髋膝关节文献精译荟萃（第397期)

本期目录：

1、股神经-坐骨神经联合阻滞对比股神经-局部浸润麻醉对全膝关节置换术后疼痛的控制

2、手工与机器人辅助翻修全膝关节置换术治疗膝关节不稳的比较

3、髋部骨折不愈合的保髋

4、盂唇在髋关节负重中的作用

5、股骨头软骨下不全骨折：诊断、治疗及预后的系统评价

6、髋关节发育不良行单纯髋臼周围截骨术后再行髋关节镜的概率

7、临界型发育不良髋中髋臼半径与股骨头半径的三维曲率不匹配程度增加

第一部分：关节置换及保膝相关文献

文献1

股神经-坐骨神经联合阻滞对比股神经-局部浸润麻醉对全膝关节置换术后疼痛的控制：一项随机对照试验的荟萃分析

译者 张轶超

背景：本研究对相应随机对照试验（RCTs）进行系统回顾和荟萃分析，目的是评估全膝关节置换术（TKA）后股神经和坐骨神经联合阻滞（SNB）与股神经和局部浸润麻醉（LIA）效果的对比。

方法：检索PubMed、Embase、Cochrane Library和Web of Science自建站至2016年6月15日的电子数据库。只有比较股神经和SNB联合与股神经和LIA联合控制疼痛的文章符合本荟萃分析的条件。本系统评价和荟萃分析是根据PRISMA声明标准进行的。主要观察节点为12、24、48 h休息时的视觉模拟评分（VAS），反映TKA后疼痛的控制情况。收集了24和48 h时膝关节主动活动度、住院时间、麻醉时间和吗啡使用的数据。术后恶心呕吐（PONV）和跌倒等并发症也被记录下来，以评估节省吗啡用量效果的安全性。在对研究的发表偏倚和异质性进行检验后，必要时将数据汇总以进行随机效应建模。

结果：Meta分析纳入了7项临床试验，共615名患者。合并结果表明，SNB与术后12小时（MD = - 6.96； 95% CI为- 8.36至- 5.56;P < 0.001）和48小时（MD = - 2.41;95% CI为−3.90 ~−0.91；P < 0.001)）较低的VAS评分相关。在24小时的VAS评分方面，SNB组和LIA组之间无显著差异（MD = 0.67; 95% CI - 0.31至1.66;P = 0.182）。LIA组麻醉时间短于SNB组，差异有统计学意义（MD = 4.31, 95% CI 1.34 ~ 7.28, P = 0.004）。两组在膝关节主动活动度、住院时间、吗啡用量、PONV和跌倒发生率方面无显著差异。

结论：在联合股神经阻滞（FNB）时，SNB可能比LIA更早发挥麻醉作用；然而，吗啡的用量、膝关节主动活动度和PONV在两组之间没有差异。LIA组麻醉操作时间更短，这表明LIA可能是一种实用且潜在更安全的替代SNB的方法。

Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials

Background: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration anesthesia (LIA) after total knee arthroplasty (TKA).

Methods: The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were eligible for this meta-analysis. This systematic review and meta-analysis was performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) score with rest at 12, 24, and 48 h, which represents the pain control after TKA. Data regarding active knee flexion, length of hospital stay, anesthesia time, and morphine use at 24 and 48 h were also compiled. The complications of postoperative nausea and vomiting (PONV) and fall were also noted to assess the safety of morphine-sparing effects. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling when necessary.

Results: Seven clinical trials with 615 patients were included in the meta-analysis. The pooled results indicated that SNB was associated with a lower VAS score at 12 h (MD = −6.96; 95% CI −8.36 to −5.56; P < 0.001) and 48 h (MD = −2. 41; 95% CI −3.90 to −0.91; P < 0.001) after TKA. There was no significant difference between the SNB group and the LIA group in terms of the VAS score at 24 h (MD = 0.67; 95% CI −0.31 to 1.66; P = 0.182). The anesthesia time in the LIA group was shorter than in the SNB group, and the difference was statistically significant (MD = 4.31, 95% CI 1.34 to 7.28, P = 0.004). There were no significant differences between the groups in terms of active knee flexion, length of hospital stay, morphine use, PONV, and the occurrence of falls.

Conclusions: SNB may provide earlier anesthesia effects than LIA when combined femoral nerve block (FNB); however, there were no differences in morphine use, active knee flexion, and PONV between the groups. The LIA group spent less time under anesthesia, suggesting that LIA may offer a practical and potentially safer alternative to SNB.

文献出处：Li J, Deng X, Jiang T. Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2016 Dec 7;11(1):158. doi: 10.1186/s13018-016-0495-6. PMID: 27923404; PMCID: PMC5142141.

文献2

手工与机器人辅助翻修全膝关节置换术治疗膝关节不稳的比较：一项一年期队列分析

译者 沈松坡

目的：全膝关节翻修术（rTKA）是治疗初次全膝关节置换术失败的一种方法，但其并发症发生率更高且技术难度更大。机器人辅助全膝关节翻修术（rarTKA）是一项新兴技术，可能改善假体对线和手术精确性。然而，其对因膝关节不稳而行rTKA患者早期术后结局的影响仍不明确。

方法： 回顾性分析单中心由两名接受关节置换专科培训的外科医师连续完成的133例因膝关节不稳接受rTKA的患者（手工组82例，机器人组51例）。所有rarTKA均采用MAKO机器人手臂系统。采用单因素分析比较两组手术时间、住院时间（LOS）、关节线改变、股骨后髁偏距（PCO）变化及术后30天/90天全因并发症。同时比较翻修假体构型。术后3个月采用关节置换版膝关节损伤与骨关节炎结局评分（KOOS-JR）评价患者报告结局，术后1年评价关节活动度（ROM）。采用Kaplan-Meier分析评估术后1年无再次手术生存率。

结果： 与手工组相比，rarTKA组获得了更大的平均PCO增加值（3.4 mm vs 1.5 mm；p = 0.014），但手术时间更长（186分钟 vs 173分钟；p = 0.037）。两组关节线变化、住院时间、术后3个月KOOS-JR评分及关节活动度无显著差异。30天并发症发生率（4.9% vs 7.8%）、90天并发症发生率（7.3% vs 11.8%）及术后1年无再次手术生存率（91.5% vs 94.1%；p = 0.900）两组相当。尽管机器人组未使用偏移连接器（offset coupler），但其翻修假体构型中增垫块（augment）的使用更为频繁。

结论： 与传统手工rTKA相比，rarTKA在获得更佳PCO重建的同时，其早期术后结局和并发症发生率相当，但手术时间更长。两组住院时间、功能结局及术后1年生存率相似。总体而言，rarTKA是一种安全且有效的技术，但仍需进一步研究以明确其长期获益及临床意义。

图：一例64岁男性全膝关节置换术患者翻修前（a、b）及翻修术后6周（c、d）的正位（AP）和侧位X线片。（a）和（c）为正位X线片，用于计算关节线位置；（b）和（d）为侧位X线片，用于测量相应时间点的股骨后髁偏心距（posterior condylar offset，PCO）。

Manual versus robotic-assisted revision total knee arthroplasty for instability : a one-year cohort analysis

Aims: Revision total knee arthroplasty (rTKA) is a treatment option for failed primary TKA but is associated with higher complication rates and technical challenges. Robotic-assisted rTKA (rarTKA) is an emerging technique that may improve component alignment and surgical precision. However, its effect on early postoperative outcomes in rTKA for instability remains unclear.

Methods: A total of 133 consecutive rTKAs for instability (82 manual and 51 robotic) performed by two fellowship-trained arthroplasty surgeons at a single institution were retrospectively analyzed. All rarTKAs used the MAKO robotic-arm system. Operating time, length of stay (LOS), joint line change, posterior condylar offset (PCO) change, and all-cause 30-/90-day complications were compared using univariable analyses. Revision implant constructs were also compared. The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and range of motion (ROM) were assessed at three months and one year, respectively. Kaplan-Meier analysis assessed one-year reoperation-free survival.

Results: RarTKA achieved a greater mean increase in PCO (3.4 mm vs 1.5 mm; p = 0.014), but required a longer operating time (186 minutes vs 173 minutes; p = 0.037). Joint line change, LOS, three-month KOOS-JR, and ROM did not differ significantly. The 30-day (4.9% vs 7.8%) and 90-day (7.3% vs 11.8%) complication rates and one-year reoperation-free survival (91.5% vs 94.1%; p = 0.900) were comparable. Although offset couplers were not used, rarTKA constructs incorporated augments more frequently.

Conclusion: RarTKA demonstrated early postoperative outcomes and complication rates comparable to those of conventional manual rTKA, while achieving improved PCO restoration despite longer operating times. LOS, functional outcomes, and one-year survivorship were similar between groups. Overall, rarTKA appears to be safe and effective; however, further investigation is required to determine the long-term benefits and clinical significance.

第二部分：保髋相关文献

文献1

髋部骨折不愈合的保髋

译者 张振东

背景：骨折不愈合是股骨颈、粗隆间或粗隆下骨折的并发症之一。治疗髋部骨折不愈合可选择保髋手术或关节置换术。本研究的目的是研究保髋手术治疗髋部骨不愈合的临床结果。

方法：本研究由骨折不愈合登记数据库中确定了在10年内因股骨颈、粗隆间或粗隆下骨折后不愈合行保髋手术的患者，对患者进行至少1年的随访。随访期间记录髋关节功能结果变化。为了比较临床结果，同时还回顾分析了在同一医疗中心因骨折不愈合接受全髋关节成形术的23名患者。分析数据包括住院时间、再次手术率和并发症发生情况。

结果：共纳入骨折后不愈合行保髋手术的30例患者，并与23名因不愈合行关节置换术的患者进行了比较。保髋手术患者中，共29例经治疗获得最终骨性愈合（平均愈合时间为6.3个月）。保髋手术组最新随访的功能结果评分较术前均有所改善（p <0.001）。5例患者（17％）需要再次手术，其中4例为骨不愈合，需要进行第二次手术以获得愈合，另外1例失败的患者直接改行关节置换手术。保髋手术失败的患者年龄比经保髋手术获得骨性愈合的患者年龄更大（p = 0.11）。与关节置换组患者相比，住院时间、并发症发生率或需再手术率没有显着差异。

结论：对于髋部骨折后不愈合患者来说，保髋手术是一个应考虑的选择。并发症发生率（20.3 vs 17.3％）和再次手术率（16.7 vs 17.3％）与关节置换术相当。通过保髋手术可以实现影像学愈合和优良的临床功能。

Hip-preserving surgery for nonunion about the hip

Introduction: Nonunions about the hip occur as a result of femoral neck, intertrochanteric, and certain subtrochanteric fractures. Treatment of a hip fracture nonunion allows for the choice between hip preservation or arthroplasty. The goal of this study was to examine outcomes of hip-preservation nonunion surgery METHODS: Patients who underwent hip preservation for a fracture nonunion of the femoral neck, intertrochanteric and subtrochanteric region to 1 cm below the lesser trochanter over a 10-year period were identified in our nonunion registry. Patients were followed for a minimum of 1 year. Functional outcomes were recorded at follow-up visits. For comparison regarding surgical and hospital outcomes, a group of 23 patients who underwent conversion total hip arthroplasties (cTHA) at the same academic medical center was reviewed. Quality measures such as length of stay, reoperation, and complications were collected. All statistics analysis utilized IBM SPSS 25 (Armonk, NY) RESULTS: Thirty patients who underwent 30 hip-preserving nonunion surgeries were analyzed and compared with 23 cTHA patients. Twenty-nine nonunions went on to heal (average time to union 6.3 months). There was improvement in functional outcome scores for the hip preservation group between baseline and latest follow-up (p < 0.001). Reoperation was required in five patients (17%), including four failed to heal and required a second repair to gain union and one failure that was converted to THA rather than attempt a second nonunion repair. Hip preservation failures were older than those that healed with the index treatment (p = 0.11). There was no significant difference in hospital length of stay, complication rate, or need for reoperation when compared to cTHA group.

Conclusion: Hip-preserving surgery is an option that should be considered for patients with nonunion of fractures about the hip. The rates of complications (20.3 vs 17.3%) and reoperation (16.7 vs 17.3%) were equivalent to conversion THA. Excellent outcomes can be achieved in terms of radiographic union and function with hip preservation.

文献出处：Egol KA, Walden T, Gabor J, Leucht P, Konda SR. Hip-preserving surgery for nonunion about the hip. Arch Orthop Trauma Surg. 2022 Jul;142(7):1451-1457. doi: 10.1007/s00402-021-03820-4. Epub 2021 Feb 26. PMID: 33635401.

文献2

盂唇在髋关节负重中的作用

译者 任宁涛

髋关节疼痛患者盂唇撕裂发生率较高，提示髋臼盂唇在体内常遭受损伤性负荷。然而，目前尚不清楚盂唇是否参与日常生活活动中跨关节的负荷转移。本研究使用特定主题的有限元分析研究了髋臼盂唇在髋臼几何正常和髋臼发育不良髋关节负荷转移中的作用。根据容积CT数据生成模型，并在日常生活活动中分析有/无盂唇时负荷的情况。发育不良模型中盂唇负荷了4 ~ 11%的跨关节总负荷转移，而正常模型的盂唇仅支撑了1 ~ 2%的总载荷。在没有盂唇的模拟中，尽管转移到髋臼软骨的载荷增加，但软骨接触应力的差异很小，这是因为软骨所支撑的载荷与软骨接触面积相关。在发育不良模型中，由于股骨头相对髋臼外移或骨性覆盖不良，更多的负荷转移到盂唇。本研究结果表明，与正常髋臼相比，髋臼盂唇在髋臼发育不良的载荷传递和关节稳定性中发挥更大的作用。

图1 正常模型和发育不良模型的盂唇负荷百分比。在所有情况下，发育不良模型中的盂唇承受的关节负荷比例都更高。

Role of the acetabular labrum in load support across the hip joint

The relatively high incidence of labral tears among patients presenting with hip pain suggests that the acetabular labrum is often subjected to injurious loading in vivo. However, it is unclear whether the labrum participates in load transfer across the joint during activities of daily living. This study examined the role of the acetabular labrum in load transfer for hips with normal acetabular geometry and acetabular dysplasia using subject-specific finite element analysis. Models were generated from volumetric CT data and analyzed with and without the labrum during activities of daily living. The labrum in the dysplastic model supported 4-11% of the total load transferred across the joint, while the labrum in the normal model supported only 1-2% of the total load. Despite the increased load transferred to the acetabular cartilage in simulations without the labrum, there were minimal differences in cartilage contact stresses. This was because the load supported by the cartilage correlated with the cartilage contact area. A higher percentage of load was transferred to the labrum in the dysplastic model because the femoral head achieved equilibrium near the lateral edge of the acetabulum. The results of this study suggest that the labrum plays a larger role in load transfer and joint stability in hips with acetabular dysplasia than in hips with normal acetabular geometry.

文献出处：Corinne R Henak , Benjamin J Ellis, Michael D Harris, Andrew E Anderson, Christopher L Peters, Jeffrey A Weiss.Role of the acetabular labrum in load support across the hip joint. J Biomech . 2011 Aug 11;44(12):2201-6.

文献3

股骨头软骨下不全骨折：诊断、治疗及预后的系统评价

译者 李勇

摘要：股骨头软骨下不全骨折（SIFFH）是导致股骨头塌陷并进而引起髋关节退变性疾病的原因之一。由于临床和影像学特征相似，SIFFH 常被误诊为股骨头坏死。这些相似性常导致漏诊或延迟诊断，从而可能延误或改变治疗策略。本文旨在系统回顾 SIFFH 的人口学特征、诊断及治疗方案（包括在年轻患者群体中的保髋治疗）。本系统评价遵循系统评价和荟萃分析优先报告条目（PRISMA）指南进行。检索了 1999 年 1 月至 2019 年 1 月期间发表于 Medline、EMBASE、Scopus 和 Web of Science 数据库的所有相关同行评审文献。系统评价共纳入 54 篇文献，涵盖 482 例患者（504 髋）确诊为 SIFFH。其中男性 176 例（35%），女性 306 例（63%），平均年龄 53.6±17.5 岁，平均体质指数 23.4±4.0 kg/m²。平均随访时间为 23.4±15.9 个月。治疗决策分布如下：非手术治疗 256 例（55%），全髋关节置换术（THA）157 例（34%），经转子前路旋转截骨术 24 例（5%），髋关节镜 9 例（2%），髋关节表面置换 7 例（2%），骨移植 3 例（1%），半髋关节置换 3 例（1%），钽棒植入 1 例（1%）。总体而言，在最终随访时，35% 的 SIFFH 患髋转为 THA。大多数 SIFFH 患者经非手术治疗后症状缓解。治疗失败后最常采用 THA。在年轻患者中，保髋技术已显示出有前景的早期效果，应作为替代方案加以考虑。

Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes

Abstract: Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m². Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.

文献出处：Michael A Gaudiani, Linsen T Samuel, Bilal Mahmood, Assem A Sultan, Atul F Kamath, Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes, Journal of Hip Preservation Surgery, Volume 7, Issue 1, 2020, Pages 85–94.

文献4

髋关节发育不良行单纯髋臼周围截骨术后再行髋关节镜的概率：6.8%

译者 陶可

背景：髋臼周围截骨术（PAO）是发育性髋关节发育不良（DDH）的标准治疗方法。尽管关节内病变（如髋臼盂唇撕裂）较为常见，但常规将PAO与髋关节镜联合应用的益处尚不明确。评估单纯PAO术后行髋关节镜检查的频率和适应症，对于确定PAO是否能充分解决关节内病变以及指导手术决策至关重要。

方法：本回顾性队列研究纳入了2018年1月1日至2023年10月1日期间在一家三级甲等教学医院接受PAO治疗的59例有症状DDH患者。对于随访时间不足一年的患者，通过电话联系收集数据。回顾了术前影像学资料和术后结果。术后平均2.6±1.5年进行了随访电话调查。主要结局指标为后续髋关节镜手术的发生率。次要结局指标包括持续性疼痛、影像学检查结果以及患者对未来手术的意愿。对接受和未接受关节镜手术的患者进行了比较分析。

结果：共纳入59例患者，其中53例（89.8%）成功完成电话访谈。术前平均LCEA为15.0°±6.8°，术后平均LCEA为28.8°±2.1°，平均变化为14.2°。51例术前行MRI检查的患者中，31例（60.7%）发现髋臼盂唇撕裂。术后4例（6.8%）患者接受了髋关节镜手术。在联系的患者中，47例（88.7%）表示对未来进行关节镜手术不感兴趣，而2例（3.8%）表示可能感兴趣。其余6例未联系到的患者没有随访手术或持续症状的记录。

结论：术前盂唇撕裂在接受髋臼周围截骨术(PAO)的患者中较为常见，但根据我们的研究结果，仅有少数患者需要后续进行关节镜手术干预。需要开展更大规模的研究来进一步评估髋关节镜在发育性髋关节发育不良(DDH)中的作用。

The rate of hip arthroscopy subsequent to isolated periacetabular osteotomy for congenital hip dysplasia

Background: Periacetabular osteotomy (PAO) is the standard treatment for developmental dysplasia of the hip (DDH). Although intra-articular pathology such as labral tears is common, the benefit of routinely combining PAO with hip arthroscopy is uncertain. Evaluating the frequency and indications for arthroscopy after isolated PAO is key to determining whether PAO alone adequately addresses intra-articular disease and to guide surgical decision-making.

Methods: This retrospective cohort study included 59 patients who underwent PAO for symptomatic DDH between January 1, 2018, to October 1, 2023, at a single tertiary academic center. Those without a minimum of one-year follow-up were contacted by phone for data collection. Preoperative imaging and postoperative outcomes were reviewed. A follow-up phone survey was conducted at a median of 2.6 ± 1.5 years postoperatively. The primary outcome was the incidence of subsequent hip arthroscopy. Secondary outcomes included persistent pain, imaging findings, and patient-reported interest in future surgery. Comparative analyses were performed between those who did and did not undergo arthroscopy.

Results: A total of 59 patients were included, with 53 (89.8 %) successfully completing phone interviews. The mean preoperative LCEA was 15.0° ±6.8, and the mean postoperative LCEA was 28.8° ±2.1, with an average change of 14.2°. Labral tears were identified in 31 of 51 (60.7 %) patients who had preoperative MRIs. Hip arthroscopy was performed in 4 (6.8 %) patients postoperatively. Of the patients contacted, 47 (88.7 %) reported no interest in future arthroscopy, while 2 (3.8 %) expressed potential interest. The 6 patients not reached had no documented evidence of follow-up surgery or continued symptoms.

Conclusion: Preoperative labral tears are common in patients undergoing PAO, but only a small percentage require subsequent arthroscopic intervention based on our findings. Larger studies are needed to further assess the role of arthroscopy in DDH.

文献出处：Hannah Smith, Albert Yim, Thomas Huff, Ryland Kagan, Andrea Herzka. The rate of hip arthroscopy subsequent to isolated periacetabular osteotomy for congenital hip dysplasia. J Clin Orthop Trauma. 2025 Oct 3:71:103224. doi: 10.1016/j.jcot.2025.103224.

文献5

临界型发育不良髋中髋臼半径与股骨头半径的三维曲率不匹配程度增加

译者 邱兴

临界型髋关节发育不良是否属于病理状态尚不明确。为评估三维关节匹配度，本研究旨在回答以下问题：临界型发育不良髋的髋臼与股骨头之间的曲率不匹配和偏心距在三维层面是否与发育不良髋或对照髋存在差异？共评估113例髋关节，按以下分组：发育不良组（外侧中心边缘角[LCEA] ≤ 20°）47髋，临界组（20° ≤ LCEA < 25°）32髋，对照组（25° ≤ LCEA < 35°）34髋。基于CT图像重建股骨和髋骨的三维（3D）骨模型。使用自行编写的Visual C++程序，计算股骨头和髋臼的曲率半径，以及股骨头和髋臼的曲率中心。随后计算髋臼半径与股骨头半径的比值（三维曲率不匹配比），以及髋臼曲率中心与股骨头中心之间的距离（三维中心偏差距离）。采用Tukey事后检验对三组间的这些指标进行统计学比较。临界组的平均三维曲率不匹配比（1.13 ± 0.05）小于发育不良组（1.23 ± 0.08，p < 0.001），大于对照组（1.07 ± 0.02，p < 0.001）。临界组的平均三维中心偏差距离（3.2 ± 1.4 mm）小于发育不良组（4.8 ± 2.3 mm，p < 0.001），大于对照组（1.6 ± 0.7 mm，p < 0.001）。这些结果表明，临界型发育不良髋的三维匹配度受损，但其不匹配程度不如发育不良髋严重。三维曲率不匹配比和三维中心偏差距离可作为临界型发育不良患者关节匹配度的有价值指标。然而，未来仍需进一步研究以明确曲率不匹配与临界型发育不良中骨关节炎发病机制之间的关联。

图1. 曲率不匹配比与中心偏差距离之间理论关系的示意图。(A) 匹配良好的同心髋；(B) 匹配较差的偏心髋。RA、RA'：髋臼曲率半径；RF：股骨头曲率半径；RA（RA'）/RF：曲率不匹配比；CD：中心偏差距离。

图2. (A) 确定股骨头表面感兴趣区域，以计算三维股骨头曲率半径及股骨头中心。(B) 股骨头表面平面投影的展开图，颜色编码表示骨性突起（红色）或凹陷（蓝色）。

图3. 各组代表性AP骨盆X线片、左侧髋关节正中矢状面CT图像及显示髋臼曲率中心与股骨头中心的三维重建模型图像。(A) 发育不良髋，LCEA = 10.0°，三维曲率不匹配比 = 1.27，三维中心偏差距离 = 6.13 mm。(B) 临界型发育不良髋，LCEA = 22.3°，三维曲率不匹配比 = 1.14，三维中心偏差距离 = 4.14 mm。(C) 对照髋，LCEA = 32.4°，三维曲率不匹配比 = 1.07，三维中心偏差距离 = 0.69 mm。红色圆圈表示髋臼曲率中心，黄色圆圈表示股骨头中心。为显示髋臼曲率与股骨头曲率之间的不匹配以及髋臼曲率中心与股骨头中心之间的偏差，后壁和股骨部分已切除。

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA ≤ 20°), 47 hips; borderline (20° ≤ LCEA < 25°), 32 hips; and control (25° ≤ LCEA < 35°), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.

文献出处： Irie, T. , Alejandro A. Espinoza Orías, Irie, T. Y. , Nho, S. J. , & Inoue, N. . (2020). Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips. {PLoS ONE}{,} {15}(4), e0231001.

来源：304关节学术

作者：34关节团队

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