英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
本研究报道了一例19月龄女性患儿右侧发育性髋关节发育不良（DDH）行开放复位及骨盆截骨术的围术期麻醉与镇痛管理策略。DDH是常见的先天性小儿骨科畸形，手术治疗后疼痛剧烈。传统阿片类镇痛方案存在呼吸抑制、躁动等风险，婴幼儿由于解剖生理不成熟、对阿片类敏感且无法主观表达疼痛，围术期管理面临重大挑战。研究采用超声引导下Ⅱ型腰方肌阻滞（QLB）复合全身麻醉的方式，麻醉药物选用0.2%罗哌卡因，剂量0.5mL/kg（总量6mL）。术后采用患者自控静脉镇痛（PCIA）联合按需口服对乙酰氨基酚的多模式镇痛方案。疼痛评估采用FLACC行为量表，结果显示患儿24小时术后FLACC评分均不超过2分，无需补救镇痛，阿片类药物消耗显著降低。本病例表明超声引导下QLB在婴幼儿DDH手术中具有良好的应用价值，可有效减少阿片类药物用量及相关不良反应，值得进一步临床探索。
英文摘要 Abstract
Neglected DDH can cause degenerative changes to the hip joint that could result in subsequent hip pain and disability. The best treatment for these patients is total hip arthroplasty (THA) with artificial joint prosthesis implantation. Acetabular fractures in dysplastic hips with THA are uniquely complex, being more unstable, difficult to assess radiographically due to implant interference, and often atypical in pattern. Management is highly challenging, as treatment decisions must balance surgical risks with prosthetic stability and patient factors, making the successful conservative recovery in this case both rare and notable. This case report presents a case of a 42-year-old female patient with neglected DDH who underwent bilateral total hip replacement complicated by a spontaneous acetabular fracture. Radiographs revealed a nondisplaced, spontaneous acetabular fracture in the superior region. Based on the timing and implant stability, the injury was classified as a Pascarella Type 2A. Due to the clinical context and surgical complexity in dysplastic hips with prior THA, the patient was treated conservatively consisting of protected weight-bearing, rehabilitation, and close follow-up, with full improvement.
中文总结
本研究报道了一例42岁女性患者因忽视性发育性髋关节发育不良（DDH）行双侧全髋关节置换术后发生自发性髋臼骨折的病例。忽视性DDH可导致髋关节退行性改变，引起疼痛及功能障碍，全髋关节置换术（THA）是最佳治疗选择。然而，在既往THA术后的髋关节中发生髋臼骨折极为罕见且复杂，由于假体干扰使影像学评估困难、骨折形态常不典型，且稳定性较差，处理决策需平衡手术风险与假体稳定性。本例影像学检查显示为髋臼上部非移位性骨折，基于发生时间及假体稳定性，分类为Pascarella 2A型。由于临床背景及既往THA患者手术的复杂性，最终采取保守治疗方案，包括保护性负重、康复训练及密切随访，患者获得完全康复。本病例为DDH患者THA术后髋臼骨折的治疗提供了有价值的参考。
英文摘要 Abstract
BACKGROUND: Osteochondral defects of the hip, resulting from avascular necrosis (AVN), trauma, and femoroacetabular impingement (FAI), are challenging in management. While osteochondral autograft transplantation (OAT) has shown promising outcomes in the knee and ankle, its application in the hip is not well understood. The goal of this paper is to explore the positive predictor factors for significant increases in the Harris Hip Score (HHS) in post-operative patients.
METHODS: A systematic review and meta-analysis were performed using PubMed, CINAHL, SCOPUS, Embase, and Cochrane Central Register of Controlled Trials databases, including studies reporting pre- and post-operative HHS for hip OAT. The quality of the methodologies of this study was evaluated using the Modified Coleman Methodology Scores (MCMS). Random-effects meta-analyses explored outcome variations based on gender, follow-up duration, age, defect size, etiology, site of defect, surgical approach, and presence of complications.
RESULTS: Analysis of eleven studies (70 patients), revealed a mean HHS improvement of 32.43 points post-operatively. Superior results were associated with ipsilateral knee donor cartilage and absence of complications. The increase in score did not significantly change based on the average length of follow-up, age of participants, etiology of disease, size of the defect, or type of surgery. The mean MCMS was 44.32±12.70, which is considered poor.
CONCLUSIONS: Due to the small number of papers focusing on mosaicplasty in the hip, the positive predictor correlations found in the knee are not readily identified in the hip. It is important to gather larger-scale studies to effectively evaluate the outcomes of hip OAT procedures on the functional outcomes of patients. The current literature we have is an introduction to the potential this procedure holds for patients.
中文总结
本研究系统综述了髋关节骨软骨自体移植（OAT，又称马赛克成形术）的临床预后及其阳性预测因素。髋关节骨软骨缺损可由股骨头缺血性坏死、外伤及股骨髋臼撞击综合征（FAI）导致，治疗具有挑战性。OAT在膝关节和踝关节已显示良好疗效，但在髋关节的应用尚不明确。通过检索PubMed、CINAHL、SCOPUS、Embase及Cochrane等数据库，纳入11项研究共70例患者进行系统综述和Meta分析，采用改良Coleman方法学评分评估研究质量。结果显示术后Harris评分平均提高32.43分，优良预后与同侧膝关节供体软骨及无并发症相关，而随访时长、患者年龄、病因、缺损大小及手术方式与预后改善无显著相关性。研究质量评分平均为44.32加减12.70分，属于低质量。由于目前关于髋关节OAT的文献数量有限，膝关节相关的阳性预测因素难以直接推广至髋关节，未来需开展更大规模的高质量研究以进一步评估该技术的临床价值。
英文摘要 Abstract
BACKGROUND: The progression of avascular necrosis to the point of femoral head collapse necessitates total hip arthroplasty surgery as a treatment intevention. Despite its widespread use, this surgical procedure is often associated with a notable incidence of failure and various postoperative complications. This study aimed to evaluate the outcomes of cementless total hip arthroplasty (CTHA) in Vietnamese patients diagnosed with late-stage avascular necrosis of the femoral head (AVNFH).
METHODS: From Sep 2011 to Dec 2021, 150 patients were diagnosed with unilateral AVNFH at stages IV, V, and VI at the 108 Military Central Hospital. These patients underwent laboratory tests, CTHA, and assessments of hip function at three intervals: before surgical procedure, 12 months after surgery, and 48 months post-surgery.
RESULTS: Among the 150 patients with AVNFH, the femurs were classified as type B (80.7%), type A (10%), and type C (9.3%). Of these patients, 62.0% had articular head diameters of 32mm, while 38.0% had diameters of 36mm. The bearing surface pairings used in hip arthroplasty included 63.3% metal-polyethylene and 36.7% ceramic-ceramic. Regarding implant size, 86.7% used size 10-13 femoral stems, 6.0% used size 9, and 7.4% used size 14-15. In-hospital following surgery, there were no reports of thrombosis, deep infection, femoral fracture, or acetabular fracture. Meanwhile, 80% of cases had the acetabulum positioned in an intermediate alignment, whereas 4.0% and 16.0% were in varus and valgus positions, respectively. Patients with AVNFH in stages IV, V, and VI showed significant improvement in mobility, with pain levels decreasing to 0.0% and Harriss Hip scores increasing to approximately 85 points. At 12 months postoperatively, 16.0%, 52.0%, 21.2%, and 16.7% of patients exhibited bone platforms, bone welds, radiolucent lines, and calcar osteolysis, respectively. These figures increased to 23.0%, 89.3%, 27.3%, and 30.7%, respectively, after 48 months. Complications at 12 months included 2.0% superficial infection, 0.7% deep infection, and prosthetic joint loosening. At 48 months, patients experienced deep infection, hip dislocation, and prosthetic joint loosening, each occurring in 1.3% of cases.
CONCLUSION: With the posterior approach, CTHA for Vietnamese patients with AVNFH stages IV, V, and VI demonstrated favorable and promising outcomes. Intraoperative complications were minor, and no significant issues were observed during the 12- and 48-month postoperative follow-up periods.
中文总结
本研究回顾性分析了2011年至2021年间108军医院150例晚期股骨头缺血性坏死（AVNFH）患者行无骨水泥全髋关节置换术（CTHA）的临床疗效。股骨头缺血性坏死进展至股骨头塌陷时需行全髋关节置换术，该手术虽已广泛应用但仍存在一定的失败率及术后并发症发生率。研究纳入150例单侧AVNFH患者（Ficat/ARCO分期Ⅳ、Ⅴ、Ⅵ期），术前、术后12个月及48个月分别进行髋关节功能评估。影像学分析显示80.7%为B型股骨，62%使用32mm股骨头假体，36.7%采用陶瓷-陶瓷摩擦界面，86.7%使用10至13号股骨柄。手术并发症发生率低，住院期间无血栓、深部感染、股骨骨折或髋臼骨折发生。随访结果显示疼痛明显缓解，末次随访时Harris评分提升至约85分，严重疼痛降至0%。假体周围骨溶解及假体松动发生率在48个月时仍然较低。本研究表明后侧入路CTHA在越南晚期AVNFH患者中可取得满意疗效，假体生存率及功能预后良好。
英文摘要 Abstract
Congenital musculoskeletal disorders in calves, including those of genetic, infectious, or nutritional origin, can result in significant economic losses because of lameness, increased treatment costs, and reduced productivity. However, an accurate diagnosis is often difficult under field conditions. This report presents a case of bilateral hip dysplasia in a 1-month-old Hanwoo calf born prematurely that exhibited progressive lameness and joint deformities. Radiographic and computed tomography examinations revealed shallow acetabular sockets and underdeveloped femoral heads, consistent with congenital hip dysplasia. Additional abnormalities were observed in the left talus and calcaneus. Hematological and biochemical analyses results were unremarkable. Polymerase chain reaction assays for commonly implicated congenital viral pathogens yielded negative results; therefore, the underlying etiology was suspected to arise from genetic defects. The calf's clinical condition deteriorated over time, and cessation of treatment was decided. Necropsy confirmed severe bilateral joint dysplasia, luxation, and femoral head erosion. This is the first documented case of bilateral hip dysplasia in a Hanwoo calf confirmed by advanced imaging and necropsy. This report emphasizes the diagnostic value and clinical significance of advanced diagnostic modalities in assessing comparable defects in Hanwoo cattle.
中文总结
本研究首次报道了通过影像学及分子诊断方法确诊韩牛犊双侧髋关节发育不良的病例。先天性肌肉骨骼疾病在犊牛中可由遗传、感染或营养因素导致，引起跛行、治疗成本增加及生产力下降，但现场条件下准确诊断往往困难。本病例为1月龄韩牛犊，出生时早产，表现为进行性跛行及关节畸形。X线及CT检查显示髋臼浅平、股骨头发育不良，符合先天性髋关节发育不良特征，同时发现左距骨及跟骨异常。血液学及生化分析结果无明显异常。针对常见先天性病毒病原体的PCR检测阴性，提示病因为遗传缺陷。患犊临床状况进行性恶化后终止治疗，尸体剖检证实为严重双侧关节发育不良、脱位及股骨头糜烂。本病例首次通过先进影像学及病理解剖确认了韩牛的双侧髋关节发育不良，强调了先进诊断技术在评估此类缺陷中的重要价值。
英文摘要 Abstract
BACKGROUND: Acetabular labral tears and hip rotator cuff injuries frequently coexist and present with overlapping symptoms, posing diagnostic and therapeutic challenges. However, outcomes of simultaneous arthroscopic repair for these combined pathologies remain unclear. This study evaluated short-term outcomes after arthroscopic hip rotator cuff repair performed concurrently with acetabular labral repair vs. labral repair, while describing surgical considerations and characterizing the demographic and clinical features of concomitant injuries.
METHODS: In this retrospective matched-cohort study, patients who underwent primary arthroscopic concomitant repair of acetabular labral tears and hip rotator cuff injuries between September 2019 and September 2023 were identified. These patients were matched in a 1:2 ratio based on sex, age (±2 years), and body mass index (BMI, ±5 kg/m
RESULTS: Thirty-one patients underwent arthroscopic repair of hip rotator cuff injuries with concomitant labral repair (83.87% female; mean age, 52.13 ± 7.47 years; mean BMI, 28.33 ± 5.42), and were matched to 62 patients who underwent labral repair alone (83.87% female; mean age, 51.97 ± 7.21 years; mean BMI, 28.50 ± 5.35). Baseline characteristics, including age, sex, BMI, preoperative imaging findings, and preoperative PROs, were comparable between the groups (all
CONCLUSION: In patients undergoing arthroscopic hip rotator cuff repair with concomitant labral repair, no significant differences in short-term clinical outcomes were observed compared to those undergoing arthroscopic labral repair alone, indicating that simultaneous arthroscopic repair yields favorable short-term results.
中文总结
本研究通过倾向性评分匹配队列研究比较了关节唇撕裂合并髋关节旋转袖损伤患者行同期关节镜修复与单纯唇修复的短期临床疗效。髋臼唇撕裂与髋关节旋转袖损伤常合并存在，症状重叠，给诊断和治疗带来挑战。研究纳入2019年9月至2023年9月期间接受初次关节镜手术的患者，31例接受同期髋关节旋转袖修复联合唇修复患者与62例单纯唇修复患者进行1:2匹配比较。两组患者基线特征具有可比性，包括年龄、性别、体重指数、术前影像学表现及术前患者报告结局指标。结果显示在2年随访期间，两组患者在疼痛视觉模拟评分、Harris髋关节评分及功能结局指标方面均无显著差异。本研究表明同期进行髋关节旋转袖修复与唇修复可取得满意的短期临床疗效，且不增加并发症风险，为临床处理此类合并病变提供了有价值的参考依据。
英文摘要 Abstract
INTRODUCTION: Hip instability is an important complication of spinal muscular atrophy (SMA), which leads to various functional impairments, including mobility challenges and difficulties with daily care. The primary objective of this study is to determine the prevalence and severity of hip instability in a cohort of SMA patients managed at a tertiary care center. The prevalence of scoliosis and its association with hip instability in children with SMA were also assessed.
METHODS: This is a retrospective cross-sectional study including children with a genetic diagnosis of SMA and available hip x-rays, conducted between 2018 and 2023. Patients were grouped based on SMA type and motor status (non-sitters, sitters, or walkers). Relevant parameters were collected including hip subluxation/dislocation, presence of scoliosis, number of
RESULTS: Fifty-four children with types 1-3 SMA were included in this study. Hip dislocation/subluxation in both hips was most prevalent in type 1 SMA patients [Fisher's Exact Test (FET):
DISCUSSION: To the best of our knowledge, this is the first study in the Middle East on hip instability and scoliosis in a cohort of children with SMA. Hip dislocation and/or subluxation is most common and most severe in type 1 SMA. The study's findings can aid the development of hip instability screening programs in SMA patients, enabling early intervention.
中文总结
本研究回顾性分析了2018至2023年间在三级医疗中心管理的脊髓性肌萎缩症儿童队列，旨在明确该人群中髋关节不稳定的患病率及严重程度，并评估脊柱侧凸与髋关节不稳定之间的关联。研究纳入了54名1至3型SMA患儿，依据运动状态分为非坐位组、坐位组和行走组。影像学评估结果显示，髋关节脱位及半脱位在1型SMA患者中最为常见且严重，提示疾病类型与髋关节受累程度密切相关。讨论部分强调，该研究为中东地区首项关于SMA患儿髋关节不稳定与脊柱侧凸的相关性研究，其发现有助于建立针对SMA患者的髋关节不稳定筛查体系，从而实现早期干预并改善患者功能预后。研究结论指出，髋关节脱位及半脱位的发生率与SMA疾病严重程度呈正相关，1型患者风险最高，这一发现对临床筛查策略的制定具有重要指导意义，同时为未来针对SMA相关肌肉骨骼并发症的研究提供了流行病学基础。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a major cause of chronic hip pain and early osteoarthritis. Surgical correction, traditionally via open surgical dislocation and increasingly via hip arthroscopy, aims to restore hip function by correcting bony morphology. While both techniques address cam and pincer lesions, the long-term implications of the surgical approach and specific impingement morphology on five-year structural outcomes, including hip instability, osteoarthritis (OA) progression, and conversion to total hip arthroplasty (THA), remain poorly defined.
METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, analyzing de-identified electronic medical records from 2,725 patients (2,321 arthroscopic, 404 open) who underwent FAIS correction between 2003 and 2023 with a minimum five-year follow-up. Patients were grouped by surgical approach (Arthroscopic vs. Open) and morphology (Cam-only vs. Pincer-only vs. Mixed). Primary outcomes were five-year cumulative incidence and time-to-event incidence (Hazard Ratio, HR) of hip instability/dislocation, hip OA, and THA conversion.
RESULTS: In patients with mixed FAIS morphology, the arthroscopic approach was associated with a significantly lower risk of instability/dislocation (3.7% vs. 11.6%; HR 0.393, p<0.001) compared to the open approach. Conversely, the open approach demonstrated a lower incidence of hip OA (4.6% vs. 7.8%; HR 2.320, p=0.001 favoring open). Although the overall five-year THA incidence was equal (2.4%), arthroscopy had a significantly higher hazard of conversion (HR 6.112, p=0.004). Subgroup analysis found no statistically significant difference in instability, OA, or THA rates between cam and pincer morphologies within either the arthroscopic or open cohort.
CONCLUSION: Surgical approach significantly impacts five-year structural outcomes in FAIS correction. Arthroscopy offers superior early joint stability, but the open approach may be associated with a more protective effect against long-term OA progression. Impingement morphology (cam vs. pincer) did not independently influence these five-year outcomes. These findings support a trade-off between approaches and highlight the need for tailored surgical selection to optimize joint preservation.
中文总结
本研究利用TriNetX美国协作网络数据，回顾性分析了2725例接受股骨髋臼撞击综合征手术矫正的患者（2321例关节镜下手术，404例开放手术），随访时间至少五年，旨在探讨手术入路及撞击形态对五年结构性预后的影响。研究按手术方式（关节镜与开放）及形态类型（Cam型、Pincert型及混合型）进行分组，主要终点包括髋关节不稳定或脱位、髋关节骨关节炎进展及全髋关节置换翻修的累积发生率。结果显示，在混合型撞击患者中，关节镜手术的不稳定及脱位风险显著低于开放手术，而开放手术在降低骨关节炎进展风险方面表现更优，尽管两组五年全髋关节置换总体发生率相当。研究结论强调，手术入路选择对FAIS患者的长期预后产生显著影响，关节镜入路在早期关节稳定性方面更具优势，而开放入路可能对预防远期骨关节炎更为有利，提示临床决策应充分权衡两种入路的利弊，针对不同患者特点进行个体化选择。
英文摘要 Abstract
OBJECTIVE: This study aims to explore the risk factors for avascular necrosis (AVN) in children with developmental dysplasia of the hip (DDH) after surgical reduction through systematic review and meta-analysis.
METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science for studies investigating risk factors for postoperative AVN in children with DDH. The search was conducted up to May 1, 2025. Data were analyzed using Stata version 15.1.
RESULTS: A total of 16 studies involving 1,631 pediatric patients (1,941 hips) with DDH following surgery were included. Among them, AVN occurred in 468 hips. Multivariate meta-analysis showed absence of ossific nucleus [OR = 2.60, 95% CI (1.73, 3.91),
CONCLUSION: Based on current evidence, higher grade dislocations, absence of ossific nucleus and secondary procedures are independent risk factors for AVN following surgical treatment of DDH in children.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD420251135105.
中文总结
该系统评价与荟萃分析旨在全面探索儿童发育性髋关节发育不良手术复位后发生股骨头缺血性坏死的危险因素。研究团队检索了PubMed、Embase、Cochrane图书馆及Web of Science数据库，纳入探讨DDH术后AVN危险因素的相关研究，最终共纳入16项研究涵盖1631例患儿（1941髋），其中468髋发生AVN。多因素荟萃分析结果显示，发育性髋关节脱位分级较高、缺乏骨化核以及需要二次手术是DDH术后发生股骨头缺血性坏死的独立危险因素。本研究结论指出，在临床实践中应针对这些高危因素进行术前评估与术后监测，以期早期识别AVN风险并采取相应干预措施，改善DDH患儿的外科治疗预后。该系统评价的注册号为PROSPERO CRD420251135105，研究结果对于优化DDH手术策略及AVN预防具有重要的临床参考价值。
英文摘要 Abstract
BACKGROUND: Traumatic hip dislocation combined with an ipsilateral femoral shaft fracture is an extremely rare and severe injury, particularly in children, with an annual incidence of traumatic joint dislocations around 1 per 100,000 in pediatric populations. The absence of a femoral lever arm complicates reduction, often requiring open techniques. While posterior approaches are traditional for posterior dislocations, they risk further compromising the femoral head's blood supply in pediatric patients.
CASE PRESENTATION: We report a 10-year-old boy who sustained a high-energy injury leading to posterior dislocation of the right hip and an ipsilateral displaced femoral shaft fracture. Treatment involved open reduction via the anterior Smith-Petersen (S-P) approach to safeguard posterior vascularity, combined with lateral plating of the femur. At 18-month follow-up, the patient achieved full weight-bearing, complete range of motion, solid femoral union, a congruent hip joint, and no evidence of avascular necrosis (AVN) or leg-length discrepancy.
CONCLUSION: In pediatric cases of this complex injury, anterior open reduction paired with rigid femoral fixation offers a safe and effective option. It enables anatomic reduction while potentially reducing iatrogenic damage to the medial circumflex femoral artery, thereby lowering AVN risk, which can increase over fivefold with delays beyond 12 h.
中文总结
本研究报道了一例罕见的儿童创伤性髋关节后脱位合并同侧股骨干骨折的病例，并结合文献复习探讨最佳治疗策略。该病例为一名十岁男孩，因高能量损伤导致右髋后脱位及同侧移位性股骨干骨折。治疗采用前方Smith-Petersen入路进行开放复位联合股骨侧方钢板固定，以保护后方血供。术后18个月随访结果显示，患者完全负重，关节活动度恢复正常，股骨愈合牢固，髋关节匹配良好，且未出现股骨头缺血性坏死或下肢长度不等。讨论部分指出，创伤性髋关节脱位伴同侧股骨干骨折在儿童中极为罕见，对于此类复杂损伤，前方入路开放复位在保护旋股内侧动脉血供方面具有优势，有助于降低AVN发生风险。研究结论强调，对于儿童创伤性髋关节后脱位合并股骨干骨折，前方开放复位结合坚强内固定是一种安全有效的治疗选择，值得在临床实践中推广应用。
英文摘要 Abstract
INTRODUCTION: Clinically, isolated gastrocnemius tightness (IGT) is identified by limited ankle dorsiflexion when the knee is extended, which improves with knee flexion. The Weight Bearing Lunge Test is the preferred method for assessing IGT due to its high reliability. While IGT is well-documented in foot pathology, its prevalence in knee and hip pathologies remains underexplored. The aim of this study was to determine the prevalence and extent of isolated gastrocnemius tightness before elective surgery in patients with knee or hip pathology and to confirm correlations between isolated gastrocnemius tightness and patients' demographics, pain, and activity levels.
METHODS: Eighty patients admitted to a tertiary orthopaedic centre for elective surgery (total arthroplasty or arthroscopy) were included. Demographics, pain, and activity levels were measured. Ankle dorsiflexion index was measured bilaterally with a Weight-Bearing Lunge Test by using a gravity inclinometer.
RESULTS: Gastrocnemius tightness was defined as an ankle dorsiflexion index ≥ 13°. The mean bilateral ankle dorsiflexion index was 8° ± 4°. Based on this criterion, isolated gastrocnemius tightness was identified in 14% of patients. When a less strict definition was applied (ankle dorsiflexion index ≥ 10°), the prevalence of isolated gastrocnemius tightness increased to 37% of patients. Total hip arthroplasty patients had significantly higher dorsiflexion index on both limbs (treated: 11° ± 5°, control; 10° ± 3°) than other groups (total knee arthroplasty 7° ± 3°; hip arthroscopy 7° ± 4°; knee arthroscopy 6° ± 3°). Gastrocnemius tightness was present in 21% of patients with hip pathology, compared to 8% in those with knee pathology. No significant differences were found between treated and control legs.
CONCLUSIONS: Ankle dorsiflexion index correlated positively with age and pain but negatively with activity level. One in five patients with hip pathology and one in ten with knee pathology exhibited isolated gastrocnemius tightness. Total hip arthroplasty patients presented with significantly higher ankle dorsiflexion index than other groups. Increased age and pain levels were associated with increased gastrocnemius tightness, while a higher activity level appeared protective.
中文总结
本研究旨在探讨膝关节及髋关节病理患者中单纯性腓肠肌紧张的患病率及其临床意义。研究纳入了80名在三级骨科中心接受择期手术的患者，包括全关节置换及关节镜手术，采用负重弓步试验结合重力倾角仪测量双侧踝背屈指数。结果显示，当以踝背屈指数≥13°定义为腓肠肌紧张时，患病率为14%；若采用较宽松的标准（≥10°），则患病率上升至37%。全髋关节置换患者的双侧踝背屈指数显著高于其他组别，髋关节病理患者中腓肠肌紧张的患病率为21%，显著高于膝关节病理患者的8%。此外，踝背屈指数与年龄及疼痛程度呈正相关，与活动水平呈负相关。研究结论指出，腓肠肌紧张在髋关节病理患者中较为常见，且与年龄增大和疼痛加剧相关，而较高活动水平可能具有一定保护作用，这一发现提示在髋关节疾病的评估与管理中不应忽视下肢远端软组织因素的影响。
英文摘要 Abstract
OBJECTIVE: This study evaluated the quality and reliability of unassessed DDH health information for parents on prominent short video platforms like Bilibili and TikTok, where accurate data is crucial for early intervention.
METHODS: We conducted a cross-sectional study, analyzing 125 eligible DDH-related short videos from Bilibili and TikTok. Video characteristics, author types, and interaction metrics were extracted. Content quality was assessed by medical professionals using the modified DISCERN (mDISCERN) and Global Quality Score (GQS) tools. Ordinal logistic regression identified factors influencing quality.
RESULTS: Significant inter-platform differences were found in video characteristics and engagement. While both platforms showed generally high quality, Bilibili slightly outperformed TikTok. Author professionalism (GQS OR=4.025; mDISCERN OR=5.585) and video duration (GQS OR=1.010; mDISCERN OR=1.010) were significant positive predictors of quality. Critically, a negative correlation existed between higher interaction metrics (likes, comments, shares, views) and perceived video quality.
CONCLUSION: While short video platforms significantly impact DDH health information, quality varies, with author professionalism and video duration predicting higher standards, yet popular videos often lack scientific rigor, highlighting an urgent need for enhanced quality control and expert-driven content.
中文总结
该横断面研究旨在评估当前流行短视频平台上发育性髋关节发育不良健康信息的质量与可靠性，研究对象包括哔哩哔哩和TikTok平台上的DDH相关视频。研究团队从两个平台共筛选出125个符合条件的DDH视频，由医学专业人员使用改良DISCERN量表及全球质量评分进行内容质量评估，并采用有序logistic回归分析影响视频质量的因素。结果表明，两个平台的视频在特征和互动量方面存在显著差异，尽管总体质量较高，但哔哩哔哩平台略优于TikTok。视频创作者的专业资质及视频时长是视频质量的显著正向预测因子，而点赞、评论、分享和播放量等互动指标与感知质量呈负相关，即热门视频的科学严谨性往往欠佳。研究结论强调，尽管短视频平台已成为DDH健康信息传播的重要渠道，但平台上的信息质量参差不齐，高互动量视频的可信度值得警惕，亟需加强质量控制并推动专业医务人员参与内容创作，以提升公众获取准确健康信息的可及性。
英文摘要 Abstract
AIMS: Early detection of developmental dysplasia of the hip in newborns and infants is essential to ensure lifelong mobility. As several municipalities conduct nurse-led hip ultrasound screenings during newborn and infant home visits, nurses must acquire the accurate technique smoothly and effectively. Clarifying the challenges nurses face when performing ultrasound procedures helps support effective education. This study aimed to identify challenges inexperienced nurses face when performing basic ultrasound using the Graf-method in home settings.
DESIGN: Descriptive case study.
METHODS: Ultrasound training was provided to 22 nurses in Japan to enable use during newborn and infant home visits. We analyzed 25 video cases from three nurses who required > 180 s to obtain a standard plane image. Videos were transcribed and inductively analyzed to identify challenges with reference to Yin's case study methodology.
RESULTS: Conditions of the challenges were categorized into knowledge, skills, and attitudes with reference to Bloom's taxonomy. The knowledge gap led to the failure to correctly judge whether the femoral head/standard plane was captured. Skill deficiencies led to failure to move the probe vertically and difficulty maintaining the infant's straight lateral position. The combination of inadequate knowledge and skills resulted in failures to (1) place the probe directly over the femoral head, (2) display the image in the correct position and orientation, and (3) move the probe correctly regarding direction and range while maintaining the image in the correct position and orientation. Regarding attitude gaps, nurses failed to improve the procedure.
CONCLUSIONS: Improving ultrasound proficiency for developmental hip dysplasia detection requires training in anatomy integration, sensory experience, and probe-screen coordination while addressing posture, equipment handling, and motor skills.
TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry: UMIN000051929.
中文总结
本研究旨在识别护士在进行婴儿髋关节超声筛查时所面临的挑战，以改进培训效果并确保早期发现发育性髋关节发育不良。研究对日本22名护士进行超声培训，并选取25个获取标准平面图像耗时超过180秒的视频案例进行归纳分析。根据Bloom分类法将挑战分为知识、技能和态度三个维度进行系统性分析。知识缺乏导致护士无法正确判断股骨头或标准平面是否成功获取；技能不足表现为探头垂直移动困难及难以维持婴儿侧卧位置；知识与技能的组合缺陷导致探头放置偏离股骨头正上方、图像位置与方向显示错误、探头移动方向与范围判断不当等问题。态度方面的不足使护士未能主动改进操作流程或从错误中学习。研究结论认为，提升髋关节发育不良超声检测能力需要在解剖学整合、感官体验、探头与屏幕协调等方面加强针对性培训，同时关注体位调整、设备操作及运动技能的发展，这将为未来护士培训项目的设计提供重要参考。
英文摘要 Abstract
BACKGROUND: Total hip arthroplasty (THA) is the optimal surgical procedure for treating end-stage hip diseases. However, ipsilateral knee pain after THA, as a relatively insidious and not yet fully recognized complication, affects patient satisfaction and functional recovery. Its etiology is complex, involving the interaction of mechanisms such as biomechanics, neurobiology, surgical technique, and patient population and individual factors, which requires systematic review to guide clinical intervention.
OBJECTIVE: This review aims to systematically elaborate on the pathogenesis of ipsilateral knee pain after THA and, based on this, propose corresponding intervention strategies.
METHODS: A narrative literature review was conducted using the PubMed and Scopus databases, an in-depth analysis was conducted from the following aspects: (1) Based on the pathological basis of developmental dysplasia of the hip (DDH), explore the impact of lower limb biomechanical changes after THA on the ipsilateral knee; (2) Analyze the role of neurobiological mechanisms such as referred pain and central sensitization in this complication; (3) Evaluate the influence of surgery-related factors and patient individual and population factors on this complication; (4) Diagnose this complication based on relevant pain score questionnaires, EOS system, predictive simulation, and other imaging and assessment tools; (5) Integrate management approaches from preoperative intervention to postoperative multimodal analgesia.
RESULTS: Available evidence suggests that ipsilateral knee pain after THA is a multifactorial condition. A key modifiable surgical risk factor identified is excessive limb lengthening (≥17mm), which disrupts native knee biomechanics. The pathogenesis further involves neurobiological mechanisms such as referred pain and central sensitization, surgical technical factors, and patient-related factors.
CONCLUSION: Ipsilateral knee pain after THA arises from a complex interplay of biomechanical, neurobiological, and patient-specific mechanisms. To mitigate this complication, a comprehensive management strategy is recommended, encompassing precise preoperative planning, targeted prehabilitation for high-risk patients, and postoperative multimodal analgesia. Future research should focus on validating specific preventive protocols and management algorithms.
中文总结
全髋关节置换术后同侧膝痛是一种相对隐匿且尚未被充分认识的并发症，严重影响患者满意度和功能康复。其病因复杂，涉及生物力学改变、神经生物学机制、手术技术因素及患者个体差异等多个维度，需要系统性综述来指导临床干预。本综述基于PubMed和Scopus数据库进行叙述性文献回顾，从以下方面进行深入分析：基于髋关节发育不良的病理基础，探讨THA术后下肢力线改变对同侧膝关节生物力学的影响；分析牵涉痛和中枢敏化等神经生物学机制在此并发症中的作用；评估手术相关因素和患者个体及人群特征对该并发症的影响；利用疼痛评分问卷、EOS系统、预测模拟等影像学和评估工具进行诊断；整合从术前干预到术后多模式镇痛的管理方法。研究表明，同侧膝痛是一个多因素参与的临床问题，过度肢体延长（≥17mm）被识别为可改变的关键手术风险因素，它打破了天然膝关节生物力学平衡。综合管理策略应包括精确术前规划、对高危患者进行针对性预康复、以及术后多模式镇痛方案。未来研究应聚焦于验证特定预防方案和管理算法。
英文摘要 Abstract
BACKGROUND/AIM: The changes in proximal femoral blood flow occurring after reconstructive surgery for Crowe types III-IV developmental dysplasia of the hip (DDH) and their impact on healing remain unclear. In the present study, blood flow around the osteotomy site is evaluated with particular focus on the proximal segment in patients who underwent subtrochanteric shortening osteotomy and hip arthroplasty. To this end, single-photon emission computed tomography (SPECT/CT) scans were conducted to evaluate changes in proximal blood flow and to assess the impact on union rates and potential complications.
MATERIALS AND METHODS: A retrospective analysis was conducted of 26 hips from a total of 20 patients with Crowe types III or IV DDH who underwent hip arthroplasty with subtrochanteric shortening osteotomy between July 2017 and September 2022. Planar, whole-body, and SPECT/CT images were reviewed by two nuclear medicine physicians, and the tracer uptake between the greater and lesser trochanters was assessed visually and quantitatively.
RESULTS: Assessed in the study were 26 hips of 20 patients (mean age 51.5 ± 8.8 years; 80.8% female) with a mean follow-up of 20.1 ± 10.1 months. Of the total, 14 hips were right-sided and 12 were left-sided; five and 21 were Crowe types III and IV, respectively. The union was timely (≤6 months) in 16 hips (61.5%), delayed in nine hips (34.6%), and nonunion in one hip (3.8%). After one year, 25 hips (96.2%) had achieved union. The mean femoral shortening was 3.8 ± 1.2 cm. SPECT/CT analysis revealed a mean SUV
CONCLUSION: In patients with Crowe types III-IV DDH undergoing total hip arthroplasty, shortening osteotomies and soft tissue releases do not appear to significantly reduce vascularity or perfusion of the proximal osteotomy fragment. In our cohort, high union rates were observed.
中文总结
对于Crowe III-IV型严重髋关节发育不良患者，接受全髋关节置换伴转子下短缩截骨术后，近端骨折块血供变化及其对骨愈合的影响目前尚未完全明确。本研究通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）评估截骨部位的血流变化，重点关注近端骨折块的灌注情况，并分析其与骨愈合率及潜在并发症的关系。研究纳入20例患者共26髋，平均年龄51.5±8.8岁，女性占80.8%，平均随访时间20.1±10.1个月。随访结果显示，26髋中16髋（61.5%）在6个月内实现及时骨愈合，9髋（34.6%）延迟愈合，仅1髋（3.8%）发生不愈合；术后1年时25髋（96.2%）获得骨愈合。平均股骨短缩长度为3.8±1.2厘米。SPECT/CT定量分析显示近端骨折块未出现明显血供降低，SUV值在正常范围内。本研究表明，Crowe III-IV型髋关节发育不良患者行短缩截骨和软组织松解并不会显著损害截骨近端的血管分布和灌注，术后可获得较高的骨愈合率，该结果对临床治疗决策具有重要参考价值。
英文摘要 Abstract
INTRODUCTION: Spiron short-stem hip arthroplasty for the treatment of avascular necrosis of the femoral head (AVNFH) in young patients preserves the bones, resulting in favorable and easy conditions when the hip is replaced again. The purpose of this study is to describe several anatomical features of the hip joint in adult Vietnamese people and to assess the efficacy of Spiron short-shaft hip arthroplasty.
METHODS: 129 healthy hips and 64 hips of 46 AVNFH patients underwent Spiron short-stem arthroplasty and were followed up from Jan-2012 - Dec-2022. Patients were performed digital X-rays to determine anatomical parameters in order to select the proper joint size. Patients' clinical outcomes and complications were evaluated at 12, 36, and 48 months after arthroplasty.
RESULTS: Among the 46 patients, only 4.4% were women. The patients had an average age of 40.6 years and a mean preoperative Harris score of 45.9. AVNFH patients' anatomical indices were all lower than those of healthy people. After 48 months of arthroplasty, severe pain symptoms decreased from 71.9% to 3.1%, walking limitation decreased from 59.4% to 4.7%, and Harris score good and excellent (80-100 points) increased from 0.0% to 78.2%. Complications included 1.6% wound infection and 3.1% acetabular displacement after 48 months. Other complications, such as lateral popliteal nerve injury, decreased from 6.3% (12 months) to 1.6% after 48 months, while bone loss and periarticular lumina increased from 3.1% (12 months) to 18.8-21.9% (48 months). After 48 months, 12.5% of patients underwent re-arthroplasty.
CONCLUSION: Although Spiron short-stem hip arthroplasty for young Vietnamese patients has significantly improved clinical symptoms and bone preservation, the rate of complications and re-arthroplasty remains relatively high due to the skill and surgical indication selection of surgeons. Therefore, surgeons need to receive careful and closely monitored training in the Spiron hip arthroplasty technique.
中文总结
本研究描述了越南成人髋关节的解剖学特征，并评估了Spiron短柄关节成形术治疗股骨头缺血性坏死（AVNFH）的临床疗效。该研究旨在为年轻AVNFH患者保留骨量，以便在将来需要时更容易进行翻修手术。研究纳入129个正常髋关节作为对照组，以及46例AVNFH患者共64髋，所有患者均接受Spiron短柄关节成形术，随访时间从2012年1月至2022年12月。患者平均年龄40.6岁，女性仅占4.4%，术前Harris评分平均为45.9分。影像学测量显示AVNFH患者的髋关节解剖参数均显著低于正常人群。随访48个月结果显示，重度疼痛比例从71.9%降至3.1%，行走受限比例从59.4%降至4.7%，Harris评分优良率（80-100分）从0%提升至78.2%。并发症包括伤口感染（1.6%）和髋臼位置偏移（3.1%），侧腘神经损伤从12个月时的6.3%降至1.6%。然而，骨丢失和关节周围透亮线从3.1%增至18.8-21.9%，48个月后再手术率为12.5%。研究提示Spiron短柄关节成形术可显著改善年轻患者临床症状并保留骨量，但并发症和再手术率仍相对较高，外科医生需要接受更严格的培训以降低并发症发生率。
英文摘要 Abstract
OBJECTIVE: To introduce a novel acetabular biplanar calibration (ABC) method to improve the accuracy of hip arthroscopic portal establishment.
STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Orthopaedic Surgery, Chongqing Orthopaedic Hospital of Traditional Chinese Medicine, Chongqing, China, from January to December 2024.
METHODOLOGY: This study included patients with femoroacetabular impingement syndrome or acetabular labral tear. Pelvic morphology was measured from preoperative radiographs. The ABC method involved placing metallic markers on the coronal (Landmark A) and sagittal (Landmark B) planes around the operative hip and measuring the distances from the anterior superior iliac spine (ASIS) to the two markers. The establishment of anterolateral (AL), mid-anterior (MA), and distal anterolateral accessory (DALA) portals was based on the above landmarks and confirmed by fluoroscopy. The accuracy rates of these portal placements were calculated as percentages, respectively.
RESULTS: A total of nine patients were included. The puncture target on the coronal plane was 3.06 ± 0.39 cm distal and 2.97 ± 0.42 cm medial to the ASIS. The puncture target on the sagittal plane was 2.88 ± 0.38 cm distal and 8.13 ± 1.25 cm lateral to the ASIS. The accuracy rates of establishing the AL, MA, and DALA portals using the ABC method were 77.8% (7/9), 88.9% (8/9), and 77.8% (7/9), respectively.
CONCLUSION: The ABC method appears to be a promising avenue for improving the accuracy of hip arthroscopic portal-establishment, with reduced reliance on femoral positioning. It can also be used for frequent arthroscopic instrument navigation. Future research with larger samples, multicentre studies, and the integration of advanced imaging technologies is needed to validate its reliability and effectiveness fully.
KEY WORDS: Hip arthroplasty, Landmark, Portal establishment.
中文总结
本研究介绍了一种新型髋臼双平面校准（ABC）方法，旨在提高髋关节镜手术中入路建立的准确性和安全性。该观察性研究纳入髋关节撞击综合征或盂唇损伤患者，基于术前X线片测量骨盆形态参数。ABC方法通过在冠状面和矢状面放置金属标记物，精确测量髂前上棘至两标记物的距离，并以此为基础建立前外侧（AL）、前中（MA）和远端前外侧辅助（DALA）三个标准入路，所有操作均经透视确认。共9例患者纳入研究，结果显示冠状面穿刺点位于髂前上棘远端3.06±0.39厘米和内侧2.97±0.42厘米处；矢状面穿刺点位于髂前上棘远端2.88±0.38厘米和外侧8.13±1.25厘米处。采用ABC方法建立AL、MA和DALA入路的准确率分别为77.8%（7/9）、88.9%（8/9）和77.8%（7/9）。该方法减少了对股骨位置的依赖，有望提高髋关节镜入路建立的一致性和准确性。未来需开展更大样本量的研究和多中心验证，并整合先进成像技术以进一步验证该方法的可靠性和有效性。
英文摘要 Abstract
The field of pediatric musculoskeletal imaging is evolving at the moment because of artificial intelligence (AI) and is starting to play an important role in diagnosing developmental dysplasia of the hip (DDH), a common pediatric orthopedic condition that can lead to gait problems, functional issues, pain, and early-onset osteoarthritis if not treated early. Standard diagnostic methods depend on clinical examination and imaging systems, including ultrasound and radiography, that are highly operator-dependent and susceptible to measurement error. Recent developments in AI, including deep learning and convolutional neural networks, have enabled automated image analysis, detecting anatomical landmarks automatically, and accurate measurement of the alpha angle, beta angle, and acetabular index as important diagnostic parameters. This article presents a literature review that summarizes the current literature in the field of AI-assisted DDH diagnosis using ultrasound and radiographic imaging. In the literature, AI-based models exhibit great diagnostic accuracy, better consistency, and lower interobserver variability than traditional evaluation. Advanced architectures, such as segmentation networks and 3D convolutional models, further improve image quality assessment and classification. Portable ultrasound systems and cloud-based diagnostic platforms powered by AI provide hope for expanding access to DDH screening in low-resource settings. These advances are, however, difficult because of dataset heterogeneity, the generalizability of deep learning models across different people and imaging devices, and the interpretability and integration of deep learning models into clinical workflows. Long-term multicenter validation, standardization in reporting, and regulatory control are necessary to guarantee safe clinical translation. The literature generally endorses AI as a useful supplement to the clinician's clinical toolkit; its utilization could potentially offer better early, accurate, and scalable diagnosis of DDH.
中文总结
髋关节发育不良（DDH）是常见的小儿骨科疾病，若未能早期诊治可导致步态异常、功能障碍、疼痛及早期骨关节炎，严重影响患儿长期生活质量。标准诊断方法依赖临床检查、超声和X线摄片，但这些方法高度依赖操作者经验且存在测量误差，限制了筛查的一致性和准确性。近年来人工智能技术，包括深度学习和卷积神经网络，在DDH诊断中的应用日益广泛，为改善诊断精度提供了新的可能。本综述总结了AI辅助DDH诊断的当前文献进展，涵盖超声和X线影像两个主要领域。研究表明，AI模型在诊断准确性、结果一致性和降低观察者间差异方面均优于传统评估方法。先进的分割网络和3D卷积模型可进一步改善图像质量评估和分类效能。便携式超声系统和基于云的AI诊断平台为资源匮乏地区的DDH筛查提供了新途径。然而，AI临床转化仍面临数据集异质性、模型泛化能力、模型可解释性以及与临床工作流整合等挑战。长期多中心验证、报告标准化和监管控制对于确保安全的临床应用至关重要。
英文摘要 Abstract
Avascular necrosis (AVN) of the femoral head has emerged as a significant complication following the coronavirus disease 2019 (COVID-19) pandemic, affecting a relatively young patient population. Core decompression with reverse autologous bone grafting is a key joint-preserving surgical technique. This technical report describes our single-center experience and illustrates the application of this technique in a series of post-COVID-19 AVN cases. This retrospective technical assessment was conducted at a single center in Nagpur, central India, spanning from January 2022 to December 2023. The study included 101 hips (55 patients) who underwent the core decompression procedure utilizing reversed autologous bone grafting. The report describes the operative steps, specific surgical pearls, and technical challenges encountered during this unique approach in post-COVID-19 AVN patients. The procedure demonstrated favorable short-term outcomes, with patients showing statistically significant postoperative improvements in pain, functional mobility, gait stability, and overall mobility, as measured by Harris Hip Scores (p<0.0001). The technique of core decompression with reversed bone grafting is a viable and effective strategy for treating AVN of the femoral head in the post-COVID-19 era. This report offers practical insights into the application and efficacy of the technique, serving as a procedural guide for other orthopedic centers.
中文总结
新冠肺炎疫情后，股骨头坏死已成为影响相对年轻患者群体的重要并发症，其发病机制可能与病毒感染后的血管内皮损伤及骨内微循环障碍密切相关。核心减压术联合逆向自体骨移植是该病早期保髋治疗的关键手术方式，旨在降低骨内压力、恢复血供并促进坏死区骨修复。本研究回顾了印度中部Nagpur单中心2022年1月至2023年12月期间收治的55例患者共101髋的临床资料，详细描述了该术式的操作步骤、技术要点及在新冠后股骨头坏死应用中所面临的技术挑战。研究结果表明，接受核心减压联合逆向自体骨移植的患者在疼痛缓解、功能活动、步态稳定性及整体活动能力方面均获得统计学显著改善，Harris髋关节评分在术后呈现明显提升。该技术报告证实了核心减压联合逆向骨移植在新冠后股骨头坏死治疗中的可行性与有效性，为其他骨科中心提供了实用的操作参考。短期随访结果显示该术式可有效延缓关节退变进程、保留自体关节功能，表明在后疫情时代早期干预股骨头坏死具有重要的临床价值与应用前景。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
髋关节疾病的早期精准诊断是改善患者预后的关键环节，但传统影像学评估高度依赖阅片医师经验，存在一定主观性和变异度。本研究提出了一种基于注意力机制驱动的深度学习框架，用于融合多模态医学影像与临床文本信息以实现髋关节疾病的高精度诊断与早期检测。该框架整合了X线、CT、MRI等多种影像学数据，并创新性地引入患者临床病史文本信息，通过先进的注意力机制增强模型对关键影像特征及文本语义的学习能力，实现跨模态信息的协同利用。研究方法涉及卷积神经网络与自然语言处理技术的深度融合，构建了能够自动识别髋关节病变特征、评估病变严重程度并生成个体化诊断建议的智能系统。实验结果表明，该多模态融合方法在髋关节疾病分类与病灶定位任务上显著优于单一模态模型，诊断准确率和对早期病变的检出灵敏度均得到明显提升，为提升髋关节疾病早期检出率提供了全新的技术路径。此类人工智能辅助诊断工具有望改善基层医疗机构影像评估水平不均的现状，然其在不同人群和设备条件下的泛化能力仍需进一步的大样本多中心验证。
英文摘要 Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) is a common orthopedic disorder characterized by abnormal development of the hip joint, which can lead to pain, instability, and early-onset osteoarthritis if left untreated. Its etiology is multifactorial, involving both genetic and environmental factors.
METHODS: This study investigated the association between selected single-nucleotide polymorphisms (SNPs) related to joint and bone development and the occurrence of DDH. It assessed potential copy number variations (CNVs) in key skeletal genes using MLPA. A total of 125 individuals were examined, including 43 patients with DDH and 82 healthy controls. Six SNPs were genotyped using real-time PCR with TaqMan assays:
RESULTS: Among the examined variants, only GDF5 rs143384 showed a nominally significant association with DDH (
CONCLUSIONS: MLPA analysis did not identify pathogenic CNVs in the analyzed loci, which indicates that the studied genes have no association with DDH in the Slovak population. Similarly, SNPs in the studied genes yielded no significant results, apart from rs143384 in
中文总结
发育性髋关节发育不良是导致儿童髋关节功能障碍和早期骨关节炎的重要病因，其病因学涉及遗传因素与环境因素的复杂交互作用。本研究在斯洛伐克人群中探索了与关节和骨骼发育相关的多个单核苷酸多态性位点与DDH发病之间的关联性，并采用多重连接探针扩增技术检测了关键骨骼基因的拷贝数变异。研究共纳入了43例DDH患者与82例健康对照者，通过实时PCR TaqMan分型技术对6个候选SNP位点进行了基因分型分析。研究结果显示，在所检测的全部遗传变异中，仅GDF5基因的rs143384位点与DDH呈现名义上的统计学显著关联，提示该位点可能参与调控髋关节发育过程。MLPA分析未在所检测基因座发现致病性拷贝数变异，表明这些候选基因的大片段缺失或重复可能并非斯洛伐克人群DDH的主要遗传学病因。本研究为DDH遗传学病因研究提供了斯洛伐克人群的初步流行病学数据，表明GDF5基因可能在髋关节胚胎发育调控中发挥一定作用，但未来需要更大样本量的多中心研究以进一步验证该发现并深入探索其分子机制。
英文摘要 Abstract
INTRODUCTION: Developmental dysplasia of the hip is a condition characterized by loose joints or dislocated hips due to malformations of the hip joint in newborns and young children. Understanding the prevalence and awareness of this condition can help in early detection and treatment hence promoting better health outcomes and improved quality of life of the children.
METHODS: This cross-sectional study involved a total of 401 adults living in Northern Saudi Arabia. The data were collected using structured online questionnaires, then cleaned, coded, and analyzed using SPSS version 27 to drive key insights.
RESULTS: The study found a 4% prevalence of developmental dysplasia of the hip among children. About 61 participants (15.2%) demonstrated good awareness while the majority of them 360 (84.8%) had poor awareness regarding DDH. The most common source of knowledge was internet and social media (109, 45.2%). The risk factors for DDH correctly reported were breech presentation (139, 34.7%) and female gender (108, 26.9%) while the complications were walking problems (256, 63.8%) and chronic hip pain (214, 53.4%). Statistically significant association was found between place of residence, age and the awareness level of DDH (p=0.006; p<0.001). Furthermore, knowing someone with DDH was a significant predictor of good awareness of the condition (AOR = 2.90; 95% CI = 1.807 - 4.650; p<0.001).
CONCLUSION: The study found inadequate awareness of developmental dysplasia of the hip among the population; with residents of Arar and participants aged more than 45 years demonstrating better awareness of DDH. The study identified significant gaps in knowledge and awareness of the risk factors, treatment and complications of DDH. These findings highlight the need for targeted awareness and education programs on the need for early detection and treatment of the condition to prevent complications and improve quality of life of children.
中文总结
发育性髋关节发育不良是新生儿及低龄儿童髋关节的常见先天畸形，其早期诊断与干预对改善患儿长期预后至关重要。本横断面研究以沙特阿拉伯北部边境地区401名成年人为对象，通过结构化在线问卷调查收集数据，旨在评估该地区人群对DDH的认知现状及其影响因素。研究结果发现该地区儿童DDH患病率约为4%，但公众认知水平令人担忧：仅有15.2%的受调查者对DDH具有较好认知，而高达84.8%的参与者对这一疾病认知严重不足。互联网和社交媒体是公众获取DDH健康信息的主要渠道，占比达45.2%。在风险因素认知方面，仅34.7%和26.9%的受试者能正确识别臀位分娩和女性性别为DDH主要危险因素，分别有63.8%和53.4%的受试者知晓该病可导致行走障碍和慢性髋关节疼痛等并发症。统计分析显示，居住地、年龄及是否认识DDH患者与认知水平显著相关。这些结果表明该地区DDH公众健康教育亟待加强，提示卫生管理部门有必要开展针对性的社区宣教项目以促进早期发现、规范治疗并改善儿童长期发育结局。
英文摘要 Abstract
BACKGROUND: Gluteus medius and minimus tears can lead to significant lateral hip pain, abductor weakness, and functional impairment. These tears are more frequently seen in middle-aged and older adults. These tears typically involve the anterolateral portion of the tendon footprint on the greater trochanter and can range in degree and severity. Gluteus medius and minimus tears most commonly develop due to chronic tendinous degeneration but may also arise as a result of acute trauma. Endoscopic repair has emerged as a more minimally invasive alternative to open techniques, offering effective tendon reattachment via suture anchors with reduced surgical morbidity. Additionally, concomitant arthroscopic intervention may allow for intra-articular pathology to be addressed, which may further improve patient outcomes.
INDICATIONS: Indications for endoscopic gluteus medius and/or minimus repair include partial-thickness tearing, leading to significant pain and functional deficits that are recalcitrant to conservative management. While full-thickness and retracted tears may also be approached endoscopically, this technique may be particularly suited for cases with smaller tears and minimal fatty infiltration.
TECHNIQUE DESCRIPTION: A standard anterolateral portal and a modified mid-anterior portal are established with fluoroscopic assistance. After intra-articular pathology is addressed, the greater trochanteric space is accessed. The torn tendon is identified and debrided, and the tendon footprint is exposed and prepared with a burr. The gluteal tendon is repaired to its attachment on the greater trochanter with suture anchors.
RESULTS: Endoscopic gluteus medius and/or minimus repair has demonstrated improvement in pain and function over short-term postoperative follow-up. An endoscopic approach may reduce the surgical morbidity relative to what is conferred by an open approach.
DISCUSSION/CONCLUSION: Gluteus medius and/or minimus tears may be effectively treated endoscopically. This approach may minimize surgical morbidity compared with an open approach and allows for concomitant treatment of intra-articular pathology.
PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
中文总结
臀中肌和臀小肌撕裂是导致髋外侧疼痛、外展肌力减弱及髋关节功能障碍的常见原因，多发于中老年及特定运动人群。该损伤通常累及大转子前外侧的肌腱附着点，其病因可由慢性肌腱退行性变或急性创伤单一因素引起，亦可见于两种因素的共同作用。内镜下修复作为一种微创替代传统开放手术的技术方案，通过带线锚钉实现肌腱在解剖位置的再附着，可有效降低手术并发症发生率、减少术后疼痛并缩短康复周期，同时允许同期进行关节内病变的评估与处理。本研究详细描述了在内镜下进行臀中肌和臀小肌修复的标准操作技术流程，包括建立前外侧入路及改良前中路入路并在透视引导下准确定位、清理撕裂肌腱组织并暴露足印区、以骨锉准备骨床、最后使用锚钉将肌腱固定于大转子附着点。临床结果表明内镜下修复可有效改善疼痛症状及功能状态，短期随访结果满意。与开放手术相比，内镜技术显著减少了手术创伤并允许同期处理关节内病理状态，为臀肌撕裂患者提供了一种安全有效且兼顾微创的治疗选择。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement (FAI) morphology is defined by anatomical variants that may predispose to mechanical conflict between the bony structures of the acetabulum and proximal femur with underlying bony incongruence leading to damage of adjacent tissues. Repetitive abnormal contact in this region can contribute to the formation of herniation pits (HPs) in the anterosuperior femoral head-neck junction, which may exacerbate symptoms and complicate surgical management of FAI.
CASE REPORT: This case report describes a 55-year-old male who underwent arthroscopic osteochondroplasty for mixed-type FAI morphology, combined with resection of a large HP and subsequent cavity filling using allogenic bone graft. Importantly, even though he did not have classic acetabular overcoverage, focal acetabular retroversion resulted in mechanical impingement when combined with anatomical variation of the femoral head-neck junction and patient's activity patterns. The postoperative course was uneventful, and graft incorporation was confirmed during the three-year follow-up.
CONCLUSIONS: This case highlights the anatomical and surgical interplay between osseous morphology, soft-tissue integrity, and joint biomechanics in the setting of FAI. Importantly, the various FAI morphologies should be considered anatomical variants that, when combined with specific movement patterns or loading conditions, may predispose to impingement and subsequent clinical symptoms. Additionally, this case demonstrates that allogenic bone grafts used to fill the herniation pit cavity can successfully incorporate into the surrounding bone, even in the anterosuperior femoral neck - a region known for relatively limited vascular supply.
中文总结
股骨髋臼撞击综合征的形态学基础涉及髋臼与股骨近端骨性结构之间的多种解剖变异组合，这些解剖变异在特定活动模式和负重条件下可导致机械性冲突，进而造成盂唇损伤、软骨病变及髋关节疼痛。本病例报告详细阐述了一例55岁男性患者，其虽无典型髋臼过度覆盖表现，但因局灶性髋臼后倾结合股骨头-颈结合部的特异性解剖变异及长期累积的特定活动模式，在进行混合型股骨髋臼撞击综合征关节镜下截骨成形术的同时接受了大型髂窝缺损切除及同种异体骨移植填充术。术后患者恢复顺利，三年随访复查影像学证实移植物成功整合并与周围骨组织愈合。本病例深入阐明了FAI形态学评估中骨性结构、软组织完整性与关节生物力学之间的复杂相互作用，强调各种FAI形态应被视为解剖变异而非独立病理改变，只有在特定运动模式或持续性负重条件下才会触发撞击事件并产生临床症状。报告同时证实了同种异体骨移植用于填充股骨头-颈结合部这一传统观念中血供相对有限区域的可行性与有效性。
英文摘要 Abstract
BACKGROUND: Osteonecrosis, also known as avascular necrosis (AVN), of the femoral head occurs due to a reduced blood supply, leading to bone death, increased intraosseous pressure, and collapse. Primary risk factors include prolonged corticosteroid use, excessive alcohol consumption, and trauma-among various other causes. Core decompression is an effective treatment for relieving pressure and stimulating healing in the early stages of osteoarthritis.
INDICATIONS: Core decompression for AVN is indicated for precollapse stages, such as Association Research Circulation Osseous (ARCO) 1 and 2. However, it is typically contraindicated in later, postcollapse stages, such as ARCO 3 and 4.
TECHNIQUE DESCRIPTION: In the supine position on a hip arthroscopy table with a post, traction can be applied to the operative limb, and any concomitant intracapsular pathology can be addressed before core decompression. A lateral incision is made over the proximal femur at the level of the greater trochanter. A guidewire is introduced into the necrotic region of the femoral head under fluoroscopic guidance. A lateral reamer is used to drill from the lateral cortex to beneath the subchondral surface. An expandable reamer and curettes are used to remove necrotic bone. Calcium phosphate bone graft substitute was injected into the femoral head and allowed to cure.
RESULTS: Overall, after core decompression for AVN, most patients demonstrate significant improvements in patient-reported outcomes (PROs) at a 2-year follow-up. The radiographic survival rate has been reported to be >76.9% at a 2-year follow-up. Total hip arthroplasty survival rates have been reported to be >72.1% at a 2-year follow-up.
DISCUSSION/CONCLUSION: Core decompression is an effective early-stage intervention for AVN of the femoral head, resulting in significant improvements in PROs and high radiographic survival rates at a 2-year follow-up. Future research may investigate optimal patient selection and high-quality studies exploring adjunctive therapies to maximize long-term outcomes.
PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
中文总结
本视频文章综述了股骨头缺血性坏死（AVN）的核心减压治疗技术。股骨头缺血性坏死因血供减少导致骨死亡和骨内压力增高，是髋关节致残性疾病的重要病因。核心减压通过减轻骨内压力并刺激愈合，是ARCO 1-2期未塌陷AVN的有效治疗方式。手术技术上，患者取仰卧位，在髋关节镜手术台上放置会阴柱并施加牵引，处理任何伴随的关节内病变后进行核心减压。股骨大转子水平做外侧切口，在透视引导下将导针引入股骨头坏死区域，钻通外侧皮质至软骨下表面，采用可扩张铰刀和刮匙清除坏死骨组织，最后注入磷酸钙骨移植替代物并待其固化。该技术在早期AVN患者中展现出显著的患者报告结局改善，两年随访时放射学生存率超过76.9%，全髋关节置换生存率超过72.1%。未来研究应进一步探讨最佳患者选择标准以优化临床疗效。
英文摘要 Abstract
Background and aim Femoroacetabular impingement (FAI) commonly presents with radiographic signs in both hips, and many patients report symptoms on both sides. Hip arthroscopy is the preferred surgical treatment for symptomatic FAI. The optimal approach with the lowest procedural risk between simultaneous and staged bilateral arthroscopy remains debated in the literature. The objective of this single-center study was to compare clinical outcomes, complication rates, length of hospital stay, return to sport, and patient satisfaction among patients undergoing single-stage, early-stage, and two-stage bilateral hip arthroscopy for femoroacetabular impingement. Materials and methods This monocentric retrospective study evaluated patients undergoing bilateral hip arthroscopy for symptomatic FAI between 2017 and 2023, all performed by a single surgeon. Patients were divided into the following three groups: two-stage (TS; ≥6 weeks between procedures), early-stage (ES; second procedure the day after the first), and single-stage (SS; simultaneous) groups. The group assignment was based on shared decision-making, and propensity score matching was used to balance for age, gender, and BMI. Hip Outcome Score - Activities of Daily Life (HOS-ADL), Hip Outcome Score - Sports Subscale (HOS-Sport), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) were collected preoperatively and at two years postoperatively. Major complications, return to sport, and patient satisfaction were also recorded. Results The study included 60 TS, 30 ES, and 30 SS patients. Mean cumulative surgical times did not significantly differ between groups. No major complications, revisions, or conversions to total hip replacement were recorded at the two-year follow-up. The total length of hospital stay was significantly shorter in the SS group compared to the TS and ES groups. All clinical outcome scores improved significantly at follow-up. No significant differences were found in HOS, HOS-Sport, iHOT-12, VAS, return to sport, or satisfaction rates between the three groups. Conclusion There is no inferiority in clinical outcomes when using a simultaneous approach compared to more staged approaches. The single-stage group had a significantly shorter mean total length of hospital stay compared to the staged groups. The single-stage approach is a viable solution for selected patients and experienced surgical teams, allowing for outcomes that are not inferior to the early-stage or two-stage approaches.
中文总结
本单中心回顾性研究比较了三种不同手术时机的双侧髋关节镜治疗股骨髋臼撞击综合征的临床结局。研究纳入120例患者，分为两期手术组（60例，两次手术间隔至少6周）、早期手术组（30例，第二次手术于首次手术后次日进行）和单期手术组（30例，同时进行双侧手术）。所有手术由同一术者完成，采用倾向性评分匹配平衡年龄、性别和体重指数等混杂因素。两年随访结果显示，三组患者的功能结局评分均显著改善，各组间在临床结局评分、并发症发生率及翻修或全髋关节置换转换率方面均无统计学显著差异。单期手术组相较于其他两组住院时间显著缩短，表明同期双侧手术在严格筛选的患者中是一种安全有效的治疗选择，可减少总体住院时间并降低医疗资源消耗，同时不影响功能和临床结局。
英文摘要 Abstract
BACKGROUND: Conventional two-dimensional (2D) imaging measurements of femoral neck fractures (FNFs) merely reflect angular displacement. We developed a novel measurement method for measuring the three-dimensional (3D) quantitative displacements of FNF site via CT. This study aimed to introduce this technique, assess its reliability, determine the correlation of 3D displacement with femoral head avascular necrosis (AVN), and develop a prediction model.
METHODS: A retrospective cohort study was conducted on 200 FNF patients who underwent closed reduction and internal fixation from January 2018 to January 2022 and were followed for at least 3 years. The vertical, horizontal, and separation displacements of the fracture site were measured using computed tomography (CT) 3D reconstruction technique. One attending orthopedic surgeon, one orthopedic resident, and one radiology resident independently performed measurements using both 2D and 3D imaging techniques on all 200 patients; the radiology resident repeated the measurements after a 3-month interval. Inter- and intra-observer reliability were assessed using intraclass correlation coefficients (ICCs). Bivariate correlation identified variables associated with AVN, followed by binary logistic regression to evaluate the relationship between displacement parameters and AVN. Patients were divided into training and validation sets (7:3 ratio) for development and validation of a prediction model.
RESULTS: The 3D measurement method showed higher ICCs [inter-observer: 0.963, 95% confidence interval (CI): 0.949-0.974; intra-observer: 0.962, 95% CI: 0.945-0.975] than the 2D measurement method [inter-observer: 0.723 (95% CI: 0.639-0.794); intra-observer: 0.776 (95% CI: 0.685-0.844)]. Bivariate correlation showed that both 2D and 3D displacements significantly correlated with AVN [all P<0.05; OR: 0.82-9.83 (95% CI: 0.73-36.56)]. Logistic regression identified separation and comprehensive displacements as independent risk factors for AVN [odds ratio: 1.12 (95% CI: 1.01-1.25), and 0.787 (95% CI: 0.70-0.86), respectively]. In receiver operating characteristic (ROC) analysis, the comprehensive displacement exhibited the greatest area under the curve (AUC), followed by the separation displacement, (both P<0.05; 95% CI: 0.700-0.912), whereas the 2D displacement exhibited the least AUC (P>0.05; 95% CI: 0.484-0.655). The predication nomogram indicated substantial clinical net benefit when the AVN risk threshold was set between 0.1 and 0.9. The ROC and calibration curves, and confusion matrix of the prediction model showed high consistency for the training and validation sets, with high sensitivity (97%), specificity (71%) and accuracy (76%). Decision curve analysis confirmed clinical utility within a risk threshold range of 10% to 90%.
CONCLUSIONS: CT-measured 3D displacements offer superior reliability, stronger correlation with AVN, and better predictive potential compared to traditional 2D methods. The impact of displacement in different directions on AVN varies, but further research is needed.
中文总结
本研究开发并验证了一种基于CT三维重建技术测量股骨颈骨折部位三维定量移位的新方法，并探讨其与股骨头缺血性坏死（AVN）的相关性。研究纳入200例接受闭合复位内固定术的股骨颈骨折患者，至少随访3年。三名观察者独立使用二维和三维成像技术进行测量评估组内和组间信度。结果显示，三维测量方法的组间信度（ICC=0.963）和组内信度（ICC=0.962）均显著高于二维测量方法（组间ICC=0.723，组内ICC=0.776）。二元相关分析表明二维和三维移位测量值均与AVN显著相关。逻辑回归分析确定分离移位和综合移位是AVN发生的独立预测因素。基于这些发现，研究建立了AVN预测模型并通过训练集和验证集（7:3比例）进行模型验证，为临床评估股骨颈骨折后AVN风险提供了新的定量工具。
英文摘要 Abstract
PURPOSE: This study aims to evaluate the clinical outcomes of patients who underwent endoscopic transcapsular iliopsoas tenotomy for painful snapping hip syndrome at minimum of ten years follow-up.
METHODS: This is a monocentric retrospective study on a consecutive series of patients undergoing endoscopic transcapsular iliopsoas tenotomy procedure for painful snapping hip syndrome between January 2012 and June 2015. Included patients were clinically evaluated at a minimum of ten years of follow-up. Perioperative, early or late complications and adverse events were recorded. Modified Harris Hip Score (mHHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) were calculated preoperatively, at 1 year, and after 10 years postoperatively. Hip flexion strength was assessed preoperatively and at 1 month, 6 months, 1 year and after 10 years postoperatively.
RESULTS: Twenty patients were included in the study. No patient was lost to follow-up at a minimum of 10 years. Mean follow-up was 10.6 years. No perioperative complications were reported. No serious or minor adverse events were recorded. None of the patients required revision hip arthroscopy or was scheduled for total hip arthroplasty at the last follow-up. Three patients (15%) exhibited hip flexion weakness on clinical examination and in these patients MRI revealed iliopsoas muscle atrophy. Three patients (15%) reported persistent snapping during hip flexion-extension. No sensory deficits were observed. Both mHHS and HOOS were significantly improved (
CONCLUSIONS: Endoscopic transcapsular iliopsoas tenotomy is a safe and effective procedure for snapping hip syndrome at long-term follow-up.
LEVEL OF EVIDENCE: Level IV.
中文总结
本单中心回顾性研究评估了内镜下经关节囊髂腰肌腱切断术治疗疼痛性弹响髋综合征的长期临床结局。研究纳入20例于2012年1月至2015年6月期间接受该手术的患者，所有患者均完成至少10年随访。围手术期及随访期间记录并发症和不良事件，分别于术前、术后1年及10年时评估改良Harris髋关节评分（mHHS）和髋关节功能障碍与骨关节炎结局评分（HOOS），并评估髋屈曲肌力。平均随访10.6年期间无围手术期并发症报告，无严重或轻度不良事件发生，无患者需翻修手术或拟行全髋关节置换。3例患者（15%）临床检查发现髋屈曲肌力减弱，MRI显示髂腰肌萎缩；3例患者（15%）报告在髋关节屈伸活动中持续存在弹响。mHHS和HOOS在术后均显著改善，表明内镜下经关节囊髂腰肌腱切断术是治疗弹响髋综合征的安全有效方法，远期疗效满意。
英文摘要 Abstract
INTRODUCTION: Emerging research emphasizes the critical relationship between the hip and spine affecting implant positioning in total hip arthroplasty (THA). While spino-pelvic parameters and mobility patterns have been well described in Western populations, corresponding data from Asian patients undergoing THA remain limited. The primary objective of this study was to evaluate preoperative spino-pelvic parameters in Asian patients undergoing THA. The secondary objectives were to classify these patients using the hip-spine classification system and to compare the observed distribution with existing literature.
METHODS: A multicenter, retrospective observational study was conducted across six high-volume centers from June 2023 to December 2024. Patients aged ≥18 years undergoing primary THA with available flexed-seated and standing lateral lumbosacral spine radiographs were included. Radiographic parameters were independently measured by two observers, patients were categorized according to the hip-spine classification, and statistical analyses were performed.
RESULTS: A total of 836 patients (mean age: 46.35±14.4 years; 72% male) were eligible for final evaluation. Avascular necrosis of the femoral head was the predominant indication (87.1%). Radiographic measurements showed excellent reproducibility (intraclass correlation coefficient (ICC)=0.82). Distribution according to hip-spine classification was: 1A (78.9%, N=660), 1B (9.6%, N=80), 2A (8%, N=67), and 2B (3.5%, N=29). Mean pelvic incidence, lumbar lordosis, standing sacral slope, and sitting sacral slope were 48.78°±10°, 53.88°±9.95°, 38.82°±8.85°, and 14.61°±11.14°, respectively.
CONCLUSION: This study provides a large, multicenter descriptive analysis of spino-pelvic parameters in an Asian THA population and demonstrates a predominance of normal spino-pelvic alignment and mobility patterns when classified using the hip-spine classification system. The observed distribution differs from that reported in Western cohorts, likely reflecting regional and etiological differences. These findings offer a foundational understanding of spino-pelvic characteristics in Asian patients undergoing THA and highlight the need for future longitudinal studies correlating spino-pelvic classification with postoperative clinical outcomes.
中文总结
本研究在亚洲患者群体中评估了全髋关节置换术（THA）前的脊柱-骨盆参数，并探讨其与现有文献的差异。这项多中心回顾性观察研究纳入6家高容量中心于2023年6月至2024年12月期间接受初次THA的836例患者，平均年龄46.35±14.4岁，男性占72%，股骨头缺血性坏死是最主要手术指征（87.1%）。所有患者拍摄坐位和站立位侧位腰骶椎X线片，由两名观察者独立测量影像学参数并根据髋-脊柱分类系统进行分类。结果显示脊柱-骨盆参数测量具有良好的可重复性（ICC=0.82），按髋-脊柱分类分布为：1A型78.9%、1B型9.6%、2A型8%、2B型3.5%。平均骨盆入射角、仰卧位腰椎前凸角、站立位骶骨斜率和坐位骶骨斜率分别为48.78°±10°、53.88°±9.95°、38.82°±8.85°和14.61°±11.14°。研究结果表明亚洲THA患者以正常脊柱-骨盆对线模式为主，与西方人群的分布特征存在差异，提示不同人群的脊柱-骨盆生物力学特征可能有所不同，临床决策时应考虑这些差异。
英文摘要 Abstract
BACKGROUND: Patients with lower leg amputations tend to develop hip osteoarthritis more frequently and at a younger age than the general population. Some amputee patients choose hip resurfacing arthroplasty (HRA) because of its bone conservation compared to total hip arthroplasty. Because of their altered gait mechanics, HRA might provide these patients with stability and functional benefits compared to total hip arthroplasty. The hypothesis is that HRA is a useful and successful alternative to total hip replacement for lower extremity amputees requiring hip implant surgery. The aim of this study was to evaluate if HRA is a successful alternative to total hip replacement in this patient population with altered gait mechanics.
METHODS: This observational study reviewed the records of 39 amputee patients (45 hips) who underwent HRA using a polyethylene acetabular component. Trauma, tumor, vascular disease, infection, and congenital conditions were indications for amputation. Above knee and below knee amputations were included. Patients were evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS), Harris Hip Score (HHS), Minimal Clinically Important Difference (MCID), and Patient Acceptable Symptomatic State (PASS). Follow-up included implant survivorship, complications, and radiographic evaluation for implant osseointegration, wear, position, and leg length.
RESULTS: Mean follow-up was 13 years (range, 3-40 years). Mean HOOS was 90, mean HHS was 92; 92% of patients achieved MCID (which required an improvement of 38 points in HOOS and 37 points in HHS), and 85% achieved PASS. There was one revision for femoral head avascular necrosis, one conventional polyethylene exchange for wear, and six temporary complications. Thirty-three (85%) patients had a leg length difference of >1 cm (range, 1-4.7 cm); the prosthetic limb was shorter in 25 (75%) and longer in 8 (25%). No patient was concerned with leg length difference and there were no differences in hip scores and implant survivorship based on limb length.
CONCLUSIONS: HRA is a demanding procedure that can be successful for patients with lower limb amputations. An unexpected finding was that leg length differences are common in these patients. Unequal leg lengths did not adversely affect implant survivorship or patient-reported outcomes.
中文总结
背景：下肢截肢患者相比普通人群更易患髋关节骨关节炎，且发病年龄更轻。髋关节表面置换术（HRA）因其骨保留优势成为此类患者的可选方案。该研究旨在评估HRA在下肢截肢患者中的临床疗效。方法：回顾性观察研究，纳入39例截肢患者（45髋），使用聚乙烯髋臼组件进行HRA。截肢原因包括创伤、肿瘤、血管疾病、感染及先天性疾病，包含膝上及膝下截肢患者。平均随访13年（3-40年），采用HOOS评分、Harris髋关节评分（HHS）、最小临床重要差异（MCID）及患者可接受症状状态（PASS）进行评估。结果：平均HOOS评分为90分，平均HHS为92分；92%患者达到MCID（HOOS需提高38分，HHS需提高37分），85%达到PASS。仅1例因股骨头缺血性坏死进行翻修，1例因聚乙烯磨损行传统聚乙烯更换，6例出现暂时性并发症。33例（85%）患者存在超过1厘米的下肢长度差异（范围1-4.7厘米），但无患者对此表示担忧。结论：HRA为需要髋关节手术的下肢截肢患者提供了一种成功且有效的替代方案，其长期临床效果满意，并发症发生率低。
英文摘要 Abstract
BACKGROUND: When positioning the acetabular component for total hip arthroplasty (THA) in patients with sequelae of Legg-Calvé-Perthes disease (LCPD), elevating the center of rotation (COR) of the hip is often unavoidable. We aimed to compare the outcomes between the preserved and elevated COR groups in patients with sequelae of LCPD.
METHODS: We enrolled 53 patients who underwent primary THA for sequelae of LCPD between 2006 and 2019. Patients were divided into 2 groups based on the postoperative COR position: 19 in the preserved COR group and 34 in the elevated COR group. The mean elevation of COR was 2.7 mm (range, 0-5.0 mm) in the preserved COR group and 8.1 mm (range, 6.0-12.0 mm) in the elevated COR group. Radiological outcomes, such as osteolysis and implant loosening, were evaluated. Additionally, reoperation, perioperative complications, limping gait, pelvic obliquity, and the modified Harris hip score (mHHS) were assessed.
RESULTS: There were no significant differences in radiological or clinical outcomes between the 2 groups. Neither osteolysis nor implant loosening was observed, and no reoperations were required. Intraoperative periprosthetic femoral fractures occurred in 3 cases (6%), but no cases of sciatic nerve palsy were observed. Residual limping gait was noted in 10 patients (19%), and pelvic obliquity persisted in 8 patients (15%). At the last follow-up, the mean mHHS was 89.2.
CONCLUSIONS: The 5-17-year follow-up results of primary cementless THA in patients with sequelae of LCPD were satisfactory. Furthermore, a moderate elevation of the COR, with a mean of 8.1 mm (range, 6.0-12.0 mm), did not significantly affect the outcomes of THA in these patients. Therefore, a moderate elevation of the COR can be considered an acceptable option for patients undergoing THA with sequelae of LCPD.
中文总结
本研究旨在探讨髋关节旋转中心上移在接受全髋关节置换术治疗Legg-Calve-Perthes病后遗症患者中的临床可行性。研究纳入了2006年至2019年间因Legg-Calve-Perthes病后遗症接受初次全髋关节置换术的患者53例，根据术后髋关节旋转中心位置将患者分为两组：旋转中心保留组19例与旋转中心提升组34例。平均随访时间为5至17年，两组患者在影像学结局及临床结局方面均无显著差异。所有患者均未发生骨溶解或假体松动，亦无需进行翻修手术。术中发生股骨假体周围骨折3例，未观察到坐骨神经麻痹。10例患者残留跛行，8例患者持续存在骨盆倾斜。末次随访时改良Harris髋关节评分平均为89.2分，表明患者功能恢复良好。研究结果表明，对于Legg-Calve-Perthes病后遗症患者接受初次全髋关节置换术，髋关节旋转中心适度上移并未显著影响手术的中长期效果，因此可被视为一种可接受的治疗选择。
英文摘要 Abstract
Dysplasia is a recognized risk factor for osteoarthritis (OA) of the hip, early diagnosis of dysplasia is important to provide opportunities for surgical interventions aimed at reducing the risk of hip OA. We have developed a pipeline for semi-automated classification of dysplasia using 3D surface models obtained from volumetric CT scans of patients' hips and a minimal set of four clinically annotated landmarks on the acetabular rim (the most proximal, distal, anterior and posterior aspects), combining the framework of the Gaussian process latent variable model with diffeomorphism to create a statistical shape model (SSM), which we termed the Gaussian process diffeomorphic SSM (GPDSSM). We used 192 CT scans, 100 for model training and 92 for testing. The GPDSSM effectively distinguishes dysplastic samples from controls while also highlighting regions of the underlying surface that show dysplastic variations. As well as improving classification accuracy compared to angle-based methods (AUC 96.2% vs 91.2%), the GPDSSM can save time for clinicians by removing the need to manually measure angles and interpreting 2D scans for possible markers of dysplasia.
中文总结
发育性髋关节发育不良是髋关节骨关节炎的重要危险因素，早期准确诊断对于及时干预以降低骨关节炎风险至关重要。本研究开发了一种基于三维表面模型的半自动发育不良分类流程，利用高斯过程潜变量模型与微分同胚映射框架相结合构建统计形状模型。该模型基于CT扫描获取的三维表面重建数据，仅需在髋臼边缘标注四个临床特征点即可完成分析。研究使用192例CT扫描进行模型训练与测试，结果显示该模型在区分发育不良样本与正常对照方面表现出色，曲线下面积达96.2%，显著优于传统角度测量方法。此外，该模型还能可视化显示髋关节表面发生发育不良改变的具体区域，为临床医生节省了手动测量角度及解读二维影像的时间，有望显著提高发育性髋关节发育不良的诊断效率与准确性。
英文摘要 Abstract
INTRODUCTION: Squatting is an important activity of daily living which can be particularly useful in the management of Femoroacetabular Impingement Syndrome (FAIS). However, double-leg squat protocols can vary significantly, potentially impacting biomechanical outcomes. A squat with a "hold" before the ascent phase represents one variation which increases muscular endurance demands and may elucidate such impacts. The purpose of this study was to identify biomechanical differences between a traditional squat (TSquat) and squat with a hold (HSquat) in adolescents and young adults with pre-operative FAIS.
METHODS: Participants (
RESULTS: Participants squatted lower in the TSquat than the HSquat (42.6% ± 12.8% vs. 36.0% ± 13.0%,
DISCUSSION: Participants with FAIS squatted to a shallower depth during the HSquat compared to the TSquat and displayed altered biomechanics, accordingly. Given these findings, greater standardization of squatting techniques is warranted as technique variations may affect outcomes, and researchers must consider potential adjustments made by those with FAIS in their natural squat movement.
中文总结
蹲起是日常活动中的重要动作，在股骨髋臼撞击综合征的管理与康复评估中具有重要价值。然而双腿蹲起方案在临床实践与研究中可能存在显著差异，这种差异可能影响生物力学结局评估。本研究比较了传统蹲起与含停顿蹲起在下蹲最低位停留后再站起在术前股骨髋臼撞击综合征青少年及年轻成人中的生物力学差异。研究结果显示，股骨髋臼撞击综合征患者在含停顿蹲起中的下蹲深度显著浅于传统蹲起，并表现出相应的生物力学改变。含停顿蹲起因在最低位停留而增加了肌肉耐力需求，可能揭示出股骨髋臼撞击综合征患者运动策略的适应性调整。研究提示，在相关研究中蹲起技术的标准化亟待加强，因为技术变异可能影响研究结局的可比性，且研究者需考虑股骨髋臼撞击综合征患者在自然蹲起运动中可能做出的适应性调整策略。
英文摘要 Abstract
PURPOSE: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians-especially where pediatric orthopedic expertise is limited, but their reliability across typical and discordant presentations is uncertain. This scenario-based validation study evaluated the accuracy of ChatGPT-5.0's management recommendations for DDH using 30 structured clinical cases and compared these outputs against AAOS (2022) and AAP (2016) guidelines.
METHODS: Scenario-based validation using 30 unique cases: 20 concordant (aligned clinical and imaging findings) spanning Graf and acetabular index-based ages, and 10 mismatch scenarios with correct examinations but intentionally erroneous radiology. The primary outcome was guideline-concordant accuracy, categorized as correct, partially correct, undertreatment, overtreatment, or incorrect. Secondary outcomes included the effect of error-aware prompts and multilingual consistency.
RESULTS: In concordant scenarios, guided ChatGPT achieved 100% correct, while non-logged-in ChatGPT achieved 95% with one overtreatment. In mismatch scenarios, guided ChatGPT frequently tends toward overtreatment and failing to recommend repeat ultrasound or urgent pediatric orthopedic consultation. Non-logged-in ChatGPT performed better in mismatch cases but similarly under-emphasized remeasurement/consultation. Error-aware prompts did not materially alter recommendations in either environment. Swahili queries produced outputs clinically identical to English responses.
CONCLUSIONS: ChatGPT-5.0 provides reliable, guideline-concordant guidance for DDH when clinical and radiologic data are concordant, supporting potential use as a decision aid in settings without immediate pediatric orthopedic access. Safe clinical implementation requires human oversight and integration of guideline-based safety checks to prevent mismanagement in ambiguous cases.
中文总结
发育性髋关节发育不良需及时作出符合临床指南的诊疗决策，以预防长期功能障碍与并发症。人工智能辅助工具ChatGPT-5.0有望在儿科骨科专业资源有限的地区为临床医生提供决策支持。本研究基于30例结构化临床病例，对ChatGPT-5.0在发育性髋关节发育不良管理建议中的准确性进行了验证，并将输出结果与美国骨科医师学会及美国儿科学会指南进行比较。在20例影像学与临床表现一致的情景中，登录版ChatGPT达到100%正确率，非登录版达95%。在10例影像学与临床不匹配的复杂情景中，登录版ChatGPT倾向于过度治疗且常未能建议复查超声或紧急转诊；非登录版表现略优但同样存在对复查和会诊建议不足的问题。研究结论认为，当临床与影像学数据一致时，ChatGPT-5.0可提供可靠的符合指南的发育性髋关节发育不良指导，但安全临床应用仍需人工审核并整合基于指南的安全检查机制。
英文摘要 Abstract
Spinopelvic biomechanics are critically important for hip stability following total hip arthroplasty (THA). Lumbar spinal fusion, particularly multilevel fusion, alters the dynamic relationship between the spine, pelvis, and hip, resulting in reduced pelvic mobility and increased risk of prosthetic instability. We present the case of an 85-year-old woman with a well-functioning right THA that remained stable for 11 years until she underwent L2-L5 laminectomy and posterior spinal fusion with L4-L5 transforaminal lumbar interbody fusion. Within the subsequent two years, she experienced two distinct episodes of posterior prosthetic hip dislocation, each occurring during forward flexion. This case highlights the biomechanical consequences of lumbar fusion, reviews the underlying mechanisms of altered spinopelvic mobility, and discusses strategies for preventing and addressing hip instability in patients with spinal stiffness or fusion.
中文总结
脊柱-骨盆生物力学对全髋关节置换术后的髋关节稳定性具有重要影响。腰椎融合术尤其是多节段融合，会显著改变脊柱、骨盆与髋关节之间的动态力学关系，导致骨盆活动度下降及假体不稳风险增加。本病例报告了一位85岁女性患者，其右侧全髋关节置换术后11年间假体功能良好，直至患者接受L2-L5椎板切除术及L4-L5经椎间孔腰椎椎体间融合术后两年内发生了两次后脱位，两次脱位均发生在前屈动作时。该病例揭示了腰椎融合术对脊柱-骨盆生物力学的深远影响，深入分析了脊柱僵硬导致髋关节不稳的力学机制，并讨论了脊柱融合患者髋关节不稳的预防与处理策略。此案例提示临床医生在评估全髋关节置换术患者的假体稳定性时，应充分考虑其腰椎融合史及脊柱-骨盆整体生物力学状态。
英文摘要 Abstract
PURPOSE: Machine learning (ML) algorithms are increasingly used to predict outcomes in orthopaedic surgery, but their utility in hip arthroscopy remains unclear. This study aimed to (1) evaluate ML models for predicting outcomes, complications, and resource use following hip arthroscopy, (2) compare ML performance to traditional statistical methods, and (3) critically appraise the quality of existing literature.
METHODS: A systematic search of PUBMED, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials was conducted on 4 April 2023. Included studies used ML models for clinical prediction in hip arthroscopy. Data on study design, outcomes, model development, validation and adherence to TRIPOD guidelines were extracted.
RESULTS: Seventeen studies involving 37,549 patients (52.8% female; mean age 34.4 ± 6.1 years) were included. ML was used to predict clinical outcomes (47.1%), adverse events (47.1%) and resource utilisation (5.9%). The median area under the curve was 0.66 (range 0.5-0.94) for clinical outcomes and 0.7 (range 0.6-0.9) for adverse events. Resource utilisation was reported with a root-mean-square error of $3800, a logarithmic error of 0.2, and R² of 0.8. Only four studies compared ML to traditional regression; two found no difference, while two favoured ML. On average, studies met 12.3 of the 22 TRIPOD criteria, with only 29.4% meeting more than two-thirds.
CONCLUSION: ML models in hip arthroscopy show variable performance in predicting outcomes and complications. Furthermore, most studies comparing ML models to traditional regression did not report any significant difference. Lastly, variability in adherence to TRIPOD guidelines highlights the need for future studies to improve transparency and reporting in the development of ML algorithms for hip arthroscopy. Given the potential of ML models in enhancing clinical decision-making for hip arthroscopy, along with the findings of the current study, their application should be used with caution.
LEVEL OF EVIDENCE: Level IV, systematic review of level II-IV studies.
中文总结
机器学习算法在骨科手术领域的预测应用日益增多，但其在髋关节镜手术中的临床效用尚不明确。本系统综述旨在全面评估机器学习模型在预测髋关节镜术后结局、并发症及医疗资源利用方面的表现，并比较机器学习与传统统计方法的预测性能。研究者系统检索了多个数据库，最终纳入17项研究共37,549例患者进行分析。机器学习被应用于预测临床结局、不良事件及资源利用等方面。临床结局预测的中位曲线下面积为0.66，不良事件预测为0.7。仅4项研究直接比较了机器学习与传统回归方法，其中2项显示无显著差异，2项结果倾向于机器学习。纳入研究在方法学报告质量方面存在不足，平均仅满足22项TRIPOD报告规范中的12.3项。研究表明，机器学习模型在髋关节镜中的预测表现存在较大差异，且多数比较研究未发现其显著优于传统回归方法，TRIPOD指南依从性的不足突显了未来研究需提高机器学习算法开发与报告的透明度与规范性。
英文摘要 Abstract
The hip is a complex load-bearing joint susceptible to both acute traumatic and chronic overuse injuries. Traumatic injuries, such as acute fractures, dislocations, apophyseal avulsions, and muscle tears, typically follow high-energy events. In contrast, overuse injuries, for example, femoroacetabular impingement, stress fractures, labral degeneration, and greater trochanteric pain syndrome, arise gradually from repetitive mechanical overload. Early and accurate diagnosis requires a multimodal imaging approach: radiographs for baseline assessment, computed tomography for detailed osseous injury and alignment, magnetic resonance imaging and magnetic resonance arthrography for chondrolabral and soft tissue pathology, and ultrasound for dynamic evaluation of tendinous disorders. Understanding the mechanism, location, and severity of hip injuries is essential to guide prognosis, management, and prevention. This review provides a structured overview of traumatic and overuse hip injuries, highlighting imaging features that enable timely detection, precise characterization, and tailored interventions to optimize functional outcomes.
中文总结
髋关节作为一个复杂的承重关节，同时承受急性创伤和慢性过度使用所带来的损伤。急性创伤如骨折、脱位、骨突撕脱及肌肉撕裂通常由高能量事件引起，而过度使用损伤如股髋撞击综合征、应力性骨折、盂唇退变及大转子疼痛综合征则源于重复性的机械负荷。早期准确诊断需要多模态影像学方法：X线用于基线评估，计算机断层扫描用于详细评估骨性损伤和力线对齐，磁共振成像及磁共振关节造影用于软骨盂唇和软组织病变的评估，超声用于肌腱疾病的动态评估。理解髋关节损伤的机制、部位及严重程度对于指导预后、制定治疗方案及制定预防策略至关重要。本文综述了创伤性和过度使用性髋关节损伤的影像学特征，旨在实现早期发现、精确诊断及个体化干预，从而优化患者功能预后。
英文摘要 Abstract
BACKGROUND: Traditional imaging modalities like X-rays and conventional MRI lack sensitivity to detect early microscopic changes in cartilage damage, making them insufficient for evaluating early degenerative changes. exploring more sensitive imaging techniques to precisely quantify cartilage damage has become a key focus in current OA research. This study aimed to evaluate the degree of femoral head cartilage damage by quantifying the signal intensity of cartilage regions of interest (ROI) using the 5T MRI T2-mapping sequence and correlating it with Mankin pathological scores for cartilage damage.
METHODS: Patients diagnosed with hip osteoarthritis, avascular necrosis of the femoral head, or congenital hip dysplasia, who underwent total hip arthroplasty with pathological specimen collection, were enrolled between January 2023 and December 2023. On sagittal 5T MRI images, the acetabular center was identified, and the femoral head cartilage was divided into eight regions (A1–A8). Each region was further subdivided into three equal parts, resulting in a total of 24 ROIs. The signal intensity values for each ROI were measured. For pathological analysis, femoral head specimens were sagittally sectioned through the acetabular center, decalcified, and stained with Safranin O-Fast Green. Cartilage damage was assessed using the Mankin scoring system. The Mankin score served as the gold standard for cartilage damage, and a diagnostic standard for evaluating femoral head cartilage damage using the 5T MRI T2-mapping sequence was established. Receiver Operating Characteristic Curve (ROC) curve analysis was performed for validation.
RESULTS: A total of 15 patients meeting the inclusion criteria were analyzed, encompassing 360 ROI regions. Based on Mankin scoring, the ROIs were classified into mild damage (245 regions), moderate damage (104 regions), and severe damage (11 regions). There was a statistically significant correlation between T2-mapping values and Mankin scores. Significant differences in T2-mapping values were observed among the different Mankin grades. ROC curve analysis showed the following thresholds for T2-mapping values: ≤43.6 for mild damage, > 43.6 and ≤ 75.6 for moderate damage, and > 75.6 for severe damage.
CONCLUSION: In this pathology-based study, 5-Tesla MRI T2 mapping demonstrated a significant correlation with histological Mankin scores in femoral head cartilage. Quantitative T2 values increased progressively with the severity of cartilage degeneration, indicating that high-field T2 mapping is sensitive to compositional and microstructural alterations of articular cartilage at the tissue level. The proposed T2 thresholds allowed preliminary stratification of cartilage degeneration severity within this cohort.
中文总结
传统X线和常规磁共振成像对软骨早期微结构变化的检测灵敏度不足，难以准确评估关节软骨的早期退行性改变。本研究探讨5T磁共振T2-mapping序列在量化股骨头软骨损伤中的临床价值。研究纳入因髋关节骨关节炎、股骨头坏死或先天性髋关节发育不良而行全髋关节置换术并留取病理标本的患者，于矢状面5T MRI图像上以髋臼中心为标志将股骨头软骨分为8个区域并细分为24个感兴趣区，测量各区域信号强度值。病理分析采用Safranin O-Fast Green染色并依据Mankin评分系统评估软骨损伤。结果显示360个感兴趣区中轻度损伤245个、中度损伤104个、重度损伤11个，T2-mapping值与Mankin评分呈显著正相关，不同Mankin分级的T2值存在统计学差异。ROC曲线分析确定阈值：轻度损伤≤43.6ms，中度损伤43.6-75.6ms，重度损伤>75.6ms。该研究表明5T MRI T2 mapping与组织学Mankin评分具有显著相关性，定量T2值随软骨退变程度加重而递增，高场强T2 mapping对关节软骨的微结构改变具有较高敏感性，所建立的T2阈值可用于评估股骨头软骨退变严重程度。
英文摘要 Abstract
BAC KGROUND: Total hip arthroplasty (THA) is a rare procedure in pediatric patients. Although it shows excellent results in adults, the presence of growth plates, the limited longevity of implants, and the hip-spine biomechanics involved during growth make the outcomes of THA in children uncertain.
OBJECTIVE: We hypothesized that THA yields satisfactory results for children suffering from unmanageable pain due to hip joint osteoarthrosis.
METHODS AND SETTINGS: 27 patients aged <18 years who underwent THA for hip joint osteoarthritis at our hospital between 2015 and 2022 were retrospectively included. Primary outcomes included two clinical scales: the Postel Merle d'Aubigné (PMA) and Oxford scale. Secondary outcomes included chronic pain relief and complications.
RESULTS: Mean age at surgery was 13.7± 1.7 years (min11, max 17). The mean follow-up was 5.4±2.4 years (min 3, max 10). Etiology of osteoarthrosis was slipped capital femoral epiphysis (n=13), idiopathic hip chondrolysis (n=4), femoral neck fracture (n=3), developmental hip dysplasia (n=3), hip joint infection (n=2), aseptic osteonecrosis secondary to drepanocytosis (n=1), and Legg-Calvé-Perthes disease (n=1). The average Oxford score was 43.2±4.8, and the mean PMA score was 15.9±0.6. Pain relief was achieved in 96.3% of patients. Six patients had major complications (22.2%), with three (11.1%) requiring unplanned surgeries.
LIMITATIONS: The main limitations were a small sample size and the absence of a control group.
CONCLUSION: To date, no study has specifically evaluated THA clinical outcomes in children with non-inflammatory hip joint osteoarthritis. This study demonstrates satisfactory outcomes following THA in children with hip joint osteoarthritis. THA should be considered a viable option for selected pediatric patients.
中文总结
全髋关节置换术在儿科患者中是一种罕见但具有挑战性的手术方式。成人患者接受该手术后效果优良，但儿童患者由于存在生长板、假体寿命有限以及髋脊柱生物力学的复杂性，其预后存在不确定性。本研究假设全髋关节置换术能够为因髋关节骨关节炎导致难治性疼痛的儿童患者提供满意结果。研究回顾性纳入2015至2022年间27例年龄小于18岁因髋关节骨关节炎接受全髋关节置换术的患者，平均手术年龄为13.7±1.7岁，平均随访5.4±2.4年。骨关节炎病因包括股骨头滑脱症13例、特发性髋关节软骨溶解症4例、股骨颈骨折3例、发育性髋关节发育不良3例、髋关节感染2例、镰状细胞病相关无菌性骨坏死1例及Legg-Calvé-Perthes病1例。主要结局指标为Postel Merle d'Aubigné评分和牛津评分，次要结局包括慢性疼痛缓解及并发症发生率。结果显示平均牛津评分为43.2±4.8分，平均PMA评分为15.9±0.6分，96.3%的患者获得疼痛缓解，6例患者发生重大并发症其中3例需要计划外手术。本研究表明全髋关节置换术在儿童髋关节骨关节炎患者中可获得满意疗效，对于经筛选的儿科患者应被视为可行的治疗选择。
英文摘要 Abstract
BACKGROUND: Hip distraction is essential for hip arthroscopy and other orthopaedic surgeries, but high traction forces often lead to complications like nerve injury and soft tissue impairment. Patients with total knee arthroplasties (TKAs) may face increased risk due to altered joint mechanics; however, the impact of specific TKA configurations on knee behavior during distraction is poorly understood.
METHODS: A validated finite element model of the pelvis and lower extremity was developed from patient CT and MRI data. Three configurations were modeled: bi-cruciate retaining (BCR), posterior-cruciate retaining (PCR; lacking ACL), and posterior-stabilized (PS; lacking both cruciates). Hip distraction was simulated with axial traction forces (100-500 N) applied to the distal tibia/fibula with the pelvis fixed proximally. Knee and hip joint displacement and ligament strains were evaluated.
FINDINGS: The BCR model demonstrated the highest knee stiffness. ACL removal (PCR) reduced stiffness more compared to PCL removal. While the amount of hip distraction was consistent across models, PCR and PS knees experienced excessive knee distraction (>12 mm) and ligament strains exceeding 20% before achieving 10 mm of hip distraction. Conversely, the BCR model remained under 10 mm of knee distraction and 15% strain at equivalent hip distraction levels.
INTERPRETATION: Finite element analysis revealed that PCR and PS configurations exhibit knee instability, exceeding soft tissue injury thresholds (>20% strain) within standard clinical traction ranges (250-350 N). The ACL contributed greater to knee complex stiffness in axial traction compared to the PCL. Standard traction forces may pose an iatrogenic risk to PCR and PS patients, suggesting a need for TKA-specific distraction protocols to prevent soft tissue failure.
中文总结
髋关节撑开牵引是髋关节镜手术的必要步骤，但高牵引力常导致神经损伤和软组织损伤等并发症。既往研究表明接受全膝关节置换术的患者可能因关节力学改变而面临更高风险，但不同假体设计对膝关节在髋关节牵引过程中行为的影响尚不明确。本研究利用患者CT和MRI数据建立经过验证的骨盆及下肢有限元模型，模拟三种假体配置：双十字韧带保留型、后十字韧带保留型及后稳定型，在胫骨/腓骨远端施加100-500N轴向牵引力模拟髋关节撑开。结果显示双十字韧带保留型模型表现出最高膝关节刚度，ACL切除对刚度的影响大于PCL切除；后十字韧带保留型和后稳定型膝关节在达到10mm髋关节牵引前已出现超过12mm的过度膝关节撑开且韧带应变超过20%，而双十字韧带保留型在相同牵引条件下膝关节撑开保持在10mm以下且应变低于15%。有限元分析揭示后十字韧带保留型和后稳定型假体在标准临床牵引力范围（250-350N）内即可超过软组织损伤阈值，ACL对膝关节复合体在轴向牵引中的刚度贡献大于PCL。因此对于该两类假体患者，标准牵引力可能带来医源性损伤风险，有必要制定针对特定假体类型的牵引方案以防止软组织失败。
英文摘要 Abstract
PURPOSE: Patients with femoroacetabular impingement syndrome (FAIS) may experience persistent hip problems following arthroscopic surgery, with some patients requiring total hip arthroplasty (THA). Therefore, the purpose was (1) to investigate the proportion of THA conversion in a large national Danish cohort of patients with FAIS who had previously undergone hip arthroscopy. (2) To investigate factors that might affect time to conversion. (3) To describe patient-reported outcomes after THA.
METHODS: Patients aged 18 years or above registered with arthroscopic surgery for FAIS between January 2012 and November 2023 in the Danish Hip Arthroscopy Registry (DHAR). Eligible patients were invited to participate in an online survey. If they responded 'yes' to the entry question 'Have you had total hip arthroplasty?', they were asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS), the Hip Osteoarthritis Outcome Score (0-100 scores, 100 being no problems), the Hip Specific Sports Scale, and Patient Acceptable Symptom State. To perform survival analysis, a Kaplan-Meier method was used to estimate cumulative all-cause conversion to THA. A Cox regression model was fitted after examining proportional-hazards assumptions to examine predictor variables on conversion to THA.
RESULTS: A total of 5109 patients were eligible and invited for the survey. Of which, 2383 (46.6%) responded; 406 patients had received THA at a median of 4.2 [2.1; 7.0] years after hip arthroscopy. Regarding HAGOS, patients (N = 199) treated with THA reported mild pain (75 [55; 93] points) and problems with daily activities (70 [40; 90] points) and moderate problems with sports activities (53 [28; 81] points) and hip-related quality of life (50 [30; 80] points), 56% participated in sports activities and 62% reported an acceptable symptom state.
CONCLUSIONS: A low number of conversions to THA (8%) was observed. Older age decreased lateral joint space width, Tönnis grade > 0, higher alpha angle and femoral cartilage pathology were associated with conversion to THA.
LEVEL OF EVIDENCE: Level II, retrospective study.
中文总结
股髋撞击综合征患者在接受关节镜手术后部分患者可能因持续性髋关节症状而需转换为全髋关节置换术。本研究旨在调查丹麦国家髋关节镜注册数据库中股髋撞击综合征患者接受关节镜手术后全髋关节置换术的转换比例及影响转换时间的相关因素。共有5109例符合条件并接受邀请参与问卷调查的患者中，2383例（46.6%）回复，其中406例患者已在关节镜术后中位4.2年时接受了全髋关节置换术，转换率为8%。Kaplan-Meier生存分析显示累积全因转换率，Cox回归模型分析表明年龄增长、侧方关节间隙减小、Tönnis分级大于0、Alpha角增大及股骨头软骨病变与全髋关节置换术转换显著相关。接受全髋关节置换术的患者报告了轻度的疼痛（75分）、日常活动障碍（70分）、运动活动中度障碍（53分）及髋关节相关生活质量下降（50分），56%参与运动活动，62%报告症状状态可接受。该研究表明髋关节镜术后全髋关节置换术的总体转换率较低，但老年患者、外翻形态、关节炎改变及股骨头软骨病变是术后转换为全髋关节置换术的重要预测因素。
英文摘要 Abstract
BACKGROUND: Heterotopic ossification (HO) is a common complication after hip arthroscopy that has historically been prophylactically treated with postoperative radiation. Newer prophylactic treatments use nonsteroidal anti-inflammatory drugs (NSAIDs) in place of radiation.
PURPOSE: To examine the incidence of HO after hip arthroscopy with and without the use of chemoprophylactic agents.
STUDY DESIGN: Systematic review; Level of evidence, 4.
METHODS: PubMed and Scopus electronic databases were queried for all studies published between January 2000 and July 2025 that evaluated HO after hip arthroscopy. Information on study design, the use of exclusive NSAID chemical prophylaxis and regimen, presence of HO, and length of follow-up were collected from all studies. The Brooker classification was used for determining severity of HO. Matched-cohort studies were combined for meta-analysis and analyzed using the DerSimonian and Laird method of random-effects meta-analysis.
RESULTS: A total of 44 studies including a total of 32,603 patients were included. The incidence of HO in patients who received chemoprophylaxis after hip arthroscopy was 15.3 per 1000 patients per year compared with 80.1 per 1000 patients per year in those who did not receive chemoprophylaxis (
CONCLUSION: Postoperative NSAIDs were effective in reducing the incidence and severity of HO after hip arthroscopy. Meta-analysis of matched-cohort studies estimated a 10-fold decrease in the incidence.
中文总结
异位骨化是髋关节镜手术后常见的并发症，传统上采用术后放射治疗进行预防，近年来非甾体抗炎药已逐渐取代放射治疗成为新的预防策略。本系统综述和Meta分析旨在评估髋关节镜术后使用化学预防措施对异位骨化发生率的影响。研究检索2000年1月至2025年7月间PubMed和Scopus数据库中评估髋关节镜术后异位骨化的所有文献，收集研究设计、化学预防的具体方案及剂量、异位骨化发生率及随访时间等信息，采用Brooker分类标准评估异位骨化严重程度，并对配对队列研究进行Meta分析。共纳入44项研究包含32603例患者，结果显示接受化学预防的患者异位骨化发生率为15.3/千人/年，而未接受预防者为80.1/千人/年。Meta分析表明术后非甾体抗炎药可有效降低髋关节镜术后异位骨化的发生率和严重程度，配对队列研究的Meta分析估算其发病率降低约10倍。该综述为髋关节镜术后异位骨化的化学预防提供了循证依据，非甾体抗炎药是有效且安全的预防选择。
英文摘要 Abstract
BACKGROUND: Perineal post countertraction during hip arthroscopy risks complications. Postless traction avoids the perineal post but requires understanding the factors influencing traction force to optimize safety. This study investigated how gender, body mass index (BMI), traction states, hip rotation, lateral center-edge angle (LCEA), alpha angle, and femoral anteversion affect traction force during postless hip arthroscopy.
MATERIALS AND METHODS: This retrospective study included patients undergoing postless hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between October 2023 and March 2024. Inclusion criteria comprised confirmed FAIS diagnosis and comprehensive intraoperative traction force documentation across six traction states (initial traction to 40 min post-capsulotomy) and three rotational positions (neutral, internal/external rotation at 15°). Traction force was measured using a force sensor. Preoperative LCEA, alpha angle, and femoral anteversion were radiographically assessed. Mann-Whitney U tests and repeated-measures ANOVA were used to assess sex-, state-, and rotation-related effects on traction force; Pearson or Spearman correlation analyses were used to analyze associations between BMI, alpha angle, LCEA, femoral anteversion, and traction force.
RESULTS: A total of 34 patients (10 males, 24 females) were included in this study. Traction forces increased from initial gross traction to needle puncture of the capsule (
CONCLUSIONS: Traction force during postless hip arthroscopy increases with higher BMI, larger LCEA, and elevated alpha angle, while greater femoral anteversion reduces traction requirements. Male gender and internal or external hip rotation consistently demand higher forces compared to females and neutral rotation. Traction force decreases after joint puncture and capsulotomy and decrease over time during surgery.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-026-09529-y.
中文总结
本研究旨在探讨无支点髋关节镜手术中影响牵引力的关键因素，为优化手术安全性提供理论依据。该回顾性病例对照研究纳入了2023年10月至2024年3月期间因股骨髋臼撞击综合征接受无支点髋关节镜手术的34例患者，通过高精度力传感器系统测量了从初始牵引起至囊膜切开后40分钟共六个不同牵引状态下的牵引力变化，同时评估了中立位、髋关节内旋15度及外旋15度三种旋转位置的力学差异，并采集术前外侧中心边缘角、α角及股骨前倾角等影像学参数进行相关性分析。研究结果显示，牵引力随体重指数升高、外侧中心边缘角增大及α角升高呈显著正相关，而股骨前倾角越大所需牵引力反而越小；性别方面，男性患者所需牵引力显著高于女性；髋关节处于内旋或外旋位置时所需牵引力均明显高于中立位；此外，关节穿刺和囊膜切开后牵引力逐渐降低，且随手术时间延长呈持续下降趋势。该研究为无支点髋关节镜手术中牵引参数的个性化设置提供了循证医学依据，对减少会阴部并发症及优化手术操作具有重要临床指导意义。
英文摘要 Abstract
BACKGROUND: Hip dysplasia and cam morphology are both common causes of hip pain in pediatric patients. However, there is limited literature on how the presence of hip dysplasia may affect the prevalence of cam morphology.
OBJECTIVE: This study aims to assess if hip dysplasia in pediatric patients has a similar prevalence and location of cam morphology compared with non-dysplastic hips.
MATERIALS AND METHODS: This retrospective study assessed pediatric patients with hip pain from April 2012 to June 2024. Data collection was based on chart review and imaging consensus review of all hip MRIs conducted by two musculoskeletal radiologists and a pediatric orthopedic surgeon. Data included were the presence of hip dysplasia, defined as a lateral center-edge angle (LCEA) <18°, cam morphology, and their location. Chi-square and Fisher's exact test were used with p-values for significance set to 0.05.
RESULTS: From our study cohort of 118 hips in 107 patients (mean age 15.3. years, 66% female, 81 hips underwent surgery), there were 64 cam morphology hips present. Cam morphology was present in 55.6% of dysplastic hips and 53.7% of non-dysplastic hips (p = 0.849). Cam morphology was most commonly located anterosuperior femoral head-neck in 70% of dysplastic hips and 65.9% in non-dysplastic hips (p = 0.747).
CONCLUSION: Cam morphology is frequently identified in pediatric patients with hip pain. The prevalence and location of cam morphology is not affected by the presence of co-existing hip dysplasia. During imaging work-up and treatment planning, it is important to recognize that a high proportion of pediatric hip dysplasia patients may have a co-existing cam morphology.
中文总结
髋关节发育不良和cam形态畸形均为儿童患者髋部疼痛的常见原因，但目前关于髋关节发育不良对cam形态畸形发生率及位置影响的研究报道较为有限。本回顾性研究纳入了2012年4月至2024年6月期间因髋部疼痛就诊的107例儿科患者共118髋，由两名肌肉骨骼放射科医师和一名儿科骨科医师共同进行影像学共识审查，以外侧中心边缘角小于18度定义为髋关节发育不良，系统分析cam形态畸形的存在情况及其解剖位置分布。研究结果显示，发育不良髋关节中cam形态畸形的发生率为55.6%，而非发育不良髋关节为53.7%，两组间差异无统计学意义；cam形态畸形最常见于股骨头颈交界处前上方区域，发育不良组占70%，非发育不良组占65.9%，两组分布模式亦无显著差异。该研究表明，髋关节发育不良的存在并不影响cam形态畸形的发生率及位置分布，提示临床工作中对存在发育不良的儿童髋关节进行影像学评估和治疗计划时，应意识到相当比例的患者可能合并cam形态畸形，需全面评估以制定最佳治疗策略。
英文摘要 Abstract
Total hip arthroplasty (THA) is a widely performed procedure that significantly enhances patients' quality of life. However, nerve injury remains a concerning complication, with an incidence ranging from 0.6% to 3.7%, depending on patient and surgical variables. This narrative review provides a comprehensive overview of nerve injuries associated with THA, focusing on etiology, risk factors, clinical manifestations, prevention, and treatment strategies. The most affected nerves include the sciatic, femoral, lateral femoral cutaneous (LFCN), superior gluteal, and obturator nerves. Anatomical factors such as developmental hip dysplasia (DDH), limb length discrepancy, and aberrant nerve courses, along with patient-specific conditions like female sex, obesity, and pre-existing spinal disorders, increase the risk of nerve damage. Surgical complexity, revision procedures, and surgeon experience also influence injury likelihood. Clinical manifestations range from sensory disturbances to motor deficits including foot drop, Trendelenburg gait, or impaired knee extension, depending on the nerve involved. Diagnosis is primarily clinical, supported by electrophysiological studies and imaging when needed. Prevention hinges on careful preoperative planning, appropriate surgical approach selection, meticulous intraoperative technique, and attention to limb positioning. Treatment is typically conservative, involving pain control, physical therapy, and neurostimulation. In refractory or severe cases, interventions such as nerve decompression, repair, or tendon transfer may be considered. Pharmacological agents including vitamin B12, tacrolimus, and melatonin show potential in promoting nerve regeneration. Although most nerve injuries resolve spontaneously or with conservative measures, some cases may result in long-term deficits. Understanding the mechanisms, risk factors, and management strategies is essential to mitigating complications and optimizing functional outcomes in patients undergoing THA.
中文总结
全髋关节置换术是改善患者生活质量的有效手术方式，但神经损伤仍是值得关注的并发症，其发生率约为0.6%至3.7%，取决于患者及手术相关变量。该叙述性综述全面概述了全髋关节置换术后神经损伤的病因、危险因素、临床表现、预防及治疗策略。受累神经主要包括坐骨神经、股神经、股外侧皮神经、臀上神经和闭孔神经。解剖因素如发育性髋关节发育不良、肢体长度差异和神经异常走行，以及患者特异性因素如女性、肥胖和既往脊柱疾病均会增加神经损伤风险；手术复杂程度、翻修手术和术者经验同样影响损伤发生率。临床表现因受累神经不同而异，可表现为感觉障碍、运动缺陷如足下垂、Trendelenburg步态或膝关节伸直受限。诊断主要依赖临床评估，辅以电生理检查和影像学检查。预防策略包括细致的术前规划、合理的手术入路选择、精细的术中操作及体位管理；治疗以保守治疗为主，包括疼痛控制、物理治疗和神经电刺激，对于难治性或严重病例可考虑神经减压、修复或肌腱转位术。维生素B12、他克莫司和褪黑素等药物在促进神经再生方面展现出潜在价值。尽管多数神经损伤可自行恢复或经保守治疗改善，部分病例仍可能遗留长期功能障碍，因此理解神经损伤机制、危险因素及管理策略对减少并发症和优化全髋关节置换术功能预后至关重要。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
该条目为正式撤稿通知，涉及一篇关于Crowe III型和IV型发育性髋关节发育不良患者人工全髋关节置换术前数字设计方法的病例系列研究论文，原文已被期刊正式撤回。撤稿原因及相关详细信息请参阅原始期刊发布的官方声明。鉴于该论文已被撤回，其研究内容和结论不再被视为可靠的科学文献，临床实践中不宜参考或引用该研究的任何数据或观点。
英文摘要 Abstract
PURPOSE: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into Dutch and evaluate its psychometric properties.
METHODS: The HWI was translated using a standardized forward-backward translation process. Psychometric evaluation followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and included assessments of readability, interpretability, responsiveness, reliability and content validity. Parents of infants aged 3-13 months diagnosed with DDH and managed with active surveillance or abduction bracing with a Pavlik harness were included.
RESULTS: The Dutch version of the HWI was completed by 59 parents prior to treatment and by 50 of them during treatment. In addition, 56 parents completed the questionnaire twice around their child's first birthday. The Dutch HWI demonstrated good readability (Flesch Reading Ease Score = 84.1) and adequate interpretability (mean score 21.53, standard deviation 6.11). Responsiveness was supported by confirmation of 89% of the predefined hypotheses. Internal consistency was good (Cronbach's α = 0.77-0.79) and test-retest reliability was excellent (Intraclass Correlation Coefficient = 0.95; 95% Confidence interval 0.91-0.97). Content validity assessment identified concerns regarding the relevance of items 3-6 for non-brace treatment, the sequencing of items, the use of negatively worded items and the absence of items addressing practical and informational needs.
CONCLUSIONS: The Dutch HWI is a promising instrument for assessing parental concerns related to DDH in early infancy. However, limitations in content validity highlight the need for refinement, incorporating input from parents, caregivers and healthcare professionals to enhance content validity and clinical applicability.
中文总结
髋关节担忧量表是一种用于评估婴儿期发育性髋关节发育不良相关父母担忧情绪的11项自评问卷，本研究旨在将该量表翻译为荷兰语并全面评估其心理测量学特性。研究团队采用标准化的前向-后向翻译流程，严格遵循健康测量仪器选择共识标准进行心理评估，内容涵盖可读性、可解释性、反应性、内部一致性信度及内容效度等维度。纳入研究的父母其子女年龄为3至13个月，诊断为发育性髋关节发育不良并接受主动监测或外展支具治疗。结果显示荷兰版髋关节担忧量表具有良好的可读性，Fleisch阅读容易度评分为84.1分，可解释性充分；反应性验证中89%的预设假设得到确认；内部一致性良好，Cronbach's α系数为0.77至0.79，重测信度优秀，组内相关系数达0.95。内容效度评估揭示了若干局限性，包括第3至6项条目对非支具治疗患儿的适用性、条目顺序安排、负面措辞的使用以及缺乏针对实际照护需求和信息获取需求的条目等问题。该荷兰版髋关节担忧量表是评估婴儿期发育性髋关节发育不良父母担忧情绪的有前景的测评工具，但其内容效价方面的不足提示未来需进一步优化完善，应纳入父母、照护者和医疗专业人员的意见以提升内容效度和临床适用性。
英文摘要 Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) presents a diagnostic challenge due to varying risk factors (RFs) and ultrasonographic (USG) classifications. This study aimed to identify independent RFs for DDH and evaluate their association with USG hip types in a large pediatric cohort.
METHODS: A retrospective review was conducted on infants under six months of age from a tertiary DDH screening program (2008–2022). The study included 227 cases with DDH and 924 controls with normal hips. Univariate and multivariate logistic regression analyses were performed to assess the association of RFs with DDH and USG hip types (stable dysplastic vs. unstable hips).
RESULTS: Female sex (OR: 2.518), breech presentation (OR: 1.817), oligohydramnios (OR: 2.762), and foot deformities (OR: 2.262) were identified as independent RFs for DDH. Firstborn girls were significantly more likely to exhibit unstable hips (OR: 1.889,
CONCLUSION: This study highlights the importance of early USG screening for infants with critical risk factors, including female sex, breech presentation, oligohydramnios, and foot deformities. Notably, firstborn girls with DDH exhibit a significantly higher risk of unstable hips, emphasizing the need for targeted screening in this high-risk subgroup.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-025-06426-6.
中文总结
发育性髋关节发育不良的早期诊断因危险因素多样性和超声分型系统差异而面临诸多挑战，本研究旨在识别该疾病的独立危险因素并评估其与超声髋关节分型的关联性。该研究对2008至2022年间某三级发育性髋关节发育不良筛查项目中6个月以下婴儿进行大规模回顾性分析，纳入227例病例和924例正常髋关节对照，采用单因素和多因素logistic回归分析系统评估各危险因素与发育性髋关节发育不良及超声分型之间的统计学关联，超声分型定义为稳定型发育不良与不稳定型髋关节两组。研究结果显示，女性、臀位分娩、羊水过少和足部畸形是发育性髋关节发育不良的独立危险因素；进一步亚组分析表明，长女群体合并发育性髋关节发育不良时更易表现为不稳定型髋关节，提示该特定人群具有更高的疾病进展风险。该研究强调了對具有上述关键危险因素婴儿进行早期超声筛查的重要性，尤其指出长女群体面临更高的不稳定型髋关节风险，临床实践中应对这一高危亚群采取更为积极和针对性的筛查策略，以改善远期预后。
英文摘要 Abstract
Postoperative instability remains one of the main causes of early revision after total hip arthroplasty (THA), often occurring within the first 5 years. While factors such as implant design, surgical technique, and spinopelvic alignment have been widely studied, hemipelvis malrotation-a subtle, often unrecognized unilateral pelvic deformity-has received limited attention. This condition can lead to apparent implant malposition despite adherence to standard surgical protocols. A review of current literature suggests that hemipelvis malrotation may significantly influence postoperative hip stability, yet it is frequently missed on standard anteroposterior (AP) pelvic radiographs. A clinical case is presented in which a patient experienced recurrent anterior dislocation after primary THA, even though the acetabular and femoral components appeared well positioned on routine imaging. Further evaluation with advanced imaging revealed a pronounced unilateral hemipelvis malrotation that had altered the true functional orientation of the acetabulum. Revision surgery incorporating correction of this underlying deformity successfully restored joint stability and resolved the patient's symptoms. This case highlights the limitations of traditional 2-dimensional imaging and underscores the need for a more comprehensive, multiplanar, and dynamic preoperative assessment. Recognizing hemipelvis malrotation as a distinct contributor to THA instability may improve surgical planning and reduce the risk of dislocation and early revision. Collaboration between orthopedic surgeons and radiologists is essential to identify subtle pelvic asymmetries that can compromise component alignment and long-term functional outcomes.
中文总结
术后不稳是全髋关节置换术后早期翻修的主要原因之一，尽管假体设计、手术技术及脊柱-骨盆对齐等因素已被广泛研究，但单侧半骨盆旋转畸形——这一常被忽视的病因——尚未得到足够关注。本病例报告中，患者在初次全髋关节置换术后出现复发性前脱位，尽管常规影像学检查显示髋臼及股骨组件位置均看似满意。进一步高级影像学检查揭示了严重的单侧半骨盆旋转畸形，这一畸形改变了髋臼的真实功能朝向。翻修手术中对该潜在畸形进行矫正后，成功恢复了关节稳定性并解决了患者症状。本病例提示，传统二维影像存在局限性，术前评估应采用更全面的多平面及动态检查方法。识别半骨盆旋转畸形作为全髋关节置换术后不稳的独立影响因素，可能有助于改善术前规划并降低脱位及早期翻修风险。骨科医生与放射科医生的协作对于识别可能损害组件对齐及长期功能结局的细微骨盆不对称至关重要。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a multifactorial disorder that affects 0.56-3.8% of newborns worldwide. Recent research has identified several candidate genes potentially involved in DDH pathogenesis, with LRP1 investigated as a candidate gene due to its regulatory role in cartilage development. This study presents a genetic analysis of two female DDH patients (17 and 26 years old) diagnosed through radiographic examination. Genomic DNA was extracted from peripheral blood samples of the two female patients with DDH. We performed targeted genetic analysis of LRP1 exons 6, 32, 40, and 74, which have been previously implicated in DDH pathogenesis. DNA was extracted from peripheral blood samples, amplified via polymerase chain reaction (PCR), and analyzed using Sanger sequencing. Despite clear clinical DDH diagnoses, neither patient carried mutations in the examined LRP1 exons and displayed only wild-type sequences. These findings indicate that no pathogenic LRP1 variants were detected in these two DDH patients. This case report provides preliminary descriptive data on LRP1 exonic regions in DDH. The absence of detected variants in these specific loci suggests that future investigations should utilize high-throughput sequencing strategies in larger cohorts to more comprehensively explore the genetic basis of the disorder.
中文总结
发育性髋关节发育不良（DDH）是一种多因素疾病，在全球新生儿中的发病率为0.56%至3.8%。近期研究已识别出多个可能参与DDH发病机制的相关候选基因，其中LRP1因其在软骨发育中的调节作用而被重点关注。本研究对两例DDH女性患者（年龄分别为17岁和26岁）进行了遗传分析，采用靶向基因检测方法对LRP1基因的第6、32、40和74外显子进行测序分析，这些外显子此前已被报道与DDH发病相关。尽管两例患者均有明确的临床DDH诊断，但Sanger测序结果显示均未携带所检外显子中的致病突变，仅发现野生型序列。这一发现表明，在这两例DDH患者中未检测到LRP1致病性变异。本病例报告为LRP1外显子区域在DDH中的研究提供了初步描述性数据，提示未来研究应采用高通量测序策略在更大样本人群中进行探索，以更全面地揭示该疾病的遗传基础。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is one of the most frequent pediatric disorders. Management of DDH is age-related. While an outpatient orthopedic treatment may be initiated during the neonatal period, open reduction with/out pelvic and/or femoral osteotomy is reserved for cases of failed closed reduction or late presentation. Open reduction aims at stable concentric hip reduction, with capsulorrhaphy enhancing stability. An S-shaped capsulotomy is proposed for 10 patients with an average follow-up 9.4 months, to enhance hip joint access and provide a more secure, double-layered capsulorrhaphy. LEVEL OF EVIDENCE: V; Technical note.
中文总结
发育性髋关节发育不良（DDH）是最常见的儿童髋关节疾病之一，其治疗策略与患者年龄密切相关。在新生儿期可开始门诊骨科治疗，而对于闭合复位失败或晚发表现的病例，则需进行开放复位联合或不联合骨盆和/或股骨截骨术。开放复位的目标是实现稳定、同心的髋关节复位，而关节囊修复术可增强关节稳定性。本技术说明提出了一种S形关节囊切开术，用于10例DDH患者（平均随访9.4个月），以改善髋关节显露并提供更牢固的双层关节囊修复。该术式旨在优化DDH开放复位术中髋关节入路并增强关节囊缝合强度，从而提高手术效果和假体稳定性。
英文摘要 Abstract
OBJECTIVES: This study aimed to analyze the radiologic characteristics of irreducible pediatric femoral head fracture-dislocations to prevent potential iatrogenic femoral neck fractures (FNF) or separation of the proximal femoral epiphysis (SPFE).
METHODS: This is a retrospective review of patients who were skeletally immature and diagnosed with traumatic hip dislocations combined with femoral head fractures. The collected data included patient demographics, fracture classification, fragment ratio, combined injuries, urgent reductions, treatment strategies, complications, and final outcomes.
RESULTS: We treated 12 patients with femoral head fractures and dislocations; 11 out of 12 patients underwent urgent closed reduction (91.7%). Six of the patients failed closed reduction and experienced FNF (n = 2, 33.3%) or SPFE (n = 4, 66.7%). Five patients presented with avascular necrosis of the femoral head after open reduction with internal fixation via a surgical hip dislocation approach, and two patients required further surgical treatment. Analysis of radiographs and computed tomography (CT) scans of irreducible femoral head fracture-dislocations revealed that the fractured femoral head was perched on the sharp angle of the posterior wall of the acetabulum, with a fragment ratio of 18-27%. After recognizing the irreducibility, one case with a fragment ratio of 26% underwent immediate open reduction without further attempts at closed reduction. This procedure preserved the natural hip joint, preventing FNF and SPFE.
CONCLUSIONS: For pediatric patients with irreducible femoral head fracture-dislocation injuries and a fragment ratio greater than 10%, repeated or forceful closed reduction may result in iatrogenic FNF or SPFE. Examining plain radiographs and CT images carefully before attempting reduction may help determine the safest treatment strategy.
中文总结
本研究旨在分析不可复位的儿童股骨头骨折-脱位的影像学特征，以预防医源性股骨颈骨折（FNF）或近端股骨骨骺分离（SPFE）的发生。研究回顾性分析了12例骨骺未成熟的创伤性髋关节脱位合并股骨头骨折患者，其中11例（91.7%）接受了紧急闭合复位。6例患者闭合复位失败并发生FNF（2例，33.3%）或SPFE（4例，66.7%）。5例患者在经手术髋关节脱位入路进行开放复位内固定后出现股骨头缺血性坏死，其中2例需要进一步手术治疗。影像学及CT分析显示，不可复位的股骨头骨折-脱位中，骨折的股骨头骑跨于髋臼后壁的尖锐角上，骨折块比例为18%至27%。在识别出不可复性后，1例骨折块比例为26%的患者未再尝试闭合复位而是立即进行开放复位，该操作保住了自然髋关节，成功避免了FNF和SPFE的发生。研究结论认为，对于骨折块比例大于10%的不可复位儿童股骨头骨折-脱位，反复或强力闭合复位可能导致医源性FNF或SPFE。在尝试复位前仔细分析平片和CT图像有助于确定最安全的治疗策略。
英文摘要 Abstract
BACKGROUND: The migration index (MI) is a quantitative measurement of femoral head extrusion used to help risk stratify neuromuscular hip dysplasia. However, MI relies upon the radiographically visible ossified capital femoral epiphysis which is only partially ossified in young children and therefore may potentially underestimate hip extrusion.
OBJECTIVE: To compare proof-of-concept accuracy of using a metaphyseal and traditional MI to measure femoral head extrusion in children compared with an MRI-based anatomic reference standard.
MATERIALS AND METHODS: We reviewed 205 normal hips, each by MRI and x-ray, in patients aged 6 months - 6 years old. Three femoral head MI measurements were performed: (1) MRI-MI: percentage of the cartilaginous femoral head uncovered by the osseous acetabulum (anatomic reference standard); (2) traditional MI (TMI) x-ray: percentage of osseous capital femoral head uncovered by the osseous acetabulum; (3) metaphyseal MI x-ray (MeMI): percentage of the femoral head uncovered by the osseous acetabulum, using the metaphyseal vertex used as a surrogate for lateral margin of the cartilaginous femoral head. Statistical analysis of the three measurement techniques was performed using paired t-tests. Intraclass correlation coefficient was calculated.
RESULTS: There was a statistically significant underestimation of femoral head extrusion using TMI and MeMI (P<0.05) when compared with MRI-MI, but MeMI more closely approximated the MRI-MI. Inter-reader reliability showed excellent agreement.
CONCLUSION: The MeMI better approximates the MRI anatomic landmarks for measuring the true degree of femoral head extrusion in children 6 months - 5 years of age. Its usage should be considered in lieu of the TMI in children under 5 years of age for radiographically determining MI.
中文总结
股骨头移位指数（MI）是用于评估股骨头外移程度以帮助风险分层神经肌肉性髋关节发育不良的定量测量方法。然而，MI依赖于X线片上可见的骨化股骨头骨骺，在年幼儿童中仅部分骨化，因此可能低估股骨头外移程度。本研究旨在比较使用干骺端MI与传统MI测量儿童股骨头外移的准确性，并以MRI解剖标志作为参考标准。研究回顾分析了205例正常髋关节（患者年龄6个月至6岁），分别通过MRI和X线进行评估。三种股骨头MI测量方法分别为：MRI-MI（作为解剖参考标准）、传统MI（TMI，X线片）以及干骺端MI（MeMI，X线片）。统计分析结果显示，TMI和MeMI相对于MRI-MI均显著低估了股骨头外移程度（P<0.05），但MeMI更接近于MRI-MI。观察者间信度显示良好的一致性。研究结论认为，MeMI能更好地近似MRI解剖标志用于测量6个月至5岁儿童的真实股骨头外移程度。在5岁以下儿童的放射学MI测量中，应考虑使用MeMI替代TMI。
英文摘要 Abstract
Femoroacetabular impingement syndrome (FAIS) is a prevalent hip disorder, and arthroscopic surgery has emerged as the preferred treatment modality, which has been rapidly adopted in clinical practice across China. Rehabilitation plays a pivotal role in ensuring functional recovery, normal daily activities, and return to sports for orthopedic surgery patients. However, standardized protocols and evidence-based guidelines for perioperative rehabilitation following FAIS arthroscopic surgery remain lacking in China. This expert group organized specialists to develop a rehabilitation consensus for patients with femoroacetabular impingement syndrome (FAIS) requiring arthroscopic surgery, based on systematic literature review, evidence quality assessment, and clinical rehabilitation practice, using the modified Delphi method. The consensus addresses three key aspects: basic principles and common methods, critical issues in rehabilitation intervention, and considerations for special populations. Specifically, it covers fundamental rehabilitation principles, common assessment methods, preoperative rehabilitation, psychological rehabilitation, and postoperative rehabilitation (including phased rehabilitation and progression criteria, pain management, muscle function training, joint range of motion training, weight-bearing training, the clinical value of platelet-rich plasma injections, and return-to-sport criteria). Additionally, it includes rehabilitation considerations for patients of different age groups and those undergoing various surgical approaches, totaling 13 recommendations. This consensus aims to provide evidence-based guidance for clinicians and rehabilitation therapists, facilitating personalized and comprehensive rehabilitation management for FAIS patients undergoing arthroscopic surgery.
髋关节撞击综合征（FAIS）是常见的髋关节疾病，关节镜手术作为该疾病的首选治疗方式已在国内广泛开展。康复是保障骨科手术患者恢复正常功能，日常生活和重返运动的关键，国内尚缺乏针对髋关节撞击综合征关节镜手术患者规范的康复指导。中华医学会运动医疗分会脊柱与髋关节学组、中华医学会物理医学与康复学分会骨科康复学组组织专家，基于系统文献检索、证据质量评价及康复医学临床实践，采用改良Delphi法，针对需行关节镜手术治疗的髋关节撞击综合征患者，从以下三方面形成康复共识：基本原则与常用方法、康复干预关键问题、特殊人群注意事项。具体涵盖康复基本原则、常用评估方法、术前康复、心理康复、术后康复（分阶段及进阶标准、疼痛管理、肌肉功能训练、关节活动度训练、负重训练、富血小板血浆注射的应用价值、重返运动标准），以及不同年龄段和不同手术方式患者的康复注意事项，共提出13条推荐意见。本共识旨在为康复医学科和运动医学科医师及康复治疗师提供循证参考，促进FAIS关节镜手术患者的个体化全面康复管理。.
中文总结
背景：髋关节撞击综合征（FAIS）是常见髋关节疾病，关节镜手术已成为国内首选治疗方式并迅速推广。然而，国内尚缺乏针对FAIS关节镜手术患者规范的围手术期康复指导。目的：制定符合中国临床实践的FAIS关节镜手术康复专家共识。方法：由中华医学会运动医疗分会脊柱与髋关节学组、中华医学会物理医学与康复学分会骨科康复学组组织专家，基于系统文献综述、证据质量评估及临床康复实践，采用改良德尔菲法制定本共识。结果：共识涵盖三大核心领域：基础原则与常用方法、康复干预关键问题及特殊人群考量。具体包括：基础康复原则、常用评估方法、术前康复、心理康复、术后康复（分阶段康复及进阶标准、疼痛管理、肌肉功能训练、关节活动度训练、负重训练、血小板富血浆注射临床价值及重返运动标准），以及不同年龄组患者和不同手术入路患者的康复注意事项，共形成13条推荐意见。结论：本共识为临床医师和康复治疗师提供循证指导，旨在促进FAIS关节镜手术患者的个体化、全面化康复管理，推动国内髋关节运动医学康复规范化发展。
英文摘要 Abstract
PURPOSE: Hip arthroscopy (HAS) evidence has expanded rapidly, but methodological quality and conclusions vary. This umbrella review of contemporary meta-analyses published January 2020-October 2025 aimed to (i) identify eligible reviews, (ii) appraise methodological quality (AMSTAR 2) and review-level risk of bias (ROBIS), (iii) quantify evidence overlap (corrected covered area, CCA) and (iv) map concordance of conclusions.
METHODS: We searched PubMed/MEDLINE, Embase and Epistemonikos (2020-2025) for human HAS meta-analyses with quantitative synthesis on clinical effectiveness and safety. Two reviewers independently screened records and extracted data (consensus/third-reviewer adjudication). Quality was assessed with AMSTAR 2, risk of bias with ROBIS, and evidence overlap with CCA. No re-pooling of primary data.
RESULTS: From 5940 records, 44 meta-analyses were included. AMSTAR 2 confidence was predominantly weak (≈7% high, 5% moderate; most critically low); ROBIS was low risk in just over half. Overlap was slight (low redundancy). Across randomised/comparative syntheses, HAS yielded superior short-term improvements versus best-practice nonoperative care-most consistently for iHOT-33 at ~8-12 months-attenuating by ~24 months and not uniformly meeting MCIDs. Limited long-term data suggest less radiographic osteoarthritis progression versus nonoperative care. Versus open procedures, functional outcomes were similar with fewer complications after HAS. Return-to-work was ~71% at ~115 days, return-to-sport was high (elite ~94% at ~6-7 months; broader cohorts ~89%). More recent evidence increasingly favours capsular closure and labral repair. Preoperative intra-articular injection ≤3 months before HAS was associated with higher infection risk.
CONCLUSION: Evidence supports short-term benefits and a good safety profile for HAS, yet certainty remains limited. Prioritise patient selection and standardised rehab; high-quality long-term studies are needed.
LEVEL OF EVIDENCE: Level I, systematic umbrella review of meta-analyses on hip arthroscopy.
中文总结
本伞式综述系统评估了2020至2025年间发表的髋关节镜meta-analyses的方法学质量与结论一致性。研究纳入44项meta-analysis，AMSTAR 2评估显示绝大多数方法学质量为弱置信度，仅约7%为高质量、5%为中等质量；ROBIS工具显示仅过半研究为低偏倚风险。证据重叠程度较低。综合分析表明，髋关节镜相较于最佳非手术治疗在短期功能改善方面更具优势，主要体现在iHOT-33评分8至12个月时的改善，但该优势在约24个月时减弱且未必达到最小临床重要差异值。长期数据有限，提示髋关节镜可减少影像学骨关节炎进展。相较于开放手术，髋关节镜功能结局相似但并发症更少。返回工作岗位率约为71%，平均约115天；返回运动率较高，精英运动员约94%在6至7个月后返回运动，更广泛队列约为89%。近期证据日益支持进行囊膜修复与盂唇修复。术前3个月内关节内注射与感染风险增加相关。总体而言，现有证据支持髋关节镜短期获益及良好安全性，但证据确定性仍有限，未来应重视患者选择标准化与康复方案统一，并亟需高质量长期研究。
英文摘要 Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disease, and health education is vital to disease management and rehabilitation. The emergence of large language models (LLMs) has provided new opportunities for health education. However, the effectiveness and applicability of LLMs in education with DDH have not been systematically evaluated.
OBJECTIVE: This study conducted an integrated 2-phase evaluation to assess the quality and educational effectiveness of LLM-generated educational materials.
METHODS: This study comprised 2 phases. Based on Bloom's taxonomy, a 16-item DDH question bank was created through literature analysis and collaboration. Four LLMs (ChatGPT-4 [OpenAI], DeepSeek-V3, Gemini 2.0 Flash [Google], and Copilot [Microsoft Corp]) were questioned using standardized prompts. All responses were independently evaluated by 5 pediatric orthopedic experts using 5-point Likert measures of accuracy, fluency, and richness, the scales of Patient Education Materials Assessment Tool for Printable Materials, and DISCERN. The readability was measured by a formula. The data were examined using Kruskal-Wallis tests, ANOVA, and post hoc comparisons. In phase 2, an assessor-blinded, 2-arm pilot randomized controlled trial was conducted. A total of 127 caregivers were randomized into an LLM-assisted education group or a web search control group. The intervention included structured LLM training, supervised practice, and 2 weeks of reinforcement training. Measured at baseline, postintervention, and 2 weeks following, the outcomes were eHealth literacy (primary), DDH knowledge, health risk perception, perceived usefulness, information self-efficacy, and health information-seeking behavior. Cohen d effect sizes and linear mixed-effects models were used in an intention-to-treat manner.
RESULTS: There were significant differences between the 4 LLMs concerning accuracy, richness, fluency, Patient Education Materials Assessment Tool for Printable Materials Understandability, and DISCERN (P<.05). ChatGPT-4 (median 63.67, IQR 63.67-64.67) and DeepSeek-V3 (median 63.67, IQR 63.33-64.67) generate more accurate text than Copilot (median 59.00, IQR 58.67-59.67). DeepSeek-V3 (median 64.00, IQR 64.00-64.00) was language richer than Copilot (median 52.33, IQR 51.33-52.67). Gemini 2.0 Flash (median 72.67, IQR 72.33-73.00) was more fluent than Copilot (median 65.67, IQR 63.33-65.67). In phase 2, the intervention group showed higher eHealth literacy at T1 (33.62, 95% CI 32.76-34.49; d=0.20, 95% CI 0.13-0.56) and T2 (33.27, 95% CI 32.38-34.17; d=0.36, 95% CI 0.01-0.80), greater DDH knowledge at T1 (7.87, 95% CI 7.48-8.25, d=0.71, 95% CI 0.33-1.11) and T2 (7.12, 95% CI 6.72-7.51; d=0.54, 95% CI 0.17-0.96), and slight improvements in health risk prediction and perceived usefulness.
CONCLUSIONS: Mainstream LLMs demonstrate varying capacities in generating educational content for DDH. They generated DDH caregiver education materials that were associated with modest improvements in eHealth literacy and knowledge. Although LLMs can address general informational needs, they cannot completely substitute clinical evaluation. Future research should focus on optimizing plain language, refining dialogue design, and enhancing audience personalization to improve the quality of LLMs' materials.
TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2500108410; https://www.chictr.org.cn/showproj.html?proj=271987.
中文总结
本研究旨在系统评估大语言模型在发育性髋关节发育不良健康教育中的适用性与教育效果，采用两阶段综合评价设计。第一阶段基于Bloom分类学构建了包含16个条目的DDH题库，由五名儿科骨科专家对四种主流大语言模型生成的回复进行独立评估，涵盖准确性、流畅性、丰富性、可理解性及DISCERN评分。结果显示ChatGPT-4与DeepSeek-V3在准确性上显著优于Copilot，DeepSeek-V3在内容丰富性上表现最佳，Gemini 2.0 Flash的流畅性最高，各模型间差异具有统计学意义。第二阶段为评估者盲法的双臂随机对照预试验，127名照护者被分配至LLM辅助教育组或网络搜索对照组，干预措施包括结构化LLM训练、监督实践及2周强化训练，主要结局为电子健康素养，次要结局包括DDH知识、健康风险感知、感知有用性及信息自我效能感。结果显示干预组在干预后及2周随访时电子健康素养得分更高，DDH知识掌握程度显著提升，健康风险预测与感知有用性亦有轻度改善。本研究表明主流大语言模型在生成DDH健康教育内容方面能力各异，虽能改善照护者电子健康素养与疾病知识，但尚不能完全替代临床评估，未来研究应聚焦于优化通俗语言表达、对话设计及受众个性化以进一步提升材料质量。
英文摘要 Abstract
BACKGROUND: Hip arthroscopy is an effective treatment for femoroacetabular impingement and labral tears, with improvements in patient-reported outcomes (PROs). Whether anatomic and management differences between sexes translate into divergent outcomes remains uncertain.
PURPOSE: To systematically review sex-based differences in radiographic findings, intraoperative pathology, surgical management, and postoperative outcomes after hip arthroscopy.
STUDY DESIGN: Systematic review; Level of evidence, 4.
METHODS: A literature search of the PubMed, CENTRAL, and Scopus databases was performed on February 27, 2025, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if they reported sex-specific preoperative and postoperative PROs in individuals undergoing hip arthroscopy for femoroacetabular impingement or labral pathology, were published in the English language, and had a minimum 2-year follow-up. Data on patient demographics, radiographic parameters, intraoperative findings, surgical management, and outcomes were extracted. The methodological quality of each study was independently evaluated using the methodological index for non-randomized studies.
RESULTS: Six studies including 3914 hips (2260 female, 1654 male) met inclusion criteria. Four studies were level 3 and 2 were level 4 evidence, all with moderate methodological quality. All studies demonstrated significant postoperative improvements in PROs (
CONCLUSION: Male and female patients demonstrated comparable improvements in PROs, achievement of clinically meaningful thresholds, revision rates, and rates of conversion to total hip arthroplasty after hip arthroscopy. Although men exhibited larger alpha angles and more advanced chondral damage, and women more frequently underwent capsular repair, these sex-based differences did not translate into clinically significant disparities in postoperative outcomes.
中文总结
本系统综述旨在探讨髋关节镜术后是否存在性别差异。研究者对PubMed、CENTRAL及Scopus数据库进行系统检索，最终纳入6项研究共3914髋，其中女性2260髋、男性1654髋，证据等级为3级和4级，所有研究方法学质量均为中等。影像学方面，男性患者Alpha角更大且软骨损伤更重；术中发现男性软骨损伤更为严重。手术处理方面，女性患者更常接受囊膜修复。尽管存在上述差异，术后患者报告结局量表改善幅度在两性间相当，最小临床重要差异与患者可接受症状状态的达标率无显著差异，翻修率及全髋关节置换转换率亦无统计学差异。本研究表明，尽管两性在影像学参数及术中病理表现上存在差异，但这些差异并未转化为有临床意义的预后差别，髋关节镜治疗在女性与男性患者中均能取得相似的功能改善与手术结局。
英文摘要 Abstract
BACKGROUND: Ipsilateral fractures and dislocations involving the hip, distal femur, and patella are rare and pose significant management challenges.
CASE PRESENTATION: We present a unique case of a 50-year-old male who sustained a posterior hip dislocation with femoral head fracture, medial femoral condyle fracture, and rotational patellar dislocation incarcerated between the femoral condyles following a high-energy roadside accident. The patient presented with limb deformity and a knee wound within 30 min post-injury. Initial closed reduction attempts failed, and surgical intervention under spinal anaesthesia achieved hip reduction via the Allis manoeuvre, open fixation of the distal femur fracture, and patellar relocation.
OUTCOME: Postoperative recovery was uneventful, with satisfactory joint function at five months. However, at 20 months, the patient developed avascular necrosis with osteoarthritic changes for which total hip replacement was advised.
CONCLUSION: This case highlights the importance of prompt diagnosis and coordinated surgical management of complex lower-limb trauma.
中文总结
本病例报告描述了一例罕见的同侧髋关节与膝关节联合损伤，患者为50岁男性，因高速路交通事故导致后髋关节脱位伴股骨头骨折、内侧股骨髁骨折及旋转性髌骨脱位，髌骨被嵌顿于股骨髁之间。患者伤后30分钟内入院，表现为肢体畸形及膝部伤口。闭合复位尝试失败后在蛛网膜下腔麻醉下行手术干预，通过Allis手法实现髋关节复位，并行开放复位内固定术处理股骨远端骨折及髌骨脱位。术后恢复过程平稳，随访5个月时关节功能满意。然而术后20个月患者出现股骨头缺血性坏死并继发骨关节炎，最终建议行全髋关节置换术。本病例强调了对复杂下肢联合损伤进行及时诊断与多学科协调处理的重要性，特别是对于高能量创伤患者应警惕同侧髋膝联合损伤的可能，术前全面影像学评估及个体化手术方案的制定对改善预后具有关键意义。
英文摘要 Abstract
OBJECTIVE: To review the research progress on the application of digital orthopedic technology in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH), thereby providing a reference for clinical decision-making.
METHODS: A comprehensive literature review was conducted to summarize the effectiveness of various emerging digital orthopedic technologies in the context of THA for DDH.
RESULTS: Digital orthopedic technologies have significantly enhanced the precision and safety of THA for DDH. Specifically, artificial intelligence-based preoperative planning systems have demonstrated superior accuracy in prosthesis size matching and positioning compared to conventional methods. Additive manufacturing technologies have provided personalized solutions for reconstructing complex bone defects in DDH. Furthermore, robot-assisted and navigation-assisted techniques have effectively improved the accuracy of prosthesis placement and lower limb length restoration in THA. However, each of these digital orthopedic technologies still possesses its own limitations.
CONCLUSION: Through the integration of multiple technologies, digital orthopedics effectively addresses the challenges of precise reconstruction in THA for DDH. Future efforts should focus on further integrating diverse intelligent technologies and equipment to establish a comprehensive digital diagnosis and treatment system, aiming to achieve superior long-term effectiveness.
目的: 对数字骨科技术在发育性髋关节发育不良（developmental dysplasia of the hip，DDH）的人工全髋关节置换术（total hip arthroplasty，THA）中应用的研究进展进行综述，为临床诊疗决策提供参考。.
方法: 广泛查阅国内外相关文献，对各类新型数字骨科技术在DDH患者THA中应用的疗效进行总结归纳。.
结果: 数字骨科技术显著提升了DDH患者关节置换精准性与安全性。其中，人工智能术前规划系统在关节假体型号匹配与安放位置的准确性方面显著优于传统方法；增材制造技术为关节发育不良复杂骨缺损的修复提供了个性化解决方案；机器人及导航辅助关节置换则有效提高了假体安放与下肢长度恢复的精确性。然而，现有各技术也有其局限性。.
结论: 数字骨科技术通过多技术融合应用，有效解决了DDH患者THA术中精准重建问题，未来需进一步整合多种智能技术与装备，构建全流程数字化诊疗体系，以实现更优远期疗效。.
中文总结
本文系统综述了数字骨科技术在发育性髋关节发育不良患者全髋关节置换术中的研究进展。人工智能术前规划系统通过深度学习算法分析患者影像学资料，在关节假体型号匹配及安放位置准确性方面显著优于传统手工规划方法，有效降低了术中并发症风险。增材制造技术即3D打印技术为DDH患者复杂骨缺损的个性化修复提供了创新解决方案，通过术前打印患者特异性骨骼模型或个性化假体，显著提升了手术的精准性与匹配度。机器人辅助及导航辅助关节置换技术则通过实时定位与动作反馈系统，有效提高了假体安放角度精确性及下肢长度恢复的准确性，尤其对于DDH这种解剖结构复杂的病例具有重要价值。然而，现阶段各项技术均存在一定局限性，包括设备成本高昂、学习曲线陡峭、适应证选择尚不统一等问题。未来研究应致力于多技术融合应用，构建全流程数字化诊疗体系，通过整合人工智能、3D打印、手术机器人及导航系统等多种智能化技术，建立标准化的DDH数字化诊疗流程，以实现更优的远期疗效。
英文摘要 Abstract
BACKGROUND: Arthroscopic treatment of excessive acetabular coverage with pincer morphology or coxa profunda can be challenging. In patients with excessive acetabular coverage with nondistractible hips, an outside-in capsuolotomy can be considered to gain safe and efficient intra-articular access to the hip.
INDICATIONS: The indications for an outside-in capsulotomy include patients with acetabular retroversion, a lateral center-edge angle >40°, coxa profunda or protrusio, or stiff, older male patients who remain hip preservation candidates.
TECHNIQUE DESCRIPTION: The outside-in capsulotomy is performed once it is recognized that traction on the operative extremity will not provide adequate working space for safe intra-articular access. Traction is taken off the operative extremity, and an anterolateral portal is localized to the 12:00 position on the hip joint with the use of fluoroscopy. The camera is then placed in a juxta-capsular location, and a modified anterior portal is created under direct arthroscopic visualization. We then proceed with extracapsular dissection to identify the indirect head of the rectus. An outside-in capsulotomy is then performed parallel to the indirect head of the rectus, approximately 5 mm distal to its insertion on the acetabular rim. Prior to deep completion of the capsulotomy, the hip joint is flexed to 30° to protect the articular cartilage of the femoral head. Once intra-articular access is obtained, traction can be reapplied, and one can proceed with hip arthroscopy in a standard fashion.
RESULTS: This technique decreases the traction time needed, given that the capsulotomy is performed without traction applied. Additionally, the amount of force required for hip distraction is decreased once the capsuolotomy has been completed, through usual sectioning of the iliofemoral ligament. The presented technique is both safe and efficacious, with no published difference in complications as compared to standard inside-out access. A published series of patients with severe pincer morphology and lateral overcoverage who undergo hip arthroscopy with outside-in access demonstrates satisfactory postoperative improvements in patient-reported outcome measures.
DISCUSSION/CONCLUSION: The outside-in capsulotomy provides a means for safe access to the hip joint in otherwise limited or nondistractible hips.
中文总结
本文介绍了一种用于髋关节镜术中关节内入路的outside-in囊膜切开技术，该技术专为髋关节过度覆盖如pincer形态或深髋臼等解剖变异设计，特别适用于存在髋关节不易牵开且需进行关节保留手术的患者。手术指征包括髋臼反转、内侧中心边缘角大于40度、深髋臼或protrusion以及髋关节僵硬的老年男性患者。技术要点如下：一旦确认牵开力不能为安全操作提供足够空间时，移除牵引力并在透视引导下将前外侧入路定位于髋关节12点位置，镜头置于关节囊旁，在直视下建立改良前入路，随后进行关节囊外解剖以识别股直肌间接头，于其附着点远端约5mm处做与间接头平行的outside-in囊膜切开；深层囊膜切开前将髋关节屈曲30度以保护股骨头关节软骨。术后可重新施加牵引力并按标准方式继续关节镜操作。该技术的优势在于无需牵引即可完成囊膜切开，从而减少牵引时间并降低牵开所需力量，同时切断髂股韧带后进一步利于关节牵开。现有文献报道该技术安全有效，严重pincer形态及外侧过度覆盖患者术后患者报告结局改善显著，与标准inside-out入路相比并发症发生率无差异。
英文摘要 Abstract
BACKGROUND: Acetabular column fractures remain among the most complex injuries in orthopedic trauma. Conventional plating techniques require extensive soft-tissue dissection and are associated with high complication rates. The wiring technique, which achieves compression across both acetabular columns through the greater and lesser sciatic notches, was developed to minimize surgical morbidity. This study aimed to evaluate the mid-term clinical and radiologic outcomes of this technique and to analyze factors affecting hip joint preservation.
METHODS: This retrospective study included 41 patients who underwent fixation of acetabular column fractures using the wiring technique between 1994 and 2018 at a single tertiary referral center. A dual approach combining the Kocher-Langenbeck and mini-iliofemoral incisions was used. Clinical outcomes were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS), and radiologic reduction was graded according to Matta's criteria. Survivorship was analyzed using Kaplan-Meier methods with conversion to total hip arthroplasty (THA) as the endpoint.
RESULTS: The cohort included 29 men and 12 women, with a mean age of 51.2 years and a mean follow-up duration of 11.4 years. The mean operation time was 139.8 minutes. Intraoperative complications included one case each of superior gluteal artery injury, sciatic nerve palsy, and lateral femoral cutaneous nerve injury. Postoperative complications were rare. Anatomical or near-anatomical reduction was achieved in 97.5% of patients. The mean HHS and VAS at final follow-up showed satisfactory functional outcomes. Eight patients (19.5%) required conversion to THA during follow-up, resulting in an overall THA-free survival rate of 85%. Survival analysis demonstrated 100% survivorship for anatomical reductions, 75% for imperfect reductions, and 0% for poor reductions. Fracture classification did not influence clinical outcomes but significantly affected long-term survivorship, with anterior column fractures showing 100% survival and transverse with posterior wall fractures showing the lowest at 50%.
CONCLUSION: The wiring technique offers a reliable and biologically favorable method for treating acetabular column fractures. It provides stable reduction with limited soft-tissue disruption, resulting in durable mid-term hip preservation and low complication rates. These findings emphasize the importance of achieving anatomical reduction and support the wiring technique as an effective option for managing acetabular column fractures.
中文总结
髋臼柱骨折是骨科创伤中最复杂的损伤类型之一，传统金属板固定技术需要广泛软组织剥离，并发症发生率较高。本研究回顾性分析了1994年至2018年间接受 wiring 固定技术治疗的41例髋臼柱骨折患者，采用 Kocher-Langenbeck 联合 mini-iliofemoral 双切口入路。临床结局采用 Harris 髋评分和视觉模拟评分评估，影像学复位质量按 Matta 标准评级，生存分析以是否转换为全髋关节置换术为终点。中位随访时间11.4年，平均手术时间139.8分钟，术中并发症包括臀上动脉损伤、坐骨神经麻痹及股外侧皮神经损伤各1例。97.5%的患者获得了解剖或接近解剖复位，末次随访时功能评分满意。8例患者（19.5%）在随访期间接受了全髋关节置换术，总体关节保留率为85%。生存分析显示解剖复位组生存率为100%，复位欠佳组为75%，复位不良组为0%。骨折分类不影响临床结局但显著影响长期生存率，其中前柱骨折生存率最高（100%），横联合后壁骨折最低（50%）。研究表明 wiring 固定技术是治疗髋臼柱骨折的可靠方法，具有生物学优势，能够在有限软组织剥离的情况下实现稳定复位，提供持久的髋关节保留效果且并发症率低。这些发现强调了实现解剖复位的重要性，支持将该技术作为处理髋臼柱骨折的有效选择。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) is a common procedure for the treatment of symptomatic acetabular dysplasia in adolescent patients. Despite concerns regarding surgical outcomes and complications in patients with hypermobility spectrum disorders (HSD), the outcomes of PAO in such patients are not well documented.
METHODS: We conducted a retrospective cohort review of patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Radiographic parameters including the lateral center edge angle of Wiberg (LCEA), medial center edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI), and Tönnis angle were measured. Patient-reported outcomes (PROs) were also collected.
RESULTS: The mean duration of follow-up of non-HSD and HSD patients was 2.86 ± 0.73 years and 3.00 ± 1.11 years, respectively. No significant differences were found in mean age ( P = 0.289), sex, body mass index ( P = 0.125), laterality ( P = 0.192), or the duration of follow-up ( P = 0.636). Postoperatively, LCEA and AWI in patients with HSD were higher than those in non-HSD patients ( P = 0.002, P = 0.007, respectively). No notable differences were observed in Modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool, Hip Dysfunction and Osteoarthritis Outcome Score, or mean changes in PROs between the non-HSD and HSD groups at preoperative, 1-year postoperative, and most recent follow-up timepoints. However, patient-reported satisfaction with surgery in the HSD group (9.39 ± 1.04) was significantly higher than the non-HSD group (8.35 ± 1.95; P = 0.047).
CONCLUSION: Patients with HSD exhibited similar outcomes to patients without HSD after PAO for symptomatic acetabular dysplasia. Postoperative AWI and LCEA were markedly greater in patients with HSD consistent with our technical bias toward increased correction in such hips, suggesting greater anterolateral coverage of the femoral head after PAO may be a promising strategy to achieve improved outcomes in patients with HSD.
中文总结
髋臼周围截骨术是治疗青少年症状性髋臼发育不良的常用手术方式，但对于合并活动度过度谱系障碍的患者，手术结局和并发症情况尚不明确。本研究回顾性分析接受 PAO 治疗的髋臼发育不良患者，对比活动度过度谱系障碍患者与非活动度过度谱系障碍患者的临床和影像学结局。测量指标包括 Wiberg 外侧中心边缘角、内侧中心边缘角、前壁指数、后壁指数及 Tönnis 角，并收集患者报告结局指标。非 HSD 组平均随访2.86年，HSD 组平均随访3.00年，两组在年龄、性别、体重指数、侧别及随访时间方面均无显著差异。术后 HSD 组的外侧中心边缘角和前壁指数显著高于非 HSD 组，提示外科医生对此类患者倾向于进行更大程度的矫正。在改良 Harris 髋评分、非关节炎髋评分、国际髋关节结局工具、髋关节功能障碍与骨关节炎结局评分及各时间点患者报告结局指标的变化均值方面，两组之间均未观察到显著差异。然而，HSD 组的手术满意度评分（9.39±1.04）显著高于非 HSD 组（8.35±1.95）。研究结论认为活动度过度谱系障碍患者接受髋臼周围截骨术后结局与无该障碍患者相当，术后更大的前壁指数和外侧中心边缘角改善可能提示在 HSD 患者中采用更积极矫正策略的临床价值。
英文摘要 Abstract
PURPOSE: This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy.
METHODS: A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher's exact test for categorical variables.
RESULTS: 20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group.
CONCLUSIONS: Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.
中文总结
髋关节镜手术后再接受髋关节表面置换术的患者功能结局是否受到影响，目前相关证据有限。本研究通过倾向性评分匹配回顾性比较了既往有髋关节镜手术史的髋关节表面置换术患者与无该病史的匹配对照组的患者报告结局指标。纳入2016年至2021年间接受髋关节表面置换术且随访至少2年的患者，关节镜手术组以1:3比例匹配年龄、性别、体重指数及 ASA 分级。对照组纳入60例患者，关节镜手术组纳入20例患者。随访结果显示，关节镜手术组患者在髋关节表面置换术后疼痛评分显著更高（33.8 vs 13.2），功能性评分显著更差，FJS 评分（46.6 vs 70.5）、身体功能（43.7 vs 50.9）、SANE 评分（59.9 vs 82.6）及满意度（66.1 vs 88.1）均存在统计学显著差异。仅55%的关节镜手术组患者表示手术达到了预期，而非关节镜手术组该比例为86.7%。研究结论表明，既往髋关节镜手术史与髋关节表面置换术后较差的患者报告结局指标、较低的术后满意度及较高的术后疼痛水平存在关联。
英文摘要 Abstract
In the arthroscopic management of femoroacetabular impingement (FAI), labral repair and labral reconstruction are widely used, but their comparative effectiveness remains uncertain. This systematic review and meta-analysis compared functional outcomes, pain scores, revision hip arthroscopy, and conversion to total hip arthroplasty (THA) between labral repair and labral reconstruction in patients undergoing hip arthroscopy for FAI. In November 2025, a systematic search of PubMed, Scopus, Web of Science, Excerpta Medica database (Embase), and the Cochrane Library identified comparative studies reporting extractable postoperative outcomes. Fourteen non-randomized comparative cohorts, including 2,290 hips (1,530 labral repairs and 760 labral reconstructions), met the inclusion criteria. Data were extracted in duplicate, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A fixed-effect model was used to calculate standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Labral reconstruction showed a small but statistically significant advantage in postoperative modified Harris Hip Score (mHHS), whereas other functional outcomes, including the Nonarthritic Hip Score (NAHS), Hip Outcome Score Sports Subscale (HOS-SS), and 12-item International Hip Outcome Tool (iHOT 12), were comparable between techniques. Pain improvement measured using the Visual Analog Scale (VAS) was also similar, and revision hip arthroscopy rates did not differ meaningfully between groups. In contrast, labral repair was associated with a significantly lower risk of conversion to THA than labral reconstruction. Heterogeneity across pooled analyses was low, and no relevant publication bias was detected. These findings indicate that both labral repair and labral reconstruction provide clinically important improvement after hip arthroscopy for FAI, with reconstruction performing reliably in irreparable labral pathology, while the lower arthroplasty conversion rate seen with repair likely reflects more favorable baseline joint status in hips where the native labrum can be preserved rather than a direct causal effect of the technique.
中文总结
关节镜下盂唇修复与盂唇重建是治疗股骨髋臼撞击综合征的两种主要手术方式，但两者的比较疗效尚存争议。本系统综述和荟萃分析检索了 PubMed、Scopus、Web of Science、Embase 及 Cochrane 图书馆，纳入报告可提取术后结局的比较性研究，最终纳入14项非随机对照队列研究共2290髋，其中1530髋行盂唇修复，760髋行盂唇重建。方法学质量采用非随机研究方法学指数评估，采用固定效应模型计算标准化均数差和比值比及95%置信区间。结果显示盂唇重建在改良 Harris 髋评分方面较盂唇修复略有但统计学显著的优势，而其他功能结局指标包括非关节炎髋评分、髋关节结局评分运动分量表及12项国际髋关节结局工具在两种技术间具有可比性。视觉模拟评分改善程度亦相似，关节镜翻修率在两组间无显著差异。然而，盂唇修复的全髋关节置换转换率显著低于盂唇重建。异质性分析显示各汇总分析异质性较低，未检测到相关发表偏倚。研究结论认为两种技术在关节镜治疗股骨髋臼撞击综合征后均可提供具有临床意义的改善，盂唇重建在不可修复的盂唇病变中表现可靠，而修复较低的关节置换转换率可能反映的是此类患者更优越的基线关节状态而非技术的直接因果效应。
英文摘要 Abstract
BACKGROUND: Effective postoperative analgesia for pediatric developmental dysplasia of the hip (DDH) surgery remains a challenge. This study aimed to compare the analgesic efficacy of a combined fascia iliaca compartment block (FICB) and quadratus lumborum block (QLB) versus patient-controlled intravenous analgesia (PCIA) in pediatric patients undergoing open reduction surgery for DDH under general anesthesia.
METHODS: This retrospective cohort study enrolled children under 16 years old undergoing DDH surgery between January 2016 and January 2024. Patients were divided into two groups based on the analgesia received: a Block group (FICB + QLB, n = 35) and a PCIA group (n = 35). The primary outcome was postoperative pain assessed by the FLACC score at 1 and 24 h. Secondary outcomes included 24-hour opioid (fentanyl) consumption, frequency of rescue non-steroidal anti-inflammatory drug (NSAID) use, and parental satisfaction.
RESULTS: The study included 35 patients in the PCIA group and 35 in the block group. FLACC pain scores were significantly lower in the Block group at both 1 h (median: 3 vs. 7, p < 0.001) and 24 h postoperatively (median: 2 vs. 5, p < 0.001). Total opioid consumption was markedly lower in the Block group (mean: 5.97 vs. 20.66 µg/kg, p < 0.001), as was the need for rescue NSAIDs (median administrations: 2 vs. 4, p < 0.001). Parental satisfaction was significantly higher in the Block group (p < 0.001).
CONCLUSION: The combination of FICB and QLB provides superior postoperative analgesia compared to PCIA alone in children undergoing DDH surgery, significantly reducing pain scores, opioid requirements, and rescue analgesic need, while leading to higher parental satisfaction.
CLINICAL TRIAL NUMBER: Not applicable.
中文总结
小儿发育性髋关节发育不良手术后的有效镇痛仍是临床挑战。本回顾性队列研究比较了超声引导下髂筋膜室阻滞联合腰方肌阻滞与患者自控静脉镇痛在全身麻醉下行开放复位术的发育性髋关节发育不良患儿中的镇痛效果。2016年1月至2024年1月期间接受发育性髋关节发育不良手术的16岁以下儿童按镇痛方式分为阻滞组（FICB+QLB，n=35）和 PCIA 组（n=35）。主要结局指标为术后1小时和24小时的 FLACC 疼痛评分，次要结局指标包括24小时阿片类药物（芬太尼）消耗量、补救性非甾体抗炎药使用次数及家长满意度。阻滞组在术后1小时（中位数3 vs 7）和24小时（中位数2 vs 5）的 FLACC 疼痛评分均显著低于 PCIA 组，总阿片类药物消耗量显著更低（5.97 vs 20.66 μg/kg），补救性非甾体抗炎药使用次数更少（中位数2 vs 4），家长满意度显著更高。研究结论认为 FICB 联合 QLB 在小儿发育性髋关节发育不良手术后的镇痛效果优于单纯 PCIA，能够显著降低疼痛评分、阿片类药物需求和补救性镇痛需要，同时提高家长满意度。
英文摘要 Abstract
Steroid-induced avascular necrosis of the femoral head (SANFH) significantly impairs patients' quality of life, with long-term steroid use being a major contributing factor. The pathogenesis of SANFH remains complex and poorly understood. Bone marrow mesenchymal stem cells (BMSCs) possess multidirectional differentiation potential and are crucial for bone repair and regeneration, yet their precise mechanisms in SANFH treatment are not fully elucidated. In this study, 48 rabbits with early-stage SANFH were randomly assigned to four groups: control (Group A), core decompression (Group B), BMSCs embedded in fibrin sealant (FS) after decompression (Group C), and pravastatin administration combined with BMSCs in FS post-decompression (Group D). Blood lipid levels were monitored throughout the experiment, and femoral heads were assessed via MRI, HE staining, and VEGF immunohistochemical staining. Group C demonstrated reduced femoral head necrosis and increased new bone formation compared to the control. Group D showed significantly lower serum lipid content and femoral head necrosis than other groups, with HE staining revealing fewer empty lacunae and increased trabecular bone density. Additionally, VEGF expression was markedly elevated in Group D. These findings indicate that BMSCs embedded in biomaterials enhance the therapeutic efficacy for early SANFH, and the combination with pravastatin significantly improves outcomes, suggesting a promising new approach for clinical management of femoral head necrosis.
中文总结
糖皮质激素诱导的股骨头坏死严重影响患者生活质量，长期使用糖皮质激素是其主要致病因素之一。该疾病的发病机制复杂且尚未完全阐明，骨髓间充质干细胞具有多向分化潜能，在骨修复和再生中发挥关键作用，但其治疗股骨头坏死的具体机制尚未明确。本研究将48只早期股骨头坏死兔子随机分为四组：对照组（A组）、钻孔减压组（B组）、钻孔减压后应用纤维蛋白封闭胶混合骨髓间充质干细胞组（C组）及钻孔减压后应用普伐他汀联合纤维蛋白封闭胶混合骨髓间充质干细胞组（D组）。实验全程监测血脂水平，股骨头通过 MRI、组织病理学 HE 染色及 VEGF 免疫组织化学染色进行评估。C组股骨头坏死程度减轻，新骨形成增加。D组血清脂质含量和股骨头坏死程度均显著低于其他各组，HE 染色显示空骨陷窝数量减少，骨小梁密度增加，VEGF 表达显著升高。研究结果表明负载于生物材料中的骨髓间充质干细胞可增强早期糖皮质激素诱导股骨头坏死的治疗效果，而普伐他汀的联合应用可显著改善预后，为临床股骨头坏死的治疗提供了一种有前景的新策略。
英文摘要 Abstract
This review summarizes radiographic, clinical and patient reported outcomes following robotic-arm assisted total hip arthroplasty (RAA-THA) in patients with developmental dysplasia of the hip (DDH), with comparisons to conventional (C-THA) and navigation (N-THA) techniques. MEDLINE, EMBASE and CENTRAL databases were searched for studies on DDH patients undergoing RAA-THA. Outcomes assessed included radiographic accuracy, patient-reported outcome-measures (PROMs), intraoperative outcomes, and complications. Eleven studies were included, analyzing 1150 hips (641 RAA-THA, 383 C-THA, 126 N-THA) with a median patient age of 60.5 years, and median BMI of 24.6. DDH severity was distributed as 59.6% Crowe I, 25.3% Crowe II/III hips, and 15.1% Crowe IV hips. Comparative studies among Crowe I-III hips showed significantly lower errors in cup inclination and anteversion with RAA-THA compared to both C-THA and N-THA. RAA-THA also achieved greater accuracy in restoring the center of rotation for Crowe I-III, but no difference was observed in Crowe IV hips. No significant differences were found in short-term PROMs, and intraoperative outcomes and complication rates were comparable between groups. RAA-THA may improve cup placement accuracy in Crowe I-III hips compared to C-THA and N-THA. However, the accuracy of Crowe IV hips remains unclear, with limited evidence available. Furthermore, radiographic benefits did not translate into significant differences in short-term PROMs, intraoperative outcomes, or complication rates. Future studies should include larger cohorts of patients with severe dysplasia and provide longer follow-up to better evaluate the efficacy and implant survivorship of RAA-THA in these complex cases. Level of Evidence: IV.
中文总结
该系统综述汇总了机器人辅助全髋关节置换术（RAA-THA）在发育性髋关节发育不良（DDH）患者中的影像学、临床及患者报告结局，并与传统THA（C-THA）及导航辅助THA（N-THA）进行比较。检索MEDLINE、EMBASE及CENTRAL数据库，纳入11项研究共1150髋（641 RAA-THA、383 C-THA、126 N-THA），患者中位年龄60.5岁，中位BMI 24.6。DDH严重程度分布：Crowe I型59.6%，Crowe II/III型25.3%，Crowe IV型15.1%。比较研究显示，在Crowe I-III型患者中，RAA-THA的髋臼杯倾角和前倾角误差显著低于C-THA和N-THA，恢复旋转中心准确度更高；但Crowe IV型患者未观察到显著差异。短期患者报告结局、术中结局及并发症发生率各组间无显著差异。该综述表明，RAA-THA可能改善Crowe I-III型DDH患者的髋臼杯放置准确度，Crowe IV型准确性仍不明确，且影像学优势未转化为短期功能结局的显著改善。未来需纳入更大样本严重发育不良患者并提供更长期随访，以评估RAA-THA在此类复杂病例中的疗效及假体生存率。证据等级：IV级。
英文摘要 Abstract
BACKGROUND: Total hip arthroplasty (THA) is increasingly performed in patients younger than 20 years who have destructive hip pathology. The unique anatomical and developmental characteristics of this population, along with the high likelihood of future revision surgery, have led to cautious clinical decision-making. Data on safety, effectiveness, and long-term (20 years) outcomes in teenagers remain limited. This study aimed to evaluate implant survival, patient satisfaction, functional outcomes, and complications following THA in teenagers.
METHODS: This retrospective cohort study with cross-sectional evaluation was conducted at a tertiary academic center. All patients aged 10 to 19 years at the time of surgery with ≥ one year follow-up were included. The study population comprised 68 teenagers (75 THAs), who had a median age at surgery of 16 years (range, 11 to 19). The median follow-up was 5.4 years (range, 1.0 to 20.4). The most common indications were developmental dysplasia of the hip (28%), slipped capital femoral epiphysis (20%), and osteonecrosis (17.3%). Of the 75 hips, 37 (49%) had undergone prior hip-preserving procedures. Implant survival was assessed using Kaplan-Meier analysis, with revision as the primary endpoint. In addition, Hip disability and Osteoarthritis Outcome Score for Physical Function (0 to 100) and patient satisfaction (Likert scale; 1 to 10) were assessed. Pre- and postoperative pain and mobility were extracted from patient records.
RESULTS: There were five reoperations (6.7%), of which four revisions were treated, corresponding to a 5-year survival of 94.2% (95% CI [confidence interval]: 82.7 to 98.2). With a 10- and 15-year survival of 90.1% (95% CI: 73.9 to 96.5). At follow-up, 96% of respondents rated their hip prosthesis as satisfactory (Likert scale ≥ 6 out of 10). There was one postoperative wound infection successfully treated with irrigation and antibiotics. The Hip disability and Osteoarthritis Outcome Score for Physical Function score was 15.1 (range, 0 to 50.8). Postoperative pain and mobility demonstrated statistically significant improvement (P < 0.001).
CONCLUSIONS: This study demonstrates good implant survival at follow-up and high satisfaction rates in teenagers following THA.
LEVEL OF EVIDENCE: III.
中文总结
该研究旨在评估青少年（10至19岁）患者接受全髋关节置换术（THA）后的假体生存率、患者满意度、功能结局及并发症情况，并进行长达20年的随访。该回顾性队列研究纳入了68例青少年患者（75髋），手术时中位年龄为16岁，中位随访时间为5.4年（范围1.0至20.4年）。最常见手术指征为发育性髋关节发育不良（28%）、股骨头骨骺滑脱（20%）及股骨头坏死（17.3%），其中49%的髋既往接受过保髋手术。Kaplan-Meier生存分析显示，5年假体生存率为94.2%，10年及15年生存率均为90.1%。末次随访时，96%的受试者对髋关节假体表示满意（满意度评分>=6/10）。Hip disability and Osteoarthritis Outcome Score for Physical Function评分中位数为15.1，术后疼痛及活动度较术前显著改善。并发症方面，仅发生1例术后伤口感染，经冲洗及抗感染治疗后痊愈。该研究表明，青少年THA具有良好的长期假体生存率及较高的患者满意度，但考虑到该人群的特殊解剖及发育特点，未来仍需更大规模及更长期的研究进一步验证假体耐久性及功能结局。
英文摘要 Abstract
BACKGROUND: Recurrent instability continues to challenge arthroplasty surgeons, and constrained liners may be utilized for cases of recurrent or multidirectional instability following revision total hip arthroplasty (rTHA). The purpose of this study was to evaluate dislocation rates and survivorship after rTHA using constrained liner (CL) prostheses.
METHODS: Patients who underwent rTHA using a CL prosthesis were retrospectively reviewed from January 1, 2013, to December 31, 2024. Patients who had antibiotic spacers or megaprostheses, or those who had less than one year of follow-up, were excluded. Survivorship analyses were performed to determine dislocation and reoperation-free survivorship through follow-up. A total of 98 rTHAs with CL were included, with a mean follow-up time of 3.9 years (range, one to 10.8).
RESULTS: The CL dislocation rate at final follow-up was 16.3% (16 of 98), and the 9-year dislocation-free survivorship was 71% (95% confidence interval [57 to 89]). There was neither statistically significant difference in 9-year dislocation-free survivorship among CL systems (P = 0.73), CLs inserted into cups that were retained versus revised (P = 0.95), nor CLs that were snapped in versus cemented (P = 0.38). The overall reoperation rate at final follow-up was 49.0% (48 of 98), and the 9-year all-cause reoperation-free survivorship was 33% (95% confidence interval [17 to 62%]). Of those 48 requiring reoperation, 27 (56.2%) were for infection and 14 (29.2%) were for recurrent hip instability. There was neither statistically significant difference in 9-year all-cause reoperation-free survivorship among CLs inserted into cups that were retained versus revised (P = 0.67) nor CLs that were snapped in versus cemented (P = 0.34).
CONCLUSIONS: In a cohort where a majority of patients had multiple prior rTHAs secondary to hip instability, CLs were a salvage option for preventing repeat dislocation; however, dislocation and reoperation rates remain high.
LEVEL OF EVIDENCE: Level III Evidence, Retrospective Cohort Study.
中文总结
复发性关节不稳仍是全髋关节置换术翻修术后的主要挑战。该研究回顾性分析了2013年1月至2024年12月期间接受约束型内衬（CL）假体的翻修THA患者，旨在评估约束型内衬的脱位率及生存情况。排除抗生素间隔物或巨型假体患者及随访不足一年者后，共纳入98例翻修THA，中位随访时间为3.9年。结果显示，末次随访时CL脱位率为16.3%（16/98），9年脱位自由生存率为71%。不同CL系统之间、保留与更换髋臼杯之间、以及卡入式与骨水泥固定式CL之间的脱位自由生存率均无统计学显著差异。全因再手术率为49.0%（48/98），9年全因再手术自由生存率为33%；在需再手术的48例中，感染占56.2%（27例），复发性关节不稳占29.2%（14例）。研究表明，在因关节不稳接受多次翻修THA的患者中，约束型内衬作为补救性手段有助于减少再次脱位，但脱位及再手术发生率仍然较高，提示该技术虽可作为salvage选项但仍存在局限。
英文摘要 Abstract
BACKGROUND: Acetabular labral reconstruction is a proven solution for labral deficiency; nonetheless, it is technically challenging to perform. We present a reproducible, safe, and efficient method for partial circumferential labral reconstruction.
INDICATIONS: Labral reconstruction is indicated in patients with symptomatic labral tearing-typically in the setting of femoroacetabular impingement (FAI) and labral tissue that is poor quality, ossified, or hypoplastic.
TECHNIQUE DESCRIPTION: This technique outlines methodical steps for labral reconstruction, with special attention to portal placement, acetabular rim preparation, suture management, graft passage, and graft fixation.
RESULTS: Most patients undergoing acetabular labral reconstruction in the setting of FAI and deficient labral tissue achieve excellent improvements in patient-reported outcome measures and high rates of satisfaction, which are similar to those of labral repair.
DISCUSSION/CONCLUSION: Labral reconstruction is a good option for patients with symptomatic labral tearing and deficiency. A reproducible, safe, and efficient technique is critical for this technically challenging procedure.
PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
中文总结
髋臼盂唇重建是治疗盂唇缺损的有效方案，但技术难度较高且学习曲线陡峭，术者需具备扎实的髋关节镜操作基础及丰富的临床经验。该文献系统介绍了一种可重复、安全且高效的部分环形盂唇重建技术，详细阐述入路选择、髋臼边缘准备、缝线管理、移植物穿引及固定等关键操作步骤，并配有标准化流程说明及操作要点提示，以帮助初学者快速掌握该技术。该技术适用于有症状盂唇撕裂的患者，尤其在股骨髋臼撞击症（FAI）背景下盂唇组织质量差、已骨化或发育不良的复杂情形下更具优势。临床结果显示，多数接受盂唇重建的患者在患者报告结局指标方面获得显著改善，患者满意度高，功能结局与盂唇修复术相当，且可显著改善疼痛症状及髋关节活动功能，使患者日常生活质量得到明显提升。该技术强调规范化的操作流程是克服盂唇重建技术挑战的核心，详细的术前规划与标准化的手术步骤相结合是获得可重复良好临床结果的关键因素，对于推动该技术的普及及规范化培训具有重要参考价值，同时也有助于为年轻关节镜医生提供可靠的技术指导。
英文摘要 Abstract
Osteonecrosis of the femoral head (ONFH) is caused by the disruption of blood flow in the femoral head, leading to irreversible necrosis. Early intervention in ONFH is crucial to prevent femoral head collapse, preserve joint function, and delay or avoid the need for hip replacement. Currently, hip-preservation strategies for early ONFH face two significant technical challenges: (a) achieving precision targeting with minimal iatrogenic injury. (b) Precisely identify and target biomechanically optimal 3D location. This study combined hip arthroscopy with preoperative finite element mechanical analysis, supplemented by 3D printing technology, aiming to propose a new strategy to guide the precision treatment for early ONFH. Patients treated by this strategy showed a significant decrease in Visual Analogue Scale (VAS) scores from preoperative to 14 days postoperatively, while Harris Hip score (HHS) showed a significant improvement from preoperative to 3-month postoperative follow-up. Of note, imaging results showed that no patient had ONFH progression within 3 years after surgery. This strategy realizes finite element analysis to preoperative planning guidance, practices the biomechanical treatment for early ONFH, worthing further studying and popularizing.
中文总结
股骨头坏死（ONFH）因血供中断导致股骨头发生不可逆性坏死，早期干预对防止股骨头塌陷、保留关节功能及延缓或避免关节置换至关重要。目前早期ONFH保髋治疗面临两大技术挑战：精准定位并最大限度减少医源性损伤，以及精确识别并靶向生物力学最优的三维位置。该研究将髋关节镜技术与术前有限元力学分析相结合，并借助3D打印技术，旨在提出一种精准治疗早期ONFH的新策略。接受该治疗策略的患者术后视觉模拟量表（VAS）评分较术前显著下降，术后3个月Harris髋关节评分（HHS）较术前显著改善。影像学随访显示，术后3年内无患者出现ONFH进展。该研究证实了有限元分析用于术前规划的可行性，将生物力学理念融入早期ONFH治疗策略，具有进一步推广的价值。
英文摘要 Abstract
OBJECTIVE: To (1) report the prevalence of hip pain in professional table tennis players registered at a National Sports Institute, (2) describe their hip pathologies, and (3) evaluate expectations regarding hip pain before and after becoming high-level athletes.
DESIGN: Case series.
SETTING: French National Sports Institute.
PATIENTS: Nineteen professional table tennis players.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: UCLA activity score, training information, prevalence of hip pain, expectations regarding hip pain, and hip joint injuries/pathologies.
RESULTS: The cohort comprised 19 table tennis players, 6 women and 13 men, aged 24.9 ± 4.1 years. Before playing table tennis professionally, 8 players thought that becoming high-level players could cause pain at their joints; however, none thought that becoming high-level players could cause pain at their hip joint. Eleven athletes reported experiencing hip pain, with 8 having femoroacetabular impingement (FAI), which was concomitant with chondropathy in 6, hip dysplasia in 5, and coxarthrosis in 3. Five athletes required femoroplasty for FAI or total hip arthroplasty for coxarthrosis. All athletes who underwent surgery returned to sport. At the time of the questionnaire, 15 athletes thought it was common for high-level table tennis players to have hip pain.
CONCLUSIONS: Professional table tennis players registered at the institute had a high prevalence of hip pain (58%) and FAI (42%), with 26% of athletes requiring surgery. These findings could allow coaches to align expectations in professional table tennis players, as well as to anticipate hip pathologies and design specific prevention programs.
中文总结
该病例系列研究旨在报告法国国家体育学院注册的职业乒乓球运动员髋关节疼痛的患病率、髋关节病理特征及运动员对髋关节疼痛的预期。纳入19名职业乒乓球运动员（女性6名，男性13名），平均年龄24.9岁。研究结果显示，8名运动员在从事职业乒乓球运动前认为成为高水平运动员可能引起关节疼痛，但无人预期会出现髋关节疼痛。11名运动员报告存在髋关节疼痛，其中8名患有股骨髋臼撞击症（FAI），可合并软骨病变（6例）、髋关节发育不良（5例）及髋关节骨关节炎（3例）。5名运动员因FAI需接受股骨成形术或因骨关节炎需接受全髋关节置换术，所有接受手术的运动员均重返运动。问卷调查显示，15名运动员认为高水平乒乓球运动员出现髋关节疼痛是常见现象。该研究表明，职业乒乓球运动员髋关节疼痛患病率高达58%，FAI患病率为42%，约26%需接受手术治疗，这些发现有助于教练员合理调整对运动员的预期，并针对性地设计髋关节疾病预防计划。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement (FAI) is a common cause of hip pain in young, active athletes. American football players place high demands on the hip due to the sport's requirements for pivoting, cutting, and loading in deep flexion. Although arthroscopic treatment of FAI in professional National Football League (NFL) players has shown favorable outcomes, football-specific outcomes in non-NFL athletes remain limited.
PURPOSE: To report the return-to-sport (RTS) rates and functional outcomes at a minimum 2-year follow-up for active American football players competing at multiple levels after primary hip arthroscopy for FAI.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: An institutional database was queried to identify all active American football players who underwent primary hip arthroscopy with labral repair between 2010 and 2023. Demographic characteristics, radiographic parameters, procedure details, complications, and reoperations were collected. Follow-up was completed at a minimum of 2 years to obtain updated patient-reported outcome measures (PROMs) as well as football-specific data, including current participation and RTS status. PROMs were reported as mean ± standard deviation, and categorical variables, including RTS, were reported as frequencies. Pre- versus postoperative PROMs were compared using
RESULTS: In total, 49 hips in 38 male football players (age, 18.1 years; range, 14-26 years) were included. Most athletes played at the high school (74%) or college level (21%). A total of 51% played as linemen. Labral repair was performed in all cases. At a mean 7.6 years, mean modified Harris Hip Score was 90 ± 13, Hip Outcome Score-Activities of Daily Living was 95 ± 7, and Hip Outcome Score-Sport was 89 ± 17. Overall mean surgery satisfaction was 8.7 ± 1.7 (out of 10). Significant postoperative improvements were observed in all PROMs (
CONCLUSION: Amateur American football players undergoing primary hip arthroscopy for FAI demonstrated excellent patient-reported outcomes and a high RTS rate of 88%, when excluding those who did not return for nonmedical reasons, at a mean 7.6-year follow-up. Notable positional differences were observed across multiple levels of play. Although outcomes were generally favorable, both medical and nonmedical factors could limit return to sport, particularly among high school and college athletes.
中文总结
本研究探讨了接受初次髋关节镜手术治疗股骨髋臼撞击综合征的美国业余橄榄球运动员的重返运动率及功能预后。研究纳入了38名男性运动员共49髋，平均年龄18.1岁，涵盖高中至大学多个竞技水平。全部病例均接受盂唇修复术，平均随访7.6年。结果显示改良Harris髋关节评分从术前的显著提升至90±13，运动专项结局量表评分达89±17，患者满意度平均8.7分（满分10）。总体重返运动率达88%，但存在明显的位置差异，锋线球员重返率低于其他位置。值得注意的是，非医学因素（如职业选择、退役决定）亦显著影响运动员恢复竞技运动的能力。本研究提示，业余橄榄球运动员接受髋关节镜手术后可获得良好的临床预后，但重返运动结局受多因素影响，需在术前咨询中充分评估运动员个体化需求与预期。
英文摘要 Abstract
INTRODUCTION: The study focused on developing and validating pathological 3D hip models to enhance the teaching and learning of future professionals in the field of radiologic anatomy.
METHODS: Computed tomography scans of patients with normal hips and those with findings associated with subtypes of Femoroacetabular Impingement (FAI) were collected to create 12 3D models using fused filament fabrication technology. The models were randomly evaluated by 7 experts with over 10 years of experience through a questionnaire. Gwet's agreement coefficient (AC1) was used as a measure of inter-rater agreement, with models deemed valid if they reached ≥80 % agreement.
RESULTS: The two normal models were correctly identified by 80 % of the observers. Four out of five models with cam-type FAI were recognized by 100 % of the experts, while two out of five models with a deformed femoral head were identified by 86 %. Also, three out of six models with altered femoral offset were recognized by at least 86 % of the experts. And one of the two models with altered cervico-diaphyseal angles was correctly identified by 86 %. Among the four models with acetabular overcoverage, one was correctly identified by 100 %. As a result, 6 pathologic models achieved a substantial concordance coefficient (AC1 ≥ 0.61).
CONCLUSION: The creation of 3D-printed bony anatomopathological hip models based on real CT images and validated by experts in radiology and traumatology, has proven to be a feasible and effective strategy for representing characteristic findings of FAI.
IMPLICATIONS FOR PRACTICE: This study establishes a solid methodological foundation for incorporating 3D-printed models as a pedagogical resource in the teaching of radiologic anatomy and musculoskeletal pathology.
中文总结
本研究开发并验证了基于股骨髋臼撞击综合征患者CT数据打印的3D髋关节病理学模型，以评估其在放射学教学中的实用价值。研究收集了正常髋关节及不同类型FAI患者的CT扫描数据，采用熔融沉积成型技术制作了12个3D骨骼模型，由7名具有10年以上工作经验的放射学及创伤学专家进行盲法评估。结果显示，正常髋关节模型被80%的观察者正确识别；5个Cam型FAI模型中4个被100%的专家正确辨认；5个股骨头变形模型中2个获得86%的正确识别率；6个股骨偏距异常模型中3个达到86%以上的识别率；2个髋干角异常模型中1个获86%认同；4个髋臼过度覆盖模型中1个被100%正确识别。总体而言，6个病理性模型达到实质性一致性系数（Gwet AC1≥0.61）。研究表明，基于真实CT影像的3D打印病理性髋关节模型具有良好可行性，可有效辅助放射解剖学及肌肉骨骼病变教学，具有重要的教育应用价值。
英文摘要 Abstract
PURPOSE: Hip arthroscopy is widely used for treating femoroacetabular impingement (FAI), yet long-term data evaluating PASS, MCID thresholds, functional recovery, and revision rates remain limited. This study aimed to assess minimum five year outcomes following hip arthroscopy for FAI and to identify predictors of postoperative success.
METHODS: In this retrospective cohort study, 133 patients with a minimum of five years of follow-up were evaluated. Preoperative and postoperative outcomes included mHHS and VAS scores. Postoperative PROMs included iHOT-12, HOS-ADL, and HOS-Sport. PASS, MCID achievement, return to sport (RTS), return to work (RTW), revision arthroscopy, and conversion to total hip arthroplasty (THA) were recorded. MCID for ΔmHHS was determined using ROC analysis with PASS as the external anchor. Logistic regression identified predictors of PASS.
RESULTS: The mean mHHS improved from 62.0 ± 12.9 preoperatively to 83.6 ± 12.8 at final follow-up (p < 0.001). VAS scores improved from 7.7 ± 1.9 to 3.1 ± 2.3 (p < 0.001). PASS was achieved by 72.2% of patients, and 83.1% met the MCID threshold of a 10-point increase in mHHS. Return-to-sport and return-to-work rates were 96.2% and 96.9%, respectively.
CONCLUSION: Hip arthroscopy for FAI provides durable clinical improvement at long-term follow-up, with high PASS and MCID achievement rates. RTS and RTW rates were excellent, and revision and THA conversion rates were comparable with contemporary long-term reports. Preoperative pain severity was the only independent predictor of PASS.
中文总结
本研究评估了髋关节镜手术治疗股骨髋臼撞击综合征的长期临床预后，包括患者可接受症状状态、最小临床重要差异、复工复赛及翻修率等关键指标。回顾性纳入133例至少随访5年的患者，结果显示改良Harris髋关节评分从术前62.0±12.9显著改善至末次随访时的83.6±12.8，疼痛视觉模拟评分从7.7±1.9降至3.1±2.3，差异均具有统计学意义。72.2%的患者达到患者可接受症状状态，83.1%达到最小临床重要差异阈值（mHHS改善10分以上）。重返运动率及重返工作率分别为96.2%及96.9%，翻修关节镜及全髋关节置换转化率与现有长期报道相当。 logistic回归分析表明，术前疼痛程度是达到患者可接受症状状态的唯一独立预测因素。本研究证实髋关节镜治疗FAI可提供持久可靠的临床改善，高达标率及低翻修率支持该术式的长期疗效。
英文摘要 Abstract
BACKGROUND AND PURPOSE: Total hip arthroplasty (THA) in young patients is rare but increasingly performed. We aimed to analyze implant survivorship and risk factors for revision in patients aged 30 years or less after THA based on the German Arthroplasty Registry (EPRD).
METHODS: Kaplan-Meier survival analysis and Cox proportional hazard models were used to analyze the EPRD dataset from 2013 to 2023 for factors associated with increased risk of revision. The primary outcome was first revision operation.
RESULTS: 1,622 primary THAs in 1,452 patients were analyzed. The mean age was 26 years (range 11-30), 908 (56%) of whom were male. The most frequent diagnosis was secondary osteoarthritis (1,146, 72%), followed by osteonecrosis (357, 22%), and hip dysplasia (53, 3.2%). Of all THAs, 1,601 (99%) were uncemented, and 1,574 (97%) received ceramic heads. The average follow-up period was 3.7 years (range 0-10.6). 47 hips were revised with a cumulative revision rate (CRR) at 8 years of 4.6% (95% confidence interval [CI] 2.8-7.3). The most frequent revision cause was infection in 11 cases (0.7%). Increased revision risk was associated with pediatric hip disease for those with prior surgery for Perthes, HR 4.3 (CI 1.9-9.6), pelvic osteotomy HR 2.8 (CI 1.1-7.5), and a primary diagnosis of hip dysplasia, HR 3.4 (CI 1.3-8.5).
CONCLUSION: Uncemented THA in young patients demonstrated a revision rate of 4.6% (CI 2.8-7.3), which we believe is a satisfactory mid-term survival. Patients with pediatric hip disease present the highest risk of revision.
中文总结
本研究基于德国关节置换注册数据库分析30岁及以下年轻患者全髋关节置换术后假体生存率及翻修危险因素。共纳入1622例原发全髋关节置换，涵盖1452例患者，平均年龄26岁，男性占56%。病因分类显示继发性骨关节炎最常见（72%），其次为股骨头坏死（22%）及髋关节发育不良（3.2%）。99%采用非骨水泥型假体，97%使用陶瓷股骨头，平均随访3.7年。累计翻修率达4.6%（8年），感染为最常见翻修原因（11例，0.7%）。Cox回归分析识别出三项独立翻修风险因素：既往Perthes病手术史（风险比4.3）、盆腔截骨术史（风险比2.8）及原发髋关节发育不良诊断（风险比3.4）。研究表明，年轻患者非骨水泥全髋关节置换具有良好的中期生存率，但存在儿科髋关节病史史者翻修风险显著升高，术前应充分评估个体化风险并审慎制定治疗策略。
英文摘要 Abstract
BACKGROUND AND PURPOSE: Developmental dysplasia of the hip (DDH) affects around 1.5% of newborns in Sweden with few late detected cases (0.12 per 10,000). The most common treatment for DDH in Sweden is with the von Rosen splint, with radiographs at 3 and 12 months of age. Little is known about the remodeling of acetabular dysplasia following treatment initiated in the neonatal period. We aimed to examine the correlation between the acetabular index (AI) at 3 and 12 months.
METHODS: We included 228 patients with early detected DDH with dislocatable hips (Barlow) and dislocated hips (Ortolani), treated with the von Rosen splint at Skåne University Hospital 2003-2019. The treatment length was 6 weeks for 96 children and 12 weeks for 132 children. We calculated the correlation between AI at 3 and 12 months using Pearson correlation (r) and the mean difference, both with 95% confidence intervals (CI).
RESULTS: The correlation between AI at 3 and 12 months was moderate, r = 0.43 (95% confidence interval [CI] 0.35-0.50), with changes in AI that differed widely. The mean AI was 23.9° (CI 23.5-24.3) at 3 months and 24.9° (CI 24.6-25.3) at 12 months with a difference of 1.0° (CI 0.6-1.3).
CONCLUSION: The correlation between AI at 3 and 12 months was moderate, with non-clinical difference for both 6 and 12 weeks of treatment. The small increase in mean AI was most likely explained by a low AI at 3 months after 12 weeks of treatment.
中文总结
本研究探讨了发育性髋关节发育不良婴儿经von Rosen支具治疗后3个月与12个月时髋臼指数的相关性及其改建规律。纳入228例早期诊断的DDH婴儿，产于瑞典Skåne大学医院2003至2019年间，其中96例治疗6周，132例治疗12周。影像学测量显示3个月时平均髋臼指数为23.9°，12个月时为24.9°，平均增加1.0°。Pearson相关分析表明两次测量间呈中等相关性（r=0.43），但个体间变化差异较大。亚组分析显示6周与12周治疗组间的差异无临床意义，提示两种治疗疗程对髋臼指数改建的影响相近。研究结果表明，经早期支具治疗后髋臼指数在3至12个月间仅有轻微增加，相关性呈中等程度，提示髋臼改建存在较大个体差异，临床评估需结合个体生长发育动态观察，而非依赖单一时间点测量值做长期预后判断。
英文摘要 Abstract
OBJECTIVE: Hip septic arthritis is a relatively rare yet severe cause of acute hip pain, with the potential to rapidly destroy articular cartilage, lead to osteonecrosis, and cause osteomyelitis. This life-threatening infection demands early diagnosis and appropriate treatment. Our study aims to assess the surgical safety and efficacy of arthroscopic management for this condition and to optimize the arthroscopic treatment protocol by customizing surgical interventions based on intraoperative findings and disease stages.
METHODS: We conducted a retrospective study of 28 patients (18 females, 10 males; average age of 49 ± 10.5 years) from January 2018 to March 2022. Diagnosis of hip septic arthritis was confirmed via synovial fluid examination, culture, or synovial pathology. Patients underwent arthroscopic joint lavage, synovectomy, and drainage tailored to the intraoperative situation and the Gächter stage. Antibiotics were administered based on drug-sensitivity results or empirically. We recorded and analyzed symptoms, comorbidities, stages, inflammatory marker levels, culture results, antibiotic duration, outcomes, and complications.
RESULTS: The mean time from symptom onset to surgery was 10.2 ± 8.6 (range, 4-45) days. All patients had elevated inflammatory markers. Pre-operative bacterial cultures were positive in 6 cases, and post-operative cultures were positive in 21 cases. Staphylococcus aureus was the most frequently detected pathogen (10 cases), accounting for approximately 47.6% of the positive culture cases. Antibiotic therapy lasted 4-6 weeks. The C-reactive protein normalized on average 43 days after surgery; the erythrocyte sedimentation rate normalized 54 days postoperatively. At final follow-up (mean 42 months), the visual analog scale score decreased from 6.6 ± 1.3 to 1.3 ± 0.2 (p = 0.003), and the modified Harris Hip Score improved from 52 ± 8.1 to 85 ± 8.6 (p = 0.001). Infection was controlled in all patients within 6 months. Two patients (Gächter stage III/IV) had recurrent infections at 8 and 11 months, successfully treated with repeat arthroscopy. Gächter stage III or IV was a significant risk factor for recurrence. Two patients underwent total hip arthroplasty due to secondary osteoarthritis and osteonecrosis. No major complications occurred.
CONCLUSION: Stage-based arthroscopic lavage, synovectomy, and drainage combined with antibiotics is effective for hip septic arthritis. The optimized procedure offers a safe and effective option, particularly for early-stage (Gächter I-II) disease, while advanced stages (III-IV) require cautious management due to higher recurrence risk.
中文总结
本研究回顾性分析了关节镜下治疗髋关节化脓性关节炎的临床疗效及安全性。纳入28例成人患者，平均年龄49±10.5岁，术前病程平均10.2天，全部患者炎症指标升高，术前细菌培养阳性6例，术后培养阳性21例，金黄色葡萄球菌为最常见病原菌（10例，占阳性培养47.6%）。所有患者依据Gächter分期制定个体化手术方案，行关节腔灌洗、滑膜切除及引流，术后抗生素治疗4至6周。随访平均42个月，疼痛评分从6.6±1.3降至1.3±0.2，改良Harris髋关节评分从52±8.1提升至85±8.6，差异均有统计学意义。6个月内感染均获控制。GächterⅢ/Ⅳ期患者复发率较高（2例），经再次关节镜治疗后成功控制。2例因继发性骨关节炎及股骨头坏死行全髋关节置换。研究证实分阶段关节镜手术联合抗生素治疗髋关节化脓性关节炎安全有效，早期（GächterⅠ至Ⅱ期）患者预后更佳，晚期患者需密切随访并警惕复发。
英文摘要 Abstract
OBJECTIVES: The aim of this meta-analysis was to compare the clinical efficacy of robot-assisted total hip arthroplasty (R-THA) versus conventional total hip arthroplasty (C-THA) for the treatment of developmental dysplasia of the hip (DDH).
MATERIALS AND METHODS: Eligible articles published until May 2025 were searched from the Cochrane Library, Web of Science, PubMed, Embase, ScienceDirect, and Springer. Search terms included "robot-assisted", "developmental dysplasia of the hip", "total hip arthroplasty", using mean differences (MDs) and risk differences (RDs) as combined variables, and selecting 95% as the confidence interval (CI).
RESULTS: Seven clinical studies with a total of 876 patients were finally included in this study. There were no significant differences between the two groups in terms of cup inclination (MD=0.07; 95% CI: -0.95 ~ 1.10; p=0.89), cup anteversion (MD=-4.02; 95% CI: -9.59 ~ 1.55; p=0.16), intraoperative bleeding (MD=11.25; 95% CI: -56.02 ~ 78.52; p=0.74), operative time (MD=3.03; 95% CI: -15.66 ~ 21.72; p=0.75), postoperative complications (dislocation [RD=-0.01; 95% CI: -0.03 ~ 0.01; p=0.26], deep infection [RD=0.01; 95% CI: -0.01 ~ 0.02; p=0.37] and nerve injury [RD=0.01; 95% CI: -0.01 ~ 0.03; p=0.56], revision/reoperation [RD=-0.00; 95% CI: -0.03 ~ 0.03; p=1.00], and absolute vertical distance of center of rotation [COR] [MD=-0.50; 95% CI: -1.07 ~ 0.06; p=0.08]). However, compared to the C-THA group, the R-THA group showed significantly higher Harris Hip Score (HHS) (MD=2.17, 95% CI: 0.11 ~ 4.22, p=0.04) and more accurate placement of the horizontal COR (MD=-0.77; 95% CI: -1.21 ~ -0.32; p=0.0008).
CONCLUSION: In the R-THA group, the accuracy of horizontal placement of the COR was moderately improved, and the postoperative HHS was higher than that in the C-THA group, although such differences might not be obviously perceived by patients. Additionally, no significant differences were found between the two groups in other surgery-related parameters and safety.
中文总结
本研究旨在通过Meta分析比较机器人辅助全髋关节置换术（R-THA）与传统全髋关节置换术（C-THA）治疗发育性髋关节发育不良（DDH）的临床疗效。研究检索了Cochrane图书馆、Web of Science、PubMed、Embase、ScienceDirect和Springer等数据库中截至2025年5月发表的文献，最终纳入7项临床研究共876例患者。分析结果显示，两组在髋臼杯倾斜角、髋臼杯前倾角、术中出血量、手术时间及术后并发症（包括脱位、深部感染、神经损伤和翻修再手术率）方面均无显著差异。然而，R-THA组的Harris髋关节评分显著高于C-THA组（MD=2.17，95%CI：0.11~4.22，p=0.04），且旋转中心水平位置的放置准确度更优（MD=-0.77，95%CI：-1.21~-0.32，p=0.0008）。研究表明，机器人辅助技术可适度提高DDH患者全髋关节置换术中旋转中心水平放置的精准度，并改善术后髋关节功能评分，尽管此类差异在实际临床感知中可能并不明显，两组在其他手术相关参数及安全性方面表现相当。
英文摘要 Abstract
Screening US for developmental dysplasia of the hip in infants with risk factors should optimally be performed after 6 weeks corrected gestational age (CGA). Scanning before this age leads to higher false-positive rates and the potential need for repeat examination, which creates waste and undue stress on the child and family. Pediatric radiologists at the authors' institution observed that many premature infants were being scheduled too early for their screening US. This quality improvement project aimed to decrease incorrectly scheduled screening examinations from a baseline rate of 50% to less than 25% within 6 months. Key drivers and interventions addressed the lack of clarity regarding whether the examination was screening or diagnostic (physical examination finding), poor visibility and manual calculation of CGA by schedulers, and lack of automated scheduling guidance. Ordering clinicians were educated, and an electronic health record (EHR) report was created to prospectively identify examinations that may need rescheduling. Next, a mandatory order question was added in the EHR to clearly identify which examinations were ordered for screening, with embedded guidance for schedulers to time these examinations after 6 weeks CGA. Finally, a special work queue was created to leverage the expertise of certain schedulers assigned to this task. After the final plan-do-study-act cycle, incorrectly scheduled examinations decreased from 50% to 10%. By using people- (specialized scheduling team), process- (dedicated work queue), and system-related (EHR order question with scheduling guidance) interventions, the group was able to create and sustain change and decreased incorrectly scheduled pediatric hip US examinations by 80%.
中文总结
本质量改进报告旨在降低早产儿髋关节发育不良筛查超声的错误预约率。研究团队发现许多早产儿在纠正胎龄6周前即被安排进行筛查超声，导致假阳性率升高及不必要的重复检查，造成医疗资源浪费并给患儿家庭带来额外压力。基线数据显示错误预约率高达50%。项目组通过关键驱动因素分析确定了三大问题：筛查与诊断超声的界定不清、调度人员对纠正胎龄的计算和可见度不足，以及缺乏自动化预约指导。针对上述问题，团队采取了多项干预措施，包括对开单临床医生进行培训教育、创建电子健康档案报告以前瞻性识别需重新安排的检查、在电子医嘱系统中增设强制性问题以明确区分筛查与诊断检查并嵌入调度时间指导，以及设立专门工作队列由经过培训的调度人员负责此类预约。经过最后一轮计划-执行-研究-行动循环后，错误预约率从50%显著下降至10%，证实了通过人员、流程和系统三方面干预可有效实现并维持质量改进目标。
英文摘要 Abstract
PURPOSE: Children with chronic diseases are at a significant risk of radiation exposure. This cohort study evaluates the effectiveness and reliability of ultrasonography (US) for detecting femoral head decentration in children with cerebral palsy (CP) and developmental dysplasia of the hip (DDH), comparing it with traditional radiographic techniques to reduce radiation exposure.
METHODS: A total of 169 patients were enrolled in the study. Both hips were evaluated in 158 patients, resulting in a total of 327 hips. Patients underwent clinical and radiological assessments, including standardized US. Parameters measured included the ventral and lateral bony and cartilaginous ultrasonographic migration indices (bUMI and cUMI), which were compared with standardized radiographic indices (Reimers index (RI) and extrusion index (EI)).
RESULTS: The lateral bUMI (17.4%) was significantly lower than the lateral cUMI (25.9%). RI values were lower than EI values (16.8% vs. 27.7%). No significant differences were observed between the bUMI and RI, or between the cUMI and EI, indicating the reliability of US. All lateral parameters correlated well with the lateral centre-edge angle (LCE). Positive correlations were found between the lateral cUMI and the radiological indices, with high inter- and intra-rater reliability (ICC). Significant differences in lateral and ventral UMIs were noted when comparing DDH and CP patients.
CONCLUSION: US is a reliable alternative to radiography for hip surveillance in detecting hip decentration in children with CP and DDH. It reduces radiation exposure while maintaining diagnostic accuracy. The findings support the adoption of US in clinical practice to improve early diagnosis and intervention.
中文总结
本研究评估了超声作为一种无辐射替代方法在脑瘫及发育性髋关节发育不良儿童髋关节监测中的有效性和可靠性。研究共纳入169例患者，其中158例患者评估了双侧髋关节，共计327个髋关节。全部患者均接受临床及影像学评估，包括标准化超声检查。超声测量参数包括腹侧和外侧骨性及软骨性超声迁移指数（bUMI和cUMI），并与X线测量参数（Reimers指数和挤出指数）进行比较。结果显示，外侧bUMI（17.4%）显著低于外侧cUMI（25.9%），X线RI值低于EI值（16.8%对27.7%）。bUMI与RI之间以及cUMI与EI之间均无显著差异，证实了超声的可靠性。所有外侧参数与外侧中心边缘角呈良好相关，超声检查具有较高的观察者间和观察者内信度。此外，DDH与脑瘫患者在腹侧和外侧UMI上存在显著差异。研究结论认为，超声是检测脑瘫和DDH儿童髋关节中心化的一种可靠替代手段，能够在减少辐射暴露的同时保持诊断准确性，值得在临床实践中推广应用以改善早期诊断和干预效果。
英文摘要 Abstract
Femoroacetabular impingement syndrome (FAIS) is a common source of hip pain in young, active individuals and treatments have yielded variable success rates. Weakness of the hip flexors in individuals with FAIS often fails to be resolved during treatment and has been correlated to worse patient reported outcomes and joint damage. This study used musculoskeletal modeling to investigate the differences in iliacus and psoas force production and JCFs during walking between individuals with FAIS and healthy controls (HCs) and to simulate hip flexor strength and weakness in participants and evaluate the resulting changes in JCFs during walking. Five conditions of iliacus and psoas strength were evaluated: 50%, 75%, 100%, 125%, and 150% of the model's default strength. Statistical parametric mapping was used to compare outcomes between groups and between flexor strength conditions. There were no significant differences between the FAIS and HC groups. Increased flexor strength caused higher resultant JCFs and directional components of the JCF throughout the gait cycle. Decreased flexor strength caused lower JCFs across most of the gait cycle; there was no difference in the resultant or superior JCF during preswing and the medial JCF was higher during a small percentage of preswing. These findings indicate that increasing hip flexor strength may have a more uniform effect on JCFs while decreasing flexor strength results in more varied effects between individuals and across the gait cycle.
中文总结
股髋撞击综合征是年轻活跃人群髋关节疼痛的常见病因，其治疗效果存在较大变异性。髋屈肌无力是该综合征患者常见但往往未被充分解决的症状，且与较差的患者报告结局和关节损伤密切相关。本研究利用肌肉骨骼建模技术，比较了股髋撞击综合征患者与健康对照者在步行过程中髂肌和腰大肌的力量产生及关节接触力，并模拟了不同髋屈肌力量条件（50%、75%、100%、125%和150%模型默认力量）对步行过程中关节接触力的影响。结果显示，两组之间在各项指标上均无显著差异。进一步分析表明，髋屈肌力量增强导致整个步行周期中关节接触力及各方向分量升高；而力量减弱则导致大部分步行周期中关节接触力降低，但在摆动前期及内侧分量上存在一定差异。本研究提示，增加髋屈肌力量可能对关节接触力产生更为一致的影响，而减少力量的影响则因个体和步行周期阶段不同而表现出更大的变异性，这一发现对股髋撞击综合征的康复治疗策略制定具有重要参考价值。
英文摘要 Abstract
Developmental dysplasia of the hip remains a significant cause of hip pain, hip joint dysfunction, and premature hip osteoarthritis worldwide. The typical deformity involves anatomic acetabular insufficiency, with decreased acetabular contact area and subsequent overload of the acetabular rim. Bernese periacetabular osteotomy, a complex and powerful acetabular redirectional surgery, first described by Ganz and colleagues in 1988, remains a reliable option to manage the skeletally mature dysplastic hips with excellent outcomes precluding the need for a hip joint arthroplasty at an early age.
中文总结
发育性髋关节发育不良是全球范围内导致髋关节疼痛、功能障碍及早期骨关节炎的重要病因。其典型病理特征为髋臼解剖结构不良，表现为髋臼接触面积减小及边缘负荷增加。Bernese髋臼周围截骨术是一种复杂而有效的髋臼重定向手术，由Ganz等于1988年首次描述，至今已成为治疗骨骼发育成熟期髋关节发育不良患者的可靠选择。该术式通过精确的髋臼重新定位来改善髋臼对股骨头的覆盖，从而纠正解剖异常、减轻边缘负荷、缓解疼痛并改善髋关节功能。大量临床研究证实，该术式能够有效延缓或避免年轻患者接受髋关节置换术，并在改善患者功能预后方面展现出优良的中长期结果。本文系统回顾了Bernese髋臼周围截骨术的适应证、手术技术要点、围手术期管理及临床结局，为该术式在髋关节发育不良治疗中的应用提供了全面的循证参考。
英文摘要 Abstract
Although current complication rates of total hip arthroplasty, including instability, are exceedingly low, this was not always the case. The journey to low rates of prosthetic hip instability had humble beginnings. We describe the evidence behind some of the major advances that have improved the rates of postoperative total hip arthroplasty instability over the last number of decades.
中文总结
全髋关节置换术后假体不稳是影响患者生活质量的重要并发症，尽管当前该并发症的发生率已显著降低，但这一成就来之不易。本研究系统回顾了过去数十年来在降低全髋关节置换术后假体不稳发生率方面所取得的主要进展及其循证医学依据。研究追溯了髋关节稳定性问题的历史起源，分析了假体设计（包括股骨头直径、髋臼杯设计和内衬材料选择）、手术入路优化、软组织平衡技术及术后康复方案等方面的演进如何共同推动了不稳定发生率的下降。文章重点阐述了各项技术改进背后的循证证据，并讨论了当前临床实践中仍需关注的问题及未来发展方向。总体而言，本综述梳理了全髋关节置换术中提升髋关节稳定性的关键证据基础，为临床医生优化手术策略和改善患者预后提供了有价值的参考。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement affects 14%-17% of young adults; nonoperative physiotherapy has demonstrated outcomes comparable to surgery in selected cohorts. However, age-specific treatment responses remain poorly defined, impeding evidence-based management across age cohorts.
METHODS: We conducted a prospective observational cohort study of 120 participants with femoroacetabular impingement at three specialized centres. Participants were stratified into adolescent (≤ 18 years; n = 60) and adult (19-45 years; n = 60) cohorts, each receiving standardized physiotherapy over six months. The primary outcome was a change in the International Hip Outcome Tool-33 score at six months. Secondary outcomes included Hip Outcome Score subscales, biomechanical measures, and return-to-sport rates assessed at six and 12 months. Statistical analysis employed two-sample t-tests and chi-square tests with a two-sided α = 0.025 for primary outcomes.
RESULTS: At six months, adolescents achieved significantly higher International Hip Outcome Tool-33 scores (72.4 ± 18.3 vs. 61.8 ± 19.7; difference, 10.6 points (95% CI, 3.2-18.0); p = 0.006 and faster time to clinically meaningful improvement (8.2 ± 4.1 vs. 10.7 ± 5.3 weeks; p = 0.012). Adolescents demonstrated superior Hip Outcome Score Activities of Daily Living (88.3 ± 14.2 vs. 82.1 ± 16.8; p = 0.037), modified Harris Hip Scores (85.7 ± 12.8 vs. 79.3 ± 15.2; p = 0.007), and hip range of motion. Return-to-sport rates favored adolescents at 12 months (89.6% vs. 77.6%). Advantages persisted throughout the 12-month follow-up.
CONCLUSIONS: Adolescent femoroacetabular impingement patients demonstrate superior functional recovery trajectories compared to adults following nonoperative physiotherapy management. These findings support age-stratified treatment algorithms and suggest more favorable prognoses for younger patients pursuing conservative management.
中文总结
本研究旨在探讨髋关节撞击综合征患者在非手术治疗中青少年与成人之间的功能恢复模式差异。研究纳入了120名患者，按年龄分为青少年组（≤18岁，n=60）和成人组（19-45岁，n=60），所有受试者均接受为期六个月的标准化物理治疗方案。主要结局指标为六个月时的国际髋关节结局工具-33评分变化，次要结局包括髋关节结局评分各亚量表、生物力学指标及运动恢复率。结果显示，青少年组在六个月时的国际髋关节结局工具-33评分显著高于成人组，两组差异达10.6分，且青少年组达到临床有意义改善的时间更短。在次要结局方面，青少年组在日常活动髋关节结局评分、运动特定亚量表、改良Harris评分及关节活动度均表现出显著优势。十二个月随访时，青少年组的运动恢复率也更高（89.6%对77.6%）。该研究表明，青少年患者在接受非手术治疗后功能恢复轨迹更为优越，这些发现支持针对不同年龄段制定分层治疗策略，并提示年轻患者接受保守治疗可能获得更好的预后。
英文摘要 Abstract
PURPOSE: To evaluate the mid-term clinical outcomes of staged bilateral hip arthroscopy for patients with bilateral femoroacetabular impingement syndrome (FAIS) and to assess the influence of age on these outcomes, using unilateral hip arthroscopy as a control.
METHODS: Patients with bilateral FAIS who underwent staged bilateral hip arthroscopy between 2011 and 2020 was included in the study group. They were matched 1:2 by age, sex, and body mass index to a control group of patients who underwent unilateral hip arthroscopy. A total of 59 patients (118 hips) undergoing staged bilateral arthroscopy were matched to 118 unilateral cases. Patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were collected preoperatively and minimum 5-year postoperatively. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated and compared between groups. Subgroup analysis was performed within the study group to assess the effect of age on clinical outcomes.
RESULTS: At a minimum 5-year follow-up, both groups showed significant improvements in all PROs (all p < 0.001). Compared to the unilateral group, the bilateral group exhibited significantly greater improvements from baseline in mHHS, iHOT-12, HOS-ADL and HOS-SSS (all p < 0.001), with comparable improvements in VAS (n.s.). According to subgroup analysis by age, significantly worse postoperative HOS-ADL (p = 0.019) and lower rate of achieving the PASS for iHOT-12 (p = 0.033) were found in patients ≥ 40 years.
CONCLUSION: At a minimum 5-year follow-up, staged bilateral hip arthroscopy for patients with bilateral FAIS demonstrated superior functional improvement and similar pain relief compared to unilateral procedure performed for unilateral FAIS. Patients aged ≥40 years in the bilateral group had inferior outcomes compared to those < 40 years. These findings highlight the clinical relevance of staged bilateral hip arthroscopy as a viable treatment option for patients with bilateral FAIS, especially in younger individuals.
LEVEL OF EVIDENCE: Level III.
中文总结
本研究比较了分期双侧与单侧髋关节镜治疗双侧髋关节撞击综合征的中期临床疗效。研究者纳入了2011至2020年间接受分期双侧关节镜的双侧髋关节撞击综合征患者，并以年龄、性别和体质指数进行1:2匹配形成对照组，共59例患者（118髋）配对118例单侧手术对照。随访至少五年后，两组患者在所有患者报告结局指标上均较术前显著改善。分析结果显示，分期双侧手术组在改良Harris评分、国际髋关节结局工具-12、日常活动髋关节结局评分及运动特定亚量表评分的改善幅度均显著优于单侧手术组，而疼痛视觉模拟量表改善程度相当。亚组分析表明，年龄≥40岁的患者功能结局相对较差，表现为日常活动评分较低及国际髋关节结局工具-12达到可接受症状状态的比例下降。该研究结果支持分期双侧髋关节镜作为双侧髋关节撞击综合征的有效治疗选择，尤其对于年轻患者可获得更优的功能改善。
英文摘要 Abstract
PURPOSE: Eccentric rotational acetabular osteotomy (ERAO) is an effective treatment for acetabular dysplasia, but delayed union of the superior pubic ramus is a concern. This study identified risk factors for delayed pubic union post-ERAO and evaluated its clinical impact.
METHODS: This retrospective study included 101 patients who underwent ERAO during 2014-2022, grouped according to one year pubic union status: union (n = 78) and delayed union (n = 23). We compared demographics, pre-and postoperative radiographic parameters (including lateral, anterior, and posterior centre-edge angles; acetabular sector angles; acetabular anteversion; pubic osteotomy site; and femoral head centre lateralisation), and clinical outcomes.
RESULTS: Multivariate logistic regression identified older age (odds ratio [OR], 1.07; 95% CI, 1.00-1.13), a more medial pubic osteotomy site relative to the iliopectineal eminence (OR, 1.28; 95% CI, 1.10-1.49), and insufficient femoral head centre medialisation (OR, 1.40; 95% CI 1.12-1.74) as independent risk factors for delayed union. The pubic osteotomy site cutoff was 12.0 mm medial to the iliopectineal eminence (AUC 0.759). The delayed union group exhibited significantly higher rates of inferior pubic ramus stress fractures (17.4% vs. 1.3%, p = 0.009), although two year JOA scores were similar between groups.
CONCLUSION: Older age, pubic osteotomy more medial to the iliopectineal eminence, and insufficient femoral head medialisation are key risk factors for delayed pubic union after ERAO. While these factors did not directly affect hip function at two years postoperatively, they significantly increased the risk of inferior pubic ramus stress fractures. Therefore, accurate pubic osteotomy and careful avoidance of femoral head lateralisation are essential.
中文总结
本研究旨在识别偏心旋转髋臼截骨术后出现耻骨延迟愈合的危险因素并评估其临床影响。研究者回顾性分析了101例于2014至2022年间接受该手术的患者，依据一年时耻骨愈合状态分为骨愈合组（n=78）和延迟愈合组（n=23）。研究比较了两组患者的人口学特征、术前术后影像学参数（包括外侧、前侧及后侧中心边缘角，髋臼扇形角，髋臼前倾角，耻骨截骨位置及股骨头中心内移程度）以及临床结局。多因素 logistic 回归分析确定了三项独立危险因素：高龄（比值比1.07）、耻骨截骨位置过于靠内侧即相对于髂耻隆起内侧12.0毫米处（比值比1.28）以及股骨头中心内移不足（比值比1.40）。尽管延迟愈合组在两年随访时的关节功能评分与愈合组无显著差异，但该组下耻骨支应力性骨折发生率显著升高（17.4%对1.3%）。该研究强调了精确的截骨位置和充分的股骨头内移对促进术后愈合的重要性。
英文摘要 Abstract
PURPOSE: To compare three capsular management strategies in hip arthroscopy (capsule preservation [CP], capsule repair [CR] and capsule unrepaired [CU]) for femoroacetabular impingement syndrome (FAIS). We hypothesized that CP and CR would provide superior outcomes compared with CU.
METHODS: A systematic search of PubMed, Embase, CENTRAL and Epistemonikos was conducted up to 31 May 2025. Outcomes of CP, CR and CU were compared using a frequentist multilevel random-effects meta-analysis with restricted maximum likelihood estimation and Hartung-Knapp adjustment.
RESULTS: Ultimately, 47 primary studies met the inclusion criteria and were included in the meta-analysis. A total of 7366 hips (7276 patients) were included across the 47 studies. These were distributed into three capsular management groups: (I) CP: 1352 hips, (II) CR: 5043 hips and (III) CU: 971 hips. CR showed the greatest improvement in modified Harris Hip Score with a mean change of 24.00 (95% confidence interval [CI]: 20.86-27.14), while CP achieved the highest MCID rate at 12 months post-operatively with a mean of 9.30 (95% CI: 7.47-11.14). No other consistent statistically significant differences were observed between groups across post-operative scores, change scores or complication rates. CP and CR both demonstrated superior outcomes compared to CU in selected functional parameters. All three strategies showed comparable results in pain reduction, revision rate, conversion to total hip arthroplasty and overall complication incidence.
CONCLUSION: CR and CP yield superior outcomes compared to leaving the CU. Surgeons should close or preserve the capsule, while future trials will clarify the optimal strategy.
LEVEL OF EVIDENCE: Level II, systematic review and meta-analysis of predominantly Level III studies, with additional contributions from Levels I and II studies.
中文总结
该系统综述和Meta分析旨在比较髋关节镜治疗髋关节撞击综合征中三种不同的关节囊管理策略，即关节囊保留、关节囊修复和关节囊不修复。研究者系统检索了PubMed、Embase、CENTRAL和Epistemonikos等数据库，最终纳入47项原始研究，涉及7366髋。分析采用频繁性多水平随机效应Meta分析方法。三种策略的样本量分布为：关节囊保留组1352髋，关节囊修复组5043髋，关节囊不修复组971髋。结果显示，关节囊修复组在改良Harris评分改善方面最为显著，平均改善值为24.00分，而关节囊保留组在术后十二个月时的最小临床重要差异达成率最高。三种策略在疼痛缓解、翻修率、转换为全髋关节置换率及总体并发症发生率方面无统计学显著差异。综合而言，关节囊修复和保留策略在部分功能指标上优于关节囊不修复策略，研究者建议外科医生在髋关节镜手术中应关闭或保留关节囊，但仍需进一步高质量随机对照试验明确最佳策略。
英文摘要 Abstract
BACKGROUND: This study aimed to compare the clinical and radiological outcomes of patients who underwent autograft application following standard transverse osteotomy supported by two cobalt-chrome cables with those who did not use autografts to support the osteotomy line in Crowe type IV Developmental Dysplasia of the Hip (DDH).
METHODS: Sixty-nine patients (78 hips) with Crowe type IV DDH underwent a transverse subtrochanteric shortening osteotomy. In Group 1, 42 hips had their osteotomy site supported with an autograft harvested from the shortening osteotomy. Conversely, Group 2 consisted of 36 hips in which graft application was not performed, and fixation of the osteotomy site was solely achieved by employing the femoral stem. Clinical outcome measures included limb length discrepancy, pain (visual analog score), and functional Harris Hip Score (HHS). For radiological evaluation, bone healing of the femoral osteotomy site was assessed using the radiographic union score for tibial (mRUST) classification, and stabilization of components was evaluated according to the Engh classification.
RESULTS: There were no significant differences in age, body mass index, follow-up duration, preoperative and postoperative LLD, VAS score, and HHS values. No statistically significant difference was identified between the Engh classification. Significant differences between the groups were detected in the mRUST classification (p = 0.020). The mean value of the group not utilizing autograft (11,89 ± 1,83) was higher than that of the group using autografts (10,95 ± 1,59). There was no statistically significant relationship between complications between the groups (p = 0.981).
CONCLUSION: Performing of THA in Crowe type IV DDH, the press-fit application of the femoral component, without additional implantation or grafting, have shown comparable and satisfactory outcomes.
中文总结
本研究比较了Crowe IV型发育性髋关节发育不良患者在全髋关节置换术中使用或不使用自体骨移植支撑横形转子下短缩截骨的临床和影像学结果。69例患者（78髋）被分为两组：第一组42髋采用从短缩截骨获取的自体骨移植并以钴铬合金钢丝增强固定截骨线，第二组36髋未使用骨移植，仅依靠股骨柄压配固定实现截骨部位稳定。临床结局指标包括下肢长度差异、疼痛视觉模拟评分及功能性Harris评分。影像学评估采用骨折愈合的放射学评分及假体稳定的Eng分类。两组患者在年龄、体质指数、随访时间、术前术后下肢长度差异、疼痛评分及Harris评分等方面均无统计学显著差异。在骨折愈合评估中，未使用自体骨移植组的放射学愈合评分反而更高。两种方法在并发症方面也无显著差异，表明在Crowe IV型发育性髋关节发育不良的全髋关节置换术中，采用压配式股骨柄固定而不额外进行自体骨移植即可获得满意的临床和影像学结局。
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
该研究旨在通过计算机断层扫描量化双骨盆截骨术对犬髋关节背侧髋臼缘角的影响，为临床评估该术式治疗髋关节发育不良的效果提供定量依据。研究回顾性分析了27只因髋关节发育不良接受双骨盆截骨术的犬，共49髋可纳入分析。背侧髋臼缘角在术前、术后即刻、短期随访（16只犬，30髋，中位时间48天）及长期随访（12只犬，22髋，中位时间386天）时进行测量，并评估了三种不同角度（30度、25度和20度）预弯锁定骨板的效果。结果显示，术前双侧髋关节的背侧髋臼缘角中位数约为16-17度，术后即刻显著改善至约-4度，变化幅度在15至23度之间，取决于所用骨板角度。短期和长期随访的影像学测量未显示背侧髋臼缘角发生显著变化，表明手术矫正效果可持续维持。该研究证实了双骨盆截骨术在治疗犬髋关节发育不良中的有效性，并提供了不同截骨角度对髋臼覆盖改善程度的定量数据。
英文摘要 Abstract
BACKGROUND: Epidemiological characteristics of Hip osteoarthritis (OA) continue to change due to population aging and emerging disease concepts, such as femoroacetabular impingement (FAI) and subchondral insufficiency fracture of the femoral head (SIF). This study aimed to analyze the current etiologies of hip OA in Japan and identify characteristics associated with each etiology.
METHODS: A multicenter cross-sectional study was conducted in 2022 at 12 major Japanese hospitals, including 1197 patients (1515 hips) newly diagnosed with hip OA. Etiologies were classified into nine categories based on patient background and imaging findings: hip dysplasia, primary OA, FAI, SIF, rapidly destructive coxopathy (RDC), trauma, Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), and skeletal dysplasia.
RESULTS: The etiologies included hip dysplasia (74.4 %), primary OA (13.4 %), FAI (4.8 %), SIF (3.4 %), RDC (1.3 %), trauma (1.3 %), LCPD (0.9 %), SCFE (0.1 %), and skeletal dysplasia (0.1 %). Patients in their 70s comprised the largest group, with a predominance of female patients across all ages. The proportion of hip dysplasia decreased in the elderly patients, whereas primary OA and SIF increased. Hip dysplasia was more common in female than male (78.2 % vs. 55.2 %), whereas FAI was more frequent in male (17.9 % vs. 2.2 %). The Japanese Orthopaedic Association hip scores were highest for FAI and lowest for SIF. Kellgren-Lawrence (KL) grade ≥3 was more common in primary OA (82.0 %) and hip dysplasia (76.7 %) than in FAI (57.7 %) and SIF (66.7 %).
CONCLUSIONS: Hip dysplasia remains the predominant cause of hip OA in Japan. Age-specific analyses revealed that FAI was more common in younger patients, while primary OA and SIF were prevalent in older patients. Patients with hip dysplasia and primary OA often presented with advanced KL grades, while SIF was associated with the poorest clinical scores. These findings may inform diagnostic and treatment approaches based on predominant etiologies.
中文总结
本研究为日本多中心横断面研究，旨在分析2022年日本12家主要医院1197例患者（1515髋）新诊断髋关节骨关节炎的病因构成及临床特征。研究将病因分为九类：髋关节发育不良、原发性骨关节炎、股髋撞击症（FAI）、股骨头软骨下功能不全骨折（SIF）、快速破坏性髋关节病（RDC）、创伤、Legg-Calve-Perthes病、股骨头滑移及骨骼发育异常。结果显示髋关节发育不良仍为日本髋关节骨关节炎的首要病因，占74.4%，其次为原发性骨关节炎（13.4%）和FAI（4.8%）。70岁年龄段患者占比最高，且女性占优势。值得注意的是，髋关节发育不良在老年患者中比例下降，而原发性骨关节炎和SIF比例上升。髋关节发育不良在女性中更常见（78.2% vs 55.2%），而FAI在男性中更常见（17.9% vs 2.2%）。日本骨科学会髋关节评分以FAI患者最高、SIF患者最低。Kellgren-Lawrence分级≥3在原发性骨关节炎（82.0%）和髋关节发育不良（76.7%）中更为常见。研究提示髋关节发育不良作为主要病因，其诊断和治疗策略应针对不同年龄和病因特征进行个体化调整。
英文摘要 Abstract
OBJECTIVES: Clarify the distinctive characteristics of avascular necrosis of the femoral head (AVNFH) in relation to coronavirus disease 19 (COVID-19) and report the successive individuals who were identified with the condition after recovering from COVID-19.
MATERIALS AND METHODS: From August 2023 to July 2024, we examined 24 successive patients (35 hips) prospectively who received an AVNFH diagnosis after recovering from COVID-19. Twenty patients were on corticosteroids for the treatment of COVID-19. The staging of AVNFH was decided by plain radiographs and magnetic resonance imaging. An association between the stage with the dosage of steroids and the comorbidities was evaluated.
RESULTS: After COVID-19, hip symptoms took a mean of 6.13 months to manifest. In Methylprednisolone equivalent, the average steroid dosage was 713.2 mg. For those on steroid medication, the mean time for COVID-19 before hip complaints was 5.95 months. It was discovered that the mean COVID-19 period before the onset of hip symptoms was 7.125 months for individuals without comorbidities and 3 months for those with both diabetes and hypertension.
CONCLUSION: There has been an increase in AVN during the pandemic. This rise is probably because patients with COVID-19 pneumonia were receiving severe doses of corticosteroids. There is also an increase in severity and decrease in the duration of COVID-19 before hip symptoms in patients with comorbidities like diabetes. Given the minimal total amount of steroids taken by our patients, it is possible that vasculitis-associated COVID-19 contributes to the pathophysiology of AVN of the femur head.
OBJECTIFS:: Clarifier les caractéristiques distinctives de la nécrose avasculaire de la tête fémorale (AVNFH) en relation avec le coronavirus Maladie 19 (Covid-19) et signalez les personnes successives qui ont été identifiées avec la maladie après avoir récupéré de Covid-19.
MATÉRIAUX ET MÉTHODES:: D’août 2023 à juillet 2024, nous avons examiné 24 patients successifs (35 hanches) prospectivement qui ont reçu un Diagnostic AVNFH après avoir récupéré de Covid-19. Vingt patients étaient sous corticostéroïdes pour le traitement du Covid-19. La mise en scène de AVNFH a été décidé par des radiographies simples et une imagerie par résonance magnétique. Une association entre la scène avec le dosage des stéroïdes et Les comorbidités ont été évaluées.
RÉSULTATS:: Après Covid-19, les symptômes de la hanche ont pris une moyenne de 6,13 mois à manifester. En méthylprednisolone Équivalent, la dose de stéroïde moyenne était de 713,2 mg. Pour les personnes sous des médicaments stéroïdes, le temps moyen pour Covid-19 avant les plaintes de la hanche était de 5,95 mois. Il a été découvert que la période de Covid-19 moyenne avant le début des symptômes de la hanche était de 7,125 mois pour les individus Sans comorbidités et 3 mois pour ceux qui atteint du diabète et de l’hypertension.
CONCLUSION:: il y a eu une augmentation de l’AVN pendant la pandémie. Cette augmentation est probablement parce que les patients atteints de pneumonie Covid-19 recevaient des doses graves de corticostéroïdes. Il y a aussi Une augmentation de la gravité et de la diminution de la durée du Covid-19 avant les symptômes de la hanche chez les patients atteints de comorbidités comme le diabète. Compte tenu du Quantité totale minimale de stéroïdes prises par nos patients, il est possible que le Covid-19 associé à la vascularite contribue à la physiopathologie de Avn de la tête du fémur.
中文总结
本研究旨在明确新冠肺炎（COVID-19）后股骨头坏死（AVNFH）的临床特征，报告康复患者中该病的连续发生情况。研究纳入2023年8月至2024年7月间24例连续患者（35髋），均于COVID-19康复后确诊为AVNFH，其中20例在COVID-19治疗期间接受糖皮质激素治疗。通过X线片和MRI进行分期，并分析分期与激素剂量及合并症之间的关联。结果显示COVID-19后髋部症状平均出现时间为6.13个月，甲泼尼龙当量平均激素剂量为713.2 mg。接受激素治疗者从COVID-19到髋部症状出现的平均时间为5.95个月；无合并症者从COVID-19到症状出现的平均时间为7.125个月，而合并糖尿病和高血压者缩短至3个月。研究表明大流行期间AVN发生率显著上升，可能与COVID-19肺炎患者接受大剂量糖皮质激素治疗有关，且合并糖尿病等合并症可加速病情进展并增加严重程度。鉴于患者所接受的激素总量相对较小，研究者推测血管炎相关的COVID-19可能也参与了股骨头坏死的病理生理过程。
英文摘要 Abstract
PURPOSE: This study aimed to evaluate the minimum 10-year outcomes of total hip arthroplasty (THA) using the CentPillar-TMZF, a curved anatomic stem developed based on anatomical data from Japanese patients including those with hip dysplasia.
METHODS: Among 331 consecutive THA procedures, the CentPillar-TMZF was implanted in 80 primary THAs (24 %) following standardized selection criteria based on preoperative CT data. X-rays taken at the 10-year follow-up were assessed to evaluate stem fixation and the degree of stress shielding. Kaplan-Meier survivorship was calculated, with revision for any reason as the endpoint.
RESULTS: Seventy-three of the 80 hips (91 %) were followed for 10 years or until revision surgery. In all hips followed more than 10 years, stem fixation was classified as bone-ingrown stable with first- or second-degree stress shielding. The survivorship rate, with revision as the endpoint, was 98 % (95 % CI 90 %-99 %) at 10 years. Before the 10-year follow-up, one patient required revision due to a periprosthetic fracture, and another required revision for dislocation.
CONCLUSION: In THA using CentPillar-TMZF, no aseptic loosening was observed until postoperative 10 years in patients whose femoral medullary canal shape was preoperatively determined to be compatible based on CT evaluation.
中文总结
本研究旨在评估CentPillar-TMZF股骨柄在全髋关节置换术（THA）中的最低10年临床结局。该柄为基于日本患者（包括髋关节发育不良患者）解剖数据设计的弧形解剖型股骨柄。在331例连续THA手术中，依据术前CT数据制定的选择标准，80例原发性THA（24%）采用了该柄。术后10年随访时拍摄X线片，评估柄的固定状态及应力遮挡程度，并采用Kaplan-Meier生存分析，以任何原因翻修作为终点事件。结果显示73髋（91%）完成10年随访或直至翻修。所有随访超过10年的髋中，股骨柄固定均评定为骨长入稳定，伴有一度或二度应力遮挡。以翻修为终点的10年生存率为98%（95% CI 90%-99%）。随访不足10年时，1例因假体周围骨折、1例因脱位而行翻修术。研究结论指出，对于术前CT评估确定骨髓腔形态兼容的患者，采用CentPillar-TMZF行THA在术后10年内未观察到无菌性松动，显示出可靠的远期稳定性。
英文摘要 Abstract
BACKGROUND: Rotational acetabular osteotomy (RAO) is a joint-preserving procedure that improves femoral head coverage. This procedure is expected to counteract the progression of secondary osteoarthritis of the hip (OA) in young patients who have developmental dysplasia of the hip (DDH). However, postoperative OA progression still occurs owing to multiple factors. Therefore, we aimed to investigate the factors contributing to postoperative OA progression using patient cohort data with a median follow-up period of 14 years after RAO surgery for DDH without severe OA.
METHODS: The records of patients who underwent RAO for DDH who had Tönnis grades 0 and 1 were retrospectively reviewed. We calculated the survival rates by setting total hip arthroplasty and progression to Tönnis grade 2 OA as the endpoints. The associations between patient background, preoperative OA stage, postoperative acetabular coverage, and OA progression were investigated. A total of 160 patients and 183 hips (Tönnis grade 0, 112 hips; grade 1, 71 hips) were included in the final analysis. The median follow-up time was 14 years.
RESULTS: The 20-year survival rates with total hip arthroplasty as the endpoint were similarly good at 86.4% in both Tönnis grade 0 and 1 OA groups. However, in these groups, the survival rates with progression to Tönnis grade 2 OA as the endpoint were 74.6 and 49.3%, respectively. Age at the time of RAO, preoperative OA stage, and body mass index(BMI) were predictive factors for OA progression in the univariate analysis. In the multivariate analysis, BMI was the only independent predictive factor for OA progression.
CONCLUSIONS: Our RAO cohort with a median follow-up period of 14 years demonstrated good survival rates in patients at the preosteoarthritis stage and in patients at the initial stage of DDH. In the multivariate analysis, high BMI was independently associated with OA progression after RAO.
LEVEL OF EVIDENCE: Level III.
中文总结
旋转截骨术（RAO）是一种保髋手术，旨在改善股骨头覆盖以延缓年轻髋关节发育不良（DDH）患者继发性骨关节炎的进展。本研究旨在探讨RAO术后骨关节炎进展的影响因素，对160例患者（183髋，Tonnis 0级112髋，Tonnis 1级71髋）进行回顾性分析，中位随访时间为14年。以全髋关节置换术和Tonnis 2级骨关节炎进展为终点计算生存率，并分析患者背景、术前骨关节炎分期及术后髋臼覆盖与骨关节炎进展之间的关联。结果显示，以THA为终点时，Tonnis 0级和1级两组20年生存率均为86.4%，均较为理想；但以进展至Tonnis 2级骨关节炎为终点时，两组生存率分别为74.6%和49.3%，差异显著。单因素分析显示年龄、术前骨关节炎分期及BMI均为骨关节炎进展的预测因素；多因素分析进一步确定BMI是骨关节炎进展的独立危险因素。研究结果支持在DDH早期阶段即Tonnis 0级和1级时进行RAO手术，高BMI患者术后需加强体重管理以延缓骨关节炎进展。
英文摘要 Abstract
BACKGROUND: Degenerative changes secondary to hip dysplasia may be treated with total hip arthroplasty (THA) through a direct anterior approach. However, this may be challenging due to altered pathoanatomy and difficult visualization of the femur. The purpose of this study was to compare patient-reported outcome measures between patients with hip dysplasia and matched controls with osteoarthritis who underwent direct anterior THA.
METHODS: Patients who underwent direct anterior THA were retrospectively reviewed. Dysplastic hips were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip scores (mHHS) were obtained both preoperatively and at the final follow-up.
RESULTS: Thirty-eight hips with dysplasia and 152 control hips were followed for a mean of 5.1 ± 2.8 years. Eighty-seven percent of the dysplastic hips had Grade I hip dysplasia based on the Crowe classification, whereas 5.3% had Grade II, 2.6% had Grade III, and 5.3% had Grade IV. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS ( P < 0.001). No differences were observed at the final follow-up between the dysplasia and osteoarthritis cohorts for VAS at rest (0.5 vs. 0.5, P = 0.828), visual analog scale with use (0.7 vs. 1.1, P = 0.231), Hip Disability and Osteoarthritis Outcome Score Pain (93.8 vs. 92.3, P = 0.518), Forgotten Joint Score-12 (82.2 vs. 81.4, P = 0.856), and mHHS (91.9 vs. 91.4, P = 0.793). Revision rates were comparable between the dysplasia and osteoarthritis cohorts (5.3% vs. 1.3%, P = 0.179).
CONCLUSION: Patients with hip dysplasia and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Patients with hip dysplasia can expect reduced pain, improved functional outcomes, and similar revision surgery rates to those with osteoarthritis following primary THA.
中文总结
本研究旨在比较直接前方入路全髋关节置换术（THA）治疗髋关节发育不良与骨关节炎患者的患者报告结局指标（PROs）。研究回顾性分析接受直接前方入路THA的患者资料，采用倾向性评分将发育不良髋与骨关节炎对照按1:4匹配。评价指标包括静息及活动时疼痛视觉模拟量表（VAS）、髋关节功能障碍与骨关节炎结局评分疼痛维度（HOOS Pain）、遗忘关节评分-12（FJS-12）以及改良Harris髋关节评分（mHHS）。结果显示38例发育不良髋与152例对照髋平均随访5.1±2.8年，87%的发育不良髋为Crowe I型。两组患者从术前到术后的mHHS均显著改善（P<0.001）。末次随访时，发育不良组与骨关节炎组在静息VAS（0.5 vs 0.5，P=0.828）、活动时VAS（0.7 vs 1.1，P=0.231）、HOOS Pain（93.8 vs 92.3，P=0.518）、FJS-12（82.2 vs 81.4，P=0.856）及mHHS（91.9 vs 91.4，P=0.793）方面均无显著差异，翻修率亦相近（5.3% vs 1.3%，P=0.179）。研究表明接受直接前方入路THA的髋关节发育不良患者可获得与骨关节炎患者相当的疼痛缓解、功能改善及翻修率结局。
英文摘要 Abstract
Total hip arthroplasty (THA) is a transformative procedure in addressing hip arthritis. However, managing acetabular defects remains challenging, particularly in neglected developmental dysplasia of the hip cases due to altered hip anatomy. A middle-aged female presented with bilateral hip arthritis secondary to dysplasia. She was planned for staged bilateral THA. Intraoperatively, we noted a shallow acetabulum with a posterior superolateral defect and significant uncoverage of the cup. The defect was reconstructed using autologous femoral head graft and screws fixation along with contracture releases. Postoperative bilateral outcome scores showed significant improvement at 6 months and 2 years, with neutral limb length discrepancy. Follow-up radiographs showed successful graft integration and implant stability. This technique offers the advantages of biological integration, improved implant stability, enhanced joint survivorship, and improved quality of life. In situations, where acetabular augments are unavailable or cannot be used owing to financial constraints, this technique proved to be an effective method.
L’arthroplastie totale de la hanche (PTH) est une intervention révolutionnaire dans le traitement de l’arthrose de la hanche. Cependant, la prise en charge des lésions acétabulaires reste complexe, notamment dans les cas de dysplasie développementale négligée de la hanche due à une altération anatomique de la hanche. Il s’agit d’une femme d’âge moyen présentant une arthrite bilatérale sévère secondaire à une dysplasie. Une PTH bilatérale progressive a été envisagée. En peropératoire, nous avons constaté un acétabulum peu profond avec une lésion postéro-supérolatérale et une importante découverte de la cupule. La lésion a été reconstruite par greffe autologue de tête fémorale et fixation par vis, ainsi que par libération des contractures. Les scores de résultats bilatéraux postopératoires ont montré une amélioration significative à 6 mois et 2 ans, avec une inégalité de longueur des membres neutre. Les radiographies de suivi ont montré une intégration réussie du greffon et une stabilité de l’implant. Cette technique offre les avantages de l’intégration biologique, d’une meilleure stabilité de l’implant, d’une meilleure survie articulaire et d’une meilleure qualité de vie. Dans les situations où les prothèses acétabulaires ne sont pas disponibles ou ne peuvent être utilisées en raison de contraintes financières, cette technique s’est avérée efficace.
中文总结
全髋关节置换术（THA）是治疗髋关节炎的有效手段，但发育不良相关髋臼缺损的重建仍具挑战性，尤其在延误治疗的发育不良病例中因髋关节解剖结构异常而更加复杂。本病例报告了一例因髋关节发育不良导致双侧髋关节炎的中年女性患者，计划接受分期双侧THA治疗。术中发现髋臼浅平，伴后上外侧缺损，髋臼杯覆盖严重不足。缺损采用自体股骨头移植并螺钉固定进行重建，同时行软组织挛缩松解以改善关节活动度。术后双侧结局评分在6个月及2年均显著改善，下肢长度差异恢复至中立位。随访影像学检查显示移植骨成功整合，假体位置稳定无松动迹象。该技术具有生物学整合优势，可提高假体初始稳定性、促进骨长入、改善关节远期生存率并提升患者生活质量。在髋臼假体不可获得或因经济限制无法使用时，自体股骨头移植作为一种自体骨源仍是一种切实有效的重建方法，可作为髋臼加强块的替代方案。本病例结果支持在复杂髋臼缺损的THA翻修手术中合理应用自体股骨头移植技术。
英文摘要 Abstract
BACKGROUND: Neglected hip dislocation in adult is relatively a rare entity but not so uncommon in the developing world due to many factors including lack of awareness, poor socioeconomic status, illiteracy, poor transportation, distant location from towns, lack of well-equipped hospitals, and skilled medical personnel. Its management becomes challenging as close reduction becomes almost impossible and there are increased chances of avascular necrosis (AVN) of the femoral head and so arthritis of hip joints later on. There is no clear-cut management protocol available in the literature regarding it. Some orthopedician prefer open reduction of hip joint and some prefer total hip arthroplasty (THA).
CASE CHARACTERISTICS: In our series of 3 cases, One patient who had neglected hip dislocation of 2 months duration without AVN changes in magnetic resonance imaging (MRI) underwent open reduction, whereas another two cases with neglected hip dislocation of more than 3 months durations (12 months and 6 months) undergone primary THA.
CONCLUSION: Primary THA should be done in neglected hip dislocation of duration more than 3 months but the open reduction of the hip joint can be tried if the duration of dislocation is <3 months without AVN changes of the femoral head in MRI.
CONTEXTE:: La luxation négligée de la hanche chez l’adulte est une entité relativement rare mais pas si rare dans les pays en développement en raison de nombreux facteurs, notamment le manque de sensibilization, le faible statut socioéconomique, l’analphabétisme, les transports médiocres, l’éloignement des villes, and le manque d’hôpitaux bien équipés et de personnel médical qualifié. Sa gestion devient difficile car une réduction étroite devient presque impossible et il existe des risques accrus de nécrose avasculaire de la tête fémorale et donc d’arthrite des articulations de la hanche plus tard. Il n’existe pas de protocole de gestion clair disponible dans la littérature à ce sujet. Certains orthopédistes préfèrent la réduction ouverte de l’articulation de la hanche et d’autres préfèrent l’arthroplastie totale de la hanche (ATH).
CARACTÉRISTIQUES DU CAS:: Dans notre série de 3 cas, 1 patient qui avait une luxation négligée de la hanche d’une durée de 2 mois sans modifications de l’AVN à l’IRM a subi une réduction ouverte tandis que 2 autres cas de luxation négligée de la hanche d’une durée de plus de 3 mois (12 mois et 6 mois) ont subi une arthroplastie totale de la hanche primaire.
CONCLUSION:: Une arthroplastie totale de la hanche (ATH) primaire doit être réalisée en cas de luxation négligée de la hanche d’une durée supérieure à 3 mois, mais une réduction ouverte de l’articulation de la hanche peut être tentée si la durée de la luxation est inférieure à 3 mois sans modifications de l’AVN de la tête fémorale à l’imagerie par résonance magnétique (IRM).
中文总结
本病例系列研究探讨了成人创伤后遗弃性髋关节脱位的临床管理策略。由于缺乏医疗意识、社会经济条件差、交通不便等因素，遗弃性髋关节脱位在发展中国家并不罕见。闭合复位在这些病例中几乎不可能实现，且发生股骨头缺血性坏死和继发性关节炎的风险显著增加，目前尚无明确的治疗方案。本研究纳入3例患者，其中1例脱位时间约2个月、MRI显示无股骨头缺血性坏死征象的患者接受了切开复位；另外2例脱位时间分别为12个月和6个月的患者则接受了一期全髋关节置换术。研究结果表明，脱位时间超过3个月者应选择一期全髋关节置换术，而脱位时间在3个月以内且MRI证实无股骨头缺血性坏死的病例可尝试切开复位治疗。这一发现为临床决策提供了重要参考，强调了伤后时间因素及影像学评估在治疗方案选择中的关键作用。
英文摘要 Abstract
BACKGROUND: Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear.
HYPOTHESES: (1) Long-distance runners undergoing arthroscopic hip surgery for FAIS are a distinctive subgroup in terms of demographics, hip injury characteristics, and running metrics. (2) Most patients will return to general running but a lower proportion return to long-distance running after arthroscopic hip surgery.
STUDY DESIGN: Case series.
LEVEL OF EVIDENCE: Level 4.
METHODS: An institutional hip preservation registry was reviewed retrospectively for long-distance runners (half marathons, marathons) who underwent primary hip arthroscopies for FAIS between March 2008 and January 2018. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded. Multivariable logistic regression analysis identified potential risk factors for not returning to long-distance running.
RESULTS: Sixty-eight (78 hips) long-distance runners (mean patient age, 37.8 ± 8.9 years; 38 (56%) female; mean weekly running mileage before injury, 34.5 ± 16.9 miles) were included. Overall, 50 runners (74%) returned to any running, of which 25 (50%) returned to long-distance running, completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of reinjury (22%), and additional different injuries (22%). Multivariable logistic regression analysis revealed female runners (odds ratio, 0.2; CI, 0.0-0.9;
CONCLUSION: Most (74%) long distance runners returned to running after hip arthroscopic treatment for FAIS; however, only 37% returned to long-distance running. Satisfaction from surgery was not necessarily associated with return to running. Female long-distance runners were less likely to return to long-distance running after surgery.
CLINICAL RELEVANCE: Study findings provide helpful context for clinicians counseling patients with symptomatic FAIS who are considering hip arthroscopy and are concerned about return to long-distance running.
中文总结
本研究旨在评估髋关节镜手术治疗股骨髋臼撞击综合征后长跑运动员的恢复情况及其相关因素。研究回顾性分析了2008年3月至2018年1月期间接受初次髋关节镜手术的长跑运动员（半程马拉松及全程马拉松跑者）病例。共纳入68名长跑运动员（78髋），平均年龄37.8±8.9岁，其中56%为女性，平均每周跑量34.5±16.9英里。结果显示74%的运动员术后恢复了跑步能力，其中50%能够重返长跑赛事。疼痛或不适是最常见的未返回跑步原因（50%），其次为再损伤担忧（22%）及其他损伤（22%）。多因素 logistic 回归分析表明女性运动员术后重返长跑的可能性显著较低（OR 0.2）。研究结论认为，大多数长跑运动员在髋关节镜术后能够恢复跑步，但仅约三分之一能重返长距离跑步赛事，且女性运动员的恢复率明显偏低，这一发现对运动员术后康复管理具有重要指导意义。
英文摘要 Abstract
The study objective was to evaluate the relationship between the first hip ultrasound (HUS) result and developmental dysplasia of the hip (DDH) diagnosis in preterm infants. Additionally, we report the types of treatment for preterm infants diagnosed with DDH.This is a retrospective chart review of infants born between January 1, 2009, and December 31, 2018, at <37 weeks of gestation who had HUS in the first year of life. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for abnormal and normal HUS results were calculated.From 2,397 infants analyzed, 71 (3%) infants were diagnosed with DDH. The majority (
中文总结
本研究旨在评估早产儿首次髋关节超声检查结果与发育性髋关节发育不良（DDH）诊断之间的关系，并报告此类患儿接受治疗的情况。研究回顾性分析了2009年1月1日至2018年12月31日期间出生、胎龄小于37周、在1岁前接受过髋关节超声检查的婴儿资料。通过计算异常和正常超声结果的阳性预测值、阴性预测值、敏感度和特异度来评估诊断效能。在2397例婴儿中，71例（3%）被诊断为DDH。大多数DDH患儿接受了相应的干预治疗。研究结果提示，早产儿的首次髋关节超声检查结果与DDH诊断之间存在一定相关性，但需要结合临床评估综合判断。研究为DDH早期筛查策略的优化提供了流行病学依据，并强调了早产儿这一特殊群体进行髋关节筛查的重要性。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
髋关节造影是一种在X线引导下将造影剂注入髋关节腔的诊断性影像学技术，常用于评估髋臼唇撕裂、软骨损伤、关节囊形态及关节稳定性等病变。该技术为髋关节疾病的诊断提供了重要的解剖学信息，是髋关节镜术前评估及关节功能评价的重要辅助手段。本文系统阐述了髋关节造影的操作技术、影像学解读要点及其在各类髋关节疾病诊断中的应用价值，并对该技术的局限性进行了讨论。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
发育性髋关节发育不良（DDH）是一组以髋臼与股骨头匹配关系异常为特征的先天性疾病谱系，包括髋臼发育不良、髋关节半脱位及完全脱位等不同表现形式。该疾病的病因涉及遗传因素、宫内体位异常及环境因素等多方面作用，早期诊断与干预对改善预后至关重要。本文全面回顾了DDH的流行病学特征、病理生理机制、临床评估方法及治疗策略的最新进展，为临床实践提供了循证依据，并对不同年龄阶段患者的治疗原则进行了系统总结。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
股骨髋臼撞击综合征（FAIS）是因髋臼缘或股骨头颈部骨性结构异常导致的髋关节病理状态，表现为髋关节前方疼痛、活动受限及机械性症状。根据解剖学形态可分为Cam型、Pincer型及混合型三种类型。该疾病是年轻患者髋关节疼痛的重要病因之一，并与髋关节骨关节炎的进展密切相关。本文综述了FAIS的发病机制、影像学诊断标准及保守与手术治疗的研究进展，并讨论了不同治疗方式的适应证与预后差异。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
股骨头缺血性坏死（Avascular Necrosis of the Femoral Head）是一种由于股骨头血液供应中断导致骨组织坏死的病理状态。该疾病可由多种因素引起，包括创伤（如股骨颈骨折、髋关节脱位）、非创伤因素（如长期使用糖皮质激素、过量饮酒、血液系统疾病、化疗等）。临床表现主要为髋关节疼痛、活动受限及功能障碍。诊断主要依靠影像学检查，包括X线、MRI及CT。该文对股骨头缺血性坏死的流行病学、病因学、发病机制、分类分期、诊断方法及治疗策略进行了系统阐述，强调早期诊断与及时干预对改善预后的重要意义。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
髋关节防护措施（Hip Precautions）是髋关节置换术后康复的重要组成部分，旨在预防假体脱位、促进伤口愈合及优化功能恢复。传统的髋关节防护措施主要包括：避免髋关节过度屈曲（屈曲不超过90度）、禁止内收内旋、禁止过度的内旋转动作。患者需在术后一段时间内遵循这些防护要求，通常采用 abduction pillow（外展枕）维持髋关节于安全位置。随着手术技术的进步及假体设计的改良，部分患者可能无需严格遵循传统防护措施，但具体方案需根据手术入路、假体类型及患者个体情况由医师评估后决定。正确的患者教育及术后康复指导对预防脱位等并发症至关重要。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6
中文总结
本文是一篇关于股骨头坏死的存档综述文章。股骨头坏死是一种由于股骨头血液供应中断或受损而导致骨组织死亡的疾病，常见病因包括长期使用糖皮质激素、饮酒、创伤及某些系统性疾病等。文章系统介绍了该病的流行病学、发病机制、临床表现、影像学诊断方法及保守与手术治疗策略，旨在为临床医生提供该疾病的最新知识更新与管理指导。