本期目錄：

1、全髖關節和全膝關節置換術后當日出院病例的失敗原因和危險因素：meta分析

2、含有抗生素的硫酸鈣珠 (Stimula) 對髖關節置換術后感染患者的療效

3、遠程營養咨詢和移動端應用程序助力關節置換患者術前減重

4、全膝關節置換術后的下肢對線代償性變化：

5、髖臼周圍截骨術是否改變脊柱骨盆矢狀面序列

6、關節過度活動、年齡≥40歲及BMI>30 kg/m2增加髖臼周圍截骨術后并發癥風險

7、腦癱患者髖關節重建術聯合對側生長引導技術：一種新型方法的初步結果

8、全長站立位X線片可用于測定股骨頸干角，但無法測定髖臼覆蓋范圍

9、股骨前傾角增大導致內八字步態中，股骨前傾角與髖部肌肉彈性是否存在相關性

10、髖臼周圍截骨術是否影響膝關節的載荷分布？

第一部分：關節置換及保膝相關文獻

文獻1

全髖關節和全膝關節置換術后當日出院病例的失敗原因和危險因素：meta分析

譯者 張軼超

近幾十年來，手術后患者當日出院（SDD）的趨勢急劇增加。開發出有效的風險分級工具來決定全髖關節置換術（THA）后采用SDD或延長住院的決策的努力仍然不夠完善。本報告的目的是明確THA和全膝關節置換術（TKA）患者中與SDD失敗相關的最常見的原因和危險因素。按照PRISMA指南要求系統地檢索了4個文獻數據庫，對當日出院成功患者和當日出院失敗患者進行比較研究。我們對當天出院失敗的原因和危險因素比較感興趣。采用二分變量計算優勢比（OR），而對平均差（MD）則采用連續變量。采用RevMan軟件進行meta分析。如果有證據表明存在異質性，則采用隨機效應。納入了8項研究，共3492名患者。SDD失敗最常見的原因是體位性低血壓，其次是身體狀況不佳、惡心/嘔吐、疼痛和尿潴留。女性是失敗的危險因素（OR 0.77, 95% CI 0.63-0.93），尤其是在THA亞組中。ASA評分IV級（OR 0.33, 95% CI 0.14-0.76）和III級 （OR 0.72, 95% CI 0.52-0.99）是危險因素，還有超過兩種過敏因素的患者和吸煙患者也是危險因素。全身麻醉會增加失敗風險（OR 0.58, 95% CI 0.42-0.80），而脊髓麻醉具有風險較低（OR 1.62, 95% CI 1.17-2.24）。直接前入路和后入路無明顯差異。綜上所述，體位性低血壓是SDD失敗的常見原因。骨科手術中SDD失敗的危險因素包括女性、ASA III和IV級、經常過敏的人、吸煙患者和全身麻醉。可以解決這些因素以提高SDD的效果。

Causes and risk factors for same?day discharge failure after total hip and knee arthroplasty: a meta?analysis

In recent decades, the trend toward early same-day discharge (SDD) after surgery has dramatically increased. Efforts to develop adequate risk stratifcation tools to guide decision-making regarding SDD versus prolonged hospitalization after total hip arthroplasty (THA) remain largely incomplete. The purpose of this report is to identify the most frequent causes and risk factors associated with SDD failure in patients undergoing THA and total knee arthroplasty (TKA). A systematic search following PRISMA guidelines of four bibliographic databases was conducted for comparative studies between patients who were successfully discharged on the same day and those who failed. Outcomes of interests were causes and risk factors associated with same-day discharge failure. Odds ratios (OR) were calculated for dichotomous variables, whereas mean differences (MD) were calculated for continuous variables. Meta-analysis was performed using RevMan software. Random effects were used if there was evidence of heterogeneity. Eight studies with 3492 patients were included. The most common cause of SDD failure was orthostatic hypotension, followed by inadequate physical condition, nausea/vomiting, pain, and urinary retention. Female sex was a risk factor for failure (OR 0.77, 95% CI 0.63–0.93), especially in the THA subgroup. ASA score IV (OR 0.33, 95% CI 0.14–0.76) and III (OR 0.72, 95% CI 0.52–0.99) were risk factors, as were having > 2 allergies and smoking patients. General anesthesia increased failure risk (OR 0.58, 95% CI 0.42–0.80), while spinal anesthesia was protective (OR 1.62, 95% CI 1.17–2.24). The direct anterior and posterior approaches showed no signifcant diferences. In conclusion, orthostatic hypotension was the primary cause of SDD failure. Risk factors identifed for SDD failure in orthopedic surgery include female sex, ASA III and IV classifcations, a higher number of allergies, smoking patients and the use of general anesthesia. These factors can be addressed to enhance SDD outcomes.

文獻出處：Lamo-Espinosa JM, Mariscal G, Gómez-álvarez J, Benlloch M, San-Julián M. Causes and risk factors for same-day discharge failure after total hip and knee arthroplasty: a meta-analysis. Sci Rep. 2024 Jun 1;14(1):12627. doi: 10.1038/s41598-024-63353-9. PMID: 38824204; PMCID: PMC11144238.

文獻2

含有抗生素的硫酸鈣珠 (Stimula) 對髖關節置換術后感染患者的療效

譯者 馬云青

背景：鑒于髖關節置換術后感染率的不斷上升，目前的治療方案之一是在感染部位應用帶抗生素的生物復合材料。其中一種使用的產品是Stimulan，這是一種完全可吸收的硫酸鈣材料，旨在治療急性和慢性感染。該生物復合材料具有可控的純度，易于與液體、粉末和抗生素混合，可直接應用于感染部位，也可注射使用。

方法：作者分析了76名患者的臨床數據，這些患者于2017年 1 月至2023年 9月期間因髖關節置換術后感染診斷住加拉茨縣圣安德烈急救臨床醫院（County Clinical Hospital of Emergency "St. Apostol Andrei" Galati）。

結果：在 69.73% 的病例（52 名患者）中，作者決定保留假體清創治療。在此亞組中，有 26 例，占保髖亞組的57.78%應用了 Stimulan。應用 Stimulan 的這 26 名患者全部獲得治愈。相比之下，在未應用 Stimulan 的保髖亞組中，治愈率較低。所有患者均接受了化學和機械清創術。24名患者需要移除取出假體，無論是否應用 Stimulan，然后進行二次假體植入翻修。

結論：應用 Stimulan 的患者平均住院時間更長。其中近半數患者需要分兩期進行手術干預。四分之一患者需要植入間隔器。而，其治愈率更高，僅在3例患者未能控制感染，且無死亡病例。本研究證實，在傳統治療基礎上加用生物復合材料（Stimulan）進行治療，對于急性和慢性感染病例均具有有效性。

含抗生素的硫酸鈣顆粒示意圖

文獻出處：Dimofte F, Dimofte C, Ungurianu S, Serban C, ?ocu G, Carneciu N, Filip I, Bezman L, Ciuntu BM, Abdulan IM, Mihailov R, Necula RD, Sabou FL, Firescu D. The Efficacy of Antibiotic-Loaded Calcium Sulfate Beads (Stimulan) in Patients with Hip Arthroplasty Infections. J Clin Med. 2024 Jul 9;13(14):4004. doi: 10.3390/jcm13144004. PMID: 39064042; PMCID: PMC11277588.

文獻3

遠程營養咨詢和移動端應用程序助力關節置換患者術前減重

一項多中心隨機對照試驗

譯者 張薔

背景：很多醫生都建議肥胖患者在關節置換手術（TJA）前減重，但鮮有研究評價減重措施效果的。本研究比較了TJA術前肥胖患者接受遠程營養師咨詢及手機應用程序（APP）與接受標準診療流程的減重效果。

方法：本多中心隨機對照試驗納入了2019年9月至2023年1月間共60例BMI在40-47kg/m2之間且計劃接受初次全髖或全膝關節置換手術的病例。平均年齡61歲，67%為女性感，平均BMI為44kg/m2。對照組（n=29）接受標準診療流程；介入組（n=31）在術前完成與營養師的視頻咨詢，并應用了12周的手機減重應用程序。我們在基線時間和12周時分別收集了體重數據和問卷結果，隨訪率為87%。我們還比較了組間的減重數據、患者自評量表結果、并發癥、翻修和再手術情況。平均隨訪時間為1.8年。

結果：與對照組相比，介入組病例減重更多（24.1 vs. 22.1kg, p=0.22），BMI降低的更多（21.4 vs. 20.9kg/m2, p=0.36），但均沒有顯著性差異。介入組病例減重后BMI將至40kg/m2以下的概率更高（概率比=1.9，p=0.44），但依然沒有顯著性差異。兩組病例的髖關節障礙與骨關節炎評分（HOOS）、膝關節損傷與骨關節炎評分（KOOS）或下肢運動評分的平均變化值均無顯著性差異。一般情況下，近三個月內曾向營養師咨詢的患者比例僅為11%。大多數患者（83%）均認為與營養師的視頻通話有幫助。兩組間并發癥情況無明顯差異；對照組內有一例髕骨骨折而介入組內有一例靜脈血栓栓塞。

結論：應用遠程營養師咨詢和移動端應用程序輔助術前減重的方法經驗證有效，并在患者間獲得好評。遠程營養師咨詢和移動應用程序可以降低TJA術前獲得減重治療的門檻。盡管介入組減了更多的體重，達成BMI<40kg/m2的概率也更高，但這些差異并未達成顯著性。為了給TJA手術帶來更為顯著的臨床效果，我們需要嘗試更多更強的介入措施。

Weight Loss Before Total Joint Arthroplasty Using a Remote Dietitian and a Mobile Application

A Multicenter Randomized Controlled Trial

Background: Many surgeons recommend weight loss for patients with obesity before total joint arthroplasty (TJA), but few studies have evaluated weight loss interventions. This study compared weight loss using a remote dietitian and a mobile application (app) with weight loss using standard care for patients with severe obesity before TJA.

Methods: This multicenter randomized controlled trial included 60 subjects with a body mass index (BMI) of 40 to 47kg/m2 who had been scheduled for primary total hip or knee arthroplasty from September 2019 to January 2023. The mean age was 61 years, 67% were women, and the mean BMI was 44kg/m2. The control subjects (n = 29) received standard care; the intervention subjects (n = 31) completed video calls with dietitians and used a mobile app for 12 weeks preoperatively. Weights and surveys were collected at baseline and 12 weeks, with 87% follow-up. Weight loss, patient reported outcomes, complications, revisions, and reoperations were compared. The mean follow-up was 1.8 years.

Results: The intervention subjects lost more weight (24.1 versus 22.1 kg, p = 0.22) and had larger decreases in BMI () than the controls, but not significantly so. The intervention subjects had higher odds of achieving a BMI of <40kg/m2 (odds ratio = 1.9, p = 0.44), but not significantly so. There were no significant differences in the mean change in the Hip disability and Osteoarthritis Outcome Score, the Knee injury and Osteoarthritis Outcome Score, or the Lower Extremity Activity Scale score. At baseline, only 11% had seen a dietitian in the last 3 months. Most subjects (83%) felt that video calls were helpful. There were no differences in complications between the groups; there was a patellar fracture in the control group and a deep venous thromboembolism in the intervention group.

Conclusions: A preoperative weight loss intervention using a dietitian and a mobile app was feasible and viewed favorably among patients. Remote dietitians and mobile apps may address gaps in access to obesity treatment before TJA. While the intervention subjects lost more weight and were more likely to achieve a BMI of <40kg/m2, the differences were not significant. More intensive interventions may be needed to achieve enough weight loss for clinically important improvements in TJA.

文獻4

全膝關節置換術后的下肢對線代償性變化：

大角度外翻膝矯正（≥10°）在踝關節及距下關節對位方面表現出顯著改變

譯者 沈松坡

目的： 本研究旨在評估在接受全膝關節置換術（TKA）后，外翻膝矯正患者的踝關節和距下關節對位變化，特別是在大角度矯正（≥10°）的情況下。

方法： 共納入52例采用機械對線方式進行TKA的外翻膝患者，按術前股脛角（FTA）矯正角度分為小角度矯正組（＜10°）與大角度矯正組（≥10°）。使用負重雙下肢立位X光與錐形束CT（CBCT）掃描評估術前及術后對位指標，包括機械遠端股骨角（mLDFA）、機械近端脛骨角（mMPTA）、踝骨傾斜角（TTA）、脛距角（TAS）、距骨偏移（TOD）、以及距骨在冠狀面上的軸線角度（TAS）和距骨-跟骨角度（TCA）。

結果： 大角度矯正組（平均FTA矯正為12.3°）在術后TAS和TOD方面均顯示出顯著變化，表明踝關節軸線和距骨位置有明顯代償性變化。術后TCA增加也提示距下關節出現調整以適應膝關節矯正。小角度矯正組這些變化則不明顯。

結論： 外翻膝矯正幅度較大的TKA患者，其踝關節和距下關節會發生顯著的對位調整，提示在術前規劃和術后康復中應考慮遠端關節的代償機制。

關鍵詞：全膝關節置換術；外翻膝；下肢對線；踝關節；距下關節；矯正代償

圖 在低劑量影像系統掃描艙中的患者體位擺放：患者以站立姿勢進行拍攝，雙腿完全伸直（圖A），并與掃描儀保持相同的距離（見圖中垂直紅線，圖B）。

圖 基于全身低劑量影像X線片的測量方法：

(A) 距下關節的內翻-外翻角：指脛骨長軸（橙色垂直線，1號）與連接距骨支持突上緣至距跟關節后緣的連線（白線，連接點2和3）之間的夾角。

(B) 脛距傾斜角：指脛骨遠端關節面下軟骨板與距骨穹頂之間的夾角。

(C) 距骨傾斜角：指距骨穹頂與地面垂線之間的夾角。

(D) 脛骨平臺傾斜角：指脛骨遠端關節面下軟骨板與地面垂線之間的夾角。

(E) 髖-膝-踝角：衡量下肢對線的指標，定義為股骨與脛骨機械軸之間的夾角（凹側為特征點）。

Compensatory changes in lower limb alignment following total knee arthroplasty: large valgus knee correction (≥ 10°) demonstrates substantial alterations in ankle and subtalar joint alignment

Introduction: Total knee arthroplasty can substantially affect global lower limb alignment. However, its specific impacts on ankle and subtalar joint alignment remain poorly understood. This study investigates changes in ankle and subtalar alignment following varying degrees of varus/valgus knee correction in order to further our understanding of this association.

Materials and methods: This retrospective study included 100 patients who underwent surgery for primary osteoarthritis. Patients diagnosed with conditions other than primary knee OA and those with incomplete or poor-quality imaging were excluded. Patients were categorized into four groups by the degree of intraoperative coronal knee alignment correction: Group 1 (< 10° varus, n = 37), Group 2 (≥ 10° varus, n = 30), Group 3 (< 10° valgus, n = 18), and Group 4 (≥ 10° valgus, n = 15). Hip-knee-ankle angle, tibial plafond inclination, talar inclination, tibiotalar tilt, and subtalar varus-valgus angle, were measured preoperatively and postoperatively on full-length, standing, anteroposterior X-ray images.

Results: TKA resulted in postoperative changes in all measured angles regardless of the degree of varus/valgus correction. Notably, ≥ 10° valgus correction led to statistically significant postoperative alterations in ankle and subtalar alignment: tibial plafond inclination from 84.9 to 89.5° (Δ 4.6, range,1.5-7.8, P <.01), tibiotalar tilt from 83.1 to 89.3° (Δ 6.2, range,1.1-9.6, P =.02), and subtalar varus-valgus angle from 66.4 to 72.6° (Δ 6.2, range,1.9-12.1, P <.01).

Conclusion: While knee deformity correction during TKA generally realigns the ankle and subtalar joint, our study has shown that large valgus knee correction (≥ 10°) during TKA significantly alters ankle and subtalar joint alignment. Thus, potentially leading to unfavorable postoperative outcomes in patients with abnormal or stiff joints. We recommend that future studies investigate the long-term effects of large valgus knee corrections during TKA on ankle and subtalar joint alignment and their impact on postoperative outcomes.

第二部分：保髖相關文獻

文獻1

髖臼周圍截骨術是否改變脊柱骨盆矢狀面序列

譯者 任寧濤

背景:目前關于髖臼周圍截骨術對脊柱骨盆矢狀面序列影響的數據很少。先前的研究試圖通過在AP 位X線片上進行測量和使用數學模型來確定術后骨盆傾斜的變化來描述兩者之間的關系。這些信息對外科醫生在術中評估髖臼/骨盆位置和了解術后脊柱-骨盆矢狀面序列變化具有臨床意義;因此，應更詳細地描述PAO引起的影像學變化。

問題/目的:在本研究中，我們的問題是:(1) 根據EOS X線片測量，PAO術后是否會導致脊柱-骨盆矢狀面序列發生對應變化?(2)單側PAO和雙側PAOs的情況是否不同?(3)這在脊柱柔韌和脊柱僵硬的情況下是否有區別?(4)是否因術前骨盆傾斜而有差異?

方法:前瞻性收集2019年1月1日至2022年1月11日由同一位外科醫生完成PAO的55例患者的術前和術后不短于1年的 (15±8個月，最短11個月，最長65個月)EOS髖-踝站立位和坐位x線片，測量骨盆入射角、骨盆傾斜角、骶骨傾斜角、腰椎前凸角、外側CE角、L1-骨盆角和恥骨聯合對骶髂指數（PS-SI）。采用配對樣本t檢驗(正態分布數據)或Wilcoxon符號秩檢驗(非正態分布數據)評估術前與術后是否有任何變化。然后根據患者是否患有單側或雙側發育不良以及單側或雙側手術進行分組，這些亞組的分析方法與整個隊列相同。根據腰椎活動度情況(定義為從坐到站的腰椎前凸角變化小于或大于1 SD)再分為兩個亞組，亞組的分析方法與整個隊列相同。最后根據術前站立位骨盆傾斜度分為站立位骨盆傾斜度< 10°和站立位骨盆傾斜度> 20°兩個亞組，并與整個隊列進行相同的分析。

結果:所有患者的站立位外側CE角中位數(IQR)增加了17°，從中位數21°(10°)增加到中位數38°(8°[95%可信區間(CI) 16°~ 20°;p < 0.05];P < 0.001)。坐位外側CE角增加了17°，從中位數18°(8°)增加到中位數35°(8°[95% CI 14°~ 19°];P < 0.001)。站立位骨盆入射角從50°±11°增加到52°±12°(平均差值2°[95% CI 1°~ 3°];P = 0.004)，但其他測量參數無變化。單側發育不良患者接受單側PAO后，任何脊柱-骨盆參數均無變化，但雙側發育不良患者接受雙側PAOs后，骨盆入射角從57°(14°)增加到60°(16°)(95% CI 1°~ 5°;p = 0.02)，恥骨聯合-骶髂指數從84 mm (24 mm)降至77 mm (23 mm) (95% CI -7°至-2°;P = 0.007)。術前腰椎柔韌性好的患者未表現出任何矢狀位脊柱骨盆參數的變化，但術前腰椎柔韌性差的患者術后出現了一些變化。站立骨盆傾斜小于10°的患者，骨盆入射角中位數(IQR)從43°(9°)增加到45°(12°[95% CI 0.3°~ 4°];P = 0.03)，但術后未發生其他矢狀位脊柱骨盆參數的改變。術前骨盆傾斜超過20°的患者矢狀位脊柱骨盆參數未發生任何改變。

結論:PAO增加骨盆入射角，可能與髖關節中心前移有關。除雙側PAO術后，其余脊柱骨盆參數無變化。此外，術前脊柱僵硬的患者，表現為站立和坐姿之間腰椎前凸的變化微小，可能會出現脊柱骨盆參數的變價，包括PAO后脊柱活動度的增加。這可能是因為增加髖臼覆蓋后代償性脊柱“夾板”效應減少，但需要進一步研究。

Does Periacetabular Osteotomy Change Sagittal Spinopelvic Alignment？

Background: There are few data on the impact of periacetabular osteotomy (PAO) on sagittal spinopelvic alignment. Prior studies have attempted to delineate the relationship by performing measurements on AP radiographs and using mathematical models to determine changes in postoperative pelvic tilt. This information is clinically significant to a surgeon when evaluating acetabular/pelvic position intraoperatively and understanding spinopelvic alignment changes postoperatively; therefore, radiographic changes from PAO should be described in more detail.

Questions/purposes: In this study, we asked: (1) Does the performance of PAO result in consistent changes in spinopelvic alignment, as measured on EOS radiographs? (2) Does this differ for unilateral versus bilateral PAOs? (3) Does this differ in the setting of a mobile spine versus an immobile spine? (4) Does this differ based on preoperative pelvic tilt?

Methods: Mean preoperative and at least 1-year postoperative (15 ± 8 months from surgery, minimum 11 months, maximum 65 months) EOS hip-to-ankle standing and sitting radiographs for 55 patients in a prospectively collected registry who underwent PAO with a single surgeon from January 1, 2019, to January 11, 2022, were measured for pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lateral center-edge angle, L1 pelvic angle, and pubic symphysis to the sacroiliac index. Normality was assessed and paired sample t-tests (normally distributed data) or Wilcoxon signed rank tests (not normally distributed data) were utilized to assess if any measurements changed from preoperative to postoperative. Patients were then divided based on whether they had unilateral or bilateral dysplasia and unilateral or bilateral surgery, and these subgroups were analyzed the same way as the entire cohort. Two more subgroups were then formed based on lumbar mobility, defined as a change in sitting-to-standing lumbar lordosis less or greater than 1 SD from the population mean preoperatively, and the subgroups were analyzed the same way as the entire cohort. Finally, two additional subgroups were formed, preoperative standing pelvic tilt less than 10° and more than 20°, and analyzed the same as the entire cohort.

Results: For the entire cohort, the median (IQR) standing lateral-center edge angle increased 17°, from a median of 21° (10°) to a median of 38° (8° [95% confidence interval (CI) 16° to 20°; p < 0.001). The median sitting lateral center-edge angle increased 17°, from a median of 18° (8°) to a median of 35° (8° [95% CI 14° to 19°]; p < 0.001). Standing pelvic incidence increased from 50° ± 11° to 52° ± 12° (mean difference 2° [95% CI 1° to 3°]; p = 0.004), but there were no changes for other measured parameters. There were no changes in any of the spinopelvic parameters for patients with unilateral dysplasia receiving a unilateral PAO, but patients with bilateral dysplasia who underwent bilateral PAOs demonstrated an increase in pelvic incidence from 57° (14°) to 60° (16°) (95% CI 1° to 5°; p = 0.02) and a decrease in pubic symphysis to sacroiliac index from 84 mm (24 mm) to 77 mm (23 mm) (95% CI -7° to -2°; p = 0.007). Patients with mobile lumbar spines preoperatively did not exhibit any changes in sagittal spinopelvic alignment, but patients with immobile lumbar spines preoperatively experienced several changes after surgery. Patients with less than 10° of standing pelvic tilt demonstrated a median (IQR) 2° increase in pelvic incidence from median 43° (9°) to 45° (12° [95% CI 0.3° to 4°]; p = 0.03), but they did not experience any other changes in sagittal spinopelvic alignment parameters postoperatively. Patients with preoperative pelvic tilt more than 20° did not experience any change in sagittal spinopelvic parameters.

Conclusion: PAO increases pelvic incidence, potentially because of anterior translation of the hip center. There were no changes in other spinopelvic parameters postoperatively except after bilateral PAO. Additionally, patients lacking spine mobility preoperatively, indicated by a minimal change in lumbar lordosis between standing and sitting positions, may experience several changes in spinopelvic alignment, including increased mobility of their spine after PAO. This may be because of decreased compensatory spine splinting after increasing acetabular coverage, but further research including patient-reported outcomes is warranted.

文獻出處：Cirrincione P, Cao N, Trotzky Z, Nichols E, Sink E. Does Periacetabular Osteotomy Change Sagittal Spinopelvic Alignment? Clin Orthop Relat Res. 2024 Apr 2. doi: 10.1097/CORR.0000000000003031. Epub ahead of print. PMID: 38564796.

文獻2

關節過度活動、年齡≥40歲及BMI>30 kg/m2增加髖臼周圍截骨術后并發癥風險

譯者 李勇

髖臼周圍截骨術（PAO）是矯正癥狀性髖臼發育不良的有效手術方式，但可能引發嚴重并發癥。本研究旨在通過經驗豐富的單一術者病例系列分析PAO的并發癥特征。回顧性分析200例患者（23例雙側，22例男性，201例女性）的223例髖關節手術。并發癥數據通過病歷和影像學評估收集，并按改良版Dindo–Clavien分級系統分級。單側髖關節可能記錄多重并發癥。患者平均手術年齡28.8歲（范圍13–48歲），平均體重70.9 kg（范圍45–115 kg）。診斷包括185例發育不良、25例髖臼后傾及13例混合型病變。平均隨訪26個月。結果顯示：61.4%髖關節（137例）無并發癥；74.0%無并發癥或僅出現I級并發癥（未改變治療方案）；52例（23%）需藥物干預（II級并發癥）；6例（2.7%）因PAO直接導致嚴重并發癥（III/IV級），無V級并發癥（死亡）。關節過度活動（Beighton評分≥6，比值比[OR]=2.525，P=0.041）、年齡≥40歲（OR=3.126，P=0.012）及BMI>30（OR=2.506，P=0.031）會增加PAO術后嚴重并發癥風險，而T?nnis分級無顯著影響（P=0.193）。 本大型醫療中心的單一術者病例系列證實：年齡≥40歲、BMI>30 kg/m2及關節過度活動會顯著增加嚴重并發癥風險。

Hypermobility, age 40 years or older and BMI >30 kg m-2 increase the risk of complications following peri-acetabular osteotomy

The peri-acetabular osteotomy (PAO) is a powerful surgical procedure for correcting symptomatic acetabular dysplasia, but it carries the potential for significant surgical complications. This study aims to determine the complication profile of PAO in a series performed by an experienced single surgeon. This was a retrospective review of 223 hips in 200 patients (23 bilateral, 22 males and 201 females). Complication data were collected from notes and radiographic review and graded according to a modified Dindo–Clavien classification. Each hip could be recorded as having more than one complication. Mean age at surgery was 28.8 years (range 13–48), mean weight was 70.9 kg (range 45–115 kg). Diagnosis was dysplasia in 185 hips, retroversion in 25 and a combination in 13. Mean follow-up was 26 months. In all, 61.4% of hips (137) had no complications; 74.0% had no complications or a Grade I complication (one that did not change management); 52 hips (23%) required pharmaceutical interventions (Grade II complications). Six hips (2.7%) suffered a major complication (Grade III or IV) as a direct consequence of the PAO. There were no Grade V complications (death). Hypermobility (Beighton’s score of ≥6, Odds ratio (OR) 2.525 P = 0.041), age 40 years or older (OR 3.126 P = 0.012) and BMI >30 (OR 2.506 P = 0.031), but not Tonnis grade (P = 0.193) increased the risk of more severe complications following a PAO. This single surgeon series from a high volume centre demonstrates that age 40 years or older and BMI >30 kg m-2 and hypermobility increase the risk of more severe complications.

文獻出處：Salih S, Groen F, Hossein F, Witt J. Hypermobility, age 40 years or older and BMI >30 kg m-2 increase the risk of complications following peri-acetabular osteotomy. J Hip Preserv Surg. 2020 Nov 5;7(3):511-517. doi: 10.1093/jhps/hnaa041. PMID: 33948206; PMCID: PMC8081425.

文獻3

腦癱患者髖關節重建術聯合對側生長引導技術：一種新型方法的初步結果

譯者 張利強

髖關節脫位是腦性癱瘓（CP）患兒常見且嚴重的并發癥，顯著影響其生活質量。對于單側髖關節脫位的治療，選擇單側還是雙側重建手術仍存在爭議。本研究探討了一種替代方案：將單側髖關節重建手術與對側股骨近端生長引導術（PFGG）相結合。2019至2022年間，某兒童神經骨科轉診中心開展了一項回顧性觀察研究，納入接受髖關節重建手術聯合對側PFGG的患兒，最短隨訪期為2年。收集數據包括人口統計學特征、臨床與手術細節、影像學參數及并發癥。共11例患者（女6例，男5例）納入研究，其功能障礙程度各異（粗大運動功能分級系統2例III級、4例IV級、5例V級）。手術中位年齡7.7歲（范圍：4.9-11歲），中位隨訪期29.6個月（范圍：24.1-55.6個月）。結果顯示重建側髖關節的所有參數及PFGG治療側髖關節的多個參數（特別是外移百分比、頸干角和HE角）均顯著改善（P <0.05）。重建髖關節的并發癥發生率顯著高于接受股骨近端生長引導術（PFGG）治療的髖關節（13例 vs 2例，P <0.001）。對于腦癱（CP）患者的單側髖關節脫位治療，將髖關節重建手術與對側PFGG聯合實施，可替代傳統的雙側重建手術方案。該術式不僅能即時矯正髖關節脫位，還能在同一手術過程中預防對側髖關節遠期移位，同時將并發癥風險降至最低。未來需進一步研究驗證該結論，并制定該手術策略的完整臨床指南。證據等級：IV級病例系列研究。

三名患者的術前（左）與術后2年（右）骨盆X線片對比。所有患者均接受股骨近端生長引導術（PFGG），采用4.5mm全螺紋空心螺釘聯合100°角度鋼板進行內翻、去旋轉及短縮截骨術（VDRO）。術中根據股骨頸直徑調整螺釘規格。如圖所示，三例病例均顯示重建髖關節顯著改善，同時PFGG髖關節保持對位良好且未發生脫位。盡管術前存在骨盆傾斜，三名患者術后2年骨盆傾斜度仍接近中立位（2°）。值得注意的是，第二例患者術前因骨盆傾斜導致低位髖關節的覆蓋度呈現虛高；術后骨盆傾斜改善時，該髖關節本應出現覆蓋不足，但PFGG成功維持髖關節復位，有效防止了進一步脫位。

Hip reconstruction surgery combined with contralateral guided growth in cerebral palsy patients: preliminary results of a novel approach

Hip dislocation is a common and severe complication in children with cerebral palsy (CP), significantly affecting their quality of life. In cases of unilateral hip dislocation, there is ongoing debate regarding the choice between unilateral versus bilateral reconstructive surgeries. This study explores an alternative approach that combines unilateral hip reconstruction surgery with contralateral Proximal Femoral Guided Growth (PFGG) as a potential solution. A retrospective observational study was conducted at a pediatric neuro-orthopedic referral center from 2019 to 2022, including children who underwent hip reconstruction surgery and contralateral PFGG. The minimum follow-up period was 2 years. Collected data included demographic, clinical, and surgical details, radiological parameters, as well as complications. Eleven patients (six females and five males) with varying levels of functional impairment (2 Gross Motor Function Classification System level III, 4 level IV, and 5 level V) were included. The median age at surgery was 7.7 years (range: 4.9–11 years), with a median follow-up period of 29.6 months (range: 24.1–55.6 months). Significant improvements were observed in all parameters for the reconstructed hip and in several parameters for the PFGG-treated hip, particularly migration percentage, head-shaft angle, and Hilgenreiner epiphyseal angle (P < 0.05). Reconstructed hips had significantly more complications than those treated with PFGG (13 versus 2, P < 0.001). Combining hip reconstruction surgery with contralateral PFGG offers a promising alternative to traditional bilateral reconstructive procedures when managing unilateral hip dislocation in CP patients. This approach not only addresses the immediate hip dislocation but also prevents future contralateral hip displacement within the same surgical session, while minimizing complication rates. Further studies are needed to validate these findings and establish comprehensive guidelines for this surgical strategy. Level of evidence: IV, case series.

文獻出處：Galán-Olleros M, Figueroa-Gatica MJ, Ramírez-Barragán A, Fraga-Collarte M, Martínez-González C, Garlito-Díaz H, Martínez-Caballero I. Hip reconstruction surgery combined with contralateral guided growth in cerebral palsy patients: preliminary results of a novel approach. J Pediatr Orthop B. 2025 Jul 1;34(4):309-314. doi: 10.1097/BPB.0000000000001240. Epub 2025 May 27. PMID: 40439061.

文獻4

全長站立位X線片可用于測定股骨頸干角，但無法測定髖臼覆蓋范圍

譯者 陶可

引言：準確評估髖臼形態對于手術規劃至關重要。髖臼的形態測量指標范圍廣泛，可通過常規前后位（ap）骨盆X線片測量得出。下肢全長負重位X線片（FLWBR）也能顯示髖臼，常用于下肢截骨術前規劃。本研究旨在確定下肢全長負重位X線片（FLWBR）是否用于評估髖臼形態。

方法：對接受髖臼檢查（包括常規ap骨盆X線片和下肢全長負重位X線片（FLWBR））的患者進行X光線片測量。測量的參數包括：股骨頭擠壓指數、前壁指數、后壁指數、外側中心邊緣角(LCE)、髖臼指數、恥骨下角和股骨頭旋轉中心-股骨頸-股骨干角(頸干角CCD)。

結果：與傳統的髖臼前位骨盆X線片相比，下肢全長負重位X線片（FLWBR）的前壁覆蓋范圍顯著減小（p = 0.049），后壁覆蓋范圍增大（p < 0.001），髖臼指數增大（p = 0.015），恥骨下角增大（p = 0.02）。CCD角 (p = 0.28)、擠壓指數 (p = 0.31)和LCE (p = 0.16)無顯著差異。

討論：股骨CCD角可通過傳統的髖臼前位X線片和全長負重X線片進行測量，以用于下肢畸形分析。然而，下肢全長負重位X線片（FLWBR）將描繪出髖臼前傾形態，使得規劃骨盆截骨術時需要傳統的前后位X線片。

Full-length standing radiographs can be used for determination of the Femoral neck-shaft angle but not acetabular coverage

Introduction: The exact evaluation of hip morphology is essential for surgical planning. A wide range of morphometric measures of the acetabulum is deduced from conventional anterior-posterior (ap) pelvic radiographs. Full-length weight-bearing radiographs (FLWBR) also depict the acetabulum and are commonly used for osteotomy planning of the lower limb. This study aimed to determine whether FLWBR can be used to evaluate acetabular morphology.

Methods: Radiographs of patients receiving a hip workup that included a conventional ap pelvic X-ray and FLWBR were utilized for radiographic measurements. The following parameters were measured: extrusion index of the femoral head, anterior wall index, posterior wall index, lateral center edge angle (LCE), acetabular index, pubic arc angle (subpubic angle), and centrum-collum-diaphyseal angle (CCD).

Results: FLWBR depicted a significantly reduced anterior coverage (p = 0.049) and increased posterior coverage (p < 0.001), higher acetabular index (p = 0.015), and higher pubic-arc angle (p = 0.02) compared to conventional ap pelvic radiographs. There were no significant differences regarding the CCD angle (p = 0.28), extrusion index (p = 0.31), and LCE (p = 0.16).

Discussion: The CCD angle of the femur can be measured on conventional ap radiographs and full-length weight-bearing X-rays for lower limb deformity analysis. However, FLWBR will depict an anteverted acetabular morphology, rendering conventional ap radiographs necessary for planning pelvic osteotomies.

文獻出處：Sufian S Ahmad, Christian Konrads, Annika Steinmeier, Max Ettinger, Henning Windhagen, Gregor M Giebel. Full-length standing radiographs can be used for determination of the Femoral neck-shaft angle but not acetabular coverage. SICOT J. 2022:8:34. doi: 10.1051/sicotj/2022033. Epub 2022 Aug 24.

文獻5

股骨前傾角增大導致內八字步態中，股骨前傾角與髖部肌肉彈性是否存在相關性？

譯者 邱興

目的： 兒童步態障礙的常見原因之一是股骨前傾角增大。關于股骨前傾角增大情況下髖關節相關肌肉的文獻報道尚不充分。本研究旨在利用剪切波彈性成像（SWE）技術，評估內八字步態兒童的股骨前傾角與髖部肌肉彈性之間的關系。

材料與方法： 本研究前瞻性納入了17例經計算機斷層掃描（CT）證實為雙側股骨前傾角增大的兒童。由兩名觀察者通過超聲彈性成像評估髖部肌肉（大收肌（內收肌）、髂腰肌（屈肌）、臀中肌（外展肌）、臀大肌（伸肌））的彈性值。使用超聲觸診組織成像量化（Virtual Touch Tissue Imaging Quantification）技術進行剪切波速度的定量測量。

結果： 兩名觀察者測量的股骨前傾角具有極佳的一致性，肌肉彈性成像評估之間也表現出良好的一致性。股骨前傾角與髂腰肌和大收肌的彈性值之間存在中度顯著相關性，但與其他肌肉的彈性測量值未發現顯著相關性。

結論： 髂腰肌和大收肌的彈性與股骨前傾角相關。我們認為，通過進一步研究，針對與股骨前傾角相關肌肉彈性的物理治療方法可能有助于減輕患者的不適癥狀。

圖 一名 5 歲股骨前傾角增大患兒的大收肌 (A)、髂腰肌 (B)、臀中肌 (C) 和臀大肌 (D) 肌肉的剪切波彈性成像（SWE）彈性測量值。

Is there a correlation between the femoral anteversion angle and the elasticity of the hip muscles in cases of intoeing gait due to increased femoral anteversion angle?

Purpose: One of the common causes of gait disturbance in children is increased femoral anteversion. There are not enough publications in the literature on muscles related to the hip joint in increased femoral anteversion. The aim of this study was to evaluate the relationship between the femoral anteversion angle and hip muscle elasticity in children walking inward, using shear wave elastography (SWE).

Material and methods: Seventeen children with bilateral increased femoral anteversion angle in computed tomography were prospectively included in this study. Elasticity values of the hip muscles (adductor magnus (adductor), iliopsoas (flexor), gluteus medius (abductor), gluteus maximus (extensor) muscles) were evaluated by ultrasound elastography by two observers. Quantitative measurements of the shear wave velocities were performed using virtual touch tissue imaging quantification.

Results: There was excellent harmony between the femoral anteversion angle measurements performed by the two observers and a good congruence between the muscle elastography evaluations. While there was a moderate significant correlation between the femoral anteversion angle and the elasticity values of the iliopsoas and adductor magnus muscles, no significant correlation was found with other muscle elasticity measurements.

Conclusion: Iliopsoas muscle and adductor magnus muscle elasticity are correlated with the femoral anteversion angle. With further studies, we think that physical therapy methods for the elasticity of the muscles associated with the femoral anteversion angle can reduce the complaints of the patients.

文獻出處：Urfali, Furkan Ertürk, et al. "Is there a correlation between the femoral anteversion angle and the elasticity of the hip muscles in cases of intoeing gait due to increased femoral anteversion angle?." Journal of Ultrasonography 22.88 (2022): e28.

文獻6

髖臼周圍截骨術是否影響膝關節的載荷分布？

譯者 徐子茵

背景：髖臼周圍截骨術（PAO）通過減輕髖關節負荷和改善關節功能來治療髖關節發育不良（DDH）。未經治療的DDH影響下肢對線并改變膝關節形態，在繼發于DDH的髖關節骨關節炎中外翻對線更明顯。雖然PAO可能影響膝關節力學，但其與脛股關節軟骨下骨密度的關系尚不清楚。

問題/目的：（1）在DDH患者的膝關節中，PAO與軟骨下骨密度分布變化的相關程度如何？(2)在DDH患者中，PAO是否與改變的軟骨下骨密度分布相關，從而使其更接近于對照組患者？

方法：我們進行了一項回顧性病歷分析，以評估女性DDH患者PAO與膝關節的相關性。從2015年1月至2021年12月，69例患者（49歲，中心-邊緣角25°）接受了PAO。其中，排除雙側手術、缺乏隨訪或CT數據不完整的患者后，納入了38%（26）的患者。根據既往研究，功效分析要求每組至少20例髖關節。為了進行比較，我們回顧了2014年1月至2024年12月期間因特發性骨壞死接受關節保留手術的63例患者，其中32%（20）的女性患者符合對照組的標準（僅單側髖關節壞死）。PAO導致足夠的髖臼覆蓋，并改善患者的臨床評分。重要的是，術后未觀察到下肢對線的變化。采用CT骨吸收測量法（CTOAM）測量脛骨近端關節面軟骨下骨密度的分布和定量。這是通過評估亨氏單位（HU）的放射密度變化并將其映射為二維可視化來實現的。這些區域內的高密度區域被定義為前20%的HU。內側和外側脛骨間室在冠狀方向上分為三個等寬的亞區：外側-外側、外側-中央、外側-內側、內側-內側、內側-中央和內側-外側。計算高密度區域所代表的每個亞區域百分比（高密度區域百分比）。我們的主要研究目的是評估PAO與DDH患者膝關節軟骨下骨密度分布變化的相關性。為了實現這一點，我們利用CT-OAM映射術前和術后的軟骨下骨密度模式。我們的次要研究目標是確定PAO是否導致DDH患者的軟骨下骨密度分布更接近于無DDH的對照隊列。為此，我們分析了影像學和CT數據，以確定脛骨平臺高密度區域的變化，并比較了PAO組內以及PAO組和對照組之間的術前和術后結果。

結果：術前，PAO組內側區高密度區的平均6SD百分比低于對照組（對照組vs PAO術前61%-612% vs 50%-620%; p = 0.02）。PAO后，內側區域高密度區的百分比增加（術前與術后50% 6 20% vs 58% 6 19%; p = 0.003），術后與對照組無差異（對照組vs PAO術后61% 6 12% vs 58% 6 19%; p = 0.16）。

結論：DDH可引起膝關節載荷分布的外側移位。基于軟骨下骨密度，PAO似乎改變了這種負荷模式，使其更類似于膝關節對照隊列中的負荷模式。然而，長期隨訪研究是必要的，以確認是否早期的變化，在軟骨下骨密度，因為PAO與隨后的膝關節退行性變。

Does Periacetabular Osteotomy Affect the Load Distribution on the Knee?

Background: Periacetabular osteotomy (PAO) treats developmental dysplasia of the hip (DDH) by reducing load on the hip and improving joint function. Untreated DDH affects lower extremity alignment and alters knee morphology, with valgus alignment more pronounced in hip osteoarthritis secondary to DDH. While PAO may influence knee mechanics, its association with subchondral bone density in the tibiofemoral joint remains unclear.

Questions/purposes: (1) To what degree is PAO associated with changes in the distribution of subchondral bone density in the knees of patients with DDH? (2) Is PAO associated with altered subchondral bone density distribution in patients with DDH such that they more closely resemble a control cohort of patients?

Methods: We conducted a retrospective chart review to evaluate the association of PAO with knees in female patients with DDH. From January 2015 to December 2021, 69 patients (≤ 49 years of age, center-edge angle ≤ 25°) underwent PAO. Of these, 38% (26) of patients were included after excluding patients for bilateral operations, lack of follow-up, or incomplete CT data. A power analysis required at least 20 hips per group based on the past study. For comparison, we reviewed 63 patients undergoing joint-preserving surgery for idiopathic osteonecrosis from January 2014 to December 2024, with 32% (20) of female patients meeting criteria (unilateral hip necrosis only) for the control group. PAO resulted in sufficient acetabular coverage and improved clinical scores in patients. Importantly, no change in lower limb alignment was observed postoperatively. The distribution and quantification of subchondral bone density in the proximal tibial articular surface were measured using CT osteoabsorptiometry (CT-OAM). This was achieved by assessing radiodensity variations in Hounsfield units (HUs) and mapping these as two-dimensional visualizations. The high-density area within these regions was defined as the top 20% of HUs. The medial and lateral tibial compartments were divided into three subregions of equal width in the coronal direction: lateral-lateral, lateral-central, lateral-medial, medial-medial, medial-central, and medial-lateral. Each subregion percentage represented by the high-density area was calculated (percentage of high-density area). Our primary study goal was to evaluate the association of PAO with changes in subchondral bone density distribution in the knees of patients with DDH. To achieve this, we utilized CT-OAM to map subchondral bone density patterns before and after surgery. Our secondary study goal was to determine whether PAO results in a subchondral bone density distribution in patients with DDH that more closely resembles that of a control cohort without DDH. For this goal, we analyzed radiographic and CT data to identify changes in high-density areas across tibial plateaus and compared preoperative and postoperative results within the PAO group and between the PAO and control groups.

Results: Preoperatively, the mean ± SD percentage of high-density area of the medial region was lower in the PAO group compared with the control group (control versus PAO preoperative 61% ± 12% versus 50% ± 20%; p = 0.02). After PAO, the percentage of high-density area of the medial region increased (preoperative versus postoperative 50% ± 20% versus 58% ± 19%; p = 0.003) and was not different from the control group postoperatively (control versus PAO postoperative 61% ± 12% versus 58% ± 19%; p = 0.16).

Conclusion: Our findings suggest that DDH may cause a lateral shift in knee loading distribution. PAO appears to modify this loading pattern, based on subchondral bone density, making it more similar to one in a control cohort of knees. However, long-term follow-up studies are necessary to confirm whether early changes in subchondral bone density because of PAO are associated with subsequent knee degeneration.

文獻來源：Ogawa, Yuki et al. “Does Periacetabular Osteotomy Affect the Load Distribution on the Knee?.” Clinical orthopaedics and related research, 10.1097/CORR.0000000000003453. 5 Mar. 2025, doi:10.1097/CORR.0000000000003453

來源：304關節學術

作者：304關節團隊

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