本期目錄：

1、全膝關節置換術：安全嗎？韓國4124名患者的單中心研究

2、肥胖不應被視為牛津單髁的禁忌：對患者報告的長期隨訪結果和 1000 例膝關節的植入物生存率的研究

3、假體周圍感染及伴隨的敗血癥-臨床表現、風險因素和患者結局

4、外翻膝全膝關節置換術后的功能活動和患者滿意度低于內翻膝

5、锝99SPECT/CT在治療兒童長骨生長紊亂中的作用

6、通過3D打印行髖臼周圍截骨術前規劃

7、關于體操運動員髖關節MRI研究

8、患者定制模板和電磁導航輔助雙側髖臼周圍截骨術用于分期矯正雙側損傷引起的髖關節發育不良

9、髖臼周圍截骨術治療髖關節發育不良、髖臼后傾、先天性髖關節脫位或Legg-Calvé-Perthes病患者后的髖關節生存率

10、髖關節存活率評估：伯爾尼髖臼周圍截骨術治療髖臼發育不良的系統綜述與薈萃分析

11、發育性髖關節發育不良閉合復位后MRI評價復位效果

第一部分：關節置換及保膝相關文獻

文獻1

全膝關節置換術：安全嗎？韓國4124名患者的單中心研究

譯者 張軼超

背景：雖然全膝關節置換術（TKA）被認為是治療膝關節骨關節炎的有效方法，但它存在并發癥的風險。隨著越來越多的老年患者進行TKA，了解死亡原因對于提高TKA的安全性至關重要。本研究旨在確定TKA術后短期和長期死亡的主要原因，并報告主要死亡原因的死亡率趨勢。

方法：對4124例做了TKA的患者進行分析。手術時的平均年齡為70.7歲。平均隨訪時間為73.5個月。通過韓國統計信息服務局的信息回顧性收集死亡原因，并根據國際疾病分類-10代碼將其分為13個亞組。在30、60、90、180天和>180天的死亡時間間隔內確定短期和長期死亡原因。計算標準死亡率（SMRs）和累積死亡發生率，以研究TKA后的死亡率趨勢。

結果：30 d短期死亡率為0.07%，60 d為0.1%，90 d為0.2%，180 d為0.2%。惡性腫瘤和心血管疾病是短期死亡的主要原因。長期（180天）死亡率為6.2%。惡性腫瘤（35%）、其他（11.7%）和呼吸系統疾?。?0.1%）是主要的長期死亡原因。男性死于呼吸、代謝和心血管疾病的累積風險更高。70歲TKA患者的年齡矯正死亡率明顯高(SMR, 4.3；95%可信區間[CI]， 3.3-5.4)，70 - 79歲之間(SMR，2.9；95% CI, 2.5-3.5)的患者也高于一般人群。

結論：TKA術后短期死亡率較低，大部分原因與TKA無關。長期死亡的主要原因與以前的發現一致。我們的研究結果可以作為了解TKA患者生存和死亡率的參考數據。

Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea

Background: Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report

mortality trends for major causes of death.

Methods: A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA.

Results: The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death. Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3–5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5–3.5) than that in the general population.

Conclusions: The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.

文獻出處：Ko K, Kim KH, Ko S, Jo C, Han HS, Lee MC, Ro DH. Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea. Clin Orthop Surg. 2023 Dec;15(6):935-941. doi: 10.4055/cios22088. Epub 2022 Dec 29. PMID: 38045584; PMCID: PMC10689220.

文獻2

肥胖不應被視為牛津單髁的禁忌：對患者報告的長期隨訪結果和 1000 例膝關節的植入物生存率的研究

譯者 馬云青

目的：一些醫療機構根據體重指數 (BMI) 選擇膝關節置換術的方式。目前還沒有關于不同 BMI 組中內側活動平臺單髁膝關節置換術 (UKA) 的長期隨訪數據。本研究旨在確定患者體重指數 (BMI) 對患者報告結果和內側 UKA 的長期生存率的影響。作者的假設是，增加 BMI 將導致更差的結果。

方法：分析來自 1000 名連續內側活動牛津 UKA 的前瞻性隊列的數據，平均隨訪 10 年?；颊叻纸M：BMI <25,BMI 25 至 < 30,BMI 30 至 < 35 和 BMI 35+。在 1 年、5 年和 10 年內評估牛津膝關節評分 (OKS) 和 Tegner 活動評分。計算并比較 BMI 組之間的 Kaplan-Meier 生存率。

結果：所有組的 OKS 和 Tegner 評分均有顯著改善。BMI 35 + kg/m2 的平均 OKS 增長最大，為 17.3 分 (p = 0.02)。十年生存率無顯著差異，從最低 BMI 組到最高 BMI 組分別為 92%、95%、94% 和 93%。

結論：不同組之間的植入物存活率沒有差異，盡管術后 OKS 沒有一致的趨勢，但 BMI 35 + 組從 UKA 中受益最大。因此，當使用 UKA 進行適當的禁忌時，高 BMI 不應被視為禁忌。此外，基于 BMI 的假體選擇似乎不合理，特別是當使用最常見的閾值 (BMI 35) 時。

文獻出處：Molloy J, Kennedy J, Jenkins C, Mellon S, Dodd C, Murray D. Obesity should not be considered a contraindication to medial Oxford UKA: long-term patient-reported outcomes and implant survival in 1000 knees. Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2259-2265.

文獻3

假體周圍感染及伴隨的敗血癥-臨床表現、風險因素和患者結局

譯者 張薔

目的：本文章研究了髖膝關節置換術后假體周圍感染（PJI）的一種危及生命的并發癥—敗血癥，以及其流行病學、危險因素和結局。

方法：敗血癥的確診標準見表1。我們比較了PJI合并敗血癥和PJI未合并敗血癥的病例。分析的指標包括患者一般信息、微生物培養結果和合并癥，結局指標包括病死率、住院時長和ICU入住情況。

結果：在所有的108例PJI（48例髖和60例膝）中，40.6%的病例符合敗血癥標準。在髖關節PJI病例中，敗血癥組的Charlson合并癥指數更高（4.0 vs. 1.0; P ≤ 0.001），且金黃色葡萄球菌感染更為常見（17例中9例 vs. 31例中6例; P = 0.04）。腎臟（概率比OR 16.9；P ≤ 0.001）及心臟（OR 12.5; P = 0.02）相關疾病會增加敗血癥風險。敗血癥與住院時間延長（54天 vs. 24天；P = 0.002）和病死率增加（23.5% vs. 3.2%; P = 0.047）相關。在膝關節PJI病例中，敗血癥病例的金黃色葡萄球菌PJI感染比例更高（28例中14例 vs. 32例中8例；P = 0.04）。房顫（OR 3.3; P = 0.04）和腎臟疾?。∣R 4.0; P = 0.02）與敗血癥的發生相關。敗血癥病例的住院時間更長（48天 vs. 29.5天；P = 0.01），ICU入住率更高（67.9% vs. 34.4%；P = 0.02）。敗血癥病例中住院期間病死率是非敗血癥組的10倍（25.0% vs. 3.3%；OR 10.3, P = 0.02）。

結論：很多PJI病例在治療過程中可加重轉為敗血癥，病死率顯著增加。需要臨床醫生嚴密監視患者病情，盡量避免忽視患者逐步惡化的病情。及早干預，分秒必爭的處置態度有助于降低這類病人的患病率和病死率。

Periprosthetic Joint Infection and Concomitant Sepsis Unveiling Clinical Manifestation, Risk Factors, and Patient Outcome

Purpose

This study investigated the epidemiology, risk factors, and outcomes of sepsis, a life threatening complication, in the context of periprosthetic joint infections (PJI) of the hip and knee.

Methods

Sepsis was determined using the Sepsis-1 criteria. The cohort with PJI and sepsis was compared to patients who had PJI without sepsis. Analyzed risk factors were patient characteristics, microbiological findings, and comorbidities. Outcome parameters were mortality, length of hospital stay, and intensive care unit stay.

Results

Among 108 PJI (48 hips and 60 knees), 40.6% met sepsis criteria. In hip PJI, the sepsis group had a higher Charlson Comorbidity Index (4.0 versus 1.0; P ≤ 0.001) with Staphylococcus aureus infections more common in septic cases (9 of 17 versus 6 of 31; P = 0.04). Renal (odds ratio (OR) 16.9; P ≤ 0.001) and cardiac (OR 12.5; P = 0.02) disease increased sepsis risk. Sepsis correlated with prolonged hospital stays (54 versus 24 days; P = 0.002) and increased mortality (23.5 versus 3.2%; P = 0.047). In knee PJI cases, septic patients had more Staphylococcus aureus PJI (14 of 28 versus 8 of 32; P = 0.04). Atrial fibrillation (OR 3.3; P = 0.04) and renal disease (OR 4.0; P = 0.02) were associated with sepsis. Sepsis cases had longer hospital stays (48 versus 29.5 days; P = 0.01) and higher ICU admissions (67.9 versus 34.4%; P = 0.02). In-hospital mortality was tenfold higher in the sepsis cohort (25.0 versus 3.3%; OR 10.3, P = 0.02).

Conclusions

In a considerable number of patients, PJI can lead to a septic course associated with increased mortality. This underscores the need for close monitoring to prevent overlooking these patients' deteriorating clinical conditions. Timely interventions, akin to the "every hour counts" approach in sepsis management, might help reduce morbidity and mortality in these patients.

文獻4

外翻膝全膝關節置換術后的功能活動和患者滿意度低于內翻膝

譯者 沈松坡

背景： 本研究旨在在背景條件匹配的隊列中，比較外翻膝與內翻膝患者接受全膝關節置換術（TKA）后的臨床結局。

方法： 對接受初次TKA的患者收集術前及術后兩年的原始和新版膝關節協會評分（OKSS和2011KSS）。通過傾向性評分匹配方法，篩選出外翻膝和內翻膝（對線偏差≥3°）患者，使其基線特征一致。并對2011KSS的功能活動評分進行多元線性回歸分析。

結果： 在1158例TKA中（外翻膝122例，中性膝110例，內翻膝924例），匹配得到了106對外翻與內翻膝患者。術后兩年，外翻膝患者的OKSS功能評分顯著低于內翻膝（69.5 ± 26.7 vs. 79.6 ± 19.3，P = 0.005），2011KSS功能活動評分（57.8 ± 23.3 vs. 66.9 ± 20.4，P = 0.007）和滿意度評分（25.1 ± 7.8 vs. 28.5 ± 7.8，P = 0.006）也均顯著較低。回歸分析顯示，年齡較大、術前為外翻畸形、類風濕關節炎、高BMI和術前功能評分較低是術后功能活動受限的獨立預測因素（R2 = 0.28）。

結論： 在背景匹配的比較中，外翻膝TKA患者術后的功能恢復和滿意度均低于內翻膝。外翻畸形是TKA后功能恢復受限的重要風險因素。

Functional activities and patient satisfaction after total knee arthroplasty for valgus knee are inferior to those for varus knee: A propensity-matched cohort study

Background: This study aimed to compare the clinical outcomes of total knee arthroplasty (TKA) for valgus and varus knees in a background-matched cohort.

Method: Preoperative and two years postoperative original and new Knee Society Scores (OKSS and 2011KSS, respectively) were obtained from patients who underwent primary TKA. Propensity score-matched cohorts were assessed for valgus and varus knees with malalignment ≥3°, ensuring parity in age, sex, primary diagnosis, body mass index, deviation from neutral alignment, surgical approach, patellar resurfacing, and implant type. Multiple linear regression analysis was performed on the 2011KSS Functional activities.

Results: Of the 1158 TKAs involving 122 valgus, 110 neutral, and 924 varus knees, propensity score matching yielded 106 valgus-varus knee pairs. Preoperatively, both groups exhibited similar scores, except for 2011KSS expectations. At two years, valgus knee showed inferior OKSS Function Score (valgus: 69.5 ± 26.7, varus: 79.6 ± 19.3, P = 0.005) and 2011KSS Functional activities (valgus: 57.8 ± 23.3, varus: 66.9 ± 20.4, P = 0.007) to varus knees. Valgus knees also showed inferior 2011KSS Satisfaction at two years (valgus: 25.1 ± 7.8, varus: 28.5 ± 7.8, P = 0.006). In the multiple linear regression analysis, older age, preoperative valgus deformity, rheumatoid arthritis, higher BMI, and lower functional scores were significant independent variables that predicted lower 2011KSS Functional activities (R2 = 0.28).

Conclusion: Postoperative clinical scores related to function after TKA were inferior in valgus knees to varus knees in the background-matched comparison. Valgus knees carry the risk of limited postoperative function after TKA.

第二部分：保髖相關文獻

文獻1

锝99SPECT/CT在治療兒童長骨生長紊亂中的作用：一項回顧性觀察研究

譯者 羅殿中

背景：明確骨骺疾病的準確位置對指導治療長骨生長紊亂尤其重要。傳統X線攝片、計算機斷層（CT）、核磁共振成像（MRI）等僅能提供骨骺的解剖信息。平面骨掃描和骨骼單光子發射計算機斷層（SPECT）或是臨床處理生長紊亂的潛在理想解決方法。因其可提供高解析度功能信息，骨骼SPECT/CT可作為評估生長紊亂的有效工具。本文的研究目的是，采用優于平面骨掃描、或SPECT的SPECT/CT來明確骨骺狀況，評估病變骨骺位置和活力；以及在兒童患者長骨生長紊亂，采用骨骼SPECT/CT所見評估手術治療效果。

方法：2018年1月至2021年1月59例患者進行锝99標記（亞甲基二磷酸鹽99mTc-DPD）的骨骼SPECT/CT檢查，納入本研究?；诓∽児趋课恢?、生長紊亂原因、畸形的形態，患者的疾病結構某種形式上提供了足夠信息來對骨骼生長紊亂進行選擇性治療（如：SPECT/CT與平面骨掃描、SPECT/CT與SPECT）。為評估術后療效，采用X線片測量（反映畸形程度的角度測量、髂嵴高度差異、尺骨變異）來評估畸形的術后進展情況。

結果：在所有10例股骨頭骨骺病變的患者中（P=0.002），骨骼SPECT/CT可提供足夠信息來選擇治療方案；在所有6例骨骺明顯畸形、或在平片上病變骨骺位置不確定的患者中（P=0.03），骨骼SPECT/CT可提供足夠信息來選擇治療方案。在脛骨近端和遠端，平面骨掃描因下肢旋轉導致脛骨和腓骨骨骺重疊，骨骼SPECT/CT在33/34例（97%）患者中可提供足夠信息；而平面骨掃描在10/34例（29%）患者中可提供足夠信息（P<0.001）, SPECT在24/34例（71%）患者中可提供足夠信息（P=0.004）。治療后無畸形進展、或復發。

結論：骨骼SPECT/CT可用于股骨近端生長紊亂、平片上病變骨骺不明確、嚴重畸形、下肢扭轉畸形、或依從性差的患者

圖. 骨骼SPECT/CT在評估股骨近端生長紊亂的優勢。一位10歲男孩、因髖關節感染后遺癥、股骨近端外翻截骨術后復發、站立位骨盆前后位片顯示，右髖表現為髖內翻畸形（A）；在T1加權MRI可見骨骺形態不規則，但難以確認骨橋形成（B）；在平面骨掃描上，股骨近端骨骺難以從髖臼軟骨分辨出來（C），但在SPECT/CT上可以明顯區分開（D和E）；在骨骼SPECT/CT上99mTc-DPD在右側股骨近端股骨頭骨骺后外側（D和E）的核素濃聚的證據，可能是畸形復發的原因。右股骨近端臺階形外翻截骨，骨骺后外側同時進行經骺貫穿固定、股骨外翻截骨、防止髖內翻復發（F和G）。直到骨骼發育成熟，未見復發（H和I）。

圖. 脛骨外側與腓骨骨骺重疊時，骨骼SPECT/CT的優勢。一位11.4歲男孩踝關節經骨骺骨折，踝穴位片可疑脛骨遠端內側骨骺骨橋形成（A）；遂進行骨骼SPECT/CT檢查，以明確骨橋周圍骨骺生長潛力；從骨骼SPECT/CT提取出的平面骨掃描顯示，由于腓骨遠端骨骺與脛骨遠端外側骨骺的重疊，脛骨遠端骨骺的活躍程度難以確定（B）。SPECT斷面上腓骨遠端與脛骨遠端區分明顯（C），SPECT/CT顯示脛骨遠端骨骺清晰閉合。SPECT和SPECT/CT顯示僅僅腓骨遠端骨骺活躍，而幾乎整個脛骨遠端骨骺活力消失?；谶@些SPECT/CT發現，最后行腓骨遠端骨骺融合術，而非脛骨遠端骨橋切除術。

圖. 一例女孩的骨骼SPECT/CT顯示脛骨近端應力不全骨折、需要選擇治療方案。她在10.8歲時右側脛骨近端干骺端骨折（A和B）。術后6個月的骨骼SPECT/CT顯示脛骨近端骨骺代謝活躍，與我們期望的骨骺低活躍程度相反（D和E）。術后10個月膝關節X線片懷疑生長紊亂（E）。由于脛骨近端廣泛骨橋（箭頭所指），隨后她采取了脛骨和腓骨近端永久性骨骺融合術（F）、以及進行性下肢不等長（G）。她計劃等到骨骼發育成熟，采取脛骨和股骨延長術進一步治療。

圖. 在矢狀面畸形中，骨骼SPECT/CT評估骨骺現狀的優勢明顯。10.7歲女孩，右股骨遠端骨骺骨折后、膝關節反屈/過伸畸形。雖然在傳統X線片上骨骺模糊不清，股骨遠端骨骺明顯過伸畸形，股骨遠端后側角為125°（A）。正位平面骨掃描顯示，股骨遠端骨骺代謝活性顯著下降（B）。矢狀位SPECT見股骨遠端前側骨骺活力下降（箭頭），進而導致股骨遠端過伸畸形（C）。SPECT/CT矢狀位斷層更為明顯的看到股骨遠端前側骨骺活力下降（D）。PDFA=股骨遠端后側角。

圖. 在評估小的長骨的骨骺早閉SPECT/CT優勢明顯。10.6歲女孩，因Leri-Weill型軟骨發育不良引起雙側腕關節Madelung畸形。在梯度自旋回波T2加權MRI上，難以辨認是否存在骨橋（B）。橈骨遠端骨骺的尺側（箭頭所示），與橈骨遠端橈側骨骺相比活性不足，提示時間越久、畸形發展越嚴重（C）。而在平面骨掃描上難以區分橈骨橈側和尺骨骨骺活躍程度是否一致（D）。

圖. 骨骼SPECT/CT在傳統攝片評估位置不明確的骨骺生長紊亂時的優勢。一位9.6歲男孩，因D-2-羥基戊二酸尿癥、干骺軟骨瘤病，表現為左膝內翻、右膝外翻、左下肢肢體短縮畸形（A）。傳統X線片上左下肢骨骺狀態不明（A）。平面骨掃描對做下肢骨骺活躍狀態評估困難（B）。由于骨骺存在畸形，且骨骺和瘤體均可攝取99mTc-DPD，SPECT同樣難以評估左下肢骨骺狀況（C）。 SPECT/CT融合技術，可追蹤腫瘤和骨骺中攝取的放射性示蹤劑、并區分開；高解析度和精確解剖定位（D）；左側股骨遠端骨骺活性尚可、稍有下降（D）。右膝內側骨骺活性正常、外側骨骺活性下降，采用螺釘對外側骨骺進行臨時骨骺阻滯術（箭頭）（D）。右膝骨骺活性存在，提示右膝內翻可以改善（A和E）。

圖. 骨骼SPECT/CT在長骨生長紊亂的治療計劃。11歲女孩因創傷后膝外翻、右下肢短縮畸形就診（A）；MRI提示右側股骨遠端外側緣骨橋形成（箭頭所示）（B）。骨骼SPECT/CT上在骨橋位置（箭頭所示）無99mTc-DPD攝入（C），而附近骨骺代謝活性正常。對她采取關節鏡輔助下骨橋切除、開放楔形股骨遠端內翻截骨術（D）。術后2.3年下肢不等長無加重，說明右下肢繼續縱向生長（E）。另一位11歲女孩創傷后膝外翻、右下肢短縮畸形（F）。MRI提示右側股骨遠端外側骨骺內橋形成（箭頭所示）（G），骨骼SPECT/CT上顯示右整個股骨遠端骨骺幾乎無活性（H），基于上述發現，該女孩采取牽張成骨，而非骨骺融合或骨橋切除術。

文獻出處：Shin CH, Whi W, Cho YJ, Yoo WJ, Choi IH, Cheon GJ, Cho TJ. The role of 99mTc-DPD bone SPECT/CT in the management of growth disturbance of the long bones in pediatric patients: a retrospective observational study. BMC Musculoskelet Disord. 2023 Aug 24;24(1):668. doi: 10.1186/s12891-023-06777-0. PMID: 37620793; PMCID: PMC10464403.

文獻2

通過3D打印行髖臼周圍截骨術前規劃

譯者 張振東

本研究目的為確定3d打印半骨盆模型用于髖臼周圍截骨術前計劃治療髖關節發育不良的可行性和臨床效益。通過回顧性研究共納入2017年1月至2020年2月行髖臼周圍截骨術的26例患者，共28例髖，雙側2例?；颊呔谐Ｒ巟線片、CT和核磁檢查。其中14例患者[平均年齡30.7 (SD 8.4)歲，11名女性]術前進行常規影像學檢查，另14例患者[平均年齡28.0 (SD 8.7)歲，13名女性]術前除進行常規影像學檢查外，還根據CT數據創建3d打印半骨盆模型，并在3d打印模型上進行預期的手術截骨規劃。所有患者均行髖臼周圍截骨術。分別統計手術時間，包括旋轉截骨塊至髖臼達到合適位置的時間和手術總時間、術中透視照射劑量和預估手術總失血量等。統計學方面，經控制了可能的混雜因素后，通過方差分析比較了兩組患者之間的結果變量。結果顯示，使用3d打印模型進行術前計劃的患者在達到合適髖臼位置時平均縮短了5.5 min，髖臼周圍截骨總時間縮短了14.5 min，但這些差異均無統計學意義(P = 0.526和0.151)。另外在透視照射劑量或總失血量方面亦無顯著差異。作者認為利用3d打印模型進行髖臼周圍截骨手術的手術計劃是可行的，一定程度上有望提高手術效率。

3D-printed models for periacetabular osteotomy surgical planning

The purpose of this study was to determine the feasibility and clinical benefits of using 3D-printed hemipelvis models for periacetabular osteotomy preoperative planning in the treatment of hip dysplasia. This retrospective study included 28 consecutive cases in 26 patients, with two bilateral cases, who underwent periacetabular osteotomy between January 2017 and February 2020 and had routine radiographs, CT and MR imaging. Of these, 14 cases [mean patient age 30.7 (SD 8.4) years, 11 female] had routine preoperative imaging, and 14 cases [mean patient age 28.0 (SD 8.7) years, 13 female] had routine preoperative imaging and creation of a full-scale 3D-printed hemipelvis model from the CT data. The expected surgical cuts were performed on the 3D-printed models. All patients underwent Bernese periacetabular osteotomy. Operative times, including time to achieve proper acetabular position and total periacetabular osteotomy time, fluoroscopy radiation dose and estimated total blood loss were compiled. ANOVA compared outcome variables between the two patient groups, controlling for possible confounders. On average, patients who had additional preoperative planning using the 3D-printed model had a 5.5-min reduction in time to achieve proper acetabular position and a 14.5-min reduction in total periacetabular osteotomy time; however, these changes were not statistically significant (P = 0.526 and 0.151, respectively). No significant difference was identified in fluoroscopy radiation dose or total blood loss. Detailed surgical planning for periacetabular osteotomy using 3D-printed models is feasible using widely available and affordable technology and shows promise to improve surgical efficiency.

文獻出處：Markhardt BK, Beilfuss MA, Hetzel SJ, Goodspeed DC, Spiker AM. 3D-printed models for periacetabular osteotomy surgical planning. J Hip Preserv Surg. 2021 Apr 12;7(4):748-754. doi: 10.1093/jhps/hnab024. PMID: 34377517; PMCID: PMC8349591.

文獻3

關于體操運動員髖關節MRI研究

譯者 任寧濤

目的：我們已經認識到某些運動可對股骨近端發育產生影響，而體操的特點是髖關節重復的軸向載荷和旋轉相結合的極端動作。目前尚不清楚這些動作是否會對未成熟的骨骼發育產生長期影響。我們試圖通過對這些專業體操運動員無癥狀的髖關節進行磁共振成像評估。

方法：我們對12名(7名男性，5名女性)骨骼成熟的無癥狀專業體操運動員(平均年齡18.6歲，至少10年的訓練)進行了病例對照研究，對這些運動員與年齡匹配的非運動員的磁共振成像進行比較。在招募時，沒有運動員有記錄的肌肉骨骼疾病或髖關節周圍的損傷。

結果：研究表明，專業體操運動員在MRI上有四個共同的形態學特征，這些特征偏離正常，被認為是體操運動適應性改變的結果: 髖外翻平均140°，圓韌帶肥大，髂脛束摩擦伴大轉子周圍水腫，坐骨股骨撞擊的放射學表現發生率高(62.5%)。

結論：我們的研究表明，專業的體操運動員在MRI上有四個共同的偏離正常的形態學特征。這些發現是在無癥狀的受試者中發現的，因此放射科醫生和關節科醫生應該了解它們，以避免不必要的治療。

The gymnasts' hip and groin a magnetic resonance imaging study in asymptomatic elite athletes

Objective: Specific patterns of developmental adaptation of the proximal femur have been recognized in some sports. Gymnastics are characterized by repetitive axial loading and hip rotations in combination with extreme hip positions. It is unknown how and if these forces can affect an immature skeleton in the long term. We sought to evaluate this, by means of magnetic resonance imaging of the hip and groin of such elite asymptomatic athletes.

Materials and methods: We performed a case-control comparative MR imaging study of both hips and groin of 12 (7 male, 5 female) skeletally mature young (mean age 18.6 years) asymptomatic international level gymnasts with a minimum of 10 years' training with age-matched non-athletes. At the time of recruitment, none of the athletes had a recorded musculoskeletal complaint or injury in the anatomical area around the hip.

Results: The study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal and are considered to be the result of adaptational changes to the specific sport: high centre-column-diaphysis angle (coxa valga140° on average), ligamentum teres hypertrophy, friction of the iliotibial band with oedema surrounding the greater trochanter, and a high incidence (62.5 %) of radiological appearances of ischiofemoral impingement.

Conclusion: Our study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal. These findings were in asymptomatic subjects; hence, radiologists and sports physicians should be aware of them in order to avoid unnecessary treatment.

文獻出處：Papavasiliou A, Siatras T, Bintoudi A, Milosis D, Lallas V, Sykaras E, Karantanas A. The gymnasts' hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skeletal Radiol. 2014 Aug;43(8):1071-7. doi: 10.1007/s00256-014-1885-7. Epub 2014 Apr 23. PMID: 24756337.

文獻4

患者定制模板和電磁導航輔助雙側髖臼周圍截骨術用于分期矯正雙側損傷引起的髖關節發育不良：一例報告

譯者 李勇

髖臼周圍截骨術（PAO）用于治療骨盆骨折后遺癥時，由于創傷后解剖結構的改變以及手術技術要求高，因此在保髖手術中面臨挑戰，且手術風險較高。為了應對這些挑戰并避免潛在的嚴重并發癥，可聯合使用患者定制模板（PST）和電磁導航（EMN）引導，以提高手術安全性及髖臼重新定位的準確性。本文報告了我們利用PST和EMN聯合輔助的雙側PAO，分期矯正雙側嚴重創傷性髖關節發育不良的經驗。該病例報告描述了一種獨特的方法，結合3D打印技術（PST）和術中電磁計算機輔助導航（EMN）輔助技術要求高的PAO手術，成功治療了嚴重的雙側創傷性髖關節發育不良，這強調了在復雜病理解剖情況下，PST和EMN在髖關節保留手術中的優勢。

Patient-Specific Template and Electromagnetic Navigation-Assisted Bilateral Periacetabular Osteotomy for Staged Correction of Bilateral Injury-Induced Hip Dysplasia: A Case Report

Abstract: Periacetabular osteotomy (PAO) for treating the sequelae of pelvic fractures presents challenges in hip preservation surgery due to altered post-traumatic anatomy and high technical demands, carrying a higher surgical risk. To address these challenges and avoid potentially severe complications, patient-specific templates (PST) and electromagnetic navigation (EMN) guidance can be combined to enhance surgical safety and the accuracy of acetabular reorientation. This article reports our experience with PST and EMN-assisted bilateral PAO for the staged correction of severe bilateral traumatic hip dysplasia. This case report describes a unique approach combining 3D printing technology (PST) and intraoperative electromagnetic computer-assisted navigation (EMN) for technically demanding PAO surgery, successfully treating severe bilateral traumatic hip dysplasia. This highlights the advantages of PST and EMN in hip preservation surgery under complex pathological anatomical conditions.

文獻出處：Brumat P, Mihali? R, Benuli? ?, Kristan A, Treb?e R. Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report. J Hip Preserv Surg. 2021 Aug 24;8(2):192-196. doi: 10.1093/jhps/hnab054. PMID: 35145717; PMCID: PMC8825680.

文獻5

髖臼周圍截骨術治療髖關節發育不良、髖臼后傾、先天性髖關節脫位或Legg-Calvé-Perthes病患者后的髖關節生存率：一項納入1,501例髖關節的隊列研究

譯者 陶可

背景與目的：既往關于髖臼周圍截骨術(PAO)后髖關節生存率的研究主要針對DDH單一疾病的數據，難以對不同患者組間進行比較。我們報告了髖關節發育不良(AD)、髖臼后傾(AR)、先天性髖關節脫位(CDH)和Legg-Calvé-Perthes病(LCPD)患者接受PAO后髖關節生存率，以全髖關節置換術(THA)為主要終點，其次是后續除THA之外的髖關節相關手術的風險。

患者與方法：1997年至2021年12月，奧登塞大學醫院（Odense University Hospital）單中心共收治1,501例髖關節（1,203例患者），并接受了PAO手術。我們通過患者檔案和丹麥國家患者登記處（DNPR）收集了轉為THA及其他后續髖關節相關手術的患者信息。

結果：在研究期間，共收治1,501例髖關節，其中123例（8.2%）轉為THA手術。24年后，Kaplan-Meier髖關節總生存率為71%（95%置信區間[CI] 61-79），平均隨訪時間為7.6年（范圍：0.02-25年）。 15年Kaplan-Meier髖關節存活率：AD為81% (CI 76-86)，AR為94% (CI 91-96)，CDH為84% (CI 66-93)，LCPD為66% (CI 49-79)?？傮w而言，再次進行髖關節相關手術的總體風險為48%（其中92%為螺釘取出手術）。

結論：令人鼓舞的是，PAO術后24年有71%的髖關節得以保留。我們發現，與其他潛在髖關節疾病相比，AR患者的15年PAO存活率最高（94%）。幾乎一半的PAO患者可能會在之后接受額外手術，其中螺釘取出是主要手術。總體長期生存率、轉為全髖關節置換術(THA)的風險因素以及再次手術的風險是影響手術決策的相關因素。

圖1 以全髖關節置換術(THA)為終點，1,501例髖臼周圍截骨術后（刪失后1,479例存在風險）的Kaplan-Meier生存曲線（95%置信區間）。每增加一例轉換為全髖關節置換術，曲線上的數值均視為下降。24年時髖關節存活率為71%（置信區間61-79）。

圖2 以全髖關節置換術為終點，4種不同適應證的Kaplan-Meier生存曲線。每次轉換為全髖關節置換術，曲線上的數值均視為下降。AD，髖臼發育不良；AR，髖臼后傾；CDH，先天性髖關節脫位；LCPD，Legg-Calvé-Perthes 病。

Hip survival after periacetabular osteotomy in patients with acetabular dysplasia, acetabular retroversion, congenital dislocation of the hip, or Legg-Calvé-Perthes disease: a cohort study on 1,501 hips

Background and purpose: Previous studies on hip survival following periacetabular osteotomy (PAO) have reported isolated data for the treatment of 1 underlying condition, making comparison between patient groups difficult. We report the hip survival after PAO in patients with acetabular dysplasia (AD), acetabular retroversion (AR), congenital dislocation of the hip (CDH), and Legg-Calvé-Perthes disease (LCPD) with total hip arthroplasty (THA) as primary endpoint and secondarily the risk of subsequent hip-related operations other than THA.

Patients and methods: From 1997 to December 2021, 1,501 hips (1,203 patients) underwent PAO in a single center (Odense University Hospital). We identified conversions to THA and other subsequent hip-related operations through patient files and the Danish National Patient Registry (DNPR).

Results: 123 (8.2%) of the total cohort of 1,501 hips were converted to THA within the study period. The overall Kaplan-Meier hip survival rate was 71% (95% confidence interval [CI] 61-79) at 24 years with a mean follow-up of 7.6 years (range 0.02-25). The individual Kaplan-Meier hip survival rates at 15 years were 81% (CI 76-86) for AD, 94% (CI 91-96) for AR, 84% (CI 66-93) for CDH, and 66% (CI 49-79) for LCPD. In total, the overall risk of additional hip-related operations was 48% (of which 92% were screw removal).

Conclusion: Encouragingly, 71% of hips were preserved 24 years after PAO. We found that AR patients had the highest (94%) PAO survivorship at 15 years compared with the other underlying hip conditions. Almost half of PAO patients may undergo later additional surgery, of which screw removal is the primary intervention. Overall long-term survival, risk factors for conversion to THA, and risk of additional surgery are relevant information for shared decision-making.

文獻出處：Anne Rosendahl Kristiansen, Anders Holsgaard-Larsen, Morten B?geh?j, S?ren Overgaard, Martin Lindberg-Larsen, Ole Ovesen. Hip survival after periacetabular osteotomy in patients with acetabular dysplasia, acetabular retroversion, congenital dislocation of the hip, or Legg-Calvé-Perthes disease: a cohort study on 1,501 hips. Acta Orthop. 2023 May 10:94:250-256. doi: 10.2340/17453674.2023.12403.

文獻6

髖關節存活率評估：伯爾尼髖臼周圍截骨術治療髖臼發育不良的系統綜述與薈萃分析

譯者 邱興

引言：伯爾尼髖臼周圍截骨術（PAO）是一種廣泛應用的保髖技術，旨在糾正髖臼發育不良相關的結構及生物力學異常。然而，關于自體髖關節的預后因素及長期存活率（以轉為全髖關節置換術[THA]為終點事件）的研究仍存在空白。本研究擬解決以下問題：(1) PAO術后自體髖關節的預期存活時間；(2) 功能預后的相關預測因素；(3) PAO的并發癥發生率及類型。

假設：通過嚴格的病例選擇標準，伯爾尼PAO可取得理想的中長期療效。

材料與方法：基于PRISMA指南開展系統綜述，納入所有報道伯爾尼PAO治療髖臼發育不良療效的研究。

結果：共納入24項研究（3471例患者，3655髖），平均隨訪54.2個月（范圍：1-336個月）。208髖（6.03%；95%CI：5.25%-6.94%）轉為THA，平均轉歸時間為4.71年（范圍：1-240個月）。單因素分析顯示：隨訪超過6年（p=0.001）、術前T?nnis分級≥2級（p<0.001）是顯著負性預后因素；隨訪超過2年后，術中透視引導（p<0.001）是顯著正性預后因素。PAO手術指征、肥胖及性別與治療失敗無顯著相關性?？傮w并發癥發生率為23.5%（95%CI：21.6%-25.6%），最常見并發癥包括股外側皮神經暫時性感覺異常（8.24%；95%CI：7.02%-9.65%）、應力性骨折（5.28%；95%CI：4.31%-6.89%）以及無需手術干預的恥骨支延遲愈合/骨不連（3.73%；95%CI：2.93%-4.75%）。

討論：PAO可顯著改變髖臼發育不良的自然病程，10年和20年髖關節存活率分別為75.9%和36.5%。理想病例應滿足：年齡<40歲、術前T?nnis分級0或1級。術中透視可提高髖臼重新定位的精確性。

Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis

Introduction: The Bernese periacetabular osteotomy (PAO) is a popular joint-preservation technique aimed at addressing the structural and biomechanical abnormalities associated with acetabular dysplasia. However, the prognostic factors and long-term survivorship of the native hip, with failure defined as conversion to total hip arthroplasty (THA), is poorly understood. Our study aims to address the following: (1) What is the estimated duration of survival of the native hip post-PAO, (2) What are some prognostic factors of functional outcome and (3) What is the complication rate and complications associated with PAO.

Hypothesis: The Bernese PAO is able to result in favourable mid- to long-term outcomes conditional on a stringent patient selection criteria.

Materials and methods: A systematic review was performed using the PRISMA guidelines. All studies that reported on the outcomes of isolated Bernese PAO for the treatment of acetabular dysplasia were included.

Results: A total of 24 studies (3471 patients, 3655 hips) were included at a mean follow-up duration of 54.2months (range: 1-336months). In total, 208 hips (6.03%; 95% CI: 5.25-6.94%) converted to THA at a mean duration of 4.71years (range: 1-240months). Univariate analysis identified advanced age beyond a follow-up duration of 6years (p=0.001) and preoperative T?nnis grade 2 and above (p<0.001) to be the most significant negative prognostic factors. Beyond a follow-up duration of 2years, intraoperative fluoroscopy proved to be a significant positive prognostic factor (p<0.001). Indications for PAO, obesity and gender were not found to be significant predictors of failure. Our study found the complication rate to be 23.5% (95% CI: 21.6-25.6%). The most common complications detailed are transient lateral femoral cutaneous nerve dysesthesia (8.24%; 95% CI: 7.02-9.65%), stress fracture (5.28%; 95% CI: 4.31-6.89%) and the delayed union, non-union or pseudoarthrosis of the ramus not necessitating surgical correction (3.73%, 95% CI: 2.93-4.75%).

Discussion: PAO alters the natural history of the dysplastic hip with a 10- and 20-year survivorship of approximately 75.9% and 36.5% of patients respectively. The ideal patient should be below 40years old, with a preoperative T?nnis grade of 0 or 1. Intraoperative fluoroscopy is able to guide a better precision when re-orientating the acetabulum.

文獻出處： Tan J H I , Tan S H S , Rajoo M S ,et al. Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis[J]. Orthopaedics & traumatology, surgery & research : OTSR, 2022, 108(4):103283.DOI:10.1016/j.otsr.2022.103283.

文獻7

發育性髖關節發育不良閉合復位后MRI評價復位效果

譯者 徐子茵

目的：髖關節發育不良（DDH）閉合復位（CR）后，偏心復位可通過股骨頭復位（靠港）變為同心復位。然而，股骨頭位置和形態的變化還沒有得到很好的理解。我們的目的是使用系列MRI評估這些變化。

方法：我們回顧了2016年1月至2020年12月在單一機構成功治療的103例DDH患者。CR后即刻和每次石膏固定結束時常規進行MRI檢查。利用MRI，我們描述了盂唇-髖臼軟骨復合體（LACC）的形態，并在中冠狀面上測量了股骨頭到三角軟骨的距離（FTD）。共排除了13例初始完全復位（即FTD < 1 mm）的髖關節和10例MRI隨訪不完全的髖關節。共86例FTD > 1 mm的患者（92例髖關節）納入分析。

結果:在第一個石膏固定期結束時，73個髖關節（79.3%）的FTD < 1 mm。多元回歸分析顯示FTD（p = 0.011）和固定時間（p = 0.028）與完全復位相關。在第二個石膏固定期結束時，所有92個髖關節均實現完全復位。初次MRI顯示LACC內翻69例（75.0%），部分內翻16例（17.4%），外翻7例（7.6%）。在第一次和第二次石膏固定結束時，LACC分別有45個髖（48.9%）和92個髖（100%）變為外翻。然而，在50/85例髖關節（58.8%）中存在殘留的盂唇內翻，初始LACC內翻或部分內翻。

結論:DDH經CR后完全復位和LACC重建后，偏心復位可變為同心復位。為了達到完全復位，需要不同的固定時間。LACC重塑后，超過一半的髖關節仍存在殘留的內翻盂唇。

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip

Aims

Eccentric reductions may become concentric through femoral head ‘docking’ (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI.

Methods

We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow--up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis.

Results

At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved

complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC.

Conclusion

An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling.

文獻來源：Fu Z, Zhang Z, Deng S, Yang J, Li B, Zhang H, Liu J. MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip. Bone Joint J. 2023 Feb;105-B(2):140-147. doi: 10.1302/0301-620X.105B2.BJJ-2022-0547.R2. PMID: 36722051; PMCID: PMC9869706.

來源：304關節學術

作者：304關節團隊

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