髋膝关节文献精译荟萃（第343期）

本期目录：

1、胫骨高位截骨术与单间室膝关节置换术治疗年轻患者Kellgren-Lawrence3-4级膝骨关节炎：根据骨关节炎级别和性别进行调整后发现患者‑报告的疗效都获得了改善

2、Legg-Calvé-Perthes病患者成年后骨盆倾斜的影响因素及其对全髋关节置换术的作用

3、游标卡尺手工验证运动学对线全膝关节置换术中股骨截骨的准确性与精确性

4、采用克氏针固定与螺钉固定效果相当：PAO中期随访

5、髋关节发育不良的诊断和治疗：从Y形软骨闭合到青年期

6、股骨颈前倾角

7、机器人辅助联合增强现实（AR）导航系统在髋臼周围截骨术中的应用

第一部分：关节置换及保膝相关文献

文献1

胫骨高位截骨术与单间室膝关节置换术治疗年轻患者Kellgren-Lawrence3-4级膝骨关节炎：根据骨关节炎级别和性别进行调整后发现患者‑报告的疗效都获得了改善

译者 张轶超

目的：以往比较胫骨高位截骨术（HTO）与单间室膝关节置换术（UKA）的研究很少考虑到两组患者的不同特征。本研究比较了HTO和UKA患者报告的预后结果（PROs），并根据术前PROs、骨关节炎等级和性别进行了调整。

方法：回顾性分析术前、术后6个月、12个月和24个月前瞻性收集的PROs，即牛津膝关节评分（OKS）和疼痛/满意度评分。纳入2016-2019年一系列内侧开放楔形HTO和内侧UKA病例，术前kellgren - lawrence评分≥3，年龄50-60岁。采用线性混合模型，以OKS随时间的变化作为主要结果进行分析。

结果：我们纳入84名HTO患者（平均年龄55.0±3.0，男性占79%，平均BMI 27.8±3.4，kellgreen - lawrence 3级占75%）和130例UKA患者（平均年龄55.7±2.8，男性47%，平均BMI 28.7±4.0，kellgreen - lawrence 3级36%）。所有时间点的回应率均≥87%。校正术前PROs、kellgreen - lawrence分级和性别后，HTO组的OKS随时间变化比UKA组低2.5点（95% CI 1.0-4.0） （p=0.001）。静止时和活动时HTO组的疼痛数字评定量表得分(NRS；0 ~ 10分）都更高（p<0.01）。随着时间的推移，HTO组EQ- 5D描述系统（p<0.01）、NRS满意度（p<0.01）、Anchor功能和疼痛评分（p<0.01）都会降低。

结论：随着时间的推移，UKA患者的OKS评分、疼痛和满意度评分均优于HTO患者。然而，观察到的差异低于他们建立的最小临床重要差异标准。因此，从患者的角度来看，在本研究概述的适应征下，HTO并不逊于UKA。

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

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

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

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

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

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

文献2

Legg-Calvé-Perthes病患者成年后骨盆倾斜的影响因素及其对全髋关节置换术的作用

译者 张蔷

背景：本篇文章的目的是分析Legg-Calvé-Perthes病（LCPD，儿童股骨头坏死）患者成年后进行全髋关节置换术（THA）之前骨盆的倾斜程度，以及术后前两年的变化情况，并鉴别其影响因素。

方法：我们回顾性收集了某医院2012年至2021年间所有带有LCPD幼年患病史的THA手术病例。并根据手术时年龄、性别和BMI按照1:1的病例选择了同样数量的因原发性骨关节炎（OA）而施行THA手术的病例。THA手术时平均年龄47岁（21-91岁），其中18例（64.3%）为男性。我们的随访时间为5.1年（2-10.1年）。在术后6周、12周、1年和2年时，我们分别评估了假体位置、软组织平衡以及骨盆倾斜度。最终入组了28髋（25名患者）的LCPD组病例和28髋的原发OA组病例。

测量骨盆倾斜度的方法：正位骨盆X光片上，倾斜度为相框边缘的平行线和双侧泪滴下缘连线之间的夹角。

结果：两组病例术后6周时的骨盆倾斜度均较术前有显著增加（3.6±2.8°至4±3.2°和1.3±1.2°至1.8±1.5°），而在术后12周、1年和2年随访时逐渐降低，最终倾斜度为LCPD组 2.2±1.5°和OA组 0.8±0.7°。而只有LCPD组的术前倾斜度与术后双下肢体长度差异增加（Rho=0.41）和股骨偏心距降低（Rho=-0.26）相关（P < 0.05）。

结论：与原发骨关节炎患者相比，有幼年LCPD病史的病例骨盆倾斜度更大，且与术后更大的肢体长度差异和更小的股骨偏心距存在相关性。对这些患者而言，THA手术会降低术后2年时的骨盆倾斜度，但在第一周会增加骨盆倾斜度，原因可能是外展肌的短缩，因此应在术前告知患者。

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

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

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

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

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

文献3

游标卡尺手工验证运动学对线全膝关节置换术中股骨截骨的准确性与精确性

译者 沈松坡

引言：在全膝关节置换术（TKA）中，截骨的准确性与精确性对于避免假体位置异常至关重要。位置不佳可能导致假体组件磨损、疼痛和不稳定性，进而降低患者满意度和假体存活率。尽管技术辅助的TKA技术旨在提升准确性，但其成本高、手术时间长，且临床效果不一。游标卡尺验证的运动学对线（KA）TKA通过精确测量截骨厚度以匹配假体厚度，力求恢复关节线。本研究评估了使用手动器械进行游标卡尺验证KA-TKA的准确性与精确性。我们假设该技术可实现高水平的准确性与精确性，实际与目标的远端与后部股骨截骨平均绝对差值不超过0.5毫米。

方法：385名连续患者接受了使用游标卡尺手共器械进行验证、非限制性的KA-TKA。通过游标卡尺测量远端内侧（DM）、远端外侧（DL）、后部内侧（PM）和后部外侧（PL）股骨髁的截骨厚度，并将其与根据软骨磨损程度、锯片切口宽度和股骨组件厚度所设定的目标值进行比较。

结果：DM、DL、PM 和 PL截骨的实际与目标厚度的平均差值分别为 0.1 ± 0.2 毫米、0.1 ± 0.3 毫米、0.3 ± 0.5 毫米和 0.2 ± 0.4 毫米（均值 ± 标准差）。绝大多数截骨与目标差值在 0.5 毫米以内：DM 97.7%，DL 94.5%，PM 85.7%，PL 89.4%。

结论：游标卡尺手工验证的KA-TKA在股骨截骨方面实现了极高的准确性与精确性，其平均绝对差值为0.175毫米。这种简洁、合理、高效且可复制的手术技术，或可作为考虑使用技术辅助选项（如患者特异性器械或机器人辅助手术）的外科医生的替代方案，尤其适用于无法获取这些高科技手段的环境。

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

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

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

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

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

第二部分：保髋相关文献

文献1

采用克氏针固定与螺钉固定效果相当：PAO中期随访

译者 罗殿中

背景：对髋臼周围截骨（PAO）的理想固定方法存在争议。有描述改良克氏针固定方法安全、可行，但采用克氏针固定的患者缺乏临床随访证据。

目的：针对PAO术中采用克氏针固定患者，评估患者报告表（PROMs），并与螺钉固定技术进行对比。

方法：自2015年1月至2017年7月，在一所大学医疗中心，共有202例连续进行PAO手术患者纳入本研究。最后有120例PAO患者完成资料搜集。PAO行克氏针固定（n=63）与螺钉固定（n=57）进行比较。对PROMs评估包括：国际髋关节临床效果表（iHOT-12）、客观髋关节评分（SHV）、及UCLA运动功能评分（UCLA）。同时评估疼痛、和患者满意度（NRS）。保髋率定义为未转换成全髋关节置换（THA）的比例。

结果：术前两组方法之间PROMs基线相同。两组之内，术后PROMs（p<0.001）、和疼痛（p<0.001）显著改善。两组之间术后功能评分相似：iHOT-12（71.8 ± 25.1 vs. 73 ± 21.1; p = 0.789）、SHV（77.9 ±21.2 vs. 82.4 ±13.1; p = 0.192）、UCLA（6.9 ± 1.6 vs. 6.9 ±1.9; p = 0.909）、疼痛（2.4 ±2.1 vs. 2.0 ±2.1; p = 0.302）。患者满意度两组之间无明显差别（7.6 ±2.6 vs. 8.2 ± 2.2; p = 0.170）。两组转为THA均较少（2例vs. 0例，p = 0.497）。

结论：在中期随访中，PAO采用克氏针固定可获得与螺钉固定相当的良好效果。PAO手术固定时，克氏针固定技术可作为备选项。

图1. （a）PAO术前骨盆前后位片；（b）PAO术后前后位片，采用克氏针固定。

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

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

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

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

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

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

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

文献2

髋关节发育不良的诊断和治疗：从Y形软骨闭合到青年期

译者 任宁涛

目前对发育成熟的髋关节因髋关节发育不良而诱发疼痛症状的的治疗主要是选择髋臼方向的纠正。在机械负荷方面，髋臼方向的矫正手术试图改善股骨头和髋臼透明软骨的解剖位置。由于伯尔尼髋臼周围截骨术是一种多方位的髋臼方向矫正技术，因此了解该手术入路和熟悉最佳矫正标准有助于获得最佳的手术矫正。股骨近端有时也伴有髋关节发育不良的特征，可能同时需要手术矫正。改善头颈偏心距以避免股骨髋臼撞击已成为许多髋臼周围截骨治疗的常规。此外，股骨转子间截骨术有助于改善关节匹配，恢复股骨颈的正常角度。其他新的外科技术可对严重股骨头畸形进行修正，进行相对的股骨颈颈部延长，以及大转子的移位和修整。越来越多的研究报道了髋臼旋转手术后良好的长期结果，预期保髋率在10年随访时为80%至90%，在20年随访时为60%至70%。理想的患者年龄为小于30岁，术前无骨关节炎症状。在20年的随访中，这些患者的关节保存率约为90%。最近的证据表明，对非球形股骨头进行额外的矫正可能会进一步改善结果。

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

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

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

文献3

股骨颈前倾角

译者 陶可

股骨颈前倾角是股骨颈与股骨干之间的夹角，提示股骨的扭转程度。股骨颈前倾角的差异会通过改变力臂长度和关节负荷等因素影响髋关节的生物力学。与股骨颈前倾角相关的步态改变也可能导致多种骨骼疾病，包括骨关节炎。在看似健康的成年人中，股骨颈前倾角的差异可达30°。股骨颈前倾角在妊娠期（胎儿阶段）大幅增加，之后稳步下降直至正常。有证据表明，成年期至老年期，股骨颈前倾角会以较低的速度逐步下降，但其机制尚未研究。股骨颈前倾角的形成似乎受到日常运动中所受到的机械压力的影响。运动受损群体（如臀位儿童或患有脑瘫等神经肌肉疾病的个体）的股骨颈前倾角存在巨大差异。可以使用多种方法来评估股骨颈前倾角，同一人的股骨颈前倾角值可能相差高达20°。虽然MRI和CT已在临床上使用，但其成本、扫描时间和电离辐射等限制限制了它们的适用性，尤其是在儿童中。虽然存在超声等方法，但它们的可靠性和有效性较差。这些问题凸显了对一种有效、可靠且普遍接受的方法的需求。临床上异常的股骨颈前倾角的治疗通常是去旋转截骨术，非手术方法没有任何效果。尽管有观察性证据表明体育活动对股骨颈前倾角发展有影响，但有针对性的体育活动的功效仍未被探索。本综述的目的是描述股骨颈前倾角的生物力学和临床结果、影响股骨颈前倾角的因素以及用于评估股骨颈前倾角的不同方法的优缺点。

图1 股骨及股骨颈前倾角(FNA)的轴位示意图。灰色区域代表股骨颈，白色区域代表股骨内外侧髁。

图2 骨骺生长板：13岁尸体股骨近端X线摄影和计算机断层扫描(CT)。上图为冠状面视图，下图为轴向视图(Kandzierski等，2012)。

图3 不同妊娠阶段胎儿股骨颈前倾角(FNA)的平均值和标准差。下图显示不同发育阶段（12周至足月）的典型胎儿股骨样本照片。图片改编自Walker和Goldsmith (1981)

图4 不同研究者测量的不同年龄段儿童股骨颈前倾角的平均值及正常限值（Shands和Steele，1958；Fabry等，1973；Tönnis 和 Heinecke，1991）。

图5 脑瘫(CP)儿童和正常发育对照儿童在生长发育过程中的股骨颈前倾角(FNA)，以平均值和标准差表示。改编自Bobroff等人，1999年 (Bobroff et al., 1999)

图6上图：不同股骨颈前倾角(FNA)评估方法示例及其对评估几何形状的影响：A、B、C、D、E为横向切片法(Hernandez et al., 1981; Murphy et al., 1987; Yoshioka et al., 1987; Waidelich et al., 1992; Jarrett et al., 2010)，F和G为斜向切片法(Yoshioka et al., 1987; Jarrett et al., 2010)。

下图显示了冠状位中切片的位置。H表示所有方法均以股骨颈后髁线为参考线。该图来自Kaiser等(2016)。

下图：左图为股骨近端和远端的叠加图。穿过股骨颈的线条表示沿股骨干轴线看去的不同颈轴和桌面髁轴：“颈”指的是Berryman方法（Berryman et al., 2014），这是一种半自动方法，它考虑了股骨头中心、股骨颈底部和股骨颈点群。Lee（Lee et al., 2006）2D方法在一个轴向切片上使用一条直线连接股骨头中心和大转子最头侧连接处。Reikeras（Reikerås et al., 1983）方法使用一条线连接一个切片上的股骨头中心和另一个切片上的股骨颈中心，该切片的股骨颈后缘和前缘平行。Murphy（Murphy 等人，1987）使用一条线连接一个轴向切片上的股骨头中心和另一个轴向切片上的股骨颈底部中心。图片来自Berryman等（2014）。右图：第1列轴向切片为头侧方向，第2列轴向切片穿过股骨颈中心，第3列轴向切片穿过股骨颈底部，剩余股骨头。A行颈轴定义为股骨头中心和股骨颈中心。B行颈轴定义为连接股骨颈宽度两个中心的线；I 上方的C行是连接股骨头和大转子外缘的线，下方的线是超声检查中股骨颈的前缘。

Femoral anteversion: significance and measurement

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

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

文献4

机器人辅助联合增强现实（AR）导航系统在髋臼周围截骨术中的应用

译者 邱兴

髋臼周围截骨术（PAO）是治疗发育性髋关节发育不良（DDH）的有效术式。然而由于髋关节周围解剖结构复杂且术中术野（FoV）受限，临床操作难度较高。为此，本研究提出一种机器人辅助联合增强现实（AR）导航系统，其核心组件包括机械臂、光学定位仪及微软HoloLens 2头显设备（该设备系新型光学透视式头戴显示器OST-HMD）。在AR引导方面，开发了基于光学标记物的空间配准算法，实现光学定位坐标系（COS）至虚拟空间的坐标转换，确保虚拟模型与实体解剖结构的精准叠加。针对截骨操作，系统可自动将骨锯与术前规划的截骨平面对齐，通过虚拟运动约束机制限制骨锯偏移，并借助AR技术提供无视觉切换的实时导航反馈，显著提升手术精度与安全性。实验结果表明：所提出的AR配准方法平均绝对距离误差（mADE）为1.96 ± 0.43 mm；机器人系统中心平移误差0.96 ± 0.23 mm，最大距离误差1.31 ± 0.20 mm，角度偏差3.77 ± 0.85°，验证了该导航系统具有可靠的配准精度与截骨精度。

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

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

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

来源：304关节学术

作者：304关节团队

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