髋膝关节文献精译荟萃（第394期)

本期目录：

1、评估手术效果：机器人辅助与传统全膝关节置换术

2、个体化步态再训练治疗内侧间室膝骨关节炎

3、在机器人辅助全膝关节置换术中，当胫骨内翻限制为6°时，对于术前MPTA ≥84°的患者，功能性对线可获得较术前MPTA <84°患者更大的术后早期疼痛改善

4、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

5、同一患者人群中3.0T MR与3.0T MR关节造影检测髋臼盂唇撕裂及软骨损伤的对比研究

6、仰卧位与站立位骨盆前后位 X 线片在钳夹型髋股撞击综合征评估中的应用

7、髋关节形态影响髋臼软骨损伤模式：股骨髋臼撞击症是髋关节早发性骨关节炎的诱因

第一部分：关节置换及保膝相关文献

文献1

评估手术效果：机器人辅助与传统全膝关节置换术

译者 张轶超

目的：本研究旨在利用机器学习算法系统评估机器人辅助全膝关节置换术（RA-TKA）和常规全膝关节置换术（C-TKA）的手术效果和术后恢复差异。目的是分析两种技术在不同参数下的优缺点，并提出优化建议。

方法：收集美国外科医师学会国家手术质量改进计划（NSQIP）临床数据库中的数据，并进行彻底的分析和标准化。提取手术时间、住院时间（LOS）和术后功能状态等关键变量进行分析。基于术后恢复数据，采用随机森林机器学习算法建立预测模型并进行训练。使用测试数据集验证模型的性能，并对RA-TKA和C-TKA的手术效果和术后恢复进行统计分析。

结果：机器学习模型的预测表明，RA-TKA在所有手术结果指标中都优于C-TKA，表现出更好的均值和方差。RA-TKA术后功能状态较好，并发症发生率（CR）较低，改良脆弱指数（mFI）较高，提示RA-TKA患者恢复更好，恢复速度较快。

结论：由机器学习算法得出的评估结果表明，RA-TKA在几个关键指标上可能比C-TKA更具优势。这些发现提供了有价值的见解，可以告知我们将来在临床实践中要努力优化外科手术和术后护理。

Evaluating surgical outcomes: robotic-assisted vs. conventional total knee arthroplasty

Purpose：This study aims to systematically assess the surgical outcomes and postoperative recovery discrepancies between Robotic-Assisted Total Knee Arthroplasty (RA-TKA) and Conventional Total Knee Arthroplasty (C-TKA) using machine learning algorithms. The objective is to analyze the advantages and disadvantages of both techniques across various parameters and propose optimization recommendations.

Methods：Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) clinical database were collected and underwent thorough cleaning and standardization. Key variables such as operative time, Length of Stay (LOS), and postoperative functional status were extracted for analysis. A predictive model was developed and trained using the random forest machine learning algorithm based on postoperative recovery data. The model’s performance was validated using a test dataset, and statistical analyses were conducted to compare the surgical outcomes and postoperative recovery between RA-TKA and C-TKA.

Results：The machine learning model’s predictions indicate that RA-TKA surpasses C-TKA in all surgical outcome metrics, exhibiting superior means and variances. Furthermore, RA-TKA demonstrates better postoperative functional status, lower Complication Rate (CR), and a higher modified frailty index (mFI), suggesting enhanced and quicker recovery for RA-TKA patients.

Conclusion：The evaluation results derived from machine learning algorithms suggest that RA-TKA may offer advantages over C-TKA in several crucial metrics. These findings provide valuable insights that could inform future efforts to optimize surgical procedures and postoperative care in clinical practice.

文献出处：Guo J, Jin Z, Xia M. Evaluating surgical outcomes: robotic-assisted vs. conventional total knee arthroplasty. J Orthop Surg Res. 2025 Feb 15;20(1):166. doi: 10.1186/s13018-025-05518-4. PMID: 39955539; PMCID: PMC11829363.

文献2

个体化步态再训练治疗内侧间室膝骨关节炎：一项随机对照试验

译者 邱兴

背景： 通过对内侧间室膝骨关节炎患者进行步态再训练，使其足步向角（即足内旋或足外旋角度）发生个体化改变，可减少与疾病进展相关的关节过度负荷。本研究旨在探讨与假干预相比，个体化足步向角调整对轻中度内侧间室膝骨关节炎患者的临床、生物力学和结构学疗效。

方法： 本单中心、平行组、随机对照试验在美国斯坦福大学人类表现实验室和Lucas影像中心，通过在线和印刷媒体招募有症状的内侧间室膝骨关节炎患者。符合条件的受试者（年龄≥18岁）由计算机按1∶1比例随机分配至干预组或假干预组。在六次大学步态实验室的步行再训练访视中，所有受试者均接受实时生物反馈，指导其以一致的个体化目标足步向角行走。干预组的目标足步向角为能最大程度减少膝关节负荷的5°或10°角度改变，假干预组的目标足步向角则为受试者自身的自然足步向角。受试者及参与数据分析的工作人员对分组情况设盲；执行步态分析访视的工作人员不设盲。主要结局指标为1年时膝内侧疼痛（数字评定量表）和膝内侧负荷（膝关节内收力矩峰值）的变化。次要结局指标为1年时基于MRI估算的软骨微结构（T1ρ和T2松弛时间）变化。通过监测不良事件的数量和类型评估安全性。采用意向性治疗线性回归分析，纳入所有随机分配的受试者。有膝骨关节炎亲身经历的患者参与了本研究的设计和实施。本研究已在ClinicalTrials.gov注册（NCT02767570），现已停止入组。

结果： 在2016年8月1日至2019年6月25日期间，共筛选1582例受试者。107例受试者完成初始步态分析，68例被随机分配至干预组（n=34）或假干预组（n=34）。68例受试者中女性41例（60%），男性27例（40%），白人54例（79%）；平均年龄64.4岁（标准差7.6）。1年后，干预组受试者的膝内侧疼痛（组间差异 -1.2，95%置信区间 -1.9至 -0.5；p=0.0013）和膝关节内收力矩峰值（组间差异 -0.26 %体重×身高，95%置信区间 -0.39至 -0.13；p=0.0001）的降低程度均大于假干预组。干预组内侧间室软骨微结构（T1ρ）的MRI估算变化小于假干预组（组间差异 -3.74 ms，95%置信区间 -6.42至 -1.05）。两组间T2差异无统计学意义。未发生严重不良事件；但干预组中有2例（6%）受试者、假干预组中有1例（3%）受试者因膝痛加重而退出研究。

解释：个体化足步向角调整可改善疼痛、降低膝关节负荷，并可能延缓骨关节炎进展，因此对于部分内侧间室膝骨关节炎患者而言，是一种有前景的非手术治疗选择。

Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial

Background: Retraining individuals with medial compartment knee osteoarthritis to walk with a patient-specific change in their foot angle (ie, toe-in or toe-out angle) can reduce excessive joint loading related to disease progression. This study investigated the clinical, biomechanical, and structural efficacy of personalised foot progression angle modifications compared with sham treatment in patients with mild-to-moderate medial compartment knee osteoarthritis.

Methods: In this single-center, parallel-group, randomised controlled trial, we recruited individuals with symptomatic medial compartment knee osteoarthritis at the Human Performance Laboratory and Lucas Center for Imaging at Stanford University, CA, USA, using online and print media. Eligible participants (aged ≥18 years) were randomly assigned (1:1) by a computer to an intervention or sham group. During six walking retraining visits to a university gait laboratory, all participants received real-time biofeedback instructing them to walk consistently with a personalised target foot progression angle. The intervention group's target was the 5° or 10° change in foot progression angle that maximally reduced their knee loading, and the sham group's target was their natural foot progression angle. Participants and staff involved in data analysis were masked to group allocation; staff performing the gait analysis visits were not. Primary outcomes were 1-year changes in medial knee pain (numeric rating scale) and medial knee loading (knee adduction moment peak). Secondary outcomes were 1-year changes in cartilage microstructure estimated from MRI (T1ρ and T2 relaxation times). We evaluated safety by monitoring the number and type of adverse events. Intention-to-treat linear regression analyses, comprising all randomly assigned participants, were conducted. People with lived experience of knee osteoarthritis were involved in the design and conduct of this study. This study is registered with ClinicalTrials.gov, NCT02767570, and is closed to enrollment.

Findings: Between Aug 1, 2016, and June 25, 2019, 1582 individuals were screened for eligibility. 107 participants completed an initial gait analysis and 68 were randomly assigned to either the intervention (n=34) or the sham (n=34) group. 41 (60%) of 68 participants were female, 27 (40%) were male, and 54 (79%) were White; mean age was 64·4 years (SD 7·6). After 1 year, participants in the intervention group had greater reductions in medial knee pain (between-group difference -1·2, 95% CI -1·9 to -0·5; p=0·0013) and knee adduction moment peak (between-group difference -0·26 % bodyweight × height, 95% CI -0·39 to -0·13; p=0·0001) than participants in the sham group. The MRI-estimated change in cartilage microstructure (T1ρ) in the medial compartment was less in the intervention group than the sham group (between-group difference -3·74 ms, 95% CI -6·42 to -1·05). There were no significant between-group differences in T2. There were no severe adverse events; however, two (6%) of 34 participants in the intervention group and one (3%) of 34 participants in the sham group dropped out of the study due to increased knee pain.

Interpretation: Personalised foot angle modifications improve pain, reduce knee loading, and might slow osteoarthritis progression, making them a promising non-surgical treatment option for some individuals with medial compartment knee osteoarthritis.

文献出处：Uhlrich SD, Mazzoli V, Silder A, Finlay AK, Kogan F, Gold GE, Delp SL, Beaupre GS, Kolesar JA. Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial. Lancet Rheumatol. 2025 Oct;7(10):e708-e718. doi: 10.1016/S2665-9913(25)00151-1. Epub 2025 Aug 12. PMID: 40816302; PMCID: PMC13034617.

文献3

在机器人辅助全膝关节置换术中，当胫骨内翻限制为6°时，对于术前MPTA ≥84°的患者，功能性对线可获得较术前MPTA <84°患者更大的术后早期疼痛改善

译者 沈松坡

背景： 全膝关节置换术（TKA）中的功能性对线（FA）旨在在安全的假体边界内维持软组织张力平衡的同时，恢复患者原生下肢几何形态。机器人辅助FA-TKA通常将胫骨内翻限制在6°（即术前胫骨近端内侧角［MPTA］84°），以防止胫骨过载。本研究旨在探讨：对于术前胫骨内翻超过6°（MPTA <84°）的患者，这一内翻限制是否会影响术后早期6个月的临床结局。

方法： 我们回顾性分析了2024年1月至2025年1月期间实施的93例连续CT基础的机器人辅助FA-TKA，纳入对象均为内翻畸形患者（术前MPTA ≤89°）。患者按术前MPTA分为<84°组（n = 49）和≥84°至89°组（n = 44）。6个月结局包括Knee Society膝评分和功能评分（KSKS、KSFS）、Oxford膝评分（OKS）、SF-36评分，以及各项患者报告结局（PRO）达到最小临床重要差异（MCID）的情况。

结果： 两组在所有PRO方面均有显著改善，总体满意度相当。术前MPTA ≥84°的患者获得了更大的SF-36躯体疼痛改善（49.4 ± 26.3 对 32.6 ± 29.9；p = 0.017），并呈现出更高MCID达成率的趋势（96.6% 对 81.0%；p = 0.05）。对于严重胫骨内翻（MPTA <81°）的亚组分析显示，其疼痛或功能与中度畸形（MPTA 81–84°）相比无显著差异。

结论： 总之，无论术前胫骨内翻严重程度如何，机器人辅助FA-TKA均可获得相似的术后早期临床结局和患者满意度；仅在可完全重建原生胫骨对线时，躯体疼痛改善方面观察到轻度差异。仍需更长期随访以评估假体生存率和持续性功能结局。

关键词：
功能性对线；机器人辅助全膝关节置换术；胫骨内翻

Functional alignment robotic-assisted total knee arthroplasty with tibial varus limited to 6° yields greater early postoperative pain improvement in patients with preoperative MPTA ≥84° compared with MPTA <84°

Background: Functional alignment (FA) in total knee arthroplasty (TKA) aims to restore native limb geometry while maintaining balanced soft-tissue tension within safe implant limits. Robotic-assisted FA-TKA typically limits tibial varus to 6° (preoperative medial proximal tibial angle [MPTA] 84°) to prevent tibial overload. This study investigates whether this varus limitation affects early 6-month outcomes in patients with preoperative tibia vara exceeding 6° (MPTA <84°).

Methods: We retrospectively reviewed 93 consecutive CT-based robotic-assisted FA-TKAs performed between January 2024 and January 2025 in patients with varus deformity (preoperative MPTA ≤89°). Patients were stratified into preoperative MPTA <84° (n = 49) and MPTA ≥84-89° (n = 44). Six-month outcomes included Knee Society Knee and Function Scores (KSKS, KSFS), Oxford Knee Score (OKS), SF-36 scores, and achievement of minimal clinically important difference (MCID) for each patient-reported outcome (PRO).

Results: Both groups showed significant improvements across all PROs with comparable overall satisfaction. Patients with preoperative MPTA ≥84° experienced greater SF-36 Bodily Pain improvement (49.4 ± 26.3 vs 32.6 ± 29.9; p = 0.017) and a trend toward higher MCID achievement (96.6% vs 81.0%; p = 0.05). Subgroup analysis of severe tibia vara (MPTA <81°) revealed no significant differences in pain or function compared with moderate deformities (MPTA 81-84°).

Conclusions: In conclusion, robotic-assisted FA-TKA yields comparable early clinical outcomes and patient satisfaction regardless of preoperative tibia vara severity, with only a modest difference in bodily pain improvement observed when native tibial alignment could be fully reproduced. Longer-term follow-up is warranted to evaluate implant survival and sustained functional outcomes.

Level of evidence: III.

Keywords: Functional alignment; Robotic-assisted total knee arthroplasty; Tibia vara.

第二部分：保髋相关文献

文献1

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2

同一患者人群中3.0T MR与3.0T MR关节造影检测髋臼盂唇撕裂及软骨损伤的对比研究

译者 李勇

目的： 报道我们在同一患者人群中应用3.0T常规MR与3.0T MR关节造影检测髋臼盂唇撕裂及软骨损伤的诊断敏感度方面的经验。

方法： 43例连续入组的患者均接受了常规髋关节MR和MR关节造影检查。由两名肌骨放射科医师以随机方式独立阅片进行回顾性评估（即MR与MR关节造影检查分别在不同场次、按随机顺序阅片，以避免阅片者偏倚）。扫描图像评估髋臼盂唇撕裂及软骨损伤。所有患者随后均接受了关节镜检查。

结果： 在这43例患者中，MR关节造影上阅片者1检出髋臼盂唇撕裂40例、阅片者2检出39例；常规MR上阅片者1检出39例、阅片者2检出38例。关节镜下43例患者中共有42例存在盂唇撕裂。与关节镜对照，阅片者1常规MR假阴性4例、MR关节造影假阴性3例；阅片者2常规MR假阴性5例、MR关节造影假阴性4例。两名阅片者在MR及MR关节造影上各有1例假阳性盂唇撕裂（与关节镜对照）。关节镜下共有32处髋臼软骨损伤。阅片者1在常规MR上发现21处、MR关节造影上发现27处软骨损伤；阅片者2在常规MR上发现19处、MR关节造影上发现25处。常规MR上软骨损伤无假阳性（与关节镜对照）；MR关节造影上阅片者1有1例假阳性、阅片者2有2例假阳性。常规MR与关节镜对照的敏感度和特异度分别为：阅片者1髋臼盂唇撕裂（敏感度90%、特异度0%），阅片者2髋臼盂唇撕裂（敏感度88%、特异度0%）。MR关节造影与关节镜对照，阅片者1的敏感度和特异度分别为93%和0%，阅片者2分别为90%和0%。髋臼软骨损伤检出的敏感度和特异度（与关节镜对照）分别为：阅片者1常规MR（敏感度65%、特异度100%），阅片者1 MR关节造影（敏感度81%、特异度91%），阅片者2常规MR（敏感度59%、特异度100%），阅片者2 MR关节造影（敏感度71%、特异度82%）。

结论： 在本组病例中，3.0T MR检测髋臼盂唇撕裂的敏感度可与3.0T MR关节造影相媲美；而在检测髋臼软骨损伤方面，3.0T MR关节造影的敏感度高于常规3.0T MR。

Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population

Objective: We report our experience in diagnostic sensitivity of 3.0-T conventional MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population.

Methods: 43 consecutive patients had both conventional hip MR and MR arthrography examinations performed. These examinations were reviewed retrospectively by independent reading of two musculoskeletal radiologists who read the MR and MR arthrogram examinations in a randomized fashion (i.e. MR and MR arthrogram examinations were read at separate sittings and in a randomized fashion so as not to bias reviewers). Scans were assessed for acetabular labral tears and chondral defects. All patients went on to arthroscopy.

Results: Of these 43 patients, 40 had acetabular labral tears read by Reader 1 and 39 had acetabular labral tears read by Reader 2 on MR arthrogram; 39 had acetabular labral tears read by Reader 1 and 38 had acetabular labral tears read by Reader 2 on conventional MR examination. There were 42 labral tears in 43 patients at arthroscopy. There were four false-negative labral tears compared with arthroscopy on MR and three false negatives on MR arthrography for Reader 1, and five false negatives on MR and four false negatives on MR arthrography for Reader 2. Each reader had one false-positive labral tear compared with arthroscopy on both MR and MR arthrography. There were 32 acetabular chondral defects at arthroscopy. Reader 1 saw 21 acetabular chondral defects on conventional MR and 27 chondral defects at MR arthrography. Reader 2 saw 19 acetabular chondral defects at conventional MR and 25 acetabular chondral defects on MR arthrography. There were no false-positive readings of chondral defects compared with arthroscopy on MR, and one false positive for Reader 1 and two false positives for Reader 2 on MR arthrography as compared with arthroscopy. On conventional MR examination, sensitivities and specificities as compared with arthroscopy were as follows: Reader 1 acetabular labral tear (90% sensitivity, 0% specificity) and Reader 2 acetabular labral tear (88% sensitivity, 0% specificity). On MR arthrogram, sensitivities and specificities as compared with arthroscopy for Reader 1 were 93% and 0%, and for Reader 2 were 90% and 0%, respectively. Sensitivities and specificities for detection of acetabular chondral defects as compared with arthroscopy were: Reader 1 conventional MR (65% sensitivity, 100% specificity), Reader 1 MR arthrography (81% sensitivity, 91% specificity), Reader 2 conventional MR (59% sensitivity, 100% specificity), and Reader 2 MR arthrography (71% sensitivity, 82% specificity).

Conclusion: In this series, 3.0-T MR demonstrated sensitivity for detection of acetabular labral tears that rivals the sensitivity of 3.0-T MR arthrography of the hip. In this series, 3.0-T MR arthrography was more sensitive than conventional 3.0-T MR for detection of acetabular chondral defects.

文献出处：Magee T. Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population. Br J Radiol. 2015 Sep;88(1053):20140817. doi:10.1259/bjr.20140817.

文献3

仰卧位与站立位骨盆前后位 X 线片在钳夹型髋股撞击综合征评估中的应用

译者 贾海港

背景: 骨盆倾斜会影响坐骨棘征和交叉征的出现。关于骨盆倾斜对钳夹型撞击影像学测量影响的大量研究表明，前倾增加与更多钳夹型撞击的影像学征象相关。然而，据我们所知，尚无研究直接比较患者仰卧位和站立位普通 X 线片在外侧中心边缘（LCE）角、臼顶倾斜角、交叉征和坐骨棘征方面的差异。

研究问题/目的: 本研究的目的是评估仰卧位和站立位骨盆正位 X 线片在成人股骨髋臼撞击症评估中，与钳夹型撞击放射学参数相关的差异，具体参数包括：骨盆内距离（骶尾骨至耻骨联合距离[SC-S]及尾骨尖至耻骨联合距离[T-S]）、交叉征（是否存在及其百分比）、LCE 角、臼顶倾斜角及坐骨棘征。

研究方法: 在 2013 年 8 月至 2014 年 6 月期间，我们为所有因髋部疼痛接受评估且年龄小于 60 岁的新患者获取了仰卧位和站立位 X 线片，前提是不考虑骨折诊断；这些病例构成了本项回顾性研究的基础。若患者存在关节炎（Tönnis 分级≥2 级）、腰椎融合术史、既往髋部手术史或 X 线片旋转不良，则予以排除。共有 46 个髋关节，即症状侧，符合纳入标准（患者年龄 33 ± 14 岁；男性 13 例，女性 33 例）。收集的影像学数据包括 SC-S 距离、T-S 距离、LCE 角、臼顶倾斜角、交叉征的有无及其百分比，以及坐骨棘征的有无。连续变量采用配对 t 检验进行比较，分类变量采用卡方检验。测量由两名独立阅片者完成。

结果: 从仰卧位片到站立位片，T-S 距离从 19 ± 18 mm 降至 6 ± 19 mm（p < 0.001），SC-S 距离从 47 ± 19 mm 降至 32 ± 20 mm（p < 0.001），提示站立位时骨盆倾斜更小。出现交叉征的髋关节数量从仰卧位（n = 18，39%）降至站立位（n = 9，20%）（p = 0.039）。交叉程度从 23% ± 10% 降至 11% ± 13%（p < 0.001）。LCE 角无变化（27° ± 7° 至 27° ± 8°）（p = 0.64），倾斜角小幅增加（4.2° ± 5° 至 5.3° ± 5°）（p = 0.002）。坐骨棘征从仰卧位（n = 20，43%）降至站立位（n = 7，15%）（p = 0.003）。

结论: 站立位骨盆正位片上骨盆倾斜程度减小，导致交叉征和坐骨棘征的发生率及程度降低，同时倾斜角轻度增加。站立位 X 线片应作为评估非关节炎性髋痛，尤其是钳夹型股骨髋臼撞击的标准。外科医生在评估钳夹型撞击时，解读仰卧位骨盆正位片，尤其是交叉征，应谨慎。

证据等级:III 级，诊断性研究。

图 1A–D X线片显示如何测量(A) SC-S 距离和 T-S 距离；(B)LCE 角；(C) 臼顶倾斜角；和 (D) 交叉征及交叉百分比。交叉百分比的测量是计算为 A/(A + B)。SC-S =骶尾骨至耻骨联合；T-S = 尾骨尖至耻骨联合；LCE =外侧中心边缘角。

Supine and Standing AP Pelvis Radiographs in the Evaluation of Pincer Femoroacetabular Impingement

Background：Pelvic tilt can affect the presence of the ischial spine sign and crossover sign. Numerous studies of pelvic tilt on radiographic measurements of pincer impingement have shown that increasing anterior tilt is associated with more radiographic signs of pincer impingement. However, to our knowledge, no study has directly compared supine and standing plain radiographs in patients with respect to lateral center-edge (LCE) angle, acetabular inclination, crossover sign, and ischial spine sign.

Questions/purposes：The purpose of this study was to evaluate the differences in supine and standing AP pelvis radiographs as they relate to the radiographic parameters of pincer impingement in an adult population evaluated for femoroacetabular impingement, specifically intrapelvic distances (sacrococcygeal to symphysis [SC-S] and coccyx tip to symphysis [T-S]), crossover sign (presence and percentage), LCE angle, inclination, and ischial spine sign.

Methods：Between August 2013 and June 2014, we obtained supine and standing radiographs for all new patients younger than 60 years who were evaluated for hip pain, when the diagnosis of fracture was not being considered; these formed the basis of this retrospective study. Patients were excluded if they had arthritis (Tönnis grade ≥ 2), lumbar fusion, previous hip surgery, or malrotated films. Forty-six hips, symptomatic side, met the inclusion criteria (age of patients, 33 ± 14 years; 13 males, 33 females). Radiographic data that were collected included SC-S distance, T-S distance, LCE angle, acetabular inclination, presence and percentage of crossover sign, and presence of ischial spine sign. A paired t-test was used to compare continuous variables and chi-square test was used for categorical variables. Two independent readers performed measurements.

Results：From supine to standing films, the T-S distance decreased from 19 ± 18 mm to 6 ± 19 mm (p < 0.001), and SC-S distance decreased from 47 ± 19 mm to 32 ± 20 mm (p < 0.001), indicating less pelvic tilt in the standing position. The number of hips that had crossover signs decreased from supine (n = 18, 39%) to standing (n = 9, 20%) (p = 0.039). The amount of crossover decreased from 23% ± 10% to 11% ±13% (p < 0.001). LCE angle did not change (27° ± 7° to 27° ± 8°) (p = 0.64) and inclination angle increased by a small amount (4.2° ± 5° to 5.3° ± 5°) (p = 0.002). The ischial spine sign decreased from supine (n = 20, 43%) to standing (n = 7, 15%) position (p = 0.003).

Conclusions：There is a decrease in the amount of pelvic tilt on standing AP pelvis radiographs resulting in a decrease in the incidence and amount of crossover sign and ischial spine sign, and a small increase in inclination. Standing radiographs should be the standard in evaluation of nonarthritic hip pain, specifically pincer femoroacetabular impingement. Surgeons should use caution in interpreting supine AP radiographs in the evaluation of pincer impingement, specifically the crossover sign.

文献出处：Adamson, G., Estess, A., & Jackson, T. (2016). Supine and Standing AP Pelvis Radiographs in the Evaluation of Pincer Femoroacetabular Impingement. Clinical Orthopaedics & Related Research, 474(7), 1692–1696. https://doi.org/10.1007/s11999-016-4766-7

文献4

髋关节形态影响髋臼软骨损伤模式：股骨髋臼撞击症是髋关节早发性骨关节炎的诱因

译者 陶可

近年研究证实，股骨髋臼撞击症是髋关节早发性骨关节炎的致病因素。撞击分为两种发病机制：1）凸轮型撞击，由股骨头形态非球形所致；2）钳夹型撞击，由髋臼过度覆盖股骨头引发。本研究假设两种撞击机制会造成截然不同的髋关节软骨损伤特征。

本研究共分析302例髋关节样本，其中单纯凸轮型撞击26例，单纯钳夹型撞击16例。凸轮型撞击会造成髋臼前上方软骨损伤，同时伴随盂唇与软骨分离；髋关节屈曲活动时，非球形股骨头对软骨产生剪切力，使软骨自骨面剥离，盂唇本身无明显损伤。

钳夹型撞击的软骨损伤呈环形分布，仅累及狭窄带状区域；髋关节活动过程中，盂唇被挤压于髋臼缘与股骨颈之间，进而出现退变、骨化改变。

凸轮型与钳夹型撞击最终均可进展为髋关节骨关节炎。盂唇损伤提示撞击持续存在，且极少单独发生。

Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip

Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement caused by excessive acetabular cover. We hypothesised that both mechanisms result in different patterns of articular damage. Of 302 analysed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Both cam and pincer impingement lead to osteoarthritis of the hip. Labral damage indicates ongoing impingement and rarely occurs alone.

文献出处：M Beck, M Kalhor, M Leunig, R Ganz. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip.J Bone Joint Surg Br . 2005 Jul;87(7):1012-8. doi: 10.1302/0301-620X.87B7.15203.

来源：304关节学术

作者：304关节团队

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