髋膝关节文献精译荟萃（第341期）

本期目录：

1、体重指数超过 30 的患者接受外侧单间室膝关节置换术的结果令人满意

2、评估新式跨平台测量工具的可行性以应对门诊关节置换手术数量增长的需求

3、高体重指数对功能对线影像导航机器人辅助全膝关节置换术的影响

4、亚洲人群髋关节发育不良患者PAO与THA术后倾向评分匹配比较

5、一种基于直接髋关节磁共振造影的髋关节软骨和盂唇自动三维分割的深度学习方法

6、DDH骨化核是否出现与股骨头缺血坏死相关

7、与酒精相关性股骨头坏死相比，糖皮质激素相关性股骨头坏死（GONFH）表现出更低的骨微结构硬化程度和更高的骨吸收活性

8、建立一种精准的术中替代技术用于测量股骨前倾角

9、双侧髋臼周围截骨术后，代偿性骨盆前倾是否会减小

10、John Charnley奖：定量透视成像工具提升髋臼周围截骨术中骨块定位精度

11、人类髋关节髋臼盂唇的三维结构

12、症状性髋关节发育不良和股骨髋臼撞击患者胫骨和股骨扭转联合异常的患病率

第一部分：关节置换及保膝相关文献

文献1

体重指数超过 30 的患者接受外侧单间室膝关节置换术的结果令人满意

译者 马云青

的： 通过 2 ~ 12 年的随访，分析体重指数 (BMI) 对骨水泥固定支撑外侧单间室膝关节置换术 (UKA) 临床疗效的影响。
方法： 2010 年 1 月至 2020 年 1 月，共植入 103 例外侧 UKA。牛津膝关节评分 (OKS) 和西安大略省和麦马士达大学骨关节炎指数的疼痛，僵硬，功能和总分被用来评估患者术前和术后的整体健康状况。WOMAC 值 > 85 分和 OKS > 40 分的结果被认为是良好或优秀的。用 Kaplan-Meier 方法描述的假体生存率被定义为在最近的随访中无翻修，并发症或进一步手术情况在随访时一同记录。P 值 < 0.05 被认为是差异显着的。
结果： 在平均 77.8 个月的随访中，评估了101例外侧UKA。没有患者接受翻修，但 2 例 (2,0%) 在术后 2 年和 5 年发生无菌性松动，但由于临床原因均未进行翻修 (5 年生存率97.2%)。总体满意度普遍较高，所有 WOMAC 分量表和所有 BMI 组的 OKS 得分均优异。考虑到疼痛分量表 (WOMAC 疼痛) ，体重正常和超重的患者比肥胖患者 (n = 0) 更多地获得优异的结果 [10 (25.64%) vs 10 (23.81%) p = 0.026] ; 另一方面，在生活质量方面 (WOMAC QoL) ，肥胖患者更多达到优异的值，甚至是统计学显著的差异[n = 15 (75.00%) p = 0.040]。
结论：虽然肥胖在历史上一直被描述为 UKA 的手术禁忌，但现代 UKA 假体设计的改善对这种传统观念已经提出了挑战。因此，体重指数 > 30 kg/m2 患者UKA的手术禁忌可能并不合理。根据目前的研究，体重指数 > 30 kg/m2 的外侧 UKA 患者与长期非肥胖患者相比，具有令人满意的患者报告结果指标，生存率与内侧 UKA 相当。肥胖患者不应被排除在外侧 UKA 手术的受益范围之外。

A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty

Purpose: The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up.

Methods: Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients' overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan-Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant.

Results: One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p = 0.026] than obese patients (n = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [n = 15 (75.00%) p = 0.040].

Conclusion: Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery.

文献出处：Giordano L, Maffulli N, Morenghi E, Quaglia A, Prospero E, Rosa F, Volpi P. A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1106-1112. doi: 10.1007/s00167-022-07253-3. Epub 2022 Dec 7. PMID: 36478285; PMCID: PMC9734769.

文献2

评估新式跨平台测量工具的可行性以应对门诊关节置换手术数量增长的需求

译者 张蔷

背景：择期初次全髋和全膝关节置换术（统称为关节置换术[TJAs]）为临床常见术式，可以缓解疼痛、改善功能。TJAs通常十分安全，但仍存在可能出现的并发症。尽管该手术通常为住院手术，但有越来越多的TJAs变为门诊手术。我们想寻找一种科学可行的跨平台测量工具，来评估住院手术和门诊手术的医疗服务质量。

方法：应用医疗保险的申领和支付数据来筛选TJA病例，我们重新指定医保和医疗补助中心（CMS）住院患者专用TJA并发症风险评估工具来分别计算住院或门诊的择期初次TJAs患者术后并发症率。我们匹配了住院和门诊手术患者的编码信息，并应用分层逻辑回归分析法来计算医院专用的标准化风险并发症率（RSCRs）。低概率意味着更高质量的医疗服务。应用CMS测量工具，我们测试了工具的可靠性以及经审核的患者关键治疗决策情况。

方法：以手术场景作为风险变量的单一组合模型得出了最高的差值（单一组合模型的场景指示符数值：0.664，住院手术模型的数值为0.651，门诊手术模型的数值为0.638）。在至少包含25例TJAs的2747家医院中，平均RSCR值（带有指示符的组合模型）为2.91%（平均RSCR：2.85%；四分位间距：2.59%-3.18%）。高风险医院的并发症发生率与低风险医院的概率比中位数为1.33。

结论：我们重新指定了一种评估住院TJA手术或门诊TJA手术疗效的工具，并测试了该工具的可靠性。本研究通过这种测量工具发现不同医院间的并发症率差异，即支持该工具在更大患者群体（现今纳入了门诊手术病例vs.既往只包含住院手术病例）内评估医院服务水平的可行性。

Testing the Feasibility of a Cross-Setting Measure to Address the Rising Trend in Hospital Outpatient TJA Procedures

Background: Elective primary total hip and total knee arthroplasty (collectively, total joint arthroplasties [TJAs]) are commonly performed procedures that can reduce pain and improve function. TJAs are generally safe, but complications can occur. Although historically performed as inpatient procedures, TJAs are increasingly being performed in the outpatient setting. We sought to develop a scientifically acceptable cross-setting measure for evaluating care quality across inpatient and outpatient settings.

Methods: Using Medicare administrative claims and enrollment data for qualifying TJA patients, we respecified the Centers for Medicare & Medicaid Services (CMS) inpatient-only risk-standardized TJA complications measure to assess complication rates following elective primary TJAs performed in an inpatient or outpatient setting. We aligned inpatient and outpatient coding practices and used hierarchical logistic regression to calculate hospital-specific, risk-standardized complication rates (RSCRs). Lower rates correspond to better quality. Using accepted approaches for CMS measures, we tested measure reliability and vetted key measure decisions with patient and provider input.

Results: A single combined model including the procedure setting as a risk variable produced the highest discrimination (C-statistic for a single combined model with a setting indicator: 0.664, C-statistic for the inpatient-only model: 0.651, C-statistic for the outpatient-only model: 0.638). Among the 2,747 hospitals with at least 25 TJAs, the mean RSCR (using the combined model with a setting indicator) was 2.91% (median RSCR: 2.85%; interquartile range: 2.59% to 3.18%). The median odds ratio for complication occurrence at a higher-risk hospital compared with a lower-risk hospital was 1.33.

Conclusions: We respecified a measure to assess hospital inpatient or outpatient TJA performance and evaluated the reliability and validity of the measure. The findings showed variation in hospital-level complication rates across settings as indicated by this measure, supporting the feasibility of evaluating hospital performance using a more representative population than inpatient TJAs alone.

文献出处：Wallace LR, Tan Z, Barthel A, Sáenz MP, Grady JN, Balestracci KMB, Bozic KJ, Myers R, McDonough DL, Lin Z, Suter LG. Testing the Feasibility of a Cross-Setting Measure to Address the Rising Trend in Hospital Outpatient TJA Procedures. J Bone Joint Surg Am. 2025 Mar 19;107(6):604-613. doi: 10.2106/JBJS.23.01395. Epub 2024 Dec 5. PMID: 39637009.

文献3

高体重指数对功能对线影像导航机器人辅助全膝关节置换术的影响：功能结果相当，但机械失败率更高

译者 沈松坡

研究目的：体重指数（BMI）升高在全膝关节置换术（TKA）中带来诸多挑战，包括并发症发生率升高。借助机器人辅助进行的功能性膝对位（FKP）提供了个体化的对线与软组织平衡方式，但其在高BMI患者中的效果尚不明确。本回顾性对照研究旨在评估肥胖及其严重程度对影像导航机器人辅助、遵循FKP原则的TKA术后临床结局与并发症的影响。

研究方法：研究纳入372名接受FKP原则指导下机器人辅助TKA的患者，按BMI分为两组（<30 kg/m² 与 ≥30 kg/m²）。在术后至少2年的随访中，评估Knee Society评分（KSS）、“遗忘关节”评分（FJS）、关节活动度（ROM）、假体位置情况及并发症等指标。

研究结果：BMI ≥30 kg/m²患者在ROM、KSS和FJS方面与BMI较低者表现相当。然而，肥胖组因机械失效导致的翻修率显著较高（2.99% vs. 0.42%，p=0.04）。除股骨外旋较少外，假体定位在两组间基本一致。

研究结论：FKP指导下的机器人辅助TKA能在肥胖患者中实现相似的功能恢复，说明该术式在解决解剖挑战方面有效。然而，肥胖仍是机械失效的重要风险因素。

Impact of High Body Mass Index on Functionally Aligned Image-Based Robotic Total Knee Arthroplasty: Comparable Functional Outcomes but Higher Mechanical Failures

Objectives: Increased body mass index (BMI) poses challenges in total knee arthroplasty (TKA), including higher complication rates. Functional knee positioning (FKP) with robotic assistance provides a personalized approach to optimize alignment and soft-tissue balance, but its impact on patients with increased BMI remains unclear. This retrospective comparative study aims to evaluate the influence of obesity and its severity on clinical outcomes and complications in TKA performed with an image-based robotic system guided by FKP principles.

Methods: This retrospective comparative study included 372 patients who underwent robotic-assisted TKA following FKP principles. Patients were stratified into two main groups based on BMI (<30 kg/m2; 238 patients and ≥30 kg/m2; 134 patients). Outcomes included Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM), implant positioning, and complications, evaluated at a minimum follow-up of two years.

Results: Patients with increased BMI (≥30 kg/m2) demonstrated similar functional outcomes to patients with BMI <30 kg/m2 in terms of ROM, KSS, and FJS. However, the revision rate due to mechanical failures was significantly higher in the obese group (2.99% vs. 0.42%, p=0.04; hazard ratio= 6.8; 95% CI, 1.09-42.31). Implant positioning was consistent across groups, except for reduced femoral external rotation in the increased BMI group (p= 0.004).

Conclusions: Robotic-assisted TKA with FKP principles achieves comparable functional outcomes for obese patients at a minimum of a 2-year follow-up, demonstrating the system's ability to address anatomical and functional challenges. However, obesity remains a critical risk factor for mechanical failures.

第二部分：保髋相关文献

文献1

亚洲人群髋关节发育不良患者PAO与THA术后倾向评分匹配比较

译者 罗殿中

背景：尚无研究针对亚洲人DDH继发OA进行PAO或THA患者满意度进行比较。

方法：对737例（251例PAO，486例THA）患者进行多元分析，以明确患者人口学特征和患者报告结果（PRO）是否与术后患者满意度有关。进而，对DDH继发OA患者PAO与THA行倾向评分匹配（K-L II级32例PAO、16例THA；K-L III级20例PAO、40例THA），比较患者术后满意度、牛津髋关节评分（OHS）、加利福尼亚大学-洛杉矶分校活动功能评分（UCLA）、运动参与度。

结果：在737例患者中，663例（93%）术后疗效满意。多元分析显示THA与患者满意度相关。进一步分析，术后OHS疼痛评分、OHS活动评分（OHS-ADL）、UCLA功能评分与满意度相关。在对PAO和THA进行倾向评分匹配患者中，K-L II级DDH继发OA患者PAO较THA满意度更高，表现在术后OHS（包括疼痛和ADL）、UCLA、和运动参与度方面；而K-L III级DDH继发OA患者THA较PAO满意度更高，表现在术后OHS-ADL、UCLA、和运动参与度方面。

结论：基于术前OA的程度，PAO和THA均取得患者满意度提高。这些发现有助于对中年有症状DDH患者手术治疗的临床决策。

译者注：PAO，髋臼周围截骨术；THA，人工全髋关节置换术；DDH，髋关节发育不良；OA，骨关节炎；K-L，Kellgren-Lawrence骨关节炎分级；ADL，日程活动能力。

图1. 本研究流程示意图（注意THA匹配人数是总人数的81/1025）。

A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort

Background:No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts.

Methods:Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients).

Results:Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries.

Conclusions:Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.

文献出处：Harada T, Hamai S, Shiomoto K, Hara D, Motomura G, Nakashima Y. A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort. Hip Int. 2023 Jul;33(4):743-751. doi: 10.1177/11207000221114272. Epub 2022 Jul 24. PMID: 35875941.

文献2

一种基于直接髋关节磁共振造影的髋关节软骨和盂唇自动三维分割的深度学习方法

译者 张振东

本研究目的是利用卷积神经网络（CNNs）基于三维MRI实现髋关节软骨和盂唇的自动分割。在这项回顾性单中心研究中，采用U-Net架构的卷积神经网络开发了一种基于MRI的髋关节软骨和盂唇全自动分割模型。

研究选取了2020年1月至2021年10月期间100名有症状患者的直接髋关节磁共振造影数据。常规扫描序列包含三维T1 mapping序列，该序列用于髋关节软骨和盂唇的手动分割。其中80个髋关节数据用于模型训练，剩余20个用于测试。模型性能通过六项评估指标进行验证，包括Dice相似系数（DSC，Dice相似系数是一种用于衡量两个样本相似度的统计指标，通常用于图像分析和医学图像处理，尤其是在分割任务中，它的值范围从0到1，其中：0 表示没有重叠，1 表示完全重叠）。此外，研究还使用来自其他机构的40名患者的三维T2加权序列组成的外部数据集测试模型性能。手动分割的评估者间一致性被作为自动分割性能的基准。

结果显示，共纳入100名患者（平均年龄30±10岁，女性占64%）。软骨分割的平均DSC为0.92±0.02（95%置信区间[CI] 0.92-0.93），盂唇为0.83±0.04（0.81-0.85），其表现与手动分割的评估者间一致性相当（p值分别为0.232和0.297）：手动分割的软骨DSC为0.93±0.04（0.92-0.95），盂唇为0.82±0.05（0.80-0.85）。在外部数据集测试中，软骨和盂唇的DSC分别为0.89±0.02（0.88-0.90）和0.71±0.04（0.69-0.73）。

研究表明，该深度学习方法能准确分割三维MRI序列中的髋关节软骨和盂唇，未来或可应用于临床实践，为快速生成精准的三维MRI模型提供支持。

A deep learning approach for automatic 3D segmentation of hip cartilage and labrum from direct hip MR arthrography

The objective was to use convolutional neural networks (CNNs) for automatic segmentation of hip cartilage and labrum based on 3D MRI. In this retrospective single-center study, CNNs with a U-Net architecture were used to develop a fully automated segmentation model for hip cartilage and labrum from MRI. Direct hip MR arthrographies (01/2020-10/2021) were selected from 100 symptomatic patients. Institutional routine protocol included a 3D T1 mapping sequence, which was used for manual segmentation of hip cartilage and labrum. 80 hips were used for training and the remaining 20 for testing. Model performance was assessed with six evaluation metrics including Dice similarity coefficient (DSC). In addition, model performance was tested on an external dataset (40 patients) with a 3D T2-weighted sequence from a different institution. Inter-rater agreement of manual segmentation served as benchmark for automatic segmentation performance. 100 patients were included (mean age 30 ± 10 years, 64% female patients). Mean DSC for cartilage was 0.92 ± 0.02 (95% confidence interval [CI] 0.92-0.93) and 0.83 ± 0.04 (0.81-0.85) for labrum and comparable (p = 0.232 and 0.297, respectively) to inter-rater agreement of manual segmentation: DSC cartilage 0.93 ± 0.04 (0.92-0.95); DSC labrum 0.82 ± 0.05 (0.80-0.85). When tested on the external dataset, the DSC was 0.89 ± 0.02 (0.88-0.90) and 0.71 ± 0.04 (0.69-0.73) for cartilage and labrum, respectively.The presented deep learning approach accurately segments hip cartilage and labrum from 3D MRI sequences and can potentially be used in clinical practice to provide rapid and accurate 3D MRI models.

文献出处：Meier MK, Helfenstein RA, Boschung A, Nanavati A, Ruckli A, Lerch TD, Gerber N, Jung B, Afacan O, Tannast M, Siebenrock KA, Steppacher SD, Schmaranzer F. A deep learning approach for automatic 3D segmentation of hip cartilage and labrum from direct hip MR arthrography. Sci Rep. 2025 Feb 7;15(1):4662. doi: 10.1038/s41598-025-86727-z. PMID: 39920175; PMCID: PMC11805980.

文献3

DDH骨化核是否出现与股骨头缺血坏死相关

译者 任宁涛

目的：本研究旨在评估DDH保守治疗时骨化核（ON）是否出现与AVN发生率的关系，迄今为止，ON 和 AVN 之间的相关性仍然不明确。

方法：选择2006年1月-2007年12月就诊于我院的148名患儿，共234例髋关节，根据超声检查，髋关节情况分为Graf IIIa, IIIb和IV型，患儿年龄>6个月时同时行标准的骨盆正位片。

结果：其中84例髋关节（35.9 %）在治疗时出现ON ，治疗初始年龄平均为5个月，先行牵引2周然后人类位石膏4周，后行Tübingen屈曲支具，最终随访时平均年龄为87个月，采用Ogden-Bucholz AVN 分型对最终随访时的影像学进行评估。小于10个月的患儿，AVN与ON(-)和ON (+)无关(P = 0.681)，然而当所有年龄组一起分析时，ON(+) 髋关节的 AVN 显着增加 (P = 0.002)。临床查体显示 ON(-) 组与 ON(+) 组在跛行、双下肢不等长和髋关节活动范围方面没有差异。

结论：无论骨化核是否出现，DDH治疗越早越好，复位不能晚于生后10个月，否则容易导致AVN发生率增加。

表1 各年龄段ON是否出现与AVN的关系

Correlation between avascular necrosis and the presence of the ossific nucleus when treating developmental dysplasia of the hip

Purpose: This study assessed whether avascular necrosis (AVN) is correlated with the presence or absence of the ossific nucleus (ON) at the initiation of conservative treatment for developmental dysplasia of the hip (DDH). To date, the correlation between the presence of the ON and AVN manifestations remains ambiguous.

Methods: The medical records of 148 patients with 234 dislocated hips who presented at our institution between January 2006 and December 2007 were reviewed. Based on ultrasound examination, the hips were classified according to Graf IIIa, IIIb, and IV criteria. Patients aged >6 months were simultaneously examined by standardized pelvis radiography.

Results: The ON was present in 84 hips (35.9 %) at the beginning of treatment. Treatment was begun at a mean age of 5 months, with overhead traction for 2 weeks followed by arthrography and a spica cast for 4 weeks. Afterwards, we used a Tübingen hip-flexion splint. The mean age at final follow-up was 87 months. Hips were radiographically evaluated at last follow-up according to the Ogden-Bucholz AVN classification scheme. There was no significant difference in AVN prevalence between ON(-) versus ON(+) hips in children aged ≤10 months (P = 0.681), whereas when all age groups were analyzed together, AVN was significantly increased in ON(+) hips (P = 0.002). Clinical examination revealed no differences in limping, leg length inequality, and range of motion of hips in the ON(-) versus ON(+) groups.

Conclusion: We conclude that DDH treatment should be performed early without regard to the presence or absence of the ON. Reduction should not be delayed beyond >10 months of age because any delay in treatment increases the incidence of AVN.

文献出处：Sabit Sllamniku, Cen Bytyqi, Ardiana Murtezani , Emir Q Haxhija. Correlation between avascular necrosis and the presence of the ossific nucleus when treating developmental dysplasia of the hip. J Child Orthop. 2013 Dec;7(6):501-5.

文献4

与酒精相关性股骨头坏死相比，糖皮质激素相关性股骨头坏死（GONFH）表现出更低的骨微结构硬化程度和更高的骨吸收活性

译者 李勇

背景： 糖皮质激素使用和酒精滥用是非创伤性股骨头坏死（ONFH）最广泛公认的危险因素。尽管糖皮质激素相关性ONFH（GONFH）和酒精相关性ONFH（AONFH）的病因不同，但关于这两种ONFH亚型在骨微结构和组织形态学特征上的差异知之甚少。

目的： 旨在研究GONFH和AONFH患者股骨头不同区域的骨微结构、骨重塑活性以及组织形态学特征。

方法： 从2015年9月至2020年10月，共招募了85名诊断为GONFH和AONFH的患者。股骨头标本在全髋关节置换术后获取。从42名GONFH患者（50个髋关节）和43名AONFH患者（50个髋关节）处获取了股骨头标本。使用Micro-CT评估股骨头9个感兴趣区域（ROIs）的微观结构。沿头尾方向（从上到下），将股骨头分为坏死区、反应界面区和正常区；沿内外侧方向，将股骨头分为内侧区、中央区和外侧区。随后进行脱钙和未脱钙骨组织学检查，以评估组织病理学改变和骨重塑水平。

结果： 在坏死区，大部分骨微结构参数在GONFH和AONFH之间没有显著差异；然而，在反应界面区和正常区，与AONFH相比，GONFH均显示出硬化程度较低的骨微结构和更高的骨重塑水平。尽管坏死区的病理表现相似，但GONFH坏死区的软骨下骨小梁微骨折更严重，反应界面区的血管更丰富。

结论： GONFH和AONFH在坏死区的骨微结构和组织病理学特征相似，而在反应界面区和正常区，GONFH则表现出硬化程度较低的骨微结构和更活跃的骨代谢状态。GONFH和AONFH在骨微结构和组织病理学特征上的这些差异，可能有助于针对不同病因制定改善ONFH病情的预防策略和治疗方法。

Less sclerotic microarchitecture pattern with increased bone resorption in glucocorticoid-associated osteonecrosis of femoral head as compared to alcohol-associated osteonecrosis of femoral head

BackgroundGlucocorticoid usage and alcohol abuse are the most widely accepted risk factors for nontraumatic osteonecrosis of femoral head (ONFH). Despite distinct etiologies between glucocorticoid-associated ONFH (GONFH) and alcohol-associated ONFH (AONFH), little is known about the differences of the microarchitectural and histomorphologic characteristics between these subtypes of ONFH.PurposesTo investigate bone microarchitecture, bone remodeling activity and histomorphology characteristics of different regions in femoral heads between GONFH and AONFH.MethodsFrom September 2015 to October 2020, 85 patients diagnosed with GONFH and AONFH were recruited. Femoral heads were obtained after total hip replacement. Femoral head specimens were obtained from 42 patients (50 hips) with GONFH and 43 patients (50 hips) with AONFH. Micro-CT was utilized to assess the microstructure of 9 regions of interest (ROIs) in the femoral head. Along the supero-inferior orientation, the femoral head was divided into necrotic region, reactive interface, and normal region; along the medio-lateral orientation, the femoral head was divided into medial region, central region and lateral region. Decalcified and undecalcified bone histology was subsequently performed to evaluate histopathological alterations and bone remodeling levels.

ResultsIn the necrotic region, most of the microarchitectural parameters did not differ significantly between GONFH and AONFH, whereas both the reactive interface and normal region revealed a less sclerotic microarchitecture but a higher bone remodeling level in GONFH than AONFH. Despite similar necrotic pathological manifestations, subchondral trabecular microfracture in the necrotic region was more severe and vasculature of the reactive interface was more abundant in GONFH.ConclusionsGONFH and AONFH shared similar microarchitecture and histopathological features in the necrotic region, while GONFH exhibited a less sclerotic microarchitecture and a more active bone metabolic status in both the reactive interface and normal region. These differences between GONFH and AONFH in bone microarchitectural and histopathological characteristics might contribute to the development of disease-modifying prevention strategies and treatments for ONFH, taking into etiologies.

文献出处：Chen Y, Miao Y, Liu K, Zhu B, Xue F, Yin J, Zou J, Li G, Zhang C, Feng Y. Less sclerotic microarchitecture pattern with increased bone resorption in glucocorticoid-associated osteonecrosis of femoral head as compared to alcohol-associated osteonecrosis of femoral head. Front Endocrinol (Lausanne). 2023 Mar 8;14:1133674. doi: 10.3389/fendo.2023.1133674. PMID: 36967755; PMCID: PMC10031038.

文献5

建立一种精准的术中替代技术用于测量股骨前倾角

译者 张利强

背景：在手术室中准确评估股骨前倾角颇具挑战性。我们评估了观察者是否能通过改良的C臂技术可靠且准确地判断出股骨颈何时平行于地面。我们将该技术与先前报道的用于术中测定股骨前倾角的改良Ogata-Goldsand技术进行了比较。

方法：为评估观察者能否判断出股骨颈何时与地面水平，我们对72具尸体股骨近端侧面进行拍摄，将股骨旋转以模拟从-20度到+20度、以5度为增量的前倾角变化。这些照片以网格布局排列，并通过3次随机化和盲法验证。5名研究者选择了他们认为最接近中立（0度）股骨前倾角的方位。然后，在手术室中对4具完整尸体进行了检查。采用改良C臂技术与改良Ogata-Goldsand 技术对每具全尺寸股骨尸体的股骨前倾角进行了评估，以广泛认可的Kingsley和Olmsted技术作为标准来测量股骨前倾角。

结果：在确定股骨颈中立位置时，观察者能够准确地确定0度前倾角，平均偏差为4.4±2.4度。改良C臂技术测量值与真实值的平均偏差为3.2±4.2度。改良的Ogata-Goldsand技术测量值与真实角度的平均偏差为2.3±2.6度。改良的C臂技术不同观察者之间的组内相关系数为0.82，与Kingsley和Olmsted方法作为标准相比为0.81，而改良的Ogata-Goldsand技术分别为0.72和0.90。

结论：观察者能够准确地感知股骨颈与虚拟地面平行的情况，这支持将此参数纳入改良C臂技术。改良C臂技术与改良Ogata-Goldsand技术相当。

临床意义：改良C臂技术相较于改良Ogata-Goldsand技术相对简单，这使得改良C臂技术成为术中测量股骨前倾角的一个合理补充选择。

关键词：术中技术、股骨前倾角、改良C臂技术

股骨近端标本 九张图像从-20度到+20度每次增加5度。在实际研究中，这9张图像是未标记的，并随机洗牌以进行有效性和可靠性测试

改良C臂技术。 A，定义膝关节正位片。 B，获取标准的髋关节侧位片，再将C臂推回膝关节，通过旋转C臂获取膝关节正位片与A图膝关节正位片匹配；C，通过读取C臂旋转角度获得前倾角度数。

改良Ogata-goldsand技术。 A，C臂位于膝盖平行的位置，以获得膝盖的真实侧面X射线，于股骨后方放置一不透X线针定义为水平面。 B，侧位X射线。股骨颈和不透X线针之间的角度是β角，。 C，通过从侧面旋转C-臂90度获得髋关节的前后（AP）X射线。 股骨颈和股骨轴之间的角度是α角。 D，尸体标本演示了图3B中的射线照相方法

Kingsley-Olmsted技术。股骨髁的后方和大转子后方置于桌子上。 获得股骨颈从近端到远端的轴向图像，其中股骨颈和桌子表面之间的角度代表股骨前倾角。

Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version

Background: Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version.

Methods: To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from −20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version.

Results: In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique.

Conclusions: Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique.

Clinical Relevance: The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version.

文献出处：Yao B, Li D, Cui J, Smith KL, Tyagi V, Kahan JB, Nicholson AD, Smith BG, Liu R, Cooperman DR. Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version. J Pediatr Orthop. 2025 Mar 21. doi: 10.1097/BPO.0000000000002920. Epub ahead of print. PMID: 40126881.

文献6

双侧髋臼周围截骨术后，代偿性骨盆前倾是否会减小？

译者 陶可

背景：腰椎、骨盆倾斜和髋关节之间存在动力学联系，但这种关系在髋关节发育不良患者中仍需进一步研究。一些前期报告表明，患者可能会通过骨盆前倾增加来代偿髋关节包容不足；目前尚不清楚这种关系是否会受到髋臼截骨重新定向的影响。

问题/目的：(1)与双侧髋臼周围截骨术(PAO)后至少6个月拍摄的图像相比，术前拍摄的站立位骨盆正位X线片上代偿性骨盆倾斜是否会减小？(2)改良的骨盆倾斜替代测量指标——耻骨联合至骶髂关节指数(PS-SI)——是否与可以直接测量骨盆倾斜的物理合成骨模型相关？(3) PS-SI指数是否具有较高的评估者间信度？

方法：我们评估了一位手术医生参与的ANCHOR注册系统的手术记录，该记录涵盖了2007年至2016年期间接受分期双侧PAO第二侧手术的患者，共计113例。其中，70例（62%）在第二次PAO后6个月内失访或未进行充分的影像学检查，另有3例（3%）因预先设定的原因被排除，剩余40例（35%）用于本回顾性研究的评估。我们采用术前站立位和术后近期正位骨盆X线片测量Tönnis角、前壁指数、后壁指数、外侧中心边缘角、耻骨联合至骶尾关节连接处距离以及PS-SI指数。最近的X线片拍摄于第二次PAO后平均16 ± 6个月。我们选择6个月作为最短时间点，因为此时大多数患者已达到最大临床改善，不再受术后肌肉功能障碍的限制。使用组内相关系数(ICC)进行统计分析，以评估评级者间信度，并使用配对t检验评估术前和术后测量值的变化。此外，使用物理合成骨模型创建了一个可以直接测量骨盆倾斜度的模型。该模型通过双侧髋臼固定在支架上，并旋转使骨盆倾斜度增加5°。在每个时间点拍摄前后位骨盆X线片，测量PS-SI指数，并进行回归分析以评估趋势。

结果：总体而言，40例患者中37名（93%）的骨盆倾斜度有所下降（以PS-SI指数衡量）。用 PS-SI指数测量的骨盆倾斜平均量在术后有所减少，将术前和术后最新的X线片结果进行比较（97 ± 14 毫米对比89 ± 13 毫米，均差8 ± 9毫米；95%置信区间，-11至-5；范围：17增加至24减少，p < 0.001）。在合成骨验证模型中，骨盆倾斜与PS-SI指数呈线性关系（PS-SI 指数 = 5.0° + 3.6°倾斜，R = 0.99）。最后，术前(ICC = 0.986)和术后(ICC = 0.988)的PS-SI指数的评级者间信度均极佳。

结论：我们发现双侧PAO后骨盆前倾略有减少。这一发现表明髋臼截骨后重新定向会影响骨盆位置。在临床实践中，髋关节发育不良患者可能通过骨盆倾斜的动态且可逆性变化进行代偿。PS-SI指数是一种可重复的工具，用于测量骨盆入口高度并评估骨盆倾斜。未来的临床研究应评估这些放射影像学发现的临床意义，包括对腰背痛的评估，尽管腰背痛可能受骨盆倾斜影响，但其影响因素可能多种多样。

Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Background: The kinetic link among the lumbar spine, pelvic tilt, and the hip has been hypothesized, but this relationship requires further study in acetabular dysplasia. Anecdotal reports suggest that patients may compensate for acetabular dysplasia with an involuntary increase in anterior pelvic tilt; it is not known if this relationship is affected by acetabular reorientation.

Questions/purposes: (1) Does compensatory pelvic tilt decrease on preoperatively obtained standing AP pelvis radiographs compared with those obtained at a minimum of 6 months after bilateral periacetabular osteotomy (PAO)? (2) Does a modified surrogate measurement of pelvic tilt, the pubic symphysis to sacroiliac (PS-SI) index, correlate with a physical synthetic bones model in which pelvic tilt can be directly measured? (3) Can the PS-SI index demonstrate high interrater reliability?

Methods: We assessed the surgical records of one surgeon, who participates in the longitudinally maintained Academic Network of Conservational Hip Outcomes Research (ANCHOR) registry, for patients who had undergone the second side of a staged bilateral PAO between 2007 and 2016; there were 113 such patients. Of those, 70 (62%) were lost to followup within 6 months of the second PAO or did not have adequate imaging studies, and another three (3%) were excluded for prespecified reasons, leaving 40 (35%) for evaluation in this retrospective study. Standing preoperative and most recent postoperative AP pelvis radiographs were used to measure the Tönnis angle, anterior wall index, posterior wall index, lateral center-edge angle, pubis symphysis-to-sacrococcygeal junction distance, and the PS-SI index. The most recent radiographs were obtained at a mean of 16 ± 6 months after the second PAO. We chose 6 months as the minimum because at this time point, the majority of patients have reached their maximum clinical improvement and are no longer limited by postoperative muscle dysfunction. Statistical analysis was performed using the intraclass correlation coefficient (ICC) for interrater reliability and paired t-tests for assessing change in measurements from pre- to postoperative. Additionally, a model was created using a physical synthetic bones model in which pelvic tilt could be directly measured. This model was secured through bilateral acetabuli on a mount and rotated through 5° increases in pelvic tilt. AP pelvis radiographs were obtained at each point, the PS-SI index was measured, and a regression analysis performed to evaluate for trend.

Results: Overall, 37 of 40 patients (93%) had a decrease in pelvic tilt, as measured by the PS-SI index. The mean amount of pelvic tilt as measured by the PS-SI index decreased after surgery when comparing the preoperative with latest radiographs on this parameter (97 ± 14 mm versus 89 ± 13 mm, mean difference 8 ± 9 mm; 95% confidence interval, -11 to -5; range 17 increase to 24 decrease, p < 0.001). A linear relationship between pelvic tilt and PS-SI index (PS-SI index = 5.0° + 3.6° tilt, R = 0.99) was identified in the synthetic bones validation model. Finally, the interrater reliability was found to be excellent for the PS-SI index preoperatively (ICC = 0.986) and postoperatively (ICC = 0.988).

Conclusions: We found a modest reduction in anterior pelvic tilt after bilateral PAO. This finding suggests that acetabular reorientation affects pelvic position. In clinical practice, patients with acetabular dysplasia may compensate with dynamic and reversible changes in pelvic tilt. The PS-SI index is a reproducible tool to measure the height of the pelvic inlet as an assessment of pelvic tilt. In the future, clinical studies should evaluate the clinical implications of these radiographic findings, including the assessment of back pain, which although multifactorial may be influenced by pelvic tilt.

文献出处：Erika Daley, Nickolas Nahm, Denise Koueiter, Ira Zaltz. Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy? Clin Orthop Relat Res. 2019 May;477(5):1168-1175. doi: 10.1097/CORR.0000000000000560.

文献7

John Charnley奖：定量透视成像工具提升髋臼周围截骨术中骨块定位精度

译者 邱兴

背景：髋臼周围截骨术（PAO）中髋臼骨块位置的影像学评估与髋关节存活率密切相关。传统术中平片检查耗时耗力，而透视成像可能因图像失真影响测量精度。本研究旨在验证使用具有失真校正功能的透视测量工具是否能改善PAO术中测量效果。

方法：通过回顾性分析570例PAO手术病例（其中136例使用失真校正透视工具，434例为采用常规透视技术的历史对照），分别在术前站立位X线片、术中透视图像和术后站立位X线片上测量外侧中心边缘角（LCEA）、髋臼指数（AI）、后壁征（PWS）和前中心边缘角（ACEA）。设定矫正目标区间为：AI 0～10°、ACEA 25～40°、LCEA 25～40°、PWS阴性。分别采用卡方检验和配对t检验比较术后矫正达标率及患者报告结局。

结果：矫正后透视测量与术后6周X线测量平均差异为：LCEA 0.21°、ACEA 0.01°、AI -0.07°（均P < 0.01），PWS一致性达92%。新型透视工具显著提升各参数达标率：LCEA从74%提升至92%（P < 0.01），ACEA从72%提升至85%（P < 0.01），AI达标率69% vs 74%（P = 0.25），但PWS无显著改善（85% vs 85%，P = 0.92）。除PROMIS心理健康评分外，所有患者报告结局均有显著改善。

结论：本研究表明采用定量透视实时测量系统可显著提升PAO术中测量精度和矫正目标达成率。该增效工具在不干扰手术流程前提下，为术者提供可靠的定量矫正评估。

John Charnley Award: A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy

Background: Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets.

Methods: We retrospectively reviewed 570 PAOs; 136 PAOs utilized a distortion correcting fluoroscopic tool, and 434 PAOs performed with routine fluoroscopy, prior to this technology. Lateral center-edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center-edge angle (ACEA) were measured on preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs. Defined target zones of correction were AI: 0-10°, ACEA: 25-40°, LCEA: 25-40°, PWS: negative. Postoperative correction in zones and patient-reported outcomes were compared using chi-square tests and paired t-tests, respectively.

Results: The average difference between postcorrection fluoroscopic measurements and 6-week postoperative radiographs was 0.21° for LCEA, 0.01° for ACEA, and -0.07° for AI (all P < .01). The PWS agreement was 92%. The percentages of hips meeting target goals overall improved with the new fluoroscopic tool: 74%-92% for LCEA (P < .01), 72%-85% for ACEA (P < .01), and 69 versus 74% for AI (P = .25), though there was no improvement in PWS (85 versus 85%, P = .92). All patient-reported outcomes except PROMIS Mental Health were significantly improved at most recent follow-up.

Conclusions: Our study demonstrated improved PAO measurements and target goals with the use of a distortion correcting quantitative fluoroscopic real-time measuring device. This value-additive tool gives reliable quantitative measurements of correction without interfering with surgical workflow.

Keywords: acetabular dysplasia; computer-assistance; fluoroscopic distortion; hip preservation; periacetabular osteotomy.

文献出处： Anderson L , Erickson J , Kapron C R ,et al.A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy.[J]. The Journal of arthroplasty, 2023.DOI:10.1016/j.arth.2023.03.052.

文献8

人类髋关节髋臼盂唇的三维结构

译者 徐子茵

随着年龄的增长，髋臼盂唇经常受损。由于胶原纤维是力量的主要来源，了解其超微结构对于确定年龄引起的变化的原因非常重要。

目的：利用扫描电镜观察构成髋臼盂唇胶原纤维的超微结构。研究了全髋关节置换术中获得的髋臼盂唇样本。在光镜和扫描电镜下观察构成盂唇的胶原纤维的立体结构。盂唇主要由软骨组织组成，软骨组织由软骨细胞和II型胶原组成，并有一层I型胶原。成人中，细胞质丰富的软骨细胞被致密的II型胶原纤维网络包围，软骨层中穿插着小束的I型胶原原纤维。在老年人中，软骨细胞萎缩，I型和II型胶原纤维稀疏。我们认为软骨有三到五层，由I型和II型胶原原纤维与固体软骨基质组成。在老年人中，软骨细胞密度降低，胶原原纤维的细胞形状和结构也发生变化。

Three‑dimensional architecture of the acetabular labrum in the human hip joint

The acetabular labrum is frequently damaged with advancing age. As collagen fibers are the main sources of strength, knowledge of their ultrastructure is important to determine the cause of age-induced changes. We aimed to investigate the ultrastructure of collagen fibers constituting the acetabular labrum using scanning electron microscopy (SEM). Acetabular labrum samples obtained during total hip arthroplasty were studied. The samples were specially prepared to observe the steric construction of collagen fibrils constituting the acetabular labrum under light microscopy followed by SEM. The acetabular labrum was mostly composed of cartilage tissue, consisting of chondrocytes and collagen type II, with a layer of collagen type I. In adults, chondrocytes with a rich cytoplasm were surrounded by a dense network of fine type II collagen fibrils, and small bundles of type I collagen fibrils were interposed in the cartilage layer. In elderly individuals, the chondrocytes atrophied and both type I and II collagen fibrils were sparse. We suggest that cartilage has three to five layers, consisting of type I and type II collagen fibrils with a solid cartilage substrate. In elderly individuals, the density of chondrocytes decreases and the cellular shape and architecture of collagen fibrils also changes.

文献来源：Nogami R, Kaku N, Shimada T, Tabata T, Tagomori H, Tsumura H. Three-dimensional architecture of the acetabular labrum in the human hip joint. Med Mol Morphol. 2020 Mar;53(1):21-27. doi: 10.1007/s00795-019-00228-3. Epub 2019 May 29. PMID: 31144043.

文献9

症状性髋关节发育不良和股骨髋臼撞击患者胫骨和股骨扭转联合异常的患病率

译者 陈志强

目的：股骨髋臼撞击（FAI）和髋关节发育不良患者股骨扭转（FT）和胫骨扭转（TT）合并异常的患病率尚不清楚。本研究旨在确定FT和TT联合异常的患病率，以及哪些亚组与FT和TT联合异常相关。

方法：我们回顾性评估了2011年9月至2016年9月期间进行CT扫描的有症状的FAI或髋关节发育不良患者。共有261例髋关节（174例患者）测量了FT和TT。平均年龄为31岁（SD 9），63%为女性（165髋）。将患者与无症状对照组（48例髋关节，27例患者）进行比较，对照组有包括股骨和胫骨在内的CT扫描可供分析，这些扫描是出于非骨科原因获得的。使用Bonferroni校正的方差分析进行比较。

结果：在整个研究组中，62%（163髋）存在FT异常。42%（109例髋关节）存在异常TT。21%（55个髋关节）则为正常FT和正常TT。最常见的异常组合是FT增加和TT正常，占32%（84例髋关节）。在髋关节发育不良组中，21%（11个髋关节）的FT增加伴TT增加。FT异常的患病率在各亚组之间差异显著（p < 0.001）。我们发现髋关节发育不良（31°; SD 15）°和髋关节外翻（42°（SD 12°））的平均FT显著高于对照组（22°（SD 8°））。我们发现，与对照组（28°（SD 8°））相比，凸轮型髋关节FAI（34°（SD 6°））和髋关节发育不良（35°（SD 9°））的平均TT显著更高（p < 0.001）。

结论：FAI患者FT和TT联合异常的发生率较高。对于髋关节发育不良，我们发现平均FT和TT显著更高，而21%的患者（11髋）合并TT增加和FT增加（合并扭转对线不良）。这在计划保髋手术（如髋臼周围截骨术和股骨去旋转截骨术）时很重要。

Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement

Aims：The prevalence of combined abnormalities of femoral torsion (FT) and tibial torsion (TT) is unknown in patients with femoroacetabular impingement (FAI) and hip dysplasia. This study aimed to determine the prevalence of combined abnormalities of FT and TT, and which subgroups are associated with combined abnormalities of FT and TT.

Methods ：We retrospectively evaluated symptomatic patients with FAI or hip dysplasia with CT scans performed between September 2011 and September 2016. A total of 261 hips (174 patients) had a measurement of FT and TT. Their mean age was 31 years (SD 9), and 63% were female (165 hips). Patients were compared to an asymptomatic control group (48 hips, 27 patients) who had CT scans including femur and tibia available for analysis, which had been acquired for nonorthopaedic reasons. Comparisons were conducted using analysis of variance with Bonferroni correction.

Results： In the overall study group, abnormal FT was present in 62% (163 hips). Abnormal TT was present in 42% (109 hips). Normal FT combined with normal TT was present in 21% (55 hips). The most frequent abnormal combination was increased FT combined with normal TT of 32% (84 hips). In the hip dysplasia group, 21% (11 hips) had increased FT combined with increased TT. The prevalence of abnormal FT varied significantly among the subgroups (p < 0.001). We found a significantly higher mean FT for hip dysplasia (31°; SD 15)° and valgus hips (42° (SD 12°)) compared with the control group (22° (SD 8°)). We found a significantly higher mean TT for hips with cam-­type-­FAI (34° (SD 6°)) and hip dysplasia (35° (SD 9°)) compared with the control group (28° (SD 8°)) (p < 0.001).

Conclusion： Patients with FAI had a high prevalence of combined abnormalities of FT and TT. For hip dysplasia, we found a significantly higher mean FT and TT, while 21% of patients (11 hips) had combined increased TT and increased FT (combined torsional malalignment). This is important when planning hip preserving surgery such as periacetabular osteomy and femoral derotation osteotomy.

文献出处：Lerch TD, Liechti EF, Todorski IAS, Schmaranzer F, Steppacher SD, Siebenrock KA, Tannast M, Klenke FM. Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement. Bone Joint J. 2020 Dec;102-B(12):1636-1645. doi: 10.1302/0301-620X.102B12.BJJ-2020-0460.R1. PMID: 33249913.

来源：304关节学术

作者：304关节团队

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