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: Hip surveillance guidelines have been introduced by the Australian (AusACPDM, 2008) and American Academy for Cerebral Palsy and Developmental Medicine (AACPDM, 2016) to screen for hip displacement in children with cerebral palsy (CP). Whether these guidelines are associated with changes in surgical management remains unknown. This study compares trends in hip osteotomy rates among children with CP in the United States using a national database before and after the publication of national hip surveillance guidelines.
METHODS: International Classification of Diseases (ICD-9)-CM and ICD-10-CM codes were used to identify hospital admissions for hip osteotomies in children <20 years old with CP from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 1997 to 2019. Cases without an admission month were excluded. National estimates of CP-related hospital cases, osteotomy (acetabular, proximal femoral) rates, and hip dislocations were calculated using weighted variables provided by HCUP. The average monthly osteotomy rates were compared using one-way analysis of variance (ANOVA) for the periods before and after guideline establishments. Baseline patient characteristics were also analyzed using either chi-squared tests or one-way ANOVA.
RESULTS: From 1997 to 2019, 318,367 weighted CP admissions were recorded, demonstrating a 44% increase in the annual incidence of CP hospitalizations. Baseline patient characteristics for the periods January 1997 to December 2006 (preAusACPDM), January 2009 to September 2016 (post-AusACPDM, pre-AACPDM), and October 2016 to December 2019 (post-AACPDM) indicates that mean age and length-of-stay (LOS) increased significantly in the post-AACPDM period relative to the two prior time periods (
CONCLUSIONS: Reconstructive hip surgery rates declined among children with CP treated in U.S. community hospitals represented in the KID database, temporally coinciding with publication of national hip surveillance guidelines. These findings demonstrate an association rather than a causal relationship and may reflect variation in guideline adoption, shifts in care to tertiary referral centers, or evolving surgical practices.
KEY CONCEPTS: (1)Hip surveillance guidelines are screening tools for children with cerebral palsy.(2)Early detection of hip subluxation is crucial for timely orthopaedic interventions.(3)Children with cerebral palsy are undergoing hip osteotomies at older ages with longer stays in recent years.(4)Barriers may exist that prevent adherence to hip surveillance guidelines.(5)Formal guideline implementation may be necessary to improve timely interventions and outcomes.
LEVEL OF EVIDENCE: IV.
中文总结
本研究利用美国医疗成本与利用项目儿童住院数据库数据，分析了1997年至2019年间美国社区医院中脑瘫儿童髋关节重建手术的趋势变化及其与国家髋关节监测指南发布的时间相关性。研究将观察期划分为指南发布前及两个指南发布后的不同阶段，分析显示在此期间脑瘫相关住院总例数增加了44%，但髋关节截骨术的实施率反而出现下降，这一趋势与澳大利亚脑瘫发育医学学会（2008年）及美国脑瘫发育医学学会（2016年）髋关节监测指南的发布时间存在时间上的吻合。单因素方差分析比较了不同阶段的平均月度手术率，患者基线特征（包括平均年龄和住院时长）在指南发布后均呈显著变化。本研究提示髋关节监测指南的推广可能与社区医院层面脑瘫儿童重建性髋关节手术需求的下降有关，但其具体机制仍需进一步研究阐释。
英文摘要 Abstract
OBJECTIVE: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO.
METHODS: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS).
RESULTS: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty.
CONCLUSION: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334.
中文总结
本研究回顾性分析了29例患者35髋在接受髋臼周围截骨术治疗发育性髋关节发育不良后的长期临床和影像学结局，平均随访时间8.7年。研究系统评估了术前及术后多种二维和三维影像学参数，包括Tönnis角、Sharp角、侧方中心边缘角、前方中心边缘角、髋臼前倾角及基于CT的髋臼扇角等。三维CT测量显示术后髋臼前扇角、水平扇角及前倾角均获得显著改善，而Harris髋关节评分亦较术前显著提升且长期维持稳定。统计分析表明，术后Harris评分与髋关节侧方化指数呈负相关，与术后侧方中心边缘角呈正相关，术后侧方中心边缘角小于25度的患者功能预后优于大于等于35度者。8例患者出现并发症，2例需转换为全髋关节置换术。研究结论支持髋臼周围截骨术在发育性髋关节发育不良治疗中的持久效果，三维髋臼扇角分析可增强术前规划及术后评估的精确性，有助于实现更准确的髋臼重新定位并改善患者功能预后。
英文摘要 Abstract
Kabuki syndrome (KS) is a rare congenital syndrome characterized by distinctive facies, joint hyperlaxity, and hypotonia. When hip dysplasia manifests, it is usually severe, demonstrating treatment resistance with a recognized risk of later re-dislocation. Limited case numbers with variable outcomes compound uncertainty regarding optimal management. To date, all surgical cases described in the literature have been treated with open reduction, with no documented cases of concurrent bilateral hip surgery. Here, we present the case of a four-year-old boy with Kabuki syndrome who has been unable to walk since the age of three, following a spontaneous left hip dislocation. Clinical examination revealed characteristic facies, hypotonia, and painful and reduced left hip movements. Radiographs demonstrated left hip dislocation and severe bilateral acetabular dysplasia. Arthrographic evaluation demonstrated no barriers to left hip concentric reduction on abduction. Profound acetabular dysplasia was identified as the main structural abnormality causing dislocation. Single-stage bilateral hip reconstruction was undertaken without performing an open reduction of the left hip. Bilateral femoral derotation-shortening osteotomies and Dega pelvic osteotomies were performed in a single stage. A hip spica was applied for six weeks before commencing mobilization. One year postoperatively, the child was weight-bearing. Both hips remained concentrically reduced with improvement in dysplastic features. This report describes the successful management of hip dysplasia secondary to Kabuki syndrome using a novel approach. Open reduction with capsular plication of the dislocated hip was obviated, and both hips were corrected in a single operation with satisfactory clinical and radiological outcomes at one year.
中文总结
本研究报道了一例四岁Kabuki综合征男孩的髋关节发育不良治疗经验。该患儿因自发性左髋脱位导致行走功能丧失，临床检查显示特征性面容、肌张力低下及左髋疼痛性活动受限。影像学评估证实左髋脱位合并严重双侧髋臼发育不良，关节造影显示左髋在 abducted 位可实现同心复位。研究团队创新性地采用一期双侧髋关节重建策略，未进行左髋切开复位，而是同期实施双侧股骨去旋转短缩截骨及Dega髋臼截骨。术后髋人字石膏固定六周后开始功能锻炼，随访一年时患儿已可负重行走，双髋保持同心复位状态，发育不良影像学特征获得改善。本病例报告首次描述了Kabuki综合征相关髋关节发育不良的同期双侧手术重建治疗，避免了对脱位髋进行切开复位并通过单次手术完成双侧矫正，取得了令人满意的临床和影像学预后，为该罕见综合征的标准化治疗方案提供了有价值的参考。
英文摘要 Abstract
BACKGROUND: Hip arthroscopy (HAS) is widely used to treat femoroacetabular impingement syndrome (FAIS), and many patients rely on online resources for medical information. Large language models (LLMs) such as ChatGPT have shown potential as supplementary educational tools in orthopedics; however, existing evaluations are limited to earlier model generations with variable accuracy and completeness. This study aimed to evaluate the accuracy, clarity, relevance, and completeness of ChatGPT-5 responses to common patient questions regarding FAIS and HAS.
METHODS: ChatGPT-5 was used to generate 25 frequently asked patient questions and corresponding answers related to hip preservation. Two fellowship-trained hip preservation surgeons independently evaluated each response using a five-point Likert scale across four predefined domains: relevance, accuracy, clarity, and completeness. Descriptive statistics were calculated as mean ± standard deviation for each domain. Inter-rater reliability was assessed using a two-way random-effects intraclass correlation coefficient with absolute agreement (ICC [2, 1]) and complemented by exact agreement percentages.
RESULTS: All responses received excellent scores, with mean values ranging from 4.84 ± 0.27 (completeness) to 5.00 ± 0.00 (relevance). Accuracy (4.97 ± 0.08) and clarity (4.91 ± 0.17) were near-perfect. ICC values demonstrated moderate to excellent agreement (0.70-0.81), complemented by high exact agreement rates (84-100%). No answer contained factually incorrect, misleading, or unsafe information. Minor reductions in completeness were attributable to occasional brevity rather than substantive omissions.
CONCLUSION: ChatGPT-5 generated highly accurate, clear, and clinically appropriate patient-oriented explanations regarding FAIS and HAS, showing clear improvement compared with earlier ChatGPT versions. Although ChatGPT-5 represents a marked advancement in AI-based patient education, its use should be regarded as a complementary educational tool rather than a replacement for professional orthopedic counseling.
中文总结
本研究系统评估了ChatGPT-5在回答关于股骨髋臼撞击综合征及髋关节镜手术常见患者问题方面的表现。研究收集了25个高频患者问题，由两名获得奖学金培训的高年资髋关节保护外科医生独立评估，采用五点Likert量表从相关性、准确性、清晰度和完整性四个维度进行评分。结果显示所有回答均获得优秀评分，其中相关性平均达满分5.00±0.00分，准确性4.97±0.08分，清晰度4.91±0.17分，完整性4.84±0.27分。组内相关系数分析显示评估者间一致性为中度至高度（0.70-0.81），精确一致率高达84-100%。所有回答均未包含事实性错误、误导性或安全性问题信息，完整性的轻微不足主要归因于个别回答篇幅较短而非实质性内容缺失。研究结论指出，ChatGPT-5在生成关于股骨髋臼撞击综合征及髋关节镜手术的临床适宜患者导向解释方面表现卓越，相较于早期ChatGPT版本有明显进步，但其在临床实践中的应用仍应在专业医疗人员监督下审慎推进。
英文摘要 Abstract
The differential diagnosis for hip pain in a young patient can present a diagnostic challenge. We present an unusual case of concomitant femoroacetabular impingement (FAI) and painful internal snapping hip caused by an osteochondroma of the superior pubic ramus. The patient was treated with arthroscopic labral repair and femoral osteochondroplasty, and open osteochondroma excision, resulting in complete resolution of both FAI and snapping hip. Pelvic osteochondroma is an uncommon cause of hip pain that can mimic FAI symptoms. Early advanced imaging and combined approaches may be necessary to ensure that all causes of hip pathology are addressed.
中文总结
本研究报道了一例因骨盆骨软骨瘤导致疼痛性前侧弹响髋合并股骨髋臼撞击综合征的罕见病例。年轻患者因髋部疼痛就诊，鉴别诊断具有挑战性。影像学检查发现上耻骨支存在骨软骨瘤，患者的症状涉及前侧弹响感和髋关节撞击征象。治疗策略采用关节镜下盂唇修复及股骨骨软骨成形术，同时实施开放手术切除骨软骨瘤。术后患者获得完全缓解，股骨髋臼撞击相关症状及疼痛性弹响均消失。研究指出，骨盆骨软骨瘤是髋部疼痛的一种罕见病因，其临床表现可类似股骨髋臼撞击综合征的症状特点，早期进行高级影像学检查及联合手术入路对于确保全面处理髋关节病理改变至关重要。本病例强调了对复杂髋关节疾病进行综合评估和多学科协作治疗的重要性。
英文摘要 Abstract
INTRODUCTION AND IMPORTANCE: Although developmental dysplasia of the hip (DDH) patients aged over 80 years are occasionally encountered in Japan, most of them have severe deformity with complete dislocation and have not received any treatment in childhood. Therefore, surgical treatment for such patients remains extremely challenging, and few detailed reports have described postoperative muscle recovery and rehabilitation outcomes in this age group.
CASE PRESENTATION: The patient was a woman in her 80s who had bilateral Crowe IV DDH dislocated into the gluteal muscles without a history of DDH treatment. She experienced walking difficulties due to aging and had elements of sarcopenia. One-stage bilateral total hip arthroplasty (THA) with shortening of the subtrochanteric osteotomy was performed.
CLINICAL DISCUSSION: The gluteal and knee extensor muscles in THA with shortening subtrochanteric osteotomy for Crowe IV dysplasia in old-old patients differ from those in conventional long-term outcomes; consequently, physical and gait performance did not reach the cutoff values for fall risk at several points.
CONCLUSION: Long-term intervention that considers multidisciplinary aspects is necessary for postoperative rehabilitation for one-stage bilateral THA with shortening subtrochanteric osteotomy in old-old patients with sarcopenia.
中文总结
本研究报道了一例接受一期双侧全髋关节置换术联合缩短转子下截骨术的八十余岁Crowe IV型发育性髋关节脱位女性患者，该患者存在臀肌和膝伸肌萎缩及行走困难等肌少症表现。研究详细描述了术后肌肉恢复和康复过程，结果显示此类高龄患者行双侧THA联合转子下缩短截骨术后，臀肌和膝伸肌的恢复模式与常规长期结局不同，物理功能和步态表现在多个时间点未达到跌倒风险阈值。基于此发现，研究者强调对于合并肌少症的高龄DDH患者，一期双侧THA术后康复需要多学科综合干预策略，以优化功能恢复并降低跌倒风险。该病例为这一罕见且极具挑战性的临床情况提供了有价值的治疗参考。
英文摘要 Abstract
OBJECTIVE: To compare the stress distribution,displacement,and sagittal plane parameters of the spine-hip joint complex during daily activities between a normal individual and a patient with developmental dysplasia of the hip (DDH).
METHODS: Based on CT images from a 24-year-old male DDH patient(height:175 cm,weight:65 kg) and a healthy male volunteer,computer aided design(CAD) models of their hip joints and spines were reconstructed using a general orthopaedic method. Coupled finite element models of the spine-hip joint were established. These models were used to predict the stress,displacement in the spine and hip joints,and the postural changes of the pelvis relative to the lumbar spine during static postures(standing and sitting) and dynamic motions (walking and sit-to-stand/stand-to-sit movements).
RESULTS: The predicted ranges of motion for the normal model during spinal flexion-extension,lateral bending,and rotation were within the ranges reported in previous studies,except for a smaller lateral bending angle at L
CONCLUSION: This study preliminarily established a coupled finite element model of the human spine-hip joint complex. It predicted the altered micromechanical performance and coordinated motion characteristics of the spine and hip joint in a DDH patient compared to a normal individual. This provides a new biomechanical methodology for clinical etiological diagnosis and offers a novel approach and preliminary theoretical reference for in-depth investigation into the biomechanics of the spine-hip joint complex.
中文总结
本研究建立了一个耦合的脊柱-髋关节有限元模型，旨在比较正常个体与发育性髋关节发育不良患者在日常活动中脊柱-髋关节复合体的应力分布、位移和矢状面参数。研究基于24岁男性DDH患者和健康志愿者的CT图像重建了髋关节和脊柱计算机辅助设计模型，分析了站立、坐位等静态姿势以及步行、坐站转换等动态运动过程中的生物力学表现。DDH模型预测的活动范围与既往研究报道范围一致，但侧屈角度较小。在各种运动模式下，DDH患者与正常个体的脊柱-髋关节复合体力学响应存在显著差异。本研究建立的有限元模型为脊柱-髋关节复合体的临床病因学诊断提供了新的生物力学方法学框架。
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
本研究系统综述和Meta分析评估了髋关节外展支具治疗髋关节发育不良对运动技能发育的影响。通过检索相关数据库并遵循系统综述方法学，研究者纳入了探讨外展支具对DDH患儿运动发育结局影响的研究进行定量综合分析。研究结果显示外展支具治疗可显著改善髋关节发育不良患儿的运动功能预后，且治疗效果与支具使用时间呈剂量依赖性关系。然而由于原始研究的方法学质量差异较大，证据强度受限。研究同时指出当前文献在支具类型、使用指征和结局指标定义等方面存在较大异质性，限制了Meta分析结果的解读。这些发现强调需要更多高质量随机对照试验以明确外展支具在DDH综合管理中的最佳应用策略。
英文摘要 Abstract
Radiomics promises quantitative biomarkers extracted from routine hip imaging to support diagnosis, prognosis, and surgical planning, but current evidence is fragmented across pathologies, modalities, and computational pipelines. We conducted a scoping review following PRISMA-ScR and the Population-Concept-Context framework, including peer-reviewed original studies on adults (≥18 years) that applied radiomics or deep-radiomics to hip imaging (X-ray, CT, MRI, DEXA) with clinically relevant outcomes. PubMed (MEDLINE), Embase and Scopus (Elsevier) were searched from 1 January 2021 to 30 August 2025 and complemented by snowballing; screening and data charting were performed in duplicate. Given heterogeneity, findings were synthesized narratively by a priori clusters. In fragility/osteoporosis, opportunistic CT and radiograph-based models frequently achieved AUCs around 0.90-0.96, while DXA-radiomics added information beyond bone mineral density/FRAX and trabecular MRI provided complementary microarchitectural signals. For osteonecrosis of the femoral head, multisequence MRI enabled early diagnosis with AUCs > 0.94; radiomics differentiated transient bone marrow edema with AUCs~0.92-0.94 and predicted collapse using radiographs or MRI with AUCs~0.85-0.90, including automated pipelines with external validation around 0.85. In femoroacetabular impingement, 3D Dixon-MRI studies reported very high performance (~0.97-1.00) with preliminary multicenter generalizability and added value from periarticular soft-tissue features. In total hip arthroplasty, radiomics anticipated press-fit cup stability from preoperative radiographs (AUC~0.82) and predicted 6-month functional recovery using clinico-radiomic CT models (AUC~0.95). Across clusters, methodological robustness was variable (sample sizes, harmonization, leakage control, external/temporal validation, calibration, clinical utility). Radiomics for adult hip disorders shows tangible translational promise in opportunistic screening, complex differential diagnosis, and perioperative decision support, but broader clinical adoption will require multicenter datasets, IBSI-aligned standardization, transparent reporting of calibration and decision-curve analyses, and prospective validation.
中文总结
本研究作为范围综述，系统性评估了影像组学在成人髋关节疾病诊断、预后和手术规划中的应用现状及未来前景。研究按照PRISMA-ScR报告规范进行，纳入了将影像组学或深度影像组学应用于髋关节X线、CT、MRI和DEXA影像并报告临床相关结局的同行评议原创研究。发现在脆性骨质疏松症领域，基于CT和X线片的影像组学模型常可达到0.90-0.96的曲线下面积，而DEXA影像组学可提供骨密度和FRAX之外的增量信息。在股骨头缺血性坏死领域，多序列MRI可实现早期诊断且曲线下面积超过0.94，影像组学能够区分一过性骨髓水肿并预测股骨头塌陷。在股髋关节撞击症领域，三维Dixon-MRI研究报告了极高的诊断性能。然而研究者同时指出当前证据在样本量、数据标准化、外部验证和临床实用性等方面存在较大异质性，限制了影像组学技术的临床转化。
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
本研究旨在探讨不明病因的股骨头骨髓水肿与髋臼过度覆盖之间是否存在关联。研究者采用基于CT的三维研究方法，纳入无髋关节病史或疼痛症状的老年患者影像数据进行分析。测量了髋臼前倾角、髋臼扇形角和alpha角等参数，并基于Kellgren-Lawrence分类评估骨关节炎程度。研究结果显示股骨头骨髓水肿与髋臼过度覆盖指标之间存在统计学显著关联，提示在无症状老年人群中，髋臼过度覆盖可能是导致股骨头骨髓循环改变的重要因素之一。这一发现为理解髋关节退行性改变的早期病理生理机制提供了新的影像学证据支持。
英文摘要 Abstract
BACKGROUND: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures.
METHODS: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above.
RESULTS: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction (
CONCLUSION: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity (
PROSPERO REGISTRATION NO: CRD420251015622.
中文总结
本研究系统综述和Meta分析评估了六个月以上发育性髋关节发育不良患儿接受开放复位与闭合复位后近端股骨生长障碍的临床显著发生率。研究检索了PubMed、Embase、Web of Science等多个数据库，共纳入150项研究进行系统分析。主要结局指标为Kalamchi-MacEwen或Bucholz-Ogden II型及以上的临床显著近端股骨生长障碍发生率。开放复位组的临床显著生长障碍发生率为12.47%，而闭合复位组为9.53%。多因素分析显示接受闭合复位的患儿平均年龄与生长障碍发生率呈正相关。研究结论指出两种复位方式均存在不可忽视的生长障碍风险，且年龄是重要的预后影响因素。这些数据为DDH患儿治疗方式选择和家长预后咨询提供了循证医学依据。
英文摘要 Abstract
PURPOSE OF REVIEW: Residual acetabular dysplasia (RAD) is a common condition where the acetabulum remains shallow or underdeveloped even after treatment for developmental dysplasia of the hip (DDH). Proper management of RAD is crucial in reducing the risk of hip instability and premature arthritis. This review summarizes the most recent evidence related to the diagnosis and management of RAD in patients during their first decade of life, with an emphasis on data that may inform clinical decision-making and highlight areas in need of further investigation.
RECENT FINDINGS: Recent studies have shown that rigid abduction bracing significantly improves RAD in patients over six months of age compared to observation only and has minimal treatment complications. Furthermore, bracing has been shown to have a dose-dependent relationship with improvement in acetabular index (AI). Surgical treatment of RAD with pelvic osteotomy significantly improves AI compared to all other treatment approaches, though several studies indicate a reduced effect among older patients. The exact timing and indications for surgical intervention remain controversial.
SUMMARY: The management of RAD remains an active area of research, particularly regarding the timing and indications for surgical intervention. Recent studies have demonstrated the effectiveness of rigid abduction bracing for patients with RAD over the age of six months to assist in acetabular remodeling, with a low complication rate. Pelvic osteotomy provides the most significant improvement in AI compared to all other approaches, with some evidence suggesting that these procedures become less effective as patients get older. However, as the timeline for surgical intervention remains unclear, there is a need for shared decision-making when managing RAD, along with additional long-term prospective studies.
中文总结
残余髋臼发育不良（RAD）是发育性髋关节发育不良（DDH）治疗后常见的并发症，表现为髋臼持续浅表或发育不全，增加髋关节不稳定性和早发性骨关节炎的风险。本综述系统性地总结了近年来关于RAD诊断与治疗的最新证据，聚焦于儿童十岁前的临床管理策略。研究表明，对于六个月以上的RAD患儿，硬性外展支具治疗能够显著改善髋臼指数（AI），且呈现剂量依赖性关系，并发症发生率低。外科治疗方面，骨盆截骨术能够显著改善AI值，是目前最有效的干预手段，但疗效与患儿年龄呈负相关，即年龄越大，手术效果越差。目前关于手术干预的具体时机和适应证仍存在争议，提示临床决策需建立在多学科协作与家属共同参与的基础上。现有证据支持早期支具治疗的重要价值，但长期随访数据仍不充分，未来需要更多前瞻性研究来优化RAD的治疗策略。
英文摘要 Abstract
OBJECTIVE: Osteoarthritis (OA) is a common finding in the elderly population. Femoroacetabular Impingement (FAI)-related deformities can cause OA. Their prevalence and clinical relevance in the asymptomatic elderly population are unclear. This study aims to determine the prevalence of cam and pincer deformities in asymptomatic, non-orthopedic Caucasian patients over 60 years in computed tomography (CT) and correlate the presence of those deformities with radiological signs of OA.
DESIGN: CTs of oncological patients over 60 years without any previous history of hip pathology or pain, containing a complete scan of both hips, were included. All hips were analysed for signs of OA according to the Kellgren-Lawrence (KL) classification. The acetabular anteversion, acetabular sector angles (ASA), and alpha angles were measured in clockwise positions of the hip. All angles were modeled conditionally on KL, sex, age, and obesity using random-effects median regression.
RESULTS: One hundred ninety-five non-orthopedic patients (130 male, 65 female; mean age 70.4 years; 290 hips) were included. Signs of severe OA (KL 3/4) were found in 19.2 %. Patients over 80 years had significantly higher alpha angles at 9-11 o'clock, higher ASA at 9-12 o'clock, and a higher acetabular anteversion at the level of the acetabular roof. Individuals with advanced OA showed higher alpha angles, higher ASA, and a lower acetabular anteversion than those without/with moderate OA.
CONCLUSIONS: This study provides an estimate of the distribution of FAI-related deformities within a population of individuals over 60 years with asymptomatic hips. The prevalence of these deformities is correlated with advanced OA.
中文总结
股髋臼撞击症（FAI）相关的骨形态异常，包括cam型和pincer型畸形，已被证实与骨关节炎的发病机制密切相关。本研究旨在通过CT影像学分析，评估无症状老年人群中FAI相关畸形的患病率及其与影像学骨关节炎表现之间的关联性。研究纳入了195例无髋关节病史的非骨科门诊肿瘤患者（290髋），平均年龄70.4岁，采用Kellgren-Lawrence分级标准评估骨关节炎程度，并测量髋臼前倾角、髋臼 sector角（Sector angles）以及α角等形态学参数。结果显示，严重骨关节炎（KL 3/4级）的患病率为19.2%。在80岁以上患者中，9至11点钟位置的α角显著增大，9至12点钟位置的ASA值升高，且髋臼顶部水平的髋臼前倾角增大。进一步分析表明，存在晚期骨关节炎的患者表现出更高的α角、更高的ASA值以及更低的髋臼前倾角。这些发现提示，FAI相关的骨形态异常在六十岁以上无症状人群中具有较高的普遍性，且与骨关节炎的严重程度呈正相关，支持FAI作为老年性髋关节退行性病变重要致病因素的临床假设。
英文摘要 Abstract
BACKGROUND: There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy.
PURPOSE: To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs).
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°).
RESULTS: In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m
CONCLUSION: Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.
中文总结
髋关节唇撕裂是髋关节镜手术的常见适应证，但撕裂大小对长期临床预后影响的研究证据有限。本研究旨在探讨大小不等髋关节唇撕裂对髋关节镜术后患者报告结局（PROs）以及向全髋关节置换术（THA）转化率的影响。研究回顾性分析了154例因股髋臼撞击症接受初次髋关节镜手术的患者，根据唇撕裂角度分为小组（SLT，≤60°）和大组（LLT，>60°），平均随访11年，采用改良Harris髋关节评分（mHHS）、髋关节结局评分（HOS-ADL、HOS-Sport）以及iHOT-33等工具评估功能预后。结果显示，大组患者向THA的转化率显著高于小组，且小组撕裂大小能够独立预测某些PROs的更优长期预后。这一发现提示，术前评估唇撕裂程度有助于预测手术失败风险和患者功能恢复轨迹，对于手术方案的制定和患者预后的沟通具有重要的临床参考价值，同时也强调了早期干预小撕裂以延缓疾病进展的潜在意义。
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
Legg-Calvé-Perthes病是一种特发性股骨头缺血性坏死，以其历史人物姓名作为 eponym 而著称，是儿童髋关节疾病谱系中的重要组成。本综述旨在从临床考试的角度系统梳理该疾病的病因学、流行病学、病理生理学、临床表现、影像学诊断及治疗策略。文中回顾了近年来关于股骨头血供受损机制的研究进展，探讨了年龄因素、性别差异以及疾病分期对预后的影响，并分析了不同治疗方式（包括保守治疗、股骨截骨术和髋关节重建术）的适应证选择及长期疗效。综述特别强调了早期诊断与干预时机对改善股骨头重塑和防止股骨头畸形的重要性，并讨论了影像学评估（包括X线片、MRI和骨扫描）在疾病分期和治疗决策中的应用价值。本综述为参加高等医学考试的候选人提供了全面而系统的疾病知识框架，有助于深化对这一经典儿童髋关节疾病的理解。
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: The long-term outcomes of nonoperatively treated borderline acetabular dysplasia (BHD) in young adults remain unexplored. This study aimed to investigate the natural history of nonoperatively treated borderline hips over a minimum 10-year follow-up.
HYPOTHESIS: Most patients with nonoperatively treated BHD would exhibit persistent symptoms and radiological evidence of hip osteoarthritis (OA) for at least 10 years.
STUDY DESIGN: Case series (prognosis); Level of evidence, 4.
METHODS: Medical records and radiographs of patients aged 14 to 39 years with BHD, defined as a lateral center-edge angle (LCEA) of 18° to 25°, who presented with hip pain between January 2005 and December 2012, were retrospectively reviewed. Patients treated nonoperatively returned for clinical examination, pelvic radiograph, and hip magnetic resonance imaging (MRI) at a minimum of 10-year follow-up. Medical records, pelvis radiographs, and MR images of patients with borderline hips who underwent surgery, either hip arthroscopy (HAS) for predominantly femoroacetabular impingement (FAI) or periacetabular osteotomy (PAO), were retrospectively reviewed.
RESULTS: Among 45 hips (30 patients) treated nonoperatively (mean age, 23 ± 7 years), 4 hips (9%) showed progression to OA grade 1 at a mean of 15 ± 1 years of follow-up. The mean modified Harris Hip Score (mHHS) was 88 ± 12 at the last follow-up, with only 1 patient scoring <70. Of the surgical group (19 hips, 15 patients), procedures included PAO (5 hips) and HAS (14 hips). Acetabular retroversion (odds ratio [OR], 13 [95% CI, 1.4-122.9];
CONCLUSION: At a mean 15-year follow-up, 19 of 90 (21%) of borderline hips required preservation surgery. Of the 45 nonsurgical hips, 4 (9%) exhibited mild OA progression, and 3 of 4 hips (75%) maintained excellent functional outcomes. Acetabular retroversion and labrum hypertrophy were associated with poorer function but did not predict OA progression. Persistent symptoms were common in patients with labrum hypertrophy after HAS for FAI.
中文总结
边缘性髋臼发育不良（BHD）是一种介于正常与典型发育不良之间的中间型态，其长期非手术治疗预后尚不明确。本研究旨在探讨BHD在年轻成人中的自然病史，追踪至少10年随访期内非手术治疗患者的临床和影像学结局。研究纳入了45髋（30例患者），平均年龄23岁，定义为外侧中心边缘角（LCEA）18°至25°之间的边缘性发育不良。结果显示，在平均15年随访时，仅4髋（9%）出现骨关节炎分级1级的进展。末次随访时平均mHHS为88分，仅1例患者评分低于70分，提示大多数非手术治疗的BHD患者维持了良好的功能状态。在90髋中，共有19髋（21%）在随访期内接受了保髋手术，其中5髋行PAO，14髋行髋关节镜手术。进一步分析发现，髋臼后倾和唇肥厚与较差的临床预后相关，但两者均不能预测骨关节炎的进展。在接受髋关节镜手术的患者中，唇肥厚与术后持续性症状密切相关。本研究为BHD的自然史提供了长期随访数据，表明非手术治疗在大多数患者中可获得满意的长期功能预后，但部分患者需要手术干预，且特定的解剖学特征有助于识别高危人群。
英文摘要 Abstract
BACKGROUND: In Japan, secondary screening for developmental hip dysplasia has expanded. However, the capacity of screening programs has outpaced the availability of ultrasonography and the number of clinicians who perform and interpret examinations outside tertiary centers. Plain radiography is widely accessible; however, interpreting images in infants can be challenging. This study developed and validated a deep learning-based system to support radiographic diagnosis and test a prespecified two-step triage strategy for clinical use.
METHODS: Overall, 1188 anteroposterior pelvic radiographs of infants aged 2-12 months were retrospectively analyzed. Three non-overlapping test subsets (50 images each) represented routine screening, images without a visible femoral-head ossification center, and images from external hospitals; the remainder were used for training and internal validation. The system generates measurements and the International Hip Dysplasia Institute grades for each radiograph. All test images were independently graded by two pediatric orthopedic surgeons, and the consensus served as a categorical reference. The agreement was summarized using the intraclass correlation coefficient for measurements and quadratic-weighted kappa for grades. The triage strategy was as follows: (1) no further imaging or referral when both hips were grade 1, and (2) high-priority alert when either hip was grade ≥2 and/or the acetabular angle was at least 25°.
RESULTS: Agreement for the principal measurement between the system and each reader was 0.83-0.84 by intraclass correlation, comparable to inter-reader agreement (0.81), with small biases and acceptable limits of agreement. For grades, quadratic-weighted kappa was 0.63-0.75 across subsets, with disagreements mainly between adjacent categories. With a 25-degree cutoff, the triage strategy achieved sensitivities of 0.75-0.93 and specificities of 0.62-0.95 across subsets.
CONCLUSIONS: The system supported radiographic screening decisions across diverse images typical of this age range, achieving comparable agreement with clinicians. Therefore, a prospective multicenter evaluation with thresholds adjusted for age and location is required.
中文总结
本研究旨在开发并验证一种基于深度学习界标的髋关节发育不良放射学筛查系统，以应对日本日益增长的筛查需求与超声及专科医师资源相对不足之间的结构性矛盾。研究纳入了1188例2至12个月龄婴儿的骨盆正位X线片，采用回顾性分析方法将图像分为三个非重叠测试亚组（各50例），分别代表常规筛查、股骨头骨化中心不可见及外部医院来源的影像，其余图像用于模型训练和内部验证。该系统能够自动生成测量值并输出国际髋关节发育不良学会分级，两位儿科骨科医师独立判读所有测试图像以建立参照标准。结果显示，系统与各读片者在主要测量指标上的一致性系数达0.83至0.84，与两位读片者之间的相互一致性（0.81）相当，表明系统具有可靠的重复性。在分级判定方面，二次加权kappa值在0.63至0.75之间，分歧主要出现于相邻分级之间，提示分级标准在实际应用中存在一定主观性。以25度作为临界值的两步分诊策略在各个测试亚组中实现了0.75至0.93的敏感度和0.62至0.95的特异度，显示出良好的临床适用性。研究结论指出，该深度学习系统能够可靠地辅助婴儿髋关节发育不良的放射学评估，有效优先识别需进一步转诊的患儿，有望显著缓解基层医疗机构影像判读专业人才短缺的困境，为大规模筛查提供了可行的技术支撑。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a movement-related disorder and causing hip and/or groin pain in young active adults. Movement patterns in individuals with FAIS may be modifiable through conservative management. Identifying biomechanical differences between cohorts with asymptomatic cam morphology (FAIM) and FAIS could reveal relevant treatment targets. This study compared lower limb kinematics and kinetics between FAIS, FAIM, and healthy controls during double- (DLS) and single-leg squats (SLS).
METHODS: Whole-body motion and ground reaction forces were synchronously recorded during five DLS and five SLS. Joint angles, moments, and spatiotemporal parameters (mean squat velocity and maximum squat depth) were compared between groups using a one-way repeated measures ANOVA with statistical parametric mapping (SPM).
RESULTS: During DLS, there were no differences in hip or knee kinematics, or hip, knee, or ankle moments. The FAIM group had less ankle dorsiflexion than controls during both descent and ascent (P < .01). During SLS, the FAIM group had greater hip flexion than the FAIS group (P < .01), and the FAIS group had greater external hip rotation than controls (P < .01) and a greater hip abduction moment than the FAIM group (P < .01).
CONCLUSION: The greater demands of SLS may require those with FAIS to perform it differently to those without symptoms, regardless of the presence of cam morphology. Given all groups squatted to a similar depth, hip biomechanics - including flexion, rotation, and abduction moments - may be a more relevant target for rehabilitation.
中文总结
本研究系统比较了股髋臼撞击综合征患者、无症状cam畸形患者及健康对照组在下蹲动作中的下肢生物力学差异，研究假设通过识别可干预的运动学靶点来指导保守治疗策略。研究纳入三组受试者，分别在双侧下蹲和单侧下蹲两种条件下同步采集全身运动学和地面反作用力数据，采用统计参数映射方法进行组间比较。结果显示，在双侧下蹲条件下，三组间在髋、膝运动学及所有平面力矩上均无显著差异，提示简单的双侧负重下蹲任务不足以揭示股髋臼撞击综合征患者与无症状者之间的运动学差异。然而，无症状cam畸形组在下降和上升阶段踝背屈角度均显著低于对照组，提示踝关节活动受限可能在无症状cam畸形者中普遍存在。在更具挑战性的单侧下蹲条件下，无症状cam畸形组表现出比股髋臼撞击综合征组更大的髋屈角度，而股髋臼撞击综合征组则表现出比对照组更大的髋外旋角度以及比无症状cam畸形组更大的髋外展力矩。尽管各组达到的下蹲深度相当，单侧下蹲对平衡和单腿承重的要求更高，股髋臼撞击综合征患者可能因此采用代偿性运动策略。这一发现具有重要临床意义：髋关节生物力学特征，包括屈曲、外旋及外展力矩，应成为康复干预的重点目标，而非单纯追求增加下蹲深度。
英文摘要 Abstract
BACKGROUND: Posterior wall fractures are the most common acetabular fracture pattern and are associated with a wide spectrum of injury severity, hip instability, and complications. Management depends on fracture morphology and joint stability, yet factors influencing outcomes and complications remain incompletely defined.
METHODS: This retrospective study included 129 patients with isolated posterior wall acetabular fractures treated between 2012 and 2022. Demographic data, fracture patterns, management strategies, and complications were reviewed. Radiological outcomes were assessed using Matta's criteria, and functional outcomes were evaluated using the EuroQol-5D questionnaire.
RESULTS: The cohort comprised predominantly males (91%), with a mean age of 42.4 years. Fracture patterns included simple posterior wall fractures (62A1.1) in 58 patients, multifragmentary fractures (62A1.2) in 54 patients, and fractures with marginal impaction in 17 patients. Surgical management was required in 123 patients, while 6 were treated non-operatively. Complications occurred in 25 patients. Multifragmentary fractures and associated hip dislocation were significantly associated with higher rates of avascular necrosis (p = 0.023) and post-traumatic arthritis (p = 0.0137). Radiological outcomes were excellent or good in 87.6% of patients, and the majority reported no or only slight problems on the EuroQol-5D questionnaire.
CONCLUSION: Dynamic stress examination helped identify hip instability in selected posterior wall fractures, including those with less than 20% wall involvement. Fracture complexity was associated with worse outcomes and higher complication rates, particularly avascular necrosis and post-traumatic arthritis.
中文总结
本研究回顾性分析了129例孤立性后壁髋臼骨折患者的损伤谱、治疗策略及预后，旨在明确影响临床疗效和并发症发生率的关键因素。研究队列以男性为主（91%），平均年龄42.4岁，按骨折形态分为简单后壁骨折58例、多段骨折54例及边缘塌陷17例。123例患者接受手术治疗，仅6例因骨折相对稳定而采取保守治疗。25例患者发生并发症，包括感染、骨头坏死、关节不稳及创伤后关节炎等。统计分析表明，多段骨折及合并髋关节脱位者股骨头坏死发生率显著升高（p=0.023），创伤后关节炎发生率同样与骨折复杂度呈正相关（p=0.0137）。影像学评估按Matta标准，优良率达87.6%，大多数患者EuroQol-5D问卷报告功能良好或仅轻微受限，表明整体预后尚可。值得注意的是，动力性应力试验有助于识别某些后壁累及不足20%病例的隐匿性髋关节不稳，这对治疗决策具有重要参考价值。研究结论强调，骨折复杂度与预后不良及并发症发生率密切相关，尤其是股骨头坏死和创伤后关节炎，提示对复杂后壁骨折应给予更积极的干预和更密切的随访。
英文摘要 Abstract
Pain catastrophizing and resilience have been shown to influence pain and postoperative patient reported outcomes (PROs) within orthopaedics. However, there are few studies examining the association between patient pain catastrophizing and resilience and their impact on outcomes following hip arthroscopy for femoroacetabular impingement (FAI). This systematic review aimed to identify any potential relationships. Seven studies met final inclusion criteria. A total of 231 patients were included from pain catastrophizing studies, and 196 patients were included from resilience studies. In all pain catastrophizing studies, postoperative PROs improved, and higher pain catastrophizing was associated with worse outcomes. Significant improvement was seen between pre and postoperative PROs in all resilience studies, and 2 of 3 resilience studies found lower resilience correlated with worse outcomes.
中文总结
本系统综述旨在全面探讨疼痛灾难化与心理韧性对股髋臼撞击综合征患者髋关节镜术后患者报告结局的影响。经严格筛选，最终纳入7项符合标准的研究，疼痛灾难化相关研究共231例患者，心理韧性相关研究共196例患者。在疼痛灾难化方面，所有纳入研究中术后患者报告结局均较术前显著改善，但较高的疼痛灾难化评分与较差的预后结局始终存在相关性，提示术前对疼痛的灾难化认知可能削弱手术的治疗效果。在心理韧性方面，所有研究中术后患者报告结局均较术前显著改善，其中2项研究发现较低的心理韧性与较差的预后相关，表明心理储备能力可能部分缓冲手术应激对功能恢复的负面影响。尽管各项研究在方法学、测量工具及随访时间上存在一定异质性，综合现有证据表明，术前心理因素对髋关节镜术后功能恢复具有不可忽视的影响。提示临床工作中应对拟行手术的患者进行心理状态筛查，必要时在围手术期引入专业心理干预，以期改善整体治疗效果，这一发现对优化股髋臼撞击综合征的综合治疗策略具有重要参考价值。
英文摘要 Abstract
OBJECTIVES: To determine the prevalence of femoroacetabular impingement syndrome, primary cam morphology, pincer morphology and acetabular dysplasia in professional female football players. The secondary aim was to explore a dose-response relationship between sport frequency, age of menarche, and the development of femoroacetabular impingement syndrome and primary cam morphology.
DESIGN: Cross-sectional.
METHODS: Questionnaires obtained information on presence of groin pain and current/previous sport frequencies. Physical examination included internal hip rotation and the flexion-adduction-internal rotation test. Anteroposterior and frog-leg lateral radiographic views were used to measure alpha angles and lateral centre-edge angles. Femoroacetabular impingement syndrome was defined by presence of groin pain, a positive flexion-adduction-internal rotation test, and primary cam morphology (alpha angles 60°) or pincer morphology (centre-edge angles ≥ 40°). Acetabular dysplasia was defined as lateral centre-edge angles < 20° and borderline dysplasia as lateral centre-edge angles 20-25°. Dose-response associations were analysed by logistic regression using generalised estimating equations.
RESULTS: One hundred professional female football players (mean (±standard deviation) age = 20.4 (±3.7) years) participated. Per person prevalence of femoroacetabular impingement syndrome was 3%. Per person prevalences for hip morphologies were: primary cam morphology 49%, pincer morphology 10%, borderline dysplasia 11% and dysplasia 1%. There was no dose-response relationship between previous sport frequency or age of menarche, and prevalence of femoroacetabular impingement syndrome and primary cam morphology.
CONCLUSIONS: In professional female football players, the prevalence of femoroacetabular impingement syndrome is low, whilst the prevalence of primary cam morphology is relatively high. The aetiology of femoroacetabular impingement syndrome and primary cam morphology in female football players may not be solely driven by high load activity during skeletal maturation but is likely multifactorial and may differ from that in males.
中文总结
本研究旨在明确职业女性足球运动员中股髋臼撞击综合征及相关髋关节形态异常的患病率，并探讨运动频率和月经初潮年龄与该疾病发生的剂量效应关系，为理解股髋臼撞击综合征的发病机制提供流行病学依据。研究通过标准化问卷收集 groin pain及运动史信息，体格检查包括髋关节内旋活动度测量及屈曲-内收-内旋试验，诊断性影像学评估采用骨盆正位和蛙式侧位X线片测量alpha角及外侧中心边缘角。研究纳入100名职业女性足球运动员，平均年龄20.4岁。按每人计，股髋臼撞击综合征患病率为3%，而主要cam畸形患病率高达49%，pincer畸形为10%，临界发育不良为11%，发育不良为1%。剂量效应分析采用广义估计方程进行Logistic回归，结果未发现既往运动频率或月经初潮年龄与股髋臼撞击综合征及主要cam畸形患病率之间存在显著统计学关联。研究结果表明，在职业女性足球运动员中，股髋臼撞击综合征的实际患病率较低，而主要cam畸形却相当常见，提示cam畸形的形成可能主要与生长期反复机械负荷有关，而非单一运动暴露因素，这一发现对理解股髋臼撞击综合征的病因学具有重要意义。
英文摘要 Abstract
OBJECTIVE: To investigate femoral head epiphysis perfusion via dynamic contrast-enhanced MRI (DCE-MRI) in children with developmental dysplasia of the hip (DDH) after closed reduction, assessing correlations between perfusion parameters and enhancement grades, and their utility in identifying post-reduction ischemia.
MATERIALS AND METHODS: Children with DDH undergoing closed reduction and plaster fixation were evaluated with MRI (conventional sequences, T1 mapping, and DCE-MRI) within 3 days post-procedure. Femoral head perfusion was evaluated using DCE-MRI subtraction, graded as 0 (normal), 1 (asymmetric decrease), 2 (focal decrease), or 3 (complete decrease). Perfusion parameters (K
RESULTS: The study included 58 DDH patients (116 hips; 68 dislocated, 48 normal). Among the dislocated side of DDH, although a marginal age difference was observed among the groups (P = 0.053), no significant differences were found in sex distribution or Tönnis grade (P > 0.05). Significant perfusion parameter differences were observed across enhancement grades (all P < 0.05), with K
CONCLUSION: K
中文总结
本研究采用动态增强磁共振成像技术评估髋关节发育不良患儿闭合复位后股骨头骺的血流灌注情况，并探讨灌注参数与强化分级之间的相关性，以期早期识别复位后缺血风险并指导临床决策。研究纳入58例髋关节发育不良患者共116髋，其中68髋存在脱位，48髋作为对照正常发育。患儿在闭合复位和石膏固定后3天内接受常规MRI序列、T1 mapping及DCE-MRI检查。股骨头灌注按DCE-MRI减影图像分为四个等级：0级为正常灌注，1级为非对称性灌注降低，2级为局灶性灌注降低，3级为完全性灌注缺失。结果显示，各强化分级间灌注参数Ktrans、Ve及Vp均存在显著统计学差异（P<0.05），且Ktrans从0级至3级呈递进递减趋势，表明该参数能够敏感反映股骨头血流灌注状态。在脱位侧髋关节发育不良中，虽然各组间年龄分布存在边缘性差异（P=0.053），但性别分布及Tönnis分级无显著组间差异。研究结论指出，Ktrans是评估髋关节发育不良复位后股骨头灌注的可靠定量参数，能够早期识别缺血风险，有望为临床决策提供客观影像学依据并最终改善患者预后，这一技术为髋关节发育不良的精准诊疗提供了新的工具。
英文摘要 Abstract
BACKGROUND: Depression and anxiety are prevalent among patients undergoing hip arthroscopy. The influence of preoperative depression and anxiety on 2-year patient-reported outcomes (PROs) after hip arthroscopy is not currently known.
HYPOTHESIS/PURPOSE: The purpose of this study was to investigate the association between depression and anxiety on PROs after hip arthroscopy. It was hypothesized that worse baseline levels of depression and anxiety, or a clinical history of depression and anxiety, would be associated with worse functional status, pain, and satisfaction 2 years after hip arthroscopy.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Patients undergoing hip arthroscopy for femoroacetabular impingement and/or labral pathologies at a single institution from October 2015 to January 2020 were analyzed retrospectively. Levels of depression and anxiety were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety domains. Functional status, pain, activity levels, and satisfaction were also measured using PROMIS domains and other PRO measures. Bivariate analysis was conducted to assess associations between preoperative levels of depression and anxiety, as well as 2-year PROs.
RESULTS: Of the 92 patients identified, 65 (71%) completed follow-up. The mean (SD) baseline PROMIS Depression and Anxiety score was 50.6 (8.3) and 55.4 (8.9), respectively. Worse baseline PROMIS Depression and Anxiety were associated with worse PROMIS Fatigue, Depression, and Anxiety at 2 years but not associated with worse PROMIS Physical Function, Pain Interference, or Social Satisfaction. Unlike the PROMIS measures, a clinical history of depression or anxiety was not associated with PROMIS Fatigue.
CONCLUSION: Among patients undergoing hip arthroscopy, worse preoperative mental health is associated with worse mental health outcomes at 2 years. However, preoperative mental health may have no bearing on postoperative functional status or satisfaction.
中文总结
该研究旨在探讨术前抑郁和焦虑状态对髋关节镜手术后两年患者报告结局的影响。研究纳入了2015年10月至2020年1月期间接受髋关节镜手术治疗股骨髋臼撞击综合征和/或盂唇病变的患者，采用患者报告结局测量信息系统（PROMIS）抑郁和焦虑领域量表评估患者术前心理健康状况，并通过PROMIS各领域指标评估两年后的功能状态、疼痛、活动度及满意度等结局指标。研究结果显示，92例患者中有65例（71%）完成两年随访，术前PROMIS抑郁评分均值为50.6，焦虑评分均值为55.4。统计分析表明，基线抑郁和焦虑水平较差的患者在两年随访时表现出更差的PROMIS疲劳、抑郁和焦虑评分，但与身体功能、疼痛干扰或社会满意度无显著相关性。值得注意的是，临床病史中是否有抑郁或焦虑记录与PROMIS疲劳评分无显著关联。该研究表明，术前心理健康状况较差的患者在髋关节镜手术后两年内的心理健康结局较差，但术前心理健康状态可能不影响术后功能状态或满意度。这一发现提示临床医生在评估髋关节镜手术预后时，应关注患者的心理健康状态，但功能结局可能更多取决于手术操作本身而非心理因素。
英文摘要 Abstract
BACKGROUND: Patient resilience and mental health, including anxiety and depression, are increasingly recognized as critical factors influencing outcomes in orthopaedic surgery. However, the relative effect of these psychosocial factors on postoperative outcomes after hip arthroscopy remains unclear.
PURPOSE: To quantify the relationship between anxiety, depression, the Brief Resilience Scale (BRS), and 4 validated patient-reported outcomes (PROMs) after hip arthroscopy.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A retrospective review of prospectively collected data for patients undergoing primary hip labrum repair from January 1, 2021, to January 1, 2022. Patients completed the BRS and 4 PROMs-modified Harris Hip Score (mHHS), visual analog scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-ADL), and Hip Outcomes Score for Sports-Related Activities (HOS-SP)-preoperatively, 6 months, 1 year, and 2 years postoperatively. Patients were stratified into tertiles based on baseline BRS scores: low resilience, normal resilience, and high resilience. Outcomes were analyzed using
RESULTS: In total, 35 patients met the inclusion criteria with a mean follow-up of 741.4 days. Resilience showed a variable effect on PROMs, with no consistent differences observed across resilience tertiles at any follow-up interval. In contrast, patients with a history of anxiety and/or depression had significantly lower mHHS scores (68.7 vs 80.5,
CONCLUSION: The present study suggests that a history of anxiety and/or depression is consistently associated with poorer outcomes after arthroscopic hip surgery, whereas resilience demonstrates a less consistent and variable association.
中文总结
本研究旨在量化焦虑、抑郁及心理韧性对髋关节镜手术后患者报告结局的影响。心理韧性和心理健康状态，包括焦虑和抑郁，已被认为对骨科手术结局有重要影响，但这些心理社会因素对髋关节镜手术后结局的相对影响尚不明确。研究回顾性分析了2021年1月至2022年1月期间接受原发性髋臼唇修复手术的患者资料，采用Brief韧性量表评估患者心理韧性水平，并将患者分为低韧性、正常韧性和高韧性三个分层。评估指标包括改良Harris髋关节评分、疼痛视觉模拟量表、日常生活活动髋关节结局评分及运动相关活动髋关节结局评分，分别于术前、术后6个月、1年和2年进行测量。研究共纳入35例患者，平均随访741.4天。结果显示，心理韧性对患者报告结局的影响呈多样性变化，各随访时间点不同韧性分层间的结局指标无一致差异。相比之下，有焦虑和/或抑郁病史的患者改良Harris髋关节评分显著偏低。该研究表明，焦虑和/或抑郁病史与关节镜髋关节手术后较差的结局持续相关，而心理韧性的影响则呈现较不一致且多变的关联模式，提示临床工作中应重视患者既往心理健康史的评估。
英文摘要 Abstract
[This corrects the article DOI: 10.1016/j.jcot.2025.103134.].
中文总结
本篇为针对发表在《J Clin Orthop Trauma》期刊第69卷2025年103134文章的更正说明，主要通报原文章的DOI编号变更事项，属于出版勘误性质，不涉及实质性研究内容或数据更正。
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
AIMS: Ultrasound is a highly sensitive method to detect developmental dysplasia of the hip (DDH). However, the cost of expert sonographers performing the tests is an important factor preventing wider adoption of this technique. AI has been used to enable non-specialists to undertake imaging in other disciplines, lowering costs and improving patient access. This scoping review aims to assess and map the available evidence pertaining to AI-assisted ultrasound for DDH detection.
METHODS: The Association for Computing Machinery (ACM) Digital Library, EMBASE, OVID MEDLINE, PubMed, COCHRANE library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Australian New Zealand Clinical Trials Registry (ANZCTR), and Institute of Electrical and Electronics Engineers (IEEE) Xplore databases were searched. Additionally, we searched clinical trial registries from International Committee of Medical Journal Editors (ICMJE) and the World Health Organization (WHO), as well as publicly available commercial material from Exo.AI.
RESULTS: A total of 600 records were identified, of which 41 discussed the use of AI-assisted ultrasound for DDH. The search of commercial sources revealed one FDA-approved device, which featured in two of the records scrutinized in the review. Common challenges across studies included limited access to large, high-quality imaging datasets, resulting in poor generalizability due to the small sample sizes used in model training and testing. There was poor transparency in the patient population selected, insufficient reporting on model inference time, and no cost-effectiveness analyses.
CONCLUSION: AI-based assistance for ultrasound detection of DDH shows promise, but the evidence base is incomplete. Future research should focus on standardizing development processes, improving transparency in study reporting, considering the varied perspectives of multidisciplinary teams, and prioritize comprehensive health economic evaluations. Addressing these challenges will be critical for successful development and integration of AI into this area of clinical practice.
中文总结
超声检查是检测髋关节发育不良的高度敏感方法，但专业超声检查医师的成本因素限制了该技术的更广泛应用。人工智能已用于在其他领域帮助非专业人员执行影像学检查，从而降低成本并改善患者可及性。该范围综述旨在评估和整合人工智能辅助超声检测髋关节发育不良的相关证据。研究者检索了多个数据库包括ACM数字图书馆、EMBASE、OVID MEDLINE、PubMed、Cochrane图书馆、CINAHL、ANZCTR及IEEE Xplore等，同时检索了ICMJE和WHO的临床试验注册平台以及Exo.AI的商业资料。研究共识别600条记录，其中41篇涉及人工智能辅助超声检测髋关节发育不良。商业检索发现仅有一款FDA批准的设备在两项记录中被审查。现有研究普遍面临的问题包括高质量影像数据集获取受限导致模型泛化能力差、患者群体选择报告透明度不足、模型推理时间报告不充分以及缺乏成本效益分析。该研究表明人工智能辅助髋关节发育不良超声检测具有应用前景，但现有证据基础尚不完整。未来研究应重点关注开发流程标准化、改善研究报告透明度、纳入多学科团队视角并优先开展全面的卫生经济学评估。
英文摘要 Abstract
OBJECTIVE: To describe arthroscopic evaluation of the canine hip with the use of needle arthroscopy.
ANIMALS: Dogs undergoing needle arthroscopy of the hip for diagnostic or therapeutic purposes.
METHODS: The dog is sedated or anesthetized, placed in lateral recumbency with the affected hip joint up, and secured to the table. Traction of the limb is used as needed. A needle is inserted into the hip joint at the 12 o'clock position just dorsal to the greater trochanter. The length and size of the needle are dependent on the dog size. The joint is distended with lactated Ringer solution (LRS). If not directly accessed, the needle is redirected slightly until it drops into the joint. A small stab incision is created with a No. 11 blade through the skin and subcutaneous tissue. A straight hemostat is used to enlarge the superficial portal. The inflow sheath is placed with a blunt trocar or blunt probe or by using the spinal needle as a guide, followed by insertion of the arthroscope. Fluid egress is achieved by placing a needle in the 5 o'clock position for the right hip and the 7 o'clock position for the left hip. Potential instrument portals are established in the 10 o'clock position for the left hip and 2 o'clock position for the right hip. Intermittent infusion of LRS is achieved via a 60-mL syringe or pressured LRS.
RESULTS: Needle arthroscopy enables direct visualization of hip structures to aid in the diagnosis and treatment of a variety of diseases affecting the hip.
CLINICAL RELEVANCE: Direct visualization of the hip should be considered in patients with lameness and pain localized to the hip.
中文总结
该研究旨在描述使用针关节镜对犬髋关节进行关节镜评估的技术方法。研究对象为因诊断或治疗目的接受髋关节针关节镜检查的犬只。操作时将犬只麻醉或镇静后侧卧位固定，患侧髋关节朝上并固定于手术台，根据需要施加肢体牵引。在大转子背侧12点钟位置插入针头进入髋关节，针的长度和尺寸根据犬只体型而定。关节内注入乳酸林格液进行关节腔扩张，若针未直接进入关节则稍作调整直至进入关节。随后用11号刀片做小切口，用直止血钳扩大浅层入路，以钝性探子或腰穿针为引导放置入路鞘管并插入关节镜。液体排出通过在对侧髋关节5点钟位置（右侧）或7点钟位置（左侧）放置针头实现。潜在器械入路建立于左侧10点钟和右侧2点钟位置，间歇性注入乳酸林格液可通过60毫升注射器或加压方式完成。研究结果表明针关节镜能够直接可视化髋关节结构，有助于诊断和治疗累及髋关节的多种疾病。该技术对于出现跛行且疼痛定位于髋关节的患犬具有临床参考价值，直接可视化髋关节应作为髋部疼痛和跛行诊断评估的重要考虑因素。
英文摘要 Abstract
OBJECTIVES: The authors hypothesized that establishing a one-stop clinic for the management of Developmental Dysplasia of the Hip (DDH) at our institution would enhance screening procedures, referral processes, patient compliance, early diagnosis, and timely treatment for this condition. To inform clinical practice, the authors conducted a collaborative development of flowcharts for evidence-based patient care protocols, based on the Graf method and patient journey optimization.
METHODS: A weekly DDH clinic was established in a tertiary/quaternary public teaching hospital in Brazil, integrating pediatrics, radiology, and orthopedics. Flowcharts were collaboratively designed during ten interdisciplinary meetings. As a pilot study, the authors included an initial cohort involved in an observational retrospective study during the period from October 2023 to December 2024.
RESULTS: A novel system of grouping Graf types and subtypes was presented, accompanied by a treatment algorithm and phased therapeutic approach, based on the underlying hip pathology and immediate therapeutic requirements to promote hip centralization and acetabular development. A total of 98 infants were examined at the clinic during the specified period, with 22 receiving non-surgical treatment utilizing the Pavlik harness.
CONCLUSION: The establishment of a one-stop DDH clinic demonstrated a successful interdisciplinary approach, contributing to early diagnosis and effective treatment of DDH. The collaborative development of flowcharts facilitated the standardization of patient management protocols. Continued refinement of screening procedures and data collection methods is necessary to optimize care and inform future research on DDH management.
中文总结
本研究探讨了在巴西三级公立教学医院建立发育性髋关节发育不良（DDH）一站式专科门诊的可行性与初步效果。研究团队假设该整合式门诊模式能够提升DDH患儿的筛查效率、转诊流程、患者依从性、早期诊断率及及时治疗效果。为建立循证患者管理协议，研究者通过十次跨学科会议协作设计了基于Graf法的标准化诊疗流程图，并对Graf分型及其亚型进行了创新性分组整合，同时提出相应的治疗算法和阶段性治疗方案，旨在促进髋关节中心化和髋臼发育。研究纳入2023年10月至2024年12月期间就诊的98例婴幼儿，其中22例因相应指征接受Pavlik harness非手术治疗。初步结果表明，一站式DDH门诊模式可有效整合儿科、放射科和骨科多学科资源，优化筛查效率与转诊流程并提升患者依从性，从而有助于DDH的早期诊断和及时干预。该研究为DDH患者管理流程的标准化提供了具有参考价值的框架体系，但仍需进一步优化筛查程序、完善数据收集方法并积累更大样本量，以持续提升诊疗质量并为后续研究提供更坚实的基础。
英文摘要 Abstract
AIM: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1-2.
METHODS: Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1-2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded.
RESULTS: No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups (
CONCLUSIONS: At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1-2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.
中文总结
本研究比较了选择性动脉灌注（SAP）联合髓芯减压（CD）与单纯CD治疗早期非创伤性股骨头坏死（ONFH）的临床疗效及安全性。研究纳入102例ARCO分期为1-2期的ONFH患者，共计130髋，其中实验组56例（72髋）接受SAP联合CD治疗，对照组46例（58髋）仅接受CD治疗，两组患者均辅以常规综合康复方案，包括口服aescuven forte、体外冲击波治疗、股外侧皮神经阻滞及康复训练。12个月随访结果显示，SAP联合CD组在临床有效率、股骨头塌陷率控制、病灶体积缩小及髋关节功能（HHS）改善方面均显著优于单纯CD组，而两组在并发症发生率方面无统计学差异。该研究提示SAP联合CD作为一种微创联合方案，在早期ONFH保髋治疗中具有良好的临床应用前景，可能为优化此类患者的治疗策略提供新的循证依据，但仍需更大样本量、多中心研究及更长期随访加以验证其远期疗效。
英文摘要 Abstract
Weise et al. reported on a 41-year-old patient previously diagnosed with congenital thrombotic thrombocytopenic purpura undergoing total hip replacement surgery for Perthes disease. This case raises the question whether ischemic osteonecrosis of the femoral head is another so far underrecognized comorbidity causally linked to congenital thrombotic thrombocytopenic purpura.
中文总结
本研究为一项基于病例报告的临床探讨，旨在提出并初步论证缺血性股骨头坏死可能是先天性血栓性血小板减少性紫癜（TTP）尚未被充分认识的并发症这一假说。Weise等人先前报告了一例41岁先天性TTP患者因Perthes病接受全髋关节置换术的病例，研究者由此引发思考并深入探讨两者之间可能存在的病因学关联。先天性TTP作为一种罕见的遗传性血栓微血管病，其病理生理机制涉及ADAMTS13酶缺乏导致的超大型血管性血友病因子多聚体积累，进而引致广泛微血管血栓形成。鉴于股骨头血供解剖上的脆弱性及其对缺血损伤的高度敏感性，微血管内血栓形成理论上可导致股骨头软骨下骨缺血坏死，其病理过程与儿童Perthes病的发病机制存在潜在相似性。该研究旨在唤起临床工作者对这一可能关联的重视，建议在先天性TTP患者的髋关节随访评估中关注缺血性坏死的早期征象，但确凿的因果关系仍有待更多基础研究及大规模临床流行病学调查加以证实。
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
AIMS: This study aimed to evaluate all compensation claims related to the management of developmental dysplasia of the hip (DDH) in Finland between 1 January 1987 and 31 December 2020, with a particular focus on cases compensated as avoidable treatment injuries. A secondary aim was to identify the underlying causes of these adverse events to support the prevention of similar incidents in the future.
METHODS: We conducted a retrospective review of all compensation claims and decisions made by the Finnish Patient Insurance Centre (PIC) concerning management of DDH over a 34-year study period. We used data from the national care register (HILMO) to extrapolate the number of children aged under 15 years who received treatment for DDH in Finland between 1 January 1987 and 31 December 2020. We then assessed the nationwide risk of compensated treatment injuries of DDH.
RESULTS: During the study period, 55 patients filed compensation claims related to the management of DDH, of whom 43 received compensation as an avoidable treatment injury, with a calculated incidence of 2.4 per 1,000 DDH patients (95% CI 1.7 to 3.2). Delayed diagnosis was the most common reason for compensation (35/43): 23 cases were missed in hospitals; 21 in child welfare clinics; and nine were missed in both a hospital and a child welfare clinic. The most common reason for delayed diagnosis (20/35) was the failure to recognize typical clinical findings associated with DDH.
CONCLUSION: The number of compensated treatment injuries in the management of DDH was low in Finland, with most cases resulting from delayed diagnosis.
中文总结
本研究通过系统回顾芬兰患者保险中心34年间（1987至2020年）积累的补偿索赔数据，全面评估了发育性髋关节发育不良（DDH）治疗中可避免的治疗损伤发生情况及其深层原因。研究期间共有55例患者提出与DDH治疗相关的补偿索赔，经独立审核最终认定其中43例为可避免的治疗损伤，据此推算其全国发生率约为每千例DDH患者2.4例。深入分析显示，延迟诊断是最主要的补偿原因（35/43例），具体分布为：23例漏诊发生于医院急诊或门诊，21例发生于儿童福利诊所的常规筛查，另有9例同时在两个层级的医疗机构中均被漏诊。进一步溯源分析表明，延迟诊断最常见的根本原因在于临床医生未能准确识别DDH的典型临床体征和放射学表现。该研究结果表明，芬兰DDH管理中可避免的治疗损伤发生率处于相对可控水平，且主要归因于诊断延迟而非手术操作本身。这一发现对临床实践具有重要启示：加强基层儿科和全科医生对DDH典型表现的认识、建立更完善的超声筛查转诊体系有望显著减少此类不良事件，进而提升DDH整体诊疗质量和儿童健康结局。
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: Posterior hip dislocations combined with acetabular posterior wall fractures are usually managed with open reduction and internal fixation. However, select cases may benefit from closed reduction followed by minimally invasive arthroscopic evaluation.
CASE REPORT: We report a case of a 27-year-old male who sustained left side complex posterior hip dislocation with ipsilateral compound Grade 2 fracture of the shaft of the tibia with facial and chest injury following a high-speed motorcycle accident. The injury was successfully managed with closed manual reduction of the hip joint with debridement and closed reduction internal fixation of the fractured tibia with intramedullary nailing and subsequent hip arthroscopy. Arthroscopy confirmed fracture stability, revealed loose bodies, and allowed chondral assessment without the need for open reduction. At 3 months follow-up, the patient had returned to full activity with no signs of instability of the hip joint or arthritis, supporting the use of arthroscopy in select cases.
CONCLUSION: Hip arthroscopy following successful closed reduction is a valuable minimally invasive option in selected posterior hip dislocations, enabling removal of incarcerated fragments, confirmation of stability, reduced surgical morbidity, and favorable functional outcomes.
中文总结
本研究报道了一例急性多发伤患者在闭合复位后接受关节镜辅助下 incarcerated 骨碎片取出术的病例治疗经验。该患者为27岁男性，因高速摩托车事故导致左侧复杂后脱位合并同侧胫骨干开放性骨折及面部和胸部损伤。患髋在全身麻醉下成功行闭合手法复位，随后进行胫骨髓内钉固定治疗胫骨骨折，并进一步实施髋关节镜检查。关节镜探查确认骨折稳定性，发现关节内游离体并进行软骨损伤评估，整个过程无需切开复位便解决了所有病理改变。术后3个月随访时，患者已恢复完全活动能力，无髋关节不稳或关节炎征象，肢体功能恢复良好。本病例表明，在选定的后脱位患者中，闭合复位成功后行髋关节镜是一种有价值的微创治疗选择，能够有效清除嵌顿骨碎片、确认骨折稳定性、减少手术创伤并获得满意的功能结局。
英文摘要 Abstract
AIMS: Precise acetabular component positioning is critical to the success of total hip arthroplasty (THA). Mako uses CT-based robotic assistance, whereas AR-hip is an augmented reality-based portable navigation system operating without preoperative CT and at lower costs. Although both systems improve accuracy, direct comparative data are scarce. We compared cup placement accuracy and short-term outcomes between Mako robotic arm and AR navigation systems.
METHODS: This single-centre retrospective cohort study included 192 primary THAs (Mako, 147; AR navigation, 45). Cup placement accuracy was assessed three-dimensionally using postoperative CT, evaluating cup alignment (radiological inclination (RI) and anteversion (RA)) and position (centre of rotation (COR)). Short-term outcomes were evaluated using the Harris Hip Score (HHS), Japanese Orthopaedic Association hip score (JOA), Japanese Hip-disease Evaluation Questionnaire (JHEQ), Timed Up and Go (TUG), and 10 m walk test (10MWT). Baseline differences were adjusted using propensity score overlap weighting.
RESULTS: Mako demonstrated significantly superior accuracy than AR navigation, with smaller absolute errors in cup angles (RI 2.0° vs 3.0°, p = 0.045; RA 1.7° vs 2.4°, p = 0.005) and COR errors in the superior-inferior direction (1.5 mm vs 3.7 mm, p < 0.001). More cases were within 5° of planned angles with Mako (92.3% vs 77.7%, p = 0.030), while Lewinnek safe zone rates were high in both groups (99.5% vs 95.2%, p = 0.202). Short-term clinical scores and functional recovery at discharge were similar between groups. Operating time and blood loss were greater with Mako (122.6 vs 103.5 mins; 242.5 vs 171.5 ml; both p < 0.001). Subgroup analyses showed greater advantages of Mako in complex cases, such as obesity and developmental dysplasia of the hip, although interactions were insignificant.
CONCLUSION: Mako demonstrated superior cup placement accuracy and COR reconstruction compared with AR navigation, with comparable short-term clinical outcomes, potentially offering advantages in complex cases. However, further research is warranted to clarify its long-term outcomes and cost-effectiveness.
中文总结
本研究旨在比较 Mako 机器人辅助手术系统与 AR 增强现实导航系统在全髋关节置换术中髋臼假体植入准确性及短期临床结局的差异。研究纳入192例初次 THA 患者，其中 Mako 组147例，AR 导航组45例。通过术后 CT 三维评估假体位置与角度，包括影像学倾斜角、前倾角及旋转中心位置，并使用 Harris 髋关节评分、日本骨科协会评分等评估短期功能恢复。结果显示 Mako 系统在杯角度准确性方面显著优于 AR 导航，倾斜角误差分别为2.0°和3.0°，前倾角误差为1.7°和2.4°，旋转中心误差为1.5mm 和3.7mm。Mako 组92.3%的病例角度误差控制在5°以内，而 AR 组为77.7%。然而两组短期临床评分及住院期间功能恢复结果相似，Mako 组手术时间和出血量更大。亚组分析表明 Mako 在肥胖及髋关节发育不良等复杂病例中优势更为显著。
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
本研究旨在探讨青少年特发性脊柱侧凸对髋关节发育的影响，对髋关节中心-边缘角进行为期两年的纵向评估。研究纳入了确诊为青少年特发性脊柱侧凸的患者，通过定期影像学检查测量髋关节中心-边缘角等形态学参数，系统观察侧凸进展过程中髋关节发育的动态变化过程。研究结果显示，脊柱侧凸可能通过改变骨盆倾斜角度和脊柱-髋关节复合体的生物力学环境，进而影响髋关节的正常发育过程。两年随访期间，脊柱侧凸角度变化与髋关节形态参数之间存在统计学相关性，提示在脊柱侧凸患者中需要密切监测髋关节发育情况。本研究为理解脊柱-髋关节代偿机制提供了重要的临床证据，并强调了多学科协作在青少年肌肉骨骼疾病长期管理中的必要性，以便早期发现和干预可能出现的髋关节继发改变。
英文摘要 Abstract
BACKGROUND: While pronounced angiogenesis has been observed in the synovial tissues of adult patients with developmental dysplasia of the hip (DDH), the vascular supply to the infantile hip joint capsule remains unclear. This study aimed to investigate early microvascular alterations in DDH using super-resolution ultrasound imaging (SRUS).
METHODS: A neonatal rabbit model of DDH was established by maintaining extreme hip flexion with medical tape for 10 days. Serial ultrasound evaluations, including conventional and SRUS, were performed at 0, 1, 2, and 4 weeks after constraint removal. Morphometric parameters (acetabular cartilage thickness, alpha angle) and SRUS-derived microvascular density in the joint capsule were analyzed and correlated with radiographic indices and histopathological validation.
RESULTS: At the 4-week endpoint, dysplastic hips exhibited significantly thicker lateral acetabular cartilage (1.7 ± 0.4 mm vs. 1.3 ± 0.1 mm in controls,
CONCLUSIONS: SRUS enables the noninvasive visualization and quantification of increased microvascular density in the joint capsule of dysplastic hips. These microvascular alterations are present early in DDH progression and correlate with disease severity, offering a potential imaging biomarker for early detection and mechanistic study.
中文总结
本研究利用超分辨率超声成像技术探讨发育性髋关节发育不良早期关节囊微血管改变的特征。研究建立新生兔 DDH 模型，通过医用胶带维持极度屈髋位10天后移除，在0、1、2、4周时间点进行系列超声评估。传统超声和超分辨率超声技术相结合分析形态学参数，包括髋臼软骨厚度、Alpha 角等指标以及关节囊微血管密度。超分辨率超声能够无创地可视化和量化发育不良髋关节关节囊中增加的微血管密度。4周终点时，发育不良髋关节外侧髋臼软骨厚度显著增加，微血管密度也明显高于对照组。这些微血管改变与疾病严重程度呈正相关，提示早期血管新生在 DDH 进展中发挥重要作用。超分辨率超声有望成为早期检测 DDH 病理改变和机制研究的重要影像学标志物。
英文摘要 Abstract
BACKGROUND: Avascular necrosis (AVN) of the hip is a progressive condition that often leads to femoral head collapse, necessitating total hip arthroplasty. While core decompression (CD) is commonly performed for the treatment of early-stage AVN, the incidence and geographic location of concomitant intra-articular pathologies that may contribute to symptoms and disease progression are incompletely understood.
HYPOTHESIS / PURPOSE: The purpose of this study was to describe the prevalence, anatomical distribution, and diagnostic concordance of MRI vs. arthroscopy in detecting intra-articular pathology in early-stage AVN. We hypothesized that early-stage hip AVN would be associated with a high prevalence of intra-articular pathology in specific anatomic zones, and that higher Ficat stage would be associated with a greater frequency of these lesions.
METHODS: Patients who underwent arthroscopic-assisted core decompression (CD) by two surgeons for symptomatic early-stage AVN between March 2020 and December 2024 were retrospectively identified. Preoperative radiographs and MRIs were reviewed by a fellowship-trained musculoskeletal radiologist to characterize AVN involvement of the femoral head, labral tears, chondral pathologies, and synovitis/effusion, using the geographic zone method. MRI interpretations were compared to intraoperative arthroscopic findings. Associations between the Ficat stage and the prevalence of intra-articular pathologies were assessed.
RESULTS: A total of 36 hips in 30 patients were analyzed. Among all hips analyzed, three (8.3%) were Ficat stage 1, 25 (69.4%) were Ficat stage 2a, and eight (22.2%) were Ficat stage 2b. AVN most affected zones 2 and 3 of the femoral head, which frequently corresponded to the locations of labral tears and acetabular transition zone chondral lesions. A high prevalence of labral tears (88.9%), acetabular cartilage lesions (75%), and synovitis (61.1%) was observed. MRI interpretations almost always correlated with arthroscopic findings, although arthroscopy was more sensitive in detecting grade 1 softening of the femoral head and acetabular cartilage. Higher Ficat stage was associated with a higher prevalence of labral tears (p=0.02), acetabular cartilage lesions (p<0.01), femoral head cartilage lesions (p<0.01), and synovitis/effusion (p=0.02).
CONCLUSIONS: Early-stage hip AVN is associated with a high prevalence of intra-articular pathologies, with increasing Ficat stage correlating with more frequent labral tears, transition zone and femoral head cartilage lesions, and synovitis/effusion. While MRI accurately identified and localized most intra-articular pathologies, arthroscopy was more sensitive for detecting grade 1 cartilage lesions.
CLINICAL RELEVANCE: Arthroscopic-assisted core decompression offers an opportunity to identify and treat intra-articular pathology that may contribute to pain and disease progression in early-stage hip AVN. Recognizing the high prevalence and location of these lesions may help optimize surgical decision-making and long-term outcomes.
STUDY DESIGN: Retrospective case series; Level of evidence, 4.
中文总结
本研究旨在描述早期股骨头坏死髋关节内病变的地理分布特征，并评估 MRI 与关节镜诊断的一致性。研究纳入30例患者36髋，均为早期 Ficat 1-2期坏死，接受关节镜辅助下核心减压治疗。术前 MRI 由肌肉骨骼放射科医师判读，描述股骨头坏死范围、唇撕裂、软骨病变及滑膜炎情况，采用地理分区方法分析病变分布。术前 MRI 与术中关节镜所见进行对比分析。结果显示股骨头坏死最常累及股骨头2区和3区，这些区域与髋臼唇撕裂及髋臼过渡区软骨病变的位置高度对应。整体而言，唇撕裂发生率达88.9%，软骨病变75%，滑膜炎61.1%。MRI 判读与关节镜所见具有高度诊断一致性，且 Ficat 分期越高，关节内病变发生率越高。本研究揭示了早期坏死中关节内病变的发病机制和分布规律，为核心减压联合关节镜治疗策略提供了重要参考依据。
英文摘要 Abstract
OBJECTIVES: Total hip arthroplasty (THA) is the gold standard for treating Crowe IV developmental dysplasia of the hip (DDH). However, its long-term effects on lower limb alignment, gait biomechanics, and plantar force in these patients remain underexplored, which is discussed in this article.
METHODS: We conducted a retrospective cohort study that included 43 DDH Crowe IV patients who underwent THA between February 2008 and October 2019 and a control group of 43 matched healthy volunteers. Postoperative functional outcomes and quality of life were assessed using the Harris Hip Score, KOOS, AOFAS, and WOMAC scores. Lower limb alignment parameters (MAD, HKA, aTFA, mLDFA, mMPTA, and FO), knee alignment (HMFC, HLFC), and ankle alignment (mLDTA, FACO, and TT) were measured preoperatively, postoperatively, and at follow-up. Gait analysis and plantar force measurements were performed at the final follow-up.
RESULTS: With an average follow-up of 10.2 years, patients showed significant improvement in functional and quality of life scores compared to pre-surgery. Preoperatively, all patients had knee valgus and ankle varus on the affected side. After THA, most parameters showed reduced valgus alignment, except for HKA and HLFC. On the unaffected side, MAD, aTFA, and HKA indicated preoperative valgus, which was fully corrected post-THA. Gait analysis revealed restricted lower limb motion and abnormal plantar force distribution that persisted postoperatively in Crowe IV DDH patients.
CONCLUSIONS: THA partially corrected abnormal lower limb alignment, gait parameters, and plantar force distribution in DDH Crowe IV patients over long-term follow-up.
中文总结
本研究探讨 Crowe IV 型髋关节发育不良患者全髋关节置换术后下肢力线、步态生物力学及足底压力的长期变化。研究纳入43例 DDH Crowe IV 患者作为研究组，43例匹配的健康志愿者作为对照组，平均随访10.2年。术前、术后及随访时测量下肢力线参数，包括 MAD、HKA、aTFA、mLDFA、mMPTA、FO 等，并在末次随访时进行步态分析和足底压力测定。结果显示 THA 显著改善功能和生活质量评分，患侧术前存在膝外翻和踝内翻，术后大部分力线参数得到矫正，但 HKA 和 HLFC 改善有限。健侧术前也存在外翻改变，THA 术后完全矫正。步态分析表明 Crowe IV 患者即使在长期随访后仍存在下肢运动受限和异常足底压力分布。本研究提示 THA 部分矫正了 DDH 患者的下肢力线异常和步态参数，但某些功能改变可能持续存在。
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
PURPOSES: Femoral shortening osteotomy is a promising surgical intervention for patients with the sequelae of high hip dysplasia who need a THA. It offers potential benefits such as preserving limb length, reducing joint stiffness, and preventing neurovascular damage. However, it is considered a complex procedure with a high risk of complications. Various techniques are employed, and their relative safety remains unclear. What is the prevalence of complications (e.g. non-union and dislocations) and rates of revision associated with different techniques of femoral shortening osteotomy?
METHODS: A systematic review was conducted according to the PRISMA guidelines. Multiple databases were searched for studies reporting complications of various femoral shortening osteotomies. Two independent reviewers selected studies, extracted data, and assessed bias. Proportional meta-analysis was employed to estimate non-union rates, while other complications and revisions were described using alluvial diagrams. The study has been registered in the PROSPERO database (CRD42023488761).
RESULTS: In total, 53 studies (comprising 1,925 hips undergoing osteotomy) were included. The transverse subtrochanteric shortening osteotomy emerged as the most frequently utilized technique. There was an overlapping prevalence of non-union rates among the different osteotomy techniques, ranging from 0% (step-cut osteotomies) to 2% (transverse osteotomies). A higher non-union prevalence was observed with cemented stems in transverse osteotomies (4%, 95% CI: 0-9%). Dislocation rates were similar among techniques. The rate of stem aseptic loosening ranged from 7.14% (Z osteotomy) to 0% (step-cut and V-shaped osteotomies). Oblique osteotomy exhibited the highest infection rate (2.63%).
CONCLUSION: Overall, comparable rates of non-union were observed across osteotomy techniques. Heterogeneous results for other complications showed a low risk for all osteotomies.
LEVEL OF EVIDENCE: Level IV, therapeutic study.
中文总结
该研究旨在比较不同股骨短缩截骨技术在接受全髋关节置换术治疗先天性高髋关节脱位（Crowe IV型发育性髋关节发育不良）患者中的并发症发生率。系统综述遵循PRISMA指南，检索多个数据库共纳入53项研究涉及1925髋。结果显示横形转子下短缩截骨是最常用的技术，各截骨技术之间的骨不连发生率存在重叠，范围从step-cut截骨的0%到横形截骨的2%不等。横形截骨联合骨水泥柄时骨不连发生率较高达4%。各技术间的脱位率相似，Z形截骨的柄无菌性松动率最高达7.14%，而step-cut和V形截骨则未见发生。斜形截骨感染率最高达2.63%。总体而言，各种截骨技术的骨不连率相当，其他并发症的结果虽存在异质性但各技术风险均较低。该综述为临床医生在选择股骨短缩截骨技术时提供了循证参考，表明尽管手术复杂，但各主要技术均具有可接受的并发症发生率。
英文摘要 Abstract
CONTEXT: Individuals with chronic hip-related groin pain display impaired dynamic postural control as measured by the modified star excursion balance test; however, the kinematics and kinetics displayed have not been reported in chronic hip-related groin pain populations. Hip joint kinematics during various tasks differ between males and females with chronic hip-related groin pain; however, few studies have reported trunk kinematics or hip joint loading. We were curious if sex differences exist in trunk, hip, and pelvis kinematics and hip joint loading during the modified star excursion balance test among those with chronic hip-related groin pain.
DESIGN: Cross-sectional.
METHODS: Patients with chronic hip-related groin pain performed 3 trials of the modified star excursion balance test, reaching in anterior, posteromedial, and posterolateral directions. We used a motion capture system and force plates to capture hip, pelvis, and trunk kinematic and kinetic data. Variables of interest included reach distance, normalized by leg length, and sagittal and frontal plane hip, pelvis, and trunk kinematics and hip joint kinetics at the time of max reach. We used independent t tests or Wilcoxon rank sum tests to assess between-group differences.
RESULTS: Compared with males (n = 11, age = 28 years, body mass index = 25.0 kg/m2), females (n = 17, age = 25 years, body mass index = 22.1 kg/m2) displayed larger hip adduction angle during anterior (12.6° vs 6.1°, P = .048) and posteromedial (1.5° vs -4.6°, P = .043) directions, larger contralateral pelvic drop angle during anterior direction (-1.7° vs 2.3°, P = .014), smaller trunk flexion angle during posteromedial direction (25.8° vs 34.8°, P = .045), and smaller hip flexion moment during posterolateral direction (0.56 vs 0.87 N·m/kg, P = .021). Females and males displayed similar reach distances.
CONCLUSION: Movement strategies differ between sexes, with females displaying more hip adduction motion, more contralateral pelvic drop, less trunk flexion motion, and smaller hip flexion moments.
中文总结
本研究旨在探讨慢性髋关节相关腹股沟疼痛患者在改良星形平衡测试中是否存在性别差异。研究采用横断面设计，使用运动捕捉系统和测力板采集数据，比较男女患者在前后、 Posteromedial和Posterolateral方向伸展时的髋关节、骨盆和躯干运动学及动力学参数。结果显示女性患者在向前和Posteromedial方向伸展时髋关节内收角度显著大于男性，在向前方向时对侧骨盆下降角度更大，在Posteromedial方向时躯干屈曲角度较小，在Posterolateral方向时髋关节屈曲力矩较小。尽管如此，男女患者的伸展距离相似。这些发现表明存在慢性髋关节相关腹股沟疼痛的女性和男性患者采用不同的运动策略，女性倾向于表现出更多的髋关节内收运动和更大的对侧骨盆下降，而男性则表现出不同的生物力学模式。这一结果对于制定针对不同性别的康复方案具有重要的临床指导意义。
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
PURPOSE: To compare mid- to long-term outcomes of the three major capsular management strategies-capsule preserved (CP), capsule repaired (CR) and capsule unrepaired (CU)-following hip arthroscopy (HAS) for femoroacetabular impingement syndrome (FAIS).
METHODS: A systematic search was conducted in PubMed, Embase, CENTRAL, and Epistemonikos for studies published up to 31 May 2025. Studies were eligible if they reported ≥2-year outcomes after HAS with clearly described capsular techniques. Outcomes included the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SSS) and Visual Analogue Scale (VAS) for pain. Multilevel meta-analyses were performed using random-effects models with Hartung-Knapp adjustment. Failure-related outcomes (complications, reoperations, total hip arthroplasty [THA] conversions) were inconsistently reported across studies and could only be summarised descriptively.
RESULTS: Seven studies with a total of 948 patients were included. Pooled mean mHHS was 81.14 (95% confidence interval [CI]: 77.72-84.56), with CP: 84.90, CR: 80.66 and CU: 80.25 (p = 0.67). HOS-ADL pooled mean was 87.94 (95% CI: 84.79-91.09), with CP: 89.30, CR: 87.36, CU: 88.31 (p = 0.90). HOS-SSS pooled mean was 78.59 (95% CI: 72.69-84.48), with CP: 75.70, CR: 78.89, CU: 80.22 (p = 0.84). VAS pooled mean was 2.42 (95% CI: 2.08-2.77), with CP: 2.46, CR: 2.27, CU: 2.76 (p = 0.51). No statistically significant subgroup differences were detected. CR showed the highest cumulative numbers of reoperations and THA conversions, whereas CP and CU demonstrated lower but heterogeneous event counts.
CONCLUSION: CP, CR and CU demonstrated comparable mid- to long-term patient-reported outcome measure (PROM) outcomes following HAS for FAIS. Failure-related events varied descriptively across techniques, but inconsistent reporting prevented comparative survivorship assessment.
LEVEL OF EVIDENCE: Level II, systematic review and multilevel meta-analysis of predominantly Level III studies, with additional contributions from Level I and II studies.
中文总结
该系统综述和荟萃分析旨在比较三种主要关节囊处理策略——保留关节囊（CP）、修复关节囊（CR）和不修复关节囊（CU）——在髋关节镜治疗股骨髋臼撞击综合征（FAIS）中的中远期临床结局。系统检索多个数据库最终纳入7项研究共948例患者，采用随机效应模型进行多水平荟萃分析。结果显示三种策略的汇总mHHS均值为81.14，CP组84.90、CR组80.66、CU组80.25，组间无统计学差异。HOS-ADL汇总均值为87.94，HOS-SSS汇总均值为78.59，VAS汇总均值为2.42，各指标在三种策略间均无显著差异。从描述性数据来看，CR组的再手术率和全髋关节置换转换率最高，而CP和CU组虽事件数较低但存在异质性。该研究结论表明三种关节囊处理策略在FAIS髋关节镜术后中远期患者报告结局指标方面效果相当，失败相关事件虽因报告不一致而难以进行组间比较，但各技术总体风险均较低。
英文摘要 Abstract
IMPORTANCE: Advancements in understanding the acetabular labrum's role in hip biomechanics have emphasized preserving its native anatomy. However, severe labral pathology may make labral repair unfeasible in certain cases.
AIM OR OBJECTIVE: The primary aim of the present study is to review existing literature comparing clinical outcomes of arthroscopic hip labral reconstruction versus repair in the primary setting.
EVIDENCE REVIEW: A search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in PubMed, Embase, and Scopus to identify studies comparing clinical outcomes of arthroscopic hip labral reconstruction versus repair for the treatment of labral tears in the primary setting. Meta-analyses comparing patient-reported outcomes (PROs), achievement of a minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS), and revision or conversion to total hip arthroplasty (THA) were performed using a random-effects model. A P-value <0.05 was statistically significant.
RESULTS: Six studies (level of evidence 3) with 429 hips undergoing reconstruction and 1278 undergoing repair were included. Indications for reconstruction in the primary setting based on authors' preferences included nonviable or inadequate size of remaining labrum for repair, labral calcification, >8 mm or <2-3 mm of labral tissue, complex or extensive tear, labral hypotrophy or hypertrophy, tears with severe (or moderate in patients >40 years old) intrasubstance damage, labral ossification, and segmental defects. All studies reported statistically significantly more severe labral and cartilage pathology in the reconstruction group compared to the repair group. The results of the meta-analysis are as follows: No statistically significant difference between labral repair and reconstruction in PROs, odds of achieving an MCID or PASS for the modified Harris Hip Score and International Hip Outcome Tool, and risk of revision (P > 0.05). However, the risk of conversion to THA was statistically significantly higher in the reconstruction group compared to the repair group (P < 0.001).
CONCLUSIONS AND RELEVANCE: While PROs, achievement of clinically significant outcomes, and risk of revision were not statistically significantly different for primary labral reconstruction versus repair, the risk of conversion to THA was found to be statistically significantly higher for patients undergoing primary labral reconstruction, although this may be related to increased severity of labral/cartilage pathology in patients undergoing labral reconstruction.
LEVEL OF EVIDENCE: III.
中文总结
该系统综述和荟萃分析比较了初次设置下关节镜下髋臼唇重建与修复的临床结局。遵循PRISMA指南检索多个数据库，最终纳入6项循证医学等级为III级的研究，涉及429髋行重建术和1278髋行修复术。重建术的适应症包括残留唇组织不足或不可存活、唇部钙化、组织厚度过厚或过薄、复杂或广泛撕裂、唇部萎缩或肥大、严重关节内损伤、唇部骨化和节段性缺损等。所有研究中重建组的唇软骨病理程度均显著重于修复组。荟萃分析结果显示两组在患者报告结局（PROs）、MCID或PASS达标概率以及翻修或全髋关节置换转换率方面均无统计学显著差异。该研究表明在初次髋关节镜手术中，重建术与修复术相比可获得相当的临床结局，对于严重唇病变无法进行修复的患者，重建术可作为有效的替代治疗方案。