本期目錄：

1、體重指數超過 30 的患者接受外側單間室膝關節置換術的結果令人滿意

2、評估新式跨平臺測量工具的可行性以應對門診關節置換手術數量增長的需求

3、高體重指數對功能對線影像導航機器人輔助全膝關節置換術的影響

4、亞洲人群髖關節發育不良患者PAO與THA術后傾向評分匹配比較

5、一種基于直接髖關節磁共振造影的髖關節軟骨和盂唇自動三維分割的深度學習方法

6、DDH骨化核是否出現與股骨頭缺血壞死相關

7、與酒精相關性股骨頭壞死相比，糖皮質激素相關性股骨頭壞死（GONFH）表現出更低的骨微結構硬化程度和更高的骨吸收活性

8、建立一種精準的術中替代技術用于測量股骨前傾角

9、雙側髖臼周圍截骨術后，代償性骨盆前傾是否會減小

10、John Charnley獎：定量透視成像工具提升髖臼周圍截骨術中骨塊定位精度

11、人類髖關節髖臼盂唇的三維結構

12、癥狀性髖關節發育不良和股骨髖臼撞擊患者脛骨和股骨扭轉聯合異常的患病率

第一部分：關節置換及保膝相關文獻

文獻1

體重指數超過 30 的患者接受外側單間室膝關節置換術的結果令人滿意

譯者 馬云青

的： 通過 2 ~ 12 年的隨訪，分析體重指數 (BMI) 對骨水泥固定支撐外側單間室膝關節置換術 (UKA) 臨床療效的影響。
方法： 2010 年 1 月至 2020 年 1 月，共植入 103 例外側 UKA。牛津膝關節評分 (OKS) 和西安大略省和麥馬士達大學骨關節炎指數的疼痛，僵硬，功能和總分被用來評估患者術前和術后的整體健康狀況。WOMAC 值 > 85 分和 OKS > 40 分的結果被認為是良好或優秀的。用 Kaplan-Meier 方法描述的假體生存率被定義為在最近的隨訪中無翻修，并發癥或進一步手術情況在隨訪時一同記錄。P 值 < 0.05 被認為是差異顯著的。
結果： 在平均 77.8 個月的隨訪中，評估了101例外側UKA。沒有患者接受翻修，但 2 例 (2,0%) 在術后 2 年和 5 年發生無菌性松動，但由于臨床原因均未進行翻修 (5 年生存率97.2%)。總體滿意度普遍較高，所有 WOMAC 分量表和所有 BMI 組的 OKS 得分均優異。考慮到疼痛分量表 (WOMAC 疼痛) ，體重正常和超重的患者比肥胖患者 (n = 0) 更多地獲得優異的結果 [10 (25.64%) vs 10 (23.81%) p = 0.026] ; 另一方面，在生活質量方面 (WOMAC QoL) ，肥胖患者更多達到優異的值，甚至是統計學顯著的差異[n = 15 (75.00%) p = 0.040]。
結論：雖然肥胖在歷史上一直被描述為 UKA 的手術禁忌，但現代 UKA 假體設計的改善對這種傳統觀念已經提出了挑戰。因此，體重指數 > 30 kg/m2 患者UKA的手術禁忌可能并不合理。根據目前的研究，體重指數 > 30 kg/m2 的外側 UKA 患者與長期非肥胖患者相比，具有令人滿意的患者報告結果指標，生存率與內側 UKA 相當。肥胖患者不應被排除在外側 UKA 手術的受益范圍之外。

A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty

Purpose: The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up.

Methods: Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients' overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan-Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant.

Results: One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p = 0.026] than obese patients (n = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [n = 15 (75.00%) p = 0.040].

Conclusion: Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery.

文獻出處：Giordano L, Maffulli N, Morenghi E, Quaglia A, Prospero E, Rosa F, Volpi P. A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1106-1112. doi: 10.1007/s00167-022-07253-3. Epub 2022 Dec 7. PMID: 36478285; PMCID: PMC9734769.

文獻2

評估新式跨平臺測量工具的可行性以應對門診關節置換手術數量增長的需求

譯者 張薔

背景：擇期初次全髖和全膝關節置換術（統稱為關節置換術[TJAs]）為臨床常見術式，可以緩解疼痛、改善功能。TJAs通常十分安全，但仍存在可能出現的并發癥。盡管該手術通常為住院手術，但有越來越多的TJAs變為門診手術。我們想尋找一種科學可行的跨平臺測量工具，來評估住院手術和門診手術的醫療服務質量。

方法：應用醫療保險的申領和支付數據來篩選TJA病例，我們重新指定醫保和醫療補助中心（CMS）住院患者專用TJA并發癥風險評估工具來分別計算住院或門診的擇期初次TJAs患者術后并發癥率。我們匹配了住院和門診手術患者的編碼信息，并應用分層邏輯回歸分析法來計算醫院專用的標準化風險并發癥率（RSCRs）。低概率意味著更高質量的醫療服務。應用CMS測量工具，我們測試了工具的可靠性以及經審核的患者關鍵治療決策情況。

方法：以手術場景作為風險變量的單一組合模型得出了最高的差值（單一組合模型的場景指示符數值：0.664，住院手術模型的數值為0.651，門診手術模型的數值為0.638）。在至少包含25例TJAs的2747家醫院中，平均RSCR值（帶有指示符的組合模型）為2.91%（平均RSCR：2.85%；四分位間距：2.59%-3.18%）。高風險醫院的并發癥發生率與低風險醫院的概率比中位數為1.33。

結論：我們重新指定了一種評估住院TJA手術或門診TJA手術療效的工具，并測試了該工具的可靠性。本研究通過這種測量工具發現不同醫院間的并發癥率差異，即支持該工具在更大患者群體（現今納入了門診手術病例vs.既往只包含住院手術病例）內評估醫院服務水平的可行性。

Testing the Feasibility of a Cross-Setting Measure to Address the Rising Trend in Hospital Outpatient TJA Procedures

Background: Elective primary total hip and total knee arthroplasty (collectively, total joint arthroplasties [TJAs]) are commonly performed procedures that can reduce pain and improve function. TJAs are generally safe, but complications can occur. Although historically performed as inpatient procedures, TJAs are increasingly being performed in the outpatient setting. We sought to develop a scientifically acceptable cross-setting measure for evaluating care quality across inpatient and outpatient settings.

Methods: Using Medicare administrative claims and enrollment data for qualifying TJA patients, we respecified the Centers for Medicare & Medicaid Services (CMS) inpatient-only risk-standardized TJA complications measure to assess complication rates following elective primary TJAs performed in an inpatient or outpatient setting. We aligned inpatient and outpatient coding practices and used hierarchical logistic regression to calculate hospital-specific, risk-standardized complication rates (RSCRs). Lower rates correspond to better quality. Using accepted approaches for CMS measures, we tested measure reliability and vetted key measure decisions with patient and provider input.

Results: A single combined model including the procedure setting as a risk variable produced the highest discrimination (C-statistic for a single combined model with a setting indicator: 0.664, C-statistic for the inpatient-only model: 0.651, C-statistic for the outpatient-only model: 0.638). Among the 2,747 hospitals with at least 25 TJAs, the mean RSCR (using the combined model with a setting indicator) was 2.91% (median RSCR: 2.85%; interquartile range: 2.59% to 3.18%). The median odds ratio for complication occurrence at a higher-risk hospital compared with a lower-risk hospital was 1.33.

Conclusions: We respecified a measure to assess hospital inpatient or outpatient TJA performance and evaluated the reliability and validity of the measure. The findings showed variation in hospital-level complication rates across settings as indicated by this measure, supporting the feasibility of evaluating hospital performance using a more representative population than inpatient TJAs alone.

文獻出處：Wallace LR, Tan Z, Barthel A, Sáenz MP, Grady JN, Balestracci KMB, Bozic KJ, Myers R, McDonough DL, Lin Z, Suter LG. Testing the Feasibility of a Cross-Setting Measure to Address the Rising Trend in Hospital Outpatient TJA Procedures. J Bone Joint Surg Am. 2025 Mar 19;107(6):604-613. doi: 10.2106/JBJS.23.01395. Epub 2024 Dec 5. PMID: 39637009.

文獻3

高體重指數對功能對線影像導航機器人輔助全膝關節置換術的影響：功能結果相當，但機械失敗率更高

譯者 沈松坡

研究目的：體重指數（BMI）升高在全膝關節置換術（TKA）中帶來諸多挑戰，包括并發癥發生率升高。借助機器人輔助進行的功能性膝對位（FKP）提供了個體化的對線與軟組織平衡方式，但其在高BMI患者中的效果尚不明確。本回顧性對照研究旨在評估肥胖及其嚴重程度對影像導航機器人輔助、遵循FKP原則的TKA術后臨床結局與并發癥的影響。

研究方法：研究納入372名接受FKP原則指導下機器人輔助TKA的患者，按BMI分為兩組（<30 kg/m2 與 ≥30 kg/m2）。在術后至少2年的隨訪中，評估Knee Society評分（KSS）、“遺忘關節”評分（FJS）、關節活動度（ROM）、假體位置情況及并發癥等指標。

研究結果：BMI ≥30 kg/m2患者在ROM、KSS和FJS方面與BMI較低者表現相當。然而，肥胖組因機械失效導致的翻修率顯著較高（2.99% vs. 0.42%，p=0.04）。除股骨外旋較少外，假體定位在兩組間基本一致。

研究結論：FKP指導下的機器人輔助TKA能在肥胖患者中實現相似的功能恢復，說明該術式在解決解剖挑戰方面有效。然而，肥胖仍是機械失效的重要風險因素。

Impact of High Body Mass Index on Functionally Aligned Image-Based Robotic Total Knee Arthroplasty: Comparable Functional Outcomes but Higher Mechanical Failures

Objectives: Increased body mass index (BMI) poses challenges in total knee arthroplasty (TKA), including higher complication rates. Functional knee positioning (FKP) with robotic assistance provides a personalized approach to optimize alignment and soft-tissue balance, but its impact on patients with increased BMI remains unclear. This retrospective comparative study aims to evaluate the influence of obesity and its severity on clinical outcomes and complications in TKA performed with an image-based robotic system guided by FKP principles.

Methods: This retrospective comparative study included 372 patients who underwent robotic-assisted TKA following FKP principles. Patients were stratified into two main groups based on BMI (<30 kg/m2; 238 patients and ≥30 kg/m2; 134 patients). Outcomes included Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM), implant positioning, and complications, evaluated at a minimum follow-up of two years.

Results: Patients with increased BMI (≥30 kg/m2) demonstrated similar functional outcomes to patients with BMI <30 kg/m2 in terms of ROM, KSS, and FJS. However, the revision rate due to mechanical failures was significantly higher in the obese group (2.99% vs. 0.42%, p=0.04; hazard ratio= 6.8; 95% CI, 1.09-42.31). Implant positioning was consistent across groups, except for reduced femoral external rotation in the increased BMI group (p= 0.004).

Conclusions: Robotic-assisted TKA with FKP principles achieves comparable functional outcomes for obese patients at a minimum of a 2-year follow-up, demonstrating the system's ability to address anatomical and functional challenges. However, obesity remains a critical risk factor for mechanical failures.

第二部分：保髖相關文獻

文獻1

亞洲人群髖關節發育不良患者PAO與THA術后傾向評分匹配比較

譯者 羅殿中

背景：尚無研究針對亞洲人DDH繼發OA進行PAO或THA患者滿意度進行比較。

方法：對737例（251例PAO，486例THA）患者進行多元分析，以明確患者人口學特征和患者報告結果（PRO）是否與術后患者滿意度有關。進而，對DDH繼發OA患者PAO與THA行傾向評分匹配（K-L II級32例PAO、16例THA；K-L III級20例PAO、40例THA），比較患者術后滿意度、牛津髖關節評分（OHS）、加利福尼亞大學-洛杉磯分校活動功能評分（UCLA）、運動參與度。

結果：在737例患者中，663例（93%）術后療效滿意。多元分析顯示THA與患者滿意度相關。進一步分析，術后OHS疼痛評分、OHS活動評分（OHS-ADL）、UCLA功能評分與滿意度相關。在對PAO和THA進行傾向評分匹配患者中，K-L II級DDH繼發OA患者PAO較THA滿意度更高，表現在術后OHS（包括疼痛和ADL）、UCLA、和運動參與度方面；而K-L III級DDH繼發OA患者THA較PAO滿意度更高，表現在術后OHS-ADL、UCLA、和運動參與度方面。

結論：基于術前OA的程度，PAO和THA均取得患者滿意度提高。這些發現有助于對中年有癥狀DDH患者手術治療的臨床決策。

譯者注：PAO，髖臼周圍截骨術；THA，人工全髖關節置換術；DDH，髖關節發育不良；OA，骨關節炎；K-L，Kellgren-Lawrence骨關節炎分級；ADL，日程活動能力。

圖1. 本研究流程示意圖（注意THA匹配人數是總人數的81/1025）。

A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort

Background:No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts.

Methods:Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients).

Results:Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries.

Conclusions:Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.

文獻出處：Harada T, Hamai S, Shiomoto K, Hara D, Motomura G, Nakashima Y. A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort. Hip Int. 2023 Jul;33(4):743-751. doi: 10.1177/11207000221114272. Epub 2022 Jul 24. PMID: 35875941.

文獻2

一種基于直接髖關節磁共振造影的髖關節軟骨和盂唇自動三維分割的深度學習方法

譯者 張振東

本研究目的是利用卷積神經網絡（CNNs）基于三維MRI實現髖關節軟骨和盂唇的自動分割。在這項回顧性單中心研究中，采用U-Net架構的卷積神經網絡開發了一種基于MRI的髖關節軟骨和盂唇全自動分割模型。

研究選取了2020年1月至2021年10月期間100名有癥狀患者的直接髖關節磁共振造影數據。常規掃描序列包含三維T1 mapping序列，該序列用于髖關節軟骨和盂唇的手動分割。其中80個髖關節數據用于模型訓練，剩余20個用于測試。模型性能通過六項評估指標進行驗證，包括Dice相似系數（DSC，Dice相似系數是一種用于衡量兩個樣本相似度的統計指標，通常用于圖像分析和醫學圖像處理，尤其是在分割任務中，它的值范圍從0到1，其中：0 表示沒有重疊，1 表示完全重疊）。此外，研究還使用來自其他機構的40名患者的三維T2加權序列組成的外部數據集測試模型性能。手動分割的評估者間一致性被作為自動分割性能的基準。

結果顯示，共納入100名患者（平均年齡30±10歲，女性占64%）。軟骨分割的平均DSC為0.92±0.02（95%置信區間[CI] 0.92-0.93），盂唇為0.83±0.04（0.81-0.85），其表現與手動分割的評估者間一致性相當（p值分別為0.232和0.297）：手動分割的軟骨DSC為0.93±0.04（0.92-0.95），盂唇為0.82±0.05（0.80-0.85）。在外部數據集測試中，軟骨和盂唇的DSC分別為0.89±0.02（0.88-0.90）和0.71±0.04（0.69-0.73）。

研究表明，該深度學習方法能準確分割三維MRI序列中的髖關節軟骨和盂唇，未來或可應用于臨床實踐，為快速生成精準的三維MRI模型提供支持。

A deep learning approach for automatic 3D segmentation of hip cartilage and labrum from direct hip MR arthrography

The objective was to use convolutional neural networks (CNNs) for automatic segmentation of hip cartilage and labrum based on 3D MRI. In this retrospective single-center study, CNNs with a U-Net architecture were used to develop a fully automated segmentation model for hip cartilage and labrum from MRI. Direct hip MR arthrographies (01/2020-10/2021) were selected from 100 symptomatic patients. Institutional routine protocol included a 3D T1 mapping sequence, which was used for manual segmentation of hip cartilage and labrum. 80 hips were used for training and the remaining 20 for testing. Model performance was assessed with six evaluation metrics including Dice similarity coefficient (DSC). In addition, model performance was tested on an external dataset (40 patients) with a 3D T2-weighted sequence from a different institution. Inter-rater agreement of manual segmentation served as benchmark for automatic segmentation performance. 100 patients were included (mean age 30 ± 10 years, 64% female patients). Mean DSC for cartilage was 0.92 ± 0.02 (95% confidence interval [CI] 0.92-0.93) and 0.83 ± 0.04 (0.81-0.85) for labrum and comparable (p = 0.232 and 0.297, respectively) to inter-rater agreement of manual segmentation: DSC cartilage 0.93 ± 0.04 (0.92-0.95); DSC labrum 0.82 ± 0.05 (0.80-0.85). When tested on the external dataset, the DSC was 0.89 ± 0.02 (0.88-0.90) and 0.71 ± 0.04 (0.69-0.73) for cartilage and labrum, respectively.The presented deep learning approach accurately segments hip cartilage and labrum from 3D MRI sequences and can potentially be used in clinical practice to provide rapid and accurate 3D MRI models.

文獻出處：Meier MK, Helfenstein RA, Boschung A, Nanavati A, Ruckli A, Lerch TD, Gerber N, Jung B, Afacan O, Tannast M, Siebenrock KA, Steppacher SD, Schmaranzer F. A deep learning approach for automatic 3D segmentation of hip cartilage and labrum from direct hip MR arthrography. Sci Rep. 2025 Feb 7;15(1):4662. doi: 10.1038/s41598-025-86727-z. PMID: 39920175; PMCID: PMC11805980.

文獻3

DDH骨化核是否出現與股骨頭缺血壞死相關

譯者 任寧濤

目的：本研究旨在評估DDH保守治療時骨化核（ON）是否出現與AVN發生率的關系，迄今為止，ON 和 AVN 之間的相關性仍然不明確。

方法：選擇2006年1月-2007年12月就診于我院的148名患兒，共234例髖關節，根據超聲檢查，髖關節情況分為Graf IIIa, IIIb和IV型，患兒年齡>6個月時同時行標準的骨盆正位片。

結果：其中84例髖關節（35.9 %）在治療時出現ON ，治療初始年齡平均為5個月，先行牽引2周然后人類位石膏4周，后行Tübingen屈曲支具，最終隨訪時平均年齡為87個月，采用Ogden-Bucholz AVN 分型對最終隨訪時的影像學進行評估。小于10個月的患兒，AVN與ON(-)和ON (+)無關(P = 0.681)，然而當所有年齡組一起分析時，ON(+) 髖關節的 AVN 顯著增加 (P = 0.002)。臨床查體顯示 ON(-) 組與 ON(+) 組在跛行、雙下肢不等長和髖關節活動范圍方面沒有差異。

結論：無論骨化核是否出現，DDH治療越早越好，復位不能晚于生后10個月，否則容易導致AVN發生率增加。

表1 各年齡段ON是否出現與AVN的關系

Correlation between avascular necrosis and the presence of the ossific nucleus when treating developmental dysplasia of the hip

Purpose: This study assessed whether avascular necrosis (AVN) is correlated with the presence or absence of the ossific nucleus (ON) at the initiation of conservative treatment for developmental dysplasia of the hip (DDH). To date, the correlation between the presence of the ON and AVN manifestations remains ambiguous.

Methods: The medical records of 148 patients with 234 dislocated hips who presented at our institution between January 2006 and December 2007 were reviewed. Based on ultrasound examination, the hips were classified according to Graf IIIa, IIIb, and IV criteria. Patients aged >6 months were simultaneously examined by standardized pelvis radiography.

Results: The ON was present in 84 hips (35.9 %) at the beginning of treatment. Treatment was begun at a mean age of 5 months, with overhead traction for 2 weeks followed by arthrography and a spica cast for 4 weeks. Afterwards, we used a Tübingen hip-flexion splint. The mean age at final follow-up was 87 months. Hips were radiographically evaluated at last follow-up according to the Ogden-Bucholz AVN classification scheme. There was no significant difference in AVN prevalence between ON(-) versus ON(+) hips in children aged ≤10 months (P = 0.681), whereas when all age groups were analyzed together, AVN was significantly increased in ON(+) hips (P = 0.002). Clinical examination revealed no differences in limping, leg length inequality, and range of motion of hips in the ON(-) versus ON(+) groups.

Conclusion: We conclude that DDH treatment should be performed early without regard to the presence or absence of the ON. Reduction should not be delayed beyond >10 months of age because any delay in treatment increases the incidence of AVN.

文獻出處：Sabit Sllamniku, Cen Bytyqi, Ardiana Murtezani , Emir Q Haxhija. Correlation between avascular necrosis and the presence of the ossific nucleus when treating developmental dysplasia of the hip. J Child Orthop. 2013 Dec;7(6):501-5.

文獻4

與酒精相關性股骨頭壞死相比，糖皮質激素相關性股骨頭壞死（GONFH）表現出更低的骨微結構硬化程度和更高的骨吸收活性

譯者 李勇

背景： 糖皮質激素使用和酒精濫用是非創傷性股骨頭壞死（ONFH）最廣泛公認的危險因素。盡管糖皮質激素相關性ONFH（GONFH）和酒精相關性ONFH（AONFH）的病因不同，但關于這兩種ONFH亞型在骨微結構和組織形態學特征上的差異知之甚少。

目的： 旨在研究GONFH和AONFH患者股骨頭不同區域的骨微結構、骨重塑活性以及組織形態學特征。

方法： 從2015年9月至2020年10月，共招募了85名診斷為GONFH和AONFH的患者。股骨頭標本在全髖關節置換術后獲取。從42名GONFH患者（50個髖關節）和43名AONFH患者（50個髖關節）處獲取了股骨頭標本。使用Micro-CT評估股骨頭9個感興趣區域（ROIs）的微觀結構。沿頭尾方向（從上到下），將股骨頭分為壞死區、反應界面區和正常區；沿內外側方向，將股骨頭分為內側區、中央區和外側區。隨后進行脫鈣和未脫鈣骨組織學檢查，以評估組織病理學改變和骨重塑水平。

結果： 在壞死區，大部分骨微結構參數在GONFH和AONFH之間沒有顯著差異；然而，在反應界面區和正常區，與AONFH相比，GONFH均顯示出硬化程度較低的骨微結構和更高的骨重塑水平。盡管壞死區的病理表現相似，但GONFH壞死區的軟骨下骨小梁微骨折更嚴重，反應界面區的血管更豐富。

結論： GONFH和AONFH在壞死區的骨微結構和組織病理學特征相似，而在反應界面區和正常區，GONFH則表現出硬化程度較低的骨微結構和更活躍的骨代謝狀態。GONFH和AONFH在骨微結構和組織病理學特征上的這些差異，可能有助于針對不同病因制定改善ONFH病情的預防策略和治療方法。

Less sclerotic microarchitecture pattern with increased bone resorption in glucocorticoid-associated osteonecrosis of femoral head as compared to alcohol-associated osteonecrosis of femoral head

BackgroundGlucocorticoid usage and alcohol abuse are the most widely accepted risk factors for nontraumatic osteonecrosis of femoral head (ONFH). Despite distinct etiologies between glucocorticoid-associated ONFH (GONFH) and alcohol-associated ONFH (AONFH), little is known about the differences of the microarchitectural and histomorphologic characteristics between these subtypes of ONFH.PurposesTo investigate bone microarchitecture, bone remodeling activity and histomorphology characteristics of different regions in femoral heads between GONFH and AONFH.MethodsFrom September 2015 to October 2020, 85 patients diagnosed with GONFH and AONFH were recruited. Femoral heads were obtained after total hip replacement. Femoral head specimens were obtained from 42 patients (50 hips) with GONFH and 43 patients (50 hips) with AONFH. Micro-CT was utilized to assess the microstructure of 9 regions of interest (ROIs) in the femoral head. Along the supero-inferior orientation, the femoral head was divided into necrotic region, reactive interface, and normal region; along the medio-lateral orientation, the femoral head was divided into medial region, central region and lateral region. Decalcified and undecalcified bone histology was subsequently performed to evaluate histopathological alterations and bone remodeling levels.

ResultsIn the necrotic region, most of the microarchitectural parameters did not differ significantly between GONFH and AONFH, whereas both the reactive interface and normal region revealed a less sclerotic microarchitecture but a higher bone remodeling level in GONFH than AONFH. Despite similar necrotic pathological manifestations, subchondral trabecular microfracture in the necrotic region was more severe and vasculature of the reactive interface was more abundant in GONFH.ConclusionsGONFH and AONFH shared similar microarchitecture and histopathological features in the necrotic region, while GONFH exhibited a less sclerotic microarchitecture and a more active bone metabolic status in both the reactive interface and normal region. These differences between GONFH and AONFH in bone microarchitectural and histopathological characteristics might contribute to the development of disease-modifying prevention strategies and treatments for ONFH, taking into etiologies.

文獻出處：Chen Y, Miao Y, Liu K, Zhu B, Xue F, Yin J, Zou J, Li G, Zhang C, Feng Y. Less sclerotic microarchitecture pattern with increased bone resorption in glucocorticoid-associated osteonecrosis of femoral head as compared to alcohol-associated osteonecrosis of femoral head. Front Endocrinol (Lausanne). 2023 Mar 8;14:1133674. doi: 10.3389/fendo.2023.1133674. PMID: 36967755; PMCID: PMC10031038.

文獻5

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。

關鍵詞：術中技術、股骨前傾角、改良C臂技術

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6

雙側髖臼周圍截骨術后，代償性骨盆前傾是否會減小？

譯者 陶可

背景：腰椎、骨盆傾斜和髖關節之間存在動力學聯系，但這種關系在髖關節發育不良患者中仍需進一步研究。一些前期報告表明，患者可能會通過骨盆前傾增加來代償髖關節包容不足；目前尚不清楚這種關系是否會受到髖臼截骨重新定向的影響。

問題/目的：(1)與雙側髖臼周圍截骨術(PAO)后至少6個月拍攝的圖像相比，術前拍攝的站立位骨盆正位X線片上代償性骨盆傾斜是否會減小？(2)改良的骨盆傾斜替代測量指標——恥骨聯合至骶髂關節指數(PS-SI)——是否與可以直接測量骨盆傾斜的物理合成骨模型相關？(3) PS-SI指數是否具有較高的評估者間信度？

方法：我們評估了一位手術醫生參與的ANCHOR注冊系統的手術記錄，該記錄涵蓋了2007年至2016年期間接受分期雙側PAO第二側手術的患者，共計113例。其中，70例（62%）在第二次PAO后6個月內失訪或未進行充分的影像學檢查，另有3例（3%）因預先設定的原因被排除，剩余40例（35%）用于本回顧性研究的評估。我們采用術前站立位和術后近期正位骨盆X線片測量T?nnis角、前壁指數、后壁指數、外側中心邊緣角、恥骨聯合至骶尾關節連接處距離以及PS-SI指數。最近的X線片拍攝于第二次PAO后平均16 ± 6個月。我們選擇6個月作為最短時間點，因為此時大多數患者已達到最大臨床改善，不再受術后肌肉功能障礙的限制。使用組內相關系數(ICC)進行統計分析，以評估評級者間信度，并使用配對t檢驗評估術前和術后測量值的變化。此外，使用物理合成骨模型創建了一個可以直接測量骨盆傾斜度的模型。該模型通過雙側髖臼固定在支架上，并旋轉使骨盆傾斜度增加5°。在每個時間點拍攝前后位骨盆X線片，測量PS-SI指數，并進行回歸分析以評估趨勢。

結果：總體而言，40例患者中37名（93%）的骨盆傾斜度有所下降（以PS-SI指數衡量）。用 PS-SI指數測量的骨盆傾斜平均量在術后有所減少，將術前和術后最新的X線片結果進行比較（97 ± 14 毫米對比89 ± 13 毫米，均差8 ± 9毫米；95%置信區間，-11至-5；范圍：17增加至24減少，p < 0.001）。在合成骨驗證模型中，骨盆傾斜與PS-SI指數呈線性關系（PS-SI 指數 = 5.0° + 3.6°傾斜，R = 0.99）。最后，術前(ICC = 0.986)和術后(ICC = 0.988)的PS-SI指數的評級者間信度均極佳。

結論：我們發現雙側PAO后骨盆前傾略有減少。這一發現表明髖臼截骨后重新定向會影響骨盆位置。在臨床實踐中，髖關節發育不良患者可能通過骨盆傾斜的動態且可逆性變化進行代償。PS-SI指數是一種可重復的工具，用于測量骨盆入口高度并評估骨盆傾斜。未來的臨床研究應評估這些放射影像學發現的臨床意義，包括對腰背痛的評估，盡管腰背痛可能受骨盆傾斜影響，但其影響因素可能多種多樣。

Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Background: The kinetic link among the lumbar spine, pelvic tilt, and the hip has been hypothesized, but this relationship requires further study in acetabular dysplasia. Anecdotal reports suggest that patients may compensate for acetabular dysplasia with an involuntary increase in anterior pelvic tilt; it is not known if this relationship is affected by acetabular reorientation.

Questions/purposes: (1) Does compensatory pelvic tilt decrease on preoperatively obtained standing AP pelvis radiographs compared with those obtained at a minimum of 6 months after bilateral periacetabular osteotomy (PAO)? (2) Does a modified surrogate measurement of pelvic tilt, the pubic symphysis to sacroiliac (PS-SI) index, correlate with a physical synthetic bones model in which pelvic tilt can be directly measured? (3) Can the PS-SI index demonstrate high interrater reliability?

Methods: We assessed the surgical records of one surgeon, who participates in the longitudinally maintained Academic Network of Conservational Hip Outcomes Research (ANCHOR) registry, for patients who had undergone the second side of a staged bilateral PAO between 2007 and 2016; there were 113 such patients. Of those, 70 (62%) were lost to followup within 6 months of the second PAO or did not have adequate imaging studies, and another three (3%) were excluded for prespecified reasons, leaving 40 (35%) for evaluation in this retrospective study. Standing preoperative and most recent postoperative AP pelvis radiographs were used to measure the T?nnis angle, anterior wall index, posterior wall index, lateral center-edge angle, pubis symphysis-to-sacrococcygeal junction distance, and the PS-SI index. The most recent radiographs were obtained at a mean of 16 ± 6 months after the second PAO. We chose 6 months as the minimum because at this time point, the majority of patients have reached their maximum clinical improvement and are no longer limited by postoperative muscle dysfunction. Statistical analysis was performed using the intraclass correlation coefficient (ICC) for interrater reliability and paired t-tests for assessing change in measurements from pre- to postoperative. Additionally, a model was created using a physical synthetic bones model in which pelvic tilt could be directly measured. This model was secured through bilateral acetabuli on a mount and rotated through 5° increases in pelvic tilt. AP pelvis radiographs were obtained at each point, the PS-SI index was measured, and a regression analysis performed to evaluate for trend.

Results: Overall, 37 of 40 patients (93%) had a decrease in pelvic tilt, as measured by the PS-SI index. The mean amount of pelvic tilt as measured by the PS-SI index decreased after surgery when comparing the preoperative with latest radiographs on this parameter (97 ± 14 mm versus 89 ± 13 mm, mean difference 8 ± 9 mm; 95% confidence interval, -11 to -5; range 17 increase to 24 decrease, p < 0.001). A linear relationship between pelvic tilt and PS-SI index (PS-SI index = 5.0° + 3.6° tilt, R = 0.99) was identified in the synthetic bones validation model. Finally, the interrater reliability was found to be excellent for the PS-SI index preoperatively (ICC = 0.986) and postoperatively (ICC = 0.988).

Conclusions: We found a modest reduction in anterior pelvic tilt after bilateral PAO. This finding suggests that acetabular reorientation affects pelvic position. In clinical practice, patients with acetabular dysplasia may compensate with dynamic and reversible changes in pelvic tilt. The PS-SI index is a reproducible tool to measure the height of the pelvic inlet as an assessment of pelvic tilt. In the future, clinical studies should evaluate the clinical implications of these radiographic findings, including the assessment of back pain, which although multifactorial may be influenced by pelvic tilt.

文獻出處：Erika Daley, Nickolas Nahm, Denise Koueiter, Ira Zaltz. Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy? Clin Orthop Relat Res. 2019 May;477(5):1168-1175. doi: 10.1097/CORR.0000000000000560.

文獻7

John Charnley獎：定量透視成像工具提升髖臼周圍截骨術中骨塊定位精度

譯者 邱興

背景：髖臼周圍截骨術（PAO）中髖臼骨塊位置的影像學評估與髖關節存活率密切相關。傳統術中平片檢查耗時耗力，而透視成像可能因圖像失真影響測量精度。本研究旨在驗證使用具有失真校正功能的透視測量工具是否能改善PAO術中測量效果。

方法：通過回顧性分析570例PAO手術病例（其中136例使用失真校正透視工具，434例為采用常規透視技術的歷史對照），分別在術前站立位X線片、術中透視圖像和術后站立位X線片上測量外側中心邊緣角（LCEA）、髖臼指數（AI）、后壁征（PWS）和前中心邊緣角（ACEA）。設定矯正目標區間為：AI 0～10°、ACEA 25～40°、LCEA 25～40°、PWS陰性。分別采用卡方檢驗和配對t檢驗比較術后矯正達標率及患者報告結局。

結果：矯正后透視測量與術后6周X線測量平均差異為：LCEA 0.21°、ACEA 0.01°、AI -0.07°（均P < 0.01），PWS一致性達92%。新型透視工具顯著提升各參數達標率：LCEA從74%提升至92%（P < 0.01），ACEA從72%提升至85%（P < 0.01），AI達標率69% vs 74%（P = 0.25），但PWS無顯著改善（85% vs 85%，P = 0.92）。除PROMIS心理健康評分外，所有患者報告結局均有顯著改善。

結論：本研究表明采用定量透視實時測量系統可顯著提升PAO術中測量精度和矯正目標達成率。該增效工具在不干擾手術流程前提下，為術者提供可靠的定量矯正評估。

John Charnley Award: A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy

Background: Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets.

Methods: We retrospectively reviewed 570 PAOs; 136 PAOs utilized a distortion correcting fluoroscopic tool, and 434 PAOs performed with routine fluoroscopy, prior to this technology. Lateral center-edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center-edge angle (ACEA) were measured on preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs. Defined target zones of correction were AI: 0-10°, ACEA: 25-40°, LCEA: 25-40°, PWS: negative. Postoperative correction in zones and patient-reported outcomes were compared using chi-square tests and paired t-tests, respectively.

Results: The average difference between postcorrection fluoroscopic measurements and 6-week postoperative radiographs was 0.21° for LCEA, 0.01° for ACEA, and -0.07° for AI (all P < .01). The PWS agreement was 92%. The percentages of hips meeting target goals overall improved with the new fluoroscopic tool: 74%-92% for LCEA (P < .01), 72%-85% for ACEA (P < .01), and 69 versus 74% for AI (P = .25), though there was no improvement in PWS (85 versus 85%, P = .92). All patient-reported outcomes except PROMIS Mental Health were significantly improved at most recent follow-up.

Conclusions: Our study demonstrated improved PAO measurements and target goals with the use of a distortion correcting quantitative fluoroscopic real-time measuring device. This value-additive tool gives reliable quantitative measurements of correction without interfering with surgical workflow.

Keywords: acetabular dysplasia; computer-assistance; fluoroscopic distortion; hip preservation; periacetabular osteotomy.

文獻出處： Anderson L , Erickson J , Kapron C R ,et al.A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy.[J]. The Journal of arthroplasty, 2023.DOI:10.1016/j.arth.2023.03.052.

文獻8

人類髖關節髖臼盂唇的三維結構

譯者 徐子茵

隨著年齡的增長，髖臼盂唇經常受損。由于膠原纖維是力量的主要來源，了解其超微結構對于確定年齡引起的變化的原因非常重要。

目的：利用掃描電鏡觀察構成髖臼盂唇膠原纖維的超微結構。研究了全髖關節置換術中獲得的髖臼盂唇樣本。在光鏡和掃描電鏡下觀察構成盂唇的膠原纖維的立體結構。盂唇主要由軟骨組織組成，軟骨組織由軟骨細胞和II型膠原組成，并有一層I型膠原。成人中，細胞質豐富的軟骨細胞被致密的II型膠原纖維網絡包圍，軟骨層中穿插著小束的I型膠原原纖維。在老年人中，軟骨細胞萎縮，I型和II型膠原纖維稀疏。我們認為軟骨有三到五層，由I型和II型膠原原纖維與固體軟骨基質組成。在老年人中，軟骨細胞密度降低，膠原原纖維的細胞形狀和結構也發生變化。

Three?dimensional architecture of the acetabular labrum in the human hip joint

The acetabular labrum is frequently damaged with advancing age. As collagen fibers are the main sources of strength, knowledge of their ultrastructure is important to determine the cause of age-induced changes. We aimed to investigate the ultrastructure of collagen fibers constituting the acetabular labrum using scanning electron microscopy (SEM). Acetabular labrum samples obtained during total hip arthroplasty were studied. The samples were specially prepared to observe the steric construction of collagen fibrils constituting the acetabular labrum under light microscopy followed by SEM. The acetabular labrum was mostly composed of cartilage tissue, consisting of chondrocytes and collagen type II, with a layer of collagen type I. In adults, chondrocytes with a rich cytoplasm were surrounded by a dense network of fine type II collagen fibrils, and small bundles of type I collagen fibrils were interposed in the cartilage layer. In elderly individuals, the chondrocytes atrophied and both type I and II collagen fibrils were sparse. We suggest that cartilage has three to five layers, consisting of type I and type II collagen fibrils with a solid cartilage substrate. In elderly individuals, the density of chondrocytes decreases and the cellular shape and architecture of collagen fibrils also changes.

文獻來源：Nogami R, Kaku N, Shimada T, Tabata T, Tagomori H, Tsumura H. Three-dimensional architecture of the acetabular labrum in the human hip joint. Med Mol Morphol. 2020 Mar;53(1):21-27. doi: 10.1007/s00795-019-00228-3. Epub 2019 May 29. PMID: 31144043.

文獻9

癥狀性髖關節發育不良和股骨髖臼撞擊患者脛骨和股骨扭轉聯合異常的患病率

譯者 陳志強

目的：股骨髖臼撞擊（FAI）和髖關節發育不良患者股骨扭轉（FT）和脛骨扭轉（TT）合并異常的患病率尚不清楚。本研究旨在確定FT和TT聯合異常的患病率，以及哪些亞組與FT和TT聯合異常相關。

方法：我們回顧性評估了2011年9月至2016年9月期間進行CT掃描的有癥狀的FAI或髖關節發育不良患者。共有261例髖關節（174例患者）測量了FT和TT。平均年齡為31歲（SD 9），63%為女性（165髖）。將患者與無癥狀對照組（48例髖關節，27例患者）進行比較，對照組有包括股骨和脛骨在內的CT掃描可供分析，這些掃描是出于非骨科原因獲得的。使用Bonferroni校正的方差分析進行比較。

結果：在整個研究組中，62%（163髖）存在FT異常。42%（109例髖關節）存在異常TT。21%（55個髖關節）則為正常FT和正常TT。最常見的異常組合是FT增加和TT正常，占32%（84例髖關節）。在髖關節發育不良組中，21%（11個髖關節）的FT增加伴TT增加。FT異常的患病率在各亞組之間差異顯著（p < 0.001）。我們發現髖關節發育不良（31°; SD 15）°和髖關節外翻（42°（SD 12°））的平均FT顯著高于對照組（22°（SD 8°））。我們發現，與對照組（28°（SD 8°））相比，凸輪型髖關節FAI（34°（SD 6°））和髖關節發育不良（35°（SD 9°））的平均TT顯著更高（p < 0.001）。

結論：FAI患者FT和TT聯合異常的發生率較高。對于髖關節發育不良，我們發現平均FT和TT顯著更高，而21%的患者（11髖）合并TT增加和FT增加（合并扭轉對線不良）。這在計劃保髖手術（如髖臼周圍截骨術和股骨去旋轉截骨術）時很重要。

Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement

Aims：The prevalence of combined abnormalities of femoral torsion (FT) and tibial torsion (TT) is unknown in patients with femoroacetabular impingement (FAI) and hip dysplasia. This study aimed to determine the prevalence of combined abnormalities of FT and TT, and which subgroups are associated with combined abnormalities of FT and TT.

Methods ：We retrospectively evaluated symptomatic patients with FAI or hip dysplasia with CT scans performed between September 2011 and September 2016. A total of 261 hips (174 patients) had a measurement of FT and TT. Their mean age was 31 years (SD 9), and 63% were female (165 hips). Patients were compared to an asymptomatic control group (48 hips, 27 patients) who had CT scans including femur and tibia available for analysis, which had been acquired for nonorthopaedic reasons. Comparisons were conducted using analysis of variance with Bonferroni correction.

Results： In the overall study group, abnormal FT was present in 62% (163 hips). Abnormal TT was present in 42% (109 hips). Normal FT combined with normal TT was present in 21% (55 hips). The most frequent abnormal combination was increased FT combined with normal TT of 32% (84 hips). In the hip dysplasia group, 21% (11 hips) had increased FT combined with increased TT. The prevalence of abnormal FT varied significantly among the subgroups (p < 0.001). We found a significantly higher mean FT for hip dysplasia (31°; SD 15)° and valgus hips (42° (SD 12°)) compared with the control group (22° (SD 8°)). We found a significantly higher mean TT for hips with cam--type--FAI (34° (SD 6°)) and hip dysplasia (35° (SD 9°)) compared with the control group (28° (SD 8°)) (p < 0.001).

Conclusion： Patients with FAI had a high prevalence of combined abnormalities of FT and TT. For hip dysplasia, we found a significantly higher mean FT and TT, while 21% of patients (11 hips) had combined increased TT and increased FT (combined torsional malalignment). This is important when planning hip preserving surgery such as periacetabular osteomy and femoral derotation osteotomy.

文獻出處：Lerch TD, Liechti EF, Todorski IAS, Schmaranzer F, Steppacher SD, Siebenrock KA, Tannast M, Klenke FM. Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement. Bone Joint J. 2020 Dec;102-B(12):1636-1645. doi: 10.1302/0301-620X.102B12.BJJ-2020-0460.R1. PMID: 33249913.

來源：304關節學術

作者：304關節團隊

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