Review Manager 5.4.1, applying fixed- or random-effects models depending on heterogeneity (I2 ). Subgroup analyses were conducted based on the type, timing, and dosage of pregabalin administered.
Results：Pregabalin was associated with significantly reduced pain during movement at 24 h (MD -0.62, 95%CI -1.02 to -0.23), 48 h (MD -0.53, 95%CI -0.90 to -0.15), and 72 h (MD -0.59, 95%CI -1.05 to -0.12) post-surgery. Opioid consumption was also significantly lower at 24 h (SMD −0.50, 95%CI -0.80 to -0.20), 48 h (SMD −0.76, 95%CI -1.34 to -0.19), and 72 h (SMD −1.33, 95%CI -2.16 to -0.49). While there were no significant improvements in the range of motion at 24 and 48 h, pregabalin was associated with significantly enhanced range of motion at 72 h (SMD 1.11, 95%CI 0.12, 2.09). Treatment with pregabalin was associated with a significant decrease in the odds of nausea (OR 0.30, 95%CI 0.09 to 0.99) and vomiting after total knee arthroplasty (TKA) (OR 0.17, 95%CI 0.04 to 0.65). Additionally, pregabalin exposure was associated with increased sedation after TKA (OR 2.27, 95%CI, 1.13 to 4.56) and total hip arthroplasty (THA) (OR 2.54, 95%CI 1.11 to 5.79), as well as blurred vision at 24 h in TKA/THA patients (OR 4.68, 95%CI 1.37 to 15.99; n=95; I2=34). There was no significant association with other adverse events. The administration of pregabalin for more than 24 h before surgery was associated with maximal reductions in pain and opioid use at 72 h post-surgery.
Conclusion：Pregabalin was associated with significantly reduced postoperative pain and opioid use following total joint arthroplasty while enhancing mobility on the third day, with acceptable tolerability and safety.
文献出处：Ruiz Ibán MÁ, Oteo-Álvaro Á, Miguéns Vázquez X, Ávila JL, Ribera H, Pérez-Páramo M. Efficacy and safety of pregabalin for postoperative pain after total hip and knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2025 Mar 11;20(1):261. doi: 10.1186/s13018-025-05675-6. PMID: 40069801; PMCID: PMC11895303.
文献2
结核性髋关节髋臼内陷：全髋关节置换术中利用自体股骨头植骨的临床疗效
译者 马云青
目的：本文报道一组髋关节结核合并髋臼内陷、大面积髋臼骨缺损病例，采用全新术式行全髋关节置换术治疗；术中未使用髋臼内陷环、金属网或髋臼加强笼。据我们所知，既往文献尚未报道过该手术方法。
方法：25例有髋关节结核既往治疗史患者就诊于本院，主诉髋关节疼痛加重、跛行。髋痛与跛行呈进行性加重，患肢出现短缩畸形。
结果：术前平均AK距离（科勒线至髋臼内侧缘水平距离）8 mm（范围1～16 mm）。髋臼假体平均外展角45°（41°～48°），平均前倾角18°（13°～24°）。术前肢体长度不等平均短缩4 mm（0～11 mm）。随访平均哈里斯髋关节评分（HHS）87.6分。
结论：对于结核性髋臼内陷患者，可采用自体股骨头植骨填充髋臼骨缺损。该方案疗效可靠，无需金属环、加强笼等内置物，不会产生额外经济负担，亦可规避此类金属植入物相关并发症。
文献出处：Kushwaha NS, Singh A, Saroj AK, Verma A, Ansari KA. Protrusio acetabuli in tubercular hip: Outcome of femoral head as autologous bone graft used during total hip replacement. J Clin Orthop Trauma. 2023 Sep 27;44:102247. doi: 10.1016/j.jcot.2023.102247. PMID: 37822476; PMCID: PMC10562844.
文献3
全髋关节置换术后30天内早期股骨侧假体周围骨折患者高企的并发症率和再骨折率
译者 张蔷
背景：本研究的目的是比较全髋关节置换术(THA) 患者在术后早期（30 天内）或更晚的时间点发生股骨侧假体周围骨折的治疗效果。
方法：本研究选择了一个大型、涵盖所有支付方的全国性数据库，以识别2010年至2022年间接受初次全髋关节置换术（THA）的患者。术后30天内股骨侧假体周围骨折的患者，根据年龄、性别和合并症负担，通过倾向评分匹配法进行病例匹配后，对照组根据骨折发生时间分为三个不同的队列：术后31至90天骨折组（n = 1,725）、术后91天至1年骨折组（n = 1,887）以及术后1年内未骨折组（n = 4,465）。术后30天内骨折组的平均年龄为66.63 ± 10.15岁，其中75%为女性。采用回归分析评估术后90天和2年的预后。以死亡为竞争终点，对感染率、再骨折率和再手术率进行了长达2 年的生存率分析。
结果：初次全髋关节置换术后30天内发生股骨侧假体周围骨折的患者，其90天内并发症率显著高于各对照组。早期骨折组的2年无再骨折和再次手术生存率显著低于（p < 0.05）其他时间点骨折的匹配患者。此外，术后30天组的2年生存率低于术后1 年内未骨折对照组：无感染生存率（87.8% [95%置信区间(CI)，86.8%-88.8%] VS. 97.7%[95%CI，97.3%-98.1%]）、再骨折生存率（57.4%[95%CI，56.0%-58.9%] VS. 99.5%[95%CI，99.3%-99.7%]）和再手术生存率（48.5%[95%CI，47.1%-50.0%] 对比97.6%[95%CI，97.2%-98.1%]）均显著降低(p < 0.05)。
结论：初次全髋关节置换术后30天内发生股骨侧假体周围骨折的患者，其并发症风险显著高于术后较晚发生股骨侧假体周围骨折的患者。与未发生股骨侧假体周围骨折的患者相比，这些患者的并发症率极高，这凸显了预防的重要性，以及在围手术期和术后采取干预措施以降低这些高危患者并发症风险的必要性。
Alarmingly High Rates of Complications and Refracture Among Patients with Early Periprosthetic Femoral Fracture Within 30 Days After THA
Background: The purpose of this study was to compare the outcomes of patients who underwent a total hip arthroplasty (THA) and sustained a postoperative periprosthetic femoral fracture either within the early postoperative period, within 30 days, or at later time points.
Methods: A large, all-payer national database was queried to identify patients who underwent a primary THA between 2010 and 2022. Patients who underwent a primary THA and sustained a periprosthetic femoral fracture within 30 days postoperatively were propensity-score matched on the basis of age, sex, and comorbidity burden to 3 separate cohorts based on timing: fracture between 31 and 90 days postoperatively (n = 1,725), fracture between 91 days and 1 year (n = 1,887), and no fracture within 1 year (n = 4,465). The 30-day fracture group had a mean age of 66.63 ± 10.15 years, and 75% of patients in this group were female. Regression analyses were utilized to evaluate outcomes at 90 days and 2 years. Survivorship analyses utilizing death as a competing end-point were conducted for rates of infection, refracture, and reoperation at up to 2 years.
Results: Patients who sustained a periprosthetic femoral fracture within 30 days after primary THA demonstrated significantly greater rates of complications within 90 days relative to each comparison cohort. The 2-year survivorships free of refracture and reoperation were significantly lower (p < 0.05) for the early fracture cohort relative to matched patients who sustained a fracture at other time points. Additionally, 2-year survivorships were poorer in the ≤30-day cohort than in the comparison cohort who had not sustained a fracture within 1 year postoperatively: survivorships free of infection (87.8% [95% confidence interval (CI), 86.8% to 88.8%] compared with 97.7% [95% CI, 97.3% to 98.1%]), refracture (57.4% [95% CI, 56.0% to 58.9%] compared with 99.5% [95% CI, 99.3% to 99.7%]), and reoperation (48.5% [95% CI, 47.1% to 50.0%] compared with 97.6% [95% CI, 97.2% to 98.1%]) were all significantly lower (p < 0.05).
Conclusions: Patients who sustained an early periprosthetic femoral fracture within 30 days following primary THA were at significantly greater risk for complications than patients who sustained a periprosthetic femoral fracture at later time points. The exceedingly high rates of complications compared with patients without a periprosthetic femoral fracture stresses the importance of not only prevention but potential interventions both perioperatively and postoperatively in an attempt to mitigate the risk of complications for these at-risk patients.
文献4
全膝关节置换术后髌骨运动学与接触力的预测：一项关于股四头肌力线不良的模拟研究
译者 沈松坡
背景： 尽管假体设计和手术技术不断进步，髌股关节并发症仍然是全膝关节置换术（TKA）后患者不满意的常见原因。异常的髌骨轨迹可导致接触应力增加、不稳定以及膝前痛，尤其见于术前存在股四头肌力线不良的患者。因此，需要特异于个体的评估工具来改善手术规划和术后结局。
方法： 本研究建立了一种个体化多体动力学（MBD）框架，用于模拟TKA后的髌股关节力学。为在受控条件下实现详细的个体化建模和实验验证，本概念验证研究选取了1例具有明显股四头肌力线不良的代表性患者。系统评估了股骨和胫骨假体定位的影响，包括内旋/外旋和内翻/外翻对线。数值预测结果通过带传感器的3D打印膝关节实验装置进行了验证。
结果： 股四头肌力线不良是髌骨不稳定的主要决定因素，可导致外移增加（bisect offset index最高达0.90，较参考条件高25%）、峰值接触力升高（增加11%），并在膝关节伸直过程中出现接近脱位。外翻对线使峰值接触力进一步增加，股骨侧最高增加3.6%，胫骨侧最高增加2.9%，同时加重了髌骨向外侧移位；而内旋使峰值接触力增加约2.2%，并恶化髌骨轨迹。相反，内翻对线和外旋可使接触力中度降低（最高达−2.5%），并使髌骨对线得到部分改善。平均总计算时间为48秒，模拟得到的运动学和接触力与实验测量结果显示出良好一致性。
结论： 所提出的计算框架能够快速、个体化地评估髌股关节力学和假体定位，并纳入个体解剖及对线特征。尽管本研究仅在概念验证场景中加以展示，但其计算效率和预测能力提示，该方法未来有望用于TKA术中的评估以及术中最后时刻的手术优化。
Predicting patellar kinematics and contact forces after TKA: a simulation study on quadriceps malalignment
Background: Patellofemoral complications remain a frequent cause of dissatisfaction following total knee arthroplasty (TKA), despite continuous advances in implant design and surgical techniques. Abnormal patellar tracking may lead to increased contact stresses, instability, and anterior knee pain, particularly in patients with preoperative quadriceps malalignment. Subject-specific assessment tools are therefore needed to improve surgical planning and postoperative outcomes.
Methods: A subject-specific multibody dynamics (MBD) framework was developed to simulate patellofemoral mechanics following TKA. A single representative patient with pronounced quadriceps malalignment was selected for this proof-of-concept study to enable detailed subject-specific modeling and experimental validation under controlled conditions. The effects of femoral and tibial component positioning, including internal/external rotation and varus/valgus alignment, were systematically evaluated. Numerical predictions were validated using a sensorized 3D-printed knee rig.
Results: Quadriceps malalignment was the primary determinant of patellar instability, leading to increased lateralization (bisect offset index up to 0.90, 25% higher than the reference condition), elevated peak contact forces (11% increase), and near-dislocation during knee extension. Valgus alignment increased peak contact forces by up to 3.6% (femur) and 2.9% (tibia) and further exacerbated lateral patellar shift, whereas internal rotation increased peak contact forces by ~ 2.2% and worsened tracking. In contrast, varus alignment and external rotation produced moderate reductions in contact forces (up to - 2.5%) and partial improvement in patellar alignment. The average total computation time was 48 s, and the simulated kinematics and contact forces showed strong agreement with the experimental measurements.
Conclusion: The proposed computational framework enables rapid, subject-specific evaluation of patellofemoral mechanics and implant positioning, incorporating individual anatomical and alignment characteristics. Although demonstrated here in a proof-of-concept setting, its computational efficiency and predictive capability suggest potential for future use in intraoperative assessment and last-minute surgical optimization in TKA.
第二部分：
保髋相关文献
文献1
基于“步态-肌肉-骨骼系统-有限元”个性化建模方法的步态周期内髋关节接触应力变化
译者 任宁涛
目的
构建一种“步态-肌肉骨骼系统(MS)-有限元(FE)”的综合仿真方法，分析髋关节动力学特性以及在一个步态周期内髋关节内接触应力的变化。
方法
招募了两名健康志愿者(男性和女性)。获得志愿者正常行走时的三维步态轨迹以及包括髋关节和股骨在内的CT图像。提取DICOM格式的CT成像数据进行三维髋关节重建。利用重建的三维模型文件实现全身肌肉骨骼模型骨盆和大腿节段的对象特异性配准。捕获的标记物轨迹数据用于驱动受试者特定的肌肉骨骼模型，完成逆动力学分析。导出动力学逆分析的结果，并应用于ABAQUS中髋关节有限元的边界和载荷设置。最后，通过有限元分析(FEA)对左脚在一个步态周期内髋关节的接触应力进行分析。
结果
在逆向动力学分析中，绘制了主要髋-股肌肌力相对于单个步态周期各阶段的动态变化。髋关节反作用力达到最大值2.9%BW(体重)，出现在终末站立阶段结束时。在初始接触阶段和最终支撑阶段分别出现双峰。有限元分析显示髋臼接触应力的时间变化。视觉应力云图中，单个步态周期中髋臼接触应力主要分布在髋臼顶和股骨头顶部前外侧区域。髋臼接触面积为293.8 ~ 998.4 mm2，最大接触面积出现在步态的支撑期中期或负重初始期。模型1和模型2在站立期末端髋臼最大接触应力分别为6.91 MPa和6.92 MPa。
结论
结合“步态-MS-FE”技术，构建了全面的仿真框架。基于人体步态轨迹及其CT图像，可实现个性化仿真建模。受试者特定的步态结合MS的逆向动力学分析为有限元模拟提供了更准确的髋关节生物力学分析的预处理参数。
图1 受试者特定的肌肉骨骼模型在正常步态周期中的肌力模式
图2 使用受试者特定运动学模型的步态周期中的8个阶段示意图。一个步态周期:阶段1，初始接触阶段; 阶段2，站立初期;阶段3，站立中期阶段; 阶段4，终末支撑阶段; 阶段5，预起步阶段; 阶段6，初始起步阶段; 阶段7，中期摇摆阶段; 阶段8，最后摇摆阶段
Changes in hip joint contact stress during a gait cycle based on the individualized modeling method of "gait-musculoskeletal system-finite element"
Objective: To construct a comprehensive simulation method of "gait-musculoskeletal system (MS)-finite element (FE)" for analysis of hip joint dynamics characteristics and the changes in the contact stress in the hip throughout a gait cycle.
Methods: Two healthy volunteers (male and female) were recruited. The 3D gait trajectories during normal walking and the CT images including the hip and femur of the volunteers were obtained. CT imaging data in the DICOM format were extracted for subjected 3D hip joint reconstruction. The reconstructed 3D model files were used to realize the subject-specific registration of the pelvis and thigh segment of general musculoskeletal model. The captured marker trajectory data were used to drive subject-specific musculoskeletal model to complete inverse dynamic analysis. Results of inverse dynamic analysis were exported and applied as boundary and load settings of the hip joint finite element in ABAQUS. Finally, the finite element analysis (FEA) was performed to analyze contact stress of hip joint during a gait cycle of left foot.
Results: In the inverse dynamic analysis, the dynamic changes of the main hip-femoral muscle force with respect to each phase of a single gait cycle were plotted. The hip joint reaction force reached a maximum value of 2.9%BW (body weight) and appeared at the end of the terminal stance phase. Twin peaks appeared at the initial contact phase and the end of the terminal stance phase, respectively. FEA showed the temporal changes in contact stress in the acetabulum. In the visual stress cloud chart, the acetabular contact stress was mainly distributed in the dome of the acetabulum and in the anterolateral area at the top of the femoral head during a single gait cycle. The acetabular contact area was between 293.8 and 998.4 mm2, and the maximum contact area appear at the mid-stance phase or the loading response phase of gait. The maximum contact stress of the acetabulum reached 6.91 MPa for the model 1 and 6.92 MPa for the model 2 at the terminal stance phase.
Conclusions: The "Gait-MS-FE" technology is integrated to construct a comprehensive simulation framework. Based on human gait trajectories and their CT images, individualized simulation modeling can be achieved. Subject-specific gait in combination with an inverse dynamic analysis of the MS provides pre-processing parameters for FE simulation for more accurate biomechanical analysis of hip joint.
文献出处：Xiong B, Yang P, Lin T, Xu J, Xie Y, Guo Y, Liu C, Zhou Q, Lai Q, He W, Wei Q, Zhang Q. Changes in hip joint contact stress during a gait cycle based on the individualized modeling method of "gait-musculoskeletal system-finite element". J Orthop Surg Res. 2022 May 14;17(1):267. doi: 10.1186/s13018-022-03094-5. PMID: 35568957; PMCID: PMC9107226.
文献2
40岁以上髋关节发育不良患者接受髋臼周围截骨术治疗的系统综述
译者 李勇
背景：关节发育不良是导致髋关节骨关节炎的重要原因之一。髋臼周围截骨术（PAO）在缓解青少年及年轻成人因该病引起的疼痛和功能障碍方面疗效确切，但对于40岁以上患者，临床上有顾虑认为术后功能障碍可能持续存在，且未来行全髋关节置换术（THA）的风险可能增高。目前，关于这一年龄段患者接受PAO治疗的高级别证据有限，也尚无系统综述对该问题进行专门梳理。本系统综述旨在总结40岁以上髋关节发育不良患者接受PAO治疗的人口学特征、患者报告结局指标（PROM）评分以及髋关节免于THA的生存率。
方法：综述遵循系统综述与荟萃分析优先报告条目（PRISMA）指南执行。检索数据库包括PubMed、OVID Medline、SCOPUS、Embase、Cochrane Library和clinicaltrials.gov。文献筛选依据预先设定的纳入与排除标准进行。
结果：纳入5项研究，入组年份跨度为1990年至2013年，累计335髋，患者平均年龄介于43.5～47.2岁，平均随访时间为4～10.8年。大多数接受保髋治疗的患者术前Tönnis骨关节炎分级为0～1级。关于40岁以上患者与40岁以下患者疗效孰优孰劣，各研究结果不尽一致；但总体来看，40岁以上组在PAO术后多数获得了良好结局。不同研究报告的髋关节生存率介于67%～100%之间，并发症发生率介于2%～36%之间，且这些并发症均未造成长期后遗症。
结论：40岁以上髋关节发育不良患者接受PAO治疗可获得较为满意的效果，但这些患者很可能经过严格筛选，通常无或仅有轻度骨关节炎、功能状态良好且全身健康状况佳。对于无关节炎改变的40岁以上髋关节发育不良患者，PAO可作为一种治疗选择，但应严格把握手术适应证。
HIP DYSPLASIA TREATED WITH PERIACETABULAR OSTEOTOMY IN PATIENTS OVER 40 YEARS OLD: A SYSTEMATIC REVIEW
Background: Hip dysplasia is a leading cause of hip osteoarthritis. While periacetabular osteotomy (PAO) is effective for relieving pain and dysfunction caused by hip dysplasia in adolescents and young adults, there is concern that patients over 40 years of age will have an increased risk of persistent dysfunction and need for total hip arthroplasty. Current available evidence for PAO in older adults is limited and there is no systematic review in the literature focusing on this topic. The current systematic review offers insight into the demographics, patient-reported outcome measure (PROM) scores, and hip survivorship from total hip arthroplasty in patients over 40 years older treated for hip dysplasia with PAO.
Methods: The review was conducted under the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Databases that were searched included PubMed, OVID Medline, SCOPUS, Embase, Cochrane Library, and clinicaltrials.gov. Studies were screened based on predetermined inclusion and exclusion criteria.
Results: Five studies were included in this systematic review. Enrollment years were 1990–2013. In total, there were 335 hips with mean ages between 43.5–47.2 years. Mean follow up was 4–10.8 years. Most patients that underwent hip preservation had Tonnis osteoarthritis grade 0–1. There was contradicting evidence whether patients >40 years did better or worse compared to <40 years; although, most patients in the >40 years group had good outcomes after PAO. PAO survivorship ranged from 67–100% depending on the study. Complications ranged from 2–36% of cases depending on the study; although, none of these complications had lasting effects.
Conclusion: Patients over 40 years old appear to have positive outcomes when treated for hip dysplasia with PAO, though these patients were likely selected for no to minimal osteoarthritis, high functional status, and good health. PAO should be considered for patients with hip dysplasia over 40 years old without hip arthritis, though we recommend very selective indications.
文献出处：O'Connor KP, Ince DJ, Clohisy JC, Willey MC. Hip Dysplasia Treated With Periacetabular Osteotomy in Patients Over 40 Years Old: A Systematic Review. Iowa Orthop J. 2024;44(1):105-112. PMID: 38919352; PMCID: PMC11195908.
文献3
预测髋臼周围截骨术后早期重返运动
译者 邱兴
目的
髋臼周围截骨术（PAO）是发育性髋关节发育不良（DDH）的主要手术治疗方式，可显著缓解疼痛并改善关节功能。对于年轻、活跃的患者而言，重返运动（RTS）是关键的临床结局。本研究旨在确定RTS时机的术前预测因素，并建立基于机器学习的预测模型，以优化患者咨询。
方法
本回顾性分析基于前瞻性收集的数据，纳入2019年1月至2023年12月期间接受PAO的235例患者。分析术前变量，包括人口学特征、功能评估和心理评估。术后3个月、6个月和12个月分别评估RTS情况。采用递归特征消除的逻辑回归和条件推断树（ctree）模型识别RTS的预测因素。
结果
术后3个月时，102例患者（43%）已重返运动，至6个月时增至182例（77%），12个月时达223例（95%）。早期RTS的关键预测因素包括：微创手术入路、术前较高的体力活动水平（≥2次/周）、较低的焦虑评分以及较高的髋关节残疾和骨关节炎结局评分（HOOS）疼痛分量表评分。男性和年龄较大与RTS延迟相关。ctree模型根据患者早期RTS的可能性进行分层，提供个体化预后。
结论
PAO可使90%以上的患者在术后一年内早期重返运动。采用允许术后即刻主动屈髋的微创入路、术前较高的活动水平以及较低的焦虑评分可显著改善RTS时机。该机器学习模型可提供精确、个体化的RTS预测，是患者咨询和康复规划的有效工具。
Predicting early return to sport after periacetabular osteotomy : a machine-learning approach
Aims: Periacetabular osteotomy (PAO) is the primary surgical treatment for developmental dysplasia of the hip (DDH), providing considerable pain relief and improved joint function. Return to sport (RTS) is a key outcome for young, active patients. This study aimed to identify preoperative predictors of RTS timing and develop a machine-learning-based prediction model to optimize patient counselling.
Methods: This retrospective analysis of prospectively collected data included 235 patients who underwent PAO between January 2019 and December 2023. Preoperative variables, including demographic, functional, and psychological assessments, were analyzed. RTS was assessed at three, six, and 12 months postoperatively. Logistic regression with recursive feature elimination and a conditional inference tree (ctree) model were used to identify predictors of RTS.
Results: At three months, 102 patients (43%) had returned to sports, increasing to 182 (77%) at six months and 223 (95%) at 12 months. Key predictors of early RTS included the minimally invasive surgical approach, higher preoperative physical activity (≥ two sessions/week), lower anxiety scores, and higher Hip disability and Osteoarthritis Outcome Score (HOOS) pain scores. Male sex and older age were associated with delayed RTS. The ctree model stratified patients based on their likelihood of early RTS, providing an individualized prognosis.
Conclusion: PAO enables early RTS in over 90% of patients within the first year. The use of a minimally invasive approach allowing immediate active hip flexion, higher preoperative activity levels, and lower anxiety scores significantly improves RTS timing. The machine-learning model provides precise, individualized RTS predictions, offering a valuable tool for patient counselling and rehabilitation planning.
文献出处：Nonnenmacher, L., Fischer, M., Kaderali, L., & Wassilew, G. I. (2025). Predicting early return to sport after periacetabular osteotomy: a machine-learning approach. Bone & Joint Open, 6(6 Supple B), 33-42.
来源：304关节学术
作者：304关节团队
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