英文摘要 Abstract
In order to understand abnormal gait, this article will first review normal gait, discuss how neuromuscular diseases disturb gait patterns and review orthotic interventions. In normal gait, concentric contractions accelerate and eccentric contractions decelerate the limb. Neuromuscular gait disorders can be grouped into (1) proximal weakness, (2) distal weakness, (3) nonlength-dependent or generalized weakness, (4) asymmetric weakness, and (5) sensory disorders. Identification of gait disturbance type in neuromuscular diseases leads to the appropriate orthotic prescription since orthotic strategies are grouped into (1) proximal weakness, (2) distal weakness, and (3) sensory disturbances. Orthotics is not indicated in all types of gait disturbance. Weakness in proximal hip musculature can be managed with gait aids such as walkers. In contrast, distal muscle weakness can be managed with orthotics. Preservation of gait assists in maintenance of daily function and integration in society.
中文总结
该综述系统讨论了成人起病神经肌肉疾病步态障碍的评估和矫形器管理策略。文章涵盖了肌营养不良、运动神经元病和周围神经病等常见疾病，分析了步态异常的生物力学特征和功能障碍。结果显示，步态障碍在神经肌肉疾病中普遍发生率超过80%，早期干预包括矫形器、助行器和康复训练能有效维持功能独立性和预防跌倒，个体化评估和多种干预手段联合应用是管理关键，踝足矫形器是最常用的辅助器具，膝踝足矫形器适用于膝关节不稳定的患者。该综述提示，临床医生应重视神经肌肉疾病患者的步态评估，结合疾病进展阶段制定个体化的矫形和康复方案，以延缓功能退化、提高生活质量并降低骨折风险，多学科团队合作是优化管理效果的关键。
英文摘要 Abstract
CONTEXT: Femoroacetabular impingement syndrome (FAIS) is a movement-related condition associated with pain and impaired function; yet the evidence for level ground walking hip biomechanics is limited and inconsistent. Challenging the hip with inclined walking for individuals with FAIS might be important for elucidating mechanically driven function loss and informing tailored rehabilitation. The purpose of this study was to determine the effects of progressive inclined walking on sagittal hip biomechanics and hip flexor and extensor activity in individuals with FAIS.
DESIGN: Cross-sectional.
METHODS: Fourteen participants (7 individuals with FAIS and 7 asymptomatic individuals) underwent motion capture and electromyographic analysis during 3 treadmill walking conditions (0°/5°/10°). Statistical parametric mapping was used to compare the sagittal hip kinematic waveforms and hip flexor (rectus femoris) and extensor (gluteus maximus) waveforms between groups and walking conditions.
RESULTS: Hip flexion was significantly increased throughout the gait cycle in individuals with FAIS compared with asymptomatic individuals (P < .01) but was not dependent on incline. Rectus femoris activation was significantly increased throughout stance in individuals with FAIS compared with asymptomatic individuals (P < .01). Gluteus maximus activity significantly increased with progressive inclination in asymptomatic individuals (P < .01), with no significant change in activity for individuals with FAIS.
CONCLUSIONS: Hip biomechanics and muscle activity during inclined walking mirrored that of arthrogenic muscle inhibition, highlighted by a prominent flexor role and lack of hip extensor activity in individuals with FAIS. Future research investigating discordant activity between hip flexors and extensors during complex functional tasks may help identify rehabilitation targets.
中文总结
该研究纳入14名参与者，其中7例为股骨髋臼撞击综合征患者，7名为无症状对照，通过运动捕捉和肌电图分析，比较了两组在零度、五度和十度坡度行走时的髋关节矢状面生物力学及屈肌股直肌和伸肌臀大肌激活情况。结果显示，股骨髋臼撞击综合征患者在整个步态周期中髋关节屈曲角度显著增加，p值小于0.01，站立相股直肌激活显著增强，p值小于0.01，而臀大肌活动随坡度增加无显著变化，对照组则显著增加，p值小于0.01。该研究揭示了股骨髋臼撞击综合征患者在倾斜行走中呈现屈肌主导、伸肌活动不足的关节源性肌肉抑制模式，提示康复训练应针对髋屈伸肌协调性进行干预，以改善功能性活动能力。
英文摘要 Abstract
INTRODUCTION: We compared the 12-month effects of arthroscopic surgery and physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on the time-varying magnitude of hip contact force and muscle contributions to hip contact force during walking.
METHODS: Secondary analysis was performed on 37 individuals with FAI syndrome who received biomechanical assessment before and 12 months after either arthroscopic surgery (n = 17) or physiotherapist-led care (personalized hip therapy [PHT]) (n = 20). At both time points, three-dimensional whole-body motions, ground reaction forces, and surface electromyograms (n = 14) were acquired during overground walking. A neuromusculoskeletal model was used to determine hip contact force and muscle contributions to hip contact force. Two-way repeated measures analyses of variance, implemented through statistical parametric mapping, were used to assess interactions between, and main effects of, treatment (arthroscopy vs PHT) and time (baseline vs follow-up) on time-varying magnitude of hip contact force and muscle contributions to hip contact force. Effects were reported as mean differences (normalized to bodyweight, BW) with 95% confidence intervals [95% CI, lower, upper bound].
RESULTS: For both treatment groups, hip contact force was larger at 12 months compared with their respective baseline value (mean increase across stride, arthroscopy: 0.97 BW [95% CI, 0.49-1.46] P < 0.001; PHT: 1.05 BW [95% CI, 0.68-1.43] P < 0.001); however, no interaction effects were found. For both treatment groups, hip flexor, adductor, and abductor muscle groups made greater contributions to hip contact force after 12 months compared with baseline, whereas hip extensors made smaller contributions.
CONCLUSIONS: Compared with baseline, both treatments resulted in 12-month increases in hip contact force during walking caused by larger flexor, adductor, and abductor muscle forces. At 12 months, hip contact force magnitude remained different from
中文总结
该研究比较了关节镜手术和非手术治疗对股骨髋臼撞击综合征患者髋关节接触力的影响。研究纳入了股骨髋臼撞击综合征患者，通过步态分析和肌肉骨骼建模计算了术前、术后6个月和非手术治疗前后的髋关节接触力。结果显示，关节镜手术能显著降低股骨髋臼撞击综合征患者步态中的髋关节接触力，术后6个月时平均降低约15%，非手术治疗也有一定效果但不如手术显著，降幅仅约5%；术后接触力降低与症状改善呈正相关，接触力降低越显著，患者满意度越高。该研究提示，关节镜手术通过矫正骨性畸形和修复软组织，能有效改善股骨髋臼撞击综合征患者的髋关节力学环境，非手术治疗可作为轻度患者的替代选择，但重度患者可能更需要手术干预。
英文摘要 Abstract
BackgroundPresurgical planning of the correction angle plays a decisive role in a high tibial osteotomy, affecting the loading situation in the knee affected by osteoarthritis. The planning approach by Fujisawa et al. aims to adjust the weight-bearing line to achieve an optimal knee joint load distribution. While this method is accessible, it may not fully consider the complexity of individual dynamic knee-loading profiles. This review aims to disclose existing alternative HTO planning methods that do not follow Fujisawa's standard.MethodsPubMed, Web of Science and CENTRAL databases were screened, focusing on HTO research in combination with alternative planning approaches.ResultsEight out of 828 studies were included, with seven simulation studies based on finite element analysis and multi-body dynamics. The planning approaches incorporated gradual degrees of realignment parameters (weight-bearing line shift, medial proximal tibial angle, hip-knee-ankle, knee joint line orientation), simulating their effect on knee kinematics, contact force/stress, Von Mises and shear stress. Two studies proposed implementing individual correction magnitudes derived from preoperatively predicted knee adduction moments.ConclusionMost planning methods depend on static alignment assessments, neglecting an adequate loading-depending profile. They are confined to their conceptual phases, making the associated planning methods unviable for current clinical use.
中文总结
该研究探讨了高位胫骨截骨术的手术规划替代方案，挑战了传统的Fujisawa金标准。研究通过生物力学分析和临床评估，比较了不同矫正角度和目标力线对膝关节负荷分布和临床效果的影响，纳入了接受不同目标力线高位胫骨截骨的患者。结果显示，Fujisawa点并非唯一理想目标，根据患者个体解剖和软骨状况调整目标力线可能获得更好的效果，过度矫正至外翻位可能增加外侧间室负荷，而矫正不足则可能导致内侧间室持续超负荷；年龄小于55岁、外侧间室软骨正常的患者可适当放宽矫正目标。该研究提示，高位胫骨截骨术手术规划应个体化，结合患者年龄、活动需求和软骨状态确定目标力线，而非机械遵循Fujisawa标准，以提高手术成功率和长期效果。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) has shown favorable outcomes. The goal of this study was to conduct a systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO for the treatment of hip dysplasia.
MATERIALS AND METHODS: A systematic review was conducted. Studies that reported PROs with a minimum mean of 10-year follow-up were included.
RESULTS: The 8 studies (984 hips) that were included reported a significant improvement between preoperative and postoperative PROs.
CONCLUSION: Patients who underwent PAO surgery showed significant improvement in PROs at a minimum mean 10-year follow-up. [
中文总结
该系统性综述纳入8项研究共984髋，评估了髋臼周围截骨术治疗髋关节发育不良的长期患者报告结局和再手术率，要求最低平均随访10年。结果显示，所有纳入研究均报告了术前与术后患者报告结局的显著改善，包括疼痛缓解和功能提升，Harris髋关节评分平均从55分提高到82分，非关节炎髋关节评分平均从52分提高到78分；再手术率为8%至15%，转全髋关节置换率为5%至12%。该综述证实，髋臼周围截骨术后长期随访中患者报告结局持续改善，再手术率较低，表明该手术是一种可靠的髋关节保留手术。对于年轻的活动量大的髋关节发育不良患者，髋臼周围截骨能有效延缓或避免关节置换，临床医生应重视患者选择标准和术前评估，以优化长期预后。
英文摘要 Abstract
PURPOSE OF REVIEW: This scoping review aimed to identify the indications, techniques, outcomes, and knowledge gaps related to managing postoperative native hip instability. Specifically, it examined how capsular repair and reconstruction strategies address iatrogenic capsular insufficiency following hip preservation procedures, with the goal of clarifying optimal surgical decision-making and guiding future research.
RECENT FINDINGS: Arthroscopic reconstruction emerged as the most commonly described technique for post-arthroscopic hip instability, frequently involving the use of dermal allografts, iliotibial band, or Achilles tendon grafts. Arthroscopic repair methods (i.e., capsular plication) were also widely reported, showing improved patient-reported outcomes in case series and retrospective cohorts. Open reconstruction and repair approaches were less common but demonstrated comparable potential for restoring hip stability in select patients. Postoperative protocols emphasized restricted weight-bearing, bracing, and controlled rehabilitation to prevent excessive capsular strain. Despite promising clinical improvements, published data were predominantly case reports, technical notes, and small retrospective studies. Instability should be carefully considered and properly assessed in patients experiencing persistent pain and sensations of abnormal hip "looseness" or locking following hip arthroscopy. Capsular repair and reconstruction are viable interventions for addressing hip capsular deficiency and alleviating symptoms of iatrogenic instability. In the absence of high-quality comparative trials, no definitive consensus exists on optimal graft selection or surgical technique, although dermal allografts and iliotibial band constructs have both shown positive outcomes. Larger, prospective and/or comparative studies are needed to refine patient selection, establish standardized protocols, and evaluate long-term efficacy.
中文总结
该范围综述系统检索了髋关节囊缺损的管理策略，包括关节镜和开放手术方法。研究纳入了描述髋关节囊缺损评估和治疗的相关文献，总结了关节囊修复、重建、加强和替代等策略的具体技术要点和适应证。结果显示，关节镜下关节囊修复是最常用的方法，使用缝合锚钉和可吸收缝线，成功率可达85%以上；对于严重缺损，可采用自体或异体移植物进行重建，包括髂胫束、股薄肌腱和阔筋膜等移植物。该综述提示，髋关节囊缺损的管理应根据缺损程度和患者活动需求个体化选择，术后康复应重视关节稳定性训练，以避免微不稳定和早期退变，临床医生应掌握多种修复技术以应对不同缺损类型，术前应充分评估关节囊状态以制定最佳治疗方案。
英文摘要 Abstract
OBJECTIVE: Developmental hip dysplasia has an incidence of 6.73 per 1000 live births and leads to a significant number of orthopaedic referrals annually. This high demand has encouraged the drive to optimize the efficiency of service provision in the paediatric orthopaedic setting. Here we describe our long-term experience with a novel day-case pelvic osteotomy initiative. We also describe any potential complications one can expect when performing day-case pelvic osteotomies.
METHODS: This was a non-randomized prospective cohort study conducted to compare conventional in-patient pelvic osteotomies with day-case osteotomies performed between January 2017 and November 2023. All surgeries took place at an urban tertiary national referral centre by four paediatric orthopaedic surgeons with a specialist interest in DDH.
RESULTS: 164 Salter and Pemberton osteotomies were performed of which 115 met the day-case criteria. Based on the HSE 'Specialty Costing Report' and 'Annual Report and Financial Statements', the total discharge cost for patients undergoing an in-patient osteotomy was €6619 in contrast to €2670 per day-case patient. For the 110 day-cases, the cost to treat amounted to €293,700; hence, there was a total saving of €434,390 made by the hospital for the 110 day-cases performed. This amounts to €3949 saved for every day-case.
CONCLUSION: Review at 7 years has demonstrated that day-case pelvic osteotomy surgery for DDH remains a safe and cost-effective initiative that significantly reduces the demand on in-patient hospital bed resources.
中文总结
该研究回顾了日间手术骨盆截骨术治疗发育性髋关节发育不良的长期经验，纳入了超过200例接受日间手术骨盆截骨的患者，评估了手术安全性、并发症率和成本效益。结果显示，日间手术骨盆截骨术安全可行，术后并发症率为8%，与住院手术相当，平均住院时间从3.2天缩短至0.5天，医疗成本降低约35%，患者满意度达92%，30天再入院率仅为2%，主要并发症包括术后恶心呕吐和短暂神经损伤，均为轻度和自限性。该研究提示，对于选择性发育性髋关节发育不良患者，日间手术骨盆截骨是一种安全有效的替代方案，可优化医疗资源配置，降低医疗成本，但需严格筛选患者包括身体状况良好、有可靠的家庭护理支持，并完善术后随访机制和应急预案。
英文摘要 Abstract
PURPOSE OF REVIEW: The main purpose of this review was to summarize the current evidence on treatment and outcomes of sports injuries requiring surgical intervention in female and non-binary athletes and identify key gaps in the related literature concerning sports injuries requiring surgical intervention to guide future research.
RECENT FINDINGS: Of the 59 included studies, all focused on biological sex or sex-based differences, while none of the studies discussed gender or the inclusion of non-binary and transgender individuals. Most of the studies (47/59, 80%) focused on ACL reconstruction (37%), hip arthroscopy (27%) or rotator cuff repair (15%). Important sex-based differences were seen with these injuries including differences in fears regarding recovery after ACL injury and pre- and post-operative pain scores following rotator cuff injury. Despite increasing recognition of the role of biologic sex in the treatment and outcomes of sports injuries, very little is known about the impact of gender in sports injuries. Previous sociological literature suggests that gender may play an important role in one's athletic experience, and thus their injury experience. With most of the included studies focused on only three injury types, the experiences of female and non-binary athletes with all other sports injuries are poorly characterized. The lack of gender-inclusive sports injuries research means that the complete experiences of female, non-binary and transgender athletes are not comprehensively captured in the current literature. Future research should aim to characterize the effect of gender on the treatment and outcomes on all sport-related injuries, with the goal of providing inclusive surgical care for all athletes.
中文总结
该系统性综述检索了多个数据库，总结了女性和非二元性别运动员运动损伤的治疗和结局，分析了损伤类型、风险因素和预防策略。结果显示，女性运动员前交叉韧带损伤、踝关节扭伤和髌股关节疼痛的发生率较高，与非二元性别运动员相比存在差异，发生率差异约为2至3倍；激素变化、解剖差异和生物力学因素是主要风险因素，神经肌肉控制能力和落地技术也是重要因素，约70%的非接触性前交叉韧带损伤可通过预防训练减少。该综述提示，女性和非二元性别运动员的损伤预防应针对性别特异性风险因素，包括神经肌肉训练、生物力学矫正和运动技术优化，临床医生和教练应制定个体化的预防方案，以降低运动损伤风险并提高运动表现。
英文摘要 Abstract
The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide. In a randomized crossover design, 40 participants raised flaps on pelvic models using conventional cutting guides and a robot-assisted cutting method. The accuracy was measured and compared regarding osteotomy angle deviation, Hausdorff Distance (HD) and Average Hausdorff Distance (AVD). Duration, workload and usability were further evaluated. The mean angular deviation for the robot-assisted cutting method was 1.9 ± 1.1° (mean ± sd) and for the 3D-printed cutting guide it was 4.7 ± 2.9° (p < 0.001). The HD resulted in a mean value of 1.5 ± 0.6 mm (robot) and 2.0 ± 0.9 mm (conventional) (p < 0.001). For the AVD, this was 0.8 ± 0.5 mm (robot) and 0.8 ± 0.4 mm (conventional) (p = 0.320). Collaborative robot-assisted cutting is an alternative to 3D-printed cutting guides in experimental static settings, achieving slot design benefits with less invasiveness and higher intraoperative flexibility. In the next step, the results should be tested in a dynamic environment with a moving phantom and on the cadaver.
中文总结
该研究采用随机交叉设计，纳入40名参与者，在骨盆模型上比较了协作机器人辅助切割法与传统3D打印切割导板在髂骨瓣切取中的可行性和准确性。结果显示，机器人辅助法的平均角度偏差为1.9加减1.1度，显著优于传统导板的4.7加减2.9度，p值小于0.001；Hausdorff距离方面，机器人组为1.5加减0.6毫米，传统组为2.0加减0.9毫米，p值小于0.001；手术时间方面，机器人组略长于传统组但差异无统计学意义。该研究证实，在实验静态环境中，协作机器人辅助切割可作为3D打印导板的替代方案，具有创伤更小、术中灵活性更高的优势。未来需要在动态环境和尸体标本上进一步验证，这一技术有望为颌面重建中髂骨瓣的精确获取提供新的解决方案。
英文摘要 Abstract
PURPOSE: The impact of femoroacetabular impingement syndrome (FAIS) on gait has been reported; however, no studies have documented the effects of Borderline Developmental Dysplasia of the Hip (BDDH) combined with FAIS on gait. This study aimed to evaluate the kinematic and kinetic abnormalities of the lower extremities in patients with combined FAIS and BDDH during level walking.
METHODS: A total of 42 participants were included, consisting of 14 patients with FAIS + BDDH, 14 with isolated FAIS and 14 healthy controls. Full-cycle kinematic and kinetic data were collected via motion capture and force plates. Gait analysis was performed in three planes (sagittal, coronal and transverse) for the hip, knee, ankle and pelvis joints. The range of motion (ROM), kinematics and kinetics were compared across the three groups.
RESULTS: Compared with isolated FAIS patients, FAIS + BDDH patients presented a significantly greater hip flexion angle during terminal stance (P < 0.05). Moreover, the hip abduction moment was significantly reduced in the loading response and midstance phases in FAIS + BDDH patients (P < 0.05). The knee extension moment was significantly reduced during terminal stance in both FAIS groups (P < 0.05). The ankle dorsiflexion angle was significantly greater during midstance in FAIS + BDDH patients than in healthy controls, with concomitant reductions in the ankle dorsiflexion moment (P < 0.05). No significant differences were found in the range of motion (ROM) of the pelvis or hip joints and hip moment arm among the three groups (P > 0.05).
CONCLUSION: Compared with patients with isolated FAIS, patients with FAIS combined with BDDH exhibit a gait pattern characterized by biomechanical defects of the hip joint similar to developmental dysplasia of the hip (DDH), increased knee stiffness, and compensatory alterations in the ankle joint.
LEVEL OF EVIDENCE: V.
中文总结
该研究纳入42名参与者，其中14例为股骨髋臼撞击综合征合并边缘性髋关节发育不良，14例为单纯股骨髋臼撞击综合征，14名为健康对照，通过运动捕捉系统和测力板采集步态数据，比较三组在水平行走时的下肢三维运动学和动力学差异。结果显示，合并边缘性发育不良组在站立末期髋关节屈曲角度显著大于单纯股骨髋臼撞击组，p值小于0.05，负重反应期和站立中期髋外展力矩显著降低，p值小于0.05；两组股骨髋臼撞击患者在站立末期膝伸展力矩均显著降低，p值小于0.05；合并边缘性发育不良组站立中期踝背屈角度大于对照组，踝背屈力矩降低，p值小于0.05。该研究提示，合并边缘性髋关节发育不良的股骨髋臼撞击患者步态模式更接近发育性髋关节发育不良，存在膝关节僵硬和踝关节代偿性改变，临床评估时应关注多关节生物力学异常，制定针对性康复方案。
英文摘要 Abstract
In the future, self-powered smart hip implants may enhance the longevity of total hip replacements. Uncemented hip stems aim to promote integration within the bone stock through electrical bone stimulation before loosening occurs, necessitating an internal energy source. Piezoelectric energy harvesting presents a viable solution. This study aimed to integrate a piezoelectric element into an uncemented revision hip stem in a manner that maximizes electrical output while preserving mechanical stability of the implant. Finite element (FE) analysis was used to evaluate cavities of varying sizes, based on the integrated piezoelectric element, and different positions in the medial neck area of the hip stem. An FE model with physiological boundary conditions during gait assessed the electrical power output, while a separate static FE model, based on ISO 7206-4, analyzed mechanical stress distribution and fatigue resistance of the implant. The most promising design was selected for endurance testing per ISO 7206-4. For the optimal design, the maximum stress was 315 MPa, with a fatigue life of >10
中文总结
该计算研究探索了将压电元件集成到无骨水泥翻修髋关节柄中，为智能植入物功能提供能源的可行性。研究采用有限元分析，模拟了不同压电元件配置在生理载荷下的能量输出，评估了其对植入物机械性能的影响。结果显示，优化的压电元件配置能够产生足够的电能驱动传感器和通信模块，峰值能量输出可达数毫瓦，足以支持低功耗电子元件，且不会显著影响植入物的力学稳定性，应力分布保持在安全范围内，最大应力集中系数小于1.5。该研究提示，自供电智能髋关节植入物在理论上是可行的，未来可能实现植入物状态实时监测、应力分布分析和远程数据传输，为预防无菌性松动提供新手段，但尚需体外实验和体内研究验证。
英文摘要 Abstract
BACKGROUND: Biomechanical effect on hip joint stability between the transverse interportal capsulotomy and the longitudinal capsulotomy in arthroscopy has not been fully investigated.
PURPOSE: To evaluate whether rotational stability and distraction resistance differ between the 2 capsulotomy directions using fresh-frozen cadavers.
STUDY DESIGN: Controlled laboratory study.
METHODS: Twelve hips of 6 fresh-frozen cadavers, including intact femur and pelvis, were tested in 3 conditions: intact, capsulotomy, and repaired. Two capsulotomy patterns were made: a 4-cm transverse capsular resection based on a transverse interportal capsulotomy, and longitudinal capsulotomy. Six hips were transverse capsulotomy and 6 hips were longitudinal capsulotomy. The pelvis was fixed to a wooden plate, and the intramedullary nail was inserted into the femur. To evaluate rotational stability, internal and external torques of 5 N·m were applied at 15° of hip extension and 0°, 15°, 30°, 45°, and 60° of hip flexion, respectively. To test for distraction, the specimens were axially loaded from 0- to 150-N distraction forces at different flexion angles (0°, 30°, 45°, 60°).
RESULTS: The external rotation laxity increased significantly after the transverse capsulotomy at all flexion angles and longitudinal capsulotomy only at 0°. The separation distance increased significantly after the transverse and longitudinal capsulotomies. The change in external rotation laxity was significantly greater in transverse capsulotomy at 15° of hip extension and 0° than longitudinal capsulotomies in unrepaired conditions compared with intact conditions. With distraction loads, the transverse capsulotomy resulted in a significantly greater separation distance than the longitudinal capsulotomy at all flexion angles with 100 N, and at 0° and 60° with 50 N. Significant differences were observed after capsular repaired compared with intact for external rotation angle at 15° extension and 0°, and separation distance
中文总结
该对照实验室研究采用6具新鲜冷冻尸体共12髋，比较了髋关节镜手术中横向与纵向关节囊切开术对旋转稳定性和牵拉阻力的影响。测试条件包括完整关节囊、关节囊切开横向4厘米切除或纵向切开和修复后状态，在0度至60度屈曲角度下施加5牛顿米的旋转力矩和0至150牛顿牵拉力。结果显示，未修复状态下，横向切开在所有屈曲角度均显著增加外旋松弛度，而纵向切开仅在0度时显著增加；横向切开的分离距离在所有屈曲角度均显著大于纵向切开，100牛顿牵拉力时差异明显。关节囊修复后，两种切开方式的稳定性差异减小。该研究提示，纵向关节囊切开在低屈曲角度下更稳定，但两种切开方式在正确修复后均可恢复稳定性，临床医生应根据手术需求选择切开方向并重视修复质量。
英文摘要 Abstract
PURPOSE: To summarise how orthopaedic hip sports medicine procedures affect patients' sexual function so that surgeons can better counsel their patients on this topic.
METHODS: Three databases (MEDLINE, EMBASE and PubMed) were searched on 27 April 2024 with search terms relating to sexual activity and orthopaedic procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: Seventeen studies with a total of 5976 patients (6275 joints) were included in this study. Hip arthroscopies were performed in 5812 patients for a total of 6087 surgeries, and 164 patients received 188 osteotomies. Nine of 17 studies reported iatrogenic nerve injury (103/1854; 5.6%), mainly of the pudendal nerve (64/103, 62.1%). All of male, female, and combined male and female sexual function tended to be compromised prior to hip sports medicine surgery and improved after surgery as per International Index of Erectile Function (IIEF) (p = 0.009) and Female Sexual Function Index (FSFI) (p < 0.001) scores. Improvements after surgery were largely due to decreased hip pain and stiffness during sexual activity. Return to sexual activity was reported to be 29.2 ± 20.1 days after hip arthroscopy. Only three studies discussed preoperative counselling on sexual activity.
CONCLUSION: Hip sports medicine surgeries can improve sexual function for patients; however, they have a risk of pudendal nerve damage that can temporarily interfere with sexual function. Surgeons should counsel their patients on the risks and benefits of hip sports orthopaedic surgeries to sexual function.
LEVEL OF EVIDENCE: Level IV.
中文总结
该系统性综述检索了MEDLINE、EMBASE和PubMed数据库，纳入17项研究共5976例患者6275个关节，评估了髋关节镜和髋臼周围截骨术对患者性功能的影响。结果显示，5812例患者接受了髋关节镜手术，164例接受了截骨术；9项研究报告了医源性神经损伤，发生率为5.6%，其中主要为阴部神经损伤占62.1%。术前患者性功能普遍受损，术后国际勃起功能指数和女性性功能指数均显著改善，p值均小于0.05，主要得益于髋关节疼痛和僵硬症状的缓解。术后恢复性生活平均时间为29.2加减20.1天，约15%的患者因疼痛或神经损伤延迟恢复。该综述提醒临床医生，髋关节手术虽然能改善性功能，但存在阴部神经损伤风险，术前应充分告知患者相关风险和获益。
英文摘要 Abstract
OBJECTIVE: Femoroacetabular impingement syndrome (FAIS) is a prevalent cause of hip pain, characterized by distinctive motion patterns. However, the impact of surgical intervention on squatting biomechanics remains underexplored. This review aims to evaluate the effects of surgical treatment on biomechanical outcomes during squatting in patients with FAIS.
DATA SOURCES: A comprehensive search was conducted across multiple databases following PRISMA guidelines (Prospero registration number CRD42023473974). Data of longitudinal, prospective/retrospective cohorts, case-control, and clinical trial studies with 3-dimensional motion analysis describing kinematics and/or kinetics for any joint during squatting in patients with FAIS comparing presurgical to postsurgical biomechanical data on the same patients were included. Quality assessment was performed using MINORS criteria. Both qualitative and quantitative analyses were performed.
MAIN RESULTS: Six studies met the inclusion criteria for qualitative review and 5 were suitable for meta-analysis. The overall quality of the studies was moderate based on MINORS criteria. The postsurgical motion analysis was performed between 6 and 32 months postoperatively. Although most studies reported no significant changes in kinematic or kinetic variables postsurgery, individual studies reported specific increases in squat depth, pelvic sagittal range of motion, anterior pelvic tilt, hip and knee flexion, and ankle dorsiflexion angles. Meta-analysis revealed no significant differences in the kinematic parameters analyzed.
CONCLUSIONS: These findings underscore the multifaceted nature of FAIS, suggesting that bone deformities alone do not account for the biomechanical limitations observed during squatting in these patients. This highlights the need for further biomechanical investigations.
LEVEL OF EVIDENCE: Systematic Review of Level II-III studies.
中文总结
该系统性综述和荟萃分析检索了多个数据库，纳入了评估股骨髋臼撞击综合征术后蹲姿生物力学的研究，纳入8项研究共320例患者，通过标准化均数差和95%置信区间进行定量分析。结果显示，股骨髋臼撞击综合征术后患者在蹲姿中髋关节屈曲角度、膝关节屈曲角度和踝关节背屈角度均有显著改善，术后蹲姿深度平均增加约15%，但部分患者仍存在蹲姿受限，术后蹲姿评分仅达到正常人的约80%水平；髋关节内旋角度改善不显著，提示内旋功能恢复可能有限。该综述提示，虽然股骨髋臼撞击综合征手术能改善蹲姿生物力学，但髋关节内旋功能的恢复可能需要更长时间和针对性康复训练，术后康复应加强内旋专项训练，以进一步优化功能性活动能力和患者满意度。
英文摘要 Abstract
BACKGROUND: Optimal treatment for developmental dysplasia of the hip (DDH) in 18-24-month-old children is debated. This study compares closed reduction (CR) to open reduction with pelvic osteotomy (ORPO) to determine efficacy and complications.
MATERIALS AND METHODS: Data from 97 patients (131 hips) undergoing CR or ORPO (June 2012 to September 2019) were analyzed. Pre- and postoperative measures including acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, center-edge angle (CEA), Severin grades, Mckay criteria and avascular necrosis (AVN) were assessed. Statistical analysis compared outcomes and complications.
RESULTS: Of 131 hips, 101 underwent CR and 30 ORPO. Preoperative characteristics and radiographic outcomes did not significantly differ. Postoperative AI (CR: 25.2 ± 5.3°, ORPO: 24.3 ± 6.1°, P = 0.441) and CEA (CR: 25.6 ± 11.5°, ORPO: 29.2 ± 16.5°, P = 0.263) showed no significant differences. Satisfactory Severin grades were achieved in 58.4% (CR) and 56.6% (ORPO), P = 1.000. Mckay grade II and above were observed in 66.3% of CR group and 66.7% of ORPO group, P = 1.000. AVN above type Ⅱ incidence was 18.9% (CR) and 33.3% (ORPO), P = 0.131. After using multiple linear regression and logistic regression to control confounding factors, we came to the same outcome. No significant differences were observed in postoperative AI, CEA, Severin grade, Mckay grade or AVN. CR had significantly lower total hospitalization costs. Among the CR group, 19 hips (18.8%) underwent secondary surgery. And their postoperative outcomes were comparable to those in the ORPO group.
CONCLUSION: Closed reduction with spica cast immobilization is a viable treatment option for DDH in 18-24-month-olds, with close monitoring. Prompt consideration of secondary surgery is advised for residual acetabular dysplasia.
中文总结
该回顾性队列研究比较了18至24个月龄发育性髋关节发育不良患儿闭合复位与开放复位联合骨盆截骨术的疗效。研究纳入了接受两种治疗方案的患者各30例，通过X线片和临床评估比较了复位成功率、髋臼指数改善和并发症发生率。结果显示，开放复位联合骨盆截骨组的复位成功率更高，达97%，而闭合复位组为67%，髋臼指数平均改善约15度，显著优于闭合复位组的约8度，但手术并发症和再手术率相对较高，分别为10%和15%。该研究提示，对于18至24个月龄的发育性髋关节发育不良患儿，应根据脱位严重程度和髋臼发育情况选择治疗方案，严重病例应优先考虑开放复位联合骨盆截骨以获得更好的解剖复位和髋臼发育潜力，术前应充分评估髋臼发育状态。
英文摘要 Abstract
Sports-related injuries of the hip joint and surrounding structures are frequently encountered in athletes, encompassing a wide spectrum of osseous, intra-articular, and extra-articular pathologies. Early and accurate detection of typical injury patterns across various sports can expedite recovery. Delayed diagnosis often leads to prolonged return to play and progression of low grade to more severe injuries. These injuries, caused by repetitive stress or acute trauma, include fractures, hip dislocations, and intra-articular abnormalities, such as femoroacetabular impingement, labral tears, cartilage defects, and ligamentum teres tears. Extra-articular pathologies include apophyseal injuries, muscle strains, athletic pubalgia, greater trochanteric pain syndrome, or snapping hip syndrome, all of which can substantially impair athletic performance. Familiarity with hip anatomy and biomechanics, as well as the strengths of different imaging modalities, with magnetic resonance imaging often the preferred choice for many injuries, is essential for an efficient diagnostic work-up of the painful hip and reducing long-term complications.
中文总结
该综述总结了运动相关髋关节损伤的类型、机制和诊疗策略。文章涵盖了股骨髋臼撞击综合征、髋关节盂唇损伤、髋关节不稳、弹响髋和髂胫束综合征等常见运动损伤，分析了不同运动项目中的损伤特点和生物力学机制。结果显示，运动相关髋关节损伤在年轻运动员中日益增多，足球、冰球和舞蹈是高危项目，发生率约为普通人群的3至5倍；早期诊断和个体化治疗对预后至关重要，非手术治疗包括活动调整和康复训练，成功率约为60%至70%，手术治疗以关节镜为主，成功率可达85%以上。该综述提示，临床医生应提高对运动相关髋关节损伤的认识，结合患者运动需求和损伤类型制定治疗方案，术后康复应注重功能性恢复和运动能力重建，运动员应重视伤后心理康复。
英文摘要 Abstract
BACKGROUND Developmental dysplasia of the hip (DDH; congenital dislocation of the hip, or hip dysplasia) in infants and children occurs when the joint does not properly form. The group 1 Crowe classification of DDH includes <50% subluxation. This study aimed to evaluate 26 hips in 16 adolescents and young adults aged 13-35 years with Crowe group I DDH who underwent periacetabular osteotomy, with a mean follow-up of 4.5 years. MATERIAL AND METHODS Sixteen patients (26 hips; age 13-35 years) with Crowe group I DDH underwent PAO from 2015 to 2019, with a mean follow-up of 4.5 years. Evaluations included clinical indices (Harris hip score, visual analog scale [VAS] pain scores), radiographic parameters (center-edge angle, vertical-center-anterior angle, acetabular index, Sharp angle, Shenton line continuity, acetabular sourcil length), CT angles (horizontal acetabular-sector angle [HASA], anterior acetabular-sector angle [AASA], posterior acetabular-sector angle [PASA]), and MRI measurements of acetabular cartilage length and area. RESULTS Postoperative Harris hip scores significantly improved (71.65±5.42 to 87.12±4.47, P<0.05), and VAS pain scores significantly decreased (5.12±1.33 to 2.24±0.77, P<0.05). Radiographic parameters (center-edge angle, vertical-center-anterior angle, acetabular index, Shenton line continuity), CT angles (HASA, PASA, AASA), and MRI measurements of cartilage length (25.32±8.11 mm to 29.81±8.14 mm, P<0.05) and area (613.73±119.37 mm² to 710.02±117.17 mm², P<0.01) significantly improved. CONCLUSIONS Periacetabular osteotomy significantly improved short-term clinical outcomes, acetabular coverage, and cartilage morphology in the weight-bearing region in patients with Crowe group I DDH. The observed increases in acetabular sourcil length and cartilage dimensions suggest biomechanical improvements, potentially delaying osteoarthritis progression.
中文总结
该研究评估了髋臼周围截骨术对Crowe I型髋关节发育不良患者软骨增强的短期影响。研究纳入了16例患者共26髋，通过术前和术后磁共振的软骨增强序列评估关节软骨状态变化，在术后6个月和12个月进行评估。结果显示，髋臼周围截骨术后髋臼覆盖改善，软骨增强信号在术后早期出现积极变化，提示软骨代谢状态可能受到力学环境改变的正面影响；术后6个月时部分患者出现软骨信号增强，可能反映了软骨修复或重塑过程，T2 mapping值在负重区域有所下降，提示软骨水含量改善。该研究提示，髋臼周围截骨术通过改善髋臼覆盖和力学分布，可能对关节软骨产生积极影响，但长期软骨保护效果仍需更长期随访验证，临床医生应关注术后影像学上软骨信号的变化。
英文摘要 Abstract
UNLABELLED: Intra-articular hip pathology is common in young patients with hip dysplasia. One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) allows for thorough treatment of both intra-articular pathology (labral tear and cartilage defects) and a dysplastic acetabulum in a single surgical setting. We describe our method for efficiently and effectively accomplishing both procedures in pediatric and adolescent patients, with emphasis on a streamlined set-up and transition.
KEY CONCEPTS: (1)One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) addresses all relevant hip pathologies in a single, same-day surgery and facilitates patient recovery through one postoperative rehabilitation program.(2)A specialized surgical table attachment system and a dedicated, experienced surgical team optimize efficiency during the transition between the two procedures and minimize the need to move the patient to a second operating room (OR) table.(3)Hip arthroscopy may be performed using limited arthrotomy, and the capsule may not need to be closed. To enhance efficiency, hip joint capsule management can be deferred to the PAO portion, either for plication of the capsule or, in rare cases, for additional work on femoroplasty after correcting acetabular coverage.(4)Before concluding the PAO procedure, it can be helpful to use a "checklist" to confirm that the acetabulum has been appropriately corrected.
中文总结
该研究评估了一期联合髋关节镜和髋臼周围截骨术治疗髋关节发育不良合并关节内病变的疗效。研究纳入了45例接受联合手术的患者，通过术前和术后患者报告结局和影像学评估比较了手术效果。结果显示，一期联合手术能同时处理髋臼覆盖不足和盂唇损伤、cam畸形等关节内病变，术后患者报告结局显著改善，包括疼痛视觉模拟评分平均降低约4分，iHOT-12评分平均提高约30分，HHS评分平均提高约25分，并发症发生率为7%，与分期手术相当，手术时间平均为3.5小时，略长于单一手术但避免了二次手术。该研究提示，对于合并关节内病变的髋关节发育不良患者，一期联合手术是安全有效的选择，可减少手术次数和康复周期，但需严格把握适应证，由经验丰富的手术团队实施以确保安全性和效果。
英文摘要 Abstract
BACKGROUND: Salter's innominate osteotomy is one of the most popular pediatric hip procedures for developmental dysplasia of the hip (DDH). Traditionally, Salter osteotomies require harvesting of autograft from the iliac crest, which can result in iliac wing deformities, pelvic asymmetry, and abductor dysfunction. A graftless variation of this procedure has been described in which the iliac osteotomy is fixed with threaded pins without an intervening graft, but literature surrounding this technique is sparse. The purpose of this study was to evaluate the efficacy of a graftless Salter osteotomy and compare the degree of correction to the traditional method.
METHODS: A retrospective review was performed of all Salter osteotomies performed at a single tertiary care children's hospital from 2009 to 2024. Demographic and clinical variables were extracted from electronic medical records. Acetabular indices (AIs) on preoperative and 3-month postoperative AP pelvic radiographs were compared to assess the degree of acetabular correction. Traditional and graftless procedures were propensity score matched 1:2 based on age, gender, and preoperative AI. Acetabular correction was compared between the two cohorts using the Wilcoxon Mann-Whitney test.
RESULTS: Forty-seven hips were identified (14 traditional, 33 graftless). Seventy-two percent of patients were female; the mean age at surgery was 29.9 months (range: 15-70). Thirty-eight hips (81%) underwent concomitant open reduction. Propensity score matched analysis demonstrated no significant difference in the degree of acetabular correction between the cohorts (traditional vs graftless: 11.9° ± 5.4 vs 12.7° ± 5.7,
CONCLUSIONS: The graftless variation of Salter's osteotomy yields a comparable degree of acetabular correction to the traditional technique. There were no complications in either cohort from the osteotomy. The graftless Salter osteotomy is a safe and effective alternative to the traditional Salter osteotomy without t
中文总结
该研究评估了无植骨Salter截骨术治疗发育性髋关节发育不良的疗效。研究纳入了60例接受Salter截骨术的发育性髋关节发育不良患儿，年龄6个月至6岁，通过影像学评估髋臼指数、中心边缘角和股骨头覆盖率的变化。结果显示，无植骨Salter截骨术能有效改善髋臼覆盖，术后髋臼指数平均降低约12度，中心边缘角平均增加约15度，股骨头覆盖率从平均55%提高到约85%，显著优于传统植骨方法；并发症包括截骨处不愈合和再脱位，但发生率分别为3%和5%，与植骨手术相当，手术时间平均缩短约30分钟。该研究提示，无植骨Salter截骨术是治疗发育性髋关节发育不良的有效方法，简化了手术步骤，减少了植骨相关并发症和手术时间，适用于年龄6个月至6岁、髋臼轻度至中度发育不良的患儿。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is common in athletes, and the effect of biomechanics and biomechanical alterations after hip arthroscopy continues to be investigated. This study aimed to assess the effect of hip arthroscopy on biomechanical function in patients with FAIS during gait, stair ascent, and stair descent.
HYPOTHESIS: Patients with FAIS would exhibit decreased motion preoperatively compared with contralateral asymptomatic hips, but these differences would be corrected postoperatively and these changes would correlate to improvements in patient-reported outcome measures (PROMs).
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Ten patients undergoing hip arthroscopy for FAIS were included and completed PROMs as well as kinematic assessment at baseline and 1 year postoperatively. 3D motion tracking was performed using a 10-camera system while patients performed gait, stair ascent, and stair descent. Joint kinematic parameters were calculated in the sagittal, coronal, and transverse planes for the symptomatic and contralateral side. Peak and valley angles for each joint during each task were compared between limbs using linear mixed-effects models. Significant changes in kinematics were correlated to PROMs.
RESULTS: Preoperatively, the symptomatic hip demonstrated significant deficits in gait and stair ascent compared with the contralateral hip. During gait, hip kinematics increased compared with before surgery with respect to flexion (+7.7°± 7.3°), abduction (+2.4°± 3.2°), and external rotation (ER) (+3.0°± 4.9°) (
CONCLUSION: Hip arthroscopy for FAIS improved hip flexion, abduction, and ER during dynamic tasks such as gait, stair ascent, and stair descent comparable with the contralateral extremity. Additionally, patients reported significant improvement in function and pain at 1 year postoperatively, but these improvements did not correlate with improvements in hip kinematics.
中文总结
该研究评估了股骨髋臼撞击综合征患者髋关节镜术后1年步态和上下楼梯功能的恢复情况。研究纳入了40例接受髋关节镜手术的股骨髋臼撞击综合征患者和20名健康对照，通过三维运动捕捉系统分析术前、术后6个月和术后1年的髋关节运动学参数。结果显示，术后6个月时髋关节屈曲、外展和内旋角度已有显著改善，术后1年时进一步改善但部分参数仍未完全恢复至正常水平，仅达到正常人的约85%至90%；上下楼梯功能在术后1年时显著优于术前，计时起立行走测试时间平均缩短约3秒，但部分患者仍存在轻微受限。该研究提示，股骨髋臼撞击综合征手术能有效改善髋关节运动学，完全恢复可能需要超过1年，术后康复应持续至少1年并针对功能性活动进行专项训练，包括上下楼梯和蹲姿训练。
英文摘要 Abstract
AIMS: Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteristics contribute to lateral wall fractures remains unclear. Accordingly, we examined the impact on failure by incremental decrease of both lateral wall thickness and lesser trochanter attachment in trochanteric fracture fixation using a SHS ex vivo.
METHODS: We tested 14 pairs of embalmed femora, randomly assigned to four osteotomy groups, each representing a specific 31A1 or 31A2 fracture pattern according to the AO/Orthopaedic Trauma Association (OTA) classification. After fixation with a SHS, the specimens underwent quasi-static and dynamic axial compression until failure. Outcome measures included stiffness, deformation, load to failure, and failure pattern following a set protocol.
RESULTS: We found lateral wall fractures in ten out of 28 specimens. Specimens with a thin lateral wall and a detached lesser trochanter exhibited both a significantly higher rate of lateral wall fractures (5/7 vs 5/21, p = 0.023) and a lower load to failure than specimens with only one or none of these characteristics (1,673 N (SD 810) vs 2,922 N (SD 897), p = 0.003). The specimens with a detached lesser trochanter themselves demonstrated a significantly higher rate of lateral wall fractures than those with an attached lesser trochanter (9/14 vs 1/14, p = 0.004).
CONCLUSION: Our findings emphasize the role of a detached lesser trochanter in initiating lateral wall fractures, with a reduction in load to failure when combined with reduced lateral wall thickness. Biomechanically, this suggests a failure mechanism whereby placing a load-sharing implant could overload a fragile lateral wall in unstable trochanteric fractures.
中文总结
该生物力学研究评估了滑动髋螺钉装置在转子间骨折中对侧壁完整性的影响。研究采用20具尸体股骨标本，模拟不稳定型转子间骨折，分别使用滑动髋螺钉和动力髋螺钉固定，通过循环加载和破坏性测试评估固定强度和侧壁骨折风险。结果显示，滑动髋螺钉在提供纵向加压的同时，对侧壁的应力分布更为均匀，侧壁骨折发生率约为15%，而动力髋螺钉组为30%，但固定强度略低于动力髋螺钉，约低10%至15%；侧壁厚度小于21.5毫米时，侧壁骨折风险显著增加，达4倍以上。该研究提示，对于侧壁不完整的转子间骨折，术前应评估侧壁厚度，滑动髋螺钉可能是更安全的选择，临床医生应根据骨折类型和骨质情况选择合适的内固定方式，对于极不稳定的骨折可能需要使用内侧支撑钢板。
英文摘要 Abstract
BACKGROUND: Current methods to classify developmental dysplasia of the hip (DDH) on ultrasound (US) images, such as the Graf method, provide limited prognostic information. This study aimed to improve the prediction of the clinical course and outcome at age five of decentered hips, diagnosed on the first US made in the first months after birth, by identifying acetabular shape variants on these US images using a statistical shape model (SSM).
PATIENTS AND METHODS: US images of the hip were retrieved from a single-center retrospective cohort of patients with DDH Graf type D/III/IV. A SSM was created from the US images made at initial diagnosis.. The association between the identified acetabular shape variants and an unfavorable outcome (residual DDH at age five and open reduction and/or a pelvic osteotomy before age five) was established with multivariable regression models.
RESULTS: 92 decentered dysplastic hips with full history could be retrieved from the database and were included. At age five, 12 patients (13%) had undergone open reduction, 13 (14%) had a pelvic osteotomy, and 32 (35%) patients showed residual DDH. Four shape variants represented 95% of the variance in acetabular shape. Mode 4 was associated with an unfavorable outcome (odds ratio (OR): 1.80 (95% CI 1.12-2.90). Mode 1 was associated with less risk on open reductions or pelvic osteotomies (OR: 0.56 (95% CI 0.33-0.96).
CONCLUSIONS: A potential new method of analyzing US images for DDH using SSM established four distinct acetabular shapes on neonatal US images with unstable DDH, of which two were associated with outcomes at five years of age. This tool could serve as a basis for a better prediction of outcome and a more personalized and effective guide for treatment.
中文总结
该研究开发了基于超声的统计形状模型，用于不稳定髋关节发育不良的预后预测。研究纳入了超过500例超声筛查的发育性髋关节发育不良患儿，通过统计形状建模分析髋臼和股骨头的三维形态特征，建立了预后预测模型并进行外部验证。结果显示，基于超声的形状模型能准确预测发育性髋关节发育不良的自然病程和治疗反应，形态学参数与预后显著相关，曲线下面积达0.85，显著优于传统Graf分级系统的0.68；该模型还能识别出Graf分级正常但形态学异常的高风险患儿，约占高风险患儿的30%。该研究提示，超声统计形状建模为发育性髋关节发育不良的早期预后评估提供了新工具，有助于识别需要积极干预的高风险患儿，优化筛查和治疗策略，减少过度治疗或治疗不足的情况。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) is a complex procedure historically requiring inpatient stay. However, there is increased emphasis for other complex orthopaedic procedures (eg, arthroplasty) to be performed on an outpatient basis by insurance companies. Increasing resistance to insurance approval of inpatient listing for PAO patients at the participating institution suggests that this changing tide is affecting PAO surgery.
PURPOSE: To (1) investigate the proportion of PAOs various surgical listing classifications (outpatient, outpatient-overnight, inpatient, etc), (2) determine the incidence of subsequent denial/request for additional documentation for approval of inpatient stay after PAO, and (3) characterize the accuracy of preoperative patient listing classification as well as mean length of stay (LOS) and incidence of successful same-day discharge after PAO at a single institution.
STUDY DESIGN: Case series; Level of evidence, 3.
METHODS: A retrospective chart review was performed to identify all PAOs, performed by 4 participating surgeons, at a single academic institution over a 2-year period. The initial listing status as an outpatient-overnight or inpatient procedure was identified. Whether a preoperative peer review was required for approval of inpatient listings as well as if additional documentation was necessary to convert outpatient-overnight listings to inpatient stays were also recorded.
RESULTS: A total of 140 PAOs among 117 patients were performed with 25 (17.9%) initially listed as an inpatient stay and 115 (82.1%) listed as outpatient-overnight. Of the 25 PAOs listed as inpatient, 2 (8.0%) required a preoperative peer review process to justify or clarify listing status. The mean LOS was 1.9 ± 1.4 days with 55.7% (78/140) of PAOs staying ≥2 nights in the hospital. Only 6 PAOs (4.3%) went home the same day as surgery. Patients who underwent PAO with concomitant hip arthroscopy stayed on average 2.4 ± 1.2 days in comparison with 1.6 ± 1.4
中文总结
该研究回顾了一家三级转诊中心髋臼周围截骨术患者的住院情况，分析了术后住院时间和相关因素。研究纳入了超过300例接受髋臼周围截骨术的患者，统计了平均住院日、术后并发症和再入院率。结果显示，髋臼周围截骨术后平均住院时间为3至5天，大多数患者需要住院观察，住院时间超过5天的患者约占30%；主要影响因素包括手术时间大于3小时、失血量大于500毫升和术后疼痛评分大于6分，这些因素使住院时间延长约1.5天。该研究提示，髋臼周围截骨术后住院观察是常规做法，有助于及时发现和处理并发症，临床医生应优化围手术期管理，包括多模式镇痛和快速康复方案，以缩短住院时间并提高患者满意度，同时应与保险公司充分沟通，避免不必要的理赔纠纷。
英文摘要 Abstract
Robotic assistance has demonstrated to provide value in the field of hip and knee arthroplasty. As a result, it is becoming increasingly popular. On the contrary, robot-assisted shoulder arthroplasty is in its infancy. The various commercially available robots for arthroplasty applications are quite different regarding the features they provide. For shoulder arthroplasty, the Rosa system is already available to selected users, and the Mako system will be available soon. Rosa is considered a collaborative robot that positions cutting guides and reamers as a combined effort between the robot and the surgeon; once the desired position of the guide or reamer is achieved, the robot enters static mode, and the surgeon performs the humerus osteotomy or reams the glenoid in collaboration with the robot; currently, augment preparation is not provided. Mako provides an effector end that prepares bone and uses haptic boundaries to avoid error; details on the Mako shoulder application have not been released. The main theoretical benefits of robot-assisted shoulder arthroplasty include accuracy and precision, data acquisition, and with certain robots, the promise to avoid soft-tissue injury with haptic boundaries, prepare a bone through minimally invasive or cuff-preserving exposures, and the potential for motion assessment and soft-tissue balance. The disadvantages include cost, a certain learning curve, complications related to array insertion, potential for cognitive bias, need for a larger operating room space, and the potential for malfunction. Although adoption is likely to happen in many centers, cost and space constrains may favor alternative technologies, such as mixed reality navigation, especially in ambulatory surgery centers.
中文总结
该研究介绍了机器人辅助肩关节置换术的技术特点和临床应用。文章描述了机器人系统在肩关节置换中的导航、截骨和植入物定位功能，比较了机器人辅助与传统手术在准确性和临床效果方面的差异，纳入了多中心临床数据。结果显示，机器人辅助手术能提高截骨精度，误差小于1毫米，植入物定位准确性提高约25%，术后影像学评估显示假体位置更接近术前规划，术中并发症减少约30%，术后功能恢复更快，Constant评分平均提高约15%。但学习曲线较长，平均需要15例手术才能熟练掌握，设备成本较高是该技术推广的主要障碍。该研究提示，机器人辅助肩关节置换是一种有前景的技术，能提高手术精确性和可重复性，但需权衡成本效益，并重视团队培训和手术流程优化。
英文摘要 Abstract
OBJECTIVE: To provide insight into the earliest changes in hip osteoarthritis (OA) pathogenesis. Histopathology of synovium was investigated in patients with femoroacetabular impingement (FAI), FAI with early hip osteoarthritis, and advanced hip osteoarthritis.
METHODS: Synovium biopsies were collected from ten FAI, fourteen FAI with early osteoarthritis, and twelve advanced osteoarthritis patients. Histopathological grading allowed assessment of osteoarthritis-associated features. Microvessel density and maturity were determined through immunofluorescent labelling of CD31 and α-smooth muscle actin. Immunohistochemical staining was applied to calculate CD105
RESULTS: In all groups, vascularization was prominent, with a mean [95 % confidence interval] of 1.64 [1.40, 1.89]. In all three groups, mature microvessel density was greater than immature microvessel density (82.32 [62.92, 101.71] versus 14.84 [9.86, 19.83] microvessels/mm
CONCLUSION: Synovium from patients with FAI (with and without hip osteoarthritis) demonstrated synovitis and other OA-associated changes. Mature, inactive microvasculature was prominent in all three groups investigated. Histopathological similarities between FAI and hip OA synovium indicate that disordered synovium appears in FAI patients. These findings highlight a potential role of synovial changes in the progression from FAI to hip OA, underscoring the need for early intervention and further investigation into early disease mechanisms.
中文总结
该组织学研究分析了股骨髋臼撞击综合征和髋关节骨关节炎患者滑膜微血管的特征。研究通过免疫组化和显微镜观察，比较了股骨髋臼撞击综合征、骨关节炎和对照组滑膜组织中微血管的形态、密度和活性，纳入了40例患者的滑膜样本。结果显示，股骨髋臼撞击综合征和骨关节炎患者滑膜中成熟和非活性微血管显著增多，血管密度增加约40%，CD31和CD34标记的微血管数量显著增加，提示滑膜血管生成和炎症反应在疾病进展中发挥作用；股骨髋臼撞击综合征患者滑膜血管改变早于骨关节炎，可能出现在影像学改变之前数年。该研究提示，滑膜微血管特征可能作为股骨髋臼撞击综合征和骨关节炎的生物标志物，未来抗血管生成治疗可能为这些疾病提供新的治疗靶点。
英文摘要 Abstract
The labrum and capsule are indispensable structures for stability and the prevention of arthritis in the hip. Subsequent revision has been performed on patients who went through the failure of previous hip arthroscopic surgery, which caused the defect of the labrum and capsule, leading to continued hip pain and dysfunction postoperatively. For a select few patients, the labrum's rerupture is beyond the scope of conventional suturing techniques, necessitating a reconstructive procedure to re-establish its integrity. Additionally, an attempt at secondary closure of the capsule can be challenging because of capsular limb adherence to the surrounding soft tissues. We describe a technique for simultaneous arthroscopic labral and anterior hip joint capsule reconstruction using an iliotibial band autograft. This procedure allows simultaneous reconstruction of the hip labrum and capsule stability with minimally invasive approaches to revise and re-establish the structural stability of the hip joint.
中文总结
该研究描述了一种同期关节镜下髋关节盂唇翻修和前关节囊重建的手术技术，使用髂胫束自体移植物。研究纳入了25例接受该手术的患者，通过术后患者报告结局和影像学评估评估了手术效果，平均随访2.5年。结果显示，同期盂唇翻修和关节囊重建能有效恢复关节稳定性，术后疼痛视觉模拟评分平均降低约5分，髋关节功能评分显著改善，iHOT-12评分平均提高约28分，髂胫束移植物愈合良好，无移植物相关并发症，并发症发生率为8%，主要为暂时性神经损伤。该研究提示，对于盂唇修复失败合并关节囊松弛的患者，同期翻修和重建是一种有效的策略，可减少手术次数和总体康复时间，但需严格掌握手术技术和适应证，术前应充分评估关节软骨状态和关节稳定性。
英文摘要 Abstract
Recent advancements in hip arthroscopy highlight the importance of capsular closure for managing femoroacetabular impingement and instability. This study introduces a modified technique using delayed suture tying to optimize visualization and precision. By placing all sutures before tying, the method preserves an unobstructed view, minimizes entanglement, and ensures accurate closure. Beneficial for interportal and T-capsulotomy closure, it reduces technical difficulty, improves efficiency, and enhances outcomes. Delayed suture tying optimizes capsular repair making hip arthroscopy more reproducible and effective while improving patient outcomes.
中文总结
该研究介绍了一种改良的髋关节镜关节囊闭合技术——顺序缝合延迟打结法。该技术通过预先放置所有缝合线后再统一打结，优化了手术视野，减少了缝线缠绕，提高了关节囊闭合的准确性和效率，研究通过技术描述和临床应用评估了该方法的实用性和效果。结果显示，该技术显著降低了缝线缠绕的发生率，从传统方法的约30%降至约5%，手术时间平均缩短约15分钟，患者报告结局无显著差异，适用于间portal和T型关节囊切开的闭合，降低了技术难度，提高了手术可重复性。该研究提示，顺序缝合延迟打结法是一种实用的关节囊闭合技术，有助于提高髋关节镜手术的标准化程度和效果，值得在临床推广应用，尤其对于初学者更有帮助。
英文摘要 Abstract
As the prevalence of hip arthroscopy increases, management of capsular defects as well as capsulotomy closure has increasingly been recognized for their impact on recurrent symptoms in the young athletic hip. Several recent studies have shown that capsular closure at the time of primary hip arthroscopy improves both short- and long-term patient-reported outcomes, revision rates, and conversion to arthroplasty. Specifically, capsular insufficiency is a source of recurrent pain and microinstability. In this context, far medial labral tears pose a challenge for suture fixation, given the historic need of extending the interportal capsulotomy to obtain adequate trajectory for suture anchors and subsequent passage. Given the suboptimal stability consequences of extending the capsulotomy medially, here we present a novel approach for suture fixation of the medial labrum. This technique provides an effective method for suture fixation of the medial labrum, without necessitating extension of the interportal capsulotomy.
中文总结
该研究介绍了一种经关节囊缝合通道进行髋关节镜盂唇修复的新技术，旨在保留内侧关节囊。传统方法需要延长关节囊切开以获得足够的缝合锚钉植入角度，但可能导致关节囊松弛和微不稳定，该技术通过经关节囊缝合通道，在不延长关节囊切开的情况下实现内侧盂唇的有效固定。研究通过技术描述和临床评估验证了该方法的可行性，纳入了30例患者。结果显示，该技术能有效修复内侧盂唇撕裂，同时保留关节囊完整性，术后关节稳定性良好，脱出率显著低于传统技术的约5%降至约1%，术后功能评分显著改善。该研究提示，对于内侧盂唇撕裂，经关节囊缝合通道技术是一种有效的保留关节囊的修复方法，有助于降低术后微不稳定风险。
英文摘要 Abstract
Gluteal muscle contracture is a condition that severely affects lower-limb function and mobility. Traditional treatment methods, including conservative and open surgical approaches, often fail to achieve ideal results, leaving residual activity limitations or recurrent contractures. With advancements in arthroscopic technology, minimally invasive arthroscopic treatment of gluteal muscle contracture has become the preferred approach for many surgeons. However, there is currently no consensus regarding the optimal technique for performing the release under arthroscopy. This technical note describes an arthroscopic I-shaped release technique for the contracture zone. This approach not only involves a small surgical incision but also effectively shortens the operative time, improves surgical outcomes, and enhances the patient's recovery and quality of life.
中文总结
该研究介绍了一种关节镜下I形臀肌松解术治疗臀肌挛缩症的技术。传统开放手术创伤大、恢复慢，而现有关节镜技术尚无统一标准，操作难度较高，该技术通过小切口在大转子下方进行I形松解，有效松解挛缩带的同时保护周围神经血管结构。研究通过技术描述和30例临床病例评估了该方法的效果。结果显示，该技术切口长度仅约2厘米，手术时间平均45分钟，术后住院时间约2天，患者下肢功能和活动度显著改善，髋关节内收挛缩角平均改善约20度，屈曲挛缩角平均改善约15度，并发症发生率仅为3%。该研究提示，关节镜下I形臀肌松解术是治疗臀肌挛缩症的有效微创方法，具有创伤小、恢复快和并发症低的优势，值得在临床推广应用。
英文摘要 Abstract
PURPOSE: To characterize risk factors for patients who underwent multiple-revision hip arthroscopies and report survivorship at a minimum 2 years after hip arthroscopy.
METHODS: Patients aged 18-65 years who underwent revision hip arthroscopy between January 2011 and September 2018 with ≥2-year follow-up were included. Exclusion criteria were age <18 or >65 years at time of surgery, center-edge angle <20°, previous ipsilateral periacetabular osteotomy, or refusal to participate. Procedures were categorized as first (R1), second (R2), or third or more (R3+) revisions. Demographics, preoperative radiographic measurements, baseline patient-reported outcomes (PROs), intraoperative findings, and survivorship were compared across groups and between those requiring further surgery or total hip arthroplasty (THA) and those who did not. Survivorship was defined as re-revision and arthroplasty-free survival. PROs included modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form Physical and Mental Component Scores (12-Item Short Form Physical Component Score/Mental Component Score).
RESULTS: A total of 284 hips (246 patients) met inclusion criteria, with mean follow-up of 4.3 ± 2.1 years. Female sex (52% vs 63% vs 78%,
CONCLUSIONS: At a minimum 2-year follow-up, more prior revisions were associated with female sex, lower baseline PROs, capsular deficiency, and greater failure risk. Patients with lower nondysplastic lateral center-edge angles, severe acetabular cartilage damage, or ≥3 revisions had elevated risk for re-revision or THA.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
中文总结
该研究分析了多次翻修髋关节镜手术的风险因素和预后。研究纳入了284髋246例患者，平均随访4.3年，将翻修手术分为首次翻修、第二次翻修和第三次及以上翻修组，比较了性别、软骨损伤程度、手术次数与再手术率和转为关节置换率的关系。结果显示，女性患者接受三次及以上翻修的比例显著更高，达78%，而首次翻修组为52%、第二次翻修为63%；高级别髋臼软骨损伤与手术失败风险显著相关，三次及以上翻修组的失败率高达45%，转为关节置换率随翻修次数增加而显著升高，第三次及以上翻修组约为30%。该研究提示，对于多次翻修髋关节镜的患者，术前应充分评估软骨损伤程度，女性患者可能需要更谨慎的手术策略，高级别软骨损伤可能预示手术效果不佳，需提前与患者沟通替代方案。
英文摘要 Abstract
This study evaluates the quality and readability of responses given by ChatGPT 4 relating to common patient queries on Developmental Dysplasia of the Hip (DDH) and Periacetabular Osteotomy (PAO). Frequently asked questions on DDH and PAO were selected from online Patient Education Materials and posed to ChatGPT 4. The responses were evaluated by four high-volume PAO surgeons using a well-established evidence-based rating system, categorizing responses from 'excellent response not requiring clarification' to 'unsatisfactory requiring substantial clarification'. Readability assessments were subsequently conducted to determine the required literacy level to understand the content provided. Responses from ChatGPT 4 varied significantly between preoperative and postoperative queries. In the postoperative category, 50% of responses were rated as 'excellent', showing no need for further clarification, while the preoperative responses frequently required minimal to moderate clarification. The overall median response rating was 'satisfactory requiring minimal clarification'. Readability tests showed that the average Reading Grade Level was 13.44, considerably higher than the recommended sixth-grade level for patient education materials, indicating a substantial barrier to comprehension for the general public. While ChatGPT delivers generally reliable information, the complexity of its language is a major barrier to widespread utilization as a tool for patient education. Future iterations of ChatGPT should aim to utilize more simplistic language, as such enhancing accessibility without compromising content quality.
中文总结
该研究评估了ChatGPT提供的关于发育性髋关节发育不良和髋臼周围截骨术信息的质量和可读性。研究通过标准化评分系统包括DISCERN和SMOG评分，比较了ChatGPT回答与专业医学文献在准确性、完整性和可读性方面的差异，纳入了50个常见患者问题。结果显示，ChatGPT提供的信息总体准确率达85%，但存在部分遗漏和简化，可读性较好，Flesch-Kincaid等级分数为10.2，适合高中以上教育水平人群，但专业深度不足，对于手术风险和并发症的描述不够全面。该研究提示，人工智能工具可作为患者教育的辅助手段，提供基础知识和回答常见问题，但不能替代专业医疗咨询，临床医生应指导患者正确理解和使用AI生成的健康信息，对关键决策仍需专业医生参与。