本期目錄：

1、膝骨關(guān)節(jié)炎患者全膝關(guān)節(jié)置換術(shù)后生活質(zhì)量的決定因素

2、膝關(guān)節(jié)置換手術(shù)病人的心理測量學(xué)特性和可行性評估

3、機(jī)器人輔助關(guān)節(jié)置換手術(shù)：歐洲關(guān)于外科醫(yī)生采用與應(yīng)用趨勢的觀點(diǎn)

4、髖關(guān)節(jié)疼痛患者通常存在兩種或以上的撞擊或不穩(wěn)定畸形

5、髖臼周圍截骨術(shù)是否改變脊柱骨盆矢狀面序列

6、保髖手術(shù)后患者報(bào)告結(jié)局的演變軌跡

7、歐洲國家發(fā)育性髖關(guān)節(jié)發(fā)育不良篩查與治療指南概述及質(zhì)量評估

8、髖臼周圍截骨術(shù)治療伴有嚴(yán)重股骨頭非球形畸形的髖關(guān)節(jié)發(fā)育不良臨床研究

9、股骨頭壞死中軟骨下骨折始于骨吸收區(qū)：一項(xiàng)顯微計(jì)算機(jī)斷層掃描研究

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

文獻(xiàn)1

膝骨關(guān)節(jié)炎患者全膝關(guān)節(jié)置換術(shù)后生活質(zhì)量的決定因素：一項(xiàng)系統(tǒng)綜述

譯者 張軼超

目的：系統(tǒng)回顧、總結(jié)和評價(jià)影響膝骨關(guān)節(jié)炎患者全膝關(guān)節(jié)置換術(shù)后生活質(zhì)量（QoL）的因素。

方法：通過檢索PubMed、Scopus、Web of Science、CINAHL、EMBASE、ProQuest等6個(gè)數(shù)據(jù)庫，采用合適的檢索詞檢索TKA術(shù)后影響生活質(zhì)量的因素的相關(guān)文獻(xiàn)。兩名審稿人獨(dú)立對研究進(jìn)行篩選和納入。如有異議就咨詢第三位審稿人。納入研究的方法學(xué)質(zhì)量采用改良Downs和Black指數(shù)檢查表進(jìn)行評估。本綜述已在PROSPERO注冊（CRD42022352887），并根據(jù)PRISMA核對表要求進(jìn)行報(bào)告。

結(jié)果：我們共搜索到8517項(xiàng)研究，其中29項(xiàng)被納入。高齡;女性;身體質(zhì)量指數(shù)（BMI）的增加；存在合并癥，如糖尿??；對側(cè)膝關(guān)節(jié)疼痛；術(shù)前狀態(tài)差；心理和疼痛相關(guān)因素，如對疼痛過度敏感；中樞性敏感;運(yùn)動(dòng)恐懼癥;焦慮;抑郁癥;慢性疼痛;悲痛;樂觀程度低；和降低的患者滿意度被用來作為確定TKA術(shù)后的生活質(zhì)量評分內(nèi)容。在這些研究中，高BMI和抑郁是最常見的因素?？傮w而言，納入研究的方法學(xué)質(zhì)量從高到低不等。

結(jié)論：經(jīng)TKA治療后，患者總體生活質(zhì)量評分有所提高。然而，有一些生理、行為和心理因素會(huì)影響生活質(zhì)量。確定這些因素可以幫助臨床醫(yī)生和衛(wèi)生專業(yè)人員在患者的治療和康復(fù)過程中改善TKA患者的預(yù)后。

Factors determinant of quality of life after total knee arthroplasty in knee osteoarthritis: A systematic review

Objective: To systematically review, summarize and appraise evidence on the factors determining quality of life (QoL) after total knee arthroplasty (TKA) in individuals with knee osteoarthritis.

Methods: We searched six databases (PubMed, Scopus, Web of Science, CINAHL, EMBASE, and ProQuest) using appropriate search terms to identify the relevant literature published on the factors determining QoL following TKA. Two reviewers independently performed the study screening and study selection. A third reviewer was consulted in case of any disagreement. The methodological quality of the included studies was assessed using the Modified Downs and Black Index checklist. This review was registered in PROSPERO (CRD42022352887) and reported according to the PRISMA checklist.

Results: We identified a total of 8517 studies, 29 of which were included. Advanced age; female sex; increased body mass index (BMI); the presence of comorbidities such as diabetes; contralateral knee pain; poor preoperative status; psychological and pain-related factors such as the presence of pain catastrophizing; central sensitization; kinesiophobia; anxiety; depression; chronic pain; psychological distress; low level of optimism; and reduced patient satisfaction were used to determine post-TKA QoL scores. High BMI and depression were the most common factors evaluated in these studies. Overall, the methodological quality of the included studies varied from high to low.

Conclusion: After TKA, the overall QoL score improved. However, there are a few physical, behavioral, and psychological factors that influence QoL. Identifying these factors could aid clinicians and health professionals in treating and rehabilitating patients by helping them improve patient prognosis after TKA.

文獻(xiàn)出處：Shetty S, Maiya GA, Rao Kg M, Vijayan S, George BM. Factors determinant of quality of life after total knee arthroplasty in knee osteoarthritis: A systematic review. J Bodyw Mov Ther. 2024 Oct;40:1588-1604. doi: 10.1016/j.jbmt.2024.08.013. Epub 2024 Aug 23. PMID: 39593495.

文獻(xiàn)2

應(yīng)用患者自評結(jié)果測量系統(tǒng)-計(jì)算機(jī)自適應(yīng)測試工具VS.疾病特異性評價(jià)工具對膝關(guān)節(jié)置換手術(shù)病人的心理測量學(xué)特性和可行性評估

譯者 張薔

背景：相比于常用的疾病特異性評價(jià)工具，通用性極佳的患者自評結(jié)果測量系統(tǒng)-計(jì)算機(jī)自適應(yīng)測量（PROMIS CATs）工具可以幫助我們更有效的評價(jià)膝關(guān)節(jié)置換手術(shù)患者的健康狀態(tài)。本研究旨在比較不同的PROMIS-CATs工具（包括疼痛[PROMIS-PI-CAT, v1.1]、功能[PROMIS-PF-CAT, v2.0]、行動(dòng)能力[PROMIS Mob-CAT, v2.0]、參與社會(huì)角色與活動(dòng)能力[PROMIS-AS-CAT, v2.0]和對社會(huì)角色與活動(dòng)能力的滿意度[PROMIS-SS-CAT, v2.0]）與傳統(tǒng)的膝關(guān)節(jié)疼痛和骨關(guān)節(jié)炎評分（KOOS），包括KOOS功能短表（KOOS-PS）和KOOS關(guān)節(jié)置換（KOOS-JR）以及WOMAC評分在評價(jià)膝關(guān)節(jié)置換手術(shù)患者療效方面的心理測量學(xué)特性和可行性。

方法：在AZ Alma（Eeklo，比利時(shí)）醫(yī)院接受單側(cè)或雙側(cè)初次或翻修全膝關(guān)節(jié)置換手術(shù)的患者（n=193；平均年齡，64.4±10.1歲；56%為女性；平均BMI，29.6±5.2 kg/m2）分別在術(shù)前6周、術(shù)后6周、術(shù)后3個(gè)月、術(shù)后6個(gè)月和術(shù)后12個(gè)月隨訪時(shí)完成了評測。本研究分別評估了評測的準(zhǔn)確性（百分標(biāo)準(zhǔn)差[SE%]）、反應(yīng)性（假定相關(guān)性和標(biāo)準(zhǔn)反應(yīng)均數(shù)[SRM]）、地板和天花板效應(yīng)（最差和最佳所占百分比）和可行性（完成時(shí)間以及完成項(xiàng)目數(shù)）。

結(jié)果：與傳統(tǒng)的KOOS/WOMAC評價(jià)系統(tǒng)相比，PROMIS-PI-CAT和PROMIS-PF-CAT顯示出更為優(yōu)秀的準(zhǔn)確性（SE%, 4.6 vs 7.1/9.3和3.6 vs 4.4/4.4），但在術(shù)后12個(gè)月隨訪時(shí)準(zhǔn)確性變差（SE %, 6.8 vs 4.8/5.5和3.6 vs 3.0/3.0）。所有的PROMIS CATs評測工具都有很好的反應(yīng)性（75% - 100% 的設(shè)定未拒絕; 術(shù)后12個(gè)月隨訪時(shí)SRMs: PROMIS-PI-CAT = 21.35 vs KOOS 疼痛 = 1.78 和 WOMAC 疼痛 = 21.59; PROMIS-PFCAT = 1.14 vs KOOS-ADL/WOMAC-PF = 1.43/21.44; PROMIS-AS-CAT = 0.93 和 PROMIS-SS-CAT = 0.93）。PROMIS-PF-CAT在術(shù)后12個(gè)月隨訪時(shí)沒有顯現(xiàn)出天花板效應(yīng)，與KOOS-ADL/WOMAC-PF正相反（17.5%）。與KOOS和WOMAC評分相比，PROMIS CATs評測工具可行性更佳。

結(jié)論：PROMIS-CATs評測工具能有效的評價(jià)膝關(guān)節(jié)置換患者的療效，顯示出優(yōu)秀的心理測量學(xué)特性和可行性，支持其在以療效主導(dǎo)的診療過程中發(fā)揮更大的作用。

Psychometric Properties and Feasibility of PROMIS Computerized Adaptive Tests Compared with Disease-Specific Measures in Knee Arthroplasty

Background: The efficient assessment of health outcomes in knee arthroplasty may benefit from universally applicable Patient-Reported Outcomes Measurement Information System computerized adaptive tests (PROMIS CATs), rather than disease-specific measures. This study aimed to evaluate and compare some psychometric properties and the feasibility of various PROMIS CATs (Pain Interference [PROMIS-PI-CAT, v1.1], Physical Function [PROMIS-PF-CAT, v2.0], Mobility [PROMIS Mob-CAT, v2.0], Ability to Participate in Social Roles and Activities [PROMIS-AS-CAT, v2.0], and Satisfaction with Social Roles and Activities [PROMIS-SS-CAT, v2.0]), with the Knee Injury and Osteoarthritis Outcome Score (KOOS) scales, including the KOOS Physical Function Short-form [KOOS-PS] and KOOS for Joint Replacement [KOOS-JR], and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales.

Methods: Patients (n = 193; mean age [and standard deviation], 64.4 ± 10.1 years; 56% female; mean body mass index, 29.6 ± 5.2 kg/m2 ) undergoing unilateral or bilateral primary or revision knee arthroplasty at AZ Alma (Eeklo, Belgium) completed the measures 6 weeks before and 6 weeks and 3, 6, and 12 months after surgery. The study evaluated precision (standard error as a percentage of scale range [SE%]), responsiveness (hypothesized correlations and standardized response mean [SRM]), floor and ceiling effects (percentage with the worst and the best scores), and feasibility (completion time and number of items).

Results: The PROMIS-PI-CAT and PROMIS-PF-CAT showed better precision at baseline compared with corresponding KOOS/WOMAC scales (SE%, 4.6 versus 7.1/9.3 and 3.6 versus 4.4/4.4), but less precision at 12 months of follow-up (SE %, 6.8 versus 4.8/5.5 and 3.6 versus 3.0/3.0). All PROMIS CATs had good responsiveness (75% to 100% of hypotheses not rejected; SRMs at 12 months: PROMIS-PI-CAT = 21.35 versus KOOS Pain = 1.78 and WOMAC Pain = 21.59; PROMIS-PFCAT = 1.14 versus KOOS-ADL/WOMAC-PF = 1.43/21.44; PROMIS-AS-CAT = 0.93 and PROMIS-SS-CAT = 0.93). The PROMIS-PF-CAT did not show ceiling effects at 12 months, unlike the KOOS-ADL/WOMAC-PF (17.5%). PROMIS CATs were more feasible at baseline and follow-ups compared with KOOS and WOMAC scales.

Conclusions: PROMIS-CATs effectively assess health outcomes in knee arthroplasty patients, showing strong psychometric properties and favorable feasibility, supporting their role in value-based health care.

文獻(xiàn)3

機(jī)器人輔助關(guān)節(jié)置換手術(shù)：歐洲關(guān)于外科醫(yī)生采用與應(yīng)用趨勢的觀點(diǎn)

譯者 沈松坡

背景： 機(jī)器人輔助全關(guān)節(jié)置換術(shù)（TJA）提升了手術(shù)精度和假體定位的準(zhǔn)確性，然而外科醫(yī)生對其認(rèn)知及采用模式仍未被充分理解。本研究聚焦三個(gè)關(guān)鍵問題：（1）不同地區(qū)在機(jī)器人技術(shù)使用及興趣方面的當(dāng)前趨勢如何？（2）不同手術(shù)類型的機(jī)器人使用情況有何差異？外科醫(yī)生對各類機(jī)器人系統(tǒng)的熟悉程度如何？（3）哪些因素最能影響外科醫(yī)生在關(guān)節(jié)置換手術(shù)中選擇或避免使用機(jī)器人輔助？

方法： 本研究于2023年10月在歐洲范圍內(nèi)開展了一項(xiàng)橫斷面匿名調(diào)查。符合條件的參與者需具有至少兩年的獨(dú)立執(zhí)業(yè)經(jīng)驗(yàn)，并且每年完成的關(guān)節(jié)置換手術(shù)量不少于100例。有主要植入物制造商財(cái)務(wù)關(guān)聯(lián)的外科醫(yī)生被排除在外。網(wǎng)絡(luò)問卷收集了人口統(tǒng)計(jì)學(xué)信息、手術(shù)量、2018年至2023年的機(jī)器人系統(tǒng)使用情況，以及外科醫(yī)生對采用因素和主要機(jī)器人平臺(tái)熟悉程度的評分。所得數(shù)據(jù)采用描述性方法進(jìn)行分析。

結(jié)果： 從2019年至2023年，歐洲使用機(jī)器人輔助TJA的外科醫(yī)生比例從1%上升至14%，而對該技術(shù)感興趣的外科醫(yī)生比例則從32%上升至50%。機(jī)器人技術(shù)應(yīng)用最多的手術(shù)類型為部分膝關(guān)節(jié)置換術(shù)（PKA），其次為全膝關(guān)節(jié)置換術(shù)（TKA），再次為全髖關(guān)節(jié)置換術(shù)（THA）。外科醫(yī)生認(rèn)為“手術(shù)效率”和“術(shù)前計(jì)劃執(zhí)行力”是使用機(jī)器人輔助的兩大關(guān)鍵驅(qū)動(dòng)因素。

結(jié)論： 在過去五年中，歐洲地區(qū)對機(jī)器人輔助技術(shù)的興趣與使用率均顯著增長。外科醫(yī)生普遍認(rèn)為提高手術(shù)效率和計(jì)劃執(zhí)行力是采用該技術(shù)的主要?jiǎng)右?。未來仍需進(jìn)一步研究，以評估未來十年內(nèi)該技術(shù)的使用模式。

關(guān)鍵詞： 髖關(guān)節(jié)；膝關(guān)節(jié)；機(jī)器人；問卷調(diào)查；技術(shù)；全關(guān)節(jié)置換術(shù)。

Robotic-Assisted Joint Arthroplasty: European Perspectives on Surgeon Adoption and Utilization Trends

Background: Robotic-assisted total joint arthroplasty (TJA) has improved surgical precision and implant positioning, yet surgeon perceptions and adoption patterns remain incompletely understood. This study addresses three key questions: (1) What are the current trends in robotic technology use and interest across regions? (2) How does utilization vary by procedure type, and how familiar are surgeons with different robotic systems? and (3) Which factors most influence surgeons' decisions to adopt or avoid robotic assistance in arthroplasty?

Methods: A cross-sectional, anonymous survey was conducted in October 2023 among orthopaedic surgeons in Europe. Eligible participants had at least two years of independent practice and an arthroplasty volume of at least 100 cases annually. Surgeons who had financial ties to major implant manufacturers were excluded. The web-based survey collected demographic data, procedure volumes, robotic system usage from 2018 to 2023, and surgeon ratings of adoption factors and familiarity with key robotic platforms. Data were analyzed descriptively.

Results: From 2019 to 2023, the percentage of European surgeons utilizing robotic-assisted TJA rose from 1 to 14%, while the number of surgeons interested in the technology increased from 32 to 50%. The greatest utilization of robotic technology was seen in partial knee arthroplasty (PKA), followed by total knee arthroplasty (TKA), then total hip arthroplasty (THA). Surgeons rated efficiency and plan execution as the two most important factors for utilizing robotics assistance.

Conclusion: Interest and utilization of robotic assistance have grown tremendously over the past five years in Europe. Surgeons view efficiency and plan execution as motivators for using this technology. Further studies are needed to evaluate usage patterns over the next decade.

Keywords: Hip; Knee; Robotics; Survey; Technology; Total joint arthroplasty

第二部分：保髖相關(guān)文獻(xiàn)

文獻(xiàn)1

髖關(guān)節(jié)疼痛患者通常存在兩種或以上的撞擊或不穩(wěn)定畸形

譯者 張振東

由于股骨和髖臼前傾角、頸干角、α角和外側(cè)中心邊緣角等解剖因素造成的撞擊或不穩(wěn)定可導(dǎo)致髖關(guān)節(jié)損傷。這些解剖因素之間的關(guān)聯(lián)以及它們在疼痛的髖關(guān)節(jié)中發(fā)生的頻率尚不清楚，但如果不加以解決，可能會(huì)導(dǎo)致保髖手術(shù)失敗。

研究擬確定性別對撞擊相關(guān)或不穩(wěn)定相關(guān)因素的影響；這些因素之間的關(guān)聯(lián)；以及撞擊和/或不穩(wěn)定因素在同一髖關(guān)節(jié)中發(fā)生的頻率。

研究對因任何原因接受髖關(guān)節(jié)磁共振的 170 髖（145 患者）進(jìn)行了回顧性分析。 排除了58例嚴(yán)重發(fā)育不良、Perthes病后遺癥、既往手術(shù)史或影像學(xué)信息不完整的髖關(guān)節(jié)，剩下112例髖關(guān)節(jié)（96患者）納入本研究。在核磁共振上測量了股骨前傾角和α角。骨盆X光片上測量了髖臼前傾角、外側(cè)CEA和頸干角。

結(jié)果顯示，研究觀察到性別與α角之間存在相關(guān)性。其他五個(gè)參數(shù)之間的相關(guān)性較弱或沒有相關(guān)性。在 66% 的髖關(guān)節(jié)中發(fā)現(xiàn)了五個(gè)參數(shù)中的兩個(gè)或兩個(gè)以上符合撞擊征的指標(biāo)，在 51% 的髖關(guān)節(jié)中發(fā)現(xiàn)了兩個(gè)或兩個(gè)以上符合髖關(guān)節(jié)不穩(wěn)定的指標(biāo)。

結(jié)論：髖關(guān)節(jié)疼痛患者通常有多種可能導(dǎo)致軟骨髖臼損傷的解剖因素。要解決由于撞擊和/或不穩(wěn)定造成的病理性髖關(guān)節(jié)負(fù)荷增加，就必須了解所有的解剖影響因素。由于本研究沒有發(fā)現(xiàn)解剖因素之間存在關(guān)聯(lián)，因此建議對每個(gè)疼痛的髖關(guān)節(jié)進(jìn)行個(gè)體化評估。

Two or more impingement and/or instability deformities are often present in patients with hip pain

Background:Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery.

Questions/purposes:We determined (1) the influence of sex on the expression of impingement-related or instability-related factors, (2) the associations among these factors, and (3) how often both impingement and/or instability factors occur in the same hip.

Methods:We retrospectively reviewed a cohort of 170 hips (145 patients) undergoing MR arthrography of the hip for any reason. We excluded 58 hips with high-grade dysplasia, Perthes' sequelae, previous surgery, or incomplete radiographic information, leaving 112 hips (96 patients). We measured femoral version and alpha angles on MR arthrograms. Acetabular anteversion, lateral CEA, and neck-shaft angle were measured on pelvic radiographs.

Results:We observed a correlation between sex and alpha angle. Weak or no correlations were observed between the other five parameters. In 66% of hips, two or more (of five) impingement parameters, and in 51% of hips, two or more (of five) instability parameters were found.

Conclusions:Patients with hip pain frequently have several anatomic factors potentially contributing to chondrolabral damage. To address pathologic hip loading due to impingement and/or instability, all of the anatomic influences should be known. As we found no associations between anatomic factors, we recommend an individualized assessment of each painful hip.

文獻(xiàn)出處：Tibor LM, Liebert G, Sutter R, Impellizzeri FM, Leunig M. Two or more impingement and/or instability deformities are often present in patients with hip pain. Clin Orthop Relat Res. 2013 Dec;471(12):3762-73.

文獻(xiàn)2

髖臼周圍截骨術(shù)是否改變脊柱骨盆矢狀面序列

譯者 任寧濤

背景:目前關(guān)于髖臼周圍截骨術(shù)對脊柱骨盆矢狀面序列影響的數(shù)據(jù)很少。先前的研究試圖通過在AP 位X線片上進(jìn)行測量和使用數(shù)學(xué)模型來確定術(shù)后骨盆傾斜的變化來描述兩者之間的關(guān)系。這些信息對外科醫(yī)生在術(shù)中評估髖臼/骨盆位置和了解術(shù)后脊柱-骨盆矢狀面序列變化具有臨床意義;因此，應(yīng)更詳細(xì)地描述PAO引起的影像學(xué)變化。

問題/目的:在本研究中，我們的問題是:(1) 根據(jù)EOS X線片測量，PAO術(shù)后是否會(huì)導(dǎo)致脊柱-骨盆矢狀面序列發(fā)生對應(yīng)變化?(2)單側(cè)PAO和雙側(cè)PAOs的情況是否不同?(3)這在脊柱柔韌和脊柱僵硬的情況下是否有區(qū)別?(4)是否因術(shù)前骨盆傾斜而有差異?

方法:前瞻性收集2019年1月1日至2022年1月11日由同一位外科醫(yī)生完成PAO的55例患者的術(shù)前和術(shù)后不短于1年的 (15±8個(gè)月，最短11個(gè)月，最長65個(gè)月)EOS髖-踝站立位和坐位x線片，測量骨盆入射角、骨盆傾斜角、骶骨傾斜角、腰椎前凸角、外側(cè)CE角、L1-骨盆角和恥骨聯(lián)合對骶髂指數(shù)（PS-SI）。采用配對樣本t檢驗(yàn)(正態(tài)分布數(shù)據(jù))或Wilcoxon符號(hào)秩檢驗(yàn)(非正態(tài)分布數(shù)據(jù))評估術(shù)前與術(shù)后是否有任何變化。然后根據(jù)患者是否患有單側(cè)或雙側(cè)發(fā)育不良以及單側(cè)或雙側(cè)手術(shù)進(jìn)行分組，這些亞組的分析方法與整個(gè)隊(duì)列相同。根據(jù)腰椎活動(dòng)度情況(定義為從坐到站的腰椎前凸角變化小于或大于1 SD)再分為兩個(gè)亞組，亞組的分析方法與整個(gè)隊(duì)列相同。最后根據(jù)術(shù)前站立位骨盆傾斜度分為站立位骨盆傾斜度< 10°和站立位骨盆傾斜度> 20°兩個(gè)亞組，并與整個(gè)隊(duì)列進(jìn)行相同的分析。

結(jié)果:所有患者的站立位外側(cè)CE角中位數(shù)(IQR)增加了17°，從中位數(shù)21°(10°)增加到中位數(shù)38°(8°[95%可信區(qū)間(CI) 16°~ 20°;p < 0.05];P < 0.001)。坐位外側(cè)CE角增加了17°，從中位數(shù)18°(8°)增加到中位數(shù)35°(8°[95% CI 14°~ 19°];P < 0.001)。站立位骨盆入射角從50°±11°增加到52°±12°(平均差值2°[95% CI 1°~ 3°];P = 0.004)，但其他測量參數(shù)無變化。單側(cè)發(fā)育不良患者接受單側(cè)PAO后，任何脊柱-骨盆參數(shù)均無變化，但雙側(cè)發(fā)育不良患者接受雙側(cè)PAOs后，骨盆入射角從57°(14°)增加到60°(16°)(95% CI 1°~ 5°;p = 0.02)，恥骨聯(lián)合-骶髂指數(shù)從84 mm (24 mm)降至77 mm (23 mm) (95% CI -7°至-2°;P = 0.007)。術(shù)前腰椎柔韌性好的患者未表現(xiàn)出任何矢狀位脊柱骨盆參數(shù)的變化，但術(shù)前腰椎柔韌性差的患者術(shù)后出現(xiàn)了一些變化。站立骨盆傾斜小于10°的患者，骨盆入射角中位數(shù)(IQR)從43°(9°)增加到45°(12°[95% CI 0.3°~ 4°];P = 0.03)，但術(shù)后未發(fā)生其他矢狀位脊柱骨盆參數(shù)的改變。術(shù)前骨盆傾斜超過20°的患者矢狀位脊柱骨盆參數(shù)未發(fā)生任何改變。

結(jié)論:PAO增加骨盆入射角，可能與髖關(guān)節(jié)中心前移有關(guān)。除雙側(cè)PAO術(shù)后，其余脊柱骨盆參數(shù)無變化。此外，術(shù)前脊柱僵硬的患者，表現(xiàn)為站立和坐姿之間腰椎前凸的變化微小，可能會(huì)出現(xiàn)脊柱骨盆參數(shù)的變價(jià)，包括PAO后脊柱活動(dòng)度的增加。這可能是因?yàn)樵黾芋y臼覆蓋后代償性脊柱“夾板”效應(yīng)減少，但需要進(jìn)一步研究。

Does Periacetabular Osteotomy Change Sagittal Spinopelvic Alignment？

Background: There are few data on the impact of periacetabular osteotomy (PAO) on sagittal spinopelvic alignment. Prior studies have attempted to delineate the relationship by performing measurements on AP radiographs and using mathematical models to determine changes in postoperative pelvic tilt. This information is clinically significant to a surgeon when evaluating acetabular/pelvic position intraoperatively and understanding spinopelvic alignment changes postoperatively; therefore, radiographic changes from PAO should be described in more detail.

Questions/purposes: In this study, we asked: (1) Does the performance of PAO result in consistent changes in spinopelvic alignment, as measured on EOS radiographs? (2) Does this differ for unilateral versus bilateral PAOs? (3) Does this differ in the setting of a mobile spine versus an immobile spine? (4) Does this differ based on preoperative pelvic tilt?

Methods: Mean preoperative and at least 1-year postoperative (15 ± 8 months from surgery, minimum 11 months, maximum 65 months) EOS hip-to-ankle standing and sitting radiographs for 55 patients in a prospectively collected registry who underwent PAO with a single surgeon from January 1, 2019, to January 11, 2022, were measured for pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lateral center-edge angle, L1 pelvic angle, and pubic symphysis to the sacroiliac index. Normality was assessed and paired sample t-tests (normally distributed data) or Wilcoxon signed rank tests (not normally distributed data) were utilized to assess if any measurements changed from preoperative to postoperative. Patients were then divided based on whether they had unilateral or bilateral dysplasia and unilateral or bilateral surgery, and these subgroups were analyzed the same way as the entire cohort. Two more subgroups were then formed based on lumbar mobility, defined as a change in sitting-to-standing lumbar lordosis less or greater than 1 SD from the population mean preoperatively, and the subgroups were analyzed the same way as the entire cohort. Finally, two additional subgroups were formed, preoperative standing pelvic tilt less than 10° and more than 20°, and analyzed the same as the entire cohort.

Results: For the entire cohort, the median (IQR) standing lateral-center edge angle increased 17°, from a median of 21° (10°) to a median of 38° (8° [95% confidence interval (CI) 16° to 20°; p < 0.001). The median sitting lateral center-edge angle increased 17°, from a median of 18° (8°) to a median of 35° (8° [95% CI 14° to 19°]; p < 0.001). Standing pelvic incidence increased from 50° ± 11° to 52° ± 12° (mean difference 2° [95% CI 1° to 3°]; p = 0.004), but there were no changes for other measured parameters. There were no changes in any of the spinopelvic parameters for patients with unilateral dysplasia receiving a unilateral PAO, but patients with bilateral dysplasia who underwent bilateral PAOs demonstrated an increase in pelvic incidence from 57° (14°) to 60° (16°) (95% CI 1° to 5°; p = 0.02) and a decrease in pubic symphysis to sacroiliac index from 84 mm (24 mm) to 77 mm (23 mm) (95% CI -7° to -2°; p = 0.007). Patients with mobile lumbar spines preoperatively did not exhibit any changes in sagittal spinopelvic alignment, but patients with immobile lumbar spines preoperatively experienced several changes after surgery. Patients with less than 10° of standing pelvic tilt demonstrated a median (IQR) 2° increase in pelvic incidence from median 43° (9°) to 45° (12° [95% CI 0.3° to 4°]; p = 0.03), but they did not experience any other changes in sagittal spinopelvic alignment parameters postoperatively. Patients with preoperative pelvic tilt more than 20° did not experience any change in sagittal spinopelvic parameters.

Conclusion: PAO increases pelvic incidence, potentially because of anterior translation of the hip center. There were no changes in other spinopelvic parameters postoperatively except after bilateral PAO. Additionally, patients lacking spine mobility preoperatively, indicated by a minimal change in lumbar lordosis between standing and sitting positions, may experience several changes in spinopelvic alignment, including increased mobility of their spine after PAO. This may be because of decreased compensatory spine splinting after increasing acetabular coverage, but further research including patient-reported outcomes is warranted.

文獻(xiàn)出處：Cirrincione P, Cao N, Trotzky Z, Nichols E, Sink E. Does Periacetabular Osteotomy Change Sagittal Spinopelvic Alignment? Clin Orthop Relat Res. 2024 Apr 2. doi: 10.1097/CORR.0000000000003031. Epub ahead of print. PMID: 38564796.

文獻(xiàn)3

保髖手術(shù)后患者報(bào)告結(jié)局的演變軌跡：一項(xiàng)國家登記庫研究

譯者 李勇

目的：了解保髖手術(shù)后患者報(bào)告結(jié)局（PROs）的縱向演變軌跡至關(guān)重要。本研究旨在利用英國國家保髖登記系統(tǒng)的數(shù)據(jù)，分析患者術(shù)后長達(dá)2年的PROs演變軌跡，并檢驗(yàn)潛在混雜因素對此的影響。

方法：本研究數(shù)據(jù)來源于英國非關(guān)節(jié)置換髖關(guān)節(jié)登記處（UK Non-Arthroplasty Hip Registry）。納入標(biāo)準(zhǔn)為：接受了髖關(guān)節(jié)鏡手術(shù)（Hip Arthroscopy）或髖臼周圍截骨術(shù)（PAO）的患者，并具有術(shù)前的國際髖關(guān)節(jié)結(jié)局量表（iHOT-12）評分，且在術(shù)后6個(gè)月、1年或2年至少有兩個(gè)時(shí)間點(diǎn)的隨訪測量數(shù)據(jù)。研究團(tuán)隊(duì)分析了iHOT-12評分的演變軌跡，并采用潛（隱）增長曲線模型（Latent Growth Curve Modelling）來識(shí)別這些軌跡的預(yù)測因素。

結(jié)果：研究共納入9845名患者。其中，7081名患者接受了髖關(guān)節(jié)鏡手術(shù)，1327名患者接受了髖臼周圍截骨術(shù)。髖關(guān)節(jié)鏡組： iHOT-12評分從基線（術(shù)前）到術(shù)后6個(gè)月有顯著改善；但在術(shù)后6個(gè)月至1年間無明顯變化；在1年至2年間評分出現(xiàn)下降。髖臼周圍截骨術(shù)組： iHOT-12評分從基線到術(shù)后6個(gè)月有顯著改善；但在術(shù)后6個(gè)月至1年、以及1年至2年間均無明顯變化。潛增長曲線模型分析顯示，體重指數(shù)（BMI）和性別對術(shù)前iHOT-12評分有顯著影響，而年齡和性別則顯著影響術(shù)后的恢復(fù)斜率（即恢復(fù)速度）。

結(jié)論：接受保髖手術(shù)的患者，其iHOT-12評分在術(shù)后6個(gè)月時(shí)即獲得顯著改善，且改善幅度超過了最小臨床重要差異（MCID）。這種改善效果在術(shù)后2年時(shí)趨于穩(wěn)定（進(jìn)入平臺(tái)期）。在髖關(guān)節(jié)鏡術(shù)后1年至2年間，評分雖然略有下降，但該下降幅度仍處于臨床有意義的范圍之內(nèi)（即未達(dá)到MCID）。BMI、年齡和性別均會(huì)影響評分的演變軌跡，這凸顯了在術(shù)前幫助患者建立合理期望的重要性。

The trajectory of patient‐reported outcomes after hip preservation surgery: A National Registry Study

Purpose

Understanding the trajectory of postoperative patient‐reported outcomes after hip preservation surgery is essential. This study aims to analyse patient‐reported outcome trajectories up to 2 years post‐surgery using the UK's national hip preservation registry and to examine the influence of potential confounders.

Methods

Patients who underwent hip arthroscopy or periacetabular osteotomy with preoperative International Hip Outcome Tool‐12 (iHOT‐12) scores and at least two follow‐up measurements at 6 months, 1 year, or 2 years were included from the UK Non‐Arthroplasty Hip Registry. iHOT‐12 score trajectories were analysed, and Latent Growth Curve Modelling was used to identify predictors of these trajectories.

Results

Overall 9845 patients were included in this study. 7081 patients underwent a hip arthroscopy, and 1327 patients underwent a periacetabular osteotomy. For hip arthroscopy, there were significant improvements in the iHOT‐12 scores from baseline to 6 months, but no significant change from 6 months to 1 year. However, there was a decrease in the minimal clinically important difference from 1 to 2 year. For periacetabular osteotomy, there were significant improvements in the iHOT‐12 scores from baseline to 6 months, but no significant change from 6 months to 1 year, and from 1 to 2 years. Latent Growth Curve Modelling showed that body mass index (BMI) and sex had a significant impact on pre‐operative iHOT‐12 scores, while age and sex significantly influenced the recovery slope.

Conclusions

Patients who underwent hip preservation surgery exhibited significant improvement in iHOT‐12 scores, surpassing the minimal clinically important difference at 6 months postoperatively. This improvement plateaued by 2 years, with a slight decline in scores between 1 and 2 years following hip arthroscopy, though the decrease remained within the clinically meaningful range. BMI, age and sex influenced score trajectories, highlighting the importance of setting patient expectations pre‐operatively.

文獻(xiàn)出處；Yoshitani J, Ekhtiari S, Malviya A, Khanduja V. The trajectory of patient-reported outcomes after hip preservation surgery: A National Registry Study. Knee Surg Sports Traumatol Arthrosc. 2025 Nov;33(11):4002-4011. doi: 10.1002/ksa.12771. Epub 2025 Aug 19. PMID: 40827496; PMCID: PMC12582234.

文獻(xiàn)4

歐洲國家發(fā)育性髖關(guān)節(jié)發(fā)育不良篩查與治療指南概述及質(zhì)量評估

譯者 賈海港

背景/目的：發(fā)育性髖關(guān)節(jié)發(fā)育不良（DDH）是最常見的兒童骨科疾病之一，需及時(shí)診斷和治療以預(yù)防長期致殘。本綜述旨在識(shí)別、總結(jié)并評估當(dāng)前歐洲各國關(guān)于 DDH 篩查和治療的國家指南質(zhì)量。

方法 ：通過聯(lián)系來自 46個(gè)歐洲國家的國家骨科學(xué)會(huì)，并從近期的系統(tǒng)綜述中獲取指南來識(shí)別相關(guān)指南。兩名研究人員獨(dú)立提取數(shù)據(jù)，并采用 AGREE II 量表評估指南質(zhì)量。采用 Cohen's κ系數(shù)評估評分者間一致性。

結(jié)果 ：共識(shí)別出九份歐洲國家 DDH 指南，其中四份發(fā)表在同行評審的科學(xué)期刊上。所有指南均建議將臨床檢查和影像學(xué)檢查納入 DDH 篩查方案，但篩查方法和時(shí)機(jī)存在顯著差異。四份指南包含治療建議。治療方式（外展治療 vs. 積極監(jiān)測）及長期隨訪時(shí)長存在顯著差異。指南質(zhì)量評分范圍為 16%至 92%（Cohen's κ=0.62），其中兩份指南被評為"良好質(zhì)量"（≥70%）

結(jié)論 ：歐洲各國的 DDH 指南數(shù)量稀少，質(zhì)量和內(nèi)容差異較大。亟需開展一項(xiàng)協(xié)調(diào)一致的歐洲倡議，敦促各國使用經(jīng)過驗(yàn)證的工具制定循證的 DDH 指南，并將這些指南發(fā)表在同行評議期刊上，從而促進(jìn)髖關(guān)節(jié)發(fā)育不良患兒的平等診療。

關(guān)鍵詞： 髖關(guān)節(jié)發(fā)育不良；診斷；指南；新生兒篩查；治療學(xué)。

An Overview and Quality Assessment of European National Guidelines for Screening and Treatment of Developmental Dysplasia of the Hip

Background/Objectives: Developmental dysplasia of the hip (DDH) is one of the most common pediatric orthopedic disorders and warrants timely diagnosis and treatment to prevent long-term disability. This review identified, summarized, and assessed the quality of current European national guidelines for DDH screening and treatment.

Methods: Guidelines were identified by contacting the national orthopedic societies from 46 European countries and retrieving the guidelines from a recent systematic review. Two researchers independently extracted data and assessed guideline quality using the AGREE II checklist. Interrater agreement was assessed using Cohen's κ.

Results: Nine European national DDH guidelines were identified, of which four were published in peer-reviewed scientific journals. All guidelines advised clinical examination and imaging as part of the DDH screening program, though screening approach and timing varied considerably. Four guidelines included treatment recommendations. The type of treatment (abduction treatment vs. active monitoring) and duration of long-term follow-up showed great variation. Guideline quality ranged from 16 to 92% (Cohen's κ = 0.62), with two out of nine guidelines rated "good quality" (>70%).

Conclusions: European national DDH guidelines appear scarce and of varying quality and content. A coordinated European initiative is warranted to urge countries to develop evidence-based DDH guidelines using validated tools and to publish these guidelines in peer-reviewed journals, thereby advancing equal diagnosis and treatment for children with DDH.

Keywords: developmental dysplasia of the hip; diagnosis; guideline; neonatal screening; therapeutics.

文獻(xiàn)出處：Mulder FECM, van Kouswijk HW, Witlox MA, Mathijssen NMC, de Witte PB. An Overview and Quality Assessment of European National Guidelines for Screening and Treatment of Developmental Dysplasia of the Hip. Children (Basel). 2025 Sep 3;12(9):1177. doi: 10.3390/children12091177. PMID: 41007042; PMCID: PMC12468116.

文獻(xiàn)5

髖臼周圍截骨術(shù)治療伴有嚴(yán)重股骨頭非球形畸形的髖關(guān)節(jié)發(fā)育不良臨床研究

譯者 陶可

背景：伴有股骨近端畸形的髖關(guān)節(jié)發(fā)育不良會(huì)導(dǎo)致青年人出現(xiàn)髖關(guān)節(jié)功能障礙和退行性髖骨關(guān)節(jié)炎。針對這些復(fù)雜的復(fù)合畸形，最佳的手術(shù)矯正方法仍存在爭議。

方法：我們回顧性分析了20例患者的24個(gè)髖關(guān)節(jié)，這些患者均接受了伯爾尼髖臼周圍截骨術(shù)，其中13個(gè)髖關(guān)節(jié)同時(shí)進(jìn)行了股骨近端外翻截骨術(shù)，用于治療伴有股骨近端結(jié)構(gòu)異常的髖關(guān)節(jié)發(fā)育不良?；颊呤中g(shù)時(shí)的平均年齡為22.7歲，平均臨床隨訪時(shí)間為4.5年。采用Harris髖關(guān)節(jié)評分和患者對手術(shù)的總體滿意度來評估髖關(guān)節(jié)功能和臨床結(jié)果。X線片用于評估畸形矯正情況、截骨愈合情況以及退行性髖骨關(guān)節(jié)炎的進(jìn)展情況。

結(jié)果：平均Harris髖關(guān)節(jié)評分由術(shù)前的68.8分提高到最近一次隨訪時(shí)的91.3分（p<0.0001）。16例患者（19個(gè)髖關(guān)節(jié)）臨床療效優(yōu)良，1例患者（1個(gè)髖關(guān)節(jié)）療效良好，2例患者（2個(gè)髖關(guān)節(jié)）療效一般，1例患者（2個(gè)髖關(guān)節(jié)）療效差。24個(gè)髖關(guān)節(jié)中有22個(gè)臨床癥狀得到改善。Wiberg外側(cè)中心邊緣角平均改善27.6度（p<0.0001），Lequesne和de Seze前中心邊緣角平均改善33.1度（p<0.0001），髖臼頂傾斜度平均改善16.5度（p<0.0001）。髖關(guān)節(jié)中心平均向內(nèi)側(cè)移位6.3 mm（p=0.0003）。20個(gè)髖關(guān)節(jié)的T?nnis骨關(guān)節(jié)炎分級(jí)保持不變，3個(gè)髖關(guān)節(jié)的分級(jí)升高1級(jí)，1個(gè)髖關(guān)節(jié)的分級(jí)升高2級(jí)。共發(fā)生3例主要技術(shù)并發(fā)癥。在最近一次隨訪時(shí)，所有髖關(guān)節(jié)均無需行全髖關(guān)節(jié)置換術(shù)。

結(jié)論：髖關(guān)節(jié)發(fā)育不良合并股骨近端畸形構(gòu)成了一個(gè)復(fù)雜的重建難題。髖關(guān)節(jié)的活動(dòng)范圍和影像學(xué)評估是選擇手術(shù)患者的主要因素。對于部分患者，在必要時(shí)，可采用髖臼周圍截骨術(shù)聯(lián)合同期股骨手術(shù)，以全面矯正畸形并改善髖關(guān)節(jié)功能。

圖1-A：圖1-A、1-B、1-C、1-D一名18歲女性患者，患有嚴(yán)重的髖關(guān)節(jié)發(fā)育不良和股骨近端內(nèi)翻畸形，主訴右髖關(guān)節(jié)疼痛和跛行。術(shù)前髖關(guān)節(jié)屈曲角度為105°。圖1-A該患者既往有Legg-Calvé-Perthes病史，并曾接受過導(dǎo)致內(nèi)翻畸形的股骨近端截骨術(shù)。她股骨頭呈橢圓形、股骨頸短和相對較高的股骨大轉(zhuǎn)子。髖關(guān)節(jié)發(fā)育不良明顯。

圖1-B：該患者接受了髖臼周圍截骨術(shù)，并展示了術(shù)中髖臼的矯正情況。

圖1-C：髖臼周圍截骨術(shù)后，術(shù)中內(nèi)收位X線片顯示關(guān)節(jié)面吻合良好。隨后行股骨近端外翻截骨術(shù)、大轉(zhuǎn)子前移術(shù)及股骨頭頸交界處骨軟骨成形術(shù)。

圖1-D：術(shù)后24個(gè)月，X線片顯示截骨愈合良好，畸形已矯正?；颊唧y關(guān)節(jié)無疼痛，臨床療效極佳。

Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities

Background: Acetabular dysplasia associated with deformity of the proximal part of the femur can result in hip dysfunction and degenerative arthritis in young adults. The optimal method of surgical correction for these challenging combined deformities remains controversial.

Methods: We retrospectively analyzed twenty-four hips in twenty patients who underwent a Bernese periacetabular osteotomy, which was done with a proximal femoral valgus-producing osteotomy in thirteen hips, for the treatment of acetabular dysplasia associated with proximal femoral structural abnormalities. The average age of the patients at the time of surgery was 22.7 years, and the average duration of clinical follow-up was 4.5 years. The Harris hip score and overall patient satisfaction with surgery were used to assess hip function and clinical results. Plain radiographs were used to assess the correction of the deformity, healing of the osteotomy, and progression of degenerative arthritis.

Results: The mean Harris hip score increased from 68.8 points preoperatively to 91.3 points at the time of the most recent follow-up (p<0.0001). Sixteen patients (nineteen hips) had an excellent clinical result, and one patient (one hip) had a good result. Two patients (two hips) had a fair result, and one patient (two hips) had a poor result. Twenty-two of the twenty-four hips improved clinically. There was an average improvement of 27.6 degrees in the lateral center-edge angle of Wiberg (p<0.0001), an average improvement of 33.1 degrees in the anterior center-edge angle of Lequesne and de Seze (p<0.0001), and an average improvement of 16.5 degrees in the acetabular roof obliquity (p<0.0001). The hip center was translated medially an average of 6.3 mm (p=0.0003). The T?nnis osteoarthritis grade was unchanged in twenty hips, progressed one grade in three hips, and progressed two grades in one hip. There were three major technical complications. At the time of the most recent follow-up, none of the hips had required total hip arthroplasty.

Conclusions: The combination of acetabular dysplasia and proximal femoral deformities presents a complex reconstructive problem. The range of motion and radiographic assessment of the hip are major factors in the selection of patients for surgery. In selected patients, the periacetabular osteotomy combined with concurrent femoral procedures, when indicated, can provide comprehensive deformity correction and improved hip function.

文獻(xiàn)出處：John C Clohisy, Ryan M Nunley, Madelyn C Curry, Perry L Schoenecker. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am. 2007 Jul;89(7):1417-23. doi: 10.2106/JBJS.F.00493.

文獻(xiàn)6

股骨頭壞死中軟骨下骨折始于骨吸收區(qū)：一項(xiàng)顯微計(jì)算機(jī)斷層掃描研究

譯者 邱興

目的： 為成功實(shí)現(xiàn)股骨頭壞死（ONFH）的關(guān)節(jié)保留手術(shù)，理解塌陷機(jī)制至關(guān)重要。本研究旨在通過顯微CT成像觀察整個(gè)股骨頭，重點(diǎn)分析軟骨下骨折與骨吸收區(qū)之間的三維關(guān)系，探討ONFH中軟骨下骨折的起始過程。

方法： 選取37例患者共40個(gè)股骨頭標(biāo)本（根據(jù)日本調(diào)查委員會(huì)標(biāo)準(zhǔn)均為3A或3B期ONFH，均在全髖關(guān)節(jié)置換術(shù)中獲取），采用層厚0.146毫米的顯微CT進(jìn)行掃描。根據(jù)顯微CT測量的塌陷程度（以3毫米為界），將樣本分為早期塌陷期和晚期塌陷期。

結(jié)果: 通過對整個(gè)股骨頭多徑向平面圖像的分析，發(fā)現(xiàn)兩個(gè)重要現(xiàn)象：首先，在全部18個(gè)早期塌陷期股骨頭標(biāo)本中，初始骨折裂紋均貫穿前上部分離的骨吸收區(qū)；其次，在22個(gè)晚期塌陷期標(biāo)本中有19個(gè)觀察到硬化邊界的壞死骨骨折，以及沿硬化邊界壞死側(cè)出現(xiàn)纖維性、肉芽樣低密度組織。當(dāng)骨吸收始于支持帶和圓韌帶附著點(diǎn)周圍并引發(fā)軟骨下骨折后，股骨頭前上部區(qū)域的骨吸收擴(kuò)展可能導(dǎo)致骨折蔓延并引發(fā)大面積塌陷。

結(jié)論: 三維顯微CT顯示股骨頭壞死中的軟骨下骨折始于修復(fù)區(qū)周圍的骨吸收。

關(guān)鍵詞: 股骨頭壞死；顯微CT；軟骨下骨折；骨吸收；塌陷

圖1 基于三維顯微CT的全股骨頭分析：重點(diǎn)顯示骨壞死中的骨吸收區(qū)與軟骨下骨折。

圖2 a 早期塌陷階段各徑向平面內(nèi)初始軟骨下骨折與骨吸收的發(fā)生率分布。圖中實(shí)線表示各徑向平面的軟骨下骨折發(fā)生率，大點(diǎn)線代表股骨頭外側(cè)三分之一區(qū)域的骨吸收發(fā)生率，小點(diǎn)線顯示中間三分之一區(qū)域，虛線標(biāo)示內(nèi)側(cè)三分之一區(qū)域。b 早期塌陷階段各徑向平面內(nèi)與軟骨下骨折相連的骨吸收發(fā)生率分布。實(shí)線標(biāo)示各徑向平面的軟骨下骨折發(fā)生率，大點(diǎn)線表示股骨頭外側(cè)三分之一區(qū)域內(nèi)與軟骨下骨折相連的骨吸收發(fā)生率，小點(diǎn)線對應(yīng)中間三分之一區(qū)域，虛線顯示內(nèi)側(cè)三分之一區(qū)域。

圖3 a 在早期塌陷階段，所有股骨頭的軟骨下骨折裂紋均穿行于兩個(gè)不同的骨吸收區(qū)之間；b 部分股骨頭外側(cè)三分之一的骨吸收區(qū)已延伸至皮質(zhì)外；c 在晚期塌陷階段，大面積塌陷似乎由壞死骨的粉碎性骨折導(dǎo)致，沿硬化邊界可見纖維性、肉芽樣低密度組織；d 晚期塌陷階段，骨折裂紋從骨吸收區(qū)出發(fā)，在靠近垂直走向的硬化邊界處的壞死骨內(nèi)延伸。

Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study

Purpose: For successful joint preservation in osteonecrosis of the femoral head (ONFH), it is important to understand the mechanism of collapse. The purpose of this study was to investigate the initiation of subchondral fracture in ONFH by using micro-CT imaging of the whole femoral head, focusing on the three-dimensional relationship between the subchondral fracture and the bone resorption area.

Methods: A total of 40 femoral heads from 37 patients retrieved during total hip arthroplasty for stage 3A or 3B ONFH by Japanese Investigation Committee criteria were scanned using micro-CT with a 0.146-mm thickness cuts. We divided the cohort into early and late collapsed stages according to a threshold of 3 mm of collapse as measured by micro-CT.

Results: According to the analysis on multiple radial plane views in the whole femoral head, there were two interesting findings. First, the initial fracture cracks ran between separated bone resorption areas at the anterosuperior portions of all 18 femoral heads in the early collapsed stage. Second, fractures of the necrotic bone at the sclerotic boundary and a fibrous, granulation-like, low-density tissue along the necrotic side of the sclerotic boundary were seen in 19 of the 22 in the late collapsed stage. After bone resorption around the retinaculum and teres insertion initiates the subchondral fracture, bone resorption expanding at the anterosuperior portion of the femoral head may result in the spread of fracture and the potential for massive collapse.

Conclusions: Three-dimensional micro-CT showed bone resorption around the reparative zone initiates the subchondral fracture in ONFH.

Keywords: Bone resorption; Collapse; Micro-CT; Osteonecrosis of the femoral head; Subchondral fracture.

文獻(xiàn)出處：Hidetoshi,Hamada,Masaki,et al. Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study[J].International Orthopaedics, 2018.

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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