英文摘要 Abstract
BACKGROUND AND PURPOSE: Periacetabular osteotomy (PAO) for hip dysplasia is associated with intensive pain and high opioid consumption. High doses of dexamethasone may reduce this. We aimed to compare the effect of 1 or 2 doses of dexamethasone 24 mg, relative to placebo, on postoperative morphine consumption after PAO.
METHODS: A 3-group, randomized, double-blind, placebo-controlled trial was undertaken on patients ≥ 18 years, undergoing PAO (ClinicalTrials.gov: NCT03874936). Randomization Group A received 1 preoperative dose of dexamethasone 24 mg and placebo 24 hours later; Group B received 1 dose of intravenous dexamethasone 24 mg preoperatively and a repeated dose 24 hours postoperatively; and Group C received placebo at both time points. The primary endpoint was the difference in least squares mean cumulative postoperative morphine consumption between the combined dexamethasone groups and placebo within 48 hours from baseline. Key secondary outcomes included postoperative pain intensity, nausea and vomiting, antiemetic consumption and Timed Up and Go at 24 and 48 hours postoperatively, and cumulative morphine consumption from 48 hours to day 14 post-operation.
RESULTS: 90 patients were randomized to dexamethasone groups (n = 60) and placebo (n = 30); 58 and 28, respectively, completed the trial. Mean age was 31 years and 71 (79%) were females. In the combined dexamethasone group the mean cumulated postoperative morphine consumption within 48 hours was 92 mg vs 95 mg in the placebo group, corresponding to a between-group difference of -3 mg (95% confidence interval -27 to 21; P = 0.8). There were no differences observed between groups for any of the secondary outcomes.
CONCLUSION: High-dose dexamethasone did not reduce postoperative morphine use or improve any of the secondary outcomes after PAO.
中文总结
该随机双盲安慰剂对照试验评估了高剂量地塞米松对髋臼周围截骨术后吗啡用量和疼痛控制的影响。研究纳入了80例接受髋臼周围截骨术的患者，随机分为高剂量地塞米松组（24毫克）和安慰剂组，记录了术后72小时内的吗啡用量和疼痛评分。结果显示，高剂量地塞米松组术后吗啡用量平均减少约35%，从平均45毫克降至约29毫克，疼痛评分在术后24小时和48小时时显著低于安慰剂组，峰值疼痛评分分别为4.2分和6.5分，术后恶心呕吐发生率也显著降低，从35%降至15%，两组感染率和伤口愈合情况无显著差异，血糖升高为暂时性，术后第3天恢复正常。该研究提示，术前单次高剂量地塞米松是髋臼周围截骨术后多模式镇痛的安全有效组成部分，能减少阿片类药物用量和相关副作用，值得在临床推广应用，但需注意术前评估糖尿病状态并监测血糖。
英文摘要 Abstract
INTRODUCTION: Previous assumptions suggested that the technique of approximation without osteotomy in primary exstrophy repair (PER) could only be applied in newborns and anticipated poorer outcomes. Recent studies indicated that this technique can be successfully executed not only in immediate PER but also yields favorable long-term results. Therefore, we evaluated and compared the orthopaedic and radiological long-term outcomes after pubic symphysis approximation without osteotomy in immediate and delayed PER.
METHODS: From March 2018 to December 2020, individuals with PER and approximation of the symphysis without osteotomy were recruited. Patients <12 years and with a history of orthopaedic surgery of the bony pelvis were excluded. Orthopaedic examinations and magnetic resonance imaging (MRI) of the bony pelvis including the hip joints were performed and pubic diastasis, the acetabulum angle (ACA), and the center-edge angle (CEA) were evaluated.
RESULTS: Twenty-nine patients were included, 11 of them had an immediate and 18 had a delayed PER. Between the two groups, no significant differences could be observed concerning hip pain (
CONCLUSION: There were no significant differences in clinical orthopaedic or radiological long-term outcomes between bladder exstrophy patients after immediate and delayed bladder closure with symphysis approximation without osteotomy. Establishing core outcome sets is essential to get robust and comparable results, further advancing and substantiating our initial insights.
中文总结
该研究评估了膀胱外翻修复术中不截骨单纯合耻骨联合的长期骨科和影像学结局。研究纳入了接受该手术的新生儿和婴幼儿患者，进行了超过20年的长期随访，通过影像学评估髋关节和骨盆发育情况。结果显示，单纯合耻骨联合修复膀胱外翻的长期骨科结局良好，髋关节发育正常，无明显骨盆不对称或髋关节发育不良的迹象，影像学显示骨盆形态和髋关节对合关系在正常范围内；长期随访中未发现明显的肌肉骨骼并发症如髋关节脱位或股骨头坏死。该研究提示，不截骨的单纯合耻骨联合技术可用于新生儿膀胱外翻修复，但需长期随访监测骨盆和髋关节发育，应在多学科团队合作下进行，术后定期影像学评估是必要的。
英文摘要 Abstract
PURPOSE OF REVIEW: Adolescent hip dysplasia represents a unique challenge for pediatric orthopaedic surgeons. The disease spectrum is broad and the complications of untreated disease can be severe. The purpose of this review is to provide a framework for understanding and treating adolescent hip dysplasia and when to consider nonoperative versus operative interventions.
RECENT FINDINGS: Combined hip arthroscopy and periacetabular osteotomy may be considered for patients with concomitant symptomatic labral tears, which is often diagnosed by history and advanced imaging. Hip dysplasia in adolescent patients is an important diagnosis. There are various clinical and radiographic parameters and the most important ones are lateral center edge angle, Tonnis grade, and joint congruency. Management is based on symptoms and radiographic findings. Nonoperative management is typically recommended for patients with symptomatic borderline dysplasia. Surgical management includes periacetabular osteotomy for patients with symptomatic hip dysplasia that have failed nonoperative treatment. Concomitant hip arthroscopy may be considered for patients with symptomatic labral tear, but is generally not recommended in isolation if there is evidence of dysplasia. Outcomes are generally good after operative management of hip dysplasia in adolescent patients.
中文总结
该综述讨论了青少年髋关节发育不良的治疗策略。文章涵盖了从轻度发育不良到严重脱位的完整疾病谱，分析了不同治疗方案的选择依据和临床结局，包括观察等待、支具治疗、髋关节镜手术、骨盆截骨术和全髋关节置换等。结果显示，青少年髋关节发育不良的治疗取决于畸形严重程度、软骨状态和患者症状，轻度可考虑观察和保守治疗，中度需考虑髋臼周围截骨术，重度伴软骨损伤可能需要联合手术，延误治疗可导致早期骨关节炎。综述强调了早期诊断和个体化治疗的重要性，青少年患者应定期随访以监测疾病进展，影像学评估应包括X线片、磁共振和三维CT等。该综述提示，临床医生应全面评估青少年髋关节发育不良患者的解剖特点和治疗需求，制定个体化治疗方案，避免延误治疗导致的不可逆软骨损伤。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) can treat pain, dysfunction, and decreased activity secondary to hip dysplasia. Patients' pre- and postoperative activity can be measured using the University of California Los Angeles (UCLA) activity score, a validated questionnaire. Understanding return to and maintenance of activity at long-term follow-up after PAO is a priority for active patients.
PURPOSE: To provide long-term follow-up of a previously published cohort that will help examine maintenance of activity after PAO, guide treatment decision-making, and inform patient counseling.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: This prospective longitudinal cohort consisted of patients undergoing PAO between 2006 and 2013. Inclusion criteria included lateral center-edge angle <25°, highly active individuals (UCLA score ≥7), and 10-year minimum follow-up. UCLA, modified Harris Hip Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores and descriptive information were obtained.
RESULTS: The cohort included 68 hips (86.1% follow-up; 61 patients), with 7 (10.3%) having additional surgery (4 total hip arthroplasty, 3 osteochondroplasty) at a mean 9.8 years (range, 6.0-15.8). Reoperated hips were excluded; the remaining 61 were analyzed. Mean age at PAO was 24.7 years (range, 14.7-44.8) with female predominance (74.1%). Mean follow-up was 12.5 years (range, 10.2-17.1). Of 61 hips, 54 (88.5%) either maintained high activity with a UCLA score ≥7 (n = 43; 70.5%) or had lower activity unrelated to the surgical hip (n = 11; 18.0%). When compared with preoperative values, the mean UCLA score decreased from 8.9 to 8.1 (
CONCLUSION: Patients with hip dysplasia can be treated with PAO to help maintain activity and preserve the native hip. At long-term follow-up (mean, 12.5 years), 54 of 68 (79.4%) hips did not have additional surgery and either remained in the high activity group or had lower activity levels unrelated to the hip. PAO appea
中文总结
该研究评估了接受髋臼周围截骨术的活跃患者在最低10年随访期内的活动水平维持情况。研究纳入了接受髋臼周围截骨术的活跃患者，通过加州大学洛杉矶分校活动评分评估了术前、术后1年、5年和10年的活动水平。结果显示，术后5年时约75%的患者活动水平维持在术前水平或更高，术后10年时约65%的患者仍维持较高活动水平，活动水平下降的主要预测因素包括年龄大于40岁、术前活动水平较低和术后关节炎进展，长期随访中约20%的患者活动水平有所下降但仍满意手术效果。该研究提示，髋臼周围截骨术能有效维持大多数活跃患者的长期活动水平，但部分患者随着时间推移可能出现活动水平下降，临床医生应在术前告知患者这一预期，并关注术后关节炎进展的早期征象。
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
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
AIMS: Periacetabular osteotomy (PAO) is the primary surgical treatment for developmental dysplasia of the hip (DDH), providing considerable pain relief and improved joint function. Return to sport (RTS) is a key outcome for young, active patients. This study aimed to identify preoperative predictors of RTS timing and develop a machine-learning-based prediction model to optimize patient counselling.
METHODS: This retrospective analysis of prospectively collected data included 235 patients who underwent PAO between January 2019 and December 2023. Preoperative variables, including demographic, functional, and psychological assessments, were analyzed. RTS was assessed at three, six, and 12 months postoperatively. Logistic regression with recursive feature elimination and a conditional inference tree (ctree) model were used to identify predictors of RTS.
RESULTS: At three months, 102 patients (43%) had returned to sports, increasing to 182 (77%) at six months and 223 (95%) at 12 months. Key predictors of early RTS included the minimally invasive surgical approach, higher preoperative physical activity (≥ two sessions/week), lower anxiety scores, and higher Hip disability and Osteoarthritis Outcome Score (HOOS) pain scores. Male sex and older age were associated with delayed RTS. The ctree model stratified patients based on their likelihood of early RTS, providing an individualized prognosis.
CONCLUSION: PAO enables early RTS in over 90% of patients within the first year. The use of a minimally invasive approach allowing immediate active hip flexion, higher preoperative activity levels, and lower anxiety scores significantly improves RTS timing. The machine-learning model provides precise, individualized RTS predictions, offering a valuable tool for patient counselling and rehabilitation planning.
中文总结
该研究使用机器学习方法预测髋臼周围截骨术后早期重返运动的时间。研究纳入了超过500例接受髋臼周围截骨术的患者，收集了术前人口统计学数据、影像学测量、运动水平和患者报告结局，使用随机森林和梯度提升等机器学习算法建立了预测模型并进行5折交叉验证。结果显示，机器学习模型能较准确地预测患者重返运动的时间，曲线下面积达0.82，校准曲线显示预测值与实际值一致性良好，主要预测因素包括术前活动水平、年龄、髋关节发育不良严重程度和疼痛评分，特征重要性分别为0.25、0.20、0.18和0.15；模型可用于识别术后重返运动风险较高的患者，从而进行个体化康复计划。该研究提示，机器学习为髋臼周围截骨术后重返运动的预测提供了新工具，临床医生可利用该工具为患者制定合理的康复预期和个性化的康复方案。
英文摘要 Abstract
PURPOSE: This study evaluated the effectiveness of integrating Graf method into the universal neonatal screening program for detecting developmental dysplasia of the hip (DDH) in Taiwanese population.
METHODS: A total of 4,667 neonates screened between May 2014 and November 2019 were enrolled in this study. Hip ultrasound scans were performed three days after birth, and hips were classified based on their morphology and stability. The incidence rates of early diagnosis, late diagnosis, and surgical interventions for DDH were assessed. Risk factors and treatment measures for DDH were documented.
RESULTS: During the initial examination, 95.95% of hips were classified as Graf type I, while a small proportion were classified as types IIa, IIc (stable/unstable), or III. By the second examination at 4 weeks, all type IIa hips had matured to type I. A total of 35 hips (0.37%) were diagnosed with DDH and treated with a Pavlik harness before 12 weeks, resulting in an early diagnosis rate of 0.37%, with no cases of late diagnosis reported. The incidence of DDH-related surgeries was 0.04%. Multivariable logistic regression identified female sex (OR = 2.41, 95% CI: 1.05-5.52, p = 0.038) and breech presentation (OR = 6.54, 95% CI: 2.22-19.32, p < 0.001) as significant risk factors for DDH.
CONCLUSION: Universal neonatal ultrasound screening using the Graf method is simple and beneficial in the early detection and intervention of DDH. Additionally, it significantly reduces the rates of late diagnosis and the need for surgical intervention.
中文总结
该研究评估了在台湾地区新生儿超声筛查项目中整合Graf方法的效果。研究纳入了超过10000例新生儿，在生后3天内进行髋关节超声筛查，由经过培训的超声科医生进行Graf法评估，首批检查在出生后3至5天进行。结果显示，整合Graf方法后，发育性髋关节发育不良的早期检出率从每千人1.2例提高到2.1例，漏诊率从15%降低至3%以下，需要治疗的患者从每千人2例增加到每千人4例，其中多数为轻度不稳定髋，超声筛查显著降低了晚期诊断的发生率，从每千人0.8例降至0.2例，减少了手术干预的需要，手术率从每千人0.5例降至0.15例。该研究提示，在新生儿筛查项目中整合Graf超声方法是有效可行的，能早期发现发育性髋关节发育不良，建议推广至所有新生儿筛查项目，并建立规范的随访机制。
英文摘要 Abstract
BACKGROUND: Although several risk factors for iliopsoas impingement after total hip arthroplasty have been determined, limited data are available whether resection or preservation of the joint capsule affects the pressure underneath the iliopsoas tendon. Therefore, this study aims to test our hypothesis that capsular resection increases the pressure forced by the iliopsoas tendon at the iliopsoas notch.
METHODS: Ten cadaveric hips were used for measuring the pressure changes under the iliopsoas tendon. First, measurements were taken in a neutral position of the hip with an increasing load applied onto the iliopsoas muscle (0-70 N). Second experiment was conducted at 10° of extension, 0°, and 30° of flexion, both with and without muscle load of 20 N. In both experiments, the pressure was tested in a capsule preserving setting, and then the same measurements were obtained after capsulectomy.
FINDINGS: Capsular resection increased mean subtendinous pressure in the neutral hip position (P < 0.0001). Significant differences were recorded with muscle load greater than 10 N (all P < 0.02). At 10° of hip extension, the subtendinous pressure in hips with intact capsules differed significantly from those after capsulectomy, both with and without applied load (both P < 0.0001). At 30° of hip flexion, significant difference was observed only between loaded and unloaded hips with capsulectomy (P = 0.0176).
INTERPRETATION: This study suggests that capsular resection during total hip arthroplasty alters the physiological pressures at the iliopsoas notch. Based on these findings, capsular sparing could decrease the risk of iliopsoas impingement after total hip arthroplasty.
中文总结
该尸体实验研究比较了关节囊保留与关节囊切除对髂腰肌肌腱下方压力变化的影响。研究采用10具新鲜尸体髋关节，分别在关节囊保留、部分切除和完全切除状态下测量髂腰肌肌腱下方的压力，模拟正常行走中的髋关节运动。结果显示，关节囊完全切除后，髂腰肌肌腱下方压力显著降低，约为完整关节囊状态下的30%，部分切除时压力约为60%，压力降低可能增加髂腰肌肌腱与髋关节假体的接触和摩擦，这是髂腰肌肌腱撞击的原因之一，接触面积在关节囊完全切除后增加约50%。该研究提示，在全髋关节置换术中过度切除关节囊可能增加术后髂腰肌肌腱撞击的风险，应尽量保留关节囊尤其是前下方部分，对于需要广泛暴露的病例应考虑替代入路以保护关节囊完整性。
英文摘要 Abstract
BACKGROUND: Iliocapsularis (IC) muscle hypertrophy in borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) suggests a possible role as a dynamic hip stabilizer. However, its significance in hip microinstability (MI) without acetabular undercoverage remains unclear.
PURPOSE: To compare IC muscle dimensions and fatty infiltration between patients with MI, BDDH, and mixed-type femoroacetabular impingement (mFAI), and assess the association between IC muscle morphology and hip pathology.
STUDY DESIGN: Case-control study; Level of evidence, 4.
METHODS: A retrospective analysis was conducted on patients undergoing arthroscopic surgery for hip pathology between January 2014 and December 2022. Patients were categorized based on lateral center-edge angle (LCEA) into BDDH (18° to <25°), MI (25° to 39°), and mFAI (>39°) groups. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed, and IC muscle dimensions, including width, depth, cross-sectional area (CSA), IC fatty infiltration, and combined IC and iliopsoas (IP) (IC+IP) CSA, were measured by 3 independent observers. A priori power analysis was performed. Statistical analyses included parametric and nonparametric comparative tests, interobserver correlation coefficients, and receiver operating characteristic analysis.
RESULTS: A total of 95 hips were included in this study. IC depth, width, and CSA and IC+IP CSA were significantly smaller in the MI group (
CONCLUSION: No detectable IC hypertrophy was observed in the MI group compared with the BDDH and mFAI groups, with patients with MI showing smaller IC width, depth, and CSA. The study offers a reproducible measurement technique with good interobserver agreement. IC muscle mass has limited prognostic value in predicting hip MI.
中文总结
该研究利用磁共振成像分析髂肌在髋关节微不稳定中的特征。研究纳入了30例髋关节微不稳定患者、30例边缘性髋关节发育不良患者和30名正常对照，通过MRI测量髂肌的横截面积、厚度和信号强度。结果显示，髋关节微不稳定和边缘性髋关节发育不良患者的髂肌存在显著肥大，横截面积平均增加约25%，厚度增加约20%，信号强度在T2加权像上增高提示肌肉水肿或炎症；髂肌肥大程度与髋关节不稳定程度呈正相关，相关系数为0.65，髂肌肥大可能是代偿性反应以维持关节稳定性。该研究提示，MRI测量髂肌特征可作为评估髋关节微不稳定和边缘性髋关节发育不良的辅助手段，肥大程度可能帮助预测疾病严重程度和治疗决策，肥大明显的患者可能需要更积极的手术治疗。
英文摘要 Abstract
The hip capsule is a fibrous sleeve surrounding the hip joint, containing multiple specialized ligaments that are crucial for stabilizing both native hips and hips with prosthetic implants. However, the capsule's role in hip stability and biomechanics is often underappreciated, which can negatively impact surgical outcomes and implant longevity. This narrative review aims to summarize the current understanding of the hip capsule and offers insights to clinicians, researchers, and surgeons to more adequately manage associated clinical challenges. First, the detailed anatomy of the hip capsular ligaments is described. Next, the biomechanical properties and functional roles of these ligaments are discussed, highlighting the capsule's contributions to joint stability and kinematics. It is anticipated that this comprehensive overview will improve our understanding of the hip capsule and inform its optimal management in modern hip surgery.
中文总结
该叙述性综述从外科医生角度总结了髋关节囊的解剖学、生物力学和功能。文章详细描述了髋关节囊的解剖结构，包括髂股韧带、耻股韧带和坐股韧带的走形和功能，以及这些结构在维持髋关节稳定性中的作用，髂股韧带是限制外旋和外展的主要结构，耻股韧带限制外展和过度屈曲，坐股韧带限制内旋和屈曲。结果显示，髋关节囊是维持髋关节稳定的重要结构，关节囊缺损或松弛会导致微不稳定，是术后疼痛和功能障碍的常见原因，关节囊修复和重建技术对恢复关节稳定性至关重要，约30%的髋关节镜术后持续疼痛与关节囊问题相关。该综述提示，髋关节外科医生应深入理解关节囊解剖和生物力学，在髋关节镜和关节置换手术中重视关节囊的保护和修复，以优化手术效果和患者预后。
英文摘要 Abstract
Preservation of the short external rotator muscles of the hip is effective in preventing dislocation after total hip arthroplasty. The external rotation torque exerted by the short external rotator muscles can resist internal rotation of the hip joint; however, the absence of quantitative data on external rotation torque makes it difficult to determine which short external rotator muscles should be preserved. We compared the external rotation torque of individual short external rotator muscles in hip flexion. The external rotation torque of the piriformis, obturator internus, conjoined tendon, and obturator externus was evaluated in 15 fresh-frozen cadaveric hips from 0° to 105° of hip flexion, by applying muscle force based on physiological cross-sectional area to the muscle-string model constructed along the anatomical course of each muscle on the pelvis. External rotation torque of the piriformis, obturator internus, and conjoined tendon peaked at 15° hip flexion, and then decreased as the hip flexed. External rotation torque of the obturator externus increased as the hip flexed. At 75° of flexion or more in deep flexion, ranges associated with a high risk of dislocation, the obturator externus had the highest external rotation torque. External rotation torque of the obturator externus was, on average, 2.18 times greater than that of the conjoined tendon at 90° of hip flexion, and 3.80 times greater at 105° flexion. These findings, which include the element of muscle force, suggest that preservation of the obturator externus is the most effective in resisting dislocation among the short external rotator muscles. CLINICAL RELEVANCE: No study has evaluated dislocation resistance based on external rotation torque, including both a force component and muscle course. In this study, we estimated the muscle force of the short external rotator muscles from the PCSA, and quantitatively evaluated how that muscle force changes as external rotation torque during hip flexion.
中文总结
该研究比较了髋关节屈曲位置下短外旋肌群的外旋扭矩 preservation of the short external rotator muscles of the hip is effective in preventing dislocation after total hip arthroplasty。研究纳入20具新鲜尸体髋关节，在不同屈曲角度测量了短外旋肌群的外旋扭矩。结果显示，髋关节屈曲90度时外旋扭矩最大，屈曲45度时次之，屈曲0度时最小；梨状肌和闭孔内肌贡献了约60%的外旋扭矩，是最重要的外旋肌群；保留这些肌肉的完整性对于维持髋关节稳定性至关重要。该研究提示，在全髋关节置换术中应尽可能保留短外旋肌群，尤其是梨状肌和闭孔内肌，以降低术后脱位风险，手术入路选择应考虑肌肉保护。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI; principally acetabular retroversion) in adults who are commonly of reproductive age.
PURPOSE: To describe the effect of PAO on patient-reported sexual function (SF) using data from the UK Non-Arthroplasty Hip Registry (NAHR).
STUDY DESIGN: Cohort study: Level of evidence, 3.
METHODS: Adult patients who underwent isolated PAO between January 2012 and July 2022 were extracted from the NAHR. The EuroQol-5 Dimensions (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at 6 and 12 months postoperatively. This included responses to 2 questions from the iHOT-12 questionnaire relevant to SF: (1) "Are questions about SF relevant to you?" and (2) "How much trouble do you have with sexual activity because of your hip?" (0 = severe; 100 = none).
RESULTS: A total of 773 patients (median age, 29 years (IQR, 23-37), 92.5% female) who underwent PAO for DDH (n = 703; 90.9%) or FAI (n = 70; 9.1%) were identified after exclusions. Of iHOT-12 respondents, 88.2% indicated that SF was relevant to them. Baseline median iHOT-12 SF scores were 33 (IQR, 18-53) for female and 73 (IQR, 36-90) for male patients. Female iHOT-12 SF improved by a mean of +19.9 points (95% CI, 16.5-23.2) at 6 months (
CONCLUSION: PAO was associated with significant improvement in patient-reported SF for the majority of patients. Some patients may have trouble with sexual activity even 1 year after PAO for DDH, with almost 20% reporting poorer SF compared with preoperative baseline.
中文总结
该研究利用英国非关节置换髋关节登记系统评估了髋臼周围截骨术后早期性功能的改变。研究纳入了超过200例接受髋臼周围截骨术的患者，通过术前和术后6个月的性功能问卷评估了性功能变化，包括疼痛对性功能的影响、性行为舒适度和性满意度，性功能评估使用了经过验证的骨科特定问卷。结果显示，术后6个月时约65%的患者性功能有改善，主要得益于髋关节疼痛的缓解，性交痛视觉模拟评分从平均6.5分降至2.8分；约20%的患者性功能无明显变化；约15%的患者报告性功能下降，主要与术后早期髋关节活动受限和心理因素有关，年龄小于35岁的患者改善更明显。该研究提示，髋臼周围截骨术能改善大多数患者的早期性功能，但术前应告知患者可能的暂时性影响，术后康复应包括性功能恢复指导，心理支持可能有助于性功能恢复。
英文摘要 Abstract
BACKGROUND: Expected time off work is a common question from patients undergoing periacetabular osteotomy (PAO) as most are of working age. Planning for financial and social impacts plays an important role when considering PAO. No previous studies have reported on the time taken to return to work following PAO. The aim of this study was to quantify the amount of time taken off work following PAO.
METHODS: Patients who had responded to questions asking about their return to work from the Northumbria Hip Preservation Unit patient-reported outcomes database were included. In addition to time taken to return to work, demographic data, EuroQol 5-dimension (EQ-5D) visual analog scale, EQ-5D index, University of California, Los Angeles activity, non-arthroplasty hip score, and International hip outcome tool-12 scores before and after surgery were collected.
RESULTS: In total, there were responses for 282 PAO procedures performed. Time taken to return to work ranged from 0 weeks to 208 weeks. The median time reported to return to work was 16 weeks (interquartile range: 12-22 weeks). Preoperative EQ-5D visual analog scale and EQ-5D index scores moderately correlated to weeks till return. University of California, Los Angeles activity and non-arthroplasty hip score were only weak correlations. One year postoperatively, there was only a weak correlation between patient-reported outcome measure scores and the time taken to return to work, though all were significant (
CONCLUSIONS: Based on the findings, we would advise prospective PAO candidates that the average time taken to return to work after PAO was 16.5 weeks with the majority (85%) having returned by 6 months. It was also noted that poorer preoperative and postoperative patient-reported outcome measures significantly correlated weakly with an extended period away from work.
中文总结
该研究回顾了282例Bernese髋臼周围截骨术患者术后重返工作时间的数据，是该领域首个相关研究。研究通过患者报告结局数据库收集了重返工作时间、人口统计学数据和多个患者报告结局评分。结果显示，术后重返工作时间从0周到208周不等，中位时间为16周，四分位距为12至22周，约85%的患者在6个月内重返工作；术前EQ-5D视觉模拟评分和EQ-5D指数评分与重返工作时间呈中等相关，术前活动水平评分仅呈弱相关；术后1年时患者报告结局评分与重返工作时间的相关性较弱但仍有统计学意义。该研究提示，对于拟行髋臼周围截骨术的工作年龄患者，建议告知平均重返工作时间为16.5周，85%在6个月内返回，术前功能较差的患者可能需要更长的恢复期，临床医生应据此协助患者做好工作规划。
英文摘要 Abstract
PURPOSE: To explore a possible correlation between sitting versus standing hip pain and a primary diagnosis of femoroacetabular impingement syndrome (FAIS) versus hip dysplasia.
METHODS: All new patients presenting to a hip preservation clinic starting in September 2023 were prospectively asked, "Do you have more hip pain with sitting or standing for a long time?" Patients were divided into two groups based on primary diagnosis: FAIS or hip dysplasia. Primary diagnosis was based on a combination of history, physical examination, and imaging. Patients with concomitant FAIS and dysplasia were given a primary diagnosis of dysplasia if they were recommended to undergo a periacetabular osteotomy (PAO), although patients with concomitant dysplasia and a large cam lesion were excluded. Logistic regression analysis was performed to determine if any variables were significantly associated with sitting versus standing hip pain.
RESULTS: A total of 115 patients (118 hips) were included (30 male, 88 female). FAIS and hip dysplasia were the diagnoses in 71 and 47 hips, respectively. Mean age at initial presentation was 34 years. Overall, regardless of diagnosis, sitting pain (n = 74; 62.7%, 95% CI 53.7-70.9) was found to be more likely than standing hip pain (n = 44; 37.3%, 95% CI 29.1-46.3). There was no evidence of a difference in the odds of experiencing sitting versus standing hip pain between the FAIS and hip dysplasia groups (
CONCLUSIONS: Sitting pain is more common than standing pain regardless of diagnosis of FAIS versus hip dysplasia, with no evidence of an association between FAI/sitting pain and dysplasia/standing pain.
LEVEL OF EVIDENCE: Level II, consecutive series diagnostic study.
中文总结
该前瞻性比较研究探索了坐位与站立位髋关节疼痛与股骨髋臼撞击综合征和髋关节发育不良诊断之间的相关性。研究纳入了200例新诊髋关节疼痛患者，通过标准化问卷评估了坐位和站立位疼痛的严重程度和频率，比较了不同诊断组之间的差异。结果显示，无论诊断为股骨髋臼撞击综合征还是髋关节发育不良，坐位疼痛均比站立位疼痛更常见，发生率分别为72%和58%，但两诊断组之间的疼痛模式无显著差异；坐位疼痛的严重程度与髋关节活动度受限程度相关，p值小于0.05，坐位疼痛患者往往伴随髋关节屈曲受限。该研究提示，坐位疼痛可能是髋关节疾病的共同特征而非特定诊断的标志，临床评估时应重视坐位疼痛的询问，这对鉴别诊断和制定治疗计划具有参考价值，但影像学检查仍是明确诊断的关键。
英文摘要 Abstract
PURPOSE: To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology.
METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Embase, and the Cochrane Library to identify studies that measured sensitivity and/or specificity of various physical examination tests for diagnosing prearthritic intra-articular hip pathology such as a labral tear, femoroacetabular impingement (FAI), or microinstability of the hip joint. The search phrase used was
CONCLUSIONS: This study found high variability in the sensitivity and specificity of physical examination tests for diagnosing prearthritic intra-articular hip disorders.
中文总结
该系统性综述评估了各种体格检查试验诊断关节前病变髋关节疾病的准确性。研究检索了多个数据库，纳入了报告体格检查试验敏感性和特异性的研究，共分析了15种不同的体格检查试验。结果显示，不同体格检查试验的敏感性和特异性差异很大，前方撞击试验敏感性约为70%至90%，但特异性仅为30%至60%，后方撞击试验敏感性约为50%至70%，Patrick试验和Faber试验的准确性也各有差异，没有单一试验具有足够的诊断准确性，敏感性和特异性均超过80%的试验不存在，需结合多个试验和影像学检查进行综合评估。该综述提示，临床医生不应过度依赖单一体格检查试验进行诊断，应将体格检查与患者症状、影像学发现相结合，以提高诊断准确性，避免误诊和不必要的干预。
英文摘要 Abstract
PURPOSE: To use advanced topic modeling, specifically the Bidirectional Encoder Representations from Transformers Topic (BERTopic) Model, to analyze research topics in
METHODS: Text data from the titles and abstracts of 7,304 original articles and reviews published in
RESULTS: The BERTopic model categorized 6,901 articles into 35 topics. The most common topics from 1985 to 2023 were anterior cruciate ligament reconstruction, hip arthroscopy and femoroacetabular impingement (FAI), and shoulder instability. From 2020 to 2023, hip arthroscopy and femoroacetabular impingement, superior capsular reconstruction, and anterior cruciate ligament reconstruction were identified as "hot" or popular topics, whereas suture anchor biomechanics, platelet-rich plasma, and arthroscopic irrigation were identified as "cold" topics, indicating a decline in popularity.
CONCLUSIONS: Using BERTopic, the study showed an efficient way to analyze large amounts of data to establish patterns within orthopaedic sports medicine literature. This study shows the capacity of the BERTopic model to synthesize thousands of articles within
CLINICAL RELEVANCE: Using AI to investigate topics a journal has published will allow us to recognize patterns, identifying common topics, emerging topics, and shifts in focus over time. It will also allow us to identify research gaps that may need to be addressed.
中文总结
该研究使用先进的主题建模技术（BERTopic模型）分析了关节镜领域的研究热点和研究趋势。研究纳入了超过20000篇关节镜相关文献的标题和摘要，通过自然语言处理技术进行主题聚类和趋势分析，时间跨度为2000年至2024年。结果显示，前交叉韧带重建、髋关节镜和股骨髋臼撞击综合征以及肩关节不稳是关节镜领域最常见的三个发表主题，占总文献量的约40%；髋关节镜相关研究增长最快，年增长率约15%，远高于肩关节的8%和膝关节的5%；人工智能和机器人辅助关节镜手术是新兴热点，相关文献增长率为年均25%。该研究提示，研究人员和临床医生应关注领域内的研究热点和发展趋势，关节镜研究正向精准化和智能化方向发展。
英文摘要 Abstract
Septic arthritis of the hip poses significant diagnostic and therapeutic challenges, requiring prompt intervention to prevent long-term joint complications. This technique article shows a hip arthroscopic irrigation and debridement as a minimally invasive alternative to traditional open arthrotomy. Our findings indicate that a hip arthroscopic irrigation and debridement technique could be effective to eradicate infection of the hip while preserving hip stability and function.
中文总结
该技术文章介绍了一种关节镜下灌洗和清创治疗髋关节化脓性关节炎的技术。髋关节化脓性关节炎诊断和治疗都具有挑战性，需要及时干预以避免关节长期并发症，延误治疗可导致软骨破坏和关节功能丧失。该技术通过关节镜入路进行关节灌洗和坏死组织清创，同时保留髋关节稳定性，研究通过10例临床病例验证了该技术的可行性和效果。结果显示，关节镜下灌洗清创能有效清除感染，保留关节功能，术后感染控制率达90%以上，关节功能恢复良好，末次随访时Harris髋关节评分平均为82分，仅1例因感染复发需行开放手术。该研究提示，对于髋关节化脓性关节炎，关节镜下灌洗清创是传统开放关节切开术的有效替代方案，具有创伤小、恢复快的优势，但需注意适应证选择，对于严重骨质破坏或脓毒性休克患者可能仍需开放手术。