髖膝關節文獻精譯薈萃（第375期）

本期目錄：

1、全膝關節置換術后假體周圍感染的診斷和治療的最新進展

2、非骨水泥全膝關節置換術

3、肥胖患者中的機器人輔助 vs 常規（傳統）全膝關節置換術

4、幼年髖關節發育不良治療史的患者成年后的生活質量

5、Dega髖臼成形術治療發育性髖關節發育不良后髖臼體積和股骨覆蓋率的變化

6、股骨的前傾

7、ChatGPT 對髖關節發育不良常見問題的回答可靠性：作為家長信息來源的評估

8、髖臼周圍截骨術相關并發癥

9、采用數字體積相關法測量人骨關節炎股骨頭軟骨下骨的異質性應變分布

10、髖關節發育不良患者終末期軟骨結構的特異性

11、股骨近端成角畸形患者行全髖關節置換術

第一部分：關節置換及保膝相關文獻

文獻1

全膝關節置換術后假體周圍感染的診斷和治療的最新進展：第2部分：采用一期還是兩期手術技術？

譯者 張軼超

全膝關節置換術后假體周圍感染（PJI）發生率約2-3%。對于患者和醫療系統來說，這個問題的處理既復雜又昂貴。多種治療選擇包括抗生素治療，外科治療和挽救措施。手術治療被認為是治療PJI的常規選擇，有多種可用的手術技術，包括一期翻修術和兩期翻修術等。兩期翻修術被認為是治療PJI的金標準。該方法包括兩個手術過程，中間間隔一段時間，第一個過程旨在根除感染，同時植入靜態或可活動的間隔物，而第二期旨在移除間隔物并植入新的假體。在間隔期間，通過一些實驗室檢查和臨床體征密切監測患者，以幫助選擇進行第二階段的最佳時間。然而，近年來，一期翻修術因其良好的結果和較少的并發癥而受到廣泛關注。與兩期翻修術相反，一期翻修術只包括一個操作過程，即移除舊的感染假體并植入新的假體。多年來，許多文章對這兩種方法進行了比較，但沒有就哪一種方法在消除感染和達到更好的結果方面達成一致。關于這兩種方法，還有很多問題有待解決，包括哪種間隔器更好、兩期之間間隔時間、哪些病例適合做一期翻修術等。我們在此，旨在解決這些問題，尋找出治療這一并發癥的最新進展，并討論分階段手術中有爭議的話題。

Review of recent advances in the diagnosis and management of periprosthetic joint infection after total knee arthroplasty part 2: single-stage or two-stage surgical technique?

Periprosthetic joint infection (PJI) after total knee arthroplasty is a complication that affects approximately 2–3% of patients. The management of this issue is complicated and expensive for both the patients and the healthcare system. Multiple management options are available including antibiotic suppressive therapy, surgical management, and salvage procedures. Surgical management is considered a popular option for treating PJI, with multiple available surgical techniques, including single-stage revision arthroplasty and two-stage revision arthroplasty among others. Two-stage revision has been considered the gold standard for treating PJI. This method consists of two surgical procedures with a time interval in between, the first procedure aims to eradicate the infection along with implanting either a static or a mobile spacer, while the second intervention aims to remove the spacer and implant a new prothesis. During the interval period the patient is closely monitored through a handful of laboratory tests and clinical signs that help in assessing the optimal time of undertaking the second stage. However, in recent years, the single-stage method has gained much attention for its comparable outcomes and fewer complications. Contrary to the two-stage method, the single-stage approach consists only of one procedure in which the old infected prosthesis is removed and a new one is implanted. Many articles have compared the two methods over the years but have not agreed on a particular approach to be more potent in eliminating infection and providing better outcomes. Plenty of questions are yet to be answered regarding the two methods, including the superior type of spacer, interim period duration, and single-stage revision inclusion criteria. We herein, aim to address these issues, highlighting recent advances in managing this morbid complication and discussing controversial topics in the staged procedures.

文獻出處：Suliman J, Warda H, Samaan M. Review of recent advances in the diagnosis and management of periprosthetic joint infection after total knee arthroplasty part 2: single-stage or two-stage surgical technique? J Orthop Surg Res. 2024 Oct 12;19(1):643. doi: 10.1186/s13018-024-05152-6. PMID: 39395987; PMCID: PMC11470652.

文獻2

非骨水泥全膝關節置換術：復興之勢——適用人群、時機、地點與方法？

譯者 丁云鵬

背景：全膝關節置換術（TKA）是骨科最常見的手術之一，但關于長期耐用性的最佳固定方式（骨水泥固定與非骨水泥骨長入固定）仍存在爭議。近期植入材料與技術的改進為非骨水泥TKA提供了可能，使其通過持久穩定的生物性固定、提升手術效率及優化長期療效（尤其對年輕活躍患者）改變臨床實踐。

方法：本研討會評估了非骨水泥TKA的發展歷程、近期復蘇趨勢及適用患者選擇標準，并分析了各組件（脛骨、股骨、髕骨）在歷史與現代兩代產品中的臨床結果。此外，還詳細介紹了確保手術效果可靠且可重復性的關鍵技術要點。

結果：歷史上骨水泥固定一直是TKA的金標準。但如今非骨水泥固定在美國及全球范圍內應用日益廣泛，在恰當選擇的患者中展現出與骨水泥固定相當或更優的效果。

結論：非骨水泥TKA能實現持久的生物性固定和成功的長期療效，同時提高手術室效率。該技術可廣泛適用于經過合理篩選的患者，術中需精細截骨以確保骨接觸面充分，促進生物性固定。

Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How?

Background: Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients.

Methods: This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed.

Results: Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients.

Conclusions: Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation.

文獻出處：Zachary A Mosher , Michael P Bolognesi , Arthur L Malkani,Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How?J Arthroplasty. 2024 Sep;39(9S2):S45-S53. doi: 10.1016/j.arth.2024.02.078. Epub 2024 Mar 7.

文獻3

肥胖患者中的機器人輔助 vs 常規（傳統）全膝關節置換術

譯者 沈松坡

目的： 全膝關節置換術（TKA）可有效治療晚期膝骨關節炎，但肥胖會增加手術復雜性與并發癥風險。機器人輔助TKA（RA-TKA）可能通過提高手術精確性來減輕這些挑戰。迄今為止，尚無研究在肥胖患者中比較機器人輔助TKA與常規全膝關節置換術。因此，我們旨在進行此類比較。

方法： 按照PRISMA 2020指南進行系統綜述與薈萃分析。自數據庫建庫至2025年7月，對MEDLINE、Scopus與Cochrane Central進行全面檢索，以識別隨機對照試驗（RCT）與觀察性研究：隨訪≥3個月，并報告至少一項結局（包括手術時間、并發癥發生率、估計失血量（EBL）、影像學對線、用于關節置換的膝損傷與骨關節炎結局評分（KOOS JR）或西安大略與麥克馬斯特大學骨關節炎指數（WOMAC））。

結果： 共納入5項研究，包含979例肥胖患者。其中561例（57.3%）接受C-TKA。RA-TKA組平均年齡為66.76 ± 2.28歲，平均BMI為33.39 ± 3.49 kg/m2。與C-TKA相比，RA-TKA的手術時間顯著更長（MD 12.14分鐘；95%CI 7.24至17.05；p < 0.001）。術后髖-膝-踝（HKA）對線顯示RA-TKA存在顯著差異（MD ?0.88°；95%CI ?1.76至?0.01；p = 0.05）。相反，其余臨床結局未檢測到顯著差異。

結論： 本薈萃分析表明，與C-TKA相比，RA-TKA需要顯著更長的手術時間，而兩種技術在其他圍手術期與功能結局方面保持可比。

證據等級： II級。

關鍵詞：肥胖、全膝關節置換術、機器人手術、臨床結局

Robotic assisted versus conventional total knee arthroplasty in obese patients: A systematic review and meta-analysis

Purpose: Total knee arthroplasty (TKA) effectively treats advanced knee osteoarthritis, but obesity increases surgical complexity and complication risk. Robotic-assisted TKA (RA-TKA) may mitigate these challenges by enhancing surgical precision. To date, no study has compared robotic-assisted TKA with conventional total knee arthroplasty in obese patients. Therefore, we aimed to conduct such a comparison.

Methods: A systematic review and meta-analysis were performed in accordance with PRISMA 2020 guidelines. A comprehensive search of MEDLINE, Scopus, and Cochrane Central was performed from database inception to July 2025, to identify randomized controlled trials (RCTs) and observational studies with ≥3 months of follow-up, reporting at least one outcome of interest including operative time, complications rates, estimated blood loss (EBL), radiological alignment, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: A total of 5 studies comprising 979 obese patients were included. Of these, 561 patients (57.3 %) underwent C-TKA. The mean age in the RA-TKA group was 66.76 ±2.28 years, with a mean BMI of 33.39 ±3.49 kg/m2. Operative time was significantly longer in patients undergoing RA-TKA compared with C-TKA (MD 12.14 min; CI 95 % 7.24 to 17.05; p =< 0.001). Postoperative hip-knee-ankle (HKA) alignment demonstrated significant difference with RA-TKA (MD -0.88?; CI 95 % ? 1.76 to ? 0.01; p =0.05). Conversely, no significant differences were detected across the remaining clinical outcomes.

Conclusions: Our meta-analysis demonstrated that RA-TKA required significantly longer operative time compared with C-TKA, while other perioperative and functional outcomes remained comparble between both techniques.

第二部分：保髖相關文獻

文獻1

幼年髖關節發育不良治療史的患者成年后的生活質量

譯者 張振東

背景：如果治療不當，髖關節發育不良（DDH）可導致髖關節功能喪失，然而很少有研究關注DDH兒童時期治療后的長期后果。

方法：本研究對兒童時期接受過髖關節脫位治療的DDH 患者進行了一項健康相關生活質量調查。研究者向在其機構接受過兒童期髖關節脫位治療的 287 例DDH 患者發放了調查問卷。使用短表-36調查了患者的人口統計學特征、特定疾病病史以及與健康相關的生活質量。 將患者的身體功能評分（PCS）、心理功能評分（MCS）和社會認知評分（RCS）與日本標準值進行了比較。經排除后，對 68 名患者進行了評估。

結果：患者的 PCS、MCS 和 RCS 總平均值與標準值相當。 PCS 一直保持到 50 歲，但有 10 名例50 歲以上的患者 PCS 顯著下降。此外，接受切開復位術的患者的 PCS 明顯低于接受保守復位術的患者。在各年齡組和治療組中，患者的 MCS 和 RCS 與標準值無差異。 PCS、MCS 和 RCS 在雙側、診斷年齡或是否需要額外手術方面也沒有差異。

結論：DDH患者的生活質量可在50歲之前一直保持不變，但之后迅速下降，尤其是那些在童年時期就需要進行切開復位的患者。

Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood

Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.

文獻出處：Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B. 2025 Jan 1;34(1):38-43.

文獻2

Dega髖臼成形術治療發育性髖關節發育不良后髖臼體積和股骨覆蓋率的變化

譯者 任寧濤

盡管Dega髖臼成形術已成為一種常用的截骨術，但關于其對髖臼體積和深度的影響仍存在爭議。本研究的目的是評估發育性髖關節發育不良（developmental dysplasia of The hip， DDH）患者行改良Dega截骨術后髖臼橫平面和髖臼角度的圖像。我們對2005年7月至2013年10月期間在我院接受改良Dega截骨手術的DDH患者的骨盆x光片和計算機斷層掃描（CT）所獲得的形態學指標進行了回顧性研究。使用術前和術后的骨盆 X 光片來測量髖臼指數和髖臼（ACM）角度。術后 CT 掃描用于測量髖臼前傾角（AAA）、髖臼深度和髖臼覆蓋深度（總髖臼指數（TAI））。以對側健側髖關節作為對照。術后髖臼指數和 ACM 值顯示出顯著改善，術后 1 年測量值接近正常水平。對 CT 掃描參數（AAA、TAI 及髖臼深度）的比較顯示，各組之間的 TAI 和髖臼深度并無顯著差異（TAI：P = 0.423；髖臼深度：P = 0.132），而 AAA 的比較則表明發育性髖關節脫位患者的髖關節（17.6°）略優于對側髖關節（13.3°，P = 0.001）。基于髖臼形態參數的圖像集，我們的研究證實了之前的報道，DDH患者行Dega髖臼成形術后髖臼體積增大，股骨頭覆蓋度明顯改善。證據級別：III 級——回顧性比較研究。

Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip

Although Dega's acetabuloplasty has become a commonly used osteotomy, there is still an ongoing debate regarding its impact on the volume and depth of the acetabulum. The purpose of our study was to assess the postoperative images of the transverse acetabular plane and version obtained from developmental dysplasia of the hip (DDH) patients after a modified Dega osteotomy. We performed a retrospective study of the morphologic indices obtained from the pelvic X-rays and computer tomography (CT) scans of patients with DDH, who were operated in our institution between July 2005 and October 2013, using the modified Dega osteotomy. Preoperative and postoperative pelvic X-rays were used to measure the acetabular index and the acetabular (ACM) angle. The postoperative CT scans were used to measure the acetabular anteversion angle (AAA), acetabular depth and depth of acetabular coverage [total acetabular index (TAI)]. The contralateral unaffected hips served as control. The postoperative acetabular indices and ACMs showed a significant improvement, with near-normal values measured 1 year after the surgery. Comparing the CT scan parameters (AAA, TAI and the depth of acetabulum) showed that TAI and the depth of acetabulum were not significantly different between the groups (TAI: P = 0.423; depth of acetabulum: P = 0.132), whereas AAA comparison implied a slight advantage of the DDH hips (17.6° DDH vs. 13.3° contralateral, P = 0.001). On the basis of images set of acetabular morphometric parameters, our study substantiates previous reports on an increase of acetabular volume and a significant improvement of femoral head coverage for patients with DDH who underwent Dega acetabuloplasty. Level of evidence: Level III - retrospective comparative study.

文獻出處：Gigi R, Lawniczak D, Kurian B, Madan S, Fernandes J. Acetabular volume and femoral coverage change following Dega-like osteotomy in treatment of developmental dysplasia of the hip. J Pediatr Orthop B. 2022 May 1;31(3):247-253. doi: 10.1097/BPB.0000000000000895. PMID: 34285163.

文獻3

股骨的前傾

譯者 李勇

雙平面X線攝影、軸向X線攝影和透視檢查是測量股骨前傾角常用的X線攝影方法。這些方法使用的是對前傾角的嚴格幾何定義。近期開發并被廣泛應用的計算機斷層掃描（CT）測量前傾角的方法，并不符合公認的前傾角定義，且尚未在大樣本系列中進行準確性測試。在本研究中，我們在32個股骨標本上測試了這種廣泛使用的CT前傾角測量法。結果顯示，與直接測量相比，該方法持續低估前傾角平均達 10 度，且可重復性誤差在 ±3.6 度以內。因此，我們開發了一種利用計算機斷層掃描測量前傾角的新方法。經在相同標本上測試，該方法的精確度達到 ±1 度。本研究從幾何學角度論證了為什么當前實行的選擇用于定義股骨頸軸線的點的CT方法不符合前傾角的幾何定義。本文描述并推薦了一種更準確的定義股骨頸軸線及測量股骨前傾角的方法供臨床使用。

圖. 如何確定中心點O (Point O)？定義： 在選定的股骨頸基底橫截面上（小轉子中心上6mm），取股骨干（Femoral Diaphysis）橫截面的“質心”（Centroid）。視覺識別： 也就是該橫截面上骨性輪廓的幾何中心。這個截面通常呈現為股骨干圓潤的輪廓，點 O 就是這個圓/橢圓的中心點。

圖. 通過股骨頸基底部的截面，我們過去把o點稱為H點，通過疊加股骨頭中心的位置得到（從另一個截面確定）。請注意，使用提出的方法（方法II）確定的線HO是水平的，并與參考前傾角(R)一致。

Femoral anteversion

Biplane roentgenography, axial roentgenography, and fluoroscopy are the usual roentgenographic methods of measuring femoral anteversion. These methods use a strict geometrical definition of anteversion. The computerized tomography method of measuring anteversion that was developed recently, and is now widely used, does not adhere to the accepted definition of anteversion and has not been tested for accuracy in a large series. In the present study, the widely used computerized-tomography method of measuring anteversion was tested on thirty-two femoral specimens. With that method, anteversion was consistently underestimated by an average of 10 degrees compared with direct measurements and was reproducible only to within ±3.6 degrees. Therefore, a new method of measuring anteversion using computerized tomography was developed. It was shown to be accurate to ±1 degree, as tested on the same specimens. This study demonstrated geometrically why the currently practiced computerized-tomography method of selecting the points that are used to define the axis of the femoral neck is not consistent with geometrical definitions of anteversion. A more accurate method for both defining the axis of the femoral neck and measuring femoral anteversion is described and recommended for clinical use.

文獻出處：Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Joint Surg Am. 1987 Oct;69(8):1169-76. PMID: 3667647.

文獻4

ChatGPT 對髖關節發育不良常見問題的回答可靠性：作為家長信息來源的評估

譯者 賈海港

背景： 人工智能（AI），尤其是基于 AI 的大型語言模型（LLM）如 ChatGPT，正日益改變人們獲取信息的方式，為患者理解復雜醫療狀況提供了新途徑。 當嬰兒被診斷為髖關節發育不良（DDH）時，父母面臨著生理、情感和后勤等多重挑戰，因此對清晰易懂的教育資源需求迫切。本研究旨在評估 ChatGPT 對 DDH 常見問題的回答質量與可靠性。

方法： 本研究評估了人工智能聊天機器人 ChatGPT 4o 對八個關于發育性髖關節發育不良 (DDH) 的常見問題的回復質量，這些問題均來自兒科骨科診所的真實咨詢。每個問題的回復均在一次互動中生成，且使用未接觸過醫療信息的 ChatGPT 賬戶。 由兩名獨立評估者采用標準化評分體系對回復進行評估，并將其與現有文獻、患者教育資源和共識指南進行比較。每個回復均根據其信息準確性和完整性進行分類，并通過描述性統計量化其表現水平。

結果：ChatGPT 4o 能夠針對八個家長問題生成結構化回答。回復的評價結果為：12.5%為優秀，25.0%為尚可（只需少量澄清），50.0%為尚可（需要適度澄清），12.5%為不合格（由于信息缺失或不準確）。

結論：ChatGPT 對 DDH 相關問題的回答令人滿意，可作為家長獲取補充信息的有用資源。然而，由于其在提供詳細的診斷和治療流程方面存在局限性，應將其視為專科醫療咨詢的輔助工具，而非替代方案。

關鍵詞： 人工智能；發育性髖關節發育不良；髖關節篩查；嬰兒髖關節；大型語言模型。

Reliability of ChatGPT answers to common questions on developmental dysplasia of the hip as an information source for parents

Background: Artificial intelligence (AI), particularly AI-based large language models (LLM) like ChatGPT, is increasingly shaping how information is accessed, offering patients a new source for understanding complex medical conditions. Given the physical, emotional, and logistical challenges that parents are faced when their baby is diagnosed with developmental dysplasia of the hip (DDH), the demand for clear and accessible educational resources is high. This study aimed to evaluate the quality and reliability of ChatGPT's responses to frequently asked questions about DDH.

Methods: This study assessed the quality of responses generated by the AI chatbot ChatGPT 4o to eight frequently asked questions about DDH, derived from real consultations in a pediatric orthopedic clinic Responses were generated during one interaction per question using a ChatGPT account not previously exposed to medical information. Responses were evaluated by two individual readers using a standardized rating system, comparing them to current literature, patient education resources, and consensus guidelines. Each response was categorized by its level of informational accuracy and completeness, and descriptive statistics were calculated to quantify performance.

Results: ChatGPT 4o was able to generate structured responses to all eight parental questions. The responses were rated in 12.5% excellent, 25.0% satisfactory with minimal clarification, 50.0% satisfactory with moderate clarification, and 12.5% unsatisfactory due to missing or inaccurate information.

Conclusion: ChatGPT provided satisfactory answers to questions about DDH and may serve as a useful supplementary information resource for parents. However, due to limitations in presenting detailed diagnostic and treatment pathways, it should be viewed as an adjunct to, not a replacement for, specialist medical consultation.

Keywords: artificial intelligence; developmental dysplasia of the hip; hip screening; infant hip; large language model.

文獻出處：Vertesich K, Ortmayr J, Windhager R, Willegger M. Reliability of ChatGPT answers to common questions on developmental dysplasia of the hip as an information source for parents. Front Pediatr. 2025 Dec 15;13:1659812. doi: 10.3389/fped.2025.1659812. PMID: 41473917; PMCID: PMC12745415.

文獻5

髖臼周圍截骨術相關并發癥：一項前瞻性多中心研究

譯者 陶可

背景：本前瞻性多中心研究旨在確定并分類由經驗豐富的醫生實施的髖臼周圍截骨術的所有相關并發癥。

方法：我們前瞻性分析了7家機構的10名外科醫生對205例單側髖臼周圍截骨術患者的圍手術期并發癥。所有圍手術期并發癥均在術后平均10周和1年時，采用標準化方法記錄，并使用經驗證的髖關節保留手術并發癥分級方案進行分級。患者平均年齡為25.4歲。其中女性143例，男性62例。最常見的診斷是發育性髖關節發育不良，同期進行的手術最常見的是股骨骨軟骨成形術（58%）或髖關節鏡檢查（20%），后者可能包括盂唇修復或切除。

結果：12例患者（5.9%）出現主要并發癥（III級或IV級）。其中7例并發癥在術后10周復診時發現，5例在術后1年復診時發現。9例并發癥需要第二次手術干預，包括髖臼移位的重新修復或植入的內固定螺釘調整（4例）、深部感染切開引流（2例），以及異位骨化切除、對側腓總神經減壓和后柱內固定（各1例）。3例血栓栓塞并發癥通過藥物治療。未發生血管損傷、永久性神經麻痹、關節內截骨和/或骨折或髖臼骨壞死。最常見的I級或II級并發癥是無癥狀性異位骨化。

結論：對于經驗豐富的髖臼周圍截骨術外科醫生而言，該手術是安全的，但在度過學習曲線后，仍存在5.9%的III級或IV級并發癥風險。大多數并發癥都可以順利解決而不會發生永久性殘疾。

Complications associated with the periacetabular osteotomy: a prospective multicenter study

Background: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons.

Methods: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures. The mean patient age was 25.4 years. There were 143 female and sixty-two male patients. The most common diagnosis was developmental acetabular dysplasia, and concomitant procedures most commonly included femoral osteochondroplasty (58%) or hip arthroscopy (20%), which could include labral repair or resection.

Results: Major complications (grade III or IV) occurred in twelve patients (5.9%). Seven complications were evident at the ten-week visit and five at the one-year visit. Nine of the complications required a second surgical intervention, including repair for acetabular migration or implant adjustment (four patients), incision and drainage for a deep infection (two patients), and heterotopic bone resection, contralateral peroneal nerve decompression, and posterior column fixation (one patient each). Three thromboembolic complications were managed medically. There were no vascular injuries, permanent nerve palsies, intra-articular osteotomies and/or fractures, or acetabular osteonecrosis. The most common grade-I or II complication was asymptomatic heterotopic ossification.

Conclusions: For surgeons experienced with the periacetabular osteotomy, it is a safe procedure but is associated with a 5.9% risk of grade-III or IV complications beyond the learning curve. The majority of these complications are resolved without permanent disability.

文獻出處：JIra Zaltz, Geneva Baca, Young-Jo Kim, Perry Schoenecker, Robert Trousdale, Rafael Sierra, Daniel Sucato, Ernie Sink, Paul Beaulé, Michael B Millis, David Podeszwa, John C Clohisy. Complications associated with the periacetabular osteotomy: a prospective multicenter study. Clinical Trial, J Bone Joint Surg Am. 2014 Dec 3;96(23):1967-74. doi: 10.2106/JBJS.N.00113.

文獻6

采用數字體積相關法測量人骨關節炎股骨頭軟骨下骨的異質性應變分布

譯者 邱興

骨關節炎是一種慢性疾病，約三分之一的45歲以上人群受其影響。盡管該疾病的病因和發病機制尚未完全明確，但力學因素在骨關節炎的發生與進展中起著重要作用。本研究通過階梯式壓縮結合微CT成像與數字體積相關法，測量并評估了單軸壓縮下骨關節炎股骨頭內部的全場應變分布。綜合分析表明，骨關節炎骨組織的微觀結構特征并未影響所采用方法的不確定性水平。研究結果揭示了應變主要集中在承載表面、低骨體積分數區域以及軟骨下囊腫區域。骨小梁厚度和連接密度被確定為僅有的兩個與表觀屈服應變處局部應變大小或超屈服應變骨體積相關的微觀結構參數。本研究提出了一種評估重度骨關節炎患者整體股骨頭力學特性的新方法。

關鍵詞：髖關節骨關節炎；微CT數字體積相關法；應變；軟骨下骨

圖1. 樣本被包埋于6毫米厚的丙烯酸樹脂板中，其中頂板依據股骨頭的弧形表面定制成型。包埋后的樣本被安置于力學測試夾具中進行加載。該加載夾具包含一個通過加載壓板施加壓力的加載螺絲、一個測力傳感器以及一個線性可變位移傳感器，分別用于測量施加的載荷和加載壓板的位移。整個系統封裝在有機玻璃管內，以確保在整個測試過程中保持可見。

圖2. (a) 應用于每個樣本的加載方案包括：進行10次循環加載至0.3 kN，并采集兩次圖像（預加載1和預加載2）；施加1.5 kN載荷并進行“第一次加載后”掃描（后加載1）；將載荷增加至3 kN并進行另一次掃描（后加載2）；最后持續施加載荷直至達到表觀失效，并進行最終掃描（后加載3）。每次施加載荷后、掃描前，均設有15分鐘的松弛期。(b) 為5個樣本記錄的載荷-位移曲線。在3 kN載荷階段之后，曲線呈現的“鋸齒狀”特征是由于嘗試通過加載螺絲施加失效載荷所致。

圖3. (a) 從一個骨關節炎樣本中提取了多個感興趣區域（VOIs），以評估具有代表性的總體區域（藍色）、骨小梁中央區域（綠色）、含囊腫區域（紅色）及硬化骨區域（黃色）內數據的不確定性。(b) 展示了四個感興趣區域在零應變（重復圖像）和1%虛擬壓縮表觀應變（1% VD）條件下的數字體積相關（DVC）應變場。(c-e) 分析結果顯示，這四個感興趣區域之間，以及在節點間距分別為1.01、1.95、2.73和3.90毫米的情況下，所測得的誤差標準差（SDER）指標均無明顯差異。

Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital

Osteoarthritis (OA) is a chronic disease, affecting approximately one third of people over the age of 45. Whilst the etiology and pathogenesis of the disease are still not well understood, mechanics play an important role in both the initiation and progression of osteoarthritis. In this study, we demonstrate the application of stepwise compression, combined with microCT imaging and digital volume correlation (DVC) to measure and evaluate full-field strain distributions within osteoarthritic femoral heads under uniaxial compression. A comprehensive analysis showed that the microstructural features inherent in OA bone did not affect the level of uncertainties associated with the applied methods. The results illustrate the localization of strains at the loading surface as well as in areas of low bone volume fraction and subchondral cysts. Trabecular thickness and connectivity density were identified as the only microstructural parameters with any association to the magnitude of local strain measured at apparent yield strain or the volume of bone exceeding yield strain. This work demonstrates a novel approach to evaluating the mechanical properties of the whole human femoral head in case of severe OA.
Keywords: hip osteoarthritis; subchondral bone; microCT digital volume correlation; strain

文獻出處：Ryan M K , Oliviero S , Costa M C ,et al.Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital Volume Correlation[J].Materials, 2020, 13.DOI:10.3390/ma13204619.

文獻7

髖關節發育不良患者終末期軟骨結構的特異性

譯者 徐子茵

發育性髖關節發育不良（DDH）表現為不同程度的股骨頭脫位，嚴重病例會在髂骨外側形成一個新的關節面——即新髖臼。盡管傳統觀點認為這不可能，但在Crowe III級和IV級患者的新髖臼和髖臼處發現了類似于透明軟骨的組織，這表明了在沒有機械壓力的情況下，透明軟骨仍具有發育潛力。為了驗證這一理論，本研究對從DDH患者獲取的髖臼和股骨頭軟骨進行了蘇木精-伊紅和甲苯胺藍染色。并進行了II型和VI型膠原蛋白以及聚集蛋白聚糖的免疫組織化學分析，以及在7.0 T微磁共振成像（MRI）設備上進行了延遲釓增強軟骨磁共振成像分析。將DDH患者的結果與對照組進行了比較。研究在DDH患者的新髖臼和髖臼中均發現了透明軟骨。組織病理學和MRI分析均證實了該組織的性質。本研究結果證實，在遺傳上傾向于形成骨組織且未承受機械應力的解剖區域，也存在透明軟骨。這是首次對晚期DDH患者的新髖臼軟骨進行了詳細表征。

關鍵詞：延遲增強軟骨MRI;髖關節發育發育異常;透明軟骨;免疫組化;新髖臼;骨關節炎。

Specificities in the Structure of the Cartilage of Patients with Advanced Stages of Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) presents varying degrees of femoral head dislocation, with severe cases leading to the formation of a new articular surface on the external side of the iliac bone—the neoacetabulum. Despite conventional understanding suggesting otherwise, a tissue resembling hyaline cartilage is found in the neoacetabulum and acetabulum of Crowe III and IV patients, indicating a potential for hyaline cartilage development without mechanical pressure. To test this theory, acetabular and femoral head cartilage obtained from patients with DDH was stained with hematoxylin-eosin and toluidine blue. The immunohistochemical analysis for collagen types II and VI and aggrecan was performed, as well as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) analysis on a 7.0 T micro-MRI machine. The results obtained from DDH patients were compared to those of the control groups. Hyaline cartilage was found in the neoacetabulum and the acetabulum of patients with DDH. The nature of the tissue was confirmed with both the histological and the MRI analyses. The results of this study proved the presence of hyaline cartilage in patients with DDH at anatomical regions genetically predisposed to be bone tissue and at regions that are not subjected to mechanical stress. This is the first time that the neoacetabular cartilage of patients with advanced stages of DDH has been characterized in detail.

Keywords: delayed gadolinium-enhanced MRI of cartilage; developmental dysplasia of the hip; hyaline cartilage; immunohistochemistry; neoacetabulum; osteoarthritis.

文獻出處：Duvan?i? T, Vukasovi? Bari?i? A, ?izmi? A, Ple?ko M, Boha?ek I, Delimar D. Specificities in the Structure of the Cartilage of Patients with Advanced Stages of Developmental Dysplasia of the Hip. Diagnostics (Basel). 2024 Apr 8;14(7):779. doi: 10.3390/diagnostics14070779. PMID: 38611693; PMCID: PMC11011320.

文獻8

股骨近端成角畸形患者行全髖關節置換術

譯者 張利強

目的

合并髖關節骨關節炎（OA）的股骨近端成角畸形，會顯著增加初次全髖關節置換術（THA）的手術技術難度。本研究旨在明確該類高難度患者行現代標準初次全髖關節置換術后的假體的長期生存率、手術失敗的危險因素、術后并發癥及臨床療效。

研究方法

本研究調取本院人工關節登記數據庫，納入1997年1月至2017年9月期間，108例股骨近端成角畸形患者接受的119臺初次全髖關節置換術病例。其中，102臺手術（86%）的股骨畸形由既往股骨截骨術所致，17臺手術（14%）的畸形源于發育性或代謝性疾病；62髖（53%）以股骨內翻畸形為主要表現。患者平均年齡44歲（標準差13），平均體質指數29kg/m2（標準差6），女性患者70例（59%）。35 例（30%）使用了帶干骺端固定的非骨水泥股骨假體，34 例（29%）使用了帶骨干固定的非骨水泥股骨假體，29 例（24%）使用了帶干骺端固定套的非骨水泥模塊化股骨假體，21 例（18%）使用了骨水泥股骨假體。對 22 例全髖關節置換術（占 18%）同時進行了股骨截骨術。本研究采用Kaplan-Meier生存分析法統計假體生存率，并采用Harris髖關節評分（HHS）評估髖關節功能；患者術后平均隨訪時長為8年（隨訪范圍2~22年）。

結果

十年內無股骨松動、股骨翻修、全髖關節翻修和再手術的生存率分別為95%、93%、90%和88%。共進行了13次翻修手術，其中3例為無菌性股骨松動，2例為股骨假體骨折，2例為脫位，2例為無菌性髖臼松動，2例為聚乙烯襯墊更換，2例為感染。術前股骨內翻畸形是全髖翻修風險升高的相關危險因素（風險比 HR=12.5，P=0.020）；同期行股骨矯形截骨術的患者，其再次手術的風險顯著升高（風險比 HR=3.6，P=0.023）。平均HHS從術前的52分顯著提高到十年后的82分（p< 0.001）。

結論

在迄今為止針對髖關節骨關節炎且伴有近端股骨角畸形患者進行初次全髖關節置換術的最大系列研究中，我們發現十年內無任何翻修手術的生存率良好。股骨內翻畸形，尤其是因畸形程度較重或畸形位置特殊、需在置換術中同期行股骨截骨矯形的病例，其后續接受再次手術的概率更高。

Total hip arthroplasty in patients with angular proximal femoral deformities

Aims

An angular proximal femoral deformity, in association with osteoarthritis (OA) of the hip, considerably increases the technical complexity of primary total hip arthroplasty (THA). The aims of this study were to determine the long-term implant survival, the risk factors for failure, complications, and clinical outcomes of contemporary primary THA in this difficult group of patients.

Methods

Our institutional total joint registry was used to identify 119 primary THAs performed
in 108 patients with an angular proximal femoral deformity, between January 1997 and September 2017. The deformity was related to a previous femoral osteotomy in 102 THAs (86%), and developmental or metabolic disorders in 17 THAs (14%). A total of 62 hips (53%) had a predominantly varus deformity. The mean age of the patients was 44 years (SD 13), their mean BMI was 29 kg/m2(SD 6), and 70 (59%) were female. An uncemented femoral component with metaphyseal fixation was used in 35 THAs (30%), an uncemented femoral component with diaphyseal fixation in 34 (29%), an uncemented modular femoral component with a metaphyseal fixation sleeve in 29 (24%), and a cemented femoral component in 21 (18%). Simultaneous corrective femoral osteotomy was performed in 22 THAs (18%). Kaplan-Meier survival and Harris Hip Scores (HHSs) were reported. The mean follow-up was eight years (2 to 22).

Results

The ten-year survival free of femoral loosening, any femoral revision, any revision and any reoperation was 95%, 93%, 90%, and 88%, respectively. A total of 13 revisions were undertaken, for aseptic femoral loosening in three, fracture of the femoral component in two, dislocation in two, aseptic acetabular loosening in two, polyethylene liner exchange in two, and infection in two. A preoperative varus deformity was associated with a higher risk of any revision (hazard ratio (HR) 12.5, p = 0.020), and those with a simultaneous osteotomy had a higher risk of any reoperation (HR 3.6, p = 0.023). The mean HHSs improved significantly from 52 preoperatively to 82 at ten years (p < 0.001).

Conclusion

In the largest series to date of primary THAs in patients with hip OA and an angular proximal femoral deformity, we found a good ten-year survival free from any revision. Varus deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher rate of further surgery.

文獻出處：Louis Dagneaux, Matthew P Abdel, Rafael J Sierra, David G Lewallen, Robert T Trousdale, Daniel J Berry; Total hip arthroplasty in patients with angular proximal femoral deformitiesBone Joint J 2025;107-B(6 Supple B):101-108 doi:10.1302/0301-620X.107B6.BJJ-2025-0305.R1

來源：304關節學術

作者：304關節團隊

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