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文献1

局部浸润与硬膜外镇痛对全膝关节或全髋关节置换术后疼痛控制的影响：随机对照试验的荟萃分析

译者 张轶超

背景：对于全膝关节或全髋关节置换术（TKA和THA）患者，局部浸润和硬膜外镇痛的术后镇痛效果不一致。因此，我们对随机对照试验（RCTs）的研究进行了荟萃分析，以评估局部浸润与硬膜外镇痛对TKA和THA的有效性和安全性。

方法：在PubMed、EmBase和Cochrane Library进行电子检索，以确定截至2020年2月的符合条件的RCTs研究。采用随机效应模型，通过计算加权平均差（WMD）和95%置信区间（95%CI）的相对风险度来评估局部浸润与硬膜外镇痛的合并效应。

结果：本meta分析共纳入7项TKA RCTs研究，共412名患者；3项THA RCTs研究，共200名患者。我们注意到在TKA患者中，局部浸润与术后48小时(WMD：1.31；95%置信区间：2.44 ~0.18;P= 0.024)和72小时(WMD：0.95；95%CI：1.39 ~  0.52；P< 0.001)休息时具有较低的视觉模拟评分（VAS）有关;而在THA患者中，局部浸润显著降低了术后12小时休息时的VAS评分(WMD: 1.00；95%CI：1.49 ~  0.51；P <0.001)。此外，局部浸润与TKA患者术后48小时运动时较低的VAS评分相关(WMD: 1.08；95%CI：1.86至0.29;P=.007)；而对于THA患者，术后24小时运动时的VAS评分较高(WMD: 1.06；95%CI: 0.67 ~ 1.45；P <0.001)。此外，我们注意到与硬膜外镇痛相比，局部浸润与术后24小时(WMD: 7.11；95%置信区间:2.30~11.93;P= 0.004)、48小时(WMD: 6.69；95%CI: 3.78 ~ 9.59；P< 0.001)和72小时(WMD: 5.19；95%置信区间:0.95~9.44;P =0 .016)具有更高的屈曲角度有关。局部浸润和硬膜外镇痛在住院时间、恶心或伤口感染方面没有显著差异。

结论：局部浸润在TKA术后疼痛的控制方面优于硬膜外镇痛，而对于THA患者，不同时间得到的结果不一致。

Local infiltration vs epidural analgesia for postoperative pain control after total knee or hip arthroplasty ：A meta-analysis of randomized controlled trials

Background: Inconsistent results have been obtained regarding postoperative pain control using local infiltration and epidural analgesia for patients after total knee or hip arthroplasty (TKA and THA). We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of local infiltration vs epidural analgesia for TKA and THA. 

Methods: Electronic searches were conducted on PubMed, EmBase, and the Cochrane library to identify eligible RCTs conducted up to February 2020. Weighted mean difference (WMD) and relative risk with 95% confidence interval (95%CI) were applied to calculate pooled effect estimates between local infiltration and epidural analgesia using the random-effects model. 

Results: Seven RCTs including a total of 412 TKA patients, and three RCTs including a total of 200 THA patients were selected for this meta-analysis. We noted that local infiltration was associated with lower visual analog scale (VAS) scores at rest after 48 hours (WMD:  1.31; 95%CI: 2.44 to 0.18; P=.024) and 72 hours (WMD:  0.95; 95%CI:  1.39 to  0.52; P<.001) for patients with TKA, while local infiltration significantly reduced VAS scores at rest after 12 hours for patients with THA (WMD: 1.00; 95%CI:  1.49 to  0.51; P<.001). Moreover, local infiltration was associated with lower VAS scores during movement after 48 hours in TKA patients (WMD: 1.08; 95%CI:  1.86 to  0.29; P=.007), while there were higher VAS scores during movement after 24 hours for patients with THA (WMD: 1.06; 95%CI: 0.67 to 1.45; P<.001). Furthermore, we noted that local infiltration was associated with higher flexion angles compared with epidural analgesia after 24 hours (WMD: 7.11; 95%CI: 2.30–11.93; P=.004), 48 hours (WMD: 6.69; 95%CI: 3.78 to 9.59; P<.001), and 72 hours (WMD: 5.19; 95%CI: 0.95–9.44; P=.016). There were no significant differences between local infiltration and epidural analgesia for the length of hospital stay, nausea, or wound infection. 

Conclusions: Local infiltration is superior to epidural analgesia for postoperative pain control after TKA, whereas for THA patients inconsistent results were obtained at various times.

文献出处：Liu X, Zhang H, Zhang H, Guo M, Gao Y, Du C. Local infiltration vs epidural analgesia for postoperative pain control after total knee or hip arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020 Oct 30;99(44):e22674. doi: 10.1097/MD.0000000000022674. PMID: 33126306; PMCID: PMC7598777.

文献2

不同的计算方法得出的用于评价关节置换手术疗效的最小临床重要差异MCID值有很大不同

译者 张蔷

背景：随着美国医疗保险系统逐步转向基于数据统计的给付体系，用于评价临床获益的最小临床重要差异值（MCID）就成为了重要的评估指标。然而由于不同的计算方法会导致对手术成功的解读各不相同，因此，目前临床中关于如何确定MCID值仍然存在较大歧义。

方法：我们最终入组了2021年6月至2023年6月间共1113例全膝关节置换（TKA）或全髋关节置换（THA）手术病例，所有病例均有术前和术后一年的患者自评结果（KOOS JR评分或HOOS JR评分）。我们应用16种不同的统计学方法计算HOOS JR和KOOS JR的MCID阈值，并将结果应用于研究组，以评估计算方法的不同对术后一年达到MCID阈值病例数的影响。

结果：本研究包含570例全膝病例和543例全髋病例。62.2%的病例为女性，平均年龄69.3±8.3岁，92.3%的病例为白人，2.9%黑人，4.8%其他族裔（如亚裔，混血或“其他”）。不同的计算方法得出的MCID阈值有显著差异。KOOS JR评分的平均MCID为11.5±9.2分（范围，0.5-36.6），HOOS JR评分的平均MCID为12.2±8.9分（范围，0.6-34.3）。基于分布的计算方法得出的MCID阈值更小但变化较大，而基于锚定的计算方法得出的MCID阈值更大但变化较小。

结论：不同的统计学方法得出的MCID阈值有较大差异，进而影响达到MCID值的病例数。本研究展示了目前临床中确定MCID方面的歧义，并解答了其在评价关节置换手术获益方面的部分疑惑。

The Minimal Clinically Important Difference (MCID) for Total Joint Arthroplasty Outcome Measures Varies Substantially by Calculation Method

Background: As the United States health-care system transitions to a value-based model, the minimal clinically important difference (MCID) has become an important metric for assessing perceived benefit in clinical settings. However, there is substantial ambiguity surrounding the MCID value because the calculation method used can lead to substantial changes in the clinical interpretation of surgical success. 

Methods: A total of 1,113 patients who underwent either total knee arthroplasty (TKA) or total hip arthroplasty (THA) between June 2021 and June 2023 and completed their patient-reported outcomes (the KOOS JR [Knee injury and Osteoarthritis Outcome Score for Joint Replacement] or HOOS JR [Hip disability and Osteoarthritis Outcome Score for Joint Replacement]) preoperatively and at 1 year postoperatively were reviewed for this study. The MCID values for the HOOS JR and KOOS JR were determined using 16 statistically appropriate methods, and the resulting MCID values were applied to the study group to assess how differences in methods changed the number of patients who met the MCID at 1 year postoperatively. 

Results: The study cohort consisted of 570 patients who underwent TKA and 543 who underwent THA. The overall cohort was 62.2% female, had a mean age of 69.3 ± 8.3 years, and was 92.3% Caucasian, 2.9% African American, and 4.8% other race (i.e., Asian, multiracial, or “other”). The MCID values varied substantially among the methods evaluated. The mean MCID was 11.5 ± 9.2 (range, 0.5 to 36.6) for the KOOS JR and 12.2 ± 8.9 (range, 0.6 to 34.3) for the HOOS JR. Distribution-based methods led to smaller but more variable MCID values, whereas anchor-based methods were noted to have larger but more consistent MCID values. 

Conclusions: Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.

文献3

既往冠状动脉造影是否影响全关节置换术的并发症，手术是否应该延期

译者 丁云鹏

背景：心血管疾病在全关节置换术（TJA）患者中很常见，其中许多人在全髋关节（THA）或膝关节（TKA）置换术前接受冠状动脉造影（CAG）。本研究评估了CAG病史是否会增加术后并发症，以及其发生时间如何影响结果。

方法：使用国家数据库，本文分析了2012年至2020年间接受THA或TKA的患者。根据患者CAG病史（有或没有支架置入）和时间间隔（6个月、6至12个月、12至18个月、18至24个月和24至36个月）进行分组。结果包括再入院、心肌梗死（MI）、脑血管意外（CVA）、静脉血栓栓塞（VTE）、手术部位感染、人工关节感染（PJI）、急性肾功能衰竭（ARF）、翻修手术和输血。采用倾向评分匹配和多元逻辑回归进行分析。

结果：与对照组相比，接受TKA并既往CAG的患者（n=4602，有支架；n=25514，无支架）的MI、CVA和输血率明显较高。在所有CAG至TKA间期，这些风险仍然较高。急性肾功能衰竭、VTE和再入院在早期时间间隔内显著增加，但通常在延迟超过12个月后恢复正常，支架亚组除外，其风险升高持续长达18个月。在两年PJI或翻修率方面没有观察到显著差异。患有THA和既往CAG的患者（有支架的n=3422；没有支架的n=14728）也经历了更高的MI、CVA和输血率。这些风险并没有随着CAG到THA间隔的延长而下降。再入院、VTE和ARF在早期时间间隔内升高，但延迟超过12个月后恢复正常。两组的PJI和翻修率相似。

结论：CAG病史，尤其是支架置入史，与较高的术后并发症有关，无论THA和TKA组的手术时间如何，MI和CVA风险仍然较高。对于既往接受过冠状动脉造影（CAG）且需进行关节置换术的患者，建议推迟全关节置换术（TJA）以应对其他并发症。

Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be Postponed

Background: Cardiovascular diseases are common in total joint arthroplasty (TJA) patients, many of whom undergo coronary angiography (CAG) before total hip (THA) or knee (TKA) arthroplasty. This study evaluated whether a history of CAG increases postoperative complications and how its timing affects outcomes.

Methods: Using a national database, we analyzed patients undergoing THA or TKA between 2012 and 2020. Patients were grouped by CAG history (with and without stent placement) and timing intervals (within six, six to 12, 12 to 18, 18 to 24, and 24 to 36 months). Outcomes included readmission, myocardial infarction (MI), cerebrovascular accident (CVA), venous thromboembolism (VTE), surgical site infection, prosthetic joint infection (PJI), acute renal failure (ARF), revision surgery, and blood transfusion. Analysis used propensity score-matching and multivariate logistic regression.

Results: Patients who underwent TKA with prior CAG (n = 4,602 with stent; n = 25,514 without stent) had significantly higher rates of MI, CVA, and blood transfusion compared to controls. These risks remained elevated across all CAG-to-TKA intervals. Acute renal failure, VTE, and readmission were significantly increased in earlier time intervals, but generally normalized with delays beyond 12 months, except in the stented subgroup, where elevated risks persisted up to 18 months. No significant differences were observed in 2-year PJI or revision rates. Patients who had a THA and a prior CAG (n = 3,422 with stent; n = 14,728 without stent) also experienced higher rates of MI, CVA, and blood transfusions. These risks did not decline with longer CAG-to-THA intervals. Readmission, VTE, and ARF were elevated in early time intervals, but normalized with delays beyond 12 months. Both PJI and revision rates were similar between groups.

Conclusions: A history of CAG, especially with stent placement, is linked to higher postoperative complications, with MI and CVA risks remaining elevated regardless of surgery timing in both THA and TKA groups. Strategic TJA delay for other complications is recommended for patients with prior CAG undergoing arthroplasty.

文献出处：Amir Human Hoveidaei , Kasra Pirahesh , Mohammad Poursalehian ,Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be PostponedJ Arthroplasty 2025 Jul 8:S0883-5403(25)00853-8. doi: 10.1016/j.arth.2025.07.002. Online ahead of print.

文献4

单髁膝关节置换术翻修的结果与初次全膝关节置换术相似，优于全膝关节置换术的翻修结果

译者 沈松坡

目的：

本研究的主要目的是分析内侧单髁膝关节置换术翻修（revision of medial unicompartmental knee arthroplasty，rUKA）是否具有比初次全膝关节置换术（primary total knee arthroplasty，TKA）翻修或全膝关节翻修（revision of total knee arthroplasty，rTKA）更好的临床结局。

方法：

研究的参考组为rUKA，与两个对照组（初次TKA和翻修TKA）进行配对。患者按照五个术前因素进行1:1:1配对：随访时间（最少60个月）、年龄、性别、体质指数（BMI）和手术侧别。临床评估使用Knee Society评分（KSS）和“遗忘关节评分”（Forgotten Joint Score，FJS）。疼痛通过视觉模拟评分（VAS）进行评估。还记录了以下并发症：术后贫血、感染和翻修手术。

结果：

每组共纳入45例患者。三组在年龄、性别、手术侧别、BMI和随访时间方面无统计学差异（p > 0.05）。最终随访时，rTKA组在KSS（rUKA=95；TKA=100；rTKA=87.5）和FJS（rUKA=95；TKA=100；rTKA=90）方面的评分低于rUKA和TKA组（p < 0.05）。在KSS评分方面，rUKA与TKA之间无显著差异（p > 0.05）。在疼痛方面，rTKA组评分低于TKA组（p=0.001；rUKA=3；TKA=2；rTKA=3）；FJS评分方面，rUKA与TKA组间亦存在差异（p=0.038）。三组在术后贫血和无菌性松动等并发症方面发生率相似（p > 0.05）。

结论：

UKA翻修术与初次TKA在临床结局和患者自评结局方面相当，优于TKA翻修术，而其医学并发症则与初次TKA相似。这些发现可为需接受UKA翻修术的患者在临床结局和并发症方面提供决策参考。

Revision of Unicompartmental Knee Arthroplasty Results in Outcomes Similar to those of Primary Total Knee Arthroplasty and Superior to those of Revision Total Knee Arthroplasty

Purpose: The main aim of this study was to analyse whether revision of medial unicompartmental knee arthroplasty (rUKA) has better clinical outcomes than revision of primary total knee arthroplasty (TKA) or revision of total knee arthroplasty(rTKA).

Methods: The study reference group (rUKA) was identified and matched with two control groups: primary TKA and revisionrTKA. Patients were matched according to five preoperative factors: follow-up (minimum of 60 months), age, sex, body mass index (BMI), and operation side at a ratio of 1:1:1. The Knee Society score (KSS) and the forgotten joint score (FJS) were used for the clinical assessment. Pain was measured via the visual analogue scale (VAS) for pain. The following complications were also recorded: postoperative anaemia, infection and revision surgeries.

Results: Forty-five patients were included in each group. The three groups did not differ in terms of age, sex, operation side,vBMI, or follow-up (p > 0.05). At the final follow-up, the rTKA group had lower values than did the rUKA and TKA groups in terms of the KSS (rUKA=95; TKA=100; rTKA=87.5) and FJS (rUKA=95; TKA=100; rTKA=90) (p<0.05). For the KSS, no difference was found between the rUKA and TKA groups (p>0.05). Regarding pain, the rTKA group had a lower value than the TKA group did (p=0.001; rUKA=3; TKA=2; rTKA=3), whereas in terms of FJS, there was also a difference between the rUKA and TKA groups

(p=0.038). The rates of complications in terms of postoperative anaemia and aseptic loosening were similar among the three groups (p > 0.05).

Conclusions: Revised UKA has comparable clinical and patient-reported outcomes to those of primary TKA and better out-comes than those of revised TKA, whereas medical complications of revised UKA are similar to those of primary TKA. These findings serve to inform discussions with patients requiring revision of a UKA regarding clinical outcomes and complications following this procedure.

文献1

双下肢不等长双侧髋关节负荷情况

译者 任宁涛

目的:双下肢不等长在健康人群和全髋关节置换术(total hip arthroplasty, THA)后都很常见。关于THA后下肢长度的研究表明，在恢复下肢长度方面存在显著的不一致性。然而，关于双下肢不等长时，步态中髋关节负荷的影响尚不清楚。本研究的目的是采用三维步态分析来评估步态中髋关节负荷，模拟下肢长度差异为2cm和4cm。9名没有任何髋关节损伤史的健康受试者参加了研究。

方法:采用标准生物力学步态模型，用6个摄像头和2个力板进行3D步态分析(Vicon, Motion System, Oxford, England)。计算了三种运动自由度下的髋关节力矩。采用重复测量方差分析进行统计学处理。

结果:短肢外展力矩峰值显著增加(P < 0.05)，长肢无明显变化。长肢内收力矩在0 ~ 4 cm范围内减小(P < 0.01)，短肢内收力矩无明显变化。长肢和短肢的髋关节内旋转力矩都没有变化。短肢外旋力矩无变化，长肢0-4 cm外旋力矩明显减小(P < 0.05)。

结论:2厘米以上的下肢长度差异会引起长肢和短肢髋关节负荷的生物力学变化，且短侧的影响更大。从长远来看，增加的压力可能会导致后续的问题。

Hip joint load in relation to leg length discrepancy

Objective: Leg length discrepancy is common both in healthy subjects and after total hip arthroplasty (THA). Studies that evaluated leg length following THA have demonstrated a notable inconsistency in restoring leg length. The effects concerning joint load during gait is however not well known. The purpose of this study was to use three-dimensional (3D) gait analysis to evaluate joint load during gait with a simulated leg length discrepancy of 2 and 4 cm. Nine healthy subjects without any history of hip injury participated.

Method: A 3D gait analysis (Vicon, Motion System, Oxford, England) was performed with 6 cameras and 2 force palates using a standard biomechanical gait model. Hip joint moments of force were calculated for all three degrees of motion freedom. ANOVA for repeated measurements was used for statistical calculations.

Results: Abduction peak moment was significantly increased at the short side (P < 0.05) but unaffected on the long side. The adduction moment decreased on the long side between 0 and 4 cm (P < 0.01) but was unaffected on the short side. The internal hip rotation moments were unchanged for both the long and the short side. The external rotation moment was unchanged on the short side and decreased between bare foot and 4 cm on the long side (P < 0.05).

Conclusion: A leg length discrepancy of 2 cm or more creates biomechanical changes concerning hip joint load both on the long and the short side and that the effects are larger on the short side. The increased stress may cause problems in the long run.

文献出处：Wretenberg P, Hugo A, Broström E. Hip joint load in relation to leg length discrepancy. Med Devices (Auckl). 2008 Jul;1:13-8. doi: 10.2147/mder.s3714. Epub 2008 Aug 11. PMID: 22915902; PMCID: PMC3417904.

文献2

人工智能驱动的聊天机器人对接受髋臼周围截骨术患者的临床结局和整体满意度的影响

译者 李勇

图. 聊天机器人对患者提出的有关疼痛控制问题的回复

Clinical Outcomes and Overall Satisfaction of Patients Enrolled in an Artificial Intelligence–Powered Chatbot Following Periacetabular Osteotomy

文献出处：Rainey JP, Metz AK, Blackburn BE, Campbell KJ, Erickson JA, Peters CL, Anderson LA. Clinical Outcomes and Overall Satisfaction of Patents Enrolled in an Artificial Intelligence-Powered Chatbot Following Periacetabular Osteotomy. Arthroplast Today. 2025 Jun 26;34:101752. doi: 10.1016/j.artd.2025.101752. PMID: 40641831; PMCID: PMC12241380.

文献3

普通青少年人群中早期钳形畸形的流行情况：一项基于人群的研究（R 世代）

译者 张利强

目的：钳夹型髋关节形态可导致股骨髋臼撞击综合征（FAIS），并且可能是髋关节骨关节炎（OA）的一个可改变的风险因素。目前尚无研究调查青春期早期（这一骨骼形态可能形成的时期）钳夹型髋关节形态的患病率。本研究旨在评估荷兰普通青春期人群中早期青少年钳夹型髋关节形态的患病率及其出生时性别分布情况。

方法：本研究纳入了荷兰鹿特丹的“R世代研究”，这是一项基于人群的前瞻性队列研究。在13岁左右，参与者接受了全身及右侧髋关节的高分辨率双能x射线骨密度测定（DXA）。根据勾勒髋关节轮廓的界标自动确定外侧中心边缘角（LCEA），钳夹型髋关节形态定义为 LCEA≥40°。总体及出生时性别特异的患病率以百分比及95%置信区间（CI）表示。 

结果：共纳入3986名青少年（中位年龄13.5岁[2.5-97.5百分位，13.2-14.6]；46.8%为男性）。钳子形态的总体患病率为3.1%（95%CI 2.6%-3.6%）。男性和女性青少年的患病率分别为3.0%（95%CI 2.2%-3.7%）和3.3%（95%CI 2.5%-4.0%）。

结论：在荷兰普通人群中，早期青少年钳状形态的估计患病率为3.1%。男性和女性青少年的钳状形态患病率相似。这些发现可为钳状形态预防策略的实施时间提供信息，从而有可能降低股骨髋臼撞击综合征和髋关节骨关节炎的风险。

关键词：钳夹撞击；股骨髋臼撞击综合征；髋关节骨关节炎；患病率；普通人群

The prevalence of pincer morphology in early adolescents from the general population: a population-based study (Generation R)

Objective：Pincer morphology can lead to femoroacetabular impingement syndrome (FAIS) and may be a modifiable risk factor for hip osteoarthritis (OA). Currently, no studies investigate the prevalence of pincer morphology in early adolescence-the period when this bony shape likely develops. The purpose of this study was to estimate the prevalence and birth-assigned sex distribution of pincer morphology in early adolescents from the general population in the Netherlands.

Methods：This study was embedded in the Generation R study, a population-based prospective cohort in Rotterdam, the Netherlands. Around the age of 13 years, participants underwent high-resolution dual-energy x-ray absorptiometry (DXA) of their full-body and right hip. The lateral center edge angle (LCEA) was automatically determined based on landmarks outlining the hip contour, and pincer morphology was defined as a LCEA ≥ 40°. The overall and birth-assigned sex-specific prevalence was presented as a percentage with 95% confidence interval (CI).

Results：A total of 3,986 adolescents (median age 13.5 years [2.5th – 97.5th percentile, 13.2 – 14.6]; 46.8% males) were included. The overall prevalence of pincer morphology was 3.1% (95% CI 2.6% – 3.6%). The prevalence in male and female adolescents was 3.0% (95% CI 2.2% – 3.7%) and 3.3% (95% CI 2.5% – 4.0%), respectively.

Conclusion：Among early adolescents from the general population in the Netherlands, the estimated prevalence of pincer morphology was 3.1%. Male and female adolescents had a similar prevalence of pincer morphology. These findings could inform the timing of prevention strategies for pincer morphology, potentially reducing the risk of FAIS and hip OA.

Keywords

Pincer impingement; Femoroacetabular impingement syndrome; Hip osteoarthritis; Prevalence; General population

文献出处：Delong Chen, Fleur Boel, Suzanne de Vos-Jakobs, Pim van Klij, Michiel M A van Buuren, Sita M A Bierma-Zeinstra, Rintje Agricola; The prevalence of pincer morphology in early adolescents from the general population: a population-based study (Generation R)Arthritis care & research 2025 Jul 07; doi:10.1002/acr.25601

文献4 

髋臼周围截骨术治疗≥40岁症状性髋关节发育不良患者：中期和长期结果及失败预测因素

译者 贾海港

背景：对于年龄≥40 岁的有症状髋臼发育不良患者，伯尔尼髋臼周围截骨术（PAO）作为治疗方法存在争议。我们进行了一项回顾性研究，旨在评估该手术的疗效、测量其生存率，并确定≥40岁患者PAO失败的相关因素。

方法：我们对年龄≥40 岁的接受 PAO 手术的患者进行了回顾性研究。符合研究纳入标准的患者有 166 例（其中 149 例为女性；平均年龄 44±3 岁），其中145例（87%）在PAO治疗术后随访≥4年。我们使用带有右删失的Kaplan-Meier曲线计算生存率，其中“失败”定义为最终随访时需要或建议进行全髋关节置换术，或 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）疼痛评分≥10 分。我们使用简单的逻辑回归模型来确定任何术前特征是否与 PAO 失败显著相关。

结果：中位随访时间为9.6年（范围：4.2至22.5年）。145例髋关节中，61例（42%，95%置信区间[CI] = 34%至51%）在随访期间出现PAO失败。中位生存期为15.5年（95% CI = 13.4至22.1年）。对于术前无或仅有轻度骨关节炎的髋关节，中位生存时间更长：Tönnis 0级骨关节炎患者中位生存期为17.0年，1级骨关节炎患者中位生存期为14.6年，2级骨关节炎患者中位生存期为12.9年。术前 Tönnis 骨关节炎分级较高（p = 0.03）和 WOMAC 功能评分较差（p < 0.001）与失败的可能性增加相关

结论：对于年龄≥40岁的患者，如果术前功能良好且无或仅有轻度骨关节炎（Tönnis 分级 0 或 1），PAO 通常能有效改善功能并保留髋关节。年龄≥40 岁且术前骨关节炎较严重（Tönnis 分级 2）或术前功能较差的患者，在 PAO 术后有较高的治疗失败风险。

证据级别：治疗级别IV。有关证据级别的完整描述，请参阅作者须知。

Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia in Patients ≥40 Years Old: Intermediate and Long-Term Outcomes and Predictors of Failure

Background: The Bernese periacetabular osteotomy (PAO) is controversial as a treatment for symptomatic acetabular dysplasia in patients ≥40 years of age. We conducted a retrospective study to evaluate the outcomes, measure the survival rate, and identify factors associated with PAO failure in patients ≥40 years of age.

Methods: We performed a retrospective study of patients ≥40 years of age undergoing PAO. Study eligibility criteria were met by 166 patients (149 women; mean age, 44 ± 3 years), and 145 (87%) were followed for ≥4 years after PAO. We used a Kaplan-Meier curve with right-censoring to calculate survivorship, with ‘failure’ defined as either conversion to or recommendation for total hip arthroplasty or a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score of ≥10 at the most recent follow-up. We used simple logistic regression models to determine whether any preoperative characteristics were significantly associated with PAO failure.

Results: The median follow-up time was 9.6 years (range, 4.2 to 22.5 years). Sixty-one of 145 hips (42%, 95% confidence interval [CI] = 34% to 51%) experienced PAO failure during follow-up. The median survival time was 15.5 years (95% CI = 13.4 to 22.1 years). The median survival time was longer for hips with no or mild preoperative osteoarthritis: 17.0 years for Tönnis grade 0, 14.6 years for grade 1, and 12.9 years for grade 2. Higher preoperative Tönnis arthritis grades (p = 0.03) and worse WOMAC function scores (p < 0.001) were associated with an increased likelihood of failure.

Conclusions: PAO is usually effective at improving function and is effective at preserving the hip in patients ≥40 years of age provided that they have good preoperative function and no or mild preoperative osteoarthritis (Tönnis grade 0 or 1). Patients who are ≥40 years old with advanced preoperative osteoarthritis (Tönnis grade 2) and those with poor preoperative dysfunction have a high risk of therapeutic failure after PAO.

Level of evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

文献出处：Novais EN, Ferraro SL, Miller P, Kim YJ, Millis MB, Clohisy JC. Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia in Patients ≥40 Years Old: Intermediate and Long-Term Outcomes and Predictors of Failure. J Bone Joint Surg Am. 2023 Aug 2;105(15):1175-1181. doi: 10.2106/JBJS.23.00001. Epub 2023 May 26. PMID: 37235681.  

文献5

髋臼周围截骨术(PAO)：从本地应用到全球推广

译者 陶可

髋臼周围截骨术(PAO)的开发基于一种结构化方法，首先分析现有手术方法，以改善（髋臼对）股骨头的覆盖，然后制定了一系列额外的目标和改进措施。尸体解剖详细描述了髋臼和髋臼周围骨的血供，为骨盆内入路奠定了基础，该入路可提供最大程度的髋臼矫正，并能安全地进行关节囊内入路。最终的截骨术方案需要开发多种器械和手术设备，然后才能在一系列尸体髋关节上测试其可行性。虽然截骨术的顺序基本保持不变（耻骨和坐骨截骨术除外），但人们已经讨论了几种更简便/创伤性更小的入路方案；其中一些方案已成为标准操作。人们努力通过视频剪辑、实践课程、奖学金、出版物和持续的指导项目来优化学习曲线并最大限度地减少失败。回顾过去近40年的经验，这些努力推动了伯尔尼髋臼周围截骨术在世界范围内的应用。

图1  髋臼周围血供的尸体研究。右髋关节，骨盆内侧截骨。截骨术中（左）和截骨块复位矫正（右）时，臀上动脉和臀下动脉的分支均可保留。

图3  骨盆塑料模型：显示髋臼骨折块与后柱分离的塑料模型，包括骶棘韧带和骶结节韧带。上：前位；下：后位。

图4  带专用骨凿和牵开器的PAO截骨器械。

图5  1984年：首例手术病例——13岁女性，左髋股骨近端包容不足（proximal femoral focal deficiency, PFFD）。a三年前行股骨转子间截骨术后，股骨近端内翻。b髋臼周围截骨后行股骨转子间复位术，以改善关节吻合度。股骨头外侧覆盖良好。术后3个月，髋臼后倾角度增加导致后半脱位，采用后置髋臼固定术治疗。c 36年后，关节退变进行性加重。用于固定髋臼的钢板仍在原位。d两年后全髋关节置换术(THR)随访X线片。患者恢复正常步态。

图6  髋臼联合股骨手术中经股骨入路行坐骨切断术。上图：可进入闭孔内肌和下孖肌之间的髋臼下沟。下图：可在切开过程中最大程度地保护坐骨神经。

图7  16岁女性，双侧重度髋关节发育不良；右侧疼痛更严重。a侧位片可见数个软骨下骨囊肿（黑色箭头）。髋臼缘骨折移位，外展活动有所减少（白色箭头）。b PAO联合股骨内翻截骨术。髋关节手术间隔6个月（首先进行右侧手术）。右侧PAO略微过度矫正，以便更好地减轻受损边缘区域的负荷。2年后进行部分金属螺钉取出。5年后观察放射学结果。c术前和术后（d）近距离观察右髋关节关键区域，显示边缘截骨块已复位且愈合（双箭头）。

图8：13岁男性患者右髋Perthes病，接受Salter截骨术治疗。a持续性髋臼脱位和内收，伴外侧柱挤压和坏死区域负重。髋臼容积自适应地增宽。右侧计算机模拟显示切除坏死区域（红色部分）后复位的股骨头，并用PAO术达到最佳覆盖效果。b术中图片显示切除坏死的股骨头中心部分，以及用两枚螺钉固定活动侧股骨头后最终大小。c术后拍片，新股骨头愈合，无坏死。

图 9 髋关节发育不良、多发性外生骨疣和半脱位。一名21岁体态纤细型女性，双侧髋关节附近均有多发性外生骨疣，伴髋关节发育不良。a左髋关节半脱位时疼痛不适，完全伸展旋转时发生撞击。侧位片（右）显示致病的股骨颈后部外生骨疣。b术后结果：髋关节外科脱位、股骨颈内翻截骨术，经股骨颈截骨术切除外生骨疣，随后进行股骨颈内翻截骨术。c 10年结果。术后不久因局部疼痛取出股骨螺钉。双髋均无疼痛。

图10 一名19岁男性的创伤后髋臼发育不良。a 3岁时遭遇车祸后，典型的右髋臼创伤后髋关节发育不良。髋臼边缘骨折块较大。由于髋臼上、后骨较厚，截骨手术操作费力。螺钉固定大边缘骨折块。髋臼骨折块最大限度向内侧移位。b 骨折愈合及截骨手术两年后的放射学结果。

图11：一名21岁患有成骨不全症的女性，伴双侧髋臼突出。右侧持续疼痛，而左侧在大多数日常活动中无痛。患者拒绝接受全髋关节置换术（THR）。上图为术前X线片，显示关节底部发生疲劳性骨折（白色箭头）。b：过度修整边缘和PAO去除髋臼头一年后的结果。疲劳性骨折愈合（黑色箭头），疼痛明显减轻。

图12 患者创伤后骨盆前突。a 一名23岁女性，创伤后骨盆前突和半骨盆变形。她的妇科医生讨论了子宫偏位导致的流产风险，这就是她要求矫正的原因。首先在塑料模型上测试了改良的PAO。借助牵引器辅助矫正前突和骨盆变形。b沿骨盆边缘放置长骨板以稳定新位置。在自然分娩前进行了超声检查。c术后16年，她已是5个孩子的母亲，非常活跃于户外活动。伸直的腿是术侧腿。

图13  一名16岁男性患者右髋关节严重畸形（图片由葡萄牙里斯本卢兹医院P. Rego教授提供），患者于1.5岁行切开复位手术，随后发生股骨头缺血性坏死。a患者于14岁时行内翻截骨术，但跛行和疼痛症状并未改善。b术后X线片显示，患者接受了复杂的手术，包括相对延长股骨颈、股骨头内截骨术（以减小股骨头尺寸）以及股骨转子下去旋转截骨术，随后进行股骨近端截骨术(PAO)。c术后4年随访结果显示患者髋关节功能良好且无疼痛。

Bernese periacetabular osteotomy (PAO): from its local inception to its worldwide adoption

文献出处：Reinhold Ganz, Michael Leunig. Bernese periacetabular osteotomy (PAO): from its local inception to its worldwide adoption. Review J Orthop Traumatol. 2023 Nov 2;24(1):55. doi: 10.1186/s10195-023-00734-2.

文献6

股骨前倾角增大导致内八字步态受试者行走时的关节接触力研究          
译者 邱兴

内八字步态是一种病理现象，表现为儿童行走时足部内旋（即呈“内八字”）而非指向前方。此病症会改变下肢结构排列，增加膝髋关节骨关节炎发病率。本研究旨在探究内八字步态受试者的运动学特征与关节负荷。实验选取两组受试者：正常组与股骨前倾角增大导致内八字步态组（每组15人）。采用Qualisys运动分析系统和Kistler测力台记录行走时的下肢运动及受力数据，并通过OpenSim软件（3.3版）分析两组受试者的关节活动度、力矩、肌力及关节接触力。

正常组步长均值（1.1±0.141米）与内八字步态组（0.94±0.183米）差异显著。内八字步态组的地面反作用力内外侧分量较正常组显著降低（p值=0.05）。与正常组相比，内八字步态组大部分髋关节肌肉的峰值肌力显著增加（p值<0.05）。研究结果表明：因股骨前倾角增大形成的内八字步态仅引起骨盆与髋关节的旋转变化。两组在步行速度及大部分地面反作用力分量上无显著差异。由于内八字步态组髋关节多数肌肉的峰值肌力显著升高，导致关节接触力增大（尤以髋关节前后向分量与膝关节内外侧分量为主），最终可能增加髋膝关节骨关节炎的发病风险。

Investigation of joint contact forces during walking in the subjects with toe in gait due to increasing in femoral head anteversion angle

文献出处：Karimi, Mohammad Taghi, et al. ‘Investigation of joint contact forces during walking in the subjects with toe in gait due to increasing in femoral head anteversion angle.’ Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 238.7 (2024): 755-763.   

文献7

髋关节发育不良患者髋关节软骨和盂唇力学特性分析

译者 徐子茵

背景：髋关节发育不良是髋关节骨关节炎（OA）发展的主要诱发因素，可能是由于软骨盂唇负荷的改变。特定受试者的有限元（FE）建模可用于评估发育不良髋关节的软骨盂唇力学，从而提供对OA之前力学的深入了解。

目的：使用经验证的受试者特定FE建模方法评价发育不良髋关节和正常髋关节的软骨盂唇接触力学和一致性。

方法：使用先前验证的方案构建了10名正常髋臼受试者和10名发育不良受试者的有限元模型。比较两组间髋臼唇载荷支持、髋臼唇与髋臼软骨接触应力和接触面积。对于两种模拟活动，在关节面处确定局部一致性。

结果：发育不良髋关节的盂唇承受的经关节传递的载荷是正常髋关节的2.8 ~ 4.0倍。发育不良髋关节在主要承重区域的一致性与正常髋关节相比没有显著差异，但在某些非承重区域的一致性较低。正常髋关节的软骨接触应力大于发育不良髋关节，在少数区域有显着差异。

结论：发育不良髋关节的盂唇在髋关节力学中的作用远比正常髋关节重要。发育不良的髋关节既不低于正常髋关节的一致性，也没有受到升高的软骨接触应力。本研究支持髋关节发育不良的OA发病机制是外部因素的概念，并且在手术中应保留发育不良髋关节的盂唇。

图.代表性正常髋关节和代表性发育不良髋关节的接触应力的冠状面横截面图像，三维骨骼显示为透明。发育不良髋关节的侧向载荷导致髋臼唇的接触应力更高，因此载荷更大。

图. 所有模拟活动期间的平均接触应力条纹图。可以看到两组中接触应力模式的定性差异，与正常髋关节相比，发育不良髋关节的外侧接触更多，内侧接触更少（每组n ¼ 10）。

Patient-specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia

Background: Acetabular dysplasia is a major predisposing factor for development of hip osteoarthritis (OA), and may result from alterations to chondrolabral loading. Subject-specific finite element (FE) modeling can be used to evaluate chondrolabral mechanics in the dysplastic hip, thereby providing insight into mechanics that precede OA. 

Objective: To evaluate chondrolabral contact mechanics and congruency in dysplastic hips and normal hips using a validated approach to subject-specific FE modeling. 

Methods: FE models of ten subjects with normal acetabula and ten subjects with dysplasia were constructed using a previously validated protocol. Labrum load support, and labrum and acetabular cartilage contact stress and contact area were compared between groups. Local congruency was determined at the articular surface for two simulated activities. 

Results: The labrum in dysplastic hips supported 2.8e4.0 times more of the load transferred across the joint than in normal hips. Dysplastic hips did not have significantly different congruency in the primary load-bearing regions than normal hips, but were less congruent in some unloaded regions. Normal hips had larger cartilage contact stress than dysplastic hips in the few regions that had significant differences. 

Conclusions: The labrum in dysplastic hips has a far more significant role in hip mechanics than it does in normal hips. The dysplastic hip is neither less congruent than the normal hip, nor subjected to elevated cartilage contact stresses. This study supports the concept of an outsideein pathogenesis of OA in dysplastic hips and that the labrum in dysplastic hips should be preserved during surgery.

文献8

异常股骨前扭转-转子下畸形

译者 陈志强

摘要：股骨旋转对线不良与疼痛和功能障碍相关，可能是髋关节撞击和不稳定的促成因素。通常，畸形可通过旋转截骨术进行手术治疗。然而，该畸形的解剖学位置存在争议.本研究的目的是使用小转子（LT）作为附加标志，进一步确定畸形发生的解剖部位。108例患者接受了基于计算机断层扫描（CT）的下肢旋转分析。测量股骨扭转（FT）和LT扭转（LTT）。计算FT和LTT之间的组合角度（CoA）。通过多元回归分析进行统计学评价。对97个肢体进行了FT和LTT检查。平均年龄为41岁（SD=16.9），范围为18-85岁。FT的平均值为20（SD=12.2），LTT的平均值为16（SD=11.3）。平均CoA为37.2（SD=8.7）。统计学分析显示，FT与LTT之间存在较强的线性关系（y=31 – 0.74x），而FT与CoA之间的关系较弱（y= 31 – 0.24x）。该研究将LT确定为可靠的标志，并显示LT的方向与LT上下股骨的总体扭转之间存在强线性关系，大约三分之二的扭转变化发生在LT远端。这些结果为转子下截骨术提供了相当大的适应症，以解决解剖学起源处股骨旋转畸形的矫正问题。

示意图显示了股骨扭转（FT）、小转子扭转（LTT）和组合角（CoA）的测量。虚线圆标记股骨颈轴在其基底部的中心。小转子表示为LT。FH，股骨头。