本期目錄：

1、全膝關(guān)節(jié)置換術(shù)：安全嗎？韓國4124名患者的單中心研究

2、肥胖不應(yīng)被視為牛津單髁的禁忌：對患者報告的長期隨訪結(jié)果和 1000 例膝關(guān)節(jié)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(xiàn)、風(fēng)險因素和患者結(jié)局

4、外翻膝全膝關(guān)節(jié)置換術(shù)后的功能活動和患者滿意度低于內(nèi)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(shù)前規(guī)劃

7、關(guān)于體操運動員髖關(guān)節(jié)MRI研究

8、患者定制模板和電磁導(dǎo)航輔助雙側(cè)髖臼周圍截骨術(shù)用于分期矯正雙側(cè)損傷引起的髖關(guān)節(jié)發(fā)育不良

9、髖臼周圍截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良、髖臼后傾、先天性髖關(guān)節(jié)脫位或Legg-Calvé-Perthes病患者后的髖關(guān)節(jié)生存率

10、髖關(guān)節(jié)存活率評估：伯爾尼髖臼周圍截骨術(shù)治療髖臼發(fā)育不良的系統(tǒng)綜述與薈萃分析

11、發(fā)育性髖關(guān)節(jié)發(fā)育不良閉合復(fù)位后MRI評價復(fù)位效果

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻

文獻1

全膝關(guān)節(jié)置換術(shù)：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(guān)節(jié)置換術(shù)（TKA）被認為是治療膝關(guān)節(jié)骨關(guān)節(jié)炎的有效方法，但它存在并發(fā)癥的風(fēng)險。隨著越來越多的老年患者進行TKA，了解死亡原因?qū)τ谔岣逿KA的安全性至關(guān)重要。本研究旨在確定TKA術(shù)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(shù)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(tǒng)計信息服務(wù)局的信息回顧性收集死亡原因，并根據(jù)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(nèi)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(fā)生率，以研究TKA后的死亡率趨勢。

結(jié)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(tǒng)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(fēng)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(qū)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(jié)論：TKA術(shù)后短期死亡率較低，大部分原因與TKA無關(guān)。長期死亡的主要原因與以前的發(fā)現(xiàn)一致。我們的研究結(jié)果可以作為了解TKA患者生存和死亡率的參考數(shù)據(jù)。

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(yīng)被視為牛津單髁的禁忌：對患者報告的長期隨訪結(jié)果和 1000 例膝關(guān)節(jié)的植入物生存率的研究

譯者 馬云青

目的：一些醫(yī)療機構(gòu)根據(jù)體重指數(shù) (BMI) 選擇膝關(guān)節(jié)置換術(shù)的方式。目前還沒有關(guān)于不同 BMI 組中內(nèi)側(cè)活動平臺單髁膝關(guān)節(jié)置換術(shù) (UKA) 的長期隨訪數(shù)據(jù)。本研究旨在確定患者體重指數(shù) (BMI) 對患者報告結(jié)果和內(nèi)側(cè) UKA 的長期生存率的影響。作者的假設(shè)是，增加 BMI 將導(dǎo)致更差的結(jié)果。

方法：分析來自 1000 名連續(xù)內(nèi)側(cè)活動牛津 UKA 的前瞻性隊列的數(shù)據(jù)，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(nèi)評估牛津膝關(guān)節(jié)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(jié)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(jié)論：不同組之間的植入物存活率沒有差異，盡管術(shù)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?shù)慕蓵r，高 BMI 不應(yīng)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(xiàn)、風(fēng)險因素和患者結(jié)局

譯者 張薔

目的：本文章研究了髖膝關(guān)節(jié)置換術(shù)后假體周圍感染（PJI）的一種危及生命的并發(fā)癥—敗血癥，以及其流行病學(xué)、危險因素和結(jié)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(yǎng)結(jié)果和合并癥，結(jié)局指標包括病死率、住院時長和ICU入住情況。

結(jié)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(guān)節(jié)PJI病例中，敗血癥組的Charlson合并癥指數(shù)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(guān)疾病會增加敗血癥風(fēng)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(guān)。在膝關(guān)節(jié)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(fā)生相關(guān)。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(jié)論：很多PJI病例在治療過程中可加重轉(zhuǎn)為敗血癥，病死率顯著增加。需要臨床醫(yī)生嚴密監(jiān)視患者病情，盡量避免忽視患者逐步惡化的病情。及早干預(yù)，分秒必爭的處置態(tài)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(guān)節(jié)置換術(shù)后的功能活動和患者滿意度低于內(nèi)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(nèi)翻膝患者接受全膝關(guān)節(jié)置換術(shù)（TKA）后的臨床結(jié)局。

方法： 對接受初次TKA的患者收集術(shù)前及術(shù)后兩年的原始和新版膝關(guān)節(jié)協(xié)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(nèi)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(jié)果： 在1158例TKA中（外翻膝122例，中性膝110例，內(nèi)翻膝924例），匹配得到了106對外翻與內(nèi)翻膝患者。術(shù)后兩年，外翻膝患者的OKSS功能評分顯著低于內(nèi)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?；貧w分析顯示，年齡較大、術(shù)前為外翻畸形、類風(fēng)濕關(guān)節(jié)炎、高BMI和術(shù)前功能評分較低是術(shù)后功能活動受限的獨立預(yù)測因素（R2 = 0.28）。

結(jié)論： 在背景匹配的比較中，外翻膝TKA患者術(shù)后的功能恢復(fù)和滿意度均低于內(nèi)翻膝。外翻畸形是TKA后功能恢復(fù)受限的重要風(fēng)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(guān)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(dǎo)治療長骨生長紊亂尤其重要。傳統(tǒng)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(fā)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(yōu)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(shù)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。基于病變骨骺位置、生長紊亂原因、畸形的形態(tài)，患者的疾病結(jié)構(gòu)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(shù)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(shù)后進展情況。

結(jié)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(zhuǎn)導(dǎo)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(fù)發(fā)。

結(jié)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(zhuǎn)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(yōu)勢。一位10歲男孩、因髖關(guān)節(jié)感染后遺癥、股骨近端外翻截骨術(shù)后復(fù)發(fā)、站立位骨盆前后位片顯示，右髖表現(xiàn)為髖內(nèi)翻畸形（A）；在T1加權(quán)MRI可見骨骺形態(tài)不規(guī)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(qū)分開（D和E）；在骨骼SPECT/CT上99mTc-DPD在右側(cè)股骨近端股骨頭骨骺后外側(cè)（D和E）的核素濃聚的證據(jù)，可能是畸形復(fù)發(fā)的原因。右股骨近端臺階形外翻截骨，骨骺后外側(cè)同時進行經(jīng)骺貫穿固定、股骨外翻截骨、防止髖內(nèi)翻復(fù)發(fā)（F和G）。直到骨骼發(fā)育成熟，未見復(fù)發(fā)（H和I）。

圖. 脛骨外側(cè)與腓骨骨骺重疊時，骨骼SPECT/CT的優(yōu)勢。一位11.4歲男孩踝關(guān)節(jié)經(jīng)骨骺骨折，踝穴位片可疑脛骨遠端內(nèi)側(cè)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(cè)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(qū)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(fā)現(xiàn)，最后行腓骨遠端骨骺融合術(shù)，而非脛骨遠端骨橋切除術(shù)。

圖. 一例女孩的骨骼SPECT/CT顯示脛骨近端應(yīng)力不全骨折、需要選擇治療方案。她在10.8歲時右側(cè)脛骨近端干骺端骨折（A和B）。術(shù)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(shù)后10個月膝關(guān)節(jié)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(shù)（F）、以及進行性下肢不等長（G）。她計劃等到骨骼發(fā)育成熟，采取脛骨和股骨延長術(shù)進一步治療。

圖. 在矢狀面畸形中，骨骼SPECT/CT評估骨骺現(xiàn)狀的優(yōu)勢明顯。10.7歲女孩，右股骨遠端骨骺骨折后、膝關(guān)節(jié)反屈/過伸畸形。雖然在傳統(tǒng)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(cè)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(cè)骨骺活力下降（箭頭），進而導(dǎo)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(cè)骨骺活力下降（D）。PDFA=股骨遠端后側(cè)角。

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

圖. 骨骼SPECT/CT在傳統(tǒng)攝片評估位置不明確的骨骺生長紊亂時的優(yōu)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(xiàn)為左膝內(nèi)翻、右膝外翻、左下肢肢體短縮畸形（A）。傳統(tǒng)X線片上左下肢骨骺狀態(tài)不明（A）。平面骨掃描對做下肢骨骺活躍狀態(tài)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(shù)，可追蹤腫瘤和骨骺中攝取的放射性示蹤劑、并區(qū)分開；高解析度和精確解剖定位（D）；左側(cè)股骨遠端骨骺活性尚可、稍有下降（D）。右膝內(nèi)側(cè)骨骺活性正常、外側(cè)骨骺活性下降，采用螺釘對外側(cè)骨骺進行臨時骨骺阻滯術(shù)（箭頭）（D）。右膝骨骺活性存在，提示右膝內(nèi)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(chuàng)傷后膝外翻、右下肢短縮畸形就診（A）；MRI提示右側(cè)股骨遠端外側(cè)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(guān)節(jié)鏡輔助下骨橋切除、開放楔形股骨遠端內(nèi)翻截骨術(shù)（D）。術(shù)后2.3年下肢不等長無加重，說明右下肢繼續(xù)縱向生長（E）。另一位11歲女孩創(chuàng)傷后膝外翻、右下肢短縮畸形（F）。MRI提示右側(cè)股骨遠端外側(cè)骨骺內(nèi)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(fā)現(xiàn)，該女孩采取牽張成骨，而非骨骺融合或骨橋切除術(shù)。

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(shù)前規(guī)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(shù)前計劃治療髖關(guān)節(jié)發(fā)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(shù)的26例患者，共28例髖，雙側(cè)2例?；颊呔谐Ｒ?guī)x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(shù)前進行常規(guī)影像學(xué)檢查，另14例患者[平均年齡28.0 (SD 8.7)歲，13名女性]術(shù)前除進行常規(guī)影像學(xué)檢查外，還根據(jù)CT數(shù)據(jù)創(chuàng)建3d打印半骨盆模型，并在3d打印模型上進行預(yù)期的手術(shù)截骨規(guī)劃。所有患者均行髖臼周圍截骨術(shù)。分別統(tǒng)計手術(shù)時間，包括旋轉(zhuǎn)截骨塊至髖臼達到合適位置的時間和手術(shù)總時間、術(shù)中透視照射劑量和預(yù)估手術(shù)總失血量等。統(tǒng)計學(xué)方面，經(jīng)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(jié)果變量。結(jié)果顯示，使用3d打印模型進行術(shù)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(tǒng)計學(xué)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(shù)的手術(shù)計劃是可行的，一定程度上有望提高手術(shù)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(guān)于體操運動員髖關(guān)節(jié)MRI研究

譯者 任寧濤

目的：我們已經(jīng)認識到某些運動可對股骨近端發(fā)育產(chǎn)生影響，而體操的特點是髖關(guān)節(jié)重復(fù)的軸向載荷和旋轉(zhuǎn)相結(jié)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(fā)育產(chǎn)生長期影響。我們試圖通過對這些專業(yè)體操運動員無癥狀的髖關(guān)節(jié)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(yè)體操運動員(平均年齡18.6歲，至少10年的訓(xùn)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(guān)節(jié)周圍的損傷。

結(jié)果：研究表明，專業(yè)體操運動員在MRI上有四個共同的形態(tài)學(xué)特征，這些特征偏離正常，被認為是體操運動適應(yīng)性改變的結(jié)果: 髖外翻平均140°，圓韌帶肥大，髂脛束摩擦伴大轉(zhuǎn)子周圍水腫，坐骨股骨撞擊的放射學(xué)表現(xiàn)發(fā)生率高(62.5%)。

結(jié)論：我們的研究表明，專業(yè)的體操運動員在MRI上有四個共同的偏離正常的形態(tài)學(xué)特征。這些發(fā)現(xiàn)是在無癥狀的受試者中發(fā)現(xiàn)的，因此放射科醫(yī)生和關(guān)節(jié)科醫(yī)生應(yīng)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(dǎo)航輔助雙側(cè)髖臼周圍截骨術(shù)用于分期矯正雙側(cè)損傷引起的髖關(guān)節(jié)發(fā)育不良：一例報告

譯者 李勇

髖臼周圍截骨術(shù)（PAO）用于治療骨盆骨折后遺癥時，由于創(chuàng)傷后解剖結(jié)構(gòu)的改變以及手術(shù)技術(shù)要求高，因此在保髖手術(shù)中面臨挑戰(zhàn)，且手術(shù)風(fēng)險較高。為了應(yīng)對這些挑戰(zhàn)并避免潛在的嚴重并發(fā)癥，可聯(lián)合使用患者定制模板（PST）和電磁導(dǎo)航（EMN）引導(dǎo)，以提高手術(shù)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(lián)合輔助的雙側(cè)PAO，分期矯正雙側(cè)嚴重創(chuàng)傷性髖關(guān)節(jié)發(fā)育不良的經(jīng)驗。該病例報告描述了一種獨特的方法，結(jié)合3D打印技術(shù)（PST）和術(shù)中電磁計算機輔助導(dǎo)航（EMN）輔助技術(shù)要求高的PAO手術(shù)，成功治療了嚴重的雙側(cè)創(chuàng)傷性髖關(guān)節(jié)發(fā)育不良，這強調(diào)了在復(fù)雜病理解剖情況下，PST和EMN在髖關(guān)節(jié)保留手術(shù)中的優(yōu)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(shù)治療髖關(guān)節(jié)發(fā)育不良、髖臼后傾、先天性髖關(guān)節(jié)脫位或Legg-Calvé-Perthes病患者后的髖關(guān)節(jié)生存率：一項納入1,501例髖關(guān)節(jié)的隊列研究

譯者 陶可

背景與目的：既往關(guān)于髖臼周圍截骨術(shù)(PAO)后髖關(guān)節(jié)生存率的研究主要針對DDH單一疾病的數(shù)據(jù)，難以對不同患者組間進行比較。我們報告了髖關(guān)節(jié)發(fā)育不良(AD)、髖臼后傾(AR)、先天性髖關(guān)節(jié)脫位(CDH)和Legg-Calvé-Perthes病(LCPD)患者接受PAO后髖關(guān)節(jié)生存率，以全髖關(guān)節(jié)置換術(shù)(THA)為主要終點，其次是后續(xù)除THA之外的髖關(guān)節(jié)相關(guān)手術(shù)的風(fēng)險。

患者與方法：1997年至2021年12月，奧登塞大學(xué)醫(yī)院（Odense University Hospital）單中心共收治1,501例髖關(guān)節(jié)（1,203例患者），并接受了PAO手術(shù)。我們通過患者檔案和丹麥國家患者登記處（DNPR）收集了轉(zhuǎn)為THA及其他后續(xù)髖關(guān)節(jié)相關(guān)手術(shù)的患者信息。

結(jié)果：在研究期間，共收治1,501例髖關(guān)節(jié)，其中123例（8.2%）轉(zhuǎn)為THA手術(shù)。24年后，Kaplan-Meier髖關(guān)節(jié)總生存率為71%（95%置信區(qū)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(guān)節(jié)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)。總體而言，再次進行髖關(guān)節(jié)相關(guān)手術(shù)的總體風(fēng)險為48%（其中92%為螺釘取出手術(shù)）。

結(jié)論：令人鼓舞的是，PAO術(shù)后24年有71%的髖關(guān)節(jié)得以保留。我們發(fā)現(xiàn)，與其他潛在髖關(guān)節(jié)疾病相比，AR患者的15年P(guān)AO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(shù)，其中螺釘取出是主要手術(shù)。總體長期生存率、轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)(THA)的風(fēng)險因素以及再次手術(shù)的風(fēng)險是影響手術(shù)決策的相關(guān)因素。

圖1 以全髖關(guān)節(jié)置換術(shù)(THA)為終點，1,501例髖臼周圍截骨術(shù)后（刪失后1,479例存在風(fēng)險）的Kaplan-Meier生存曲線（95%置信區(qū)間）。每增加一例轉(zhuǎn)換為全髖關(guān)節(jié)置換術(shù)，曲線上的數(shù)值均視為下降。24年時髖關(guān)節(jié)存活率為71%（置信區(qū)間61-79）。

圖2 以全髖關(guān)節(jié)置換術(shù)為終點，4種不同適應(yīng)證的Kaplan-Meier生存曲線。每次轉(zhuǎn)換為全髖關(guān)節(jié)置換術(shù)，曲線上的數(shù)值均視為下降。AD，髖臼發(fā)育不良；AR，髖臼后傾；CDH，先天性髖關(guān)節(jié)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(guān)節(jié)存活率評估：伯爾尼髖臼周圍截骨術(shù)治療髖臼發(fā)育不良的系統(tǒng)綜述與薈萃分析

譯者 邱興

引言：伯爾尼髖臼周圍截骨術(shù)（PAO）是一種廣泛應(yīng)用的保髖技術(shù)，旨在糾正髖臼發(fā)育不良相關(guān)的結(jié)構(gòu)及生物力學(xué)異常。然而，關(guān)于自體髖關(guān)節(jié)的預(yù)后因素及長期存活率（以轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)[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(shù)后自體髖關(guān)節(jié)的預(yù)期存活時間；(2) 功能預(yù)后的相關(guān)預(yù)測因素；(3) PAO的并發(fā)癥發(fā)生率及類型。

假設(shè)：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(tǒng)綜述，納入所有報道伯爾尼PAO治療髖臼發(fā)育不良療效的研究。

結(jié)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(zhuǎn)為THA，平均轉(zhuǎn)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(shù)前T?nnis分級≥2級（p<0.001）是顯著負性預(yù)后因素；隨訪超過2年后，術(shù)中透視引導(dǎo)（p<0.001）是顯著正性預(yù)后因素。PAO手術(shù)指征、肥胖及性別與治療失敗無顯著相關(guān)性?？傮w并發(fā)癥發(fā)生率為23.5%（95%CI：21.6%-25.6%），最常見并發(fā)癥包括股外側(cè)皮神經(jīng)暫時性感覺異常（8.24%；95%CI：7.02%-9.65%）、應(yīng)力性骨折（5.28%；95%CI：4.31%-6.89%）以及無需手術(shù)干預(yù)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(fā)育不良的自然病程，10年和20年髖關(guān)節(jié)存活率分別為75.9%和36.5%。理想病例應(yīng)滿足：年齡<40歲、術(shù)前T?nnis分級0或1級。術(shù)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(fā)育性髖關(guān)節(jié)發(fā)育不良閉合復(fù)位后MRI評價復(fù)位效果

譯者 徐子茵

目的：髖關(guān)節(jié)發(fā)育不良（DDH）閉合復(fù)位（CR）后，偏心復(fù)位可通過股骨頭復(fù)位（靠港）變?yōu)橥膹?fù)位。然而，股骨頭位置和形態(tài)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(gòu)成功治療的103例DDH患者。CR后即刻和每次石膏固定結(jié)束時常規(guī)進行MRI檢查。利用MRI，我們描述了盂唇-髖臼軟骨復(fù)合體（LACC）的形態(tài)，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(fù)位（即FTD < 1 mm）的髖關(guān)節(jié)和10例MRI隨訪不完全的髖關(guān)節(jié)。共86例FTD > 1 mm的患者（92例髖關(guān)節(jié)）納入分析。

結(jié)果:在第一個石膏固定期結(jié)束時，73個髖關(guān)節(jié)（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(fù)位相關(guān)。在第二個石膏固定期結(jié)束時，所有92個髖關(guān)節(jié)均實現(xiàn)完全復(fù)位。初次MRI顯示LACC內(nèi)翻69例（75.0%），部分內(nèi)翻16例（17.4%），外翻7例（7.6%）。在第一次和第二次石膏固定結(jié)束時，LACC分別有45個髖（48.9%）和92個髖（100%）變?yōu)橥夥Ｈ欢?0/85例髖關(guān)節(jié)（58.8%）中存在殘留的盂唇內(nèi)翻，初始LACC內(nèi)翻或部分內(nèi)翻。

結(jié)論:DDH經(jīng)CR后完全復(fù)位和LACC重建后，偏心復(fù)位可變?yōu)橥膹?fù)位。為了達到完全復(fù)位，需要不同的固定時間。LACC重塑后，超過一半的髖關(guān)節(jié)仍存在殘留的內(nèi)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(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團隊

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