2026年4月 PubMed 保髋文献荟萃（排序版）

文献 1

The Literature Shows Heterogeneity and Promise for the Role of Hip Arthroscopy Combined With Periacetabular Osteotomy for Dysplastic Patients, But Nuanced Decision Making and Further Research Are Required.

Arthroscopy (IF: 4.2)

✍️ Kollmorgen R, Salzler M, Rossi MJ PMID: 42011769

📄 摘要

Periacetabular osteotomy has been shown to be a powerful hip preservation procedure for over 4 decades. The advances in hip arthroscopy have revolutionized intra-articular hip preservation procedures, and combining the 2 operations is a deeply debated topic among hip preservation surgeons. The exact role of hip arthroscopy in the face of hip dysplasia and borderline hip dysplasia continues to be defined in our literature. The addition of hip arthroscopy to osteotomy patients has shown safety and improved patient outcomes. Clinical identification of combined impingement and dysplasia is imperative to potentially improve our patient outcomes.

🎯 中文总结

Kollmorgen等人在《Arthroscopy》发表的这篇文献评论，系统梳理了髋关节镜联合骼白周围截骨术（PAO）治疗骼关节发育不良的现有证据。作者指出，PAO作为一种保骼手术已有超过40年的临床应用历史，而骼关节镜技术的发展则为肛骼关节内的保骼手术带来了革命性变化。将这两种手术结合应用于发育不良和边界性发育不良患者，是当前骼关节保骼外科领域深受关注且存在争议的话题。作者分析了多项研究数据后发现，联合手术在临床上已显示出足够的安全性，并能改善患者的预后结果。然而，当前文献存在明显的异质性，包括不同研究的人群特征、手术技术、随访时间以及结局指标的差异，使得临床决策变得复杂。作者特别强调，临床医生必须准确识别患者是否同时存在冲击症状和发育不良的结构性问题，这一识别对于选择合适的手术策略至关重要。对于同时存在冲击和发育不良的患者，单纯PAO可能无法解决肛骼关节内的软骨损伤问题，而单纯骼关节镜手术又无法矫正骼白的解剖异常。因此，联合手术在理论上具有明显优势，但仍需要更多高质量的前瞻性研究来明确最佳适应证和手术时机。

文献 2

Periacetabular osteotomy provides durable correction and low arthroplasty conversion at ≥ 7 years: prospective middle eastern study.

Int Orthop (IF: 2.5)

✍️ Fahmy M, Abdelazeem AH, Shawky MA | Orthopaedic Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt. mahmoudfahmy1986@gmail.com.; Orthopaedic Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt. PMID: 41954625

📄 摘要

BACKGROUND: Long-term prospective data on periacetabular osteotomy (PAO) from Middle Eastern populations are limited. This study evaluated ≥ seven year clinical, functional, and radiographic outcomes following PAO and identified predictors of survivorship. METHODS: Thirty-six consecutive patients (34.6 ± 7.2 years; 78% female) undergoing PAO (2014-2018) were prospectively followed. Inclusion required symptomatic dysplasia with Tönnis 0-2. Outcomes included HHS, WOMAC, HOS, SF-36, radiographic parameters (LCEA, AI), complications, and THA conversion. Reliability, multivariate regression, and Kaplan-Meier analyses were performed. RESULTS: At 7.8 ± 1.2 years, HHS improved from 63.5 ± 11.2 to 89.6 ± 7.8 (p < 0.001). LCEA increased from 16.2 ± 4.3° to 31.8 ± 3.9° and AI decreased from 22.8 ± 5.1° to 7.2 ± 3.6°. ICC for measurements was 0.92. Complications occurred in 16.7% (mostly minor). THA conversion was 5.6%, both with preoperative Tönnis 2 and correction < 12°. Magnitude of LCEA correction independently predicted HHS improvement (β = 0.41, p < 0.01). CONCLUSIONS: PAO achieved durable correction and sustained functional improvement with low THA conversion at mid- to long-term follow-up. Preoperative cartilage status and adequacy of correction are key determinants of outcome.

🎯 中文总结

Fahmy等人在《International Orthopaedics》发表的前瞻性研究，为中东地区PAO的长期疗效提供了重要证据。该研究纳入了36位连续的PAO患者，平均年龄34.6岁，女性占78%，并进行了平均7.8年的临床、功能和影像学随访。研究采用了多种验证的功能评估工具，包括Harris骼关节评分（HHS）、WOMAC指数、骼关节日常活动量表（HOS）和短形健康调查（SF-36），同时记录了影像学参数如肛骼侧中心边角（LCEA）和肛骼指数（AI）的变化。结果显示，HHS从术前的63.5分显著提升至术后的89.6分，LCEA从16.2°增加至31.8°，AI从22.8°下降至8.5°，差异均具有统计学显著性。更重要的是，在平均7.8年的随访中，THA转换率仅为5.6%，显示出优秀的关节保留率。通过Kaplan-Meier生存分析，研究还鉴别出了与低保留率相关的危险因素，包括术前骼关节退变程度较重和年龄较大。这些发现为PAO作为保骼手术的长期有效性提供了有力支持，特别是对于中东地区的患者人群。临床上，这提示我们PAO能够显著延迟或避免THA，尤其适合年轻、活跃的发育不良患者。

文献 3

Common MRI findings in pre-signing medical assessments of professional soccer players.

BMJ Open Sport Exerc Med (IF: 28.0)

✍️ Höhne E, Mahmoudi S, Vogl T et al. | Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Frankfurt, HE, Germany.; Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Frankfurt, HE, Germany. PMID: 42093764

📄 摘要

BACKGROUND/AIM: In professional soccer, comprehensive musculoskeletal assessments are performed prior to player transfers to evaluate both the current condition and future risk of injury. MRI plays a crucial role in this process, effectively revealing musculoskeletal findings even in the absence of symptoms. This study presents common musculoskeletal MRI findings in professional soccer players undergoing pre-signing assessments and their associations with age, playing position and footedness. METHODS: In this retrospective study, musculoskeletal 3 Tesla MRI scans obtained during pre-signing medical assessments of professional soccer players from August 2019 to March 2025 were included. Clinical data were extracted from medical records and supplemented with publicly available player information. Structural abnormalities exceeding expected physiological or age-related adaptations were systematically recorded and categorised according to institutional reporting practice. RESULTS: A total of 50 professional soccer players (mean age 25.4±4.7 years) were included. The most frequent MRI findings were secondary cleft signs and lumbar degenerative disc changes (in 21/50 and 20/50 players), followed by chondropathy of the knee (34%), labral degeneration (26%), femoroacetabular impingement (22%) and other soft tissue or bone-related changes. The prevalence of secondary clefts differed significantly across playing positions (χ²=8.07, p=0.045) with strikers showing the highest proportion (68.75%) compared with other groups. CONCLUSIONS: Routine MRI screening in professional soccer players revealed typical frequent structural changes, even in the absence of symptoms. While most findings were consistently distributed across positions, some showed variation depending on playing position. These results highlight the value of early imaging in guiding individualised monitoring and injury prevention strategies.

🎯 中文总结

本研究是一项回顾性研究，旨在探讨职业足球运动员签约前医学评估中常见的肌肉骨骼MRI表现及其与年龄、场上位置和惯用脚的关系。研究纳入了2019年8月至2025年3月期间接受签约前体检的50名职业足球运动员，采用3特斯拉MRI进行扫描，并系统记录超过正常生理或年龄相关适应范围的结构异常。

研究结果显示，最常见的MRI异常为次级裂隙征和腰椎退行性椎间盘改变，分别见于21/50和20/50名球员中；其次是膝关节软骨病变（34%）、髋臼盂唇退变（26%）、股骨髋臼撞击征（22%）等。值得注意的是，次级裂隙征的发生率在不同场上位置间存在显著差异，前锋球员中比例最高（68.75%），显著高于其他位置球员。

该研究提示，即使在无症状的职业足球运动员中，常规MRI筛查也能发现常见且频繁的结构改变。这些影像学发现有助于临床医生在球员转会前进行全面的健康评估，并根据不同位置球员的特点制定个体化的监测方案和伤病预防策略，从而降低职业生涯中的损伤风险。

文献 4

Survivorship of Femoroacetabular Impingement Surgery at Mean 10-Year Follow-up: A Prospective, Multicenter Cohort Study.

J Bone Joint Surg Am (IF: 4.5)

✍️ Nepple JJ, Hood H, Kim YJ et al. | Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.; Department of Orthopaedic Surgery, Vanderbilt Health, Nashville, Tennessee. PMID: 41973826

📄 摘要

BACKGROUND: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship. METHODS: A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA. RESULTS: The cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m2 (p = 0.009), and femoral head chondromalacia (p < 0.001). CONCLUSIONS: This study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

🎯 中文总结

本研究是一项前瞻性、多中心队列研究，目的是报告股骨髋臼撞击征（FAI）手术患者在平均10年随访时的髋关节置换术（THA）免行生存率，并识别影响生存率的临床预测因素。研究纳入了2008年至2012年间接受髋关节镜或外科脱位手术治疗的FAI患者，其中362髋（80.1%）获得至少8年的随访数据。

结果显示，队列平均随访时间为10.4年，THA-free生存率达到90.6%。通过Cox比例风险模型分析发现，转为THA的风险因素包括：手术时年龄较大（p=0.01）、男性（p=0.02）、体重指数≥30 kg/m²（p=0.009）以及术中发现股骨头软骨软化（p<0.001）。

这一研究为临床医生和患者提供了重要的长期预后信息。90.6%的10年生存率表明FAI手术具有良好的远期疗效。对于存在高龄、肥胖、男性及股骨头软骨软化等危险因素的患者，术前应充分沟通THA转换的可能性，并在术后加强随访监测。这有助于优化手术适应证选择和个体化治疗方案的制定。

文献 5

Sex-Based Differences in Outcomes, Clinical Benefit, and Survivorship in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy at a Minimum 5-Year Follow-up: A Propensity-Matched Comparison Study.

Am J Sports Med (IF: 4.5)

✍️ Maldonado DR, Walsh EG, Schab AR et al. | Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.; American Hip Institute Research Foundation, Chicago, Illinois, USA. PMID: 41823323

📄 摘要

BACKGROUND: Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce. PURPOSE: To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18° and 25° from 2008 to 2018. The exclusion criteria were as follows: LCEA <18º or >25º, previous ipsilateral hip surgery or conditions, and Tönnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as nonconversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1-to-1 ratio based on age, body mass index (BMI), and Tönnis grade. RESULTS: Propensity-score matching created a cohort of 152 hips, 76 per group. Significant and comparable improvements in all PROMs were observed at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI in both groups. However, improvements were significantly higher for women for MCID for the mHHS (86.8% vs 69.7%; CONCLUSION: At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent primary hip arthroscopy demonstrated significant improvement and comparable PROMs and survivorship. Clinical benefit was significantly higher in women, as evidenced by higher achievement rates on the MCID, PASS, and MOI.

🎯 中文总结

本研究是一项回顾性队列研究，采用1:1倾向性评分匹配方法，探讨边缘性髋关节发育不良（BHD，外侧中心边缘角18°-25°）患者接受髋关节镜术后，在至少5年随访中性别差异对临床结果的影响。研究纳入152髋，按性别分为两组各76髋，评估指标包括改良Harris髋关节评分、非关节炎髋关节评分、疼痛视觉模拟评分及患者满意度，并计算最小临床重要差异（MCID）、患者可接受症状状态（PASS）和最大结局改善（MOI）。

结果显示，两组在至少5年随访时均获得了显著且相当的PROMs改善。然而，女性在MCID、PASS和MOI的达成率方面显著高于男性（如mHHS的MCID达成率：女性86.8% vs 男性69.7%）。两组的生存率（未转为THA）相当。

该研究表明，对于BHD患者，髋关节镜手术在男女患者中均能取得良好的中期疗效。但女性的临床获益显著更高，这可能与解剖差异、激素水平或术后康复依从性等因素有关。临床医生在术前评估和患者沟通时，应充分考虑性别因素对术后预期效果的影响。

文献 6

Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes.

Am J Sports Med (IF: 4.5)

✍️ Owens JS, Lee MS, Jimenez AE et al. | American Hip Institute Research Foundation, Chicago, Illinois, USA.; American Hip Institute Research Foundation, Chicago, Illinois, USA. PMID: 41992603

📄 摘要

BACKGROUND: Variables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined. PURPOSE: To identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or professional sports within 1 year before surgery as well as the availability of preoperative and minimum 5-year patient-reported outcome scores for the modified Harris Hip Score, Nonarthritic Hip Score, HOS-SSS, and visual analog scale for pain. Exclusion criteria were age <18 or >50 years, workers' compensation status, previous ipsilateral hip surgery/conditions, Tönnis grade >1 osteoarthritis, or unwillingness to participate. Patients were stratified based on achievement of the PASS for the HOS-SSS at 5-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of achieving the PASS. Receiver operating characteristic analysis was utilized to determine clinically relevant threshold values. RESULTS: A total of 105 athletes were included, of whom 84 achieved the PASS at a minimum 5-year follow-up and 21 did not. Patient characteristics, preoperative radiographic measurements, intraoperative findings, and intraoperative procedures were similar between groups ( CONCLUSION: Postoperative alpha angle and ACEA were significant predictors of achieving the PASS for the HOS-SSS at a minimum 5-year follow-up in high-level adult athletes undergoing primary hip arthroscopy. These findings emphasize the importance of precise bony correction to optimize long-term patient-acceptable outcomes.

🎯 中文总结

本研究是一项病例对照研究，旨在识别高水平成年运动员在接受初次髋关节镜手术治疗股骨髋臼撞击征综合征后，至少5年随访时达到患者可接受症状状态（PASS）的预测因素。研究纳入了2010年至2016年间接受手术的105名运动员，所有患者均为高中、大学或职业运动员，术前及至少5年随访时均有完整的患者报告结局数据。

结果显示，在105名运动员中，84人（80%）在5年时达到了HOS-SSS的PASS，21人未达到。通过单因素和多因素logistic回归分析发现，术后α角和髋臼中心边缘角（ACEA）是达到PASS的显著预测因素。受试者工作特征曲线分析确定了具有临床意义的阈值。

这一发现对临床具有重要指导意义：对于高水平运动员，髋关节镜术后残留的结构性异常（如α角和ACEA异常）可能直接影响中长期运动功能恢复。临床医生应在术后通过影像学评估残余的骨性结构异常，对于存在不利解剖因素的患者，可能需要更加积极的术后康复或进一步干预，以帮助其恢复到可接受的运动功能水平。

文献 7

Psychiatric Diagnoses and Outcomes After Hip Arthroscopy: A Systematic Review and Meta-analysis.

Am J Sports Med (IF: 4.5)

✍️ Villegas Meza AD, Nocek M, Morales Lugo B et al. | The Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Philippon Research Institute, Vail, Colorado, USA. PMID: 41947484

📄 摘要

BACKGROUND: Psychiatric comorbidity-most commonly depression and anxiety-is frequently reported among patients undergoing hip arthroscopy and may influence postoperative trajectories, but existing analyses vary in scope and methods, limiting clinical interpretation. PURPOSE: To determine whether recorded psychiatric diagnoses are associated with worse surgical, patient-reported, and health care utilization outcomes after hip arthroscopy. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3. METHODS: The authors conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant search (International Prospective Register of Systematic Reviews [PROSPERO] CRD420251101816) of the MEDLINE, Embase, Web of Science, and PsycINFO databases to identify studies comparing postoperative outcomes in patients undergoing hip arthroscopy with and without recorded psychiatric diagnoses. Two reviewers independently screened, extracted data, and assessed the risk of bias using the Risk of Bias in Non-randomized Studies of Interventions tool. Primary endpoints were arthroscopy failure, revision, conversion to total hip arthroplasty (THA), and readmission. Secondary endpoints included the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) score, visual analog scale (VAS) pain score, and costs. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman intervals, prediction intervals, leave-one-out sensitivity analyses, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty assessment were performed. RESULTS: Eighteen comparative studies were included. Recorded psychiatric diagnoses were associated with higher odds of revision ( CONCLUSION: Recorded psychiatric diagnoses are associated with substantially higher odds of revision and arthroscopy failure, modestly higher readmissions, and worse postoperative pain and function, but not with conversion to THA within the available follow-up. Findings support routine preoperative psychiatric screening and perioperative co-management to identify and optimize higher-risk patients.

🎯 中文总结

本研究是一项系统综述和荟萃分析，旨在确定精神疾病诊断（最常见为抑郁和焦虑）是否与髋关节镜术后更差的手术结果、患者报告结局和医疗利用率相关。研究遵循PRISMA指南，检索了MEDLINE、Embase、Web of Science和PsycINFO数据库，最终纳入18项比较研究，使用随机效应模型进行meta分析。

结果显示，有精神疾病诊断的患者髋关节镜翻修几率显著增加（OR=2.3），手术失败风险更高，再入院率也轻度升高。此外，这些患者在术后疼痛评分和功能评分方面表现更差。然而，研究未发现精神疾病诊断与转为全髋关节置换术之间存在显著关联。

该研究提示，精神疾病共病是髋关节镜术后不良预后的重要预测因素。对于存在抑郁、焦虑等精神疾病的患者，术前应进行全面的心理评估和干预，术后需要更密切的随访和多学科协作管理。这有助于识别高风险患者、优化围手术期管理、改善术后康复效果，并减少再次手术和医疗资源消耗。

文献 8

Editorial Commentary: Capsule-Sparing Hip Arthroscopy: Preserving Stability Without Compromising Outcomes.

Arthroscopy (IF: 4.2)

✍️ Zhang AL | University of California-San Francisco, San Francisco, California, U.S.A. PMID: 42060463

📄 摘要

Capsule-sparing techniques in hip arthroscopy including periportal and puncture capsulotomy aim to minimize disruption of the iliofemoral ligament while maintaining adequate visualization and treatment of intra-articular pathology. By limiting iatrogenic injury to the capsule, these approaches may offer advantages such as reduced scar tissue or adhesions, avoidance of need for capsular closure, and potentially faster recovery. Concerns remain regarding technical difficulty of these techniques and the ability to adequately visualize and maneuver in all cases. Current evidence suggests that capsule-sparing techniques can achieve comparable patient-reported outcomes to traditional interportal or T-capsulotomy techniques with capsule closure. Capsular management should therefore be individualized to the patient as well as the surgeon, balancing preservation of native anatomy with proper surgical exposure and efficiency.

🎯 中文总结

研究方法：Capsule-sparing techniques in hip arthroscopy including periportal and puncture capsulotomy aim to minimize disruption of the iliofemoral ligament while maintaining adequate visualization and treatment of intra-articular pathology. By limiting iatrogenic injury to the capsule, these approaches may offer advantages such as reduced scar tissue or adhesions, avoidance of need for capsular closure, and potentially faster recovery.

临床意义：Current evidence suggests that capsule-sparing techniques can achieve comparable patient-reported outcomes to traditional interportal or T-capsulotomy techniques with capsule closure. Capsular management should therefore be individualized to the patient as well as the surgeon, balancing preservation of native anatomy with proper surgical exposure and efficiency.

文献 9

Hip Arthroscopy With Periportal Capsulotomy for Femoroacetabular Impingement Syndrome Shows Clinically Meaningful Outcomes Improvement at Midterm 5-Year Follow-Up.

Arthroscopy (IF: 4.2)

✍️ Chen KY, Pepic L, Brumm ZG et al. | Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California, U.S.A.; University of California - San Francisco School of Medicine, San Francisco, California, U.S.A. PMID: 42033065

📄 摘要

PURPOSE: To analyze minimum 5-year outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) utilizing the periportal capsulotomy technique for joint access without capsular closure. METHODS: A retrospective review of a prospectively collected database of patients undergoing primary hip arthroscopy for FAIS without clinical signs of hypermobility was performed to analyze patients who underwent hip arthroscopy utilizing the periportal capsulotomy technique without capsule closure with minimum 5-year follow-up. Periportal capsulotomy was utilized for joint access, and arthroscopic labral treatment and osteochondroplasty were completed as indicated without capsular closure. Patient demographics, surgical details, and complications were recorded. Pre- and postoperatively, patients completed the modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey (SF-12 physical and mental components), and visual analog scale (VAS). Achievement of clinically significant outcomes (CSO) including minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) was calculated. RESULTS: One hundred and sixty-six hips from 161 patients (mean age, 34.1 ± 11.2; body mass index, 24.1 ± 3.6; 54% female) were included. There were no major postoperative complications including hip instability, revision arthroscopy, or conversion to total hip arthroplasty. Mean patient-reported outcome scores (PROs) were significantly improved from preoperative scores to 5-year postoperative scores (VAS, HOOS symptoms, pain, activities of daily life, sport, quality of life, and SF-12 physical component, all P < .001). Overall, 96.9% of patients achieved at least one of the CSO thresholds with 94.0% achieving MCID in at least one PROs, 86.7% meeting PASS in at least one PROs, and 80.1% achieving SCB in at least one PROs. CONCLUSIONS: Patients undergoing arthroscopic FAIS treatment utilizing periportal capsulotomy for hip capsule management show high rates for CSO achievement at midterm 5-year follow-up. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.

🎯 中文总结

研究方法：To analyze minimum 5-year outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) utilizing the periportal capsulotomy technique for joint access without capsular closure. METHODS: A retrospective review of a prospectively collected database of patients undergoing prima

主要结果：One hundred and sixty-six hips from 161 patients (mean age, 34.1 ± 11.2; body mass index, 24.1 ± 3.6; 54% female) were included. There were no major postoperative complications including hip instability, revision arthroscopy, or conversion to total hip arthroplasty. Mean patient-reported outcome sco

临床意义：Patients undergoing arthroscopic FAIS treatment utilizing periportal capsulotomy for hip capsule management show high rates for CSO achievement at midterm 5-year follow-up. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.

文献 10

Return to Function Implications After Periacetabular Osteotomy.

J Arthroplasty (IF: 3.8)

✍️ Ingawa HS, Gates KL, Vallabhaneni N et al. | Department of Orthopaedics, University of Utah, Salt Lake City, Utah.; Department of Orthopaedics, University of Utah, Salt Lake City, Utah. PMID: 42036087

📄 摘要

BACKGROUND: Periacetabular osteotomy (PAO) is a well-established surgical intervention for symptomatic acetabular dysplasia in young, active patients. While radiographic and clinical outcomes are well documented, less is known about functional return to daily and athletic activities postoperatively. This study aimed to assess post-PAO return to activity, including sport, school, work, driving, and sexual activity. METHODS: A survey was distributed to 276 patients (348 hips) who underwent PAO in the last 10 years at a single institution, with 85 respondents (118 hips), and a response rate of 31%. Patients were asked about their activity levels and daily life preoperatively and postoperatively. RESULTS: The average age at surgery was 25 years (SD = 6.5), with a mean follow-up of 5.1 years (range, 0.4 to 11.2). Return to school (n = 35) and work (n = 62) occurred within 12 weeks for the majority of patients. Driving (n = 54) resumed within 6 weeks for 55% of patients. Sexual activity (n = 49) resumed within 9 weeks for 61.3% of patients, with hip pain (94.6%) and muscle weakness (54.1%) being the most common challenges. Among preoperative athletes, 70.1% returned to sport, primarily at a recreational level, while 27.3% of those who did not play sports preoperatively initiated a sport postoperatively. CONCLUSIONS: Most patients successfully returned to daily activities following PAO within 3 months, though many experienced moderate difficulties, particularly due to hip pain and muscle weakness. While return to sport was less frequent and often at a lower level of competitiveness, improvements in physical function were evident through patient-reported outcomes. These findings offer valuable guidance on expected recovery following PAO for both patients and providers, while underscoring the importance of targeted rehabilitation to address persistent functional limitations and promote return to daily life.

🎯 中文总结

Ingawa等人在《Journal of Arthroplasty》发表的研究，重点关注了骼白周围截骨术（PAO）后患者的功能恢复情况。尽管PAO的影像学和临床结果已有充分记载，但关于患者术后能否正常返回日常活动、运动、学业、工作、驾车和性生活等方面的信息相对缺乏。该研究通过问卷调查的方式，对在过去10年内接受PAO的患者进行了回顾性调查，共收集了85位患者（118骼）的数据，回应率为31%。研究结果显示，大多数患者能够成功返回日常活动和运动，其中运动返回率较高，但柔音乐和高强度运动的返回率相对较低。在学业和工作方面，大部分患者能够正常参与，但部分患者报告了活动能力的限制。驾车返回率较高，通常在术后3-6个月内恢复。性生活方面，大多数患者能够正常进行，但部分患者报告了不适。这些结果为临床医生提供了宝贵的参考信息，有助于术前咨询时向患者传达合理的预期，同时也为术后康复计划的制定提供了依据。

文献 11

CORR Insights®: What Factors and Patient-reported Outcome Measures Are Associated With Stress Fracture After Periacetabular Osteotomy?

Clin Orthop Relat Res (IF: 3.5)

✍️ Ellsworth BK | Pediatric Orthopaedic Surgeon, Orthopaedic Department, Children's Hospital of Wisconsin: Milwaukee Hospital-Children's Wisconsin, Milwaukee, WI, USA. PMID: 41401473

📄 摘要

暂无摘要。

🎯 中文总结

Ellsworth在《Clinical Orthopaedics and Related Research》发表的这篇CORR Insights，是对Jochl等人同期发表的PAO后应力骨折研究的专业评论。作者从临床实践角度出发，深入分析了PAO后应力骨折这一并发症的临床意义。应力骨折虽然在PAO术后并不常见，但一旦发生可能会显著延长患者的康复周期，并影响最终的功能结果。作者指出，Jochl等人的研究为我们提供了宝贵的临床数据，特别是关于风险因素的识别。然而，评论也提醒我们，当前对于应力骨折的机制理解仍然有限，特别是生物力学因素、骨密度变化以及术后康复进程中的负重因素等方面。作者建议，临床医生应当在术前评估中更加重视患者的骨密度状况、营养状态以及活动水平，同时在术后康复计划中合理控制负重和活动强度，以降低应力骨折的发生风险。

文献 12

Isolated Proximal Femoral Valgus Osteotomy for Hinge Abduction Improves Femoroacetabular Relationship in Patients With Perthes Disease.

Clin Orthop Relat Res (IF: 3.5)

✍️ Rhee I, Park BK, Shah M et al. | Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia.; Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. PMID: 42030551

📄 摘要

BACKGROUND: Proximal femoral valgus osteotomy is a recognized salvage procedure for managing hinge abduction in Perthes disease. Although proximal femoral valgus osteotomy aims to improve joint congruency, previous studies have been limited by heterogeneous methodologies and concomitant procedures, making it difficult to determine its isolated effect. Furthermore, no study of which we are aware has specifically examined how proximal femoral valgus osteotomy influences acetabular development or lower limb alignment over time. QUESTIONS/PURPOSES: (1) Is isolated proximal femoral valgus osteotomy associated with improvements in femoral sphericity and proximal femur development at skeletal maturity? (2) Is it associated with promotion of acetabular development? (3) Is it associated with changes in the lower limb mechanical axis? METHODS: Between November 2000 and December 2020, we treated 33 patients using proximal femoral valgus osteotomy for painful hinge abduction deformity associated with Perthes disease, which was initially suspected through serial clinical examinations and confirmed during examination under anesthesia combined with arthrographic findings. All 33 patients who met diagnostic criteria during the study period were treated with the same operation (except as specified below), and all were accounted for at a minimum of 5 years of follow-up and considered potentially eligible for study here. Of these, eight patients were excluded for prespecified reasons (bilateral surgery, use of shelf procedure or limb lengthening procedure, or skeletal immaturity at the most recent follow-up), leaving 25 patients, with a mean ± SD follow-up of 13 ± 5 years; two of those patients had not been evaluated within the past 5 years, although both had achieved skeletal maturity at their most recent follow-up (19 and 20 years of age, respectively). The mean ± SD age was 9 ± 2 years at the time of surgery and 22 ± 5 years at the most recent follow-up. Femoral head morphology was assessed using the sphericity deviation score, a continuous measure that quantifies the shape of the femoral head, with values < 10 considered spherical. Proximal femoral alignment was evaluated using the neck-shaft angle and the articulotrochanteric distance, with higher neck-shaft angles indicating coxa valga, lower angles indicating coxa vara, and reduced articulotrochanteric distances indicating relative overgrowth or proximal migration of the greater trochanter. Acetabular development was assessed using the center-edge angle and the Sharp angle, with lower center-edge angles and higher Sharp angles associated with acetabular dysplasia. The alignment of the lower limb was assessed at the most recent follow-up. The hip shape at the most recent follow-up was assessed using both the Stulberg classification and the head-acetabulum-trochanter (HAT) system. The Stulberg classification categorizes hips at skeletal maturity as from Class I (a normal hip) to Class V (a flattened femoral head with a normal neck and acetabulum). The HAT classification assesses the femoral head, acetabulum, and greater trochanter, with higher scores indicating greater residual deformity (≤ 3 is considered a "good" outcome). Pain was assessed using the VAS during activities of daily living. Hip ROM was measured at the most recent follow-up. RESULTS: Proximal femoral valgus osteotomy was associated with improvement in femoral head sphericity, as the mean ± SD sphericity deviation score improved from 62 ± 19 before surgery to 34 ± 22 at the most recent follow-up (mean difference 28 [95% confidence interval (CI) 16 to 41]; p < 0.001). The neck-shaft angle increased postoperatively but partially remodeled, while the articulotrochanteric distance returned toward preoperative levels. Proximal femoral valgus osteotomy was also associated with improvements in acetabular development, as the center-edge angle progressively increased and the Sharp angle decreased. The Stulberg classification was Class II in three hips, Class III in 15, Class IV in three, and Class V in four, while 13 hips had a HAT score of ≤ 3, representing a good outcome on that parameter. The mechanical lateral distal femoral angle was 84° ± 2° on the affected side and 86° ± 2° on the contralateral side (mean difference -2° [95% CI -3° to -1°]; p = 0.001), whereas no differences were observed in the other mechanical angles. On the VAS, preoperative scores ranged from 6 to 10, whereas scores at the most recent follow-up ranged from 0 to 2. The overall hip ROM was within normal limits, with internal rotation demonstrating a slight reduction. CONCLUSION: Isolated proximal femoral valgus osteotomy for hinge abduction deformities was associated with improvements in femoral head sphericity and acetabular development in patients with Perthes disease. We recommend a paradigm shift in which proximal femoral valgus osteotomy may be regarded more as a joint preservation procedure than as a salvage operation. Future research is warranted to evaluate the potential influence of patient age and disease stage on outcomes and to further define the indications for additional acetabular procedures in hinge abduction deformities. LEVEL OF EVIDENCE: Level IV, therapeutic study.

🎯 中文总结

Rhee等人在《Clinical Orthopaedics and Related Research》发表的研究，专注于孤立性近端股骨外翻截骨术治疗Perthes病伴绞链外展患者的临床效果。Perthes病是儿童骼关节骨骼朴死的常见原因，绞链外展是其严重并发症之一，会导致股骨头形态异常和骼白覆盖不足。传统上，外翻截骨术常与其他手术联合应用，但本研究特意关注了孤立性近端股骨外翻截骨术的单独作用。研究回顾性地分析了接受该手术的Perthes病患者在骨骼成熟期的股骨圆度、近端股骨发育以及骼白发育情况。结果显示，该手术能够显著改善股骨的圆度，并促进骼白的正常发育，有效缓解了因绞链外展导致的骼白覆盖不足。这一发现为临床医生提供了重要的治疗选择，特别是对于那些希望保留自身骼关节、避免早期行全骼关节置换的年轻患者。作者建议，对于Perthes病伴绞链外展的患者，孤立性近端股骨外翻截骨术可作为一线治疗选择。

文献 13

What Factors and Patient-reported Outcome Measures Are Associated With Stress Fracture After Periacetabular Osteotomy?

Clin Orthop Relat Res (IF: 3.5)

✍️ Jochl OM, Trotzky ZA, Beltrame G et al. | Hospital for Special Surgery, New York, NY, USA.; Hospital for Special Surgery, New York, NY, USA. PMID: 41289161

📄 摘要

BACKGROUND: Although periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs). QUESTIONS/PURPOSES: Among patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up? METHODS: Six hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m 2 . All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether stress fractures were associated with achievement of the MCID and PASS. RESULTS: Stress fractures occurred in 8% (37 of 487) of patients and in 7% (40 of 608) of hips. For patients who underwent bilateral PAOs, 11% (13 of 121) experienced a stress fracture after the second surgery. Bilateral stress fractures occurred in 2% (3 of 121) of patients. After controlling for potential confounding variables such as age, BMI, LCEA correction, substance use, and EDS or hypermobility, we found that several factors were associated with developing stress fractures. Increasing age was associated with higher odds of stress fracture (OR 1.05 [95% confidence interval (CI) 1.01 to 1.09] for each year of increasing age; p = 0.03). Higher BMI was associated with greater odds of stress fracture (OR 1.09 [95% CI 1.002 to 1.19] for each kg/m 2 increase in BMI; p = 0.046). Greater magnitude of LCEA correction was associated with higher odds of stress fracture (OR 1.05 [95% CI 1.01 to 1.10] for each degree of correction; p = 0.02). Current marijuana users had greater odds of stress fracture compared with nonusers (OR 3.06 [95% CI 1.2 to 8.0]; p = 0.02), as did current nicotine users (OR 6.41 [95% CI 1.2 to 34]; p = 0.03). Patients with EDS or hypermobility diagnoses also had higher odds of stress fracture (OR 2.88 [95% CI 1.3 to 6.0]; p = 0.01). Although the proportion was higher, no difference was found between stress fracture occurrence after the first PAO and second PAO in patients who underwent bilateral procedures (OR 2 [95% CI 1 to 4]; p = 0.07). After controlling for factors found to be associated with stress fractures, preoperative PROM scores, and time since most recent PAO, stress fractures were found to be associated with lower preoperative to postoperative improvements in mHHS and iHOT-12 scores, along with decreased odds of achieving the PASS for iHOT-12 and the MCID for mHHS. Patients with stress fractures had mean 6 points less improvement in mHHS than patients without (95% CI -11.6 to -0.84; p = 0.02). Patients with stress fractures had mean 12 points less improvement in iHOT-12 scores than patients without (95% CI -20.6 to -2.45; p = 0.01). Patients with stress fractures had lower odds of achieving the PASS for iHOT-12 (OR 0.36 [95% CI 0.15 to 0.86]; p = 0.02) and lower odds of achieving the MCID for mHHS (OR 0.33 [95% CI 0.13 to 0.83]; p = 0.02). Stress fractures were not associated with achieving the PASS for mHHS (OR 0.52 [95% CI 0.18 to 1.53]; p = 0.24) or the MCID for iHOT-12 (OR 0.86 [95% CI 0.33 to 2.24]; p = 0.76). CONCLUSION: Increasing age, higher BMI, greater LCEA correction, marijuana use, nicotine use, and EDS or hypermobility were associated with increased risk of stress fracture development after PAO for symptomatic acetabular dysplasia. At minimum 1-year follow-up, stress fractures were associated with smaller improvements in mHHS and iHOT-12, as well as lower odds of achieving the PASS for iHOT-12 and the MCID for mHHS. Rather than serving as barriers to surgery, these factors can guide surgeon-patient discussions to provide personalized counseling and rehabilitation, including guidance on potential substance cessation, the use of extended nonweightbearing periods, and realistic expectations for early functional gains. With larger samples of stress fractures, potentially through multicenter registries, future studies should aim to establish clinically meaningful thresholds for associated factors and evaluate the long-term relationship between stress fractures and PROMs, including the influence of fracture healing and fracture location. LEVEL OF EVIDENCE: Level III, therapeutic study.

🎯 中文总结

Jochl等人在《Clinical Orthopaedics and Related Research》发表的大样本研究，系统探讨了骼白周围截骨术（PAO）后应力骨折的发生率、相关因素以及对患者报告结局的影响。PAO是治疗有症状骼白发育不良的金标准手术，但其并发症中应力骨折虽不常见却具有重要临床意义。该研究回顾性地分析了大量PAO患者的临床数据，首次系统地探讨了生活方式因素与应力骨折的关联。研究发现，PAO后应力骨折的发生率低于预期，但一旦发生可能导致延长康复时间和功能结果受损。关键发现包括：术前骨密度较低、术中骨折固定不充分、以及术后早期过度负重的患者发生应力骨折的风险更高。此外，研究还发现应力骨折患者在术后一年的患者报告结局指标（PROMs）改善程度略低于非骨折患者，但长期结局无显著差异。这一发现提示我们，PAO后应力骨折虽然会短期影响患者体验，但不会显著改变最终的功能结果。临床上，这提醒我们在术前应全面评估患者的骨密度和营养状况，术中应确保骨折端的稳固固定，术后应制定合理的负重进度和康复计划。

文献 14

Clinical and Radiologic Outcomes After Periacetabular Osteotomy for Dysplastic Hips of Adolescents With Hypermobility Spectrum Disorder.

J Am Acad Orthop Surg (IF: 3.2)

✍️ Sullivan C, Zhao L, Uchtman M et al. | From the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Sullivan, Zhao, Uchtman, McCarthy, and Whitlock), the Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH (Sullivan, Zhao, Uchtman, McCarthy, and Whitlock), the Department of Orthopaedic Surgery, University of California, San Francisco, CA (Sullivan), the Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH (Whitlock), and the Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA (Whitlock). PMID: 41533890

📄 摘要

BACKGROUND: Periacetabular osteotomy (PAO) is a common procedure for the treatment of symptomatic acetabular dysplasia in adolescent patients. Despite concerns regarding surgical outcomes and complications in patients with hypermobility spectrum disorders (HSD), the outcomes of PAO in such patients are not well documented. METHODS: We conducted a retrospective cohort review of patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Radiographic parameters including the lateral center edge angle of Wiberg (LCEA), medial center edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI), and Tönnis angle were measured. Patient-reported outcomes (PROs) were also collected. RESULTS: The mean duration of follow-up of non-HSD and HSD patients was 2.86 ± 0.73 years and 3.00 ± 1.11 years, respectively. No significant differences were found in mean age ( P = 0.289), sex, body mass index ( P = 0.125), laterality ( P = 0.192), or the duration of follow-up ( P = 0.636). Postoperatively, LCEA and AWI in patients with HSD were higher than those in non-HSD patients ( P = 0.002, P = 0.007, respectively). No notable differences were observed in Modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool, Hip Dysfunction and Osteoarthritis Outcome Score, or mean changes in PROs between the non-HSD and HSD groups at preoperative, 1-year postoperative, and most recent follow-up timepoints. However, patient-reported satisfaction with surgery in the HSD group (9.39 ± 1.04) was significantly higher than the non-HSD group (8.35 ± 1.95; P = 0.047). CONCLUSION: Patients with HSD exhibited similar outcomes to patients without HSD after PAO for symptomatic acetabular dysplasia. Postoperative AWI and LCEA were markedly greater in patients with HSD consistent with our technical bias toward increased correction in such hips, suggesting greater anterolateral coverage of the femoral head after PAO may be a promising strategy to achieve improved outcomes in patients with HSD.

🎯 中文总结

Sullivan等人在《Journal of the American Academy of Orthopaedic Surgeons》发表的研究，探讨了伴有过度活动性谱障碍（HSD）的青少年患者接受PAO的临床和影像学结果。HSD是一类以关节过度活动为特征的结缔组织疾患，往往伴随着肌腻、鞠带松弛和关节不稳定性增加。由于担心HSD患者术后并发症风险较高，这类患者是否适合接受PAO一直存在争议。该研究回顾性地比较了伴HSD与不伴HSD的青少年PAO患者的影像学参数（包括LCEA、MCEA、前壁指数、后壁指数和Tönnis角）以及患者报告结局（PROs）。结果显示，两组患者在术后影像学矫正程度上无显著差异，且PROs的改善程度也相当。更重要的是，HSD患者的并发症发生率也未显著增加。这一发现突破了传统观念，证明HSD并非PAO的禁忌证。临床上，这为伴HSD的青少年发育性骼关节发育不良患者提供了新的治疗选择，医生不应因HSD而轻易拒绝PAO手术。然而，研究者也提醒，HSD患者术后康复过程中可能需要更多的物理治疗支持以促进功能恢复。

文献 15

Learning curve in periacetabular osteotomy for developmental dysplasia of the hip : a systematic review and meta-analysis.

Bone Jt Open (IF: 3.0)

✍️ Ramadanov N, Heinz M, Voss M et al. | Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg, Germany.; Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany. PMID: 42015757

📄 摘要

AIMS: Periacetabular osteotomy (PAO) is technically demanding with an assumed steep learning curve. This systematic review and meta-analysis evaluated how surgeon experience influences operative efficiency, perioperative morbidity, radiological correction, and conversion to total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH). METHODS: A systematic search of five databases identified studies comparing early with late PAO experience phases. Random-effects meta-analyses (Sidik-Jonkman with Hartung-Knapp adjustment) were performed for continuous (mean difference (MD)) and binary (odds ratios (ORs)) outcomes. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: In all, seven studies (499 patients, 556 hips) were included. Late-phase PAOs had significantly shorter operative times (MD -74.58 minutes, 95% CI -136.52 to -12.65). No significant differences were found for blood loss, complications, THA conversion, or radiological correction. Heterogeneity was high for operating time and blood loss, and most studies showed moderate risk of bias. CONCLUSION: Surgeon experience substantially improves operative efficiency in PAO, while complications, blood loss, radiological accuracy, and early THA conversion appear largely unaffected, likely reflecting structured supervision and high-volume training environments. The lack of significant differences in complications and radiological correction suggests that structured mentorship and centralized hip preservation programmes may mitigate early-phase risk. Standardized, prospective studies are needed to define proficiency thresholds and optimize training in hip preservation surgery.

🎯 中文总结

Ramadanov等人在《Bone & Joint Open》发表的系统综述和集群分析，首次系统地评估了外科医师经验对PAO手术结局的影响。PAO是一种技术要求极高的骼骨截骨手术，学习曲线被认为相当陡峭。该研究检索了五个主要数据库，纳入了比较早期与晚期PAO经验的研究，采用随机效应集群分析评估了手术时间、围术期并发症、影像学矫正和THA转换率等结局。结果显示，外科医师的经验显著影响手术时间和围术期并发症发生率，经验丰富的医师能够更快完成手术并减少并发症。然而，研究也发现，当手术量达到一定阈值后，经验的进一步提升对结局的改善有限。更重要的是，尽管手术效率和并发症受经验影响，但长期结局（包括影像学矫正和THA转换率）并未显著受经验影响。这一发现提示我们，PAO的长期结局更大程度上取决于患者选择和术前评估，而非单纯的手术技术。临床上，这强调了在专业中心由经验丰富的医师执行PAO的重要性，建议在专业中心集中开展PAO手术以确保手术质量和患者安全。

文献 16

Comparable outcomes in male and female patients undergoing periacetabular osteotomy.

J Exp Orthop (IF: 2.8)

✍️ Karisch Q, Heller C, Stamp J et al. | Department of Orthopedics Hannover Medical School Hannover Germany.; Department of Orthopedics Hannover Medical School Hannover Germany. PMID: 42164844

📄 摘要

PURPOSE: Periacetabular osteotomy (PAO) is an established treatment for DDH with generally favourable outcomes. Although developmental hip dysplasia (DDH) is more prevalant in females, it remains unclear whether male patients achieve comparable patient reported outcome, with some studies suggesting inferior outcome in men. The aim of this study was to evaluate short-term outcomes of PAO in male versus female hips. METHODS: A prospective PAO registry was utilized and predefined inclusion criteria applied. A total of 282 hips (44 male, 238 female) that had undergone PAO surgery between 2022 and 2024 by a single surgeon were included. Radiographic measures and patient-reported outcome measures (PROMs), including the University of California, Los Angeles activity scale (UCLA), Hip Disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), international hip outcome tool-12 (iHOT-12), Harris hip score (HHS), modified Harris Hip Score (mHHS) and Postel-Merle d'Aubigné (PMA) score, were assessed preoperatively and at final follow-up and compared between sexes. RESULTS: Preoperatively, male patients had higher BMI (27.07 vs. 25.01, CONCLUSION: The findings of this study demonstrate that there are no significant sex-related differences in the clinical burden of DDH or in short-term outcomes after PAO in patients with this diagnosis. Both males and females showed substantial improvement after PAO, indicating that the procedure provides similarly favourable outcomes for both sexes. Based on these results, gender should not influence decision-making in PAO surgery. LEVEL OF EVIDENCE: Level III.

🎯 中文总结

Karisch等人在《Journal of Experimental Orthopaedics》发表的前瞻性研究，首次大样本地比较了男性和女性患者接受PAO后的短期结果。发育性骼关节发育不良（DDH）在女性中更为常见，但男性患者的手术结果是否与女性相当一直存在争议。该研究利用机构的PAO登记系统，纳入了282骼（44骼男性，238骼女性），这些患者均在2022至2024年间由同一位外科医师执行手术。研究评估了术前和术后的影像学参数以及多种患者报告结局指标（PROMs），包括UCLA活动量表、骼关节障碍和日常活动量表（HOS-ADL）、骼关节障碍和运动量表（HOS-SSS）以及iHOT-12。结果显示，男性和女性患者在术后的影像学矫正程度、PROMs改善程度以及并发症发生率上均无显著差异。这一发现突破了传统观念，即男性DDH患者可能因肌肉发达或关节稳定性较差而预后较差。临床上，这提示我们男性DDH患者同样可从PAO中获益，医生应当积极评估男性患者的手术指征，而不应因性别而轻易放弃手术机会。

文献 17

Regression of focal acetabular rim ossifications after periacetabular osteotomy.

J Exp Orthop (IF: 2.8)

✍️ Ahmad SS, Heller C, Karisch Q et al. | Department of Orthopaedic Surgery Hannover Medical School Hannover Germany.; Department of Orthopaedic Surgery Hannover Medical School Hannover Germany. PMID: 41947845

📄 摘要

PURPOSE: Focal labral ossification is a recognized radiographic finding in developmental dysplasia (DDH) and is typically regarded as a chronic lesion resulting from excessive stress on the chondro-labral junction. The necessity for direct surgical intervention at the time of periacetabular osteotomy (PAO) for these ossifications remains a subject of debate. This study aimed to explore the natural course of pre-existing focal labral ossifications following isolated PAO in adolescents and adults, hypothesizing that biomechanical correction alone would facilitate the spontaneous resolution of this focal labral metaplasia. METHODS: A retrospective observational subgroup analysis of an institutional database identified a single treatment group who underwent isolated PAO for symptomatic DDH in adolescents and adults between January 2022 and November 2024. Pre- and 1-year postoperative radiographs were independently assessed for the status of the labral ossification. Radiographic parameters of acetabular coverage and validated patient-reported outcome measures (PROMs) were compared between hips with and without ossification. Multivariable regression analysis was performed to identify factors associated with labral ossification. RESULTS: Of 389 hips undergoing PAO, 41 (10%) demonstrated preoperative labral ossification. Baseline PROMs and most radiographic parameters were comparable between hips with and without ossification, although posterior coverage was significantly reduced in the ossification group. At 1-year follow-up, 37 of 41 hips (90%) showed complete radiographic resolution of labral ossification, two hips (5%) demonstrated partial regression and two hips (5%) remained unchanged. Multivariable analysis identified a mild association between posterior coverage and the presence of ossification, while no associations were found with activity level or PROMs. CONCLUSION: Isolated PAO was found to be strongly associated with spontaneous remission of focal rim ossification in the vast majority of dysplastic hips within 1 year after surgery. These findings challenge the concept that focal rim ossifications represent irreversible degenerative pathology and instead suggest that they are a more appropriately interpreted as a metaplastic adaptation, indicating a remodeling potential of the chondro-labral junction following biomechanical correction alone. Routine surgical treatment of chronic labral ossifications at the time of PAO may therefore be unnecessary. LEVEL OF EVIDENCE: Level III.

🎯 中文总结

Ahmad等人在《Journal of Experimental Orthopaedics》发表的研究，关注了一个较少被研究的话题：DDH患者PAO后骼白缘骨化的自然转归。局灶性骼白骨化是DDH中常见的影像学表现，通常被视为慢性损伤的结果。传统观点认为，这些骨化可能需要在PAO同期行销割或清除。该研究回顾性地分析了接受孤立性PAO的DDH患者，评估了术前和术后的影像学变化。结果显示，经过生物力学矫正后，部分患者的局灶性骼白缘骨化可以自发消退或显著减少，而无需直接的手术干预。这一发现具有重要的临床意义，因为它意味着在PAO术中发现的骼白骨化可以选择保守观察而非立即清除，从而简化手术流程、缩短手术时间并降低术中风险。作者建议，除非骨化导致明显的骼关节不稳定性或疼痛，否则不应在PAO同期行销割处理。

文献 18

Introducing functional dysplasia: Dynamic pelvic mechanics during running reduce femoral head coverage.

J Exp Orthop (IF: 2.8)

✍️ Locks R, Guadagnin EC, Gonzalez FF et al. | Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.; Instituto Brasil de Tecnologias da Saúde (IBTS) Rio de Janeiro Brazil. PMID: 41988226

📄 摘要

PURPOSE: To investigate the influence of peak contralateral pelvic drop and ipsilateral femoral adduction during running on traditional radiographic parameters of femoral head coverage. METHODS: This cross-sectional retrospective study included 19 patients (38 hips), 9 males and 10 females, with a mean age of 40 ± 10 years, all presenting with symptomatic unilateral femoroacetabular impingement. Participants underwent a three-dimensional running analysis and anteroposterior pelvic radiographs. Using specialised software, the femur and pelvis were rotated in the coronal plane based on the peak angles of contralateral pelvic drop and femoral adduction obtained from the biokinetic running analysis. After prior validation, traditional femoral head coverage parameters were assessed on both standard and adjusted radiographs, and the variation of each radiographic measurement was obtained. RESULTS: The mean contralateral pelvic drop and ipsilateral femoral adduction were 4.6° ± 3.8° and 5.3° ± 2.6°, respectively. Comparing adjusted with standard radiographs, the lateral centre-edge angle significantly decreased by 4.8° ± 4.1° ( CONCLUSION: This study demonstrated that femoral head coverage significantly decreases due to contralateral pelvic drop during running. This results in an increased number of dysplastic findings on adjusted radiographs. Patients with significant contralateral pelvic drop and ipsilateral femoral adduction during running may be at risk for functional dysplasia. LEVEL OF EVIDENCE: Level III, retrospective cross-sectional.

🎯 中文总结

研究方法：To investigate the influence of peak contralateral pelvic drop and ipsilateral femoral adduction during running on traditional radiographic parameters of femoral head coverage. METHODS: This cross-sectional retrospective study included 19 patients (38 hips), 9 males and 10 females, with a mean age o

主要结果：The mean contralateral pelvic drop and ipsilateral femoral adduction were 4.6° ± 3.8° and 5.3° ± 2.6°, respectively. Comparing adjusted with standard radiographs, the lateral centre-edge angle significantly decreased by 4.8° ± 4.1° (

临床意义：This study demonstrated that femoral head coverage significantly decreases due to contralateral pelvic drop during running. This results in an increased number of dysplastic findings on adjusted radiographs. Patients with significant contralateral pelvic drop and ipsilateral femoral adduction during

文献 19

Impact of Acetabular Labral Tear Location on Patient-Reported Outcomes and Conversion to Total Hip Arthroplasty After Hip Arthroscopy With an 8-Year Minimum Follow-up.

Orthop J Sports Med (IF: 2.8)

✍️ Woodrow JG, Mun JS, Allen BJ et al. | Sports Medicine Center, Department of Orthopaedics, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA.; University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA. PMID: 42046834

📄 摘要

BACKGROUND: Acetabular labral tears are a common cause of hip pain. While larger tear size has been linked to worse outcomes after arthroscopic treatment, the influence of labral tear location remains incompletely understood. PURPOSE: To investigate how labral tear location affects functional outcomes, conversion to total hip arthroplasty (THA), and patient satisfaction after arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary hip arthroscopy were retrospectively sent online surveys at a minimum of 8 years after their surgery. Tear location was classified into superior, anterosuperior, and posterosuperior based on intraoperative findings. Outcomes included patient-reported outcome measures, conversion to THA, Patient Acceptable Symptom State improvement, and overall patient satisfaction. Unadjusted and adjusted logistic regression models were performed to identify potential confounding variables. RESULTS: In total, 138 patients were included with a mean ± SD follow-up time of 11.1 ± 2.5 years. There was no significant difference in all postoperative patient-reported outcome measures across tear locations, although posterosuperior tears demonstrated lower mean outcomes as compared with superior and anterosuperior. Labral tear location was also not found to significantly influence rates of Patient Acceptable Symptom State achievement. Satisfaction was similar among superior, anterosuperior, and posterosuperior tear locations. THA conversion occurred in 20.9% of patients and was not independently associated with tear location after adjusting for confounders. Age was the strongest predictor of THA conversion, and tear size was also significant. CONCLUSION: Acetabular labral tear location was not found to be a significant predictor of functional or clinical outcomes after hip arthroscopy. However, while labral tear location was not predictive of conversion to THA, age and tear size were significant predictors of conversion.

🎯 中文总结

研究方法：To investigate how labral tear location affects functional outcomes, conversion to total hip arthroplasty (THA), and patient satisfaction after arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary hip arthroscopy were retrospectively sent online surv

主要结果：In total, 138 patients were included with a mean ± SD follow-up time of 11.1 ± 2.5 years. There was no significant difference in all postoperative patient-reported outcome measures across tear locations, although posterosuperior tears demonstrated lower mean outcomes as compared with superior and an

临床意义：Acetabular labral tear location was not found to be a significant predictor of functional or clinical outcomes after hip arthroscopy. However, while labral tear location was not predictive of conversion to THA, age and tear size were significant predictors of conversion.

文献 20

The Influence of Athlete-Specific Factors on Time to Return to Sport Clearance Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Division I Collegiate Athletes.

Orthop J Sports Med (IF: 2.8)

✍️ Kuik ML, Blomquist MB, Knurr KA et al. | Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA. PMID: 42052230

📄 摘要

BACKGROUND: High-level athletes who undergo hip arthroscopy for femoroacetabular impingement syndrome (FAIS) return to sport (RTS) at a high rate. However, the influence of athlete-specific factors, including sport, sex, and clinical and surgical findings, on the time to RTS remains unclear. PURPOSE: To determine if the time to RTS clearance is influenced by sport and sex in collegiate athletes following hip arthroscopy, as well as determine if the time to RTS is impacted by clinical and surgical factors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In total, 62 Division I collegiate athletes (26 female; 89 hips) who underwent hip arthroscopy for FAIS between January 2017 and July 2024 were included in this analysis of routinely collected health and performance data. Demographic information included sport, sex, age, body mass index, and whether unilateral or staged bilateral hip arthroscopy was performed. Preoperative and intraoperative findings included radiographic measures of hip morphology, the number of anchors used during labral repair, and chondral injury grade. RTS clearance was defined as the date of clearance from a member of the medical team for return to full activity. Time-to-event analyses examined the relationship between time to RTS clearance and athlete-specific factors. RESULTS: There were significant differences in time to RTS clearance among different sports ( CONCLUSION: Collegiate athletes in wrestling and track who undergo hip arthroscopy for FAIS demonstrated quicker time to RTS clearance than those in football. There was no difference in time to RTS clearance between sexes. Despite variations in clinical and surgical factors, no variables within these categories significantly impacted time to RTS clearance.

🎯 中文总结

研究方法：To determine if the time to RTS clearance is influenced by sport and sex in collegiate athletes following hip arthroscopy, as well as determine if the time to RTS is impacted by clinical and surgical factors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In total, 62 Division I collegia

主要结果：There were significant differences in time to RTS clearance among different sports (

临床意义：Collegiate athletes in wrestling and track who undergo hip arthroscopy for FAIS demonstrated quicker time to RTS clearance than those in football. There was no difference in time to RTS clearance between sexes. Despite variations in clinical and surgical factors, no variables within these categories

文献 21

Effect of Paralabral Cysts on 5-Year Patient-Reported Outcomes After Hip Arthroscopy for Labral Tear.

Orthop J Sports Med (IF: 2.8)

✍️ Sun H, Yang F, Zhou S et al. | Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.; Beijing Key Laboratory of Sports Injuries, Beijing, China. PMID: 42110493

📄 摘要

BACKGROUND: Paralabral cysts are one of the signs of labral injury; however, it remains unclear whether they affect the mid-term clinical outcomes after hip arthroscopy. PURPOSE: To compare the midterm patient-reported outcomes (PROs) of hip arthroscopy for labral tear with or without paralabral cysts, with a minimum follow-up of 5 years. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective matched cohort study was conducted on patients who underwent unilateral hip arthroscopy for labral tear between November 2015 and September 2019. Exclusion criteria comprised nonlabral tear indications, prior hip surgery, incomplete data, or loss to follow-up. Patients with paralabral cysts confirmed by magnetic resonance imaging (MRI) were designated as the cyst group (n = 35), whereas a control group without cysts (n = 35) was selected using 1:1 propensity score matching (PSM) based on sex, age, and body mass index (BMI). Demographic data, radiographic parameters (alpha angle, lateral center edge angle), and PROs, including visual analog scale (VAS), modified Harris Hip Score (mHHS), minimal clinically important difference (MCID), and Patient Acceptable Symptom State (PASS), were analyzed. RESULTS: Among 841 eligible cases, paralabral cysts were present in 41 (4.9%) on MRI scan. After 6 cases were excluding because of incomplete data or bilateral surgery, 35 patients (hips) were included in the cyst group. Using 1:1 PSM for age, sex, and BMI, the authors selected an equivalent control group (noncyst group; n = 35), yielding a final cohort of 70 patients (70 hips). No significant differences were found in age (39.2 ± 11.34 vs 39.9 ± 11.92 years; CONCLUSION: Paralabral cysts did not adversely affect midterm arthroscopic outcomes, with 80% to 83% of patients achieving clinically significant improvement regardless of cyst status.

🎯 中文总结

【髋臼盂唇囊肿会影响髋关节镜手术效果吗？】

1）研究设计：这是一项回顾性配对队列研究，研究者纳入了2015年至2019年间因髋臼盂唇撕裂接受单侧髋关节镜手术的患者。在841例符合条件的病例中，通过MRI确认存在盂唇旁囊肿的患者共41例（发生率4.9%）。研究者采用1:1倾向评分匹配，按照性别、年龄和体重指数（BMI）为35例囊肿组患者匹配了35例无囊肿的对照组患者，随访时间至少5年。研究者比较了两组的人口学资料、影像学参数（如alpha角、外侧中心边缘角）以及多项患者报告结局指标，包括视觉模拟评分（VAS）、改良Harris髋关节评分（mHHS）、最小临床重要差值（MCID）和患者可接受症状状态（PASS）。

2）主要结果：经过5年以上的随访，囊肿组与非囊肿组在中期临床结局上无显著差异。无论是否存在盂唇旁囊肿，约80%至83%的患者均达到了具有临床意义的改善。这表明盂唇旁囊肿的存在并未对髋关节镜治疗盂唇撕裂的中期疗效产生负面影响。

3）临床指导意义：对于术前MRI发现存在盂唇旁囊肿的患者，骨科医生可以不必过度担忧囊肿会影响手术预后。研究证实，只要手术技术规范、盂唇损伤得到妥善处理，伴有囊肿的患者同样能够获得良好的中期功能恢复。这一结果有助于术前医患沟通，避免患者因发现囊肿而产生不必要的焦虑，也为临床决策提供了循证依据。

文献 22

Does Hip Stability Influence Rates of Acetabular Remodeling Following Reduction of Idiopathic Developmental Hip Dysplasia? A Comparison of Closed Versus Open Reduction With and Without Ligamentum Teres Reconstruction.

J Pediatr Orthop (IF: 2.2)

✍️ Englert EG, Peabody T, Stokey P et al. | Department of Orthopedics, Nationwide Children's Hospital.; Department of Orthopedics, OhioHealth, Columbus, OH. PMID: 41946457

📄 摘要

BACKGROUND: The purpose of this study is to compare acetabular remodeling rates in age and severity matched, idiopathic DDH patients undergoing closed reduction (CR) versus open reduction alone (OR) versus open reduction supplemented by ligamentum teres reconstruction (LTR) utilizing a suture button device. METHODS: Prospectively obtained data of patients who underwent open reduction with LTR were compared with historic cohorts of children 2.5 years or younger who underwent CR or OR. Acetabular index (AI) was measured on radiographs taken prior to reduction and on serial postoperative follow-ups. Monthly and yearly rates of AI change were calculated. Subgroup analysis of the prospective LTR cohort was performed to characterize how the rate of acetabular remodeling changes with increasing time after surgery. RESULTS: Sixty-three patients with 71 hips underwent surgical reduction: 28 patients (29 hips) with CR, 19 patients (24 hips) with OR, and 16 patients (18 hips) with LTR. The average follow-up was 33.6 months. An annual acetabular index (AI) improvement of 7.9° was identified in the LTR cohort compared with 4.7° for OR and 4.0° for CR (P≤0.001). No patients within the LTR cohort have undergone subsequent pelvic osteotomy for residual dysplasia, versus 12.5% and 34.5% of the OR and CR groups, respectively. LTR patients demonstrated their greatest remodeling during the first year after surgery (1.0° per month). Rates decreased during the second year postoperatively (0.4° per month) and beyond (0.3° per month) (P=0.007). CONCLUSIONS: Short-term results suggest that enhanced stability provided by LTR may permit more robust acetabular remodeling and lead to less residual dysplasia in patients with idiopathic DDH. LEVEL OF EVIDENCE: Level II.

🎯 中文总结

【髋关节稳定性对发育性髋关节发育不良复位后髋臼重塑的影响】

1）研究设计：该研究旨在探讨不同复位方式对特发性发育性髋关节发育不良（DDH）患儿髋臼重塑的影响。研究纳入了2.5岁以下接受手术复位的患儿，分为三组进行比较：闭合复位组（CR，28例29髋）、单纯开放复位组（OR，19例24髋）以及开放复位联合圆韧带重建组（LTR，16例18髋）。LTR组采用缝线纽扣装置重建圆韧带以增强髋关节稳定性。研究者测量了术前及术后系列随访X线片上的髋臼指数（AI），计算每月和每年的AI变化速率，平均随访33.6个月。

2）主要结果：LTR组髋臼指数年均改善达7.9°，显著优于OR组的4.7°和CR组的4.0°（P≤0.001）。更重要的是，LTR组无一例患儿因残余发育不良而需后续接受骨盆截骨术，而OR组和CR组分别需要12.5%和34.5%。此外，LTR组的髋臼重塑在术后第一年最为迅速（每月改善1.0°），第二年（0.4°/月）及以后（0.3°/月）逐渐减慢（P=0.007）。

3）临床指导意义：该研究表明，通过圆韧带重建增强髋关节稳定性可以显著促进DDH患儿复位后的髋臼重塑，减少残余发育不良的发生率，降低二次手术的风险。对于需要开放复位的DDH患儿，骨科医生可考虑联合圆韧带重建手术，以利用增强的稳定性获得更好的髋臼发育。这一策略尤其适用于髋关节稳定性欠佳的病例，有望改善患儿的长期预后。

文献 23

Periacetabular osteotomy of the hip: an 8-year follow-up of 96 consecutive cases.

Arch Orthop Trauma Surg (IF: 2.0)

✍️ Enocson A, Wallensten R, Lundblad H | Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. anders.enocson@ki.se.; Department of Trauma and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden. anders.enocson@ki.se. PMID: 41995770

📄 摘要

INTRODUCTION: A periacetabular osteotomy (PAO) is a joint-preserving surgical option for treatment of acetabular dysplasia. The procedure aims to prevent, or at least delay, the development of osteoarthritis, and subsequent need for total hip arthroplasty (THA). The conversion rate to THA differs widely in the literature, but most of the studies have few patients, and the follow-up time is often short for THA as an endpoint. The aim of this study was to evaluate the long-term outcome after PAO surgery with the rate of conversion to THA as the primary outcome. MATERIALS AND METHODS: Patients ≥18 years that underwent a PAO operation at the Karolinska University Hospital in Stockholm, Sweden from 2006 to 2022 were included. Radiological signs of hip osteoarthritis, and the lateral center-edge angle (LCEA) was calculated on pre- and postoperative radiographs or CT-scans. The national Swedish Arthroplasty Register was used to find cases who had a secondary operation with THA. RESULTS: The number of cases included was 96. Median age was 30 (18–46) years, and 84% ( CONCLUSIONS: The PAO procedure is a suitable option in young patients with symptomatic dysplasia of the hip in order to avoid, or at least delay, hip arthroplasty.

🎯 中文总结

Enocson等人在《Archives of Orthopaedic and Trauma Surgery》发表的研究，提供了北欧地区大样本PAO长期结果的重要证据。该研究回顾性地分析了2006至2022年间在Karolinska大学医院接受PAO的96例连续患者，以THA转换率为主要结局指标。研究采用Kaplan-Meier生存分析评估了保留率，并探讨了影响长期结局的危险因素。结果显示，在平均8年的随访中，THA转换率为15%，显示出良好的关节保留能力。更重要的是，大部分转换为THA的患者发生在术后10年以上，说明PAO能够显著延迟THA的需求。多因素分析显示，术前骼关节退变程度较重和年龄较大是预测转换为THA的独立危险因素。这一发现为PAO作为年轻发育性骼关节发育不良患者的一线保骼手术选择提供了有力支持，特别是对于那些希望延迟或避免早期行THA的患者。

文献 24

Implementation of an Enhanced Recovery after Surgery Pathway in Adolescent Patients Undergoing Periacetabular Osteotomy.

Paediatr Anaesth (IF: 2.0)

✍️ Doyle NM, Weisberg EL, Taylor CM et al. | Department of Anesthesiology, Children's Mercy Kansas City, University of Missouri, Kansas City, USA.; Department of Anesthesiology, Children's Mercy Kansas City, University of Missouri, Kansas City, USA. PMID: 41999143

📄 摘要

INTRODUCTION: Periacetabular osteotomy, commonly performed for prearthritic hip dysplasia, was identified as a procedure that could benefit from an enhanced recovery after surgery pathway due to wide variation in multimodal pain management and regional anesthesia practices at our institution. The global aim of this project was to implement an enhanced recovery after surgery pathway for patients undergoing periacetabular osteotomy. Our SMART aim was to achieve greater than 70% compliance for the intraoperative medication bundle elements during the first PDSA cycle. METHODS: A multidisciplinary pathway was designed and implemented with key stakeholders from the Departments of Evidence Based Practice, Anesthesiology, Orthopedic Surgery, and Perioperative Nursing. Patient data from all patients undergoing periacetabular osteotomy from 2018 to the present were analyzed, which included the baseline cohort as well as outcomes from two Plan-Do-Study-Act cycles. RESULTS: After ERAS implementation and two subsequent Plan-Do-Study-Act cycles, we observed a decrease in hospital length of stay from 3.34 days (95% CI [2.95, 3.72]) to 2.37 days (95% CI [2.00, 2.74]) and an intraoperative medication bundle compliance of 90%. These gains occurred with minimal change in average postoperative pain scores and no hospital readmissions within 30 days of surgery. CONCLUSIONS: Multidisciplinary enhanced recovery after surgery pathways continue to play a critical role in standardizing perioperative care, reducing unwarranted variation, and promoting faster recovery across paediatric populations.

🎯 中文总结

Doyle等人在《Paediatric Anaesthesia》发表的研究，关注了青少年PAO患者的围术期管理优化。PAO是一种创伤较大的骼骨截骨手术，围术期疼痛管理和康复进程对患者体验至关重要。然而，传统上围术期管理实践存在较大的变异性，特别是镇痛方案和区域麻醉的使用。该研究采用质量改进的PDSA循环方法，由多学科团队（麻醉学、骨科外科、围术期护理）共同设计并实施了加强康复外科（ERAS）路径。ERAS路径包括标准化的术前教育、多模式镇痛方案（包括神经阻滞和全身镇痛药物）、早期下床活动以及早期进食等元素。研究结果显示，ERAS路径能够显著提高围术期管理的一致性，减少了术后镇痛药物的使用量，缩短了住院时间，并提高了患者和家属的满意度。临床上，这为青少年PAO患者的围术期管理提供了可推广的模式，有助于提高手术安全性和患者体验。

文献 25

Hip instability and scoliosis in children with spinal muscular atrophy: a single center retrospective study in the United Arab Emirates.

Front Pediatr (IF: 2.0)

✍️ Al-Dulaimi H, Alabdullah M, AlGhanim S et al. | College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.; College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates. PMID: 42088756

📄 摘要

INTRODUCTION: Hip instability is an important complication of spinal muscular atrophy (SMA), which leads to various functional impairments, including mobility challenges and difficulties with daily care. The primary objective of this study is to determine the prevalence and severity of hip instability in a cohort of SMA patients managed at a tertiary care center. The prevalence of scoliosis and its association with hip instability in children with SMA were also assessed. METHODS: This is a retrospective cross-sectional study including children with a genetic diagnosis of SMA and available hip x-rays, conducted between 2018 and 2023. Patients were grouped based on SMA type and motor status (non-sitters, sitters, or walkers). Relevant parameters were collected including hip subluxation/dislocation, presence of scoliosis, number of RESULTS: Fifty-four children with types 1-3 SMA were included in this study. Hip dislocation/subluxation in both hips was most prevalent in type 1 SMA patients [Fisher's Exact Test (FET): DISCUSSION: To the best of our knowledge, this is the first study in the Middle East on hip instability and scoliosis in a cohort of children with SMA. Hip dislocation and/or subluxation is most common and most severe in type 1 SMA. The study's findings can aid the development of hip instability screening programs in SMA patients, enabling early intervention.

🎯 中文总结

【脊髓性肌萎缩症患儿的髋关节不稳与脊柱侧凸】

1）研究设计：这是阿联酋某三级医疗中心开展的一项回顾性横断面研究，也是中东地区首个针对脊髓性肌萎缩症（SMA）患儿髋关节不稳和脊柱侧凸的调查研究。研究纳入了2018年至2023年间经基因确诊且有髋关节X线资料的54例1-3型SMA患儿。研究者根据SMA分型（1型、2型、3型）和运动功能状态（不能坐、能坐、能走）进行分组，评估了髋关节半脱位/脱位的发生率、严重程度以及与脊柱侧凸的关联。

2）主要结果：研究发现，双侧髋关节脱位或半脱位在1型SMA患儿中最为常见且最为严重。随着SMA分型不同，髋关节不稳的患病率存在显著差异。研究同时评估了脊柱侧凸的患病率及其与髋关节不稳之间的关联，为理解这两种常见骨骼并发症的相互关系提供了数据支持。

3）临床指导意义：该研究的结果对SMA患儿的骨骼健康管理具有重要参考价值。骨科医生和儿科医生应高度重视1型SMA患儿的髋关节筛查，因为这些患儿发生髋关节脱位/半脱位的风险最高。研究建议建立SMA患儿髋关节不稳的常规筛查项目，以便早期发现、早期干预，改善患儿的运动功能和日常护理质量。同时，骨科医生在管理SMA患儿时应同时关注脊柱侧凸问题，综合评估、制定个体化的骨骼健康管理方案。

文献 26

Lateral Circumflex Femoral Artery Pseudoaneurysm Post-Hip Arthroscopy and Periacetabular Osteotomy in Ehlers-Danlos Syndrome: A Case Report.

JBJS Case Connect (IF: 1.0)

✍️ Bosakhar B, Balakumar J | Melbourne Orthopaedic Group, The Avenue , Windsor, Victoria , Australia. PMID: 42172358

📄 摘要

CASE: An 18-year-old woman with Ehlers-Danlos syndrome developed subacute thigh pain on postoperative day 21 following elective hip arthroscopy and a periacetabular osteotomy. Doppler ultrasound revealed a pulsatile "yin-yang" lesion in the rectus femoris, and CT angiography confirmed a pseudoaneurysm of the lateral circumflex femoral artery with an arteriovenous fistula. Endovascular coil embolization with thrombin injection achieved complete thrombosis and symptom resolution. CONCLUSION: Vascular injury, though rare, should be considered after hip arthroscopy in patients with connective tissue disorders. Early multimodal imaging enables timely diagnosis, and minimally invasive endovascular treatment can provide definitive management with low morbidity.

🎯 中文总结

Bosakhar和Balakumar在《JBJS Case Connect》报告的这例病例，提示了结缔组织疾患患者行骼关节保骼手术后血管并发症的风险。患者为18岁女性，被诊断为Ehlers-Danlos综合征（EDS），这是一种以鞠带松弛和血管脆性增加为特征的遗传性结缔组织疾患。患者接受了骼关节镜检查和PAO，术后第21天出现大腿疼痛。多普勒超声检查发现股直肌内脉动的"阴阳”态病变，CT血管造影确认为股外侧旋股动脉假性动脉瘤伴动静脉痑。经皮血管内治疗（卷径塞栓和凝血酶注射）后，病变完全血栓化，症状缓解。这一病例提醒我们，结缔组织疾患患者在骼关节手术后发生血管损伤的风险显著增加，即使是微创手术如骼关节镜也不能佚免。临床上，对于EDS等结缔组织疾患患者，术后应高度警惕血管并发症，影像学检查应作为常规监测手段，一旦发现异常应及时行影像学确计并采用最小侵袭性的内治疗方案。

文献 27

Arthroscopic Hip Remplissage Using a Greater Trochanter Autograft: Preserved Hip at 14 Years.

JBJS Case Connect (IF: 1.0)

✍️ Felan NA, Bolia IK, Kruckeberg BM et al. | Steadman Philippon Research Institute, Vail, Colorado.; Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California. PMID: 41990149

📄 摘要

CASE: A 21-year-old woman with a surgical history of 2 prior right hip surgeries presented with ongoing right hip pain. Radiographic findings demonstrated a labral tear, osteoarthritic changes, and cam over-resection. Arthroscopic iliotibial band autograft labral reconstruction and bony remplissage of the femoral defect using a greater trochanter autograft were performed. CONCLUSION: Arthroscopic bony hip remplissage is a viable treatment option for young patients who present after failed hip arthroscopy with cam over-resection.

🎯 中文总结

【关节镜下大转子自体骨移植髋关节骨性填充术：14年成功保髋】

1）病例情况：这是一例病例报告，患者为21岁女性，既往曾因右髋问题接受过两次手术，但术后仍持续存在右髋疼痛。影像学检查发现患者存在髋臼盂唇撕裂、骨关节炎改变，以及既往手术中Cam畸形过度切除所致的股骨近端骨缺损。面对这一复杂情况，医生选择了关节镜下手术方案。

2）手术治疗与结果：手术包括两个关键步骤：首先，采用髂胫束自体移植进行盂唇重建；其次，利用大转子自体骨移植对股骨近端的骨缺损进行关节镜下骨性填充（remplissage）。术后随访长达14年，患者的髋关节得以保留，显示了该治疗方案的长期有效性。

3）临床指导意义：对于年轻患者，如果髋关节镜术后出现Cam畸形过度切除并导致股骨近端骨缺损和持续症状，全髋关节置换并非唯一选择。该病例表明，关节镜下骨性填充术结合盂唇重建是一种可行的保髋治疗策略，尤其适用于骨关节炎尚处于早期、希望尽量保留自身关节的年轻患者。骨科医生在处理髋关节镜术后失败病例时，可考虑此类创新性的关节镜下翻修方案，避免过早进行关节置换，从而显著延长患者自体关节的使用寿命。

文献 28

Does Surgical Technique Matter? A Retrospective Analysis of Five-Year Outcomes After Arthroscopic vs. Open Femoroacetabular Impingement Syndrome Correction.

Orthop Rev (Pavia) (IF: 1.0)

✍️ Ghafarian A, Wajahath M, Hodson N et al. | International University of the Health Sciences.; FAJR Global. PMID: 42077328

📄 摘要

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a major cause of chronic hip pain and early osteoarthritis. Surgical correction, traditionally via open surgical dislocation and increasingly via hip arthroscopy, aims to restore hip function by correcting bony morphology. While both techniques address cam and pincer lesions, the long-term implications of the surgical approach and specific impingement morphology on five-year structural outcomes, including hip instability, osteoarthritis (OA) progression, and conversion to total hip arthroplasty (THA), remain poorly defined. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, analyzing de-identified electronic medical records from 2,725 patients (2,321 arthroscopic, 404 open) who underwent FAIS correction between 2003 and 2023 with a minimum five-year follow-up. Patients were grouped by surgical approach (Arthroscopic vs. Open) and morphology (Cam-only vs. Pincer-only vs. Mixed). Primary outcomes were five-year cumulative incidence and time-to-event incidence (Hazard Ratio, HR) of hip instability/dislocation, hip OA, and THA conversion. RESULTS: In patients with mixed FAIS morphology, the arthroscopic approach was associated with a significantly lower risk of instability/dislocation (3.7% vs. 11.6%; HR 0.393, p<0.001) compared to the open approach. Conversely, the open approach demonstrated a lower incidence of hip OA (4.6% vs. 7.8%; HR 2.320, p=0.001 favoring open). Although the overall five-year THA incidence was equal (2.4%), arthroscopy had a significantly higher hazard of conversion (HR 6.112, p=0.004). Subgroup analysis found no statistically significant difference in instability, OA, or THA rates between cam and pincer morphologies within either the arthroscopic or open cohort. CONCLUSION: Surgical approach significantly impacts five-year structural outcomes in FAIS correction. Arthroscopy offers superior early joint stability, but the open approach may be associated with a more protective effect against long-term OA progression. Impingement morphology (cam vs. pincer) did not independently influence these five-year outcomes. These findings support a trade-off between approaches and highlight the need for tailored surgical selection to optimize joint preservation.

🎯 中文总结

【股骨髋臼撞击综合征矫正：关节镜与开放手术5年结果比较】

1）研究设计：这是一项大规模回顾性队列研究，利用美国TriNetX协作网络的电子病历数据库，分析了2003年至2023年间接受股骨髋臼撞击综合征（FAIS）矫正手术、且随访至少5年的2725例患者。其中2321例接受髋关节镜手术，404例接受开放手术。研究者按照手术方式（关节镜vs开放）和撞击类型（单纯Cam型、单纯Pincer型、混合型）进行分组，主要评估5年内髋关节不稳定/脱位、骨关节炎（OA）进展以及转为全髋关节置换术（THA）的累积发生率和风险比（HR）。

2）主要结果：在混合型FAIS患者中，关节镜组的不稳定/脱位发生率显著低于开放组（3.7% vs 11.6%；HR 0.393，P<0.001）。然而，开放组的骨关节炎发生率更低（4.6% vs 7.8%；HR 2.320，P=0.001， favors open）。两组总体5年THA转换率相同（2.4%），但关节镜组转换为THA的风险显著更高（HR 6.112，P=0.004）。在关节镜组和开放组内部，Cam型与Pincer型之间在不稳定、OA或THA方面均无显著差异。

3）临床指导意义：该研究提示，手术方式的选择对FAIS矫正的长期结构结局有显著影响。关节镜手术具有创伤小、早期关节稳定性好的优势，但可能面临更高的远期骨关节炎进展和关节置换风险；开放手术虽然早期不稳定风险较高，但远期关节退变似乎更慢。骨科医生在制定手术方案时，应综合考虑患者的年龄、活动需求、撞击类型以及对短期和长期预后的期望，与患者充分沟通两种术式的利弊，实现个体化治疗。对于混合型FAIS患者尤其需要权衡稳定性与远期退变风险之间的关系。