髋膝关节文献精译荟萃（第400期)

本期目录：

1、胫骨高位截骨与单髁置换术翻修成全膝关节置换术的效果比较

2、机器人辅助无骨水泥全膝关节置换术后追踪器固定针孔影像学恢复的自然病程

3、股骨头软骨下不全骨折可能和髋关节发育不良相关

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、股骨近端截骨术在治疗股骨头缺血性坏死中的作用

6、髋关节生物力学

7、步态中足前进角的变化可降低膝关节内收力矩，且不会增加膝骨关节炎患者的髋关节力矩

第一部分：关节置换及保膝相关文献

文献1

胫骨高位截骨与单髁置换术翻修成全膝关节置换术的效果比较：系统回顾和荟萃分析

译者 张轶超

目的：胫骨高位截骨术（HTO）和单髁置换术（UKA）是治疗单间室膝关节骨关节炎的两种常用方法。然而，这两种方法最终都可能需要翻修成全膝关节置换术（TKA）。本研究旨在比较HTO翻修成TKA （HTO-TKA）与UKA翻修成TKA （UKA-TKA）的临床结果和功能表现。研究结果旨在为临床实践中选择更好的膝骨关节炎治疗策略提供有价值的建议。

方法：综合检索截至2024年10月的PubMed、Embase、Cochrane Library和Web of Science数据库中的相关文献，用来评估HTO-TKA和UKA-TKA术后临床疗效和功能结果。主要关注点包括膝关节功能评分、术后并发症和翻修率。次要关注点包括手术时间、活动范围（ROM）、术后感染和使用的翻修假体类型。

结果：本荟萃分析包括11项回顾性研究，共涉及10045名患者。结果显示，HTO-TKA组膝关节功能评分明显优于UKA-TKA组（MD=3.35, 95% CI: [0.84, 5.87], I²=95%，P=0.009）。虽然HTO-TKA组的膝关节功能评分在统计学上较高，但平均差异（MD=3.35）未达到KSS评分的MCID阈值（6-10分），表明该差异的临床意义尚不确定。此外，HTO-TKA组所需翻修假体植入物较少（OR=0.11, 95%CI: [0.05, 0.23], I²=90%，P<0.00001）。然而，两组在术后并发症（OR=1.21, 95%CI: [0.67, 2.17], I²=59%，P=0.53），翻修率（OR=0.81, 95%CI: [0.53, 1.26], I²=76%，P=0.35），手术时间（MD=-2.00, 95%CI: [-11.22, 7.21], I²=91%，P=0.67），活动范围（MD=-0.04, 95%CI: [-3.69, 3.61], I²=0%，P=0.98），或术后感染（OR=0.81, 95%CI: [0.56, 1.17], I²=48%，P=0.26）方面均无统计学差异。敏感性分析显示异质性，提示需要进行亚组分析。手工整理后发现，HTO-TKA组的翻修率低于UKA-TKA组（OR=0.65, 95% CI: [0.51, 0.83], I²=18%，P=0.0006）， HTO-TKA组的手术时间较UKA-TKA组短，有统计学意义（MD=-9.15, 95% CI: [-11.97, -6.33], I²=33%，P<0.00001）。

结论：虽然与UKA-TKA相比，HTO-TKA具有更好的膝关节功能评分和使用更少的翻修假体植入物，但这些差异的临床相关性仍不确定。临床医生在为内侧间室KOA患者选择HTO或UKA时，应权衡这些发现结果是否和回顾性数据的局限性和不断发展的手术技术相冲突。

Comparative outcomes of revision total knee arthroplasty: a systematic review and meta-Analysis of high tibial osteotomy vs. unicompartmental knee arthroplasty

Purpose：High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two common approaches for managing unicompartmental knee osteoarthritis. However, both procedures may eventually require revision to total knee arthroplasty (TKA). This study aims to compare the clinical outcomes and functional performance of revision TKA following HTO (HTO-TKA) versus revision TKA following UKA (UKA-TKA). The findings are intended to offer valuable insights for optimizing treatment strategies for patients with knee osteoarthritis in clinical practice.

Methods：The postoperative clinical outcomes and functional results of HTO-TKA and UKA-TKA were assessed through a comprehensive review of relevant literature from PubMed, Embase, the Cochrane Library, and Web of Science up to October 2024. Primary endpoints included knee function scores, postoperative complications, and revision rates. Secondary endpoints encompassed operation time, range of motion (ROM), postoperative infections, and the types of revision implants used.

Results：This meta-analysis included 11 retrospective studies involving a total of 10,045 patients. The results demonstrated that the HTO-TKA group had significantly better knee function scores compared to the UKA-TKA group (MD=3.35, 95% CI: [0.84, 5.87], I²=95%, P=0.009). Although the HTO-TKA group showed statistically higher knee function scores, the mean difference (MD=3.35) did not reach the established MCID threshold for KSS (6–10 points), indicating that the clinical significance of this difference remains uncertain. Additionally, fewer revision implants were required in the HTO-TKA group (OR=0.11, 95%CI: [0.05, 0.23], I²=90%, P<0.00001). However, no statistically significant differences were observed between the two groups in terms of postoperative complications (OR=1.21, 95% CI: [0.67, 2.17], I²=59%, P=0.53), revision rates (OR=0.81, 95% CI: [0.53, 1.26], I²=76%, P=0.35), operation time (MD=-2.00, 95%CI: [-11.22, 7.21], I²=91%, P=0.67), range of motion (ROM) (MD=-0.04, 95% CI: [-3.69, 3.61], I²=0%, P=0.98), or postoperative infections (OR=0.81, 95% CI: [0.56, 1.17], I²=48%, P=0.26). Sensitivity analysis indicated heterogeneity, prompting the need for a subgroup analysis. After manual removal, the HTO-TKA group had a lower revision rate compared to the UKA-TKA group (OR=0.65, 95% CI: [0.51, 0.83], I²=18%, P=0.0006), and the HTO-TKA group had a statistically significant shorter operative time compared to the UKA-TKA group (MD=-9.15, 95% CI: [-11.97, -6.33], I²=33%, P<0.00001).

Conclusion While HTO-TKA was associated with marginally better knee function scores and reduced revision implant usage compared to UKA-TKA, the clinical relevance of these differences remains uncertain. Clinicians should weigh these findings against the limitations of retrospective data and evolving surgical techniques when selecting between HTO and UKA for patients with medial compartment KOA.

文献出处：Li P, Qiao Y, Zhou Y, Li J, Lin Z, Cao Y, Tan F, Zeng J, Song X, Liu P, Ye S, Zhuang K, Gao Q, Zhou S. Comparative outcomes of revision total knee arthroplasty: a systematic review and meta-Analysis of high tibial osteotomy vs. unicompartmental knee arthroplasty. BMC Musculoskelet Disord. 2025 Aug 12;26(1):780. doi: 10.1186/s12891-025-08891-7. PMID: 40796820; PMCID: PMC12341320.

文献2

机器人辅助无骨水泥全膝关节置换术后追踪器固定针孔影像学恢复的自然病程

译者 沈松坡

机器人辅助全膝关节置换术（RATKA）需要放置追踪器固定针，从而形成皮质骨针孔，这些针孔在术后X线片上可能持续可见。本研究旨在评估RATKA术后追踪器固定针孔影像学恢复的自然病程。本回顾性队列研究纳入369例连续接受初次机器人辅助全膝关节置换术的患者，均采用4.0 mm双皮质固定阵列针。所有患者均于术后约1个月、3～4个月、5～6个月及9～12个月各接受1次X线检查；术后7～8个月未安排常规X线检查。根据恢复情况分为3种恢复表型：5～6个月恢复者定义为早期恢复（n=224），首次于9～12个月恢复者定义为延迟恢复（n=74），9～12个月评估时针孔仍持续可见者定义为持续可见（n=70）。另有1例针孔相关骨折作为独立不良事件单独分析。采用独立的探索性Logistic回归模型分别比较延迟恢复与早期恢复、持续可见与早期恢复，并采用Benjamini-Hochberg假发现率（false discovery rate，FDR）进行校正。术后1个月及3～4个月均未观察到完全恢复。224膝（60.7%）于5～6个月恢复，74膝（20.1%）于9～12个月恢复，70膝（19.0%）于9～12个月时针孔仍持续可见，另有1例（0.3%）发生针孔部位相关骨折。总体而言，298膝（80.8%）于晚期评估时已达到影像学恢复。三种恢复组间BMI存在显著差异（Kruskal–Wallis检验，p=0.002）。校正分析显示，较高BMI与延迟恢复（相对于早期恢复）相关（校正OR=1.10/每增加1 kg/m²，95%CI 1.04～1.17；p=0.002；FDR校正q=0.022），但与针孔持续可见无关。糖尿病及吸烟均与两种恢复轨迹无显著相关性。共发生2例假体周围骨折（0.5%），均需再次手术，其中仅1例累及追踪器针孔区域。研究期间未发生翻修全膝关节置换术，亦未发现股骨透亮线或进行性透亮线。RATKA术后追踪器针孔可逐渐发生皮质骨重塑，大多数病例于术后5～6个月恢复，术后9～12个月可观察到进一步恢复。在探索性校正模型中，较高BMI与恢复延迟但最终恢复相关，而与针孔持续可见无关。针孔持续可见并未伴随假体-骨界面进行性透亮线。直接累及追踪器针孔的骨折较为罕见。

关键词

机器人辅助全膝关节置换术；追踪器固定针孔；皮质骨重塑；无骨水泥固定；假体周围骨折。

图：A 机器人辅助无骨水泥全膝关节置换术后追踪器针孔早期影像学恢复的代表性病例。术后1个月站立位正位（a）及侧位（b）X线片可见股骨远端及胫骨近端追踪器针孔（箭头）。术后5个月站立位正位（c）及侧位（d）X线片显示针孔影像学消失，皮质骨连续性恢复，符合早期恢复。

B 机器人辅助无骨水泥全膝关节置换术后追踪器针孔延迟影像学恢复的代表性病例。术后1个月站立位正位（a）及侧位（b）X线片可见股骨远端及胫骨近端追踪器针孔（箭头）。术后9个月随访站立位正位（c）及侧位（d）X线片显示针孔影像学消失，皮质骨连续性恢复，符合延迟恢复。

C 机器人辅助无骨水泥全膝关节置换术后追踪器针孔持续影像学可见的代表性病例。术后1个月正位（a）及侧位（b）X线片可见股骨远端及胫骨近端追踪器针孔（箭头）。术后12个月随访侧位（c）及正位（d）X线片显示追踪器针孔区域仍持续可见，皮质骨连续性尚未完全恢复。

Natural history of radiographic tracker pinhole recovery after robotic-assisted cementless total knee arthroplasty

Robotic-assisted total knee arthroplasty (RATKA) requires tracker pin placement, creating cortical pinholes that may remain visible on postoperative radiographs. This study evaluated the radiographic natural history of tracker pinhole recovery after RATKA. This retrospective cohort study included 369 consecutive primary RATKAs performed using 4.0-mm bicortical array pins. Each patient had one radiograph within approximately 1 month, 3-4 months, 5-6 months, and 9-12 months; no routine radiographs were scheduled at 7-8 months. Recovery phenotypes were early recovery at 5-6 months (n = 224), delayed recovery first documented at 9-12 months (n = 74), and persistent visibility at the 9-12-month assessment (n = 70). One pinhole-related fracture was analyzed separately. Separate exploratory logistic-regression models compared delayed versus early recovery and persistent visibility versus early recovery, with Benjamini-Hochberg false-discovery-rate adjustment. No complete recovery was observed at 1 month or 3-4 months. Early recovery occurred in 224 knees (60.7%), delayed recovery in 74 (20.1%), persistent visibility at 9-12 months in 70 (19.0%), and an adverse pin-site fracture in one (0.3%). Overall, 298 knees (80.8%) demonstrated radiographic recovery by the late assessment. BMI differed across the three recovery groups (Kruskal-Wallis p = 0.002). In adjusted analysis, higher BMI was associated with delayed versus early recovery (adjusted OR 1.10 per kg/m², 95% CI 1.04-1.17; p = 0.002; false-discovery-rate q = 0.022), but not with persistent visibility. Diabetes and smoking were not associated with either trajectory. Two periprosthetic fractures occurred (0.5%), both requiring reoperation; only one involved the tracker pinhole region. No revision TKA, femoral radiolucency, or progressive radiolucency was recorded. Tracker pinholes after RATKA remodel progressively, with most recovery documented by 5-6 months and additional recovery at the 9-12-month assessment. Higher BMI was associated with delayed but eventual recovery in an exploratory adjusted model, while no association was observed with persistent visibility. Persistent visibility was not accompanied by progressive implant-interface radiolucency. A fracture directly involving a tracker pinhole was rare.

第二部分：保髋相关文献

文献1

股骨头软骨下不全骨折可能和髋关节发育不良相关

译者 张振东

背景：股骨头软骨下不全骨折主要发生在患有骨质疏松症的老年患者身上。有些患者在接受非手术治疗后可自然痊愈，而另一些患者则表现为进行性关节破坏，需要进行全髋关节置换术。一些研究报告称，发育不良的髋关节也会发生股骨头软骨下不全骨折。

问题/目的：本研究旨在确定股骨头软骨下不全骨折患者的髋关节发育不良程度或骨质疏松症程度是否高于正常对照组。

方法：本研究比较了 13 例股骨头软骨下不全骨折患者（其中男性1例，女性12例，年龄：61岁-81岁，平均年龄71.2岁。左侧病变6例，右侧病变7例）和 12 例无症状髋关节（计划接受 TKA 的患者）的临床和影像学检查结果。两组患者的年龄、性别和体重指数相当。

结果：与无症状髋关节患者相比，股骨头软骨下不全骨折患者的平均Sharp 角更大、股骨头覆盖指数更小、外侧中心-边缘角更小以及臼顶角更大，这表明患者的髋关节发育不良程度更高。两组患者的骨密度和血清中I型胶原交联N-肽及骨碱性磷酸酶水平相似。

结论：本研究推测，发育不良对髋臼边缘造成的过大压力可能与老年患者股骨头软骨下不全骨折的发生有关。

Subchondral insufficiency fracture of the femoral head may be associated with hip dysplasia: a pilot study

Background: Subchondral insufficiency fracture of the femoral head occurs mainly in elderly patients with osteoporosis. Spontaneous resolution is observed after nonoperative treatment in some patients whereas other show progressive joint destruction requiring THA. Several studies report the occurrence of subchondral insufficiency fracture of the femoral head in dysplastic hips.

Questions/purposes: We asked whether the extent of hip dysplasia or osteoporosis was greater in patients with subchondral insufficiency fracture of the femoral head than in normal control subjects.

Patients and methods: We compared the clinical and imaging findings of 13 patients with subchondral insufficiency fractures of the femoral head and 12 patients scheduled for TKA with asymptomatic hips. Age, gender, and body mass index were comparable in the two groups.

Results: Higher mean Sharp angles, lower acetabular head indices, lower center-edge angles, and higher acetabular roof angles in patients with subchondral insufficiency fracture of the femoral head than in those with asymptomatic hips suggested a greater degree of hip dysplasia. Bone mineral density and serum levels of Type I collagen cross-linked N-telopeptide and bone alkaline phosphatase were similar in the two groups.

Conclusions: We speculate an excessive amount of stress on the acetabular edge from dysplasia may be associated with the occurrence of subchondral insufficiency fracture of the femoral head.

文献出处：Ishihara K, Miyanishi K, Ihara H, Jingushi S, Torisu T. Subchondral insufficiency fracture of the femoral head may be associated with hip dysplasia: a pilot study. Clin Orthop Relat Res. 2010 May;468(5):1331-5. doi: 10.1007/s11999-009-1213-z. Epub 2010 Jan 8. PMID: 20058110; PMCID: PMC2853656.

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

股骨近端截骨术在治疗股骨头缺血性坏死中的作用：临床及患者报告结局的系统评价

译者 李勇

背景/目的：股骨头缺血性坏死是一种致残性疾病，若不加干预，将进展为进行性关节炎，最终需行全髋关节置换术。在年轻成人患者中，临床倾向于采用保髋手术，尤其当核心减压或带血管骨移植等替代技术预期可能失败时。股骨近端截骨术旨在将坏死区域移出负重区。本系统评价旨在评估该技术在股骨头缺血性坏死治疗中的有效性，报告其转换为全髋关节置换术的比率及患者报告结局。方法：本系统评价遵循PRISMA指南进行。检索了PubMed、Ovid Medline、EMBASE和Cochrane Library数据库，使用预先设定的检索词。提取数据并呈现描述性资料。采用美国国立卫生研究院（NIH）病例系列研究质量评估工具对每项研究进行质量评价。结果：共纳入53项研究，包含2686例截骨术的数据。40%的病例出现影像学关节炎进展，20.3%的患者在平均75.4个月（范围20–132个月）时接受了全髋关节置换术。1416例患者记录了患者报告结局指标，其中最常用的是Harris髋关节评分。该评分在平均随访102个月时，从术前的平均58.3分改善至84.4分。结论：截骨术是治疗股骨头缺血性坏死的有效保髋技术之一，术后7年时有20.3%的患者需转换为全髋关节置换术。在无需行全髋关节置换的患者中，其患者报告结局指标与人工关节置换人群相似。

The Role of Proximal Femoral Osteotomy for the Treatment of Avascular Necrosis: A Systematic Review of Clinical and Patient‑Reported Outcomes

Background/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint‑preserving procedures, particularly where alternative techniques such as core decompression or vascularised bone grafting are anticipated to fail. Proximal femoral osteotomy is a technique that aims to remove the necrotic segment from the weight bearing area. The presented review aims to examine the efficacy of this technique in the management of avascular necrosis of the femoral head, reporting both rates of conversion to total hip replacement and patient reported outcomes. Methods: This systematic review was conducted according to PRISMA guidelines. A search was conducted of PubMed, Ovid Medline, EMBASE, and the Cochrane Library using pre‑defined search terms. Data were extracted, and descriptive data presented. Quality of each study was assessed using the NIH quality assessment tool for case series studies. Results: Fifty‑three studies with data for 2686 osteotomies are presented. Progression of radiological arthrosis was present in 40% of cases, with 20.3% of patients having undergone conversion to THR at a mean of 75.4 months (range 20–132 months). Patient‑reported outcome measures were recorded in 1416 patients, of which the Harris Hip Score was the most commonly utilised. This score improved from a mean of 58.3 to 84.4 at a mean follow‑up of 102 months. Conclusions: Osteotomy represented a valid head‑preserving technique in the armamentarium against avascular necrosis of the femoral head, with conversion to THR required in 20.3% of patients at 7 years. In those patients who did not require THR, PROMs were similar to the arthroplasty population.

文献出处：Rodham, P.L.; Jido, J.T.; Bethell, H.; Giannoudis, V.P.; Panteli, M.; Kanakaris, N.K.; Giannoudis, P.V. The Role of Proximal Femoral Osteotomy for the Treatment of Avascular Necrosis: A Systematic Review of Clinical and Patient-Reported Outcomes. J. Clin. Med. 2025, 14, 5592. https://doi.org/10.3390/jcm14155592

文献4

髋关节生物力学

译者 陶可

髋关节作为躯干与下肢之间最主要的连接结构，在日常活动及体育运动的力产生与力传导过程中发挥关键作用。该关节具备极强的骨性固有稳定性，骨性解剖形态的差异会显著改变人体髋关节的生物力学特性。这些生物力学原理对于髋关节结构性病变的诊断与外科治疗具有重要指导意义；同时体育运动带给髋关节的高负荷，也容易诱发损伤或其他慢性病理改变。

为了解决与人类髋关节功能相关的生物力学原理，必须考虑股骨近端和骨盆的正常解剖结构，因为肌肉、韧带和骨结构都有助于实现力的平衡，从而在股骨-髋臼关节处实现受控运动。尽管髋关节周围的局部解剖结构很重要，但也应该强调的是，髋关节是躯干和下肢之间的纽带，这些更偏远的结构对髋关节的生物力学有很大贡献。但为了简化起见，躯干和下肢的解剖结构将不会特别提及。

髋关节传统上被描述为股骨近端球形股骨头和髋凹窝（称为髋臼）之间的球窝关节。股骨头和髋臼共同形成球窝关节。髋臼位于骨盆髂骨、坐骨和耻骨的汇合处，即Y形软骨，早在妊娠8周就开始发育，在妊娠11周时髋关节完全形成。正常的髋臼开口随着股骨头的存在而发育，朝向下侧、外侧和前侧。髋臼开口的尺寸和方向可以通过放射学上的外侧中心边缘角、前侧中心边缘角和Tonnis角或髋臼倾斜度来描述；这些角度的值与髋臼的深度、其承重面的倾斜度以及股骨头的相应覆盖量有关。髋臼发育持续到Y形软骨融合，通常在16至18岁之间。

图：平衡状态下单腿站立时髋关节受力示意图，图中包含：重力W、外展肌肌力A、髋关节反作用力F、外展肌力臂l、重力力臂d

Hip biomechanics

As the primary link between the trunk and the lower limb, the hip joint plays an important role in the generation and transmission of forces during routine activities of daily living and athletic activities alike. This joint is characterized by an extraordinary amount of inherent bony stability, with differences in osseous anatomy significantly impacting the biomechanical properties of the human hip. These biomechanical principles have important implications relative to the diagnosis and surgical treatment of structural hip abnormalities, and the physical demands placed on the hip joint during athletic activities may predispose to injury or other chronic pathologic processes.

Results: Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between groups. No AVN was seen.

Conclusions: Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatment rates were not associated with AVN.

文献出处：Gregory G Polkowski, John C Clohisy. Hip biomechanics.Review, Sports Med Arthrosc Rev . 2010 Jun;18(2):56-62. doi: 10.1097/JSA.0b013e3181dc5774.

文献5

步态中足前进角的变化可降低膝关节内收力矩，且不会增加膝骨关节炎患者的髋关节力矩

译者 邱兴

膝骨关节炎患者在步态中采用调整后的足前进角（FPA）时，通常可获得膝关节内收力矩的降低。然而，FPA的改变是否会导致髋关节力矩（髋关节负荷的替代指标）增加，从而提高关节的机械需求，目前尚不清楚。本研究旨在探讨改变FPA对髋关节力矩的影响。膝骨关节炎患者在测力跑台上分别以基线步态、足内旋10°步态和足外旋10°步态行走。使用肌肉骨骼建模软件包根据实验数据计算关节力矩。从一项更大规模的研究中选取50例通过调整FPA可降低膝关节内收力矩峰值的受试者。在该组中，足内旋10°步态使膝关节内收力矩第一峰值降低7.6%，足外旋10°步态使第二峰值降低11.0%。FPA调整后，在髋关节接触力峰值时刻，足内旋10°步态使站立早期髋关节外展力矩降低（4.3%±1.3%，p=0.005，d=0.49），足外旋10°步态亦使其降低（4.6%±1.1%，p<0.001，d=0.59），而屈曲力矩和内旋力矩未见增加（p>0.15）。此外，74%的受试者在调整FPA后，其髋关节接触力峰值时刻的总髋关节力矩降低。总之，采用可降低膝关节内收力矩的FPA调整策略时，受试者平均未出现髋关节负荷替代指标的增加。

图1、足内旋（蓝色）和足外旋（红色）步态调整的角度冲量百分比变化的均值及标准差（误差线）。与基线步态相比，受试者在10°足内旋和10°足外旋步态下冠状面角冲量降低。矢状面和横断面角冲量在基线步态与足内旋或足外旋步态之间未观察到显著差异。（*p<0.01）

图2、所有受试者（n=50）在站立相期间的整体平均髋关节角度曲线。第一行将基线步态（黑色虚线）的髋关节角度与10°足内旋步态（蓝色实线）进行比较，第二行与10°足外旋步态（红色实线）进行比较。阴影区域表示平均髋关节角度的一个标准差。与基线相比，10°足内旋步态和10°足外旋步态的髋关节内收角峰值和伸展角峰值均显著减小（p<0.01）。与基线相比，10°足内旋步态的髋关节内旋角峰值显著增大，而10°足外旋步态则显著减小（p<0.001）。

Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis

People with knee osteoarthritis who adopt a modified foot progression angle (FPA) during gait often benefit from a reduction in the knee adduction moment. It is unknown, however, whether changes in the FPA increase hip moments, a surrogate measure of hip loading, which will increase the mechanical demand on the joint. This study examined how altering the FPA affects hip moments. Individuals with knee osteoarthritis walked on an instrumented treadmill with their baseline gait, 10° toe-in gait, and 10° toe-out gait. A musculoskeletal modeling package was used to compute joint moments from the experimental data. Fifty participants were selected from a larger study who reduced their peak knee adduction moment with a modified FPA. In this group, participants reduced the first peak of the knee adduction moment by 7.6% with 10° toe-in gait and reduced the second peak by 11.0% with 10° toe-out gait. Modifying the FPA reduced the early-stance hip abduction moment, at the time of peak hip contact force, by 4.3% ± 1.3% for 10° toe-in gait (p = 0.005, d = 0.49) and by 4.6% ± 1.1% for 10° toe-out gait (p < 0.001, d = 0.59) without increasing the flexion and internal rotation moments (p > 0.15). Additionally, 74% of individuals reduced their total hip moment at time of peak hip contact force with a modified FPA. In summary, when adopting a FPA modification that reduced the knee adduction moment, participants, on average, did not increase surrogate measures of hip loading.

文献出处: Seagers, Kirsten, Scott D. Uhlrich, Julie A. Kolesar, Madeleine Berkson, Janelle M. Kaneda, Gary S. Beaupre, and Scott L. Delp. "Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis." Journal of biomechanics 141 (2022): 111204.

来源：304关节学术

作者：304关节团队

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