本期目录：
1、全膝关节置换术后假体周围骨折的危险因素
2、全膝关节置换术中聚乙烯垫片厚度的精确性与准确性
3、个体化步态再训练治疗内侧间室膝骨关节炎
4、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
5、国际骨循环研究会2019年修订版股骨头坏死分期系统
6、年轻成人髋关节疾病的髋臼周围截骨术、髋关节镜手术和全髋关节置换术的如何选择
7、髋关节镜联合髋臼周围截骨可获得可靠中期疗效及较高临床改善
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骨折的危险因素：系统回顾和荟萃分析
译者 张轶超
背景：全膝关节置换术（TKA）后假体周围骨折（PPFs）导致反复住院并产生大量医疗费用。然而，导致TKA后PPF的风险因素仍存在高度争议。本研究对这些危险因素进行了全面、定量的分析，为指导临床预防策略的制定提供了科学依据。
方法：系统检索截至2024年10月1日的PubMed、Embase、Web of Science和Cochrane Library数据库的文献。我们纳入了所有评估TKA后PPF风险因素的英语研究。纽卡斯尔-渥太华量表用于评估纳入研究的质量，而优势比（OR）和95%置信区间（CI）用于评估各种危险因素与TKA后PPF可能性之间的关联。本方案已在国际前瞻性系统评价注册库注册（注册号：CRD42024601636）。共纳入24项研究，包括3,759,394例TKA病例。
结果：荟萃分析确定了TKA后PPFs的几个危险因素，包括性别（OR 1.81, 95% CI: 1.12至2.92）、股骨前方Notching（OR 3.12, 95% CI: 1.35至7.20）、骨质疏松（OR 1.68, 95% CI: 1.51至1.87）、帕金森病（OR 7.48, 95% CI: 1.15至48.83）、心血管疾病（OR 2.23, 95% CI: 1.01至4.94）和左下肢手术（OR 1.68, 95% CI: 1.01至2.79）。
结论：性别、骨质疏松、股骨前方Notching、左下肢手术、帕金森病和心血管疾病是TKA后PPFs的重要危险因素。
Risk Factors for Periprosthetic Fractures After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Background: Periprosthetic fractures (PPFs) following total knee arthroplasty (TKA) result in repeated hospitalizations and incur substantial medical costs. However, the risk factors contributing to PPFs postTKA remain highly debated. This study provides a comprehensive and quantitative analysis of these risk factors, offering scientific evidence to guide the development of clinical prevention strategies.
Methods: A systematic literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library databases up to October 1, 2024. We included all English-language studies that evaluated the risk factors for PPFs after TKA. The Newcastle-Ottawa Scale was leveraged to appraise the quality of the included studies, while odds ratios (OR) and 95% confidence intervals (CI) were used to assess the associations between various risk factors and the likelihood of PPFs after TKA. This protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42024601636). A total of 24 studies were included, encompassing 3,759,394 TKA cases.
Results: The meta-analysis identified several risk factors for PPFs after TKA, including sex (OR ¼ 1.81, 95% CI: 1.12 to 2.92), presence of an anterior femoral notching (OR ¼ 3.12, 95% CI: 1.35 to 7.20), osteoporosis (OR ¼ 1.68, 95% CI: 1.51 to 1.87), Parkinson's disease (OR ¼ 7.48, 95% CI: 1.15 to 48.83), cardiovascular diseases (OR ¼ 2.23, 95% CI: 1.01 to 4.94), and laterality (OR ¼ 1.68, 95% CI: 1.01 to 2.79).
Conclusions: Sex, osteoporosis, presence of anterior femoral notching, laterality, Parkinson's disease, and cardiovascular diseases are significant risk factors for PPFs after TKA.
文献出处：Li H, Liu C, Jin G, Teng Y, Zhang W, Jin R. Risk Factors for Periprosthetic Fractures After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2025 Nov;40(11):3046-3055.e5. doi: 10.1016/j.arth.2025.05.044. Epub 2025 May 19. PMID: 40398582.
文献2
全膝关节置换术中聚乙烯垫片厚度的精确性与准确性：传统测量截骨技术与机器人辅助技术的比较
译者 沈松坡
背景： 全膝关节置换术（TKA）的目标是通过精确截骨及平衡屈曲、伸直间隙恢复膝关节原有运动学。聚乙烯垫片厚度是决定关节线维持和关节稳定性的关键因素。本研究比较机器人辅助（RA）TKA与传统（C）TKA中聚乙烯垫片相对于术前计划的植入准确性和精确性。
方法： 回顾性分析2018年3月1日至2022年7月31日期间，由同一术者在单一医疗中心实施的所有TKA患者。患者根据接受机器人辅助TKA（RA-TKA）或传统TKA（C-TKA）进行分组。所有病例均计划采用9 mm聚乙烯垫片，以获得平衡的屈曲与伸直间隙。记录患者人口学资料及最终植入的聚乙烯垫片厚度。比较最终厚度与计划厚度之间的平均差值、偏离计划程度及厚度变异性。
结果： 共纳入815例患者，其中404例（49.6%）接受C-TKA，411例（50.4%）接受RA-TKA。两组性别分布无差异，但RA-TKA组患者年龄更大（70.46 ± 8.52岁 vs 69.14 ± 8.34岁，P = 0.027）。C-TKA组平均聚乙烯垫片厚度高于RA-TKA组（10.67 ± 1.18 mm vs 9.34 ± 0.61 mm，P < 0.001），其与计划厚度的平均差值分别为1.67 mm和0.34 mm。RA-TKA组达到计划厚度的比例更高（72.26% vs 16.09%），且厚度变异性显著更低（0.37 vs 1.39，P < 0.001）。
结论： 与传统TKA相比，RA-TKA在实现计划聚乙烯垫片厚度方面具有更高的准确性和精确性，提示其能够更准确地执行术前手术计划，并获得更加一致的间隙平衡。未来仍需开展前瞻性研究，以确定这些差异是否能够转化为更优的临床结局。
关键词
聚乙烯垫片厚度；全膝关节置换术；机器人辅助技术；手工技术；间隙平衡。
Precision and Accuracy of Polyethylene Thickness in Total Knee Arthroplasty: A Comparison of Conventional Measured Resection and Robotic-Assisted Techniques
Background: Total knee arthroplasty (TKA) aims to restore native knee kinematics through accurate bone resection and balanced flexion and extension gaps. Polyethylene thickness is a critical determinant of joint line preservation and stability. This study compared polyethylene implant accuracy and precision relative to the preoperative plan in robotic-assisted (RA) and conventional (C) TKA.
Methods: A retrospective review was performed of all patients who underwent TKA by a single surgeon at a single institution between March 1, 2018, and July 31, 2022. Patients were classified as having undergone either RA-TKA or C-TKA. A 9-mm polyethylene thickness was planned in all cases to achieve balanced flexion and extension gaps. Patient demographics and final polyethylene thickness were recorded. Mean differences from the planned thickness, deviation from the plan, and variance were compared.
Results: A total of 815 patients were included, with 404 (49.6%) undergoing C-TKA and 411 (50.4%) undergoing RA-TKA. Sex distribution did not differ between groups, though patients in the RA-TKA group were significantly older (70.46 ± 8.52 years vs 69.14 ± 8.34 years, P = .027). Mean polyethylene thickness was greater in C-TKA than RA-TKA (10.67 mm ± 1.18 mm vs 9.34 mm ± 0.61 mm, P < .001) with mean differences of 1.67 mm and 0.34 mm, respectively. Adherence to the planned thickness was higher in RA-TKA (72.26% vs 16.09%) and variance was significantly lower (0.37 vs 1.39, P < .001).
Conclusions: RA-TKA demonstrated greater accuracy and precision in achieving planned polyethylene thickness, suggesting improved execution of the surgical plan and more consistent gap balancing. Prospective studies should determine whether these differences translate to superior clinical outcomes.
Keywords: Gap balancing; Manual techniques; Polyethylene thickness; Robotic-assisted techniques; Total knee arthroplasty.
文献3
个体化步态再训练治疗内侧间室膝骨关节炎：一项随机对照试验
译者 邱兴
背景： 通过对内侧间室膝骨关节炎患者进行步态再训练，使其足角（即足内旋或足外旋角度）发生个体化改变，可减少与疾病进展相关的关节过度负荷。本研究旨在探讨与假干预相比，个体化足前进角调整对轻中度内侧间室膝骨关节炎患者的临床、生物力学和结构学疗效。
方法： 本单中心、平行组、随机对照试验在美国斯坦福大学人类表现实验室和Lucas影像中心，通过在线和印刷媒体招募有症状的内侧间室膝骨关节炎患者。符合条件的受试者（年龄≥18岁）由计算机按1∶1比例随机分配至干预组或假干预组。在六次大学步态实验室的步行再训练访视中，所有受试者均接受实时生物反馈，指导其以一致的个体化目标足前进角行走。干预组的目标足前进角为能最大程度减少膝关节负荷的5°或10°角度改变，假干预组的目标足前进角则为受试者自身的自然足前进角。受试者及参与数据分析的工作人员对分组情况设盲；执行步态分析访视的工作人员不设盲。主要结局指标为1年时膝内侧疼痛（数字评定量表）和膝内侧负荷（膝关节内收力矩峰值）的变化。次要结局指标为1年时基于MRI估算的软骨微结构（T1ρ和T2松弛时间）变化。通过监测不良事件的数量和类型评估安全性。采用意向性治疗线性回归分析，纳入所有随机分配的受试者。有膝骨关节炎亲身经历的患者参与了本研究的设计和实施。本研究已在ClinicalTrials.gov注册（NCT02767570），现已停止入组。
结果： 在2016年8月1日至2019年6月25日期间，共筛选1582例受试者。107例受试者完成初始步态分析，68例被随机分配至干预组（n=34）或假干预组（n=34）。68例受试者中女性41例（60%），男性27例（40%），白人54例（79%）；平均年龄64.4岁（标准差7.6）。1年后，干预组受试者的膝内侧疼痛（组间差异 -1.2，95%置信区间 -1.9至 -0.5；p=0.0013）和膝关节内收力矩峰值（组间差异 -0.26 %体重×身高，95%置信区间 -0.39至 -0.13；p=0.0001）的降低程度均大于假干预组。干预组内侧间室软骨微结构（T1ρ）的MRI估算变化小于假干预组（组间差异 -3.74 ms，95%置信区间 -6.42至 -1.05）。两组间T2差异无统计学意义。未发生严重不良事件；但干预组中有2例（6%）受试者、假干预组中有1例（3%）受试者因膝痛加重而退出研究。
解释： 个体化足角调整可改善疼痛、降低膝关节负荷，并可能延缓骨关节炎进展，因此对于部分内侧间室膝骨关节炎患者而言，是一种有前景的非手术治疗选择。
资助： 美国退伍军人事务部。
图1：试验流程图（即研究参与者的筛选、随机分组及随访流程示意图）。
图2：膝内侧疼痛及膝关节内收力矩峰值的变化
图中显示了数字评定量表（NRS，0～10分）评估的膝内侧疼痛变化均值及95%置信区间（p=0.0013）（A图，n=68 [100%]，意向性治疗分析）。负值表示疼痛改善。NRS疼痛改善1分被认为是最小临床重要改善¹⁸。图中标出了完成1年疼痛评估的56例个体的变化值（散点），并显示了全部68例个体（100%，意向性治疗）中达到缓解（疼痛改善≥1分）的比例。B图显示了干预组相比假干预组获得临床意义疼痛改善的相对可能性（95%置信区间），数值大于1表示干预组获得临床意义疼痛改善的可能性更高。C图显示了从第0周至第1年膝关节内收力矩峰值的变化均值及95%置信区间（p=0.0001）（n=68 [100%]，意向性治疗），负值表示膝关节内侧间室负荷降低。图中还显示了完成1年步态分析的49例（占68例的72%）个体的变化值（散点）。MCII=最小临床重要改善；NRS=数字评定量表。
图3：基于MRI的股骨软骨质量变化
图中显示从第0周至第1年内侧间室和外侧间室T1ρ变化的均值及95%置信区间（A图，n=68 [100%]，意向性治疗分析，*95%置信区间不包含0）。T1ρ升高提示软骨退变。图中还显示了代表性受试者在第0周和第1年的股骨软骨T1ρ投影图（B–E）。红色区域对应T1ρ弛豫时间延长及软骨质量降低（即软骨退变更严重）。
Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial
Background: Retraining individuals with medial compartment knee osteoarthritis to walk with a patient-specific change in their foot angle (ie, toe-in or toe-out angle) can reduce excessive joint loading related to disease progression. This study investigated the clinical, biomechanical, and structural efficacy of personalised foot progression angle modifications compared with sham treatment in patients with mild-to-moderate medial compartment knee osteoarthritis.
Methods: In this single-center, parallel-group, randomised controlled trial, we recruited individuals with symptomatic medial compartment knee osteoarthritis at the Human Performance Laboratory and Lucas Center for Imaging at Stanford University, CA, USA, using online and print media. Eligible participants (aged ≥18 years) were randomly assigned (1:1) by a computer to an intervention or sham group. During six walking retraining visits to a university gait laboratory, all participants received real-time biofeedback instructing them to walk consistently with a personalised target foot progression angle. The intervention group's target was the 5° or 10° change in foot progression angle that maximally reduced their knee loading, and the sham group's target was their natural foot progression angle. Participants and staff involved in data analysis were masked to group allocation; staff performing the gait analysis visits were not. Primary outcomes were 1-year changes in medial knee pain (numeric rating scale) and medial knee loading (knee adduction moment peak). Secondary outcomes were 1-year changes in cartilage microstructure estimated from MRI (T1ρ and T2 relaxation times). We evaluated safety by monitoring the number and type of adverse events. Intention-to-treat linear regression analyses, comprising all randomly assigned participants, were conducted. People with lived experience of knee osteoarthritis were involved in the design and conduct of this study. This study is registered with ClinicalTrials.gov, NCT02767570, and is closed to enrollment.
Findings: Between Aug 1, 2016, and June 25, 2019, 1582 individuals were screened for eligibility. 107 participants completed an initial gait analysis and 68 were randomly assigned to either the intervention (n=34) or the sham (n=34) group. 41 (60%) of 68 participants were female, 27 (40%) were male, and 54 (79%) were White; mean age was 64·4 years (SD 7·6). After 1 year, participants in the intervention group had greater reductions in medial knee pain (between-group difference -1·2, 95% CI -1·9 to -0·5; p=0·0013) and knee adduction moment peak (between-group difference -0·26 % bodyweight × height, 95% CI -0·39 to -0·13; p=0·0001) than participants in the sham group. The MRI-estimated change in cartilage microstructure (T1ρ) in the medial compartment was less in the intervention group than the sham group (between-group difference -3·74 ms, 95% CI -6·42 to -1·05). There were no significant between-group differences in T2. There were no severe adverse events; however, two (6%) of 34 participants in the intervention group and one (3%) of 34 participants in the sham group dropped out of the study due to increased knee pain.
Interpretation: Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them a promising non-surgical treatment option for some individuals with medial compartment knee osteoarthritis.
Funding: US Department of Veterans Affairs.
文献出处：Uhlrich, S. D. , Mazzoli, V. , Silder, A. , Finlay, A. K. , Kogan, F. , & Prof, G. E. G. , et al. (2025). Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial. {The Lancet Rheumatology}{,} {7}(10), e708-e718.
第二部分：保髋相关文献
文献1
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2
国际骨循环研究会2019年修订版股骨头坏死分期系统
译者 李勇
目的：国际骨循环研究会（ARCO）基于1994年ARCO分类标准，提出2019年修订版股骨头坏死（ONFH）分期系统。
方法：2018年10月，ARCO成立了一个专门工作组来修订ONFH分期系统，工作组由29位专家组成，采用基于网络的调查方式进行国际合作，计算每个答案的内容效度比以确定共识水平，对于评级问题，当超过70%的专家组委员在5级评分中给出“4”或“5”分时即定义为达成共识。
结果：回应率为93.1%至100%，经过四轮德尔菲研究，成功修订了1994年ARCO股骨头坏死分类，最终共识形成以下4期系统：1期，X线正常，但磁共振（MRI）或骨扫描阳性；2期，X线异常（股骨头骨质硬化、局灶性骨质疏松或囊性变的轻微征象），但无任何软骨下骨折、坏死区骨折或股骨头塌陷的证据；3期，X线或计算机断层扫描（CT）可见软骨下区或坏死区骨折，该期进一步分为3A期（早期，股骨头塌陷≤2 mm）和3B期（晚期，股骨头塌陷>2 mm）；4期，X线有骨关节炎证据，伴有关节间隙狭窄、髋臼改变和/或关节破坏。本修订版分期系统未纳入既往的亚分类或量化参数，但专家组同意将来另行开发用于预测疾病进展的分级系统。
结论：通过基于专家组的德尔菲调查，制定了一个修订1994年ARCO股骨头坏死分类的分期系统，ARCO已批准并推荐该修订系统作为股骨头坏死的通用分期标准。
The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head
Objective: The Association Research Circulation Osseous (ARCO) presents the 2019 revised staging system of osteonecrosis of the femoral head (ONFH) based on the 1994 ARCO classification.
Methods: In October 2018, ARCO established a task force to revise the staging system of ONFH. The task force involved 29 experts who used a web-based survey for international collaboration. Content validity ratios for each answer were calculated to identify the levels of agreement. For the rating queries, a consensus was defined when more than 70% of the panel members scored a “4” or “5” rating on a 5-point scale.
Results: Response rates were 93.1 to 100%, and through the four-round Delphi study, the 1994 ARCO classification for ONFH was successfully revised. The final consensus resulted in the following 4-staged system: Stage 1: x-ray is normal, but either magnetic resonance (MRI) or bone scan is positive; Stage 2: x-ray abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head), but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; Stage 3: fracture in the subchondral or necrotic zone as seen on x-ray or computed tomography (CT) scans. This stage is further divided into stage 3A (early, femoral head depression ≤ 2 mm) and stage 3B (late, femoral head depression > 2 mm); and Stage 4: x-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. This revised staging system does not incorporate the previous subclassification or quantitation parameters, but the panels agreed on the future development of a separate grading system for predicting disease progression.
Conclusion: A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. ARCO approved and recommends this revised system as a universal staging of ONFH.
文献出处：Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, Drescher W, Gangji V, Goodman SB, Ha YC, Hernigou P, Hungerford MW, Iorio R, Jo WL, Jones LC, Khanduja V, Kim HKW, Kim SY, Kim TY, Lee HY, Lee MS, Lee YK, Lee YJ, Nakamura J, Parvizi J, Sakai T, Sugano N, Takao M, Yamamoto T, Zhao DW. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. J Arthroplasty. 2020 Apr;35(4):933-940. doi: 10.1016/j.arth.2019.11.029. Epub 2019 Nov 27. PMID: 31866252.
文献3
年轻成人髋关节疾病的髋臼周围截骨术、髋关节镜手术和全髋关节置换术的如何选择
译者 陶可
髋关节疼痛在年轻人和老年人群中均十分常见。老年患者的疼痛最常见于骨关节炎（OA）引起的疼痛，而年轻患者的疼痛则更常由非退行性疾病引起。髋关节发育不良和股骨髋臼撞击综合征（FAI）也可能导致疼痛。一些学者认为，髋关节力学异常是导致高达80%的髋关节骨关节炎的原因。因此，对于治疗年轻髋关节疼痛患者而言，纠正这些异常情况至关重要。髋关节发育不良可通过测量骨盆站立位X线片上CE角<25°来诊断。发育不良或后倾的髋臼伴有明显症状应行髋臼周围截骨术（PAO）。伴有明显症状的股骨髋臼撞击综合征（FAI）应进行充分切除，必要时进行髋臼盂唇手术。如果存在保髋手术预后不良的风险因素（年龄>45至50岁、存在骨关节炎、关节间隙<3 mm或活动范围受限），则应考虑行全髋关节置换术（THA）而非PAO。PAO后行THA的疗效与初次THA相似。髋关节镜适用于FAI（凸轮型和钳夹型）和/或髋臼盂唇撕裂。
图1 a)女性患者术前和术后X线片。术前左侧CE角为17°，右侧为12°。术前左侧髋臼指数角为19°，右侧为11°。b)术后，CE角为30°，AI角为0°。矫正目标是使AI角接近0°。AI角小于0°会导致撞击。c)术后一年，截骨处已愈合。
图2 a)站立位骨盆正位X线片，可见双侧交叉征、后壁征和坐骨棘突出。b)术后一年站立位骨盆正位X线片。截骨处已愈合，交叉征和后壁征消失。
图3 髋关节和腹股沟疼痛的治疗流程图。
图4 典型的凸轮型髋臼唇损伤，位于髋关节前上方。髋臼盂唇显示滑膜炎征象，并部分脱离髋臼窝。通常还可见邻近软骨的剥离，即所谓的波浪征。
图5 在处理所有关节内病变（例如潜在的髂前下棘棘下撞击、股骨头韧带病变、软骨损伤等）后，进行适度的髋臼缘修整，然后用缝合锚钉重新固定髋臼盂唇损伤。通过稳定软骨-髋臼盂唇连接处的关节一致性，重建髋臼盂唇的吸附密封功能。
图6 一名22岁男性患者左髋的凸轮型股骨髋臼撞击综合征(FAI)。a)术前骨盆正位X线片显示α角为89°。b)术前侧位X线片，α角79°。c)术前轴位CT，α角68°。d)术后轴位CT，α角50°。e)术后三维CT扫描，显示股骨头颈交界处的病灶切除情况。
The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip.
Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI).Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain.Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis.Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO).FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery.If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO.THA can be performed following PAO with outcomes similar to a primary THA.Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears.
文献出处：Stig Storgaard Jakobsen, Søren Overgaard, Kjeld Søballe, Ole Ovesen, Bjarne Mygind-Klavsen, Christian Andreas Dippmann, Michael Ulrich Jensen, Jens Stürup, Jens Retpen. The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. EFORT Open Rev. 2018 Jul 11;3(7):408-417. doi: 10.1302/2058-5241.3.170042.
文献4
髋关节镜联合髋臼周围截骨可获得可靠中期疗效及较高临床改善
译者 徐子茵
目的：评估髋关节镜联合髋臼周围截骨术（PAO）治疗髋关节发育不良及关节内病变后的5年疗效，重点关注达到具有临床意义结局阈值的比例。
方法：从前瞻性数据库中检索至少5年随访结局数据，纳入2010年10月至2019年7月接受同期髋关节镜和PAO的患者。评估的患者报告结局包括改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节结局评分运动专项分量表（HOS-SSS）和国际髋关节结局工具12项量表（iHOT12）。同时评估具有临床意义的阈值，包括最小临床重要差异（MCID）、患者可接受症状状态（PASS）和显著临床获益（SCB）。
结果：本研究共纳入32髋。所有患者报告结局评分从术前基线至5年随访均显著改善（P < 0.001）。临床结局保持持久，2年与5年随访之间未观察到显著下降（mHHS P = 0.612；NAHS P = 0.701；iHOT-12 P = 0.284；HOS-SSS P = 0.158）。同样，MCID、PASS和SCB阈值的达标率随时间保持稳定（P = 0.105至 >0.999）。2髋（5.7%）转为全髋关节置换术（THA）。
结论：同期髋关节镜与PAO是一种有效术式，具有持久的5年疗效。患者改善得以维持，且具有临床意义的成功率较高，支持在适当选择病例中应用该联合治疗方案的价值。
证据等级： IV级：回顾性治疗性病例系列研究。
Durable Mid-Term Outcomes and High Rates of Meaningful Improvement After Hip Arthroscopy With Concomitant Periacetabular Osteotomy
Purpose: To evaluate 5-year outcomes following combined hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of acetabular dysplasia and intra-articular pathology, with a focus on the rates of achieving clinically meaningful outcome thresholds.
Methods: Minimum 5-year outcome data from a prospectively maintained database were queried to identify patients who underwent concomitant primary hip arthroscopy and PAO between October 2010 and July 2019. Patient-reported outcomes evaluated included the modified Harris Hip Score (mHHS), non-arthritic hip score (NAHS), hip outcome score sport-specific subscale (HOS-SSS), and international hip outcome tool 12 (iHOT12). Clinically meaningful thresholds were also assessed, including minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB).
Results: A total of 32 hips were included in this study. All PROs demonstrated significant improvement from the preoperative baseline to the 5-year follow-up (P < .001). Clinical outcomes remained durable, with no significant decline observed between 2-year and 5-year follow-ups (mHHS P = 0.612; NAHS P = 0.701; iHOT-12 P = 0.284; HOS-SSS P = 0.158). Similarly, achievement rates for MCID, PASS, and SCB thresholds were sustained over time (P = 0.105 to >0.999). Two hips (5.7%) converted to total hip arthroplasty (THA).
Conclusions: Concomitant hip arthroscopy and PAO are an effective procedure with durable 5-year outcomes. Patients demonstrated sustained improvements and a high rate of clinically meaningful success, supporting the value of this combined approach in appropriately selected cases.
Level of Evidence: Level IV: Retrospective therapeutic case series.
文献出处：Kahana-Rojkind AH, Walsh EG, Quesada-Jimenez R, Kuhns BD, LaReau JM, Domb BG. Durable Mid-Term Outcomes and High Rates of Meaningful Improvement After Hip Arthroscopy With Concomitant Periacetabular Osteotomy. Arthrosc Sports Med Rehabil. 2025;7(6):101290. Published 2025 Oct 15. doi:10.1016/j.asmr.2025.101290
来源：304关节学术
作者：304关节团队
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