本期目錄：

1、全膝關節置換術后使用低溫加壓裝置促進恢復的作用

2、激素替代療法不能消除全關節置換術后關節并發癥的危險因素

3、脛骨平臺無菌性松動與骨水泥厚度相關

4、全膝關節置換術的翻修原因分析

5、全髖關節置換術后股骨前傾變化如何影響股骨旋轉和前偏心距

6、歐亞健康中年人群下肢扭轉顯著不同

7、Perthes病患者大轉子阻滯術術后的影像學結果

8、骨關節炎綜述

9、兒童Legg-Calve-Perthes病行股骨近端內翻截骨術后生活質量的長期改善

10、前傾髖臼周圍截骨術治療有癥狀的髖臼后傾

11、髖關節發育不良中髖臼覆蓋特征的性別差異

第一部分：關節置換及保膝相關文獻

文獻1

全膝關節置換術后使用低溫加壓裝置促進恢復的作用：一項隨機對照試驗

譯者 張軼超

目的：本研究旨在探討低溫加壓Game Ready?（GR）與常規護理方案（UC）對全膝關節置換術后早期康復的有效性。

方法：本研究前瞻性地隨機選擇72例全膝關節置換術患者，進行為期2周（從術后第0天開始）的GR治療（n=36, 63.9%的女性）或冰敷UC靜態加壓（n=36, 45.7%的女性）治療。術后第1、2、14天和6周記錄膝關節屈伸活動度（ROM）、視覺模擬疼痛量表和肢體圍度。記錄了藥物使用情況和住院時間。患者報告的結果評測（PROMs）包括膝關節損傷和骨關節炎療效評分和患者滿意度問卷。采用線性混合模型進行統計分析，采用Satterthwaite法進行方差表分析，并采用雙尾t檢驗。

結果：對于任何結果間都不存在顯著的以時間分組的相互影響。在2周時GR組有19%失去隨訪，而UC組有8%。與UC組相比，GR組在第1天（p=0.048）和第14天（p=0.007）在膝關節伸直度數上表現出明顯更好的結果。在疼痛、關節屈曲角度、肢體圍度、阿片類藥物使用或PROMs方面沒有觀察到組間差異。總體而言，疼痛程度越高導致阿片類藥物攝入量增加（p=0.002），老年患者使用阿片類藥物明顯更少（p<0.001），男性報告的疼痛明顯少于女性（p=0.048）。兩種方案均未觀察到不良反應。

結論：盡管在最初的兩周干預期內，與UC相比，使用GR的患者具有更好的膝關節伸直度數，但這種影響可能是偶然的。在干預期間或結束后，兩組之間沒有觀察到更多方面的顯著差異。

圖. GRPro? 2.1 系統，用于膝關節術后康復。

The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial

Purpose：The study sought to investigate the efectiveness of a cryocompression Game Ready? (GR) versus usual care protocol (UC) on early post-operative recovery following total knee arthroplasty.

Methods：This study prospectively randomised 72 total knee arthroplasties to a 2-week (from day 0) intervention of GR treatment (n=36, 63.9% females) or UC of ice with static compression (n=36, 45.7% females). Knee fexion and extension range of motion (ROM), a visual analogue pain scale and limb circumference were documented at day 1, 2 and 14, as well as 6 weeks post-surgery. Medication usage and length of hospital stay were documented. Patient-reported outcome measures (PROMs) included the Knee Injury and Osteoarthritis Outcome Score and a Patient Satisfaction Questionnaire. Statistical analysis using linear mixed modelling and analysis of variance table with Satterthwaite's method were used along with two-tailed t-tests.

Results：There were no signifcant group-by-time interactions regarding any of the outcomes. The GR group had 19% lost to follow-up at 2 weeks, while the UC group had 8%. The GR group demonstrated signifcantly better knee extension ROM at day 1 (p=0.048) and day 14 (p=0.007) compared with the UC group. There were no group diferences (n.s.) observed in pain, fexion ROM, limb circumference, opioid use or PROMs. Overall, higher pain levels resulted in increased opioid intake (p=0.002), older patients used signifcantly less opioids (p<0.001) and males reported signifcantly less pain than females (p=0.048). No adverse efects were observed due to either protocol.

Conclusion：Despite patients gaining signifcantly more knee extension during the initial two-week intervention period when using GR compared to UC, this efect was likely due to chance. No further signifcant diferences were observed between the groups during or after cession of the intervention.

文獻出處：Marinova M, Sundaram A, Holtham K, Ebert JR, Wysocki D, Meyerkort D, Radic R. The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4422-4429. doi: 10.1007/s00167-023-07455-3. Epub 2023 Jul 18. PMID: 37464101; PMCID: PMC10471706.

文獻2

激素替代療法不能消除全關節置換術后關節并發癥的危險因素

譯者 馬云青

摘要：年齡增長會導致睪丸激素和雌激素的減少，這與骨密度的降低有關。激素替代療法及其對關節成形術結果的影響尚不清楚。本研究旨在分析睪酮替代療法 (TRT) 和雌激素替代療法 (ERT) 對全髖關節置換術 (THA) 和全膝關節置換術 (TKA) 的內科和關節置換術后療效的影響。使用 PearlDiver 數據庫進行回顧性隊列研究。圍手術期接受 TRT 或 ERT 的患者與對照組相匹配。詢問 90 天內科并發癥和 2 年關節并發癥的發生率。與對照組相比，接受 TRT 的患者在 THA 后 2 年內翻修，假體周圍感染和合并關節并發癥的風險增加，敗血癥和無菌性翻修以及 TKA 后無菌性松動的發生率增加。接受 ERT 治療的患者在全髖關節置換術后 2 年內無菌性松動和合并關節并發癥的發生率增加，全因翻修和合并關節并發癥的發生率增加。接受 TRT 治療的患者顯示出更高的翻修率和 PJI 發生率。接受圍手術期 ERT 治療的患者翻修率和關節感染的風險明顯增加。

Hormone Replacement Therapy Does Not Eliminate Risk Factors for Joint Complications following Total Joint Arthroplasty: A Matched Cohort Study

Aging causes a reduction in testosterone and estrogen, which is linked to diminished bone mineral density. Hormone replacement therapy and its effect on the outcome of joint arthroplasties is unclear. The purpose of this study was to analyze the impact of testosterone replacement therapy (TRT) and estrogen replacement therapy (ERT) on the medical and joint outcomes of total hip (THA) and total knee arthroplasties (TKA). A retrospective cohort study was conducted using the PearlDiver database. Patients who received TRT or ERT perioperatively were matched to controls. Rates of 90-day medical complications and 2-year joint complications were queried. Patients who received TRT had an increased risk of revision, periprosthetic joint infection, and pooled joint complications within 2 years following a THA and increased rates of septic and aseptic revisions, and aseptic loosening after TKA compared to the control cohort. Patients receiving ERT had increased rates of aseptic loosening and pooled joint complications within 2 years following THA and increased rates of all-cause revisions and pooled joint complications after TKA. Patients who received TRT demonstrated significantly higher rates of revision rates and PJI. Patients who received perioperative ERT were significantly more likely to have increased risks of revision rates and joint infections.

文獻出處：Collins LK, Cole MW, Waters TL, Iloanya M, Massey PA, Sherman WF. Hormone Replacement Therapy Does Not Eliminate Risk Factors for Joint Complications following Total Joint Arthroplasty: A Matched Cohort Study. Pathophysiology. 2023 Apr 4;30(2):123-135. doi: 10.3390/pathophysiology30020011. PMID: 37092525; PMCID: PMC10123744.

文獻3

脛骨平臺無菌性松動與骨水泥厚度相關

譯者 張薔

背景：全膝關節置換（TKA）的骨水泥技術對于達成牢固固定和假體長期生存至關重要。脛骨-假體界面的骨水泥厚度可能與脛骨側無菌性松動相關。然而，迄今為止，沒有一篇文章明確證實骨水泥厚度與脛骨側無菌性松動率的直接相關性。

方法：我們回顧性選擇了某醫療中心2013年-2021年間共28327例至少包含兩年隨訪結果的骨水泥型初次全膝關節置換手術病例。共有115例因脛骨側無菌性松動接受了翻修手術。其中23例因松動相關原因而假體召回的病例被排除后，剩余92例脛骨側無菌性松動病例，我們按照2:1的比例匹配了沒有脛骨側松動的對照組。最終，我們挑選兩位獨立觀察員在術后平片上沿骨-假體界面的10個不同位點分別測量骨水泥厚度，并應用獨立t檢驗分析了所有采集的測量數據。

正位和側位上各5個不同位置的骨水泥厚度測量點

結果：使用A假體（施樂輝Legion，n=75）并出現脛骨側無菌性松動病例的骨水泥厚度在10個位點均顯著低于對照組。使用B假體（史賽克Triathlon，n=17）并出現脛骨側無菌性松動病例的骨水泥厚度也在所有位點均低于對照組，但只在背托內、龍骨內、龍骨外、龍骨前和背托后這幾個位點存在顯著性差異。

結論：在兩種廣泛應用的全膝關節假體上我們發現，與未出現松動的對照組相比，存在脛骨側無菌性松動病例的骨-假體界面骨水泥厚度明顯更薄。我們在未來需要進行更多研究來確定最佳的龍骨設計以及最薄的可接受骨水泥厚度，以避免可能出現的假體松動情況。

Aseptic Tibial Loosening is Associated with Thickness of the Cement

A Radiographic Case-Control Study

Background: The cementation technique is crucial for achieving adequate fixation and optimal survivorship in total knee arthroplasty (TKA). The thickness of the cement at the tibial bone implant surface may be related to aseptic tibial loosening. However, to date, no studies have demonstrated a direct association between cement thickness and rates of aseptic tibial loosening.

Methods: We performed a retrospective review to identify 28,327 primary cemented TKAs with at least two years of follow-up at an academic health system from 2013 to 2021. A total of 115 cases underwent revision surgery for aseptic tibial loosening. Cases where the implant was recalled specifically for loosening (n = 23) were excluded. The remaining 92 aseptic tibial loosening cases were 2:1 propensity score matched and implant-matched to control patients who did not have tibial loosening. There were two independent reviewers who then measured the thickness of the cement interface in ten locations along the bone-implant interface from initial postoperative radiographs. The averages of the reviewers’ measurements were calculated and then compared using independent t-tests.

Results: Aseptic tibial loosening cases involving implant A tibial baseplate (n = 75) had significantly thinner cement interfaces than matched controls at all ten locations measured. Aseptic loosening cases involving implant B (n = 17) also displayed a thinner cement interface than matched controls in all locations, but this result was only statistically significant at the medial baseplate, medial keel, lateral keel, anterior keel, and posterior baseplate.

Conclusion: In two widely used TKA systems, tibial aseptic loosening was associated with significantly thinner cement interfaces when compared to propensity-matched controls in two different implant types. Further prospective studies are needed to identify the optimal keel preparation and design as well as minimal cement interface thickness to avoid implant loosening.

文獻4

全膝關節置換術的翻修原因分析

譯者 沈松坡

背景：在許多國家，全膝關節翻修術（TKA）的數量正在增加。本研究旨在前瞻性評估導致TKA翻修的原因，并將這些原因與以前發布的數據進行比較。

方法：本研究前瞻性納入了2010至2015年間進行TKA翻修術的患者。翻修原因通過患者的所有可用記錄信息進行分類，包括術前診斷、術中發現以及假體周圍組織分析的結果。根據以往的研究，患者分為早期翻修（2年內）和晚期翻修（2年以上）。此外，還包括已經進行過TKA翻修術的再次翻修病例。

結果：我們評估了312名患者，他們共進行了402次TKA翻修，其中89.6%的患者是由于轉診到我們的中心進行翻修手術。在289名患者（71.9%）中，這是首次進行的翻修手術。首次翻修手術中，大多數為晚期翻修（73.7%）。113名患者（28.1%）已經進行過一次或多次翻修手術。總體而言，翻修最常見的原因是感染（36.1%），其次是無菌性松動（21.9%）和假體周圍骨折（13.7%）。

結論：在專業的關節置換中心，假體周圍關節感染（PJI）是最常見的TKA翻修和再翻修的原因。這與基于人口的登記數據相反，并且對這些中心的成本和成功率具有重要影響。

Analysis of Total Knee Arthroplasty revision causes

Background: The number of revision Total Knee Arthroplasty (TKA) is rising in many countries. The aim of this study was the prospective assessment of the underlying causes leading to revision TKA in a tertiary care hospital and the comparison of those reasons with previously published data.

Methods: In this study patients who had revision TKA between 2010 and 2015 were prospectively included. Revision causes were categorized using all available information from patients' records including preoperative diagnostics, intraoperative findings as well as the results of the periprosthetic tissue analysis. According to previous studies patients were divided into early (up to 2 years) and late revision (more than 2 years). Additional also re-revisions after already performed revision TKA were included.

Results: We assessed 312 patients who underwent 402 revision TKA, 89.6% of them were referred to our center for revision surgery. In 289 patients (71.9%) this was the first revision surgery after primary TKA. Among the first revisions the majority was late revisions (73.7%). One hundred thirteen patients (28.1%) had already had one or more revision surgeries before. Overall, the most frequent reason for revision was infection (36.1%) followed by aseptic loosening (21.9%) and periprosthetic fracture (13.7%).

Conclusions: In a specialized arthroplasty center periprosthetic joint infection (PJI) was the most common reason for revision and re-revision TKA. This is in contrast to population-based registry data and has consequences on costs as well as on success rates in such centers.

文獻5

全髖關節置換術后股骨前傾變化如何影響股骨旋轉和前偏心距

譯者 邱興

背景：股骨前傾角變化對全髖關節置換術（THA）后股骨旋轉及前偏心距影響尚未得到充分研究。因此，本研究探討了THA術前術后股骨前傾角、前偏心距與股骨旋轉之間關系。

方法：995例接受分階段行雙側初次THA患者，在每次THA術前均按照標準化方案接受仰臥位計算機斷層掃描（CT）用于手術規劃。分別在首次手術髖關節的術前（首次CT）和術后（第二次CT）測量以下參數：股骨解剖前傾角（定義為股骨頸或假體頸軸與后髁軸之間的夾角）、股骨旋轉（定義為后髁軸相對于CT冠狀面的角度）以及股骨前偏心距（定義為股骨頭中心到包含股骨內側髁、外側髁和梨狀窩和梨狀窩的股骨平面的最短距離）。兩次CT掃描的平均間隔時間為11個月（范圍2-44個月）。使用線性回歸（β=斜率）和Pearson相關系數（r）描述變量間關聯，并通過t分布檢驗相關性。

結果：術前（β=0.565，r=0.914，P<0.001）和術后（β=0.671，r=0.958，P<0.001），股骨前傾角均與前偏心距顯著相關；術前（β=0.623，r=0.575，P<0.001）和術后（β=0.459，r=0.517，P<0.001），股骨前傾角亦與股骨旋轉顯著相關。前傾角從術前到術后的增加會導致前偏心距增加（β=0.621，r=0.908，P<0.001）和股骨內旋（IR）增加（β=0.241，r=0.273，P<0.001）。前傾角增加>20°的患者（平均增加26°，范圍20-40.5°，n=71），其股骨內旋平均增加9.6±9.8°。

結論：增加股骨前傾角會增大前偏心距并增加股骨內旋，平均每增加4°前傾角，內旋約增加1°。外科醫生在THA規劃時應充分重視調整前傾角對術后效果的影響。

圖1. (A) 股骨前傾角的測量方法：術前（左圖）與術后（右圖）均通過連接股骨頭中心與股骨頸中心的軸線（頭頸軸線）與后髁軸之間的夾角進行測量。(B) 股骨旋轉角的測量方法：術前（左圖）與術后（右圖）將CT掃描冠狀面與后髁軸之間的夾角投影至（CT）橫斷面上進行測量。

圖2：股骨前偏距（Anterior femoral offset）定義為股骨頭中心至股骨內側髁、外側髁及梨狀窩確定的股骨平面的距離。當股骨頭中心位于股骨平面后方時，前側偏移為負值。圖示：(A) 術前側位觀，(B) 術前軸位觀，(C) 術后軸位觀。

圖3.示意圖展示股骨前傾角變化引起的肌肉張力平衡調節機制假設。左圖：自然髖關節術前狀態，前部與后部肌肉張力平衡；中圖：術后股骨前傾角增加導致大轉子后移，內旋肌群張力增加而外旋肌群松弛；右圖：繼發性股骨內旋隨后發生以恢復肌肉平衡。

How Do Changes in Femoral Anteversion Impact Femoral Rotation and Anterior Offset After Total Hip Arthroplasty?

Background: The impact of femoral anteversion changes on femoral rotation and anterior offset following total hip arthroplasty (THA) has not been well studied. This study therefore investigated the relationship among femoral anteversion, anterior offset, and femoral rotation before and after THA.

Methods: There were 995 patients who had staged primary bilateral THAs who received a preoperative supine computerized axial tomography (CT) scan, following a standardized protocol, for surgical planning prior to each THA. The following measurements were performed for the first operative hip preoperatively and postoperatively on the first and second CT scans, respectively: femoral anatomic anteversion, defined as the angle between the native femoral neck or stem neck axis and the posterior condylar axis; femoral rotation, defined as the angle of the posterior condylar axis relative to the coronal plane of the CT; and femoral anterior offset, defined as the shortest distance between the femoral head center and a femoral plane containing the epicondyles and the piriformis fossa. The mean time between imagings was 11 months (range, 2 to 44). Associations are described using linear regression (β = slope) and Pearson correlation (r) coefficients. A t distribution was used for testing correlation.

Results: Femoral anteversion correlated with femoral anterior offset preoperatively (β = 0.565, r = 0.914, P < 0.001) and postoperatively (β = 0.671, r = 0.958, P < 0.001), and with femoral rotation preoperatively (β = 0.623, r = 0.575, P < 0.001) and postoperatively (β = 0.459, r = 0.517, P < 0.001). Increasing anteversion from preoperatively to postoperatively increased anterior offset (β = 0.621, r = 0.908, P < 0.001) and femoral internal rotation (IR) (β = 0.241, r = 0.273, P < 0.001). Patients who had >20° increase in anteversion (mean increase 26°, range 20 to 40.5°, n = 71) had a mean increase in femoral IR of 9.6 ± 9.8°.

Conclusions: Increasing femoral anteversion increases anterior offset and IR of the femur, with approximately a 1° increase in IR for every 4° increase in anteversion on average. Surgeons should appreciate the implications of changing anteversion during THA planning.

Keywords: femoral anteversion; femoral offset; femoral rotation; hip biomechanics; prosthetic alignment.

文獻出處：Dennis D A , Bryman J A , Smith G H ,et al. How Do Changes in Femoral Anteversion Impact Femoral Rotation and Anterior Offset After Total Hip Arthroplasty? The Journal of Arthroplasty[2025-02-16].DOI:10.1016/j.arth.2024.07.027.

第二部分：保髖相關文獻

文獻1

歐亞健康中年人群下肢扭轉顯著不同

譯者 羅殿中

目的：目前缺乏一種可靠的測量下肢扭轉力線的方法。已經發表的文獻中，下肢扭轉的正常值也缺乏一致性。采用3D-CT對健康人進行測量，并針對不同人口學指標確定其股骨頸扭轉角（FNV）和脛骨扭轉角（TT）。本研究的目的：1）確定下肢扭轉力線的正常值；2）明確正常人群下肢扭轉畸形個體自身、與個體間的差異。假定情況是：股骨頸扭轉角（FNV）和脛骨扭轉角（TT）受性別、年齡、種族等個體特征影響，而左右側別差別不大。

方法：191例成人健康個體采用3D-CT檢查后，自動檢測其下肢扭轉相關骨性標志。股骨頸扭轉角（FNV）是指股骨頸軸線與股骨后髁連線之間的夾角；脛骨扭轉角（TT）是指脛骨平臺軸線與踝關節軸線之間的夾角。對于脛骨平臺軸線有兩種測量方法：一是脛骨平臺內髁和外髁最突出點的連線（方法1，TT1），二是脛骨平臺內髁和外髁后緣連線（方法2，TT2）；對于踝關節軸線，定義為內踝和外踝之間的連線。上述參考線均為自動測量。并對每個個體的性別、年齡、種族、和BMI進行記錄。P<0.05視為存在顯著統計學差異。

結果：整體結果來看，平均FNV為15.3±9.5°，平均TT為31.6±6.3°。女性髖關節較男性前傾角更大。高加索人髖關節前傾角較亞洲人更小，但脛骨外旋角更大。年齡和BMI對下肢扭轉解剖指標沒有影響。值得注意的是同一個體左右側下肢力線存在差異，FNV平均相差6.3°（絕對差值AD），不對稱比例為47%（As%）；TT1的AD為3°，As%為12%；TT2的AD為4.9°，As%為9%（P=0.008）。

結論：該研究發現下肢扭轉指標患者與患者之間、同一患者左右腿之間的差異很大。對健康人群股骨扭轉角和脛骨外旋角的正常值理解，可幫助外科醫生對病理性FNV和TT的確定，對下肢扭轉畸形的矯正同樣有幫助。

圖1. 股骨前傾/扭轉角測量。采用此前標記的內外髁最后面骨性標志，后髁連線作為后髁軸線（PCA），PCA與股骨頸軸線投射在軸位面上，期間的夾角為股骨扭轉角（FNV）。

圖2. 脛骨扭轉角測量。脛骨近端軸線有兩種測量方法，TT1是脛骨內外側平臺最外側點之間的連線，TT2是脛骨內外側平臺后側緣之間的連線。踝關節軸線為內外踝之間的連線。期間的夾角為脛骨扭轉角（TT）。

表1. 下肢扭轉力線與性別，P值采用Student t檢驗

CI，confident interval,置信區間；SD，standard deviation, 標準差；n.s. 沒有顯著差異

表2. 下肢扭轉力線與種族，P值采用Student t檢驗

CI，confident interval,置信區間；SD，standard deviation, 標準差

Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion

Purpose:There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals' lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.

Methods:Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.

Results:Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).

Conclusion:The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.

文獻出處：Mathon P, Micicoi G, Seil R, Kacaoglu B, Cerciello S, Ahmad F, LiArno S, Teitge R, Ollivier M. Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion. Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1083-1089. doi: 10.1007/s00167-020-06096-0. Epub 2020 Jun 16. PMID: 32548676.

文獻2

Perthes病患者大轉子阻滯術術后的影像學結果

譯者 任寧濤

目的：Legg-Calvé-Perthes病常導致大轉子高位，對髖關節的生物力學產生負面影響。本研究的目的是評估大轉子的生長和大轉子阻滯術的放射學效果。

方法：回顧性分析46名單側Legg-Calvé-Perthes患兒的臨床資料，其中男33例，平均年齡(8±1.3)歲，行股骨大轉子骨骺固定及局部骨骺融合術。通過術前和術后的骨盆x線片(平均隨訪3.5年)，確定大轉子高度、關節大轉子距離和關節中心大轉子距離，并與未受影響側進行比較。建立大轉子高度、關節大轉子距離和關節中心大轉子距離隨時間的生理發育參考值。

結果:以大轉子高度衡量，大轉子阻滯術使大轉子生長降低29%，但僅在<8歲組有統計學意義(p = 0.02)。回歸分析顯示，大轉子生長抑制率為0.92 mm/年。在隨訪期間，患側和健側關節大轉子距離和關節中心大轉子距離趨同:患側髖關節大轉子距離增加(術前:11.2±7 mm，發育成熟:18.5±10 mm;P < 0.01)，而健側無變化(術前:19.3±5 mm，發育成熟:18±6 mm;P = 0.69)。患側髖中心轉子距離保持不變(術前:(-7.9)±7 mm，發育成熟(-7.8)±9 mm;P = 0.13)。在健側，關節中心大轉子距離變為負值(術前:0.9±6mm，發育成熟:(-6.5)±5mm;P < 0.001)。以關節大轉子距離和中心大轉子距離測量，31.8%的患者獲得最佳結果。

結論：大轉子阻滯術對抑制大轉子的生長有積極的影響，從而對髖關節的解剖有積極的影響。進一步的研究必須證明這些積極的影響是否也會導致生物力學和功能上的好處。

圖1 大轉子高度（TH）：大轉子尖和大轉子最底部兩個平行線之間的距離，兩個平行線垂直于股骨干軸線。關節大轉子距離（ATD）：大轉子尖和股骨頭最頂部兩個平行線之間的距離，兩個平行線垂直于股骨干軸線。關節中心大轉子距離(CTD)：大轉子尖和股骨頭中心兩個之間的距離，垂直于股骨干軸線。

圖2 男，11歲，因LCPD行Salter截骨治療，后行大轉子阻滯術。

Radiographic outcome after greater trochanteric epiphysiodesis in patients with Perthes disease

Purpose: Legg-Calvé-Perthes disease often leads to greater trochanteric overgrowth, which negatively affects the biomechanics of the hip joint. This study aimed to evaluate the physiologic growth of the greater trochanter and the effectiveness of greater trochanteric epiphysiodesis radiographically.

Methods: Retrospectively, 46 children (33 male, average age at greater trochanteric epiphysiodesis 8 ± 1.3 years) with unilateral Legg-Calvé-Perthes disease undergoing greater trochanteric epiphysiodesis with screws and curettage of the epiphysis were included. On radiographs of the pelvis pre- and postoperatively (mean follow-up 3.5 years), trochanteric height, articulotrochanteric distance, and center-trochanter distance were determined and compared to the unaffected side. Reference values for the physiological development of trochanteric height, articulotrochanteric distance, and center-trochanter distance over time were established.

Results: Greater trochanteric epiphysiodesis reduced trochanteric growth by 29% measured by trochanteric height, but only statistically significant in the group "<8 years" (p = 0.02). Regression analysis revealed inhibition of trochanteric growth of 0.92 mm/year. Both articulotrochanteric distance and center-trochanter distance of the affected and unaffected side converged during the follow-up period: articulotrochanteric distance of the affected hip increased (preop: 11.2 ± 7 mm, maturity: 18.5 ± 10 mm; p < 0.01) compared to no change on the unaffected side (preop: 19.3 ± 5 mm, maturity: 18 ± 6 mm; p = 0.69). Center-trochanter distance of the affected hip stayed unchanged (preop: (-7.9) ± 7 mm, maturity: (-7.8) ± 9 mm; p = 0.13). On the unaffected side, center-trochanter distance became negative (preop: 0.9 ± 6 mm, maturity: (-6.5) ± 5 mm; p < 0.001). Measured by articulotrochanteric distance and center-trochanter distance, 31.8% achieved an optimal result.

Conclusion: Greater trochanteric epiphysiodesis has a positive effect on greater trochanter growth and therefore on hip anatomy. Further studies must show whether these positive effects also result in biomechanical and functional benefits.

文獻出處：Osterholt AC, Bittersohl B, Westhoff B. Radiographic outcome after greater trochanteric epiphysiodesis in patients with Perthes disease. J Child Orthop. 2024 Feb 4;18(2):153-161. doi: 10.1177/18632521241228700. PMID: 38567042; PMCID: PMC10984151.

文獻3

骨關節炎綜述

譯者 李勇

骨關節炎是一種具有異質性的全身關節疾病，其引發的疼痛是導致功能障礙和過早喪失勞動能力的主要原因。肥胖和關節損傷作為首要風險因素已獲學界公認且具有可干預性。目前研究正通過深入解析包括炎癥反應、代謝異常及創傷后修復在內的復雜致病機制，以及疼痛的病理生理學基礎，為靶向治療策略的制定提供理論依據。

在臨床管理層面，現階段主要采用生活方式干預措施（如自我管理方案、健康教育、體能鍛煉和體重控制）來緩解疼痛和改善關節功能障礙。然而，全球范圍內疾病負擔居高不下的重要誘因，在于患者對現有有效治療方案的依從性不足。對于核心治療效果欠佳且癥狀持續影響生活質量的患者群體，關節置換術可作為備選治療方案。

這種疾病所造成的負擔對受影響的個人的生活質量造成重大影響。對社會而言，這種疾病是保健費用增加和就業不足的主要驅動因素。本綜述基于最新循證醫學證據，系統闡述該領域研究進展并剖析現存學術爭議。

nature reviews：Osteoarthritis

Osteoarthritis is a heterogeneous whole-joint disease that can cause pain and is a leading cause of disability and premature work loss. The predominant disease risk factors-obesity and joint injury-are well recognized and modifiable. A greater understanding of the complex mechanisms, including inflammatory, metabolic and post-traumatic processes, that can lead to disease and of the pathophysiology of pain is helping to delineate mechanistic targets.

Currently, management is primarily focused on alleviating the main symptoms of pain and obstructed function through lifestyle interventions such as self-management programmes, education, physical activity, exercise and weight management. However, lack of adherence to known effective osteoarthritis therapeutic strategies also contributes to the high global disease burden. For those who have persistent symptoms that are compromising quality of life and have not responded adequately to core treatments, joint replacement is an option to consider.

The burden imparted by the disease causes a substantiald impact on individuals affected in terms of quality of life. For society, this disease is a substantial driver of increased health-care costs and underemployment. This Primer highlights advances and controversies in osteoarthritis, drawing key insights from the current evidence base.

文獻出處：Tang S, Zhang C, Oo WM, Fu K, Risberg MA, Bierma-Zeinstra SM, Neogi T, Atukorala I, Malfait AM, Ding C, Hunter DJ. Osteoarthritis. Nat Rev Dis Primers. 2025 Feb 13;11(1):10. doi: 10.1038/s41572-025-00594-6. PMID: 39948092.

文獻4

兒童Legg-Calve-Perthes病行股骨近端內翻截骨術后生活質量的長期改善

譯者 張利強

背景：股骨近端內翻截骨術（PFVO）常用于改善Legg-Calve-Perthes病（LCPD）患者的股骨頭包容性并減少畸形。目前關于PFVO術后對患者生活質量的影響知之甚少。本研究的目的是確定PFVO術后患者報告的身體、心理和社會健康指標的長期變化。

方法：本研究對前瞻性收集的20例接受PFVO治療的單側LCPD患者的患者報告結局測量信息系統（PROMIS）數據進行了回顧性分析。我們在術前及術后大約1、3、8、12和18個月收集了七項PROMIS指標（行動能力、焦慮、疲勞、抑郁癥狀、疼痛干擾、憤怒和同伴關系）。使用重復測量方差分析和Tukey調整的多重配對比較，對不同時間點的PROMIS評分進行了比較。使用Spearman相關性分析了術前和術后心理健康評分之間的關系。

結果：PFVO手術時的平均年齡為8.2±1.6歲。平均隨訪時間為17.0±2.1個月。行動能力評分在術前與術后12個月（P=0.0031）和18個月（P<0.0001）之間有顯著改善。焦慮評分在術前與術后18個月之間有顯著改善（P=0.0014）。疼痛干擾評分在術前與術后12個月和18個月之間有顯著降低（P<0.0001）。同伴關系在術后1個月至18個月之間有顯著改善（P=0.0355）。個體間也存在差異表現為一些患者的抑郁癥狀和焦慮評分較高。術前和術后的焦慮及抑郁癥狀評分之間存在中度相關性。

結論：PFVO術后，PROMIS的行動能力、焦慮、疼痛干擾和同伴關系評分均有顯著改善。雖然每次隨訪時的平均焦慮、抑郁癥狀、同伴關系和憤怒評分均在正常范圍內，但觀察到個體間存在差異，部分患者的焦慮和抑郁癥狀評分較高。這些新的長期PROMIS數據將更好地為患者及其家庭提供關于PFVO術后生活質量和恢復經歷的信息。

Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus Osteotomy

Background: Proximal femoral varus osteotomy (PFVO) is commonly performed to improve femoral head containment and decrease deformity in Legg-Calve-Perthes disease (LCPD). Little is known about how PFVO impacts the quality of life after surgery. The purpose of this study was to determine the longitudinal changes to patient-reported physical, mental, and social health measures after PFVO.

Methods: This is a retrospective review of prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) data from 20 patients with unilateral LCPD treated with a PFVO. We collected seven PROMIS measures (mobility, anxiety, fatigue, depressive symptoms, pain interference, anger, and peer relationships) before and approximately 1, 3, 8, 12, and 18 months after surgery. We compared PROMIS scores across different time points using repeated measures ANOVA and multiple pairwise comparisons with Tukey adjustment. The relationship between presurgery and postsurgery mental health scores was analyzed using a Spearman correlation.

Results: The mean age at PFVO was 8.2 ± 1.6 years. The mean length of follow-up was 17.0 ± 2.1 months. There was a significant improvement in the mobility score between preoperation and 12 months (P= 0.0031) and 18 months postoperation (P< 0.0001). Anxiety scores significantly improved from preoperation and 18 months postoperation (P= 0.0014). A significant reduction in the pain interference score between preoperation and 12 and 18 months postoperation (P<0.0001) was observed. Peer relationships significantly improved from one month postoperatively to 18 months postoperation (P=0.0355). Individual variations were also observed with some patients having elevated depressive symptoms and anxiety scores. Moderate correlations between preoperative and postoperative anxiety and depressive symptoms scores were observed.

Conclusions: PROMIS mobility, anxiety, pain interference, and peer relationship scores improved significantly after PFVO. While the mean anxiety, depressive symptoms, peer relationships, and anger scores were in normal ranges at each visit, individual variations with elevated anxiety and depressive symptom scores were observed. This new longitudinal PROMIS data will better inform patients and families about the quality of life and recovery experience after PFVO.

文獻出處：Angel A Valencia, Dang-Huy Do, Chan-Hee Jo, Harry K W Kim; Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus OsteotomyJournal of pediatric orthopedics 2025 Jan 15; doi:10.1097/BPO.0000000000002896

文獻5

前傾髖臼周圍截骨術治療有癥狀的髖臼后傾：10年隨訪的結果

譯者 陶可

背景：髖臼后傾與鉗夾型股骨髖臼撞擊有關，可導致髖骨關節炎。我們報告了先前描述的一組患者10年后的結果，這些患者接受了矯正性髖臼周圍截骨術治療有癥狀的髖臼后傾。

方法：在術前以及術后2年和10年評估臨床和放射學參數。對22名患者（29髖）進行了Kaplan-Meier生存率分析，平均隨訪期（和標準差）為11 ± 1年（范圍：9至12年）。此外，還進行了單變量Cox回歸分析，以轉為全髖關節置換術為主要終點，以骨關節炎進展、根據Merle d'Aubigné評分為一般或較差的結果或需要進行翻修手術為次要終點。

結果：平均Merle d'Aubigné評分從術前的14 ± 1.4分（范圍：12至17分）顯著提高到10年時的16.9 ± 0.9分（范圍：15至18分）（p < 0.001）。與術前相比，髖關節屈曲(p = 0.003)、內旋(p = 0.003)和內收(p = 0.002)也有顯著改善。10年內平均T?nnis骨關節炎評分無顯著增加(p = 0.06)。以轉為全髖關節置換術為主要終點的累計10年生存率為100%。達到次要終點之一的累計10年生存率為71% (95%置信區間，54%至88%)。預后不良的預測因素是股骨偏心距調整不足和髖臼前傾過度矯正導致前傾過度。

結論：前傾髖臼周圍截骨術治療髖臼后傾可獲得良好的長期效果，平均10年內保留原生髖關節。過度矯正導致髖關節過度前傾和忽略股骨頭頸連接處隨之產生的偏心距，會導致不良后果。

圖 1-A、1-B和1-C 一名患有髖臼后傾的16歲女性患者。圖1-A術前前后位X線片顯示交叉征陽性、后壁征陽性和坐骨棘征陽性。圖1-B前傾髖臼周圍截骨術后拍攝的X線片。圖1-C 10年后隨訪，Merle d’Aubign'e 評分為18分（優秀），無骨關節炎證據。

圖2-A至2-D 一名患有有癥狀的髖臼后傾的18歲女性患者。圖2-A術前X線片。圖2-B前傾髖臼周圍截骨術后拍攝的X線片。圖2-C術后4年，患者報告髖后部疼痛。當時拍攝的X線片顯示髖臼后壁相對突出，并出現雙輪廓（箭頭），這是后撞擊的征象。圖2-D X線片顯示患者隨后接受髖關節脫位后壁修整并在一年后取出部分螺釘后的最終結果。

Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years

Background: Acetabular retroversion is associated with pincer-type femoroacetabular impingement and can lead to hip osteoarthritis. We report the ten-year results of a previously described patient cohort that had corrective periacetabular osteotomy for the treatment of symptomatic acetabular retroversion.

Methods: Clinical and radiographic parameters were assessed preoperatively and at two and ten years postoperatively. A Kaplan-Meier survivorship analysis of the twenty-two patients (twenty-nine hips) with a mean follow-up (and standard deviation) of 11 ± 1 years (range, nine to twelve years) was performed. In addition, a univariate Cox regression analysis was done with conversion to total hip arthroplasty as the primary end point and progression of the osteoarthritis, a fair or poor result according to the Merle d'Aubigné score, or the need for revision surgery as the secondary end points.

Results: The mean Merle d'Aubigné score improved significantly from 14 ± 1.4 points (range, 12 to 17 points) preoperatively to 16.9 ± 0.9 points (range, 15 to 18 points) at ten years (p < 0.001). There were also significant improvements with regard to hip flexion (p = 0.003), internal rotation (p = 0.003), and adduction (p = 0.002) compared with the preoperative status. No significant increase of the mean T?nnis osteoarthritis score was seen at ten years (p = 0.06). The cumulative ten-year survivorship, with conversion to a total hip arthroplasty as the primary end point, was 100%. The cumulative ten-year survivorship in achievement of one of the secondary end points was 71% (95% confidence interval, 54% to 88%). Predictors for poor outcome were the lack of femoral offset creation and overcorrection of the acetabular version resulting in excessive anteversion.

Conclusions: Anteverting periacetabular osteotomy for acetabular retroversion leads to favorable long-term results with preservation of the native hip at a mean of ten years. Overcorrection resulting in excessive anteversion of the hip and omitting concomitant offset creation of the femoral head-neck junction are associated with an unfavorable outcome.

文獻出處：Klaus A Siebenrock, Claudio Schaller, Moritz Tannast, Marius Keel, Lorenz Büchler. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am. 2014 Nov 5;96(21):1785-92. doi: 10.2106/JBJS.M.00842.

文獻6

髖關節發育不良中髖臼覆蓋特征的性別差異

譯者 陳志強

背景：進行偏心髖臼旋轉截骨術（ERAO）是為了預防由發育性髖關節發育不良 （DDH） 引起的骨關節炎。為了獲得足夠的髖臼覆蓋，了解 DDH 中髖臼覆蓋的特征是必要的。然而，DDH 男性髖臼覆蓋的特征仍不清楚。我們認為女性和男性之間髖臼覆蓋率的差異可能與不同性別骨盆形態的差異有關。

問題/目的：(1) 女性和男性 DDH 患者的髖臼覆蓋率有何不同？(2) DDH 女性和男性的髂骨和坐骨的旋轉有何不同？(3) DDH女性和男性的髂骨和坐骨的旋轉在不同高度位置上與髖臼覆蓋率之間的關系？

方法：2016年至2023年間，我院共有114名患者（138個髖關節）接受了ERAO。我們排除了T?nnis 2級或以上、LCEA為25o或以上以及骨盆或股骨畸形的患者，最終納入了100名患者（122個髖關節）。女性患者（98 個髖關節）的年齡中位數（范圍）為 40 歲（10 -58 歲），男性患者（24 個髖關節）的年齡中位數（范圍）為 31 歲（14 -53 歲）。我們使用了所有患者的術前骨盆正位片和CT 數據。通過骨盆正位X光片評估了交叉征、后壁征和骨盆寬度指數。我們在兩個不同的高度評估了髂骨在軸向平面的旋轉情況，特別是在通過髂前上棘的平面處，以及在 CT 數據中通過恥骨聯合和坐骨棘的平面處。此外，我們還評估了髖臼前后扇形角。我們還比較了每位患者中女性和男性的骨盆骨測量值和髖臼覆蓋測量值的相關變量。我們分別評估了女性和男性骨盆形態測量值與髖臼覆蓋率之間的相關性，然后將結果進行比較，以確定是否存在性別差異。對于連續變量，我們采用了 t 檢驗；對于分類變量，我們采用了Fisher精確檢驗。P值小于0.05被認為具有統計學意義。

結果：在評估骨盆正位X光片時，髖臼后傾的指標--交叉征在性別間沒有差異，而后壁征（女性 46% [98 例中的 45 例] 髖關節與男性 75% [24 例中的 18 例] 髖關節，OR 3. 50[95%置信區間 (CI) 1.20 至 11.71]；P = 0.01）和骨盆寬度指數小于 56%（女性為 1%[98 例中的 1 例]，男性為 17%[24 例中的 4 例]，OR 18.71 [95% CI 1.74 至 958.90]；P = 0.005）的發生率男性高于女性。髂骨旋轉參數沒有差異，但男性的坐骨外旋更多（女性為 30° ± 2°，男性為 24° ± 1°；p < 0.001）。在髖臼覆蓋方面，女性和男性的髖臼前扇形角沒有差異。相反，男性的髖臼后扇形角值小于女性（85° ± 9° 對 91° ± 7°；p = 0.002）。在女性中，髂骨旋轉與髖臼扇形角之間存在相關性（髖臼前扇形角：r = -0.35 [95% CI -0.05 to 0.16]；p < 0.001，髖臼后扇形角：r = 0.42 [95% CI 0.24 to 0.57]；p < 0.001）。同樣，髖臼旋轉也與兩個髖臼扇形角相關（髖臼前扇形角：r = -0.34 [95% CI -0.51 to -0.15]；p < 0.001；髖臼后扇形角：r = 0.45 [95% CI 0.27 to 0.59]；p < 0.001）。因此，在女性中，我們觀察到坐骨外旋和骶骨內旋與髖臼前部覆蓋增加和后部覆蓋減少相關。相反，雖然男性的髖臼覆蓋率與髂骨旋轉有相關性（髖臼前扇形角：r = -0.55 [95% CI -0.78 to -0.18]；p = 0.006；髖臼后扇形角：r = 0.74 [95% CI 0.48 to 0.88]；p < 0.001），但與坐骨旋轉沒有相關性。

結論：在男性中，髖臼后傾比女性更常見，這歸因于他們的髖臼后覆蓋率降低。在女性中，髖臼后覆蓋率的增加與坐骨的外旋角相關，而在男性中，坐骨旋轉與髖臼后覆蓋之間沒有相關性。在通過ERAO治療男性 DDH 時，必須調整截骨塊以防止髖臼后部覆蓋不足。未來的研究可能需要研究不同下肢位置下男性和女性髖臼覆蓋率的差異，并考慮截骨塊旋轉的方向。

臨床相關性：研究結果表明，患有 DDH 的男性比女性更頻繁地表現出髖臼后傾，這歸因于在男性中觀察到的髖臼后覆蓋率低。男性髖臼后部覆蓋率較小可能與性別之間坐骨形態的差異有關。在男性 DDH 患者的ERAO中，充分旋轉的髖臼骨塊可能有助于補償髖臼后側覆蓋不足。

What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia?

Background:Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes.

Questions/purposes:(1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?

Methods:Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with T?nnis Grade 2 or higher, a lateral center-edge angle of 25o or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.

Results:In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation.

Conclusion:In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation.

Clinical relevance:Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.

來源：304關節學術

作者：304關節團隊

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