本期目錄：

1、住院患者與門診患者髖關節或膝關節置換術后功能結果的比較

2、股骨頸骨折的全髖關節置換：比較標準頭、大頭、雙動杯和限制性內襯的翻修率和脫位率

3、絕經后婦女應用激素替代療法可降低全髖關節置換術后10年內股骨側假體周圍骨折概率

4、活動平臺假體在外側單髁膝關節置換術中的長期療效研究

5、Pemberton截骨與改良San Diego髖臼成形治療DDH療效比較

6、單純PAO未處理關節內病變的術后功能結果

7、通過吻合骨內動脈重建股骨頭血供的方法

8、殘余Legg-Calvé-Perthes病的髖關節前間隙

9、髖關節發育不良的骨盆傾斜度是多少，髖臼周圍截骨術后會發生變化嗎

10、患者感知的髖臼周圍截骨術（PAO）術后并發癥的社交媒體分析

11、癥狀性盂唇撕裂髖關節鏡術后軟骨盂唇交界處破裂與轉為全髖關節置換術之間的關聯

12、突出的髂前下棘形態在接受髖臼周圍截骨術的髖關節發育不良患者中很常見

第一部分：關節置換及保膝相關文獻

文獻1

住院患者與門診患者髖關節或膝關節置換術后功能結果的比較

譯者 張軼超

背景：在過去的十年中，下肢關節置換術后的住院時間迅速減少，主要原因是由于圍手術期治療方案的改進，但也是由于髖關節和膝關節置換術的快速增長所帶來的經濟需求的增加。由此隨著下肢關節置換術后新的治療方法的不斷改進發展，使得這類手術越來越多地可以在門診完成，并允許手術后當天出院。雖然已經比較了住院和門診手術的成本和并發癥，但似乎很少有人知道門診髖關節或膝關節置換術對患者功能的影響。因此，本系統綜述旨在探討住院患者與門診患者髖關節或膝關節置換術對功能效果影響的現有證據。

方法：本系統綜述遵循PRISMA指南，前瞻性注冊（https://osf. io / 8 bfae /)。對三個在線數據庫（PubMed、CINAHL和EMBASE）進行電子檢索，以確定符合條件的研究。納入所有比較住院和門診髖關節或膝關節置換術患者的研究，評估一項或多項功能結果。對本綜述中的最終研究進行了方法學質量評價。以表格和數字形式的定量結果來描述結果的敘述性合成。

結果：本綜述共納入7項研究，共1876名受試者。四項研究評估THA人群，兩項評估TKA人群，一項兩者都得到了評估。功能結果各不相同，使用了20種不同的功能評估方法，其中18種是基于患者報告效果的工具。對于住院和門診患者的功能效果表現出不同的結果。

結論：本綜述的結果表明，髖關節或膝關節置換術的門診或住院路徑選擇不應僅基于功能效果。然而，鑒于有越來越多的證據支持擇期患者采用門診途徑完成手術可以節省成本而不會增加并發癥，兩種手術途徑具有相同的術后效果，因此術后當天出院更有優勢。

A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty

Background: The length of hospital stay after lower limb arthroplasty has rapidly decreased in the last decade, largely in part due to the rise of improved perioperative protocols, but also as a response to the increased economic demand associated with the rapid growth in hip and knee arthroplasty procedures. In line with this, the development of a new pathway after lower limb arthroplasty that allows for the surgery to be performed in an outpatient setting and permits for same-day discharge after the procedure is increasingly being offered. Although costs and complications between the inpatient and outpatient models have been compared, there appears to be little known about the efects on a patient’s physical function after undergoing hip or knee outpatient arthroplasty. Therefore, this systematic review aims to explore the available evidence for the efect on functional outcomes following inpatient versus outpatient hip or knee arthroplasty.

Methods: This systematic review adhered to the PRISMA guidelines and was prospectively registered (https://osf. io/8bfae/). An electronic search of three online databases (PubMed, CINAHL and EMBASE) was conducted to identify eligible studies. All studies investigating inpatient and outpatient comparator groups, for a population of patients undergoing hip or knee arthroplasty, that assessed one or more functional outcomes, were included. A methodological quality appraisal was undertaken for the fnal studies contained in this review. A narrative synthesis of results is described along with quantitative outcomes presented in tables and figures.

Results: A total of seven studies containing 1,876 participants were included in this review. Four studies assessed a THA population, two assessed TKA and one assessed both. Functional outcomes varied, with 20 different functional outcomes utilised, of which 18 were patient-reported tools. Results of functional outcomes offered mixed support for both inpatient and outpatient pathways.

Conclusions: The results of this review suggest that outpatient or inpatient pathway selection for hip or knee arthroplasty should not be based on the superiority of functional outcomes alone. However, given there is growing evidence in support of an outpatient pathway in select patients with respect to cost savings and without any increase in complications, it could be proposed that an equivalency of post-operative function between the two settings makes same-day discharge favourable.

文獻出處：Sattler L, Kisaloff L, Cragnolini T, Peters R, Hing W. A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty. J Orthop Surg Res. 2022 Aug 2;17(1):372. doi: 10.1186/s13018-022-03270-7. PMID: 35918770; PMCID: PMC9344712.

文獻2

股骨頸骨折的全髖關節置換：比較標準頭、大頭、雙動杯和限制性內襯的翻修率和脫位率

譯者 馬云青

背景： 對于一些股骨頸骨折患者，全髖關節置換術是一種合理的手術選擇，但存在假體脫位的風險。應用各種假體以降低脫位風險和翻修手術率尚不清楚。
目的：在接受股骨頸骨折初次THA 治療的患者中，(1) 全因翻修率或 (2) 標準股骨頭，大直徑股骨頭，雙動杯 (DM) 或限制性內襯的 翻修率是否不同？(3) 手術時患者按年齡分層的翻修風險有差異嗎？
方法：對 2008 年 1 月至 2018 年 12 月澳大利亞骨科協會國家關節置換登記處 (aOANjRR) 報告的 16,692 例股骨頸骨折患者進行全髖關節置換術治療的數據進行分析，其中包括首次使用 DM 假體。AOANJRR 包括超過 98% 在澳大利亞進行的髖關節置換的信息。大多數患者為女性 (72%) ，平均年齡為 74 歲 ± 11 歲。標準頭假體 8582 例，大頭假體 5820 例，DM 假體 1778 例，限制性假體 512 例。累積翻修百分比 (CPR) 被確定為所有原因，包括脫位。第一次翻修的時間使用 Kaplan-Meier 的生存率估計來描述，在分析時對死亡或數據停止進行正確的審查。未經調整的 CPR 在標準假體的前 10 年，大頭假體的 10 年，限制性襯的 8 年和 DM 假體的 7 年中每年進行估計，使用未經調整的點式 Greenwood 估計的 95% 置信區間。結果根據年齡、性別、股骨內固定和股骨頭大小進行了適當的調整，并分別以< 70 歲和≥70 歲兩個年齡段分析。
結果：調整年齡、性別、股骨類型和股骨頭大小后，四組患者在 7 年時的全因翻修率沒有差異。當患者年齡 < 70 歲或≥70 歲時，全因翻修率沒有差異。脫位是最常見的翻修原因 (32%)。當單獨分析脫位翻修時，與標準頭相比，大頭假體THA 的脫位翻修率較低 (HR 0.6 [95% CI 0.4-0.8] ; p <0.001) ，術后前3個月DM 假體的脫位翻修率低于標準頭 (HR 0.3 [95% CI 0.1-0.7] ; p <0.004) ，但在此時間點之后沒有差異。
結論：澳大利亞注冊系統研究表明，對于所有患者或分層為 70 歲以下和70歲以上年齡組的患者，標準頭、大頭、 DM 假體或限制性內襯 THA 在治療股骨頸骨折后的全因翻修率沒有差異。脫位是最常見的翻修原因。大頭假體的脫位翻修風險較低，DM 假體的脫位翻修率僅在頭 3 個月內低于標準頭。用 THA 治療股骨頸骨折的外科醫生，如果髖臼的直徑允許的話，可以考慮較大的股骨頭假體尺寸，如果不可能有較大假體，則可以考慮使用 DM 假體。股骨頸骨折患者的年齡、預期壽命和運動功能水平使這些假體長期潛在影響表小。大多數假體在生存率方面缺乏顯著差異，這意味著外科醫生應該繼續尋找股骨頭大小和假體以外的因素，以盡量減少脫位和翻修手術。

文獻出處：Hoskins W, Griffin X, Hatton A, de Steiger RN, Bingham R. THA for a Fractured Femoral Neck: Comparing the Revision and Dislocation Rates of Standard-head, Large-head, Dual-mobility, and Constrained Liners. Clin Orthop Relat Res. 2021 Jan 1;479(1):72-81. doi: 10.1097/CORR.0000000000001447. PMID: 32876424; PMCID: PMC7899725.

文獻3

絕經后婦女應用激素替代療法可降低全髖關節置換術后10年內股骨側假體周圍骨折概率

譯者 張薔

背景：對于雌激素缺乏的絕境后婦女來說，應用激素替代療法（HRT）可以降低脆性骨折風險。然而，既往文獻中鮮有探究激素替代療法與全髖關節置換（THA）術后假體周圍骨折（PPF）風險相關性的文章。本研究的目的是明確激素替代療法對THA術后10年內PPF風險的影響。

方法：我們運用某全國大型數據庫資料進行回顧性隊列研究。所有施行擇期THA手術的女性患者按照術前HRT的使用情況（少于六個月）進行分組。應用HRT的病例按照1:2比例匹配了無HRT應用史的病例。我們應用Kaplan-Meier曲線和Cox比例風險模型分析的方法推算了術后10年的假體周圍骨折率、翻修率和無菌性松動率。我們應用回歸分析法在匹配了圍術期抗凝用藥情況后確定了術后90天的靜脈血栓栓塞率（VTE）。最終，共有21220例病例入組。

結果：在THA術前應用HRT療法的病例THA術后10年的PPF風險更低（概率比：0.8；95%置信區間：0.6-0.9），但全因翻修率和無菌性松動翻修率近似。激素替代療法組的深靜脈血栓發生率更低（OR：0.7；95%CI：0.6-1.0），而肺栓塞率近似。

結論：對絕經期婦女來講，擇期THA手術前應用激素替代療法與THA術后10年假體周圍骨折發生率更低相關，同時與靜脈血栓栓塞風險增加無關。考慮到以上結果，我們認為對適宜患者應用激素替代療法對降低THA術后假體周圍骨折概率有重要作用。

Hormone Replacement Therapy in Post-Menopausal Women Undergoing Total Hip Arthroplasty is Associated with Reduced 10-Year Periprosthetic Femur Fracture Rate

Introduction: In postmenopausal women who are estrogen deficient, hormone replacement therapy (HRT) has been shown to improve fragility fracture risk. However, few studies have examined the relationship between HRT and periprosthetic fracture (PPF) risk after total hip arthroplasty (THA). The purpose of this study was to determine the impact of HRT use on 10-year PPF risk following THA.

Methods: A retrospective cohort study was conducted using a large national database. Women who underwent elective THA were identified and stratified based on preoperative (< six months) HRT use. Those taking HRT were propensity-score matched at a 1:2 ratio to those who do not have a history of HRT use based on age and Charlson Comorbidity Index score. Kaplan Meier and Cox proportional hazards analyses were conducted to determine rates of PPF, revision, and aseptic loosening within 10 years of surgery. Regression analyses were performed to determine 90-day rates of venous thromboembolism (VTE) after controlling for perioperative VTE prophylaxis. In total, 21,220 patients were included.

Results: Patients who were taking HRT before THA demonstrated a lower risk of PPF (hazard ratio [HR]: 0.8; 95% confidence interval [CI]: 0.6 to 0.9) within 10 years of THA, but a similar risk of all-cause revision surgery and revision for aseptic loosening. The HRT cohort demonstrated lower odds of deep vein thrombosis (OR: 0.7; 95% CI: 0.6 to 1.0) and similar rates of pulmonary embolism.

Conclusion: In postmenopausal women, HRT use prior to elective THA was associated with lower rates of PPF within 10 years of surgery and was not associated with increased VTE risk. Given these results, appropriate HRT usage in patients may have a role in reducing PPF after THA.

文獻4

活動平臺假體在外側單髁膝關節置換術中的長期療效研究

譯者 沈松坡

目的： 單髁膝關節置換術（UKA）是治療單間室嚴重骨關節炎（OA）的一種選擇。盡管針對內側移動平臺（MB）UKA的長期研究較多，但關于外側MB-UKA的證據仍然有限。Oxford Domed Lateral (ODL) 假體旨在通過增強平臺固定性來降低外側MB-UKA的墊片脫位率。然而，該假體的長期表現仍不明確。本研究評估了ODL在非設計中心的長期存活率和臨床結果。

方法： 本研究為單中心回顧性分析，納入了2006年1月至2014年12月間接受ODL外側MB-UKA的115例患者。研究的主要終點是假體的存活率，即因任何原因需翻修的時間。次要研究終點包括Oxford膝關節評分（OKS）、遺忘關節評分（FJS）、疼痛程度、患者滿意度以及Tegner活動評分（TAS）。存活率采用Kaplan-Meier分析進行評估。

結果： 十年后，累積假體存活率為74.8%（95% CI 65.2 至 82.1；風險人數=71），其中墊片脫位（8.5%）和骨關節炎進展（10.4%）是主要的翻修原因。在55例未翻修膝關節的患者中（平均隨訪13.4年，SD 1.8），術后OKS評分顯著提高至37.8（SD 9.1）（p < 0.001）。此外，85.5%的患者（n = 47）表示滿意，FJS均值為65.9（SD 32.2），TAS均值為2.8（SD 1.1）。然而，僅76.4%（n = 42）的患者達到了OKS和FJS的可接受癥狀狀態（PASS）。

結論： 這是首個來自非設計中心的ODL長期研究。結果顯示，盡管未翻修患者的臨床效果良好，但由于墊片脫位和骨關節炎進展導致的高失敗率，建議放棄MB設計，轉而采用固定平臺（FB）裝置進行外側UKA。

Long-term results of lateral unicompartmental knee arthroplasty with a mobile-bearing device

Aims: Unicompartmental knee arthroplasty (UKA) is one option in the treatment of isolated unicompartmental advanced osteoarthritis (OA). While long-term results exist for medial mobile-bearing (MB) UKA, evidence regarding lateral MB-UKA is still limited. The Oxford Domed Lateral (ODL) implant aims to reduce the bearing dislocation rate in lateral MB-UKA through enhanced bearing entrapment. However, the long-term performance of this implant remains unclear. This study evaluated the long-term survival and clinical outcomes of the ODL in a non-designer centre.

Methods: This single-centre retrospective analysis included 115 lateral MB-UKAs using the ODL performed between January 2006 and December 2014. The primary endpoint of the study was implant survival, defined as the time until a revision procedure was required for any reason. Secondary outcomes included Oxford Knee Score (OKS), Forgotten Joint Score (FJS), pain, satisfaction, and Tegner Activity Scale (TAS). Survival was assessed using Kaplan-Meier analysis.

Results: At ten years, the cumulative implant survival rate was 74.8% (95% CI 65.2 to 82.1; number at risk = 71), with bearing dislocation (8.5%) and OA progression (10.4%) as leading revision causes. In 55 non-revised knees with a mean follow-up of 13.4 years (SD 1.8), the mean postoperative OKS improved significantly to 37.8 (SD 9.1) (p < 0.001). Additionally, 85.5% of patients (n = 47) reported satisfaction, with a mean FJS of 65.9 (SD 32.2) and TAS of 2.8 (SD 1.1). However, only 76.4% (n = 42) attained the patient-acceptable symptom state for OKS and FJS.

Conclusion: This is the first long-term ODL study from a non-designer centre; our results demonstrated high failure rates due to bearing dislocation and OA progression, despite satisfactory clinical outcomes in non-revised patients. The disproportionately high risk of failure suggests that the MB design should be abandoned in favour of a fixed-bearing device for lateral UKA.

第二部分：保髖相關文獻

文獻1

Pemberton截骨與改良San Diego髖臼成形治療DDH療效比較

譯者 羅殿中

目的：發育性髖關節發育不良（DDH）患者需要進行骨盆截骨術矯正髖臼發育不良。外科治療DDH時，Pemberton截骨與改良San Diego髖臼成形是兩種常用的手術方法。該研究的目的是針對典型DDH患者，比較Pemberton截骨與改良San Diego髖臼成形的治療效果。

方法：改良San Diego髖臼成形組我們納入了45髖，Pemberton組38髖。排除了不足2年隨訪病例、和合并神經肌肉診斷的患者。術后臨床隨訪采用改良McKay進行分類；影像學隨訪采用Severin評分進行分級。股骨頭壞死（AVN）采用Kalamchi和McEwen指標進行評價。

結果：平均隨訪4.9年（2.1年至11.2年）。兩種手術方法髖臼指數降低到相似水平（改良San Diego髖臼成形組17.0°，Pemberton組15.2°，P=0.846）。采用改良McKay指標進行評價，多數髖關節均取得良好效果（改良San Diego髖臼成形組78%，Pemberton組94%，P=0.055）。采用Severin指標進行評價，多數髖關節均取得良好效果（改良San Diego髖臼成形組100%，Pemberton組97%，P=0.485）。2級及以上股骨頭壞死發生率，兩組之間相似（改良San Diego髖臼成形組0%，Pemberton組3%，P=0.458）。

結論：針對典型DDH患者，改良San Diego髖臼成形術是安全、有效的治療選擇。通過保留骨盆內皮質完整性，髖臼成形可以依據患者自身特殊的髖臼發育不良，進行個性化的髖臼塑形。

圖1. （a）Pemberton髖臼成形術示意圖；（b）Pemberton髖臼成形術前、和術后攝片。

圖2. 原始版本San Diego髖臼成形術示意圖（為治療神經肌肉型髖關節發育不良設計-三角形支撐楔形骨塊相同）。

圖3. （a）改良的San Diego髖臼成形術示意圖（為治療典型髖關節發育不良的前外側缺損設計-三角形支撐楔形骨塊不相同，最大楔形骨塊置于另外兩個楔形骨塊前方）；（b）采用改良San Diego髖臼成形術治療一例典型髖關節發育不良患者，術前、和術后攝片。

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Purpose:Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH.

Methods:We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria.

Results:Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0? versus Pemberton: 15.2?; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458).

Conclusion:The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient's specific acetabular deficiency.

文獻出處：Badrinath R, Bomar JD, Wenger DR, Mubarak SJ, Upasani VV. Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip. J Child Orthop. 2019 Apr 1;13(2):172-179. doi: 10.1302/1863-2548.13.190004. PMID: 30996742; PMCID: PMC6442505.

文獻2

單純PAO未處理關節內病變的術后功能結果

譯者 任寧濤

發育性髖關節發育不良 (DDH) 可促進骨關節炎的發生,而髖臼周圍截骨術（PAO）在DDH保髖治療中已顯現出良好的手術效果。然而，關節內損傷可能是術后持續癥狀的原因，因此在 PAO 前或同時行關節內損傷治療已成為解決它的替代方法。本研究旨在確定長期隨訪中關節內損傷的發生率，單純行PAO未行關節內損傷治療的患者的功能結果以及髖關節存活率(THA為終點)。對 92 名患者 103 例髖關節進行回顧性研究，平均年齡 26 歲（19-31 歲），96% 為女性。平均隨訪時間為7年（范圍：3-16）。在進行PAO 之前使用高分辨率磁共振成像 (MRI) 評估關節內損傷，使用國際軟骨修復協會分類評估軟骨損傷，所有患者均登記 Harris 髖關節評分 (HHS)。所有患者在 MRI 上有盂唇撕裂，80.8% 的盂唇肥大和 20.8% 的盂唇囊腫。88.5% 的髖關節髖臼軟骨損傷為2級。HHS良好且優秀的比例為94%。15年的髖關節存活率為87%。軟骨盂唇損傷是 DDH 患者的常見表現。盡管如此，在沒有盂唇修復的情況下，PAO 也可獲得極好的結果。因此我們認為重點應放在 DDH 患者髖關節的生物力學和解剖學矯正上。

Bernese periacetabular osteotomy functional outcomes in patients with untreated intra-articular lesions

Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19-31), 96% females. Mean follow-up 7 years (range: 3-16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.

文獻出處：Joaquín Lara , Alan Garín, Cristhián Herrera, Selim Abara, Javier Besomi, Diego Villegas, Hassan Neumann, Carlos Tobar. Bernese periacetabular osteotomy functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg . 2020 Apr 13;7(2):256-261.

文獻3

通過吻合骨內動脈重建股骨頭血供的方法

譯者 李勇

背景：重建股骨頭血供對治療股骨頭缺血性壞死及相關疾病至關重要。本研究提出一種通過吻合骨內動脈重建股骨頭血供的方法。
方法：對6頭雄性長白豬的股骨頭進行手術暴露，并人為制造股骨頸頭下骨折。在顯微鏡引導下，識別后支持帶動脈的滋養孔。隨后，通過開三角形骨窗暴露骨內動脈。固定股骨頭后，將骨內動脈與骨折遠端后下支持帶動脈吻合。采用克氏針孔及血管造影技術評估股骨頭血供。
結果：吻合后的骨內動脈呈鮮紅色，提示灌注充足，并觀察到搏動性血流。股骨頭表面針孔可見持續血流，血管造影進一步證實血運重建成功：造影劑經股深動脈發出的下支持帶動脈分支進入股骨頭，到達骨內動脈吻合部位。值得注意的是，血管造影還顯示可見的內部分支，表明功能性血管網絡已建立。
討論：通過吻合骨內動脈重建股骨頭血供的方法能夠利用股骨頭內現有血供系統。本研究是對這一創新技術的初步探索，未來或可應用于預防和/或治療股骨頸骨折后股骨頭壞死。通過恢復病變區域的血流，該方法有望保留股骨頭的活力與功能，最終改善患者預后。

Method for Reconstructing Femoral Head Blood Supply by Anastomosing the Intraosseous Artery

Background: Reconstruction of femoral head blood supply is critical for managing avascular necrosis and related conditions. This study proposes a method to reconstruct femoral head blood supply through anastomosis of the intraosseous artery.
Methods: Surgical exposure of the femoral heads was performed in six male Landrace swine, and subcapital femoral neck fractures were intentionally created. Under microscopic guidance, the nutrient foramen of the posterior retinacular artery was identified. A triangular bone window was then crafted to expose the intraosseous artery. After femoral head fixation, anastomosis was performed between the intraosseous artery and the posteroinferior retinacular artery at the distal fracture end. Femoral head blood supply was evaluated using Kirschner wire pinholes and angiography.
Results: The anastomosed intraosseous artery exhibited a vibrant red color, indicating sufficient perfusion, with observable pulsatile flow. Continuous blood flow was noted through pinholes on the femoral head surface. Angiography confirmed successful revascularization: contrast agent entered the femoral head via the inferior retinacular artery branch from the deep femoral artery, reaching the intraosseous artery anastomosis site. Notably, angiography also revealed visible internal branches, demonstrating the establishment of a functional vascular network.
Discussion: This method leverages the existing blood supply system within the femoral head by anastomosing the intraosseous artery. As a preliminary study of this innovative technique, it holds potential for preventing and/or treating femoral head necrosis following femoral neck fractures. Restoring blood flow to the affected area may preserve femoral head viability and function, ultimately improving patient outcomes.

文獻出處：Wang H, Wang D, Wan J, Wang X, Hou R. Method for reconstructing femoral head blood supply by anastomosing the intraosseous artery. Heliyon. 2024 Feb 3;10(3):e25555. doi: 10.1016/j.heliyon.2024.e25555. PMID: 38356595; PMCID: PMC10865311.

文獻4

殘余Legg-Calvé-Perthes病的髖關節前間隙

譯者 張利強

背景：殘余Legg-Calvé-Perthes病（LCPD）畸形患者的髖關節機械環境仍然知之甚少。前撞擊認為會導致不良的長期結果，例如早發性骨關節炎，但尚未使用高屈曲影像直接測量。這項研究的目的是確定LCPD畸形的放射學形態學評分與髖關節前間隙減少之間的關聯。

方法：我們使用站立開放式MRI掃描儀測量了20例LCPD患者（17例患者）在4種功能姿勢下掃描的前間隙（β角）。混合效應模型用于描述β角，姿勢和畸形形態測量之間的關系（Stulberg分類和球形度偏差評分）。

結果：髖關節β角與姿勢顯著相關（P＜0.001）。與球形（StulbergI至II）髖關節相比，非球面（StulbergIII至V）髖關節在所有姿勢中的β均較低（β=-39.1度；95%CI:-71.9至-6.2度；P=0.020）。SDS升高與中立髖關節姿勢中β降低密切相關（分別為P=0.002、0.005），但與內收和內旋增加無關。由于形態異質性，6髖（總共20髖）不符合總體趨勢。

結論：我們的研究結果顯示，更嚴重的影像學畸形與更大的潛在前部撞擊之間存在關聯，這是軟骨退化的已知原因。然而，大部分形態畸形與功能間隙不一致的病例表明，目前的畸形影像學測量可能不足以預測每位LCPD患者的長期預后。

臨床相關性：（1）LCPD中的髖關節非球面性與較低的前部間隙和較高屈曲姿勢下前部撞擊的可能性相關。（2）考慮形態學和功能參數可以提高我們對LCPD疼痛和早發性骨關節炎原因的理解，而不單純是形態學。

Anterior Hip Clearance in Residual Legg-Calvé-Perthes Disease

Background: The mechanical environment in the hip in people with residual Legg-Calvé-Perthes disease (LCPD) deformity is still poorly understood. Anterior impingement is thought to contribute to poor long-term outcomes such as early-onset osteoarthritis, but it has not been measured directly using imaging in high flexion. Our objective in this study was to determine the association between radiographic morphologic scores of LCPD deformity and reduced anterior hip clearance.

Methods: We measured the anterior clearance (β-angle) of 20 LCPD affected hips (17 patients) scanned in 4 functional postures using an upright open MRI scanner. Mixed effects models were used to describe the relationship between β, posture, and morphologic measures of deformity (Stulberg classification and Sphericity Deviation Score).

Results: Hip β-angle was significantly associated with posture (P< 0.001). Aspherical (Stulberg III to V) hips had lower β across all postures compared with spherical (Stulberg I to II) hips (difference in β = ?39.1 degrees; 95% CI: ?71.9 to ?6.2 degrees; P= 0.020). An increased SDS was strongly associated with reduced β in neutral hip postures (P=0.002, 0.005, respectively), but not with elevated adduction and internal rotation. Due to morphologic heterogeneity, 6 hips (out of 20 overall) did not fit the overall trend.

Conclusions: Our results show an association between more severe radiographic deformity and a greater potential for anterior impingement, a known contributor to cartilage degradation. However, the large proportion of cases where morphologic deformity does not align with functional clearance suggests current radiographic measures of deformity may not be sufficient to predict long-term outcomes in every LCPD patient.

Clinical Relevance: (1) Hip joint asphericity in LCPD is associated with less anterior clearance and a greater potential for anterior impingement in high flexion postures. (2) Considering both morphologic and functional parameters may improve our understanding of the causes of pain and early-onset osteoarthritisin LCPD, as opposed to morphology alone.

Key Words: Legg-Calvé-Perthes disease, magnetic resonance imaging, hip impingement, hip joint, osteoarthritis, femur, acetabulum

文獻出處：Luke G Johnson, Honglin Zhang, Benjamin Joseph, Emily K Schaeffer, Kishore Mulpuri, David R Wilson; Anterior Hip Clearance in Residual Legg-Calvé-Perthes DiseaseJournal of pediatric orthopedics 2025 Mar 10; doi:10.1097/BPO.0000000000002949

文獻5

髖關節發育不良的骨盆傾斜度是多少，髖臼周圍截骨術后會發生變化嗎？

譯者 陶可

為了量化有癥狀的髖關節發育不良患者的骨盆傾斜(PT)并確定它是否代表改善股骨頭覆蓋的補償機制，我們研究了一組16名接受32次雙側分期PAO截骨治療髖關節發育不良的患者，并將其與一組32名接受PAO治療單側髖關節發育不良的患者進行了比較，所有患者的隨訪時間均超過1年。PT的變化通過兩種經過驗證的方法確定，即骶骨-股骨-恥骨(SFP)角和恥骨聯合至骶髂指數(PS-SI)。盡管在PAO后外側中心邊緣角和T?nnis角有所改善，并處于正常范圍內，但單側和雙側髖關節發育不良患者的術前(8° ± 5°)和術后(9° ± 5°)的PT相似。使用SFP角時，僅6名患者(13%)觀察到>5°的變化，使用PS-SI時，5名患者(10%)觀察到>10°的變化，所有患者均有所增加（骨盆后旋）。未觀察到任何患者的PT變化>10°。我們研究組中觀察到的PT與正常人群和有癥狀的髖臼后傾患者的PT相同。這些發現都表明PT是形態學的，而不是補償機制的結果，即使它是補償性的，在PAO后似乎也不會發生顯著逆轉。因此，髖臼重新定向的目標保持不變。

圖1 髖臼參數測量，包括術前外側中心邊緣角(LCEA，a)、術后LCEA (b)、術前T?nnis角 (c) 和術后T?nnis角 (d)。

圖2 骨盆傾斜度測定。術前(a)和術后(b)測量的骶骨-股骨-恥骨角(SFP)，以及術前(c)和術后(d)測量的恥骨聯合至骶髂指數(PS-SI)。

圖3 雙側和單側髖關節發育不良術前和術后外側中心邊緣角(a)和T?nnis角 (b)。

圖4 術前和術后骨盆傾斜度由恥骨聯合-股骨-恥骨角(SFP)確定，其中骨盆傾斜度= SFP-75。PAO術前與術后相比，骨盆傾斜度無顯著差別。

圖5 髖臼周圍截骨術(PAO)后骨盆傾斜度的變化，由(a)恥骨聯合-股骨-恥骨角(SFP)和(b)恥骨聯合-骶髂指數(PS-SI)決定。

What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

To quantify the pelvic tilt (PT) in patients with symptomatic acetabular dysplasia and determine if it represents a compensatory mechanism to improve femoral head coverage, we studied a cohort of 16 patients undergoing 32 bilateral staged PAOs for acetabular dysplasia and compared this to a matched cohort of 32 patients undergoing PAO for unilateral acetabular dysplasia all with >1 year follow-up. The change in PT was determined with two validated methods, namely, the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac index (PS-SI). Despite an improvement in the lateral centre-edge and T?nnis angles to within normal limits following PAO, patients with unilateral and bilateral acetabular dysplasia have similar PT pre-operatively (8° ± 5°) and post-operatively (9° ± 5°). A change of >5° was observed in only six patients (13%) using the SFP angle, and five patients (10%) using the PS-SI, all increased (posterior rotation of the pelvis). No patients were observed to have a change in PT >10°. The observed PT in our study group is equivalent to that found in the normal population and in patient with symptomatic acetabular retroversion. These findings all suggest that PT is morphological rather than a result of a compensatory mechanism, and even if it was compensatory, it does not appear to reverse significantly following PAO. The target for acetabular reorientation, therefore, remains constant.

文獻出處：Mark A Roussot, Saif Salih, George Grammatopoulos, Johan D Witt.What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy? J Hip Preserv Surg. 2021 Apr 10;7(4):777-785. doi: 10.1093/jhps/hnab023. eCollection 2020 Dec.

文獻6

患者感知的髖臼周圍截骨術（PAO）術后并發癥的社交媒體分析：一項回顧性觀察研究

譯者 邱興

背景：社交媒體已成為患者獲取醫療信息和分享治療經驗的重要平臺。髖臼周圍截骨術（PAO）是治療癥狀性髖臼發育不良的常用術式，專業文獻報道其在專科中心實施時并發癥發生率較低。目前關于患者在社交媒體平臺自述PAO術后并發癥的情況尚未明確。本研究旨在分析社交媒體平臺上患者自述的PAO相關并發癥，并探討術后時間窗、伴隨手術等其他因素與這些并發癥報告的相關性。

方法：檢索2018年2月1日至2023年2月1日期間Facebook和Instagram數據，擴大檢索范圍至2011年2月1日獲取Twitter數據。從"Periacetabular Osteotomy"和"PAO Australia"兩個最大用戶群組收集1054條Facebook帖子，同時使用#PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, 和 #PAOrecovery等五個常用標簽獲取1003條Instagram帖子和502條推文。對帖子進行人口統計學特征、視角、時間節點（術后早期/晚期）、附加手術、并發癥類型及互動情況分析。

結果：共分析2559條社交媒體內容（Facebook 1054條，Instagram 1003條，Twitter 502條），13.6%的帖子提及并發癥。多數并發癥報告出現于術后6個月以上，其中疼痛問題最為突出（57.2%），包括慢性疼痛（41.8%）、急性疼痛（6.7%）和神經性疼痛（8.8%）。其他并發癥包括骨性并發癥（6.7%）、神經/精神系統并發癥（3.8%）、腫脹（1.7%）、感染（1.4%）、其他明確并發癥（16.2%）和非特異性并發癥（10.2%）。并發癥報告與術后時間窗呈正相關，與附加手術呈負相關。涉及并發癥的帖子用戶互動度較低。

結論：較少患者在社交媒體報告PAO相關并發癥。在報告者中，多數反映術后晚期存在難治性疼痛。并發癥報告率與術后時間呈正相關，與附加手術呈負相關。本研究發現的疼痛并發癥發生率高于既往研究，但總體并發癥率較低。結合社交媒體患者自述并發癥與傳統療效指標，可更全面了解術后恢復過程中患者最關注的臨床問題。

A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study

Background: Social media is a popular resource for patients seeking medical information and sharing experiences. Periacetabular osteotomy (PAO) is an accepted treatment for symptomatic acetabular dysplasia with a low published complication profile in specialty centers. Little is known regarding patient reporting of complications on social media following PAO. The purpose of this study was to describe the patient-perceived complications of PAO posted on social media and analyze how additional factors (postoperative timeframe, concomitant surgery) correlate with these complication posts.

Methods: Facebook and Instagram were queried from 02/01/18-02/01/23; Twitter was searched over an extended range back to 02/01/11. Facebook posts (1054) were collected from the two most populated interest groups; "Periacetabular Osteotomy" and "PAO Australia." Instagram posts (1003) and Tweets (502) were found using the same five most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data, perspective, timing (early postoperative or late postoperative), additional surgeries, type of complication, and post engagement.

Results: Facebook posts (1054), Instagram posts (1003), and Tweets (502) were assessed; 13.6% of posts included a complication. The majority of complications were reported > 6 months postoperatively with excessive pain being the most common complication (57.2%), including chronic pain (41.8%), acute pain (6.7%), and nerve pain (8.8%). Bony complications (6.7%), neurologic/psychiatric complications (3.8%), swelling (1.7%), infection (1.4%), other specified complications (16.2%), and unspecified complications (10.2%) were reported. Complication posts were found to be correlated with postoperative timeframe and concomitant surgery. Post engagement decreased in complication-related posts.

Conclusions: Few patients posted a perceived complication associated with PAO surgery. Of those who did, the majority reported unmanageable pain during the late postoperative period. Posts including a perceived complication were found to be positively correlated with postoperative timeframe and negatively correlated with concomitant surgery. This study found a higher pain complication rate, but a lower overall complication rate compared to prior studies. Considering the social media reported complications of PAO patients in addition to traditional outcome measures reveals which aspects of postoperative recovery are most important to patients themselves.

文獻出處：Laboret B, Bialaszewski R, Gaddis J, Middleton E, Kendall B, Lynch K, Stewart A, Wells J. A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study. BMC Surg. 2024 Jan 24;24(1):36.

文獻7

癥狀性盂唇撕裂髖關節鏡手術后軟骨盂唇交界處破裂與轉為全髖關節置換術之間的關聯：至少8年隨訪

譯者 徐子茵

背景： 關節鏡治療股骨髖臼撞擊綜合征（FAI）和癥狀性盂唇撕裂具有短期到中期的益處，但需要進一步的長期證據。此外，盡管軟骨關節連接處（CLJ）具有生理和生物力學意義，但該過渡區損傷的臨床意義仍未得到充分研究。

目的： (1)報告FAI髖關節鏡術后至少8年的生存率和患者報告的結果測量；(2)確定結果與患者特征（年齡、體重指數、性別）、病理之間的關系

研究設計： 隊列研究；證據水平3.

方法： 這項回顧性隊列研究納入了2002年至2013年間由單一外科醫生因FAI繼發的癥狀性盂唇撕裂接受原發性髖關節鏡檢查的患者。所有患者年齡≥18歲，隨訪至少8年，術前有x線片。主要結果是轉為全髖關節置換術（THA），次要結果包括關節鏡翻修、患者報告的結果測量和患者滿意度。CLJ分解采用Beck分類進行評估。Kaplan-Meier估計和加權Cox回歸用于估計10年生存率（未轉化為THA），并確定與THA轉化相關的危險因素。

結果： 在這項174髖的研究中(50.6%為女性；平均年齡（37.8±11.2歲），平均隨訪11.1±2.5年，10年生存率為81.6% （95% CI, 75.9% ~ 87.7%）。術后平均4.7±3.8年轉為THA。未經調整的分析揭示了幾個與THA轉換顯著相關的變量，包括年齡；較高的身體質量指數；T?nnis等級較高；上方盂唇的清理;以及CLJ、唇狀關節或關節軟骨的嚴重破裂。表現嚴重的患者(43.6%；95% CI, 31.9%-59.7%)與輕度(97.9%；95% CI, 95.1%-100%) CLJ的分解(P <.001)相比，10年生存率較低。多變量分析將CLJ分解惡化(每增加1個單位的加權風險比為6.41；95% CI, 3.11-13.24)，年齡較大(1.09；95% CI, 1.04-1.14)，更高的T?nnis等級(4.59；95% CI, 2.13-9.90)定義為獨立的負面預測因子(P <.001)。

結論： 盡管大多數患者獲得了至少8年良好的預后，但一些術前和術中因素與THA轉換相關；其中，較差的CLJ撕裂分離、較高的T?nnis分級和年齡較大是最強的預測因子。

Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up

Background: Arthroscopic treatment of femoroacetabular impingement （FAI） and symptomatic labral tears confers short- to midterm benefits， yet further long-term evidence is needed. Moreover， despite the physiological and biomechanical significance of the chondrolabral junction （CLJ）， the clinical implications of damage to this transition zone remain understudied.

Purpose: To （1） report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and （2） characterize associations between outcomes and patient characteristics （age， body mass index， sex）， pathological parameters （T?nnis angle， alpha angle， type of FAI， CLJ breakdown）， and procedures performed （labral management， FAI treatment， microfracture）.

Study design: Cohort study；Level of evidence， 3.

Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty （THA）， and secondary outcomes included revision arthroscopy， patient-reported outcome measures， and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship （no conversion to THA） and identify risk factors associated with THA conversion.

Results: In this study of 174 hips （50.6% female；mean age， 37.8 ± 11.2 years） with mean follow-up of 11.1 ± 2.5 years， the 10-year survivorship rate was 81.6% （95% CI， 75.9%-87.7%）. Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion， including older age；higher body mass index；higher T?nnis grade；labral debridement；and advanced breakdown of the CLJ， labrum， or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe （43.6%；95% CI， 31.9%-59.7%） versus mild （97.9%；95% CI， 95.1%-100%） breakdown of the CLJ （P < .001）. Multivariable analysis identified worsening CLJ breakdown （weighted hazard ratio per 1-unit increase， 6.41；95% CI， 3.11-13.24）， older age （1.09；95% CI， 1.04-1.14）， and higher T?nnis grade （4.59；95% CI， 2.13-9.90） as independent negative prognosticators （P < .001 for all）.

Conclusion: Although most patients achieved favorable minimum 8-year outcomes， several pre- and intraoperative factors were associated with THA conversion；of these， worse CLJ breakdown， higher T?nnis grade， and older age were the strongest predictors.

文獻8

突出的髂前下棘形態在接受髖臼周圍截骨術的髖關節發育不良患者中很常見

譯者 陳志強

背景：在股骨髖臼撞擊綜合癥（FAI）中，髂前下棘（AIIS）的突出越來越受到重視。髖關節發育不良患者髖臼重新定向后，AIIS突出可能會導致髖關節屈曲度降低。AIIS的形態已在許多人群中被描述，包括無癥狀人群、FAI人群和運動員人群，但對接受髖臼周圍截骨術（PAO）的有癥狀髖關節發育不良患者的AIIS形態尚未進行研究。在髖關節發育不良的患者中，髖臼前上緣的缺損很常見，可能導致 AIIS 的位置更靠近髖臼邊緣。了解有癥狀髖關節發育不良患者 AIIS 的形態變化及其與發育不良亞型和嚴重程度的關系有助于術前規劃、手術技巧選擇和 PAO 術后問題的評估。

問題/目的：在這項研究中，我們試圖確定：(1) 有癥狀的髖關節發育不良髖關節中 AIIS 形態類型的變異性；(2) 發育不良模式和嚴重程度亞型之間是否存在 AIIS 形態比例的差異。

方法：通過保髖數據庫，我們確定了 2013 年 10 月至 2015 年 7 月期間接受 PAO 的 153 個髖關節（148 名患者）。本次研究的納入標準為（外側中心邊緣角 [LCEA] < 20°）、骨盆 AP 平片 T?nnis 分級為 0 或 1、接受過術前低劑量 CT 掃描、既往未接受過手術、創傷、神經肌肉、缺血性壞死或 Perthes 樣畸形。共有 50 名有癥狀的髖臼發育不良患者（50 髖）接受了 PAO 手術計劃評估，我們對這些患者的低劑量 CT 掃描結果進行了回顧性評估。研究中患者的年齡中位數為 24 歲（范圍13 至 49 歲）。90%的髖關節（50 例中的 45 例）為女性患者，10%的髖關節（50 例中的 5 例）為男性患者。AIIS 的形態是根據之前公布的三維 CT 重建進行分類的，以確定 AIIS 與髖臼邊緣之間的關系。AIIS的形態分為I型（AIIS位于髖臼邊緣近端）、II型（AIIS延伸至髖臼邊緣平面）或III型（AIIS延伸至髖臼邊緣遠端）。髖關節發育不良亞型的特征根據先前的方案確定，主要是髖臼前上方缺損、髖臼后上方缺損或整體髖臼缺損。髖關節發育不良的嚴重程度分為輕度（LCEA 15°- 20°）和中度/重度（LCEA < 15°）。為了回答第一個問題，即每種 AIIS 形態在發育不良人群中的比例，我們計算了比例和 95% CI 估計值。為了回答第二個問題，我們使用卡方檢驗或Fisher精確檢驗來比較分類變量。P ＜ 0.05 即為顯著。

結果：72%的患者（50 例中有 36 例；95% CI 58% 至 83%）具有 II 型或 III 型 AIIS 形態。28%的患者（50例中有14例；95% CI 18% 至 42%）出現I型AIIS形態，62% 的患者（50 例中有31例；95% CI 48% 至 74%）出現II型AIIS形態，10%的患者（50例中有5例；95% CI 4% 至 21%）出現 III 型 AIIS形態。在 15 位髖臼前上方缺損患者中，有 7 位屬于 I 型 AIIS；在 18 位髖臼整體缺損患者中，有 3 位屬于 I 型 AIIS；在 17 位髖臼后上方缺損患者中，有 4 位屬于 I 型 AIIS（P = 0.08）。不同亞型髖關節發育不良模式之間的 AIIS 形態變異性沒有差異，輕度與中度/重度發育不良患者之間的 AIIS 形態變異性也沒有差異。

結論：髖關節發育不良患者 AIIS 的形態通常很突出，72% 的髖關節具有 II 型或 III 型形態。

臨床意義：在接受 PAO 的髖關節發育不良患者中，無論發育不良模式或嚴重程度如何，AIIS 通常都很突出。突出的 AIIS 形態可能會影響髖臼重新定向后的髖關節屈曲 ROM。AIIS 形態是 PAO 術前計劃中應考慮的一個變量。未來的研究需要評估突出的 AIIS 對 PAO 術中發現和術后狀態的臨床意義。

Prominent Anterior Inferior Iliac Spine Morphologies Are Common in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy

Background：The anterior inferior iliac spine (AIIS) prominence is increasingly recognized in the setting of femoroacetabular impingement (FAI). The AIIS prominence may contribute to decreased hip flexion after acetabular reorientation in patients with acetabular dysplasia. AIIS morphologies have been characterized in numerous populations including asymptomatic, FAI, and athletic populations, but the morphology of the AIIS in patients with symptomatic acetabular dysplasia undergoing periacetabular osteotomy (PAO) has not been studied. In acetabular dysplasia, deficiency of the anterosuperior acetabular rim is commonly present and may result in the AIIS being positioned closer to the acetabular rim. Understanding morphological variation of the AIIS in patients with symptomatic dysplasia, and its relationship to dysplasia subtype and severity may aid preoperative planning, surgical technique, and evaluation of postoperative issues after PAO.

Questions/purposes:In this study, we sought to determine: (1) the variability of AIIS morphology types in hips with symptomatic acetabular dysplasia and (2) whether the differences in the proportion of AIIS morphologies are present between dysplasia pattern and severity subtypes.

Methods:Using our hip preservation database, we identified 153 hips (148 patients) who underwent PAO from October 2013 to July 2015. Inclusion criteria for the current study were (lateral center-edge angle [LCEA] < 20°), T?nnis Grade of 0 or 1 on plain AP radiographs of the pelvis, preoperative low-dose CT scan, and no prior surgery, trauma, neuromuscular, ischemic necrosis, or Perthes-like deformity. A total of 50 patients (50 hips) with symptomatic acetabular dysplasia undergoing evaluation for surgical planning of PAO remained for retrospective evaluation; we used these patients’ low-dose CT scans for analysis. The median (range) age of patients in the study was 24 years (13 to 49). Ninety percent (45 of 50) of the hips were in female patients, whereas 10% (5 of 50) were in male patients. The morphology of the AIIS was classified on three-dimensional CT reconstructions according to a previously published classification to define the relationship between the AIIS and the acetabular rim. The morphology of the AIIS was classified as Type I (AIIS well proximal to acetabular rim), Type II (AIIS extending to level of acetabular rim), or Type III (AIIS extending distal to acetabular rim). Acetabular dysplasia subtype was characterized according to a prior protocol as either predominantly an anterosuperior acetabular deficiency, a posterosuperior acetabular deficiency, or a global acetabular deficiency. Acetabular dysplasia severity was distinguished as mild (LCEA 15° to 20°) or moderate/severe (LCEA < 15°). To answer our first question, regarding the proportions of each AIIS morphology in the dysplasia population, we calculated proportions and 95% CI estimates. To answer our second question, regarding the proposition of AIIS type between subtypes of dysplasia type and severity, we used a chi-square test or Fisher’s exact test to compare categorical variables. A p value of < 0.05 was considered significant.

Results:Seventy-two percent (36 of 50; 95% CI 58% to 83%) of patients had a Type II or III AIIS morphology. Type I AIIS morphology was found in 28% of patients (14 of 50; 95% CI 18% to 42%), Type II AIIS morphology in 62% (31 of 50; 95% CI 48% to 74%), and Type III AIIS/morphology in 10% (5 of 50; 95% CI 4% to 21%). A Type I AIIS was seen in seven of 15 of patients with anterosuperior acetabular deficiency, three of 18 of patients with global deficiency, and four of 17 patients with posterosuperior deficiency (p = 0.08). There was no difference in the variability of AIIS morphologies between the different subtypes of acetabular dysplasia pattern and no difference in AIIS morphology variability between patients with mild versus moderate/severe dysplasia.

Conclusions:The morphology of the AIIS in patients with acetabular dysplasia is commonly prominent, with 72% of hips having Type II or Type III morphologies.

Clinical Relevance:The AIIS is often prominent in patients with acetabular dysplasia undergoing PAO, regardless of dysplasia pattern or severity. Prominent AIIS morphologies may affect hip flexion ROM after acetabular reorientation. AIIS morphology is a variable that should be considered during preoperative planning for PAO. Future studies are needed to assess the clinical significance of a prominent AIIS on intraoperative findings and postoperative status after PAO.

文獻出處：Nestorovski D, Wasko M, Fowler LM, Harris MD, Clohisy JC, Nepple JJ. Prominent Anterior Inferior Iliac Spine Morphologies Are Common in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy. Clin Orthop Relat Res. 2021 May 1;479(5):991-999. doi: 10.1097/CORR.0000000000001547. PMID: 33861213; PMCID: PMC8052058.

來源：304關節學術

作者：304關節團隊

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