1、采用個性化力線對齊的雙交叉韌帶保留型全膝關節置換術的短期臨床效果

2、在固定良好的髖臼杯中固定雙動杯是否是髖關節翻修術的可靠選擇

3、患者恢復能力對日間初次全髖和全膝關節置換術及其術后療效的影響

4、肥胖對單髁膝關節置換術的影響

5、圣地亞哥骨盆截骨治療骨骺閉合患者

6、髖關節發育不良并發股骨骨骺外側生長障礙的髖臼發育情況

7、術前定量影像學在預測髖臼盂唇修復與重建術中決策中的應用

8、Perthes病的發病風險因素

9、髖臼周圍截骨術評估

10、股骨頭骨壞死與軟骨下不全骨折外側塌陷病灶顯微結構特征的差異

11、與接受髖臼周圍截骨術的男性相比，女性的骨盆前傾和腰椎活動度更大

第一部分：關節置換及保膝相關文獻

文獻1

采用個性化力線對齊的雙交叉韌帶保留型全膝關節置換術的短期臨床效果

譯者 張軼超

背景：雙交叉韌帶保留（BCR）假體已經被引入，通過保留前后交叉韌帶來重建正常的膝關節運動。然而，由于一些令人失望的報道，BCR全膝關節置換術（TKA）的使用仍然存在爭議。我們一直在做帶有個性化力線對齊（PA）的BCR TKA。本研究旨在揭示PA-BCR膝關節置換術（PA-BCR TKA）的下肢對線和軟組織平衡情況，并比較PA-BCR TKA與單間室膝關節置換術（UKA）的臨床結果。

方法：50例BCR TKA和58例UKA納入本研究。術中評估BCR TKA的假體間間隙，術后通過全長站立位X線片測量髖關節-膝關節-踝關節（HKA）角、脛骨內側近端角（MPTA）和股骨外側遠端角（LDFA）。采用2011膝關節協會評分（KSS）系統和膝關節損傷及骨關節炎預后評分（KOOS）在平均術后2年（1-4年）時比較BCR TKA與UKA的短期臨床結局。

結果：PA-BCR TKA的冠狀力線值如下：HKA角 177.9°±2.3°；MPTA 85.4°±1.9°;LDFA 87.5°±1.9°。假體間在膝關節屈曲10°、30°、60°和90°時的間隙，內側室分別為11.1±1.2、10.9±1.4、10.7±1.3和11.2±1.4 mm，外側室分別為12.9±1.5、12.6±1.8、12.5±1.8和12.5±1.7 mm。PA-BCR TKA患者的期望值評分和最大伸直角度均明顯優于UKAs。

結論：PA-BCR TKA的短期臨床結果與UKAs相當或略優于UKAs。

圖1.圖示是測量內外側間隙的一種牽張器。

圖2.采用導航系統結合給與內外翻應力來評估內外側的松弛度。

Short-term clinical results of bicruciate-retaining total knee arthroplasty using personalized alignment

Background：Bicruciate-retaining (BCR) prosthesis has been introduced to recreate normal knee movement by preserving both the anterior and posterior cruciate ligaments. However, the use of BCR total knee arthroplasty (TKA) is still debatable because of several disappointing reports. We have been performing BCR TKAs with personalized alignment (PA). This study aimed to reveal the limb alignment and soft tissue balance of PA-BCR TKAs and compare the clinical outcomes of PA-BCR TKAs with those of unicompartmental knee arthroplasty (UKA).

Methods：Fifty BCR TKAs and 58 UKAs were included in this study. The joint component gaps of BCR TKA were evaluated intraoperatively and the postoperative hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were measured using full-length standing radiography. The short-term clinical outcomes of BCR TKAs were compared with those of UKA using the scoring system of 2011 Knee Society Scoring (KSS) and the knee injury and osteoarthritis outcome score (KOOS) at an average of 2 years postoperatively (1-4yeras).

Results：The coronal alignment values of PA-BCR TKA were as follows: HKA angle, 177.9°±2.3°; MPTA, 85.4°±1.9°; and LDFA, 87.5°±1.9°. The joint component gaps at fexion angles of 10°, 30°, 60°, and 90° were 11.1±1.2, 10.9±1.4, 10.7±1.3, and 11.2±1.4 mm for the medial compartment and 12.9±1.5, 12.6±1.8, 12.5±1.8 and 12.5±1.7 mm for the lateral compartment, respectively. The patient expectation score and maximum extension angle of PA-BCR TKA were signifcantly better than those of UKAs.

Conclusions：The short-term clinical outcomes of PA-BCR TKA were comparable or a slightly superior to those of UKAs.

文獻出處：Inui H, Yamagami R, Kono K, Kawaguchi K, Kage T, Murakami R, Nakamura H, Saita K, Taketomi S, Tanaka S. Short-term clinical results of bicruciate-retaining total knee arthroplasty using personalized alignment. BMC Musculoskelet Disord. 2023 Dec 12;24(1):965. doi: 10.1186/s12891-023-07083-5. PMID: 38087214; PMCID: PMC10714564.

文獻2

在固定良好的髖臼杯中固定雙動杯 —— 是否是髖關節翻修術的可靠選擇？

譯者 馬云青

背景：“杯中杯” 技術允許在非骨水泥杯型髖臼杯固定良好的情況下對失敗的全髖關節置換 (THA) 進行翻修。此外，它可用于襯墊磨損或襯墊機械故障，當不可能更換新的襯墊。最近，“杯中杯” 技術結合雙動杯 (DMC) 已經引起了越來越多的關注。作者的目的是報告這類手術后的臨床和影像學結果。
方法：回顧性分析 2015 ~ 2020 年采用DMC-“杯中杯” 技術治療的 33 例患者的臨床資料。14名患者死亡，19 名患者接受最終隨訪，其中 15 名患者接受了查體和放射線檢查，2 名患者僅接受了放射線檢查，2 名患者僅接受了電話訪談?；颊呦嚓P的結果測量包括 HHS 和 WOMAC評分。X 線片評估假體的松動和位置。主要終點是任何原因的翻修，次要終點是在最近的隨訪中 DMC 的松動。生存分析采用 Kaplan-Meier 方法。
結果：平均手術年齡為 78.6 ± 7.1 (63-93) 歲，平均手術時間為 124.4 ± 52.0 (60-245) 分鐘。復發性脫位 (42.4%)、假體周圍骨折 (39.4%) 和聚乙烯磨損 (6.1%) 是最常見的手術原因。平均隨訪持續時間 (n = 19) 為 28.5 ± 17.3 (3-64) 個月。隨訪的平均 HHS 評分為 59.4 ± 22.2 (29-91) ，平均 WOMAC 評分為 59.7 ± 25.6 (15.6-93.8)。由于關節不穩定而翻修了兩個髖臼杯，并且由于假體周圍關節感染而進行了一次翻修，平均隨訪為 22.9 ± 18.0 (1.5-64.6) 個月后，總髖臼假體存活率為 86.8% 。術后平均隨訪為 22.3 ± 18.5 (1.5 ~ 64.7) 個月，無松動存活率為 90.9% 。
結論：作者發現在固定良好的杯中粘固 DMC 是解決 THA 不穩定性的一種有希望的中短期治療方法，特別是對于老年人和體弱患者，他們受益于縮短的手術時間。正確的水泥固定技術、適當的杯定位以及選擇足夠大假體型號是治療成功的關鍵。為了進一步證明該技術的優點，將來需要更長的隨訪。

文獻出處：Bellova P, Koch F, Stiehler M, Hartmann A, Fritzsche H, Günther KP, Goronzy J. Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty? BMC Musculoskelet Disord. 2021 Nov 24;22(1):982. doi: 10.1186/s12891-021-04835-z. PMID: 34819056; PMCID: PMC8613958.

文獻3

患者恢復能力對日間初次全髖和全膝關節置換術及其術后療效的影響

譯者 張薔

背景：門診施行的全髖和全膝關節置換術在美國逐年增加?；颊叩膹驮芰κ轻t生在判斷患者是否適合施行日間手術過程中考量的重要指標。本篇文章研究了患者復原力與日間手術條件下施行初次全髖和全膝關節置換手術取得成功之間的關系。

方法：我們進行了一項回顧性研究，探索了患者術前復原力評分（疼痛自我效能問卷簡式2項表[PSEQ-2]）對日間手術率和術后3個月及1年患者自評量表（PROMs）的影響。我們應用回歸分析法評價日間手術（SDD）成功率與術前PSEQ-2復原力評分的關系。同時，我們還應用混合線性模型評估術前PSEQ-2復原力評分與術后PROMs的關系。

結果：在對700例全膝關節置換手術（TKA）病例配平一般指標后（如年齡和BMI），我們發現術后當日出院的患者（日間）術前PSEQ-2評分明顯更高（P = 0.022），且差距有統計學意義。而同樣配平530例全髖關節置換手術（THA）病例的一般指標后，我們發現術后當日出院的患者術前PSEQ-2評分更高，但差距并無統計學意義（P = 0.058）。我們同時還發現術前的PSEQ-2評分與術后3個月和1年的全球心理健康評分呈負相關性（P = 0.023）。而除此之外，我們沒有發現術前PSEQ-2評分與其他PROMs之間存在統計學相關性。

結論：施行初次全髖和全膝關節置換術后當日出院的日間患者術前復原力評分明顯更高。但術前復原力評分并不能預測術后PROMs評分的高低。

The Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty

Background Total hip and knee arthroplasty rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge. This study examined the relationship between resilience and success of same-day discharge in patients undergoing primary total hip and knee arthroplasty.

Methods A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated 2-Item Form [PSEQ-2]) on same-day discharge rates and patient-reported outcome measures (PROMs) at three months and one year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of same-day discharge (SDD) success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs.

Results Of the cohort of 700 total knee arthroplasty (TKA) patients, after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 total hip arthroplasty (THA) patients, again after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery trended towards significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at three months and one year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs.

Conclusions Preoperative resiliency scores were significantly higher in patients undergoing primary total hip and knee arthroplasty that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.

文獻4

肥胖對單髁膝關節置換術的影響

譯者 沈松坡

背景： 先前的研究表明，肥胖可能會增加單髁膝關節置換術（UKA）的失敗風險。本研究評估了肥胖對UKA術后結果的影響。

方法： 研究分析了2000年至2022年間，由8位外科醫生完成的4,973例初次水泥固定內側UKA。主要研究終點為假體存活率，次要研究終點包括翻修率、翻修原因、患者報告結果（PROMs）及臨床指標。患者的平均年齡為66歲（范圍：33至96歲），女性占54.6%，平均體重指數（BMI）為29.9（范圍：15.6至63.4），平均隨訪時間為5.1年。根據BMI值（30、35、40）分組，分別形成以下組別：BMI ≤ 30（N = 2,858），BMI > 30（N = 2,115）；BMI ≤ 35（N = 4,137），BMI > 35（N = 836）；BMI ≤ 40（N = 4,680），BMI > 40（N = 293）。

結果： 在5年和10年時，假體存活率分別為95.7%和92.8%。5年存活率雖仍然較高，但在BMI 30和35的分界點上略有下降（BMI ≤ 30：96.7%，BMI > 30：94.2%，P < 0.001；BMI ≤ 35：95.8%，BMI > 35：94.9%，P = 0.005），而BMI > 40組的存活率略有增加但無統計學意義（BMI ≤ 40：95.7%，BMI > 40：96.0%；P = 0.325）。關節炎進展是最常見的翻修原因，并且在高BMI組中更為常見。感染率在所有BMI組別中均保持較低水平。使用KOOS, JR評分評估的最低臨床重要差異（MCID）在各BMI分界點間無顯著差異，但BMI > 30組的患者術后評分提升幅度更大（P = 0.034）。

結論： 盡管高BMI患者的翻修率略有增加，但由于所有BMI組的感染率均較低，且患者報告結果（PROMs）有所改善，我們仍然對UKA在肥胖患者中的應用持積極態度。

The Influence of Obesity on Unicondylar Knee Arthroplasty

Introduction: Some prior studies suggest obesity increases unicondylar knee arthroplasty (UKA) failure risk. This study evaluated obesity's impact on UKA outcomes at a single institution.

Methods: We analyzed 4,973 primary cemented medial UKAs performed by eight surgeons from 2000 to 2022. The primary outcome was implant survivorship. Secondary outcomes included revision rates, reasons for revision, patient-reported outcomes, and clinical metrics. The mean age was 66 years (range, 33 to 96), 54.6% were women, body mass index (BMI) averaged 29.9 (range, 15.6 to 63.4), and follow-up averaged 5.1 years. Outcomes were stratified by BMI cutoffs (BMI: 30; 35; 40), yielding group sizes of ≤ 30 (N = 2,858), > 30 (N = 2,115), ≤ 35 (N = 4,137), > 35 (N = 836), ≤ 40 (N = 4,680), and > 40 (N = 293).

Results: At five and 10-years, implant survivorship was 95.7 and 92.8%, respectively. At five years, survivorship remained high but declined slightly with increased BMI for the 30 and 35 cutoffs (≤ 30: 96.7%, > 30: 94.2%, P < 0.001; ≤ 35: 95.8%, > 35: 94.9%; P = 0.005), while a slight, non-significant increase occurred for BMI > 40 (≤ 40: 95.7%, > 40: 96.0%; P = 0.325). Arthritis progression was the most common revision reason, increasing with BMI. Infection rates remained low across all BMI's. There was no difference in the percentage of patients achieving a minimal clinically important difference using the Knee Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) with each BMI cutoff, but KOOS, JR score changes were significantly greater in the higher BMI patients using the BMI 30 cutoff (P = 0.034).

Conclusions: While higher BMI patients had marginally higher rates of revision, we remain enthusiastic about UKA in these patients due to low infection rates across all BMI cohorts and improvements in PROMs.

第二部分：保髖相關文獻

文獻1

圣地亞哥骨盆截骨治療骨骺閉合患者

譯者 羅殿中

目的：圣地亞哥骨盆截骨術（San Diego Pelvic Osteotomy）常用于神經肌肉疾病患者髖關節脫位的外科治療。該短期隨訪研究的目的是比較該手術針對骨骺閉合與骨骺未閉患者的療效。

方法：該回顧性研究納入43例（44髖）神經肌肉型髖關節脫位患者，通過圣地亞哥骨盆截骨術（San Diego Pelvic Osteotomy）治療。其中24髖在手術時Y形軟骨未閉合，20髖手術時已經閉合。術前、術后和最終隨訪時記錄中心邊緣角（CEA）、臼頂傾斜角（AA）、Reimer指數（RI），并進行統計學分析。

結果：在術前術后影像上，骨骺未閉患者CEA改善了39°（7°-69°），骨骺閉合患者CEA改善了30°（9°-80°）；兩組之間的改善程度無顯著性差異（p=0.084）。術前術后AA改善程度，兩組之間無統計學差異（p=0.65），其中骨骺未閉組AA改善了11°（3°-23°）、骨骺閉合組AA改善了10°（4°-21°）。RI骨骺未閉組由61%改善到11%，骨骺閉合組由51%改善到12%。RI在術前、術后即刻和末次隨訪的影像上，均無統計學差異。在末次隨訪時，CEA、AA、RI等指標兩組患者中均保持穩定。

結論：圣地亞哥骨盆截骨術（San Diego Pelvic Osteotomy）治療神經肌肉型髖關節脫位，針對骨骺閉合與骨骺未閉合同樣有效。該研究對“骨骺閉合是圣地亞哥骨盆截骨術（San Diego Pelvic Osteotomy）禁忌癥”的觀念提出了挑戰。

圖1. 骨骺未閉合患者示例，術前、術后即刻和近期隨訪。

圖2. 骨骺閉合患者示例，術前、術后即刻和近期隨訪。

文獻出處：Murar J, Dias LS, Swaroop VT. San Diego pelvic osteotomy in patients with closed triradiate cartilage. J Child Orthop. 2018 Oct 1;12(5):461-471. doi: 10.1302/1863-2548.12.180046. PMID: 30294370; PMCID: PMC6169559.

文獻2

髖關節發育不良并發股骨骨骺外側生長障礙的髖臼發育情況

譯者 任寧濤

背景:股骨頭骨骺外側生長障礙是髖關節發育不良治療過程中最常見的骨骺生長障礙類型。雖然這種類型的骨骺生長障礙被認為可導致髖臼發育不良，但這種生長障礙模式對髖關節發育不良影響的自然史尚不清楚。為了探討這一問題，我們對48名DDH患者治療后發生股骨頭骨骺外側生長障礙的58例髖臼發育情況進行了回顧性研究。

方法:58例髖關節中，36例行閉合復位，22例行切開復位。復位時患者平均年齡為22個月(范圍，3 ~ 97個月)，最近一次隨訪評估時為21歲(范圍，10 ~ 55歲)。隨訪時Severin I級(優)或II級(良)為臨床效果滿意， Severin III級(可)或IV級(差)的被認為是臨床效果不滿意。在連續的影像學上觀察股骨頭的特定變化，在后期隨訪期間，測量髖關節的各種影像學參數，包括股骨骨骺的側傾程度，并在四個時間節點(復位前、復位后兩年、6至8歲和最終隨訪時)對劃分為滿意和不滿意的髖關節進行比較。

結果:平均10歲(4 ~ 14歲)首次出現股骨頭骨骺外側生長發育障礙。在骨骺、骨骺或干骺端中沒有一致的早期變化模式與骨骺外翻傾斜的后期發展有關。末次隨訪時34例髖(59%)滿意，24例髖不滿意。不滿意的髖關節平均在7歲時表現為髖臼發育不良。隨著時間的推移，骨骺板的傾斜逐漸變得更水平甚至倒置; 然而，連續測量的傾斜度并不是Severin分類的顯著預測因子。

結論：股骨頭骨骺外側生長障礙并不一定與髖臼發育不良有關，因為當發育不良確實發生時，通常在確定骨骺生長障礙之前就很明顯了。重要的是監測復位后髖臼的發育，而不是尋找骨骺生長發育的影像學變化，這在幼兒中很難發現。

圖1 25個月大小患兒，右髖高脫位，行內收肌松解閉合復位

圖2 該患者9歲時，股骨近端骨骺外側傾斜，股骨頸上外側可見向外延續的“骨板”。股骨頭部略扁平，髖臼發育不良。

圖3 該患者11歲時，股骨頭嚴重外翻畸形，伴有殘余髖臼發育不良，淚滴形態異常，右髖關節半脫位。

Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis

Background: Lateral growth disturbance of the capital femoral epiphysis is the most common type of physeal arrest complicating the treatment of developmental hip dysplasia. Although this type of physeal damage has been assumed to result in poor acetabular development, the natural history of dysplastic hips affected by this pattern of growth disturbance is still unclear. To investigate this issue, we evaluated acetabular development in a retrospective study of fifty-eight hips in forty-eight patients who had lateral physeal arrest after management of developmental hip dysplasia.

Methods: Of the fifty-eight hips, thirty-six were reduced closed and twenty-two were reduced open. The average age of the patients was twenty-two months (range, three to ninety-seven months) at the time of the reduction and twenty-one years (range, ten to fifty-five years) at the time of the latest follow-up evaluation. Hips rated as Severin class I (an excellent result) or II (a good result) were defined as having a satisfactory result, and those rated as Severin class III (a fair result) or IV (a poor result) were considered to have an unsatisfactory result. Specific femoral head changes were sought in the complete radiographic files on all hips. Various radiographic parameters of hip integrity, including the degree of lateral tilt of the capital femoral epiphysis, were measured over time, and comparisons were made between hips classified as satisfactory and those classified as unsatisfactory at four time-points: before the reduction, at two years after the reduction, at six to eight years of age, and at the time of the final follow-up.

Results: Lateral growth disturbance of the capital femoral epiphysis was first evident by an average of ten years of age (range, four to fourteen years of age). There was no consistent early pattern of changes in the epiphysis, physis, or metaphysis related to later development of valgus tilt of the epiphysis. Thirty-four hips (59 percent) were rated as satisfactory and twenty-four were rated as unsatisfactory at the latest follow-up evaluation. Hips classified as unsatisfactory exhibited poor acetabular development by an average age of seven years. The inclination of the epiphyseal plate became progressively more horizontal or even reversed over time; however, serial measurements of inclination were not significant predictors of Severin classification.

Conclusions: Lateral growth disturbance of the capital femoral epiphysis is not necessarily associated with poor acetabular development, as when dysplasia does occur it is generally evident prior to the identification of the physeal arrest. It is important to monitor acetabular development after reduction rather than search for radiographic changes of physeal arrest, which are difficult to detect in young children.

文獻出處：Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000 Dec;82(12):1692-700.

文獻3

術前定量影像學在預測髖臼盂唇修復與重建術中決策中的應用

譯者 李勇

摘要：術中評估髖臼盂唇的質量決定了關節鏡下修復與重建治療髖臼盂唇撕裂的選擇。T2 映射技術能夠區分健康與受損的軟骨。本研究探討了 T2 映射磁共振成像（MRI）是否可以在術前預測髖臼盂唇修復與重建。這項回顧性比較研究納入了在 2021 年 3 月至 2023 年 2 月期間在一家機構接受髖臼盂唇修復或重建手術并進行了術前 T2 映射 MRI 的患者。三位評審員使用 Syngovia 記錄了患者矢狀切面上髖臼盂唇、髖臼軟骨和股骨軟骨的平均 T2 映射值。通過組內相關系數評估評審員對 T2 值的一致性。使用 t 檢驗比較 T2 平均值。構建了三個貝葉斯回歸模型，分別分析髖臼盂唇、髖臼軟骨和股骨軟骨的 T2 映射值。95% 可信區間用于確定回歸系數的顯著性。共納入 63 例手術：14 例重建和 49 例修復。參與者年齡在 14 至 50 歲之間，其中 35 名女性和 28 名男性。評審員對 T2 測量值的一致性非常好。修復組和重建組之間的平均 T2 值沒有顯著差異。所有三個模型均顯示，髖臼盂唇重建的幾率與 T2 映射值呈負相關，與年齡呈正相關，并且在男性中增加。術前髖臼盂唇、髖臼軟骨和股骨軟骨的 T2 映射值與需要進行髖臼盂唇重建的幾率呈負相關。年齡增加和男性與需要進行髖臼盂唇重建的幾率增加相關。本研究將進一步評估其他預測髖臼盂唇修復與重建的變量。

Preoperative quantitative imaging use in predicting intraoperative decision for hip labral repair versus reconstruction

Intraoperative assessment of labral quality determines arthroscopic repair versus reconstruction for hip labral tear treatment. T2 mapping technology discriminates between healthy and damaged cartilage. This study investigated if T2 mapping magnetic resonance imaging (MRI) can preoperatively predict labral repair versus reconstruction. This retrospective comparative study included patients with preoperative T2 mapping MRI who underwent hip labral repair or reconstruction at a single institution between March 2021 and February 2023. Three reviewers using Syngovia recorded average T2 mapping values for the labrum, acetabular cartilage, and femoral cartilage on patients’ sagittal cut. Intraclass correlation values estimated rater agreement of T2 values. T2 means were compared using t-tests. Three Bayesian regression models were created, separately analyzing the labrum, acetabular cartilage, and femoral cartilage mapping values. The 95% credible intervals determined the significance of regression coefficients. A total of 63 operations were included: 14 reconstructions and 49 repairs. Participants were 14- to 50-years-old, with 35 females and 28 males. There was excellent agreement among raters for T2 measurements. There was no significant difference in average T2 values between the repair and reconstruction groups. All three models showed that the odds of labral reconstruction were negatively associated with T2 mapping values, positively associated with age, and increased in males. Preoperative T2 mapping values from the labrum, acetabular, and femoral cartilage are negatively associated with the odds of needing a labral reconstruction. Increased age and being male are associated with increased odds of needing a labral reconstruction. This study will allow further evaluation into other variables that predict labral repair versus reconstruction.

文獻出處：Alder CC, Wait TJ, Wipf CJ, Keeter CL, Peszek A, Mayer SW, Ho CP, Orahovats A, Genuario JW. Preoperative quantitative imaging use in predicting intraoperative decision for hip labral repair versus reconstruction. J Hip Preserv Surg. 2024 Nov 15;11(4):287-297. doi: 10.1093/jhps/hnae035. PMID: 39839552; PMCID: PMC11744471.

文獻4

Perthes病的發病風險因素：一項為期二十年的全國性綜合分析

譯者 張利強

背景：Perthes病是一種罕見的影響髖關節的兒童疾病，可導致股骨頭不同程度的壞死。Perthes病的根本病因仍未知，因此，確定與其發病相關的風險因素對于早期診斷和干預至關重要。本研究旨在對一個大規模的隊列中與Perthes病相關的風險因素進行分析。

方法：使用2003年至2023年美國國家數據庫數據進行一項病例對照研究。將確診為Perthes病的患者與未患病者進行比較。采用多變量邏輯回歸模型對可能與Perthes病相關的變量進行分析，并計算了調整后的比值比（AOR）及其95%置信區間。使用統計學檢驗顯著性，P值小于0.05認為具有顯著意義。

結果：本研究納入了4034例Perthes病患者和3483745例年齡匹配的對照患者。Perthes病患者的平均年齡為8.38歲，對照組為8.35歲（P=0.27）。確定的顯著風險因素包括男性（AOR：3.14，P < 0.001）、白種人（AOR：2.16，P < 0.001）和肥胖（AOR：2.21，P < 0.001）。相反，黑種人（AOR：0.26，P < 0.001）、西班牙裔（AOR：0.53，P < 0.001）和亞裔（AOR：0.55，P < 0.001）種族與患Perthes病的幾率較低相關。其他顯著的風險因素包括吸煙暴露（AOR：1.25，P = 0.02）、高血壓（AOR：1.64，P < 0.001）和易栓癥（AOR：9.17，P < 0.001）。

結論：本研究是文獻中關于Perthes病的最大規模研究，確定了包括男性、白種人、肥胖、吸煙暴露、高血壓、易栓癥在內的多個獨立風險因素。在Perthes病患兒中，盡管易栓癥較為罕見，但其調整后的比值比最高。這些發現為進一步研究易栓癥病的潛在病因提供了寶貴的見解，特別是在血管和代謝途徑方面的作用。

Risk Factors for Developing Perthes Disease: A Comprehensive National Analysis Spanning 2 Decades

Background: Perthes disease is an uncommon pediatric condition affecting the hip joint, causing varying degrees of femoral head necrosis. The underlying cause of Perthes remains unknown, thus it is crucial to identify risk factors associated with its development to aid in early diagnosis and intervention. This study aimed to analyze risk factors associated with Perthes in a large cohort.

Methods: A case-control study was conducted using data from a U.S. national database from 2003 to 2023. Patients diagnosed with Perthes were compared with those without the disease. Variables potentially associated with Perthes were analyzed using multivariable logit models, and adjusted odds ratios (AOR) with 95% CI were calculated. Statistical significance was determined, and a P-value < 0.05 was considered significant.

Results: The study included 4034 patients with Perthes and 3,483,745 age-matched controls. The mean age of patients with Perthes was 8.38 years, compared with 8.35 years in the control group (P= 0.27). Significant risk factors identified included male sex (AOR: 3.14, P< 0.001), white race (AOR: 2.16, P< 0.001), and obesity (AOR: 2.21, P< 0.001). Conversely, Black (AOR: 0.26, P< 0.001), Hispanic (AOR: 0.53, P< 0.001), and Asian (AOR: 0.55, P<0.001) races were associated with lower odds of developing Perthes. Additional significant risk factors included tobacco exposure (AOR: 1.25, P= 0.02), hypertension (AOR: 1.64, P< 0.001), and thrombophilia (AOR: 9.17, P< 0.001).

Conclusions: This study is the largest study on Perthes disease in literature, identifying several independent risk factors, including male sex, white race, obesity, tobacco exposure, hypertension, obesity, and thrombophilia. Among children with Perthes, thrombophilia exhibited the highest adjusted odds ratio, despite its rarity. These findings offer valuable insights for further research aimed at elucidating the underlying etiology of Perthes disease, particularly with regards to the roles of vascular and metabolic pathways.

文獻出處：Tanya Boghosian, David Momtaz, Jad Lawand, Jacob Jahn, Blaire Peterson, Abdullah Ghali, Pooya Hosseinzadeh; Risk Factors for Developing Perthes Disease: A Comprehensive National Analysis Spanning 2 DecadesJournal of pediatric orthopedics 2025 Mar 05; doi:10.1097/BPO.0000000000002914

文獻5

髖臼周圍截骨術評估：一項前瞻性研究旨在評估預計的負重區、骨密度、軟骨厚度和截骨調整位置

譯者 陶可

髖關節發育不良的特征是髖臼和股骨頸位置異常、股骨頭覆蓋不足以及髖臼緣骨質破壞?；加畜y關節發育不良的人群中，有許多人會在年輕時出現髖關節或腹股溝疼痛、髖關節功能下降和骨關節炎髖臼周圍截骨術是為了預防髖關節發育不良患者的骨關節炎而實施的，自1996年以來，丹麥奧胡斯(Aarhus)大學醫院已實施了500多例截骨術。多年來，一直在進行治療研究和質量改進，這篇博士論文就是這一過程的一部分。本論文的目的是評估髖臼周圍截骨術后的結果，包括：I）評估髖臼周圍截骨術前后預計的負重區，II）評估髖臼周圍截骨術后髖臼的骨密度變化，III）開發一種精確有效地評估髖關節關節軟骨厚度的技術，IV）檢查髖臼周圍截骨術后重新定位的髖臼的穩定性。

在研究I中，我們應用了基于3D計算機斷層掃描(CT)的立體學方法來評估六個正常髖關節和六個發育不良髖關節的預計負重區。在髖臼周圍截骨術之前和之后對發育不良髖關節進行了CT掃描。我們發現，術前股骨頭投影承重面平均面積為7.4（范圍6.5-8.4）cm2，術后為11（9.8-14.3）cm2。術后投影承重面面積顯著增加，平均增加了49%（34-70%），與正常對照組的承重面相當。

在研究II中，采用基于CT和3D設計取樣原理的方法來估計髖臼不同區域的骨密度。在髖臼周圍截骨術后前7天內測量基線密度，并與術后2年的密度進行比較。對3名患者進行了兩次測量，誤差方差估計為0.05。六名因髖關節發育不良而計劃接受髖臼周圍截骨術的患者被納入研究。在兩個時間點之間，髖臼前內側象限和后內側象限的骨密度顯著增加。在前外側象限，手術后骨密度保持不變，在后外側象限也是如此。我們認為，觀察到的內側骨密度增加代表了對髖臼周圍截骨術后改變的負荷分布的重塑反應。所述方法是估計髖臼骨密度變化的精確工具。

研究III，由于對髖關節發育不良實施髖臼周圍截骨術以防止骨關節炎進展，因此關節軟骨厚度的變化是需要隨時間跟蹤的中心變量。22名女性和4名男性的26個發育不良髖關節在術前接受了磁共振成像(MRI)。前13名患者接受了兩次檢查，患者完全重新定位并進行了設置，以估計所用方法的精確度。為了分別顯示髖臼和股骨軟骨，在MRI期間使用了踝關節牽引裝置。該裝置以10公斤的負載將腿向遠端拉。髖臼軟骨的平均厚度為1.26毫米，標準差0.04毫米。股骨軟骨的平均厚度為1.18毫米，標準差0.06。計算誤差方差的精度估計為髖臼軟骨厚度為0.01，股骨軟骨厚度為0.02。我們認為該方法有利于評估髖臼周圍截骨術后發育不良髖關節的骨關節炎。

在研究IV中，研究納入了32個發育不良髖關節，其中27 個為女性，5個為男性。在術后1周、4周、8周和6個月進行放射立體測量檢查(RSA)。數據以平均值 + SD表示。術后6個月，髖臼截骨塊向內側移位0.7 mm + 0.8，向近端移位0.7 mm + 0.5。內收平均旋轉為0.5度 + 1.3。在其他方向上，平均移位低于0.5 mm/度。術后8周和24周的移位在平移或旋轉方面沒有統計學差異。由于移位有限，我們認為術后部分負重方案是安全的。

總之，本論文的研究表明，接受髖臼周圍截骨術的患者髖關節的預計承重面積顯著增加，并描述了一種估算該面積的方法。術后兩年內側象限的骨密度增加，并開發了一種在CT圖像上精確估算骨密度的方法。此外，還提出了一種精確估計軟骨厚度的方法，我們認為該方法有利于評估髖臼周圍截骨術后發育不良髖關節骨關節炎的進展。由于用兩枚螺釘固定的髖臼碎片的移位非常有限，我們認為我們的固定是足夠的，術后部分負重方案是安全的。

圖1. 從骨盆內部和外部觀察恥骨、髂骨和骨盆截骨術。請注意，骨盆后柱保持完好。

圖2. 髖臼周圍截骨術前和術后6個月的X線片。術前，股骨頭覆蓋不足，髖臼頂傾斜。術后，股骨頭被髖臼覆蓋，髖臼頂水平。

圖3. 骨盆和髖臼截骨塊的旋轉和平移軸向（棕色區域）。

文獻出處：Inger Mechlenburg. Evaluation of Bernese periacetabular osteotomy: prospective studies examining projected load-bearing area, bone density, cartilage thickness and migration. Acta Orthop Suppl. 2008 Jun;79(329):4-43. doi: 10.1080/17453690610046558.

文獻6

股骨頭骨壞死與軟骨下不全骨折外側塌陷病灶顯微結構特征的差異

譯者 邱興

背景：與股骨頭壞死（osteonecrosis of the femoral head, ONFH）類似，股骨頭軟骨下不全骨折（subchondral insufficiency fracture of the femoral head, SIF）也可導致股骨頭塌陷。然而，關于這兩種疾病塌陷病灶形態學特征的差異尚不明確。本研究假設ONFH與SIF的外側塌陷病灶形態特征存在差異。

方法：本研究納入經組織病理學確診的20個股骨頭標本（ONFH組n=10，SIF組n=10）。在每例標本的外側塌陷病灶中，分別于塌陷區及鄰近非塌陷區的軟骨下區域選取立方體感興趣區（regions of interest, ROIs），比較兩組間基于顯微CT的微結構參數差異，并分析組織病理學特征與微結構參數的相關性。

結果：ONFH組塌陷區的骨體積分數、骨小梁厚度及骨礦物質密度均顯著低于鄰近非塌陷區，后者可見增厚的骨小梁伴貼附性骨形成；而SIF組塌陷區與非塌陷區的上述參數無顯著差異。組織病理學顯示，SIF組外側塌陷病灶周圍可見不同程度的軟骨下骨板骨折伴骨痂形成。

結論：ONFH與SIF的外側塌陷病灶形態特征存在顯著差異，提示兩者股骨頭塌陷的病理機制不同。

Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head

Background: Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF.

Methods: Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated.

Results: In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion.

Conclusion: The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.

文獻出處：Kawano, K. , Motomura, G. , Ikemura, S. , Yamaguchi, R. , Baba, S. , & Xu, M. , et al. Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head. Bone, 141. DOI：10.1016/j.bone.2020.115585

文獻7

與接受髖臼周圍截骨術的男性相比，女性的骨盆前傾和腰椎活動度更大：一項匹配的隊列研究

譯者 徐子茵

目的： 功能性髖關節-脊柱相互作用在髖臼周圍截骨術 （PAO） 的保髖手術中越來越明顯，同時可能影響無撞擊的髖臼重新定位。然而，臨床上相關的髖脊柱性別相關差異研究不足。因此，本研究的目的是評估匹配的 PAO 患者隊列中髖脊柱關系的性別相關差異。

方法： 在 2024 年 1 月至 2024 年 9 月期間接受 PAO 的 138 名患者中，包括 68 例患者（34 名男性，34 名女性）。前瞻性收集了該診斷隊列研究的數據集，患者在性別、年齡和髖臼形態 （髖關節發育不良、臨界髖關節發育不良、髖臼后傾） 方面以 1：1 的比例匹配。通過連續矢狀面骨盆-腰椎 X 線片在站立、放松坐位和深坐位時評估力線關系。分析每張 X 線片的骨盆傾斜 （PT）、腰椎前凸和骶骨斜度。

結果： 女性在站立 （7.8 vs. 14.3°，p < 0.001）、放松坐姿 （28.1 vs. 34.9°，p = 0.012） 和深坐 （3.7 vs. 11.0°，p = 0.013） 姿勢的 PT 顯著降低。此外，女性的腰椎活動度顯著增加 （Δ 松弛坐位 - 深坐位 - 35.4° vs. 27.0°，p = 0.003），而骶骨活動度沒有性別相關差異 （p > 0.05）。

結論： 接受 PAO 的患者在日常生活中不同位置的功能性腰盆對線存在性別相關差異。前部 PT 較大時，女性有發生髖部前撞擊的風險。因此，PAO 的術中前壁和后壁重新定位應適應與性別相關的腰椎骨盆對線，以確保無撞擊發生。

Greater anterior pelvic tilt and lumbar mobility in females compared to males undergoing periacetabular osteotomy: A matched cohort study

Purpose: The functional hip-spine interaction is increasingly noted in hip preservation by periacetabular osteotomy (PAO), while potentially affecting the impingement-free acetabular reorientation. However, the clinically relevant sex-related differences in lumbopelvic alignment have been poorly studied. Thus, the purpose of this study was to evaluate a matched PAO patient cohort for sex-related differences in lumbopelvic alignment.

Methods: Out of 138 patients undergoing PAO between January 2024 and September 2024 at one high-volume centre, there were 68 data sets (34 male, 34 female) included. The data sets of this diagnostic cohort study were prospectively collected, and the patients were matched in a 1:1 ratio for sex, age and acetabular morphology (hip dysplasia, borderline hip dysplasia, acetabular retroversion). Lumbopelvic alignment was assessed with serial sagittal lumbopelvic radiographs in standing, relaxed-seated and deep-seated positions. Each radiograph was reviewed for pelvic tilt (PT), lumbar lordosis and sacral slope.

Results: Females showed a significantly lower PT in standing (7.8 vs. 14.3°, p < 0.001), relaxed-seated (28.1 vs. 34.9°, p = 0.012) and deep-seated (3.7 vs. 11.0°, p = 0.013) positions. Furthermore, females had a significantly increased lumbar mobility (Δ relaxed-seated - deep-seated position - 35.4° vs. 27.0°, p = 0.003), while there was no sex-related difference in sacral mobility (p > 0.05).

Conclusion: There are sex-related differences in functional lumbopelvic alignment across various positions of daily living in patients undergoing PAO. With a greater anterior PT, females are at risk of an anterior hip impingement. Thus, the intraoperative anterior and posterior wall reorientation by PAO should be adapted to the sex-related lumbopelvic alignment to ensure an impingement-free surgical outcome.

文獻來源：Fischer M, Nonnenmacher L, Nitsch A, Mühler MR, Hofer A, Wassilew GI. Greater anterior pelvic tilt and lumbar mobility in females compared to males undergoing periacetabular osteotomy: A matched cohort study. J Exp Orthop. 2025 Feb 10;12(1):e70167. doi: 10.1002/jeo2.70167. PMID: 39931153; PMCID: PMC11808264.

來源：304關節學術

作者：304關節團隊

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