本期目录：

1、减肥手术在减少全膝关节置换术假体周围感染的作用-系统回顾和荟萃分析

2、初次全关节置换术患者血清低钾血症的术后患病率及危险因素

3、全膝关节置换术中内侧副韧带损伤后应用限制性假体和韧带修复对间隙平衡的影响

4、在保留后交叉韧带的全膝关节置换术不稳定中，单纯股骨翻修的疗效

5、盂唇内翻是DDH患儿Pavlik挽具治疗失败的预测因素

6、使用术中实时三维CT与机器人C形臂系统进行弧形髋臼周围截骨术

7、髋关节镜手术安全入路分步指南

8、髋关节发育不良的发病趋势与围产期危险因素：来自韩国的全国人口基线研究

9、一种新型微创球形髋臼周围截骨术：术前三维模板化保留骨盆环并进行患者特异性截骨

10、青少年股骨头坏死大面积塌陷的高角度后方旋转截骨治疗：平均10年随访的重塑效果与结果分析

11、对45岁及以上的活跃患者进行分期髋关节镜和髋臼周围截骨术的结果评分改善与年轻患者相当

第一部分：关节置换及保膝相关文献

文献1

减肥手术在减少全膝关节置换术假体周围感染的作用-系统回顾和荟萃分析

译者 张轶超

背景：肥胖在世界范围内呈逐年上升趋势。在骨科领域，肥胖是导致骨关节炎而需要全关节置换术（Total Joint Arthroplasty， TJA）的主要原因之一。由此可见，肥胖也是关节置换术并发症和失败的最重要的危险因素之一。因此，减肥手术（BS）正成为控制体重和减轻肥胖相关风险因素的一种有价值的选择。本文献综述和荟萃分析旨在评估BS术后患者与未行BS手术的肥胖患者相比，接受TKA手术后假体周围关节感染（PJI）和手术部位感染（SSI）的发生率。

方法：截至2023年10月，根据系统回顾和荟萃分析指南的首选报告项目（PRISMA）进行系统评价。我们纳入了纵向研究，比较减肥手术后接受全膝关节置换术的肥胖患者（研究组）和接受全膝关节置换术的肥胖患者（对照组）。采用荟萃分析方法比较各组手术部位感染和假体周围感染率。

结果：在线数据库和参考文献调查确定了125项研究。PJI发生率组间差异有统计学意义（z = -21.8928, p<0.0001）， BS组风险较低（z = -10.3114, p<0.0001），而SSI的组间风险差异无统计学意义（z = -0.6784, p=0.4975）。

结论：目前的文献表明，减肥手术可以减少TKA患者的感染并发症，使肥胖患者治疗膝骨关节炎的效果更好，相关费用更低。

Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and metaanalysis

Background： Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI)

rates in patients who underwent TKA after BS compared to obese patients without BS.

Methods：Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using

a meta-analytical approach.

Results：The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p<0.0001), with a lower risk in the BS group (z = -10.3114, p<0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p=0.4975).

Conclusions：The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.

文献出处：De Mauro D, Balato G, Festa E, Di Cristo A, Marasco L, Loffredo G, Di Lauro P, Di Gennaro D, Maccauro G, Rosa D. Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Apr 1;25(1):248. doi: 10.1186/s12891-024-07288-2. PMID: 38561717; PMCID: PMC10983737.

文献2

初次全关节置换术患者血清低钾血症的术后患病率及危险因素

译者 马云青

目的：定期监测全关节置换术后血钾水平 (TJA) 是一种常规检查形式，可以帮助检测血钾水平异常，并降低术后低血钾不良事件的发生率。以前的研究很少讨论关节置换术后的低钾问题。在本研究的主要目标是调查全髋关节和膝关节置换术后低血钾的发生率和可能的危险因素。

方法：研究包括 2017 年 4 月至 2018 年 3 月在单中心接受单侧全膝关节置换术或髋关节置换术的患者。收集术前和术后血钾水平并进行回顾性分析。比较术后不同时间被诊断为低血钾患者和非低血钾患者在年龄、性别、体重指数 (BMI)、疾病史、红细胞 (RBC)、血红蛋白、血细胞比容、肾功能过滤率、射出分率、血糖、尿肌酐、尿氮、术中出血、手术时间、引流、术前钾、手术类型等方面的差异。然后，采用统计程序多 Logit 模型分析术后低血钾患者的危险因素。

结果：TJA 术后低钾血症的风险为 53.1%, 而术后第 1、3、5 天的风险分别为 12.5%、40.7% 和 9.6%。术后第 1、3、5 天的血钾水平分别为 3.84 ± 0.32、3.59 ± 0.34 和 3.80 ± 0.32 mmol/L。然而，第 3 天的血钾水平似乎是所有这些水平中最低的 (p=0.015)。全髋关节和膝关节置换术后低钾血症的独立风险因素包括术前血钾浓度 (p=0.011)、术前红细胞计数 (p=0.027) 和糖尿病史 (p=0.007)。

结论：TJA 后应定期监测血钾浓度。需要更多地关注患者术前的钾水平以及红细胞计数，特别是对于被诊断为 2 型糖尿病的患者。

文献出处：Pan P, Zhang Z, Zhang X, Jiang Q, Xu Z. Postoperative Prevalence and Risk Factors for Serum Hypokalemia in Patients with Primary Total Joint Arthroplasty. Orthop Surg. 2024 Jan;16(1):72-77. doi: 10.1111/os.13922. Epub 2023 Nov 28. PMID: 38014456; PMCID: PMC10782241.

文献3

全膝关节置换术中内侧副韧带损伤后应用限制性假体和韧带修复对间隙平衡的影响

译者 张蔷

背景：内侧副韧带（MCL）的体部损伤是全膝关节置换（TKA）术中极具破坏性的并发症。目前并无单一的治疗方法可以完美解决关节稳定性问题。本尸体研究旨在比较一期MCL修复、应用限制性假体和两种方法联合在修复术中医源性MCL损伤中的作用。

方法：我们应用机器人辅助技术（CORI；施乐辉）施行了16台尸膝TKA手术，并分别在屈膝10°、30°、60°和90°记录股胫关节间隙张力，后稳定型（PS）假体作为对照组。试验组包括不修复MCL+应用PS假体，不修复MCL+应用内外翻限制性（VVC）假体，修复MCL+应用PS假体，和修复MCL+应用VVC假体。MCL通过两根不可吸收线缝合修复。所有病例的间隙平衡均由单一术者施行。三种目标方法（不修复MCL+应用VVC假体、修复MCL+应用PS假体，和修复MCL+应用VVC假体）修复后的内侧间隙与对照组比较缺陷率（RD），与不修复MCL+应用PS假体组比较改善率（RI）。我们应用简单统计学方法来计算内侧间隙平衡的均值，应用方差分析法（ANOVA）来确定RD和RI的变化均值，显著性定义为p < 0.05。

结果：与对照组相比，不修复MCL+应用PS假体组的平均缺陷率最高，为621.13%，意味着内侧间隙平均增加六倍。其次是不修复MCL+应用VVC假体组，为93.02%，修复MCL+应用PS假体组为65.66%，而修复MCL+应用VVC假体组为20.01%（p < 0.001）。修复MCL+应用VVC假体组的平均改善率最高，为83.08%，意味着与不修复MCL+应用PS假体相比，修复MCL+应用VVC假体组的内侧股胫关节间隙改善率为83%。其次是修复MCL+应用PS假体组76.62%，最低是不修复MCL+应用VVC假体组72.95%（p < 0.001）。

结论：本尸体研究显示为了尽可能减低术中MCL损伤造成的功能障碍，一期MCL修复+应用VVC假体是最佳治疗方式，缺陷率最低。而修复MCL+应用PS假体和不修复MCL+应用VVC假体是效果稍差的次选。本研究支持应用MCL一期修复联合应用VVC假体作为术中MCL损伤的最佳治疗方法。

The Effect of Implant Constraint and Ligament Repair on Compartment Balancing After Medial Collateral Ligament Injury in TKA

Background: An intraoperative midsubstance injury to the medial collateral ligament (MCL) is a devastating complication of total knee arthroplasty (TKA). No single treatment method has been shown to yield optimal stability. This cadaveric study compared primary MCL repair, increasing prosthetic constraint, and a combination of both techniques on tibio-femoral compartment gapping after an iatrogenic MCL injury.

Methods: We performed 16 cadaveric, robotic-assisted TKAs (CORI; Smith&Nephew) and recorded tibiofemoral gap measurements at 10°, 30°, 60°, and 90° of flexion with a posterior-stabilized (PS) prosthesis as the control group. The experimental groups had no MCL repair and a PS component, no MCL repair and a varus-valgus constrained (VVC) component, MCL repair with a PS component, and MCL repair with a VVC component. The MCL was repaired with 2 figure-8 nonabsorbable sutures. Gap measurements were manually tensioned by the same surgeon for all specimens. The mean medial tibiofemoral gap with the 3 different methods of interest (the no MCL repair with VVC component group, the MCL repair with PS component group, and the MCL repair with VVC component group) was compared with the control group for the rate of deficit (RD) and was compared with the no MCL repair and PS component group for the rate of improvement (RI). Simple statistics were used to calculate the mean medial balance for the groups, and analysis of variance (ANOVA) modeling was used to determine the mean changes in RD and RI, with significance set at p < 0.05.

Results: The mean RD was highest for the no MCL repair with PS component group at 621.13%, demonstrating an approximately 6-fold increase in medial tibiofemoral gapping compared with the control group. This was followed by the no MCL repair with VVC component group at 93.02%, the MCL repair with PS component group at 65.66%, and the MCL repair with VVC component group at 20.01% (p < 0.001). The mean RI for the MCL repair with VVC component group was highest at 83.08%, meaning that the combination of VVC component and MCL repair resulted in an 83% improvement in medial tibiofemoral gapping from no MCL repair with PS component. This was followed by the MCL repair with PS component group at 76.62% and the no MCL repair with VVC component group at 72.95% (p < 0.001).

Conclusions: This cadaveric study demonstrates that primary MCL repair with VVC component was the best for minimizing the deficit after an MCL injury and provided the highest RI. MCL repair with PS component and no MCL repair with VVC component were less effective reconstructive choices. This study supports the combination of a simple MCL repair with VVC component as the most stable reconstructive option following an intraoperative MCL injury.

文献4

在保留后交叉韧带的全膝关节置换术不稳定中，单纯股骨翻修的疗效

译者 沈松坡

目的： 本研究比较了在保留后交叉韧带（CR）假体中，针对屈曲不稳时，单纯股骨全膝关节置换（TKA）翻修（prTKA）与全TKA翻修（frTKA）在临床结局、假体存活率和围手术期因素方面的差异。

方法： 这项回顾性对照病例系列研究纳入了66例连续患者，他们在2015年至2021年间因CR TKA后的屈曲不稳接受了全TKA翻修（n=34）或单纯股骨TKA翻修（n=32）。为确保组间的可比性，仅纳入使用同一假体系统（Stryker Triathlon）的患者。比较了两组的术前人口学数据及影像学参数（如前后向不稳和中屈曲不稳的量化）。术后进行假体存活率和临床结局评分评估，最短随访时间为2年。患者自述结局指标（PROM）分析包括视觉模拟量表（VAS）、Kujala评分、牛津膝关节评分（OKS）、WOMAC指数、遗忘关节评分（FJS）、UCLA活动水平评分及膝骨关节炎结局评分（KOOS）。统计学分析采用非配对的非参数t检验和Wilcoxon检验；假体存活率通过Kaplan–Meier分析及log-rank检验评估。显著性水平定义为p<0.05。

结果： 在多种PROMs指标上，prTKA组与frTKA组的临床结局无显著差异。假体存活率相当（prTKA为96.9%，frTKA为97.1%）。与frTKA相比，prTKA显著缩短了住院时间（p=0.002）、缩短了手术时间（p<0.001）、减少了失血量（p=0.001），并降低了炎症反应（p<0.001）。

结论： 在保留交叉韧带假体中，针对屈曲不稳行单纯股骨TKA翻修，在短至中期随访中获得了与全TKA翻修相当的临床结局和假体存活率。该研究结果提示，单纯股骨翻修可能是对屈曲不稳患者的可行选择，其临床疗效与全翻修相似，同时在围手术期具有潜在优势。

证据等级： Ⅲ级。

关键词：交叉韧带保留、屈曲不稳、后稳定型、翻修、全膝关节置换术

Efficacy of isolated femoral revision in cruciate-retaining total knee arthroplasty instability: A comparative study

Purpose: This study compares clinical outcomes, implant survival rates and perioperative factors between isolated femoral total knee arthroplasty (TKA) revision (prTKA) and full TKA revision (frTKA) for flexion instability in cruciate-retaining (CR) prostheses.

Methods: This retrospective, controlled case series included 66 consecutive patients treated with either full TKA revision (n = 34) or isolated femoral TKA revision (n = 32) with flexion instability after CR TKA between 2015 and 2021. To ensure that the groups were uniformly comparable, only patients with one implant system (Triathlon, Stryker) were included. Preoperative demographic data and radiological parameters (e.g., quantification of anteroposterior instability and midflexion instability) were compared between the groups. Postoperative evaluation of implant survival and clinical outcome scores was performed with a minimum follow-up of 2 years. Patient-reported outcome measures (PROM) analysis included the Visual Analogue Scale, Kujala, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, University of California at Los Angeles Activity-Level Scale and Knee Osteoarthritis Outcome scores. Statistical evaluations included unpaired, nonparametric t-tests and Wilcoxon tests for nominal data. Implant survival analysis was conducted using Kaplan-Meier analysis and log-rank test. Statistical significance was defined as a p-value < 0.05.

Results: No significant differences were found in the clinical outcomes between the prTKA and frTKA groups across various PROMs. Implant survival rates were comparable (96.9% for prTKA vs. 97.1% for frTKA). Compared to frTKA, prTKA resulted in significantly shorter hospital stays (p = 0.002), reduced operative time (p < 0.001), lower blood loss (p = 0.001) and a decreased inflammatory response (p < 0.001).

Conclusions: Partial femoral TKA revision for flexion instability in cruciate-retaining prostheses yielded clinical outcomes and implant survival rates comparable to full TKA revision in the short- to mid-term follow-up. These findings suggest that partial femoral revision may be a viable option for carefully selected patients with flexion instability, offering similar clinical efficacy and potential perioperative advantages over complete revision.

Level of evidence: Level III.

Keywords: cruciate‐retaining; flexion instability; posterior‐stabilized; revision; total knee arthroplasty.

第二部分：保髋相关文献

文献1

盂唇内翻是DDH患儿Pavlik挽具治疗失败的预测因素

译者 任宁涛

介绍

据报道，Pavlik挽具治疗髋关节发育不良(DDH)的失败率高达55%。本研究的目的是探讨髋臼盂唇内翻对Pavlik挽具治疗DDH疗效的影响。

方法

回顾性分析2004 - 2016年某三级儿科医院DDH患儿，纳入采用Pavlik挽具进行治疗并随访时间不短于12个月的DDH患儿。统计纳入患儿的人口学信息、治疗和随访结果，比较盂唇内翻和无盂唇内翻患儿的预后。

结果

共纳入156名患儿，229例髋关节发育不良。开始治疗的平均年龄为1.9±1.4个月，平均随访时间为37.7±23.0个月。46%(73/156)的患儿诊断为双侧DDH。总共有37%(75/229)髋关节Pavlik挽具治疗失败。进一步治疗中，91%(68/75)的髋关节为硬性外展支具，5%(4/75)的髋关节为闭合复位，4%(3/75)的髋关节为切开复位。10%(22/229)的患儿存在髋关节盂唇内翻。内翻盂唇组Pavlik挽具治疗失败的发生率为91%(20/22)，而对照组为27% (55/207)(P<0.001)。盂唇内翻组86%(15/22)需要闭合或切开复位，对照组3% (7/207)(P<0.001)。盂唇内翻组的缺血性坏死发生率为18%(4/22)，对照组为0.4% (1/207)(P<0.001)。

结论

在接受Pavlik挽具治疗的DDH患儿中，髋臼盂唇内翻的存在是治疗失败的有力预测因素。与没有内翻盂唇的髋关节相比，有内翻盂唇的髋关节需要闭合或切开复位和发生缺血性坏死的风险也明显更高。

图1 生后1周女性患儿，髋关节超声检查可见双侧DDH，B图箭头处可见左髋内翻盂唇，采用Pavlik挽具治疗6周，右髋治疗效果良好，左髋因盂唇内翻接受了进一步的硬性支具的治疗，最终采用闭合复位石膏外固定治疗。

An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia

Introduction: The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH.

Methods: A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum.

Results: A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9±1.4 months and mean follow-up was 37.7±23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001).

Conclusions: In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum.

文献出处Lin AJ, Siddiqui AA, Lai LM, Goldstein RY. An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia. J Pediatr Orthop. 2021 Sep 1;41(8):479-482. doi: 10.1097/BPO.0000000000001916. PMID: 34267151.

文献2

使用术中实时三维CT与机器人C形臂系统进行弧形髋臼周围截骨术：一个病例报告

译者 李勇

基本原理：弧形髋臼周围截骨术（CPO）是一种为发育性髋关节发育不良（DDH）患者设计的手术，具有出色的手术效果。然而，手术结果取决于外科医生的经验和熟练程度。
患者信息：一名38岁女性，行走时左髋部疼痛。
诊断：该患者被诊断为由于发育性髋关节发育不良（DDH）导致的早期髋关节骨关节炎。
手术方法：患者接受了弧形髋臼周围截骨术（CPO），同时使用三维平板C形臂（Artis zeego；西门子医疗，德国福希海姆）在手术过程中确认实时三维计算机断层扫描（CT）图像。 在手术中，通过CT图像两次确认了精确的截骨曲线：一次在坐骨截骨时，另一次在四边体截骨时。
结果：术后CT图像显示形成了理想的C形截骨线。此外，未发现髋臼后柱骨折或关节内截骨。
经验教训：使用Artis zeego进行的弧形髋臼周围截骨术（CPO）取得了令人满意的结果，这是世界上第一份讨论Artis zeego在骨盆截骨术中益处的报告。

图 1. (A) 混合手术室中Artis zeego成像系统的示意图。 (B) Artis zeego在手术过程中捕捉图像的示意图。

图 2. (A) 第一张实时三维计算机断层扫描（3D-CT）图像。实时系列CT图像的其中一个切片显示骨刀已插入坐骨截骨区域。CT图像证实截骨线未达到髋臼后柱。 (B) 第二张实时三维CT图像。实时系列CT图像的其中一个切片显示弯曲的骨刀到达了四边体区域。CT图像证实C形截骨线最终可以与坐骨截骨线“会师”。

Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system：A case report

Rationale: Curved periacetabular osteotomy (CPO) is a procedure with excellent surgical outcome that has been proposed for patients with development dysplasia of the hip (DDH). However, the surgical outcomes depend on the surgeon's experience and proficiency. Patient concerns: A 38-year-old female indicated she was experiencing left hip pain while walking. Diagnoses: The patient was diagnosed with early-stage hip osteoarthritis due to DDH. Interventions: The patient underwent CPO while a 3-dimensional flat-panel C-arm (Artis zeego; Sciemens Healthcare, Forchheim, Germany) was used to confirm the real-time 3-dimensional computed tomography (CT) images during surgery. It was possible tol confirm the accurate osteotomy curve using CT images twice during surgery: at the time of the ischial osteotomy and the quadrilateral surface osteotomy. Outcomes: An ideal C-shaped osteotomy line was created as shown onthe postoperative CT images. In addition, neither posterior column fracture nor intra-articular osteotomy was confirmed. Lessons: The CPO using Artis zeego resulted is a satisfactory outcome, and this is the 1st report in the world to discuss the benefits of Artis zeego in pelvic osteotomy.

文献出处：Goshi A, Fukunishi S, Okahisa S, Okada T, Yoshiya S. Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system: A case report. Medicine (Baltimore). 2018 Nov;97(48):e13519. doi: 10.1097/MD.0000000000013519. PMID: 30508981; PMCID: PMC6283227.

文献3

髋关节镜手术安全入路分步指南

译者 张利强

摘要：髋关节镜手术是治疗关节炎前髋关节病变的重要但技术要求较高的术式。规范的操作技术对成功进入髋关节至关重要。然而，该技术的学习曲线陡峭，而关节入路被认为是手术中最具挑战性的环节之一。操作不当可能导致医源性软骨或盂唇损伤，并增加后续手术步骤的技术难度。本技术指南旨在描述一种安全、可重复的髋关节镜手术入路方法。

右髋关节正位透视显示关节囊内空气充盈（箭头）。

右髋关节正位透视显示髋关节撑开适当，关节间隙约15mm（双头箭头）。

(A)右髋关节正位透视显示前外侧入路合适的穿刺针轨迹（箭头）。注意，在这张图片中，针头放置在病人的皮肤上；它并不像看上去的那样在髋关节。(B)外科医生于仰卧位右髋关节上握住脊髓针（箭头）并标记(A)所示入路的图像。

右髋关节正位透视显示一根脊髓针（箭头）插入前外侧入路位置，停在关节囊边缘。注意针头的倾角是向下的，以避免医源性股骨头损伤。

右髋关节侧位透视显示脊髓针（箭头）插入前外侧入路位置。 如果虚线在相同的轨迹上继续，它应该大致将股骨头分成两半并进入髋臼窝。

右髋关节正位透视显示脊髓针（黑色箭头）插入前外侧入路位置，刺穿关节囊。 镍钛诺金属针（黄色箭头）完全进入并停在髋臼窝内

右髋仰卧位，约5度头低脚高（Trendelenburg体位），并标出前外侧（AL）和中前（MAP）入路。这两个入路相距7厘米。

从前外侧入路关节镜下的右髋关节图像显示由股骨头（FH）、髋臼(A)/盂唇(L)和前关节囊(C)组成的三角形。

表 1. 技术优缺点

表2 技术要点和陷阱

Step-by-Step Guide for Safe Joint Access During Hip Arthroscopy

Abstract: Hip arthroscopy is a valuable yet technically demanding procedure for the treatment of prearthritic hip pathologies. Proper technique is essential for successful hip joint entry. However, the learning curve to become proficient in hip arthroscopy is steep, and joint entry is arguably one of the most difficult aspects of the procedure. Improper technique poses risk of iatrogenic chondral and labral damage and may make the rest of the procedure technically more difficult. The purpose of this Technical Note is to describe a technique to facilitate safe and reproducible joint entry during hip arthroscopy.

文献出处：Messer KP, Price AD, Kraeutler MJ. Step-by-Step Guide for Safe Joint Access During Hip Arthroscopy. Arthrosc Tech. 2025 Mar 19;14(6):103524. doi: 10.1016/j.eats.2025.103524. PMID: 40656695; PMCID: PMC12255417.

文献4

髋关节发育不良的发病趋势与围产期危险因素：来自韩国的全国人口基线研究

译者 贾海港

背景与目的：韩国已实施《婴儿和儿童国家健康筛查计划》（NHSPIC），其中包括从 4 个月龄开始进行髋关节临床筛查，并进行选择性髋关节超声检查。本研究旨在探讨髋关节发育不良（DDH）的发病趋势、相关危险因素，以及至学龄前儿童的生长和运动发育结局。

方法： 我们纳入了一项回顾性、基于人群的出生队列研究，研究对象为 2008 年至 2015 年出生的儿童。根据诊断年龄（早期诊断[<1岁] vs 晚期诊断[≥1岁]）和治疗方式（大手术、小手术或非手术治疗）对诊断为DDH的患者进行了分层。生长和运动发育结局通过NHSPIC数据进行评估，数据收集截至6岁。

结果： 在 2,518,805 名儿童中，4,854 名（0.19%）被诊断为发育性髋臼发育不良（DDH）。DDH 的发病率从每 1,000 人中 1.29 例增加到 2.37 例，其中早期诊断的DDH 发病率从每 1,000 人中 0.70 例增加到 1.94 例。然而，手术治疗率保持不变（每 1,000 人中为 0.19-0.28）。接受 DDH 手术治疗的儿童身材矮小和粗大运动发育迟缓的发生率显著升高

结论： NHSPIC 髋关节筛查项目实施后，DDH 的总体发病率和早期诊断发病率均有所上升，但手术治疗率无显著变化。DDH 手术治疗与身材矮小和粗大运动发育迟缓均存在显著相关性。

Incidence trends and perinatal risk factors of developmental dysplasia of the hip: a nationwide population-based study from South Korea

Background and purpose: South Korea has implemented the National Health Screening Program for Infants and Children (NHSPIC), which includes clinical hip screening with selective hip ultrasonography beginning at 4 months of age. We aimed to investigate the trends in developmental dysplasia of the hip (DDH), associated risk factors, and growth and motor developmental outcomes up to preschool age.

Methods: We included a retrospective, population-based birth cohort of children born between 2008 and 2015. Patients diagnosed with DDH were stratified by age at detection (early diagnosed [<1 year] vs late diagnosed [≥1 year]) and treatment modalities (major surgery, minor surgery, or nonoperative). Growth and motor developmental outcomes were assessed using NHSPIC data collected up to 6 years of age.

Results: Among 2,518,805 children, 4,854 (0.19%) were diagnosed with DDH. The incidence of DDH increased from 1.29 to 2.37 per 1,000 individuals, with the incidence of early diagnosed DDH increased from 0.70 to 1.94 per 1,000. However, the rate of surgical treatment remained unchanged (0.19-0.28 per 1,000). Children who underwent surgical treatment for DDH had a significantly higher incidences of short stature, and delayed gross motor development.

Conclusion: After the introduction of the NHSPIC hip screening program, incidences of overall and early diagnosed DDH increased, whereas the surgical treatment rate showed no significant change. Surgical treatment for DDH was significantly associated with both short stature and delayed gross motor development.

文献出处：Bae K, Cha JH, Kim JA, Ryu S, Na JY, Choi YJ. Incidence trends and perinatal risk factors of developmental dysplasia of the hip: a nationwide population-based study from South Korea. Acta Orthop. 2025 Jun 26;96:477-484. doi: 10.2340/17453674.2025.43980. PMID: 40567113; PMCID: PMC12198684.

文献5

一种新型微创球形髋臼周围截骨术：术前三维模板化保留骨盆环并进行患者特异性截骨

译者 陶可

背景：球形髋臼周围截骨术(SPO)是一种新型截骨术，涉及劈开泪滴状结构，采用患者特异性术前规划，仅需7厘米皮肤切口。我们报告了SPO的术前规划方法和短期疗效。

方法：在术前规划中，将计算机断层扫描(CT)图像导入三维模板化软件。测量弯凿的半径使其穿过泪滴状结构、坐骨髋臼下沟以及髂前上棘和髂前下棘之间的区域。测量截骨高度和骨凿预计插入深度，并在手术中重现这些数值。我们对52例（55髋）髋关节发育不良患者进行了连续回顾性分析，这些患者均接受了SPO治疗并随访至少2年：27髋为Tönnis 0级，21髋为1级，7髋为2级。手术时平均年龄为38岁（范围：17至56岁）。旋转的骨碎块和髂嵴用可吸收螺钉固定。使用配对t检验进行统计学分析。

结果：术前外侧中心边缘角和臼顶倾斜角的平均值（范围）分别为6.0°（-20°至18°）和26.0°（13° 至 38°），术后外侧中心边缘角和臼顶倾斜角的平均值（范围）分别为30.0°（15°至43°）和3.8°（-4°至27°）（p < 0.001）。然而，11髋（20%）出现骨旋转矫正丢失（<3 mm）或臼顶倾斜角丢失（<3°）。X线片显示所有髋关节在术后3个月内骨愈合。2髋进行了与可吸收螺钉相关的早期第二次手术。在撰写本文时，没有患者需要转为全髋关节置换术。2年随访时临床评分显著改善（p < 0.001）。股外侧皮神经区域的感觉异常非常常见，但在2年的随访中92%的患者感觉异常已得到缓解。

结论：SPO是一种新型的微创髋臼周围截骨术，其潜在缺点是早期矫正度丧失（在本研究中20%的髋关节出现此情况），但可能具有降低耻骨截骨部位骨不连风险的优势。

图 确定截骨线。图3-A将克氏针弯曲至图1-B所示长度，并放置在髂窝处。当针尖位于股骨头上端时，克氏针的弯曲处（①）指示截骨的顶点。图3-B在术前计划时也测量了从股骨头顶部到截骨最外侧点的距离，并将该长度的弯曲克氏针放置在髂前下棘上方。针尖的弯曲角（②）指示点B，如文中所述。图3-C弯曲的截骨线由骨盆内皮质上的箭头指示。该线从泪滴区之间的远端部分经由①到截骨最外侧点（②）。将铝制牵开器置于四边形表面和耻骨上，牵开髂肌。

图 股骨头顶部下方截骨术。图4-A和4-B钝头骨凿具有钝凿尖头，可安全插入，避免刺穿关节和泪滴状区域内的内皮质。凿子上标有刻度，便于确定骨凿在关节旁的位置。图4-C和4-D使用特殊的锋利弯曲凿子，沿着钝头骨凿创建的手术入路，刺穿髋臼后皮质。图4-E将弯曲凿子插入泪滴状区域的下端，将其劈开。图4-B 4-F和4-G使用Cobb骨切开器从坐骨前表面经股骨头前部插入，仅对坐骨前表面皮质骨进行截骨。

图 截骨后骨片旋转固定示意图。图5-A截骨完成后，使用椎板撑开器（①）将骨片向外侧移动，同时使用牵开器（②）向上旋转裂口内骨片远端。图5-B通过X线片确认旋转骨片位置后，使用2枚可吸收螺钉（③）固定骨片。将b-TCP骨块（④）作为垫块插入宿主骨和旋转骨片之间的间隙。将已截骨的髂嵴部分复位，并用2枚可吸收螺钉（⑤）固定。

图 沿髂前上棘周围作平均约7 cm长的皮肤切口。

图 一名43岁女性，无髋骨关节炎X线表现，为典型病例。图7-A左髋关节术前前后位X线片。外侧中心缘角为0°，臼顶倾斜角为26°，髋臼头指数为59%。图7-B术后一周X线片显示外侧中心缘角为25°，臼顶倾斜角为2°，髋臼头指数改善至94%。术中使用单个b-TCP骨块（白色箭头），大小为1×1×2 cm。泪滴状骨块被分成两段，可见其沿着旋转的骨块（黑色箭头）向上移动。图7-C术后两年X线片显示骨愈合良好，b-TCP骨改建良好。关节间隙未见狭窄。

图 图7患者术后1周的CT图像。图8-A和8-B正位和60°斜位。截骨后的骨块已旋转，以便更好地覆盖股骨头。黑色箭头表示b-TCP骨块。四边形表面完整，耻骨未完全切除(①)。用于骨固定的可吸收螺钉头可见（白色箭头）。图8-C和8-D截骨后方部位。将弯凿穿过泪滴区，在髋臼后壁近中心位置进行截骨。按照计划，截骨位置位于坐骨髋臼下沟(②)。骨盆环保留。

图9 图7患者术后6个月的X线片和CT图像。图9-A前后位X线片。可见骨性愈合及b-TCP改建。图9-B、9-C、9-D与图8相比，截骨处间隙可见改建，可见骨性愈合。

图 患者，女性，26岁，右侧髋关节骨关节炎晚期。图10-A术前X线片。关节间隙变窄，最小关节间隙为≤2 mm。髋臼已发育成双层，股骨头上已形成骨赘。外侧中心边缘角为12°，臼顶倾斜角为24°。因患者年轻，髋外展位骨盆X线片证实关节间隙维持，故安排SPO。图10-B术后立即拍摄的X线片。关节间隙有所扩大。股骨头覆盖范围有所改善，外侧中心缘角和臼顶倾斜角分别改善为30°和2°。使用两块b-TCP，每块1×1×2 cm。图10-C术后6个月拍摄的X线片。骨性愈合已实现，b-TCP可见重塑。图10-D术后2年拍摄的X线片。关节间隙比术前仍然更宽。b-TCP重塑不完全，但该区域未见明显间隙。

A Novel Minimally Invasive Spherical Periacetabular Osteotomy: Pelvic Ring Preservation and Patient-Specific Osteotomy by Preoperative 3-Dimensional Templating

Background: Spherical periacetabular osteotomy (SPO) is a novel osteotomy involving splitting the teardrop, using patient-specific preoperative planning, and requiring only a 7-cm skin incision. We report preoperative planning methods and short-term results of SPO.

Methods: In preoperative planning, computed tomography (CT) images were imported into 3-dimensional templating software. The radius of the curved chisel was mapped to pass through the teardrop, the infracotyloid groove of the ischium, and the area between the anterior superior iliac spine and the anterior inferior iliac spine. The osteotomy height and the predicted depth of osteotome insertion were measured, and those values were reproduced during surgery. We performed a retrospective analysis of data on 52 consecutive patients (55 hips) with hip dysplasia who underwent SPO and were followed for at least 2 years: 27 hips had Tönnis grade 0, 21 had grade 1, and 7 had grade 2. The mean age at surgery was 38 years (range, 17 to 56 years). The rotated bone fragment and iliac crest were fixed with absorbable screws. Statistical analysis was performed with the paired t test.

Results: The mean (range) of the lateral center-edge and sourcil angles were 6.0° (-20° to 18°) and 26.0 (13° to 38°), respectively, before surgery and 30.0° (15° to 43°) and 3.8° (-4° to 27°), respectively, after surgery (p < 0.001). However, 11 hips (20%) showed a loss of correction of bone rotation (<3 mm) or the sourcil angle (<3°). Radiographs showed bone union in all hips within 3 months after the surgery. Early second surgery related to absorbable screws was performed in 2 hips. No patient had required conversion to total hip arthroplasty at the time of writing. Clinical scores were significantly improved at the 2-year follow-up (p < 0.001). Paresthesia of the lateral femoral cutaneous nerve area was very common but had resolved in 92% of the patients at the 2-year follow-up.

Conclusions: SPO is a novel minimally invasive periacetabular osteotomy that has the potential disadvantage of early loss of correction (observed in 20% of the hips in the present study) but may provide the benefit of decreasing the risk of nonunion at the pubis osteotomy site.

文献出处：Ayumi Kaneuji, Toshihiko Hara, Eiji Takahashi, Kiyokazu Fukui, Toru Ichiseki, Norio Kawahara. A Novel Minimally Invasive Spherical Periacetabular Osteotomy: Pelvic Ring Preservation and Patient-Specific Osteotomy by Preoperative 3-Dimensional Templating. J Bone Joint Surg Am. 2021 Sep 15;103(18):1724-1733. doi: 10.2106/JBJS.20.00940.

文献6

青少年股骨头坏死大面积塌陷的高角度后方旋转截骨治疗：平均10年随访的重塑效果与结果分析
译者 邱兴

目的：探讨高角度后方旋转截骨术治疗青少年股骨头坏死大面积塌陷的临床疗效。

方法：回顾性分析35例（40髋）采用该术式治疗的股骨头严重塌陷坏死患者资料，平均随访时间9.7年（范围5-25年）。其中13髋有激素使用史，9髋合并股骨头骺滑脱，9髋曾有股骨颈骨折，2髋存在创伤性脱位伴骨折，7髋无明确致病因素。患者平均年龄14.8岁（女性18例，男性17例）。所有病例均表现为髋臼顶下方的广泛塌陷，其中20髋术前存在关节间隙狭窄（ARCO分期4期）。股骨头侧位X线片显示坏死灶从前向后广泛累及。手术实现平均118°的后旋角度，并采用内翻位（平均19°，范围10°-30°）。通过常规正位X线片及45°屈曲位评估术前术后股骨头存活区范围，采用Stulberg分类系统基于常规正位片评估进一步塌陷、关节间隙变化、股骨头形态及髋臼匹配度，末次随访采用Merle d'Aubigné髋关节评分进行临床评估。

结果：术后早期即可观察到股骨头负重区的存活区显现，坏死灶随术后时间逐渐改善。髋臼顶下方存活骨占比由术后6个月时的48%提升至末次随访时的92%；45°屈曲位投照显示存活区比例由术后6个月的54%提升至89%。38髋（95%）未出现进一步塌陷。20例术前关节间隙狭窄者中，19髋初期得到改善，但末次随访时9髋（总计40髋）出现进行性狭窄。34髋临床疗效达优或良，6髋为可或差。

结论：对于青少年严重股骨头坏死病例，若术中能将足够范围的存活骨转移至髋臼负重区下方，本术式可有效延缓关节退变进展。

图1 A-G 一例15岁男性股骨颈骨折术后患者
该患者10个月前于外院接受骨折手术。A 术前左髋正位X线片显示大面积塌陷病灶。B 术前45度屈曲正位片显示股骨头前部存在显著广泛塌陷。C 术前130度屈曲位片显示前下方存活关节面呈球形且血运良好。此片用于确定旋转及内翻角度。D 行130度后方旋转截骨联合25度内翻定位术后2个月正位片显示：髋臼顶下方出现球形且充足的存活关节面。可见坏死灶已转移至内侧区域。E 术后2个月45度屈曲正位片显示股骨头前部呈球形且血运良好。F 术后7年随访显示未出现进一步塌陷，关节间隙无狭窄。整个股骨距已完成完全改建。G 术后7年45度屈曲正位片显示内侧坏死灶与股骨距呈现显著改建。

C 术后18年正位片显示未出现继发塌陷。塌陷区域完成完全改建，股骨头内侧形态恢复球形。注意关节间隙保持良好，髋臼软骨下顶形态恢复均匀。股骨距完成完全改建
D 术后18年45度屈曲正位片显示股骨头前部呈球形且血运良好

图3 高角度后方旋转截骨术示意图（前视图）
A 确定垂直于股骨颈轴的经转子区截骨平面
B 确定垂直于股骨颈轴的截骨方向后实施截骨。沿股骨颈轴进行高角度后旋操作，通过大幅度后旋将塌陷的坏死灶（阴影区）转移至关节的内侧至后内侧非负重区。术后未塌陷的前方存活区转移至髋臼顶下方的负重区。后上支持带动脉（箭头所示）处于松弛无张力状态，表明血运未受损
C 屈曲位时，前方球形存活区转移至髋臼顶下方

High-degree posterior rotational osteotomy for extensive collapsed femoral head osteonecrosis in teenagers: remodeling and results with a mean of 10-year follow-up

Introduction: This study evaluated the effectiveness of high-degree posterior rotational osteotomy for teenagers with extensively collapsed femoral head osteonecrosis.

Materials and methods: We reviewed 40 hips in 35 patients with severely collapsed femoral head osteonecrosis treated by this procedure with a mean follow-up period of 9.7 years (range 5-25 years). Thirteen hips had a history of steroid administration. Nine had slipped capital femoral epiphysis. Nine had femoral neck fracture. Two had traumatic dislocation and fracture. Seven had no apparent risk factors. The mean age of the patients (18 women and 17 men) was 14.8 years. All femoral heads were extensively collapsed below the acetabular roof, and 20 hips showed preoperative joint space narrowing (ARCO stage 4). Lateral radiographs of the femoral head revealed extensive lesions from the posterior to anterior portion. The mean degree of posterior rotation was 118° with intentional varus positioning [mean: 19° (range 10-30)]. The pre- and postoperative extent of the viable area of the femoral head was assessed using conventional anteroposterior radiographs and 45-degree flexion radiography. Further collapse, joint space narrowing, femoral head morphology, and congruency with the acetabulum based on the Stulberg classification were assessed using conventional anteroposterior radiographs. The clinical assessment was conducted using the Merle d'Aubigné hip scores at the last follow-up.

Results: The viable area of the femoral head on the loaded portion was seen during a short period after operations. The necrotic lesions were gradually improved postoperatively. The mean extent of viable bone below the acetabular roof was 48% at less than 6 months after surgery and 92% at the final follow-up. The mean extent on 45° flexion radiography was 54% at less than 6 months after surgery and 89% at the final follow-up. Further collapse was prevented in 38 hips (95%). In 19 of 20 hips with preoperative narrowing of the joint space, the joint space was first improved, but narrowing progressively observed in 9 of 40 hips at the final follow-up. Thirty-four hips had excellent or good clinical outcomes, whereas 6 had fair or poor outcomes.

Conclusions: We concluded that this procedure is effective at delaying the progression of degeneration if adequate area of viable bone can be moved under the loaded portion of the acetabulum in teenagers with severe femoral head osteonecrosis.

Keywords: Femoral osteotomy; Osteonecrosis; Osteonecrosis of the femoral head; Posterior rotational osteotomy; Teenagers.

文献出处：Takashi A , Ryosuke N , Yasushi N K I .High-degree posterior rotational osteotomy for extensive collapsed femoral head osteonecrosis in teenagers: remodeling and results with a mean of 10-year follow-up[J]. Archives of orthopaedic and trauma surgery. 2023, 143(10):6039-6048.DOI:10.1007/s00402-023-04864-4.

文献7

对45岁及以上的活跃患者进行分期髋关节镜和髋臼周围截骨术的结果评分改善与年轻患者相当

译者 陈志强

目的：确定与年轻组相比，45 岁及以上活跃患者的分期髋关节镜治疗和髋臼周围截骨术 （PAO） 中期结果。

方法；回顾性分析所有在 2015 年至2021年期间接受分期关节镜治疗和 PAO的45岁及以上患者，并与病例匹配的年轻患者对照组进行比较。所有患者在手术前都接受了至少 6 个月的非手术治疗。在 PAO 之前，所有患者都接受了髋关节镜来解决关节内病变。实验组由年龄在 45 岁及以上且没有明显骨关节炎的DDH患者组成，他们接受了PAO并在术后至少 1 年报告了患者的结果。使用国际髋关节结果工具12（iHOT-12）评分和非关节炎髋关节评分（NAHS）对患者报告的结果进行量化。

结果：该队列由 5名患者（44 个髋关节）组成，平均年龄为49.4岁± 3.8岁。侧向中心边缘角（LCEA）从术前（20.1°±4.5）到术后（33.2°±3.2°，P < .001）显着改善。45岁及以上PAO队列术后平均随访期为2.80年（SD=1.3年）。患者报告iHOT-12评分（术前36.6±14.1，最近一次随访时为81.2±21.0，P <.001）和NAHS（术前 59.2±15.5，最近一次随访时为87.4±13.1，P <.001）有显着改善。与对照组相比，年龄较大的队列在任何时候都没有报告显着差异的 iHOT-12 分数，并且年龄对任何一个结果分数都没有显着影响 （P > .05）。

结论：45 岁及以上的患者报告说，在分期髋关节镜手术和 PAO 后，髋关节功能和疼痛有统计学意义的改善，其结果评分与年轻队列相当。我们的研究结果表明，适当选择的老年DDH患者，没有明显的髋骨关节炎，在保髋手术后髋关节疼痛和功能方面有临床意义的改善。

证据水平：III 级、回顾性、比较病例系列。

Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients Aged 45 Years and Older Produce Comparable Improvements in Outcome Scores to Younger Patients

Purpose

To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group.

Methods

All patients aged 45 years and older who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared with a case-matched control group of younger patients. All patients underwent at least 6 months of nonoperative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of patients with dysplasia aged 45 years and older without significant osteoarthritis who underwent PAO and reported patient-reported outcomes for a minimum of 1 year postoperatively. Patient-reported outcomes were quantified using the International Hip Outcome Tool 12 (iHOT-12) score and Non-arthritic Hip Score (NAHS).

Results

The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center-edge angle significantly improved from preoperatively (20.1° ± 4.5°) to postoperatively (33.2° ± 3.2°, P < .001). The mean follow-up period in the PAO cohort aged 45 years and older was 2.80 years (standard deviation, 1.3 years) postoperatively. Patients reported significant improvements in the iHOT-12 score (36.6 ± 14.1 preoperatively vs 81.2 ± 21.0 at latest follow-up, P < .001) and NAHS (59.2 ± 15.5 preoperatively vs 87.4 ± 13.1 at latest follow-up, P < .001). The older cohort did not report significantly different iHOT-12 scores compared with the control group at any point, and age did not significantly affect either outcome score (P > .05).

Conclusions

Patients aged 45 years and older reported a statistically significant improvement in hip function and pain after staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings show that appropriately selected older patients with dysplasia without significant pre-existing hip osteoarthritis experience clinically meaningful improvements in hip pain and function after hip preservation surgery.

文献出处：Lee JH, Girardi NG, Kraeutler MJ, Keeter C, Genuario JW, Garabekyan T, Mei-Dan O. Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients Aged 45 Years and Older Produce Comparable Improvements in Outcome Scores to Younger Patients. Arthroscopy. 2025 Jul;41(7):2351-2361. doi: 10.1016/j.arthro.2024.10.039. Epub 2024 Nov 7. PMID: 39521385.

来源：304关节学术

作者：304关节团队

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