本期目錄：

1、外側(cè)閉合楔形脛骨高位截骨后全膝關(guān)節(jié)置換術(shù)與初次全膝關(guān)節(jié)置換術(shù)比較

2、初次全膝關(guān)節(jié)置換術(shù)后恢復(fù)駕車的影響因素分析

3、膝關(guān)節(jié)內(nèi)側(cè)單髁置換術(shù)后的臨床結(jié)局評(píng)分：MAKO機(jī)器人輔助手術(shù)與牛津傳統(tǒng)手術(shù)方法的比較

4、旋轉(zhuǎn)生長(zhǎng)引導(dǎo)技術(shù)：兒童應(yīng)用初步報(bào)告

5、DDH患兒髖關(guān)節(jié)重建術(shù)后早期活動(dòng)

6、人工智能輔助成像對(duì)髖關(guān)節(jié)發(fā)育不良的診斷價(jià)值

7、髖臼周圍截骨術(shù)中骨盆后傾-如何避免系統(tǒng)誤差導(dǎo)致髖臼后傾和可能的股骨髖臼撞擊

8、髖臼前傾角測(cè)量：面積法測(cè)量髖臼前傾角

9、髖關(guān)節(jié)發(fā)育不良解剖結(jié)構(gòu)改變步態(tài)中肌肉力矩臂長(zhǎng)度、作用線及其對(duì)關(guān)節(jié)反作用力的貢獻(xiàn)

10、髖臼深度、髖臼發(fā)育的早期預(yù)測(cè)因素：切開復(fù)位后髖關(guān)節(jié)發(fā)育不良患者M(jìn)RI觀察

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

文獻(xiàn)1

外側(cè)閉合楔形脛骨高位截骨后全膝關(guān)節(jié)置換術(shù)與初次全膝關(guān)節(jié)置換術(shù)比較：傾向性評(píng)分匹配研究

譯者 張軼超

背景：患者報(bào)告的脛骨高位截骨術(shù)（HTO）后全膝關(guān)節(jié)置換術(shù)（TKA）與初次全膝關(guān)節(jié)置換術(shù)（TKA）預(yù)后的差異尚未被完全了解。本研究旨在比較HTO后TKA與初次TKA患者報(bào)告的預(yù)后、影像學(xué)參數(shù)和并發(fā)癥發(fā)生率。

方法：在術(shù)后6個(gè)月和1年時(shí)，對(duì)65例外側(cè)閉合楔形HTO術(shù)后行TKA的患者和相匹配的初次TKA患者進(jìn)行比較。年齡、性別、吸煙狀況、體重指數(shù)、術(shù)前休息時(shí)的疼痛數(shù)字評(píng)定量表（NRS）、膝關(guān)節(jié)損傷和骨關(guān)節(jié)炎效果評(píng)分-身體功能簡(jiǎn)表（KOOS-PS）、EuroQol五維（EQ-5D）總體健康評(píng)分和牛津膝關(guān)節(jié)評(píng)分（OKS）中的組間混雜因素通過傾向性評(píng)分匹配進(jìn)行平衡。患者報(bào)告的效果通過NRS休息疼痛、KOOS-PS、EQ-5D總體健康評(píng)分和OKS來評(píng)測(cè)。影像學(xué)參數(shù)為股脛角、脛骨內(nèi)側(cè)近端角、股骨遠(yuǎn)端外側(cè)解剖角、脛骨后傾角和髕骨高度（install - salvati 比率）。比較兩組TKA的并發(fā)癥發(fā)生率。通過HTO術(shù)后行TKA患者的取釘時(shí)間是在TKA前還是同時(shí)進(jìn)行來評(píng)估HTO生存時(shí)間，還有評(píng)估髕骨表面置換率。經(jīng)Bonferroni校正，p值<0.0125表示有統(tǒng)計(jì)學(xué)意義。

結(jié)果：傾向性評(píng)分匹配后，在患者報(bào)告的效果、影像學(xué)參數(shù)和并發(fā)癥發(fā)生率方面，組間無(wú)顯著差異（p > 0.0125）。在HTO后TKA組中，平均HTO生存時(shí)間為8.7年，TKA前有46例（71%）和TKA期間有19例（19例）患者拆除了固定釘，11例（17%）患者進(jìn)行了髕骨表面置換。在原發(fā)性TKA組，15例（23%）患者進(jìn)行了髕骨置換。

結(jié)論：HTO術(shù)后TKA的短期評(píng)估結(jié)果與初次TKA相似。既往的HTO不會(huì)影響后續(xù)TKA的早期結(jié)果，這表明既往的HTO對(duì)TKA結(jié)果的影響很小。

Total knee arthroplasty following lateral closing-wedge high tibial osteotomy versus primary total knee arthroplasty: a propensity score matching study

Background：The disparity in patient-reported outcomes between total knee arthroplasty (TKA) following high tibial osteotomy (HTO) and primary TKA has yet to be fully comprehended. This study aims to compare the patientreported outcomes, radiological parameters and complication rates between TKA following HTO and primary TKA.

Methods：Sixty-fve patients who underwent TKA following lateral closing-wedge HTO were compared to a matched group of primary TKA at postoperative 6-months and 1-year. Between-group confounders of age, gender, smoking status, Body Mass index, preoperative Numeric Rating Scale (NRS) pain in rest, Knee injury and Osteoarthritis Outcome Score-Physical function Shortform (KOOS-PS), EuroQol fve-dimensional (EQ-5D) overall health score, and Oxford Knee Score (OKS) were balanced by propensity score matching. Patient-reported outcome measures were NRS pain in rest, KOOS-PS, EQ-5D overall health score, and OKS. Radiological parameters were femorotibial angle, medial proximal tibial angle, anatomical lateral distal femoral angle, posterior tibial slope, and patellar height assessed by Insall-Salvati ratio. The complication rates of TKA were compared between the two groups. The HTO survival time, the choice of staple removal before or during TKA in patients who underwent TKA following HTO patients, and the rate of patellar resurfacing were assessed. The p value<0.0125 indicates statistical signifcance after Bonferroni correction.

Results：After propensity score matching, no signifcant between-group diferences in the patient-reported outcome measures, radiographical parameters and complication rates were found (p>0.0125). In the TKA following HTO group, with an average HTO survival time of 8.7 years, staples were removed before TKA in 46 patients (71%) and during TKA in 19 patients, and 11 cases (17%) had patella resurfacing. In the primary TKA group, 15 cases (23%) had patella resurfacing.

Conclusion：The short-term assessment of TKA following HTO indicates outcomes similar to primary TKA. A previous HTO does not impact the early results of subsequent TKA, suggesting that the previous HTO has minimal infuence on TKA outcomes.

文獻(xiàn)出處：Xie T, de Vries AJ, van der Veen HC, Brouwer RW. Total knee arthroplasty following lateral closing-wedge high tibial osteotomy versus primary total knee arthroplasty: a propensity score matching study. J Orthop Surg Res. 2024 May 7;19(1):283. doi: 10.1186/s13018-024-04760-6. PMID: 38715064; PMCID: PMC11077886.

文獻(xiàn)2

初次全膝關(guān)節(jié)置換術(shù)后恢復(fù)駕車的影響因素分析

譯者 張薔

背景：全膝關(guān)節(jié)置換（TKA）術(shù)后患者何時(shí)可以恢復(fù)駕車目前并不明確。盡管患者間年齡、一般健康狀況和運(yùn)動(dòng)能力存在較大差異，絕大多數(shù)術(shù)者普遍限制患者TKA術(shù)后駕車的時(shí)間為4-6周。本研究的主要目的是創(chuàng)造全膝的臨床預(yù)測(cè)工具來評(píng)估初次TKA術(shù)后恢復(fù)駕車的時(shí)間。

方法：本前瞻性研究共入組了167例患者。受試者術(shù)后每三天接受一次短信調(diào)查隨訪以決定恢復(fù)駕車的時(shí)間。受試者還需在術(shù)后2周、6周和12周的門診隨訪時(shí)需要完成8項(xiàng)運(yùn)動(dòng)評(píng)測(cè)。最后，受試者需要完成所有的恢復(fù)駕車調(diào)查和固定的回訪。我們收集了一般信息、手術(shù)相關(guān)信息、患者自評(píng)療效和患者相關(guān)因素。最后，我們應(yīng)用Cox比例風(fēng)險(xiǎn)模型和參數(shù)化生存模型來創(chuàng)造兩種全新的預(yù)測(cè)恢復(fù)駕車時(shí)間的計(jì)算工具。

結(jié)果：共有156名患者（平均年齡67.7歲[39-83歲]）完成了所有研究項(xiàng)目。恢復(fù)駕車的中位時(shí)間為18天（四分位數(shù)[IQR]，12-27天）。單因素分析顯示男性患者（18天）恢復(fù)駕車時(shí)間早于女性患者（25.3天）（p < 0.001），且左膝手術(shù)的患者（20.1天）恢復(fù)駕車的時(shí)間早于右膝手術(shù)的患者（24.4天）（p = 0.021）。術(shù)前因素中，年齡、性別、術(shù)側(cè)和術(shù)前膝關(guān)節(jié)損傷與骨關(guān)節(jié)炎評(píng)分（KOOS）對(duì)恢復(fù)駕車時(shí)間有影響，因此被列入術(shù)前臨床預(yù)測(cè)工具中。術(shù)后因素中，年齡、性別、術(shù)側(cè)、術(shù)前KOOS評(píng)分和6項(xiàng)運(yùn)動(dòng)評(píng)測(cè)項(xiàng)目對(duì)恢復(fù)駕車時(shí)間有影響，因此被列入術(shù)后基于運(yùn)動(dòng)水平的計(jì)算工具中。

結(jié)論：最終我們發(fā)現(xiàn)，接受初次TKA手術(shù)的患者術(shù)后恢復(fù)駕車的時(shí)間比之前普遍預(yù)想的要早很多。患者相關(guān)因素和術(shù)后運(yùn)動(dòng)能力顯著影響恢復(fù)駕車的時(shí)間。應(yīng)用全新的術(shù)前臨床預(yù)測(cè)工具，我們可以給每位患者關(guān)于恢復(fù)駕車時(shí)間的個(gè)體化建議。而在術(shù)后，我們應(yīng)用全新的基于運(yùn)動(dòng)水平的計(jì)算工具，可以在患者具備恢復(fù)駕車的條件時(shí)及時(shí)告知患者。

掃描二維碼可查看兩種計(jì)算工具。

Factors That Influence Returning to Driving Following Primary Total Knee Arthroplasty

A Prospective Investigation

Background: It is unclear when a patient can return to driving after total knee arthroplasty (TKA). Currently, most surgeons simply restrict all patients from driving for 4 to 6 weeks after TKA despite variability in patient age, general health, and physical capabilities. The primary objective of this study was to create novel clinical prediction calculators to estimate the return-to-driving time following primary TKA.

Methods: In this study, 167 patients who were undergoing a primary TKA were prospectively enrolled. Subjects received text message surveys every third day postoperatively to determine when they returned to driving. Subjects completed 8 physical performance maneuvers at their 2, 6, and 12-week postoperative clinical appointments. Additionally, subjects completed return-to-driving surveys and a structured interview. Data on demographic characteristics, operative factors, patient-reported outcomes, and patient factors were collected. Cox proportional hazard and parametric survival models were utilized to create 2 novel calculators for predicting return-to-driving time.

Results: There were 156 patients (mean age, 67.7 years [range, 39 to 83 years]) who completed the study. The median return-to-driving time was 18 days (interquartile range [IQR], 12 to 27 days). Univariate analysis demonstrated that male patients returned to driving sooner (18 days) than female patients (25.3 days) (p < 0.001) and that patients who underwent left-sided surgery returned to driving sooner (20.1 days) than patients who underwent right-sided surgery (24.4 days) (p = 0.021). For preoperative factors, age, sex, laterality, and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) had an effect on return-to-driving time and therefore were included in the novel preoperative clinical prediction calculator. For postoperative factors, age, sex, laterality, preoperative KOOS, and 6 metrics from the physical performance maneuvers had an effect on return-to-driving time and therefore were included in the novel postoperative physical performance-based instrument.

Conclusions: Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.

文獻(xiàn)3

膝關(guān)節(jié)內(nèi)側(cè)單髁置換術(shù)后的臨床結(jié)局評(píng)分：MAKO機(jī)器人輔助手術(shù)與牛津傳統(tǒng)手術(shù)方法的比較

譯者 沈松坡

背景：內(nèi)側(cè)單髁膝關(guān)節(jié)置換術(shù)（UKA）是一種治療膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎的可行手術(shù)方案。由于在假體定位和對(duì)線方面的精確性，機(jī)器人輔助手術(shù)UKA逐漸普及。本研究比較了MAKO機(jī)器人輔助手術(shù)UKA與傳統(tǒng)牛津UKA的臨床結(jié)局。

方法：本回顧性研究納入了2019年1月至2020年12月期間接受內(nèi)側(cè)UKA的患者。MAKO組（n=47）與牛津組（n=60）分別比較了術(shù)前和術(shù)后患者報(bào)告的結(jié)局指標(biāo)（PROMs），包括牛津膝關(guān)節(jié)評(píng)分（OKS）、遺忘關(guān)節(jié)評(píng)分-12（FJS-12）及患者滿意度評(píng)分。

結(jié)果：兩組術(shù)后OKS和FJS-12評(píng)分均顯著改善。與牛津組相比，MAKO組的術(shù)后平均OKS評(píng)分（43.3 vs 41.0，p=0.048）和FJS-12評(píng)分（75.1 vs 68.6，p=0.042）更高。患者滿意度在MAKO組也顯著更高（p=0.039）。

結(jié)論：在功能評(píng)分和患者滿意度方面，MAKO機(jī)器人輔助手術(shù)UKA較傳統(tǒng)牛津UKA可獲得更優(yōu)越的短期臨床結(jié)局。

圖 (a) 術(shù)前規(guī)劃的股骨截骨與假體定位。(b) 術(shù)前規(guī)劃的脛骨截骨與假體定位。

Clinical Outcome Scores Post Medial Unicompartmental Knee Arthroplasty: A Comparison of the MAKO Robotic Arm versus the Oxford Conventional Approach

Introduction: Unicompartmental knee arthroplasty (UKA) has significant advantages over total knee arthroplasty (TKA). However, due to its need for precise positioning and soft tissue balancing, UKA failures and revision rates may be higher than that of TKA. Robotic-assisted UKA offers more accurate implant positioning, soft tissue balancing, improved lower limb alignment, and a reduction in surgical error. There are few studies studying functional outcomes post robotic-assisted UKA. The aim of this study was to compare the functional outcomes between robotic-assisted and conventional medial UKA.

Material and methods: A retrospective review was done of 159 patients; 110 patients underwent conventional UKA while 49 patients underwent robotic-assisted UKA. Outcome measures included the Oxford Knee Score (OKS), Knee Society Score (KSS), Visual Analogue Score (VAS) for pain, and range of motion (ROM) at three months, one-year and two years post-UKA.

Results: Pre-operative patient demographics and outcome scores were not significantly different between both groups. ROM was significantly greater in the MAKO compared to the Oxford group at 3 months (p=0.039), 1 year (0.053) and 2 years (0.001) post-operation. While OKS, KSS and VAS scores improved for both groups, there were no significant differences in the final outcome measures. None of the patients experienced a mechanical failure, infection, or revision post-surgery. One patient each in the Oxford and MAKO group suffered a periprosthetic fracture.

Conclusion: Both robotic-assisted MAKO UKA and conventional Oxford UKA showed good clinical outcomes. Robotic-assisted MAKO UKA had superior ROM outcomes compared to conventional Oxford UKA up to two years post-surgery.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

旋轉(zhuǎn)生長(zhǎng)引導(dǎo)技術(shù)：兒童應(yīng)用初步報(bào)告

譯者 羅殿中

兒童下肢扭轉(zhuǎn)異常較為常見，很難自我塑形，或需要手術(shù)治療。一般來說需要開放截骨來矯正。微創(chuàng)角度調(diào)整的生長(zhǎng)引導(dǎo)技術(shù)已經(jīng)成為（內(nèi)外翻矯形的）金標(biāo)準(zhǔn)；并開始用于對(duì)扭轉(zhuǎn)畸形的調(diào)整探索。

該研究展示了我們的研究結(jié)果，采用脛骨或股骨外周彈力帶新技術(shù)。5個(gè)患者8處骨骼，采用合頁(yè)板（加拿大）彈力帶技術(shù)進(jìn)行治療。荷葉板呈45°角分別固定于骺端和干骺端，然后用纖維束帶（美國(guó)）進(jìn)行固定。內(nèi)植物分別固定于內(nèi)側(cè)和外側(cè)，45°相反方向，取決于希望矯正的方向。平均治療時(shí)間為12個(gè)月，在臨床評(píng)估中，所有患者的扭轉(zhuǎn)畸形均得到矯正。平均矯正角度股骨為30°、脛骨為9.5°。而且，在平均18個(gè)月的隨訪中，扭轉(zhuǎn)畸形無(wú)復(fù)發(fā)。在雙側(cè)均矯形的患者，縱向生長(zhǎng)未受影響。

采用彈力帶進(jìn)行扭轉(zhuǎn)畸形生長(zhǎng)引導(dǎo)，是一項(xiàng)新的技術(shù)，可以在無(wú)需截骨的情況下，成功治療扭轉(zhuǎn)畸形。

圖1. 俯臥位檢查足股軸線（左圖）；俯臥位檢查髖關(guān)節(jié)內(nèi)旋（中圖）；俯臥位檢查髖關(guān)節(jié)外旋（右圖）。

圖2. 旋轉(zhuǎn)生長(zhǎng)引導(dǎo)內(nèi)植物示意圖。采用一對(duì)對(duì)稱合頁(yè)鋼板；通過纖維束帶環(huán)繞聯(lián)接；鋼板采用螺釘固定于骨骼。示意圖版權(quán)歸屬Paley基金會(huì)，刊印已獲授權(quán)。

圖3. 一組鋼板傾斜置于股骨髁內(nèi)側(cè)，另一組鋼板傾斜置于股骨髁外側(cè)，交叉角度盡可能接近90°。示意圖版權(quán)歸屬Paley基金會(huì)，刊印已獲授權(quán)。

圖4. 旋轉(zhuǎn)生長(zhǎng)引導(dǎo)術(shù)前術(shù)后膝關(guān)節(jié)前面觀、后面觀、外側(cè)觀、內(nèi)側(cè)觀示意圖。示意圖版權(quán)歸屬Paley基金會(huì)，刊印已獲授權(quán)。

圖5. 雙側(cè)股骨遠(yuǎn)端旋轉(zhuǎn)生長(zhǎng)引導(dǎo)術(shù)后髖關(guān)節(jié)內(nèi)旋（左圖）、外旋（右圖）；同一患者與圖1術(shù)前情況進(jìn)行比較。

圖6. 圖1、圖5同一患者雙下肢站立位全長(zhǎng)正位片。旋轉(zhuǎn)生長(zhǎng)引導(dǎo)裝置植入時(shí)片（左上圖）；旋轉(zhuǎn)生長(zhǎng)引導(dǎo)完成后片（中上圖）；采用內(nèi)側(cè)固定行內(nèi)側(cè)半骺融合術(shù)矯正膝外翻（右上圖）。左下圖可以看到旋轉(zhuǎn)生長(zhǎng)引導(dǎo)鋼板植入時(shí)交叉角度，與右下圖矯正完成時(shí)交叉角度進(jìn)行比較，可以看到交叉角度的變化。

圖7. 旋轉(zhuǎn)生長(zhǎng)引導(dǎo)技術(shù)在脛骨的應(yīng)用。左圖為矯正開始時(shí)側(cè)位片，右圖為矯正結(jié)束時(shí)側(cè)位片，可以看出交叉角度的變化。該病例矯正角度為17°。

文獻(xiàn)出處：Paley D, Shannon C. Rotational Guided Growth: A Preliminary Study of Its Use in Children. Children (Basel). 2022 Dec 29;10(1):70. doi: 10.3390/children10010070. PMID: 36670621; PMCID: PMC9856838.

文獻(xiàn)2

DDH患兒髖關(guān)節(jié)重建術(shù)后早期活動(dòng)

譯者 任寧濤

背景

針對(duì)DDH患兒髖關(guān)節(jié)重建術(shù)后，絕大多數(shù)小兒骨科醫(yī)生喜歡石膏制動(dòng)4-12周，石膏制動(dòng)可引起石膏固定相關(guān)并發(fā)癥，對(duì)DDH患兒髖關(guān)節(jié)重建術(shù)后不選擇石膏制動(dòng)，選擇早期活動(dòng)的研究甚少。

方法

對(duì)行髖關(guān)節(jié)重建手術(shù)（Dega、股骨近端截骨、切開復(fù)位）的患兒進(jìn)行回顧性研究，共納入27名患兒（3.4±2.0歲），包括33例髖關(guān)節(jié)，涵蓋發(fā)育不良和脫位（T?nnis1-4），術(shù)后患兒放置在泡沫殼內(nèi)，保持髖關(guān)節(jié)中立位屈曲外展30度，手術(shù)后幾天內(nèi)進(jìn)行早期被動(dòng)活動(dòng)，術(shù)后3-4周完全負(fù)重，記錄患兒術(shù)前和術(shù)后查體和影像學(xué)評(píng)估情況，隨訪時(shí)間12.3±2.9月。

結(jié)果

術(shù)后AI從36.9°降低到21.7°，CE角從9.9°增加到28.6°，終末隨訪時(shí)所有的髖關(guān)節(jié)復(fù)位達(dá)到了T?nnis 1，未發(fā)現(xiàn)骨塊移位、股骨頭或髖臼缺血壞死、不愈合和神經(jīng)損傷。

結(jié)論

此隊(duì)列研究發(fā)現(xiàn)，髖關(guān)節(jié)重建術(shù)后早期活動(dòng)不影響臨床和影像學(xué)效果，DDH髖關(guān)節(jié)重建術(shù)后可進(jìn)行早期活動(dòng)。

圖 泡沫殼，保持髖關(guān)節(jié)中立位屈曲外展。

Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation

Background: Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia. This challenging treatment may be associated with complications. Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction.

Methods: Twenty-seven children (3.4±2.0 years), including 33 hips with developmental hip dysplasia (DDH) and dislocation of the hip (T?nnis grade 1 to 4), who underwent hip reconstruction (Dega acetabuloplasty, varisation-derotation osteotomy and facultative open reduction) were retrospectively included in this study. Postoperatively the patients were placed in an individual foam shell with 30 degrees of hip abduction, hip extension, and neutral rotation. Early mobilization physiotherapy was performed within the first few days after the surgery under epidural anaesthesia. Full weight bearing was allowed after 3-4 weeks. All children received a clinical examination and radiographic evaluation before and after surgical intervention. The follow-up period was 12.3±2.9 months.

Results: On average, the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 degrees. All hips had reached T?nnis grade 1 at the time of the last follow-up. No complications such as dislocation of the bone wedge, avascular necrosis of the acetabulum or femur, lack of non-union, or nerve injury, were reported.

Conclusions: In this cohort study, hip reconstruction was successful according to clinical and radiographic outcome parameters after early mobilization without cast therapy. Early mobilization may be used as an alternative treatment option after hip reconstruction in DDH.

文獻(xiàn)出處：Katharina Susanne Gather, Eva von Stillfried, Sebastien Hagmann Sebastian Müller, Thomas Dreher. Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation. World J Pediatr. 2018 Apr;14(2):176-183.

文獻(xiàn)3

人工智能輔助成像對(duì)髖關(guān)節(jié)發(fā)育不良的診斷價(jià)值：系統(tǒng)綜述與薈萃分析

譯者 李勇

目的 通過薈萃分析，闡明人工智能（AI）輔助成像對(duì)髖關(guān)節(jié)發(fā)育不良（developmental dysplasia， DDH）的診斷價(jià)值。

方法 截止2024年4月4日，檢索PubMed、Web of Science、Embase、The Cochrane Library數(shù)據(jù)庫(kù)中有關(guān)人工智能早期診斷DDH的相關(guān)文獻(xiàn)。使用診斷準(zhǔn)確性研究質(zhì)量評(píng)估工具評(píng)估納入研究的質(zhì)量。采用Revman5.4和StataSE-64軟件計(jì)算AI輔助成像診斷DDH的綜合靈敏度、特異度、AUC值和DOC值。

結(jié)果 meta分析納入13項(xiàng)研究（6項(xiàng)前瞻性研究，7項(xiàng)回顧性研究），28個(gè)人工智能模型，共10,673個(gè)樣本。總結(jié)靈敏度、特異度、AUC值、DOC值分別為99.0% （95% Cl: 97.0 ~ 100.0%）、94.0% （95% Cl: 89.0 ~ 96.0%）、99.0% （95% Cl: 98.0 ~ 100.0%）、1342 （95% Cl: 469 ~ 3842）。

結(jié)論 AI輔助成像對(duì)DDH有較高的診斷效能，提高了DDH早期影像學(xué)檢查的準(zhǔn)確性。需要更多的前瞻性研究來進(jìn)一步證實(shí)AI輔助成像在DDH早期診斷中的價(jià)值。

The diagnostic value of artificial intelligenceassisted imaging for developmental dysplasia of the hip: a systematic review and metaanalysis

Objective To clarify the efficacy of artificial intelligence (Al)-assisted imaging in the diagnosis of developmental dysplasia of the hip (DDH) through a meta-analysis. Methods Relevant literature on Al for early DDH diagnosis was searched in PubMed, Web of Science, Embase, and The Cochrane Library databases until April 4, 2024. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of included studies. Revman5.4 and StataSE-64 software were used to calculate the combined sensitivity, specificity, AUC value, and DOC value of Al-assisted imaging for DDH diagnosis. Results The meta-analysis included 13 studies (6 prospective and 7 retrospective) with 28 Al models and a total of 10,673 samples. The summary sensitivity, specificity, AUC value, and DOC value were 99.0% (95% Cl: 97.0-100.0%),94.0% (95% Cl: 89.0-96.0%), 99.0% (95% Cl: 98.0-100.0%), and 1342 (95% Cl: 469-3842), respectively. Conclusion Al-assisted imaging demonstrates high diagnostic efficacy for DDH detection, improving the accuracy of early DDH imaging examination. More prospective studies are needed to further confirm the value of Al-assisted imaging for early DDH diagnosis. Keywords Artificial intelligence, Diagnostic value, Developmental dysplasia of the hip, Meta-analysis

文獻(xiàn)出處：Chen M, Cai R, Zhang A, Chi X, Qian J. The diagnostic value of artificial intelligence-assisted imaging for developmental dysplasia of the hip: a systematic review and meta-analysis. J Orthop Surg Res. 2024 Aug 29;19(1):522. doi: 10.1186/s13018-024-05003-4. PMID: 39210407; PMCID: PMC11360681.

文獻(xiàn)4

髖臼周圍截骨術(shù)中骨盆后傾-如何避免系統(tǒng)誤差導(dǎo)致髖臼后傾和可能的股骨髖臼撞擊

譯者 張利強(qiáng)

背景：骨盆傾斜直接影響X線片上髖臼扭轉(zhuǎn)角度。骨盆傾斜度的改變可能影響髖臼周圍截骨術(shù)（periacetabular osteotomy, PAO）后的髖臼再定位。

目的：(1)比較髖關(guān)節(jié)發(fā)育不良和髖臼后傾、單側(cè)和雙側(cè)PAO、男性和女性患者的恥骨聯(lián)合高度與骶髂寬度的比值（PS-SI）。(2)通過追蹤PAO術(shù)后患者術(shù)前、術(shù)中、術(shù)后及中短期隨訪的骨盆傾斜度（PS-SI比值量化）來評(píng)估PAO術(shù)后患者的骨盆傾斜度。

研究設(shè)計(jì)：病例系列；證據(jù)等級(jí)，4級(jí)。

方法：回顧性分析2005年1月至2019年12月接受PAO治療的124例（139髖）髖關(guān)節(jié)發(fā)育不良患者和46例（57髖）髖臼后傾患者的臨床資料。排除標(biāo)準(zhǔn)包括影像學(xué)資料不足、既往或同期有髖關(guān)節(jié)手術(shù)、創(chuàng)傷后或兒童畸形，或者發(fā)育不良合并后傾（90例患者，95髖）。發(fā)育不良定義為外側(cè)中心邊緣角<23°；后傾定義為同時(shí)出現(xiàn)后傾指數(shù)30%和坐骨棘陽(yáng)性和后壁征。分別于術(shù)前、PAO時(shí)、術(shù)后及短期和中期隨訪時(shí)拍攝仰臥位骨盆正位X線片(均值± SD[范圍]；9 ± 3周[5-23周]和21 ± 21周[6-125個(gè)月])。在5個(gè)觀察期（術(shù)前至中期隨訪）計(jì)算不同亞組（發(fā)育不良與后傾、單側(cè)手術(shù)與雙側(cè)手術(shù)、男性與女性）的PS-SI比值，并進(jìn)行組內(nèi)和組間一致性檢驗(yàn)[組內(nèi)相關(guān)系數(shù)（ICC）分別為0.984 （95%CI, 0.976 ~ 0.989）和0.991 (95%CI, 0.987 ~ 0.994)]。

結(jié)果：在所有觀察期內(nèi)，發(fā)育不良與后傾的PS-SI比值均有差異（P = .041至P<.001）。男性發(fā)育不良髖關(guān)節(jié)PS-SI比值在各觀察時(shí)間段均低于女性（P< 0.05）。001至P = .005)。在髖臼后傾患者中，男性的PS-SI比值在短期和中期隨訪時(shí)均低于女性（P = .024和.003）。在單側(cè)和雙側(cè)手術(shù)之間沒有差異（P = .306到P = .905），除了短期隨訪的發(fā)育不良組（P = .040）。術(shù)前、術(shù)中和術(shù)后各亞組PS-SI比值均較術(shù)前降低（P< 0.05）。P = 0.031)。術(shù)后近、中期隨訪時(shí)PS-SI比值較術(shù)中升高（P< 0.05）。從0.001到P = .044)，所有亞組與術(shù)前相比無(wú)差異（P = .370到P = .795）。

結(jié)論：男性和發(fā)育不良髖關(guān)節(jié)的PS-SI比值較低。所有亞組術(shù)中PS-SI比值均降低，提示骨盆后傾。術(shù)中正確的骨盆定向?qū)y臼精確再定位至關(guān)重要。術(shù)中后傾導(dǎo)致低估了髖臼骨塊的旋轉(zhuǎn)角度和隨訪時(shí)髖臼醫(yī)源性后傾，使骨盆處于正確且更前傾的方向。PAO術(shù)中不考慮后傾可能導(dǎo)致股骨髖臼撞擊。因此，我們改變了我們的術(shù)中設(shè)置，通過調(diào)整透視角度來補(bǔ)償骨盆后傾。

關(guān)鍵詞：髖臼后傾；髖臼的發(fā)育不良;骨盆傾斜;髖臼周圍截骨術(shù)

（a）PS-SI比在截骨術(shù)之前，期中和之后量化骨盆傾斜度。 PS-SI比定義為恥骨聯(lián)合（PS）高度與sacroiliac（SI）寬度的比率。 從（b）術(shù)前到（c）術(shù)后，PS-SI比降低，表明骨盆傾斜降低

Retrotilt of the Pelvis During Periacetabular Osteotomy

How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement

Background: Pelvic tilt directly influences acetabular version on radiographs. Changes of pelvic tilt potentially affect acetabular reorientation after periacetabular osteotomy (PAO).

Purpose: (1) To compare the ratio of the pubic symphysis height to the sacroiliac width (PS-SI) between hips with dysplasia and acetabular retroversion, uni- and bilateral PAO, and male and female patients. (2) To evaluate pelvic tilt (quantified using the PS-SI ratio) in patients after PAO by tracking it from preoperative to intra- and postoperative and short- and middle-term follow-up.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective and radiographic study was conducted evaluating pelvic tilt in 124 patients (139 hips) with dysplasia and 46 patients (57 hips) with acetabular retroversion who were undergoing PAO (January 2005–December 2019). Patients were excluded if they had insufficient radiographic data, previous or concomitant hip surgery, posttraumatic or pediatric deformities, or combined dysplasia and retroversion (90 patients, 95 hips). Dysplasia was defined as a lateral center-edge angle < 23°; retroversion was defined by simultaneous appearance of a retroversion index 30% and positive ischial spine and posterior wall signs. Anteroposterior pelvic radiographs were taken in the supine position preoperatively, during PAO, postoperatively, and at shortand middle-term follow-up (mean ± SD [range]; 9 ± 3 weeks [5-23 weeks] and 21 ± 21 weeks [6-125 months]). The PS-SI ratio was calculated at 5 observation periods (preoperatively to middle-term follow-up) for different subgroups (dysplasia vs retroversion, uni- vs bilateral surgery, male vs female) and validated with intra- and interobserver agreement (intraclass correlation coefficients, 0.984 (95%CI, 0.976-0.989) and 0.991 (95% CI, 0.987-0.994), respectively).

Results: The PS-SI ratio differed between dysplasia and retroversion at all observation periods (P = .041 to P<.001). Male dysplastic hips had a lower PS-SI ratio when compared with female dysplastic hips at all observation periods (P<.001 to P = .005). In hips with acetabular retroversion, the PS-SI ratio was lower in men than women at short- and middle-term follow-up (P = .024 and .003). No difference was found between uni- and bilateral surgery (P = .306 to P = .905) except for short-term follow-up in dysplasia (P = .040). The PS-SI ratio decreased in all subgroups preoperatively to intra- or postoperatively (P<.001 to P = .031). At short- and middle-term follow-up, the PS-SI ratio increased as compared with intraoperatively (P<.001 to P = .044) and did not differ from preoperatively in all subgroups (P = .370 to P = .795).

Conclusion: A lower PS-SI ratio was found for male or dysplastic hips. In all subgroups, the PS-SI ratio decreased during surgery, indicating retrotilt of the pelvis. Correct pelvic orientation during surgery is crucial for accurate acetabular reorientation. Retrotilt during surgery results in underestimation of acetabular version and iatrogenic retroversion of the acetabulum at follow-up, with the pelvis in the correct and more forward-tilted orientation. Not taking into account retrotilt during PAO potentially results in femoroacetabular impingement. Therefore, we changed our intraoperative setting with adjustment of the central beam to compensate for retrotilt of the pelvis.

文獻(xiàn)出處：Vuillemin N, Meier MK, Moosmann AM, Siebenrock KA, Steppacher SD. Retrotilt of the Pelvis During Periacetabular Osteotomy: How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement. Am J Sports Med. 2023 Apr;51(5):1224-1233. doi: 10.1177/03635465231155201. Epub 2023 Mar 6. PMID: 36876866.

文獻(xiàn)5

髖臼前傾角測(cè)量：面積法測(cè)量髖臼前傾角

譯者 陶可

目前已描述了幾種用于測(cè)量全髖關(guān)節(jié)置換術(shù)后髖臼杯假體前傾角的放射學(xué)方法，這些方法均耗時(shí)且重復(fù)性各異。本研究旨在將近期提出的面積法與真實(shí)髖臼前傾角進(jìn)行比較。

本研究進(jìn)一步以編程方式應(yīng)用該方法，使用兩個(gè)計(jì)算機(jī)程序自主確定髖臼的放射學(xué)方向，然后將這些結(jié)果與手動(dòng)測(cè)量和加速度計(jì)測(cè)量結(jié)果進(jìn)行比較。對(duì)裝有全髖關(guān)節(jié)置換系統(tǒng)的標(biāo)準(zhǔn)假骨骨盆拍攝了160張前后位骨盆X線片。在每次拍攝之間重新調(diào)整髖臼杯的方向，使其前傾角范圍為0°至90°。在髖臼上安裝一個(gè)加速度計(jì)來測(cè)量真實(shí)的髖臼前傾角。通過三種方法獨(dú)立測(cè)量髖臼影像學(xué)方向：手動(dòng)測(cè)量、線性圖像處理和機(jī)器學(xué)習(xí)。將測(cè)量結(jié)果與三軸加速度計(jì)記錄進(jìn)行比較。手動(dòng)測(cè)量、機(jī)器學(xué)習(xí)和線性圖像處理的判定系數(shù)(R2)分別為0.997、0.991和0.989。機(jī)器學(xué)習(xí)程序和手動(dòng)測(cè)量分別高估了前傾0.70°和0.02°。使用線性技術(shù)的程序低估了前傾5.02°。機(jī)器學(xué)習(xí)和線性圖像處理程序的平均運(yùn)行時(shí)間分別為0.03和0.59秒。當(dāng)真正的髖臼前傾小于51°時(shí)，機(jī)器學(xué)習(xí)程序的平均杯形方向誤差在1°以內(nèi)，當(dāng)前傾小于85°時(shí)，機(jī)器學(xué)習(xí)程序的平均杯形方向誤差在2°以內(nèi)。與真實(shí)前傾相比，面積法通過手動(dòng)測(cè)量顯示出很高的準(zhǔn)確性和可靠性。本研究結(jié)果支持使用機(jī)器學(xué)習(xí)準(zhǔn)確、及時(shí)、自主地評(píng)估髖臼杯方向。

圖1 測(cè)量者徒手測(cè)量（綠色圓圈）、使用線性圖像處理技術(shù)的程序（橙色方塊）和機(jī)器學(xué)習(xí)程序（灰色三角形）的前傾角測(cè)量值與髖臼杯加速度計(jì)獲得的前傾角的對(duì)比。

圖2 (a)線性圖像處理技術(shù)顯示像素強(qiáng)度閾值大于0.2（綠色）、0.4（紅色）、0.6（藍(lán)色）和0.8（青色）。髖臼后部不成比例地被股骨頭遮擋。(b)線性圖像處理技術(shù)顯示像素強(qiáng)度閾值大于0.40（綠色）、0.60（紅色）、0.80（藍(lán)色）和0.86（青色）。閾值的增加表明閾值的增加趨勢(shì)向中心方向和髖臼杯被遮擋的部分發(fā)展。

The area method for measuring acetabular cup anteversion: An accurate and autonomous solution

Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty have been described, all time-consuming and with varying reproducibility. This study aimed to compare the recently proposed Area method to true cup anteversion as determined by an accelerometer. This study further applied this method programmatically to autonomously determine radiographic cup orientation using two computer programs, then compared these results to hand and accelerometer measurements. 160 anteroposterior pelvis radiographs were taken of a standard Sawbones? pelvis fitted with a total hip arthroplasty system. The acetabular cup was re-oriented between each radiograph, with anteversion ranging from 0° to 90°. An accelerometer was mounted to the cup to measure true cup anteversion. Radiographic anteversion was independently measured via three methods: by hand, linear image processing, and machine learning. Measurements were compared to triaxial accelerometer recordings. Coefficient of determination (R2) was found to be 0.997, 0.991, and 0.989 for hand measurements, the machine learning, and linear image processing, respectively. The machine learning program and hand measurements overestimated anteversion by 0.70° and 0.02° respectively. The program using linear techniques underestimated anteversion by 5.02°. Average runtime was 0.03 and 0.59 s for the machine learning and linear image processing program, respectively. The machine learning program averaged within 1° of cup orientation given a true cup anteversion less than 51°, and within 2° given an anteversion less than 85°. The Area method showed great accuracy and reliability with hand measurements compared to true anteversion. The results of this study support the use of machine learning for accurate, timely, autonomous assessment of cup orientation.

文獻(xiàn)出處：Michael P Murphy, Cameron J Killen, Steven J Ralles, Nicholas M Brown, Albert J Song, Karen Wu. The area method for measuring acetabular cup anteversion: An accurate and autonomous solution. J Clin Orthop Trauma. 2021 Apr 14:18:61-65. doi: 10.1016/j.jcot.2021.04.002. eCollection 2021 Jul.

文獻(xiàn)6

髖關(guān)節(jié)發(fā)育不良解剖結(jié)構(gòu)改變步態(tài)中肌肉力矩臂長(zhǎng)度、作用線及其對(duì)關(guān)節(jié)反作用力的貢獻(xiàn)

譯者 邱興

髖關(guān)節(jié)發(fā)育不良（developmental dysplasia of the hip, DDH）以異常骨性解剖結(jié)構(gòu)為特征，可導(dǎo)致有害的髖關(guān)節(jié)負(fù)荷并引發(fā)繼發(fā)性骨關(guān)節(jié)炎。髖關(guān)節(jié)負(fù)荷部分取決于肌肉誘發(fā)的關(guān)節(jié)反作用力（joint reaction forces, JRFs），因此受髖部肌肉力矩臂長(zhǎng)度（moment arm lengths, MALs）和作用線（lines of action, LoAs）的影響。本研究采用個(gè)體化肌肉骨骼模型和體內(nèi)運(yùn)動(dòng)分析技術(shù)，量化DDH骨性解剖結(jié)構(gòu)對(duì)步態(tài)早期支撐相（約17%）和晚期支撐相（約52%）動(dòng)態(tài)肌肉MALs、LoAs及其對(duì)JRF峰值貢獻(xiàn)的影響。與健康髖關(guān)節(jié)（N=15，16-39歲）相比，未經(jīng)治療的DDH患者（N=15，16-39歲）的外展肌具有更小的外展MALs（例如臀中肌前部：早期支撐相35.3 vs. 41.6 mm，晚期支撐相45.4 vs. 52.6 mm，p≤0.01）和更偏向內(nèi)側(cè)的LoAs。主要髖屈肌（如股直肌和髂肌）的外展-內(nèi)收及旋轉(zhuǎn)MALs也存在差異。DDH患者的異常MALs對(duì)應(yīng)更高的髖外展肌力、內(nèi)側(cè)JRFs（早期支撐相1.26 vs. 0.87×體重（body weight, BW），p=0.03）及合成JRFs（晚期支撐相5.71 vs. 4.97×BW，p=0.05）。DDH解剖結(jié)構(gòu)不僅影響髖部肌肉在主要功能平面的力量生成，還改變其跨平面力學(xué)特性，共同導(dǎo)致JRFs升高。總體而言，DDH骨性解剖顯著改變了髖部肌肉MALs及其對(duì)JRFs的貢獻(xiàn)。因此，為深入理解關(guān)節(jié)退變機(jī)制并優(yōu)化DDH治療策略，需綜合考量動(dòng)態(tài)解剖-力學(xué)關(guān)系和髖周肌群的多平面功能。

圖1.（A）示例模型展示個(gè)體化骨盆與股骨幾何形態(tài)、髖關(guān)節(jié)中心（hip joint center, HJC）定位及肌肉路徑（muscle paths）。（B）髖部肌肉力矩臂（muscle moment arm, MAL）示例（臀中肌前部“GMedAnt”，紅色箭頭示意）。在完整步態(tài)周期中提取髖關(guān)節(jié)屈曲、外展及旋轉(zhuǎn)方向的MALs。（C）髖部肌肉作用線（lines of action, LoAs）示例。各肌肉LoA在骨盆坐標(biāo)系中的前后（anteroposterior, AP）、上下（superoinferior, SI）及內(nèi)外側(cè)（mediolateral, ML）分量，表示其凈力在特定方向上的百分比分布。

圖2. 主要髖部外展肌、屈肌及外旋肌的平均肌肉力矩臂（左側(cè)、中部）與作用線（右側(cè)）。陰影區(qū)域表示±1個(gè)標(biāo)準(zhǔn)差（standard deviation, SD）。垂直突出顯示區(qū)域標(biāo)記步態(tài)早期支撐相（JRF1）和晚期支撐相（JRF2）的關(guān)節(jié)反作用力（joint reaction forces, JRFs）峰值時(shí)間。“*”表示組間統(tǒng)計(jì)學(xué)顯著性差異。肌肉縮寫：臀中肌前部（anterior gluteus medius, GMedAnt）；闊筋膜張肌（tensor fasciae latae, TFL）；股直肌（rectus femoris, RF）；髂肌（iliacus, IL）；臀大肌前部（anterior gluteus maximus, GMaxAnt）。

圖3. 髖關(guān)節(jié)平均關(guān)節(jié)反作用力（joint reaction forces, JRFs）分量與外展肌及外旋肌肌力的疊加顯示。內(nèi)旋肌肌力（未顯示）與外展肌呈現(xiàn)相似的變化模式。陰影區(qū)域表示±1個(gè)標(biāo)準(zhǔn)差（standard deviation, SD）。垂直突出區(qū)域標(biāo)記髖關(guān)節(jié)JRF峰值出現(xiàn)的時(shí)間點(diǎn)。“*”表示組間統(tǒng)計(jì)學(xué)顯著性差異。

圖4. 臀中肌（gluteus medius, GMed）與闊筋膜張肌（tensor fasciae latae, TFL）的平均肌力。DDH組與健康組存在肌力差異的三塊肌肉為：臀中肌、闊筋膜張肌（僅合成分力與上部分力）及臀小肌（變化模式與臀中肌相似）。陰影區(qū)域表示±1個(gè)標(biāo)準(zhǔn)差（standard deviation, SD）。垂直高亮區(qū)域標(biāo)記髖關(guān)節(jié)關(guān)節(jié)反作用力（joint reaction forces, JRFs）峰值出現(xiàn)的時(shí)間點(diǎn)。“*”表示組間統(tǒng)計(jì)學(xué)顯著性差異。

Dysplastic hip anatomy alters muscle moment arm lengths, lines of action, and contributions to joint reaction forces during gait

Developmental dysplasia of the hip (DDH) is characterized by abnormal bony anatomy, which causes detrimental hip joint loading and leads to secondary osteoarthritis. Hip joint loading depends, in part, on muscle-induced joint reaction forces (JRFs), and therefore, is influenced by hip muscle moment arm lengths (MALs) and lines of action (LoAs). The current study used subject-specific musculoskeletal models and in-vivo motion analysis to quantify the effects of DDH bony anatomy on dynamic muscle MALs, LoAs, and their contributions to JRF peaks during early (~17%) and late-stance (~52%) of gait. Compared to healthy hips (N = 15, 16-39 y/o), the abductor muscles in patients with untreated DDH (N = 15, 16-39 y/o) had smaller abduction MALs (e.g. anterior gluteus medius, 35.3 vs. 41.6 mm in early stance, 45.4 vs. 52.6 mm late stance, p ≤ 0.01) and more medially-directed LoAs. Abduction-adduction and rotation MALs also differed for major hip flexors such as rectus femoris and iliacus. The altered MALs in DDH corresponded to higher hip abductor forces, medial JRFs (1.26 vs. 0.87 × BW early stance, p = 0.03), and resultant JRFs (5.71 vs. 4.97 × BW late stance, p = 0.05). DDH anatomy not only affected hip muscle force generation in the primary plane of function, but also their out-of-plane mechanics, which collectively elevated JRFs. Overall, hip muscle MALs and their contributions to JRFs were significantly altered by DDH bony anatomy. Therefore, to better understand the mechanisms of joint degeneration and improve the efficacy of treatments for DDH, the dynamic anatomy-force relationships and multi-planar functions of the whole hip musculature must be collectively considered.

文獻(xiàn)出處： Song K, Gaffney B M M, Shelburne K B, et al. Dysplastic hip anatomy alters muscle moment arm lengths, lines of action, and contributions to joint reaction forces during gait[J]. Journal of biomechanics, 2020, 110: 109968.

文獻(xiàn)7

髖臼深度，髖臼發(fā)育的早期預(yù)測(cè)因素：切開復(fù)位后髖關(guān)節(jié)發(fā)育不良患者的 MRI

譯者 徐子茵

早期預(yù)測(cè)未來髖臼發(fā)育對(duì)于確定髖關(guān)節(jié)發(fā)育不良 （DDH） 是否手術(shù)干預(yù)很重要。本研究的目的是使用 MRI 調(diào)查髖臼發(fā)育的預(yù)測(cè)因素。

本研究回顧性調(diào)查了 37 例 DDH 兒科患者 （9 例男性和 28 例女性） 的 40 個(gè)髖關(guān)節(jié)脫位和 34 個(gè)正常髖關(guān)節(jié)，這些患者在行走年齡后接受了切開復(fù)位。我們?cè)?5 歲時(shí)使用冠狀 MRI T2加權(quán)圖像評(píng)估了患者的軟骨髖臼和盂唇。手術(shù)時(shí)的平均年齡為 22 個(gè)月，末次隨訪平均年齡為 19 歲。在最終隨訪時(shí)，我們根據(jù) Severin 分類將患者分為兩組。使用每側(cè)的 MRI 參數(shù)比較預(yù)后良好 （患側(cè)26 個(gè)髖關(guān)節(jié)和對(duì)側(cè)27 個(gè)髖關(guān)節(jié)） 和預(yù)后不良 （分別為14 個(gè)髖關(guān)節(jié)和 7 個(gè)髖關(guān)節(jié)） 的組。使用logistic 回歸分析確定髖臼發(fā)育的預(yù)測(cè)因素。結(jié)果顯示，5 歲時(shí)髖臼頂深度和盂唇-髖關(guān)節(jié)中心間距是患側(cè)切開復(fù)位后的預(yù)測(cè)因素 （比值比 0.27，P = 0.035;比值比 3.4，P = 0.028），骨性髖關(guān)節(jié)中心距離為患側(cè)的預(yù)測(cè)因素 （比值比 2.6，P = 0.049）。健側(cè)的髖臼發(fā)育可以通過骨性指標(biāo)評(píng)估來預(yù)測(cè)，而患側(cè)的髖臼發(fā)育必須通過使用 MRI 的盂唇進(jìn)行評(píng)估。

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction

Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.

文獻(xiàn)來源：Kawamura, Yoshi et al. “Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction.” Journal of pediatric orthopedics. Part B vol. 30,6 (2021): 509-514. doi:10.1097/BPB.0000000000000799

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊(duì)

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