本期目錄：

1、度洛西汀能夠減少全髖關(guān)節(jié)或全膝關(guān)節(jié)置換術(shù)后阿片類藥物的用量和術(shù)后疼痛

2、與全髖關(guān)節(jié)置換術(shù)后假體周圍感染相關(guān)的長(zhǎng)期病死率

3、在初次髖關(guān)節(jié)或膝關(guān)節(jié)置換術(shù)中局部使用萬古霉素是否可以預(yù)防感染

4、創(chuàng)傷后骨關(guān)節(jié)炎行全膝關(guān)節(jié)置換術(shù)中的微生物學(xué)取樣

5、類固醇性骨壞死:類固醇劑量風(fēng)險(xiǎn)分析

6、冠狀面髖臼矯正對(duì)髖臼周圍截骨術(shù)中關(guān)節(jié)接觸壓力的影響

7、利用人工韌帶對(duì)臨界發(fā)育性髖關(guān)節(jié)發(fā)育不良進(jìn)行關(guān)節(jié)鏡下關(guān)節(jié)囊修復(fù)術(shù)

8、髖臼周圍截骨術(shù)治療成人髖關(guān)節(jié)發(fā)育不良的手術(shù)進(jìn)展

9、髖臼旋轉(zhuǎn)截骨術(shù)后骨關(guān)節(jié)炎進(jìn)展的影響因素

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

文獻(xiàn)1

度洛西汀能夠減少全髖關(guān)節(jié)或全膝關(guān)節(jié)置換術(shù)后阿片類藥物的用量和術(shù)后疼痛：隨機(jī)對(duì)照試驗(yàn)的薈萃分析

譯者 張軼超

目的：目前文獻(xiàn)對(duì)度洛西汀在全髖關(guān)節(jié)置換術(shù)（THA）或全膝關(guān)節(jié)置換術(shù)（TKA）后的鎮(zhèn)痛作用尚未達(dá)成共識(shí)。因此，我們?cè)O(shè)計(jì)了這項(xiàng)薈萃分析，以證明度洛西汀在TKA或THA治療過程中的鎮(zhèn)痛效果和安全性。

方法：截至到2022年10月，由兩位作者（L.C.和w.q.j）獨(dú)立檢索了五個(gè)主要數(shù)據(jù)庫(kù)（EMBASE、Web of Science、PubMed、Cochrane Library和谷歌學(xué)術(shù)搜索）以查找相關(guān)研究。將關(guān)于度洛西汀與安慰劑對(duì)TKA或THA術(shù)后鎮(zhèn)痛療效的隨機(jī)對(duì)照試驗(yàn)（RCTs）研究納入本研究。我們將圍手術(shù)期阿片類藥物總消耗量作為主要指標(biāo)。次要指標(biāo)包括靜息或活動(dòng)時(shí)的疼痛評(píng)分、胃腸道不良事件、神經(jīng)系統(tǒng)不良事件和其他不良反應(yīng)。

結(jié)果：本研究納入了8項(xiàng)隨機(jī)對(duì)照試驗(yàn)中的695名患者。本薈萃分析表明，高證據(jù)表明度洛西汀可有效減少圍手術(shù)期阿片類藥物的消耗量（標(biāo)準(zhǔn)平均差[SMD]= - 0.50, 95%可信區(qū)間[CI]: - 0.70至- 0.31，P<0.00001），低至中等證據(jù)表明度洛西汀可在術(shù)后三周內(nèi)減輕疼痛。從低到高的證據(jù)表明，兩組在大多數(shù)不良事件方面沒有差異。大量證據(jù)表明度洛西汀可減少術(shù)后惡心嘔吐（風(fēng)險(xiǎn)比[RR]=0.69, 95% CI: 0.50 ~ 0.95， P=0.02, I2=4%）。然而，中度證據(jù)表明度洛西汀可能與術(shù)后嗜睡增加有關(guān)（RR=1.83, 95% CI: 1.08 ~ 3.09， P=0.02, I2=0%）。

結(jié)論：度洛西汀可減少圍手術(shù)期阿片類藥物的總體消耗量，減輕術(shù)后3周內(nèi)的疼痛，且不會(huì)增加藥物不良事件的風(fēng)險(xiǎn)。度洛西汀可作為TKA和THA患者多模式鎮(zhèn)痛治療方案的一部分。

Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose： There is no consensus in the current literature on the analgesic role of duloxetine after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Thus, we designed this meta-analysis to reveal the analgesic effectiveness and safety of duloxetine in TKA or THA.

Methods： As of October 2022, two authors (L.C. and W.Q.J.) independently searched five main databases (EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar) to find relevant studies. Duloxetine vs. placebo in randomized controlled trials (RCTs) for THA or TKA were included. We set perioperative total opioid consumption as the primary outcome. Secondary outcomes included resting or dynamic pain scores over time, gastrointestinal adverse events, neurological adverse events, and other adverse reactions.

Results： Eight RCTs with 695 patients were incorporated in our study. This meta-analysis showed high evidence that duloxetine was effective in reducing perioperative opioid consumption (Standard mean difference [SMD]=?0.50, 95% confidence intervals [CI]: ?0.70 to ?0.31, P<0.00001) and low to moderate evidence that duloxetine could reduce pain within three weeks after surgery. Low to high evidence showed no differences between the two groups for most adverse events. Substantial evidence suggests that duloxetine can reduce nausea and vomiting after surgery (Risk ratio [RR]=0.69, 95% CI: 0.50 to 0.95, P=0.02, I2=4%). However, moderate evidence suggested that duloxetine might be associated with increased postoperative drowsiness (RR=1.83, 95% CI: 1.08 to 3.09, P=0.02, I2=0%).

Conclusion： Duloxetine reduced overall opioid consumption in the perioperative period and relieved pain within three weeks after surgery without increasing the risk of adverse drug events. Duloxetine can be part of a multimodal management regimen in patients with THA and TKA.

文獻(xiàn)出處：Lin Y, Jiang M, Liao C, Wu Q, Zhao J. Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2024 Mar 13;19(1):181. doi: 10.1186/s13018-024-04648-5. PMID: 38481321; PMCID: PMC10936099.

文獻(xiàn)2

與全髖關(guān)節(jié)置換術(shù)后假體周圍感染相關(guān)的長(zhǎng)期病死率：一項(xiàng)包含了4651例感染翻修病例的數(shù)據(jù)庫(kù)研究

譯者 張薔

背景：與全髖關(guān)節(jié)翻修術(shù)（THA）或假體周圍感染（PJI）相關(guān)的病死率已在多篇文獻(xiàn)中被詳細(xì)探討，但與病死率相關(guān)的危險(xiǎn)因素卻鮮有涉及。在本篇文章中，我們希望能夠明確與全髖翻修手術(shù)或假體周圍感染相關(guān)的長(zhǎng)期病死率以及相關(guān)危險(xiǎn)因素。

方法：我們選擇了澳洲骨科協(xié)會(huì)國(guó)家關(guān)節(jié)登記庫(kù)（AOANJRR）中自1999年9月至2022年12月間因骨關(guān)節(jié)炎而施行的THA手術(shù)以及后續(xù)的翻修病例。我們使用Kaplan-Meier曲線和基于澳洲時(shí)期生命表的標(biāo)準(zhǔn)死亡比（SMRs）來總結(jié)并計(jì)算初次THA和首次翻修后的總體生存率。最后，我們使用配平了年齡和性別之后的Cox比例風(fēng)險(xiǎn)模型來確定與病死率相關(guān)的危險(xiǎn)因素。

結(jié)果：共有548061例因骨關(guān)節(jié)炎而施行的初次THA手術(shù)病例；有4651例因感染而施行的初次翻修手術(shù)病例和15891例非感染與骨折原因而施行的初次翻修手術(shù)病例。在術(shù)后5年、10年和15年的三個(gè)時(shí)間點(diǎn)上，因PJI而施行翻修手術(shù)的累計(jì)病死率分別為14.5%、34.7%和57.5%。感染翻修手術(shù)病例的病死率顯著高于一般人群，且對(duì)應(yīng)的SMR（1.31; 95%置信區(qū)間[CI]: 1.24 - 1.39）也高于初次THA（0.81; 95% CI: 0.81 - 0.82）或無菌性松動(dòng)翻修（0.95; 95% CI: 0.92 - 0.99）的病例。年齡小于65歲病例和女性病例的感染翻修后SMR更高，且此后15年逐年升高。處置假體周圍感染的手術(shù)無論大小，病死率均近似。

結(jié)論：與普通大眾、初次THA患者或無菌性松動(dòng)翻修患者相比，感染翻修患者的病死率更高。且這種風(fēng)險(xiǎn)在術(shù)后15年中持續(xù)存在，特別是相對(duì)年輕的病例。

Long-Term Mortality Associated with Periprosthetic Infection in Total Hip Arthroplasty Infection in Total Hip Arthroplasty A Registry Study of 4,651 Revisions for Infection

Background: While the morbidity associated with revision total hip arthroplasty (THA) or periprosthetic infection (PJI) has been well characterized, less is known about the risk of mortality. With this study, we aimed to determine the long-term mortality associated with revision THA for PJI and associated risk factors.

Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to study mortality associated with THA procedures for osteoarthritis and subsequent revisions from September 1999 through December 2022. Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables were used to summarize the overall survival following the primary and first revision THA. Risk factors associated with mortality were identified using Cox proportional hazards models, adjusted for age and gender.

Results: There were 548,061 primary THA procedures for osteoarthritis; 4,651 first revision procedures for infection and 15,891 first revisions for reasons other than infection and fracture were recorded. At 5, 10, and 15 years, the cumulative mortality rate for revision for PJI was 14.5%, 34.7%, and 57.5%, respectively. Patients who underwent revision for PJI had higher mortality rates than expected compared with the general population, and the corresponding SMR (1.31; 95% confidence interval [CI]: 1.24 to 1.39) was greater than that for patients undergoing primary THA (0.81; 95% CI: 0.81 to 0.82) or aseptic revision (0.95; 95% CI: 0.92 to 0.99). A higher SMR following revision for PJI was observed in patients <65 years of age and in female patients, and continued to increase beyond 15 years. There were no differences in mortality rates according to whether a major or minor revision was performed to manage PJI.

Conclusions: Patients revised for infection had increased mortality rates compared with the general population and those undergoing primary THA or aseptic revision. This excess risk persisted beyond 15 years, especially in younger patients.

文獻(xiàn)3

在初次髖關(guān)節(jié)或膝關(guān)節(jié)置換術(shù)中局部使用萬古霉素是否可以預(yù)防感染？

譯者 丁云鵬

背景： 感染是髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)的主要并發(fā)癥之一。局部應(yīng)用萬古霉素預(yù)防脊柱外科術(shù)后感染是有效的，并在關(guān)節(jié)置換手術(shù)中得到推廣。然而，其臨床相關(guān)性和安全性仍存在爭(zhēng)議。因此，我們進(jìn)行了本研究，以（1）評(píng)估局部使用萬古霉素是否會(huì)降低假體周圍感染率，以及（2）研究其對(duì)手術(shù)傷口并發(fā)癥的影響。

假設(shè)：我們的假設(shè)是關(guān)節(jié)置換術(shù)中局部使用稀釋萬古霉素可以降低術(shù)后第1年的感染率。

材料和方法：2014年至2021年間，在同一家醫(yī)院共進(jìn)行了1900例髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)。2018年7月至2021年12月，910例關(guān)節(jié)置換應(yīng)用萬古霉素和氨甲環(huán)酸。2014年11月至2018年6月，990例關(guān)節(jié)置換不應(yīng)用萬古霉素。在至少12個(gè)月的隨訪中，記錄術(shù)后第1年發(fā)生的假體周圍感染，以及萬古霉素引起的全身或皮膚并發(fā)癥。

結(jié)果：對(duì)照組9/990例（0.91%）假體周圍感染，萬古霉素組10/910例（1.1%）假體周圍感染（p = 0.82）。同時(shí)，我們觀察到對(duì)照組和萬古霉素組分別有19/990例（1.9%）和10/910例（1.1%）出現(xiàn)創(chuàng)面并發(fā)癥（紅斑、血腫、血腫、裂開和創(chuàng)面愈合延遲）（p = 0.19）。萬古霉素的應(yīng)用沒有引起一般并發(fā)癥。

討論：局部稀釋萬古霉素不能降低假體周圍感染風(fēng)險(xiǎn)，對(duì)手術(shù)傷口并發(fā)癥的發(fā)生無影響。考慮到目前的研究結(jié)果，在目前的實(shí)踐中不推薦使用萬古霉素來預(yù)防髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)后的感染。最后，它的使用不會(huì)引起任何特定的并發(fā)癥，無論是局部（瘢痕）還是全身（與耳毒性或腎毒性有關(guān)）。

Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections?

Background: Infection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications.

Hypothesis: Our hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year.

Material and methods: In total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications.

Results: We observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin.

Discussion: Topical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity).

文獻(xiàn)出處：Fran?ois Laudet , Alice Gay , Hervé Dutronc ,Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections? Orthop Traumatol Surg Res. 2025 Feb;111(1):103984.doi: 10.1016/j.otsr.2024.103984. Epub 2024 Sep 3.

文獻(xiàn)4

創(chuàng)傷后骨關(guān)節(jié)炎行全膝關(guān)節(jié)置換術(shù)中的微生物學(xué)取樣：假體周圍關(guān)節(jié)感染發(fā)生率及對(duì)取樣于無明顯異常組織的爭(zhēng)議

譯者 沈松坡

背景： 脛骨近端骨折可導(dǎo)致創(chuàng)傷后骨關(guān)節(jié)炎（PTOA），此類患者后續(xù)接受全膝關(guān)節(jié)置換術(shù)（TKA）時(shí)并發(fā)癥發(fā)生率升高。推薦采用分期手術(shù)策略，先擇期移除內(nèi)固定材料，再行TKA。術(shù)中對(duì)肉眼無異常組織進(jìn)行微生物學(xué)取樣的價(jià)值仍存在爭(zhēng)議。

目的： 回顧性評(píng)估PTOA后TKA的假體周圍關(guān)節(jié)感染（PJI）發(fā)生率，并探討術(shù)中微生物學(xué)取樣的潛在價(jià)值。次要目標(biāo)是評(píng)估受累病例中內(nèi)固定材料的潛在細(xì)菌定植情況。

患者與方法： 回顧性篩查醫(yī)院數(shù)據(jù)庫(kù)中2008年至2022年間AO/OTA 41-B與41-C型骨折病例?；颊弑环譃槿咏M（TKA術(shù)中進(jìn)行微生物學(xué)取樣）與對(duì)照組（未取樣）。所有患者均接受術(shù)后隨訪，以評(píng)估并發(fā)癥。

結(jié)果： 共納入40例患者。取樣組（n=29）中，17.24%的患者需要再次手術(shù)，PJI發(fā)生率為3.45%。對(duì)照組（n=11）中，18.14%的患者接受了翻修手術(shù)，PJI發(fā)生率為9.09%。平均隨訪時(shí)間為4.35年（范圍2–11.6年）。

討論： PTOA患者接受TKA的并發(fā)癥風(fēng)險(xiǎn)較高。本研究觀察到系統(tǒng)性術(shù)中微生物取樣可能與較低的PJI發(fā)生率相關(guān)。盡管樣本量較小無法明確因果關(guān)系，但結(jié)果支持術(shù)中一致性取樣的潛在價(jià)值。

Microbiological Sampling in Total Knee Arthroplasty After Post-Traumatic Osteoarthritis: Rate of Periprosthetic Joint Infection and the Debate Around Sampling Unremarkable Tissue

Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial.

Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases.

Patients and methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications.

Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2-11.6 years).

Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling.

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

類固醇性骨壞死:類固醇劑量風(fēng)險(xiǎn)分析

譯者 任寧濤

骨壞死是一種涉及骨破壞的嚴(yán)重疾病，通常需要手術(shù)治療來重建受損的關(guān)節(jié)。雖然有大量文獻(xiàn)記錄了皮質(zhì)類固醇相關(guān)的骨壞死，但對(duì)于類固醇經(jīng)非腸道、口服、外用、吸入和其他途徑給藥后發(fā)生骨壞死的相對(duì)風(fēng)險(xiǎn)還沒有共識(shí)，這種風(fēng)險(xiǎn)是一個(gè)重要的預(yù)后指標(biāo),因?yàn)樽R(shí)別和保守的干預(yù)可以降低發(fā)病率與過度手術(shù)治療骨壞死發(fā)生率，這篇文章是基于使用皮質(zhì)類固醇導(dǎo)致發(fā)生骨壞死風(fēng)險(xiǎn)指南上的見解。對(duì)不同皮質(zhì)類固醇和不同劑量的人類進(jìn)行了病例研究、回顧性研究和前瞻性研究。大多數(shù)骨壞死病例繼發(fā)于全身給藥皮質(zhì)類固醇和/或每日高劑量治療，特別是伴有結(jié)締組織疾病、高脂血癥或既往創(chuàng)傷等潛在合并癥的患者。以往報(bào)告的與吸入或局部使用類固醇相關(guān)的骨壞死病例，由于在絕大多數(shù)病例中，患者在發(fā)生骨壞死之前也接受了全身性類固醇治療，因此變得復(fù)雜?；谖墨I(xiàn)，我們制定了一套關(guān)于使用類固醇的患者發(fā)生骨壞死風(fēng)險(xiǎn)的建議。

1. 開藥者應(yīng)意識(shí)到接受皮質(zhì)類固醇治療的患者，特別是腸外或口服制劑，以及具有某些特定潛在疾病狀態(tài)的患者發(fā)生骨壞死的潛在風(fēng)險(xiǎn)。

2. 通過其他途徑接受類固醇治療的患者，如內(nèi)注射、吸入或鼻內(nèi)注射，發(fā)生骨壞死的風(fēng)險(xiǎn)很低，但并非為零。當(dāng)使用高劑量吸入性皮質(zhì)類固醇時(shí)，如嚴(yán)重持續(xù)性哮喘或嗜酸性食管炎，有可能發(fā)生骨壞死。

3. 無論何時(shí)使用類固醇，都應(yīng)告知患者發(fā)生骨壞死的風(fēng)險(xiǎn)。

Steroid induced osteonecrosis An analysis of steroid dosing risk

Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

文獻(xiàn)出處：Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010 Sep;9(11):721-43. doi: 10.1016/j.autrev.2010.06.007. Epub 2010 Jul 9. PMID: 20621176; PMCID: PMC7105235.

文獻(xiàn)2

冠狀面髖臼矯正對(duì)髖臼周圍截骨術(shù)中關(guān)節(jié)接觸壓力的影響：有限元分析
譯者 李勇

背景：在髖臼周圍截骨術(shù)（PAO）中，優(yōu)化髖關(guān)節(jié)生物力學(xué)的理想髖臼位置仍不明確。本研究旨在確定冠狀面髖臼矯正與關(guān)節(jié)接觸壓力（CP）之間的關(guān)系，并識(shí)別矯正后仍存在異常CP的形態(tài)學(xué)因素。
方法：通過使用44名髖關(guān)節(jié)發(fā)育不良患者的CT圖像，我們?cè)诨颊咛囟ǖ?D髖關(guān)節(jié)模型上進(jìn)行了三種虛擬PAO模式，其中髖臼向外旋轉(zhuǎn)至30°、35°和40°的外側(cè)中心緣角（LCEA）。使用有限元分析計(jì)算單腿站立時(shí)髖臼軟骨的CP。
結(jié)果：將LCEA矯正為30°時(shí)，最大CP的中位數(shù)較術(shù)前減少了0.5倍（p < 0.001）。將LCEA進(jìn)一步矯正為40°時(shí)，CP在15個(gè)髖關(guān)節(jié)（34%）中進(jìn)一步減少，但在29個(gè)髖關(guān)節(jié)（66%）中反而增加。CP的增加與較大的術(shù)前外翻指數(shù)（p = 0.030）和圓度指數(shù)（p = 0.038）相關(guān)。總體而言，虛擬PAO未能在11個(gè)髖關(guān)節(jié)（25%）中正常化CP，且小的前壁指數(shù)（p = 0.049）和大的圓度指數(shù)（p = 0.003）與殘余異常CP相關(guān)。
結(jié)論：在冠狀面髖臼矯正中，CP最小化的髖臼矯正程度因患者而異。單獨(dú)的冠狀面矯正未能使本研究中25%的患者CP正?；Ｔ诨加星绑y臼缺損（前壁指數(shù)<0.21）和非球形股骨頭（圓度指數(shù)>53.2%）的患者中，單純的冠狀面矯正可能無法使CP正?；Ｐ枰M(jìn)一步研究以明確包括矢狀面和軸向面在內(nèi)的多平面矯正對(duì)優(yōu)化髖關(guān)節(jié)接觸力學(xué)的有效性。

圖：一個(gè)髖關(guān)節(jié)發(fā)育不良經(jīng)虛擬髖臼周圍截骨術(shù)后的代表性有限元模型，并顯示彈性模量的分布。骨模型采用2毫米四面體單元和表面0.4毫米三角形殼單元構(gòu)建。髖臼和股骨頭的軟骨以1.8毫米的恒定厚度創(chuàng)建，并在髖臼軟骨的承重區(qū)域采用局部細(xì)化的0.5毫米至2.0毫米四面體單元進(jìn)行網(wǎng)格劃分。為了可視化髖臼軟骨上承受的接觸壓力，在其表面放置了厚度為0.0005毫米的三節(jié)點(diǎn)殼單元。載荷情景基于單腿站立姿態(tài)，髖關(guān)節(jié)接觸力作用于股骨頭中心的節(jié)點(diǎn)。載荷施加過程中，髂嵴和恥骨區(qū)完全固定，而股骨遠(yuǎn)端僅在Z軸方向自由，但在X和Y軸方向受限。分別在軟骨-骨界面和軟骨-軟骨界面設(shè)置了綁定接觸和滑動(dòng)接觸約束。髖臼碎片通過綁定接觸重新連接到骨盆，以模擬完全骨性愈合。接觸關(guān)節(jié)面之間的摩擦剪應(yīng)力被忽略。

Effect of Coronal Plane Acetabular Correction on Joint Contact Pressure in Periacetabular Osteotomy: A Finite-Element Analysis

Background: The ideal acetabular position for optimizing hip joint biomechanics in periacetabular osteotomy (PAO) remains unclear. We aimed to determine the relationship between acetabular correction in the coronal plane and joint contact pressure (CP) and identify morphological factors associated with residual abnormal CP after correction.
Methods: Using CT images from 44 patients with hip dysplasia, we performed three patterns of virtual PAOs on patient-specific 3D hip models, where the acetabulum was rotated laterally to the lateral center-edge angles (LCEA) of 30°, 35°, and 40°. Finite-element analysis was used to calculate the CP of the acetabular cartilage during a single-leg stance.
Results: Coronal correction to the LCEA of 30° decreased the median maximum CP by 0.5-fold compared to preoperatively (p < 0.001). Additional correction to the LCEA of 40° further decreased CP in 15 hips (34%) but conversely increased CP in 29 hips (66%). The increase in CP was associated with a greater preoperative extrusion index (p = 0.030) and roundness index (p = 0.038). Overall, virtual PAO failed to normalize CP in 11 hips (25%), and a small anterior wall index (p = 0.049) and a large roundness index (p = 0.003) were associated with residual abnormal CP.
Conclusions: The degree of acetabular correction in the coronal plane where CP is minimized varied among patients. Coronal plane correction alone failed to normalize CP in 25% of patients in this study. In patients with an anterior acetabular deficiency (anterior wall index <0.21) and an aspherical femoral head (roundness index > 53.2%), coronal plane correction alone may not normalize CP. Further studies are needed to clarify the effectiveness of multiplanar correction, including in the sagittal and axial planes, in optimizing the hip joint's contact mechanics.

文獻(xiàn)出處：Kitamura K, Fujii M, Iwamoto M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Effect of coronal plane acetabular correction on joint contact pressure in Periacetabular osteotomy: a finite-element analysis. BMC Musculoskelet Disord. 2022 Jan 14;23(1):48. doi: 10.1186/s12891-022-05005-5. PMID: 35031030; PMCID: PMC8760799.

文獻(xiàn)3

利用人工韌帶對(duì)臨界發(fā)育性髖關(guān)節(jié)發(fā)育不良進(jìn)行關(guān)節(jié)鏡下關(guān)節(jié)囊修復(fù)術(shù)

譯者 張利強(qiáng)

鑒于髂股韌帶在維持髖關(guān)節(jié)穩(wěn)定性方面具有積極作用，尤其是在患有臨界發(fā)育性髖關(guān)節(jié)發(fā)育不良的患者中，一些外科醫(yī)生建議通過保守的關(guān)節(jié)囊切開術(shù)并最終縫合來恢復(fù)其原始結(jié)構(gòu)。在各種不同的關(guān)節(jié)囊切開術(shù)中，縱向關(guān)節(jié)囊切開術(shù)是一種能夠減少對(duì)髂股韌帶損傷的技術(shù)。這種保護(hù)作用足以使患有股骨髖臼撞擊癥的患者恢復(fù)髖關(guān)節(jié)穩(wěn)定性，但對(duì)于患有臨界發(fā)育性髖關(guān)節(jié)發(fā)育不良的患者而言，由于其關(guān)節(jié)囊松弛和不穩(wěn)定，這種保護(hù)作用可能不夠充分。因此，我們提出了一種手術(shù)技術(shù)，即在縱向關(guān)節(jié)囊切開術(shù)后利用人工韌帶對(duì)前關(guān)節(jié)囊進(jìn)行增強(qiáng)修復(fù)。

右側(cè)髖關(guān)節(jié)的關(guān)節(jié)鏡圖像展示使用30度關(guān)節(jié)鏡進(jìn)行加強(qiáng)手術(shù)的關(guān)鍵步驟。患者仰臥于牽引床上，術(shù)側(cè)下肢置于旋轉(zhuǎn)中立和輕度屈曲位。(A)通過前內(nèi)側(cè)入路，關(guān)節(jié)囊縱向切開向上延伸至盂唇，向下延伸至股骨頸。(B、C)用射頻探針識(shí)別并標(biāo)記髂股韌帶內(nèi)側(cè)束和外側(cè)束的固定點(diǎn)。(D)預(yù)鉆近端隧道。(E)通過遠(yuǎn)端外側(cè)輔助入路將裝有LARS縫合線帶的錨釘置入近端隧道。(F)在伸直位固定并拉緊LARS。(G)縫線穿過切開的關(guān)節(jié)囊兩側(cè)。(H)最終關(guān)節(jié)鏡圖像顯示關(guān)節(jié)囊完全閉合。(C，關(guān)節(jié)囊；FM，股骨頭；IH，反折頭；L，盂唇；LARS，韌帶高級(jí)加強(qiáng)系統(tǒng)；LD，髂股韌帶外側(cè)束；MD，髂股韌帶內(nèi)側(cè)束。)

準(zhǔn)備韌帶高級(jí)加強(qiáng)系統(tǒng)線帶。（A、B）將韌帶高級(jí)加強(qiáng)系統(tǒng)線帶穿過錨釘?shù)目撞⒄郫B。（C）在近端隧道置入第一枚錨釘后，從前中間切口牽出線帶兩端，并穿過第二枚和第三枚錨釘?shù)目住?/p>

右髖關(guān)節(jié)示意圖展示從中前側(cè)切口進(jìn)行加強(qiáng)術(shù)的主要步驟。（A）采用縱向“由外向內(nèi)”的關(guān)節(jié)囊切開技術(shù)切開。（B）確定固定點(diǎn)：髂前下極下方區(qū)域、髂股韌帶的外側(cè)束以及內(nèi)側(cè)束的末端。（C）將韌帶高級(jí)加強(qiáng)系統(tǒng)固定在3個(gè)固定點(diǎn)上以增強(qiáng)髂股韌帶，隨后對(duì)縱向切口進(jìn)行端端縫合。

Arthroscopic Augmentation of the Anterior Capsule Using Artificial Tape for Borderline Developmental Dysplasia of the Hip

With the recognition of the positive effect of the iliofemoral ligament in maintaining hip stability, particularly in patients with borderline developmental dysplasia of the hip, some surgeons recommend restoring its native anatomy through conservative capsulotomy and final closure. In the many different kinds of capsulotomy, longitudinal capsulotomy is a technique that can reduce damage to the iliofemoral ligament. This protective effect is sufficient to restore hip stability in patients with femoroacetabular impingement but may be inadequate for patients with borderline developmental dysplasia of the hip because of the laxity and capsular instability. Therefore, we propose a surgical technique that utilizes artificial tape to augment the anterior capsule under longitudinal capsulotomy.

文獻(xiàn)出處：Zhang J, Sha SY, Liang T, Liu Y, Yin QF. Arthroscopic Augmentation of the Anterior Capsule Using Artificial Tape for Borderline Developmental Dysplasia of the Hip. Arthrosc Tech. 2025 Apr 3;14(6):103534. doi: 10.1016/j.eats.2025.103534. PMID: 40656720; PMCID: PMC12255451.

文獻(xiàn)4

髖臼周圍截骨術(shù)治療成人髖關(guān)節(jié)發(fā)育不良的手術(shù)進(jìn)展

譯者 陶可

引言：髖關(guān)節(jié)發(fā)育不良的特征是髖臼過度傾斜且臼窩較淺，股骨頭覆蓋不足。它是年輕人髖關(guān)節(jié)疼痛和早期骨關(guān)節(jié)炎發(fā)展的已知原因。髖臼周圍截骨術(shù)是年輕成人出現(xiàn)癥狀性髖關(guān)節(jié)發(fā)育不良的首選保髖治療方法。這項(xiàng)手術(shù)旨在重新定向髖臼，以改善覆蓋范圍并消除病理性髖關(guān)節(jié)應(yīng)力集中。因此，術(shù)中對(duì)已實(shí)現(xiàn)的髖臼重新定向進(jìn)行評(píng)估至關(guān)重要。髖臼周圍截骨術(shù)的“經(jīng)典”手術(shù)入路會(huì)對(duì)組織造成廣泛的創(chuàng)傷，有些甚至?xí)?dǎo)致肌肉脫離。手術(shù)入路的類型可能會(huì)影響并發(fā)癥的發(fā)生、手術(shù)時(shí)間、術(shù)中失血量、輸血需求和住院時(shí)間。本博士論文旨在：I）評(píng)估一種新型經(jīng)髖臼周圍微創(chuàng)入路截骨術(shù)的效果；II）比較該微創(chuàng)入路與以往使用的“經(jīng)典”髂腹股溝入路差異；III）評(píng)估一種用于術(shù)中評(píng)估髖臼復(fù)位效果的新型裝置的可靠性。

方法：本博士論文包含三項(xiàng)研究。在研究I和II中，通過數(shù)據(jù)庫(kù)查詢和影像學(xué)資料評(píng)估，回顧性地評(píng)估了微創(chuàng)入路和髂腹股溝入路的經(jīng)驗(yàn)?；颊呷丝诮y(tǒng)計(jì)學(xué)信息、病史、術(shù)中測(cè)量和并發(fā)癥數(shù)據(jù)均記錄在經(jīng)過驗(yàn)證的數(shù)據(jù)庫(kù)中。在術(shù)前和術(shù)后骨盆X線片中測(cè)量外側(cè)中心邊緣角和髖臼指數(shù)角，以評(píng)估術(shù)前發(fā)育不良和髖臼復(fù)位效果。在研究I和II中，明確定義的研究組分別包含94例和263例髖臼周圍截骨術(shù)。在研究三中，前瞻性地對(duì)35例髖臼周圍截骨術(shù)進(jìn)行了術(shù)中角度測(cè)量。將獲得的測(cè)量值（外側(cè)中心邊緣角和髖臼指數(shù)角）與術(shù)后骨盆X線片的測(cè)量值進(jìn)行比較。此外，還進(jìn)行了一項(xiàng)尸體研究，以評(píng)估該裝置的觀察者內(nèi)和觀察者間變異性，并評(píng)估骨盆位置是否影響測(cè)量值的變異性。對(duì)所應(yīng)用的方法進(jìn)行了嚴(yán)格審查。

結(jié)果：研究一——微創(chuàng)手術(shù)的結(jié)果如下。平均手術(shù)時(shí)間為73分鐘，術(shù)中失血量中位數(shù)為250毫升。3%的手術(shù)后需要輸血。沒有出現(xiàn)中度或重度技術(shù)和神經(jīng)血管并發(fā)癥，所獲得的中心邊緣角和髖臼指數(shù)角表明可以實(shí)現(xiàn)最佳的重新定位。以全髖關(guān)節(jié)置換術(shù)為終點(diǎn)的髖關(guān)節(jié)存活率為98%，隨訪時(shí)間為4.3年。

研究二——與髂腹股溝入路的結(jié)果相比，采用微創(chuàng)入路進(jìn)行的手術(shù)具有統(tǒng)計(jì)學(xué)上顯著的手術(shù)時(shí)間更短、術(shù)中失血量和血紅蛋白降低更少以及輸血需求更少的特點(diǎn)。兩組之間實(shí)現(xiàn)的重新定位效果相當(dāng)。微創(chuàng)組無中度或重度并發(fā)癥病例，髂腹股溝組有3例（3%）動(dòng)脈血栓形成病例。在髖關(guān)節(jié)手術(shù)后4.9年的隨訪中，微創(chuàng)組的生存率為97%，髂腹股溝組的生存率為93%。

研究三——術(shù)中測(cè)量的角度與術(shù)后骨盆X線片上的測(cè)量值相差不到 +/- 5度，并且該裝置的觀察者內(nèi)和觀察者之間的差異均在 +/- 5度以內(nèi)。除了觀察者內(nèi)的裝置差異外，定位對(duì)角度測(cè)量差異的影響并不大。

解讀：新的微創(chuàng)經(jīng)髖臼入路似乎是一種安全的技術(shù)，可實(shí)現(xiàn)最佳的髖臼復(fù)位，并似乎可最大限度地減少組織創(chuàng)傷。此外，短期髖關(guān)節(jié)成活率令人鼓舞。其結(jié)果與髂腹股溝入路相比更為有利，并且結(jié)果支持繼續(xù)使用微創(chuàng)入路進(jìn)行髖臼周圍截骨術(shù)。在髖臼周圍截骨術(shù)中，髖臼的最佳復(fù)位至關(guān)重要。這種新型測(cè)量裝置是術(shù)中評(píng)估外側(cè)中心邊緣和髖臼指數(shù)角度的潛在有用工具。它使用簡(jiǎn)單，便于在髖臼復(fù)位期間重復(fù)可靠的角度測(cè)量，從而無需術(shù)中拍攝X線片。這種新的微創(chuàng)入路和新型測(cè)量裝置代表了當(dāng)代髖臼周圍截骨術(shù)的重要手術(shù)進(jìn)展。

圖 改良 Smith-Petersen入路（綠色）和髂腹股溝入路（藍(lán)色）的切口。髂前上棘標(biāo)記為ASIS。

圖. 測(cè)量裝置在前后位透視下使用。它安裝在雙側(cè)髂前上棘上。通過插入克氏針固定。為了確保骨盆與角度測(cè)量的對(duì)齊，一根桿連接上述固定的克氏針。測(cè)量裝置在手術(shù)過程中與用于測(cè)量外側(cè)中心邊緣角的角度測(cè)量盤鏈接在一起。

圖 用于測(cè)量外側(cè)中心邊緣角的角度測(cè)量盤。通過識(shí)別股骨頭中心和硬化髖臼頂?shù)耐鈧?cè)邊界作為標(biāo)志（藍(lán)色箭頭）來定位。0°標(biāo)記已標(biāo)記。本例中測(cè)量的角度為35°（黃色箭頭）。

圖. 以全髖關(guān)節(jié)置換術(shù)為終點(diǎn)的髖臼周圍截骨術(shù)后的Kaplan-Meier髖關(guān)節(jié)存活曲線。彩色區(qū)域（微創(chuàng)=紅色；髂腹股溝=藍(lán)色）表示存活率的95%置信區(qū)間。x軸下方給出了每組隨訪年數(shù)的剩余髖關(guān)節(jié)數(shù)量。請(qǐng)注意，y軸并非從“0”開始。隨訪4.9年，微創(chuàng)組髖關(guān)節(jié)存活率為97%，髂腹股溝組髖關(guān)節(jié)存活率為93%（圖11）。

Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults

Introduction: Hip dysplasia is characterized by an excessively oblique and shallow acetabulum with insufficient coverage of the femoral head. It is a known cause of pain and the development of early osteoarthritis in young adults. The periacetabular osteotomy is the joint-preserving treatment of choice in young adults with symptomatic hip dysplasia. The surgical aim of this extensive procedure is to reorient the acetabulum to improve coverage and eliminate the pathological hip joint mechanics. Intraoperative assessment of the achieved acetabular reorientation is therefore crucial. The "classic" surgical approaches for the periacetabular osteotomy inflict extensive trauma to the tissues and some involve detachment of muscles. The type of surgical approach may affect the occurrence of complications, duration of surgery, intraoperative blood loss, transfusion requirements, and length of hospital stay. The aims of the PhD thesis were I) to assess the outcome of a new, minimally invasive transsartorial approach for periacetabular osteotomy; II) to compare the minimally invasive approach with the previously used "classic" ilioinguinal approach; and III) to assess the reliability of a novel device for intraoperative assessment of the achieved acetabular reorientation.

Methods: Three studies underly this PhD thesis. In studies I and II, the experience with the minimally invasive and ilioinguinal approaches was retrospectively assessed by database inquiry and evaluation of radiographic material. Data regarding patient demographics, patient history, intraoperative measures and complications was recorded in a validated database. Center-edge and acetabular index angles were measured in preoperative and postoperative pelvic radiographs to assess preoperative dysplasia and the achieved acetabular reorientation. The well-defined study groups consisted of 94 and 263 periacetabular osteotomies in studies I and II, respectively. In study III, intraoperative angle measurements were carried out prospectively in 35 periacetabular osteotomies. The obtained measures (center-edge and acetabular index angles) were compared with those of postoperative pelvic radiographs. Furthermore, a cadaver study was conducted to evaluate intra- and interobserver variability of the device and to assess whether pelvic positioning influenced the variability of measurements. The applied methodology was critically reviewed.

Results: Study I--The minimally invasive approach had the following outcome. The mean duration of surgery was 73 min and the median intraoperative blood loss was 250 ml. Blood transfusion was required following 3% of the procedures. There were no cases of moderate or severe technical and neurovascular complications, and the achieved center-edge and acetabular index angles suggest that optimal reorientation can be achieved. Hip joint survival with total hip arthroplasty as the end point was 98% at 4.3 years. Study II--When compared with the outcome of the ilioinguinal approach, the procedures performed by using the minimally invasive approach had a statistically significant shorter duration of surgery, less intraoperative blood loss and hemoglobin reduction, and fewer transfusion requirements. The achieved reorientation was comparable between groups. There were no cases of moderate or severe complications in the minimally invasive group and three cases (3%) of arterial thrombosis in the ilioinguinal group. At follow-up 4.9 years after hip joint surgery, survival rates were 97% in the minimally invasive group and 93% in the ilioinguinal group. Study III--Intraoperatively obtained angle measures differed less than +/- 5 degrees from measurements on postoperative pelvic radiographs, and the intra- and interobserver variability of the device was confined well within +/-5 degrees. Positioning did not influence the variation of angle measurements beyond intraobserver variability of the device.

Interpretation: The new minimally invasive transsartorial approach appears to be a safe technique, allowing optimal acetabular reorientation, and seems to minimize tissue trauma. In addition, short-term hip joint survival rate is encouraging. The outcome compares favorably with that of the ilioinguinal approach, and the results support continued use of the minimally invasive approach for periacetabular osteotomy. Optimal reorientation of the acetabulum is crucial in periacetabular osteotomy. The novel measuring device is a potentially helpful tool for intraoperative assessment of center-edge and acetabular index angels. It is simple to use and facilitates repeated reliable angle measurements during acetabular reorientation, making intraoperative radiographs unnecessary. The new, minimally invasive approach and the novel measuring device represent important surgical advances in contemporary periacetabular osteotomy.

文獻(xiàn)出處：Anders Troelsen. Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults. Acta Orthop Suppl. 2009 Apr;80(332):1-33. doi: 10.1080/17453690610046585.

文獻(xiàn)5

髖臼旋轉(zhuǎn)截骨術(shù)后骨關(guān)節(jié)炎進(jìn)展的影響因素：183例髖關(guān)節(jié)中位隨訪期14年的研究

譯者 徐子茵

背景：髖臼旋轉(zhuǎn)截骨術(shù)（RAO）是一種保髖手術(shù)，可改善股骨頭覆蓋。該手術(shù)有望減緩髖關(guān)節(jié)發(fā)育不良（DDH）的年輕患者繼發(fā)骨性關(guān)節(jié)炎（OA）的進(jìn)展。然而，由于多種因素，術(shù)后OA進(jìn)展仍會(huì)發(fā)生。因此，我們的目的是使用患者隊(duì)列數(shù)據(jù)研究術(shù)后OA進(jìn)展的因素，RAO手術(shù)后的中位隨訪期為14年，無嚴(yán)重OA的DDH。

方法：回顧性分析因DDH接受RAO的患者的記錄，這些患者的T€onnis分級(jí)為0和1。我們通過將全髖關(guān)節(jié)置換術(shù)和進(jìn)展至Tonnis 2級(jí)OA作為終點(diǎn)來計(jì)算生存率。研究患者術(shù)前OA分期、術(shù)后髖臼覆蓋率和OA進(jìn)展之間的關(guān)系。最終分析共納入160例患者和183例髖關(guān)節(jié)（Tonnis 0級(jí)，112例髖關(guān)節(jié); 1級(jí)，71例髖關(guān)節(jié)）。中位隨訪時(shí)間為14年。

結(jié)果：以全髖關(guān)節(jié)置換術(shù)為終點(diǎn)，Tonnis 0級(jí)和1級(jí)OA組的20年生存率相似，均為86.4%。然而，在這些組中，以進(jìn)展至Tonnis 2級(jí)OA為終點(diǎn)的生存率分別為74.6%和49.3%。在單變量分析中，RAO時(shí)的年齡、術(shù)前OA分期和體重指數(shù)（BMI）是OA進(jìn)展的預(yù)測(cè)因素。在多變量分析中，BMI是OA進(jìn)展的唯一獨(dú)立預(yù)測(cè)因素。

結(jié)論：我們的RAO隊(duì)列的中位隨訪期為14年，在骨關(guān)節(jié)炎前期和DDH發(fā)病初期的患者中顯示出良好的生存率。在多變量分析中，高BMI與RAO后OA進(jìn)展獨(dú)立相關(guān)。

Factors Contributing to the Progression of Osteoarthritis After Rotational Acetabular Osteotomy: A Study of 183 Hips With a Median Follow-Up Period of 14 Years

Background: Rotational acetabular osteotomy (RAO) is a joint-preserving procedure that improves femoral head coverage. This procedure is expected to counteract the progression of secondary osteo- arthritis of the hip (OA) in young patients who have developmental dysplasia of the hip (DDH). How-ever, postoperative OA progression still occurs owing to multiple factors. Therefore, we aimed to investigate the factors contributing to postoperative OA progression using patient cohort data with a median follow-up period of 14 years after RAO surgery for DDH without severe OA.

Methods: The records of patients who underwent RAO for DDH who had T€onnis grades 0 and 1 were retrospectively reviewed. We calculated the survival rates by setting total hip arthroplasty and pro- gression to T€onnis grade 2 OA as the endpoints. The associations between patient background, preop- erative OA stage, postoperative acetabular coverage, and OA progression were investigated. A total of 160 patients and 183 hips (Tonnis grade 0, 112 hips; grade 1, 71 hips) were included in the final analysis. The median follow-up time was 14 years.

Results: The 20-year survival rates with total hip arthroplasty as the endpoint were similarly good at 86.4% in both Tonnis grade 0 and 1 OA groups. However, in these groups, the survival rates with pro- gression to T€onnis grade 2 OA as the endpoint were 74.6 and 49.3%, respectively. Age at the time of RAO, preoperative OA stage, and body mass index(BMI) were predictive factors for OA progression in the univariate analysis. In the multivariate analysis, BMI was the only independent predictive factor for OA progression.

Conclusions: Our RAO cohort with a median follow-up period of 14 years demonstrated good survival rates in patients at the preosteoarthritis stage and in patients at the initial stage of DDH. In the multivariate analysis, high BMI was independently associated with OA progression after RAO.

文獻(xiàn)來源：Yoshikawa Y, Okano I, Usui Y, Nishi M, Nakamura S, Kudo Y. Factors Contributing to the Progression of Osteoarthritis After Rotational Acetabular Osteotomy: A Study of 183 Hips With a Median Follow-Up Period of 14 Years. J Arthroplasty. Published online June 11, 2025. doi:10.1016/j.arth.2025.06.021

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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