髋膝关节文献精译荟萃（第362期）

本期目录：

1、单间室膝关节置换术的翻修：系统性回顾

2、无感染情况下股骨颈骨折髋关节置换术后C反应蛋白的自然变化趋势

3、初次全髋或全膝关节置换术后10年平均BMI并无显著变化

4、成人重建专科医师培训与全膝关节置换术后两年内并发症减少相关

5、婴幼儿晚期髋脱位的相关风险因素和特点

6、开放手术和关节镜手术治疗股骨髋臼撞击症：当前概念的综述

7、青少年患者前交叉韧带与半月板伴发损伤时前交叉韧带重建与半月板自发愈合的时机

8、髋臼覆盖特征在髋关节发育不良患者中存在哪些性别差异？

9、95°角钢板在复杂股骨近端骨折治疗中的疗效分析

第一部分：

关节置换及保膝相关文献

文献1

单间室膝关节置换术的翻修：系统性回顾

译者 张轶超

背景：单间室膝关节置换术（UKA）是一种治疗单侧间室骨关节炎的外科手术，最常见的是膝关节内侧间室。本系统综述探讨了UKA翻修的原因。令我们感兴趣的是在长期和中期随访中，明确其翻修率、翻修时间和最常见的翻修原因。

方法：本研究按照2020 PRISMA声明进行。在2024年10月，访问了以下数据库：PubMed， Web of Science，谷歌Scholar和Embase。我们查阅了所有讨论UKA翻修率和原因的临床研究。只入选了至少随访10年的研究。

结果：收集了56项研究（13540例患者）的数据。其中，女性占65.6%。平均随访时间13.1±3.0年。患者平均年龄为65.6±5.6岁，平均BMI为28.5±2.2 kg/m2。8.8%（30140例中的2641例）的UKA进行了修复。从手术到翻修的平均时间为6.5±2.6年（范围：2.5 ~ 13.0）年。

结论：8.8%（2641 / 30140）的UKA在平均6.5±2.6年的时间内被翻修。

表 总体结果（二分值是根据给定分析考虑的纳入研究中报告的累积事件和观察的实际数量予以加权）

Revision of unicompartmental knee arthroplasty: a systematic review

Background：Unicompartmental knee arthroplasty (UKA) is a surgical procedure for managing osteoarthritis of one joint compartment, most commonly the medial side. This systematic review investigates the causes of UKA revision. The outcomes of interest were establishing the revision rate, time to revision, and the most common causes of revision in the long- and midterm follow-up.

Methods：This study was conducted according to the 2020 PRISMA statement. In October 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the clinical studies investigating the rate and causes of revision in UKA were accessed. Only studies with a minimum of 10 years of follow-up were considered.

Results：Data from 56 studies (13,540 patients) were collected. Of them, 65.6% were women. The mean length of the follow-up was 13.1±3.0 years. The mean age of the patients was 65.6±5.6 years, and the mean BMI was 28.5±2.2 kg/m2 . Revisions were performed in 8.8% (2641 of 30,140) of implanted UKAs. The mean time to revision was 6.5±2.6 (range, 2.5 to 13.0) years.

Conclusion：8.8% (2641 of 30,140) of UKAs were revised at a mean time of 6.5±2.6 years.

文献出处：Migliorini F, Bosco F, Schäfer L, Cocconi F, Kämmer D, Bell A, Vaish A, Koettnitz J, Eschweiler J, Vaishya R. Revision of unicompartmental knee arthroplasty: a systematic review. BMC Musculoskelet Disord. 2024 Dec 2;25(1):985. doi: 10.1186/s12891-024-08112-7. PMID: 39623393; PMCID: PMC11610075.

文献2

无感染情况下股骨颈骨折髋关节置换术后C反应蛋白的自然变化趋势

译者 马云青

本研究旨在评估股骨颈骨折髋关节置换术后2周及4周时C反应蛋白（CRP）恢复正常水平的程度，并比较全髋关节置换术（THA）与双极半髋关节置换术（BH）后CRP恢复情况的差异，同时分析影响CRP恢复的患者因素。我们回顾性分析了2015年1月至2019年12月期间由同一术者实施的135例股骨颈骨折手术患者（其中THA 32例，BH 103例），检测了患者术前、术后早期、术后2周及术后4周的CRP水平。结果显示：THA组术后2周和4周CRP恢复正常者分别为4例（12.5%）和15例（46.9%）；BH组分别为16例（15.5%）和52例（50.5%）。两组间无统计学差异。男性患者术后2周CRP恢复正常可能性较女性低3.78倍（95%置信区间1.05-13.63，P=0.042），术后4周恢复正常可能性较女性低3.01倍（95%置信区间1.44-6.27，P=0.003）。研究表明：仅50%患者术后4周内CRP水平恢复正常；男性患者在整个观察期内CRP水平均显著高于女性；THA组仅在术后早期CRP水平高于BH组，此后无显著差异。

The natural trends of C-reactive protein after hip arthroplasty for femoral neck fracture without infection

The aim of this study was to estimate the degree of normalization of C-reactive protein (CRP) at 2-weeks and 4-weeks after hip arthroplasty after femoral neck fracture. We also wished to determine whether the degree of CRP normalization differs after total hip arthroplasty (THA) compared to bipolar hemiarthroplasty (BH). We also wanted to analyze the patient factors that may influence CRP normalization.We conducted a retrospective study of 135 patients who had undergone THA (32 cases) or BH (103 cases) for femoral neck fracture by single surgeon from January 2015 to December 2019. We analyzed CRP levels during the preoperative period, the early postoperative period, the 2-week postoperative period, and the 4-week postoperative period.In THA, CRP was normalized in 4 patients (12.5%) and in 15 patients (46.9%) within 2-weeks and 4-weeks after surgery, respectively. In BH, CRP was normalized in 16 patients (15.5%) and in 52 patients (50.5%) within 2-weeks and 4-weeks after surgery, respectively. There were no statistical differences between THA and BH. Compared to women, men were 3.78 (95% confidence interval, 1.05-13.63) times less likely to have normalized CRP at 2-weeks after surgery (P = .042). Compared to women, men were 3.01 (95% confidence interval, 1.44-6.27) times less likely to have normalized CRP at 4-weeks after surgery (P = .003).Only 50% of patient's CRP level was normalized during 4-week postoperative period. In men, CRP levels were significantly higher than women in whole period. In the case of THA, the CRP level was higher only in early postoperative period compared to BH, and there was no difference since then.

文献出处：Cho MR, Choi WK, Jun CM, Song SK. The natural trends of C-reactive protein after hip arthroplasty for femoral neck fracture without infection. Medicine (Baltimore). 2021 Sep 24;100(38):e27299. doi: 10.1097/MD.0000000000027299. PMID: 34559143; PMCID: PMC8462584.

文献3

初次全髋或全膝关节置换术后10年平均BMI并无显著变化

译者 张蔷

背景：尽管患者在接受全髋（THA）或全膝（TKA）关节置换手术之后通常的预期都是体重会下降，体重指数（BMI）的长期变化却并不明确。我们分析了初次THA和TKA术后2年、5年和10年的BMI变化，并确定其变化的预测因素。

方法：我们选择了2001年至2011年间因骨关节炎而接受初次THA或TKA患者，且病历资料中需包括术前、术后2年、5年和10年随访时的BMI数据。最终收集了763位患者的病历资料（其中310例THA和453例TKA）。平均年龄66岁，60%为女性患者。我们应用重复测量方差分析法分析了BMI变化情况，并应用多元回归分析法确定了BMI变化的影响因素。

结果：THA术后，平均BMI从术前的30.3kg/m2增加至术后2年（p = 0.003）和5年（p = 0.002）的30.9kg/m2。TKA术后，平均BMI从术前的32.7kg/m2增加至术后2年（p = 0.053）和5年（p = 0.040）的33.1kg/m2。术后10年，THA患者的平均BMI为30.6kg/m2 (p = 0.453)，而TKA患者的平均BMI为32.6kg/m2 (p = 0.947)，均与术前近似。在术后10年，27%的THA患者和30%的TKA患者BMI减少超过5%，而有30%的THA患者和32%的TKA患者BMI增加超过5%。女性会增加THA患者术后10年BMI增加超过5%的概率(概率比 [OR], 2.1; p = 0.006)。而高龄会增加TKA患者术后10年BMI增加超过5%的概率(OR, 0.95; p < 0.001)。

结论：尽管在初次THA或TKA术后10年时，大多数患者的BMI变化均超过5%，但术后2年、5年或10年随访时的平均BMI并无显著变化。我们并不能将关节置换视为改善患者BMI的方式，而女性和高龄可以预测关节置换术后10年时BMI的显著变化。

Mean Body Mass Index Does Not Increase or Decrease at 10 Years After Primary Total Hip or Knee Arthroplasty

Background: Although patients often aim to lose weight after total hip arthroplasty (THA) or total knee arthroplasty (TKA), long-term changes in body mass index (BMI) are unknown. We analyzed BMI at 2, 5, and 10 years after primary THA and TKA and determined predictors of BMI change.

Methods: We identified patients who underwent primary THA or TKA for osteoarthritis between 2001 and 2011 and had a BMI at surgery and at 2, 5, and 10 years postoperatively. This resulted in 763 patients (310 who underwent THA and 453 who underwent TKA). The mean patient age was 66 years, and 60% of patients were female. BMI changes were analyzed with repeated-measures analysis of variance. Multinomial logistic regression determined predictors of BMI change.

Results: Following THA, the mean BMI increased from 30.3kg/m2 at surgery to 30.9kg/m2 at both 2 years (p = 0.003) and 5 years (p = 0.002). Following TKA, the mean BMI increased from 32.7kg/m2 at surgery to 33.1kg/m2 at both 2 years (p = 0.053) and 5 years (p = 0.040). By 10 years, the mean BMI was 30.6kg/m2 (p = 0.453) for patients undergoing THA and 32.6kg/m2 (p = 0.947) for patients undergoing TKA, similar to the BMIs at surgery. At 10 years, 27% of patients who underwent THA and 30% of patients who underwent TKA had a BMI decrease of >5%, whereas 30% of patients who underwent THA and 32% of patients who underwent TKA had a BMI increase of >5%. Female sex among patients who underwent THA increased the odds of a >5% BMI increase at 10 years (odds ratio [OR], 2.1; p = 0.006). Older age among patients who underwent TKA decreased the odds of a >5% BMI increase at 10 years (OR per year, 0.95; p < 0.001).

Conclusions: Although most patients experienced a BMI change of >5% at 10 years, the mean BMI did not meaningfully change 2, 5, or 10 years after THA or TKA. Arthroplasty should not be viewed as a gateway to BMI improvement for patients overall, but female sex and older age may predict clinically important weight changes 10 years after arthroplasty.

文献4

成人重建专科医师培训与全膝关节置换术后两年内并发症减少相关

译者 沈松坡

背景：骨科住院医师中进修专科培训的趋势日益普遍，但其对关节置换术结局的影响尚未得到充分探讨。本研究旨在比较接受由接受过关节置换专科培训的外科医生与未接受此类培训的外科医生实施的初次全膝关节置换术（TKA）患者，在术后90天、1年及2年内的并发症发生率，包括假体周围关节感染（PJI）、麻醉下手法松解术（MUA）、无菌翻修术及无菌松动。

方法：本研究使用2010年至2021年间的全国性保险数据库，筛选接受择期TKA的患者。根据手术医生姓名及国家执业医师识别号（NPI），通过网络检索确定其是否接受过成人重建专科培训。随后，将患者分为由接受关节置换培训的外科医生手术组与未接受培训的外科医生手术组。为控制人口学差异，采用倾向评分匹配（1:1），最终每组包含361,362名患者。

结果：在术后90天内，由未接受关节置换培训外科医生手术的患者出现较高的手术部位感染（比值比 OR 1.39，95%置信区间 CI 1.26–1.54）、静脉血栓栓塞（OR 1.14，95% CI 1.02–1.26）、假体周围感染（PJI）（OR 1.40，95% CI 1.24–1.58）、无菌松动（OR 1.62，95% CI 1.15–2.29）及麻醉下手法松解（MUA）（OR 1.23，95% CI 1.16–1.30）的发生率。术后一年及两年时，非专科培训组的PJI、无菌松动及MUA发生率持续较高。此外，该组在术后一年（OR 1.16，95% CI 1.04–1.28）及两年（OR 1.28，95% CI 1.18–1.39）时的无菌翻修率也较高。

结论：由接受过关节置换专科培训的外科医生实施的TKA患者，在术后90天、一年及两年内出现的并发症更少。

关键词：专科培训；成人重建；全膝关节置换术；并发症；翻修；关节假体周围感染

Fellowship Training in Adult Reconstruction Is Associated with Decreased Complications

up to Two Years following Total Knee Arthroplasty

Background: Fellowship training has become increasingly popular among orthopaedic residents, though its impact on arthroplasty outcomes has been underexplored. This study aimed to compare the incidences of complications, including periprosthetic joint infection (PJI), manipulation under anesthesia (MUA), aseptic revision, and aseptic loosening between patients who underwent primary TKA by an arthroplasty-trained surgeon versus a non-arthroplasty-trained surgeon at 90 days, one year, and two years postoperatively.

Methods: A national insurance database was used to identify patients who underwent elective TKA from 2010 to 2021. A physician report was obtained for this cohort of patients, which included the name and National Provider Identifier (NPI) of the operative surgeon. Using this information, we performed a web search to identify whether each physician had undergone adult reconstruction fellowship training. Once surgeons were classified by training, we split the patients into two cohorts: those operated on by arthroplasty-trained surgeons and non-arthroplasty-trained surgeons. We employed a propensity-score match to account for demographic differences, resulting in two cohorts with 361,362 patients each.

Results: At 90 days, patients who were operated on by non-arthroplasty-trained surgeons experienced increased rates of surgical site infection (odds ratio (OR) 1.39, 95% confidence interval (CI) 1.26 to 1.54), venous thromboembolism (OR 1.14, 95% CI 1.02 to 1.26), periprosthetic joint infection (PJI) (OR 1.40, 95% CI 1.24 to 1.58), aseptic loosening (OR 1.62, 95% CI 1.15 to 2.29), and manipulation under anesthesia (MUA) (OR 1.23, 95% CI 1.16 to 1.30). At one and two years, higher incidences of PJI, aseptic loosening, and MUA persisted in the non-arthroplasty cohort. Additionally, the non-arthroplasty cohort demonstrated higher odds of aseptic revision at one year (OR 1.16, 95% CI 1.04 to 1.28) and two years (OR 1.28, 95% CI 1.18 to 1.39).

Conclusions: Patients who underwent TKA with arthroplasty-trained surgeons experienced fewer complications at ninety days, one year, and two years postoperatively.

Keywords：Fellowship training; Adult reconstruction; Total knee arthroplasty; Complications; Revision; Periprosthetic joint infection

第二部分：

保髋相关文献

文献1

婴幼儿晚期髋脱位的相关风险因素和特点

译者 任宁涛

背景：大多数婴幼儿在生后3个月内就可被诊断为DDH，然而也会出现晚期DDH（生后3个月才诊断为DDH），并且治疗起来更加复杂，增加远期并发症的发生率。关于晚期DDH 的特殊风险因素知之甚少，明确相关的因素将有助于晚期DDH筛查、检测和预防。

目的：根据多中心DDH患者数据，我们拟比较早期DDH和晚期DDH（1）风险因素（2）脱位性质（侧别和关节松弛）是否相同。

方法：对2010年-2014年多中心的DDH患者的前瞻性数据进行回顾性研究，采集两组人口统计学信息（早期DDH组（0-3个月），晚期DDH组（3-18个月））胎位（头位/臀位）、分娩方式（顺产/剖宫产）、出生体重、产妇年龄、胎次、孕龄、家族史和襁褓史。共纳入392名患儿（0-18个月，单侧或双侧脱位），其中早期DDH组259名患儿，晚期DDH组133名患儿，98%的患儿来自9个治疗中心。

结果：进行了单变量/多变量分析，比较早期和晚期患儿之间的人口统计学信息，在控制相关混杂变量后，与早期DDH 相比，两个变量被确定为晚期DDH 的危险因素：头位和襁褓史。与早期DDH患儿相比，晚期DDH患儿头位发生率更高(88% [117/133] VS 65% [169/259]；OR 5.366；95% CI 2.44-11.78；p < 0.001)。此外晚期DDH组襁褓发生率更高，(40% [53 /133] VS 25% [64 / 259]；OR 2.053；95% CI, 1.22-3.45； p = 0.0016)。两组性别 (p = 0.63)、分娩方式 (p = 0.088)、出生体重 (p = 0.90)、产妇年龄 (p = 0.39)、胎次 (p = 0.54)、孕龄 (p = 0.42) 没有差异 )，两组之间的家族史 (p = 0.11)也无统计学差异。与早期DDH相比，晚期DDH更加难以复位(56% [82 /147] VS 19% [63 / 333]; OR, 5.407; 95% CI, 3.532-8.275; p < 0.001)，双侧脱位发生率低(11% [14 /133] versus 28% [73/259]; OR, 0.300; 95% CI, 0.162-0.555; p = 0.002)。

结论：常规的风险因素（如臀位）并不是晚期DDH的风险因素，所以晚期DDH常被漏诊，因此所有婴儿都应进行DDH筛查，而不仅仅是那些具有 DDH危险因素的婴儿进行选择性筛查。需要进一步研究以确定襁褓是否是大龄婴儿发生髋关节脱位的危险因素。还应该对选择性筛查方法进行更严格的检查，以确定目前的筛查是否足够，以及晚期DDH是否早期存在和遗漏，或者是否随着时间的推移而加重。

证据等级：III级，回顾性研究。

What Risk Factors and Characteristics Are Associated With Late presenting Dislocations of the Hip in Infants

Background: Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition.

Questions/purposes: Using a multicenter database of patients with DDH, we sought to determine whether there were differences in (1) risk factors or (2) the nature of the dislocation (laterality and joint laxity) when comparing patients with early versus late presentation.

Methods: A retrospective review of prospectively collected data from a multicenter database of patients with dislocated hips was conducted from 2010 to 2014. Baseline demographics for fetal presentation (cephalic/breech), birth presentation (vaginal/cesarean), birth weight, maternal age, maternal parity, gestational age, family history, and swaddling history of patients were compared among nine different sites for patients who were enrolled at age younger than 3 months and those enrolled between 3 and 18 months of age. A total of 392 patients were enrolled at baseline between 0 and 18 months of age with at least one dislocated hip. Of that group, 259 patients were younger than 3 months of age and 133 were 3 to 18 months of age. The proportion of patients with DDH who were enrolled and followed at the nine participating centers was 98%.

Results: A univariate/multivariate analysis was performed comparing key baseline demographics between early- and late-presenting patients. After controlling for relevant confounding variables, two variables were identified as risk factors for late-presenting DDH as compared with early-presenting: cephalic presentation at birth and swaddling history. Late-presenting patients were more likely to have had a cephalic presentation than early-presenting patients (88% [117 of 133] versus 65% [169 or 259]; odds ratio [OR], 5.366; 95% confidence interval [CI], 2.44-11.78; p < 0.001). Additionally, late-presenting patients were more likely to have had a history of swaddling (40% [53 of 133] versus 25% [64 of 259]; OR, 2.053; 95% CI, 1.22-3.45; p = 0.0016). No difference was seen for sex (p = 0.63), birth presentation (p = 0.088), birth weight (p = 0.90), maternal age (p = 0.39), maternal parity (p = 0.54), gestational age (p = 0.42), or family history (p = 0.11) between the two groups. Late presenters were more likely to present with an irreducible dislocation than early presenters (56% [82 of 147 hips] versus 19% [63 of 333 hips]; OR, 5.407; 95% CI, 3.532-8.275; p < 0.001) and were less likely to have a bilateral dislocation (11% [14 of 133] versus 28% [73 of 259]; OR, 0.300; 95% CI, 0.162-0.555; p = 0.002).

Conclusions: Those presenting with DDH after 3 months of age have fewer of the traditional risk factors for DDH (such as breech birth), which may explain the reason for a missed diagnosis at a younger age. In addition, swaddling history was more common in late-presenting infants. A high index of suspicion for DDH should be maintained for all infants, not just those with traditional risk factors for DDH. Further investigation is required to determine if swaddling is a risk factor for the development of hip dislocations in older infants. More rigorous examination into traditional screening methods should also be performed to determine whether current screening is sufficient and whether late-presenting dislocations are present early and missed or whether they develop over time.

Level of evidence: Level III, retrospective study.

文献出处：Kishore Mulpuri , Emily K Schaeffer, Janice Andrade, Wudbhav N Sankar, Nicole Williams, Travis H Matheney, Scott J Mubarak , Peter J Cundy, Charles T Price. What Risk Factors and Characteristics Are Associated With Late presenting Dislocations of the Hip in Infants.Multicenter Study Clin Orthop Relat Res . 2016 May;474(5):1131-7.

文献2

开放手术和关节镜手术治疗股骨髋臼撞击症：当前概念的综述

译者 李勇

股骨髋臼撞击症（FAI）是一种常见的股骨和/或髋臼异常，可导致髋关节的进行性损伤和骨关节炎。FAI可能是股骨头/颈过度生长、髋臼过度生长或两者兼有的结果，导致原生髋关节生物力学丧失以及在髋关节屈曲和旋转时出现疼痛。影像学证据可包括股骨颈球面度丧失（凸轮型撞击）和/或伴有局部或全部过度覆盖的髋臼后倾（钳夹型撞击）。对于保守治疗失败、有撞击的影像学证据且髋关节炎性改变极小的症状性患者，应进行手术干预，旨在恢复正常的髋关节生物力学并减轻疼痛。这通过股骨和/或髋臼成形术纠正股骨头颈与髋臼的关系，并治疗伴随的髋关节病变来完成。在月状面较小的钳夹型撞击病例中，由于髋臼成形术会减小本已很小的关节面，因此适合进行反向髋臼周围截骨术。虽然外科脱位被认为是传统的金标准，但髋关节镜手术近年来已得到广泛应用。比较开放手术和关节镜手术的研究表明，两者在长期疼痛减轻、髋功能临床指标改善以及全髋关节置换术转换率方面具有可比性。然而，关节镜手术有改善更早、恢复更快以及更快重返运动的趋势。本研究的目的是回顾关于FAI开放性和关节镜治疗的最新文献。

Open and arthroscopic management of femoroacetabular impingement: a review of current concepts

Femoroacetabular impingement (FAI) is a common femoral and/or acetabular abnormality that can cause progressive damage to the hip and osteoarthritis. FAI can be the result of femoral head/neck overgrowth, acetabular overgrowth or both femoral and acetabular abnormalities, resulting in a loss of native hip biomechanics and pain upon hip flexion and rotation. Radiographic evidence can include loss of sphericity of the femoral neck (cam impingement) and/or acetabular retroversion with focal or global overcoverage (pincer impingement). Operative intervention is indicated in symptomatic patients after failed conservative management with radiographic evidence of impingement and minimal arthritic changes of the hip, with the goal of restoring normal hip biomechanics and reducing pain. This is done by correcting the femoral head-neck relationship to the acetabulum through femoral and/or acetabular osteoplasty and treatment of concomitant hip pathology. In pincer impingement cases with small lunate surfaces, reverse periacetabular osteotomy is indicated as acetabular osteoplasty can decrease an already small articular surface. While surgical dislocation is regarded as the traditional gold standard, hip arthroscopy has become widely utilized in recent years. Studies comparing both open surgery and arthroscopy have shown comparable long-term pain reduction and improvements in clinical measures of hip function, as well as similar conversion rates to total hip arthroplasty. However, arthroscopy has trended toward earlier improvement, quicker recovery and faster return to sports. The purpose of this study was to review the recent literature on open and arthroscopic management of FAI.

文献出处：Hassan MM, Farooqi AS, Feroe AG, Lee A, Cusano A, Novais E, Wuerz TH, Kim YJ, Parisien RL. Open and arthroscopic management of femoroacetabular impingement: a review of current concepts. J Hip Preserv Surg. 2022 Oct 13;9(4):265-275. doi: 10.1093/jhps/hnac043. PMID: 36908557; PMCID: PMC9993460.

文献3

青少年患者前交叉韧带与半月板伴发损伤时前交叉韧带重建与半月板自发愈合的时机

译者 张利强

背景：半月板损伤常伴随急性前交叉韧带撕裂，这为确定最佳手术时机带来了临床难题。虽然延迟重建会增加半月板进行性损伤的风险，但早期干预可能会影响青少年人群的自然愈合能力。本研究探讨了青少年ACL损伤中，手术时机、详细的撕裂特征与半月板愈合模式之间的关系。

方法：一项回顾性队列分析，纳入55例接受关节镜下ACL重建的青少年患者（平均年龄：14.9 ±1.9岁，范围：11.9至18岁；63.6%为男性；2015年至2024年），比较了术前MRI发现与术中半月板评估结果。对每个半月板撕裂（n=64）均按其解剖位置和形态构型进行了特征描述。主要结局指标是半月板愈合（即术前MRI可见的撕裂在术中未见）。次要分析按撕裂位置和作为连续变量的手术时机检查愈合率。采用多变量逻辑回归识别独立预测因素。

结果：在64处独立撕裂中，29处（45.3%）显示自发愈合。连续的时序分析显示，撕裂平均在手术后169.8±78.4天愈合，而持续存在的撕裂则在203.4±89.2天仍未愈合（差值：33.6天，P=0.021）。内侧半月板撕裂的愈合率显著高于外侧撕裂（60.0% vs. 27.6%，P=0.006）。多变量分析确定了3个独立预测因素：内侧位置（OR: 3.9, 95% CI: 1.5-10.1, P=0.005）、更早的手术时机（每天）（OR: 0.994, 95% CI: 0.989-0.999, P=0.021）以及后角位置（OR: 2.8, 95% CI: 1.1-7.2, P=0.031）。术中发现6处新的撕裂（发生率10.9%），其中5处发生在延迟手术（伤后>120天）的患者中。

结论：本分析表明，在青少年ACL损伤中，手术时机与半月板愈合存在显著关联，每延迟一天，愈合几率降低0.6%。这些初步发现需要在更大规模的前瞻性研究中得到验证，才能影响治疗决策，但可能为患者关于预期结果的咨询提供信息。

证据等级：III级——回顾性队列研究。

关键词：青少年ACL重建，半月板愈合，手术时机，撕裂特征，关节镜检查

Timing of ACL Reconstruction and Spontaneous Meniscal Healing in Adolescent Patients With Concomitant Injuries

Background: Meniscal injuries frequently accompany acute anterior cruciate ligament (ACL) tears, creating clinical dilemmas regarding optimal surgical timing. While delayed reconstruction increases risks of progressive meniscal damage, early intervention may interrupt natural healing capacity in the adolescent population. This study examines relationships between surgical timing, detailed tear characteristics, and meniscal healing patterns in adolescent ACL injuries.

Methods: A retrospective cohort analysis of 55 adolescent patients (mean age: 14.9 ±1.9 y, range: 11.9 to 18; 63.6% male) undergoing arthroscopic ACL reconstruction (2015 to 2024) compared preoperative MRI findings with intraoperative meniscal evaluations. Individual meniscal tears (n =64) were characterized by anatomic location and morphologic configuration. Meniscal healing (absence of arthroscopically visible tears previously seen on MRI) was the primary outcome. Secondary analyses examined healing rates by location and surgical timing as a continuous variable. Multivariate logistic regression identified independent predictors.

Results: Among 64 individual tears, 29 (45.3%) demonstrated spontaneous healing. Continuous timing analysis revealed healed tears averaged earlier surgery at 169.8± 78.4 days versus persistent tears at 203.4 ± 89.2 days (difference: 33.6 d, P= 0.021). Medial meniscal tears showed significantly higher healing rates than lateral tears (60.0% vs. 27.6%, P= 0.006). Multivariate analysis identified 3 independent predictors: medial location (OR: 3.9, 95% CI: 1.5-10.1, P= 0.005), earlier surgical timing per day (OR: 0.994, 95% CI: 0.989-0.999, P= 0.021), and posterior horn location (OR: 2.8, 95% CI: 1.1-7.2, P= 0.031). Six new tears were identified at surgery (10.9% rate), with 5 occurring in patients with delayed surgery ( >120 d from injury).

Conclusion: This analysis demonstrates significant associations between surgical timing and meniscal healing in adolescent ACL injuries, with each day of delay associated with a 0.6% reduction in healing odds. These preliminary findings require validation in larger prospective studies before influencing treatment decisions but may inform patient counseling regarding expected outcomes.

Level of Evidence: Level III—retrospective cohort study.

Key Words: Adolescent ACL Reconstruction, meniscal healing, surgical timing, tear characteristics, arthroscopy

文献出处：Graif N, Rachevski G, Qual R, Cohen R, Yaniv M, Gigi R. Timing of ACL Reconstruction and Spontaneous Meniscal Healing in Adolescent Patients With Concomitant Injuries. J Pediatr Orthop. 2025 Oct 8. doi: 10.1097/BPO.0000000000003133. Epub ahead of print. PMID: 41059607.

文献4

髋臼覆盖特征在髋关节发育不良患者中存在哪些性别差异？

译者 陶可

背景：髋臼偏心旋转截骨术用于预防由髋关节发育不良(DDH)引起的骨关节炎。为了获得足够的髋臼覆盖，了解DDH患者髋臼覆盖的特征至关重要。然而，男性DDH患者髋臼覆盖的特征尚不清楚。我们认为，女性和男性髋臼覆盖的差异可能与两性骨盆形态的差异有关。

问题/目的：(1)女性和男性DDH患者髋臼覆盖有何差异？(2)女性和男性DDH患者髂骨和坐骨旋转有何差异？(3)女性和男性DDH患者髂骨和坐骨旋转与各高度髋臼覆盖之间有何关系？

方法：2016年至2023年间，我院共纳入114例（138髋）髋臼偏心旋转截骨术患者。排除Tönnis 2级及以上、外侧中心边缘角≥25°、以及存在骨盆或股骨畸形的患者，最终纳入100例（122髋）患者。女性患者（98髋）的中位年龄（范围）为40岁（10～58岁），男性患者（24髋）的中位年龄为31岁（14～53岁）。我们采集了所有患者术前的（髋关节）前后位X线片和CT影像数据。在前后位X线片上评估了交叉征、后壁征和骨盆宽度指数。在两个不同的高度评估了髋骨在轴位上的旋转，具体是在CT数据中穿过髂前上棘的水平位片及穿过耻骨联合和坐骨棘的水平位片。此外，我们评估了髋臼前后扇面区角度。对每位患者中女性和男性的髋骨测量值和髋臼覆盖率测量值相关变量进行了比较。分别评估了女性和男性的骨盆形态测量值和髋臼覆盖率之间的相关性，然后比较结果以确定任何性别特异性差异。对于连续变量，我们使用了Student t检验；对于二元变量，我们使用了Fisher精确概率法检验。p值小于0.05被认为具有统计学意义。

结果：在前后位X线片评估中，髋臼后倾的指标——交叉征在两性之间没有差异，而后壁征（女性46% [45/98]髋vs男性75% [18/24]髋，OR 3.50 [95%置信区间(CI) 1.20至11.71]；p = 0.01）和骨盆宽度指数小于56%（女性1% [1/98] vs男性17% [4/24]，OR 18.71 [95% CI 1.74至958.90]；p = 0.005）在男性中的发生率高于女性。髂骨旋转参数无差异，但男性坐骨外旋程度更大（女性30° ± 2° vs 男性 24° ± 1°；p < 0.001）。髋臼覆盖方面，髋臼前区角度在女性和男性之间无差异。相比之下，男性髋臼后区角度的数值小于女性（85° ± 9° vs 91° ± 7°；p = 0.002）。在女性中，髂骨旋转与髋臼扇形角之间存在相关性（髋臼前扇形角：r = -0.35 [95% CI -0.05 至 0.16]；p < 0.001，髋臼后扇形角：r = 0.42 [95% CI 0.24 至 0.57]；p < 0.001）。同样，坐骨旋转与两个髋臼扇形角均呈相关性（前髋臼扇形角：r = -0.34 [95% CI -0.51 至 -0.15]；p < 0.001和髋臼后扇形角：r = 0.45 [95% CI 0.27至0.59]；p < 0.001）。因此，我们观察到，在女性中，髂骨外旋和坐骨内旋与髋臼前覆盖增加和后覆盖减少相关。相反，尽管男性的髋臼覆盖与髂骨旋转相关（髋臼前扇形角：r = -0.55 [95% CI -0.78 至 -0.18]；p = 0.006；髋臼后扇形角：r = 0.74 [95% CI 0.48 至 0.88]；p < 0.001），但未观察到与坐骨旋转的相关性。

结论：男性髋臼后倾比女性更常见，这是由于男性髋臼后覆盖减少所致。在女性中，髋臼后覆盖度的增加与坐骨外旋角度相关，而在男性中，坐骨旋转与髋臼后覆盖度之间无相关性。在通过偏心旋转髋臼截骨术治疗男性DDH时，调整截骨块以防止髋臼后覆盖度不足至关重要。未来的研究可能需要探讨男性和女性髋臼覆盖度的差异。

图 髋臼后倾的指标。(A)交叉征是指髋臼前后缘相交的征象。(B)髋臼后壁未延伸至股骨头中心，即定义为后壁征阳性。(C)骨盆宽度指数计算公式为A/B。

图2 髋臼旋转相关变量。(A)髂骨上翼角是指髂前上棘内缘与骶髂关节前缘连线与轴位线的交点。(B)髂骨下翼角是指髂前下棘前部与髂骨后部连线与轴位线的交点。(C)坐骨耻骨角是指耻骨联合前上缘与坐骨棘连线与矢状线的交点；SIA =髂骨上翼角；IIA =髂骨下翼角；IPA =坐骨耻骨角。

图 髋臼覆盖参数。(A)髋臼倾斜角是在通过股骨头中心的冠状面内测量的。髋臼倾斜角由连接髋臼上下缘的连线与水平线形成。(B)髋臼上扇形角是在通过股骨头中心的冠状面内测量的。髋臼扇形角是由连接股骨头中心和髋臼边缘的连线与水平线的交点形成。(C)髋臼前倾角是在通过股骨头中心的轴平面内测量的。它被确定为连接髋臼前后边缘的线与矢状线相交形成的角度。(D)代表前后髋臼扇形角的角度是在通过股骨头中心的轴平面内确定的。髋臼扇形角是通过连接股骨头中心和髋臼边缘的线与水平线的交点确定的。(E)髋臼前倾角、前髋臼扇形角和后髋臼扇形角的测量以5毫米的间隔进行，从股骨头中心远端10毫米开始，一直持续到股骨头中心近端20毫米。（F）每个髋臼水平的后ASA和前ASA的3D图像图；AI =髋臼倾斜度；ASA =髋臼扇区角；AcAV =髋臼前倾角。

What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia?

Background: Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes.

Questions/purposes: (1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH?

Methods: Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant.

Results: In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation.

Conclusion: In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation.

Clinical relevance: Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.

文献出处：Hiroto Funahashi, Yusuke Osawa, Yasuhiko Takegami, Hiroki Iida, Yuto Ozawa, Hiroaki Ido, Shiro Imagama. What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia? Comparative Study, Clin Orthop Relat Res. 2024 Nov 1;482(11):1971-1983. doi: 10.1097/CORR.0000000000003126. Epub 2024 Jul 12.

文献5

95°角钢板在复杂股骨近端骨折治疗中的疗效分析
译者 邱兴

背景：在涉及股骨近端干区的创伤性损伤领域，95°角钢板（ABP）已被公认为处理转子周围/转子下骨折延迟愈合及骨不连的首选方案。本研究旨在强调ABP不仅适用于股骨近端骨折延迟愈合或骨不连病例，还可作为早期内固定失败、感染性骨折、伴骨缺损的骨折以及特定骨折类型（包括反向斜形骨折和延伸至骨干的转子下骨折）的可靠治疗手段。

材料与方法：2016年1月至2020年3月期间，本三级医疗中心共对18例复杂股骨近端骨折患者实施手术。采用AO/OTA分型对骨折进行分类，记录每位患者的附加手术操作、从初诊至手术的时间及术后结局。所有患者均使用95°ABP进行手术，并于术后3、6、9、12个月定期通过影像学检查和临床评估追踪骨折愈合情况。

结果：研究队列包含18例患者（男性11例，女性7例），平均年龄47.3岁。9例患者（50%）术后6个月实现骨折愈合，6例患者（28%）于9个月时愈合，2例患者（17%）在12个月时愈合。1例患者（5.5%）因术后感染可能，骨折未在12个月内愈合。

结论：95°ABP在股骨近端骨折翻修及复杂病例中疗效显著。本研究通过证实ABP即使在早期内固定失败、伴骨缺损或复杂感染的骨折、以及伴或不伴内侧粉碎的反向斜形骨折等情况下仍能提供稳定固定和可预期的愈合效果，拓宽了该植入物的应用范围。
关键词：角钢板，粉碎性骨折，内固定失败，股骨近端骨折，愈合

Outcome Analysis of the Role of 95° Angled Blade Plate in the Management of Difficult Proximal Femur Fractures

Background: In the realm of traumatic injuries affecting the proximal femoral shaft, a 95° angled blade plate (ABP) has already garnered recognition as the go-to choice for addressing delayed union and nonunion cases associated with peritrochanteric/subtrochanteric fractures. The study’s primary objective is to emphasize the pivotal role of the ABP not only in cases of delayed union or nonunion of proximal femur fractures but also as a reliable solution for early implant failure, infections, fractures involving bone loss, and specific fracture types, including reverse oblique fractures and subtrochanteric fractures extending into the diaphysis. Materials and methods: A total of 18 patients with complex proximal femur fractures were operated on from January 2016 to March 2020 in our tertiary care setup. The fractures were classified using AO/OTA classification, and any additional procedures, time from initial presentation to surgery, and postoperative outcomes were noted in each case. The patients were operated on using a 95° ABP and were periodically followed up with radiographs and clinical examinations for fracture union at 3, 6, 9, and 12 months. Results: The study cohort consisted of 18 patients (11 males, 7 females) with a mean age of 47.3 years. In 9 patients (50%), the fracture healed in 6 months following surgery, whereas in 6 patients (28%), the fracture healed in 9 months, and in 2 patients (17%), it healed in 12 months. In 1 patient (5.5%), the fracture did not unite at 12 months, probably attributed to infection following surgery. Conclusion: A 95° ABP works very well in revision and complex scenarios of proximal femur fractures. Our study findings widen the scope of the ABP as an implant by providing stable fixation and predictable union even in situations such as early implant failure, fractures with bone loss or complicated infections, and in reverse oblique type fractures with or without medial comminution. Keywords: Angled blade plate, Comminuted, Implant failure, Proximal femur fracture, Union.

文献出处：Dash S K, Sahu H, Arora G, et al. Outcome Analysis of the Role of 95° Angled Blade Plate in the Management of Difficult Proximal Femur Fractures[J]. Journal of Orthopedics and Joint Surgery, 2025, 7(2): 259-263.

来源：304关节学术

作者：304关节团队

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