髖膝關節文獻精譯薈萃（第366期）

本期目錄：

1、在接受膝關節或髖關節置換術的患者中使用運動肌貼的效果：隨機對照試驗的系統回顧和薈萃分析

2、全髖關節置換術后，局部抗生素注射治療假肢周圍關節感染

3、髖、膝骨關節炎的注射治療

4、既往膝關節手術會增加膝關節置換術后翻修、感染、疼痛和僵硬的風險

5、全膝關節置換術中的手術考量、手術技術、療效以及未來展望的綜合綜述

6、髖關節超聲篩查正常并不能完全排除DDH：仍需后期的隨訪

7、無論診斷為股骨髖臼撞擊綜合征還是髖關節發育不良，坐位髖部疼痛均比站立位疼痛更常見

8、沙特阿拉伯朱夫省髖關節發育不良患病率

9、髖臼周圍截骨術治療成人髖關節發育不良

10、股骨頭骨壞死與軟骨下不全骨折外側塌陷病灶的微觀結構特征差異

第一部分：關節置換及保膝相關文獻

文獻1

在接受膝關節或髖關節置換術的患者中使用運動肌貼的效果：隨機對照試驗的系統回顧和薈萃分析

譯者 張軼超

目的：評估運動肌貼對膝關節或髖關節置換術后疼痛、水腫、活動范圍和關節功能的影響。

方法：檢索8個數據庫截至2024年1月9日的數據。包括膝關節或髖關節置換術后接受康復治療的患者。干預組采用肌內效貼貼扎配合術后康復治療，對照組僅采用術后康復治療。膝關節置換術患者的預后評估包括疼痛、水腫、活動范圍和特種外科醫院膝關節評分。對于髖關節置換術，效果主要集中在疼痛上。

結果：符合納入標準的包括11項隨機對照試驗納入774名受試者。在膝關節置換術患者中，運動肌貼可顯著減輕疼痛（標準化平均差[SMD]= -0.53, 95% CI -0.91至-0.14,p=0.007），降低大腿（SMD= -0.38, 95% CI -0.65至-0.12,p=0.005）和踝關節周徑（SMD= -0.53, 95% CI -0.95至-0.12,p=0.01）。改善了總的活動范圍（SMD=1.26, 95% CI 0.93 ~ 1.60, p<0.00001）和特種外科醫院膝關節評分（SMD=2.17, 95% CI 1.70 ~ 2.65, p<0.00001）。髖關節置換術患者疼痛強度無明顯降低（p=0.25）。

結論：肌內效貼敷聯合術后康復能有效減輕膝關節置換術患者的水腫和疼痛，改善關節功能，但不能減輕髖關節置換術后患者的疼痛。

EFFECTS OF KINESIO TAPING IN PATIENTS UNDERGOING KNEE OR HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objective: To assess the effects of kinesio taping on pain, oedema, range of motion, and joint function following knee or hip arthroplasty.

Methods: Eight databases were searched up to 9 January 2024. Patients undergoing rehabilitation after knee or hip arthroplasty were included. The intervention group received kinesio taping with postoperative rehabilitation, while the control group received postoperative rehabilitation alone. Outcomes for knee arthroplasty patients, included pain, oedema, range of motion, and the Hospital for Special Surgery knee score. For hip arthroplasty, the outcome focused on pain.

Results: Eleven randomized controlled trials involving 774 participants met the inclusion criteria. In knee arthroplasty patients, kinesio taping significantly reduced pain (standardized mean difference [SMD]=–0.53, 95% CI –0.91 to –0.14, p=0.007), and relieved thigh (SMD=–0.38, 95% CI –0.65 to –0.12, p=0.005) and ankle circumferences (SMD=–0.53, 95% CI –0.95 to –0.12, p=0.01). It improved the total range of motion (SMD=1.26, 95% CI 0.93 to 1.60, p<0.00001) and Hospital for Special Surgery knee score (SMD=2.17, 95% CI 1.70 to 2.65, p<0.00001). No significant pain intensity reduction was observed in hip arthroplasty patients (p=0.25).

Conclusion: Kinesio taping combined with postoperative rehabilitation effectively reduces oedema and pain, and improves joint function in knee arthroplasty patients, but does not alleviate pain in patients following hip arthroplasty.

文獻出處：Mei T, Shuai Y, Wu D, Yu H. Effects of kinesio taping in patients undergoing knee or hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Rehabil Med. 2025 Feb 5;57:jrm40784. doi: 10.2340/jrm.v57.40784. PMID: 39907217; PMCID: PMC11812274.

文獻2

全髖關節置換術后，局部抗生素注射治療假肢周圍關節感染

譯者 馬云青

局部抗生素輸注作為一種前景廣闊的輔助療法，可通過將高濃度抗生素直接遞送至感染部位，在減少長期全身用藥相關副作用的同時增強病原體清除效果。本文通過納入10篇文獻，對全髖關節置換術后假體周圍感染（PJI）的三種手術方式——清創+抗生素灌洗+假體保留（DAIR）、單階段翻修術和兩階段翻修術進行了敘述性綜述。最新研究顯示，接受DAIR治療的患者成功率可達90%-100%，單階段翻修術為82%-100%，兩階段翻修術成功率約為80%。在全髖關節置換術后PJI的治療中，聯合使用局部抗生素輸注輔助手術治療可顯著提高成功率，并有效降低腎毒性等全身性并發癥風險。后續仍需開展高質量隨機對照試驗進一步驗證和優化治療方案，以確保持續有效的治療效果與安全性。

Local Antibiotic Infusion in Periprosthetic Joint Infection Following Total Hip Arthroplasty

Local antibiotic infusion has emerged as a promising adjunctive therapy, delivering high concentrations of antibiotics directly to the infection site. This approach aims to enhance eradication of pathogens while minimizing systemic side effects associated with prolonged antibiotic use. This narrative review encompassed 10 articles focused on all three procedures of surgical intervention for periprosthetic joint injection (PJI) following total hip arthroplasty (THA): debridement, antibiotics, and implant retention (DAIR), single-stage revision arthroplasty, and two-stage revision arthroplasty. Recent studies report success rates ranging from 90 to 100% in patients undergoing DAIR, 82 to 100% in single-stage revision arthroplasty, and 80% in two-stage revision arthroplasty. The adjunctive use of local antibiotic infusion alongside surgical treatment for PJI following THA provides high success rates and is associated with low systemic complications, such as renal toxicity. Further research, particularly high-quality randomized controlled trials (RCTs), is warranted to validate and refine treatment protocols, ensuring consistent efficacy and safety.

文獻出處：Jarusriwanna A, Mu W, Parvizi J. Local Antibiotic Infusion in Periprosthetic Joint Infection Following Total Hip Arthroplasty. J Clin Med. 2024 Aug 16;13(16):4848. doi: 10.3390/jcm13164848. PMID: 39200989; PMCID: PMC11355570.

文獻3

髖、膝骨關節炎的注射治療

譯者 張薔

I 激素注射絕大多數時候是安全的，但醫生和患者均需要留心其可能出現的副作用和有限的作用時間。此外，注射的時間應與手術時間協調好。

II 不推薦把玻璃酸鈉注射作為骨關節炎的常規治療，但有一部分其他治療失敗的患者會從中受益。

III 局麻藥常與激素聯用加強鎮痛；但由于其潛在的軟骨毒性，臨床上應謹慎使用。把握患者適應證十分重要，且不推薦擴大其診斷性目的的應用范圍。

IV 目前，既往文獻中并無充足證據支持增生注射療法、骨髓穿刺提取物注射療法、脂肪組織血管基質注射療法和間充質干細胞注射療法的臨床常規應用。

V 關節內注射生理鹽水常作為對照組出現在臨床研究中，但近期文獻顯示關節內注射生理鹽水可以明顯改善患者的疼痛評分和功能評分，術者應在未來的研究設計中加入此項考量。

Injection-Based Therapies for the Management of Hip and Knee Osteoarthritis

Corticosteroid injections are largely safe, but patients and practitioners should be aware of the small risk of adverse side effects, and their limited duration of efficacy. The timing of injection should be coordinated with potential surgical dates.

The routine use of hyaluronic acid injections for osteoarthritis is not recommended, but there are certain subsets of patients, such as those who have undergone other therapies that failed, who may benefit from it.

Local anesthetics are frequently used in conjunction with corticosteroids for enhanced pain control; however, caution is needed because of concerns regarding chondrotoxicity. Proper patient selection is crucial, and their overuse for diagnostic purposes is not recommended.

There is currently insufficient evidence to support the routine use of prolotherapy, bone marrow aspirate concentrate, stromal vascular fraction, and mesenchymal stromal cell injections.

Intra-articular saline solution has been associated with improvements in both patient-reported pain and function scores, and this should be considered in future study designs.

文獻4

既往膝關節手術會增加膝關節置換術后翻修、感染、疼痛和僵硬的風險：系統評價和薈萃分析

譯者 丁云鵬

背景： 膝關節置換術 （KRA），包括全膝關節置換術 （TKA） 和單間室膝關節置換術 （UKA），是治療終末期膝骨關節炎 （KOA） 的主要方法。然而，既往膝關節手術史（如膝關節鏡檢查、韌帶重建、半月板切除術、脛骨高位截骨術等）可能會影響膝關節置換術后的功能恢復和并發癥風險。盡管一些研究提出了這種關聯，但現有證據仍存在爭議，并且缺乏系統的定量分析。本研究旨在評估既往膝關節手術對 KRA 后功能結果和并發癥的影響。

方法： 根據 PRISMA 指南，在 PubMed、Embase、Cochrane Library 和 Web of Science 數據庫中進行了系統檢索，檢索了截至 2024 年 8 月 4 日的相關研究。在有和沒有既往膝關節手術史的患者中評估了初次 KRA 后的人口統計學數據、術后并發癥和功能變化。使用Stata 15.1軟件對納入的研究進行統計分析。紐卡斯爾-渥太華量表 （NOS） 用于評估研究的質量。

結果： 這項meta分析納入了28項研究，涉及703,103名患者（35,535名既往有膝關節手術史，667,568名原發性KRA患者）。與初次膝關節手術組相比，既往膝關節手術組假體無菌翻修率（RR（95%CI）=1.45（1.18-1.78））顯著更高（相對風險，RR;置信區間，CI）、感染（RR（95%CI）=1.36（1.11-1.67））、膝關節僵硬（RR（95%CI）=1.73（1.02-2.96））和膝關節疼痛（RR（95%CI）=1.21（1.08-1.34））。然而，膝關節社會評分（KSS）功能變化（WMD（95%CI）=-0.51（-1.73至0.72））（加權平均差，WMD）、KSS疼痛評分（WMD（95%CI）=0.41（-2.97至3.79））或其他膝關節功能評分的變化無統計學意義。

結論： 既往有膝關節手術史的患者進行假體翻修的可能性更高，手術部位感染或假體周圍感染的風險更大，并且 KRA 后膝關節僵硬和膝關節疼痛的發生率顯著更高。

Previous knee surgery increases risks of revision, infection, pain and stiffness after knee replacement arthroplasty: a systematic review and meta-analysis

Knee replacement arthroplasty(KRA), including Total knee arthroplasty (TKA) and Unicompartmental knee arthroplasty (UKA), is the primary method for treating end-stage knee osteoarthritis (KOA). However, a history of previous knee surgeries (such as knee arthroscopy, ligament reconstruction, meniscectomy, high tibial osteotomy, etc.) may potentially affect functional recovery and complication risks after knee replacement. Although some studies have proposed such associations, the existing evidence remains controversial, and there is a lack of systematic quantitative analysis. This study aims to assess the impact of previous knee surgery on functional outcomes and complications following KRA. Methods

Following the PRISMA Guidelines, a systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases up to August 4, 2024, for relevant studies. Demographic data, postoperative complications, and functional changes after primary KRA were evaluated in patients with and without a history of previous knee surgery. Statistical analysis of the included studies was performed using Stata 15.1 software. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.

Results

This meta-analysis included 28 studies with 703,103 patients (35,535 with a history of previous knee surgery and 667,568 primary KRA patients). Compared to the primary knee surgery group, the previous knee surgery group had significantly higher rates of prosthetic aseptic revision (RR(95%CI) = 1.45 (1.18–1.78)) (relative risk, RR; Confidence Interval, CI), infection (RR(95%CI) = 1.36 (1.11–1.67)), knee stiffness (RR(95%CI) = 1.73 (1.02–2.96)), and knee pain (RR(95%CI) = 1.21 (1.08–1.34)). However, there were no significant differences in changes in Knee Society Score (KSS) function (WMD(95%CI) = -0.51 (-1.73 to 0.72)) (weighted mean difference, WMD), KSS pain score (WMD(95%CI) = 0.41 (-2.97 to 3.79)), or other knee function scores

Conclusion

Patients with a history of previous knee surgery have a higher likelihood of prosthetic revision, a greater risk of surgical site infections or periprosthetic infections, and a significantly higher incidence of knee stiffness and knee pain following KRA.

文獻出處Yanlun Li1 , Asha Ajia1and Pingxi ，Fan1Previous knee surgery increases risks of revision, infection, pain and stiffness after knee replacement arthroplasty: a systematic review and meta-analysis.Li et al. BMC Musculoskeletal Disorders (2025) 26:869.

文獻5

全膝關節置換術中的手術考量、手術技術、療效以及未來展望的綜合綜述

譯者 沈松坡

全膝關節置換術（TKA）仍然是治療膝關節終末期骨關節炎的金標準外科手術，這種疾病影響著全球數以百萬計的患者，并是致殘的重要原因之一。隨著患病率的上升，TKA 手術的數量也持續增加。本綜述涵蓋了手術歷史、假體選擇、圍手術期指南以及塑造 TKA 未來發展的相關技術。

我們對已發表文獻中關于 TKA 的多個方面進行了全面的敘述性綜述。重點比較的領域包括：有水泥與無水泥固定方式、活動平臺與固定平臺、后穩定型與超吻合型設計、單半徑與多半徑股骨設計等。綜述內容涵蓋術前優化、對線方法、機器人及傳感器輔助手術、術后康復以及療效。數據來源于經過同行評議的期刊、隨機對照試驗、臨床試驗以及系統綜述。

有水泥固定的 TKA 仍是主流，但在年輕患者中，無水泥固定的效果與其相當。活動平臺設計可能在功能上具有輕微優勢，而新型設計（如內側樞軸型假體）旨在優化膝關節運動學表現。機器人和傳感器系統提高了假體植入的精準度和軟組織平衡度，在短期內可帶來功能改善、減少誤差與減少失血的優勢。然而，長期結果（包括假體耐久性和持續功能）仍不確定。術前狀態的優化與患者教育對術后恢復有重大影響，而微創入路通常帶來更早期的功能優勢。諸多新興進展，如人工智能輔助手術、日間關節置換以及 3D 患者特異性打印假體，可能對 TKA 的規劃與實施產生積極影響。但這些技術的廣泛應用受到高成本、可及性有限以及需更多大樣本長期研究驗證的限制。

在這些技術能夠無縫納入標準臨床流程之前，這些證據空缺必須得到填補。然而，上述技術與方法仍需進一步研究來確認其有效性與安全性。盡管 TKA 的效果依然卓越，但持續改進技術、器械以及患者選擇仍然是實現最優長期療效并減少并發癥的關鍵。

關鍵詞： 假體設計、術后結果、術前優化、機器人輔助手術、手術技術、全膝關節置換

A Comprehensive Review of Operative Considerations, Surgical Techniques, Outcomes, and Future Perspectives in Total Knee Arthroplasty

Total knee arthroplasty (TKA) is still the gold-standard operative procedure for treating end-stage knee osteoarthritis, a disease impacting millions of patients worldwide and a key contributor to disability. As prevalence rates rise, the number of TKA procedures continues to increase. This review covers surgical procedure history, implant choices, perioperative guidelines, and technologies shaping TKA's future.

We performed a comprehensive narrative review of published literature on several aspects of TKA. Significant areas of comparison include cemented versus cementless fixation, mobile versus fixed bearing, posterior-stabilized versus ultra-congruent design, and single-radius versus multi-radius femoral design. The review encompasses preoperative optimization, alignment methods, robotic and sensor-aided surgery, postoperative rehabilitation, and outcomes. The data were collected from peer-reviewed journals, randomized controlled trials, clinical trials, and systematic reviews.

Cemented TKA remains the norm, but a cementless approach has equivalent outcomes in younger patients. Subtle functional benefits may exist with mobile-bearing designs, and newer designs, such as medial pivot implants, aim at optimizing kinematics. Robotic and sensor systems enhance implant accuracy and soft-tissue balance, providing short-term benefits such as improved function, reduced errors, and decreased blood loss. However, long-term outcomes, including implant durability and sustained function, remain uncertain. Optimizing the preoperative state and providing patient education have a significant impact on the postoperative state, and an early functional advantage is often associated with minimally invasive approaches. Several upcoming advancements, like AI-assisted surgery, outpatient arthroplasty, and 3D patient-specific printed implants, could positively influence the planning and execution of TKA. Nonetheless, their broad adoption is hindered by high costs, limited accessibility, and the requirement for additional validation via extensive, long-term studies.

These evidence gaps need to be filled before such technologies can be seamlessly incorporated into standard clinical routines. However, the aforementioned technologies and approaches require further studies to confirm their efficacy and safety. While TKA outcomes remain excellent, the continuous improvement of techniques, devices, and patient selection remains crucial to achieving optimal long-term outcomes with fewer complications.

Keywords: implant design; postoperative outcomes; preoperative optimization; robotic-assisted surgery; surgical techniques; total knee arthroplasty.

第二部分：保髖相關文獻

文獻1

髖關節超聲篩查正常并不能完全排除DDH：仍需后期的隨訪

譯者 任寧濤

無論是選擇性髖關節超聲篩查還是普遍性髖關節超聲篩查都推進了DDH的篩查，一些學者提出了遲發型DDH的可能性，因此建議后期進行影像學隨訪。

目的

選取我院生后6周行髖關節超聲檢查為正常髖關節的兒童，對其6月齡時進行影像學檢查評估髖關節情況， 并對其影響學結果進行記錄。

方法

對2015年1月-12月的嬰幼兒髖關節超聲進行回顧性研究，納入有超聲篩查，并且為正常髖關節的，以及6月齡行影像學檢查的嬰幼兒。

結果

共納入839名嬰幼兒，63名（8%）在6月齡行影像學檢查時診斷為DDH，占研究期間所有DDH 的34%，63名患兒有5名失隨訪，58名患兒行Boston支具治療，4名患兒未見好轉，行進一步檢查治療。后期截骨率超聲正常影像學異常的為2%，超聲檢查為髖關節不穩的為6%，超聲檢查確診的為3%。

結論

髖關節超聲檢查正常，6月齡時影像學檢查有8%的嬰幼兒為DDH，當年我院DDH發生率為34%，因此即便髖關節超聲正常，我們仍建議生后6個月時行影像學檢查。

A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia further follow-up is required

Background: Screening for developmental hip dysplasia (DDH) continues to evolve with the use of ultrasound (US) in either selective or universal screening methods. The possibility of delayed evidence of DDH, and thus the need for radiographic follow-up at a later stage of development have been suggested by some authors.

Aims: The aim of this review was to evaluate the number of patients in our hospital network with a normal screening US at 6 weeks with evidence of DDH at the time of radiographic review at 6 months. Secondary aim; to determine the outcomes for these patients.

Methods: A retrospective review was done to infants undergoing DDH ultrasound screening between January and December 2015. Initial US and radiographs at 6 months were reviewed. Patients with normal screening US who had subsequent radiographs were included for analysis.

Results: In total, there were 829 patients included for analysis. Sixty-three patients (8%) had evidence of DDH at 6 months, representing 34% of all DDH diagnoses for the study period. Five of the 63 patients were lost to follow-up. The remaining 58 babies were treated in Boston bracing. Four patients with evidence of persistent DDH were referred for tertiary review. The osteotomy rate in the radiograph diagnosed group was 2%, versus 6% and 3% in the unstable and US diagnosed groups, respectively.

Conclusion: Eight percent of patients with a normal screening US had evidence of DDH at time of radiograph at 6 months, reflecting 34% of all our DDH cases for the year. Based on these findings, patients in our hospital network undergo radiographic evaluation at 6 months even if the initial screening US is normal.

文獻出處：Jill Mulrain , Jennifer Hennebry , Patrick Dicker , James Condren , Donal O'Driscoll , Joseph O'Beirne. A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia further follow-up is required. Ir J Med Sci. 2021 Feb;190(1):233-238.

文獻2

無論診斷為股骨髖臼撞擊綜合征還是髖關節發育不良，坐位髖部疼痛均比站立位疼痛更常見：一項前瞻性對比研究

譯者 李勇

目的：探討“坐位 vs 站立位髖部疼痛”與“股骨髖臼撞擊綜合征 (FAIS) vs 髖關節發育不良”這兩種主要診斷之間是否存在潛在關聯。

方法：自2023年9月起，研究者前瞻性地詢問所有首診于保髖門診的新患者：“您是長時間坐著時髖部更痛，還是長時間站立時更痛？”。根據主要診斷（FAIS或髖關節發育不良），將患者分為兩組。主要診斷基于病史、體格檢查和影像學資料的綜合判斷。對于同時患有FAIS和發育不良的患者，如果他們被推薦接受髖臼周圍截骨術（PAO），則將其主要診斷歸為發育不良；但同時患有發育不良和巨大Cam（凸輪）畸形的患者被排除在外。本研究采用 Logistic 回歸分析來確定是否存在任何變量與“坐位 vs 站立位疼痛”顯著相關。

結果：研究共納入115名患者（118髖），包括30名男性和88名女性。其中，FAIS診斷為71髖，髖關節發育不良診斷為47髖。患者初次就診時的平均年齡為34歲。總體而言，無論診斷為何，坐位疼痛（n = 74; 62.7%）均比站立位疼痛（n = 44; 37.3%）更為常見。FAIS組與髖關節發育不良組在經歷“坐位 vs 站立位疼痛”的幾率上，未見統計學差異（P = .85）。此外，也無證據表明年齡、性別、LCE角（外側中心邊緣角）、股骨扭轉角或Alpha角與“坐位 vs 站立位疼痛”的發生幾率相關。

結論：無論患者診斷為FAIS還是髖關節發育不良，坐位疼痛均比站立位疼痛更常見。目前沒有證據表明 FAIS 與坐位疼痛、或發育不良與站立位疼痛之間存在特定關聯。

Sitting Pain Is More Common Than Standing Hip Pain Regardless of Diagnosis of Femoroacetabular Impingement Syndrome Versus Hip Dysplasia: A Prospective Comparative Study

Purpose: To explore a possible correlation between sitting versus standing hip pain and a primary diagnosis of femoroacetabular impingement syndrome (FAIS) versus hip dysplasia.

Methods: All new patients presenting to a hip preservation clinic starting in September 2023 were prospectively asked, "Do you have more hip pain with sitting or standing for a long time?" Patients were divided into two groups based on primary diagnosis: FAIS or hip dysplasia. Primary diagnosis was based on a combination of history, physical examination, and imaging. Patients with concomitant FAIS and dysplasia were given a primary diagnosis of dysplasia if they were recommended to undergo a periacetabular osteotomy (PAO), although patients with concomitant dysplasia and a large cam lesion were excluded. Logistic regression analysis was performed to determine if any variables were significantly associated with sitting versus standing hip pain.

Results: A total of 115 patients (118 hips) were included (30 male, 88 female). FAIS and hip dysplasia were the diagnoses in 71 and 47 hips, respectively. Mean age at initial presentation was 34 years. Overall, regardless of diagnosis, sitting pain (n = 74; 62.7%, 95% CI 53.7-70.9) was found to be more likely than standing hip pain (n = 44; 37.3%, 95% CI 29.1-46.3). There was no evidence of a difference in the odds of experiencing sitting versus standing hip pain between the FAIS and hip dysplasia groups (P = .85). There was also no evidence that age, sex, lateral center edge angle, femoral torsion angle, or alpha angle contribute to the odds of experiencing sitting versus standing pain.

Conclusions: Sitting pain is more common than standing hip pain regardless of diagnosis of FAIS versus hip dysplasia, with no evidence of an association between FAI/sitting pain and dysplasia/standing pain.

文獻出處：Kraeutler MJ, Nguyen BQ, Keeter C, Jamar KSJ, Samuelsson K, Lee JH, Mei-Dan O. Sitting Pain Is More Common Than Standing Hip Pain Regardless of Diagnosis of Femoroacetabular Impingement Syndrome Versus Hip Dysplasia: A Prospective Comparative Study. Arthrosc Sports Med Rehabil. 2025 Mar 13;7(3):101116. doi: 10.1016/j.asmr.2025.101116. PMID: 40692926; PMCID: PMC12276537.

文獻3

沙特阿拉伯朱夫省髖關節發育不良患病率

譯者 賈海港

背景： 髖關節發育不良是一種廣泛存在且致殘的肌肉骨骼疾病，影響兒童群體。其發病率在不同國家存在差異。

目的： 評估朱夫省兒童群體中發育性髖關節發育不良（DDH）的患病率。

方法： 本回顧性橫斷面研究納入 2018 年 1 月至 2023 年 12 月期間朱夫省所有城市患有發育性髖關節脫位的兒童。計算了該省整體及轄區內各城市的疾病患病率。

結果： 該研究納入了 427 名 DDH 患者，總患病率為 0.50%，即每 1000 名活產兒中有 5.0 例。在城市層面，薩卡卡（Sakaka）的患病率最高，為每 1000 名活產兒 14.2 例，其次是庫賴亞特（Qurayyat），為每 1000 名活產兒 2.2 例。相比之下，蘇韋爾（Suwayr）、阿布阿杰拉姆（Abu Ajram）和米戈瓦（Meegowa）等城市未出現 DDH 病例。在不同城市之間，社會人口學特征（如年齡、性別和國籍）存在顯著差異（P < 0.05）。

結論： 阿爾朱夫省的先天性髖關節發育不良患病率較高。該數據為阿爾朱夫地區先天性髖關節發育不良的流行病學研究提供了寶貴見解。研究結果強調了在全省范圍內開展針對性篩查的必要性。

關鍵詞： 阿爾朱夫；發育性髖關節發育不良；流行病學；患病率；沙特阿拉伯。

Prevalence of developmental dysplasia of the hip in Al Jouf province, Saudi Arabia

Background:Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children. Its prevalence varies across different nations.

Aim:To evaluate the prevalence of developmental hip dysplasia (DDH) within the pediatric population of Al Jouf province.

Methods:From January 2018 to December 2023, children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study. The disease prevalence was calculated for the entire province as well as for individual cities within the territory.

Results:The study included 427 patients with DDH with an overall prevalence of 0.50%, or 5.0 per 1000 live births. At the city level, Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births. In contrast, cities like Suwayr, Abu Ajram, and Meegowa did not show any incidence of DDH. Significant differences were observed in the sociodemographic characteristics, such as age, sex, and nationality, across the different cities (P < 0.05).

Conclusion:The prevalence of DDH in the Al Jouf province is high. The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality. The findings highlight the need for targeted screening of DDH across the province.

Keywords: Al Jouf; Developmental dysplasia of the hip; Developmental hip dysplasia; Epidemiology; Prevalence; Saudi Arabia.

文獻出處：Alanazi ZA, Alshammari AM, Alruwaili RM, Alnasser RM, Alkhalifah HN, Alakkas EA. Prevalence of developmental dysplasia of the hip in Al Jouf province, Saudi Arabia. World J Orthop. 2025 Jun 18;16(6):107423. doi: 10.5312/wjo.v16.i6.107423. PMID: 40547240; PMCID: PMC12179865.

文獻4

髖臼周圍截骨術治療成人髖關節發育不良

譯者 陶可

成人髖關節發育不良會導致髖關節因髖臼軟骨缺損或力線錯位而出現力學功能障礙。髖臼覆蓋不足和力線錯位會導致髖關節內力學傳遞異常，進而引起病理性軟骨應力集中。病理性軟骨應力集中會隨時間累積，影響軟骨代謝。維持健康軟骨的正常合成代謝/分解代謝平衡被打破，導致分解代謝酶活性升高。促炎酶的產生也增加。這些代謝和炎癥變化會導致關節疼痛和局部軟骨退變。局部軟骨丟失會加劇異常應力傳遞，形成病理性力學級聯反應，最終導致軟骨進一步丟失。軟骨丟失導致剩余軟骨應力增加，進而導致軟骨進一步丟失，最終發展為關節軟骨廣泛破壞和終末期骨關節炎，形成惡性循環。成人髖關節發育不良是成人髖臼覆蓋不足和力線不良的最常見原因，但其他原因，例如髖臼后傾、Perthes病和創傷，也可能導致類似的病理改變。

無論病因如何，引發髖關節炎的病理力學級聯反應的誘發因素是髖關節覆蓋不足、髖臼對線不良或二者共同作用導致的異常應力傳遞。由于成人髖關節發育不良(AHD)是最常見的病因，本文將重點討論成人髖關節發育不良的髖臼手術矯正。典型的成人髖關節發育不良特征是髖臼淺，無法完全覆蓋股骨頭。髖臼覆蓋存在外側、前側和后側的缺損。此外，髖關節發育不良可能伴有對線不良，通常表現為過度后傾。每位患者的髖關節發育不良和對線不良情況各不相同，需要仔細評估以確定最佳治療方案。普通X線片結合計算機斷層掃描（CT）和磁共振成像（MRI）等先進影像技術，可為主治醫生提供必要的畸形信息。

成人髖關節發育不良手術的目標是將髖臼重新調整到最佳力學位置。需要注意的是，髖臼矯正手術并不能使髖臼恢復正常。該手術旨在重新調整異常淺的髖臼位置，以優化關節應力傳遞。外科醫生已設計出多種手術方法來矯正髖臼。以往的髖臼截骨術包括沿髖臼內側切開上支，沿髖臼下方切開坐骨，最后沿髖臼上方切至坐骨大切跡。這些手術雖然能完全活動髖臼，但由于將后柱與骨盆完全分離，導致骨盆環不穩定。術后恢復期延長和骨不連的發生促使人們發展出保留后柱的截骨術。這類手術旨在恢復髖臼的活動度，以便進行復位，同時又不破壞骨盆的穩定性。最初由Reinhold Ganz描述的伯爾尼髖臼周圍截骨術（PAO）（該手術通常被稱為“Ganz截骨術”）已成為應用最廣泛的保留后柱的髖臼截骨術。

髖臼重建的力學目標是通過增加受累髖關節的接觸面積來降低關節面接觸應力。一些研究者已建立了髖關節發育不良的生物力學模型。例如，一項研究發現，在發育不良髖關節中，累積異常應力超過10 MPa年（假設異常應力的閾值為2 MPa）可預測地導致一組隨訪數10年的患者發生髖骨關節炎。一些研究者已證實，采用伯爾尼髖臼周圍截骨術（PAO）進行髖臼重建可顯著降低接觸應力。例如，一項研究利用離散元分析技術對正交X線片進行分析，發現伯爾尼PAO使12例患者的接觸應力降低了1.7倍。另一項研究采用立體學方法對6例接受髖臼周圍截骨術（PAO）患者的CT掃描圖像進行分析，結果表明髖臼重新定位可將承重面積從7.4 cm2增加到11.0 cm2。近期研究表明，伯爾尼PAO可通過降低步態過程中的髖關節加速度來改善髖關節的機械穩定性。使用三軸加速度計測量結果顯示，患者術前的髖關節加速度為2.30 m/s2，術后1年降至1.55 m/s2。

伯爾尼PAO最初是通過髖關節前側入路進行的。手術過程中，需將髖臼周圍的肌肉從骨盆中分離出來，包括進行廣泛的解剖。分離闊筋膜張肌、髂肌和股直肌。完全切斷恥骨上支，然后在髖臼下方，經坐骨向坐骨棘方向進行不完全切開（切開方向不穿透后柱后部）。隨后，從髂前下棘上方開始，向后、內側和下方切開髖臼上方的骨組織，直至坐骨大切跡。此切口止于骨盆緣下方（再次保持后柱的完整性）。最后，通過主要穿過髖臼后緣和后柱后緣之間四邊體的切口會師，將髖臼上方的切口與穿過坐骨下方的切口連接起來。將游離的髖臼重新定位到最佳位置，并用內固定固定。在Ganz最初的描述中，他為75名患者實施了該手術，首例手術于1984年進行。早期并發癥極少。

伯爾尼髖臼周圍截骨術（Bernese PAO）已成為應用最廣泛的保留后柱的髖臼截骨術。Ganz最初手術的75例患者的11年隨訪結果顯示，82%的髖關節得以保留。其中73%的患者術后功能良好或極佳。手術時年齡較小以及骨關節炎病變輕微或無病變是預測手術成功的最佳因素。近期，研究人員對Ganz最初報告的75例髖關節中的68例進行了20年隨訪評估。結果顯示，68例髖關節中有41例得以保留（60%）。預測長期成功的因素包括：初次手術時髖關節關節炎程度較輕、手術時年齡較小、術后未因過度矯正而出現撞擊綜合征，以及側方覆蓋充分。總之，采用該技術治療的最初期的患者群體獲得了60%的長期成功率。初次手術時患有中度至重度關節炎的患者預后較差。研究人員還發現，矯正效果不佳，尤其是過度矯正導致撞擊綜合征的患者，預后也較差。最后，初次手術時年齡小于35歲的患者預后更佳。

自該手術最初描述以來，該技術已發展出一些細微的改進。現在通常會保留骨盆外壁的肌肉，使闊筋膜張肌和臀中肌保持完整。該手術操作簡便，無需分離股直肌，從而進一步減少了解剖過程中對軟組織的損傷。這些改進顯著減少了異位骨化的形成，并加快了肌肉恢復。一些作者報道了經髂腹股溝入路行伯爾尼髖臼周圍截骨術（Bernese PAO）。然而，手術時間較長，出血量較多，且易發生股動脈血栓形成。這種入路已被基本棄用。近期，有報道采用經縫匠肌的有限開放式入路，切口僅4～5 cm。作者指出，該方法可實現充分矯正，且并發癥極少。然而，這些結果尚未得到重復驗證。

一些作者報道了與Ganz團隊最初報告的病例相似的中期結果。在術后平均隨訪9年的135例髖關節中，76%的髖關節得以保留。預測手術成功的因素包括患者年齡小于35歲，以及術前髖關節匹配良好且退行性改變輕微。在另一項研究中，116例髖關節中82%在術后平均9年仍保持完整。作者再次發現，術前骨關節炎是手術失敗的預測因素。此外，放射學征象所顯示的原發性髖關節發育不良的嚴重程度，包括髖臼緣短、股骨頭半脫位和髖臼邊緣骨贅形成，也是預后不良的預測因素。其他中心報告的短期和中期結果也顯示出非常相似的療效。

雖然大多數作者都認為，手術時放射學顯示的髖關節退變程度和發育不良的嚴重程度直接影響髖臼周圍截骨術（PAO）的療效，但對于手術時患者年齡如何影響療效，目前尚無定論，證據也存在爭議。一些研究表明，年齡超過35-40歲是預后不良的指標。然而，也有研究報告稱，年齡高達55歲的患者也取得了良好的療效。然而，對于這組老年患者而言，髖關節關節面吻合良好且退變程度極輕或無退變似乎是確保良好療效的必要條件。

總之，伯爾尼髖臼周圍截骨術（Bernese PAO）已成為最常用的保留后柱的髖臼重建截骨術。該手術旨在重建髖臼（對股骨頭的良好覆蓋關系）。

圖1 女性，39歲，雙側髖關節發育不良，右側髖關節疼痛4年余，術前雙髖關節正位X線片

圖2 上述患者術后第2天雙髖關節正位X線片，顯示截骨調整位置較滿意

圖3 該患者術后1年后復查，顯示截骨處骨質已完全愈合，無明顯骨關節炎進展，患者右側髖關節再站立、行走時無明顯疼痛感，恢復滿意

圖4 該患者于術后1年后，取出內固定物

文獻出處：Todd O McKinley. The Bernese periacetabular osteotomy for treatment of adult hip dysplasia. Skeletal Radiol. 2010 Nov;39(11):1057-9. doi: 10.1007/s00256-010-0985-2.

文獻5

股骨頭骨壞死與軟骨下不全骨折外側塌陷病灶的微觀結構特征差異

譯者 邱興

背景：與股骨頭壞死相似，股骨頭軟骨下不全骨折也可導致股骨頭塌陷。然而，關于這兩種疾病在塌陷病灶形態特征上的差異，目前尚不明確。本研究旨在驗證以下假設：股骨頭壞死與軟骨下不全骨折的外側塌陷病灶形態特征存在差異。

方法：本研究采用經組織病理學確診的20例股骨頭標本，包括股骨頭壞死10例和軟骨下不全骨折10例。在每位患者股骨頭外側塌陷病灶中，分別于塌陷區及鄰近未塌陷的軟骨下區域設立立方體狀感興趣區。基于顯微CT技術，比較兩種疾病中各感興趣區的微結構參數，并評估組織病理學特征與微結構參數之間的相關性。

結果：在股骨頭壞死組中，塌陷區域的骨體積分數、骨小梁厚度和骨礦物質密度均顯著低于鄰近未塌陷區域。組織病理學顯示，未塌陷區域始終存在伴有附著性骨形成的骨小梁增厚現象。而在軟骨下不全骨折組中，上述微結構參數在塌陷區與未塌陷區之間無顯著差異。組織病理學觀察發現，外側塌陷病灶周圍軟骨下板骨折處存在不同程度的骨痂形成。

結論：股骨頭壞死與軟骨下不全骨折的外側塌陷病灶形態特征存在顯著差異，提示二者具有不同的股骨頭塌陷發病機制。

關鍵詞：塌陷；微結構；股骨頭壞死；股骨頭軟骨下不全骨折

圖1、二維顯微CT圖像分別顯示了股骨頭壞死(ONFH)與股骨頭軟骨下不全骨折(SIF)的股骨頭中央切片。白色箭頭指示軟骨下骨板斷裂處。為進行微結構分析，在股骨頭兩個軟骨下區域分別設置了由兩個5毫米立方體構成的感興趣區：(1)未塌陷區；(2)鄰近塌陷區。在對照組中，于外側區域設置了兩組相鄰的立方體感興趣區，分別對應SIF組中的(3)未塌陷區與(4)塌陷區。三維顯微CT圖像中的黑色虛線標示出軟骨下骨板的骨折線。

圖2、組織病理學結果顯示股骨頭壞死(ONFH)非塌陷區與塌陷區的不同特征。A圖中黑色箭頭指示外側軟骨下骨折。B圖非塌陷區可見具有附著性骨形成的骨小梁增厚（黑色三角箭頭），這是ONFH修復帶的典型特征。C圖塌陷區可見骨小梁變薄及大量空骨陷窩（黑色箭頭），這是ONFH壞死區的典型表現。D圖顯示股骨頭軟骨下不全骨折(SIF)非塌陷區與塌陷區具有相似病理表現。外側塌陷病灶周圍可見覆蓋軟骨下板骨折的橋接骨痂形成。黑色三角箭頭指示與外側塌陷病灶相關的關節軟骨凹陷，黑色箭頭指示外側軟骨下骨折。E圖SIF外側塌陷病灶周圍的軟骨下區可見活躍的骨痂形成。F圖SIF塌陷區可見大量多核巨細胞（黑色箭頭）。

Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head

Background: Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF.

Methods: Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated.

Results: In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion.

Conclusion: The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.

Keywords: Collapse; Microarchitecture; Osteonecrosis of the femoral head; Subchondral insufficiency fracture of the femoral head.

文獻出處： Kawano, K., Motomura, G., Ikemura, S., Yamaguchi, R., Baba, S., Xu, M., & Nakashima, Y. (2020). Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head. Bone, 141, 115585.

來源：304關節學術

作者：304關節團隊

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