髋膝关节文献精译荟萃（第385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、满意但失败的全膝关节置换术

3、机器人辅助与传统全膝关节置换术后的住院结局和住院费用

4、骨盆内移截骨术可减缓多发骨骺发育不良和假性软骨发育不全患者的髋关节退变

5、出生时因髋关节发育不良而接受治疗，治疗后1年时髋臼指数正常的儿童:随访5年时出现髋关节发育不良的发生率

6、髋臼周围截骨术治疗发育性髋关节发育不良的学习曲线

7、改良 Dunn 手术治疗中重度股骨头滑脱的长期疗效

8、三维双回声稳态（DESS）MR髋关节造影量化髋臼软骨厚度的准确性研究

9、基于视觉-惯性传感器融合的骨科手术训练六维物体姿态跟踪

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.

文献出处：Ye X, Xu B, Huang N, Wu Z, He J, Li C, Tang J. Ankle alignment before and after total knee arthroplasty in patients with valgus knee deformity. J Orthop Surg Res. 2025 Apr 18;20(1):389. doi: 10.1186/s13018-025-05800-5. PMID: 40247287; PMCID: PMC12007289.

文献2

满意但失败的全膝关节置换术-患者满意度与医疗保险和医疗补助服务中心手术成功定义的对比研究

译者 张蔷

背景：在美国，每年施行的全膝关节置换（TKAs）手术超过一百万例，主要目的是缓解膝关节疼痛、恢复关节功能并提高生活质量。然而，有接近1/5的病人在术后1年以后对疗效并不满意。我们尝试把患者满意度与美国医疗保险和医疗补助服务中心（CMS）对TKA手术成功的定义进行对比。

方法：我们进行了一项关于初次单侧TKA手术的多中心队列研究，比较患者满意度与CMS定义的手术成功标准，即在术后1年随访时KOOS JR评分（0-100）至少提高20分。我们交叉比较了患者满意度和成功手术的定义，并应用多元回归分析寻找患者满意却被定义为失败病例的影响因素。

结果：我们共入组了8444例平均年龄为68岁（分为30-64岁年龄组和65-95岁年龄组）的TKA病例。这些病人中，67%为女性，60%为肥胖病例。至于患者的种族和国籍，81%为白人，17%为黑人，1%为亚裔，0.6%为美洲或阿拉斯加本土土著，0.3%为夏威夷本地人或其他太平洋岛国人种。尽管有84%的患者对手术疗效满意，但被定义为成功的病例只占64%。满意的病例中，只有71%的病例被定义为成功病例，该种不一致受基础评分影响。对于疗效满意但基础评分较差（KOOS JR评分<40）的病例，91%均符合CMS的手术成功定义。与之相反，对于疗效满意但基础评分更好（KOOS JR评分≥60）的病例，只有39%符合CMS的手术成功定义。此种患者满意但定义为失败的情况还与年轻、背痛、对侧膝关节疼痛、健康认知较低、糖尿病和精神状况较差相关。将基础KOOS JR值加入模型后可以显著提高预测准确性（受试者工作特征曲线下面积从0.58升至0.79）。

结论：我们发现TKA患者术后满意度与CMS对手术成功的定义间存在较大差异。将手术成功定义分级，同时根据患者基础状态进行风险调整后，该定义与患者满意度的一致性会显著提升。由于患者术前的基础评分较高而难以在术后出现显著进步，在评分项目中加入几项关于关节疼痛和关节功能的专属问题能否更精准的反映患者术前术后改善情况，这是一个值得进一步研究的课题。

Satisfied but Failed Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare & Medicaid Services

Background: More than 1 million total knee arthroplasties (TKAs) are performed annually in the United States to reduce knee pain, restore physical function, and enhance quality of life. However, nearly 1 in 5 patients are not satisfied after 1 year. We aimed to compare patient satisfaction with the U.S. Centers for Medicare & Medicaid Services (CMS) definition of success in TKA.

Methods: We studied a multicenter cohort of patients undergoing primary unilateral TKA, comparing patient satisfaction with CMS-defined surgery success, which is a minimum 20-point improvement in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR, scored 0 to 100) at 1 year. We cross-classified surgeries by satisfaction and success and used multivariable logistic regression to identify factors associated with satisfied patients being deemed as having undergone surgeries that failed.

Results: We studied 8,444 patients with a mean age of 68 years (with patients grouped by age: 30 to 64 years and 65 to 95 years). Of the patients, 67% were women and 60% were obese. With regard to the patients’ race and/or ethnicity, 81% were White, 17% were Black, 1% were Asian, 0.6% were Native American or Alaskan Native, and 0.3% were native Hawaiian or other Pacific Islander. Although 84% of all patients reported satisfaction with the surgery, only 64% of surgeries were deemed successful. Among satisfied patients, only 71% underwent a surgery that was deemed to be successful, and discordance depended strongly on their baseline score. For satisfied patients with the worst baseline status (KOOS JR of <40), the CMS deemed the surgeries to be successful 91% of the time. In contrast, for satisfied patients with better baseline status (KOOS JR of ≥60), the CMS determined that only 39% of the surgeries were successful. Surgical failure in satisfied patients was also associated with younger age, back pain, contralateral knee pain, lower health literacy, diabetes, and poorer mental health. Including the baseline KOOS JR in the model significantly increased predictive accuracy (the area under the receiver operating characteristic curve rose from 0.58 to 0.79).

Conclusions: We found substantial discordance between patients’ satisfaction with the procedure and how the CMS currently assesses TKA success. A graded success metric, risk-adjusted for patients’ baseline status, would align better with satisfaction. It is also worth exploring whether adding a few questions on joint-specific pain and function could better capture meaningful changes in patients whose high baseline status leaves little room for improvement on the KOOS JR.

文献出处：Zheng H, Ash AS, Liu SH, Yousef M, Allison J, Ayers DC. Satisfied but Failed: Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare & Medicaid Services. J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00896. Epub ahead of print. PMID: 41460960.

文献3

机器人辅助与传统全膝关节置换术后的住院结局和住院费用：一项基于2016–2022年全国住院患者样本的研究

译者 沈松坡

背景：机器人辅助全膝关节置换术已被采用以提高手术精准度，但关于其临床和经济结局的当代全国性证据仍然有限。

目的：使用近期全国性数据，比较机器人辅助全膝关节置换术与传统全膝关节置换术之间的住院并发症、住院时间和住院费用。

方法：我们使用2016–2022年全国住院患者样本开展了一项回顾性队列研究。纳入成年择期初次膝关节置换术住院病例；排除翻修手术病例或有记录的新型冠状病毒病病例。在按照人口学因素、医院因素、合并症和入院年份进行1:1倾向评分匹配后，比较机器人辅助和传统手术。每组队列均包括173,565例患者。结局指标包括住院时间、总住院费用以及主要住院期间并发症。采用双侧检验，显著性阈值设定为0.05。

结果：机器人辅助手术所占比例从2016年的0.7%增加至2022年的14.9%。匹配后，机器人辅助手术与更短的平均住院时间相关，分别为1.9天和2.7天；p < 0.001，并且多种并发症发生率更低。当以相对风险表示时，相对风险定义为传统全膝关节置换术风险除以机器人辅助全膝关节置换术风险，传统组输血、肺炎、肺栓塞、延长机械通气和深静脉血栓形成风险均更高，分别为输血RR 3.7、肺炎RR 3.0、肺栓塞RR 2.6、延长机械通气RR 2.1、深静脉血栓形成RR 1.8，均p < 0.01。急性肾损伤在机器人辅助组中略更常见，相对风险0.9；p = 0.03。机器人辅助术式的平均住院费用更高，分别为70,758美元和62,618美元；p < 0.001。

结论：在这一大型当代全国性队列中，与传统手术相比，机器人辅助全膝关节置换术与更少的住院期间并发症和更短的住院时间相关，但住院费用更高。这些发现支持机器人辅助在住院期间可能具有安全性优势，并提示有必要进一步研究其长期临床和经济结局。

In-hospital outcomes and hospital charges after robotic-assisted versus conventional total knee arthroplasty: A 2016-2022 Nationwide Inpatient Sample study

Abstract

Background: Robotic-assisted total knee arthroplasty has been adopted to enhance surgical precision, yet contemporary national evidence on clinical and economic outcomes remains limited.

Objective: To compare in-hospital complications, length of stay, and hospital charges between robotic-assisted and conventional total knee arthroplasty using recent nationwide data.

Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2016-2022. Adult elective primary knee arthroplasty admissions were identified; cases with revision procedures or documented coronavirus disease were excluded. Robotic-assisted and conventional procedures were compared after 1:1 propensity score matching on demographics, hospital factors, and comorbidities and year of admission (two cohorts of 173,565 patients each). Outcomes included length of stay, total hospital charges, and major in-hospital complications. Two-sided tests were used with a significance threshold of 0.05.

Results: The proportion of robotic-assisted procedures increased from 0.7% in 2016 to 14.9% in 2022. After matching, robotic-assisted surgery was associated with a shorter mean length of stay (1.9 vs 2.7 days; p < 0.001) and lower rates of several complications. When expressed as relative risks (RR) (risk in conventional TKA divided by risk in robotic-assisted TKA), transfusion (RR 3.7), pneumonia (RR 3.0), pulmonary embolism (RR 2.6), prolonged ventilation (RR 2.1), and deep vein thrombosis (RR 1.8) were all higher in the conventional group (all p < 0.01). Acute kidney injury was marginally more frequent with robotic assistance (relative risk 0.9; p = 0.03). Mean hospital charges were higher for robotic-assisted procedures (US$70,758 vs US$62,618; p < 0.001).

Conclusions: In a large, contemporary national cohort, robotic-assisted total knee arthroplasty was associated with fewer in-hospital complications and shorter hospital stays than conventional surgery, while incurring higher hospital charges. These findings support a potential safety advantage for robotic assistance during the index admission and motivate further study of longer-term clinical and economic outcomes. Levels of Evidence: LEVEL III.

文献出处：Maman D, Steinfeld Y, Berkovich Y. In-hospital outcomes and hospital charges after robotic-assisted versus conventional total knee arthroplasty: A 2016-2022 Nationwide Inpatient Sample study. PLoS One. 2026 Apr 22;21(4):e0346031. doi: 10.1371/journal.pone.0346031. PMID: 42018543; PMCID: PMC13102188.

第二部分：保髋相关文献

文献1

骨盆内移截骨术可减缓多发骨骺发育不良和假性软骨发育不全患者的髋关节退变

译者 张振东

背景：多发骨骺发育不良(multiple epiphyseal dysplasia，MED)和假性软骨发育不全(pseudoachondroplasia，PSACH)是以骨骺不规则、轻度或重度矮小和早发性骨关节炎为特征的先天性骨骼疾病，常累及髋关节。本研究评估了Chiari骨盆内移截骨术在MED和PSACH患者中的长期效果。

方法：回顾性分析了20例患者(14例MED, 6例PSACH)。 临床评估采用Postel Merle d'Aubigné (PMA)评分和髋关节功能障碍和骨关节炎结果评分(HOOS)。 术前和末次随访时x线片测量Risser指数、Sharp角、髋臼指数、中心-边缘角、Tönnis角和股骨头覆盖。同时评估Treble指数，用于确定髋关节发生骨关节炎风险：I型早期骨关节炎发生风险高；II型关节炎进展相对正常。 髋关节骨关节炎程度使用Stulberg分级(I - V级)评估。 统计学分析确定术前和术后各指标的差异。

结果：纳入20例行Chiari截骨术的患者共33髋。平均随访时间为20.1年。末次随访时PMA评分明显优于术前。所有影像学参数均有显著改善。此外，在髋关节骨性成熟时，Sharp角、中心-边缘角和股骨头覆盖均改善到正常值。所有手术髋关节的Treble指数均为I型。大部分髋关节在骨性成熟时呈非球形匹配(Stulberg分级为III级和IV级)。若以关节置换为终点，术后24年髋关节的生存率为80.7%。

结论：Chiari截骨术可有效治疗伴有严重髋关节症状的MED和PSACH患者。长期随访显示，该手术可减轻疼痛并改善髋关节功能，从而推迟全髋关节置换术。

Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia?

Background: Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are congenital skeletal disorders characterized by irregular epiphyses, mild or severe short stature and early-onset osteoarthritis which frequently affect the hips. The current study evaluates the long-term results of the Chiari osteotomy in MED and PSACH patients.

Methods: Twenty patients (14 MED and 6 PSACH) were retrospectively included. Clinical assessment used the Postel Merle d'Aubigné (PMA) score and the Hip disability and Osteoarthritis Outcome Score (HOOS). Risser index, Sharp angle, acetabular depth index, center-edge angle, Tönnis angle, and femoral head coverage were measured on the preoperative radiographs and at last follow-up. The Treble index, which identifies the hip at risk in MED patients, was also determined. Stulberg classification (grades I to V) was used to evaluate the risk of osteoarthritis in the mature hips.Statistical analyses determined differences between preoperative and postoperative data. The Kaplan Meier method was used to calculate the survival rate of the operated hips using total hip arthroplasty as the endpoint.

Results: Thirty-three hips which underwent a Chiari osteotomy were reviewed. The average follow-up was 20.1 years. The PMA scores were significantly better at last follow-up than preoperatively. All radiographic parameters significantly improved. Moreover, the Sharp angle, center-edge angle, and femoral head coverage improved to a normal value at hip maturity. All of the operated hips had a Treble index of type I. At hip maturity, a majority of hip were aspherical congruent (Stulberg grades of III and IV). The survival rate of the operated hips was 80.7% at 24 years postoperative

Conclusions: The Chiari osteotomy is a satisfying solution for severe symptomatic hip lesions in MED and PSACH patients. At long-term follow-up, this procedure lessens pain and improves hip function, which delays total hip arthroplasty indication.

文献出处：Andrzejewski A, Péjin Z, Finidori G, Badina A, Glorion C, Wicart P. Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia? J Pediatr Orthop. 2021 Feb 1;41(2):e135-e140.

文献2

出生时因髋关节发育不良而接受治疗，治疗后1年时髋臼指数正常的儿童:随访5年时出现髋关节发育不良的发生率?

译者 任宁涛

目的:本研究的目的是评估对髋关节发育不良儿童进行进一步随访的效果，这些儿童在治疗后1年时的临床和放射学表现正常，对其随访5年时出现髋关节发育不良的发生率进行统计。

方法:选取2003 - 2015年在挪威Sør-Trøndelag县出生的47,289名儿童中，265名儿童患有髋关节发育不良，其中164例(239髋)因发育性髋关节发育不良接受治疗，且在治疗后1年时临床表现和髋臼指数正常的儿童被纳入研究，统计随访5年时出现髋关节发育不良的发生率。联合测量外侧CE角，影像学上进一步确认是否存在DDH的情况。

结果:治疗后1年时共239髋恢复正常。随访5年时，10(4.2%)例髋关节髋臼指数异常，没有一例因测量不准确而被归类为髋关节发育不良。8例(3.3%)髋外侧CE角测量异常，4例髋关节髋臼指数和外侧CE角异常，其中3例髋关节进行了手术治疗。观察者内部和观察者之间的重复性系数在3.1°-6.6°之间。

结论:髋臼指数测量的可重复性较高，考虑到这种可重复性，5年随访时无法将所有髋关节划分为发育性髋关节发育不良，因此需结合外侧CE角的测量。我们建议对这些儿童进行进一步随访。

Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year：How many had residual dysplasia at 5 years？

Purpose: The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years.

Methods: Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle.

Results: A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°-6.6°.

Conclusion: The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children.

文献出处：Håberg Ø, Bremnes T, Foss OA, Angenete O, Lian ØB, Holen KJ. Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years? J Child Orthop. 2022 Jun;16(3):183-190. doi: 10.1177/18632521221106376. Epub 2022 Jun 30. PMID: 35800653; PMCID: PMC9254022.

文献3

髋臼周围截骨术治疗发育性髋关节发育不良的学习曲线：一项系统评价与荟萃分析

译者 李勇

目的：髋臼周围截骨术（PAO）技术难度高，被认为学习曲线陡峭。本系统评价与荟萃分析评估了外科医生经验如何影响发育性髋关节发育不良（DDH）患者的手术效率、围手术期并发症发生率、影像学矫正效果及中转全髋关节置换术（THA）的比率。

方法：对五个数据库进行系统检索，筛选出比较PAO早期与后期经验阶段的研究。采用随机效应荟萃分析（Sidik‑Jonkman法及Hartung‑Knapp校正）处理连续性结局（均数差，MD）和二分类结局（比值比，OR）。使用非随机干预研究偏倚风险评估工具（ROBINS‑I）评估偏倚风险，并使用推荐分级的评估、制定与评价（GRADE）系统评估证据质量。

结果：共纳入7项研究（499例患者，556髋）。后期PAO的手术时间显著缩短（均数差 –74.58分钟，95%置信区间 –136.52至 –12.65）。在失血量、并发症、中转THA或影像学矫正方面未发现显著差异。手术时间和失血量的异质性较高，多数研究显示中等偏倚风险。

结论：外科医生经验可显著提高PAO的手术效率，而并发症、失血量、影像学准确性及早期THA中转率似乎基本不受影响，这可能反映了结构化的监督指导和高手术量培训环境。并发症与影像学矫正无显著差异，提示有组织的导师制和集中的保髋手术中心可能降低早期阶段的风险。需要开展标准化、前瞻性研究来确定熟练度阈值并优化保髋手术培训。

Learning curve in periacetabular osteotomy for developmental dysplasia of the hip: a systematic review and meta-analysis

Aims: Periacetabular osteotomy (PAO) is technically demanding with an assumed steep learning curve. This systematic review and meta-analysis evaluated how surgeon experience influences operative efficiency, perioperative morbidity, radiological correction, and conversion to total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH).

Methods: A systematic search of five databases identified studies comparing early with late PAO experience phases. Random-effects meta-analyses (Sidik-Jonkman with Hartung-Knapp adjustment) were performed for continuous (mean difference (MD)) and binary (odds ratios (ORs)) outcomes. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results: In all, seven studies (499 patients, 556 hips) were included. Late-phase PAOs had significantly shorter operative times (MD –74.58 minutes, 95% CI –136.52 to –12.65). No significant differences were found for blood loss, complications, THA conversion, or radiological correction. Heterogeneity was high for operating time and blood loss, and most studies showed moderate risk of bias.

Conclusion: Surgeon experience substantially improves operative efficiency in PAO, while complications, blood loss, radiological accuracy, and early THA conversion appear largely unaffected, likely reflecting structured supervision and high-volume training environments. The lack of significant differences in complications and radiological correction suggests that structured mentorship and centralized hip preservation programmes may mitigate early-phase risk. Standardized, prospective studies are needed to define proficiency thresholds and optimize training in hip preservation surgery.

文献出处：Ramadanov N, Heinz M, Voss M, Hable R, Becker R, Ahmad SS. Learning curve in periacetabular osteotomy for developmental dysplasia of the hip : a systematic review and meta-analysis. Bone Jt Open. 2026 Apr 22;7(4):574-583.

文献4

改良 Dunn 手术治疗中重度股骨头滑脱的长期疗效：一项随访 7 年的前瞻性病例系列研究

译者 贾海港

引言： 股骨头滑脱（SCFE）是青少年中最常见的髋关节疾病，若治疗不当，可能导致股骨髋臼撞击症、早期骨关节炎及长期功能障碍。虽然原位钉固定仍是轻度滑脱的标准治疗方法，但对于中重度病例，该方法无法纠正畸形，可能增加发生退行性改变的风险。 改良 Dunn 手术（MDP）旨在通过髋关节外科脱位技术，在保留血管供应的同时恢复股骨近端解剖结构。本研究旨在评估 MDP 治疗中度（14 例）和重度（10 例）SCFE 患者的长期影像学及功能预后，并评估股骨头缺血性坏死（AVN）、骨关节炎及其他并发症的发生率。

方法：本研究为前瞻性病例系列研究，于 2015 年 8 月至 2019 年 1 月在一家三级医疗机构进行。共 24 例中重度 SCFE 且骨骺未闭合的髋关节接受了经髋关节外科脱位的 MDP 治疗，排除轻度及单纯急性滑脱病例。MDP 作为一期手术，对重度滑脱患者早期实施，对部分中度滑脱患者经临床评估后选择性实施。患者接受临床及影像学随访，平均随访时间为 84±2.6 个月（范围 80~88 个月）。采用 Harris 髋关节评分（HHS）和 Merle d'Aubigné-Postel 评分评估功能结果，并记录影像学结果及并发症（包括 AVN 和继发性关节炎）。根据术中情况，采用 Schanz 螺钉、空心螺钉或克氏针进行内固定。

结果： 术前平均滑移角（48.3° ± 7.2°）在术后显著改善（11.4° ± 3.1°，p < 0.001）。 HHS 评分从术前的平均值 70.4 ± 5.8 提高到最终随访时的 92.9 ± 4.2（p < 0.001）。 Merle d'Aubigné-Postel 评分从术前的 13.8 ± 1.6 提高到最终随访时的 17.5 ± 0.9（p < 0.001）。24 个髋关节中有 4 个（16.7%）出现了股骨头坏死。 24例髋关节中有2例发生关节炎（8.3%，为退行性骨关节炎；无化脓性关节炎或软骨溶解），若与股骨头坏死合并计算，则共有6例（25%）出现严重并发症。未发生术后不稳或切口感染。大多数患者的功能评分显示持续改善。

结论： 改良 Dunn 手术（MDP）在中重度股骨头骨骺滑脱（SCFE）中可提供良好的长期解剖矫正效果和功能恢复，然而，由于存在股骨头缺血性坏死 (AVN) 和关节炎的风险（尤其是在不稳定型或重症病例中），因此需要严格掌握病例选择并确保手术操作的精准度。长期随访对于发现晚期并发症及评估手术持久性至关重要。

关键词： 缺血性骨坏死；髋关节保髋手术；长期预后；改良 Dunn 手术；股骨头骨骺滑脱；髋关节外科脱位手术。

Long-term outcomes of the modified Dunn procedure in moderate and severe slipped capital femoral epiphysis: a prospective case series with 7-year follow-up

Introduction:Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequately treated. While in situ pinning remains the standard treatment for mild slips, it fails to correct the deformity in moderate and severe cases, potentially predisposing to degenerative changes. The modified Dunn procedure (MDP) was developed to restore proximal femoral anatomy through surgical hip dislocation while preserving vascular supply. The aim of the study is to evaluate the long-term radiological and functional outcomes of the MDP in patients with moderate (14 cases) and severe (10 cases) SCFE, and to assess the incidence of avascular necrosis (AVN), osteoarthritis, and other complications.

Methods:A prospective case series was conducted between August 2015 and January 2019 at a single tertiary institution. A total of 24 hips with moderate-to-severe SCFE and open physis were treated using the MDP via surgical hip dislocation. Mild and acute-only slips were excluded. MDP was used as a primary procedure, performed early in severe slips and in selected moderate slips after clinical assessment. Patients were followed clinically and radiologically for a mean duration of 84 ± 2.6 months (range 80-88 months). Functional outcomes were assessed using the Harris Hip Score (HHS) and Merle d'Aubigné and Postel score. Radiographic outcomes and complications, including AVN and secondary arthritis, were documented. Fixation was performed using Schanz screws, cannulated screws, or K-wires according to intraoperative findings.

Results:The mean preoperative slip angle (48.3° ± 7.2°) significantly improved postoperatively (11.4° ± 3.1°, p < 0.001). HHS improved from a preoperative mean of 70.4 ± 5.8 to 92.9 ± 4.2 at final follow-up (p < 0.001). The Merle d'Aubigné and Postel score improved from 13.8 ± 1.6 preoperatively to 17.5 ± 0.9 at final follow-up (p < 0.001). AVN developed in 4 out of 24 hips (16.7%). Arthritis developed in 2 out of 24 hips (8.3%, degenerative OA; no septic arthritis or chondrolysis), representing a total of 6 out of 24 hips (25%) with significant complications when combined with AVN. No cases of postoperative instability or wound infection occurred. Functional scores showed sustained improvement in the majority of patients.

Conclusions:MDP offers favorable long-term anatomical correction and functional recovery in moderate-to-severe SCFE. However, the risk of AVN and arthritis, particularly in unstable or severe cases, warrants careful patient selection and technical precision. Extended follow-up is essential to detect late complications and evaluate procedural durability.

Keywords: Avascular necrosis; Hip preservation surgery; Long-term outcomes; Modified Dunn procedure; Slipped capital femoral epiphysis; Surgical hip dislocation.

文献出处：Fahmy M, Abdelazeem AH, Shawky MA. Long-term outcomes of the modified Dunn procedure in moderate and severe slipped capital femoral epiphysis: a prospective case series with 7-year follow-up. J Orthop Traumatol. 2026 Feb 10;27(1):5. doi: 10.1186/s10195-026-00899-6. PMID: 41665709; PMCID: PMC12901798.

文献5

三维双回声稳态（DESS）MR髋关节造影量化髋臼软骨厚度的准确性研究

译者 陶可

目的：探索量化髋关节牵引状态下的三维双回波稳态（DESS）MR髋关节造影检查对髋臼软骨成像的准确性。用于对髋关节软骨进行成像的临床磁共振成像（MRI）序列通常会降低平面外分辨率，并且可能缺乏足够的信噪比来对软骨进行成像。

材料和方法：将生理盐水注射到四个牵引下的尸体髋关节中。在从髋臼采集软骨髓芯之前和之后获得3D DESS MRI扫描；两个MRI在空间上与所选取的髓芯位置对齐。在显微镜下测量软骨髓芯的厚度，作为参考标准。使用自动和半自动图像分析生成软骨和软骨下骨的3D重建。使用Bland-Altman图将3D重建估计的软骨厚度与物理测量值进行比较。

结果：如自动分析模式所示，盐水在整个髋关节表面占据了髋关节空间，但两个髋关节的后下区域除外。引入气泡的位置和疑似低密度骨的区域破坏了原本平滑的自动分析模式。自动和半自动分割分别产生了0.10±0.51 mm（-0.41至0.61 mm）和0.06±0.43 mm（-0.37至0.49 mm）的偏差±重复性系数（95%的一致性极限）。

结论：使用3D重建DESS MR髋关节造影图像可以估计软骨厚度在物理值的±0.5mm范围内，置信度为95%。手动校正自动分析模式可以提高重建精度。

髋臼及软骨髓芯的照片。左图：采集5.3毫米软骨髓芯后暴露的髋臼。右图：25倍放大显微镜下的骨软骨髓芯剖面图像。虚线标注骨-软骨界面，箭头指示软骨厚度测量点。

MRI后处理工作流程。首次和第二次MRI分析（按列分隔）在不同阶段（按行分隔）进行，包括分割、表面生成，最终以标记点处软骨厚度的测定结果为结束点。

三维重建示例的DESS图像。左图：DESS MRI中股骨中段冠状切面，骨、软骨及生理盐水清晰可见。髋臼皮质骨与软骨自动定义的区域分别以黄色和蓝色标记。右图：髋臼皮质骨与软骨表面重建的侧视图，后下方（PI）、后上方（PS）、前上方（AS）、前下方（AI）区域已标注，并标示出软骨髓芯的近似位置。

同一具尸体两侧髋关节软骨厚度图。盂唇包括在软骨表面重建中，并且比关节软骨厚得多（由厚度图上的红色表示）；图示中并没有进行盂唇厚度的分析。髋臼外上侧和后内侧分别观察到最厚和最薄的软骨。

Accuracy of 3D dual echo steady state (DESS) MR arthrography to quantify acetabular cartilage thickness

Purpose: To deploy and quantify the accuracy of 3D dual echo steady state (DESS) MR arthrography with hip traction to image acetabular cartilage. Clinical magnetic resonance imaging (MRI) sequences used to image hip cartilage often have reduced out-of-plane resolution and may lack adequate signal-to-noise to image cartilage.

Materials and methods: Saline was injected into four cadaver hips placed under traction. 3D DESS MRI scans were obtained before and after cores of cartilage were harvested from the acetabulum; the two MRIs were spatially aligned to reference core positions. The thickness of cartilage cores was measured under microscopy to serve as the reference standard. 3D reconstructions of cartilage and subchondral bone were generated using automatic and semiautomatic image segmentation. Cartilage thickness estimated from the 3D reconstructions was compared to physical measurements using Bland-Altman plots.

Results: As revealed by the automatic segmentation mask, saline imbibed the joint space throughout the articulating surface, with the exception of the posteroinferior region in two hips. Locations where air bubbles were introduced and regions of suspected low density bone disrupted an otherwise smooth automatic segmentation mask. Automatic and semiautomatic segmentation yielded a bias ± repeatability coefficient (95% limits of agreement) of 0.10 ± 0.51 mm (-0.41 to 0.61 mm) and 0.06 ± 0.43 mm (-0.37 to 0.49 mm), respectively.

Conclusion: Cartilage thickness can be estimated to within ∼0.5 mm of the physical value with 95% confidence using 3D reconstructions of 3D DESS MR arthrography images. Manual correction of the automatic segmentation mask may improve reconstruction accuracy.

文献出处：Christine L Abraham, Neal K Bangerter, Lance S McGavin, Christopher L Peters, Alex J Drew, Christopher J Hanrahan, Andrew E Anderson.Accuracy of 3D dual echo steady state (DESS) MR arthrography to quantify acetabular cartilage thickness.J Magn Reson Imaging. 2015 Nov;42(5):1329-38. doi: 10.1002/jmri.24902.

文献6

基于视觉-惯性传感器融合的骨科手术训练六维物体姿态跟踪

译者 邱兴

本研数字训练模拟器在骨科手术中发挥着日益重要的作用，能够提供逼真、标准化且无风险的学习环境，无需持续的专家监督。为使模拟器具备真实的触觉反馈与力觉感受，需要对手术工具及解剖结构进行实时精确跟踪。然而，现有物体跟踪方案通常价格昂贵、难以集成至训练流程，或稳健性不足。针对这些局限，我们提出了一种面向骨科手术训练的新型视觉-惯性六维物体姿态跟踪系统。该方法采用一种定制标志物，将多个 ArUco 标记与一个惯性测量单元（IMU）相融合；搭建双摄像头配置以增强遮挡鲁棒性；并设计了一种传感器融合算法，在保证精确坐标与时间同步的前提下，将高频 IMU 数据与基于视觉的跟踪相结合。评估中，我们实现了标志物姿态精度为 0.9 mm/（原文旋转精度值缺失），并在模拟手术流程中提取钻孔测量指标，平均位置误差、角度误差与长度误差分别为 1.7 mm、（原文角度误差值缺失）和 1.0 mm，同时展现出较低的遮挡率。本方案成本效益高、易于集成，满足临床训练要求，标志着向可扩展且广泛可及的数字骨科模拟器迈出了重要一步。跟踪代码见：https://github.com/MountainCoot/fusionpose。

关键词：数字手术训练 · 骨科手术 · 六维姿态估计 · 传感器融合 · 惯性测量单元

6D Object Pose Tracking for Orthopedic Surgical Training using Visual-Inertial Sensor Fusion

Digital training simulators play a growing role in orthopedic surgery, offering realistic, standardized, and risk-free learning environments without the need for constant expert supervision. To enable simulators with realistic tactile feedback and haptic sensations, accurate tracking of surgical tools and anatomical structures in real-time is required. However, existing object tracking solutions are often expensive, difficult to integrate into training workflows, or lack robustness. To address these limitations, we propose a novel visual-inertial 6D object pose tracking system for orthopedic surgical training. Our approach features a custom fiducial object that combines multiple ArUco markers with an Inertial Measurement Unit, a dual-camera setup to improve occlusion robustness, and a sensor fusion algorithm that integrates high-frequency IMU data with vision-based tracking while ensuring precise coordinate and time synchronization. In our evaluation, we achieve a fiducial object pose accuracy of 0.9 mm/ and extract drill hole metrics in a mock surgical procedure with average position, angle, and length errors of 1.7 mm, , and 1.0 mm, respectively, while demonstrating low occlusion rates. Our cost-effective and easily integrated solution meets clinical training requirements and marks a step towards scalable and widely accessible digital orthopedic simulators. The tracking code is available at https://github.com/MountainCoot/fusionpose.

Keywords: Digital Surgical Training · Orthopedic Surgery · 6D Pose Estimation · Sensor Fusion · Inertial Measurement Unit

文献出处：Hogenkamp, M., Stauffer, T., Lohmeyer, Q., & Meboldt, M. (2025, September). 6D Object Pose Tracking for Orthopedic Surgical Training Using Visual-Inertial Sensor Fusion. In International Conference on Medical Image Computing and Computer-Assisted Intervention (pp. 13-23). Cham: Springer Nature Switzerland.

来源：304关节学术

作者：304关节团队

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