本期目录：
1、与导航技术相比，机器人辅助全膝关节置换术减少了术后并发症和住院时间，且不增加成本
2、关节置换术者翻修率与患者报告术后得分是否存在相关性
3、全膝关节置换术中磨钻与摆锯切割工具的热效应
4、脑瘫患者髋关节影像学标准化监测
5、图像分析软件的应用可提高髋臼周围截骨术骨块放置的准确性
6、髋关节发育不良筛查策略：一项随机对照试验的长期结局
7、无症状志愿者仰卧位与站立位髋臼X线形态如何变化？
第一部分：关节置换及保膝相关文献
文献1
与导航技术相比，机器人辅助全膝关节置换术减少了术后并发症和住院时间，且不增加成本：一项全国分析
译者 张轶超
介绍：本研究比较了机器人辅助全膝关节置换术（RA - TKA）和导航引导全膝关节置换术（NG - TKA）的术后效果。使用国家住院病人样本（NIS）数据，它提供了术后并发症、死亡率、住院费用和住院时间的分析。
方法：本研究使用2016年至2019年的NIS数据分析了217,715例患者（81,830例RA - TKA； 135,885例NG - TKA）。通过国际疾病分类第十次修订代码找出择期TKA患者。统计分析，包括逻辑回归模型，使用社会科学统计软件包和MATLAB进行。
结果：RA - TKA患者更年轻（66.1 vs. 67.1岁，p < 0.0001），死亡率相似（0.024% vs. 0.018%, p = 0.342），但住院时间（LOS）更短（1.89 vs. 2.1天，p < 0.0001）。RA - TKA（66,180美元）和NG - TKA（66,251美元，p = 0.669）的平均总费用相当。RA - TKA的血液相关并发症（11.67%比14.19%,p < 0.0001），肺水肿（0.0306%比0.066%,p < 0.0001），深静脉血栓（0.196%比0.254%,p = 0.006）和急性肾损伤（AKI）（1.356%比1.483%,p = 0.016）的发生率较低。
结论：RA - TKA在不增加成本的情况下减少了术后并发症和LOS，突出了该技术在患者治疗中的意义。
Robotic‐assisted total knee arthroplasty reduces postoperative complications and length of stay without increased cost compared to navigation‐guided techniques: A national analysis
Introduction: This study compares postoperative outcomes of robotic‐assisted total knee arthroplasty (RA‐TKA) versus navigation‐guided total knee arthroplasty (NG‐TKA). Using Nationwide Inpatient Sample (NIS) data, it provides an analysis of postoperative complications, mortality, hospital costs and duration of stay.
Methods: The study analysed 217,715 patients (81,830 RA‐TKA; 135,885 NG‐TKA) using NIS data from 2016 to 2019. Elective TKA patients were identified through the International Classification of Diseases, 10th Revision codes. Statistical analyses, including logistic regression modelling, were
performed using Statistical Package for the Social Sciences and MATLAB.
Results: RA‐TKA patients were younger (66.1 vs. 67.1 years, p < 0.0001) and had similar mortality rates (0.024% vs. 0.018%, p = 0.342) but shorter length of stay (LOS) (1.89 vs. 2.1 days, p < 0.0001). Mean total charges were comparable between RA‐TKA ($66,180) and NG‐TKA ($66,251, p = 0.669). RA‐TKA demonstrated lower incidences of blood‐related complications (11.67% vs. 14.19%, p < 0.0001), pulmonary oedema (0.0306% vs. 0.066%, p < 0.0001), deep vein thrombosis (0.196% vs. 0.254%, p = 0.006) and acute kidney injury (AKI) (1.356% vs. 1.483%, p = 0.016).
Conclusion: RA‐TKA reduces postoperative complications and LOS without increasing costs, highlighting the relevance of this technology in patient care.
文献出处：Maman D, Laver L, Becker R, Mahamid A, Berkovich Y. Robotic-assisted total knee arthroplasty reduces postoperative complications and length of stay without increased cost compared to navigation-guided techniques: A national analysis. Knee Surg Sports Traumatol Arthrosc. 2025 Jan;33(1):336-342. doi: 10.1002/ksa.12348. Epub 2024 Jul 2. PMID: 38953206; PMCID: PMC11716347.
文献2
关节置换术者翻修率与患者报告术后得分是否存在相关性？——澳大利亚骨科协会全国关节置换登记库研究
译者 马云青
背景：多数关节置换登记系统将翻修率作为评判手术成功的标准，而患者报告结局评分（PROMs）是一种实用、高效的术后疗效评估手段，可用于评价关节置换术后翻修之外的功能恢复情况。翻修率与患者报告结局评分这两项质量评价指标之间的相互关系尚不明确；并非所有功能恢复不佳的手术病例都会接受翻修。有观点认为：外科医生翻修率越高，其对应患者的患者报告结局评分得分越低，二者呈负相关，但该假说尚未得到验证。
研究问题/研究目的：本研究依托大型全国关节置换登记库数据，探究：(1) 外科医生全髋关节置换术（THA）早期累计百分比翻修率（CPR），以及(2)全膝关节置换术（TKA）早期累计百分比翻修率，是否分别与初次全髋、全膝置换术后未行翻修手术患者的术后患者报告结局评分结果存在相关性。
方法：本研究纳入澳大利亚骨科协会全国关节置换登记库‑患者报告结局评分项目中，2018年8月—2020年12月登记、诊断为骨关节炎的择期初次全髋、全膝关节置换病例。主要分析的入组条件：具备术后6个月患者报告结局数据、手术医生信息明确，且该医生至少完成50例初次置换手术。
符合条件的全髋关节置换共17 668例；排除8878例未匹配患者报告结局评分项目的病例，剩余8790例；再排除790例术者信息不明、术者不符合入组标准或已行翻修的病例，最终纳入235名外科医生完成的8000例全髋置换。其中4256例（53%；3744例数据缺失）有术后牛津髋关节评分，4242例（53%；3758例数据缺失）记录术后EQ‑VAS评分。牛津髋关节评分完整协变量数据3939例，EQ‑VAS完整协变量数据3941例。
符合条件的全膝关节置换共26 624例；排除12 685例未匹配患者报告结局评分项目的病例，剩余13 939例；再排除920例术者信息不明、术者不符合入组标准或已行翻修的病例，最终纳入276名外科医生完成的13 019例全膝置换。其中6730例（52%；6289例数据缺失）有术后牛津膝关节评分，6728例（52%；6291例数据缺失）记录术后EQ‑VAS评分。牛津膝关节评分完整协变量数据6228例，EQ‑VAS完整协变量数据6241例。
针对未接受翻修的全髋、全膝置换病例，分析外科医生2年累计百分比翻修率与术后6个月EQ‑VAS健康评分、牛津髋/膝关节评分的斯皮尔曼相关系数。采用多元托比特回归与概率链接累积链接模型，在校正患者年龄、性别、ASA分级、BMI分组、术前患者报告结局得分，以及全髋置换手术入路等混杂因素后，评估术后牛津评分、EQ‑VAS评分与外科医生2年累计百分比翻修率的关联。采用多重插补处理缺失数据，分别设置随机缺失假设以及最坏情况场景开展模型运算。
结果：全髋关节置换入组病例中，术后牛津髋关节评分与外科医生2年累计百分比翻修率相关性极弱，不具备临床意义（斯皮尔曼相关系数ρ = ‑0.09；P＜0.001）；术后EQ‑VAS评分与翻修率几乎无相关性（ρ = ‑0.02；P = 0.25）。全膝关节置换入组病例中，术后牛津膝关节评分、EQ‑VAS评分与外科医生2年累计百分比翻修率同样呈极弱相关，无临床实际意义（分别ρ = ‑0.04，P = 0.004；ρ = 0.03，P = 0.006）。所有针对缺失数据校正的模型均得到一致结果。
结论：外科医生2年累计百分比翻修率，与全髋、全膝置换术后患者报告结局得分不存在具有临床意义的相关性；不同外科医生手术患者的术后牛津评分水平相近。无论单独使用患者报告结局评分、翻修率，还是二者联用，都不能完美、精准评判关节置换手术的成功与否。本研究结果受缺失数据局限，但在多种缺失数据假设情景下结论均保持稳定。关节置换预后受大量因素共同影响，包括患者个体因素、假体设计差异、手术技术质量。患者报告结局测评与翻修率反映的是关节置换术后功能结局的两个不同维度。虽然术者相关因素会影响翻修率，但患者自身因素对功能预后的影响可能更大。后续研究需要挖掘与功能预后真正相关的变量。此外，牛津评分仅能反映整体粗略功能水平，亟需可以识别临床有意义功能差异的结局评价工具；全国关节置换登记库继续使用牛津评分的合理性值得商榷。
Do the Revision Rates of Arthroplasty Surgeons Correlate With Postoperative Patient-reported Outcome Measure Scores? A Study From the Australian Orthopaedic Association National Joint Replacement Registry
Background:Patient-reported outcome measures (PROMs) are a pragmatic and efficient means to evaluate the functional quality of arthroplasty beyond revision rates, which are used by most joint replacement registries to judge success. The relationship between these two measures of quality-revision rates and PROMs-is unknown, and not every procedure with a poor functional result is revised. It is logical-although still untested-that higher cumulative revision rates correlate inversely with PROMs for individual surgeons; more revisions are associated with lower PROM scores.
Questions/purposes:We used data from a large national joint replacement registry to ask: (1) Does a surgeon's early THA cumulative percent revision (CPR) rate and (2) early TKA CPR rate correlate with the postoperative PROMs of patients undergoing primary THA and TKA, respectively, who have not undergone revision?
Methods:Elective primary THA and TKA procedures in patients with a primary diagnosis of osteoarthritis that were performed between August 2018 and December 2020 and registered in the Australian Orthopaedic Association National Joint Replacement Registry PROMs program were eligible. THAs and TKAs were eligible for inclusion in the primary analysis if 6-month postoperative PROMs were available, the operating surgeon was clearly identified, and the surgeon had performed at least 50 primary THAs or TKAs. Based on the inclusion criteria, 17,668 THAs were performed at eligible sites. We excluded 8878 procedures that were not matched to the PROMs program, leaving 8790 procedures. A further 790 were excluded because they were performed by unknown or ineligible surgeons or were revised, leaving 8000 procedures performed by 235 eligible surgeons, including 4256 (53%; 3744 cases of missing data) patients who had postoperative Oxford Hip Scores and 4242 (53%; 3758 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 3939 procedures for the Oxford Hip Score and for 3941 procedures for the EQ-VAS. A total of 26,624 TKAs were performed at eligible sites. We excluded 12,685 procedures that were not matched to the PROMs program, leaving 13,939 procedures. A further 920 were excluded because they were performed by unknown or ineligible surgeons, or because they were revisions, leaving 13,019 procedures performed by 276 eligible surgeons, including 6730 (52%; 6289 cases of missing data) patients who had had postoperative Oxford Knee Scores and 6728 (52%; 6291 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 6228 procedures for the Oxford Knee Score and for 6241 procedures for the EQ-VAS. The Spearman correlation between the operating surgeon's 2-year CPR and 6-month postoperative EQ-VAS Health and Oxford Hip or Oxford Knee Score was evaluated for THA and TKA procedures where a revision had not been performed. Associations between postoperative Oxford and EQ-VAS scores and a surgeon's 2-year CPR were estimated based on multivariate Tobit regressions and a cumulative link model with a probit link, adjusting for patient age, gender, ASA score, BMI category, preoperative PROMs, as well as surgical approach for THA. Missing data were accounted for using multiple imputation, with models assuming they were missing at random and a worst-case scenario.
Results:Of the eligible THA procedures, postoperative Oxford Hip Score and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (Spearman correlation ρ = -0.09; p < 0.001), and the correlation with postoperative EQ-VAS was close to zero (ρ = -0.02; p = 0.25). Of the eligible TKA procedures, postoperative Oxford Knee Score and EQ-VAS and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (ρ = -0.04; p = 0.004 and ρ = 0.03; p = 0.006, respectively). All models accounting for missing data found the same result.
Conclusion:A surgeon's 2-year CPR did not exhibit a clinically relevant correlation with PROMs after THA or TKA, and all surgeons had similar postoperative Oxford scores. PROMs, revision rates, or both may be inaccurate or imperfect indicators of successful arthroplasty. Missing data may limit the findings of this study, although the results were consistent under a variety of different missing data scenarios. Innumerable factors contribute to arthroplasty results, including patient-related variables, differences in implant design, and the technical quality of the procedure. PROMs and revision rates may be analyzing two different facets of function after arthroplasty. Although surgeon variables are associated with revision rates, patient factors may exert a stronger influence on functional outcomes. Future research should identify variables that correlate with functional outcome. Additionally, given the gross level of function that Oxford scores record, outcome measures that can identify clinically meaningful functional differences are required. The use of Oxford scores in national arthroplasty registries may rightfully be questioned.
文献出处：Hoskins W, Bingham R, Corfield S, Harries D, Harris IA, Vince KG. Do the Revision Rates of Arthroplasty Surgeons Correlate With Postoperative Patient-reported Outcome Measure Scores? A Study From the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res. 2024 Jan 1;482(1):98-112. doi: 10.1097/CORR.0000000000002737. Epub 2023 Jun 20. PMID: 37339166; PMCID: PMC10723865.
文献3
全膝关节置换术中磨钻与摆锯切割工具的热效应
译者 沈松坡
目的： 全膝关节置换术（TKA）术后无菌性松动可能继发于动力工具引起的骨热损伤。本研究比较机器人辅助TKA（rTKA）中旋转磨钻与传统TKA（cTKA）中摆锯在术中产生的骨温度。
方法： 本项单中心观察性研究采用红外热成像技术（30 Hz，±0.05℃），记录14例初次TKA患者股骨远端截骨过程中骨表面温度（rTKA 6例，cTKA 8例）。机器人组采用直径6 mm球形磨钻，转速80,000 rpm；传统组采用Stryker摆锯锯片。提取并比较峰值温度、平均温度，以及温度高于47℃、56℃和70℃的持续时间，采用Mann–Whitney检验进行统计分析。
结果： 所有病例骨温度均超过骨坏死阈值（47℃）；所有磨钻病例及5/8摆锯病例的最高温度均超过90℃。磨钻组股骨远端截骨中位时间为241 s，而摆锯组为26 s（p = 0.002）。磨钻组骨温度高于47℃的持续时间中位数为107 s（四分位距138 s），约为摆锯组（8 s；四分位距10 s）的4倍（p < 0.001）。在56℃（65 s vs. 3 s）和70℃（15 s vs. 0.5 s）以上持续时间也观察到类似差异。两种工具产生的平均温度（约51℃）无显著差异。
结论： 在TKA过程中，旋转磨钻和摆锯均可产生具有潜在危害的高温；然而，磨钻会显著延长骨组织暴露于细胞毒性温度的时间，并增加手术时间。这些结果提示，在未采取主动冷却措施的情况下，磨钻可能具有更高的热介导骨损伤及后续假体松动的理论风险。未来应开展更大规模的对照研究，以评估灌洗、冷却器械或优化切割方案等降温策略的效果。
Thermal Effects of Burr and Saw Cutting Tools in Total Knee Arthroplasty
Aims: Aseptic loosening after total knee arthroplasty (TKA) can follow thermal bone injury produced by power tools. This study compared the intraoperative bone temperatures generated by rotary burrs used in robotic-assisted TKA (rTKA) with those from oscillating saws used in conventional TKA (cTKA).
Methods: A single-centre observational trial employed infrared thermography (30 Hz, ±0.05°C) to record surface temperatures during the distal femoral cut in 14 primary TKAs (rTKA = 6, cTKA = 8). Burr cuts used a 6-mm spherical burr at 80,000 rpm; saw cuts used Stryker sagittal blades. Peak and mean temperatures and the time spent above 47°C, 56°C and 70°C were extracted from the recordings and compared with Mann-Whitney tests.
Results: All procedures exceeded the osteonecrosis threshold (47°C); maximal temperatures surpassed 90°C in every burr case and in 5/8 saw cases. Median cutting time was 241 s with the burr versus 26 s with the saw (p = 0.002). The bone remained above 47°C for a median 107 s (IQR 138) with the burr, nearly four-fold longer than with the saw (8 s; IQR 10; p < 0.001). Similar differences were observed above 56°C (65 s vs. 3 s) and 70°C (15 s vs. 0.5 s). Mean temperatures (∼51°C) did not differ significantly between devices.
Conclusion: Rotary burrs and oscillating saws both generate potentially harmful heat during TKA, but burrs markedly prolong exposure to cytotoxic temperatures and lengthen operative time. These findings suggest a higher theoretical risk of thermally mediated bone injury and subsequent implant loosening when burrs are used without active cooling. Larger controlled studies should assess mitigation strategies such as irrigation, cooled instrumentation or modified cutting protocols.
第二部分：保髋相关文献
文献1
脑瘫患者髋关节影像学标准化监测
译者 张振东
背景：通过影像学监测观察脑瘫(cerebral palsy，CP)患儿的髋关节脱位程度可以预防髋关节脱位。移位百分比(migration Percentage，MP)是公认的在骨盆x光片上测量脑瘫患儿髋关节半脱位程度的方法，本研究的目标是明确标准化x线测量技术在脑瘫患儿髋关节监测计划中的应用，并报道相应的影像学监测结果。
方法：本研究首先对脑瘫患儿骨盆x线检查进行回顾性观察。然后对放射科医生和相关技术人员进行培训，包括标准化影像学技术以及结构化的放射学报告，报告中包含MP测量和脱位风险分类。再对结构化报告的执行情况进行了10个月的跟踪。影像学图像和报告同时也由骨科医生评估其质量和准确性。
结果：培训前影像学报告并没有显示出一致性。在标准化培训后，即2019年5月至2020年2月，共有449名CP患儿(平均年龄:7.3±4.2岁)接受了盆骨x线监测。经统计，大约90%的报告符合规范。8例(89%)髋关节脱位高危儿童是在培训期间被诊断出来，且与之前的检查结果相比，MP均有逐渐增加趋势。所有接受问卷调查的医生都认为包括MP在内的标准化报告对他们的临床实践有帮助。
结论：采用循证及质量控制方法，作者使CP患儿的髋关节监测更为标准化。包括MP和髋关节脱位风险类别在内的放射科报告可以为临床医生提供清晰的认识，并以此做到早期发现和治疗，从而提供更好的预后。
Standardized Process Measures in Radiographic Hip Surveillance for Children with Cerebral Palsy
Abstract
Detection of hip migration in children with cerebral palsy (CP) through radiographic surveillance can prevent dislocations. Migration Percentage (MP) is the accepted method for quantifying hip subluxation in CP on pelvis x-ray but was not being reported at our institution. Our objective was to improve care for children with CP by standardizing radiographic techniques and reporting radiographs obtained as part of a hip surveillance program.
Methods: A baseline retrospective review of CP surveillance pelvis x-ray reports was performed. We then educated radiologists and technologists, standardized imaging techniques, and required structured radiology reporting to include MP measurement and dislocation risk categories. We tracked compliance with the reporting template for 10 months. Images and reports were also assessed for quality and accuracy by an orthopedic surgeon.
Results: Baseline period reports showed no consistency. In total, 449 children with CP (mean age: 7.3 years ± 4.2) had a surveillance pelvis radiograph during the postintervention study period (May 2019-February 2020). An estimated 90% reporting compliance was achieved and sustained by 5 months. Eight (89%) of the children with high-risk hips were newly diagnosed during our study period; all had a progressive increase in MP from prior examinations. All clinicians surveyed agreed that the standardized reports, including MP, were helpful to their practice.
Conclusions: Using evidence-based process measures and quality improvement methodology, we standardized hip surveillance for children with CP. Radiology reports that include MP and risk category for hip dislocation enable clear communication for referrals across specialties and early detection and treatment for better outcomes.
文献出处：Milks KS, Mesi EL, Whitaker AT, Ruess L. Standardized Process Measures in Radiographic Hip Surveillance for Children with Cerebral Palsy. Pediatr Qual Saf. 2021 Dec 15;6(6):e485. doi: 10.1097/pq9.0000000000000485. PMID: 34934874; PMCID: PMC8677969.
文献2
图像分析软件的应用可提高髋臼周围截骨术骨块放置的准确性
译者 李勇
本研究旨在报告图像分析技术在提高髋臼周围截骨术（PAO）术中成像及矫正效果评估准确性方面的应用。本回顾性研究报告了前25例借助图像分析工具完成的PAO手术。该技术用于术中评估仰卧位冠状位图像与术前站立位图像的对应关系，并通过骨盆倾斜（PT）比值进行校正。比较术中PT、Tönnis角、外侧中心边缘角（LCEA）及前壁指数与术后图像的测量值。同时，将研究组的术后影像学参数与软件应用前实施的PAO病例（对照组）进行比较。图像分析软件能够获得与术前站立位成像相当的术中仰卧位成像。与未使用软件的PAO病例相比，使用软件的研究组倾向于更接近术者设定的目标影像学参数范围，其中LCEA的差异具有统计学意义。该工具有助于术者确认术中用于手术决策的图像能够反映功能性X线片。应用该技术的PAO在目标参数范围内表现出更高的矫正准确性，从而有助于术者将髋臼骨块更精确地放置于预设的髋臼再定向矫正参数范围内。
图1. 术中配置：上方为术前骨盆前后位X线片，下方为术中拼接透视数字图像。
The use of image analysis software increases the accuracy of the periacetabular osteotomy fragment placement
The purpose of this study was to report on the use of image analysis technology to enhance accuracy of intra-operative imaging and evaluation of periacetabular osteotomy (PAO) correction. This was a retrospective study reporting on the first 25 cases of PAO performed with the use of an image analysis tool. This technology was used intra-operatively to assess the position of the supine coronal image in comparison to pre-operative standing images using a ratio of pelvic tilt (PT). Intra-operative PT, Tönnis angle, lateral center-edge angle (LCEA) and anterior wall index were compared to post-operative images. Post-operative radiographic parameters in the study group were compared with a control group of PAO cases performed prior to the implementation of the new software. The image analysis software was able to obtain intra-operative supine imaging that was equivalent to pre-operative standing imaging. When comparing the PAOs performed with the use of the software versus those without, the study group trended toward being more likely within the surgeon's defined target range of radiographic values, which was statistically significant for LCEA. This tool can be used to assure the surgeon that the intra-operative image being used for surgical decision-making is representative of the functional radiograph. PAOs performed with the use of this technology showed enhanced accuracy of surgical correction for the parameters within our defined target ranges. This may increase the ability of the surgeon to place the acetabular fragment more precisely within his or her goal parameters for acetabular reorientation correction.
文献3
髋关节发育不良筛查策略：一项随机对照试验的长期结局
译者 陶可
目的：髋关节发育不良的筛查方案目前仍存在争议。既往一项随机对照试验显示，在常规临床查体基础上开展全民超声筛查或选择性超声筛查，虽可使晚期发病病例发生率出现无统计学意义的下降，但会带来治疗率升高。本研究评估3种新生儿筛查策略在骨骼发育成熟后的结局差异，观察指标包括髋关节发育不良的影像学指标、早期退行性改变，以及新生儿期治疗后继发的股骨头缺血性坏死（AVN）。
方法：原始试验共纳入11925名新生儿，从中选取3935名青少年作为基于人群的随访样本，在18-20岁时开展随访。采集标准化负重位骨盆前后位X线片。评估结局包括：发育不良影像学指标（外侧中心边缘角、股骨头外移指数、髋臼深宽比、Sharp角、发育不良主观评估）以及退行性改变（关节间隙宽度），同时记录股骨头缺血性坏死相关征象。
结果：受邀的3935名受试者中，2038人（51.8%）完成骨骼成熟阶段随访，最终纳入2011人（女性占58.2%）；其中全民超声筛查组551例、选择性超声筛查组665例、单纯临床检查组795例。各组与发育不良或退行性改变相关的影像学阳性检出率随选用的影像指标不同而变化，但组间未发现统计学差异；全部样本未观察到股骨头缺血性坏死病例。
结论：相较于专业临床查体方案，选择性超声筛查与全民超声筛查仅能使晚期发病病例出现无统计学差异的降低；本研究未能证实上述超声筛查可以进一步降低骨骼成熟阶段的髋关节发育不良或髋关节退行性改变的影像学异常发生率。治疗率上升并未伴随股骨头缺血性坏死的发生。
Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial
Objective: Screening for hip dysplasia is controversial. A previous randomized controlled trial revealed that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but with higher treatment rates. This study assesses differences in outcome at skeletal maturity for the 3 newborn screening strategies in terms of radiographic markers of acetabular dysplasia and early degenerative change and avascular necrosis (AVN) secondary to neonatal treatment.
Methods: From the initial trial including 11 925 newborns, a population-based sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp's angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). Signs of AVN were documented.
Results: Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between groups. No AVN was seen.
Conclusions: Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatment rates were not associated with AVN.
文献出处：Lene B Laborie, Ingvild Ø Engesæter, Trude G Lehmann, Deborah M Eastwood, Lars B Engesæter, Karen Rosendahl. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Randomized Controlled Trial Pediatrics . 2013 Sep;132(3):492-501. doi: 10.1542/peds.2013-0911. Epub 2013 Aug 19.
文献4
无症状志愿者仰卧位与站立位髋臼X线形态如何变化？
译者 邱兴
背景： 髋部疾病患者的髋臼X线表现在仰卧位和站立位之间存在差异。体位转换时骨盆倾斜发生变化，导致髋臼前倾角和覆盖范围出现变异。然而，在无疼痛代偿模式的健康志愿者中，这些变异的程度尚不清楚。
问题/目的： 本研究旨在（1）量化无症状、功能良好的志愿者在仰卧位与站立位之间转换时髋臼X线测量值的差异；（2）评估体位间骨盆倾斜的差异；（3）检验个体解剖参数是否与倾斜变化相关。
方法： 本研究为单中心前瞻性研究，在一家学术转诊中心进行。共邀请100名髋关节功能良好（Oxford髋关节评分≥45）的志愿者（学生、职工及上肢损伤患者）参与，其中女性45例（45%），平均年龄（37±14）岁，平均体质指数（BMI）为（25±2）kg/m²。对仰卧位和站立位骨盆前后位X线片进行分析，测定多项髋臼参数，包括外侧中心边缘角（LCEA）、髋臼指数（AI）、前壁指数（AWI）、后壁指数（PWI）、交叉征（COS）、交叉比（COR）、后壁征（PWS）、坐骨棘征（ISS）及股骨骨骺髋臼顶指数（FEAR），以及骨盆参数骶股耻骨角（SFP）。脊柱-骨盆参数通过站立位侧位脊柱-骨盆X线片测量。影像学测量由一名保髋方向研究者和一名接受过专科培训的资深外科医生共同完成。根据既往研究，将髋臼角度测量差值大于3°、髋臼比值测量差值大于0.03定义为具有临床重要意义的差异。
结果： 侧方覆盖角度在体位间未显示出临床重要差异。站立位时AWI降低（0.47±0.13比0.41±0.14；p<0.001），而仰卧位时髋臼后倾征象更为明显（COS：34% [34/100]比19% [19/100]；PWS：68% [68/100]比38% [38/100]；ISS：34% [34/100]比14% [14/100]；所有p值均<0.05）。站立位时骨盆倾斜平均增加（4°±4°），但变化范围从-15°至7°。AWI（ρ=0.47；p<0.001）、PWI（ρ=-0.45；p<0.001）和COR（ρ=0.52；p<0.001）在体位间的变化与ΔSFP相关。存在脊柱失衡（骨盆入射角与腰椎前凸角之差[PI-LL] >10°）的志愿者表现出更大的骨盆倾斜变化（ΔSFP）（-7°±3°比-4°±4°；p=0.02）和更明显的AWI降低（约10%）。这些志愿者的站立位腰椎前凸角度减小（45°±11°比61°±10°；p=0.001）。
结论： 从仰卧位到站立位，由于骨盆倾斜增加，髋臼前倾角增大。体位间骨盆倾斜的变化存在显著个体差异。在给定骨盆入射角值下腰椎前凸减小的个体表现出更大的骨盆活动度。仰卧位X线片上未发现与倾斜变化相关的特征。
临床相关性： 在仰卧位X线片之外加做站立位X线片，有助于识别存在诊断困难的异常生理模式，并可能有助于临床决策。骨盆倾斜变化的规范性数据可帮助临床医生识别倾斜变化过大并导致异常髋关节病理力学的患者。
图1. （A）志愿者骨盆前后位X线片和（B）站立位侧位脊柱-骨盆X线片，展示了本研究中进行的各项测量。SFP = S1上终板中点（通过确定L5至S1关节突关节侧块之间连线的中点得出）至髋臼中心连线与耻骨联合上缘中点之间的夹角；LL = L1上终板切线至S1上终板切线之间的Cobb角；SS = S1上终板切线与水平轴之间的夹角；PI = 股骨头中心至S1上终板中点连线与该中点至S1上终板垂线之间的夹角；PT = 股骨头中心至S1上终板中点连线与垂直轴之间的夹角；PFA = 股骨头中心至S1上终板中点连线与股骨轴之间的夹角；APP = 双侧髂前上棘至耻骨联合连线与垂直轴之间的夹角。
How Does Radiographic Acetabular Morphology Change Between the Supine and Standing Positions in Asymptomatic Volunteers?
Background: The radiographic appearance of the acetabulum differs between the supine and standing positions in patients with hip conditions. The pelvis undergoes a change in tilt when transitioning between positions, resulting in variations in version and acetabular coverage. However, the extent of these variations in well-functioning volunteers without compensatory patterns caused by pain is unknown.
Questions/purposes: We performed this study to (1) quantify differences in radiographic acetabular measurements when transitioning between supine and standing among asymptomatic, well-functioning volunteers; (2) assess differences in pelvic tilt between positions; and (3) test whether individual anatomic parameters are associated with the change in tilt.
Methods: This was a prospective, single-center study performed at an academic referral center. One hundred volunteers (students, staff, and patients with upper limb injuries) with well-functioning hips (Oxford hip score ≥ 45) were invited to participate. A total of 45% (45) of them were female, their mean age was 37 ± 14 years, and their mean BMI was 25 ± 2 kg/m 2 . Supine and standing AP pelvic radiographs were analyzed to determine numerous acetabular parameters including the lateral center-edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI), crossover sign (COS), crossover ratio (COR), posterior wall sign (PWS), ischial spine sign (ISS), and femoroepiphyseal acetabular roof index (FEAR), as well as pelvic parameters including the sacrofemoral-pubic angle (SFP). Spinopelvic parameters were measured from lateral standing spinopelvic radiographs. Radiographic measurements were performed by one hip preservation research fellow and a fellowship-trained staff surgeon. Differences in parameters were determined, and correlations between postural differences and morphological parameters were tested. Clinically important differences were defined as a difference greater than 3° for acetabular angle measurements and 0.03 for acetabular ratio measurements, based on previous studies.
Results: Lateral coverage angles did not show a clinically important difference between positions. AWI decreased when standing (0.47 ± 0.13 versus 0.41 ± 0.14; p < 0.001), whereas acetabular retroversion signs were more pronounced when supine (COS: 34% [34 of 100], PWS: 68% [68 of 100], and ISS: 34% [34 of 100] versus COS: 19% [19 of 100], PWS: 38% [38 of 100], and ISS: 14% [14 of 100]; all p values < 0.05). Pelvic tilt increased by a mean of 4° ± 4° when standing, but the range of change was from -15° to 7°. The change in AWI (ρ = 0.47; p < 0.001), PWI (ρ = -0.45; p < 0.001), and COR (ρ = 0.52; p < 0.001) between positions correlated with ΔSFP. Volunteers with spinal imbalance (pelvic incidence lumbar lordosis > 10°) demonstrated greater change in pelvic tilt (ΔSFP) (-7° ± 3° versus -4° ± 4°; p = 0.02) and a greater reduction in AWI (by 10%). These volunteers demonstrated reduced standing lumbar lordosis angles (45° ± 11° versus 61° ± 10°; p = 0.001).
Conclusion: Acetabular version increases from supine to standing because of an increase in pelvic tilt. The change in pelvic tilt between positions exhibited substantial variability. Individuals with reduced lumbar lordosis for a given pelvic incidence value demonstrated greater pelvic mobility. No features on supine radiographs were associated with the change in tilt.
Clinical relevance: Performing standing radiographs in addition to supine views can help identify aberrant physiologic patterns in patients with diagnostic dilemmas and might thus help with management. Normative data of pelvic tilt change can help clinicians identify patients who demonstrate excessive change in tilt that contributes to abnormal hip pathomechanics.
文献出处：Vorimore C, Verhaegen JCF, Kashanian K, Horton I, Beaule P, Grammatopoulos G. How Does Radiographic Acetabular Morphology Change Between the Supine and Standing Positions in Asymptomatic Volunteers? Clin Orthop Relat Res. 2024 Sep 1;482(9):1550-1561. doi: 10.1097/CORR.0000000000003073. Epub 2024 Apr 23. PMID: 39031038; PMCID: PMC11343526.
来源：304关节学术
作者：304关节团队
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