髋膝关节文献精译荟萃（第384期)

本期目录：

1、外翻膝患者全膝关节置换术前后的踝关节对线

2、固定良好金属髋臼外杯内应用骨水泥固定聚乙烯内治疗髋臼周围骨溶解

3、机器人辅助全膝关节置换术在复杂初次及翻修病例中的应用

4、改良钻孔骨骺阻滞和人类学预测方法治疗下肢不等长

5、利用骨盆正位X线片评估骨盆倾斜

6、髋臼软骨厚度：在尸体研究中采用多层螺旋CT关节造影三维重建的准确性研究

7、Retuve：基于开源人工智能的髋关节发育不良多模态自动化分析

第一部分：关节置换及保膝相关文献

文献1

外翻膝患者全膝关节置换术前后的踝关节对线

译者 张轶超

背景：全膝关节置换术（TKA）对外翻膝患者双侧踝关节生物力学的影响尚不清楚。本研究旨在评估单侧TKA如何影响外翻膝患者双侧踝关节的倾斜、肢体对线和生物力学。

方法：在2021年1月至2023年6月期间接受TKA治疗的105例终末期膝骨关节炎伴轻到中度外翻畸形患者中，有86例被纳入本回顾性研究。通过术前和术后站立下肢全长x线片测量了髋-膝-踝关节角（HKA）、负重线比（WBLR）、膝关节线汇聚角（KJLCA）、膝关节线倾斜角（KJLO）、胫骨前表面角（TAS）、胫骨平台后倾角（TPI）、距骨后倾角（TI）、胫距倾斜角（TT），术后平均随访10.4个月。根据患者下肢力线矫正程度分为A组（0°~5°，25个膝关节）、B组（5°~10°，40个膝关节）、C组（10°~15°，21个膝关节）。此外，根据术前对侧膝关节HKA角度将患者分为对侧膝关节内翻（30个膝关节）和外翻（56个膝关节）组。

结果：随着HKA的改变，TAS和TT会同时发生变化。术后TAS[93.2(86.9, 116.8)]和TT[-0.4(-5.9, 8.1)]的绝对值较术前TAS[90.3(83.1, 100.5)]和TT[0.2(-5.2, 6.4)]有显著升高（P<0.05）。这表明TKA可能通过纠正下肢机械力线来改变距骨关节面的后倾角。术后各矫正组ΔTPI、ΔTI比较，差异有统计学意义（P<0.05）。这些结果表明，较大的膝关节畸形与术前胫骨远端关节面与水平面之间的夹角较大有关。严重畸形的矫正会增加术后TI角，导致距骨关节面更倾斜。术前和术后HKA与对侧踝关节力线没有相关性。

结论：TKA前后同侧踝关节后倾角会随之变化。对于严重的膝关节外翻畸形，术后应考虑保留一些外翻畸形，以避免踝关节术后并发症。

图.下肢力线测量。A.股骨力线；B.胫骨力线；C.下肢力线；D.股骨远端软骨下骨连线；E.胫骨平台切线；F.平行地面的水平线；G.胫骨解剖轴；H.胫骨远端软骨下骨切线；I.距骨穹顶关节面切线；J.地面垂线。

HKA：A和B线的外侧夹角；WBLR：指C和E的交汇点L到胫骨平台最内侧点M的距离占胫骨平台内外侧（M到K）距离的比例；KJLCA：D和E的夹角；KJLO：E和F夹角；TAS：G和I夹角；TPI：H和J夹角；TI：I和G夹角；TT：H和I夹角。

Ankle alignment before and after total knee arthroplasty in patients with valgus knee deformity

Background：The impact of Total Knee Arthroplasty (TKA) on the biomechanics of bilateral ankle joints with valgus knees remains unclear. This study aimed to evaluate how unilateral TKA affects bilateral ankle tilt, limb alignment, and biomechanics in knee valgus.

Methods：Among 105 patients with end-stage knee osteoarthritis and mild-to-moderate valgus deformity who underwent TKA between January 2021 and June 2023, 86 were included in the study retrospectively. The hipknee-ankle angle (HKA), weight-bearing line ratio (WBLR), knee joint line convergence angle (KJLCA), knee joint line obliquity (KJLO), tibial anterior surface angle (TAS), tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt (TT) were measured on standing full-length lower limb radiographs preoperatively and postoperatively, with postoperative follow-up averaging 10.4 months. Patients were divided into Group A (0°~5°, 25 knees), Group B (5°~10°, 40 knees), and Group C (10°~15°, 21 knees) based on the degree of lower limb alignment correction. Additionally, patients were classified into contralateral knee varus (30 knees) and valgus (56 knees) groups based on the preoperative HKA angle of the contralateral knee.

Results：With changes in HKA, both TAS and TT showed concurrent change. Postoperative TAS [93.2 (86.9, 116.8)] and TT [-0.4 ( -5.9, 8.1)] showed a significant increase in absolute value compared to preoperative TAS [90.3 (83.1, 100.5)] and TT [0.2 ( -5.2, 6.4)] (P<0.05). This suggests that TKA may alter the inclination angle of the talar articular surface by correcting the lower limb mechanical axis. Postoperative comparisons of ΔTPI and ΔTI across correction groups revealed statistically significant differences (P<0.05). These findings indicate that greater knee deformity

is associated with a larger preoperative angle between the distal tibial articular surface and the horizontal plane. Correction of severe deformities increases the postoperative TI angle, leading to a more inclined talar articular surface. No correlation was observed between preoperative and postoperative HKA and alignment of the contralateral ankle joint.

Conclusion：Before and after TKA, concurrent changes were observed in the ipsilateral ankle’s inclination angle. For severe knee valgus deformities, maintaining a residual valgus deformity postoperatively should be considered to avoid postoperative ankle complications.

文献2

固定良好金属髋臼外杯内应用骨水泥固定聚乙烯内治疗髋臼周围骨溶解

译者 马云青

研究背景：对于全髋关节置换术后髋臼周围骨溶解，且髋臼假体固定良好、内衬锁定结构完整的患者，聚乙烯内衬置换联合植骨术是一种有效的手术方案。

研究目的：旨在评估采用聚乙烯内衬置换联合植骨术治疗髋臼周围骨溶解后的无菌翻修生存率，以及术后影像学骨溶解病灶的进展情况。

研究方法：对相关文献进行系统评价。检索1999年1月至2023年1月发表于Medline、EMBASE及Cochrane图书馆的文献，检索关键词包括：“骨溶解”AND“固定良好”、“骨溶解”AND“髋臼后方”、“植骨”AND（“保留”OR“留存”OR“稳定”）AND“髋臼杯”，以及“非骨水泥型内衬”AND“固定良好”。

研究结果：共检索到596篇文献，最终纳入9篇研究（合计227例患者，平均随访时间43.6个月）。内衬置换术后总体髋臼杯翻修率为6.6%（15髋），翻修原因包括：进行性骨溶解（5髋）、髋臼假体无菌性松动（5髋）、假体脱位（4髋）及假体周围感染（1髋）。

在所有提供影像学测量数据的病例中（52髋），髋臼周围骨溶解病灶均实现影像学愈合或缩小，仅1例（1.9%）病灶进展并需行翻修手术。所有报道临床结局的研究均显示，患者术后疼痛缓解、功能评分显著改善。

研究结论：本系统评价结果表明，针对髋臼假体固定良好的髋臼周围骨溶解，单纯行内衬置换联合植骨术，在中短期随访中可获得较高的无菌翻修生存率（93.4%），骨溶解病灶影像学进展率极低（1.9%）。

对于髋臼杯固定良好、存在较大髋臼周围骨溶解病灶（＞450 mm²）的患者，推荐采用内衬置换联合植骨术治疗。建议未来研究建立骨溶解病灶分级评分系统，以指导临床诊疗决策及患者风险分层。

Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review

Background: Polyethylene liner exchange and bone grafting is an effective surgical option for the management of periacetabular osteolysis following total hip arthroplasty with well-fixed cups and intact liner locking mechanisms. Purpose: We aimed to evaluate the revision-free survivorship and radiographic lesion progression after polyethylene liner exchange and bone grafting is performed for periacetabular osteolysis. Methods: A systematic review of the literature was performed. We queried Medline, EMBASE, and Cochrane Library for articles published from January 1999 to January 2023 using the following keywords: "osteolysis" AND "well-fixed," "osteolysis" AND "retro-acetabular," "bone graft" AND ("retention" OR "retained" OR "stable") AND "cup," and "uncemented liner" AND "well-fixed." Results: Of 596 articles found, 9 articles were selected for final inclusion (227 cases, mean follow-up time 43.6 months). The overall cup revision rate after liner exchange was 6.6% (15 hips) due to progressive osteolysis (5 hips), aseptic loosening of the acetabular component (5 hips), dislocation (4 hips), and periprosthetic infection (1 hip). There was either radiographic resolution or regression of periacetabular osteolysis in all reported cases that provided measurements (52 hips) except 1 (1.9%) requiring revision. All studies reporting clinical outcomes indicated improved pain and functional scores. Conclusion: This systematic review found that isolated liner exchange with bone grafting for the management of periacetabular osteolysis was associated with a high revision-free survival rate (93.4%) and minimal radiographic progression (1.9%) of osteolytic lesions at short-term to medium-term follow-up. Liner exchange with bone grafting is recommended for the management of large periacetabular osteolytic lesions (> 450 mm2) in well-fixed acetabular cups. We encourage future studies to develop a grading scale for lesions to guide clinical management and risk stratification for patients.

文献出处：Ricotti RG, Alexander-Malahias M, Ma QL, Jang SJ, Loucas R, Gkiatas I, Manolopoulos PP, Gu A, Togninalli D, Nikolaou VS, Sculco PK. Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review. HSS J. 2024 Nov;20(4):567-576. doi: 10.1177/15563316231189736. Epub 2023 Sep 7. PMID: 39494435; PMCID: PMC11528827.

文献3

机器人辅助全膝关节置换术在复杂初次及翻修病例中的应用

译者 沈松坡

综述目的：本研究系统回顾了机器人辅助全膝关节置换术（rTKA）在复杂初次置换及翻修病例中的结局，并与传统全膝关节置换术（cTKA）进行比较。复杂病例包括严重冠状面畸形、高体重指数（BMI）、固定屈曲畸形以及翻修关节置换。评估结局包括冠状面对线、围手术期指标及患者报告结局。

最新发现：共纳入19项研究，包含2482例患者（2535膝：1931膝rTKA，604膝cTKA）。机器人辅助TKA可稳定地恢复冠状面对线，其中改善最明显者见于中至重度内翻和外翻畸形。于翻修病例中，机器人辅助可实现接近中立位的髋-膝-踝对线（平均偏差−1.05°）、较低并发症发生率（4%–17.9%）以及较高的假体生存率（97.1%）。在肥胖患者中，机器人辅助TKA提高了对线精确性，但功能结局与传统技术相似。机器人系统减少了广泛软组织松解的需要，并可实现可靠的早期功能恢复。大多数研究为回顾性研究，由于混杂因素以及患者群体、手术复杂性和机器人平台的异质性，存在中度至重度偏倚风险。

总结：在复杂初次和翻修病例中，机器人辅助TKA能够可靠地恢复冠状面对线，并取得与传统技术相当的围手术期及患者报告结局。在严重畸形或解剖结构具有挑战性的膝关节中，其对线优势尤为明显。尽管这些结果令人鼓舞，但应结合目前证据主要来自回顾性数据、结局报告异质性较高及长期随访有限这一背景进行解读。未来仍需开展前瞻性、纵向、随机研究，并采用标准化报告，以证实机器人辅助技术对复杂TKA长期功能结局和假体生存率的影响。

关键词：机器人辅助TKA；复杂膝关节置换；翻修TKA；内翻畸形；外翻畸形；肥胖；患者报告结局。

Robotic-Assisted Total Knee Arthroplasty in Complex Primary and Revision Cases: A Systematic Review

Purpose of review: This study systematically reviews outcomes of robotic-assisted total knee arthroplasty (rTKA) in complex primary and revision cases, compared with conventional TKA (cTKA). Complex cases include severe coronal deformity, high BMI, fixed flexion deformity, and revision arthroplasty. Outcomes assessed included coronal alignment, perioperative metrics, and patient-reported outcomes.

Recent findings: Nineteen studies comprising 2,482 patients (2,535 knees: 1,931 rTKA, 604 cTKA) were included. Robotic-assisted TKA consistently restored coronal alignment, with greatest improvements observed in moderate-to-severe varus and valgus deformities. In revision cases, robotic assistance achieved near-neutral hip-knee-ankle alignment (mean deviation - 1.05°), low complication rates (4-17.9%), and high implant survival (97.1%). In obese patients, robotic-assisted TKA improved alignment precision, though functional outcomes were similar to conventional techniques. Robotic systems reduced the need for extensive soft tissue releases and enabled reliable early functional recovery. Most studies were retrospective, with moderate-to-serious risk of bias due to confounding and heterogeneity in patient populations, surgical complexity, and robotic platforms. Robotic-assisted TKA reliably restored coronal alignment and achieved perioperative andpatient-reported outcomes comparable to conventional techniques in complex primary andrevision cases. Alignment advantages were particularly evident in severe deformities oranatomically challenging knees. While these findings are encouraging, they should be3interpreted in the context of predominantly retrospective data, heterogeneous outcomereporting, and limited long-term follow-up. Future prospective, longitudinal randomizedstudies with standardized reporting are needed to confirm the impact of robotic-assistedapproaches on long-term functional outcomes and implant survival, in complex TKA.

Keywords: Complex knee arthroplasty; Obesity; Patient-reported outcomes; Revision TKA; Robotic-assisted TKA; Valgus deformity; Varus deformity.

第二部分：保髋相关文献

文献1

改良钻孔骨骺阻滞和人类学预测方法治疗下肢不等长：长期随访结果

译者 任宁涛

本研究旨在总结我们改良钻孔骨骺阻滞的经验和准确手术时机的预测方法，并与其他作者最近的研究结果进行比较。采用Macnicol和Gupta改良钻孔技术。在 2004 年至 2016 年期间，对 42 名儿童（21 名男孩，21 名女孩；手术时的中位年龄为 12.6 岁，年龄范围为 9.4 - 15.4 岁）进行了远端股骨和/或胫骨近端永久性骨骺阻滞手术。基于先前研究的基础，我们开发了一种辅助学预测方法。通过临床检查评估肢体长度差异（LLD），并通过髋关节x线片（站立时，短肢垫高）证实。预测阻滞效果长度为2.7 cm±1.1 cm。骨骼发育成熟后的差值为（0.5±0.5）cm。在 26 名患者（61.9%）中，实现了双下肢的等长（0 - 0.5 厘米）。在 4 名患者（9.5%）中，残存下肢长度差超过 1.0 厘米。2例患者（0.5 cm和0.6 cm）最初较长的腿变短。1例患者生长板阻滞失败。另外 3 名患者中，胫骨骨骺固定的效果不理想。5例出现轻微并发症，但均未出现冠状面、矢状面成角畸形或腓骨近端过度生长。3例（7.1%）需翻修。与已发表的数据相比，更多的患者获得了下肢等长。本研究的结果验证了基于Shapiro发现的LLD的预测算法的准确性。Shapiro分型1和3的手术效果相当。体格检查、骨龄评估和性成熟是确定手术时机的重要工具。

Lower extremity length discrepancy solution by modified drilling epiphysiodesis and anthropological prediction methods: long-term results

This study aimed to summarize our experience with modified drilling epiphysiodesis and prediction methods for accurate timing of surgery and to compare the results with those of recent work by other authors. The Macnicol and Gupta modified drilling technique was used. Distal femoral and/or proximal tibial permanent epiphysiodesis was performed in 42 children (21 boys, 21 girls; median age at surgery=12.6 years, age range=9.4-15.4 years) between 2004 and 2016. Based on the groundwork of previous studies, we developed an auxological prediction method. The limb length discrepancy (LLD) was assessed by clinical examination and verified by an x-ray of the hips when standing with blocks under the shorter leg. The predicted shortening was 2.7 cm ± 1.1 cm. The final discrepancy after finishing skeletal growth was 0.5 ± 0.5 cm. In 26 patients (61.9%), equalization of both legs was achieved (0-0.5 cm). In 4 patients (9.5%), the remaining shortening was more than 1.0 cm. Shortening of an initially longer leg occurred in two patients (0.5 cm and 0.6 cm). Failure of growth plate arrest was observed in 1 patient. In another 3 patients, the efficacy of tibial epiphysiodesis was unsatisfactory. Minor complications occurred in 5 cases, but there was no evidence of angular deformity in the frontal and sagittal planes or proximal fibula overgrowth. Three patients (7.1%) returned to the operating room. Compared to published data, more patients achieved complete equalization of leg length. The results of this study verified the accuracy of the auxological prediction algorithm of LLD based on Shapiro's findings. The surgical outcome is comparable between Shapiro patterns 1 and 3. Auxological examination, assessment of bone age, and sexual maturation are crucial tools for accurate timing of surgery.

文献出处：Petr K, Daniela Z, Radek M, Sarka P, Ivo M. Lower extremity length discrepancy solution by modified drilling epiphysiodesis and anthropological prediction methods: long-term results. Acta Orthop Traumatol Turc. 2024 Jul 9;58(3):155-160. doi: 10.5152/j.aott.2024.21095. PMID: 39165099; PMCID: PMC11363206.

文献2

利用骨盆正位X线片评估骨盆倾斜：一项系统综述

译者 李勇

背景： 骨盆倾斜是髋关节和脊柱手术中常规评估的参数，通常通过在骨盆矢状位X线片上测量获得。然而，由于标志点可见性、骨盆异常及内置物存在等限制，该方法并非总是可行。为此，大量研究致力于利用骨盆正位X线片来评估矢状面上的骨盆倾斜。因此，本系统综述旨在收集这些方法并评估其性能。

方法： 两名独立评审员于2023年6月检索了PubMed、Ovid、Cochrane和Web of Science数据库，并追溯了参考文献（利用Google Scholar存档）。共纳入30项研究。采用预测模型偏倚风险评估工具评估偏倚风险。相关数据以标准化表格提取，用于评估绝对骨盆倾斜或相对骨盆倾斜。分歧通过与资深作者讨论解决。

结果： 共涉及19个基于骨盆正位X线片的参数，另有4项研究采用人工智能、目测或统计形状模型方法，未涉及特定参数。将骨盆矢状位X线片测量的骨盆倾斜值与基于正位X线片推算的值进行比较，发现最高相关系数为0.91。平均绝对差值为2.6°，最大误差达10.9°。大多数研究支持利用正位参数计算骨盆倾斜的变化具有可行性。

结论： 未发现任何单一正位参数能够精确估算绝对骨盆倾斜值。然而，通过评估同一患者在不同体位下的系列正位X线片，并采用任意正位参数，可以获得相对骨盆倾斜值。

图. 纳入研究中骨盆倾斜定义的示意图

Evaluating Pelvic Tilt Using the Pelvic Antero-Posterior Projection Images: A Systematic Review

Background: Pelvic tilt (PT) is a routinely evaluated parameter in hip and spine surgeries and is usually measured on a sagittal pelvic radiograph. This may not always be feasible due to limitations such as landmark visibility, pelvic anomaly, and hardware presence. Tremendous efforts have been dedicated to using pelvic antero-posterior (AP) radiographs for assessing sagittal PT. Thus, this systematic review aimed to collect these methods and evaluate their performances.

Methods: Two independent reviewers searched the PubMed, Ovid, Cochrane, and Web of Science databases in June 2023 with backward reference trailing (Google Scholar archive). There were 30 studies recruited. Risk of bias was assessed using the prediction model risk of bias assessment tool. The relevant data were tabulated in a standardized form for evaluating either the absolute PT or relative PT. Disagreement was resolved by discussing with the senior author.

Results: There were 19 parameters from pelvic AP projection images involved, with 4 studies which used artificial intelligence, eyeball, or statistical shape method not involving a specific parameter. In comparing the PT values from pelvic sagittal images with those extrapolated from antero-posterior projection images, the highest correlation coefficient was found to be 0.91. The mean absolute difference (error) was 2.6, with a maximum error reaching 10.9. Most studies supported the feasibility of using AP parameters to calculate changes in PT.

Conclusions: No individual AP parameter was found to precisely estimate absolute PT. However, relative PT can be derived by evaluating serial AP radiographs of a patient in varying postures, employing any AP parameters.

文献出处：Chai Y, Boudali AM, Veltman ES, Farey JE, Walter WL. Evaluating pelvic tilt using the pelvic antero-posterior radiographs: A novel method. J Orthop Res. 2024 Oct;42(10):2318-2326. doi: 10.1002/jor.25907. Epub 2024 May 30. PMID: 38814154.

文献3

髋臼软骨厚度：在尸体研究中采用多层螺旋CT关节造影三维重建的准确性研究

译者 陶可

目的：前瞻性地通过量化分割多层螺旋CT关节造影生成的三维（3D）表面以评估髋臼软骨厚度的准确性，并以软骨厚度的直接物理测量值为参考标准。

材料与方法：本研究获取了来自两名男性捐献者（年龄分别为43岁和46岁）的尸体共四侧新鲜冷冻髋关节标本；并已获得机构审查委员会对尸体研究的批准。在四侧尸体髋臼（两具标本）上垂直于软骨钻取十六个孔。手术缝合髋关节囊，注入造影剂，并使用多层螺旋CT进行扫描。扫描后，在每个钻孔处同心取5.3 mm的软骨髓芯，并使用显微镜测量软骨厚度。使用商业软件对软骨进行三维重建。测量由两位作者重复进行。重建的软骨厚度采用已发表的算法确定。使用Bland-Altman图和线性回归评估准确性。重复性通过变异系数、组内相关系数（ICC）、重复性系数和变异百分比进行量化。

结果：软骨重建的偏差为-0.13 mm，重复性系数为±0.46 mm。散点图回归分析表明多层螺旋CT倾向于高估软骨厚度。观察者内和观察者间的重复性均良好。观察者内相关性方面，变异系数为14.80%，组内相关系数（ICC）为0.88，重复性系数为0.55 mm，变异百分比为11.77%。观察者间相关性方面，变异系数为13.47%，组内相关系数（ICC）为0.90，重复性系数为0.52 mm，变异百分比为11.77%。概率为 11.63%。

结论：多层螺旋CT关节造影数据重建软骨几何结构可作为术前手术计划工具，只要精确度约为±0.5 mm即可满足上述要求。

图1：髋关节离断照片显示股骨头、关节囊、髋臼盂唇和髋臼。在髋臼的四个象限内，沿菱形排列垂直于软骨表面钻取四个孔。箭头所示为后上象限的钻孔（取样本前）。

髋臼骨软骨取样髓芯切开后的数字显微镜图像（放大倍数40倍）显示软骨下骨与软骨的界面（虚线）；在多层螺旋CT关节造影前钻取的直径1.5 mm的孔洞作为图像数据中的参考点。成像后，在钻孔中心周围取取直径5.3 mm的骨软骨髓芯。在钻孔附近（黑色箭头所示位置）测量软骨髓芯的厚度。可见刻度为0.10 mm的光学测量网格。白色箭头所示为孔洞和软骨髓芯的尺寸。

右侧髋臼示意图。(a)矢状位多层螺旋CT关节造影显示1.5 mm钻孔、软骨、造影剂和软骨下骨（箭头所示）。注意，钻孔内未充满造影剂，这可能是由于造影剂的表面张力和高粘度所致。(b)半自动分割后，骨（深灰色）和软骨（浅灰色）的侧位斜位三维重建图像。

右侧髋臼示意图。(a)矢状位多层螺旋CT关节造影显示1.5 mm钻孔、软骨、造影剂和软骨下骨（箭头所示）。注意，钻孔内未充满造影剂，这可能是由于造影剂的表面张力和高粘度所致。(b)半自动分割后，骨（深灰色）和软骨（浅灰色）的侧位、斜位三维重建图像。

图4：同一标本，左右髋关节髋臼软骨厚度的条纹图。较厚的软骨主要分布于前上部区域；较薄的软骨主要局限于后月状面。* = 物理测量的近似位置。

Bland-Altman图显示了平均软骨厚度与差值的关系。图中绘制了观察者1（观察者＃1）两次试验的数据点。观察者1（实线）和观察者2（观察者＃2，虚线）的最佳拟合线几乎重合。点线 = 观察者1 的 95%置信区间。两条最佳拟合线的方程均表明，多层螺旋CT (MDCT)倾向于分别高估和低估厚度大于约1.25 mm和小于约1.25 mm的软骨厚度。

图6：软骨厚度物理测量值（Phy. Thick.）与多层螺旋CT测量值（MDCT. Thick.）的散点图。图中绘制了观察者1（Ob. ＃1）两次试验的数据点。观察者1（实线）和观察者2（Ob. ＃2，虚线）的线性回归表明，多层螺旋CT倾向于高估软骨厚度。较高的决定系数（R²）表明，多层螺旋CT图像的三维重建非常适合用于测量髋臼软骨厚度。

Acetabular cartilage thickness: accuracy of three-dimensional reconstructions from multidetector CT arthrograms in a cadaver study

Purpose: To prospectively quantify the accuracy of hip cartilage thickness estimated from three-dimensional (3D) surfaces, generated by segmenting multidetector computed tomographic (CT) arthrograms by using direct physical measurements of cartilage thickness as the reference standard.

Materials and methods: Four fresh-frozen cadaver hip joints from two male donors, ages 43 and 46 years, were obtained; institutional review board approval for cadaver research was also obtained. Sixteen holes were drilled perpendicular to the cartilage of four cadaveric acetabula (two specimens). Hip capsules were surgically closed, injected with contrast material, and scanned by using multidetector CT. After scanning, 5.3-mmcores were harvested concentrically at each drill hole and cartilage thickness was measured with a microscope. Cartilage was reconstructed in 3D by using commercial software. Segmentations were repeated by two authors. Reconstructed cartilage thickness was determined by using a published algorithm. Bland-Altman plots and linear regression were used to assess accuracy. Repeatability was quantified by using the coefficient of variation, intraclass correlation coefficient (ICC), repeatability coefficient, and percentage variability.

Results: Cartilage was reconstructed to a bias of -0.13 mm and a repeatability coefficient of + or - 0.46 mm. Regression of the scatterplots indicated a tendency for multidetector CT to overestimate thickness. Intra- and interobserver repeatability were very good. For intraobserver correlation, the coefficient of variation was 14.80%, the ICC was 0.88, the repeatability coefficient was 0.55 mm, and the percentage variability was 11.77%. For interobserver correlation, the coefficient of variation was 13.47%, the ICC was 0.90, the repeatability coefficient was 0.52 mm, and the percentage variability was 11.63%.

Conclusion: Assuming that an accuracy of approximately + or - 0.5 mm is sufficient, reconstructions of cartilage geometry from multidetector CT arthrographic data could be used as a preoperative surgical planning tool.

文献出处：Bryce C Allen, Christopher L Peters, Nicholas A T Brown, Andrew E Anderson. Acetabular cartilage thickness: accuracy of three-dimensional reconstructions from multidetector CT arthrograms in a cadaver study. Radiology. 2010 May;255(2):544-52. doi: 10.1148/radiol.10081876.

文献4

Retuve：基于开源人工智能的髋关节发育不良多模态自动化分析

译者 邱兴

发育性髋关节发育不良（DDH）给诊断带来显著挑战，阻碍了及时干预。当前的筛查方法缺乏标准化，而基于人工智能的研究由于数据和代码的可用性有限，存在可重复性问题。为解决这些不足，我们提出了 Retuve——一个用于 DDH 多模态分析的开源框架，涵盖超声（US）和 X 射线成像两种模态。Retuve 提供了完整且可重复的工作流程，包括由专家标注的超声和 X 射线图像组成的开放数据集、附带训练代码和权重的预训练模型，以及用户友好的 Python 应用程序编程接口（API）。该框架整合了分割和关键点检测模型，能够自动测量 α 角和髋臼指数等关键诊断参数。通过遵循开源原则，Retuve 促进了 DDH 研究的透明性、协作性和可及性。该框架有望推动 DDH 筛查的普及，助力早期诊断，并通过实现广泛筛查和早期干预来改善患者预后。GitHub 仓库/代码可通过以下链接获取：https://github.com/radoss-org/retuve

图1. Retuve 可轻松通过基于任意数据训练得到的定制化人工智能进行调整，包括由持有私有数据的用户分叉生成封闭版本

图2. X 射线算法。利用三角形分割定位骨盆两侧的内侧（黄色）、外侧（蓝色）和下方（绿色，h 点）标志点。由此可计算髋臼指数、Wilberg 指数及 IHDI 分级。

图3. Retuve 与 PACS-AI 的集成使其能够在无需基础设施改造的情况下无缝部署于临床工作流程。左侧为 PACS-AI 界面，右侧为使用 Retuve PACS-AI 插件生成的 DDH 报告。

Retuve: Automated multi-modality analysis of hip dysplasia with open source AI

Developmental dysplasia of the hip (DDH) poses significant diagnostic challenges, hindering timely intervention. Current screening methodologies lack standardization, and AI-driven studies suffer from reproducibility issues due to limited data and code availability. To address these limitations, we introduce Retuve, an open-source framework for multi-modality DDH analysis, encompassing both ultrasound (US) and X-ray imaging. Retuve provides a complete and reproducible workflow, offering open datasets comprising expert-annotated US and X-ray images, pre-trained models with training code and weights, and a user-friendly Python Application Programming Interface (API). The framework integrates segmentation and landmark detection models, enabling automated measurement of key diagnostic parameters such as the alpha angle and acetabular index. By adhering to open-source principles, Retuve promotes transparency, collaboration, and accessibility in DDH research. This framework can democratize DDH screening, facilitate early diagnosis, and improve patient outcomes by enabling widespread screening and early intervention. The GitHub repository/code can be found here: https://github.com/radoss-org/retuve

文献出处：McArthur, A., Wichuk, S., Burnside, S., Kirby, A., Scammon, A., Sol, D., ... & Jaremko, J. L. (2025). Retuve: Automated multi-modality analysis of hip dysplasia with open source AI. Software Impacts, 100791.

来源：304关节学术

作者：304关节团队

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