本期目錄：

1、無骨水泥和骨水泥型單間室膝關節置換術脛骨假體周圍骨折的發生率比較

2、關節置換圍術期老年病科會診與術后急診就診減少相關

3、功能性與機械性對線全膝關節置換術結局比較

4、嬰幼兒切開復位預期結果如何

5、胚胎期和胎兒早期骨盆骨骼的軟骨形成

6、計算機輔助髖臼周圍截骨術與傳統截骨術治療髖關節發育不良的療效比較

7、建立一種精準的術中替代技術用于測量股骨前傾角

8、髖臼周圍截骨術會改變骨盆前后傾嗎

9、微創壞死骨沖洗技術促進股骨頭缺血性壞死后的骨愈合：基于幼豬模型的實驗研究

10、髖臼周圍截骨術后臨界髖關節發育不良患者的結局和恢復運動率

11、關節鏡下減壓及盂唇修復術治療髖關節旁囊腫

第一部分：關節置換及保膝相關文獻

文獻1

無骨水泥和骨水泥型單間室膝關節置換術脛骨假體周圍骨折的發生率比較：系統回顧和meta分析

譯者 張軼超

目的：(1)確定骨水泥和非骨水泥型單間室膝關節置換（UKA）術脛骨假體周圍骨折的發生率和（2）總結UKA假體周圍骨折的特征和危險因素。

方法：綜合檢索Pubmed、Cochrane和Embase數據庫。納入所有描述了UKA患者脛骨假體周圍骨折的比例、特征或危險因素的臨床、實驗室研究或病例報告研究。評估骨折發生率的比例分析僅使用臨床研究的數據。評估和總結相關特征和危險因素的信息。

結果：共有81項研究被認為符合納入條件。根據41項臨床研究，非骨水泥假體的骨折發生率為1.24% (95%CI 0.64-2.41)，骨水泥假體（9451例）的骨折發生率為1.58% （95%CI 1.06-2.36）。

目前文獻中報道大多數骨折發生在手術中或術后3個月內（91 / 127例;72%)和非創傷性的(113/95例；84%)。在21張X線片上觀察到6種不同的骨折類型。實驗室研究顯示，過度壓配（壓配），過度脛骨截除，后位縱向切割太深和較低的骨密度（BMD）減小了導致脛骨假體周圍骨折所需的力。臨床研究表明，脛骨假體周圍骨折與體重指數增加和術后下肢力線角度增加，高齡，骨密度下降，女性，脛骨內側髁過度突出存在相關性。

結論：非骨水泥和骨水泥型UKA脛骨假體周圍骨折發生率相當低。然而，外科醫生應注意非骨水泥UKA在打入假體時的過重打擊操作可能會帶來骨折風險，因此需要更加小心那些手術中可能出現的錯誤和有脛骨假體周圍骨折高風險的患者。

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta?analysis

Purpose：(I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA.

Methods: Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized.

Results: A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64–2.41) for cementless and 1.58% (95%CI 1.06–2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six diferent fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative

alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle.

Conclusion: Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures.

文獻出處：Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):852-874. doi: 10.1007/s00167-021-06449-3. Epub 2021 Feb 2. PMID: 33528591; PMCID: PMC8901491.

文獻2

關節置換圍術期老年病科會診與術后急診就診減少相關

譯者 張薔

背景：既往研究指出老年病科會診可以給老年髖部骨折的患者帶來治療獲益，主要表現在改善術后功能和降低病死率。然而，我們還未深入探究老年病科會診對擇期關節置換手術（TJA）的影響。本研究的目的是明確術前或術后老年病科參與診治是否與關節置換術后住院時長和急診就診（ED）次數的變化相關。

方法：本回顧性隊列研究檢索了某地區多家醫院的聯合數據庫中所有年齡≥65歲的擇期初次關節置換手術病例。記錄的信息包括在TJA術前90天至TJA術后90天的時間范圍內有老年病科會診。我們應用了雙變量分析和多元回歸模型來評估老年病科會診與住院時長和急診就診次數變化之間的關系。

結果：最終入組了16076例初次TJA病例。其中，9677（60.2%）例為全膝關節置換，6087（37.9%）例為全髖關節置換，其中1416（8.8%）例曾有老年病科會診記錄。在置換術前一周內有至少一次老年病科會診記錄的病例在術后需要急診就診的概率更低（概率比OR，0.97[95%置信區間CI，0.68-0.99]）。這種情況在65歲以上病例中更為明顯（OR，0.66[95%]，0.45-0.98）。

結論：本研究找到了明確證據支持圍術期老年病科會診對TJA術后療效的正面影響。術前會診與TJA術后90天內急診就診次數減少有相關性。因此，擇期TJA手術圍術期老年病科參與診治可以提升療效，降低患者的病死率和醫療支出，并降低術者和醫療機構的醫療成本。

Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits after Total Joint Arthroplasty

Background: Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.

Methods: This retrospective cohort study screened the medical records of patients ≥65 years of age undergoing primary elective TJA in a network of tertiary hospitals. Geriatrician consultations occurring within a period spanning 90 days before to 90 days after TJA were recorded. Bivariate analysis and multivariable regression models were used to assess the relationship between receiving these consultations and changes in the length of stay and ED visits.

Results: A total of 16,076 patients undergoing primary TJA were included. Of these surgical procedures, 9,677 (60.2%) were total knee arthroplasties and 6,087 (37.9%) were total hip arthroplasties; 1,416 (8.8%) of cases had geriatrician visits. Patients had lower odds of requiring postoperative ED visits when they had at least 1 geriatrician appointment within the week preceding an arthroplasty (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.68 to 0.99]; p = 0.005). This effect was most notable for 65-year-old patients (OR, 0.66 [95% CI, 0.45 to 0.98]).

Conclusion: This study reports promising evidence supporting the benefits of perioperative geriatrician visits on TJA outcomes. Preoperative visits were shown to be associated with decreased odds of ED visits after TJA in patients for up to 90 days postoperatively. Thus, geriatrician involvement in elective TJAs has the potential to improve outcomes and reduce morbidity and costs for patients and reduce costs for surgeons and institutions.

文獻3

功能性與機械性對線全膝關節置換術結局比較：基于髖-跟骨X線片的膝關節與地面平行性及負重位分析

譯者 沈松坡

背景： 本研究的目的是比較接受機械性對位的傳統全膝關節置換術（MA-CTKA）與接受功能性對位的機器人輔助手術（FA-RTKA）患者的術后結局。

方法： 我們回顧性分析了一項前瞻性收集的數據庫，該數據庫包含 2022 年 6 月至 2023 年 5 月期間因膝骨關節炎接受初次全膝關節置換術（TKA）的連續患者。根據研究期間引入機器人輔助手術系統的情況，患者被分為兩組：MA-CTKA 組（n = 50）和 FA-RTKA 組（n = 50）。通過全長站立位髖-跟骨 X 線片評估髖-膝-踝（HKA）角、關節線相對于地面的取向角（JLOA）以及負重線（WBL）比例，以比較兩組之間傳統機械軸（MA）和經過膝關節的地面機械軸（GA）。同時比較兩組的臨床結局。

結果： 由于兩組在目標對位策略上的差異，術后 HKA 角無顯著差異（FA-RTKA：2.0° vs. MA-CTKA：0.5°，p = 0.001）。FA-RTKA 組術后 JLOA 更接近平行于地面，而 MA-CTKA 組的關節線則向外側呈向下傾斜（0.6° vs. ?2.7°，p < 0.001）。在 FA-RTKA 組中，GA 經過跟骨時處于中立位置，而 MA-CTKA 組的 GA 位置更偏向外側（48.8% vs. 53.8%，p = 0.001）。兩組在臨床結局方面無顯著差異，但 FA-RTKA 組表現出更高的“遺忘關節評分”（Forgotten Joint Score）和更大的活動度（均 p < 0.05）。

結論： 與機械性對位的 TKA 相比，功能性對位的 TKA 術后關節線更加平行于地面，且在 GA 方面表現出更中立的負重對齊。這些發現表明，FA-RTKA 可在膝關節內實現更均衡的負荷分布，這可能有助于其優越的臨床結局。

圖1. 采用功能性對位原則的術中假體位置。

脛骨假體對位首先在冠狀面對準至 3.0°（內翻），以保持原生關節線在邊界內；隨后，通過在所有三個維度上微調股骨組件對位來平衡伸展間隙和屈曲間隙。股骨組件的冠狀面對位設定為 ?1.1°（外翻），并相對于股骨后髁軸外旋 3.9°。符號表示相同的參考點。

圖2. 髖-跟骨X線片上JLOA的評估。

(A) 在功能性對位組中，術后JLOA與地面平行。

(B) 在機械性對位組中，術后JLOA向外側呈向下傾斜。

虛線表示地面方向（G）。JLOA定義為脛骨近端關節面（實心紅線）與地面（虛線紅線）之間的夾角。

圖3. 髖-跟骨X線片上功能性對位全膝關節置換術中膝關節的負重位置評估。

(A) 地面機械軸（GA）（實心紅線）定義為從股骨頭中心延伸至跟骨最低點的連線，其位置相對于傳統機械軸（MA）（虛線紅線）更偏向外側。

(B) 在“真實”條件下，考慮跟骨因素后，GA 通過膝關節中心。

(C) 相比之下，傳統 MA 略微偏內側通過膝關節。

X 線標記中的“R”符號表示“右側”。

Comparison of Outcomes Between Functionally and Mechanically Aligned Total Knee Arthroplasty: Analysis of Parallelism to the Ground and Weight-Bearing Position of the Knee Using Hip-to-Calcaneus Radiographs

Background: The objective of this study was to compare the outcomes between patients undergoing mechanically aligned conventional total knee arthroplasty (MA-CTKA) and functionally aligned robotic-arm-assisted TKA (FA-RTKA).

Methods: We reviewed a prospectively collected database of consecutive patients who underwent primary total knee arthroplasty (TKA) for knee osteoarthritis between June 2022 and May 2023. Patients were divided into two groups-MA-CTKA (n = 50) and FA-RTKA (n = 50)-based on the introduction of a robotic-arm-assisted system during the study period. The hip-knee-ankle (HKA) angle, joint line orientation angle (JLOA) relative to the floor, and weight-bearing line (WBL) ratio were evaluated using full-length standing hip-to-calcaneus radiographs to compare the conventional mechanical axis (MA) and the ground mechanical axis (GA) passing through the knee joint between the groups. Clinical outcomes were also compared between the two groups.

Results: There were no significant differences in the postoperative HKA angle between the groups, due to discrepancies in the targeted alignment strategies (FA-RTKA: 2.0° vs. MA-CTKA: 0.5°; p = 0.001). The postoperative JLOA in the FA-RTKA group was more parallel to the floor, whereas the MA-CTKA group showed a downward angulation toward the lateral side (0.6° vs. -2.7°; p < 0.001). In the FA-RTKA group, the GA passed through a neutral position when accounting for the calcaneus, while the MA-CTKA group showed a more lateral GA position (48.8% vs. 53.8%; p = 0.001). No significant differences in clinical outcomes were shown between the FA-RTKA and MA-CTKA groups, with the FA-RTKA group demonstrating higher Forgotten Joint Scores and a greater range of motion (all p < 0.05).

Conclusions: Functionally aligned TKA demonstrated improved joint line parallelism to the floor and more neutral weight-bearing alignment in the GA compared to mechanically aligned TKA. These findings indicate a more balanced load distribution across the knee, which may contribute to the superior clinical outcomes observed in the functionally aligned group.

第二部分：保髖相關文獻

文獻1

嬰幼兒切開復位預期結果如何？----一項DDH前瞻性多中心研究

譯者 羅殿中

背景：針對嬰幼兒發育性髖關節發育不良（DDH）切開復位的效果，雖然有少數單個中心的研究報告，罕有前瞻性研究文獻數據。本研究為針對嬰幼兒DDH切開復位（OR）的前瞻性、多中心臨床研究。

方法：該前瞻性研究資料來自國際多中心研究小組，針對所有的嬰幼兒DDH切開復位（OR）；至少隨訪1年；通過回顧形成共識，股骨近端生長干擾（PFGD）采用Salter法；殘余髖臼發育不良定義為髖臼指數超過同年齡分布的90%（單側十分之一分位）；運用統計學分析，比較術前資料、手術信息，以預測再脫位、PFGD、及殘余發育不良的風險因素。

結果：本研究共納入195例232髖，切開復位時平均年齡（中位數）為19個月（四分位數為13至28個月）；平均隨訪時間為21個月（四分位數為16至32個月）。再脫位的發生率為7%（n=16/228）；多數再脫位發生在切開復位（OR）術后1年之內（81%，n=13/16）。排除再脫位病例，末次隨訪時94.5%的髖關節表現為IHDI 1型。通過對末次隨訪影像的嚴格分析，在44%（n=101/230）的患髖出現不同程度的PFGD。與正常數據庫對照，發現78例（55%）髖關節表現為殘余發育不良。經至少2年隨訪，初次手術進行骨盆截骨的患髖近半數出現殘余發育不良（39%，n=32/82），而初次手術未行骨盆截骨的患髖殘余發育不良發生率更高（78%，n=46/59）。

結論：迄今在這項最大規模的前瞻性、多中心研究中，針對嬰幼兒DDH切開復位的短期隨訪中，7%出現再脫位，44%出現股骨近端生長干擾（PFGD），55%出現殘余髖臼發育不良。不良臨床結果的發生率較以前的報告要高。切開復位同時行骨盆截骨手術的髖關節殘余發育不良的發生率較低。該前瞻性、多中心研究結果，為患者家長提供了更多的信息，提高家長認識、并設立恰當的期望值。

圖 （A）左髖前后位片顯示一個28個月男孩，切開復位術后13個月，左股骨近端生長干擾（PFGD）；（B）骨盆前后位片顯示一個33個月女孩未行骨盆截骨、右髖切開復位術后26個月，殘余髖臼發育不良（AI=34°）。

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Background:Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population.

Methods:The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter's criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia.

Results:A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59).

Conclusions:In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations.

文獻出處：Kiani SN, Gornitzky AL, Matheney TH, Schaeffer EK, Mulpuri K, Shah HH, Yihua G, Upasani V, Aroojis A, Krishnamoorthy V, Sankar WN; Global Hip Dysplasia Registry. A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction? J Pediatr Orthop. 2023 May-Jun 01;43(5):279-285. doi: 10.1097/BPO.0000000000002383. Epub 2023 Mar 8. PMID: 36882887.

文獻2

胚胎期和胎兒早期骨盆骨骼的軟骨形成

譯者 任寧濤

骨盆骨骼是通過軟骨內骨化形成的。然而，目前尚不清楚正常軟骨是如何在骨化發生前形成的。此外，骨盆軟骨形成的總體時間和軟骨形態尚不清楚。本研究使用相位對比計算機斷層掃描和7T磁共振成像，觀察了25例人類胎兒(冠-臀長[CRL] = 11.9-75.0 mm)骨盆骨骼的軟骨形成。髂骨、坐骨、恥骨的軟骨中心在卡內基期(CS) 18首次同時出現，位于髖臼周圍，后期呈放射狀生長。髂嵴在CS20階段形成，而髂體中央部分仍呈軟骨狀。髂骨體在CS22階段形成一個盤狀結構。髂骨的生長速率大于骶骨-尾骨、恥骨和坐骨。在有限的時間內形成連接和關節，骶髂關節在CS21階段形成。在CS23階段可觀察到恥骨聯合關節、骶髂關節連接、髖骨三部分與髖臼Y形連接;在胎兒早期（EF）觀察到坐骨和恥骨分支的連接。此外，在不同的樣本中，骶骨中心的連接程度也不同。大多數盆腔測量數據顯示與CRL高度相關。小骨盆入口的橫向徑和前后徑在不同的樣本中存在差異(R2 = 0.11)。恥骨下角也有變化(65 ~ 90°)，與CRL無關(R2 = 0.22)。此外，軟骨結構的形成似乎影響骨結構。這項研究為骨盆結構的形態發生提供了有價值的信息。

圖 盆腔環形成。骨盆骨骼軟骨形成的三維重建視圖。藍色：股骨; 綠色：恥骨; 淺藍色：尾骨; 橙色：主動脈和髂總動脈。紫色：髂骨; 紅色：骶骨; 黃色：坐骨。括號中的數字為CRL (mm)。刻度條表示1mm。

Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period

The pelvic skeleton is formed via endochondral ossification. However, it is not known how the normal cartilage is formed before ossification occurs. Furthermore, the overall timeline of cartilage formation and the morphology of the cartilage in the pelvis are unclear. In this study, cartilage formation in the pelvic skeletons of 25 human fetuses (crown-rump length [CRL] = 11.9-75.0 mm) was observed using phase-contrast computed tomography and 7T magnetic resonance imaging. The chondrification center of the ilium, ischium, and pubis first appeared simultaneously at Carnegie stage (CS) 18, was located around the acetabulum, and grew radially in the later stage. The iliac crest formed at CS20 while the iliac body's central part remained chondrified. The iliac body formed a discoid at CS22. The growth rate was greater in the ilium than in the sacrum-coccyx, pubis, and ischium. Connection and articulation formed in a limited period, while the sacroiliac joint formed at CS21. The articulation of the pubic symphysis, connection of the articular column in the sacrum, and Y-shape connection of the three parts of the hip bones to the acetabulum were observed at CS23; the connection of the ischium and pubic ramus was observed at the early-fetal stage. Furthermore, the degree of connection at the center of the sacrum varied among samples. Most of the pelvimetry data showed a high correlation with CRL. The transverse and antero-posterior lengths of the pelvic inlet of the lesser pelvis varied among samples (R2 = 0.11). The subpubic angle also varied (65-90°) and was not correlated with CRL (R2 = 0.22). Moreover, cartilaginous structure formation appeared to influence bone structure. This study provides valuable information regarding the morphogenesis of the pelvic structure.

文獻出處：Okumura M, Ishikawa A, Aoyama T, Yamada S, Uwabe C, Imai H, Matsuda T, Yoneyama A, Takeda T, Takakuwa T. Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period. PLoS One. 2017 Apr 6;12(4):e0173852. doi: 10.1371/journal.pone.0173852. PMID: 28384153; PMCID: PMC5383024

文獻3

計算機輔助髖臼周圍截骨術與傳統截骨術治療髖關節發育不良的療效比較

譯者 李勇

目的 比較計算機輔助髖臼周圍截骨術（PAO）與傳統PAO治療髖關節發育不良（DDH）的療效。

方法 納入91例患者（98髖），每個DDH病例均采用常規PAO（術中x線檢查確定截骨角度和方向）或計算機輔助PAO（使用3D導航系統）治療。其中，40髖行常規PAO， 58髖行計算機輔助PAO。

結果 常規PAO患者的日本骨科協會髖關節評分從術前70.0分提高到術后90.7分，計算機輔助PAO患者的髖關節評分從術前74.5分提高到術后94.2分。在所有計算機輔助PAO患者中，術后頭臼指數（AHI）和前臼頂傾斜角（VCA）均在放射靶區內。部分常規PAO患者術后AHI和VCA角不在靶區。在平均隨訪5.4年之后，我們對98例PAO髖關節中的5例（5.1%）進行了全髖關節置換術（THA）。58例髖關節（0%）采用計算機輔助PAO，均未進行翻修。

結論 計算機輔助PAO可以術中確認截骨部位，實時確認截骨塊的位置。與傳統PAO相比，計算機輔助PAO患者股骨頭前方和外側有足夠的覆蓋，不需要早期轉換為THA。結論計算機輔助PAO不僅提高了準確性和安全性，而且獲得了足夠的前外側位移，預防了DDH的進展。

Outcomes of Computer-Assisted Peri-Acetabular Osteotomy Compared with Conventional Osteotomy in Hip Dysplasia

This study compared the efficacy of computer-assisted peri-acetabular osteotomy (PAO) with conventional PAO in treating developmental dysplasia of the hip (DDH). Ninety-one patients (98 hips) were enrolled: 40 hips underwent conventional PAO (guided by intraoperative X-ray), and 58 hips underwent computer-assisted PAO (using 3D navigation). Results showed significant improvement in Japanese Orthopaedic Association (JOA) hip scores: from 70.0 preoperatively to 90.7 postoperatively in the conventional group, and from 74.5 to 94.2 in the computer-assisted group. Postoperative acetabular head index (AHI) and vertical center anterior (VCA) angles were within radiographic targets for all computer-assisted PAO cases, while some conventional PAO cases exceeded thresholds. Over a mean follow-up of 5.4 years, 5 of 98 hips (5.1%) required conversion to total hip arthroplasty (THA), all from the conventional group. Computer-assisted PAO enabled real-time visualization of osteotomy sites and fragment positioning, achieving superior anterolateral femoral head coverage and preventing DDH progression.

文獻出處：Imai H, Kamada T, Miyawaki J, Maruishi A, Mashima N, Miura H. Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia. Int Orthop. 2020 Jun;44(6):1055-1061.

文獻4

建立一種精準的術中替代技術用于測量股骨前傾角

譯者 張利強

背景：在手術室中準確評估股骨前傾角頗具挑戰性。我們評估了觀察者是否能通過改良的C臂技術可靠且準確地判斷出股骨頸何時平行于地面。我們將該技術與先前報道的用于術中測定股骨前傾角的改良Ogata-Goldsand技術進行了比較。

方法：為評估觀察者能否判斷出股骨頸何時與地面水平，我們對72具尸體股骨近端側面進行拍攝，將股骨旋轉以模擬從-20度到+20度、以5度為增量的前傾角變化。這些照片以網格布局排列，并通過3次隨機化和盲法驗證。5名研究者選擇了他們認為最接近中立（0度）股骨前傾角的方位。然后，在手術室中對4具完整尸體進行了檢查。采用改良C臂技術與改良Ogata-Goldsand 技術對每具全尺寸股骨尸體的股骨前傾角進行了評估，以廣泛認可的Kingsley和Olmsted技術作為標準來測量股骨前傾角。

結果：在確定股骨頸中立位置時，觀察者能夠準確地確定0度前傾角，平均偏差為4.4±2.4度。改良C臂技術測量值與真實值的平均偏差為3.2±4.2度。改良的Ogata-Goldsand技術測量值與真實角度的平均偏差為2.3±2.6度。改良的C臂技術不同觀察者之間的組內相關系數為0.82，與Kingsley和Olmsted方法作為標準相比為0.81，而改良的Ogata-Goldsand技術分別為0.72和0.90。

結論：觀察者能夠準確地感知股骨頸與虛擬地面平行的情況，這支持將此參數納入改良C臂技術。改良C臂技術與改良Ogata-Goldsand技術相當。

臨床意義：改良C臂技術相較于改良Ogata-Goldsand技術相對簡單，這使得改良C臂技術成為術中測量股骨前傾角的一個合理補充選擇。

股骨近端標本：九張圖像從-20度到+20度每次增加5度。在實際研究中，這9張圖像是未標記的，并隨機洗牌以進行有效性和可靠性測試

改良C臂技術。 A，定義膝關節正位片。 B，獲取標準的髖關節側位片，再將C臂推回膝關節，通過旋轉C臂獲取膝關節正位片與A圖膝關節正位片匹配；C，通過讀取C臂旋轉角度獲得前傾角度數。

改良Ogata-goldsand技術。 A，C臂位于膝蓋平行的位置，以獲得膝蓋的真實側面X射線，于股骨后方放置一不透X線針定義為水平面。 B，側位X射線。股骨頸和不透X線針之間的角度是β角，。 C，通過從側面旋轉C-臂90度獲得髖關節的前后（AP）X射線。 股骨頸和股骨軸之間的角度是α角。 D，尸體標本演示了圖3B中的射線照相方法

Kingsley-Olmsted技術。股骨髁的后方和大轉子后方置于桌子上。 獲得股骨頸從近端到遠端的軸向圖像，其中股骨頸和桌子表面之間的角度代表股骨前傾角。

Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version

Background: Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version.

Methods: To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from ?20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version.

Results: In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique.

Conclusions: Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique.

Clinical Relevance: The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version.

文獻出處：Yao B, Li D, Cui J, Smith KL, Tyagi V, Kahan JB, Nicholson AD, Smith BG, Liu R, Cooperman DR. Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version. J Pediatr Orthop. 2025 Mar 21. doi: 10.1097/BPO.0000000000002920. Epub ahead of print. PMID: 40126881.

文獻5

髖臼周圍截骨術會改變骨盆前后傾嗎

譯者 陶可

髖臼周圍截骨術(PAO)期間和之后骨盆傾斜(PT)的變化對于手術規劃非常重要。本研究的目的是(i)確定接受PAO治療的患者的PT在整個治療過程中如何變化，(ii)測試哪些因素會影響PT的變化，以及(iii)評估PT的變化是否影響所實現的截骨矯形。

這是一項回顧性、單中心、連續病例系列研究，納入了111名接受PAO治療的患者，這些患者患有整體(n = 79)、后傾(n = 49)或前傾發育不良(n = 6)（平均年齡：27.3 ± 7.7歲；85%為女性）。PT是在術前、術中、術后1天、6周和1年通過仰臥位、前后位骨盆X線片測定的，使用骶骨-股骨-恥骨(SFP)角，這是一種經過驗證的PT替代標記。最佳髖臼矯正度取決于外側中心邊緣角（25°-40°）、髖臼指數（-5° 至 10°）和交叉征比值（<20%）。

術前（70.1° ± 4.8°）、1天（71.7° ± 4.3°；P < 0.001）和術后早期SFP（70.6° ± 4.7°；P = 0.004）之間存在顯著差異。

術前和術后1年之間的SPF差異為-0.5° ± 3.1°（P = 0.043），9%的病例差異>5°。

SFP的差異與年齡、性別、體重指數、發育不良類型或實現最佳髖臼矯正度無關（P = 0.1-0.9）。

在術后早期，PT會減小，導致髖臼相對后傾，這種后傾會逐漸糾正，并通過每年的隨訪恢復。PAO期間PT的變化程度不會對骨折塊方向產生不利影響。大多數接受PAO治療的患者PT不會發生明顯變化，因此似乎不是一種代償機制。

圖1 矢狀位骨盆傾斜(PT)的差異；PT減小導致骨盆在矢狀面前旋，減小髖臼傾斜角度（a），而PT增大導致骨盆在矢狀面后旋，增大髖臼傾斜角度（b）。

圖2 隨訪期間不同時間間隔的骶骨-股骨-恥骨(SFP)角測量值。

圖3 PAO截骨患者在術前、術中和術后不同時間點的SFB角。

圖4 術后1天SFB角變化與術前值相比大于5°的髖關節。

圖5 術后1年SFB角變化與術前值相比大于5°的髖關節。

Does pelvic tilt change with a peri-acetabular osteotomy?

Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°-40°), acetabular index (-5° to 10°) and cross-over ratio (<20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P < 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was -0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of >5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1-0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.

文獻出處：Jeroen C F Verhaegen, Emin Süha Dedeo?ullar?, Isabel S Horton, Paul E Beaulé, George Grammatopoulos. Does pelvic tilt change with a peri-acetabular osteotomy? J Hip Preserv Surg. 2023 Sep 9;10(3-4):204-213. doi: 10.1093/jhps/hnad029. eCollection 2023 Aug-Dec.

文獻6

微創壞死骨沖洗技術促進股骨頭缺血性壞死后的骨愈合：基于幼豬模型的實驗研究

譯者 邱興

背景： 股骨頭缺血性壞死可致骨髓腔內積聚壞死細胞碎片及炎性因子，引發慢性炎癥性修復反應。本研究旨在通過幼豬模型探究沖洗清除壞死細胞碎片與炎性蛋白對骨修復的影響。

方法: 對12頭幼豬右后肢股骨頸實施結扎術誘導股骨頭壞死。術后1周，6頭實驗組動物接受經皮三針骨沖洗術（單側股骨頭總沖洗量450 mL）聯合右后肢免負重治療（沖洗組），術中連續收集沖洗液進行分析；另6頭僅接受免負重治療（免負重組）。術后8周通過影像學、顯微CT及組織學評估骨修復，并與既往發表的6例接受多針骨骺鉆孔術（MED組）聯合免負重（未行骨沖洗）的研究數據進行對比。

結果: 缺血誘導1周后，骨沖洗液中檢出壞死細胞及炎性蛋白。隨著沖洗進程，沖洗液內蛋白質與甘油三酯濃度顯著降低（p < 0.005）。術后8周，沖洗組骨體積顯著高于MED組及免負重組（p < 0.0001）。組織學分析顯示，沖洗組骨形成指標較MED組（p = 0.002）和免負重組（p < 0.0001）顯著提升，且巨噬細胞數量明顯減少。

結論: 經皮三針沖洗術可有效清除壞死股骨頭內的細胞碎片及炎性蛋白，減少破骨細胞與巨噬細胞浸潤，促進缺血性骨壞死后的骨形成。

臨床意義: 本研究首次驗證了通過壞死骨沖洗改善骨愈合的創新理念。該微創技術為優化缺血性骨壞死后的局部微環境及促進骨修復提供了潛在治療策略。

Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs

Background: Ischemic osteonecrosis of the femoral head produces necrotic cell debris and inflammatory molecules in the marrow space, which elicit a chronic inflammatory repair response. The purpose of this study was to determine the effects of flushing out the necrotic cell debris and inflammatory proteins on bone repair in a piglet model of ischemic osteonecrosis.

Methods: Osteonecrosis of the femoral head of the right hindlimb was induced in 12 piglets by tying a ligature tightly around the femoral neck. One week after the surgery, 6 animals were treated with a percutaneous 3-needle bone washing procedure and non-weight-bearing (NWB) of the right hindlimb (wash group). The total saline solution wash volume was 450 mL per femoral head. Serial wash solutions were collected and analyzed. The remaining 6 animals were treated with NWB only (NWB group). At 8 weeks after the surgery, the femoral heads were assessed using radiography, micro-computed tomography (micro-CT), and histological analysis. In addition, we compared the results for these piglets with our published results for 6 piglets treated with multiple epiphyseal drilling (MED) plus NWB without bone washing (MED group).

Results: Necrotic cells and inflammatory proteins were present in the bone wash solution collected 1 week after ischemia induction. The protein and triglyceride concentrations decreased significantly with subsequent washing (p < 0.005). At 8 weeks after ischemia induction, the wash group had a significantly higher bone volume than the MED or NWB group (p < 0.0001). Histological bone-formation measures were also significantly increased in the wash group compared with the MED group (p = 0.002) or NWB group (p < 0.0001) while macrophage numbers were significantly decreased in the wash group.

Conclusions: The percutaneous 3-needle procedure flushed out cell debris and inflammatory proteins from the necrotic femoral heads, decreased osteoclasts and macrophages, and increased bone formation following induction of ischemic osteonecrosis.

Clinical relevance: We believe that this is the first study to investigate the concept of washing out the necrotic femoral head to improve bone healing. The minimally invasive procedure may be useful to improve the necrotic bone environment and bone repair following ischemic osteonecrosis.

文獻出處：Kim HKW, Park MS, Alves do Monte F, Gokani V, Aruwajoye OO, Ren Y. Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs. J Bone Joint Surg Am. 2021 Jul 7;103(13):1193-1202. doi: 10.2106/JBJS.20.00578. PMID: 33877059.

文獻7

髖臼周圍截骨術后臨界髖關節發育不良患者的結局和恢復運動率：5 年隨訪的病例系列

譯者 陳志強

背景：臨界髖關節發育不良（BDDH）患者的最佳手術方法仍存在爭議。髖關節鏡檢查和髖臼周圍截骨術（PAO）都通常用于該患者群體。參加體育運動的人希望在手術后恢復并維持體育活動，而這種能力在治療方法的選擇中起著重要作用。據我們所知，之前沒有研究評估過PAO后BDDH患者的恢復運動率和活動水平。

目的：根據加利福尼亞大學洛杉磯分校（UCLA）的活動量表以及患者報告的結果指標，評估換著重返運動場的比率和術后活動水平。同時從定性和定量兩方面評估運動量的變化以及造成這些變化的根本原因。

方法：我們對2015年1月至 2017年 6月期間接受PAO 的 52 例 BDDH患者的55個髖關節的前瞻性數據進行了回顧性分析。記錄恢復運動率、UCLA 活動評分、國際髖關節結果工具-12評分、主觀髖關節評分、髖關節殘疾和骨關節炎結果評分子評分、運動活動、體育活動的頻率和持續時間、術后變化以及根本原因。

結果：平均隨訪時間為 62.8 ± 9.0 個月。術前活躍患者的恢復運動率為 92.5%。大多數患者在6個月（50%）或3至6個月后（37.5%）恢復體育活動。UCLA活動評分顯著提高（從 5.2 ± 2.4 提高到 7.0 ± 1.8;P < .001）。國際髖關節結果工具-12 、主觀髖關節值評分、髖關節殘疾和骨關節炎結果評分也顯著提高（全部，P < .001）。PAO 后 34.5% 的病例發生體育活動變化。34.5%的病例在 PAO 后改變了體育活動。術后從事低強度運動的患者明顯增多。參與高強度運動的人數沒有明顯減少。變化的原因既有與髖關節相關的，也有與髖關節無關的。從數量上看，患者的運動頻率（P = .007）和持續時間（P = .007）都有明顯增加。

結論：PAO 后BDDH患者的恢復運動率高達 92% 以上。大多數患者在 6 個月或 3 至 6 個月后恢復運動。總體而言，PAO 后活動水平和髖關節功能有所改善。一些患者在 PAO 后調整了他們的運動活動。雖然更多的患者參與了低強度運動，但術后仍堅持參與高強度運動。這項研究的結果可能有助于患者和骨科醫生在BDDH的情況下決定最佳的手術方法。

Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up

Background:The optimal surgical approach in patients with borderline hip dysplasia (BHD) remains controversial. Both hip arthroscopy and periacetabular osteotomy (PAO) are commonly employed in this patient population. Those who participate in sports want to resume and maintain sports activities after surgery, and the ability to do so plays an important role in the choice of a treatment method. To our knowledge, no previous study has assessed return-to-sports rates and activity levels in patients with BHD after PAO.

Purpose:To assess return-to-sports rates and postoperative activity levels as measured by the University of California, Los Angeles (UCLA), activity scale as well as patient-reported outcome measures. Also to assess changes in sports activity both qualitatively and quantitatively as well as underlying reasons for these changes.

Methods:We conducted a retrospective analysis of prospectively collected data from 55 hips in 52 patients with BHD who underwent PAO between January 2015 and June 2017. Return-to-sports rates, UCLA activity scores, International Hip Outcome Tool–12 scores, Subjective Hip Value scores, Hip disability and Osteoarthritis Outcome Score subscores, sports practiced, frequency and duration of sports activity, and postoperative changes as well as underlying reasons were recorded.

Results:The mean follow-up was 62.8 ± 9.0 months. The return-to-sports rate among preoperatively active patients was 92.5%. Most patients resumed sports activity after 6 months (50%) or after 3 to 6 months (37.5%). The UCLA activity score improved significantly (from 5.2 ± 2.4 to 7.0 ± 1.8; P < .001). The International Hip Outcome Tool-12, Subjective Hip Value, and Hip disability and Osteoarthritis Outcome Score scores also improved significantly (all, P < .001). Changes in sports activity occurred in 34.5% of cases after PAO. Significantly more patients engaged in low-impact sports postoperatively. Participation in high-impact sports did not decrease significantly. Reasons for changes were both hip related and non–hip related. Quantitatively, patients were able to significantly increase both the frequency (P = .007) and duration (P = .007) of sports activity.

Conclusion:The return-to-sports rate in patients with BHD after PAO was high at over 92%. Most patients returned to sports after a period of 6 months or 3 to 6 months. Overall, activity levels and hip function improved after PAO. A number of patients adjusted their sports activity after PAO. Although more patients engaged in low-impact sports, participation in high-impact sports was maintained postoperatively. The results of this study may help both patients and orthopaedic surgeons in deciding on the best surgical procedure in the setting of BHD.

文獻出處：Leopold VJ, Szarek A, Hipfl C, B?rtl S, Perka C, Hardt S. Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up. Am J Sports Med. 2024 Feb;52(2):383-389. doi: 10.1177/03635465231217736.

文獻8

關節鏡下減壓及盂唇修復術治髖關節旁囊腫

譯者 徐子茵

在股骨髖臼撞擊的情況下，盂唇囊腫是有充分證據的后遺癥。這些囊腫通常與由CAM和/或鉗型骨病變引起的盂唇損傷有關。滑膜液通過盂唇處的撕裂滲出，類似腘窩囊腫，導致囊腫的形成，通常是自限性的。很少有文獻記載的囊腫壓迫附近神經血管結構的病例存在。有幾項研究記錄了關節鏡下對這些囊腫的減壓，但沒有報道囊腫壓迫股靜脈導致深靜脈血栓形成。我們的病例是，一個大的前側囊腫導致壓迫右股靜脈受壓，病人表現為深靜脈血栓形成和髖關節疼痛。治療包括關節鏡下減壓，然后盂唇修復和髖關節成形術后，再行介入穿刺抽吸。本病例報告的目的是記錄這種罕見的表現，并從我們的經驗中提供學習點。

圖1.右側腹股溝診斷性超聲圖像顯示股總靜脈閉塞性深靜脈血栓形成，鄰近一個大的低回聲腫塊。

圖2.右腹股溝帶標記的橫切面US圖像顯示一個大的低回聲腫塊，引起股總靜脈與大隱靜脈的連接處的腫塊效應。

圖6.右髖關節軸向t2加權MRI顯示盂唇撕裂伴盂唇旁囊腫并壓迫股神經血管束。

Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair

In the setting of femoroacetabular impingement of the hip joint, paralabral cysts are well-documented sequelae. These cysts are typically associated with labral tears caused by CAM and/or pincer-type bony lesions. Synovial fluid extravasation through a tear in the labrum, similar to a popliteus cyst, leads to formation of a capsular-based cyst that is usually self-limiting. Few documented cases of these cysts causing compression of nearby neurovascular structures exist. There are several studies documenting arthroscopic decompression of these cysts, but none reporting compression of the femoral vein by a paralabral cyst resulting in deep vein thrombosis. We present the case of a large anterior paralabral cyst causing compression of the right femoral vein in a patient presenting with deep vein thrombosis and hip pain. Treatment consisted of arthroscopic decompression, followed by definitive aspiration by interventional radiology after labral repair and bipolar hip osteoplasty. The purpose of this case report was to document this rare presentation and offer learning points from our experience.

文獻出處：Goodwin TM, White CC, Wetzler A, Cincere BA. Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair. J Am Acad Orthop Surg Glob Res Rev. 2024 Jan 24;8(1):e23.00178. doi: 10.5435/JAAOSGlobal-D-23-00178. PMID: 38265245; PMCID: PMC10807876.

來源：304關節學術

作者：304關節團隊

聲明：本文內容及圖片均為轉載內容，如涉及版權問題請相關權利人及時與我們聯系，我們會立即處理配合采取保護措施，以保障雙方利益。

為什么要投稿？是為了記錄自己的醫學之路！是為了與更多的骨科同道交流分享！是為了讓更多的人看到而受益！讓傳播知識成為一種習慣，是“玖玖骨科”讓你投稿的理由！