髖膝關(guān)節(jié)文獻(xiàn)精譯薈萃（第369期）

本期目錄：

1、固定平臺內(nèi)側(cè)單髁膝關(guān)節(jié)置換術(shù)：在前交叉韌帶功能不全膝關(guān)節(jié)中的新適應(yīng)證

2、非骨水泥固定在全膝關(guān)節(jié)置換術(shù)中的應(yīng)用：目前的證據(jù)和未來的展望

3、全髖關(guān)節(jié)置換術(shù)中手術(shù)入路與強(qiáng)化技術(shù)使用的當(dāng)前趨勢

4、兒童感染性髖關(guān)節(jié)炎后遺癥：一種改良分型和病例報(bào)告

5、盂唇內(nèi)翻是DDH患兒Pavlik挽具治療失敗的預(yù)測因素

6、骨盆形態(tài)在旋轉(zhuǎn)和傾斜度上存在差異：發(fā)育性髖關(guān)節(jié)發(fā)育不良與髖臼后傾的對比研究

7、巴基斯坦髖關(guān)節(jié)發(fā)育不良的流行病學(xué)研究

8、髖臼周圍截骨術(shù)治療青少年髖關(guān)節(jié)發(fā)育不良的并發(fā)癥

9、有癥狀的發(fā)育性髖關(guān)節(jié)發(fā)育不良患者從仰臥位到站立位的骨盆后傾

第一部分：關(guān)節(jié)置換及保膝相關(guān)文獻(xiàn)

文獻(xiàn)1

固定平臺內(nèi)側(cè)單髁膝關(guān)節(jié)置換術(shù)：在前交叉韌帶功能不全膝關(guān)節(jié)中的新適應(yīng)證

譯者 馬云青

前交叉韌帶功能不全合并骨關(guān)節(jié)炎的膝關(guān)節(jié)是一種具有挑戰(zhàn)性的疾病類型，其治療需要審慎考量，達(dá)到恢復(fù)關(guān)節(jié)功能并幫助患者重返活動。隨著技術(shù)與手術(shù)方法的進(jìn)步，單髁關(guān)節(jié)置換術(shù)的適應(yīng)癥已擴(kuò)展至經(jīng)過嚴(yán)格篩選的前交叉韌帶功能不全患者。深入理解此類膝關(guān)節(jié)的病理特征，有助于臨床醫(yī)生制定決策以恢復(fù)膝關(guān)節(jié)功能。

對于前交叉韌帶功能不全合并單間室骨關(guān)節(jié)炎的膝關(guān)節(jié)，患者主訴常涉及前后向不穩(wěn)定。在處理前交叉韌帶功能不全的膝關(guān)節(jié)時(shí)，相比活動平臺單髁置換術(shù)（后者可能存在偏心負(fù)荷增加和聚乙烯磨損等問題），采用固定平臺單髁假體可以更好地恢復(fù)關(guān)節(jié)運(yùn)動學(xué)，并避免早期結(jié)果中的相關(guān)擔(dān)憂。謹(jǐn)慎且有選擇地清理髁間窩骨贅，對于維持單髁置換術(shù)后的膝關(guān)節(jié)穩(wěn)定性至關(guān)重要。

證據(jù)表明，在前交叉韌帶功能不全的膝關(guān)節(jié)進(jìn)行單髁置換時(shí)，將脛骨后傾角控制在4至7度之間是最佳的，這有助于維持膝關(guān)節(jié)穩(wěn)定性并促進(jìn)屈膝活動。

Fixed-bearing medial unicompartmental knee arthroplasty: New indications in the anterior cruciate ligament-deficient knee

The anterior cruciate ligament (ACL)-deficient osteoarthritic knee presents a challenging disease entity, which requires careful thought to restore function and enable return to activities. Advancements in technology and surgical techniques have expanded indications for unicompartmental knee arthroplasty (UKA), to inlcude ACL-deficiency in appropriately-selected patients. An improved understanding of the ACL-deficient osteoarthritic knee can aid in clinical and surgeon decision-making to restore knee function. This review will discuss current practice guidelines for the ACL-deficient knee with single-compartment osteoarthritis, including pathoanatomy,indications,contraindications,technical considerations, and clinical outcomes.

文獻(xiàn)出處：Plancher KD, Braun GE, Petterson SC. Fixed-bearing medial unicompartmental knee arthroplasty: New indications in the anterior cruciate ligament-deficient knee. J ISAKOS. 2024 Dec;9(6):100337. doi: 10.1016/j.jisako.2024.100337. Epub 2024 Oct 12. PMID: 39401701.

文獻(xiàn)2

非骨水泥固定在全膝關(guān)節(jié)置換術(shù)中的應(yīng)用：目前的證據(jù)和未來的展望

譯者 丁云鵬

非骨水泥固定在全膝關(guān)節(jié)置換術(shù)（TKA）中扮演著越來越重要的角色。這篇綜述文章的目的是分析非骨水泥TKA的功能結(jié)局和生存率。

材料和方法：對非骨水泥TKA的預(yù)后和生存率進(jìn)行了全面的文獻(xiàn)檢索。該檢索基于PRISMA 2020指南，使用PubMed、Medline和Embase。納入的研究由兩名獨(dú)立觀察員篩選。

結(jié)果：2010 - 2022年共納入15項(xiàng)研究。11項(xiàng)研究比較了非水泥TKA和水泥TKA。四項(xiàng)研究僅涉及非骨水泥假體。非骨水泥TKA的生存和功能結(jié)果至少與骨水泥假體相當(dāng)。

結(jié)論：隨著制造技術(shù)的進(jìn)步和更精確的手術(shù)工具的使用，如機(jī)器人輔助TKA和3D打印假體，由于更多的生物固定，更好的存活率和療效，可以預(yù)期非骨水泥TKA的使用會增加。

Cementless fixation in total knee arthroplasty: current evidence and future perspective

Introduction: Cementless fixation plays an increasing role in total knee arthroplasty (TKA). The objective of this review article is to analyze functional outcomes and survivorship of cementless TKA.

Materials and methods: A comprehensive literature search for studies reviewing the outcome and survivorship of cementless TKA was conducted. This search was based on the PRISMA 2020 guidelines using PubMed, Medline, and Embase. The included studies were screened by two independent observers.

Results: From 2010 to 2022, fifteen studies were included. Eleven studies compared cementless and cemented TKA. Four studies only covered cementless implants. Survivorship and functional outcomes of cementless TKA are at least comparable to those of cemented implants.

Conclusion: With improvement in manufacturing, and surgical tools for more precise delivery, such as robotic assisted TKA and 3D-printed implants, one can expect increase in usage of cementless TKA, due to a more biological fixation, better survivorship, and outcomes.

文獻(xiàn)出處：David J Haslhofer , Nikolaus Kraml ， Christian Stadler ，Cementless fixation in total knee arthroplasty: current evidence and future perspective.Arch Orthop Trauma Surg. 2024 Dec 28;145(1):101.

文獻(xiàn)3

全髖關(guān)節(jié)置換術(shù)中手術(shù)入路與強(qiáng)化技術(shù)使用的當(dāng)前趨勢：利用美國骨科醫(yī)師協(xié)會口試與再認(rèn)證數(shù)據(jù)，對早期職業(yè)與更有經(jīng)驗(yàn)的外科醫(yī)生進(jìn)行比較

譯者 沈松坡

背景： 全髖關(guān)節(jié)置換術(shù)（THA）一直是醫(yī)學(xué)中最成功的手術(shù)之一，但其優(yōu)選入路及強(qiáng)化技術(shù)的使用正在不斷發(fā)展。本研究旨在明確早期職業(yè)外科醫(yī)生與更有經(jīng)驗(yàn)外科醫(yī)生在當(dāng)前 THA 實(shí)踐中的（手術(shù)入路以及強(qiáng)化技術(shù)使用）情況。本研究的第二個(gè)目標(biāo)是識別 6 個(gè)月時(shí)患者報(bào)告結(jié)局測量信息系統(tǒng)（PROMIS）的疼痛干擾或功能評分以及早期并發(fā)癥的差異。

方法： 在 2022 年和 2023 年，共有 35,068 例 THA 由參加美國骨科醫(yī)師協(xié)會（ABOS）第二部分口試的考生（14,993 例）以及作為再認(rèn)證過程的一部分由已獲得認(rèn)證的醫(yī)師（20,075 例）提交。患者平均年齡為 66 歲，54% 為女性。第二部分考生組中，有 2,019 名患者獲得了基線和 6 個(gè)月的 PROMIS 疼痛干擾與功能問卷。所有患者的術(shù)后并發(fā)癥均由考生或再認(rèn)證醫(yī)師報(bào)告。

結(jié)果： 第二部分考生選擇的手術(shù)入路為：直接前方（DA）69%，后方 26%，直接外側(cè) 2%，其他 2%。再認(rèn)證醫(yī)師的手術(shù)入路為：DA 43%，后方 43%，直接外側(cè) 6%，其他 7%。機(jī)器人或?qū)Ш降氖褂寐史謩e為 18% 和 15%。所有組的 PROMIS 功能均有等量改善。第二部分考生報(bào)告的顯著手術(shù)并發(fā)癥高于再認(rèn)證考生（8.4% vs 2.7%，P < 0.001），其中骨折是最常見的并發(fā)癥（第二部分：2.3%；再認(rèn)證：0.6%）。

結(jié)論： 第二部分考生比再認(rèn)證考生更可能選擇 DA 入路。第二部分考生報(bào)告的術(shù)后并發(fā)癥率更高。然而，基于手術(shù)入路，在外科醫(yī)生報(bào)告的并發(fā)癥或骨折率中并無差異。機(jī)器人與導(dǎo)航的總體使用率低于 20%。所有 THA 組的 PROMs 均有等量改善。

關(guān)鍵詞：全髖關(guān)節(jié)置換；手術(shù)入路；機(jī)器人或?qū)Ш剑皇中g(shù)并發(fā)癥；結(jié)局

Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data

Background: Total hip arthroplasty (THA) has been among the most successful procedures in medicine, but the preferred approach and use of enhancing technologies are evolving. This study was conducted to define current THA practice (surgical approach and use of enhancing technologies) among early-career and more experienced surgeons. A secondary goal of this study was to identify differences in 6-month Patient-Reported Outcome Measurement Information System (PROMIS) pain interference or function scores and early complications.

Methods: In 2022 and 2023, 35,068 THAs were submitted to the American Board of Orthopaedic Surgery by candidates for the part II oral certification examination (14,993) and by Diplomates as part of the recertification process (20,075). The average patient age was 66 years, and 54% of patients were women. Baseline and 6-month PROMIS pain interference and function surveys were obtained from 2,019 patients in the Part II group. Postoperative complications were reported by the candidates or diplomates for all patients.

Results: Part II candidate surgical approach was direct anterior (DA) (69%), posterior (26%), direct lateral (2%), and other (2%). For recertification candidates, the surgical approach was DA (43%), posterior (43%), direct lateral (6%), and other (7%). Robotics or navigation was utilized in 18 and 15%, respectively. There were equivalent improvements in the PROMIS function in all groups. The surgeon-reported significant surgical complications were higher in part II candidates (8.4%) than in candidates undergoing recertification (2.7%, P < 0.001), with bone fracture the most common in each group (part II: 2.3%; recertification at 0.6%).

Conclusions: The part II candidates are more likely to utilize the DA approach compared to recertification candidates. The Part II candidates report higher rates of postoperative complications. However, there was no difference in the rate of surgeon-reported surgical complications or fractures based on surgical approach. Robotics and navigation are utilized in less than 20% of THA cases. The PROMs improved equally in all THA groups.

Keywords: outcomes; robotics or navigation; surgical approach; surgical complications; total hip arthroplasty.

文獻(xiàn)出處：Nelson CL, Harrast JJ, Jacobs JJ, Martin DF, Garvin KL. Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data. J Arthroplasty. 2025 Aug;40(8S1):S96-S100. doi: 10.1016/j.arth.2025.02.069. Epub 2025 Mar 4. PMID: 40049563.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

兒童感染性髖關(guān)節(jié)炎后遺癥：一種改良分型和病例報(bào)告

譯者 羅殿中

背景：現(xiàn)有的兒童感染性髖關(guān)節(jié)炎（SAH）的分類系統(tǒng)非常復(fù)雜。本文介紹一種新的分類方法—西安紅會醫(yī)院兒童骨科分類（HHPO），該分類設(shè)計(jì)增強(qiáng)了對于該疾病的治療方案、和預(yù)后評估。

方法：本文對18例兒童感染性髖關(guān)節(jié)炎（SAH）進(jìn)行回顧性研究，通過骨盆片評估股骨頭頸的完整性、及其與髖臼的空間對合關(guān)系。基于這些評估內(nèi)容，形成了HHPO分類系統(tǒng)。6位觀察者分別獨(dú)立對每一例進(jìn)行HHPO和Choi分類。針對這兩種分類方法，比較觀察者之間、2周重復(fù)觀察者內(nèi)可靠性。

結(jié)果：HHPO的分類結(jié)果如下：IA型5髖、IB型6髖、ID型2髖、IIA型3髖、IIB型2髖。HHPO分類方法較Choi分類方法具有更高的觀察者間和觀察者內(nèi)一致性。臨床來說，治療后5髖嚴(yán)重疼痛，2髖偶爾疼痛，11髖無疼痛。大部分髖關(guān)節(jié)（88.9%）活動度滿意；72.2%在影像上穩(wěn)定。感染發(fā)生越早、治療效果月嚴(yán)重。

結(jié)論：HHPO兒童感染性髖關(guān)節(jié)炎分類系統(tǒng)簡單、可重復(fù)性強(qiáng)，在本組病例中展示出治療兒童SAH后遺癥時(shí)的潛在作用。

表1, 感染性髖關(guān)節(jié)炎后遺癥紅會醫(yī)院分型（HHPO）

圖1. a-j 病例2，12歲女孩，肺部感染后繼發(fā)左側(cè)SAH。經(jīng)過2次關(guān)節(jié)切開引流、靜脈用萬古霉素、口服利奈唑胺，感染得到控制。但急性期治療期間，感染由局部擴(kuò)散至多個(gè)部位（左側(cè)脛骨遠(yuǎn)端、左股骨、左髂骨）（a-d）。一年后，患者最終形成ID型髖感染后遺癥、并下肢不等長（LLD）（e-h）。此后對她進(jìn)行大轉(zhuǎn)子下移（GTA）+股骨截骨延長術(shù)（i和j），改善了髖關(guān)節(jié)功能和步態(tài)。

圖2. a-g 病例13，4-6歲情況，她因新生兒感染致右髖SAH，外院靜脈用萬古霉素控制良好后出院，右髖未行切開和引流，口服頭孢甲肟一月。4歲時(shí)發(fā)現(xiàn)右髖疼痛、活動受限、步態(tài)異常。檢查發(fā)現(xiàn)為ID型髖感染后遺癥和下肢不等長（LLD）短縮16.4mm（a-e）。最后，在本中心行大轉(zhuǎn)子下移（GTE）、股骨近端去旋轉(zhuǎn)截骨+Salter骨盆截骨術(shù)，術(shù)后右髖疼痛消失，關(guān)節(jié)功能和步態(tài)改善（f和g）。

圖3, a-j 病例3，兩歲前左髖SAH，當(dāng)前7-8歲。當(dāng)時(shí)靜脈使用抗生素、關(guān)節(jié)切開引流控制感染，證明有效。他左髖遺留半脫位（a），行股骨近端內(nèi)翻截骨（b）。股骨愈合取出內(nèi)固定（c），密切觀察隨訪至7歲（d-g）。此時(shí)，患兒跛行，影像證實(shí)左髖股骨頸前傾角顯著增大，髖臼包容不良，髖臼外緣吸收。患兒再次行股骨近端去旋轉(zhuǎn)截骨+Salter骨盆截骨（h）。術(shù)后患兒髖關(guān)節(jié)穩(wěn)定，肢體短縮<2cm，代償性脊柱側(cè)彎。截骨愈合取出內(nèi)固定后，髖關(guān)節(jié)功能好、步態(tài)正常（i和j）。

圖4, a-g 病例4，7-8歲女孩，3-4歲時(shí)發(fā)現(xiàn)左髖SAH。當(dāng)時(shí)外院行抗生素治療、關(guān)節(jié)切開引流。一年前她左髖疼痛跛行，骨盆片顯示，左髖關(guān)節(jié)半脫位、股骨頭部分消失（IIA型）（a）。對她采用Pemberton骨盆截骨+股骨大轉(zhuǎn)子下移+股骨去旋轉(zhuǎn)截骨術(shù)治療（b）。術(shù)后截骨愈合，髖關(guān)節(jié)穩(wěn)定，髖臼包容好，無下肢不等長（LLD）等其它并發(fā)癥。術(shù)后一年髖關(guān)節(jié)功能良好（c-e），內(nèi)固定取出后影像（f和g）

圖5, a-h 病例11，9-10歲男孩，2歲前左髖SAH，5歲時(shí)左髖跛行。影像顯示左髖關(guān)節(jié)脫位，左股骨頸吸收，股骨頭殘留，為IIB型（a）。保守治療并隨訪，無明顯改善（b-d），并出現(xiàn)左髖疼痛。最終，該患兒行股骨近端外翻截骨+Chiari骨盆內(nèi)移截骨術(shù)（e-g）。近期隨訪顯示，截骨愈合，髖關(guān)節(jié)穩(wěn)定，髖關(guān)節(jié)功能好，但遺留下肢不等長3cm。

圖6, a-i 病例11，12-13歲男孩，患兒1-2歲出現(xiàn)左髖SAH，導(dǎo)致左髖關(guān)節(jié)脫位，髖臼發(fā)育不良，股骨頭股骨頸大部分消失（a）。對他行骨贅切除改善臀中肌步態(tài)，下肢延長，髖關(guān)節(jié)穩(wěn)定手術(shù)（b-d）。但內(nèi)固定取出后在密切隨訪時(shí)，發(fā)現(xiàn)左髖脫位復(fù)發(fā)。特別是內(nèi)固定取出后，左髖脫位，肢體短縮小于2cm（e-i）。隨后決定行髖臼截骨，采用股骨大轉(zhuǎn)子重建股骨頭，并穩(wěn)定髖關(guān)節(jié)。但當(dāng)患肢穿增高鞋、髖關(guān)節(jié)功能可、幾乎無疼痛、對日常生活無影響。另外患兒父母對髖關(guān)節(jié)重建手術(shù)缺乏信心，故患者未行手術(shù)，繼續(xù)觀察隨訪。

The sequelae of septic hip arthritis in children: a revised classification and case review

Background:Existing classification systems for sequelae of pediatric septic arthritis of the hip (SAH) are notably complex. This study introduces a simplified radiographic classification-the Xi'an Honghui Hospital Paediatric Orthopaedic Classification (HHPO classification)-designed to enhance accuracy in treatment planning and prognostic evaluation.

Methods:A retrospective analysis was conducted involving 18 pediatric patients with SAH. Pelvic radiographs were evaluated to assess the structural integrity of the femoral head and neck and their spatial relationship with the acetabulum. Based on these assessments, the HHPO classification was developed. Six independent observers classified each case using both the HHPO and Choi systems. Interobserver reliability and two-week intraobserver consistency were assessed and compared between the two classifications.

Results:The distribution according to the HHPO classification was as follows: Type IA (n=5), Type IB (n=6), Type ID (n=2), Type IIA (n=3), and Type IIB (n=2). The HHPO system demonstrated significantly higher inter- and intraobserver agreement compared to the Choi classification. Clinically, severe hip pain was reported in 5 patients, occasional pain in 2, and no pain in 11. The majority of hips (88.9%) exhibited satisfactory range of motion, and 72.2% were radiologically stable. Earlier onset of infection was associated with more severe sequelae.

Conclusion:The HHPO classification is simpler, more reproducible, and demonstrates potential clinical utility for managing pediatric SAH sequelae in this cohort.

文獻(xiàn)出處：Qi B, Lu Q, Wang X, Jie Q, Su F, Liu C, Yang Y. The sequelae of septic hip arthritis in children: a revised classification and case review. Ann Med. 2025 Dec;57(1):2553878. doi: 10.1080/07853890.2025.2553878. Epub 2025 Sep 5. PMID: 40908846; PMCID: PMC12416003.

文獻(xiàn)2

盂唇內(nèi)翻是DDH患兒Pavlik挽具治療失敗的預(yù)測因素

譯者 任寧濤

介紹

據(jù)報(bào)道，Pavlik挽具治療髖關(guān)節(jié)發(fā)育不良(DDH)的失敗率高達(dá)55%。本研究的目的是探討髖臼盂唇內(nèi)翻對Pavlik挽具治療DDH療效的影響。

方法

回顧性分析2004 - 2016年某三級兒科醫(yī)院DDH患兒，納入采用Pavlik挽具進(jìn)行治療并隨訪時(shí)間不短于12個(gè)月的DDH患兒。統(tǒng)計(jì)納入患兒的人口學(xué)信息、治療和隨訪結(jié)果，比較盂唇內(nèi)翻和無盂唇內(nèi)翻患兒的預(yù)后。

結(jié)果

共納入156名患兒，229例髖關(guān)節(jié)發(fā)育不良。開始治療的平均年齡為1.9±1.4個(gè)月，平均隨訪時(shí)間為37.7±23.0個(gè)月。46%(73/156)的患兒診斷為雙側(cè)DDH。總共有37%(75/229)髖關(guān)節(jié)Pavlik挽具治療失敗。進(jìn)一步治療中，91%(68/75)的髖關(guān)節(jié)為硬性外展支具，5%(4/75)的髖關(guān)節(jié)為閉合復(fù)位，4%(3/75)的髖關(guān)節(jié)為切開復(fù)位。10%(22/229)的患兒存在髖關(guān)節(jié)盂唇內(nèi)翻。內(nèi)翻盂唇組Pavlik挽具治療失敗的發(fā)生率為91%(20/22)，而對照組為27% (55/207)(P<0.001)。盂唇內(nèi)翻組86%(15/22)需要閉合或切開復(fù)位，對照組3% (7/207)(P<0.001)。盂唇內(nèi)翻組的缺血性壞死發(fā)生率為18%(4/22)，對照組為0.4% (1/207)(P<0.001)。

結(jié)論

在接受Pavlik挽具治療的DDH患兒中，髖臼盂唇內(nèi)翻的存在是治療失敗的有力預(yù)測因素。與沒有內(nèi)翻盂唇的髖關(guān)節(jié)相比，有內(nèi)翻盂唇的髖關(guān)節(jié)需要閉合或切開復(fù)位和發(fā)生缺血性壞死的風(fēng)險(xiǎn)也明顯更高。

圖1 生后1周女性患兒，髖關(guān)節(jié)超聲檢查可見雙側(cè)DDH，B圖箭頭處可見左髖內(nèi)翻盂唇，采用Pavlik挽具治療6周，右髖治療效果良好，左髖因盂唇內(nèi)翻接受了進(jìn)一步的硬性支具的治療，最終采用閉合復(fù)位石膏外固定治療。

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

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

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

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

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

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

文獻(xiàn)3

骨盆形態(tài)在旋轉(zhuǎn)和傾斜度上存在差異：發(fā)育性髖關(guān)節(jié)發(fā)育不良與髖臼后傾的對比研究

譯者 李勇

背景：發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）和髖臼后傾是兩種不同的髖臼形態(tài)病理改變。兩者均與骨盆形態(tài)的變化相關(guān)。在髖臼的直接X線評估困難或不可行時(shí)，或者在DDH與后傾混合存在的病例中，額外的間接骨盆測量參數(shù)將有助于識別主要潛在的結(jié)構(gòu)異常。

問題/目的：我們探究：通過骨盆寬度指數(shù)、髂前下棘征（AIIS征）、髂坐骨角和閉孔指數(shù)來測量，DDH和髖臼后傾在旋轉(zhuǎn)和冠狀面傾斜度上有何不同？以及每個(gè)變量在檢測髖臼后傾方面的預(yù)測價(jià)值如何？

方法：我們回顧性分析了51例發(fā)育不良髖和51例后傾髖的骨盆前后位X光片。發(fā)育不良的診斷基于外側(cè)中心邊緣角小于20°且髖臼指數(shù)大于14°。后傾的診斷基于外側(cè)中心邊緣角大于25°并同時(shí)存在交叉征/坐骨棘征/后壁征。我們計(jì)算了用于診斷髖臼后傾的每個(gè)變量的敏感性、特異性和受試者工作特征曲線下面積。

結(jié)果：我們發(fā)現(xiàn)，在髖臼后傾中，骨盆寬度指數(shù)較低，AIIS征的出現(xiàn)率較高，髂坐骨角較高，閉孔指數(shù)較低。整個(gè)髖骨在DDH中呈內(nèi)旋，而在后傾中呈外旋。ROC曲線下面積分別為：0.969（骨盆寬度指數(shù)）、0.776（AIIS征）、0.971（髂坐骨角）和0.925（閉孔指數(shù)）。

結(jié)論：骨盆形態(tài)與髖臼的病理形態(tài)相關(guān)。我們的測量指標(biāo)（除AIIS征外）是髖臼后傾的間接指標(biāo)。數(shù)據(jù)表明，當(dāng)髖臼緣顯示不清且后傾不明顯時(shí)，可以使用這些指標(biāo)。

圖 1A-D 這些圖表說明了如何（A）計(jì)算骨盆寬度指數(shù)（a/b），（B）確定髂前上棘征，（C）確定髂坐骨角，以及（D）計(jì)算閉孔指數(shù)（c/d）

Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion

Background: Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality.

Questions/purposes: We asked: How does DDH and retroversion differ with respect to rotation and coronal obliquity as measured by the pelvic width index, anterior inferior iliac spine (AIIS) sign, ilioischial angle, and obturator index? And what is the predictive value of each variable in detecting acetabular retroversion?

Methods: We reviewed AP pelvis radiographs for 51 dysplastic and 51 retroverted hips. Dysplasia was diagnosed based on a lateral center-edge angle of less than 20° and an acetabular index of greater than 14°. Retroversion was diagnosed based on a lateral center-edge angle of greater than 25° and concomitant presence of the crossover/ischial spine/posterior wall signs. We calculated sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for each variable used to diagnose acetabular retroversion.

Results: We found a lower pelvic width index, higher prevalence of the AIIS sign, higher ilioischial angle, and lower obturator index in acetabular retroversion. The entire innominate bone is internally rotated in DDH and externally rotated in retroversion. The areas under the ROC curve were 0.969 (pelvic width index), 0.776 (AIIS sign), 0.971 (ilioischial angle), and 0.925 (obturator index).

Conclusions: Pelvic morphology is associated with acetabular pathomorphology. Our measurements, except the AIIS sign, are indirect indicators of acetabular retroversion. The data suggest they can be used when the acetabular rim is not clearly visible and retroversion is not obvious.

文獻(xiàn)出處：Tannast M, Pfannebecker P, Schwab JM, Albers CE, Siebenrock KA, Büchler L. Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion. Clin Orthop Relat Res. 2012 Dec;470(12):3297-305. doi: 10.1007/s11999-012-2473-6. PMID: 22798136; PMCID: PMC3492631.

文獻(xiàn)4

巴基斯坦髖關(guān)節(jié)發(fā)育不良的流行病學(xué)研究：基于巴基斯坦兒科骨科登記系統(tǒng)（PORP）的見解

譯者 賈海港

目的：本研究旨在確定巴基斯坦髖關(guān)節(jié)發(fā)育不良的患病率、風(fēng)險(xiǎn)因素及地理分布情況，評估各種治療方法的累積療效，并提出建議以建立巴基斯坦的預(yù)防策略和最佳治療實(shí)踐。

方法：本多中心回顧性研究分析了巴基斯坦 PORP 注冊中心發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）部分的臨床數(shù)據(jù)。由第 1、3-11 作者上傳，涵蓋過去三十年間的治療病例。 評估參數(shù)涵蓋 25 個(gè)變量，包括患者基本人口統(tǒng)計(jì)學(xué)特征、地域性發(fā)病率、DDH 特征及相關(guān)危險(xiǎn)因素。此外，還分析了不同年齡組和不同嚴(yán)重程度的 DDH 患者的治療方法和累積療效

結(jié)果：本研究納入 755 例患者，共 1107 個(gè)受累髖關(guān)節(jié)，年齡從出生 1 天到 8 歲以上不等。其中 86.25%的患者在 18 個(gè)月后確診，11.7%確診時(shí)年齡超過 8 歲。在 104 例新生兒中，23%接受了新生兒篩查。 男女比例為 3:1。21%的患者有發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）家族史，24%的患者來自偏遠(yuǎn)農(nóng)村地區(qū)。46.6%的患者為雙側(cè) DDH。48.43%的患者髖臼指數(shù)明顯鈍化（≥3-45°）。髖臼指數(shù)（AI）與年齡呈顯著正相關(guān)（p=0.001）。88%的單側(cè)正常髖關(guān)節(jié) AI≥30°，11%的單側(cè)髖關(guān)節(jié) AI 為中度發(fā)育不良（30°-45°）。 129 例患者接受了非手術(shù)治療，至少三年隨訪后成功率為 83.72%。Pavlik 吊帶的失敗率為 25%。626 例患者接受了開放復(fù)位手術(shù)，至少一年隨訪后成功率為 70.42%。保守治療和手術(shù)治療的失敗病例大多發(fā)生在雙側(cè)病例的單側(cè)。10 年隨訪期間的遠(yuǎn)期并發(fā)癥包括股骨頸偏短、髖臼過大和殘余髖臼發(fā)育不良。

結(jié)論：本研究利用 PORP 登記數(shù)據(jù)，識別了發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）的人口統(tǒng)計(jì)學(xué)特征、風(fēng)險(xiǎn)因素和治療結(jié)果。研究強(qiáng)調(diào)了建立肌肉骨骼篩查方案的必要性，以便盡早診斷 DDH，防止因治療延誤而導(dǎo)致的殘疾，并促進(jìn) DDH 管理的最佳實(shí)踐。

關(guān)鍵詞： 并發(fā)癥；DDH；DDH 預(yù)后；人口統(tǒng)計(jì)學(xué)特征；發(fā)育性髖關(guān)節(jié)發(fā)育不良；危險(xiǎn)因素；地域分布。

Epidemiology of Developmental Dysplasia of Hip in Pakistan: Insights from the Paediatric Orthopaedic Registry Pakistan (PORP)

Objective:This study aims to determine prevalence, risk factors and geographic distribution of Developmental Dysplasia of the Hip in Pakistan and to assess the cumulative outcomes of various treatments used and propose recommendations to establish preventive strategies and best treatment practices in Pakistan.

Methods:This multicentric retrospective study was conducted with analysis of data from DDH section of PORP registry of Pakistan. The data was uploaded by 1,3-11 authors, which were treated during last three decades. The evaluation parameters included 25 variables of basic demographics of patients, geographic prevalence, characteristics of DDH and related risk factors. The data was also analyzed to know methods of treatment used and cumulative outcomes in various age groups and severity of dysplasia.

Results:The study included 755 patients with 1,107 affected hips, aged one day to over eight years. Of these, 86.25% were diagnosed after 18 months, 11.7% were over eight years. Among 104 neonates, 23% had neonatal screening. The female-to-male ratio was 3:1. 21% had history of DDH in family, and 24% were from remote rural areas. 46.6% had bilateral DDH. 48.43% patients had significantly obtuse acetabular index >45°. The acetabular index (AI) found highly associated with age bilaterally (p=0.001). 88% of normal unilateral hips had AI <30°, and 11% have moderate dysplasia of 30°-45°. 129 patients were treated non-operatively with 83.72% success rate at minimum three years follow-up. The failure rate of Pavlik harness was 25%. Six hundred twenty six (626) patients underwent open reduction with 70.42% success rate at minimum one year follow-up. Most failures in conservative and operative treatment were on one side of bilateral cases. Late complications over 10 years follow-up was short femoral neck offset, coxa magna and residual acetabular dysplasia.

Conclusion:This study leverages PORP registry data to identify DDH demographics, risk factors, and treatment outcomes. It highlights the need for establishment of MSK screening protocols, to diagnose DDH at earliest, to prevent development of disability of late treatment and enhance best practices in DDH management.

Keywords:Complications; DDH; DDH Outcomes; Demographics; Developmental Dysplasia Hips; Risk factors; Topographic Distribution.

文獻(xiàn)出處：Bhatti A, Soomro MH, Chinoy MA, Zaman AU, Baloch MA, Ali P, Khan MA, Nadeem U, Zafir MB, Jamil M, Peracha A, Pirwani MA, Ahmed Z. Epidemiology of Developmental Dysplasia of Hip in Pakistan: Insights from the Paediatric Orthopaedic Registry Pakistan (PORP). Pak J Med Sci. 2025 Mar;41(3):668-675. doi: 10.12669/pjms.41.3.10922. PMID: 40103867; PMCID: PMC11911762.

文獻(xiàn)5

髖臼周圍截骨術(shù)治療青少年髖關(guān)節(jié)發(fā)育不良的并發(fā)癥

譯者 陶可

背景：髖臼周圍截骨術(shù)是一種有效的髖臼重新定位手術(shù)，可使髖臼恢復(fù)正常位置，從而改善成人髖關(guān)節(jié)發(fā)育不良患者的股骨頭解剖覆蓋和髖關(guān)節(jié)內(nèi)移。然而，該手術(shù)難度較高，目前尚無研究專門分析青少年患者接受此手術(shù)的并發(fā)癥及其相關(guān)因素。

方法：本研究回顧性分析了一系列接受伯爾尼髖臼周圍截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的青少年患者的臨床和影像學(xué)資料。

結(jié)果：共對76例患者進(jìn)行了83次截骨術(shù)，患者平均年齡（及標(biāo)準(zhǔn)差）為15.6±2.4歲。影像學(xué)檢查顯示，從術(shù)前到術(shù)后2年隨訪評估，外側(cè)中心邊緣角（-0.14°至35.5°）、前方中心邊緣角（-5.13°至31.3°）和股骨頭外移指數(shù)（38.4%至7.7%）均有顯著改善（所有指標(biāo)p<0.0001）。共發(fā)生3例主要并發(fā)癥，包括：一例既往行髖臼成形術(shù)的患者出現(xiàn)動脈出血過多，需行栓塞治療；一例伴有嚴(yán)重髖關(guān)節(jié)發(fā)育不良和半脫位的患者出現(xiàn)髖臼骨壞死；以及一例患有夏科-馬里-圖斯病（Charcot-Marie-Tooth disease）的患者在行髖臼周圍和股骨聯(lián)合截骨術(shù)后出現(xiàn)股骨頭壞死。18例髖關(guān)節(jié)（22%）出現(xiàn)輕微并發(fā)癥，包括恥骨上支截骨不愈合（5例）、淺表縫線膿腫（4例）和暫時(shí)性股外側(cè)皮神經(jīng)麻痹（4例）。9例髖關(guān)節(jié)（11%）因螺釘刺激癥狀而需手術(shù)取出螺釘，其中2例需要第二次手術(shù)以復(fù)位髖臼截骨塊。除發(fā)育性髖關(guān)節(jié)發(fā)育不良外的其他潛在診斷會增加輕微并發(fā)癥的發(fā)生率（p = 0.0017）外，手術(shù)時(shí)間延長、出血量增加以及近端股骨截骨則更易導(dǎo)致嚴(yán)重并發(fā)癥。

結(jié)論：髖臼周圍截骨術(shù)作為保髖手術(shù)，能夠非常有效地矯正青少年患者的髖關(guān)節(jié)發(fā)育不良，并能改善影像學(xué)結(jié)果且并發(fā)癥發(fā)生率低。雖然除發(fā)育性髖關(guān)節(jié)發(fā)育不良外的其他潛在診斷會增加輕微并發(fā)癥的發(fā)生率，但未發(fā)現(xiàn)其他預(yù)測因素。然而，手術(shù)時(shí)間越長，同時(shí)進(jìn)行股骨內(nèi)翻截骨術(shù)，發(fā)生嚴(yán)重并發(fā)癥的可能性就越大。

Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents

Background: The Bernese (Ganz) periacetabular osteotomy is an effective surgical procedure to reorient the acetabulum, allowing restoration of anatomic femoral head coverage and medial translation of the hip in adults with hip dysplasia. However, it is a challenging surgical procedure, and we know of no study that has specifically analyzed the complications and associated factors seen with this procedure in adolescent patients.

Methods: A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted.

Results: Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 +/- 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (-0.14 degrees to 35.5 degrees), the ventral center-edge angle (-5.13 degrees to 31.3 degrees), and the femoral head extrusion index (38.4% to 7.7%) (p < 0.0001 for all). There were three major complications, including excessive arterial bleeding requiring embolization in a patient with a prior acetabuloplasty, osteonecrosis of the acetabular fragment in a patient with severe dysplasia and subluxation of the hip, and osteonecrosis of the femoral head following combined periacetabular and femoral osteotomies in a patient with Charcot-Marie-Tooth disease. Eighteen hips (22%) had minor complications, including nonunion of the superior pubic ramus osteotomy (five hips), a superficial stitch abscess (four), and transient lateral femoral cutaneous nerve palsy (four). Nine hips (11%) underwent removal of symptomatic screws, and two required a second operation to reposition the acetabular fragment. An underlying diagnosis other than developmental dysplasia increased the prevalence of minor complications (p = 0.0017), while a major complication was more likely with longer surgery time, greater blood loss, and proximal femoral osteotomy.

Conclusions: The Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.

文獻(xiàn)出處：Dinesh Thawrani, Daniel J Sucato, David A Podeszwa, Adriana DeLaRocha. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am. 2010 Jul 21;92(8):1707-14. doi: 10.2106/JBJS.I.00829.

文獻(xiàn)6

有癥狀的發(fā)育性髖關(guān)節(jié)發(fā)育不良患者從仰臥位到站立位的骨盆后傾

譯者 邱興

骨盆矢狀面傾斜度顯著影響發(fā)育性髖關(guān)節(jié)發(fā)育不良患者的髖臼對股骨頭的覆蓋程度，但目前尚無研究量化DDH患者在仰臥位和站立位時(shí)的PSI。此外，關(guān)于髖臼周圍截骨術(shù)后PSI如何變化也知之甚少。本研究旨在量化DDH患者術(shù)前及術(shù)后仰臥位與站立位的PSI。

我們分析了25例接受髖臼周圍截骨術(shù)的DDH患者。采用X光片與計(jì)算機(jī)斷層掃描圖像的配準(zhǔn)技術(shù)，測量了術(shù)前及術(shù)后2年時(shí)仰臥位和站立位的PSI。同時(shí)，量化了從仰臥位變?yōu)檎玖⑽粫r(shí)PSI變化超過10°的患者比例。

術(shù)前，從仰臥位到站立位，骨盆平均向后傾斜8.2 ± 5.0°。其中9例（36%）患者出現(xiàn)超過10°的骨盆后傾。髖臼周圍截骨術(shù)后2年，體位性PSI變化為平均向后傾斜7.1 ± 3.9°。比較術(shù)前與術(shù)后的PSI值發(fā)現(xiàn)，站立位PSI無顯著差異（p = 0.20）。同樣，從仰臥位到站立位的PSI變化量也無顯著差異（p = 0.26）。

結(jié)論：在有癥狀的DDH患者中，術(shù)前即存在站立位時(shí)的骨盆后傾，且該現(xiàn)象在髖臼周圍截骨術(shù)后2年依然存在。這種PSI的體位性變化似乎并未影響髖臼周圍截骨術(shù)的手術(shù)效果。然而，在進(jìn)行術(shù)前規(guī)劃時(shí)，外科醫(yī)生應(yīng)認(rèn)識到，部分DDH患者的髖臼前傾角或髖臼前側(cè)覆蓋度在仰臥位和站立位之間存在差異。

關(guān)鍵詞： 2D-3D配準(zhǔn)；發(fā)育性髖關(guān)節(jié)發(fā)育不良；骨盆矢狀面傾斜度；髖臼周圍截骨術(shù)；術(shù)后分析。

圖1. 仰臥位與站立位骨盆矢狀面傾斜度的定義。(A) 仰臥位PSI 定義為骨盆前平面（白色線）與平行于地面的直線（黑色線）之間的夾角。(B) 站立位PSI 定義為骨盆前平面（白色線）與垂直于地面的直線（黑色線）之間的夾角。(C) 仰臥位（青色）與站立位（黃色）骨盆位置的比較。 為清晰起見，將兩種體位的垂直軸與恥骨結(jié)節(jié)位置進(jìn)行了匹配。PSI值設(shè)定為：骨盆前旋為正，后旋為負(fù)。

圖2 應(yīng)用放射性立體測量分析評估二維-三維（2D-3D）配準(zhǔn)的準(zhǔn)確性。(A) 固定于定制傾斜平臺上的干燥骨骼，分別展示其水平與傾斜位置。(B) 干燥骨骼在水平及傾斜位置（帶有性腺防護(hù)罩）拍攝的前后位X光片。(C) 水平與傾斜位置的2D-3D配準(zhǔn)結(jié)果（此處顯示為根據(jù)計(jì)算機(jī)斷層掃描圖像生成并與X光片配準(zhǔn)的表面模型）。

Posterior Pelvic Tilt From Supine to Standing in Patients With Symptomatic Developmental Dysplasia of the Hip

Pelvic sagittal inclination (PSI) significantly affects the femoral head coverage by the acetabulum in patients with developmental dysplasia of the hip (DDH), while no reports have quantified PSI in DDH patients in the supine and standing positions. Furthermore, little is known about how PSI changes after periacetabular osteotomies. Herein, PSI in the supine and standing positions was quantified in DDH patients preoperatively and postoperatively. Twenty-five patients with DDH who had undergone periacetabular osteotomies were analyzed. The preoperative PSI and the PSI 2 years after surgery were measured in the supine and standing positions using the image registration technique between radiographs and computed tomographic images. The percentage of patients who showed PSI changes of more than 10° from the supine to the standing position was quantified. PSI changed 8.2 ± 5.0° posteriorly from the supine to the standing position during the preoperative period. Posterior pelvic tilt of more than 10° was found in nine cases (36%). Two years after periacetabular osteotomies, the postural PSI change was 7.1 ± 3.9° posteriorly. When the preoperative and postoperative PSI values were compared, PSI in the standing position did not differ (p = 0.20). Similarly, the amount of PSI change from the supine to standing position was not significantly different (p = 0.26). In conclusion, posterior pelvic tilt in the standing position was found preoperatively in symptomatic DDH patients, and it remained for 2 years after periacetabular osteotomies. This postural change in PSI does not seem to influence the outcome of periacetabular osteotomy. However, during preoperative planning, surgeons should recognize that acetabular anteversion or anterior acetabular coverage differs between the supine and standing positions in some patients with DDH.

Keywords: 2D-3D registration; developmental dysplasia of the hip (DDH); pelvic sagittal inclination; periacetabular osteotomy; postoperative analysis.

文獻(xiàn)出處：Tani, Tetsuro, Masaki Takao, Keisuke Uemura, Yoshito Otake, Hidetoshi Hamada, Wataru Ando, Yoshinobu Sato, and Nobuhiko Sugano. "Posterior pelvic tilt from supine to standing in patients with symptomatic developmental dysplasia of the hip." Journal of Orthopaedic Research? 38, no. 3 (2020): 578-587.

來源：304關(guān)節(jié)學(xué)術(shù)

作者：304關(guān)節(jié)團(tuán)隊(duì)

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