本期目錄：

1、脛骨高位截骨術(shù)與單間室膝關(guān)節(jié)置換術(shù)治療年輕患者Kellgren-Lawrence3-4級膝骨關(guān)節(jié)炎：根據(jù)骨關(guān)節(jié)炎級別和性別進(jìn)行調(diào)整后發(fā)現(xiàn)患者?報告的療效都獲得了改善

2、Legg-Calvé-Perthes病患者成年后骨盆傾斜的影響因素及其對全髖關(guān)節(jié)置換術(shù)的作用

3、游標(biāo)卡尺手工驗證運(yùn)動學(xué)對線全膝關(guān)節(jié)置換術(shù)中股骨截骨的準(zhǔn)確性與精確性

4、采用克氏針固定與螺釘固定效果相當(dāng)：PAO中期隨訪

5、髖關(guān)節(jié)發(fā)育不良的診斷和治療：從Y形軟骨閉合到青年期

6、股骨頸前傾角

7、機(jī)器人輔助聯(lián)合增強(qiáng)現(xiàn)實(shí)（AR）導(dǎo)航系統(tǒng)在髖臼周圍截骨術(shù)中的應(yīng)用

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)

文獻(xiàn)1

脛骨高位截骨術(shù)與單間室膝關(guān)節(jié)置換術(shù)治療年輕患者Kellgren-Lawrence3-4級膝骨關(guān)節(jié)炎：根據(jù)骨關(guān)節(jié)炎級別和性別進(jìn)行調(diào)整后發(fā)現(xiàn)患者?報告的療效都獲得了改善

譯者 張軼超

目的：以往比較脛骨高位截骨術(shù)（HTO）與單間室膝關(guān)節(jié)置換術(shù)（UKA）的研究很少考慮到兩組患者的不同特征。本研究比較了HTO和UKA患者報告的預(yù)后結(jié)果（PROs），并根據(jù)術(shù)前PROs、骨關(guān)節(jié)炎等級和性別進(jìn)行了調(diào)整。

方法：回顧性分析術(shù)前、術(shù)后6個月、12個月和24個月前瞻性收集的PROs，即牛津膝關(guān)節(jié)評分（OKS）和疼痛/滿意度評分。納入2016-2019年一系列內(nèi)側(cè)開放楔形HTO和內(nèi)側(cè)UKA病例，術(shù)前kellgren - lawrence評分≥3，年齡50-60歲。采用線性混合模型，以O(shè)KS隨時間的變化作為主要結(jié)果進(jìn)行分析。

結(jié)果：我們納入84名HTO患者（平均年齡55.0±3.0，男性占79%，平均BMI 27.8±3.4，kellgreen - lawrence 3級占75%）和130例UKA患者（平均年齡55.7±2.8，男性47%，平均BMI 28.7±4.0，kellgreen - lawrence 3級36%）。所有時間點(diǎn)的回應(yīng)率均≥87%。校正術(shù)前PROs、kellgreen - lawrence分級和性別后，HTO組的OKS隨時間變化比UKA組低2.5點(diǎn)（95% CI 1.0-4.0） （p=0.001）。靜止時和活動時HTO組的疼痛數(shù)字評定量表得分(NRS；0 ~ 10分）都更高（p<0.01）。隨著時間的推移，HTO組EQ- 5D描述系統(tǒng)（p<0.01）、NRS滿意度（p<0.01）、Anchor功能和疼痛評分（p<0.01）都會降低。

結(jié)論：隨著時間的推移，UKA患者的OKS評分、疼痛和滿意度評分均優(yōu)于HTO患者。然而，觀察到的差異低于他們建立的最小臨床重要差異標(biāo)準(zhǔn)。因此，從患者的角度來看，在本研究概述的適應(yīng)征下，HTO并不遜于UKA。

High tibial osteotomy versus unicompartmental knee arthroplasty for Kellgren–Lawrence grade 3–4 knee osteoarthritis in younger patients: comparable improvements in patient?reported outcomes, adjusted for osteoarthritis grade and sex

Purpose：Previous studies comparing high tibial osteotomy (HTO) with unicompartmental knee arthroplasty (UKA) have seldom accounted for difering patient characteristics between both groups. This study compared patient-reported outcomes (PROs) of HTO and UKA patients, adjusted for preoperative PROs, osteoarthritis grade and sex.

Methods：A retrospective study was performed analysing prospectively collected PROs, namely the Oxford Knee Score (OKS) and pain/satisfaction scores, collected preoperatively and at 6 months, 12 months and 24 months postoperatively. Consecutive medial opening-wedge HTOs and medial UKAs from 2016–2019, with a preoperative Kellgren–Lawrence grade≥3, aged 50–60 years, were included. Linear mixed model analyses, with the OKS over time as the primary outcome, were used.

Results：We included 84 HTO patients (mean age 55.0±3.0, 79% male, mean BMI 27.8±3.4, 75% Kellgren–Lawrence grade 3) and 130 UKA patients (mean age 55.7±2.8, 47% male, mean BMI 28.7±4.0, 36% Kellgren–Lawrence grade 3). Response rates were≥87% at all time points. Corrected for preoperative PROs, Kellgren–Lawrence grade and sex, the HTO group had a 2.5 (95% CI 1.0–4.0) points lower OKS over time than the UKA group (p=0.001). The Numeric Rating Scale scores (NRS; 0–10) for pain at rest and during activity were higher (p<0.01) in the HTO group. The EQ-5D-descriptive system (p<0.01), NRS satisfaction (p<0.01), anchor function and pain scores (p<0.01) were lower over time in the HTO group.

Conclusion：UKA patients had better OKS scores, pain and satisfaction scores over time than HTO patients. However, the observed diferences were below their established minimal clinically important diferences. Therefore, from the patients’ perspective, HTO did not appear to be inferior to UKA under the indications outlined in this study.

文獻(xiàn)出處：Hoorntje A, Pronk Y, Brinkman JM, van Geenen RCI, van Heerwaarden RJ. High tibial osteotomy versus unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3-4 knee osteoarthritis in younger patients: comparable improvements in patient-reported outcomes, adjusted for osteoarthritis grade and sex. Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4861-4870. doi: 10.1007/s00167-023-07526-5. Epub 2023 Aug 12. PMID: 37572139; PMCID: PMC10598142.

文獻(xiàn)2

Legg-Calvé-Perthes病患者成年后骨盆傾斜的影響因素及其對全髖關(guān)節(jié)置換術(shù)的作用

譯者 張薔

背景：本篇文章的目的是分析Legg-Calvé-Perthes病（LCPD，兒童股骨頭壞死）患者成年后進(jìn)行全髖關(guān)節(jié)置換術(shù)（THA）之前骨盆的傾斜程度，以及術(shù)后前兩年的變化情況，并鑒別其影響因素。

方法：我們回顧性收集了某醫(yī)院2012年至2021年間所有帶有LCPD幼年患病史的THA手術(shù)病例。并根據(jù)手術(shù)時年齡、性別和BMI按照1:1的病例選擇了同樣數(shù)量的因原發(fā)性骨關(guān)節(jié)炎（OA）而施行THA手術(shù)的病例。THA手術(shù)時平均年齡47歲（21-91歲），其中18例（64.3%）為男性。我們的隨訪時間為5.1年（2-10.1年）。在術(shù)后6周、12周、1年和2年時，我們分別評估了假體位置、軟組織平衡以及骨盆傾斜度。最終入組了28髖（25名患者）的LCPD組病例和28髖的原發(fā)OA組病例。

測量骨盆傾斜度的方法：正位骨盆X光片上，傾斜度為相框邊緣的平行線和雙側(cè)淚滴下緣連線之間的夾角。

結(jié)果：兩組病例術(shù)后6周時的骨盆傾斜度均較術(shù)前有顯著增加（3.6±2.8°至4±3.2°和1.3±1.2°至1.8±1.5°），而在術(shù)后12周、1年和2年隨訪時逐漸降低，最終傾斜度為LCPD組 2.2±1.5°和OA組 0.8±0.7°。而只有LCPD組的術(shù)前傾斜度與術(shù)后雙下肢體長度差異增加（Rho=0.41）和股骨偏心距降低（Rho=-0.26）相關(guān)（P < 0.05）。

結(jié)論：與原發(fā)骨關(guān)節(jié)炎患者相比，有幼年LCPD病史的病例骨盆傾斜度更大，且與術(shù)后更大的肢體長度差異和更小的股骨偏心距存在相關(guān)性。對這些患者而言，THA手術(shù)會降低術(shù)后2年時的骨盆傾斜度，但在第一周會增加骨盆傾斜度，原因可能是外展肌的短縮，因此應(yīng)在術(shù)前告知患者。

Factors that Determine Pelvic Obliquity in Adults Who Suffered Legg-Calvé-Perthes Disease and the Role of Total Hip Arthroplasty in Its Restoration

BACKGROUND The purpose of the study was to analyze the appearance of pelvic obliquity before total hip arthroplasty (THA) in adults who have Legg-Calvé-Perthes disease (LCPD) sequelae and its evolution in the first two postoperative years, identifying which factors influence its development.

METHODS The THAs performed between 2012 and 2021 at a single institution in adults who had LCPD during childhood were retrospectively identified. Each case was matched 1:1, based on age at surgery, sex, and body mass index, with a primary THA performed for hip osteoarthritis (primary OA). A THA was implanted at a mean age of 47 years (range, 21 to 91), and 18 patients (64.3%) were men. We conducted a mean follow-up of 5.1 years (range, two to 10.1). Implant position, soft tissue balance, and pelvic obliquity were evaluated at six and 12 weeks and at one and two years. There were 28 THAs in 25 adults who suffered LCPD, and 28 THAs in patients who underwent surgery due to primary OA were included.

RESULTS An increase in the initial pelvic obliquity at six weeks of THA was observed in both groups (from 3.6 ± 2.8 to 4 ± 3.2 and from 1.3 ± 1.2 to 1.8 ± 1.5, respectively), which progressively decreased at 12 weeks, one year, and two years after surgery, with final values of 2.2 ± 1.5 and 0.8 ± 0.7 for the LCPD and OA groups, respectively. Only in the LCPD group were the preoperative values associated with a greater limb length discrepancy (Rho = 0.41) and a lower femoral offset (Rho = -0.26) (P < 0.05).

CONCLUSION Patients who suffered LCPD in childhood have greater pelvic obliquity than those who have primary OA, and this is associated with greater limb length discrepancy and less femoral offset. In these patients, THA decreases pelvic obliquity two years after its implantation, although it increases in the first weeks, probably due to the shortening of the abductor muscles, so patients should be warned before surgery.

文獻(xiàn)3

游標(biāo)卡尺手工驗證運(yùn)動學(xué)對線全膝關(guān)節(jié)置換術(shù)中股骨截骨的準(zhǔn)確性與精確性

譯者 沈松坡

引言：在全膝關(guān)節(jié)置換術(shù)（TKA）中，截骨的準(zhǔn)確性與精確性對于避免假體位置異常至關(guān)重要。位置不佳可能導(dǎo)致假體組件磨損、疼痛和不穩(wěn)定性，進(jìn)而降低患者滿意度和假體存活率。盡管技術(shù)輔助的TKA技術(shù)旨在提升準(zhǔn)確性，但其成本高、手術(shù)時間長，且臨床效果不一。游標(biāo)卡尺驗證的運(yùn)動學(xué)對線（KA）TKA通過精確測量截骨厚度以匹配假體厚度，力求恢復(fù)關(guān)節(jié)線。本研究評估了使用手動器械進(jìn)行游標(biāo)卡尺驗證KA-TKA的準(zhǔn)確性與精確性。我們假設(shè)該技術(shù)可實(shí)現(xiàn)高水平的準(zhǔn)確性與精確性，實(shí)際與目標(biāo)的遠(yuǎn)端與后部股骨截骨平均絕對差值不超過0.5毫米。

方法：385名連續(xù)患者接受了使用游標(biāo)卡尺手共器械進(jìn)行驗證、非限制性的KA-TKA。通過游標(biāo)卡尺測量遠(yuǎn)端內(nèi)側(cè)（DM）、遠(yuǎn)端外側(cè)（DL）、后部內(nèi)側(cè)（PM）和后部外側(cè)（PL）股骨髁的截骨厚度，并將其與根據(jù)軟骨磨損程度、鋸片切口寬度和股骨組件厚度所設(shè)定的目標(biāo)值進(jìn)行比較。

結(jié)果：DM、DL、PM 和 PL截骨的實(shí)際與目標(biāo)厚度的平均差值分別為 0.1 ± 0.2 毫米、0.1 ± 0.3 毫米、0.3 ± 0.5 毫米和 0.2 ± 0.4 毫米（均值 ± 標(biāo)準(zhǔn)差）。絕大多數(shù)截骨與目標(biāo)差值在 0.5 毫米以內(nèi)：DM 97.7%，DL 94.5%，PM 85.7%，PL 89.4%。

結(jié)論：游標(biāo)卡尺手工驗證的KA-TKA在股骨截骨方面實(shí)現(xiàn)了極高的準(zhǔn)確性與精確性，其平均絕對差值為0.175毫米。這種簡潔、合理、高效且可復(fù)制的手術(shù)技術(shù)，或可作為考慮使用技術(shù)輔助選項（如患者特異性器械或機(jī)器人輔助手術(shù)）的外科醫(yī)生的替代方案，尤其適用于無法獲取這些高科技手段的環(huán)境。

Femoral resection accuracy and precision in manual caliper-verified kinematic alignment total knee arthroplasty

Introduction: The accuracy and precision of bone resections in total knee arthroplasty (TKA) are essential to avoid poor implant positioning, which can lead to component wear, pain, and instability, reducing patient satisfaction and implant survivorship. Technology-assisted TKA techniques aim to improve accuracy but come with added costs, increased operative time, and varying success in clinical outcomes. Caliper-verified kinematic alignment (KA) attempts to restore the joint line by precisely measuring resections to equal implant thickness. We evaluated the accuracy and precision of caliper-verified KA-TKA performed with manual instruments. We hypothesised that this technique would achieve high accuracy and precision, with an average absolute difference between actual and target distal and posterior femoral resection measurements of ≤ 0.5 mm.

Methods: 385 consecutive patients underwent primary unrestricted caliper-verified KA-TKA with manual instrumentation. The thickness of the distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femoral condyle resections were measured with a caliper and compared to a target determined by the degree of cartilage loss, saw blade kerf, and femoral component thickness.

Results: The mean differences between the resected and target thicknesses for DM, DL, PM and PL femoral resections were 0.1 ± 0.2 mm, 0.1 ± 0.3 mm, 0.3 ± 0.5 mm and 0.2 ± 0.4 mm, respectively (mean ± std. dev.). Most femoral resections were within 0.5 mm of the target-97.7%, 94.5%, 85.7% and 89.4% of DM, DL, PM and PL resections, respectively.

Conclusion: Manual caliper-verified KA-TKA achieved highly accurate and precise femoral resections with absolute differences from target that averaged 0.175 mm. This simple, logical, efficient, and reproducible surgical technique may be an option for surgeons contemplating the use of technology-assisted options, such as patient-specific instrumentation or robotic arm-assisted TKA, and surgeons without access to such technologies.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

采用克氏針固定與螺釘固定效果相當(dāng)：PAO中期隨訪

譯者 羅殿中

背景：對髖臼周圍截骨（PAO）的理想固定方法存在爭議。有描述改良克氏針固定方法安全、可行，但采用克氏針固定的患者缺乏臨床隨訪證據(jù)。

目的：針對PAO術(shù)中采用克氏針固定患者，評估患者報告表（PROMs），并與螺釘固定技術(shù)進(jìn)行對比。

方法：自2015年1月至2017年7月，在一所大學(xué)醫(yī)療中心，共有202例連續(xù)進(jìn)行PAO手術(shù)患者納入本研究。最后有120例PAO患者完成資料搜集。PAO行克氏針固定（n=63）與螺釘固定（n=57）進(jìn)行比較。對PROMs評估包括：國際髖關(guān)節(jié)臨床效果表（iHOT-12）、客觀髖關(guān)節(jié)評分（SHV）、及UCLA運(yùn)動功能評分（UCLA）。同時評估疼痛、和患者滿意度（NRS）。保髖率定義為未轉(zhuǎn)換成全髖關(guān)節(jié)置換（THA）的比例。

結(jié)果：術(shù)前兩組方法之間PROMs基線相同。兩組之內(nèi)，術(shù)后PROMs（p<0.001）、和疼痛（p<0.001）顯著改善。兩組之間術(shù)后功能評分相似：iHOT-12（71.8 ± 25.1 vs. 73 ± 21.1; p = 0.789）、SHV（77.9 ±21.2 vs. 82.4 ±13.1; p = 0.192）、UCLA（6.9 ± 1.6 vs. 6.9 ±1.9; p = 0.909）、疼痛（2.4 ±2.1 vs. 2.0 ±2.1; p = 0.302）。患者滿意度兩組之間無明顯差別（7.6 ±2.6 vs. 8.2 ± 2.2; p = 0.170）。兩組轉(zhuǎn)為THA均較少（2例vs. 0例，p = 0.497）。

結(jié)論：在中期隨訪中，PAO采用克氏針固定可獲得與螺釘固定相當(dāng)?shù)牧己眯ЧAO手術(shù)固定時，克氏針固定技術(shù)可作為備選項。

圖1. （a）PAO術(shù)前骨盆前后位片；（b）PAO術(shù)后前后位片，采用克氏針固定。

Periacetabular Osteotomy with a Modified Fixation Technique Using K-Wires Shows Clinical Results Comparable to Screw Fixation at Mid-Term Follow-Up

Background:The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. Modified fixation with Kirschner wires (K-wires) was described as a feasible and safe alternative. However, clinical follow-up of patients treated with this technique is lacking.

Aims:To assess patient-reported outcomes (PROMs) in patients treated with PAO with the K-wire fixation technique and to compare it with the screw fixation technique.

Methods:We conducted an analysis of 202 consecutive PAOs at a single university center between January 2015 and June 2017. A total of 120 cases with complete datasets were included in the final analysis. PAOs with K-wire fixation (n = 63) were compared with screw fixation (n = 57). Mean follow-up was 63 ± 10 months. PROMs assessed included the International Hip Outcome Tool (iHOT 12), Subjective Hip Value (SHV), and UCLA activity score (UCLA). Pain and patient satisfaction (NRS) were evaluated. Joint preservation was defined as non-conversion to total hip arthroplasty (THA).

Results:Preoperative baseline PROMs in both fixation groups were similar. In both groups, PROMs (p = <0.001) and pain (p = <0.001) improved significantly. Postoperative functional outcome was similar in both groups: iHOT 12 (71.8 ± 25.1 vs. 73 ± 21.1; p = 0.789), SHV (77.9 ± 21.2 vs. 82.4 ± 13.1; p = 0.192), UCLA (6.9 ± 1.6 vs. 6.9 ± 1.9; p = 0.909), and pain (2.4 ± 2.1 vs. 2.0 ± 2.1; p = 0.302). Patient satisfaction did not differ significantly (7.6 ± 2.6 vs. 8.2 ± 2.2; p = 0.170). Conversion to THA was low in both groups (two vs. none; p = 0.497).

Conclusion:Periacetabular osteotomy with K-wire fixation provided good clinical results at mid-term follow-up, comparable to those of screw fixation. The technique can therefore be considered a viable option when deciding on the fixation technique in PAO.

文獻(xiàn)出處：Leopold VJ, Hipfl C, Zahn RK, Pumberger M, Perka C, Hardt S. Periacetabular Osteotomy with a Modified Fixation Technique Using K-Wires Shows Clinical Results Comparable to Screw Fixation at Mid-Term Follow-Up. J Clin Med. 2023 Sep 26;12(19):6204. doi: 10.3390/jcm12196204. PMID: 37834848; PMCID: PMC10573708.

文獻(xiàn)2

髖關(guān)節(jié)發(fā)育不良的診斷和治療：從Y形軟骨閉合到青年期

譯者 任寧濤

目前對發(fā)育成熟的髖關(guān)節(jié)因髖關(guān)節(jié)發(fā)育不良而誘發(fā)疼痛癥狀的的治療主要是選擇髖臼方向的糾正。在機(jī)械負(fù)荷方面，髖臼方向的矯正手術(shù)試圖改善股骨頭和髖臼透明軟骨的解剖位置。由于伯爾尼髖臼周圍截骨術(shù)是一種多方位的髖臼方向矯正技術(shù)，因此了解該手術(shù)入路和熟悉最佳矯正標(biāo)準(zhǔn)有助于獲得最佳的手術(shù)矯正。股骨近端有時也伴有髖關(guān)節(jié)發(fā)育不良的特征，可能同時需要手術(shù)矯正。改善頭頸偏心距以避免股骨髖臼撞擊已成為許多髖臼周圍截骨治療的常規(guī)。此外，股骨轉(zhuǎn)子間截骨術(shù)有助于改善關(guān)節(jié)匹配，恢復(fù)股骨頸的正常角度。其他新的外科技術(shù)可對嚴(yán)重股骨頭畸形進(jìn)行修正，進(jìn)行相對的股骨頸頸部延長，以及大轉(zhuǎn)子的移位和修整。越來越多的研究報道了髖臼旋轉(zhuǎn)手術(shù)后良好的長期結(jié)果，預(yù)期保髖率在10年隨訪時為80%至90%，在20年隨訪時為60%至70%。理想的患者年齡為小于30歲，術(shù)前無骨關(guān)節(jié)炎癥狀。在20年的隨訪中，這些患者的關(guān)節(jié)保存率約為90%。最近的證據(jù)表明，對非球形股骨頭進(jìn)行額外的矯正可能會進(jìn)一步改善結(jié)果。

Diagnosis and management of developmental dysplasia of the hip from triradiate closure through young adulthood

The current treatment of painful hip dysplasia in the mature skeleton is based on acetabular reorientation. Reorientation procedures attempt to optimize the anatomic position of the hyaline cartilage of the femoral head and acetabulum in regard to mechanical loading. Because the Bernese periacetabular osteotomy is a versatile technique for acetabular reorientation, it is helpful to understand the approach and be familiar with the criteria for an optimal surgical correction. The femoral side bears stigmata of hip dysplasia that may require surgical correction. Improvement of the head-neck offset to avoid femoroacetabular impingement has become routine in many hips treated with periacetabular osteotomy. In addition, intertrochanteric osteotomies can help improve joint congruency and normalize the femoral neck orientation. Other new surgical techniques allow trimming or reducing a severely deformed head, performing a relative neck lengthening, and trimming or distalizing the greater trochanter. An increasing number of studies have reported good long-term results after acetabular reorientation procedures, with expected joint preservation rates ranging from 80% to 90% at the 10-year follow-up and 60% to 70% at the 20-year follow-up. An ideal candidate is younger than 30 years, with no preoperative signs of osteoarthritis. Predicted joint preservation in these patients is approximately 90% at the 20-year follow-up. Recent evidence indicates that additional correction of an aspheric head may further improve results.

文獻(xiàn)出處：Siebenrock KA, Steppacher SD, Albers CE, Haefeli PC, Tannast M. Diagnosis and management of developmental dysplasia of the hip from triradiate closure through young adulthood. J Bone Joint Surg Am. 2013 Apr 17;95(8):748-55. doi: 10.2106/00004623-201304170-00012. PMID: 23776944.

文獻(xiàn)3

股骨頸前傾角

譯者 陶可

股骨頸前傾角是股骨頸與股骨干之間的夾角，提示股骨的扭轉(zhuǎn)程度。股骨頸前傾角的差異會通過改變力臂長度和關(guān)節(jié)負(fù)荷等因素影響髖關(guān)節(jié)的生物力學(xué)。與股骨頸前傾角相關(guān)的步態(tài)改變也可能導(dǎo)致多種骨骼疾病，包括骨關(guān)節(jié)炎。在看似健康的成年人中，股骨頸前傾角的差異可達(dá)30°。股骨頸前傾角在妊娠期（胎兒階段）大幅增加，之后穩(wěn)步下降直至正常。有證據(jù)表明，成年期至老年期，股骨頸前傾角會以較低的速度逐步下降，但其機(jī)制尚未研究。股骨頸前傾角的形成似乎受到日常運(yùn)動中所受到的機(jī)械壓力的影響。運(yùn)動受損群體（如臀位兒童或患有腦癱等神經(jīng)肌肉疾病的個體）的股骨頸前傾角存在巨大差異。可以使用多種方法來評估股骨頸前傾角，同一人的股骨頸前傾角值可能相差高達(dá)20°。雖然MRI和CT已在臨床上使用，但其成本、掃描時間和電離輻射等限制限制了它們的適用性，尤其是在兒童中。雖然存在超聲等方法，但它們的可靠性和有效性較差。這些問題凸顯了對一種有效、可靠且普遍接受的方法的需求。臨床上異常的股骨頸前傾角的治療通常是去旋轉(zhuǎn)截骨術(shù)，非手術(shù)方法沒有任何效果。盡管有觀察性證據(jù)表明體育活動對股骨頸前傾角發(fā)展有影響，但有針對性的體育活動的功效仍未被探索。本綜述的目的是描述股骨頸前傾角的生物力學(xué)和臨床結(jié)果、影響股骨頸前傾角的因素以及用于評估股骨頸前傾角的不同方法的優(yōu)缺點(diǎn)。

圖1 股骨及股骨頸前傾角(FNA)的軸位示意圖。灰色區(qū)域代表股骨頸，白色區(qū)域代表股骨內(nèi)外側(cè)髁。

圖2 骨骺生長板：13歲尸體股骨近端X線攝影和計算機(jī)斷層掃描(CT)。上圖為冠狀面視圖，下圖為軸向視圖(Kandzierski等，2012)。

圖3 不同妊娠階段胎兒股骨頸前傾角(FNA)的平均值和標(biāo)準(zhǔn)差。下圖顯示不同發(fā)育階段（12周至足月）的典型胎兒股骨樣本照片。圖片改編自Walker和Goldsmith (1981)

圖4 不同研究者測量的不同年齡段兒童股骨頸前傾角的平均值及正常限值（Shands和Steele，1958；Fabry等，1973；T?nnis 和 Heinecke，1991）。

圖5 腦癱(CP)兒童和正常發(fā)育對照兒童在生長發(fā)育過程中的股骨頸前傾角(FNA)，以平均值和標(biāo)準(zhǔn)差表示。改編自Bobroff等人，1999年 (Bobroff et al., 1999)

圖6上圖：不同股骨頸前傾角(FNA)評估方法示例及其對評估幾何形狀的影響：A、B、C、D、E為橫向切片法(Hernandez et al., 1981; Murphy et al., 1987; Yoshioka et al., 1987; Waidelich et al., 1992; Jarrett et al., 2010)，F(xiàn)和G為斜向切片法(Yoshioka et al., 1987; Jarrett et al., 2010)。

下圖顯示了冠狀位中切片的位置。H表示所有方法均以股骨頸后髁線為參考線。該圖來自Kaiser等(2016)。

下圖：左圖為股骨近端和遠(yuǎn)端的疊加圖。穿過股骨頸的線條表示沿股骨干軸線看去的不同頸軸和桌面髁軸：“頸”指的是Berryman方法（Berryman et al., 2014），這是一種半自動方法，它考慮了股骨頭中心、股骨頸底部和股骨頸點(diǎn)群。Lee（Lee et al., 2006）2D方法在一個軸向切片上使用一條直線連接股骨頭中心和大轉(zhuǎn)子最頭側(cè)連接處。Reikeras（Reiker?s et al., 1983）方法使用一條線連接一個切片上的股骨頭中心和另一個切片上的股骨頸中心，該切片的股骨頸后緣和前緣平行。Murphy（Murphy 等人，1987）使用一條線連接一個軸向切片上的股骨頭中心和另一個軸向切片上的股骨頸底部中心。圖片來自Berryman等（2014）。右圖：第1列軸向切片為頭側(cè)方向，第2列軸向切片穿過股骨頸中心，第3列軸向切片穿過股骨頸底部，剩余股骨頭。A行頸軸定義為股骨頭中心和股骨頸中心。B行頸軸定義為連接股骨頸寬度兩個中心的線；I 上方的C行是連接股骨頭和大轉(zhuǎn)子外緣的線，下方的線是超聲檢查中股骨頸的前緣。

Femoral anteversion: significance and measurement

Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Differences in FNA affect the biomechanics of the hip, through alterations in factors such as moment arm lengths and joint loading. Altered gait associated with differences in FNA may also contribute to the development of a wide range of skeletal disorders including osteoarthritis. FNA varies by up to 30° within apparently healthy adults. FNA increases substantially during gestation and thereafter decreases steadily until maturity. There is some evidence of a further decrease at a much lower rate during adulthood into old age, but the mechanisms behind it have never been studied. Development of FNA appears to be strongly influenced by mechanical forces experienced during everyday movements. This is evidenced by large differences in FNA in groups where movement is impaired, such as children born breech or individuals with neuromuscular conditions such as cerebral palsy. Several methods can be used to assess FNA, which may yield different values by up to 20° in the same participant. While MRI and CT are used clinically, limitations such as their cost, scanning time and exposure to ionising radiation limit their applicability in longitudinal and population studies, particularly in children. More broadly, applicable measures such as ultrasound and functional tests exist, but they are limited by poor reliability and validity. These issues highlight the need for a valid and reliable universally accepted method. Treatment for clinically problematic FNA is usually de-rotational osteotomy; passive, non-operative methods do not have any effect. Despite observational evidence for the effects of physical activity on FNA development, the efficacy of targeted physical activity remains unexplored. The aim of this review is to describe the biomechanical and clinical consequences of FNA, factors influencing FNA and the strengths and weaknesses of different methods used to assess FNA.

文獻(xiàn)出處：Matteo Scorcelletti, Neil D Reeves, J?rn Rittweger, Alex Ireland. Femoral anteversion: significance and measurement. Review, J Anat. 2020 Nov;237(5):811-826. doi: 10.1111/joa.13249. Epub 2020 Jun 24.

文獻(xiàn)4

機(jī)器人輔助聯(lián)合增強(qiáng)現(xiàn)實(shí)（AR）導(dǎo)航系統(tǒng)在髖臼周圍截骨術(shù)中的應(yīng)用

譯者 邱興

髖臼周圍截骨術(shù)（PAO）是治療發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的有效術(shù)式。然而由于髖關(guān)節(jié)周圍解剖結(jié)構(gòu)復(fù)雜且術(shù)中術(shù)野（FoV）受限，臨床操作難度較高。為此，本研究提出一種機(jī)器人輔助聯(lián)合增強(qiáng)現(xiàn)實(shí)（AR）導(dǎo)航系統(tǒng)，其核心組件包括機(jī)械臂、光學(xué)定位儀及微軟HoloLens 2頭顯設(shè)備（該設(shè)備系新型光學(xué)透視式頭戴顯示器OST-HMD）。在AR引導(dǎo)方面，開發(fā)了基于光學(xué)標(biāo)記物的空間配準(zhǔn)算法，實(shí)現(xiàn)光學(xué)定位坐標(biāo)系（COS）至虛擬空間的坐標(biāo)轉(zhuǎn)換，確保虛擬模型與實(shí)體解剖結(jié)構(gòu)的精準(zhǔn)疊加。針對截骨操作，系統(tǒng)可自動將骨鋸與術(shù)前規(guī)劃的截骨平面對齊，通過虛擬運(yùn)動約束機(jī)制限制骨鋸偏移，并借助AR技術(shù)提供無視覺切換的實(shí)時導(dǎo)航反饋，顯著提升手術(shù)精度與安全性。實(shí)驗結(jié)果表明：所提出的AR配準(zhǔn)方法平均絕對距離誤差（mADE）為1.96 ± 0.43 mm；機(jī)器人系統(tǒng)中心平移誤差0.96 ± 0.23 mm，最大距離誤差1.31 ± 0.20 mm，角度偏差3.77 ± 0.85°，驗證了該導(dǎo)航系統(tǒng)具有可靠的配準(zhǔn)精度與截骨精度。

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

Periacetabular osteotomy (PAO) is an effective approach for the surgical treatment of developmental dysplasia of the hip (DDH). However, due to the complex anatomical structure around the hip joint and the limited field of view (FoV) during the surgery, it is challenging for surgeons to perform a PAO surgery. To solve this challenge, we propose a robot-assisted, augmented reality (AR)-guided surgical navigation system for PAO. The system mainly consists of a robot arm, an optical tracker, and a Microsoft HoloLens 2 headset, which is a state-of-the-art (SOTA) optical see-through (OST) head-mounted display (HMD). For AR guidance, we propose an optical marker-based AR registration method to estimate a transformation from the optical tracker coordinate system (COS) to the virtual space COS such that the virtual models can be superimposed on the corresponding physical counterparts. Furthermore, to guide the osteotomy, the developed system automatically aligns a bone saw with osteotomy planes planned in preoperative images. Then, it provides surgeons with not only virtual constraints to restrict movement of the bone saw but also AR guidance for visual feedback without sight diversion, leading to higher surgical accuracy and improved surgical safety. Comprehensive experiments were conducted to evaluate both the AR registration accuracy and osteotomy accuracy of the developed navigation system. The proposed AR registration method achieved an average mean absolute distance error (mADE) of 1.96 ± 0.43 mm. The robotic system achieved an average center translation error of 0.96 ± 0.23 mm, an average maximum distance of 1.31 ± 0.20 mm, and an average angular deviation of 3.77 ± 0.85°. Experimental results demonstrated both the AR registration accuracy and the osteotomy accuracy of the developed system.

文獻(xiàn)出處： Ding H , Sun W , Zheng G .Robot-Assisted Augmented Reality (AR)-Guided Surgical Navigation for Periacetabular Osteotomy[J].Sensors (14248220), 2024, 24(14).DOI:10.3390/s24144754.

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊

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