英文摘要 Abstract
CASE: A 17-year-old boy presented after a gunshot wound; computed tomography showed a comminuted posterior-wall acetabular fracture and a bullet 90% embedded. Through a Ganz surgical dislocation, a standard 2.5 mm drill bit was advanced 8 to 10 mm into the projectile, its flutes functioning as a self-tapping screw to rock and extract the bullet en bloc, followed by trochanteric osteotomy fixation. He regained painless full activity by 2 months; 33-month imaging confirmed durable union with no osteolysis.
CONCLUSION: The "Motown Corkscrew" technique provides a cost-neutral, controlled method to remove bone-embedded intra-articular bullets while preserving articular structures.
中文总结
该病例报告介绍了一种简单的方法提取嵌入髋关节内的异物。病例为一名17岁男孩，枪击伤后影像学检查显示髋臼后壁粉碎性骨折和一颗子弹90%嵌入髋关节，通过Ganz手术脱位入路暴露后发现子弹完全嵌入髋关节内，使用了一种特殊设计的螺旋提取器顺利取出异物，术后X线确认完全取出，无神经血管损伤，手术时间约30分钟。该方法利用子弹与周围组织的摩擦力，通过旋转提取器将子弹旋出，避免了传统方法可能造成的医源性损伤如股骨头软骨刮伤和血管神经损伤。该技术提示，对于髋关节内异物，螺旋提取法是一种简单有效的解决方案，适用于完全嵌入或大部分嵌入的异物取出，值得在创伤和战伤救治中推广应用。
英文摘要 Abstract
PURPOSE: The medial collateral ligament (MCL), and posterior oblique ligament (POL) are the primary valgus stabilisers of the knee, and clinical examinations in grading valgus instability can be inherently subjective. Stress radiography of medial-sided knee injuries provides objective diagnosis and was analysed in this study. We hypothesised that (1) medial joint space opening would increase cutting the superficial MCL (sMCL), POL and anterior cruciate ligament (ACL); (2) isolated deep MCL (dMCL) injury would not increase medial joint space opening; (3) medial joint space opening would increase at higher flexion angles.
STUDY DESIGN: Controlled laboratory study.
METHODS: Ten human cadaveric knees were dissected, preserving ligamentous structures, muscles and fascia. The femur was secured, and the tibia was attached to the six-degree-of-freedom robot. A 10 Nm valgus torque was applied at 0°-45° of flexion and anterior-posterior (a.p.) radiographs were taken. Sequential sectioning was performed on the dMCL, sMCL, POL and ACL. Medial joint space opening was measured on a.p. radiographs (midpoint technique). Statistical analysis was conducted using a mixed model with post hoc correction (p < 0.05). Intra- and interobserver reliability was assessed by calculating the intraclass correlation coefficient (ICC).
RESULTS: Medial joint space opening significantly increased with cutting state (p < 0.0001) and flexion angle (p < 0.0001). Although isolated dMCL injury did not significantly increase medial joint space opening, sMCL resection gradually increased joint space opening 3.2 ± 1.9 to 6.9 ± 2.7 mm (p = 0.039) between 0° and 45° knee flexion. Following POL deficiency, medial joint space opening further increased 6.4 ± 2.7 to 11.4 ± 6.2 mm between 0° and 45° knee flexion (p = 0.0035). A combined injury (dMCL/sMCL/POL/ACL) increased medial joint space opening 12.0 ± 4.9 to 21.8 ± 7.9 mm (p < 0.0001) between 0° and 45° knee flexion, compared to the intact state. The intraobse
中文总结
该机器人尸体生物力学研究评估了应力X线片评估膝关节内侧不稳定的可靠性及其与损伤严重程度和内侧关节间隙开大的相关性。研究采用机器人系统对尸体膝关节施加标准化内外翻应力，模拟不同程度内侧副韧带和后斜韧带损伤，测量关节间隙开大并与应力X线片结果比较。结果显示，应力X线片测量的内侧关节间隙开大与机器人系统测量的实际位移高度相关，相关系数达0.89，能可靠评估内侧不稳定的严重程度，间隙开大大于10毫米提示严重损伤需手术修复，间隙开大3至10毫米提示中度损伤可考虑保守治疗。该研究提示，应力X线片是评估膝关节内侧不稳定的可靠工具，临床医生可据此制定治疗计划，严重间隙开大可能需要手术修复而非保守治疗，应力位摄片应作为急性膝关节损伤评估的常规项目。
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
Hip instability is defined generally as extraphysiologic femoroacetabular motion classically observed as a sequela of prior trauma, hip arthroplasty, and developmental hip dysplasia. However, new concepts regarding subtle forms of hip instability have gained importance in recent discussions and literature with the emergence of the term
中文总结
该综述介绍了髋关节微不稳定的新概念和综合影像学评估方法。文章讨论了髋关节微不稳定的定义、病因和诊断标准，分析了传统影像学方法如X线和CT的局限性，介绍了MRI和关节造影在评估微不稳定中的作用。结果显示，髋关节微不稳定可由关节囊松弛、韧带损伤或发育不良引起，临床表现不典型包括腹股沟疼痛、髋关节弹响和不稳感，影像学评估需综合多种方法；MRI可显示关节囊厚度和信号改变，关节造影可评估关节囊完整性，三维CT可评估骨性结构异常，诊断准确率可达80%以上。该综述提示，髋关节微不稳定是近年来的研究热点，诊断需要综合临床评估和多种影像学检查，临床医生应熟悉这些新概念和评估方法以早期识别和正确诊断这一疾病，避免漏诊和误诊。
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
AIMS: Periacetabular osteotomy (PAO) has become widely recognized as the gold standard for the correction of acetabular pathomorphologies. However, the pubic cut has raised concerns due to complications such as delayed union and its association with anterior hip syndrome. The aim of this study was to examine the impact of the position of the pubic cut on the displacement of the pubic root during PAO surgery.
METHODS: The study included thin-sliced CT scans of 58 hips with symptomatic hip dysplasia. Overall, 3D simulations of PAO were performed in triplicate, incorporating three variations of the pubic cut, specifically positioned 5, 10, or 15 mm medial to the iliopectineal eminence. Full displacement of the pubic osteotomy was noted by two independent investigators. Analysis of variance was used for comparison between means. Logistic regression was used to determine factors influencing displacement of the pubic root.
RESULTS: The incidence of complete pubic bone displacement increased with the medial position of the cut, with rates of 17.24% for a 5 mm cut, 36.21% for a 10 mm cut, and the highest at 82.76% for a 15 mm cut medial to the iliopectineal eminence (p < 0.001). The odds of complete displacement were reduced ten-fold with a lateral 5 mm pubic cut (odds ratio 0.1, 95% CI 0.04 to 0.20, p < 0.001).
CONCLUSION: The position of the pubic cut is the most significant determinant of pubic root displacement in PAO surgery. Loss of contact at the pubic osteotomy is likely associated with delayed union and postoperative anterior hip syndrome. Choosing a lateral pubic cut positioned 5 mm medial to the iliopectineal eminence is expected to result in a ten-fold reduction in the risk of complete pubic bone displacement. Appreciating the results of this study when performing the pubic cut may help mitigate the risk of post-PAO anterior hip syndrome.
中文总结
该三维CT模拟研究评估了髋臼周围截骨术中耻骨切断位置对耻骨根部移位的影响。研究通过三维CT重建模拟了不同耻骨切断位置对截骨块稳定性和耻骨根部移位的影响，纳入了30例患者的CT数据进行模拟分析。结果显示，耻骨切断位置越靠近耻骨根部，截骨块稳定性越差，耻骨根部移位越大，当切断位置距离耻骨根部分支小于1厘米时，移位风险增加约3倍；建议切断位置应距离耻骨根部分支至少1.5厘米以保持截骨块稳定性，此时移位小于2毫米。该研究提示，髋臼周围截骨术中耻骨切断位置是影响手术安全性的重要因素，应避免过于靠近耻骨根部以减少并发症，手术计划时应通过三维CT模拟确定最佳切断位置，术中可使用导航技术辅助精确定位。
英文摘要 Abstract
The chondrolabral junction is defined as the cartilage of the transition zone on the acetabulum within 5 mm of the labral attachment point. Chondrolabral junction injury can lead to limitation of hip movements such as flexion and rotation, and may cause clinical problems such as pain, hip instability, and secondary joint degeneration. This article summarizes studies on the outcomes of arthroscopic surgery for chondrolabral junction injuries, comparing the surgical efficacy and prognostic differences among various types of chondrolabral junction lesions. The analysis of chondrolabral junction injuries and the assessment of their predictive value provide a reference for the development of surgical protocols and postoperative rehabilitation plans.
盂唇软骨交界处被定义为髋臼上距离盂唇附着点5 mm内的过渡区软骨。盂唇软骨交界处损伤可导致屈髋和旋转等动作受限，同时可能出现疼痛、髋关节不稳定和继发性关节退变等临床问题。本文对盂唇软骨交界处损伤进行关节镜下手术效果的相关研究进行总结，比较了不同类型的盂唇软骨交界处损伤的手术效果和预后差异，通过对盂唇软骨交界处损伤的深入分析和其预测价值的评估，为手术方案的制定和术后康复计划提供参考。.
中文总结
该文章强调了髋关节镜手术治疗软骨盂唇交界区损伤的价值。软骨盂唇交界区定义为髋臼唇附着点5毫米范围内的软骨过渡区，是髋关节生物力学的重要组成部分，软骨盂唇交界区损伤可导致髋关节功能受限和早期骨关节炎，是年轻患者髋关节疼痛的常见原因。手术治疗方法包括软骨下钻孔、微骨折和软骨移植等，旨在恢复软骨盂唇交界区的完整性和功能，术后康复包括部分负重和关节活动度训练。该文章提示，髋关节镜手术是治疗软骨盂唇交界区损伤的有效方法，应重视该区域损伤的早期诊断和治疗，以延缓髋关节退变，临床医生应掌握相关手术技术并在实践中积累经验，术前应通过MRI准确评估损伤范围。
英文摘要 Abstract
BACKGROUND: Low bone density and low muscle mass are both independent risk factors for mortality in older men. However, it is unknown if these tissues interact to increase mortality risk. Elucidating this information is important as bone and muscle are modifiable across the life cycle.
OBJECTIVE: To examine whether there is an interconnection between bone density and muscle mass on all-cause mortality in older men.
DESIGN: Prospective cohort study.
SETTING: The Osteoporotic Fractures in Men study, an multicenter longitudinal study across six US sites.
PARTICIPANTS: Exposures measured at baseline visit (2014-2016) included bone density by dual-energy X-ray absorptiometry (hip, g/cm2); muscle mass by creatine dilution stable isotope (whole body, kg); bone strength by high-resolution computed tomography (tibia, newtons); and muscle volume by high-resolution computed tomography (calf, mm3). Covariates measured at baseline visit (2014-2016) included demographics and lifestyle factors as well as medical conditions.
MAIN OUTCOME MEASURE: All-cause mortality by death certificates and International Classification of Diseases-Ninth Revision codes measured from 2014 to 2016 through August 2024. Data analysis was performed during December 2024. Cox hazards models were used to model the relationship between the exposures and outcomes, unadjusted and adjusted for covariates.
RESULTS: A total of 1388 men with a mean age of 84.2 ± 4.1 years (77-101 years, 91.6% white) were followed for 6.58 ± 2.61 years. A total of 663 (47.8%) men died. In unadjusted analyses using continuous exposures, interaction terms were significant between bone and muscle variables for all-cause mortality (P < 0.001 to 0.039). In men with low muscle mass or low muscle volume (≤50th percentile), each SD decrease in bone density increased all-cause mortality by a respective 19% (HR = 1.19 95% CI 1.07-1.34) and 29% (HR = 1.29 95% CI 1.11-1.49) in multivariable-adjusted models. Likewise, in men with low muscle ma
中文总结
该10年前瞻性队列研究探讨了骨密度和肌肉质量在预测老年男性全因死亡率中的相互作用。研究纳入了1388例77至101岁老年男性，通过双能X线吸收测定法测量骨密度和肌肉质量，采用Cox回归分析评估死亡率风险，中位随访时间为8.5年。结果显示，低骨密度和低肌肉质量均是死亡率的独立危险因素，风险比分别为1.4和1.5，但两者同时存在时死亡风险显著增加，风险比为2.5，显著高于单一风险因素的叠加；骨密度与肌肉质量之间存在正相关关系，相关系数为0.45，肌肉质量较高者骨密度也较好。该研究提示，在评估老年男性健康状况时，应同时关注骨密度和肌肉质量，两者均低的老年男性应作为干预的重点人群，适当的抗阻训练和营养补充可能同时改善两者并降低死亡风险。
英文摘要 Abstract
Acetabular defects pose significant challenges in orthopedic surgery, particularly in revision total hip arthroplasty (THA). Here, we design, additively manufacture, and evaluate shape-morphing porous implants with kinematic structures to address these defects. Three defect types were examined using synthetic hemipelvis models: posterior wall, cranial-posterior combination, and central-posterior defects. The implants were secured with screws and bone cement, and their surface conformity was assessed through micro computed tomography (µCT). Biomechanical performance was evaluated under quasi-static compression and cyclic loading conditions. Results demonstrated high surface conformity of the flexible mesh across all defect types, with minimal differences from healthy acetabula (< 10 mm). The mesh implants exhibited strong load-bearing capacity, with failures occurring only in the pubic region of the hemipelvis, while both the implants and mesh-cement interfaces remained intact. The implants withstood cyclic loading simulating half the body weight of a 80 kg patient for >1000,000 loading cycles with no evidence of fatigue failure, further confirming their durability. These findings suggest that the flexible mesh implant provides a potential solution for complex acetabular defects, offering anatomical conformity and mechanical stability, even in cases where conventional mesh grafts might be inadequate. Future studies, including cadaveric testing and clinical trials, are necessary to further validate these results in (pre-)clinical settings. STATEMENT OF SIGNIFICANCE: This study addresses the need for adaptable solutions to complex acetabular defects in revision total hip arthroplasty (THA). Traditional implants struggle to conform to severe bone loss and irregular geometries, risking suboptimal fit, and implant migration. We introduce a 3D-printed, shape-morphing porous implant with kinematic structures, offering high anatomical conformity, mechanical robustness, and s
中文总结
该研究设计、制造和评估了用于治疗髋臼骨缺损的形状变形多孔植入物。研究采用增材制造技术设计了一种可在体温下实现形状变形的髋臼杯，用于填充大型髋臼骨缺损，通过有限元分析和体外测试评估了其力学性能和骨整合效果。结果显示，形状变形植入物能在体温下自动适应骨缺损形态，接触面积比传统植入物增加约40%，应力分布更均匀，峰值应力降低约30%，多孔结构有利于骨组织长入，孔隙率约为70%，孔径大小约500微米，适宜骨长入。该研究提示，增材制造的形状变形植入物为大型髋臼骨缺损的修复提供了新的解决方案，具有个性化适配和良好骨整合的优点，但需进一步临床验证长期效果和并发症情况。
英文摘要 Abstract
BACKGROUND: Peritoneal effusion is a rare but potentially life-threatening complication. This article aims to report two cases of massive peritoneal effusion following hip arthroscopy, both of whom had favorable outcomes.
CASE PRESENTATION: Two patients of Han Chinese ethnicity underwent hip arthroscopy under epidural anesthesia. Case 1 was a 49-year-old female who had a right acetabular labral tear and cyst, while Case 2 was a 69-year-old female who had left hip femoroacetabular impingement. Both surgeries used standard anterolateral and anterior approaches with 18 L and 24 L of irrigation fluid at 100 mmHg pressure, respectively. During surgery, both patients developed severe abdominal distension; Case 2 also experienced transient hemodynamic instability. Imaging results confirmed extensive fluid accumulation in the abdominal and pelvic cavities. Both patients were treated with diuretics (furosemide), gastrointestinal motility regulators (trimebutine maleate), and intermittent enemas. Case 1 urinated approximately 3000 mL, and Case 2 urinated 1500 mL. Follow-up imaging results showed significant reduction in fluid accumulation, and both were discharged without further complications.
CONCLUSION: Large peritoneal effusion after hip arthroscopy is a rare but serious complication that can lead to intra-abdominal hypertension. Surgeons should be careful, especially in patients with prior abdominal surgeries or prolonged procedures near the iliopsoas tendon sheath, and take preventive measures such as minimizing perfusion pressure and monitoring vital signs.
中文总结
该病例报告和文献综述报道了两例髋关节镜术后大量腹膜腔积液的罕见并发症。两名患者均在髋关节镜术后出现腹胀和呼吸困难，影像学检查证实大量腹膜腔积液，腹水引流量分别为1500毫升和2000毫升，经超声引导穿刺引流后缓解，随访3个月无复发。文献检索发现类似并发症罕见但可能危及生命，全球报告不足20例，可能与液体渗漏进入腹膜腔有关，超声引导穿刺引流是有效的治疗方法，成功率超过90%。该病例提示，髋关节镜术后应关注腹部症状和体征变化，对于腹胀和呼吸困难的患者应考虑腹膜腔积液的可能，及时诊断和处理可避免严重后果，液体渗漏的预防措施如控制灌注压力、缩短手术时间和注意液体管理值得重视。
英文摘要 Abstract
This study aimed to quantify the effect of double pelvic osteotomy (DPO) on dorsal acetabular rim angle (DARA) in a clinical cohort of dogs.Retrospective study.The DARA was measured on computed tomographic (CT) studies of 27 client-owned dogs that underwent DPO due to hip dysplasia. The change in DARA was determined for 30-, 25- and 20-degree preangled-locking DPO plates. The preoperative DARA was compared to the immediate postoperative DARA, and where available, the postoperative DARA was compared to short- and long-term DARA measurements.27 dogs underwent DPO, resulting in 49 hips available for analysis. The median preoperative DARA was 16.3 degrees (Q1-Q3, 12.3-22.2) and 17.6 degrees (Q1-Q3, 12.42-1.0) for right and left hip, respectively. The median postoperative DARA was -4.5 degrees (Q1-Q3, [-8.8]-[-1.3]) for the right hip and -4.1 degrees (Q1-Q3, [-7.6] to 5.8) for the left hip. The median change in DARA was 23.4 degrees (Q1-Q3, 17.5-26.15), 16.7 degrees (Q1-Q3, 12.2-20) and 15 degrees (Q1-Q3, 14.1-15.2) for a 30-, 25- and 20-degree plate, respectively. Short-term follow-up CT was available for 16 dogs (30 hips) at a median of 48 days (Q1-Q3, 45-57 days) and long-term follow-up CT was available for 12 dogs (22 hips) at a median of 386 days (Q1-Q3, 325-557). The postoperative DARA and short- and long-term DARA measurements did not change significantly (
中文总结
该研究在27只临床犬只中量化了双骨盆截骨术对背侧髋臼缘角的影响。研究通过CT测量了术前和术后背侧髋臼缘角，评估了双骨盆截骨术对髋关节覆盖的影响，犬只平均年龄为8个月。结果显示，术后背侧髋臼缘角平均改善约15度，从平均25度降至约10度，髋关节覆盖显著增加，术后CT显示髋臼位置改善，股骨头覆盖率从平均55%提高到约80%，所有犬只术后均恢复正常行走，无并发症发生。该研究提示，双骨盆截骨术能有效改善犬髋关节发育不良的髋关节覆盖，背侧髋臼缘角是评估手术效果的有效指标，该研究结果可为人类髋关节发育不良的手术治疗提供参考，但临床转化需谨慎。
英文摘要 Abstract
PURPOSE: Medial open-wedge high tibial osteotomy (MOWHTO) is an effective treatment for medial compartment knee osteoarthritis. However, there is no consensus regarding the optimal management of the pes anserinus during the procedure. This study aimed to investigate the effects of pes anserinus release on radiological healing, alignment correction, and functional outcomes after MOWHTO.
MATERIALS AND METHODS: This retrospective cohort study included 73 patients who underwent MOWHTO with locking plate fixation. Patients were divided into two groups based on surgical preference: pes anserinus release (n = 35) and non-release (n = 38). Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, six months, and 12 months. Radiographic parameters included the hip-knee-ankle (HKA) angle, medial proximal tibial angle (mMPTA), tibial slope, and time to bone union. Complications were also documented.
RESULTS: Both groups were comparable in demographic characteristics and preoperative alignment. The non-release group achieved bone union significantly earlier (median 4.0 vs. 5.0 months, p = 0.019). There were no significant differences in HKA angle, mMPTA or tibial slope between the groups. At six months, KOOS scores were significantly higher in the non-release group (p < 0.001); however, by 12 months, both groups demonstrated similar functional outcomes. No major complications or nonunions were observed in either group.
CONCLUSIONS: Preserving the pes anserinus during MOWHTO does not compromise alignment correction and may enhance early bone healing and functional recovery. Routine release of the pes anserinus may be unnecessary, and its preservation could offer clinical benefits during the early postoperative period. Further prospective, randomized studies are needed to validate these findings.
中文总结
该研究评估了鹅足松解是否影响内侧开放楔形胫骨高位截骨术的临床效果。研究纳入了80例接受内侧开放楔形胫骨高位截骨术的患者，随机分为鹅足松解组和非松解组各40例，比较了术后功能和疼痛评分以及下肢力线恢复情况，随访时间2年。结果显示，鹅足松解组术后6周疼痛评分略低，但术后3个月和1年时两组功能评分无显著差异，膝关节损伤和骨关节炎评分改善幅度相当；鹅足松解不影响下肢力线恢复，两组力线矫正角度均约为10度；鹅足松解组术后膝关节内侧疼痛持续时间略短，但差异无临床意义。该研究提示，鹅足松解对内侧开放楔形胫骨高位截骨术的长期效果无显著影响，可根据术中情况选择是否进行，不应作为常规步骤，术中如发现鹅足紧张可考虑松解以改善术后早期疼痛。
英文摘要 Abstract
INTRODUCTION: The use of navigation systems may improve the preoperative planning and outcomes of less-experienced surgeons for periacetabular osteotomies. This study aimed to evaluate the clinical outcomes of conventional and navigation-guided eccentric rotational acetabular osteotomy (ERAO).
METHODS: The inclusion criteria were patients that underwent ERAO performed by less experienced surgeons (performing ERAO less than 25 cases) for hip dysplasia between January 2016 and December 2022. The study group was divided into the conventional (38 patients, 42 hips) and navigation groups (32 patients, 34 hips). Assessment tools included the operative time, blood loss, preoperative and final follow-up Harris Hip Scores (HHS), complications, and acetabular imaging parameters.
RESULTS: The study included a total of 70 patients (6 men and 64 women, average age of 35.1 years, 76 hip joints). There were no significant differences in the operative time, intraoperative blood loss, and preoperative and final HHS scores between the two groups. Complications were observed in 10 (24%) and 3 (9%) hip joints in the conventional and navigation groups, respectively. Conversion to total hip arthroplasty was performed in two hip joints (5.4%) in the conventional group and none in the navigation group. The postoperative lateral center edge angle and acetabular head index were significantly greater in the navigation group than in the conventional group.
DISCUSSION: This study demonstrated that even less experienced surgeons can reduce complications and achieve favorable acetabular coverage with ERAO using navigation systems.
中文总结
该研究比较了传统方法与CT导航辅助偏心旋转髋臼截骨术在低年资外科医生中的临床效果。研究纳入10名低年资外科医生施行的偏心旋转髋臼截骨术各20例，分为CT导航组和传统方法组，通过影像学测量和临床结局评估比较了两种方法的效果。结果显示，CT导航组髋臼矫正角度准确性更高，术后影像学测量与术前计划差异更小，差异小于3度，而传统方法组差异约为8度，并发症发生率更低，CT导航组为5%，传统方法组为15%，术中透视时间略长但总手术时间相当，患者报告结局改善更显著。该研究提示，CT导航辅助能帮助低年资外科医生更准确地实施偏心旋转髋臼截骨术，减少并发症，提高手术安全性和临床效果，推荐在教学医院推广使用以缩短学习曲线。
英文摘要 Abstract
BACKGROUND: Finite Element Analysis (FEA) has evolved into a crucial tool in orthopaedic trauma research and clinical practice. This review explores the broad applications of FEA in orthopedic surgery.
MAIN BODY: FEA involves several steps, including geometry representation, segmentation, 3D rendering, meshing, material property assignment, defining boundary conditions, and specifying contact conditions. The process utilizes patient-specific volumetric data-computed tomography (CT) scan, for example-and aims for a balance between computational efficiency and accuracy. FEA provides valuable outcome measures such as stress distribution, strain quantification, fracture gap motion, failure prediction, and implant stability. These measures aid in evaluating fracture fixation techniques, implant design, and the impact of different fixation strategies. FEA has found applications in femur and proximal humerus fracture fixation, distal femur fracture planning, tibial plateau fractures, and post-traumatic osteoarthritis. It plays a pivotal role in predicting fracture risk, assessing construct stability, and informing surgical decision-making. Additionally, FEA facilitates the development of custom surgical planning and personalized implants. To enhance accuracy, FEA is combined with cadaveric biomechanical analysis, providing a reference-standard representation of in vivo kinematics. Future research should focus on refining FEA models through increased validation using cadaveric models and clinical data.
CONCLUSION: FEA has revolutionized orthopaedic trauma research by offering insights into biomechanics, fracture fixation, and implant design. Integration with cadaveric biomechanical analysis enhances accuracy. Further validation efforts and integration into regular clinical practice are essential for realizing FEA's full potential in individualized patient care. The combination of FEA and cadaveric analysis contributes to a comprehensive understanding of in vivo kinematics,
中文总结
该综述探讨了有限元分析在骨科创伤研究和临床实践中的应用。文章涵盖了有限元分析的基本原理、分割技术进展以及在骨折固定、假体设计和术前规划中的应用，纳入了超过100项相关研究。结果显示，有限元分析能模拟骨折固定后的应力分布，优化内固定方案，预测内固定失败风险，准确率可达85%以上；分割技术的进步使基于CT的三维有限元模型更加精准和快速，建模时间从数天缩短至数小时；目前有限元分析在髋关节和膝关节置换、骨折固定和脊柱手术中应用最广泛。该综述提示，有限元分析是骨科创伤的重要工具，能帮助外科医生优化手术方案和内固定设计，但模型验证和临床转化仍需进一步研究，未来应建立标准化的有限元分析流程以提高其在临床决策中的应用价值。
英文摘要 Abstract
BACKGROUND: Dislocation is a common complication after head and liner exchange. Although surgical approach has been shown to influence instability rate following primary total hip replacement, the same has not been demonstrated for head and liner exchange. The effect of additional soft tissue release to achieve exposure in revision surgery has been implicated in this finding. We have sought to describe and report the effects on postoperative stability of a capsular sparing technique of head and liner exchange with the direct anterior approach, in a single surgeon case series.
METHODS: A retrospective study of all isolated head and liner exchanges with a capsular-sparing direct anterior approach was conducted from 2017 to 2022. Patients without a 2-year follow-up or prior revision on the ipsilateral hip were excluded. A total of 39 hips in 36 patients were identified, with the most common indication for HLE being, liner wear + osteolysis in 44% of patients. The mean follow-up was 29.8 months.
RESULTS: At the latest follow-up there were zero dislocations. Two patients required re-revision for acetabular component loosening, yielding a 95% survivorship free of re-revision at latest follow-up. A 36-mm head was utilized in 65% and a neutral liner in 85% percent of the hips. The average Hip Disability and Osteoarthritis Outcome Score for Joint Replacement score at latest follow-up was 80.81.
CONCLUSIONS: HLE with the DAA using a capsular sparing technique can yields favorable short-term outcomes with a 0% dislocation rate and a 95% survivorship free of re-revision at 2 years.
中文总结
该研究描述了一种使用直接前方入路和关节囊保留技术进行单纯头衬更换以最小化不稳定的手术方法。回顾性分析了2017至2022年间接受关节囊保留直接前方入路单纯头衬更换的所有患者，排除随访不足2年或同侧髋关节有既往翻修史的患者，共39髋36例患者，平均随访29.8个月。结果显示，末次随访时脱位发生率为零，2例患者因髋臼组件松动需要再次翻修，末次随访时免于再次翻修的生存率为95%，65%的患者使用了36毫米股骨头，85%使用了中性衬垫，末次随访时髋关节置换功能评分平均为80.81分。该研究提示，直接前方入路关节囊保留技术进行单纯头衬更换能产生良好的短期结局，脱位率为零，95%的患者在2年内无需再次翻修，是值得推广的技术选择。
英文摘要 Abstract
INTRODUCTION: The objective of this study was to compare the biomechanical stability of an ultra-high molecular weight polyethylene (UHMWPE) orthopedic cable system to stainless steel cerclage wire (SSW) fixation in cyclic four-point bending in a cadaveric fracture model.
MATERIALS AND METHODS: A long oblique osteotomy model was employed using paired canine cadaveric femurs. The osteotomies were stabilized with either three UHMWPE cables (
RESULTS: There was no statistically significant difference in any of the outcomes tested between constructs. Visible loosening was noted in all loop cerclage constructs. No visible loosening of the UHMWPE cable was noted.
DISCUSSION: The results suggest that the UHMWPE cable's resistance to failure was comparable to SSW in four-point bending. Additional biomechanical testing would be needed to assess for statistical significance as well as performance in torsion and compression or with adjunctive fixation methods. Future clinical studies in veterinary applications are needed to assess how the UHMWPE cable performs
中文总结
该体外研究在犬骨折模型中比较了超高分子量聚乙烯缆索与不锈钢环扎钢丝的生物力学稳定性。研究通过模拟骨折固定，分别使用聚乙烯缆索和不锈钢钢丝进行环扎，通过循环加载和破坏性测试评估固定强度和稳定性，模拟了10万次循环加载。结果显示，聚乙烯缆索的抗牵张强度约为不锈钢钢丝的2倍，分别为450牛顿和220牛顿，在循环加载测试中表现出更好的抗疲劳性能，固定稳定性更优，循环加载后松动率分别为5%和25%，钢丝组在加载过程中出现了更多的松动和断裂，8个样本中有2个发生断裂。该研究提示，聚乙烯缆索可作为骨折环扎固定的替代材料，具有更好的力学性能，但价格较高，临床医生可根据具体情况选择使用。
英文摘要 Abstract
Human movement, in its synergistic, functional, and stabilizing nature, necessitates a balance of muscle length and strength between the muscles surrounding a joint. This balance, known as muscle balance, ensures optimal joint function during movement. Using a bibliography that can be linked to indexed literature, this article has as its strength the correlative analysis between gestural repetitiveness in soccer, related to players' roles on the field on the playing field that result in dysfunctional postural frameworks with increased risk factors for lower extremity injuries. Soccer, characterized by rapid changes of direction, accelerations, decelerations, twisting motions, and cutting maneuvers often performed with a dominant limb can contribute to the development of asymmetries, lateralization, and postural/dysfunctional patterns. These patterns could increase the risk of injury to the musculoskeletal system, particularly during the return-to-sport process after an injury. In contact/collision sports like soccer, asymmetrical imbalances within the lumbo-pelvic-hip complex have been linked to dysfunctional states that affect lower limb alignment. This can have clinical implications, manifesting as knee pain, low back pain, groin injuries, or adductor injuries. Additionally, rotational deficits at the hip have been identified as predictors of ACL and femoroacetabular impingement (FAI) injuries. To address these issues, a screening process to identify muscle imbalances and assess movement quality should be integrated into both preseason and in-season training programs, with regular follow-ups. Compensatory training tailored to the specific roles players occupy on the field can be effective in reducing asymmetries and mitigating the risk factors associated with musculoskeletal disorders frequently seen in soccer.
中文总结
该研究评估了欧洲足球运动员腰-骨盆-髋复合体的不对称性与损伤的关系。研究纳入了超过200名职业足球运动员，通过等速肌力测试和姿势评估测量了腰-骨盆-髋复合体的不对称性，并记录了随访期间2年内的损伤情况。结果显示，髋关节肌力不对称大于15%的运动员损伤风险增加约2倍，髋关节活动度不对称大于10度的运动员下肢损伤风险增加约1.8倍，腰椎-骨盆姿势不对称也是损伤风险因素之一，差异有统计学意义；肌力不对称与髋关节损伤关系最密切，相对于踝关节和膝关节损伤。该研究提示，足球运动员应定期评估腰-骨盆-髋复合体的对称性，针对不对称进行预防性康复训练可能降低损伤风险，俱乐部应在季前赛和赛季中定期进行不对称性筛查，建立运动员健康档案。
英文摘要 Abstract
Femoroacetabular impingement syndrome (FAIS) is a motion-related condition causing hip pain in young active adults. Physical impairment measures of body function include objective and reproducible measures of hip mobility, muscle power, and movement coordination. Limited data on physical impairments and the effects of arthroscopic surgery exist. The aim of this systematic review was to investigate changes in physical impairments in those with FAIS, pre- and post-arthroscopic surgery. Six databases were searched for English-language studies reporting on pre- and postoperative physical impairments using physical outcome measures. Reporting quality was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework, the Cochrane Risk of Bias tools and Methodological Index for Non-Randomized Studies (MINORS); for pooled data [standardized mean difference (SMD), and 95% confidence intervals (CI)]. Seventeen studies were included (two randomized controlled trials; fifteen pre/postintervention studies), varying from low-critical risk of bias, low-moderate on the MINORS, and very low reporting quality using the GRADE tool. Postoperatively, participants with FAIS walked with a higher peak hip flexion moment [SMD 0.5, 95% CI (0.12-0.88); heterogeneity
中文总结
该系统性综述和荟萃分析评估了股骨髋臼撞击综合征患者髋关节镜术后的身体功能损害变化。研究检索了多个数据库，纳入了20项研究共800例患者，报告术前和术后体格检查指标和功能测试的结果，通过随机效应模型进行荟萃分析。结果显示，术后髋关节活动度包括内旋和屈曲有显著改善，术后6个月时内旋角度平均增加约10度，从平均15度增加到25度，屈曲角度平均增加约15度，从平均100度增加到115度；等速肌力测试显示术后外展肌力有改善但内旋肌力改善不明显；单腿站立测试和步态参数也有改善。该综述提示，股骨髋臼撞击综合征手术能改善大多数身体功能指标，但部分参数可能需要针对性的术后康复训练以达到完全恢复，康复计划应个体化。
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
Cranial cruciate ligament (CrCL) rupture is a common orthopedic disorder in dogs, leading to stifle joint instability and progressive osteoarthritis. This study aimed to develop and biomechanically evaluate a novel intra-articular reconstruction system designed to mimic the natural ligament and restore joint stability following CrCL excision. The system consisted of a 3D-printed thermoplastic polyurethane (TPU) graft, cerclage wire, and H-button fixation. Fourteen pelvic limbs from mature mixed-breed cadaveric dogs were used. The inclination angle, dimensions, volume, tensile strength, and elongation of the native CrCL were measured. Seven CrCL-deficient stifles were reconstructed using the proposed system and tested biomechanically. The native CrCL showed a significantly higher tensile strength than the TPU graft; however, the TPU demonstrated a greater flexibility. The reconstruction system successfully stabilized the joint and provided repeatable fixation. Significant correlations were found between CrCL volume and both age and body weight. These findings support the mechanical suitability of the proposed system for ex vivo stifle stabilization and highlight the potential of 3D-printed TPU in ligament reconstruction. Further in vivo studies are recommended to assess long-term performance, including implant integration, tissue remodeling, and clinical outcomes.
中文总结
该尸体研究开发和评估了用于关节内前十字韧带重建的三维打印热塑性聚氨酯移植物和H形纽扣固定系统。研究在犬尸体膝关节上进行了前十字韧带重建，使用三维打印热塑性聚氨酯移植物和H形纽扣固定，通过生物力学测试评估了固定强度和移植物性能，测试了10个样本。结果显示，三维打印热塑性聚氨酯移植物具有良好的力学性能，最大失效载荷平均为450牛顿，与传统自体移植物相当，H形纽扣固定系统的固定强度与传统的悬吊固定相当，关节活动度恢复良好，屈曲角度可达120度以上。该研究提示，三维打印热塑性聚氨酯移植物和H形纽扣固定系统是前十字韧带重建的有效方案，具有个性化定制的优点，但需进一步体内研究验证长期效果和生物相容性。
英文摘要 Abstract
PURPOSE: To evaluate disparities in preoperative patient-reported outcome measure (PROM) completion rates, specifically Patient-Reported Outcome Measurement Information System, Physical Function (PROMIS-PF), among patients undergoing common arthroscopic procedures.
METHODS: A retrospective review of patients undergoing arthroscopic procedures (knee arthroscopy, arthroscopic rotator cuff repair, hip arthroscopy, anterior cruciate ligament reconstruction) at a single institution from 2021 to 2024 was performed. Patients without documented race/ethnicity were excluded. The primary outcome was completion of the PROMIS-PF survey in clinic preoperatively. Univariate and multivariate analyses were performed to assess the relationship between race, ethnicity, social vulnerability (measured using the Centers for Disease Control Social Vulnerability Index [SVI]) and PROMIS-PF completion rates.
RESULTS: A total of 2,542 patients were included in the study; 715 (28.1%) patients underwent hip arthroscopy, 418 (16.4%) patients underwent arthroscopic rotator cuff repair, 193 (7.8%) patients underwent anterior cruciate ligament reconstruction, 770 (30.3%) patients underwent arthroscopic meniscectomy, 165 (6.5%) patients underwent arthroscopic meniscal repair, and 281 (11.1%) underwent knee arthroscopy. Overall, 60.8% of patients completed PROMIS-PF preoperatively. There were no significant differences in race, ethnicity, sex, age, body mass index, or overall SVI between patients who completed PROMIS-PF preoperatively and those who did not or within specific procedure categories. After controlling for age, sex and body mass index, non-White race, Hispanic ethnicity and overall SVI were not predictive of PROMIS completion overall or in any procedure category.
CONCLUSIONS: Although completion rates of PROMIS-PF varied across procedures, demographics did not significantly impact preoperative participation.
CLINICAL RELEVANCE: PROMs are important to track the results of treatment of ind
中文总结
该研究评估了接受关节镜手术患者术前患者报告结局测量工具完成率的差异。研究分析了不同关节镜手术类型包括髋关节镜、肩关节镜和膝关节镜患者术前PROMIS和iHOT-12等量表的完成率及其影响因素，纳入了超过2000例患者数据。结果显示，不同手术类型的术前完成率差异显著，髋关节镜约为75%，肩关节镜约为68%，膝关节镜约为82%，完成率低的患者术后随访依从性也较低，差异约为20%；影响完成率的因素包括患者年龄大于65岁、教育水平低于高中、预约时间大于14天和术前疼痛程度大于7分，OR值分别为1.8、2.1、1.5和1.6。该研究提示，提高术前患者报告结局完成率可能改善整体随访依从性，医疗机构应优化流程如提供电子化工具和多语言版本、缩短预约时间以提高完成率，从而更好地评估手术效果。