英文摘要 Abstract
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
髋臼周围截骨术（PAO）作为经典的保髋手术已应用超过40年。近年来，髋关节镜技术的进步极大地推动了关节内保髋手术的发展，将关节镜与PAO联合应用的指征在保髋外科领域引发了广泛讨论。目前，联合手术的确切适应证尚不明确。近期一项系统综述报告了联合手术可改善患者预后，但证据质量较低。本文指出，未来需要更多高质量的临床研究，以明确髋关节镜联合PAO的最佳适应人群和手术时机。
英文摘要 Abstract
BACKGROUND: Differences in outcomes between primary and revision hip arthroscopy are well documented; however, specific comparisons between revision and primary labral reconstruction are limited, especially regarding midterm outcomes.
PURPOSE: To evaluate whether revision arthroscopic labral reconstruction achieves minimum 5-year patient-reported outcomes (PROs) and survivorship comparable to primary labral reconstruction.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A retrospective review was conducted of patients undergoing labral reconstruction between June 2008 and December 2019. Inclusion required a minimum 5-year follow-up for PROs, including the Nonarthritic Hip Score, International Hip Outcome Tool-12, and Hip Outcome Score-Sports Specific Subscale. Exclusion criteria included Tönnis grade >1, preexisting hip conditions, lateral center-edge angle <20°, active workers' compensation claims, and intraoperative gluteus medius repair. Revision cases (n = 36) were matched 1:1 with primary reconstruction cases (n = 36) based on age, sex, body mass index, lateral center-edge angle, and capsular treatment strategy.
RESULTS: Preoperatively, the primary reconstruction cohort had greater cartilage damage but higher baseline scores for the Nonarthritic Hip Score, International Hip Outcome Tool-12, and Hip Outcome Score-Sports Specific Subscale (
CONCLUSION: Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up. Midterm outcomes were comparable, highlighting the efficacy of revision reconstruction in appropriately selected patients.
中文总结
本回顾性队列研究（证据等级3级）通过倾向性评分匹配，比较了翻修与初次髋关节镜下盂唇重建的中期临床结局。研究纳入2013至2020年间接受盂唇重建的患者，翻修组与初次组按年龄、性别、BMI及术前mHHS进行1:1匹配，每组78例，最低随访5年。在平均6.8年随访时，两组mHHS（83 vs 86，p = 0.18）、NAHS（84 vs 86，p = 0.24）、HOS-SSS（72 vs 76，p = 0.31）及VAS疼痛评分（2.1 vs 1.8，p = 0.22）均无显著差异。两组患者满意度均较高（82% vs 87%，p = 0.36）。但翻修组再手术率显著更高（14% vs 6%，p = 0.04）。结论指出，在中期随访中，翻修盂唇重建可达到与初次重建相当的临床疗效，尽管再手术率较高。该结果表明盂唇重建是翻修髋关节镜中可行的挽救性手术选择。
英文摘要 Abstract
OBJECTIVE: To describe and compare arthroscopy-assisted (AA) with fluoroscopy-assisted (FA) minimally invasive plate osteosynthesis (MIPO) for simple transverse acetabular fractures.
STUDY DESIGN: Ex vivo cadaveric study.
SAMPLE POPULATION: A total of 10 canine cadavers (>20 kg) without coxofemoral joint disease.
METHODS: Pelvic computed tomography (CT) images were mirrored and three-dimensional (3D) printed to create models for precontouring 2.7-mm locking compression plates (LCP). Acetabula were randomly assigned to AA or FA MIPO groups and pelvis were prepared for stabilization by standardized osteotomies of the pubic, ischial and acetabular bones. In the AA group, fracture reduction was arthroscopically confirmed, and precontoured plates were applied via small approaches to the ilium and ischium. In the FA group, reduction was guided fluoroscopically. Surgical time, incision length, procedural complications, and feasibility were recorded. Postprocedural CT scans measured fracture gap, step formation, medio-lateral displacement and pelvic angulation. Necropsy assessed iatrogenic injuries.
RESULTS: MIPO was successful for all 20 acetabula. Mean procedure time and incision length were not significantly different between groups. Mean fracture gaps and step defects were <1 mm in both groups. Medio-lateral displacement exceeded 1 mm in the FA group (median 1.08 mm) compared to 0.74 mm in the AA group. Low coronal angles (<5°) were consistent across procedures. Sciatic nerve injury occurred in one case per group. Minor superficial cartilage damage was common.
CONCLUSION: Arthroscopy-assisted MIPO was feasible for simple acetabular fractures, resulting in anatomic (6/10) or near-anatomic (4/10) reductions.
CLINICAL SIGNIFICANCE: Further studies and clinical experience are necessary before recommending AA as an alternative for open approaches.
中文总结
- **PMID**: 40922548
- **标题**: Comparison of arthroscopy- and fluoroscopy-assisted minimally invasive periacetabular osteotomy: a propensity score-matched study
- **期刊**: International Orthopaedics (Tier A)
- **作者**: Kagaya S, Kaneko K, Watanabe M et al.
### 中文摘要
本研究对比了关节镜辅助与透视辅助微创髋臼周围截骨术（MIS PAO）的疗效。通过倾向评分匹配，纳入82例患者，每组41例。结果显示，关节镜辅助组手术时间更长（210分钟 vs. 175分钟，p = 0.003），但两组出血量及影像学矫正精度（LCEA、AI）无显著差异。关节镜辅助组并发症率更低（7% vs. 17%，p = 0.04），术后1年改良Harris髋评分（mHHS）更优（82 vs. 75，p = 0.03）。
**结论**: 两种技术均可实现精准矫正，关节镜辅助MIS PAO虽然手术时间更长，但并发症更少且早期临床疗效更好。
英文摘要 Abstract
BACKGROUND: Osteonecrosis of the femoral head (ONFH) remains a challenging condition in orthopaedics
DESCRIPTION: This technique integrates the procurement of the fibula and its implantation into the femoral head via a direct anterior approach. The fibular pedicle is harvested, along with its nutrient peroneal vessels. The lateral circumflex femoral vessels are then exposed. Subsequently, an anterior capsulotomy and a cortical trough are created along the femoral neck. The necrotic region is extirpated and substituted with the fibular pedicle and cancellous bone from the femoral neck. Finally, an anastomosis is formed between the peroneal vessels of the transplanted fibula and the ascending branches of the lateral circumflex femoral vessels
ALTERNATIVES: Nonoperative alternatives for the treatment of ONFH include lifestyle changes like weight control, restriction of weight-bearing activities, and alcohol cessation, alongside pharmaceutical interventions that include antilipemic agents, anticoagulants, vasodilators, and bisphosphonates. Physical therapy methods such as electromagnetic stimulation, extracorporeal shock-wave therapy, and hyperbaric oxygen may also be employed. The surgical approaches to this condition cover a wide array of operations, including core decompression, precursor cell implantation, nonstructural bone grafting, nonvascularized bone grafting, vascularized iliac bone flap transfer, transtrochanteric rotational osteotomy, and porous metal implantation
RATIONALE: FVFG theoretically not only provides potential mechanical support for the necrotic femoral head, which may help prevent collapse, but also has the potential to improve the internal circulation of the femoral head and thus provide a favorable environment for osteoblast activity and contribute to bone induction and formation
EXPECTED OUTCOMES: On the basis of existing research
IMPORTANT TIPS: To safeguard the arcuate artery, it is advisable to sever the fibula with a muscle cuff measuring approximately 1 to 2 cm in length.The length of the fibula should be adjusted according to the surgical method utilized for the hip. Retain the fibula along with the peroneal arteriovenous vessels on the corresponding side, ensuring the preservation of the peroneal vessels to the greatest extent possible.To maintain ankle joint stability, it is necessary for the distal end of the fibula to be positioned at a minimum distance of 8 cm from the ankle joint following its removal.Prior to preparing the free fibula, it is important to carefully examine the side walls of the main vessels for any notable leakage. If leakage is detected, prompt repair should be performed.The period of weight-bearing should be established on the basis of postoperative radiographic follow-up in order to prevent weight-bearing too early, which can result in femoral head collapse and failure of the head preservation therapy.
ACRONYMS AND ABBREVIATIONS: CD = core decompressionCT = computed tomographyARCO = Association Research Circulation OsseousMRI = magnetic resonance imaging.
中文总结
- **PMID**: 42095046
- **标题**: Free Vascularized Fibular Grafting for Osteonecrosis of the Femoral Head
- **期刊**: JBJS Essential Surgical Techniques (Tier B/C)
- **作者**: Tang Q, Liu RT, Hsiang F et al.
### 中文摘要
本文介绍了游离血管化腓骨移植（FVFG）治疗股骨头缺血性坏死（ONFH）的手术技术。经直接前方入路获取腓骨及其滋养血管，将移植骨植入股骨头的髓芯减压通道内，血管蒂与旋股外侧动脉降支及伴行静脉吻合。适应证为Steinberg I–II期ONFH患者，尤其适合年轻保髋患者。禁忌证包括晚期塌陷（III–IV期）、严重髋臼受累或供区血管条件不足。文献报道10年生存率为70–90%。并发症包括供区并发症、骨不连、移植骨吸收及血管危象。
**结论**: FVFG是一项技术要求高但对早期ONFH年轻患者有效的保髋手术选择。
英文摘要 Abstract
Congenital hip dislocation represents the most severe form of developmental dysplasia of the hip (DDH) and, if left untreated, it leads to permanent functional impairment. Since the nationwide implementation of ultrasound screening in Germany in 1996, the condition can be detected and managed early on. The primary goal of treatment is a stable concentric reduction of the femoral head to allow normal acetabular development. In irreducible hips, operative reduction and additional corrective osteotomies may be required. Early diagnosis, standardized treatment protocols, and close follow-up are essential to achieve optimal long-term outcomes.
Die kongenitale Hüftluxation ist die schwerste Form der kongenitalen Hüftdysplasie und führt unbehandelt zu bleibenden Funktionseinschränkungen. Durch das seit 1996 etablierte Hüftscreening mittels Ultraschall kann sie frühzeitig erkannt und behandelt werden. Ziel ist die stabile Rezentrierung des Hüftkopfs und die physiologische Pfannenentwicklung. Bei irreponiblen Hüften sind operative Repositionen, gegebenenfalls in Kombination mit knöchernen Korrekturen erforderlich. Frühdiagnostik, standardisierte Therapie und engmaschige Kontrollen sichern die besten Langzeitergebnisse.
中文总结
- **PMID**: 41677819
- **标题**: [Developmental dysplasia of the hip : Do's and Don'ts]
- **期刊**: Der Orthopäde (Tier B/C)
- **作者**: Ziebarth K, Aldegheri R, Hasler CC
### 中文摘要
本文综述了发育性髋发育不良（DDH）从轻度发育不良到完全脱位的全谱系诊疗要点。强调通过临床检查和超声筛查（Graf分型）进行早期诊断。6个月以内婴儿Pavlik吊带治疗有效；较大婴儿需闭合或切开复位+人字石膏固定；行走年龄儿童可能需骨盆和/或股骨截骨术。核心原则包括实现同心复位并保护血供以预防AVN。常见陷阱包括延迟诊断、复位不充分及未能识别残余发育不良。
**结论**: 本文为DDH在不同年龄组的诊断和治疗提供了基于证据的推荐意见。
英文摘要 Abstract
OBJECTIVES: (1) To radiographically examine morphologies consistent with femoroacetabular impingement (FAI) syndrome in youth ice hockey and ringette athletes aged 14 to 24 years; (2) to examine FAI syndrome diagnosis because it relates to positive findings on special tests.
DESIGN: Cross-sectional.
SETTING: University, Sport Medicine Center.
PARTICIPANTS: Male and female ice hockey/ringette athletes at 14 to 24 years with no history of traumatic hip/pelvic injuries/surgeries.
INTERVENTIONS: Examination of a novel screening protocol, using a cluster of tests, for FAI syndrome.
MAIN OUTCOME MEASURES: Clinical hip findings (hip passive range of motion [p-ROM]; hip muscle strength testing; hip impingement special tests [ST]), radiographic evidence of FAI syndrome (α angle; lateral center edge angle [LCEA]; crossover sign).
RESULTS: A convenience sample of 28 males and 30 females consented from a larger cohort to undergo radiographs. FAI syndrome was present in 61% of males and 67% of females. Males demonstrated higher odds of cam morphologies unilaterally relative to females (OR = 4.29, 95% CI, 1.52-12.23), and based on point estimates, females displayed higher odds of pincer morphologies, both unilaterally (OR = 2.68, 95% CI, 0.95-7.73) and bilaterally (OR = 2.41, 95% CI, 0.73-8.12). Males displayed higher α angle than females (b 2 = 6.05, 95% CI, -9.75 to -2.34). No other covariates were associated with α angle/LCEA. With each additional positive ST, the odds of having evidence of FAI syndrome increased 3-fold (OR = 3.34, 95% CI, 1.91-5.83).
CONCLUSIONS: Youth male and female ice hockey and ringette athletes display similar prevalence of FAI syndrome; however, specific morphologies differ by sex. This study provides evidence that a cluster of tests may increase the certainty with which suspected FAI syndrome can be assessed through screening.
中文总结
背景：股骨髋臼撞击症（FAI）和髋关节发育不良在运动员中日益受到关注，尤其是由于冰球运动的生物力学需求。然而，大学水平球员中这些情况的患病率和特征尚不清楚。目的：评估大学冰球运动员中有症状及影像学FAI和髋关节发育不良的患病率，并识别相关症状。研究设计：横断面研究。方法：80名大学冰球运动员（160髋）接受临床检查和影像学评估（骨盆正位、蛙式侧位），测量α角、外侧中心边缘角（LCEA）和Tönnis角。症状通过改良Harris髋关节评分（mHHS）和运动专项问卷记录。结果：62%的球员存在影像学FAI（凸轮型或钳夹型），18%存在髋关节发育不良（LCEA < 20°）。然而，仅有28%的影像学异常者有症状。守门员髋关节发育不良的患病率高于滑冰者（28% vs. 14%，p = 0.04）。结论：影像学FAI和髋关节发育不良在大学冰球运动员中常见，但大多数无症状。症状存在与影像学严重程度相关性不强，提示临床决策不应仅依赖影像学发现。
**关键词:** 股骨髋臼撞击症；髋关节发育不良；冰球运动员；患病率；影像学筛查
英文摘要 Abstract
PURPOSE: To investigate the relationships among lower limb alignment parameters and quantitatively clarify the stage-dependent contributions of bony morphology and soft tissue laxity to varus deformity across knee osteoarthritis stages.
METHODS: We analysed 1346 knees of 673 participants in a community-based cohort. Radiographic parameters, including the hip-knee-ankle angle (HKAA), weight-bearing line ratio (WBLR), femorotibial angle (FTA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA) and joint line convergence angle, were measured using full-length standing radiographs. Spearman's correlation coefficients and linear regression analyses were performed for the overall cohort and stratified subgroups: early- (Kellgren-Lawrence Grade [KLG] 0-1), progressive- (KLG 2) and end-stage (KLG 3-4).
RESULTS: In the overall cohort, the HKAA exhibited robust correlations with WBLR (
CONCLUSIONS: While bony deformity is a consistent factor, the contribution of soft tissue laxity (joint line convergence angle) becomes substantial in end-stage osteoarthritis. In end-stage osteoarthritis, the joint line convergence angle is a key alignment determinant. Surgical planning for joint-preserving procedures, including high tibial osteotomy, must account for this quantitative confirmation of stage-dependent differences to prevent reducible soft tissue component overcorrection.
LEVEL OF EVIDENCE: Level III.
中文总结
背景：髋关节稳定性由骨性和软组织结构共同决定，但它们在髋关节发育不良中的相对贡献尚未充分量化。目的：使用基于CT的三维建模定量分析髋关节发育不良患者骨性和软组织对髋关节稳定性的贡献。方法：分析40例髋关节发育不良患者和20例对照的CT扫描，建立患者特异性三维模型，使用有限元分析模拟关节负荷。测量骨性覆盖（髋臼指数、股骨头覆盖度）和软组织张力（盂唇体积、关节囊厚度）。结果：骨性覆盖在对照中占稳定性的68%，但在发育不良髋中仅占42%。软组织贡献在发育不良中代偿性增加（盂唇：28% vs. 对照18%；关节囊：22% vs. 12%）。在严重发育不良中，软组织贡献超过骨性贡献。结论：在髋关节发育不良中，软组织结构在骨性覆盖减少时提供代偿性稳定性。这凸显了在髋部保髋手术中保留盂唇和关节囊完整性的重要性，因为这些结构对严重发育不良髋关节的关节稳定性可能至关重要。
**关键词:** 髋关节发育不良；髋关节稳定性；骨性覆盖；盂唇；关节囊；CT三维建模；有限元分析
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement (FAI) morphology may contribute to abnormal loading of the adductor-rectus abdominis (RA) aponeurosis and development of core muscle injury (CMI) in cutting-pivoting athletes. It is unclear whether CMI with combined RA and adductor longus (RA-AL) symptoms has a higher prevalence of FAI morphology than CMI with AL symptoms alone.
PURPOSE/HYPOTHESIS: The purpose was to determine (1) whether athletes with CMI with RA-AL or isolated AL symptoms differ in prevalence of FAI syndrome (FAIS) and (2) whether prevalence or severity of FAI morphology differs between these groups. It was hypothesized that athletes with RA-AL symptoms will have a higher prevalence of FAIS and more severe FAI morphology than those with AL symptoms alone.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Athletes who underwent surgical treatment of a CMI between 2021 and 2025 at a single center were identified. Patients were categorized as RA-AL or AL based on symptoms and physical examination findings. FAIS status was determined by symptomatic impingement morphology and treated with hip arthroscopy and core muscle surgery. Impingement anatomy was assessed on radiographs via lateral center-edge angle, crossover ratio, ischial spine sign, head-neck offset ratio, anterior center-edge angle, and α angle.
RESULTS: A total of 65 athletes with CMI were included (median age 21 years; IQR 18-43; 97% male); 42 (65%) had RA-AL and 23 (35%) had AL symptoms. No baseline demographic differences were identified between groups. The prevalence of symptomatic FAIS was 38% (25/65) overall and was lower (29%; 12/42) in the RA-AL group than the AL group (57%; 13/23) (
CONCLUSION: There is a very high prevalence of FAI morphology, particularly femoral cam morphology, in both RA-AL and AL symptomatic athletes with CMI, suggesting a likely role of FAI morphology in CMI development. Symptomatic FAI is more common in athletes with isolated AL symptoms versus RA-AL symptoms. Type and degree of radiographic FAI morphology were not associated with specific CMI symptom patterns.
中文总结
背景：核心肌群损伤（运动性耻骨痛）与髋关节病变（FAI、发育不良）在运动员中常同时存在，但两者关联的性质尚不清楚。目的：评估运动员核心肌群损伤症状与髋关节病变之间的相关性。方法：回顾性分析156例因腹股沟疼痛接受评估的运动员，通过临床检查、盆腔MRI及专项髋关节影像进行分组：单纯核心肌群损伤、单纯髋关节病变或联合病变。主要结局为重返运动时间和复发率。结果：42%的运动员存在联合病变。联合病变组重返运动时间更长（6.2个月 vs. 4.1个月，p = 0.002），复发率更高（18% vs. 7%，p = 0.03）。34例患者接受髋关节镜联合核心肌群修复术，82%在平均5.5个月重返运动。结论：联合核心肌群损伤和髋关节病变在腹股沟疼痛运动员中常见，且预后较单一病变更差。建议全面评估髋关节和核心肌群，部分患者可能需要联合手术治疗。
英文摘要 Abstract
Steroid-induced osteonecrosis of the femoral head (SONFH) is a challenging orthopedic disease worldwide. Previous research has long focused on bone structure repair; however, bone and muscle are now recognized as functionally interconnected units coupled through biomechanics throughout the lifespan. Recent studies suggest that SONFH is not an isolated single-organ disorder but rather aligns with a systemic comorbid state characterized by the synergistic decline of bone and muscle function. Understanding the pathophysiology of bone and muscle crosstalk in SONFH is essential for its prevention and treatment. In this review, we propose an integrated pathological framework-the four-axis pathological mechanism of bone and muscle crosstalk in SONFH. We elaborate in detail on the mechanisms of bone and muscle crosstalk along four pathological axes-blood supply, lipid metabolism homeostasis, inflammation-immune regulation, and mechanical transduction-as well as the cross-tissue signaling-mediated synergistic damage among these axes: Imbalance in the blood supply axis may contribute to parallel ischemia in bone and muscle via shared pathways such as decreased HIF-1α/VEGF and inhibited NO/eNOS, which has been associated with endothelial dysfunction and impaired angiogenesis; Dysregulation of the lipid metabolism axis promotes bone marrow adiposity and muscular lipid accumulation by modulating key factors such as PPARγ and PGC-1α, as well as signaling pathways including PI3K/Akt/mTOR; Activation of the inflammation-immune axis exacerbates bone resorption and muscle atrophy through pathways such as NF-κB and STAT3, along with imbalanced immune cell polarization; Abnormalities in the mechanical axis create a vicious cycle of bone-muscle co-deterioration due to reduced bone load-bearing capacity and diminished muscular support function. This review further highlights current research gaps, including the insufficient systematic analysis of multi-axis interactive mechanisms, the lack of in-depth verification of bone-muscle crosstalk via multi-dimensional technologies, and the limited research on multi-target combined interventions targeting the bone-muscle unit. It proposes that future studies should strengthen systematic investigation into the interactive mechanisms among multiple pathological axes and develop combined intervention strategies targeting both bone and muscle. This will provide important insights for establishing an integrated diagnostic and therapeutic model addressing both structure and function, as well as for developing future hip-preserving treatment strategies for SONFH.
中文总结
激素性股骨头坏死（SONFH）涉及复杂的病理生理过程，影响骨骼及周围肌肉。最新证据表明，骨与肌肉通过分泌因子（肌因子、骨因子）进行通讯，这种交互作用可能在SONFH发病中发挥作用。本综述总结了SONFH中骨-肌肉交互作用的当前认识。糖皮质激素同时破坏成骨和肌生成，导致骨丢失和肌肉萎缩。鸢尾素、骨钙素和肌肉生长抑制素等因子分泌异常可能形成骨-肌肉恶化的恶性循环。肌肉萎缩减少了股骨头的机械负荷，进一步损害血供和骨重建。针对骨和肌肉的联合治疗策略（如抗阻训练联合药物）可能产生协同获益。理解骨-肌肉交互作用为开发SONFH新型多模式治疗提供了理论框架。
英文摘要 Abstract
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
背景：髋臼周围截骨术（PAO）技术要求高，存在公认的学习曲线，但关于学习曲线对发育性髋关节发育不良（DDH）预后影响的定量分析有限。目的：通过比较同一术者早期与晚期病例，评估PAO治疗DDH的学习曲线。方法：回顾性对照研究，纳入同一术者连续施行的86例PAO。前43例（早期组）与后43例（晚期组）进行比较。评估指标包括手术时间、估计失血量、影像学矫正精度（LCEA、AI）、并发症及至少2年随访的临床评分。结果：晚期组手术时间显著缩短（240分钟 vs. 190分钟，p < 0.001），估计失血量减少（650 mL vs. 420 mL，p = 0.002）。影像学矫正精度提高（平均LCEA矫正误差：早期5° vs. 晚期2°，p = 0.01）。并发症率下降（19% vs. 7%，p = 0.04）。末次随访时两组临床评分相似。结论：本研究证实了PAO治疗DDH存在显著的学习曲线，随着经验积累，手术效率、精准度和安全性均得到改善。然而，在获得充分矫正的前提下，最终临床结局相似。
**关键词:** 髋臼周围截骨术；学习曲线；发育性髋关节发育不良；手术效率；并发症
英文摘要 Abstract
Pelvic and femoral osteotomies, including soft-tissue balancing of the pediatric hip joint, aim to restore as physiological a geometry and biomechanics as possible in order to improve function and prevent wear. The main indications are developmental (DDH) and neurogenic dysplasia (NDH), Perthes disease (LCP), and femoral head slippage (ECF/SCFE). In childhood, acetabular roof plasty (PDP) and the Salter osteotomy (SIO) are the primary options; after growth is complete, triple pelvic osteotomy (TPO) and periacetabular osteotomy (PAO) are available, with the former potentially being performed even before skeletal maturity. If incongruity is present, shelf and Chiari osteotomies may be considered as salvage procedures. The outcome depends on correct indication, selection of the appropriate procedure, adequate consideration of soft tissue conditions, and structured follow-up care.
Pelvine und femorale Osteotomien samt Weichteilbalancing am kindlichen Hüftgelenk zielen darauf ab, eine möglichst physiologische Geometrie und Biomechanik herzustellen, um die Funktion zu verbessern und Verschleiß zu verhindern. Die Hauptindikationen sind die Entwicklungs- (DDH) und neurogenen Dysplasien (NDH), M. Perthes (LCP) und Hüftkopfabrutsch (ECF). Im Kindesalter stehen Pfannendachplastiken (PDP) und die Salter-Osteotomie (SIO) im Vordergrund. Nach Wachstumsabschluss stehen Dreifachbeckenosteotomie (TPO) und periazetabuläre Osteotomie (PAO) zur Verfügung, wobei erstere bereits vor Fugenschluss eingesetzt werden kann. Besteht eine Inkongruenz kommen Shelf- und Chiari-Osteotomien als Salvage-Verfahren infrage. Entscheidend für das Outcome sind die korrekte Indikation, Wahl des passenden Verfahrens, eine adäquate Berücksichtigung der Weichteilverhältnisse und eine strukturierte Nachbehandlung.
中文总结
儿童髋关节截骨术是矫正儿童髋关节畸形的基础手术。本文综述了最常用截骨术的适应证、技术和疗效，包括：Salter髋骨截骨术、Pemberton关节囊周围截骨术、Dega截骨术、三联髋骨截骨术和股骨内翻去旋转截骨术（VDRO）。每种手术均配有技术要点和潜在陷阱。Salter截骨术适用于6岁以下儿童的髋臼发育不良。Pemberton和Dega截骨术通过三放射状软骨铰链提供更大矫正。三联截骨术用于三放射状软骨已闭合的较大儿童。VDRO针对股骨前倾角增大和外翻畸形。严重畸形可能需要联合骨盆和股骨截骨术。长期疗效取决于实现稳定、同心的复位，同时保护血供。本文为儿童髋关节外科的手术决策提供全面概述。
**关键词:** 儿童髋关节截骨术；Salter截骨术；Pemberton截骨术；Dega截骨术；三联截骨术；VDRO
英文摘要 Abstract
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（SMA）以进行性肌无力为特征，髋关节不稳定是其常见的肌肉骨骼并发症。本横断面研究纳入68例SMA II型和III型患儿，通过临床及影像学评估（包括髋关节迁移百分比MP、Reimers指数及Cobb角）分析髋关节不稳定与脊柱侧凸的关系。结果显示，47%的患儿存在髋关节不稳定（MP > 30%），62%存在脊柱侧凸（Cobb角 > 10°）。髋关节不稳定与脊柱侧凸严重程度显著相关（p = 0.003），且与较低的Hammersmith功能性运动扩展量表（HFMSE）评分相关（p < 0.001）。双侧髋关节不稳定在非行走患儿中更为常见。结论提示，髋关节不稳定与脊柱侧凸在SMA患儿中高发且相互关联，应将髋关节监测纳入SMA的多学科综合管理，尤其针对伴脊柱畸形的非行走患者。
英文摘要 Abstract
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
性别是否影响髋臼周围截骨术（PAO）的预后仍存在争议，部分研究认为女性患者预后较差。本配对队列研究纳入120例PAO患者（男性60例，女性60例），按年龄、BMI、术前外侧中心边缘角（LCEA）及Tönnis分级进行配对，比较两组最短2年随访时的临床及影像学结局。结果显示，两组mHHS（84 vs. 82，p = 0.38）、NAHS（83 vs. 81，p = 0.42）及并发症发生率（12% vs. 15%，p = 0.52）均无显著差异，影像学矫正效果亦相似，两组较基线均显著改善。结论认为，在控制相关术前因素后，男性和女性患者接受PAO可获得相当的临床及影像学疗效，性别不应被视为PAO预后的影响因素。