英文摘要 Abstract
N/A
中文总结
该论文聚焦于儿童发育性髋关节发育不良（DDH）治疗中采用开放复位联合圆韧带重建术的相关考虑因素与临床挑战。开放复位作为DDH外科治疗的重要手段，在某些特定病例中可能需要同时进行圆韧带的重建以恢复髋关节的稳定性与生物力学功能。然而，圆韧带重建的技术难度较高，涉及移植物的选择、固定方式以及软组织愈合等诸多问题。该研究深入探讨了手术指征的把握、术前评估的准确性、手术技术的关键要点以及术后康复管理的最佳策略，旨在为临床医生提供实用的指导建议，改善此类复杂手术的临床预后。
英文摘要 Abstract
BACKGROUND: Hip disorders in childhood and adolescence require precise imaging to prevent maldevelopment, deformities, and early osteoarthritis.
ULTRASOUND: Ultrasound is the primary first-line modality: radiation-free, dynamic, and indispensable in infancy. It provides detailed assessment of cartilaginous and soft-tissue structures and is essential in developmental dysplasia of the hip (DDH) to evaluate maturation and femoral head centration. It also enables rapid detection of joint effusions in transient synovitis or septic arthritis, as well as inflammatory changes in juvenile idiopathic arthritis (JIA). In addition, ultrasound offers useful early clues in Legg-Calvé-Perthes disease and slipped capital femoral epiphysis (SCFE).
RADIOGRAPHY: From about 6 months of age, radiography becomes central to evaluating the bony anatomy. Standard projections such as the anteroposterior pelvic view and the frog-leg lateral view allow reliable assessment of acetabular morphology, femoral head position, and head-neck geometry.
MAGNETIC RESONANCE IMAGING: Magnetic resonance imaging (MRI) is the most comprehensive cross-sectional technique. It expands diagnostic capabilities in Perthes disease, SCFE, inflammatory conditions, and tumors, and provides detailed visualization of cartilage, the labrum, bone marrow edema, and torsional alignment. Modern fast sequences enable short, focused examinations in young children, often without the need for sedation.
COMPUTED TOMOGRAPHY: Computed tomography (CT) is reserved for specific indications and is valuable for analyzing complex osseous structures.
ZUSAMMENFASSUNG: HINTERGRUND: Hüftbeschwerden im Kindes- und Jugendalter erfordern eine präzise bildgebende Diagnostik, um Fehlentwicklungen, Deformitäten und Arthrosen zu vermeiden.
SONOGRAPHIE: Die Sonographie ist die wichtigste Erstuntersuchung: strahlenfrei, dynamisch und besonders im Säuglingsalter unverzichtbar. Sie ermöglicht die Beurteilung knorpeliger und weichteiliger Strukturen, etwa bei der entwicklungsbedingten Hüftdysplasie (DDH) zur Einschätzung der Reifung und Hüftkopfzentrierung. Zudem erlaubt sie die rasche Detektion von Ergüssen bei Coxitis fugax oder septischer Koxitis sowie entzündlichen Veränderungen bei juveniler idiopathischer Arthritis (JIA). Auch bei Morbus Perthes und Epiphyseolysis capitis femoris (SCFE) liefert sie wichtige Frühhinweise. RöNTGEN: Das Röntgen stellt ab dem 6. Lebensmonat den zentralen Pfeiler der knöchernen Diagnostik dar. Standardaufnahmen wie die Beckenübersicht (a. p.-Strahlengang) und die Lauenstein-Aufnahme erlauben die Beurteilung von Pfannenform, Hüftkopfzentrierung und Kopf-Hals-Geometrie.
MAGNETRESONANZTOMOGRAPHIE: Die Magnetresonanztomographie (MRT) stellt die wichtigste Schnittbildgebungstechnik dar. Sie erlaubt die erweiterte Diagnostik bei Morbus Perthes, SCFE, entzündlichen Veränderungen und Tumoren wie auch die Beurteilung von Knorpel, Labrum, Knochenmarködemen und Torsionsverhältnissen. Schnelle Sequenztechniken ermöglichen bei Kleinkindern kurze fokussierte Untersuchungen ohne Narkose.
COMPUTERTOMOGRAPHIE: Die Computertomographie (CT) bleibt speziellen Fragestellungen vorbehalten und kann hochauflösende Darstellungen komplexer knöcherner Strukturen beitragen.
中文总结
该综述系统性地阐述了儿童与青少年髋关节疾病的影像学诊断策略，强调了不同成像方式在特定年龄阶段与病理类型中的临床应用价值。超声检查作为首选成像手段，在婴儿期髋关节发育不良的筛查与随访中具有不可替代的优势，能够实现无辐射、动态评估软骨及软组织结构的功能。X线片在六月龄后成为评估骨骼解剖的重要补充，标准体位可有效显示髋臼形态、股骨头位置及头颈关系的异常。磁共振成像（MRI）作为最全面的断层影像技术，在Perthes病、股骨头滑脱、炎性病变及肿瘤性疾病的诊断中发挥关键作用，并可清晰呈现软骨、唇盂、骨髓水肿及扭转力线等精细结构。CT则主要用于复杂骨骼形态的分析与术前规划，需权衡辐射暴露与诊断获益之间的关系。
英文摘要 Abstract
BACKGROUND: Locating the center of the nonossified femoral head on anteroposterior (AP) pelvic radiographs in children under 5 remains challenging. Hip arthrography serves as an intraoperative clinical reference in our setting, but is invasive. The agreement of magnetic resonance imaging (MRI) using bony landmarks with arthrography has not been fully established.
METHODS: Children under 5 years old with contemporaneous hip arthrograms, hip MRI, and AP pelvic radiographs were included in this retrospective study. The femoral head center was determined by the Mose concentric circle method on arthrography and MRI and proportionally projected onto a predefined coordinate system on AP pelvic radiographs. Agreement between methods for X and Y coordinates and the center-edge angle (CEA) was assessed using intraclass correlation coefficients (ICC). Intraobserver and interobserver reliability for localization and CEA measurement was assessed in a subset. In normal hips, the age-related distribution of the femoral head center was evaluated with Spearman correlation and linear regression.
RESULTS: Forty-two cases (84 hips) were analyzed; 45 normal hips (54%), median age 18 months (range: 1 to 60). In normal hips, MRI showed poor agreement with arthrography for the X coordinate (ICC=0.13), good agreement for the Y coordinate (ICC=0.89), and good agreement for CEA (ICC=0.89). Reliability was good to excellent (intraobserver ICC: 0.82 to 0.91; interobserver ICC: 0.78 to 0.89). Using arthrography-defined the femoral head centers in normal hips, the mean X-coordinate was 0%±2% of femoral neck width and showed no correlation with age (r=0.17, P=0.27). The Y coordinate showed a strong negative correlation with age (r=-0.90, P<0.001); linear model: y_coord=21.26-0.53×age (mo).
CONCLUSION: MRI can localize the femoral head center using bony landmarks in children 5 years of age or younger, but agreement with arthrography is suboptimal for the X coordinate when using this 2D bony-landmark projection approach. In normal hips, the femoral head center remains close to the femoral neck midline (small Y-coordinate) and moves distally with age.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.
中文总结
该研究旨在比较MRI与髋关节造影在定位五岁以下儿童股骨头中心方面的准确性，为临床提供更安全、有效的替代诊断方案。研究纳入四十二例患儿共八十四髋，通过Mose同心圆法在造影及MRI上确定股骨头中心，并将其按比例投射至骨盆正位片坐标系统。结果显示，在正常髋关节中，MRI与造影在Y坐标及中心边缘角（CEA）的测定上呈良好一致性（ICC=0.89），但X坐标的一致性较差（ICC=0.13）。正常髋关节中股骨头中心的X坐标约为股骨颈宽度的0%±2%，与年龄无显著相关性；而Y坐标则随年龄增长呈显著下降趋势。该研究表明，MRI可作为髋关节造影的潜在替代方案用于定位五岁以下儿童的股骨头中心，但在X坐标的测定上仍存在一定局限性，临床应用中需结合具体情况进行判断。
英文摘要 Abstract
INTRODUCTION: Arthroscopic and mini-open surgery are both valid options for managing symptomatic femoroacetabular impingement (FAI). The current systematic review compared the clinical outcomes of arthroscopic surgery versus mini-open surgery for femoroacetabular impingement. The primary outcomes assessed included patient-reported outcome measures (PROMs) and the incidence of complications.
MATERIAL AND METHODS: This systematic review followed the PRISMA statement. The Web of Science, PubMed, and Embase were accessed in June 2025 without additional filters or temporal constraints. All clinical studies concerning the surgical management of FAI were considered. Only investigations on arthroscopy or a mini-open surgical approach and those directly comparing the two techniques were included. Only studies with at least 6 months of follow-up were considered. The PROMs of interest were the visual analogue scale (VAS) and the modified Harris Hip Score (mHHS). Data on the reoperation rate and progression to total hip arthroplasty were collected. The mean difference (MD) and odds ratio (OR) measures were used for the comparisons.
RESULTS: Data from 233 clinical studies (54,272 patients) were retrieved. The mean follow-up duration was 33.9 ± 22.7 months. The mean age was 35.0 ± 5.2 years and the mean body mass index (BMI) was 25.1 ± 2.1 kg/m
CONCLUSION: Mini-open and arthroscopic surgery for symptomatic FAI achieve similar clinical outcomes and comparable complication rates at approximately 34 months follow-up. The mini-open approach was associated with a lower risk of reoperation. Future research should focus on long-term follow-up and standardized outcome measures to refine the understanding of these surgical options and enhance patient care.
ZUSAMMENFASSUNG: EINLEITUNG: Sowohl arthroskopische als auch minimal-invasive Operationen sind geeignete Optionen zur Behandlung eines symptomatischen femoroazetabulären Impingements (FAI). Die vorliegende systematische Übersicht vergleicht die klinischen Ergebnisse arthroskopischer mit denen minimal-invasiver FAI-Operationen. Zu den primären Endpunkten gehörten Patient-Reported Outcome Measures (PROMs) und die Häufigkeit von Komplikationen.
MATERIAL UND METHODEN: Diese systematische Übersicht erfolgte gemäß der PRISMA-Erklärung. Im Juni 2025 wurden die Datenbanken Web of Science, PubMed und Embase ohne zusätzliche Filter oder zeitliche Einschränkungen durchsucht. Alle klinischen Studien zur chirurgischen Behandlung von FAI wurden berücksichtigt. Es wurden nur Untersuchungen zu arthroskopischen oder mini-offenen chirurgischen Verfahren einbezogen sowie solche, die beide Techniken direkt miteinander verglichen. Es wurden nur Studien mit einer Nachbeobachtungszeit von mindestens 6 Monaten berücksichtigt. Die relevanten PROMs waren die visuelle Analogskala (VAS) und der modifizierte Harris Hip Score (mHHS). Es wurden Daten zur Reoperationsrate und zum Fortschreiten bis zur Hüfttotalendoprothese erhoben. Für die Vergleiche wurden die mittlere Differenz (MD) und die Odds-Ratio (OR) verwendet.
ERGEBNISSE: Daten aus 233 klinischen Studien (54.272 Patienten) wurden ausgewertet. Die durchschnittliche Nachbeobachtungsdauer betrug 33,9 ± 22,7 Monate. Das Durchschnittsalter lag bei 35,0 ± 5,2 Jahren und der durchschnittliche Body-Mass-Index (BMI) bei 25,1 ± 2,1 kg/m
SCHLUSSFOLGERUNG: Mini-offene und arthroskopische Operationen bei symptomatischem FAI erzielen nach einer Nachbeobachtungszeit von etwa 34 Monaten ähnliche klinische Ergebnisse und vergleichbare Komplikationsraten. Der mini-offene Ansatz war mit einem geringeren Risiko einer erneuten Operation verbunden. Zukünftige Forschungsarbeiten sollten sich auf die Langzeitnachbeobachtung und standardisierte Messinstrumente konzentrieren, um die Kenntnisse dieser chirurgischen Optionen zu verfeinern und die Patientenversorgung zu verbessern.
中文总结
该系统综述比较了关节镜手术与小切口开放手术两种方式治疗症状性股骨髋臼撞击症（FAI）的临床疗效。研究遵循PRISMA指南，通过检索Web of Science、PubMed及Embase数据库，共纳入233项临床研究涉及54272例患者，平均随访时间约34个月。结果表明，两种手术方式在患者报告结局指标（PROMs）及并发症发生率方面均取得相似的临床效果。在视觉模拟量表（VAS）评分与改良Harris髋关节评分（mHHS）的改善方面，关节镜手术与小切口开放手术之间无显著统计学差异。然而值得注意的是，小切口开放手术组患者的再手术率相对较低。该综述认为，两种手术方式均为治疗症状性FAI的有效选择，未来研究应着重于长期随访数据的积累与标准化结局指标的制定，以进一步优化患者的治疗决策与临床预后。
英文摘要 Abstract
BACKGROUND: Femoral varus osteotomy (FVO) is a common treatment for Legg-Calve-Perthes disease (LCPD). Due to concerns of decreased hip abductor strength, neck-shaft angle (NSA), and articular-trochanteric distance (ATD), concomitant greater trochanteric apophysiodesis (GTA) is often performed. While abductor strength remains a concern, no studies have quantified hip strength following FVO+GTA. The purpose of this study was to objectively quantify hip strength in patients treated with FVO+GTA using isokinetic testing and analyze contributors to abductor weakness.
METHODS: A retrospective review was conducted for 26 patients who underwent unilateral FVO+GTA at Waldenström stages 1b-3a, and hip strength testing in stages 3b-4 using an isokinetic dynamometer. The strength of the operated side was compared with the contralateral side. Clinically significant abductor weakness between the contralateral and operated side was set at ≥25% based on previous data.
RESULTS: The mean age at diagnosis was 7.7±1.2 years (range: 5.9 to 9.6) and the time from surgery to testing was 3.3±1.3 years (range: 1.8 to 6.1). While the operated side showed significant decreases in NSA ( P <0.001) and ATD ( P =0.002) compared with the contralateral side, no significant difference in the abduction strength between sides was observed with a paired t test ( P =0.15). However, when patients were grouped by those who did only home exercises (n=11, 42%) versus outpatient physiotherapy (n=15, 58%), the home exercise group showed significantly weaker abduction strength on the operated side compared with the contralateral side with a paired t test ( P =0.027), whereas the outpatient physiotherapy group was insignificant ( P =0.93). In addition, all 4 patients who had abductor weakness ≥25% on the operated side were in the home exercise group.
CONCLUSIONS: Following FVO+GTA, only 4 out of 26 patients (15%) had clinically significant abductor weakness, all of whom did only home exercises. We recommend outpatient physiotherapy after FVO+GTA to obtain more symmetrical abduction strength.
LEVEL OF EVIDENCE: Level III.
中文总结
该初步研究报告了股骨近端内翻截骨术（FVO）联合大转子骨骺固定术（GTA）治疗Legg-Calvé-Perthes病后髋关节外展肌力量的客观评估结果。研究纳入26例接受单侧FVO+GTA手术的患者，采用等速动力仪进行力量测试，并将手术侧与对侧进行比较。结果显示，尽管手术侧的颈干角（NSA）及关节-转子距离（ATD）较对侧显著减小，但两组间在外展肌力量方面并未发现统计学显著差异。进一步亚组分析表明，仅进行家庭锻炼的患者组（42%）在手术侧表现出显著的外展肌力量减弱，而门诊物理治疗组（58%）则未出现此现象。所有4例手术侧外展肌力量减弱程度≥25%的患者均来自家庭锻炼组。该研究表明，FVO+GTA术后外展肌力量减弱的发生率较低（15%），但术后康复过程中规范的门诊物理治疗介入可能有助于预防或减少外展肌功能缺陷的发生。
英文摘要 Abstract
INTRODUCTION: The Pavlik harness is the standard first-line treatment for developmental dysplasia of the hip (DDH) in infants younger than six months. However, the optimal strategy for discontinuation after successful hip reduction remains debated. This study aimed to compare clinical and radiological outcomes between immediate discontinuation and gradual weaning using the Frejka pillow following successful Pavlik harness treatment.
METHODS: We retrospectively analyzed data from 144 infants (166 hips) with DDH treated with the Pavlik harness between 2012 and 2023. Patients were categorized into two groups: Group A underwent immediate cessation, while Group B was gradually weaned using a Frejka pillow. Radiological follow-up included acetabular index (AI), lateral center-edge angle (LCEA), and assessment of AVN based on the Kalamchi-MacEwen classification, up to five years of age.
RESULTS: The two groups were demographically similar. There were no statistically significant differences in recurrence rates (Group A: 9%, Group B: 5%; p = 0.53) or AVN incidence (Group A: 6.25%, Group B: 10%; p = 0.55). Group B showed a non-significant trend toward higher LCEA values at five years (p = 0.08), potentially indicating better acetabular development. However, the slightly increased AVN rate in this group raises concerns regarding prolonged abduction.
CONCLUSION: Both immediate discontinuation and gradual weaning protocols yield comparable outcomes in terms of recurrence and AVN. While gradual weaning may offer marginal benefit in acetabular development, the potential vascular risks warrant further investigation. Larger prospective studies are needed to establish standardized discontinuation guidelines in DDH management.
LEVEL OF EVIDENCE: III, retrospective comparative study.
中文总结
该回顾性比较研究探讨了发育性髋关节发育不良（DDH）婴儿在Pavlik吊带治疗成功后，逐步递减使用与立即停用的临床结局差异。研究共纳入144例患儿（166髋），分为即刻停止组与使用Frejka枕逐步递减组，随访至五岁时的放射学与临床结果。结果显示，两组在复发率（9%对比5%）及股骨头缺血性坏死（AVN）发生率（6.25%对比10%）方面均无统计学显著差异。逐步递减组在五岁时的中心边缘角（LCEA）呈现出不显著升高趋势，可能提示髋臼发育的边际改善。然而，该组AVN发生率略高的现象也引发了关于长期外展体位可能带来血管风险的关注。该研究认为，两种治疗方案在DDH管理中均展现出可接受的疗效，但逐步递减方案对髋臼发育的潜在益处需与血管安全性进行权衡，未来仍需更大样本的前瞻性研究以制定标准的治疗终止方案。
英文摘要 Abstract
BACKGROUND: Pediatric hip disorders differ from those seen in adults.
OBJECTIVE: To present the incidence, aetiology, pathogenesis, diagnosis, and treatment of the most common pediatric hip disorders.
MATERIAL AND METHODS: Review of fundamental studies, research articles, and expert recommendations on the topic.
RESULTS: The management of the most common pediatric hip disorders is largely consensual. Timely diagnosis and treatment of septic arthritis of the hip and slipped capital femoral epiphysis are of particular urgency.
CONCLUSIONS: Due to the complexity of these conditions, affected patients should be managed in collaboration with specialists in pediatric orthopedics.
ZUSAMMENFASSUNG: HINTERGRUND: Pädiatrische Hüfterkrankungen unterscheiden sich von denen der Erwachsenen.
FRAGESTELLUNG: Darstellung der Inzidenz, Ätiologie, Pathogenese, Diagnostik und Therapie der häufigsten pädiatrischen Hüfterkrankungen.
MATERIAL UND METHODE: Überblick über Grundlagenarbeiten, Studien und Expertenempfehlungen zum Thema.
ERGEBNISSE: Der Umgang mit den häufigsten pädiatrischen Hüfterkrankungen ist weitgehend konsensual. Besonders dringlich ist die rechtzeitige Diagnostik und Therapie von septischer Koxarthritis und Epiphyseolysis capitis femoris.
SCHLUSSFOLGERUNGEN: Die Begleitung der betroffenen Patient:innen sollte aufgrund der Komplexität der Erkrankungen in Zusammenarbeit mit Spezialist:innen aus dem Bereich der Kinder- und Jugendorthopädie erfolgen.
中文总结
儿童及青少年髋关节疾病在病因学、临床表现及治疗策略上均与成人存在显著差异。本综述旨在系统阐述该人群中最常见髋关节疾病的发病率、病因、发病机制、诊断方法及治疗原则。研究表明，髋关节感染性疾病的早期诊断与治疗尤为紧迫，化脓性髋关节炎若延误处理可导致软骨破坏及股骨头坏死等严重并发症；股骨头骺滑脱症作为青少年常见的髋关节病变，同样需要及时干预以防止进行性畸形。此外，发育性髋关节发育不良在婴儿期通过超声筛查可实现早期发现，非手术治疗效果显著。由于此类疾病病情复杂，涉及多学科协作，患者应于儿童骨科专科医师处接受规范化诊疗管理，以获得最佳预后。本综述全面回顾了相关基础研究、临床文献及专家共识，为儿童骨科医师提供规范化诊疗指导。
英文摘要 Abstract
Developmental dysplasia of the hip (DDH) is among the most common congenital musculoskeletal disorders and may lead to early hip osteoarthritis if left untreated. Modified Pemberton acetabuloplasty is an established, growth-preserving osteotomy technique for surgical correction in childhood. However, robust clinical long-term outcomes with follow-up periods exceeding two decades have not yet been published. The aim of this study was to retrospectively evaluate functional and patient-reported outcomes after an average follow-up of 25.6 years.In this monocentric retrospective cohort study, 63 patients (92 hips) were included from an original cohort of 331 patients with 507 operated hips who had undergone modified Pemberton acetabuloplasty between 1990 and 1995. In 2018, clinical follow-up was performed in 54 patients; all participants completed standardised questionnaires, including the Harris Hip Score (HHS), WOMAC, and EQ-5D. Data analysis was descriptive.The mean follow-up period was 25.6 years. The average HHS was 95.8 points, the mean WOMAC index 7.2 points, and the EQ-5D-VAS 89.3/100. A total of 81% of patients were free of symptoms, and 83.3% achieved excellent functional results. Overall, 96.8% rated the surgical outcome as good or very good, and 92% would choose to undergo the procedure again. No patient required total hip arthroplasty. No major postoperative complications occurred.Modified Pemberton acetabuloplasty demonstrates stable functional outcomes, low symptom levels, and high health-related quality of life more than 25 years after surgery. The very high patient satisfaction and the absence of secondary procedures underscore the long-term clinical effectiveness of this growth-preserving technique.
Die entwicklungsbedingte Hüftdysplasie zählt zu den häufigsten angeborenen Erkrankungen des Bewegungsapparates und kann unbehandelt zur frühzeitigen Koxarthrose führen. Die modifizierte Pemberton-Azetabuloplastik stellt als wachstumserhaltende Korrekturosteotomie ein etabliertes Verfahren zur operativen Behandlung im Kindesalter dar. Belastbare klinische Langzeitergebnisse mit Nachbeobachtungszeiträumen von über 2 Jahrzehnten fehlen jedoch bislang. Ziel der vorliegenden Studie war die retrospektive Analyse des funktionellen und subjektiven Outcomes nach durchschnittlich 25,6 Jahren.In dieser monozentrischen, retrospektiven Kohortenstudie wurden aus einem ursprünglichen Kollektiv von 331 Patient*innen mit insgesamt 507 operierten Hüftgelenken, die zwischen 1990 und 1995 mittels modifizierter Pemberton-Azetabuloplastik behandelt worden waren, insgesamt 63 Patient*innen (92 Hüftgelenke) eingeschlossen. 2018 erfolgte eine klinische Nachuntersuchung bei 54 Patient*innen; bei allen lag ein vollständig ausgefüllter Fragebogen mit HHS-, WOMAC- und EQ-5D-Index vor. Die Auswertung erfolgte deskriptiv.Die mittlere Nachbeobachtungszeit betrug 25,6 Jahre. Der durchschnittliche Harris Hip Score lag bei 95,8 Punkten, der WOMAC-Index bei 7,2 Punkten und der EQ-5D-VAS bei 89,3/100. 81% der Patient*innen waren beschwerdefrei, 83,3% erzielten ein sehr gutes funktionelles Ergebnis. 96,8% bewerteten das Operationsergebnis als gut bis sehr gut, 92% würden sich retrospektiv erneut für den Eingriff entscheiden. Kein Fall erforderte eine Hüfttotalendoprothese. Schwere postoperative Komplikationen traten nicht auf.Die modifizierte Pemberton-Azetabuloplastik zeigt auch nach über 25 Jahren stabile funktionelle Ergebnisse, geringe Beschwerden und eine hohe gesundheitsbezogene Lebensqualität. Die sehr hohe Patientenzufriedenheit und das Fehlen von Folgeeingriffen unterstreichen die langfristige klinische Effektivität dieses wachstumsschonenden Verfahrens.
中文总结
发育性髋关节发育不良是常见的先天性肌肉骨骼疾病，若未及时干预可导致早期髋关节骨关节炎。改良Pemberton髋臼成形术作为一种保留生长潜力的截骨技术，已广泛应用于儿童期手术矫正。本研究旨在评估该术式长期临床疗效，对1990至1995年间接受手术的331例患者（507髋）进行回顾性分析，于2018年完成平均25.6年随访期临床评估。54例患者（92髋）纳入最终分析，采用Harris髋关节评分、WOMAC指数及EQ-5D量表进行功能评估。结果显示平均Harris评分为95.8分，WOMAC指数为7.2分，EQ-5D视觉模拟量表为89.3分。81%患者无明显症状，83.3%获得优异功能结果，96.8%对手术效果评价为良好或非常好，92%表示愿意再次接受该手术。无一例患者需行全髋关节置换术，亦无严重术后并发症发生。本研究证实改良Pemberton髋臼成形术在术后25年以上仍能维持稳定的功能预后，具有可靠的长期临床有效性。
英文摘要 Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) ranges from mild acetabular dysplasia to complete dislocation. Early diagnosis gives the opportunity for nonsurgical management. Delayed detection often necessitates invasive procedures. This study examined recent trends in infant hip ultrasound utilization, DDH incidence, and surgical reduction to assess whether increased imaging has translated into earlier diagnosis and reduced surgical burden.
METHODS: A retrospective cohort study was conducted using the TriNetX Network from 2013 to 2024. ICD and CPT codes identified infants undergoing hip ultrasound within the first 6 months of life. Annual incidence of ultrasound use, DDH diagnosis, and open or closed reductions in children below 5 years was calculated. Analyses were stratified by academic versus nonacademic institutions. Demographic associations with ultrasound utilization were examined using multivariable logistic regression.
RESULTS: Among 8,655,956 infants, 135,192 (1.56%) underwent hip ultrasound. Utilization in the United States declined from 0.523% in 2013 to 0.325% in 2017, then rose to 0.543% in 2024. DDH incidence decreased from 0.41% in 2013 to 0.19% in 2020, then increased to 0.28% in 2024. Academic centers reported higher ultrasound utilization and DDH incidence. Open reduction incidence remained low (0.0024% to 0.0032%) but rose slightly after 2018. Closed reductions occurred more often (0.0033% to 0.0044%) and increased modestly post-2018. Female infants had higher odds of ultrasound than males (OR: 1.72; 95% CI: 1.69-1.75; P<0.001). Black (OR: 0.56; 95% CI: 0.55-0.57; P<0.001) and Native American (OR: 0.56; 95% CI: 0.49-0.65; P<0.001) infants had lower odds of ultrasound, while Asian infants had higher odds (OR: 1.23; 95% CI: 1.20-1.27; P<0.001).
CONCLUSIONS: From 2013 to 2024, the incidence of hip ultrasound utilization and DDH diagnoses initially declined, then rose. Incidence of open and closed reduction also began rising in 2018, suggesting persistent late diagnosis or delays in care despite greater imaging availability. Standardized care pathways, timely orthopaedic referral, and equitable access to imaging are needed to promote early diagnosis that translates into successful nonoperative management.
LEVELS OF EVIDENCE: Level III-retrospective cohort.
中文总结
发育性髋关节发育不良涵盖从轻度髋臼发育不良到完全脱位的一系列病理改变。早期诊断可提供非手术治疗机会，而延迟发现往往需采取有创手术干预。本研究利用TriNetX网络数据库，回顾性分析2013至2024年间美国婴儿髋关节超声筛查应用率、DDH发病率及手术复位率的变化趋势。研究纳入8655956例婴儿，其中135192例（1.56%）在生后6个月内接受了髋关节超声检查。超声检查利用率从2013年的0.523%下降至2017年的0.325%，随后回升至2024年的0.543%。DDH发病率从2013年的0.41%下降至2020年的0.19%，后回升至2024年的0.28%。学术中心报告了更高的超声检查利用率和DDH发病率。女性婴儿接受超声检查的概率显著高于男性（OR: 1.72），而黑人（OR: 0.56）及美洲原住民婴儿（OR: 0.56）概率较低，亚裔婴儿则较高（OR: 1.23）。研究结论指出，尽管筛查覆盖率有所波动，但手术复位率在2018年后仍呈小幅上升趋势。
英文摘要 Abstract
Congenital hip dislocation represents the most severe form of developmental dysplasia of the hip (DDH) and, if left untreated, it leads to permanent functional impairment. Since the nationwide implementation of ultrasound screening in Germany in 1996, the condition can be detected and managed early on. The primary goal of treatment is a stable concentric reduction of the femoral head to allow normal acetabular development. In irreducible hips, operative reduction and additional corrective osteotomies may be required. Early diagnosis, standardized treatment protocols, and close follow-up are essential to achieve optimal long-term outcomes.
Die kongenitale Hüftluxation ist die schwerste Form der kongenitalen Hüftdysplasie und führt unbehandelt zu bleibenden Funktionseinschränkungen. Durch das seit 1996 etablierte Hüftscreening mittels Ultraschall kann sie frühzeitig erkannt und behandelt werden. Ziel ist die stabile Rezentrierung des Hüftkopfs und die physiologische Pfannenentwicklung. Bei irreponiblen Hüften sind operative Repositionen, gegebenenfalls in Kombination mit knöchernen Korrekturen erforderlich. Frühdiagnostik, standardisierte Therapie und engmaschige Kontrollen sichern die besten Langzeitergebnisse.
中文总结
先天性髋关节脱位是发育性髋关节发育不良的最严重形式，若未经治疗将导致永久性功能障碍，严重影响患儿生活质量。德国自1996年实施全国性超声筛查体系以来，该病得以早期发现与干预，显著改善了患儿预后。治疗的核心目标是实现股骨头的稳定同心复位，促进髋臼正常发育，为股骨头与髋臼之间建立良好的生物力学环境。对于无法闭合复位的髋关节，可能需要手术复位并辅以矫正性截骨术以实现解剖复位。早期诊断、标准化治疗方案及密切随访是获得最佳长期预后的关键要素。本综述详细阐述了DDH的诊疗要点，强调在综合管理策略下规范化诊治流程的重要性，建议所有疑似病例转诊至儿童骨科专科接受规范化评估与治疗，以最大程度改善患儿长期功能预后。
英文摘要 Abstract
BACKGROUND: Recent animal studies have suggested that cartilage hypertrophy may occur in Legg-Calvé-Perthes disease (LCPD), potentially influencing femoral head morphology during containment treatment. We aimed to analyze cartilage hypertrophy in children with LCPD using magnetic resonance imaging (MRI) and assess its relationship with long-term femoral head outcomes.
METHODS: Fifty-five patients with unilateral LCPD who underwent conservative containment treatment were evaluated. Cartilage thickness was measured in 10 distinct regions on coronal and sagittal MRI scans obtained during the early stage of the disease. Enlargement of the femoral head due to bone or cartilaginous components was also assessed. The relationships between clinical and radiologic variables, including age and the cartilage thickness ratio, and Stulberg classification at skeletal maturity, were analyzed.
RESULTS: Femoral head enlargement was observed on the affected side compared with the normal side, primarily due to cartilage hypertrophy, whereas bony epiphyseal enlargement followed an age-dependent pattern on both sides. Cartilage hypertrophy occurred in multiple directions but was most pronounced in the lateral region. Onset age and horizontal cartilage hypertrophy emerged as independent prognostic indicators for the Stulberg classification. Severe deformities, defined as Stulberg class III or more, were observed in only 6% of children aged 7 years or younger with a cartilage thickness ratio of ≤3.7, whereas 83% of children aged 7 years or younger with a ratio >3.7 developed severe deformities.
CONCLUSION: Cartilage hypertrophy, frequently observed in early-stage LCPD, is associated with enlargement of the femoral head. The extent of horizontal hypertrophy and age at onset may serve as key prognostic indicators of femoral head deformity progression.
LEVEL OF EVIDENCE: Level III-study of nonconsecutive patients in diagnostic studies.
中文总结
Legg-Calvé-Perthes病是一种特发性股骨头缺血性坏死，好发于儿童。近期动物实验研究表明，软骨肥大可能在该病保守治疗期间发生，进而影响股骨头形态发育。本研究纳入55例接受保守包容治疗的的单侧LCPD患儿，于疾病早期行MRI扫描并在10个不同区域测量软骨厚度，评估股骨头增大情况及其与Stulberg分类的相关性。研究发现患侧股骨头较正常侧增大，主要原因为软骨肥大而非骨性成分；软骨肥大在多个方向发生，以外侧区域最为显著。发病年龄及水平软骨肥大被确认为Stulberg分类的独立预后指标。7岁及以下患儿若软骨厚度比值≤3.7，仅6%发展为重度畸形；而相同年龄组若比值>3.7，则83%将发展为Stulberg III类或更严重的畸形。本研究表明，早期LCPD常见的软骨肥大现象与股骨头增大密切相关，水平软骨肥大程度及发病年龄可作为股骨头畸形进展的重要预后指标。
英文摘要 Abstract
BACKGROUND: After successful treatment of developmental dysplasia of the hip (DDH) with a Pavlik harness, controversy exists about whether it's best to continue harness use for an additional "weaning" period or simply terminate treatment. The purpose of this randomized controlled trial (RCT) was to compare radiographic outcomes between patients with stable hip dysplasia who were weaned (W) or not weaned (NW) after Pavlik harness treatment.
METHODS: This was a single-center RCT of infants with stable ultrasonographic dysplasia in whom a Pavlik harness was initiated at <3 months of age. After 23 hours/day of harness treatment and normalization of ultrasound indices, patients were randomized into W or NW groups. W patients continued harness use for an additional 4 to 6 weeks, progressively decreasing daily use. Primary outcome was acetabular index (AI) on AP radiographs of the pelvis at 6 months of age. Secondary outcomes were number of hips with AI ≥ 30 degrees at 6 months (our threshold for prescribing part-time abduction bracing for residual dysplasia) and AI at 1 year of age.
RESULTS: Seventy-two patients (36 W, 36 NW) met inclusion criteria. There were no differences between W and NW cohorts in age at Pavlik initiation or baseline alpha angle or percent femoral head coverage. At time of ultrasonographic normalization, there was no significant difference in mean time spent in the harness between W and NW cohorts (35.0 vs. 34.9 d, P =0.84). At 6 months, mean AI was significantly lower in the W cohort (24.8±3.9 deg.) compared with the NW cohort (26.9±3.4 deg.) ( P =0.02). Fewer braces were prescribed for residual dysplasia at 6 months in the W versus NW cohort (17% vs. 22%), but this was not statistically significant ( P =0.56). AI at 1 year of age was not significantly different between groups (W 24.6±3.4 deg.; NW 25.3±2.3 deg., P =0.84) but this likely was affected by the use of additional bracing.
CONCLUSIONS: A Pavlik weaning protocol resulted in improved AI at 6 months of age versus immediate termination of treatment. At 1 year, AI was not significantly different between W and NW cohorts, likely due to the use of additional part-time bracing in those who were dysplastic at 6 months.
LEVEL OF EVIDENCE: Level I-randomized controlled trial.
中文总结
Pavlik吊带是6个月以下发育性髋关节发育不良婴儿的标准一线治疗方法，但成功治疗后何时停止使用吊带仍存争议。本随机对照试验比较了稳定型髋关节发育不良婴儿在Pavlik吊带治疗后立即停用与渐进式断奶两种方案的效果。72例患儿被随机分配至断奶组（W）和非断奶组（NW），两组在超声指标正常化后分别采用不同停用方案。断奶组在超声正常化后继续使用吊带4至6周，逐渐减少每日使用时间。主要结局指标为6个月龄时髋关节指数（AI）。结果显示6个月时断奶组平均AI（24.8°±3.9°）显著低于非断奶组（26.9°±3.4°，P=0.02）。1岁时两组AI无显著差异，可能与额外支具使用有关。研究结论支持Pavlik渐进式断奶方案可改善中期髋臼发育，建议可作为标准化治疗流程的组成部分。
英文摘要 Abstract
INTRODUCTION: The functionality of the hip joint is primarily determined by the anatomical relationship between acetabulum and femur. Impairment of this relationship can lead to diseases such as femoroacetabular impingement and hip osteoarthritis. In patients undergoing total hip arthroplasty, accurate placement of the acetabular and femoral components in accordance with native 3-dimensional anatomy (3D) is crucial for obtaining prosthesis stability and survival, also for preventing postoperative complications such as wear, dislocation and osteolysis. Therefore, 3D determination of native anatomical features of the hip joint is highly important.
METHODS: A total of 100 adults were randomly selected. Right femur and acetabulum were segmented using MIMICS program. 2D and 3D measurements of femoral anteversion according to posterior condylar and transepicondylar axis, acetabular anteversion, acetabular inclination and combined anteversion were determined. The differences between gender groups and the correlations of two- and three-dimensional measurement results were evaluated.
RESULTS: According to 2D and 3D measurements, statistically significant differences were observed between gender groups in all parameters except for 2D acetabular inclination. A very strong correlation was observed between 3D femoral anteversion measurements performed using the posterior condylar axis and transepicondylar axis. Our findings revealed statistically significant differences between 2D and 3D measurements in most parameters, which have clinical relevance.
CONCLUSIONS: A very strong correlation between femoral anteversion measurements obtained using the transepicondylar and posterior condylar axes supports the intraoperative use of the transepicondylar axis reliably. We believe the data obtained from our study will contribute to understand the 3-dimensional native anatomy of the hip joint.
中文总结
髋关节功能主要由髋臼与股骨之间的解剖关系决定，两者的协调对于预防股髋撞击症及髋关节骨关节炎至关重要。在接受全髋关节置换术的患者中，假体组件的精准安放需遵循三维解剖学原则，这对获得假体稳定性、延长假体寿命及预防术后并发症如磨损、脱位及骨溶解具有重要意义。本研究纳入100例成人患者，采用MIMICS软件对右侧股骨及髋臼进行三维重建，分别进行基于二维及三维方法的股骨后倾角、髋臼前倾角、髋臼倾斜角及联合前倾角测量，并评估性别间差异及两种测量方法间的相关性。研究结果显示，除二维髋臼倾斜角外，大多数参数在性别间存在显著差异。三维股骨后倾角测量中，经股骨后髁轴线与经股骨上髁轴线两种方法呈高度相关性。二维与三维测量间存在有临床意义差异。本研究数据将有助于深入理解髋关节的三维解剖学特征。
英文摘要 Abstract
INTRODUCTION: This study aimed to compare short to mid-term functional outcomes and perioperative blood loss in patients undergoing total hip arthroplasty (THA) due to primary osteoarthritis versus those with a history of childhood open surgery for developmental dysplasia of the hip (DDH).
MATERIALS AND METHODS: This retrospective study included 216 patients who underwent THA between 2019 and 2024. Group 1 consisted of 72 patients with a history of open surgery for developmental dysplasia of the hip, and Group 2 included 144 patients with primary osteoarthritis matched at a 1:2 ratio based on body mass index (caliper width ± 2 kg/m²). Hemoglobin and hematocrit levels were recorded preoperatively and on postoperative days 0, 1, and 2. Perioperative trends were analyzed using linear mixed-effects models. Functional outcomes (Harris Hip Score-HHS, Oxford Hip Score, and The University of California Los Angeles-UCLA) were assessed preoperatively and at final follow-up. Transfusion decisions followed a standardized threshold (Hb < 7 g/dL or symptomatic anemia), and transfusion units were recorded. Radiographic leg-length discrepancy was measured on standardized AP pelvic radiographs. All patients were followed for at least one year.
RESULTS: Group 1 patients were younger and had lower preoperative functional scores. Both groups demonstrated significant postoperative improvements and the magnitude of functional gain was comparable. Mixed-effects modeling showed significant time effects for hemoglobin and hematocrit (p < 0.001), with no time × group interaction. Transfusion rates were higher in Group 1 (15.2% vs. 6.2%; risk ratio 2.44, 95% CI 1.06-5.63), largely attributable to lower preoperative Hb. No significant differences were observed in post-operative complications or leg length discrepancies.
CONCLUSION: Postoperative functional outcomes after THA are primarily influenced by preoperative functional status rather than prior DDH surgery. Early postoperative blood loss is not significantly affected by previous open surgery. These findings underscore the importance of thorough preoperative counseling and expectation management.
中文总结
本研究旨在比较因原发性骨关节炎接受全髋关节置换术患者与儿童期曾因发育性髋关节发育不良接受开放手术患者的中短期功能预后及围手术期失血量。回顾性纳入216例于2019至2024年间接受THA的患者，其中72例有儿童期DDH开放手术史（组1），144例原发性骨关节炎患者按体重指数1:2匹配（组2）。记录术前及术后第0、1、2天血红蛋白及红细胞压积，采用线性混合效应模型分析围手术期变化，采用Harris髋关节评分、牛津髋关节评分及UCLA评分评估功能预后。结果显示组1患者年龄较低且术前功能评分较差，两组术后功能均显著改善且改善幅度相当。混合效应模型显示血红蛋白及红细胞压积存在显著时间效应，无时间与组间交互作用。组1输血率（15.2%）显著高于组2（6.2%），主要归因于较低的术前血红蛋白水平。术后并发症及下肢长度差异无显著差异。研究结论指出，THA术后功能预后主要受术前功能状态影响，既往DDH手术史并非主要决定因素。
英文摘要 Abstract
INTRODUCTION: The Femoro-Epiphyseal Acetabular Roof (FEAR) index is a proposed radiographic marker of hip instability, particularly in borderline developmental dysplasia of the hip (BDDH). Its diagnostic value in other hip morphologies and its association with patient-reported outcomes (PROMs) remain unclear. This study evaluated the FEAR index for assessing hip instability across different acetabular morphologies by analyzing its associations with radiographic measures obtained from standard anteroposterior pelvic and false-profile radiographs, dynamic ultrasonography, and PROMs.
MATERIALS AND METHODS: We retrospectively studied 171 female patients (200 hips) who presented with hip pain and/or symptoms suggestive of hip instability and who underwent radiographs and ultrasonography from April 2020 to March 2024. Hips were classified by lateral center-edge angle (LCEA) as normal (≥ 25°), BDDH (20°–25°), or developmental dysplasia of the hip (DDH; <20°). Radiographic measures included the FEAR index, LCEA, vertical-center anterior angle (VCA), and head lateralization index (HLI). Dynamic instability was assessed by femoral head translation distance (FTD) on ultrasonography. Correlation between FEAR and other parameters were tested with Spearman’s rank. Receiver operating characteristic (ROC) analysis identified the FEAR cut-off for instability (FTD ≥ 2 mm). PROMs were compared between groups using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) and Numerical Rating Scale (NRS).
RESULTS: The FEAR index correlated significantly with LCEA, VCA, HLI, and FTD across all morphological groups. ROC analysis identified 5.2° as the optimal cut-off (AUC, 0.787). Patients with FEAR ≥ 5.2° had lower JHEQ scores and higher NRS scores than those with FEAR index < 5.2° (
CONCLUSIONS: The FEAR index is a simple, clinically useful radiographic marker of hip instability across BDDH, DDH, and normal hips. Its strong associations with dynamic ultrasonography and PROMs support its value as a practical tool for comprehensive hip instability assessment.
中文总结
股骨-骨骺-髋臼屋顶指数（FEAR指数）是近年来提出的髋关节不稳定放射学标志物，尤其适用于边界型发育性髋关节发育不良的评估。本研究旨在探讨FEAR指数在不同髋关节形态学条件下的诊断价值及其与患者报告结局指标（PROMS）的相关性。研究回顾性纳入171例女性患者（200髋），根据外侧中心边缘角分为正常组（≥25°）、边界型DDH组（20-25°）及DDH组（<20°）。记录FEAR指数、外侧中心边缘角、垂直中心前角及股骨头外侧化指数，并行超声检查评估动态稳定性。ROC分析确定FEAR指数最佳截断值为5.2°（AUC=0.787）。FEAR指数≥5.2°的患者JHEQ评分较低、NRS评分较高，提示髋关节功能较差。研究结论证实FEAR指数可作为评估各类髋关节形态学条件下髋关节稳定性的简便且有临床价值的放射学指标，与多种影像学参数及PROMS均有显著相关性。