英文摘要 Abstract
OBJECTIVES: Hip arthroplasty instability is one of the most worrisome complications and one of the main indications for revision surgery. We present a retrospective study evaluating the results of revision hip replacement surgery performed for instability.
MATERIAL AND METHODS: Observational, retrospective study from 1/12/2010 to 1/12/2022. Fifty-nine medical records of patients operated for hip dislocation were reviewed. Epidemiological variables and data such as type of dislocation based on Wera classification, cup position based on Lewinnek, type of implants, associated surgical techniques and the results in terms of recurrence of dislocation or reoperation were recorded.
RESULTS: Fifty-nine patients: 33 women, 26 men, mean age 77.0 years. Mean follow-up 3.2 years (range 1.6-13.1). Based on Wera: had a single cause 37 cases, 2 causes 19 and 3 causes or more, 3 cases. In 61% of the cases in the series, malposition of the cup played an essential role in the dislocation (type I Wera). In the series, the Lewinnek zone could not be evaluated in 7 cases. For the remaining patients, 30% were within the Lewinnek zone. Only one patient in the series had a history of lumbar instrumentation. Implant used: double mobility (DM) in 17 cases (28.8%) and a constrained system in 38 cases (64.4%). Heads with adaptive cone were used in 2 cases (3%). In 4 cases (6%) a modified Whiteside type plasty was associated. Girdlestone was indicated in 2 cases (3%). Recurrence of dislocation 1 occasion: 18 cases (31%); 2 or more occasions: 7 cases (12%). Reoperation 15 cases (25%) range (1-5), main reasons: instability, infection or peri-prosthetic fractures. Probability of success defined as no recurrence: at one year is 80.5%, and at two years is 70.6%, showing no differences between constrained or dual-mobility implant.
COMMENTS AND CONCLUSIONS: Hip prosthesis dislocation is multifactorial in origin, although in most cases in the series the key factor was malposition of the acetabulum. Constrained and DM implants showed similar effectiveness. The results of this study emphasize the need for techniques that allow adequate positioning and orientation of the acetabular component to prevent, in a high percentage of cases, the need for this type of revision surgery.
中文总结
该研究为一项回顾性观察性研究，纳入2010年12月至2022年12月期间因髋关节假体不稳接受翻修手术的59例患者，平均随访时间为3.2年。研究旨在评估翻修手术治疗假体不稳的临床效果。患者平均年龄77岁，其中女性33例，男性26例。根据Wera分类标准，单一原因导致脱位者37例，两个原因者19例，三个及以上原因者3例。研究发现杯位置不良在61%的病例中起到关键作用，属于Wera I型脱位。在假体选择方面，约束型假体使用最多（64.4%），其次为双动型假体（28.8%），另有少量自适应锥形头假体（3%）。术后脱位复发1次者18例（31%），复发2次及以上者7例（12%），再手术15例（25%），主要原因为不稳、感染或假体周围骨折。数据分析显示一年成功率为80.5%，两年成功率为70.6%，且约束型与双动型假体间无显著差异。研究结论指出髋关节假体不稳的原因是多因素的，虽然杯位置不良是最主要的致病因素，但术后管理策略同样需要个体化考量，精确的假体定位和合适的假体选择对预防复发具有重要意义。
英文摘要 Abstract
CASE: We report the management and functional outcome of Crowe-IV developmental dysplasia of the right hip in a 32-year-old man with short stature. Surgery involved robotic-assisted reaming of the acetabulum, 4 cm subtrochanteric shortening osteotomy, and total hip arthroplasty (THA) with a modular S-ROM stem. There were no complications. The Harris Hip Score improved from 52.65 to 90 at 2-year follow-up. This is the first reported case of CT-planned robotic execution of THA for these concomitant conditions.
CONCLUSION: CT-based planning with robotic arm-assisted execution provides excellent radiographic and early functional results, anatomic limb correction, and acetabular component control.
中文总结
本病例报告首次描述了针对合并身材矮小与Crowe-IV型发育性髋关节发育不良患者采用CT规划机器人辅助全髋关节置换术的成功经验。患者为32岁男性，因右髋Crowe-IV型发育性髋关节发育不良伴身材矮小就诊。术前通过薄层CT扫描进行详细的三维规划，包括髋臼磨锉的机器人辅助操作、转子下4厘米短缩截骨以及S-ROM模块化股骨柄的植入。手术过程顺利，未发生术中或术后并发症。术前Harris髋关节评分为52.65分，术后2年随访时提升至90分，肢体长度也得到有效恢复。该病例展示了基于CT的术前规划结合机器人臂辅助执行的优势，能够实现精确的髋臼组件定位、良好的放射学结果、解剖学肢体长度纠正以及早期功能恢复。
英文摘要 Abstract
CASE: A 13-year-old girl with acetabular dysplasia developed global paralysis of the left lower limb after undergoing a left periacetabular osteotomy. Electromyography revealed no nerve injury. However, symptoms persisted for 3 months. Psychiatric evaluation confirmed a functional neurological disorder diagnosis. Multidisciplinary treatment led to complete recovery.
CONCLUSION: Functional neurological disorder may present as postoperative paralysis after periacetabular osteotomy, mimicking nerve injury. Early recognition based on positive clinical signs and prompt multidisciplinary management is essential to prevent unnecessary interventions and achieve full functional recovery. Awareness of this infrequent entity is indispensable when evaluating postoperative motor deficits.
中文总结
本病例报告了一例罕见的髋臼周围截骨术后功能性神经障碍。一名13岁女孩因髋臼发育不良接受左侧髋臼周围截骨术，术后出现左下肢完全性瘫痪。肌电图检查未发现任何神经损伤迹象，但患者症状持续了3个月。经过详细的精神科评估，最终确诊为功能性神经障碍，这是一种以神经系统症状为特征的器质性疾病，但缺乏可检测的神经结构损伤。确诊后患者接受了多学科综合治疗，包括康复训练和心理干预，最终实现完全功能恢复。本病例强调功能性神经障碍可表现为髋臼周围截骨术后的术后瘫痪，其临床症状易与神经损伤混淆。早期识别基于阳性临床征象而非排除性诊断，及时的多学科管理对于避免不必要的再次手术和促进完全康复至关重要。临床医生在评估髋关节术后运动功能缺陷时，必须将这一罕见情况纳入鉴别诊断。
英文摘要 Abstract
CASE: An 11-year-old boy with hemoglobin SC sickle cell disease (SCD) presented with progressive left hip pain, limited range of motion, and chronic gait abnormality. Imaging revealed bilateral osteonecrosis with severe central collapse and lateral extrusion of the left femoral head. He underwent staged hip preservation: examination under anesthesia, adductor tenotomy, femoral head elevation with trephine decompression and cancellous autograft and allograft, followed by femoral varus osteotomy (FVO) and anterior osteochondroplasty. At the 2-year follow-up, pain, gait, mobility, and hip motion markedly improved with maintained femoral head containment.
CONCLUSION: Femoral head elevation combined with FVO may improve symptoms and delay arthroplasty in advanced pediatric SCD hip osteonecrosis.
中文总结
本病例报告了一例11岁镰状细胞病男性患儿左髋严重股骨头坏死的分期保髋治疗经验。患儿表现为进行性左髋疼痛、关节活动受限及慢性步态异常。影像学检查证实为双侧股骨头坏死，左侧股骨头存在严重中央塌陷及外侧突出，属于Hemoglobin SC型镰状细胞病相关的严重并发症。治疗策略采用分期保髋手术：第一阶段在麻醉下行检查、内收肌切断术、股骨头抬起复位伴钻孔减压，并使用自体和同种异体松质骨移植填充骨缺损；第二阶段随后进行股骨近端内翻截骨以改善股骨头包容性，并行前侧骨软骨成形术解除撞击。术后2年随访时，患儿疼痛明显缓解，步态恢复正常，活动度和髋关节活动度均显著改善，影像学检查显示股骨头包容性得以维持。本病例表明对于严重的儿童镰状细胞病髋关节坏死，股骨头抬起联合内翻截骨的分期手术策略可能有效改善症状并延缓全髋关节置换的时间。
英文摘要 Abstract
CASE: We describe a case of late dislocation of the hip in a male infant at the age of 5 months after a normal screening ultrasound study using multiplanar static and dynamic images at the age of 6 weeks. The patient was treated with adductor tenotomy, closed reduction, and spica casting, and followed to the age of 7 years with normal hip stability.
CONCLUSION: This case demonstrates that despite evidence of both static and dynamic stability on ultrasonography earlier in life, late developmental hip dislocation can occur.
中文总结
本病例报告了一例特殊且具有警示意义的情况，即6周龄时多平面静态和动态超声筛查结果均正常的男性婴儿，在5月龄时发生了晚期髋关节脱位。该病例具有重要的临床意义，提示尽管早期超声检查显示静态和动态稳定性均正常，发育性髋关节发育不良相关的晚期脱位仍可能发生。患儿随后接受了内收肌切断术、闭合复位及髋人字形石膏固定治疗，并随访至7岁，期间髋关节稳定性维持正常。本病例强调了对于疑似发育性髋关节发育不良的评估，不能完全依赖单一的早期超声筛查结果进行判断。即使初始超声筛查正常的婴儿，仍需要结合持续的临床随访和定期影像学监测，以便及时发现可能出现的晚期病理改变。这种情况提示临床医生在DDH筛查和随访策略的制定中需要保持高度警惕，不能因早期筛查结果正常而放松警惕。
英文摘要 Abstract
BACKGROUND: Identifying patients at the highest risk of developmental dysplasia of the hip (DDH) is critical to the success of an efficient selective screening program. Defining and evaluating risk factors is, therefore, vital. This study was designed to analyze the relationship between classic risk factors and rates of DDH in a contemporary United States-based population.
METHODS: All patients presenting before 12 months of age to a single tertiary care pediatric hospital's orthopaedic department for DDH screening, with explicit medical record documentation of DDH risk factors from 2018 to 2022 were included. Classic risk factors were defined as breech presentation, female sex, firstborn status, and family history of hip dysplasia. Ultrasounds and radiographs obtained at initial presentation were reviewed to determine Graf and IHDI classifications. Reasons for referral for DDH screening were obtained from the chart review.
RESULTS: One thousand two hundred twenty-six patients were eligible for the study. The probability of having DDH increased as the number of risk factors present for DDH increased ( P <0.001). Female sex and firstborn status were found to be independent risk factors for DDH. Females were 2.5 times more likely to have DDH than males ( P <0.001). Firstborn children were 1.3 times more likely to have DDH than subsequent birth-order children ( P =0.048). There was no difference in the proportion of DDH in breech presenting patients compared with non-breech ( P =0.511) or in subjects with a family history of DDH ( P =0.16).
CONCLUSIONS: The primary risk factor for DDH in this contemporary cohort was female sex. Female patients without any other risk factors for DDH had a 25.2% rate of DDH, significantly higher than the estimated population incidence. Fifteen percent of these patients had no notable physical exam findings consistent with DDH. Given the high rate of DDH in female patients in the absence of notable physical exam findings, universal ultrasound screening for females at the age of 6 weeks should be considered.
LEVEL OF EVIDENCE: Level IV.
中文总结
该研究旨在分析当代美国人群中经典风险因素与发育性髋关节发育不良发生率之间的关系，以改进风险分层策略。研究纳入了2018至2022年间就诊于单一三级儿科医院骨科门诊的1226例12月龄以下进行DDH筛查的患儿，系统性评估了经典风险因素与DDH检出率的相关性。经典风险因素包括臀位分娩、女性、头胎及髋关节发育不良家族史。研究结果显示，DDH发生概率随风险因素数量增加而显著升高。统计分析表明女性和头胎状态是DDH的独立风险因素，女性患儿DDH风险是男性的2.5倍，头胎儿童风险较后续出生顺序儿童高1.3倍。值得注意的是，臀位分娩和家族史在本组人群中与DDH发生率无显著统计学差异。进一步分析发现，25.2%的无其他风险因素的女性患儿存在DDH，明显高于估计的人群发病率，其中15%的患者缺乏明显的体格检查异常。该研究强调了女性性别是DDH的主要风险因素，建议对女性患儿即使无明显临床体征也需给予高度关注，这一发现对优化DDH筛查策略具有重要指导意义。
英文摘要 Abstract
BACKGROUND: Axial imaging is typically obtained following operative reduction of developmental dysplasia of the hip (DDH) to confirm a concentric reduction. Although the utility of axial imaging has been studied following the index reduction, its value following spica cast exchange remains unclear.
METHODS: This single-center study included all children 2 years or younger with idiopathic DDH who underwent closed or open reduction between 2012 and 2023. Patients with concurrent osteotomies or dysplasia secondary to syndromic/neuromuscular causes were excluded. Institutional protocol during this period consisted of 3 months of immobilization with a spica cast exchange at 6 weeks for all closed or medial open reductions. Axial imaging (CT or MRI) was typically obtained after both the index procedure and cast exchange to confirm reduction. A retrospective review was conducted to assess how often axial imaging directly altered clinical management, defined as an unplanned return to the operating room or a documented change in management based on imaging findings per the treating surgeon's notes. Minimum follow-up was 1 year. Descriptive statistics were used to summarize patient characteristics and arthrogram findings.
RESULTS: The cohort included 91 patients (124 hips): 92 (74%) hips underwent closed reduction, and 32 (26%) underwent open reduction. The median age at index reduction was 7.7 months, with 52% (n=47/91) above 6 months old. Of those with preoperative radiographs (n=98), most hips were IHDI grade 3 (29%, n=27) or 4 (39%, n=38). Axial imaging changed management in 3% of hips after the index reduction (4/92 closed reductions, 0/32 open reductions). Among 124 hips receiving axial imaging at cast exchange (92=MRI, 32=CT), only 1 hip was dislocated (<1%). Analysis of a separate cohort of 12 hips that did not receive axial imaging at cast exchange suggests that an adequate arthrogram (no medial dye pool and deep concentric reduction) is sufficient to confirm reduction.
CONCLUSIONS: Axial imaging at the time of spica cast exchange rarely alters clinical management and should not be routinely obtained unless otherwise indicated by a concerning intraoperative arthrogram.
LEVEL OF EVIDENCE: Level IV-retrospective case series.
中文总结
本研究探讨了婴儿髋关节发育不良（DDH）在进行髋人字形石膏交换时是否需要常规获取轴向影像学检查。研究纳入2012至2023年间接受闭合或开放复位的2岁以下特发性DDH患儿，排除合并截骨术或继发于综合征/神经肌肉疾病的病例。91例患者（124髋）被纳入分析，其中74%接受闭合复位，26%接受开放复位。术后6周进行石膏交换时绝大多数患者接受了MRI或CT检查。结果显示，在初始复位后轴向影像仅改变了3%病例的临床管理，而在石膏交换时仅不到1%的髋关节存在脱位。进一步分析表明，术中关节造影若显示无内侧造影剂池且复位同心度良好，则足以确认复位效果，无需额外轴向影像检查。研究结论认为，石膏交换时的轴向影像检查很少改变临床管理，不应常规进行，除非关节造影结果令人担忧。该研究为减少不必要辐射暴露提供了循证依据。
英文摘要 Abstract
PURPOSE: To examine the effects of superior lateralisation of the centre of rotation and femoral offset shortening on the gluteus medius in developmental dysplasia of the hip (DDH), and the impact of biomechanical restoration by total hip arthroplasty (THA).
METHODS: Horizontal (femoral, acetabular, and combined offset) and vertical (centre height, leg length) radiographic parameters, as well as gluteus medius radiodensity measured by computed tomography, were evaluated preoperatively and 1 year postoperatively in 100 hips (87 patients). Patients were grouped by whether radiodensity improved postoperatively. Correlations between parameter changes and radiodensity were analysed.
RESULTS: In advanced osteoarthritis, radiodensity deterioration correlated with femoral offset shortening (
CONCLUSIONS: Gluteus medius fatty infiltration improved mainly with leg lengthening, but insufficient combined offset limited this recovery.
中文总结
本研究旨在探讨髋关节发育不良（DDH）伴骨关节炎患者中旋转中心外上方移位及股骨偏心距缩短对臀中肌的影响，以及全髋关节置换术（THA）后生物力学恢复的效果。研究纳入100髋（87例患者），通过术前及术后1年的水平位和垂直位放射学参数测量，以及CT评估臀中肌脂肪浸润程度。结果显示，在晚期骨关节炎患者中，臀中肌放射密度恶化与股骨偏心距缩短呈正相关。THA术后臀中肌脂肪浸润的改善主要取决于下肢延长的程度，但联合偏心距恢复不足会限制该肌肉的康复效果。这一发现提示，在DDH相关骨关节炎的THA手术中，恢复适当的下肢长度和股骨偏心距对于促进臀中肌功能恢复具有重要意义，术中应注重生物力学参数的全面重建以优化术后肌肉状态。
英文摘要 Abstract
PURPOSE: Understanding the trajectory of recovery after hip arthroscopy is valuable to help manage expectations and recognise patients at risk for delayed recovery. The purpose of this study was to determine the recovery profile of function, pain, and activity level up to 2 years after hip arthroscopy.
METHODS: Patients from a single centre's orthopaedic registry who underwent hip arthroscopy were identified. Function, pain, and activity level were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), a numeric pain scale (NPS), and Tegner Activity Scale (TAS) up to 2 years postoperatively. Nonlinear growth models were used to estimate the effect of recovery time on each outcome.
RESULTS: Of 92 patients identified, 64 (70%) were followed up to 2 years. There was significant improvement in all outcome measures at 2 years. The time to 50% recovery for PROMIS PF, PROMIS PI, and TAS was 11.0, 6.7, and 18.5 weeks, respectively. The time, in weeks, to full recovery of PROMIS PF, PROMIS PI, and TAS was estimated at 17.0, 37.4, and 28.8 respectively. NPS declined at a rate of -0.22 points per week, plateauing by 12 weeks.
CONCLUSIONS: Physical function and activity levels plateau at 4 and 7 months respectively, while pain recovery is more variable. These results can help guide discussions with patients regarding recovery after hip arthroscopy and provide benchmarks for identifying patients who could benefit from changes in postoperative protocol.
中文总结
本研究旨在描绘髋关节镜术后患者功能、疼痛及活动水平的恢复轨迹，以帮助设定合理的康复预期并识别恢复延迟的高风险患者。研究从单一骨科登记数据库中纳入92例髋关节镜手术患者，采用PROMIS躯体功能量表、PROMIS疼痛干扰量表、数字疼痛评分及Tegner活动量表评估术前至术后2年的恢复进程。非线性增长模型分析显示，PROMIS躯体功能、疼痛干扰及活动水平的50%恢复时间分别为11.0周、6.7周和18.5周，达到完全恢复的时间分别为17.0周、37.4周和28.8周。数字疼痛评分以每周0.22分的速度下降，约12周后趋于平台期。研究表明，髋关节镜术后躯体功能和活动水平分别在4个月和7个月左右达到平台期，而疼痛恢复则存在更大的变异性。这些结果可用于指导术前患者教育，并为识别可能需要调整术后康复方案的患者提供参考基准。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) is a well-established surgical treatment of symptomatic developmental dysplasia of the hip in young patients by improving the lateral centre-edge angle (LCEA) and the acetabular index (AI). Hence, the correction of the acetabular fragment is a hallmark of the PAO procedure.
PURPOSE: To evaluate the efficacy of fluoroscopy-guided visual estimation of the correction of the fragment during PAO.
METHODS: 49 patients undergoing PAO were enrolled. The surgeons (3) were asked to visual assess the perioperative LCEA and AI. Perioperative assessments were compared with perioperative and postoperative measurements. Interobserver variation was assessed by regression analysis. Bland-Altman analysis was used to determine correlation between visual assessment and measurements.
RESULTS: Mean correction of the LCEA was 11.1° (-4-23.5°) and the average AI correction was -10.7° (-20- 4°). The interobserver agreement was high for LCEA (R
CONCLUSIONS: Perioperative visual estimation is on average sufficient for assessing the postoperative correction of LCEA and AI in PAO. Outliers are however observed.
中文总结
骨盆三联截骨术（PAO）是治疗年轻患者症状性髋关节发育不良的标准术式，通过改善外侧中心边缘角（LCEA）和髋臼指数（AI）来重新定位髋臼骨块。本研究评估术中透视引导下视觉估计骨块矫正程度的可靠性。49例接受PAO的患者被纳入分析，3名术者被要求目测评估术中LCEA和AI，并与术后影像学测量结果进行比较。结果显示，LCEA平均矫正11.1度，AI平均矫正-10.7度，术者间对LCEA评估的一致性较高。 Bland-Altman分析表明，视觉评估与实际测量结果具有较好的相关性。虽然平均而言视觉估计足以评估PAO术后LCEA和AI的矫正情况，但仍有部分极端值病例超出可接受范围。研究结论认为，PAO术中透视下的视觉估计在多数情况下足以评估骨块矫正效果，但需意识到存在个别偏差点，必要时可借助术后影像确认。
英文摘要 Abstract
PURPOSE OF THE STUDY: Reconstruction of acetabular posterior wall fractures is challenging. This study evaluates the use of iliac crest graft to reconstruct the posterior wall of the acetabulum.
MATERIAL AND METHODS: The study population included all patients with high-grade acetabular posterior wall fractures who were treated with acetabular posterior wall reconstruction using iliac strut graft. In this study, patients with high-grade acetabular posterior wall fracture (based on Letournel and Judet's classification of acetabular fracture equivalent to grade 2 or 3 and based on AO type A1 classification) were treated with acetabular posterior wall reconstruction using iliac strut patients over 70 years old and under 18 years old were excluded from the study.
RESULTS: In this study, 14 patients, 10 men and 4 women, with posterior acetabular wall fractures were treated using the acetabular posterior wall reconstruction method using iliac strut graft. The average age of these patients was 60 years. One patient had evidence of avascular necrosis after 6 months. In all 8 patients, the radiological results showed that the femoral head did not completely match the acetabulum after the operation. The condition of the 48-year-old patient was good to excellent. Three patients under 50 years of age without post-traumatic osteoarthritis at the time of reconstruction had good clinical results and good radiological results. Patients with post-traumatic osteoarthritis at the time of reconstruction had poor clinical and radiological results and sometimes required THA.
CONCLUSIONS: The results of this study show that reconstruction of the posterior wall of the acetabulum with iliac crest graft is a suitable option for children or adult patients without post-traumatic osteoarthritis at the time of reconstruction. Mid-term follow-up showed good to excellent clinical results. However, this method is not recommended for adult patients with post-traumatic osteoarthritis during reconstruction. Such patients are likely to require THA.
中文总结
髋臼后壁骨折的重建是骨科创伤领域的难题。本研究评估了使用髂骨支撑植骨重建髋臼后壁的临床效果。研究纳入14例高位髋臼后壁骨折患者（10男4女），平均年龄60岁，排除70岁以上及18岁以下患者。术后6个月随访时，1例患者出现股骨头缺血性坏死。所有患者中8例影像学显示股骨头与髋臼未完全匹配。48岁患者预后良好至优秀。50岁以下无创伤后骨关节炎的患者临床和影像学结果均良好，而伴有创伤后骨关节炎的患者临床和影像学结果欠佳，部分最终需行全髋关节置换术。研究结论认为，髂骨植骨是重建髋臼后壁的良好选择，适用于无创伤后骨关节炎的儿童或成年患者，但对于已存在创伤后骨关节炎的患者不推荐使用，因其很可能需要后续全髋关节置换。
英文摘要 Abstract
INTRODUCTION: Due to demographic shifts and an increasing proportion of older adults at higher fracture risk, the overall burden of proximal femur fractures has risen significantly in recent years, placing a burden on patients and healthcare systems. Despite extensive research on hip fracture epidemiology and treatment, the specific influences of femoral and acetabular parameters on fracture localisation remain underexplored. This study evaluates the impact of these parameters on proximal femur fracture localisation.
MATERIALS AND METHODS: This retrospective cohort study analysed data from 400 patients with proximal femur fractures, including medial and lateral femoral neck fractures (FNFs), pertrochanteric, and subtrochanteric fractures, treated at a university hospital between 2010 and 2022. Radiographic measurements of femoral head size and other morphological parameters were conducted using pre-operative pelvic radiographs. Statistical analyses included multivariate logistic regression.
RESULTS: A larger head-radius vertical (HRV) was associated with an increased risk of lateral FNFs (OR 1.11;
CONCLUSIONS: The study identified key variables associated with proximal femur fracture localisation. Morphological parameters such as HRV, FHEI, canal width, and LCEA, as well as BMI for subtrochanteric fractures, significantly influence fracture localisation, highlighting their importance for personalised risk assessment and preventive strategies.
中文总结
随着人口老龄化进展，股骨近端骨折的疾病负担显著增加。本研究探讨股骨和髋臼形态学参数对骨折定位的影响，回顾性分析了2010至2022年间400例股骨近端骨折患者的数据，包括股骨颈骨折（内侧及外侧）、粗隆间骨折和粗隆下骨折。术前骨盆平片测量股骨头大小及其他形态学参数，多因素 logistic 回归分析显示，较大的头半径垂直值（HRV）与外侧股骨颈骨折风险增加显著相关（OR 1.11）。股骨头高度指数（FHEI）、髓腔宽度及LCEA等参数也对骨折定位具有显著影响，而BMI仅对粗隆下骨折有预测价值。研究识别了与股骨近端骨折定位相关的关键变量，强调了形态学参数在个性化风险评估和预防策略制定中的重要性，有助于识别高风险患者并指导针对性预防措施。
英文摘要 Abstract
INTRODUCTION: Legg-Calvé-Perthes disease (LCPD) often causes residual deformities, typically manifesting as an ellipsoidal femoral head shape. This condition arises from initial bone collapse and necrosis, inhibiting growth at the anterosuperior femoral head and resulting in asymmetric growth. The aim of this study is to assess the effectiveness of selective hemiepiphysiodesis in improving femoral head sphericity in patients with LCPD with previous onset of ovalization.
METHODS: We compared 71 hips undergoing prophylactic selective hemiepiphysiodesis (surgical group) against 86 hips managed nonsurgically (control group). Radiographic evaluations were performed at 3 time points (3 y after disease onset, 5 y after disease onset, and skeletal maturity) to assess disease progression and intervention effects, measuring the ellipsoidal index (EI), the Reimer migration index (RMI), and the articulotrochanteric distance (ATD), with classifications according to the Herring scale and final sphericity assessments.
RESULTS: Both cohorts were initially comparable in terms of age at onset, sex, and degree of deformity, showing similar EI, Herring classifications, and RMI ( P >0.05). At T2, significant improvements were observed in the EI, RMI, and ATD in the surgical group compared with the control group. At skeletal maturity, the surgical group demonstrated significantly improved sphericity across all 3 indices ( P <0.05), confirming the effectiveness of selective hemiepiphysiodesis in halting and partially reversing the ovalization process. The sphericity deviation score was significantly lower in the operated group (28±12) compared with the control group (43±28), the EI improved to 1.68±0.25 in the operated group from 2.11±0.33 in the controls, and the RMI showed a marked improvement (24.0±8.1) compared with controls (32.4±7.3).
CONCLUSIONS: Growth modulation by selective hemiepiphysiodesis effectively disrupts the progression of femoral head ovalization and enhances sphericity. This intervention presents a viable option for mitigating the ellipsoidal process in patients with LCPD, suggesting a significant potential to improve long-term outcomes by addressing early signs of deformity.
LEVEL OF EVIDENCE: Level III-retrospective cohort study.
中文总结
Legg-Calvé-Perthes病（LCPD）常导致股骨头残余畸形，表现为椭圆形股骨头。本研究评估选择性半骺骨干固定术改善LCPD患者股骨头球形度的效果。研究比较了71髋接受预防性选择性半骺骨干固定术的手术组与86髋非手术管理的对照组，在疾病发作后3年、5年及骨骼成熟时三个时间点进行影像学评估，测量椭圆形指数（EI）、Reimer迁移指数（RMI）及 articulotrochanteric距离（ATD）。结果显示，术后5年及骨骼成熟时，手术组在所有三项指标上均显著优于对照组。手术组球形度偏差评分为28±12，显著低于对照组的43±28；椭圆形指数改善至1.68±0.25（对照组为2.11±0.33）；RMI也显著改善（24.0±8.1 vs 32.4±7.3）。研究表明，选择性半骺骨干固定术能有效阻断股骨头椭圆形化的进展并改善球形度，为LCPD患者提供了一种有价值的干预手段，有望改善长期预后。
英文摘要 Abstract
BACKGROUND: Slipped capital femoral epiphysis (SCFE) requires surgical treatment. In German-speaking countries, dynamic in-situ fixation is commonly used for mild SCFE lenta. Various implants are available for this purpose.
OBJECTIVE: High complication rates have been reported for the removal of titanium gliding screws. In this retrospective study, we analyzed the complications in the treatment of SCFE, particularly focusing on the removal of sliding screws made of stainless steel and K‑wires.
MATERIALS AND METHODS: A total of 111 patients with SCFE were treated, including 96 fixations using stainless steel sliding screws, 93 wire pinning procedures, and 69 hips treated with a combination of both techniques. Additionally, 43 Imhäuser osteotomies were performed. Complications arising from these treatments were analyzed.
RESULTS: In 14 patients, 23 complications were observed. Avascular necrosis of the femoral head occurred in three cases. Two patients sustained a fracture of the proximal femur. One patient presented with soft tissue irritation following fixation with both sliding screws and K‑wires. Infections occurred in three patients. Due to implant misplacement or breakage, 6 patients required a total of 12 revision surgeries. Two patients developed postoperative hematomas, which were surgically evacuated. No complications were observed related to implant removal.
DISCUSSION: The issues described in the literature regarding the removal of titanium screws were not observed with stainless steel screws. This difference can be attributed to material properties: titanium screws have lower torsional strength and require higher torque for removal.
ZUSAMMENFASSUNG: HINTERGRUND: Epiphyseolysis capitis femoris (ECF) erfordert eine operative Behandlung. Im deutschsprachigen Raum erfolgt bei der milden Form ECF lenta eine dynamische In-situ-Fixierung. Verschiedene Implantate stehen zu Verfügung.
ZIEL DER ARBEIT: Bei der Materialentfernung (ME) von Gleitschrauben aus Titan werden hohe Komplikationsraten beschrieben. In dieser retrospektiven Studie analysieren wir die Komplikationen bei der Behandlung der ECF, insbesondere bei der Metallentfernung von Gleitschrauben aus Stahl und K‑Drähten.
MATERIAL UND METHODEN: Bei 111 Patienten mit ECF erfolgten insgesamt 96 Fixierungen mittels Gleitschraube aus Stahl, 93 Drahtspickungen und 69 Hüften wurden mit einer Kombination beider Verfahren versorgt. Zusätzlich erfolgten 43 Imhäuser-Osteotomien. Die Komplikationen, die bei dieser Behandlung aufgetreten sind, wurden analysiert.
ERGEBNISSE: Bei 14 Patienten wurden 23 Komplikationen beobachtet. In 3 Fällen kam es zu einer avaskulären Nekrose des Femurkopfes. 2 Patienten zogen sich eine proximale Femurfraktur zu. Ein Patient stellte sich nach Fixierung mittels Gleitschraube und Kirschner-Drähten mit einer Weichteilirritation vor. Bei 3 Patienten traten Infektionen auf. Aufgrund einer Fehllage oder eines Bruchs des Implantates wurden 6 Patienten insgesamt 12-mal revidiert. Bei 2 Patienten bildete sich postoperativ ein Hämatom, das operativ evakuiert wurde. In Bezug auf ME stellten wir keine Komplikationen fest.
DISKUSSION: Die in der Literatur beschriebene Problematik bei der ME von Titanschrauben konnten wir bei den Stahlschrauben nicht feststellen. Der Unterschied ist auf die Materialeigenschaften zurückzuführen. Titanschrauben verfügen über eine niedrigere Torsionsstärke und es ist ein höheres Drehmoment für die Entfernung notwendig.
中文总结
股骨头骨骺滑脱症（SCFE）需手术治疗，德语区对轻度慢性SCFE常采用动力性原位固定。本研究回顾性分析了111例SCFE患者的治疗并发症，特别关注不锈钢滑动螺钉和克氏针的取出并发症。111例患者中，96例使用不锈钢滑动螺钉固定，93例行克氏针固定，69髋联合两种技术，另有43例行Imhäuser截骨术。结果显示14例患者发生23例次并发症，其中股骨头缺血性坏死3例、近端股骨骨折2例、软组织刺激1例、感染3例。6例患者因植入物位置不当或断裂需进行12次翻修手术，2例出现术后血肿需手术清除。值得注意的是，文献中报道的钛螺钉取出困难问题在不锈钢植入物中未观察到，这可能与钛螺钉较低的抗扭矩强度有关。不锈钢滑动螺钉或许是相对安全的内固定选择。
英文摘要 Abstract
OBJECTIVES: Hip arthroplasty instability is one of the most worrisome complications and one of the main indications for revision surgery. We present a retrospective study evaluating the results of revision hip replacement surgery performed for instability.
MATERIAL AND METHODS: Observational, retrospective study from 1/12/2010 to 1/12/2022. Fifty-nine medical records of patients operated for hip dislocation were reviewed. Epidemiological variables and data such as type of dislocation based on Wera classification, cup position based on Lewinnek, type of implants, associated surgical techniques and the results in terms of recurrence of dislocation or reoperation were recorded.
RESULTS: Fifty-nine patients: 33 women, 26 men, mean age 77.0 years. Mean follow-up 3.2 years (range 1.6-13.1). Based on Wera: had a single cause 37 cases, 2 causes 19 and 3 causes or more, 3 cases. In 61% of the cases in the series, malposition of the cup played an essential role in the dislocation (type I Wera). In the series, the Lewinnek zone could not be evaluated in 7 cases. For the remaining patients, 30% were within the Lewinnek zone. Only one patient in the series had a history of lumbar instrumentation. Implant used: double mobility (DM) in 17 cases (28.8%) and a constrained system in 38 cases (64.4%). Heads with adaptive cone were used in 2 cases (3%). In 4 cases (6%) a modified Whiteside type plasty was associated. Girdlestone was indicated in 2 cases (3%). Recurrence of dislocation 1 occasion: 18 cases (31%); 2 or more occasions 7 cases (12%). Re-operation 15 cases (25%) range (1-5), main reasons: instability, infection or peri-prosthetic fractures. Probability of success defined as no recurrence: at one year is 80.5%, and at two years is 70.6%, showing no differences between constrained or dual mobility implant.
COMMENTS AND CONCLUSIONS: Hip prosthesis dislocation is multifactorial in origin, although in most cases in the series the key factor was malposition of the acetabulum. Constrained and DM implants showed similar effectiveness. The results of this study emphasize the need for techniques that allow adequate positioning and orientation of the acetabular component to prevent, in a high percentage of cases, the need for this type of revision surgery.
中文总结
髋关节置换术后不稳是关节外科最棘手的并发症之一，也是翻修手术的主要指征。本研究回顾性分析了2010至2022年间59例因髋关节脱位行翻修手术患者的临床资料，记录流行病学数据、脱位类型（Wera分类）、髋臼位置（Lewinnek分区）、植入物类型及相关手术技术。59例患者平均年龄77岁，平均随访3.2年。61%的病例中髋臼位置不良在脱位中起关键作用（Wera I型），仅30%的患者髋臼杯位置在Lewinnek安全区内。翻修术中64%使用约束型假体，29%使用双动髋假体。脱位复发1次者18例（31%），2次及以上者7例（12%），25%需行翻修手术。1年成功率为80.5%，2年为70.6%，约束型与双动假体效果相似。研究表明，髋关节假体脱位是多因素所致，髋臼杯位置不良是主要因素，强调精准的髋臼杯定位技术对于预防脱位的重要性。