髖膝關(guān)節(jié)文獻精譯薈萃（第361期）

本期目錄：

1、單髁置換術(shù)：什么是獲得手術(shù)成功的最佳力線？運動對線的作用

2、初次膝關(guān)節(jié)置換術(shù)中非骨水泥與骨水泥型假體療效相當，但配對隨機對照試驗發(fā)現(xiàn)非骨水泥型髕骨組件出現(xiàn)移位

3、全膝關(guān)節(jié)置換脛骨側(cè)假體周圍骨折300例病例分析

4、無影像導(dǎo)航機器人手術(shù)與個體化方法：優(yōu)化前交叉韌帶重建術(shù)后全膝關(guān)節(jié)置換術(shù)

5、髖關(guān)節(jié)外展肌無力對正常行走中關(guān)節(jié)負荷的影響

6、大轉(zhuǎn)子截骨術(shù)：對臀中肌功能的影響

7、股骨旋轉(zhuǎn)截骨術(shù)與凸輪切除可改善股骨前傾角不足型髖關(guān)節(jié)撞擊綜合征患者的髖關(guān)節(jié)功能及內(nèi)旋活動度

8、反向髖臼周圍截骨術(shù)治療癥狀性髖臼過度覆蓋的早期效果如何

9、亞洲髖關(guān)節(jié)發(fā)育不良女性半脫位百分比與髖臼寬度的關(guān)系

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻

文獻1

單髁置換術(shù)：什么是獲得手術(shù)成功的最佳力線？運動對線的作用

譯者 張軼超

單室膝關(guān)節(jié)置換術(shù)（UKA）在許多方面都是一種終極的運動學(xué)手術(shù)，因為其明確的目標是進行關(guān)節(jié)病變側(cè)表面置換，并在保持前后交叉韌帶完整性的同時恢復(fù)關(guān)節(jié)病變前的力線和平衡。越來越多的知識將UKA的結(jié)果與關(guān)節(jié)炎前的關(guān)節(jié)解剖聯(lián)系在一起，而不是隨意定義的中立位。膝關(guān)節(jié)冠狀面力線（CPAK）分型為計算關(guān)節(jié)炎前肢體力線（演算髖關(guān)節(jié)-膝關(guān)節(jié)-踝關(guān)節(jié)角度（aHKA））和關(guān)節(jié)線傾斜角（JLO）提供了一種有效的技術(shù)，并將使人們更好地理解關(guān)節(jié)炎前解剖、假體位置選擇和效果之間的相互作用關(guān)系。如果沒有考慮到關(guān)節(jié)炎前的下肢力線，那么術(shù)后對于內(nèi)側(cè)UKA的輕至中度內(nèi)翻力線和外側(cè)UKA的中度外翻的肢體力線似乎可以達到最好的結(jié)果。當考慮到關(guān)節(jié)炎前的解剖結(jié)構(gòu)時，有報道認為當術(shù)后恢復(fù)到關(guān)節(jié)炎前的肢體力線和關(guān)節(jié)線傾斜度會有更好的結(jié)果。在應(yīng)用這種新方式時，脛骨側(cè)假體冠狀角和髖-膝-踝關(guān)節(jié)（HKA）角的標準尚未被明確定義，但現(xiàn)有證據(jù)表明，脛骨冠狀角的內(nèi)翻限制為6°可能是一個合理的標準。外側(cè)UKA在脛骨假體的位置和韌帶平衡方面具有固有的差異。移動平臺UKA需要對影響墊片穩(wěn)定性的假體位置有一個三維理解。改良技術(shù)是必要的，通過手術(shù)器械的設(shè)計改進使得脛骨假體角度達到解剖機械對線。機器人技術(shù)可以準確地重建關(guān)節(jié)炎前的解剖結(jié)構(gòu)，精確地再現(xiàn)患者個性化的虛擬規(guī)劃，同樣精確地達到軟組織平衡，未來使用這些平臺的研究可以進一步闡明理想的患者個性化假體和肢體對線目標。

Unicompartmental Knee Arthroplasty: What is the optimal alignment correction to achieve success? The role of kinematic alignment

Unicompartmental knee arthroplasty (UKA) is in many ways the ultimate kinematic operation, as the express aim is to resurface the diseased side of the joint and restore pre-arthritic alignment and balance while maintaining integrity of both cruciate ligaments. An increasing body of knowledge relates the outcomes of UKA to pre-arthritic anatomy rather than an arbitrarily defined neutral. The Coronal Plane Alignment of the Knee (CPAK) classification provides a validated technique for calculating pre-arthritic limb alignment (the arithmetic hip-knee-ankle angle (aHKA)) and joint line obliquity (JLO) and will enable a greater understanding of the interactions between pre-arthritic anatomy, choice of prosthetic position and outcomes. When pre-arthritic alignment is not taken into consideration a post-operative limb alignment of mild to moderate varus for medial UKA and moderate valgus for lateral UKA appears to produce the best outcomes. When pre-arthritic anatomy is taken into account, superior results have been reported with restoration of pre-arthritic limb alignment and joint line obliquity. Restriction boundaries have yet to be clearly defined for tibial component coronal and hip-knee-ankle (HKA) angles when applying this new paradigm, but existing evidence would suggest a 6 varus limit for the tibial coronal angle may be a reasonable starting point. Lateral UKA has inherent differences in terms of tibial component positioning and ligament balance targets. Mobile bearing UKA demands a three-dimensional understanding of the effect of implant position on bearing stability. Modification of technique is necessary to produce anatomic tibia component angles with equipment designed for mechanical alignment. Robotic technology allows accurate understanding of pre-arthritic anatomy, precise reproduction of patient specific virtual planning, equally precise manipulation of soft tissue balance, and future research using these platforms is likely to further clarify in terms of ideal patientspecific component and limb alignment targets.

文獻出處：McEwen P, Omar A, Hiranaka T. Unicompartmental Knee Arthroplasty: What is the optimal alignment correction to achieve success? The role of kinematic alignment. J ISAKOS. 2024 Dec;9(6):100334. doi: 10.1016/j.jisako.2024.100334. Epub 2024 Oct 16. PMID: 39419311.

文獻2

初次膝關(guān)節(jié)置換術(shù)中非骨水泥與骨水泥型假體療效相當，但配對隨機對照試驗發(fā)現(xiàn)非骨水泥型髕骨組件出現(xiàn)移位

譯者 馬云青

背景：非骨水泥型全膝關(guān)節(jié)置換術(shù)（TKA）日益普及，但部分外科醫(yī)生對其術(shù)后疼痛、假體穩(wěn)定性及金屬底座髕骨組件存活率存在顧慮。本研究通過雙側(cè)同期置換病例對比非骨水泥型與骨水泥型TKA的臨床效果。

方法：研究納入40例雙側(cè)骨關(guān)節(jié)炎患者（共80膝），均在單次麻醉下接受雙側(cè)TKA，并行髕骨表面置換。所有患者一側(cè)膝關(guān)節(jié)植入非骨水泥型假體，對側(cè)植入骨水泥型假體。評估指標包括：遺忘關(guān)節(jié)評分、改良WOMAC骨關(guān)節(jié)炎指數(shù)、膝關(guān)節(jié)活動度、疼痛程度、手術(shù)時間、影像學(xué)結(jié)果及并發(fā)癥。所有病例均完成至少2年（2-3年）隨訪。

結(jié)果：兩組在功能結(jié)局方面無顯著差異：遺忘關(guān)節(jié)評分（97±5分 vs 98±3分，P=0.52）、改良WOMAC評分（3±4分 vs 3±2分，P=0.96）及關(guān)節(jié)活動度（134±7° vs 134±7°，P=0.16）。術(shù)后疼痛程度亦無統(tǒng)計學(xué)差異（P>0.05）。非骨水泥組中4例髕骨組件出現(xiàn)平均3.5mm（范圍1.77-4.16mm）的上方位移，但無松動征象，移位均發(fā)生于術(shù)后4周（范圍2-6周）。

結(jié)論：非骨水泥型TKA可獲得與骨水泥型TKA相似的功能結(jié)局及恢復(fù)軌跡，但需關(guān)注非骨水泥髕骨組件的移位風(fēng)險。

Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial

Background:Cementless total knee arthroplasty (TKA) has become increasingly popular. Some surgeons are concerned about pain, implant stability, and metal-backed patellar component survivorship. This study investigated the outcomes of cementless compared with cemented TKA in bilateral cases.

Methods:We randomized 80 knees in 40 osteoarthritic knee patients who underwent bilateral TKA with patellar resurfacing under one anesthesia. All participants received cementless prostheses in one knee and cemented prostheses in the other. The outcomes were knee function measured by the forgotten joint scores, modified Western Ontario and McMaster Universities Osteoarthritis Index, knee ranges of motion, pain levels, operative times, radiographic outcomes, and complications. All knees were followed for a minimum of 2 years (2 to 3 years).

Results:Cementless and cemented TKA had similar functional outcomes in forgotten joint score (97 ± 5 versus 98 ± 3 points, P = .52), modified Western Ontario and McMaster Universities Osteoarthritis Index score (3 ± 4 versus 3 ± 2 points, P = .96), and ranges of motion (134 ± 7° versus 134 ± 7°, P = .16). The postoperative pain was also similar (P > .05). There were 4 cementless patellar components had superior migration for an average of 3.5 mm (range, 1.77 to 4.16) without loosening. The mean time of migration was 4 (range, 2 to 6) weeks.

Conclusions:Cementless TKA had similar functional outcomes and recovery patterns compared with cemented TKA. However, there was concern of cementless component migration at patellae.

文獻出處：Tanariyakul Y, Kanitnate S, Tammachote N. Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial. J Arthroplasty. 2024 May;39(5):1266-1272. doi: 10.1016/j.arth.2023.10.055. Epub 2023 Nov 2. PMID: 37924989.

文獻3

全膝關(guān)節(jié)置換脛骨側(cè)假體周圍骨折300例病例分析

單一醫(yī)學(xué)中心的病例分類及療效分析

譯者 張薔

背景：全膝關(guān)節(jié)置換（TKR）脛骨側(cè)假體周圍骨折是一項處理起來十分具有挑戰(zhàn)性的并發(fā)癥，既往文獻中鮮有相關(guān)治療指導(dǎo)。本篇文章的目的是回顧單一醫(yī)學(xué)中心迄今為止最大樣本量的一組脛骨側(cè)假體周圍骨折病例，分析其疾病分型并總結(jié)治療經(jīng)驗。

方法：我們選擇了本醫(yī)療中心自1996年至2020年共300例（285位患者）全膝關(guān)節(jié)置換（43%為初次全膝，57%為全膝翻修）脛骨側(cè)假體周圍骨折病例。根據(jù)Felix等人的分型標準，I型為累及平臺的骨折，II型為累及假體的骨折，III型為假體遠端的骨折和IV型為脛骨結(jié)節(jié)的骨折，亞型A為假體牢固固定，亞型B為假體松動，亞型C為術(shù)中骨折。本研究的病例中，53%為I型，24%為II型，16%為III型，8%為IV型。有46%的骨折發(fā)生于術(shù)中，其余54%發(fā)生于術(shù)后（61%為亞型A，39%為亞型B）。骨折時平均年齡為67歲，64%為女性。平均隨訪時間為6年。

I型：累及平臺的骨折。II型：累及假體的骨折。III型：假體遠端的骨折。IV型：脛骨結(jié)節(jié)的骨折。

亞型A為術(shù)后骨折，脛骨假體固定牢靠。亞型B為術(shù)后骨折，脛骨假體松動。亞型C為術(shù)中骨折。

結(jié)果：全膝翻修術(shù)中骨折的概率為1.40%，初次全膝術(shù)中骨折的概率為0.10%。術(shù)中骨折的病例中，術(shù)后2年除外脛骨假體再翻修的生存率最高為I型（100%），最低為IV型（67%）（P < 0.001）。術(shù)后骨折的病例中，術(shù)后2年除外任意再手術(shù)的生存率為29%，術(shù)后2年除外脛骨假體再翻修的生存率為51%。I型術(shù)后骨折術(shù)后2年除外脛骨假體再翻修的生存率最低（10%），而III型的生存率最高（88%）（P < 0.001）。

結(jié)論：全膝翻修病例術(shù)中脛骨側(cè)假體周圍骨折的概率是初次全膝病例的14倍。在所有術(shù)中骨折病例中，I型骨折的耐受性最好，術(shù)后2年除外脛骨假體翻修的生存率為100%。而相反的，I型術(shù)后骨折術(shù)后2年生存率僅為10%。

Three Hundred Periprosthetic Tibial Fractures around a Total Knee Replacement

Classification and Outcomes from a Single Institution

Background: Periprosthetic tibial fractures around a total knee replacement (TKR) remain challenging to manage, with little published information for guidance. The purpose of this study was to review the types, management techniques, and outcomes of periprosthetic tibial fractures in the largest series to date.

Methods: We identified 300 periprosthetic tibial fractures (285 patients) around a TKR (43% in primary TKRs and 57% in revision TKRs) sustained between 1996 and 2020. Fractures were classified according to Felix et al. as Type I (tibial plateau), Type II (adjacent to stem), Type III (distal to stem), or Type IV (tibial tubercle), with subtypes A (well-fixed component), B (loose component), and C (intraoperative fracture). Of the fractures in this study, 53% were Type I, 24% were Type II, 16% were Type III, and 8% were Type IV. A total of 46% of fractures occurred intraoperatively, and 54% of fractures occurred postoperatively (61% subtype A, 39% subtype B). The mean patient age at fracture was 67 years, and 64% of patients were female. The mean follow-up was 6 years.

Results: The intraoperative fracture incidence was 1.40% in revision TKRs and 0.10% in primary TKRs. Among intraoperative fractures, the 2-year survivorship free from tibial component revision was highest in Type I (100%) and lowest in Type IV (67%) (P < 0.001). For postoperative fractures, the 2-year survivorship free from any reoperation was 29% and the 2-year survivorship free from tibial component revision was 51%. Type-I postoperative fractures had the lowest 2-year survivorship free from tibial component revision (10%), whereas Type-III fractures had the highest survivorship (88%) (P < 0.001).

Conclusions: Intraoperative periprosthetic fracture of the tibia was fourteen-fold more likely in revision TKRs compared with primary TKRs. Among all intraoperative fractures, Type-I fractures were well-tolerated, with 100% survivorship free from tibial component revision at 2 years. Conversely, Type-I postoperative fractures had only 10% survivorship at 2 years.

文獻4

無影像導(dǎo)航機器人手術(shù)與個體化方法：優(yōu)化前交叉韌帶重建術(shù)后全膝關(guān)節(jié)置換術(shù)

譯者 沈松坡

背景：前交叉韌帶重建（ACLR）會增加膝關(guān)節(jié)骨關(guān)節(jié)炎（OA）及全膝關(guān)節(jié)置換術(shù)（TKA）的發(fā)生風(fēng)險，并伴隨更高的并發(fā)癥發(fā)生率。本前瞻性研究的目的，是評估無影像導(dǎo)航機器人手術(shù)及個體化方法在既往ACLR患者接受TKA時的作用。

方法：本前瞻性研究納入70例接受初次TKA的患者：其中35例為既往ACLR組，35例為原發(fā)性O(shè)A組。所有手術(shù)均采用無影像導(dǎo)航機器人系統(tǒng)實施。分析患者的人口學(xué)資料、術(shù)中及術(shù)后數(shù)據(jù)，包括膝關(guān)節(jié)功能（活動度ROM、膝關(guān)節(jié)評分KSS、西安大略和麥克馬斯特大學(xué)骨關(guān)節(jié)炎指數(shù)WOMAC）、并發(fā)癥及影像學(xué)結(jié)果。

結(jié)果：盡管ACLR組術(shù)前在最大屈曲角度（p=0.021）、KSS-膝關(guān)節(jié)評分（p=0.041）、KSS-功能評分（p=0.032）、WOMAC-僵硬度（p=0.017）及WOMAC-功能（p=0.035）方面均顯著低于原發(fā)OA組，但術(shù)后兩組總體療效相當，僅在ACLR組膝關(guān)節(jié)屈曲角仍有殘余下降（114.41° vs 128.61°，p<0.001）。術(shù)中調(diào)整在ACLR組更為頻繁，其脛骨再次截骨率顯著更高（20% vs 2.8%，p=0.017）。三年隨訪期內(nèi)未報告重大并發(fā)癥或翻修病例。

結(jié)論：無影像導(dǎo)航機器人手術(shù)結(jié)合個體化方法，可使ACLR術(shù)后接受TKA的患者與原發(fā)性O(shè)A患者獲得相當?shù)男g(shù)后療效，同時減少ACLR病史患者TKA常見的手術(shù)問題。總體結(jié)果表明，機器人輔助手術(shù)的TKA對該類患者是一種安全且有效的治療選擇。

證據(jù)等級： II級。

關(guān)鍵詞（Keywords） 前交叉韌帶重建、全膝關(guān)節(jié)置換術(shù)、個體化對線、無影像導(dǎo)航、機器人手術(shù)、全膝關(guān)節(jié)置換術(shù)

圖1. 一名 51歲男性患者 的術(shù)前X線片，其右膝患有骨關(guān)節(jié)炎，并于29年前接受過前交叉韌帶重建術(shù)。術(shù)前膝關(guān)節(jié)活動范圍（ROM）為0–105°，伴有外側(cè)推力表現(xiàn)。

圖2. 與圖1為同一名患者的術(shù)中截圖，來自 ROSA 膝關(guān)節(jié)機器人系統(tǒng)（Zimmer Biomet，美國印第安納州華沙）。在圖(a)中，可見伸直位存在11°的內(nèi)翻畸形（varus deformity），同時在伸直位與90°屈曲位均存在明顯的關(guān)節(jié)松弛，分別為5 mm與4 mm。在圖(b)中，可觀察到關(guān)節(jié)運動學(xué)得到改善，冠狀面畸形得到矯正，并且在伸直位與90°屈曲位均實現(xiàn)了良好的平衡。

圖3. 與圖1和圖2為同一名患者的術(shù)后X線片。手術(shù)中使用了 Persona? 型人工膝關(guān)節(jié)假體（Zimmer Biomet，美國印第安納州華沙），配有后穩(wěn)定型（Posterior-Stabilized）襯墊和14 × 30 mm的脛骨延長柄。術(shù)中脛骨端的固定裝置已被移除，而股骨端的固定裝置則保留原位。

Imageless robotic surgery and a personalized approach: optimizing TKA after ACL reconstruction

Background: Anterior cruciate ligament reconstruction (ACLR) increases the risk of knee osteoarthritis (OA) and the need for total knee arthroplasty (TKA), with an increased rate of complications. The aim of this prospective study is to evaluate the role of imageless robotic surgery and a personalized approach in TKA after prior ACLR.

Methods: This prospective study involved 70 patients who underwent primary TKA: 35 with prior ACLR and 35 with primary OA. All surgeries were performed using an imageless robotic system. Demographic, intraoperative, and postoperative data were analyzed, including knee function (ROM, KSS, WOMAC), complications, and radiographic outcomes.

Results: Despite significantly lower preoperative values in the ACLR group for maximum flexion (p = 0.021), KSS-knee (p = 0.041), KSS-function (p = 0.032), WOMAC-stiffness (p = 0.017), and WOMAC-function (p = 0.035), postoperative outcomes were comparable between the two groups, except for a residual reduction in knee flexion in the ACLR group (114.41° vs 128.61°, p < 0.001). Intraoperative adjustments were more frequent in the ACLR group, with a significantly higher rate of tibial recuts (20 % vs 2.8 %, p = 0.017). No major complications or revisions were reported at the three-year follow-up.

Conclusions: The use of imageless robotic surgery combined with a personalized approach can achieve comparable postoperative outcomes between patients undergoing TKA after ACLR and those with primary OA, while also reducing common issues associated with TKA in patients with a history of ACLR. The overall results indicate that robotic-assisted TKA is a safe and effective option for these patients.

Level of evidence: Level II.

Keywords: Anterior cruciate ligament reconstruction; Imageless; Personalized alignment; Robotic surgery; TKA.

文獻出處：Andriollo L, Picchi A, Demattia G, Marescalchi M, Sangaletti R, Benazzo F, Rossi SMP. Imageless robotic surgery and a personalized approach: optimizing TKA after ACL reconstruction. Knee. 2025 Oct 8;57:353-360. doi: 10.1016/j.knee.2025.09.007. Epub ahead of print. PMID: 41067207.

第二部分：保髖相關(guān)文獻

文獻1

髖關(guān)節(jié)外展肌無力對正常行走中關(guān)節(jié)負荷的影響: 建模之概率模型

譯者 任寧濤

髖關(guān)節(jié)外展肌無力與下肢關(guān)節(jié)骨關(guān)節(jié)炎相關(guān)，關(guān)節(jié)超負荷可能增加疾病進展風(fēng)險。肌力、結(jié)構(gòu)性關(guān)節(jié)退化和關(guān)節(jié)負荷之間的關(guān)系使后者成為研究疾病發(fā)生和隨訪的重要參數(shù)。由于髖關(guān)節(jié)外展肌無力和關(guān)節(jié)負荷之間的關(guān)系仍然是一個懸而未決的問題，本研究的目的是采用概率建模的方法，以了解在正常步態(tài)的情況下，髖關(guān)節(jié)外展肌無力如何影響同側(cè)關(guān)節(jié)負荷。將一個通用的肌肉骨骼模型縮放到研究中的每個健康受試者，并對模型中每個髖關(guān)節(jié)外展肌的最大發(fā)力能力進行調(diào)整，以評估髖關(guān)節(jié)外展肌無力在生理學(xué)上可能的因素如何影響行走時的關(guān)節(jié)負荷。一般來說，肌肉系統(tǒng)能夠補償髖關(guān)節(jié)外展肌無力。外展肌發(fā)力能力的降低對關(guān)節(jié)負荷的影響程度較輕，第50分位的平均差異可達0.5 BW(最大1.7 BW)。膝關(guān)節(jié)負荷峰值比髖關(guān)節(jié)或踝關(guān)節(jié)負荷增加更大。臀中肌，尤其是前間室，是對髖、膝關(guān)節(jié)負荷影響最大的外展肌。進一步的研究應(yīng)該評估這些關(guān)節(jié)負荷的增加是否會影響骨關(guān)節(jié)炎的發(fā)生和進展。

Influence of weak hip abductor muscles on joint contact forces during normal walking： probabilistic modeling analysis

The weakness of hip abductor muscles is related to lower-limb joint osteoarthritis, and joint overloading may increase the risk for disease progression. The relationship between muscle strength, structural joint deterioration and joint loading makes the latter an important parameter in the study of onset and follow-up of the disease. Since the relationship between hip abductor weakness and joint loading still remains an open question, the purpose of this study was to adopt a probabilistic modeling approach to give insights into how the weakness of hip abductor muscles, in the extent to which normal gait could be unaltered, affects ipsilateral joint contact forces. A generic musculoskeletal model was scaled to each healthy subject included in the study, and the maximum force-generating capacity of each hip abductor muscle in the model was perturbed to evaluate how all physiologically possible configurations of hip abductor weakness affected the joint contact forces during walking. In general, the muscular system was able to compensate for abductor weakness. The reduced force-generating capacity of the abductor muscles affected joint contact forces to a mild extent, with 50th percentile mean differences up to 0.5 BW (maximum 1.7 BW). There were greater increases in the peak knee joint loads than in loads at the hip or ankle. Gluteus medius, particularly the anterior compartment, was the abductor muscle with the most influence on hip and knee loads. Further studies should assess if these increases in joint loading may affect initiation and progression of osteoarthritis.

文獻出處：Valente G, Taddei F, Jonkers I. Influence of weak hip abductor muscles on joint contact forces during normal walking: probabilistic modeling analysis. J Biomech. 2013 Sep 3;46(13):2186-93. doi: 10.1016/j.jbiomech.2013.06.030. Epub 2013 Jul 24. PMID: 23891175.

文獻2

大轉(zhuǎn)子截骨術(shù)：對臀中肌功能的影響

譯者 李勇

目的： 大轉(zhuǎn)子前移會改變臀中肌的功能。然而，除臨床研究和生物力學(xué)力臂研究外，目前尚無出版物分析大轉(zhuǎn)子前移對肌肉功能的影響。本研究旨在實驗室環(huán)境下分析大轉(zhuǎn)子截骨術(shù)后臀中肌的力學(xué)變化。

方法： 對四個髖關(guān)節(jié)進行了臀中肌起源和插入的解剖學(xué)研究。基于解剖，開發(fā)了將肌肉分為五個部分的弦模型。測量每 10° 屈曲、內(nèi)旋和外旋以及外展，轉(zhuǎn)子處于解剖、近端和遠端位置，肌纖維長度的變化。

結(jié)果： 轉(zhuǎn)子遠移導(dǎo)致肌肉動作不平衡，肌肉的等長部分向前移動，屈曲時活躍的肌肉部分較多，伸展時活動的肌肉部分較少。肌肉的拉伸增加了被動力，但降低了肌肉的發(fā)力能力，同時增加的肌纖維偏移可能需要更多的能量消耗，這可以解釋轉(zhuǎn)子遠移后外展肌組織的早期疲勞。對于外展，肌肉附著的遠端化導(dǎo)致收縮模式從等長變?yōu)榈葷B。當大轉(zhuǎn)子的尖端與髖關(guān)節(jié)旋轉(zhuǎn)中心齊平時，肌肉的最佳平衡和偏移是肌肉的最佳平衡和偏移。

結(jié)論： 對于存在高位大轉(zhuǎn)子的髖關(guān)節(jié)，其最佳位置是與髖關(guān)節(jié)旋轉(zhuǎn)中心齊平。應(yīng)避免過度遠移。由于該結(jié)論及相關(guān)考量基于實驗室環(huán)境得出，因此未必能直接應(yīng)用于臨床實踐。

Osteotomy of the greater trochanter: effect on gluteus medius function

Purpose: Advancement of the greater trochanter alters the function of the gluteus medius muscle. However, with the exception of clinical studies and biomechanical lever arm studies, no publications that analyze the consequences of advancement of the greater trochanter on the muscle function exist. The aim of the study was to analyze the mechanical changes of gluteus medius after osteotomy of the greater trochanter in a lab setting.

Methods: An anatomical study of origin and insertion of the gluteus medius was carried out on four hips. Based on the dissections, a string model was developed dividing the muscle into five sectors. Changes in muscle fiber length were measured for every 10° of flexion, internal and external rotation and abduction with the trochanter in anatomic, proximalized and distalized positions.

Results: Distalization of the trochanter leads to an imbalance of muscle action, moving the isometric sector of the muscle anteriorly with more muscle sectors being active during flexion and less during extension. Stretching of the muscle increases passive forces but decreases the force generation capacity of the muscle and at the same time increased muscle fiber excursion may require more energy consumption, which may explain earlier fatigue of the abductor musculature after distalization of the trochanter. For abduction, distalization of the muscle attachment leads to a change in contraction pattern from isometric to isotonic. Optimal balancing and excursion of the muscle is when the tip of the greater trochanter is at level with the hip rotation center.

Conclusions: In hips with high riding trochanter, the optimal position is at the level of the center of hip rotation. Excessive distalization should be avoided. As the conclusions and considerations are based on a lab setting, transfer to clinical practice may not necessarily apply.

文獻出處：Beck M, Krüger A, Katthagen C, Kohl S. Osteotomy of the greater trochanter: effect on gluteus medius function. Surg Radiol Anat. 2015 Aug;37(6):599-607. doi: 10.1007/s00276-015-1466-z. Epub 2015 Apr 1. PMID: 25828839.

文獻3

股骨旋轉(zhuǎn)截骨術(shù)與凸輪切除可改善股骨前傾角不足型髖關(guān)節(jié)撞擊綜合征患者的髖關(guān)節(jié)功能及內(nèi)旋活動度

譯者 邱興

目前針對股骨前傾角（FV）減小的股骨髖臼撞擊綜合征（FAI）患者的研究尚不充分。本研究旨在評估：（i）接受股骨旋轉(zhuǎn)截骨術(shù)的有癥狀患者的髖關(guān)節(jié)疼痛及活動范圍；（ii）主觀滿意度；（iii）后續(xù)手術(shù)情況。研究采用回顧性病例系列分析，納入2014-2018年間18例（23髖）因股骨前傾角減小伴髖前疼痛接受股骨旋轉(zhuǎn)截骨術(shù)的患者。術(shù)前平均年齡25±6歲（男性占57%），所有患者股骨前傾角均<10°且完成至少1年隨訪（平均隨訪時間2±1年）。手術(shù)指征包括：前撞擊試驗陽性、屈曲90°時內(nèi)旋（IR）受限（平均10±8°）、伸直位內(nèi)旋受限（平均24±11°）、磁共振關(guān)節(jié)造影顯示前上側(cè)軟骨盂唇損傷、CT測量確認股骨前傾角減小（平均5±3°，采用Murphy測量法）且無骨關(guān)節(jié)炎（T?nnis分級0級）。多數(shù)患者存在關(guān)節(jié)內(nèi)與關(guān)節(jié)外髂前下棘撞擊（基于患者特異性三維撞擊模擬）。通過轉(zhuǎn)子下股骨旋轉(zhuǎn)截骨術(shù)增加股骨前傾角（矯正角度20±4°），并聯(lián)合實施凸輪切除（78%）和外科髖關(guān)節(jié)脫位（91%）。（i）前撞擊試驗陽性率從術(shù)前至術(shù)后顯著下降（100%降至9%，P<0.001）；屈曲90°時內(nèi)旋角度顯著增加（10±8°增至31±10°，P<0.001）。（ii）主觀滿意度從術(shù)前至術(shù)后顯著提升（33%上升至77%，P<0.001）；Merle d'Aubigné-Postel評分從術(shù)前14±2分（范圍8-15）顯著提高至17±1分（范圍13-18，P<0.001）。85%患者在隨訪中表示愿意再次接受該手術(shù)。（iii）末次隨訪時所有23髖均獲得保留（未轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)），其中1髖（4%）接受內(nèi)固定翻修術(shù)。結(jié)論：對于股骨前傾角減小的FAI患者，近端股骨旋轉(zhuǎn)截骨術(shù)聯(lián)合凸輪切除在短期隨訪中可有效改善髖部疼痛及內(nèi)旋功能。增加股骨前傾角的旋轉(zhuǎn)截骨術(shù)安全可靠。

圖1. 一名20歲男性患者的術(shù)前影像資料：正位X光片（A）、股骨前傾角測量（B）及基于三維CT的骨盆與近端股骨模型（C），其中顯示存在關(guān)節(jié)內(nèi)與關(guān)節(jié)外髖關(guān)節(jié)前撞擊；該患者后續(xù)接受了轉(zhuǎn)子下股骨旋轉(zhuǎn)截骨術(shù)聯(lián)合外科髖關(guān)節(jié)脫位術(shù)（D）以增大股骨前傾角。

Rotational femoral osteotomies and cam resection improve hip function and internal rotation for patients with anterior hip impingement and decreased femoral version

Femoroacetabular impingement (FAI) patients with reduced femoral version (FV) are poorly understood. The aim of this study is to assess (i) hip pain and range of motion, (ii) subjective satisfaction and (iii) subsequent surgeries of symptomatic patients who underwent rotational femoral osteotomies. A retrospective case series involving 18 patients (23 hips, 2014-2018) with anterior hip pain that underwent rotational femoral osteotomies for treatment of decreased FV was performed. The mean preoperative age was 25 ± 6 years (57% male), and all patients had decreased FV < 10° and minimum 1-year follow-up (mean follow-up 2 ± 1 years). Surgical indication was the positive anterior impingement test, limited internal rotation (IR) in 90° of flexion (mean 10 ± 8°) and IR in extension (mean 24 ± 11°), anterosuperior chondrolabral damage in Magnet resonance (MR) arthrography, CT-based measurement of decreased FV (mean 5 ± 3°, Murphy method) and no osteoarthritis (T?nnis Grade 0). Most patients had intra- and extra-articular subspine FAI (patient-specific 3D impingement simulation). Subtrochanteric rotational femoral osteotomies to increase FV (correction 20 ± 4°) were combined with cam resection (78%) and surgical hip dislocation (91%). (i) The positive anterior impingement test decreased significantly (P < 0.001) from pre- to postoperatively (100% to 9%). IR in 90° of flexion increased significantly (P < 0.001, 10 ± 8° to 31 ± 10°). (ii) Subjective satisfaction increased significantly (P < 0.001) from pre- to postoperatively (33% 77%). The mean Merle d'Aubigné and Postel score increased significantly (P < 0.001) from 14 ± 2 (8-15) points to 17 ± 1 (13-18, P < 0.001) points. Most patients (85%) reported at follow-up that they would undergo surgery again. (iii) At follow-up, all 23 hips were preserved (no conversion to total hip arthroplasty). One hip (4%) underwent revision osteosynthesis. Proximal rotational femoral osteotomies combined with cam resection improve hip pain and IR in most FAI patients with decreased FV at short-term follow-up. Rotational femoral osteotomies to increase FV are safe and effective.

文獻出處：Lerch, T. D., Meier, M. K., Hanke, M. S., Boschung, A., Schmaranzer, F., Siebenrock, K. A., ... & Steppacher, S. D. (2024). Rotational femoral osteotomies and cam resection improve hip function and internal rotation for patients with anterior hip impingement and decreased femoral version. Journal of Hip Preservation Surgery, 11(2), 85-91.

文獻4

反向髖臼周圍截骨術(shù)治療癥狀性髖臼過度覆蓋的早期效果如何？

譯者 陶可

背景：髖臼過度覆蓋與鉗夾型股骨髖臼撞擊綜合征(FAI)有關(guān)。髖臼過度覆蓋的一個亞型是由于髖臼深且髖臼頂傾斜引起的，在這種情況下，髖臼重新定向可能是比單純修整邊緣以暴露股骨頭更好的替代方案。我們于2003年引入了真正的反向髖臼周圍截骨術(shù)(PAO)，與前傾式PAO不同，它還能使髖臼相對于完整的髂骨屈曲和外展，以減少股骨頭前后側(cè)覆蓋并糾正髖臼頂?shù)呢搩A斜。據(jù)我們所知，真正的反向PAO的臨床結(jié)果尚未得到評估。

問題/目的：針對一組接受反向PAO的患者，(1)接受反向PAO的患者是否在短期內(nèi)表現(xiàn)出疼痛、功能和髖關(guān)節(jié)活動度的改善，以及髖臼覆蓋度（以外側(cè)和前方中心邊緣角以及T?nnis角定義）的降低？(2)是否存在與反向PAO成功或不良結(jié)局（以再次手術(shù)、轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)或患者報告結(jié)果評分不佳定義）相關(guān)的可識別因素？(3)是否存在與早期并發(fā)癥相關(guān)的可識別因素？

方法：2003年至2017年間，兩名外科醫(yī)生為37例患者實施了49例反向PAO。其中25例患者為單側(cè)反向PAO，12例患者為分期雙側(cè)反向PAO。為了確保每個髖關(guān)節(jié)作為獨立的數(shù)據(jù)點進行統(tǒng)計分析，我們選擇僅納入接受雙側(cè)反向PAO的患者的第一髖。在研究期間，我們將該手術(shù)的一般適應(yīng)癥定義為：有癥狀的髖臼外側(cè)和前側(cè)覆蓋過度導(dǎo)致的FAI，且既往保守或手術(shù)治療無效。本回顧性研究納入了37例患者，共37個髖關(guān)節(jié)，中位年齡（范圍）為18歲（12至41歲；四分位距16至21歲），隨訪時間最短為2年（中位時間6年；范圍2至17年）。34例患者完成了問卷調(diào)查，24例患者接受了X線評估，23例患者接受了髖關(guān)節(jié)ROM臨床檢查。然而，7例患者已超過5年未復(fù)診。我們從縱向維護的機構(gòu)數(shù)據(jù)庫中選取了37例接受反向PAO治療的髖關(guān)節(jié)患者，并對其術(shù)前和術(shù)后臨床和X線參數(shù)進行了回顧性研究。不良結(jié)局定義為術(shù)后至少2年轉(zhuǎn)為全髖關(guān)節(jié)置換術(shù)（THA）或WOMAC疼痛評分大于10。術(shù)前及最近一次隨訪時，根據(jù)情況使用配對t檢驗或McNemar檢驗評估患者報告的結(jié)局、X線測量值和髖關(guān)節(jié)活動度（ROM）。采用線性回歸分析評估與臨床結(jié)局相關(guān)的可識別因素。采用邏輯回歸分析評估與不良結(jié)局和手術(shù)并發(fā)癥相關(guān)的可識別因素。所有檢驗均為雙側(cè)檢驗，p值小于0.05被認為具有顯著差異。

結(jié)果：術(shù)后至少2年，患者的WOMAC疼痛評分（-7 [95% CI -9至-5]；p < 0.001）、僵硬評分（-2 [95% CI -3至-1]；p < 0.001）、功能評分（-18 [95% CI -24至-12]；p < 0.001）和改良Harris髖關(guān)節(jié)評分（mHHS）（20 [95% CI 13至27]；p < 0.001）均有所改善。術(shù)后髖關(guān)節(jié)平均內(nèi)旋活動度（8° [95% CI 2°至14°]；p = 0.007）均有所改善。髖臼覆蓋度（以外側(cè)中心邊緣角(LCEA)、前中心邊緣角(ACEA) 和 T?nnis 角定義）LCEA改善-8°（95% CI -12° 至 -5°；p < 0.001），ACEA改善 -12°（95% CI -15° 至 -9°；p < 0.001），T?nnis角改善9°（95% CI 6° 至 13°；p < 0.001）。術(shù)后放射學(xué)關(guān)節(jié)炎的嚴重程度與較差的WOMAC功能評分相關(guān)，因此，術(shù)后每個T?nnis等級，WOMAC功能評分都會增加12分（95% CI 2 至 22；p = 0.03）。術(shù)后T?nnis分級越高，mHHS越差，平均每增加一個T?nnis分級，mHHS就會下降12 分（95% CI -20 至 -4；p = 0.008）。術(shù)后前撞擊試驗陽性與隨訪時mHHS評分下降相關(guān)，mHHS平均下降23 分（95% CI -34 至 -12；p = 0.001）。19%（37例中的7例）的髖關(guān)節(jié)出現(xiàn)了手術(shù)相關(guān)并發(fā)癥。4例髖關(guān)節(jié)在最終隨訪中出現(xiàn)不良反應(yīng)，其中2例患者隨后接受了THA，2例患者的WOMAC疼痛評分大于10分。我們沒有發(fā)現(xiàn)與并發(fā)癥或不良反應(yīng)相關(guān)的因素。

結(jié)論：真正的反向PAO的早期臨床和影像學(xué)結(jié)果與鉗狀FAI的其他外科治療方法相比具有優(yōu)勢，提示反向PAO是治療鉗狀FAI（由于廣泛的髖臼超覆蓋造成的）的一種有效的方法。然而，該手術(shù)技術(shù)復(fù)雜，需要熟悉標準PAO的外科醫(yī)生進行大量的培訓(xùn)和準備，并且必須向患者仔細講解該手術(shù)的潛在風(fēng)險和益處。未來需要進一步研究以進一步完善反向PAO的適應(yīng)癥并確定其長期療效。

圖1 A-C (A)這張術(shù)前X線片來自一名18歲女性，因髖臼過度覆蓋導(dǎo)致右髖疼痛。術(shù)前，她的外側(cè)中心邊緣角(LCEA)為36°，前方中心邊緣角(ACEA)為50°。(B)反向PAO術(shù)后，她的LCEA 為21°，ACEA為35°。(C)反向PAO術(shù)后9年的最終隨訪X線片顯示，與術(shù)前相比，股骨頭外側(cè)和前方覆蓋減少，關(guān)節(jié)間隙得以維持。

圖2 A-K這些插圖展示了反向PAO的手術(shù)技巧。(A)坐骨、恥骨上支和髂骨截骨術(shù)按常規(guī)方式進行。(B)后柱截骨術(shù)呈曲線形，并向前凹入坐骨截骨術(shù)。(C) 5號截骨術(shù)是在完整的髂骨上開一個小口，以進一步穩(wěn)定截骨。6號截骨術(shù)是髂骨成形術(shù)，在內(nèi)側(cè)突出的髂前下棘和髖臼碎片的髂前緣進行，以減輕股骨神經(jīng)血管結(jié)構(gòu)的壓力。(D)將骨撐開器放置在髂骨和后柱截骨處，以幫助釋放髖臼。(E)使用有角度的Ganz鑿子沿遠端和外側(cè)方向直接切開坐骨。(F)用反向Hohmann牽開器的下鈍尖端在骨盆內(nèi)向前外側(cè)推壓髖臼碎片的前下緣，有助于完成坐骨截骨處的移位。(G)在髖臼相對于完整髂骨進行屈曲、外展和內(nèi)旋的聯(lián)合矯正操作期間，使用Schanz螺釘、T型手柄和Weber骨夾來控制髖臼碎片。(H)髖臼碎片的另一個視圖，顯示矯正操作期間產(chǎn)生的髖臼屈曲。(I)應(yīng)對內(nèi)側(cè)突出的髂骨進行廣泛的髂骨成形術(shù)，以減少該突出對髂腰肌和股神經(jīng)血管結(jié)構(gòu)的術(shù)后壓力。(J)使用多個螺釘實現(xiàn)最終固定。髂骨成形術(shù)中切除的骨骼可用作自體骨移植，以填補截骨術(shù)中的任何間隙。(K)髖臼碎片的最終位置顯示髖臼相對于完整髂骨的內(nèi)旋和外展。經(jīng)兒童骨科手術(shù)基金會許可發(fā)表。

What Are the Early Outcomes of True Reverse Periacetabular Osteotomy for Symptomatic Hip Overcoverage?

Background: Acetabular overcoverage is associated with pincer-type femoroacetabular impingement (FAI). A subtype of acetabular overcoverage is caused by a deep acetabulum with a negatively tilted acetabular roof, in which acetabular reorientation may be a preferable alternative to rim trimming to uncover the femoral head. We introduced the true reverse periacetabular osteotomy (PAO) in 2003, which in contrast to an anteverting PAO, also flexes and abducts the acetabulum relative to the intact ilium to decrease anterior and lateral femoral head coverage and correct negative tilt of the acetabular roof. To our knowledge, the clinical results of the true reverse PAO have not been evaluated.

Questions/purposes: For a group of patients who underwent reverse PAO, (1) Do patients undergoing reverse PAO demonstrate short-term improvement in pain, function, and hip ROM, and decreased acetabular coverage, as defined by lateral and anterior center-edge angle and T?nnis angle? (2) Are there identifiable factors associated with success or adverse outcomes of reverse PAO as defined by reoperation, conversion to THA, or poor patient-reported outcome scores? (3) Are there identifiable factors associated with early complications?

Methods: Between 2003 and 2017, two surgeons carried out 49 reverse PAOs in 37 patients. Twenty-five patients had unilateral reverse PAO and 12 patients had staged, bilateral reverse PAOs. To ensure that each hip was an independent data point for statistical analysis, we chose to include in our series only the first hip in the patients who had bilateral reverse PAOs. During the study period, our general indications for this operation were symptomatic lateral and anterior acetabular overcoverage causing FAI that had failed to respond to previous conservative or surgical treatment. Thirty-seven hips in 37 patients with a median (range) age of 18 years (12 to 41; interquartile range 16 to 21) were included in this retrospective study at a minimum follow-up of 2 years (median 6 years; range 2 to 17). Thirty-four patients completed questionnaires, 24 patients had radiographic evaluation, and 23 patients received hip ROM clinical examination. However, seven patients had not been seen in more than 5 years. The clinical and radiographic parameters of all 37 hips that underwent reverse PAO in 37 patients from a longitudinally maintained institutional database were retrospectively studied preoperatively and postoperatively. Adverse outcomes were considered conversion to THA or a WOMAC pain score greater than 10 at least 2 years postoperatively. Patient-reported outcomes, radiographic measurements, and hip ROM were evaluated preoperatively and at most recent follow-up using a paired t-test or McNemar test, as appropriate. Linear regression analysis was used to assess for identifiable factors associated with clinical outcomes. Logistic regression analysis was used to assess for identifiable factors associated with adverse outcomes and surgical complications. All tests were two-sided, and p values less than 0.05 were considered significant.

Results: At a minimum of 2 years after reverse PAO, patients experienced improvement in WOMAC pain (-7 [95% CI -9 to -5]; p < 0.001), stiffness (-2 [95% CI -3 to -1]; p < 0.001), and function scores (-18 [95% CI -24 to -12]; p < 0.001) and modified Harris Hip Score (mHHS) (20 [95% CI 13 to 27]; p < 0.001). The mean postoperative hip ROM improved in internal rotation (8° [95% CI 2° to 14°]; p = 0.007). Acetabular coverage, as defined by lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), and T?nnis angle, improved by -8° (95% CI -12° to -5°; p < 0.001) for LCEA, -12° (95% CI -15° to -9°; p < 0.001) for ACEA, and 9° (95% CI 6° to 13°; p < 0.001) for T?nnis angle. The postoperative severity of radiographic arthritis was associated with worse WOMAC function scores such that for each postoperative T?nnis grade, WOMAC function score increased by 12 points (95% CI 2 to 22; p = 0.03). A greater postoperative T?nnis grade was also correlated with worse mHHS, with an average decrease of 12 points (95% CI -20 to -4; p = 0.008) in mHHS for each additional T?nnis grade. Presence of a positive postoperative anterior impingement test was associated with a decrease in mHHS score at follow-up, with an average 23-point decrease in mHHS (95% CI -34 to -12; p = 0.001). Nineteen percent (7 of 37) of hips had surgery-related complications. Four hips experienced adverse outcomes at final follow-up, with two patients undergoing subsequent THA and two with a WOMAC pain score greater than 10. We found no factors associated with complications or adverse outcomes.

Conclusion: The early clinical and radiographic results of true reverse PAO compare favorably to other surgical treatments for pincer FAI, suggesting that reverse PAO is a promising treatment for cases of pincer FAI caused by global acetabular overcoverage. However, it is a technically complex procedure that requires substantial training and preparation by a surgeon who is already familiar with standard PAO, and it must be carefully presented to patients with discussion of the potential risks and benefits. Future studies are needed to further refine the indications and to determine the long-term outcomes of reverse PAO.

文獻出處：Stephanie Y Pun, Shayan Hosseinzadeh, Roya Dastjerdi, Michael B Millis. What Are the Early Outcomes of True Reverse Periacetabular Osteotomy for Symptomatic Hip Overcoverage? Clin Orthop Relat Res. 2021 May 1;479(5):1081-1093. doi: 10.1097/CORR.0000000000001549.

文獻5

亞洲髖關(guān)節(jié)發(fā)育不良女性關(guān)節(jié)半脫位百分比與髖臼寬度的關(guān)系

譯者 徐子茵

背景： 將髖臼杯假體植入髖臼的“真實”位置是全髖關(guān)節(jié)置換術(shù)的基本原則，用于治療因髖關(guān)節(jié)發(fā)育不良 （DDH） 引起的繼發(fā)性骨關(guān)節(jié)炎。由于準確放置需要了解髖臼形態(tài)，因此我們研究了髖臼寬度與髖關(guān)節(jié)半脫位百分比的 Crowe 分類之間的關(guān)系。我們還分析了與髖臼寬度比 （AWR） 相關(guān)的因素，AWR 定義為發(fā)育不良髖關(guān)節(jié)的髖臼寬度除以未受影響的對側(cè)髖關(guān)節(jié)的髖臼寬度。

方法： 我們完成了對 207 名因單側(cè) DDH 接受初次全髖關(guān)節(jié)置換術(shù)的女性患者的術(shù)前標準前后位 X 光片和計算機斷層掃描 （CT） 掃描的回顧性評價。每次 CT 重建中的“真正”髖臼平面被定義為垂直于骨盆前平面、平行于淚滴線并穿過未受影響的對側(cè)股骨頭中心的平面。在真正的髖臼平面上測量受影響髖關(guān)節(jié)和對側(cè)參考髖關(guān)節(jié)的髖臼寬度，髖臼寬度定義為髖臼前壁和后壁邊緣之間的距離。所有髖關(guān)節(jié)均根據(jù)發(fā)育不良髖關(guān)節(jié)的半脫位百分比根據(jù) Crowe 分組進行分類;半脫位百分比從I組增加到IV組，IVb組出現(xiàn)關(guān)節(jié)脫位。

結(jié)果： 髖臼寬度從 Crowe 組 I 減小到 IVb，AWR 與半脫位百分比之間呈負相關(guān)（Spearman 相關(guān)系數(shù)，ρ = -0.404;p < 0.001）。多因素回歸分析確定半脫位百分比和股骨頸干角是與 AWR 相關(guān)的獨立因素。

結(jié)論： 半脫位百分比和股骨頸干角，將指導(dǎo)外科醫(yī)生在 DDH 患者的全髖關(guān)節(jié)置換術(shù)期間正確植入髖臼杯假體。

The Relationship Between Subluxation Percentage of the Femoroacetabular Joint and Acetabular Width in Asian Women with Developmental Dysplasia of the Hip

Background: Implantation of the acetabular cup insert in the "true" location of the acetabulum is a fundamental principle of total hip arthroplasty for the treatment of secondary osteoarthritis due to developmental dysplasia of the hip (DDH). As knowledge of the morphology of the acetabulum is required for accurate placement, we investigated the relationship between acetabular width and the Crowe classification of subluxation percentage of the hip. We also analyzed factors associated with the acetabular width ratio (AWR), defined as the acetabular width of the dysplastic hip divided by that of the unaffected, contralateral hip.

Methods: We completed a retrospective review of the preoperative standard anteroposterior radiographs and computed tomography (CT) scans of 207 female patients who underwent primary total hip arthroplasty for unilateral DDH. The "true" acetabular plane was defined on each CT reconstruction as a plane perpendicular to the anterior pelvic plane, parallel to the teardrop line, and passing through the center of the femoral head on the unaffected, contralateral side. The acetabular width was measured for both the affected hip and the contralateral, reference hip on the true acetabular plane, with the acetabular width defined as the distance between the edges of the anterior and posterior walls of the acetabulum. All hips were classified according to the Crowe groupings on the basis of the subluxation percentage of the dysplastic hip; the subluxation percentage increased from groups I to IV, with group IVb showing joint dislocation.

Results: The acetabular width decreased from Crowe groups I to IVb, with a negative correlation found between the AWR and the subluxation percentage (Spearman correlation coefficient, ρ = -0.404; p < 0.001). Multivariate regression analysis identified subluxation percentage and femoral neck-shaft angle as independent factors associated with the AWR.

Conclusions: Characterization of factors associated with the AWR, namely subluxation percentage and femoral neck-shaft angle, will guide surgeons in correctly implanting the acetabular cup insert during total hip arthroplasty in patients with DDH.

文獻來源：Okuzu Y, Goto K, Kawata T, So K, Kuroda Y, Matsuda S. The Relationship Between Subluxation Percentage of the Femoroacetabular Joint and Acetabular Width in Asian Women with Developmental Dysplasia of the Hip. J Bone Joint Surg Am. 2017;99(7):e31. doi:10.2106/JBJS.16.00444

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團隊

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