髋膝关节文献精译荟萃（第339期）

本期目录：

1、住院患者与门诊患者髋关节或膝关节置换术后功能结果的比较

2、股骨颈骨折的全髋关节置换：比较标准头、大头、双动杯和限制性内衬的翻修率和脱位率

3、绝经后妇女应用激素替代疗法可降低全髋关节置换术后10年内股骨侧假体周围骨折概率

4、活动平台假体在外侧单髁膝关节置换术中的长期疗效研究

5、Pemberton截骨与改良San Diego髋臼成形治疗DDH疗效比较

6、单纯PAO未处理关节内病变的术后功能结果

7、通过吻合骨内动脉重建股骨头血供的方法

8、残余Legg-Calvé-Perthes病的髋关节前间隙

9、髋关节发育不良的骨盆倾斜度是多少，髋臼周围截骨术后会发生变化吗

10、患者感知的髋臼周围截骨术（PAO）术后并发症的社交媒体分析

11、症状性盂唇撕裂髋关节镜术后软骨盂唇交界处破裂与转为全髋关节置换术之间的关联

12、突出的髂前下棘形态在接受髋臼周围截骨术的髋关节发育不良患者中很常见

第一部分：关节置换及保膝相关文献

文献1

住院患者与门诊患者髋关节或膝关节置换术后功能结果的比较

译者 张轶超

背景：在过去的十年中，下肢关节置换术后的住院时间迅速减少，主要原因是由于围手术期治疗方案的改进，但也是由于髋关节和膝关节置换术的快速增长所带来的经济需求的增加。由此随着下肢关节置换术后新的治疗方法的不断改进发展，使得这类手术越来越多地可以在门诊完成，并允许手术后当天出院。虽然已经比较了住院和门诊手术的成本和并发症，但似乎很少有人知道门诊髋关节或膝关节置换术对患者功能的影响。因此，本系统综述旨在探讨住院患者与门诊患者髋关节或膝关节置换术对功能效果影响的现有证据。

方法：本系统综述遵循PRISMA指南，前瞻性注册（https://osf. io / 8 bfae /)。对三个在线数据库（PubMed、CINAHL和EMBASE）进行电子检索，以确定符合条件的研究。纳入所有比较住院和门诊髋关节或膝关节置换术患者的研究，评估一项或多项功能结果。对本综述中的最终研究进行了方法学质量评价。以表格和数字形式的定量结果来描述结果的叙述性合成。

结果：本综述共纳入7项研究，共1876名受试者。四项研究评估THA人群，两项评估TKA人群，一项两者都得到了评估。功能结果各不相同，使用了20种不同的功能评估方法，其中18种是基于患者报告效果的工具。对于住院和门诊患者的功能效果表现出不同的结果。

结论：本综述的结果表明，髋关节或膝关节置换术的门诊或住院路径选择不应仅基于功能效果。然而，鉴于有越来越多的证据支持择期患者采用门诊途径完成手术可以节省成本而不会增加并发症，两种手术途径具有相同的术后效果，因此术后当天出院更有优势。

A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty

Background: The length of hospital stay after lower limb arthroplasty has rapidly decreased in the last decade, largely in part due to the rise of improved perioperative protocols, but also as a response to the increased economic demand associated with the rapid growth in hip and knee arthroplasty procedures. In line with this, the development of a new pathway after lower limb arthroplasty that allows for the surgery to be performed in an outpatient setting and permits for same-day discharge after the procedure is increasingly being offered. Although costs and complications between the inpatient and outpatient models have been compared, there appears to be little known about the efects on a patient’s physical function after undergoing hip or knee outpatient arthroplasty. Therefore, this systematic review aims to explore the available evidence for the efect on functional outcomes following inpatient versus outpatient hip or knee arthroplasty.

Methods: This systematic review adhered to the PRISMA guidelines and was prospectively registered (https://osf. io/8bfae/). An electronic search of three online databases (PubMed, CINAHL and EMBASE) was conducted to identify eligible studies. All studies investigating inpatient and outpatient comparator groups, for a population of patients undergoing hip or knee arthroplasty, that assessed one or more functional outcomes, were included. A methodological quality appraisal was undertaken for the fnal studies contained in this review. A narrative synthesis of results is described along with quantitative outcomes presented in tables and figures.

Results: A total of seven studies containing 1,876 participants were included in this review. Four studies assessed a THA population, two assessed TKA and one assessed both. Functional outcomes varied, with 20 different functional outcomes utilised, of which 18 were patient-reported tools. Results of functional outcomes offered mixed support for both inpatient and outpatient pathways.

Conclusions: The results of this review suggest that outpatient or inpatient pathway selection for hip or knee arthroplasty should not be based on the superiority of functional outcomes alone. However, given there is growing evidence in support of an outpatient pathway in select patients with respect to cost savings and without any increase in complications, it could be proposed that an equivalency of post-operative function between the two settings makes same-day discharge favourable.

文献出处：Sattler L, Kisaloff L, Cragnolini T, Peters R, Hing W. A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty. J Orthop Surg Res. 2022 Aug 2;17(1):372. doi: 10.1186/s13018-022-03270-7. PMID: 35918770; PMCID: PMC9344712.

文献2

股骨颈骨折的全髋关节置换：比较标准头、大头、双动杯和限制性内衬的翻修率和脱位率

译者 马云青

背景： 对于一些股骨颈骨折患者，全髋关节置换术是一种合理的手术选择，但存在假体脱位的风险。应用各种假体以降低脱位风险和翻修手术率尚不清楚。
目的：在接受股骨颈骨折初次THA 治疗的患者中，(1) 全因翻修率或 (2) 标准股骨头，大直径股骨头，双动杯 (DM) 或限制性内衬的 翻修率是否不同？(3) 手术时患者按年龄分层的翻修风险有差异吗？
方法：对 2008 年 1 月至 2018 年 12 月澳大利亚骨科协会国家关节置换登记处 (aOANjRR) 报告的 16,692 例股骨颈骨折患者进行全髋关节置换术治疗的数据进行分析，其中包括首次使用 DM 假体。AOANJRR 包括超过 98% 在澳大利亚进行的髋关节置换的信息。大多数患者为女性 (72%) ，平均年龄为 74 岁 ± 11 岁。标准头假体 8582 例，大头假体 5820 例，DM 假体 1778 例，限制性假体 512 例。累积翻修百分比 (CPR) 被确定为所有原因，包括脱位。第一次翻修的时间使用 Kaplan-Meier 的生存率估计来描述，在分析时对死亡或数据停止进行正确的审查。未经调整的 CPR 在标准假体的前 10 年，大头假体的 10 年，限制性衬的 8 年和 DM 假体的 7 年中每年进行估计，使用未经调整的点式 Greenwood 估计的 95% 置信区间。结果根据年龄、性别、股骨内固定和股骨头大小进行了适当的调整，并分别以< 70 岁和≥70 岁两个年龄段分析。
结果：调整年龄、性别、股骨类型和股骨头大小后，四组患者在 7 年时的全因翻修率没有差异。当患者年龄 < 70 岁或≥70 岁时，全因翻修率没有差异。脱位是最常见的翻修原因 (32%)。当单独分析脱位翻修时，与标准头相比，大头假体THA 的脱位翻修率较低 (HR 0.6 [95% CI 0.4-0.8] ; p <0.001) ，术后前3个月DM 假体的脱位翻修率低于标准头 (HR 0.3 [95% CI 0.1-0.7] ; p <0.004) ，但在此时间点之后没有差异。
结论：澳大利亚注册系统研究表明，对于所有患者或分层为 70 岁以下和70岁以上年龄组的患者，标准头、大头、 DM 假体或限制性内衬 THA 在治疗股骨颈骨折后的全因翻修率没有差异。脱位是最常见的翻修原因。大头假体的脱位翻修风险较低，DM 假体的脱位翻修率仅在头 3 个月内低于标准头。用 THA 治疗股骨颈骨折的外科医生，如果髋臼的直径允许的话，可以考虑较大的股骨头假体尺寸，如果不可能有较大假体，则可以考虑使用 DM 假体。股骨颈骨折患者的年龄、预期寿命和运动功能水平使这些假体长期潜在影响表小。大多数假体在生存率方面缺乏显著差异，这意味着外科医生应该继续寻找股骨头大小和假体以外的因素，以尽量减少脱位和翻修手术。

文献出处：Hoskins W, Griffin X, Hatton A, de Steiger RN, Bingham R. THA for a Fractured Femoral Neck: Comparing the Revision and Dislocation Rates of Standard-head, Large-head, Dual-mobility, and Constrained Liners. Clin Orthop Relat Res. 2021 Jan 1;479(1):72-81. doi: 10.1097/CORR.0000000000001447. PMID: 32876424; PMCID: PMC7899725.

文献3

绝经后妇女应用激素替代疗法可降低全髋关节置换术后10年内股骨侧假体周围骨折概率

译者 张蔷

背景：对于雌激素缺乏的绝境后妇女来说，应用激素替代疗法（HRT）可以降低脆性骨折风险。然而，既往文献中鲜有探究激素替代疗法与全髋关节置换（THA）术后假体周围骨折（PPF）风险相关性的文章。本研究的目的是明确激素替代疗法对THA术后10年内PPF风险的影响。

方法：我们运用某全国大型数据库资料进行回顾性队列研究。所有施行择期THA手术的女性患者按照术前HRT的使用情况（少于六个月）进行分组。应用HRT的病例按照1:2比例匹配了无HRT应用史的病例。我们应用Kaplan-Meier曲线和Cox比例风险模型分析的方法推算了术后10年的假体周围骨折率、翻修率和无菌性松动率。我们应用回归分析法在匹配了围术期抗凝用药情况后确定了术后90天的静脉血栓栓塞率（VTE）。最终，共有21220例病例入组。

结果：在THA术前应用HRT疗法的病例THA术后10年的PPF风险更低（概率比：0.8；95%置信区间：0.6-0.9），但全因翻修率和无菌性松动翻修率近似。激素替代疗法组的深静脉血栓发生率更低（OR：0.7；95%CI：0.6-1.0），而肺栓塞率近似。

结论：对绝经期妇女来讲，择期THA手术前应用激素替代疗法与THA术后10年假体周围骨折发生率更低相关，同时与静脉血栓栓塞风险增加无关。考虑到以上结果，我们认为对适宜患者应用激素替代疗法对降低THA术后假体周围骨折概率有重要作用。

Hormone Replacement Therapy in Post-Menopausal Women Undergoing Total Hip Arthroplasty is Associated with Reduced 10-Year Periprosthetic Femur Fracture Rate

Introduction: In postmenopausal women who are estrogen deficient, hormone replacement therapy (HRT) has been shown to improve fragility fracture risk. However, few studies have examined the relationship between HRT and periprosthetic fracture (PPF) risk after total hip arthroplasty (THA). The purpose of this study was to determine the impact of HRT use on 10-year PPF risk following THA.

Methods: A retrospective cohort study was conducted using a large national database. Women who underwent elective THA were identified and stratified based on preoperative (< six months) HRT use. Those taking HRT were propensity-score matched at a 1:2 ratio to those who do not have a history of HRT use based on age and Charlson Comorbidity Index score. Kaplan Meier and Cox proportional hazards analyses were conducted to determine rates of PPF, revision, and aseptic loosening within 10 years of surgery. Regression analyses were performed to determine 90-day rates of venous thromboembolism (VTE) after controlling for perioperative VTE prophylaxis. In total, 21,220 patients were included.

Results: Patients who were taking HRT before THA demonstrated a lower risk of PPF (hazard ratio [HR]: 0.8; 95% confidence interval [CI]: 0.6 to 0.9) within 10 years of THA, but a similar risk of all-cause revision surgery and revision for aseptic loosening. The HRT cohort demonstrated lower odds of deep vein thrombosis (OR: 0.7; 95% CI: 0.6 to 1.0) and similar rates of pulmonary embolism.

Conclusion: In postmenopausal women, HRT use prior to elective THA was associated with lower rates of PPF within 10 years of surgery and was not associated with increased VTE risk. Given these results, appropriate HRT usage in patients may have a role in reducing PPF after THA.

文献4

活动平台假体在外侧单髁膝关节置换术中的长期疗效研究

译者 沈松坡

目的： 单髁膝关节置换术（UKA）是治疗单间室严重骨关节炎（OA）的一种选择。尽管针对内侧移动平台（MB）UKA的长期研究较多，但关于外侧MB-UKA的证据仍然有限。Oxford Domed Lateral (ODL) 假体旨在通过增强平台固定性来降低外侧MB-UKA的垫片脱位率。然而，该假体的长期表现仍不明确。本研究评估了ODL在非设计中心的长期存活率和临床结果。

方法： 本研究为单中心回顾性分析，纳入了2006年1月至2014年12月间接受ODL外侧MB-UKA的115例患者。研究的主要终点是假体的存活率，即因任何原因需翻修的时间。次要研究终点包括Oxford膝关节评分（OKS）、遗忘关节评分（FJS）、疼痛程度、患者满意度以及Tegner活动评分（TAS）。存活率采用Kaplan-Meier分析进行评估。

结果： 十年后，累积假体存活率为74.8%（95% CI 65.2 至 82.1；风险人数=71），其中垫片脱位（8.5%）和骨关节炎进展（10.4%）是主要的翻修原因。在55例未翻修膝关节的患者中（平均随访13.4年，SD 1.8），术后OKS评分显著提高至37.8（SD 9.1）（p < 0.001）。此外，85.5%的患者（n = 47）表示满意，FJS均值为65.9（SD 32.2），TAS均值为2.8（SD 1.1）。然而，仅76.4%（n = 42）的患者达到了OKS和FJS的可接受症状状态（PASS）。

结论： 这是首个来自非设计中心的ODL长期研究。结果显示，尽管未翻修患者的临床效果良好，但由于垫片脱位和骨关节炎进展导致的高失败率，建议放弃MB设计，转而采用固定平台（FB）装置进行外侧UKA。

Long-term results of lateral unicompartmental knee arthroplasty with a mobile-bearing device

Aims: Unicompartmental knee arthroplasty (UKA) is one option in the treatment of isolated unicompartmental advanced osteoarthritis (OA). While long-term results exist for medial mobile-bearing (MB) UKA, evidence regarding lateral MB-UKA is still limited. The Oxford Domed Lateral (ODL) implant aims to reduce the bearing dislocation rate in lateral MB-UKA through enhanced bearing entrapment. However, the long-term performance of this implant remains unclear. This study evaluated the long-term survival and clinical outcomes of the ODL in a non-designer centre.

Methods: This single-centre retrospective analysis included 115 lateral MB-UKAs using the ODL performed between January 2006 and December 2014. The primary endpoint of the study was implant survival, defined as the time until a revision procedure was required for any reason. Secondary outcomes included Oxford Knee Score (OKS), Forgotten Joint Score (FJS), pain, satisfaction, and Tegner Activity Scale (TAS). Survival was assessed using Kaplan-Meier analysis.

Results: At ten years, the cumulative implant survival rate was 74.8% (95% CI 65.2 to 82.1; number at risk = 71), with bearing dislocation (8.5%) and OA progression (10.4%) as leading revision causes. In 55 non-revised knees with a mean follow-up of 13.4 years (SD 1.8), the mean postoperative OKS improved significantly to 37.8 (SD 9.1) (p < 0.001). Additionally, 85.5% of patients (n = 47) reported satisfaction, with a mean FJS of 65.9 (SD 32.2) and TAS of 2.8 (SD 1.1). However, only 76.4% (n = 42) attained the patient-acceptable symptom state for OKS and FJS.

Conclusion: This is the first long-term ODL study from a non-designer centre; our results demonstrated high failure rates due to bearing dislocation and OA progression, despite satisfactory clinical outcomes in non-revised patients. The disproportionately high risk of failure suggests that the MB design should be abandoned in favour of a fixed-bearing device for lateral UKA.

第二部分：保髋相关文献

文献1

Pemberton截骨与改良San Diego髋臼成形治疗DDH疗效比较

译者 罗殿中

目的：发育性髋关节发育不良（DDH）患者需要进行骨盆截骨术矫正髋臼发育不良。外科治疗DDH时，Pemberton截骨与改良San Diego髋臼成形是两种常用的手术方法。该研究的目的是针对典型DDH患者，比较Pemberton截骨与改良San Diego髋臼成形的治疗效果。

方法：改良San Diego髋臼成形组我们纳入了45髋，Pemberton组38髋。排除了不足2年随访病例、和合并神经肌肉诊断的患者。术后临床随访采用改良McKay进行分类；影像学随访采用Severin评分进行分级。股骨头坏死（AVN）采用Kalamchi和McEwen指标进行评价。

结果：平均随访4.9年（2.1年至11.2年）。两种手术方法髋臼指数降低到相似水平（改良San Diego髋臼成形组17.0°，Pemberton组15.2°，P=0.846）。采用改良McKay指标进行评价，多数髋关节均取得良好效果（改良San Diego髋臼成形组78%，Pemberton组94%，P=0.055）。采用Severin指标进行评价，多数髋关节均取得良好效果（改良San Diego髋臼成形组100%，Pemberton组97%，P=0.485）。2级及以上股骨头坏死发生率，两组之间相似（改良San Diego髋臼成形组0%，Pemberton组3%，P=0.458）。

结论：针对典型DDH患者，改良San Diego髋臼成形术是安全、有效的治疗选择。通过保留骨盆内皮质完整性，髋臼成形可以依据患者自身特殊的髋臼发育不良，进行个性化的髋臼塑形。

图1. （a）Pemberton髋臼成形术示意图；（b）Pemberton髋臼成形术前、和术后摄片。

图2. 原始版本San Diego髋臼成形术示意图（为治疗神经肌肉型髋关节发育不良设计-三角形支撑楔形骨块相同）。

图3. （a）改良的San Diego髋臼成形术示意图（为治疗典型髋关节发育不良的前外侧缺损设计-三角形支撑楔形骨块不相同，最大楔形骨块置于另外两个楔形骨块前方）；（b）采用改良San Diego髋臼成形术治疗一例典型髋关节发育不良患者，术前、和术后摄片。

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Purpose:Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH.

Methods:We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria.

Results:Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458).

Conclusion:The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient's specific acetabular deficiency.

文献出处：Badrinath R, Bomar JD, Wenger DR, Mubarak SJ, Upasani VV. Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip. J Child Orthop. 2019 Apr 1;13(2):172-179. doi: 10.1302/1863-2548.13.190004. PMID: 30996742; PMCID: PMC6442505.

文献2

单纯PAO未处理关节内病变的术后功能结果

译者 任宁涛

发育性髋关节发育不良 (DDH) 可促进骨关节炎的发生,而髋臼周围截骨术（PAO）在DDH保髋治疗中已显现出良好的手术效果。然而，关节内损伤可能是术后持续症状的原因，因此在 PAO 前或同时行关节内损伤治疗已成为解决它的替代方法。本研究旨在确定长期随访中关节内损伤的发生率，单纯行PAO未行关节内损伤治疗的患者的功能结果以及髋关节存活率(THA为终点)。对 92 名患者 103 例髋关节进行回顾性研究，平均年龄 26 岁（19-31 岁），96% 为女性。平均随访时间为7年（范围：3-16）。在进行PAO 之前使用高分辨率磁共振成像 (MRI) 评估关节内损伤，使用国际软骨修复协会分类评估软骨损伤，所有患者均登记 Harris 髋关节评分 (HHS)。所有患者在 MRI 上有盂唇撕裂，80.8% 的盂唇肥大和 20.8% 的盂唇囊肿。88.5% 的髋关节髋臼软骨损伤为2级。HHS良好且优秀的比例为94%。15年的髋关节存活率为87%。软骨盂唇损伤是 DDH 患者的常见表现。尽管如此，在没有盂唇修复的情况下，PAO 也可获得极好的结果。因此我们认为重点应放在 DDH 患者髋关节的生物力学和解剖学矫正上。

Bernese periacetabular osteotomy functional outcomes in patients with untreated intra-articular lesions

Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19-31), 96% females. Mean follow-up 7 years (range: 3-16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.

文献出处：Joaquín Lara , Alan Garín, Cristhián Herrera, Selim Abara, Javier Besomi, Diego Villegas, Hassan Neumann, Carlos Tobar. Bernese periacetabular osteotomy functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg . 2020 Apr 13;7(2):256-261.

文献3

通过吻合骨内动脉重建股骨头血供的方法

译者 李勇

背景：重建股骨头血供对治疗股骨头缺血性坏死及相关疾病至关重要。本研究提出一种通过吻合骨内动脉重建股骨头血供的方法。
方法：对6头雄性长白猪的股骨头进行手术暴露，并人为制造股骨颈头下骨折。在显微镜引导下，识别后支持带动脉的滋养孔。随后，通过开三角形骨窗暴露骨内动脉。固定股骨头后，将骨内动脉与骨折远端后下支持带动脉吻合。采用克氏针孔及血管造影技术评估股骨头血供。
结果：吻合后的骨内动脉呈鲜红色，提示灌注充足，并观察到搏动性血流。股骨头表面针孔可见持续血流，血管造影进一步证实血运重建成功：造影剂经股深动脉发出的下支持带动脉分支进入股骨头，到达骨内动脉吻合部位。值得注意的是，血管造影还显示可见的内部分支，表明功能性血管网络已建立。
讨论：通过吻合骨内动脉重建股骨头血供的方法能够利用股骨头内现有血供系统。本研究是对这一创新技术的初步探索，未来或可应用于预防和/或治疗股骨颈骨折后股骨头坏死。通过恢复病变区域的血流，该方法有望保留股骨头的活力与功能，最终改善患者预后。

Method for Reconstructing Femoral Head Blood Supply by Anastomosing the Intraosseous Artery

Background: Reconstruction of femoral head blood supply is critical for managing avascular necrosis and related conditions. This study proposes a method to reconstruct femoral head blood supply through anastomosis of the intraosseous artery.
Methods: Surgical exposure of the femoral heads was performed in six male Landrace swine, and subcapital femoral neck fractures were intentionally created. Under microscopic guidance, the nutrient foramen of the posterior retinacular artery was identified. A triangular bone window was then crafted to expose the intraosseous artery. After femoral head fixation, anastomosis was performed between the intraosseous artery and the posteroinferior retinacular artery at the distal fracture end. Femoral head blood supply was evaluated using Kirschner wire pinholes and angiography.
Results: The anastomosed intraosseous artery exhibited a vibrant red color, indicating sufficient perfusion, with observable pulsatile flow. Continuous blood flow was noted through pinholes on the femoral head surface. Angiography confirmed successful revascularization: contrast agent entered the femoral head via the inferior retinacular artery branch from the deep femoral artery, reaching the intraosseous artery anastomosis site. Notably, angiography also revealed visible internal branches, demonstrating the establishment of a functional vascular network.
Discussion: This method leverages the existing blood supply system within the femoral head by anastomosing the intraosseous artery. As a preliminary study of this innovative technique, it holds potential for preventing and/or treating femoral head necrosis following femoral neck fractures. Restoring blood flow to the affected area may preserve femoral head viability and function, ultimately improving patient outcomes.

文献出处：Wang H, Wang D, Wan J, Wang X, Hou R. Method for reconstructing femoral head blood supply by anastomosing the intraosseous artery. Heliyon. 2024 Feb 3;10(3):e25555. doi: 10.1016/j.heliyon.2024.e25555. PMID: 38356595; PMCID: PMC10865311.

文献4

残余Legg-Calvé-Perthes病的髋关节前间隙

译者 张利强

背景：残余Legg-Calvé-Perthes病（LCPD）畸形患者的髋关节机械环境仍然知之甚少。前撞击认为会导致不良的长期结果，例如早发性骨关节炎，但尚未使用高屈曲影像直接测量。这项研究的目的是确定LCPD畸形的放射学形态学评分与髋关节前间隙减少之间的关联。

方法：我们使用站立开放式MRI扫描仪测量了20例LCPD患者（17例患者）在4种功能姿势下扫描的前间隙（β角）。混合效应模型用于描述β角，姿势和畸形形态测量之间的关系（Stulberg分类和球形度偏差评分）。

结果：髋关节β角与姿势显著相关（P＜0.001）。与球形（StulbergI至II）髋关节相比，非球面（StulbergIII至V）髋关节在所有姿势中的β均较低（β=-39.1度；95%CI:-71.9至-6.2度；P=0.020）。SDS升高与中立髋关节姿势中β降低密切相关（分别为P=0.002、0.005），但与内收和内旋增加无关。由于形态异质性，6髋（总共20髋）不符合总体趋势。

结论：我们的研究结果显示，更严重的影像学畸形与更大的潜在前部撞击之间存在关联，这是软骨退化的已知原因。然而，大部分形态畸形与功能间隙不一致的病例表明，目前的畸形影像学测量可能不足以预测每位LCPD患者的长期预后。

临床相关性：（1）LCPD中的髋关节非球面性与较低的前部间隙和较高屈曲姿势下前部撞击的可能性相关。（2）考虑形态学和功能参数可以提高我们对LCPD疼痛和早发性骨关节炎原因的理解，而不单纯是形态学。

Anterior Hip Clearance in Residual Legg-Calvé-Perthes Disease

Background: The mechanical environment in the hip in people with residual Legg-Calvé-Perthes disease (LCPD) deformity is still poorly understood. Anterior impingement is thought to contribute to poor long-term outcomes such as early-onset osteoarthritis, but it has not been measured directly using imaging in high flexion. Our objective in this study was to determine the association between radiographic morphologic scores of LCPD deformity and reduced anterior hip clearance.

Methods: We measured the anterior clearance (β-angle) of 20 LCPD affected hips (17 patients) scanned in 4 functional postures using an upright open MRI scanner. Mixed effects models were used to describe the relationship between β, posture, and morphologic measures of deformity (Stulberg classification and Sphericity Deviation Score).

Results: Hip β-angle was significantly associated with posture (P< 0.001). Aspherical (Stulberg III to V) hips had lower β across all postures compared with spherical (Stulberg I to II) hips (difference in β = −39.1 degrees; 95% CI: −71.9 to −6.2 degrees; P= 0.020). An increased SDS was strongly associated with reduced β in neutral hip postures (P=0.002, 0.005, respectively), but not with elevated adduction and internal rotation. Due to morphologic heterogeneity, 6 hips (out of 20 overall) did not fit the overall trend.

Conclusions: Our results show an association between more severe radiographic deformity and a greater potential for anterior impingement, a known contributor to cartilage degradation. However, the large proportion of cases where morphologic deformity does not align with functional clearance suggests current radiographic measures of deformity may not be sufficient to predict long-term outcomes in every LCPD patient.

Clinical Relevance: (1) Hip joint asphericity in LCPD is associated with less anterior clearance and a greater potential for anterior impingement in high flexion postures. (2) Considering both morphologic and functional parameters may improve our understanding of the causes of pain and early-onset osteoarthritisin LCPD, as opposed to morphology alone.

Key Words: Legg-Calvé-Perthes disease, magnetic resonance imaging, hip impingement, hip joint, osteoarthritis, femur, acetabulum

文献出处：Luke G Johnson, Honglin Zhang, Benjamin Joseph, Emily K Schaeffer, Kishore Mulpuri, David R Wilson; Anterior Hip Clearance in Residual Legg-Calvé-Perthes DiseaseJournal of pediatric orthopedics 2025 Mar 10; doi:10.1097/BPO.0000000000002949

文献5

髋关节发育不良的骨盆倾斜度是多少，髋臼周围截骨术后会发生变化吗？

译者 陶可

为了量化有症状的髋关节发育不良患者的骨盆倾斜(PT)并确定它是否代表改善股骨头覆盖的补偿机制，我们研究了一组16名接受32次双侧分期PAO截骨治疗髋关节发育不良的患者，并将其与一组32名接受PAO治疗单侧髋关节发育不良的患者进行了比较，所有患者的随访时间均超过1年。PT的变化通过两种经过验证的方法确定，即骶骨-股骨-耻骨(SFP)角和耻骨联合至骶髂指数(PS-SI)。尽管在PAO后外侧中心边缘角和Tönnis角有所改善，并处于正常范围内，但单侧和双侧髋关节发育不良患者的术前(8° ± 5°)和术后(9° ± 5°)的PT相似。使用SFP角时，仅6名患者(13%)观察到>5°的变化，使用PS-SI时，5名患者(10%)观察到>10°的变化，所有患者均有所增加（骨盆后旋）。未观察到任何患者的PT变化>10°。我们研究组中观察到的PT与正常人群和有症状的髋臼后倾患者的PT相同。这些发现都表明PT是形态学的，而不是补偿机制的结果，即使它是补偿性的，在PAO后似乎也不会发生显着逆转。因此，髋臼重新定向的目标保持不变。

图1 髋臼参数测量，包括术前外侧中心边缘角(LCEA，a)、术后LCEA (b)、术前Tönnis角 (c) 和术后Tönnis角 (d)。

图2 骨盆倾斜度测定。术前(a)和术后(b)测量的骶骨-股骨-耻骨角(SFP)，以及术前(c)和术后(d)测量的耻骨联合至骶髂指数(PS-SI)。

图3 双侧和单侧髋关节发育不良术前和术后外侧中心边缘角(a)和Tönnis角 (b)。

图4 术前和术后骨盆倾斜度由耻骨联合-股骨-耻骨角(SFP)确定，其中骨盆倾斜度= SFP-75。PAO术前与术后相比，骨盆倾斜度无显著差别。

图5 髋臼周围截骨术(PAO)后骨盆倾斜度的变化，由(a)耻骨联合-股骨-耻骨角(SFP)和(b)耻骨联合-骶髂指数(PS-SI)决定。

What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

To quantify the pelvic tilt (PT) in patients with symptomatic acetabular dysplasia and determine if it represents a compensatory mechanism to improve femoral head coverage, we studied a cohort of 16 patients undergoing 32 bilateral staged PAOs for acetabular dysplasia and compared this to a matched cohort of 32 patients undergoing PAO for unilateral acetabular dysplasia all with >1 year follow-up. The change in PT was determined with two validated methods, namely, the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac index (PS-SI). Despite an improvement in the lateral centre-edge and Tönnis angles to within normal limits following PAO, patients with unilateral and bilateral acetabular dysplasia have similar PT pre-operatively (8° ± 5°) and post-operatively (9° ± 5°). A change of >5° was observed in only six patients (13%) using the SFP angle, and five patients (10%) using the PS-SI, all increased (posterior rotation of the pelvis). No patients were observed to have a change in PT >10°. The observed PT in our study group is equivalent to that found in the normal population and in patient with symptomatic acetabular retroversion. These findings all suggest that PT is morphological rather than a result of a compensatory mechanism, and even if it was compensatory, it does not appear to reverse significantly following PAO. The target for acetabular reorientation, therefore, remains constant.

文献出处：Mark A Roussot, Saif Salih, George Grammatopoulos, Johan D Witt.What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy? J Hip Preserv Surg. 2021 Apr 10;7(4):777-785. doi: 10.1093/jhps/hnab023. eCollection 2020 Dec.

文献6

患者感知的髋臼周围截骨术（PAO）术后并发症的社交媒体分析：一项回顾性观察研究

译者 邱兴

背景：社交媒体已成为患者获取医疗信息和分享治疗经验的重要平台。髋臼周围截骨术（PAO）是治疗症状性髋臼发育不良的常用术式，专业文献报道其在专科中心实施时并发症发生率较低。目前关于患者在社交媒体平台自述PAO术后并发症的情况尚未明确。本研究旨在分析社交媒体平台上患者自述的PAO相关并发症，并探讨术后时间窗、伴随手术等其他因素与这些并发症报告的相关性。

方法：检索2018年2月1日至2023年2月1日期间Facebook和Instagram数据，扩大检索范围至2011年2月1日获取Twitter数据。从"Periacetabular Osteotomy"和"PAO Australia"两个最大用户群组收集1054条Facebook帖子，同时使用#PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, 和 #PAOrecovery等五个常用标签获取1003条Instagram帖子和502条推文。对帖子进行人口统计学特征、视角、时间节点（术后早期/晚期）、附加手术、并发症类型及互动情况分析。

结果：共分析2559条社交媒体内容（Facebook 1054条，Instagram 1003条，Twitter 502条），13.6%的帖子提及并发症。多数并发症报告出现于术后6个月以上，其中疼痛问题最为突出（57.2%），包括慢性疼痛（41.8%）、急性疼痛（6.7%）和神经性疼痛（8.8%）。其他并发症包括骨性并发症（6.7%）、神经/精神系统并发症（3.8%）、肿胀（1.7%）、感染（1.4%）、其他明确并发症（16.2%）和非特异性并发症（10.2%）。并发症报告与术后时间窗呈正相关，与附加手术呈负相关。涉及并发症的帖子用户互动度较低。

结论：较少患者在社交媒体报告PAO相关并发症。在报告者中，多数反映术后晚期存在难治性疼痛。并发症报告率与术后时间呈正相关，与附加手术呈负相关。本研究发现的疼痛并发症发生率高于既往研究，但总体并发症率较低。结合社交媒体患者自述并发症与传统疗效指标，可更全面了解术后恢复过程中患者最关注的临床问题。

A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study

Background: Social media is a popular resource for patients seeking medical information and sharing experiences. Periacetabular osteotomy (PAO) is an accepted treatment for symptomatic acetabular dysplasia with a low published complication profile in specialty centers. Little is known regarding patient reporting of complications on social media following PAO. The purpose of this study was to describe the patient-perceived complications of PAO posted on social media and analyze how additional factors (postoperative timeframe, concomitant surgery) correlate with these complication posts.

Methods: Facebook and Instagram were queried from 02/01/18-02/01/23; Twitter was searched over an extended range back to 02/01/11. Facebook posts (1054) were collected from the two most populated interest groups; "Periacetabular Osteotomy" and "PAO Australia." Instagram posts (1003) and Tweets (502) were found using the same five most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data, perspective, timing (early postoperative or late postoperative), additional surgeries, type of complication, and post engagement.

Results: Facebook posts (1054), Instagram posts (1003), and Tweets (502) were assessed; 13.6% of posts included a complication. The majority of complications were reported > 6 months postoperatively with excessive pain being the most common complication (57.2%), including chronic pain (41.8%), acute pain (6.7%), and nerve pain (8.8%). Bony complications (6.7%), neurologic/psychiatric complications (3.8%), swelling (1.7%), infection (1.4%), other specified complications (16.2%), and unspecified complications (10.2%) were reported. Complication posts were found to be correlated with postoperative timeframe and concomitant surgery. Post engagement decreased in complication-related posts.

Conclusions: Few patients posted a perceived complication associated with PAO surgery. Of those who did, the majority reported unmanageable pain during the late postoperative period. Posts including a perceived complication were found to be positively correlated with postoperative timeframe and negatively correlated with concomitant surgery. This study found a higher pain complication rate, but a lower overall complication rate compared to prior studies. Considering the social media reported complications of PAO patients in addition to traditional outcome measures reveals which aspects of postoperative recovery are most important to patients themselves.

文献出处：Laboret B, Bialaszewski R, Gaddis J, Middleton E, Kendall B, Lynch K, Stewart A, Wells J. A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study. BMC Surg. 2024 Jan 24;24(1):36.

文献7

症状性盂唇撕裂髋关节镜手术后软骨盂唇交界处破裂与转为全髋关节置换术之间的关联：至少8年随访

译者 徐子茵

背景： 关节镜治疗股骨髋臼撞击综合征（FAI）和症状性盂唇撕裂具有短期到中期的益处，但需要进一步的长期证据。此外，尽管软骨关节连接处（CLJ）具有生理和生物力学意义，但该过渡区损伤的临床意义仍未得到充分研究。

目的： (1)报告FAI髋关节镜术后至少8年的生存率和患者报告的结果测量；(2)确定结果与患者特征（年龄、体重指数、性别）、病理之间的关系

研究设计： 队列研究；证据水平3.

方法： 这项回顾性队列研究纳入了2002年至2013年间由单一外科医生因FAI继发的症状性盂唇撕裂接受原发性髋关节镜检查的患者。所有患者年龄≥18岁，随访至少8年，术前有x线片。主要结果是转为全髋关节置换术（THA），次要结果包括关节镜翻修、患者报告的结果测量和患者满意度。CLJ分解采用Beck分类进行评估。Kaplan-Meier估计和加权Cox回归用于估计10年生存率（未转化为THA），并确定与THA转化相关的危险因素。

结果： 在这项174髋的研究中(50.6%为女性；平均年龄（37.8±11.2岁），平均随访11.1±2.5年，10年生存率为81.6% （95% CI, 75.9% ~ 87.7%）。术后平均4.7±3.8年转为THA。未经调整的分析揭示了几个与THA转换显著相关的变量，包括年龄；较高的身体质量指数；Tönnis等级较高；上方盂唇的清理;以及CLJ、唇状关节或关节软骨的严重破裂。表现严重的患者(43.6%；95% CI, 31.9%-59.7%)与轻度(97.9%；95% CI, 95.1%-100%) CLJ的分解(P <.001)相比，10年生存率较低。多变量分析将CLJ分解恶化(每增加1个单位的加权风险比为6.41；95% CI, 3.11-13.24)，年龄较大(1.09；95% CI, 1.04-1.14)，更高的Tönnis等级(4.59；95% CI, 2.13-9.90)定义为独立的负面预测因子(P <.001)。

结论： 尽管大多数患者获得了至少8年良好的预后，但一些术前和术中因素与THA转换相关；其中，较差的CLJ撕裂分离、较高的Tönnis分级和年龄较大是最强的预测因子。

Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up

Background: Arthroscopic treatment of femoroacetabular impingement （FAI） and symptomatic labral tears confers short- to midterm benefits， yet further long-term evidence is needed. Moreover， despite the physiological and biomechanical significance of the chondrolabral junction （CLJ）， the clinical implications of damage to this transition zone remain understudied.

Purpose: To （1） report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and （2） characterize associations between outcomes and patient characteristics （age， body mass index， sex）， pathological parameters （Tönnis angle， alpha angle， type of FAI， CLJ breakdown）， and procedures performed （labral management， FAI treatment， microfracture）.

Study design: Cohort study；Level of evidence， 3.

Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty （THA）， and secondary outcomes included revision arthroscopy， patient-reported outcome measures， and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship （no conversion to THA） and identify risk factors associated with THA conversion.

Results: In this study of 174 hips （50.6% female；mean age， 37.8 ± 11.2 years） with mean follow-up of 11.1 ± 2.5 years， the 10-year survivorship rate was 81.6% （95% CI， 75.9%-87.7%）. Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion， including older age；higher body mass index；higher Tönnis grade；labral debridement；and advanced breakdown of the CLJ， labrum， or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe （43.6%；95% CI， 31.9%-59.7%） versus mild （97.9%；95% CI， 95.1%-100%） breakdown of the CLJ （P < .001）. Multivariable analysis identified worsening CLJ breakdown （weighted hazard ratio per 1-unit increase， 6.41；95% CI， 3.11-13.24）， older age （1.09；95% CI， 1.04-1.14）， and higher Tönnis grade （4.59；95% CI， 2.13-9.90） as independent negative prognosticators （P < .001 for all）.

Conclusion: Although most patients achieved favorable minimum 8-year outcomes， several pre- and intraoperative factors were associated with THA conversion；of these， worse CLJ breakdown， higher Tönnis grade， and older age were the strongest predictors.

文献8

突出的髂前下棘形态在接受髋臼周围截骨术的髋关节发育不良患者中很常见

译者 陈志强

背景：在股骨髋臼撞击综合症（FAI）中，髂前下棘（AIIS）的突出越来越受到重视。髋关节发育不良患者髋臼重新定向后，AIIS突出可能会导致髋关节屈曲度降低。AIIS的形态已在许多人群中被描述，包括无症状人群、FAI人群和运动员人群，但对接受髋臼周围截骨术（PAO）的有症状髋关节发育不良患者的AIIS形态尚未进行研究。在髋关节发育不良的患者中，髋臼前上缘的缺损很常见，可能导致 AIIS 的位置更靠近髋臼边缘。了解有症状髋关节发育不良患者 AIIS 的形态变化及其与发育不良亚型和严重程度的关系有助于术前规划、手术技巧选择和 PAO 术后问题的评估。

问题/目的：在这项研究中，我们试图确定：(1) 有症状的髋关节发育不良髋关节中 AIIS 形态类型的变异性；(2) 发育不良模式和严重程度亚型之间是否存在 AIIS 形态比例的差异。

方法：通过保髋数据库，我们确定了 2013 年 10 月至 2015 年 7 月期间接受 PAO 的 153 个髋关节（148 名患者）。本次研究的纳入标准为（外侧中心边缘角 [LCEA] < 20°）、骨盆 AP 平片 Tönnis 分级为 0 或 1、接受过术前低剂量 CT 扫描、既往未接受过手术、创伤、神经肌肉、缺血性坏死或 Perthes 样畸形。共有 50 名有症状的髋臼发育不良患者（50 髋）接受了 PAO 手术计划评估，我们对这些患者的低剂量 CT 扫描结果进行了回顾性评估。研究中患者的年龄中位数为 24 岁（范围13 至 49 岁）。90%的髋关节（50 例中的 45 例）为女性患者，10%的髋关节（50 例中的 5 例）为男性患者。AIIS 的形态是根据之前公布的三维 CT 重建进行分类的，以确定 AIIS 与髋臼边缘之间的关系。AIIS的形态分为I型（AIIS位于髋臼边缘近端）、II型（AIIS延伸至髋臼边缘平面）或III型（AIIS延伸至髋臼边缘远端）。髋关节发育不良亚型的特征根据先前的方案确定，主要是髋臼前上方缺损、髋臼后上方缺损或整体髋臼缺损。髋关节发育不良的严重程度分为轻度（LCEA 15°- 20°）和中度/重度（LCEA < 15°）。为了回答第一个问题，即每种 AIIS 形态在发育不良人群中的比例，我们计算了比例和 95% CI 估计值。为了回答第二个问题，我们使用卡方检验或Fisher精确检验来比较分类变量。P ＜ 0.05 即为显著。

结果：72%的患者（50 例中有 36 例；95% CI 58% 至 83%）具有 II 型或 III 型 AIIS 形态。28%的患者（50例中有14例；95% CI 18% 至 42%）出现I型AIIS形态，62% 的患者（50 例中有31例；95% CI 48% 至 74%）出现II型AIIS形态，10%的患者（50例中有5例；95% CI 4% 至 21%）出现 III 型 AIIS形态。在 15 位髋臼前上方缺损患者中，有 7 位属于 I 型 AIIS；在 18 位髋臼整体缺损患者中，有 3 位属于 I 型 AIIS；在 17 位髋臼后上方缺损患者中，有 4 位属于 I 型 AIIS（P = 0.08）。不同亚型髋关节发育不良模式之间的 AIIS 形态变异性没有差异，轻度与中度/重度发育不良患者之间的 AIIS 形态变异性也没有差异。

结论：髋关节发育不良患者 AIIS 的形态通常很突出，72% 的髋关节具有 II 型或 III 型形态。

临床意义：在接受 PAO 的髋关节发育不良患者中，无论发育不良模式或严重程度如何，AIIS 通常都很突出。突出的 AIIS 形态可能会影响髋臼重新定向后的髋关节屈曲 ROM。AIIS 形态是 PAO 术前计划中应考虑的一个变量。未来的研究需要评估突出的 AIIS 对 PAO 术中发现和术后状态的临床意义。

Prominent Anterior Inferior Iliac Spine Morphologies Are Common in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy

Background：The anterior inferior iliac spine (AIIS) prominence is increasingly recognized in the setting of femoroacetabular impingement (FAI). The AIIS prominence may contribute to decreased hip flexion after acetabular reorientation in patients with acetabular dysplasia. AIIS morphologies have been characterized in numerous populations including asymptomatic, FAI, and athletic populations, but the morphology of the AIIS in patients with symptomatic acetabular dysplasia undergoing periacetabular osteotomy (PAO) has not been studied. In acetabular dysplasia, deficiency of the anterosuperior acetabular rim is commonly present and may result in the AIIS being positioned closer to the acetabular rim. Understanding morphological variation of the AIIS in patients with symptomatic dysplasia, and its relationship to dysplasia subtype and severity may aid preoperative planning, surgical technique, and evaluation of postoperative issues after PAO.

Questions/purposes:In this study, we sought to determine: (1) the variability of AIIS morphology types in hips with symptomatic acetabular dysplasia and (2) whether the differences in the proportion of AIIS morphologies are present between dysplasia pattern and severity subtypes.

Methods:Using our hip preservation database, we identified 153 hips (148 patients) who underwent PAO from October 2013 to July 2015. Inclusion criteria for the current study were (lateral center-edge angle [LCEA] < 20°), Tönnis Grade of 0 or 1 on plain AP radiographs of the pelvis, preoperative low-dose CT scan, and no prior surgery, trauma, neuromuscular, ischemic necrosis, or Perthes-like deformity. A total of 50 patients (50 hips) with symptomatic acetabular dysplasia undergoing evaluation for surgical planning of PAO remained for retrospective evaluation; we used these patients’ low-dose CT scans for analysis. The median (range) age of patients in the study was 24 years (13 to 49). Ninety percent (45 of 50) of the hips were in female patients, whereas 10% (5 of 50) were in male patients. The morphology of the AIIS was classified on three-dimensional CT reconstructions according to a previously published classification to define the relationship between the AIIS and the acetabular rim. The morphology of the AIIS was classified as Type I (AIIS well proximal to acetabular rim), Type II (AIIS extending to level of acetabular rim), or Type III (AIIS extending distal to acetabular rim). Acetabular dysplasia subtype was characterized according to a prior protocol as either predominantly an anterosuperior acetabular deficiency, a posterosuperior acetabular deficiency, or a global acetabular deficiency. Acetabular dysplasia severity was distinguished as mild (LCEA 15° to 20°) or moderate/severe (LCEA < 15°). To answer our first question, regarding the proportions of each AIIS morphology in the dysplasia population, we calculated proportions and 95% CI estimates. To answer our second question, regarding the proposition of AIIS type between subtypes of dysplasia type and severity, we used a chi-square test or Fisher’s exact test to compare categorical variables. A p value of < 0.05 was considered significant.

Results:Seventy-two percent (36 of 50; 95% CI 58% to 83%) of patients had a Type II or III AIIS morphology. Type I AIIS morphology was found in 28% of patients (14 of 50; 95% CI 18% to 42%), Type II AIIS morphology in 62% (31 of 50; 95% CI 48% to 74%), and Type III AIIS/morphology in 10% (5 of 50; 95% CI 4% to 21%). A Type I AIIS was seen in seven of 15 of patients with anterosuperior acetabular deficiency, three of 18 of patients with global deficiency, and four of 17 patients with posterosuperior deficiency (p = 0.08). There was no difference in the variability of AIIS morphologies between the different subtypes of acetabular dysplasia pattern and no difference in AIIS morphology variability between patients with mild versus moderate/severe dysplasia.

Conclusions:The morphology of the AIIS in patients with acetabular dysplasia is commonly prominent, with 72% of hips having Type II or Type III morphologies.

Clinical Relevance:The AIIS is often prominent in patients with acetabular dysplasia undergoing PAO, regardless of dysplasia pattern or severity. Prominent AIIS morphologies may affect hip flexion ROM after acetabular reorientation. AIIS morphology is a variable that should be considered during preoperative planning for PAO. Future studies are needed to assess the clinical significance of a prominent AIIS on intraoperative findings and postoperative status after PAO.

文献出处：Nestorovski D, Wasko M, Fowler LM, Harris MD, Clohisy JC, Nepple JJ. Prominent Anterior Inferior Iliac Spine Morphologies Are Common in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy. Clin Orthop Relat Res. 2021 May 1;479(5):991-999. doi: 10.1097/CORR.0000000000001547. PMID: 33861213; PMCID: PMC8052058.

来源：304关节学术

作者：304关节团队

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