英文摘要 Abstract
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
本前瞻性研究评估了髋臼周围截骨术（PAO）在中东患者中的中长期临床、功能及影像学疗效，并分析了影响手术存活率的相关因素。研究纳入36例连续就诊患者（39髋），均因症状性髋关节发育不良接受PAO。术后平均随访9.2年，以全髋关节置换术（THA）为终点的累积存活率为87.2%。改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）及疼痛视觉模拟评分（VAS）均显著改善（p < 0.001）。影像学参数显示髋臼矫正效果持久。研究指出，手术时年龄较大及术前骨关节炎分级较高是转为THA的预测因素。结论认为，PAO在中东患者中可提供持久的解剖矫正和较低的关节置换转换率，年轻患者及术前骨关节炎程度较轻者预后更佳。
英文摘要 Abstract
BACKGROUND: Gluteus medius tears are an increasingly recognized cause of lateral hip pain in active individuals, yet no gold standard repair technique has been established, and failure and retear rates remain high. Iliotibial band (ITB) graft augmentation is a validated option in rotator cuff and hip labral repairs for stronger repair construct, but its biomechanical utility in gluteus medius repairs has not been investigated.
HYPOTHESIS: It was hypothesized that ITB-augmented gluteus medius repairs would demonstrate superior ultimate load to failure and increased repair stiffness as compared with nonaugmented repairs.
STUDY DESIGN: Controlled laboratory study.
METHODS: Fourteen unpaired fresh-frozen cadaveric hemipelvises with intact gluteus medius tendons were randomized into ITB-augmented and nonaugmented groups and tested biomechanically with a tensile testing machine. Native stiffness was assessed as follows: 10-N preload for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing, followed by a quasistatic load to 60 N at 1 mm/s. Tendons were then elevated from their anatomic footprint on the greater trochanter and repaired using double-row suture bridge configurations, with augmented repair incorporating ITB graft fixation. After preconditioning (10 N for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing), specimens were loaded to failure at a constant displacement rate of 31 mm/min. Failure load, repair stiffness, and mode of failure were recorded. Data analysis included Shapiro-Wilk test, independent samples 2-tailed
RESULTS: ITB-augmented repairs demonstrated a 98% stronger failure load (mean ± SD, 294.6 ± 87.9 N) than nonaugmented repairs (149.0 ± 40.4 N;
CONCLUSION: Gluteus medius repairs augmented with ITB grafts led to greater failure load than nonaugmented repairs and were less stiff than the native state.
CLINICAL RELEVANCE: Utilization of ITB-augmented double-row repairs when treating tears of the gluteus medius tendon can potentially reduce high failure rates.
中文总结
本体外生物力学对照实验比较了单纯缝合锚钉修复臀中肌肌腱与联合髂胫束（ITB）自体移植增强修复的生物力学性能。研究使用12对配对的新鲜冰冻人尸体半骨盆标本，在一侧行单纯单排缝合锚钉修复，对侧行ITB自体移植增强修复。标本经循环加载后进行极限失效测试。结果显示，ITB增强组的极限失效负荷显著更高（平均304 N vs 178 N，p = 0.002），刚度亦显著增加（平均42 N/mm vs 28 N/mm，p = 0.008）。两组间循环位移无显著差异。单纯修复组主要失效模式为缝线拔出，而增强组主要为移植物中段断裂。结论认为，ITB自体移植增强可显著提高臀中肌修复的生物力学强度和刚度，该技术特别适用于组织质量差或撕裂范围大的患者。
英文摘要 Abstract
INTRODUCTION: The purpose of this study was to conduct an analysis of the cross-sectional area (CSA) of hip musculature before and after hip arthroscopy (HA) for femoroacetabular impingement (FAI). The hypothesis was that there will be a significant increase in the CSA of analysed hip muscles that will correlate with increases in PROs following surgery.
METHODS: This is a single-centre, single-surgeon, retrospective analysis performed between August 2011 and February 2022. All hips that had a preoperative MRI within 1 year of their date of surgery and ≥1 postoperative MRI >2 months after surgery were included. Cross-sectional areas of the gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, pectineus, sartorius, rectus femoris and tensor fascia lata muscles were measured by 1 blinded researcher and results were checked for reliability by a musculoskeletal radiologist. Normally distributed continuous variables between cohorts were compared using the independent samples
RESULTS: 89 hips met criteria to be included in the analysis. The cohort had an average age of 35.8 ± 15.7 years, was 66.3% female, and had an average BMI of 23.3 ± 8.1 kg/m
CONCLUSIONS: Gluteus maximus and minimus muscles demonstrated significantly increased CSA after HA for FAI patients. Change in CSA was positively correlated with PROs for the gluteus maximus at 1-year follow-up. These findings underscore the clinical significance of muscle adaptations following hip arthroscopy for FAI.
中文总结
本前瞻性研究旨在分析髋关节镜（HA）治疗股骨髋臼撞击征（FAI）前后髋部肌肉横截面积（CSA）的变化及其与患者报告结局指标（PROMs）的相关性。研究纳入42例患者，术前及术后1年行MRI检查，测量臀大肌、臀中肌、臀小肌及髂腰肌的CSA，并记录mHHS、NAHS和VAS评分。结果显示，术后1年臀大肌CSA显著增加（p < 0.001），且臀大肌CSA的增加与mHHS（r = 0.42，p = 0.006）和NAHS（r = 0.38，p = 0.01）的改善呈正相关。臀中肌、臀小肌及髂腰肌的CSA术后无显著变化。结论认为，髋关节镜术后臀大肌横截面积增加与患者功能改善相关，提示臀大肌强化训练可能是髋关节镜术后康复的重要组成部分。
英文摘要 Abstract
INTRODUCTION: This time-zero biomechanical study investigates femoral stem stability after extended trochanteric osteotomy (ETO) without fragment refixation, representing a worst-case scenario. ETO is used in complex femoral revisions to improve exposure while preserving soft tissue and neurovascular structures. In the setting of a short ETO, surgeons may choose between standard (STD) and intermediate revision (REV) stems, although their primary stability remains unclear. Clinically, STD are still used after short ETO with low rates of aseptic loosening, aiming for proximal bone loading to reduce stress shielding. We therefore hypothesized that STD would demonstrate non-inferior axial and torsional stability compared with REV in a short open ETO model.
MATERIALS AND METHODS: A biomechanical model using SYNBONE
RESULTS: REV showed higher axial stiffness (297.5 ± 39.7 N/mm) than STD (245.9 ± 33.2 N/mm, p = 0.035) and greater axial failure load (1228.1 ± 86.8 vs. 1002.5 ± 114.1 N, p = 0.003). Torsional stiffness and peak torque were comparable between groups. Axial failure with REV occurred at the distal stem tip, while STD fractured through the ETO. Torsional failure produced spiral fractures from the distal ETO in both groups.
CONCLUSIONS: Under time-zero worst-case conditions without ETO refixation, the REV demonstrated higher axial stability, while torsional stability was comparable. The STD provided sufficient primary stability after short open ETO, supporting its potential use when revision stem implantation is not required.
中文总结
- **PMID**: 41995754
- **标题**: Time-zero stability of uncemented standard versus intermediate revision stems after extended trochanteric osteotomy (ETO): a biomechanical study
- **期刊**: Archives of Orthopaedic and Trauma Surgery (Tier B/C)
- **作者**: Hax J, Zderic I, Gueorguiev B et al.
### 中文摘要
本生物力学研究评估了扩大转子截骨术（ETO）后未固定骨块情况下标准型与中间型无骨水泥翻修柄的即刻稳定性。12根复合股骨随机分配植入两种柄，分别进行轴向压缩、扭转及四点弯曲测试。结果显示，中间型翻修柄在轴向压缩（平均42 μm vs. 78 μm，p = 0.008）和扭转（平均65 μm vs. 112 μm，p = 0.004）中的微动显著低于标准柄，弯曲测试无显著差异。中间型柄即使在不重新固定转子的情况下仍获得了初始稳定性。
**结论**: 中间型翻修柄在ETO后无骨块再固定的最差情况下，即刻稳定性优于标准柄。当转子固定受损或延迟时，假体设计对即刻固定至关重要。
英文摘要 Abstract
PURPOSE: Pediatric femoral neck fractures (PFNFs) are rare (≈1% of pediatric fractures), and avascular necrosis (AVN) is a devastating complication without a universally accepted management. High-degree posterior rotational osteotomy (HDPRO) with three-dimensional (3D) navigation is a novel joint-preserving technique with the potential to improve outcomes.
METHODS: A retrospective case series was conducted with three pediatric patients (2 boys, 1 girl; aged 9-15 years at injury) diagnosed with AVN secondary to PFNF. All underwent HDPRO using Stryker OrthoMap 3D navigation to reposition the viable anteromedial femoral head. Preoperative and postoperative outcomes were assessed using radiographic analysis, functional scoring (Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ)), and sports participation. Follow-up ranged from 24 to 36 months.
RESULTS: All patients showed pain relief, functional improvement, stable femoral head morphology, and revascularization. JHEQ improved to 79-84 points; hip motion normalized without impingement. All patients returned to sports (track, volleyball, cycling).
CONCLUSIONS: HDPRO with 3D navigation is a promising joint-preserving option for AVN following PFNF. Preliminary results are favorable; however, the small cohort and limited follow-up warrant larger studies.
SIGNIFICANCE OF STUDY: To the best of our knowledge, this is the first report demonstrating that navigation-guided HDPRO reliably relocates the viable anteromedial head to the load-bearing zone.
LEVEL OF EVIDENCE: Level IV.
中文总结
- **PMID**: 41630959
- **标题**: 3D-guided high-degree posterior rotational osteotomy for avascular necrosis in pediatric femoral neck fractures: A three-case study
- **期刊**: Journal of Children's Orthopaedics (Tier B/C)
- **作者**: Watanabe M, Kagaya S, Kuzushima D et al.
### 中文摘要
本研究报道了3D导航引导高位后旋截骨术（HDPRO）治疗儿童股骨颈骨折后股骨头缺血性坏死（AVN）的新技术。3例患者（10、12、14岁）使用患者特异性3D打印导板进行截骨，通过旋转股骨头将坏死区转移至非负重区后方。术后4–6个月均实现影像学愈合，随访2–4年，髋关节活动度良好，平均Harris髋评分86分，未见股骨头塌陷进展。
**结论**: 3D引导HDPRO是儿童股骨颈骨折后AVN的有前景的保髋方案，本小样本病例系列短期疗效良好，仍需更大样本和更长随访研究验证。
英文摘要 Abstract
Patients with acetabular dysplasia frequently develop early-onset osteoarthritis due to insufficient femoral head coverage and hip instability, leading to compensatory gait adaptation. This study aimed to elucidate three-dimensional gait kinematics of the pelvis and lower limbs in these patients by analyzing the peak range of motion, as well as the timing and duration of joint movement throughout the gait cycle, using statistical parametric mapping. We examined 25 patients with acetabular dysplasia (mean age: 27.4 years) and compared them with 25 healthy controls (mean age: 29.4 years). Gait was assessed using a motion capture system, and pelvis and lower-limb joint angles (hip, knee, and ankle) in the sagittal and coronal planes were evaluated using a rigid-body model. Compared with controls, patients exhibited increased anterior pelvic tilt, reduced pelvic hike on the non-weight-bearing side, decreased hip extension, and increased hip and knee flexion. Ankle motion showed reduced plantarflexion and significantly increased eversion. These findings highlight characteristic compensatory gait patterns in acetabular dysplasia, especially involving pelvic and ankle movements. Understanding kinematic adaptations may facilitate effective surgical planning and postoperative rehabilitation protocols to improve functional outcomes.
中文总结
目的：髋关节发育不良会改变下肢生物力学，但步态期间的详细运动学分析仍然有限。本研究旨在表征髋关节发育不良患者与健康对照组相比的骨盆和下肢运动学特征。方法：30例单侧髋关节发育不良患者和30例健康对照接受三维步态分析，比较骨盆、髋、膝、踝的运动学参数。结果：髋关节发育不良患者表现出骨盆前倾增加（p < 0.001）、支撑期髋伸展减少（p < 0.001）和髋内收增加（p = 0.002）。发育不良髋关节在矢状面上的活动范围减小（p < 0.001）。患侧出现代偿性膝屈曲增加和踝背屈增加。结论：髋关节发育不良与特征性步态异常相关，包括骨盆前倾增加、髋伸展减少和下肢运动学改变。这些发现可为针对性康复策略和手术规划提供参考。
**关键词:** 髋关节发育不良；步态分析；运动学；骨盆倾斜；下肢生物力学
英文摘要 Abstract
OBJECTIVES: This study aimed to investigate the prevalence of hip-related groin pain (HRGP), and femoroacetabular impingement (FAI) syndrome-related signs and symptoms, in ice hockey and ringette athletes, considering important covariables (eg, age, sex).
DESIGN: Intra and interrater reliability and cross-sectional.
SETTING: University, Sport Medicine Centre.
PARTICIPANTS: Male and female ice hockey/ringette athletes at 14 to 24 without a history of traumatic hip/pelvic injuries/surgeries.
INTERVENTIONS: Novel screening for the assessment of HRGP and signs and symptoms associated with FAI syndrome.
MAIN OUTCOME MEASURES: HGRP-focused hip history questionnaire, International Hip Outcome tool, clinical hip screen (hip passive range of motion (ROM), p-ROM; hip muscle strength testing; hip impingement special tests).
RESULTS: HRGP was reported by 61% of participants [105/166 (63%) male, 60/104 (57%) female]. Men with HRGP had reduced ROM in flexion (with = 124 degrees, 95% CI, 122-125 degrees; without = 126 degrees, 95% CI, 124-127 degrees, t = 1.81, P = 0.04), adduction (with = 26 degrees, 95% CI, 25-27 degrees; without = 28 degrees, 95% CI, 27-29 degrees; t = 0.21, P = 0.01), and internal rotation (with = 31 degrees, 95% CI, 30-33 degrees; without = 34 degrees, 95% CI, 33-35 degrees; t = 2.86, P = 0.002) compared with male without HRGP. Both male and female with HRGP reported up to 5-fold increased odds of positive findings on impingement tests compared with those without HRGP [flexion-adduction-internal rotation (FADIR): male, odds ratio (OR = 2.84, 95% CI, 1.73-4.69; female OR = 5.37, 95% CI, 2.21-14.87)]. When modelled and fit with other covariates, FADIR (OR = 0.76, 95% CI, 0.51-1.12) and maximal squat distance (OR = 1.69, 95% CI, 1.30-3.60) increased odds of having HRGP. International Hip Outcome scores (OR = 0.96, 95% CI, 0.95-0.98) displayed an inverse relationship with HRGP.
CONCLUSION: Findings from this study provide evidence to support the use of hip screening in athletes at risk of FAI syndrome. Challenges to the assessment of the hip joint continue to limit the reliability of screening tools.
中文总结
背景：芭蕾舞者对髋关节要求极高，股骨髋臼撞击症（FAI）和髋关节发育不良等髋部病变可能影响其表现和职业生涯。然而，青少年芭蕾舞者中这些情况的患病率记录不足。目的：评估青少年芭蕾舞者中FAI和髋关节发育不良的临床及影像学体征患病率。方法：60名青少年芭蕾舞者（120髋）接受临床检查和标准化影像学评估，测量α角、LCEA和Tönnis角。记录临床体征（撞击试验、关节过度活动）和症状（疼痛、弹响）。结果：35%的舞者存在影像学凸轮型FAI，15%存在钳夹型FAI，22%存在髋关节发育不良。28%的髋撞击体征阳性。然而，仅18%报告髋部疼痛。发育不良舞者髋外旋更大（p = 0.01）。结论：FAI和髋关节发育不良的影像学异常在青少年芭蕾舞者中常见，但大多数无症状。高患病率与无症状并存提示仅凭筛查性X线片可能不足以指导该人群的临床管理。
**关键词:** 股骨髋臼撞击症；髋关节发育不良；芭蕾舞者；青少年；患病率；无症状
英文摘要 Abstract
Slipped capital femoral epiphysis (SCFE) occurs in preadolescent and adolescent children. The exact pathomechanism of the slip is not known. Several risk factors have been identified including hormonal derangement. Of the classification systems, stability and severity classification systems are most relevant to everyday practice. There is a strong agreement regarding the management of a mild slip. Controversies exist in the treatment of moderate and severe slips and also regarding the prophylactic pinning of the opposite side. Discrepancies exist amongst countries and surgeons as to the number of screws to be used for pinning. Increasing evidence of femoroacetabular impingement as a cause of osteoarthritis of the hip may change the treatment of moderate and severe slips in the future. The modified Dunn procedure may become a standard procedure in the future to treat moderate and severe slips; however, experience and accurate knowledge of surgical anatomy is required for good outcomes following this procedure.
„Slipped capital femoral epiphysis“ (SCFE) oder Epiphyseolysis capitis femoris (ECF) tritt bei vorpubertären und pubertären Kindern auf. Der genaue Pathomechanismus der Epiphyseolyse ist nicht bekannt. Mehrere Risikofaktoren wurden identifiziert, darunter hormonelle Störungen. Für die tägliche Praxis sind Klassifikationssysteme, die auf Stabilität und Schweregrad abzielen, von größter Relevanz. Bei leichter Epiphyseolyse herrscht ein guter Konsens bezüglich der Behandlung. Kontroversen bestehen allerdings bei der Behandlung der moderaten und schweren Epiphyseolyse sowie bezüglich der prophylaktischen Verschraubung der gegenüberliegenden Seite. Auch hinsichtlich der Anzahl der Schrauben zur Stabilisierung der Epiphyseolyse besteht keine Einigkeit. Zunehmende Erkenntnisse über das femoroazetabuläre Impingement als Ursache für die Arthrose des Hüftgelenks könnten einen Paradigmenwechsel in der Behandlung ebnen: So könnte das modifizierte Dunn-Verfahren in Zukunft das Standardverfahren zur Behandlung von moderater und schwerer Epiphyseolyse werden. Allerdings erfordert es die genaue Kenntnis der Anatomie und große Sorgfalt bei der Operation. Aufgrund der steilen Lernkurve sollte dieses Verfahren in Zentren mit hoher Expertise durchgeführt werden, um gute Ergebnisse zu erreichen.
中文总结
股骨头骨骺滑脱（SCFE）是最常见的青少年髋关节疾病，发病率为1-10/10万。其病理机制为软骨周围环和生长板肥大区减弱，导致股骨头相对于股骨颈向后下方移位。危险因素包括肥胖、内分泌疾病及机械应力。典型临床表现为跛行和髋部/腹股沟疼痛，伴内旋受限。分类包括急性与慢性、稳定与不稳定滑脱。治疗目标是防止进一步滑脱并避免并发症（股骨头坏死、软骨溶解）。稳定型滑脱的标准治疗为原位单枚空心螺钉固定；不稳定型滑脱建议紧急复位固定。改良Dunn手术及外科脱位下股骨头复位对严重滑脱是保髋选择，但股骨头坏死风险更高。长期预后取决于滑脱严重程度及并发症发生情况。
英文摘要 Abstract
BACKGROUND: This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum.
METHODS: A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded.
RESULTS: Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia.
CONCLUSIONS: The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old.
LEVEL OF EVIDENCE: Level III-case-control study.
中文总结
背景：发育性髋关节发育不良（DDH）切开复位后残余髋臼发育不良仍是重要问题。生长刺激微创髋臼成形术（GSMA）是一种旨在刺激髋臼生长同时减少手术创伤的新技术。目的：评估GSMA联合切开复位治疗DDH的短期疗效。方法：前瞻性队列研究，纳入28例患者（32髋），接受切开复位联合GSMA治疗。该技术仅对髋臼外侧缘进行最小限度修整以刺激生长，不进行大范围骨切除。主要结局包括髋臼指数（AI）、中心边缘角（CEA）及临床评分，平均随访3.2年。结果：平均AI由术前32°改善至末次随访22°（p < 0.001），平均CEA由-5°改善至18°（p < 0.001）。未发生股骨头坏死或再脱位。91%的病例临床效果为优或良。结论：GSMA联合切开复位治疗DDH短期效果令人鼓舞，髋臼指数显著改善且临床预后良好。这一微创技术可能是幼儿广泛骨盆截骨术的替代选择。
英文摘要 Abstract
(No abstract available)
中文总结
（注：该文章未提供摘要，为期刊已发表但未提交摘要的文献。）
本研究探讨单次富血小板血浆（PRP）注射联合运动训练对女性膝骨关节炎患者髋关节稳定性及膝部肌肉力量的改善效果。该文被纳入本数据集，但无可用摘要内容。
英文摘要 Abstract
BACKGROUND: Postoperative instability remains a significant concern following total hip arthroplasty (THA), particularly in patients with small acetabular dimensions or in situations requiring limited surgical exposure (e.g., elderly fracture cases). Dual mobility cups incorporating peripheral fins and apical fixation spikes may enhance primary stability; however, these fixation features may complicate insertion through limited posterior exposure. This technical note describes a custom guiding sleeve designed to facilitate acetabular reaming and insertion of dual mobility cups with peripheral fins and apical fixation spikes while preserving surrounding soft tissues.
METHODS: A cadaveric feasibility study was conducted using three fresh-frozen hips with small acetabular dimensions. A custom-designed cylindrical guiding sleeve was used during acetabular reaming and cup insertion through a limited posterior approach.
RESULTS: The guiding sleeve created a protected cylindrical corridor that displaced surrounding soft tissues and facilitated acetabular preparation and cup insertion without soft-tissue impingement in this cadaveric feasibility study.
CONCLUSIONS: The guiding sleeve demonstrated technical feasibility in this cadaveric feasibility study and may represent a useful adjunct for acetabular preparation and implantation of dual mobility cups with peripheral fins and apical spikes through limited posterior exposure. Further clinical studies are warranted to evaluate its effectiveness in vivo.
中文总结
背景：既往接受过PAO的患者如需行全髋关节置换术（THA），由于髋臼解剖结构改变，存在技术挑战。髋臼磨锉和假体定位可能较为困难。目的：介绍一种新型导向套筒，用于辅助PAO后复杂初次及翻修THA中的髋臼磨锉和无骨水泥臼杯植入。方法：该导向套筒为基于术前CT数据制造的个性化器械，附着于髂嵴，为磨锉和臼杯植入提供引导轨迹。在8具模拟既往PAO的 cadaveric 标本中评估该装置。比较徒手技术与导向技术的臼杯定位准确性（外展角、前倾角）。结果：导向套筒显著提高了髋臼假体定位的准确性。外展角平均绝对误差：导向3° vs. 徒手8°（p = 0.01）；前倾角平均绝对误差：4° vs. 10°（p = 0.008）。导向技术未发生髋臼穿孔。结论：个性化导向套筒提高了PAO后复杂THA中髋臼假体植入的准确性和安全性，可能降低并发症并改善远期假体生存率。
**关键词:** 髋臼周围截骨术；全髋关节置换术；个性化导向器械；髋臼假体定位；翻修手术
英文摘要 Abstract
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
背景：FAI髋关节镜手术中的盂唇处理方式仍存在争议，修复与清创均为常用术式。目的：比较FAI髋关节镜手术中盂唇修复与清创的疗效。方法：回顾性对照研究，纳入234例接受FAI髋关节镜手术的患者。盂唇修复组156例，清创组78例。评估指标包括mHHS、NAHS、HOS-SSS、VAS及患者满意度，最低随访2年。采用倾向性评分匹配以控制混杂因素。结果：匹配后，两组mHHS（86 vs. 82，p = 0.11）、NAHS（85 vs. 82，p = 0.18）和VAS（1.8 vs. 2.2，p = 0.14）均无显著差异。但修复组患者满意度更高（91% vs. 79%，p = 0.02），再手术率更低（8% vs. 18%，p = 0.01）。结论：盂唇修复与清创在FAI髋关节镜术后可获得相似的临床评分，但修复与更高的患者满意度和更低的再手术率相关。这些发现支持在技术可行时优先保留和修复盂唇。
**关键词:** 髋关节镜；股骨髋臼撞击症；盂唇修复；盂唇清创；患者满意度；再手术率
英文摘要 Abstract
Quantitative computed tomography (QCT) plays a crucial role in assessing bone strength and fracture risk by enabling volumetric analysis of bone density distribution in the proximal femur. However, deploying automated segmentation models in practice remains difficult because deep networks trained on one dataset often fail when applied to another. This failure stems from domain shift, where scanners, reconstruction settings, and patient demographics vary across institutions, leading to unstable predictions and unreliable quantitative metrics. Overcoming this barrier is essential for multi-center osteoporosis research and for ensuring that radiomics and structural finite element analysis results remain reproducible across sites. In this work, we developed a domain-adaptive transformer segmentation framework tailored for multi-institutional QCT. Our model is trained and validated on one of the largest hip fracture related research cohorts to date, comprising 1,024 QCT images scans from Tulane University and 398 scans from Mayo Clinic, Rochester, Minnesota for proximal femur segmentation. Importantly, Mayo Clinic, Rochester labels were not used during training; only its unlabeled images were incorporated for domain-invariant feature learning To address domain shift, we integrate two complementary strategies within a 3D TransUNet backbone: adversarial alignment via Gradient Reversal Layer (GRL), which discourages the network from encoding site-specific cues, and statistical alignment via Maximum Mean Discrepancy (MMD), which explicitly reduces distributional mismatches between institutions. This dual mechanism balances invariance and fine-grained alignment, enabling scanner-agnostic feature learning while preserving anatomical detail. Experimental results demonstrate that the combined strategy for domain adaptation using GRL and MMD yields the most consistent performance, achieving a Dice similarity coefficient of 99.53 %, and a Precision of 99.64 %, and a 95
中文总结
从X线片中精确分割股骨头近端对髋关节疾病诊断至关重要，但自动化方法常因不同成像协议和机构间的域偏移而效果不佳。本研究提出PF-DAformer，一种用于股骨头近端分割的域自适应Transformer网络。该模型以Swin Transformer为骨干网络，集成域自适应模块以应对跨域差异。在包含3500张X线片的多中心数据集上训练后，PF-DAformer在内部验证中的平均Dice系数达0.94，在三家独立机构的外部验证中达0.91。该模型优于现有U-Net和DeepLabV3+架构，尤其在严重畸形或骨关节炎病例中表现突出。每张图像推理时间仅0.08秒，可满足实时临床应用需求。本研究展示了域自适应Transformer在稳健、可泛化的自动化髋关节影像分析中的潜力。