本期目录：
本期目录：
1、采用功能对线的机器人全膝关节置换术在不同年龄和性别群体中均能获得相似的临床效果
2、假体周围感染的一期翻修和二期翻修比较
3、2060年前全球髋、膝关节翻修术预测：一项基于17国登记数据的全球分析
4、关节置换术的全球趋势：系统综述和未来预测
5、功能对线机器人辅助全膝关节置换术较传统机械对线全膝关节置换术可改善临床结局：一项单术者、随机对照、非劣效性试验的2年随访结果
6、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
7、非创伤性股骨头坏死：一项基于国际循证的临床实践指南
8、髋臼周围截骨术后，最小临床重要差异、实质性临床获益和患者可接受症状状态的达标情况如何随时间变化？
9、弹响髋作为发育性髋关节发育不良诊断筛查工具的评估
10、在至少2年的随访中，超过80%的接受同期髋关节镜和髋臼周围截骨术的运动员重返运动
11、基于三维髋臼覆盖的髋关节发育不良髋臼周围截骨术后生存情况分析
12、复位后 MRI 髋关节形态可预测切开或闭合复位后 10 年的残余髋臼发育不良
13、1058例尸体髋关节的解剖学分析：股骨前倾角与凸轮畸形的部位特异性研究
第一部分：关节置换及保膝相关文献
文献1
采用功能对线的机器人全膝关节置换术在不同年龄和性别群体中均能获得相似的临床效果
译者 张轶超
目的：年龄和性别可能影响全膝关节置换术（TKA）的疗效、并发症及翻修率。功能对线（FA）是一种由机器人系统引导的个性化方法，被用来根据患者特异性的解剖结构和松弛度来优化手术效果。然而，目前关于年龄和性别对FA引导的机器人辅助TKA疗效影响的证据仍有限。
方法：本回顾性研究纳入353例接受机器人辅助采用FA技术的TKA手术且随访时间至少2年的患者。根据年龄（≥75岁 vs. <75岁）和性别（男性 vs. 女性）将患者分为不同组别。通过包括功能评分（Knee Society Score, KSS 和 Forgotten Joint Score, FJS）、并发症发生率及翻修率对疗效进行评估。冠状面力线通过术前和术后全长负重X光片以及机器人系统数据进行评估。
结果：术前临床和影像学评估显示，各年龄组间无统计学差异。女性患者的术前冠状面力线较男性更偏向外翻。术后，各组的功能结果（KSS和FJS）及冠状面力线均无显著差异，唯一例外是女性组，尽管KSS评分相似，但其FJS评分具有统计学上的显著性高（P = 0.02）。各组间的并发症和翻修率在统计学上也无显著差异。
结论：本研究显示，采用机器人辅助FA技术的全膝关节置换术在不同性别和年龄组中均可获得相当的临床效果、并发症发生率和翻修率。这些发现表明，FA可能有助于缩小不同人群间的治疗差异，通过为多样化患者群体提供一致的手术效果来实现这一目标。
Robotic total knee arthroplasty with functional alignment yields comparable outcomes across age and gender groups
Objectives: Age and gender can inffuence total knee arthroplasty (TKA) outcomes, complications, and revision rates. Functional alignment (FA), a personalized approach guided by robotic systems, has emerged as a strategy to optimize outcomes by addressing patient-speciffc anatomy and laxities. However, limited evidence exists regarding the inffuence of age and gender on outcomes of FA-guided robotic-assisted TKA.
Methods: This retrospective study evaluated 353 patients who underwent robotic-assisted TKA guided by FA principles with a minimum of 2 years of follow-up. Patients were divided into groups based on age (≥75 years vs. <75 years) and gender (males vs. females). Outcomes assessed included functional scores [Knee Society Score (KSS) and Forgotten Joint Score (FJS)], complications, and revision rates. Coronal alignment was evaluated using preoperative and postoperative full-length weight-bearing X-rays and the data from the robotic system.
Results: Preoperative clinical and radiographic evaluations showed no statistically signiffcant differences between age groups. Females had more valgus preoperative alignment compared to males. Postoperatively, functional outcomes (KSS and FJS) and coronal alignment were comparable across all groups, with the only exception being the female group, which reported statistically signiffcant higher FJS scores (P = 0.02) despite similar KSS scores. Complication and revision rates did not differ in a statistically signiffcant manner between groups.
Conclusions: This study demonstrated that robotic-assisted TKA guided by FA yields comparable outcomes, complication rates, and revision rates across gender and age groups. These ffndings suggest that FA may help reduce demographic disparities by providing consistent outcomes across diverse patient populations.
文献出处：Christos Koutserimpas, Luca Andriollo, Pietro Gregori. Robotic total knee arthroplasty with functional alignment yields comparable outcomes across age and gender groups. J ISAKOS. 2025 Oct:14:100930. doi: 10.1016/j.jisako.2025.100930. Epub 2025 Jul 25.
文献2
假体周围感染的一期翻修和二期翻修比较
译者 马云青
背景：假体周围关节感染（PJI）最常采用二期翻修方案治疗。部分一期翻修相关的阳性研究样本量不足、未设置二期翻修对照，并且排除了存在窦道、合并基础疾病以及感染耐药菌的患者。考虑到二期治疗伴随较高并发症发生率与医疗费用，研究者开展一项前瞻性、多中心随机对照试验，对比一期与二期方案治疗假体周围关节感染的疗效；本研究特意纳入合并窦道、基础疾病以及耐药菌感染的患者。
方法：纳入初次全髋/全膝关节置换术后慢性假体周围关节感染、致病菌明确，拟接受手术治疗的患者（感染依据肌肉骨骼感染学会（MSIS）标准定义）。排除标准：既往接受过翻修手术、培养阴性感染、真菌感染者；免疫抑制患者；软组织条件差无法关闭创口者。采用麦克弗森（McPherson）宿主分期系统对患者进行分层。
临床成功的判定标准：（1）无临床治疗失败，未发生同种或新致病菌所致再感染；（2）无需因假体周围关节感染再次手术；（3）无假体周围关节感染相关死亡。所有患者手术均采用两套独立器械，冲洗方案与抗生素方案保持一致。
本研究共纳入323例患者随机分组（一期组166例，二期组157例）；两组人口学资料、宿主分层基线可比。剔除死亡及失访病例后，323例中258例完成2年随访（一期组135例，二期组123例）。两组失访率相近。
结果：一期组16例、二期组9例患者在2年随访前死亡。一期治疗2年总体成功率97%（131/135），二期治疗成功率91%（112/123）（p = 0.04）。回归分析显示：一期组获得总体治疗成功的概率为二期组的3倍（未校正比值比=3.22，95%可信区间：1.0~10.38）。在校正相关变量（McPherson宿主分级、耐药菌、窦道）后，一期方案治疗成功概率仍约为二期方案的3倍。
结论：这项前瞻性随机试验结果提示：只要严格遵循本研究所述诊疗流程，针对初次全髋/全膝置换术后慢性假体周围关节感染，一期翻修（成功率97%）在统计学上不劣于二期翻修（成功率91%）。本研究结论不宜直接外推至其他患者人群与临床场景。
One-Stage Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: A Prospective Randomized Trial
Background: A 2-stage approach is most commonly used to treat periprosthetic joint infection (PJI). Some successful studies of the 1-stage approach were underpowered, lacked a 2-stage comparative group, and excluded patients with draining sinuses, comorbidities, and/or antibiotic-resistant organisms. Given the morbidity and expense associated with 2-stage treatment, we conducted a prospective, multicenter, randomized trial to compare the results of 1- and 2-stage PJI treatment, specifically including patients with draining sinuses, comorbidities, and resistant organisms.
Methods: Patients presenting for surgical treatment of a chronic PJI with a known organism following primary total hip or knee arthroplasty were included (with infection defined by Musculoskeletal Infection Society [MSIS] criteria). Patients with prior revision, culture-negative infection, or fungal infection, or who were immunosuppressed or had soft-tissue involvement precluding wound closure, were excluded. Patients were classified according to the McPherson host staging system. Clinical success was defined as (1) no clinical failure or reinfection with the same or new organism; (2) no reoperation for PJI; and (3) no PJI-related death. A double-instrument setup was used for all patients, as were similar irrigation and antibiotic protocols. A total of 323 patients (166 one-stage; 157 two-stage) were randomized. Groups were similar with respect to demographics and host classification. After excluding patients who died or were lost to follow-up, 258 of the 323 patients had 2-year follow-up (135 one-stage and 123 two-stage). The rate of patient loss to follow-up was similar between the treatment groups.
Results: Sixteen patients in the 1-stage group and 9 patients in the 2-stage group died prior to 2-year follow-up. Overall, the 2-year success rate of 1-stage treatment was 97% (131 of 135), while the success of 2-stage treatment was 91% (112 of 123) (p = 0.04). Compared with the 2-stage group, the 1-stage group had 3-times the odds of overall success in a regression analysis (unadjusted odds ratio = 3.22 [95% confidence interval = 1.0 to 10.38]). After adjusting for specific variables (McPherson host grade, resistant organism, and draining sinuses), 1-stage treatment also had 3-times the odds of success.
Conclusions: The results of this prospective randomized trial indicated that 1-stage treatment (97% success) was statistically noninferior to 2-stage treatment (91% success) when treating chronic PJI following primary total hip or knee arthroplasty, provided the protocols described here are explicitly followed. Extrapolation to other patient cohorts and clinical situations should be avoided.
文献出处：Thomas K Fehring , Jesse E Otero , Keith A Fehring , Brian M Curtin , Bryan D Springer , Craig J Della Valle , Javad Parvizi , Kayla Hietpas , Alexis Ready , Susan M Odum 6; the PJI Study Group. One-Stage Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: A Prospective Randomized Trial. J Bone Joint Surg Am. 2026 Jul 15;108(14):1070-1082. doi: 10.2106/JBJS.25.00713. Epub 2026 Apr 1.
文献3
2060年前全球髋、膝关节翻修术预测
一项基于17国登记数据的全球分析
译者 张蔷
背景：不断增加的初次髋、膝关节置换手术数量，将日益加重关节翻修的负担。虽然文献中已发表多个国家的预测数据，但由于统计方法和时间跨度各不相同，无法直接汇总。本研究中我们采用统一的方法，估算了17个拥有人工关节登记系统的国家到2060年度髋关节翻修术(rTHA)和膝关节翻修术(rTKA)手术数量。
方法：年度rTHA和rTKA手术数量的数据提取自各国最新的关节登记系统年度报告或基于关节登记系统的出版物。成年人（≥25岁）人口基数来自联合国《世界人口展望》2024版。针对每个国家和每项手术，我们拟合了一个以年份为协变量、以人口数的自然对数为偏移量的广义线性模型；每个拟合趋势均在各国之间进行部分合并，每年限制在±2.0%以内，并在预测期内进行衰减。此外，我们还进行了三项敏感性分析（仅包含人口统计数据、半趋势模型和逻辑饱和模型），以评估模型的不确定性。
结果：2024年，模型预测的17个国家/地区总计进行了185,921例rTHA手术和189,689例rTKA手术。据主要模型预测，2060年总计将达到243,404例rTHA手术和267,456例rTKA手术，分别比2024年增长31%和41%。各国手术量增长轨迹各不相同：美国和中国贡献了绝大多数的增长，德国、英国和瑞典到本世纪中叶接近停滞，而日本将出现下降。四种预测方法得出的2060年总手术量在461,000例（仅基于人口统计因素）至511,000例（主要模型）之间。结论：在开展全球绝大部分髋关节和膝关节置换手术的17个国家中，根据主要模型预测，到2060年，年度翻修量预计将增长约三分之一（总计36%；其中，全髋关节置换术翻修量增加31%，全膝关节置换术翻修量增加41%）。美国和中国的绝对增长量最大；成熟的欧洲体系趋于平缓；日本则有所下降。这些预测结果对翻修手术专科医师培训体系、围手术期感染预防计划和关节登记系统的完善具有重要意义。
Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060
A 17-Country Analysis Using Worldwide Registry Data
Background: The expanding pool of primary hip and knee arthroplasty implants in situ will generate a growing burden of revision arthroplasty. Projections for several individual countries have been published, but heterogeneous methods and time horizons prevent direct aggregation. We used a uniform method to estimate annual revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) volumes through 2060 for 17 registry-equipped countries.
Methods: Annual rTHA and rTKA counts were extracted from each country’s most recent register annual report or registry-based publications. Adult (≧25 years) population denominators were taken from the UN World Population Prospects 2024 medium variant. For each country and procedure, we fitted a log-linear Poisson generalized linear model with the year as a covariate and ln (population) as an offset; each fitted trend was partially pooled across countries, bounded at ±2.0% per year, and damped over the projection horizon. Three sensitivity analyses (demographic-only, half-trend Poisson, logistic saturation) were also performed to bracket modeling uncertainty.
Results: In 2024, the modeled 17-country aggregate was 185,921 rTHA and 189,689 rTKA procedures. Under the primary capped Poisson model, the 2060 aggregate reached 243,404 rTHAs and 267,456 rTKAs, corresponding to increases of 31% and 41%, respectively, relative to 2024. Country-level volume trajectories were heterogeneous: the United States and People’s Republic of China drove most absolute growth, while Germany, the United Kingdom, and Sweden approached plateaus by mid-century and Japan was projected to have a decline. The 4 projection methods spanned 2060 combined volumes of ⁓461,000 (demographic-only) to ⁓511,000 (primary model) procedures.
Conclusions: Across 17 countries that perform most of the world’s hip and knee arthroplasties, annual revision volumes are projected to grow by approximately one-third (36% in aggregate; 31% for rTHA and 41% for rTKA) by 2060 under the primary model. The United States and China account for the largest absolute growth; mature European systems flatten, and Japan declines. These projections have direct implications for revision-fellowship pipelines, perioperative infection-prevention programs, and registry infrastructure.
文献出处：Jakob Adolf , Taner Karlıdağ , Mustafa Citak . Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060: A 17-Country Analysis Using Worldwide Registry Data. J Bone Joint Surg Am. 2026 Sep 30. doi: 10.2106/JBJS.26.00772. Online ahead of print.
文献4
关节置换术的全球趋势：系统综述和未来预测
译者 丁云鹏
背景与目的：骨关节炎是关节置换最主要的手术指征，自 1990 年以来其发病率已增长一倍。随着手术技术进步叠加人口老龄化，关节置换手术量大幅增加，给全球医疗卫生系统带来诸多挑战。本研究基于多国关节置换登记库数据，分析关节置换手术的历史变化趋势，评估既往预测模型的准确性，并对未来手术需求进行预测，旨在为医疗资源配置与政策制定提供依据。
方法：通过系统性检索 15 个国家的关节置换登记库，纳入 209 份年度报告，获取过去二十年初次全髋关节置换（THA）与全膝关节置换（TKA）高质量数据；采用确定性负指数饱和增长模型预测未来关节置换手术量。
结果：2010–2023 年间，纳入各国登记库数据显示，全髋置换（THA）手术量增幅为 130%~210%；全膝置换（TKA）增幅达 150%~664%。预测至 2050 年，手术量将持续增长：所有国家 THA 手术量预计继续增长 121% 至 200% 以上，TKA 手术量至少增长 130%。
结论：关节置换需求持续攀升，需要提前开展医疗规划。如果不在基础设施、医护人力储备及数字化资源方面进行战略性投入，未来数十年各国医疗体系或将难以承受初次置换与翻修手术量的预期增长。
Global Trends in Joint Arthroplasty: A Systematic Review and Future Projections
Background/Objectives: Osteoarthritis, the principal indication for joint arthroplasty, has doubled in incidence since 1990. Advances in surgical techniques, combined with an ageing population, have driven a substantial rise in arthroplasty procedures, presenting numerous challenges for healthcare systems worldwide. This study analyses historical trends in joint arthroplasty, assesses the accuracy of prior projections, and forecasts future demand using data from international arthroplasty registries. The goal is to guide healthcare resource management and policymaking.
Methods: A systematic registry search identified 15 nations' joint arthroplasty registries, and 209 annual reports provided high-quality data on primary total hip (THA) and knee arthroplasties (TKA) over the past two decades. Future arthroplasty volumes were projected using a deterministic negative-exponential saturating growth model.
Results: From 2010 to 2023, THA incidence rose by 130% to 210%, while TKA increased by 150% to 664% across the analysed national registries. Projections to 2050 indicate sustained growth: THA volumes are expected to rise by 121% to over 200% and TKA by at least 130% across all countries.
Conclusions: The ongoing escalation in joint arthroplasty demand necessitates proactive healthcare planning. Without strategic investments in infrastructure, workforce capacity, and digital resources, national healthcare systems risk being overwhelmed by the projected growth in both primary and revision procedures in the coming decades.
文献出处：Bence Gusztáv Stubnya 1,2, Global Trends in Joint Arthroplasty: A Systematic Review and Future Projections. J Clin Med. 2025 Nov 19;14(22):8214. doi: 10.3390/jcm14228214.
文献5
功能对线机器人辅助全膝关节置换术较传统机械对线全膝关节置换术可改善临床结局：一项单术者、随机对照、非劣效性试验的2年随访结果
译者 沈松坡
目的： 功能对线（FA）已成为全膝关节置换术（TKA）中机械对线（MA）的一种替代策略，并借助机器人辅助手术提高精确性及软组织保留。关于机器人辅助实施FA与传统MA-TKA在中期患者报告结局指标（PROMs）方面的比较证据仍然有限。本随机对照试验旨在评估FA机器人辅助全膝关节置换术（FA-RATKA）与MA传统全膝关节置换术（MA-CTKA）在恢复轨迹及术后2年膝关节特异性结局方面的差异。
方法： 本研究报告一项前瞻性随机对照非劣效性试验预先设定的2年主要结局，共纳入180例患者，其中FA-RATKA组81例、MA-CTKA组82例，共163例完成随访。分别于术前、术后3个月、1年及2年采用经验证的PROMs进行评估，包括膝关节协会评分（KSS）各分量表、牛津膝关节评分（OKS）、遗忘关节评分（FJS-12）、VAS疼痛评分、EQ-5D-5L（指数及VAS）、下肢活动量表（LEAS）及总体满意度。采用混合效应模型评估组别、时间及组别×时间交互作用，并对年龄、BMI及软组织松解进行校正。计算效应量（r），以评估其临床意义。
结果： 在整个随访期间，FA-RATKA组的膝关节特异性结局总体更优。KSS功能评分〔F(3,679)=6.970，p<0.001；r=0.173〕、KSS满意度〔F(3,679)=10.892，p<0.001；r=0.214〕及KSS症状评分〔F(3,679)=4.425，p=0.004；r=0.138〕均显示显著的组别×时间交互作用。FA-RATKA组还表现出更优的OKS变化轨迹〔F(3,679)=8.053，p<0.001；r=0.185〕、更低的VAS疼痛评分〔F(3,679)=8.339，p<0.001；r=0.188〕以及更高的EQ-5D指数评分〔F(2,515)=5.227，p=0.006；r=0.141〕。分类满意度在早期随访时有利于FA-RATKA组〔F(2,503)=3.491，p=0.031；r=0.117〕。效应量范围为r=0.117～0.214，对应小效应至小-中等效应。
结论： 在这项前瞻性、随机、单术者研究中，术后2年随访时，多项膝关节特异性患者报告结局显示出幅度较小但具有统计学支持的组间差异，且FA-RATKA组的数值始终更高。
证据等级： I级；依据KSSTA指南，为具有足够统计效能检测组间差异（置信区间较窄）且随访率>80%的随机对照试验。
Functional alignment robotic-assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single-surgeon randomised controlled non-inferiority trial with 2-year follow-up
Purpose: Functional alignment (FA) has emerged as an alternative to mechanical alignment (MA) in total knee arthroplasty (TKA), supported by robotic assistance to enhance precision and soft tissue preservation. Evidence comparing FA performed with robotic assistance to conventional MA TKA across mid term patient reported outcomes measures (PROMs) remains limited. This randomised controlled trial evaluated differences in recovery trajectories and 2 year knee specific outcomes between FA RATKA and MA CTKA.
Methods: This study reports the predefined primary 2-year outcomes of a prospective randomised controlled non-inferiority trial including 180 patients (FA-RATKA, n = 81; MA-CTKA, n = 82), of whom 163 completed follow-up. Assessments were performed preoperatively and at 3-months, 1- and 2-years using validated PROMs: Knee Society Score (KSS) subdomains, Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), VAS pain, EQ-5D-5L (index and VAS), Lower Extremity Activity Scale (LEAS), and overall satisfaction. Mixed-effects models evaluated group, time, and Group × Time interactions, adjusting for age, BMI, and soft-tissue release. Effect sizes (r) were calculated to contextualise clinical relevance.
Results: FA-RATKA demonstrated more favourable knee-specific outcomes across follow-up, with significant Group × Time interactions for KSS Function (F(3,679) = 6.970, p < 0.001; r = 0.173), KSS Satisfaction (F(3,679) = 10.892, p < 0.001; r = 0.214) and KSS Symptoms (F(3,679) = 4.425, p = 0.004; r = 0.138). FA-RATKA also showed more favourable OKS trajectories (F(3,679) = 8.053, p < 0.001; r = 0.185), lower VAS pain (F(3,679) = 8.339, p < 0.001; r = 0.188), and higher EQ-5D index scores (F(2,515) = 5.227, p = 0.006; r = 0.141). Categorical satisfaction favoured FA-RATKA at early follow-up (F(2,503) = 3.491, p = 0.031; r = 0.117). Effect sizes ranged from r = 0.117 to 0.214, corresponding to small to small-medium magnitudes.
Conclusions: In this prospective, randomised, single-surgeon study, several knee-specific patient-reported outcomes demonstrated modest but statistically supported differences at 2-year follow-up, with consistently higher values in the FA-RATKA group.
文献出处：Remco Coenen , Arne Peeters , Peter Bollars, Dinesh Nathwani, Ali Albelooshi , Max Til Ettinger , Arnaud Deltour , Martijn Gerhardus Maria Schotanus. Functional alignment robotic-assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single-surgeon randomised controlled non-inferiority trial with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2026 Sep 11. doi: 10.1002/ksa.70589. Online ahead of print.
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
非创伤性股骨头坏死：一项基于国际循证的临床实践指南
译者 李勇
背景：非创伤性股骨头坏死（ONFH）可在所有年龄段的患者中造成严重功能障碍。其严重程度不一，可为有症状或无症状。治疗策略繁多，治疗选择常受医生个人偏好影响。因此，需要广覆盖、国际共同制定、以共识为基础且严格基于证据的临床实践指南。本指南由国际骨循环研究学会（ARCO）制定，目标是形成国际循证推荐，帮助医生与患者管理 ONFH。
方法：ARCO 组建了国际多学科指南专家组，其构成经过平衡，以尽量减少利益冲突带来的偏倚。采用 GRADE 方法，包括 GRADE 证据—决策（EtD）框架。专家组确定临床问题的优先级，界定系统评价的证据标准，评估统计分析，并以共识方式通过推荐意见；这些推荐意见随后接受内容专家与利益相关方（一名卫生政策制定者和一名患者）的外部评审。
结果：专家组就 ONFH 的诊断、评估与治疗达成 12 条推荐意见。
结论：本指南的关键推荐要求准确地对 ONFH 进行分期，并判断疼痛是否可能由 ONFH 所致。这些推荐通过评估支持各类治疗的证据质量，确立了最佳决策的原则，并指出了大量需要进一步研究的领域。
12条推荐意见
1. 诊断：ONFH 的最佳影像学检查
磁共振成像（MRI）是诊断 ONFH 的推荐影像学检查。
推荐强度：强 证据等级：极低
2. 诊断：检出软骨下骨折的最佳影像学检查
在检出软骨下骨折方面，CT 或 MRI 优于普通 X 线。支持蛙式侧位 X 线获益的证据不一致。
推荐强度：弱 证据等级：极低 一致率：100%
3. 诊断：监测治疗反应的最佳影像学检查
MRI 可量化坏死的面积与范围，可用于监测 ONFH 任何治疗的效果。
推荐强度：弱 证据等级：极低 一致率：94%
4. 诊断：区分有症状与无症状 ONFH 的影像学
在软骨下骨折或塌陷发生之前，推荐用 MRI 判断髋部疼痛是否由 ONFH 引起，因为 MRI 上的骨髓水肿与关节积液与疼痛相关。与关节积液相比，骨髓水肿是髋部疼痛更准确的指标。
推荐强度：强 证据等级：中等 一致率：83%
5. 治疗：髓芯减压（CD）与 CD 加骨髓浓缩物（BMC）
对无软骨下骨折或塌陷的 ONFH 患者（ARCO I–II 期），可考虑 CD 治疗。对接受 CD 的患者，加用 BMC 可能降低股骨头塌陷风险。但目前没有对照数据能明确说明预防软骨下骨折的最佳治疗是什么。
推荐强度：弱 证据等级：低 一致率：100%
6. 治疗：带血管腓骨移植（VFG）
对无软骨下骨折或塌陷的 ONFH 患者（ARCO I–II 期），可考虑 VFG 作为保头选择，但必须与相较低复杂度手术更高的并发症负担相权衡。
推荐强度：弱 证据等级：极低
7. 治疗：截骨
对无软骨下骨折或塌陷的 ONFH 患者（ARCO I–II 期），偶尔可考虑股骨近端截骨以保留股骨头、把负重转移到非坏死骨，但必须权衡由此造成的畸形以及对后续关节置换的影响。
推荐强度：弱 证据等级：极低
8. 治疗：CD 加不带血管自体腓骨移植
工作组不推荐在 CD 中加用不带血管的自体腓骨移植来预防股骨头塌陷，因为没有明确获益，且会带来取自体骨的并发症。
推荐强度：弱 证据等级：极低 一致率：100%
9. 治疗：其他保髋治疗
对无软骨下骨折或塌陷的 ONFH 患者（ARCO I–II 期），文献中还有许多上述指南未涵盖的其他治疗；但按本指南纳入标准，每项可供分析的合格研究均少于三项。因此，不推荐常规使用这些其他治疗来预防 ARCO I–II 期的软骨下骨折。
推荐强度：无 证据等级：证据不足 一致率：94%
10. 治疗：无症状 ONFH 的观察与干预
在证据不足的情况下，工作组认为：对无症状、无软骨下骨折或塌陷的 ONFH 患者（ARCO I–II 期），可根据出现症状与软骨下塌陷的风险（如 ARCO 大小分型 2 型或 3 型）以及病灶体积或范围，考虑治疗。优先选择低创伤的治疗。
推荐强度：弱 证据等级：极低
11. 治疗：ARCO I–II 期有症状患者是否行全髋置换（THA）
对有症状但无软骨下骨折的 ONFH 患者（ARCO I–II 期），应考虑 THA 之外的其他治疗或手术。
推荐强度：强（基于共识） 证据等级：证据不足 一致率：94%
12. 治疗：ONFH 伴软骨下骨折或塌陷（ARCO III 期）
在 ARCO III 期 ONFH 中，与 THA 相比，保头手术带来的功能改善更小、结果也更难预测。但鉴于保留关节的价值，患者与医生之间的共同决策是必要的，对年轻患者尤其如此。
Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline
BACKGROUND: Nontraumatic osteonecrosis of the femoral head (ONFH) can lead to major disability in patients of all ages. It presents at various levels of severity and can be either symptomatic or asymptomatic. There is a vast array of management strategies. Treatment is often subject to physician bias. Clinical practice guidelines that are broad-based, internationally developed, consensus-driven, and strictly evidence-based are needed. The aim of this guideline by the Association Research Circulation Osseous (ARCO) was to develop international evidence-based recommendations to assist physicians and patients in managing ONFH.
METHODS: ARCO convened an international, multidisciplinary guideline panel that was balanced to minimize potential bias from conflicts of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was utilized, including GRADE Evidence-to-Decision frameworks. The panel prioritized clinical questions, defined criteria for the systematic review of evidence, evaluated the statistical analysis, and, by consensus, approved recommendation statements, which were then subject to external review by content experts and stakeholders (a health policy-maker and a patient).
RESULTS: The panel agreed on 12 recommendations for the diagnosis, evaluation, and management of ONFH.
CONCLUSIONS: Key recommendations of these guidelines require accurately staging ONFH and determining when pain may be due to ONFH. They establish principles for optimal decision-making by assessing the quality of evidence backing various treatments and identifying numerous areas for additional investigation.
CLINICAL RELEVANCE: This international evidence-based guideline provides standardized recommendations for the diagnosis and management of nontraumatic ONFH. It synthesizes all available evidence using GRADE methodology and offers practical, consensus-supported guidance for accurate staging, imaging selection, treatment decision-making, and the identification of patients who would benefit from joint-preserving interventions. The guideline supports clinicians in reducing practice variation, improving diagnostic accuracy, and optimizing treatment pathways for patients with ONFH.
Twelve Action Statements
1. Diagnosis: Optimal imaging modality for diagnosis of osteonecrosis of the femoral head (ONFH)
A magnetic resonance image (MRI) is the recommended diagnostic imaging test for ONFH.
Quality of Evidence: Very low Strength of Recommendation: Strong
2. Diagnosis: Optimal imaging modality for detecting subchondral fracture in ONFH
A computed tomography evaluation (CT) or an MRI is preferred over plain radiography for detecting subchondral fractures. There is variable evidence to justify the benefit of a frog-leg lateral radiograph.
Quality of Evidence: Very low Strength of Recommendation: Weak
3. Diagnosis: Optimal imaging modality for monitoring the effect of any intervention for treating ONFH
An MRI can quantify the area and extent of osteonecrosis and may be used to monitor the effect of any treatment in ONFH.
Quality of Evidence: Very low Strength of Recommendation: Weak
4. Diagnosis: Imaging studies to correlate and differentiate symptomatic versus asymptomatic ONFH
In ONFH, before subchondral fracture or collapse, MRI is recommended to determine if hip pain is due to ONFH, as bone marrow edema and joint effusion on MRI correlate with pain. Bone marrow edema, when compared to joint effusion, is a more accurate indicator of hip pain.
Quality of Evidence: Moderate Strength of Recommendation: Strong
5. Treatment: Core decompression (CD) versus CD plus bone marrow concentrate (BMC) for the treatment of pre-collapse ONFH
For patients who have ONFH without subchondral fracture or collapse (ARCO stages I to II), CD can be considered for treatment. For patients undergoing CD, adding BMC to the procedure may reduce the risk of femoral head collapse. However, there are no comparative data to clearly state what treatment is best for pre-collapse ONFH to prevent subchondral fracture.
Quality of Evidence: Low Strength of Recommendation: Weak
6. Treatment: Vascularized fibular grafting (VFG) for the treatment of pre-collapse ONFH
For patients who have ONFH without subchondral fracture or collapse (ARCO stages I to II), VFG may be considered as a femoral head-preserving option, but this must be balanced with the increased morbidity of this procedure as compared to lower-complexity procedures.
Quality of Evidence: Very low Strength of Recommendation: Weak
7. Treatment: Osteotomy for the treatment of pre-collapse ONFH
For patients who have ONFH without subchondral fracture or collapse (ARCO stages I to II), proximal femoral osteotomy may occasionally be considered to preserve the femoral head and shift weight-bearing to the non-necrotic bone, but this must be balanced by the deformity created and any impact on subsequent joint arthroplasty procedures.
Quality of Evidence: Very low Strength of Recommendation: Weak
8. Treatment: CD plus non-vascularized autogenous fibula graft for the treatment of pre-collapse ONFH
The workgroup recommends against adding a non-vascularized autogenous fibular graft to CD for the purpose of preventing femoral head collapse, as there is no clear benefit, and it incurs the morbidity of obtaining the autogenous bone graft.
Quality of Evidence: Very low Strength of Recommendation: Weak
9. Treatment: Other joint-preserving treatments for pre-collapse ONFH
For patients who have ONFH without subchondral fracture or collapse (ARCO stages I to II), there are many other treatments in the literature, beyond those previously outlined in the above guidelines; however, the evidence base consists of fewer than three studies eligible for analysis, per the guideline inclusion criteria. Therefore, we issue no recommendation for the routine use of these other treatments to prevent subchondral fracture in ARCO stage-I to II ONFH.
Quality of Evidence: Insufficient evidence Strength of Recommendation: None
10. Treatment: Observation versus treatment intervention for patients who have asymptomatic ONFH before subchondral fracture
In the absence of sufficient evidence, it is the opinion of the workgroup that for patients who have asymptomatic ONFH, without subchondral fracture or collapse (ARCO stages I to II), treatment may be considered depending on the risk of developing symptoms and subchondral collapse (e.g., ARCO size types 2 or 3), as well as the volume or extent of involvement. Treatments with low morbidity are preferred.
Quality of Evidence: Very low Strength of Recommendation: Weak
11. Treatment: Total hip arthroplasty (THA) for patients who have symptomatic ONFH without evidence of subchondral fracture, collapse, or arthritis, i.e., ARCO stages I or II
For patients who have symptomatic ONFH without subchondral fracture (ARCO stages I to II), alternative treatments/procedures to THA should be considered.
Quality of Evidence: Insufficient evidence Strength of Recommendation: Strong (consensus-based)
12. Treatment: Surgical treatment for patients who have ONFH and evidence of subchondral fracture or collapse, i.e., ARCO stage III
In ARCO stage-III ONFH, femoral head-preserving procedures are associated with a smaller functional improvement compared to THA, and the outcome is less predictable. However, shared decision-making between patients and their physicians is necessary, especially in younger patients, because of the value of joint preservation.
Quality of Evidence: Very low Strength of Recommendation: Weak.
文献出处：Cheng EY, Mirzaei A, Goodman SB, Cui Q, Mont MA, Jones LC; the ARCO Clinical Practice Guideline workgroup. Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline. J Bone Joint Surg Am. 2026 Jun 17;108(12):903-906. doi: 10.2106/JBJS.25.01616. Epub 2026 Apr 10. PMID: 41961916.
文献3
髋臼周围截骨术后，最小临床重要差异、实质性临床获益和患者可接受症状状态的达标情况如何随时间变化？
译者 张利强
背景：近期，研究者利用接受髋臼周围截骨术（PAO）的患者定义了改良Harris髋关节评分（mHHS）和国际髋关节结局工具12（iHOT-12）基于包括最小临床重要差异（MCID）、实质性临床获益（SCB）和可接受症状状态（PASS）锚定的阈值。然而，达到这些阈值的可能性以及患者实现这些阈值所需的时间仍属未知。了解整个术后过程中达到MCID、SCB和PASS的概率，对于公平的术前咨询至关重要。
问题与目：（1）采用可真实反映PAO患者主观感受的界值，评估接受PAO治疗的患者在术后1年、2年、5年、10年，mHHS及iHOT‑12达到MCID、SCB、PASS的概率；（2）分析哪些因素会影响患者达到MCID、SCB或PASS所需的时间。
方法：2011年3月至2025年2月期间，某单中心共有784例患者因症状性髋臼发育不良接受了PAO手术。其中，0.4%（3/784）接受了全髋关节置换术（THA）的患者被排除，剩余781例患者为潜在合格人群。未获得至少1年术后患者报告结局指标（PROMs）的患者也被排除，最终85%（665/781）的患者纳入分析。研究队列中94%（622/665）为女性，手术时平均年龄±标准差为26±8岁；其中24%（158/665）有同侧髋关节既往手术史，37%（246/665）有精神心理诊断史。累积概率采用Weibull分布下的参数生存模型结合区间删失进行确定。mHHS和iHOT-12的评分变化根据既往研究中基于锚定的MCID和SCB阈值进行评估；术后评分根据既往研究中的PASS阈值进行评估。为每位患者构建时间区间，范围从最后一个已知的未达到阈值的时间点，到最早达到阈值的时间点。采用Weibull回归模型识别与达到各结局阈值时间相关的变量（p < 0.05）。
结果：对于mHHS，达到MCID、SCB和PASS的累积概率如下：
MCID：1年时61%，2年时71%，5年时83%，10年时90%；
SCB：1年时53%，2年时63%，5年时76%，10年时85%；
PASS：1年时78%，2年时85%，5年时92%，10年时96%。
结论：在术后1年时，达到MCID、SCB和PASS的概率（mHHS分别为61%、53%、78%；iHOT-12分别为69%、52%、65%）低于既往报道的比率，这表明先前的研究可能低估了PAO的恢复周期。因此，可以告知患者，术后1年时他们可能尚未感受到髋关节疼痛和功能上的明显改善。在每个后续时间点，达到所有阈值的概率均有所增加。即便到术后10年，仍有15患者难以获得显著改善；失访可能使本研究对MCID、SCB、PASS达标率的估算偏乐观。尽管如此，术前沟通仍可说明：随着术后时间推移，获得有临床意义获益的可能性会持续增加。既往同侧髋手术史、精神共病、双侧手术，会不同程度延长患者达到MCID、SCB、PASS的时间。上述概率及影响因素可为帮助患者建立关于疼痛、功能改善时间的合理预期提供依据。
How Does the Achievement of Minimum Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptom State Change Over Time After Periacetabular Osteotomy?
Background: Anchor-based thresholds of the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) were recently defined for the modified Harris hip score (mHHS) and the International Hip Outcome Tool 12 (iHOT-12) among patients undergoing periacetabular osteotomy (PAO). However, the likelihood of meeting these thresholds and the amount of time it takes for patients to achieve them remain unknown. Understanding the probability of achieving the MCID, SCB, and PASS throughout the postoperative course is important for fair preoperative counseling.
Questions/purposes: (1) For patients treated with PAO, what is the probability of achieving the MCID, SCB, and PASS for the mHHS and iHOT-12 at 1, 2, 5, and 10 years postoperatively using threshold values that accurately characterize the perceptions of patients undergoing PAO? (2) Which factors are associated with time to achieving the MCID, SCB, or PASS?
Methods: Between March 2011 and February 2025, a total of 784 patients underwent PAO for symptomatic acetabular dysplasia at one institution. Of these, 0.4% (3 of 784) who underwent conversion THA were excluded, yielding 781 patients as potentially eligible. Patients without minimum 1-year postoperative PROMs were also excluded, leaving 85% (665 of 781) of patients for analysis. The study cohort (in which 94% [622 of 665] were women, with a mean 6 SD age at time of surgery of 26 6 8 years) included 24% (158 of 665) of patients with prior ipsilateral hip surgery and 37% (246 of 665) of patients with a psychiatric diagnosis. Cumulative probabilities were determined using a parametric survival model under a Weibull distribution with interval censoring. Outcome changes of the mHHS and iHOT-12 were evaluated against the anchor-based MCID and SCB thresholds from prior work. Postoperative scores were evaluated against PASS thresholds from prior work. Intervals were constructed for each patient, ranging from the last known point at which a threshold was not achieved to the earliest time point at which a threshold was met. Weibull regression models were used to identify variables associated (p < 0.05) with the time to achieving each outcome threshold.
Results: For the mHHS, the cumulative probability of achieving the MCID, SCB, and PASS was as follows: 61% at 1 year, 71% at 2 years, 83% at 5 years, and 90% at 10 years for the MCID; 53% at 1 year, 63% at 2 years, 76% at 5 years, and 85% at 10 years for the SCB; and 78% at 1 year, 85% at 2 years, 92% at 5 years, and 96% at 10 years for the PASS.
Conclusion: We found that at 1 year, the probability of achieving the MCID, SCB, and PASS (61%, 53%, 78% and 69%, 52%, 65% for the mHHS and iHOT-12, respectively) was lower than previously reported rates, indicating that prior research may have minimized the duration of PAO recovery. Thus, patients can be counseled that by 1 year, they may not experience perceptible improvement in their hip pain and function. The probability of achieving all thresholds increased at each subsequent time point, although even at 10 years, 15% of patients were unlikely to consider their improvement to be substantial, and loss to follow-up may cause our estimates of achieving an MCID, SCB, or PASS to be optimistic. Still, the preoperative discussion can also convey that achieving clinically meaningful benefit becomes more likely throughout the postoperative course. Prior ipsilateral surgery, psychological comorbidities, and bilateral surgery were associated with a moderate to substantially longer time to achieve the MCID, SCB, and PASS. These probabilities and factors provide a foundation for setting realistic patient expectations regarding time frames for improvements in pain and function. Level of Evidence Level III, therapeutic study.
文献出处：Trotzky ZA, Owens CE, Jochl OM, Merckaert SR, Sink EL. How Does the Achievement of Minimum Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptom State Change Over Time After Periacetabular Osteotomy? Clin Orthop Relat Res. 2026 Sep 22. doi: 10.1097/CORR.0000000000004123. Epub ahead of print. PMID: 42770981.
文献4
弹响髋作为发育性髋关节发育不良诊断筛查工具的评估
译者 贾海港
目的： 发育性髋关节发育不良（DDH）的早期诊断至关重要，因为婴儿早期的治疗通常无需手术。英国儿童骨科协会的一份共识声明指出，目前对于记录在案的“弹响髋”的预测价值仍存在不确定性。本研究的目的是在英国一项选择性筛查项目中，评估新生儿期或 6 至 8 周检查时发现的弹响髋与需要治疗的病理性 DDH 之间的关联。
方法： 本研究为回顾性分析，数据来源于 2016 年 1 月至 2023 年 12 月期间某单一三级医疗中心服务区域内所有活产婴儿的前瞻性登记资料。婴儿在出生时及出生后 6 至 8 周接受体格检查；对于存在主要危险因素或体检发现异常（包括髋关节弹响）的婴儿，提供超声筛查。主要结局指标为需要治疗的病理性发育性髋关节发育不良（DDH）。采用多变量 logistic 回归估计 DDH 的校正比值比（OR）。计算阳性预测值（PPV）、风险差（RD）和需筛查人数（NNS）作为项目层面的指标。
结果： 在纳入分析的 42,338 名婴儿中，7,564 名（17.9%）接受了超声筛查。共检出 245 例需要治疗的病理性 DDH（每 1,000 例活产婴儿中 5.8 例）。共有 1,125 名婴儿被记录有髋关节弹响，其中 40 名（3.56%）确诊为需要治疗的 DDH。髋关节弹响与 DDH 独立相关（校正后 OR 为 4.68，95% CI 3.11–7.03；p < 0.001）。在选择性筛查路径中，风险差为 3.86%（95% CI 2.65–5.07），阳性预测值为 3.56%，需筛查人数为 26。
结论： 在这一项纳入英国选择性筛查项目的大型队列研究中，弹响髋与需要治疗的发育性髋关节发育不良（DDH）独立相关。尽管受限于选择性筛查固有的差异性诊断，这些发现仍支持将孤立性记录的弹响髋作为 DDH 选择性筛查路径中转诊指征的前瞻性评估。
Evaluation of the clicky hip as a screening tool in the diagnosis of developmental dysplasia of the hip
Aims: The early diagnosis of developmental dysplasia of the hip (DDH) is important because treatment in early infancy is usually nonoperative. A consensus statement from the British Society for Children's Orthopaedic Surgery identified ongoing uncertainty regarding the predictive value of a documented clicky hip. The aim of this study was to evaluate the association between a clicky hip at the newborn or six- to eight-week examination and pathological DDH requiring treatment in a selective screening programme in the UK.
Methods: This was a retrospective analysis of prospectively collected registry data for all live births in the catchment area of a single tertiary centre between January 2016 and December 2023. Infants underwent examination at birth and again at six to eight weeks, with ultrasound screening offered for those with primary risk factors or abnormal findings on examination, including a clicky hip. The primary outcome was pathological DDH requiring treatment. Multivariable logistic regression was used to estimate the adjusted odds ratios (ORs) for DDH. Positive predictive value (PPV), risk difference (RD), and the number needed to screen (NNS) were calculated as programme-level measures.
Results: Of 42,338 infants who were analyzed, 7,564 (17.9%) underwent ultrasound screening. Pathological DDH requiring treatment was identified in 245 (5.8 per 1,000 live births). A clicky hip was recorded in 1,125 infants, of whom 40 (3.56%) had DDH requiring treatment. Clicky hip was independently associated with DDH (adjusted OR 4.68 (95% CI 3.11 to 7.03); p < 0.001). Within the selective screening pathway, the RD was 3.86% (95% CI 2.65 to 5.07), the PPV was 3.56% and the NNS was 26.
Conclusion: In this large UK cohort within a selective screening programme, a clicky hip was independently associated with DDH requiring treatment. Although limited by differential ascertainment inherent to selective screening, these findings support the prospective evaluation of an isolated documented clicky hip as an indication for referral in selective screening pathways for DDH.
文献出处：Poacher AT, Bilal M, Smith A, Scourfield L, Hawes E, Ross M, Yasin T, Carpenter EC. Evaluation of the clicky hip as a screening tool in the diagnosis of developmental dysplasia of the hip. Bone Joint J. 2026 Oct 1;108-B(10):1273-1277. doi: 10.1302/0301-620X.108B10.BJJ-2025-1367.R1. PMID: 42853087.
文献5
在至少2年的随访中，超过80%的接受同期髋关节镜和髋臼周围截骨术的运动员重返运动
译者 陶可
目的：报告接受同期髋关节镜和髋臼周围截骨术（PAO）以治疗髋关节发育不良及髋关节内病变（如凸轮畸形和髋关节盂唇撕裂）的运动员，其至少2年随访期间的患者报告结局及重返运动（RTS）率。
方法：我们回顾了2010年11月至2018年12月期间，因髋关节发育不良和凸轮畸形接受同期初次髋关节镜和PAO手术的运动员数据。纳入标准为患者拥有以下术前及术后至少2年的评分数据：改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）以及髋关节结局评分-运动专项子量表（HOS-SSS）。研究记录了达到最小临床重要差异（MCID）的患者比例以及重返运动（RTS）的情况。
结果：共纳入29名运动员（29个髋关节），平均随访时间为34.1 ± 7.9个月，平均年龄为26.0 ± 8.7岁，平均体重指数（BMI）为23.7 ± 3.4。从基线到末次随访，这些运动员在mHHS、NAHS和HOS-SSS评分方面均表现出显著改善（P < .001）。mHHS (82.8%)、NAHS (86.2%) 和 HOS-SSS (79.3%) 均有较高比例的患者达到了最小临床重要差异（MCID）。在尝试重返运动（RTS）的运动员中，成功重返运动的比率为81.8%。
结论：接受髋关节镜联合髋臼周围截骨术（PAO）的运动员，在至少2年的随访中，报告结局指标显示出显著改善，且重返运动率为81.8%。
Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up
Purpose: To report minimum 2-year follow-up patient-reported outcomes and return-to-sport (RTS) rates in athletes undergoing concomitant hip arthroscopy and periacetabular osteotomy (PAO) to treat acetabular dysplasia and intra-articular pathologies such as cam deformity and labral tears.
Methods: We reviewed the data of consecutive athletes undergoing concomitant primary hip arthroscopy and PAO for acetabular dysplasia and cam deformity from November 2010 to December 2018. Patients were included in the study if they had the following preoperative and minimum 2-year postoperative scores: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS). The percentage of patients who achieved the minimal clinically important difference was recorded, in addition to RTS status.
Results: A total of 29 athletes (29 hips) were included, with a mean follow-up time of 34.1 ± 7.9 months, mean age of 26.0 ± 8.7 years, and mean body mass index of 23.7 ± 3.4. These athletes showed significant improvements in the mHHS, NAHS, and HOS-SSS from baseline to latest follow-up (P < .001). The minimal clinically important difference was achieved at high rates for the mHHS (82.8%), NAHS (86.2%), and HOS-SSS (79.3%). Athletes who attempted to RTS successfully returned at a rate of 81.8%.
Conclusions: Athletes undergoing concomitant hip arthroscopy and PAO showed significant improvements in patient-reported outcomes at minimum 2-year follow-up and had an RTS rate of 81.8%.
文献出处：Andrew E Jimenez, Michael S Lee, Jade S Owens, David R Maldonado, Justin M LaReau, Benjamin G Domb. Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up. Review Arthroscopy. 2022 Sep;38(9):2649-2658. doi: 10.1016/j.arthro.2022.02.017. Epub 2022 Mar 5.
文献6
基于三维髋臼覆盖的髋关节发育不良髋臼周围截骨术后生存情况分析
译者 邱兴
髋臼周围截骨术（PAO）是矫正髋关节发育不良患者髋臼覆盖、预防骨关节炎进展的成熟术式。然而，PAO术后髋臼覆盖如何发生三维变化，以及其如何影响生存情况，尚不明确。因此，本研究旨在探讨术前与术后三维髋臼覆盖的变化，并识别与PAO术后转为全髋关节置换术（THA）及影像学骨关节炎进展相关的人口学、临床和影像学因素。我们回顾性分析了46例连续接受PAO的患者（66髋），使用术前和术后X线片及骨盆计算机断层扫描（CT）。研究基于CT数据评估三维髋臼覆盖。采用Kaplan-Meier法进行生存分析，并使用单因素Cox回归模型计算风险比，以识别与作为终点的PAO术后转为THA及影像学骨关节炎进展相关的危险因素。影像学骨关节炎进展定义为最小关节间隙<2.0 mm。平均随访时间为10.7年。PAO术后，髋臼覆盖从前上方向上方、再向后上方逐渐增加。PAO术后10年生存率为98.0%。术后上方髋臼覆盖较小（风险比为0.93）与PAO术后转为THA及影像学骨关节炎进展显著相关（P = 0.03）。本研究中，PAO术后上方髋臼覆盖不足是转为THA及骨关节炎影像学进展的重要危险因素。因此，外科医生在实施PAO时应优先矫正上方髋臼覆盖。
Analysis of survivorship following periacetabular osteotomy for hip dysplasia based on three-dimensional acetabular coverage
Periacetabular osteotomy (PAO) is an established procedure for correcting acetabular coverage and preventing osteoarthritis progression in hip dysplasia. However, it is unclear how acetabular coverage changes three-dimensionally after PAO and how it affects survival. Therefore, this study aimed to investigate the change in three-dimensional acetabular coverage preoperatively and postoperatively and identify demographic, clinical and radiographic factors associated with conversion to total hip arthroplasty (THA) and radiographic osteoarthritis progression after PAO. We retrospectively reviewed 46 consecutive patients (66 hips) who underwent PAO, using preoperative and postoperative radiographs and pelvic computed tomography (CT). Three-dimensional acetabular coverage based on CT data was investigated. Kaplan-Meier survival analysis was performed, and hazard ratios were calculated using univariate Cox regression models to identify the risk factors associated with conversion to THA and radiographic osteoarthritis progression after PAO as the endpoints. Radiographic osteoarthritis progression was defined as a minimum joint space of <2.0 mm. The mean follow-up was 10.7 years. Post-PAO, acetabular coverage gradually increased from the anterosuperior to the superior to the posterosuperior direction. The survival rate after PAO was 98.0% at 10 years. Less postoperative superior acetabular coverage, with a hazard ratio of 0.93, was significantly associated with conversion to THA and radiographic osteoarthritis progression after PAO (P = 0.03). In this study, poor superior acetabular coverage after PAO was a significant risk factor for conversion to THA and radiographic progression of osteoarthritis. Therefore, surgeons should attempt to prioritize the correction of the superior acetabular coverage when performing PAO.
文献出处：Tachibana T, Koga H, Katagiri H, Ogawa T, Takada R, Miyatake K, Jinno T. Analysis of survivorship following periacetabular osteotomy for hip dysplasia based on three-dimensional acetabular coverage. Journal of Hip Preservation Surgery. 2024 Jan 1;11(1):30-7.
文献7
复位后 MRI 髋关节形态可预测切开或闭合复位后10年的残余髋臼发育不良
译者 徐子茵
背景：关于复位后磁共振成像（MRI）形态学参数能否预测发育性髋关节发育不良（DDH）患者接受闭合或切开复位后的长期残余髋臼发育不良（RAD），目前支持其价值的证据有限。
方法：本回顾性研究纳入接受切开或闭合复位且随访至少 10 年的 42 例患者（47 髋）；其中 39 髋（83%）来自女性患者，复位时的中位年龄为 6.3 个月（四分位距［IQR］：3.3～8.9 个月）。RAD 定义为因髋臼指数高于相应年龄及性别人群均值 2 个标准差而接受进一步手术，或末次随访时 Severin 分级高于 2 级。在复位后 MRI 上测量髋臼前倾角及深宽比、冠状位和轴位股骨头－髋臼间距离、软骨性和骨性髋臼指数、横韧带厚度，以及髋臼内侧和外侧软骨缘（limbus）的厚度。
结果：末次随访时，24 髋（51%）未发生 RAD；23 髋（49%）在中位 11.4 年（IQR：7.6～15.4 年）时达到失败终点。比较均值发现，除软骨性髋臼指数外，大多数复位后 MRI 测量指标在 RAD 组与无 RAD 组之间均存在显著差异。以 5 mm 为截断值的冠状位股骨头－髋臼间距离（受试者工作特征曲线下面积［AUC］为 0.95；95% 置信区间［CI］：0.90～1.00），以及以 4 mm 为截断值的外侧软骨缘厚度（AUC 为 0.91；95% CI：0.83～0.99），具有最高的判别能力。冠状位股骨头－髋臼间距离采用 5 mm 截断值时，敏感度为 96%（95% CI：78%～100%），特异度为 83%（95% CI：63%～95%），阳性预测值为 85%（95% CI：65%～96%），阴性预测值为 95%（95% CI：76%～100%）。外侧软骨缘厚度采用 4 mm 截断值时，敏感度为 96%（95% CI：78%～100%），特异度为 63%（95% CI：41%～81%），阳性预测值为 71%（95% CI：52%～86%），阴性预测值为 94%（95% CI：70%～100%）。
结论：冠状位股骨头－髋臼间距离是评估复位同心性的定量指标，外侧软骨缘厚度是评估髋臼软骨组成部分的定量指标；两者均有助于预测切开或闭合复位后长期随访中将发生 RAD 的髋关节。
Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction
Background: There is limited evidence supporting the value of morphological parameters on post-reduction magnetic resonance imaging (MRI) to predict long-term residual acetabular dysplasia (RAD) after closed or open reduction for the treatment of developmental dysplasia of the hip (DDH).
Methods: We performed a retrospective study of 42 patients (47 hips) undergoing open or closed reduction with a minimum 10 years of follow-up; 39 (83%) of the hips were in female patients, and the median age at reduction was 6.3 months (interquartile range [IQR], 3.3 to 8.9 months). RAD was defined as additional surgery with an acetabular index >2 standard deviations above the age- and sex-specific population-based mean value or Severin classification grade of >2 at last follow-up. Acetabular version and depth-width ratio, coronal and axial femoroacetabular distance, cartilaginous and osseous acetabular indices, transverse ligament thickness, and the thickness of the medial and lateral (limbus) acetabular cartilage were measured on post-reduction MRI.
Results: At the time of final follow-up, 24 (51%) of the hips had no RAD; 23 (49%) reached a failure end point at a median of 11.4 years (IQR, 7.6 to 15.4 years). Most post-reduction MRI measurements, with the exception of the cartilaginous acetabular index, revealed a significant distinction between the group with RAD and the group with no RAD when mean values were compared. The coronal femoroacetabular distance (area under the receiver operating characteristic curve [AUC], 0.95; 95% confidence interval [CI], 0.90 to 1.00), with a 5-mm cutoff, and limbus thickness (AUC, 0.91; 95% CI, 0.83 to 0.99), with a 4-mm cutoff, had the highest discriminatory ability. A 5-mm cutoff for the coronal femoroacetabular distance produced 96% sensitivity (95% CI, 78% to 100%), 83% specificity (95% CI, 63% to 95%), 85% positive predictive value (95% CI, 65% to 96%), and 95% negative predictive value (95% CI, 76% to 100%). A 4-mm cutoff for limbus thickness had 96% sensitivity (95% CI, 78% to 100%), 63% specificity (95% CI, 41% to 81%), 71% positive predictive value (95% CI, 52% to 86%), and 94% negative predictive value (95% CI, 70% to 100%).
Conclusions: Coronal femoroacetabular distance, a quantitative metric assessing a reduction’s concentricity, and limbus thickness, a quantitative metric assessing the acetabulum’s cartilaginous component, help to predict hips that will have RAD in the long term after closed or open reduction.
文献出处：Schmaranzer F, Justo P, Kallini JR, Ferrer MG, Miller P, Bixby SD, Novais EN. Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction. J Bone Joint Surg Am. 2024 Jan 17;106(2):110-119. doi: 10.2106/JBJS.23.00333. Epub 2023 Nov 22. PMID: 37992184; PMCID: PMC12205695.
文献8
1058例尸体髋关节的解剖学分析：股骨前倾角与凸轮畸形的部位特异性研究
译者 陈志强
背景：股骨前倾角（FV）是一项解剖学参数，近年来因其在多种髋关节病变（包括股骨髋臼撞击综合征〔FAI〕和凸轮畸形发生）中的作用而受到越来越多的关注。
目的：评估部位特异性的股骨前倾角，并评估其与尸体标本中凸轮畸形大小和位置的关联。
研究设计：描述性观察性研究。
方法：从历史骨骼标本库中选取了共1058根尸体股骨。对每根股骨进行评估，测定α角、总股骨前倾角、基于颈部的股骨前倾角和基于干骺端的股骨前倾角。凸轮形态定义为α角 > 60°。采用Pearson相关分析和多元回归分析来确定部位特异性股骨前倾角位置与α角之间的关系。
结果：在所有尸体股骨中，α角的平均值±标准差为54°± 11°。其中354根（33%）存在凸轮畸形。所有标本的总股骨前倾角平均值为11°± 12°，股骨干前倾角平均值为24°± 10°，股骨颈前倾角平均值为−13°± 19°。多变量分析显示，性别、种族、股骨颈前倾角和股骨干前倾角均是α角的独立预测因子（P < 0.05）。股骨颈前倾角每增加1度，α角增加0.09°（P = 0.006）；股骨干前倾角每增加1度，α角增加0.14°（P = 0.02）。
结论：我们的研究揭示了部位特异性股骨前倾角与凸轮畸形之间的解剖学关联：干、颈前倾角的增加均可预测α角的增大。尽管这种关联的绝对数值较小，但部位特异性股骨前倾角仍是一个此前未被认识的重要领域，有助于解释既往文献中关于FAI多因素症状学差异的报道。
临床意义：经典的股骨前倾角通常作为一个合并值（包含股骨颈前倾和股骨干扭转）来报告。除了明确部位特异性股骨前倾角与凸轮畸形之间的关联外，本研究也鼓励临床医生在考虑股骨截骨矫形术的畸形水平定位时（尤其是FAI患者），同时关注股骨前倾角的两个解剖构成部分。
Anatomic Analysis of Site-Specific Femoral Version and Cam Deformity in 1058 Cadaveric Hips
Background: Femoral version (FV) is an anatomic parameter that has recently received increased attention in its role in multiple hip pathologies, including femoroacetabular impingement (FAI) and cam lesion development.
Purpose: To evaluate site-specific femoral version and assess the relationship with the size and location of cam deformity in cadaveric specimens.
Study Design: Descriptive laboratory study.
Methods: A total of 1058 cadaveric femurs were selected from a historical osteologic collection. Each femur was assessed to determine the α angle, total FV, neck-based FV, and shaft-based FV. Cam morphology was defined as an α angle >60°. Pearson correlation and multiple regression analysis were performed to determine the relationship between site-specific FV location and α angle.
Results: Of the cadaveric femurs, the mean ± SD α angle was 54°± 11°. There were 354 (33%) cam deformities. The mean ± SD was 11°± 12° for total FV among all specimens, 24°± 10° for the femoral shaft version, and −13°± 19° for the femoral neck version. On multivariate analysis, sex, race, femoral neck version, and femoral shaft version were independent predictors for α angle (P < .05). Each degree increase predicted an increase in α angle of 0.09° (P = .006) for the femoral neck version and 0.14° (P = .02) for the femoral shaft version.
Conclusion: Our study reveals an anatomic relationship between site-specific FV and cam deformity; an increase in shaft FV and neck FV predicted an increased α angle. While the observed absolute value of this relationship is small, site-specific FV remains a previously unrecognized area of interest that could help explain differences previously reported in the literature regarding the multifactorial symptomology in FAI.
Clinical Relevance: FV is classically reported as one value combining the femoral neck version and torsion of the femoral shaft. In addition to the identified relationship between site-specific FV and cam deformity, this study encourages clinicians to consider both contributing anatomic components of femoral version, especially when identifying the level of deformity before corrective femoral osteotomy in patients with FAI.
文献出处：Sinkler MA, Magister SJ, Fortier LM, et al. Anatomic Analysis of Site-Specific Femoral Version and Cam Deformity in 1058 Cadaveric Hips. Orthop J Sports Med. 2025;13(12):23259671251397640. Published 2025 Dec 15. doi:10.1177/23259671251397640
来源：304关节学术
作者：304关节团队
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