英文摘要 Abstract
INTRODUCTION: The purpose of this study was to conduct an analysis of the cross-sectional area (CSA) of hip musculature before and after hip arthroscopy (HA) for femoroacetabular impingement (FAI). The hypothesis was that there will be a significant increase in the CSA of analysed hip muscles that will correlate with increases in PROs following surgery.
METHODS: This is a single-centre, single-surgeon, retrospective analysis performed between August 2011 and February 2022. All hips that had a preoperative MRI within 1 year of their date of surgery and ≥1 postoperative MRI >2 months after surgery were included. Cross-sectional areas of the gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, pectineus, sartorius, rectus femoris and tensor fascia lata muscles were measured by 1 blinded researcher and results were checked for reliability by a musculoskeletal radiologist.
RESULTS: 89 hips met criteria to be included in the analysis. The cohort had an average age of 35.8 ± 15.7 years, was 66.3% female, and had an average BMI of 23.3 ± 8.1 kg/m
CONCLUSIONS: Gluteus maximus and minimus muscles demonstrated significantly increased CSA after HA for FAI patients. Change in CSA was positively correlated with PROs for the gluteus maximus at 1-year follow-up. These findings underscore the clinical significance of muscle adaptations following hip arthroscopy for FAI.
中文总结
这项来自Hip Int的研究挺有意思，它关注的是髋关节镜术后肌肉形态变化与临床结局的关系。我们知道，股骨髋臼撞击症做完关节镜之后，患者报告的临床评分确实会改善，但肌肉层面发生了什么变化，之前研究不多。这项研究纳入89例患者，通过MRI测量臀大肌、臀中肌、臀小肌、髂腰肌等多个肌肉的横截面积，结果发现臀大肌和臀小肌在术后显著增大，而且臀大肌横截面积的增加与患者报告结局的改善呈正相关。这说明什么呢？说明术后康复不仅仅是疼痛减轻和活动度改善，肌肉重塑也是功能恢复的重要组成部分。对于我们临床医生来说，这意味着术后康复计划应该重视髋周肌力的训练，特别是臀大肌的强化可能对远期疗效有重要意义。当然，这是一个单中心回顾性研究，样本量也不算大，还需要更大规模的前瞻性研究来验证。
英文摘要 Abstract
Reduced weight bearing during growth can induce bony morphological characteristics of developmental dysplasia of the hip, a risk factor for hip osteoarthritis (OA). However, the long-term effects of reloading remain unknown. This study aimed to evaluate the immediate and long-term effects of hindlimb suspension (HS) during growth on hip bone morphology, alignment, and histopathology. Four-week-old female rats were subjected to HS for four or eight weeks to reduce weight bearing. After 4 or 8 weeks of HS, the rats were reloaded until 54 weeks of age, which corresponds to human middle age. Age-matched animals served as controls. Bone morphology and alignment parameters were measured using three-dimensional reconstructed images from X-ray computed tomography. A histopathological analysis of the femoral head was also performed. Immediately after four and eight weeks of HS, increased femoral anteversion (FeAV) and acetabular anteversion (AcAV), as well as decreased femoral head diameter (characteristics of hip OA), were detected. After reloading until 54 weeks of age, these features persisted, and an increase of distraction index, which are indicators of structural instability, appeared in rats after 4 and/or 8weeks of HS. Furthermore, OA-like changes, such as articular cartilage thinning and subchondral bone sclerosis, were observed in the femoral head after long-term reloading. Additionally, FeAV was significantly correlated with several histopathological indices of femoral head cartilage. These results suggest that reduced weight bearing during growth may lead to hip morphological and alignment abnormalities, which could result in limited OA-like hip joint changes in the long term.
中文总结
这篇发表在Tissue Cell的动物实验研究探讨了一个很有临床意义的问题：青少年时期负重不足会对髋关节发育产生什么影响？研究者用4周龄雌性大鼠做模型，通过悬吊后肢模拟生长期间负重减少，分别观察4周和8周悬吊后的即刻变化，以及恢复正常负重后到54周龄相当于人类中年的长期影响。结果很有意思：负重减少后立即出现了股骨前倾角增大、髋臼前倾角增大和股骨头直径减小等髋关节发育不良的特征，而且即使恢复负重到成年，这些异常形态依然存在。更值得关注的是，长期随访发现了关节软骨变薄、软骨下骨硬化等骨关节炎样改变，而且股骨前倾角的增大程度与软骨病理评分密切相关。这个研究给我们的启示是，儿童青少年时期的机械环境对髋关节正常发育至关重要，负重不足可能导致不可逆的形态学改变和早发性骨关节炎风险。对于临床而言，提醒我们要关注青少年运动员的早期运动负荷管理，避免过度限制负重。
英文摘要 Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance postoperative hip stability while preserving the ligament's anatomic course.
METHODS: Pediatric patients with grade ≥III DDH, as classified by the International Hip Dysplasia Institute (IHDI), underwent open reduction using a novel ligamentum teres ligamentodesis technique to enhance joint stability. The ligament was detached, sutured, and tunneled intraosseously from the fovea to the greater trochanter, then anchored to the periosteum. Postoperative evaluation included gait status, pain, hip range of motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars, growth arrest, complications, and need for reintervention.
RESULTS: Nineteen hips in 16 patients (14 females, 2 males) with a median age of 24 months underwent LT intraosseous ligamentodesis combined with femoral and pelvic osteotomies. At a median follow-up of 23 months, all patients were pain-free, had normal gait, and no functional limitations, except for one case of persistent limping and one hip with mild limitation of abduction. Radiographically, all hips achieved satisfactory outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases of redislocation, dysplasia, infection, physeal bars, or growth arrest were observed. Two hips (10.5%) developed asymptomatic AVN.
CONCLUSIONS: The ligamentum teres intraosseous ligamentodesis ("Teretization") is a safe and technically feasible adjunct to open reduction in severe DDH, demonstrating favorable mid-term outcomes with no redislocations and low complication rates. These findings support its potential role in enhancing hip stability without jeopardizing femoral head physis and vascularity.
LEVEL OF EVIDENCE: Level IV-therapeutic case series.
中文总结
今天想跟大家分享一篇关于发育性髋关节发育不良手术的新技术文章，发表在J Pediatr Orthop上。这项研究来自南美哥伦比亚的团队，他们针对严重DDH即国际髋关节发育不良协会分级III级以上的病例，提出了一种叫'Teretization'的新手术方式。传统上，DDH的开放复位虽然能把股骨头放回髋臼，但长期稳定性仍是难题。这项技术的核心是通过骨内隧道将圆韧带从股骨头凹重新固定到大转子，利用自身解剖结构增强关节稳定性。研究纳入了16例患者19髋，中位年龄24个月，结合股骨和骨盆截骨术，随访23个月结果很鼓舞人心：所有患儿均无疼痛、行走正常，没有再脱位发生，影像学上髋关节发育良好。并发症方面，仅2例出现无症状的股骨头坏死，发生率约10.5%，在可接受范围内。这个技术为严重DDH的手术治疗提供了一种新思路，特别是对那些闭合复位失败或年龄偏大的患儿，值得我们关注和学习。
英文摘要 Abstract
BACKGROUND: The purpose of this study is to compare acetabular remodeling rates in age and severity matched, idiopathic DDH patients undergoing closed reduction (CR) versus open reduction alone (OR) versus open reduction supplemented by ligamentum teres reconstruction (LTR) utilizing a suture button device.
METHODS: Prospectively obtained data of patients who underwent open reduction with LTR were compared with historic cohorts of children 2.5 years or younger who underwent CR or OR. Acetabular index (AI) was measured on radiographs taken prior to reduction and on serial postoperative follow-ups. Monthly and yearly rates of AI change were calculated. Subgroup analysis of the prospective LTR cohort was performed to characterize how the rate of acetabular remodeling changes with increasing time after surgery.
RESULTS: Sixty-three patients with 71 hips underwent surgical reduction: 28 patients (29 hips) with CR, 19 patients (24 hips) with OR, and 16 patients (18 hips) with LTR. The average follow-up was 33.6 months. An annual acetabular index (AI) improvement of 7.9° was identified in the LTR cohort compared with 4.7° for OR and 4.0° for CR (P≤0.001). No patients within the LTR cohort have undergone subsequent pelvic osteotomy for residual dysplasia, versus 12.5% and 34.5% of the OR and CR groups, respectively. LTR patients demonstrated their greatest remodeling during the first year after surgery (1.0° per month). Rates decreased during the second year postoperatively (0.4° per month) and beyond (0.3° per month) (P=0.007).
CONCLUSIONS: Short-term results suggest that enhanced stability provided by LTR may permit more robust acetabular remodeling and lead to less residual dysplasia in patients with idiopathic DDH.
LEVEL OF EVIDENCE: Level II.
中文总结
这篇J Pediatr Orthop的文章回答了一个很多小儿骨科医生关心的问题：髋关节稳定性到底会不会影响发育性髋关节发育不良复位后的髋臼重塑？研究团队比较了三组治疗方案：闭合复位、开放复位、以及开放复位联合圆韧带重建。结果发现，圆韧带重建组的年髋臼指数改善幅度达到7.9度，显著优于开放复位的4.7度和闭合复位的4.0度。更重要的是，圆韧带重建组没有一例需要再做骨盆截骨来矫正残余发育不良，而开放复位组有12.5%、闭合复位组有34.5%最终需要二次手术。重塑速度方面，圆韧带重建组在术后第一年最快，每月改善约1度，之后逐渐放缓。这个研究提示我们，关节稳定性可能是促进髋臼正常发育的关键因素之一，增强稳定性或许能为髋关节发育创造更好的力学环境，从而减少残余畸形和后续手术的需要。当然，这是一项非随机对照研究，证据级别有一定局限性，但结果很有启发性。
英文摘要 Abstract
CASE: A 40-month-old nonambulatory girl with Aicardi-Goutières syndrome presented with spastic dystonic quadriplegia and painful right hip dislocation. Radiographs showed right hip dislocation with acetabular dysplasia. She underwent adductor tenotomy, open reduction, and proximal femur varus derotation osteotomy, achieving stable hip containment. Acetabular index and migration percentage improved from 42° and 100% at presentation to 26° and 31%, respectively, at the 40-month follow-up.
CONCLUSION: This is the first report of spastic hip dislocation in Aicardi-Goutières syndrome. The case underscores the importance of structured hip surveillance to detect early hip migration in children with severe spasticity and prevent late dislocation.
中文总结
这是一篇来自JBJS Case Connect的病例报告，讲述了一个特殊疾病相关的髋关节脱位。Aicardi-Goutières综合征是一种罕见的遗传性免疫失调疾病，主要表现为基底节钙化、脑萎缩和严重的痉挛性四肢瘫。这个病例是一名40个月大的不能行走的小女孩，因右髋关节脱位伴疼痛就诊。影像学检查显示右髋完全脱位且髋臼发育不良。治疗上采用了内收肌切断、开放复位和近端股骨内翻旋转截骨的联合方案。术后随访40个月，髋臼指数从42度改善到26度，迁移百分比从100%降到31%，获得了稳定的髋关节复位和良好的包容。这个病例之所以重要，是因为Aicardi-Goutières综合征相关的髋关节脱位此前从未被报道过，而且它提醒我们，对于这类伴有严重痉挛和肌张力障碍的神经性疾病患儿，需要建立规律的髋关节监测机制，早期发现髋关节问题，避免发展到完全脱位才处理。早期干预预后会好得多。
英文摘要 Abstract
BACKGROUND: This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum.
METHODS: A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded.
RESULTS: Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia.
CONCLUSIONS: The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old.
LEVEL OF EVIDENCE: Level III-case-control study.
中文总结
这篇文章介绍了一种针对发育性髋关节发育不良的创新手术方法——生长刺激型最小化髋臼成形术。该术式与髋关节开放复位联合使用，专为1至2.5岁的婴幼儿设计。研究团队报道了167髋154例患儿的长期随访结果，平均随访年限达到4至16年，其中21%的病例随访至骨骼发育成熟。术前77%的髋关节为四型脱位，33%为三型，平均髋臼指数高达41.3度。经过手术矫形后，98.2%的髋关节获得了Severin评分1级或2级的优良结果，髋臼指数恢复正常，股骨头覆盖良好，平均中心边缘角达到35.7度。仅3.6%的病例因残余发育不良需要再次行骨盆截骨术。作者认为该术式操作相对简单、手术时间短，且效果不劣于传统髋臼截骨术，推荐作为婴幼儿发育性髋关节发育不良的常规辅助手术。长期随访结果令人鼓舞，为临床提供了一种值得考虑的改良方案。
英文摘要 Abstract
CASE: An 18-year-old woman with Ehlers-Danlos syndrome developed subacute thigh pain on postoperative day 21 following elective hip arthroscopy and a periacetabular osteotomy. Doppler ultrasound revealed a pulsatile "yin-yang" lesion in the rectus femoris, and CT angiography confirmed a pseudoaneurysm of the lateral circumflex femoral artery with an arteriovenous fistula. Endovascular coil embolization with thrombin injection achieved complete thrombosis and symptom resolution.
CONCLUSION: Vascular injury, though rare, should be considered after hip arthroscopy in patients with connective tissue disorders. Early multimodal imaging enables timely diagnosis, and minimally invasive endovascular treatment can provide definitive management with low morbidity.
中文总结
最后一篇也是JBJS Case Connect的病例报告，讲的是髋关节镜和保髋手术后的一个少见血管并发症 Ehlers-Danlos综合征患者的假性动脉瘤。这位18岁女性在髋关节镜联合PAO术后21天出现了亚急性大腿疼痛，影像学检查发现是旋股外侧动脉的假性动脉瘤合并动静脉瘘。Ehlers-Danlos综合征是一种结缔组织疾病，患者组织脆性增加，血管壁结构也存在缺陷，所以更容易出现医源性血管损伤。幸运的是，这个病例通过介入栓塞和凝血酶注射成功治愈，避免了开放手术。这个案例给我们的重要提示是，对于已知合并结缔组织疾病的患者，术前应该充分评估血管条件，术中操作要格外轻柔谨慎，术后出现不明原因疼痛时要想到血管并发症的可能。早期进行多模态影像学检查可以及时确诊，而微创的介入治疗在很多情况下能够安全有效地解决问题，避免二次大手术的创伤。
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（DDH）中最严重的表现形式，如果不及时治疗，将导致永久性的功能障碍。幸运的是，德国自1996年起在全国范围内开展了髋关节超声筛查，使这一疾病能够在早期被发现和干预。治疗的核心目标是实现股骨头稳定、同心的复位，从而为髋臼的正常发育创造条件。对于那些无法通过闭合方式复位的髋关节，则需要考虑手术切开复位，必要时还需联合截骨等矫形手术来重建髋关节的解剖结构。临床上，早期诊断、遵循规范化的治疗方案以及密切随访，是获得良好长期预后的关键因素。这一理念对于我们日常诊疗儿童髋关节疾病具有重要的指导意义——无论是家长还是临床医生，都应该提高对这类疾病的认识，做到早发现、早干预，避免错过最佳治疗时机而导致不可逆的功能损害。
英文摘要 Abstract
BACKGROUND: Neurogenic hip dysplasia (NHD) is a clinically significant musculoskeletal complication in children with neurological disorders, particularly infantile cerebral palsy (CP). It contributes substantially to pain, functional limitations, and reduced quality of life. Muscle imbalance and impaired dynamic hip stability lead to progressive deformity of the femoral head and acetabulum, increasing the risk of subluxation and dislocation. Risk strongly correlates with GMFCS level and is highest in non-ambulatory children (levels IV-V).
DIAGNOSTICS: Diagnosis and monitoring rely on radiographic parameters such as the Reimers migration index, Rutz classification and other classification systems, although some measures have limitations in CP. Management requires long-term, interdisciplinary care. GMFCS-based hip surveillance enables early detection and timely intervention before irreversible damage occurs.
THERAPY: Treatment decisions must be individualized, as not all dysplasia is symptomatic. Options range from conservative measures with limited long-term efficacy to soft-tissue procedures and reconstructive surgery (e.g., VDRO with or without pelvic osteotomy), while salvage procedures are reserved for severe cases.
CONCLUSION: Overall, NHD is a multifactorial, complex disease that requires structured diagnostics, continuous monitoring, and early, patient-specific therapy with the active involvement of families, with the aim of improving function and quality of life.
中文总结
神经源性髋关节发育不良（NHD）是脑瘫等神经系统疾病儿童中非常常见的肌肉骨骼并发症，主要表现为髋关节的疼痛、功能受限以及生活质量的下降。其发病机制与肌肉力量不平衡和髋关节动态稳定性受损密切相关，这些因素会导致股骨头和髋臼进行性的畸形改变，进而增加半脱位甚至完全脱位的风险。临床评估中，我们通常采用Reimers迁移指数、Rutz分类等影像学参数来诊断和监测病情进展，但需要认识到这些指标在脑瘫患儿中具有一定的局限性。治疗策略的制定必须个体化，因为并非所有发育不良都会出现症状。对于有症状的病例，治疗选择从保守治疗到软组织手术，再到股骨近端截骨联合或不联合骨盆截骨的重建手术不等，而对于严重病例则可能需要行 salvage 手术。总体而言，NHD是一种多因素、复杂的疾病，需要系统化的诊断、持续监测以及早期、个性化的干预，同时积极调动家庭的参与，才能最大限度地改善患儿的功能和生活质量。
英文摘要 Abstract
Hip arthroscopy has grown exponentially over the past decade, with a parallel rise in revisions, underscoring the importance of refined patient selection and diagnostic accuracy. This review outlines the most common causes of failure after primary hip arthroscopy and provides a framework for evaluation, imaging, and management. Notably, differentiating between impingement and instability is crucial, as misclassification can worsen outcomes. Revision procedures may provide clinically meaningful improvement in patient-reported outcomes and delay total hip arthroplasty in well-selected patients. However, recognizing when to shift from preservation to replacement is key to optimizing outcomes.
中文总结
过去十年间，髋关节镜技术经历了飞速发展，与之伴随的是接受该手术的患者数量大幅增加，同时也带来了翻修手术需求的相应增长。这一趋势提醒我们，必须更加审慎地进行患者筛选并提高诊断的准确性。在翻修髋关节镜的评估中，区分撞击与不稳至关重要——一旦分类错误，患者的预后可能会进一步恶化。这篇综述系统梳理了初次髋关节镜失败最常见的原因，并提供了评估、影像学检查和管理的基本框架。对于那些经过仔细筛选的病例，翻修手术能够带来有临床意义的患者报告结局改善，并延缓全髋关节置换的时间节点。然而，我们需要具备敏锐的临床判断力，在适当的时候识别出何时应该从保髋治疗转向置换手术——这往往是获得最佳治疗效果的关键所在。作为关节外科医生，我们既要掌握精湛的镜下技术，也要深刻理解疾病自然史和手术时机，方能为患者提供最合理的治疗方案。
英文摘要 Abstract
Slipped capital femoral epiphysis (SCFE) occurs in preadolescent and adolescent children. The exact pathomechanism of the slip is not known. Several risk factors have been identified including hormonal derangement. Of the classification systems, stability and severity classification systems are most relevant to everyday practice. There is a strong agreement regarding the management of a mild slip. Controversies exist in the treatment of moderate and severe slips and also regarding the prophylactic pinning of the opposite side. Discrepancies exist amongst countries and surgeons as to the number of screws to be used for pinning. Increasing evidence of femoroacetabular impingement as a cause of osteoarthritis of the hip may change the treatment of moderate and severe slips in the future. The modified Dunn procedure may become a standard procedure in the future to treat moderate and severe slips; however, experience and accurate knowledge of surgical anatomy is required for good outcomes following this procedure.
中文总结
股骨头骨骺滑脱（SCFE）是青春期前和青春期儿童常见的髋关节疾病，尽管其确切的发病机制尚未完全阐明，但已知的危险因素包括内分泌紊乱等。关于分类系统，稳定性分型和严重程度分型与日常临床实践最为相关。对于轻度滑脱的治疗，学界已达成较一致的共识；而中度和重度滑脱的治疗方案目前仍存在争议，同时关于对侧预防性固定的最优策略也未形成统一观点。此外，不同国家和外科医生在固定用螺钉数量方面也存在差异。近年来，越来越多的证据表明股骨髋臼撞击症（FAI）是髋关节骨关节炎的重要病因之一，这一认识可能会改变我们对中重度SCFE的治疗理念。可以预见的是，改良Dunn手术有望成为未来治疗中重度SCFE的标准术式，但必须强调的是，实施这一手术需要丰富的经验和对局部解剖的精准掌握，这是获得良好临床结果的前提条件。
英文摘要 Abstract
Pelvic and femoral osteotomies, including soft-tissue balancing of the pediatric hip joint, aim to restore as physiological a geometry and biomechanics as possible in order to improve function and prevent wear. The main indications are developmental (DDH) and neurogenic dysplasia (NDH), Perthes disease (LCP), and femoral head slippage (ECF/SCFE). In childhood, acetabular roof plasty (PDP) and the Salter osteotomy (SIO) are the primary options; after growth is complete, triple pelvic osteotomy (TPO) and periacetabular osteotomy (PAO) are available, with the former potentially being performed even before skeletal maturity. If incongruity is present, shelf and Chiari osteotomies may be considered as salvage procedures. The outcome depends on correct indication, selection of the appropriate procedure, adequate consideration of soft tissue conditions, and structured follow-up care.
中文总结
儿童髋关节的骨盆截骨和股骨截骨手术，辅以软组织平衡技术，其核心目标是通过重建接近生理状态的关节几何结构和生物力学环境，来改善功能和延缓退变。这类手术的主要适应证包括发育性髋关节发育不良（DDH）、神经源性髋关节发育不良（NDH）、Perthes病（LCP）以及股骨头骨骺滑脱（SCFE/ECF）等。在儿童期，髋臼加盖术（PDP）和Salter截骨术（SIO）是最常用的术式；当骨骼发育成熟后，则可选择三联截骨术（TPO）或髋臼周围截骨术（PAO），其中三联截骨术甚至可以在骨骼成熟前进行。对于存在关节不相匹配的病例，Shelf截骨和Chiari截骨则可作为 salvage 手术的选择。手术成功的关键在于准确把握手术指征、合理选择术式、充分评估软组织条件以及术后系统化的康复随访。这一领域的治疗决策需要丰富的临床经验和严谨的随访体系作为支撑，方能为患儿提供最优的长期预后。
英文摘要 Abstract
Osteoarthritis of the ankle joint affects a younger and often occupational and sport-active patient group than hip and knee arthritis and in the majority of cases has a secondary or posttraumatic origin. Corrective osteotomy is a biological and functionally attractive option for these young and active patients with asymmetric arthritis and correctable malalignment as the native joint is preserved and subsequent arthrosis can be potentially prevented or delayed by arthrodesis. Decisive for the success are consistent 3-dimensional diagnostics, precise planning, correct interpretation of the indications as well as completely addressing the fibular, hindfoot and instability components.
中文总结
踝关节骨关节炎与髋关节和膝关节骨关节炎不同，它更多累及年轻患者，且这些患者往往保持着较高的职业和运动需求。在病因方面，大多数踝关节骨关节炎属于继发性或创伤后改变。对于这类年轻、活跃的患者，如果存在不对称性的关节炎且可以矫正的力线异常，截骨矫形是一种兼具生物学优势和功能吸引力的治疗选择——因为它保留了患者自身的关节，有可能预防或延缓后续需要行关节融合的进程。手术成功取决于几个关键因素：完善的三维诊断评估、精准的术前规划、准确的适应证把握，以及对腓骨、后足和关节不稳等问题的全面处理。作为运动医学和关节外科医生，我们既要掌握踝关节的生物力学特点，也需要在临床决策中平衡患者的个体化需求与循证医学证据，为患者制定最适合的治疗方案。