OBJECTIVE: To evaluate the diagnostic performance of combined X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) for femoroacetabular impingement (FAI) syndrome and its subtypes, and to explore potential factors associated with FAI.
METHODS: A total of 86 patients with FAI syndrome (FAI group) and 70 individuals without hip joint abnormalities (control group) were retrospectively enrolled. All participants underwent X-ray, CT, and MRI examinations. The imaging findings were collected and analyzed. The diagnostic performance of each modality and their combination for FAI syndrome was analyzed using the receiver operating characteristic (ROC) curve analysis. Subsequently, independent risk factors were identified, and a nomogram prediction model was built and validated.
RESULTS: The area under the ROC curve (AUC) for diagnosing FAI syndrome using X-ray, CT, and MRI was 0.792, 0.845, and 0.889, respectively, whereas the combined diagnostic model achieved an AUC of 0.932 (specificity: 90.70%, sensitivity: 95.71%, accuracy: 92.95%). Multivariate analysis further identified age, high-intensity exercise history (Hx_HIE), α angle, and center-edge (CE) angle as independent risk factors for FAI syndrome, while femoral offset played a protective role. The constructed nomogram demonstrated excellent predictive performance, with a C-index of 0.966 and high calibration accuracy, particularly in the high-risk range.
CONCLUSION: The joint screening using X-ray, CT, and MRI can significantly improve the diagnostic accuracy for FAI syndrome. Age ≥32 years, a history of high-intensity exercise, increased α/CE angles, and decreased femoral offset are associated with a higher risk of developing FAI syndrome.
该研究旨在评价X线、CT与MRI联合应用诊断股骨髋臼撞击（FAI）综合征及其亚型的效能，并探索与FAI相关的因素。回顾性纳入86例FAI综合征患者与70例无髋关节异常者，全部接受X线、CT与MRI检查，收集分析影像表现，用ROC曲线评价各模态及联合方案的诊断效能，并识别独立危险因素、建立并验证列线图预测模型。结果：X线、CT与MRI诊断FAI的AUC分别为0.792、0.845与0.889，联合诊断模型AUC达0.932（特异度90.70%、敏感度95.71%、准确率92.95%）；多因素分析显示年龄、高强度运动史（Hx_HIE）、α角与中心边缘角（CE角）为独立危险因素，股骨偏心距为保护因素；所建列线图C指数0.966、校准良好，在高风险区间尤为突出。结论：X线、CT与MRI联合筛查能显著提高FAI综合征的诊断准确率；年龄≥32岁、有高强度运动史、α角与CE角增大及股骨偏心距减小者风险更高。临床意义：三模态联合可减少漏诊并指导高危人群的随访。
BACKGROUND: This study evaluated stress distribution across the entire pelvis following rotational acetabular osteotomy (RAO) for osteoarthritis secondary to acetabular dysplasia using finite element analysis (FEA). Additionally, we aimed to elucidate the mechanisms underlying postoperative posterior column and inferior pubic ramus fractures, which are recognized complications of RAO.
METHODS: FEA was conducted based on the computed tomography (CT) images of a 26-year-old female patient who developed a posterior column fracture following RAO. Three pelvic models were constructed: preoperative, immediately postoperative, and 1 year postoperatively, in which osseous union was achieved between the rotated fragment and the ilium; however, the osteotomy site at the superior pubic ramus resulted in nonunion. Additionally, a Union model, simulating the continuity of the superior pubic ramus in both postoperative stages, was created for comparison with the Nonunion model. A load of 500 N was applied in a sitting position, with the von Mises stress distribution and element failure patterns analyzed.
RESULTS: In the Nonunion model, von Mises stress at the inferior pubic ramus was approximately 3.6 times higher immediately after surgery than preoperatively (43.0 MPa) and approximately 2.6 times higher than in the Union model. Similarly, the stress in the posterior column increased approximately 5.1-fold (53.9 MPa) immediately postoperatively in the Nonunion model, which was approximately 3.2 times higher (34.2 MPa) than in the Union model. Furthermore, element failure was observed in areas where stress exceeded 30 MPa, with a high incidence of failure in the immediate postoperative Nonunion model.
CONCLUSION: Early post-RAO fractures of the posterior column and inferior pubic ramus are significantly influenced by the continuity of the superior pubic ramus. Notably, even before weight-bearing begins, the presence of a gap at the pubic osteotomy site immediately after RAO may substantially elevate fracture risk.
该研究应用有限元分析（FEA）评估髋臼旋转截骨术（RAO）后骨盆应力分布，探讨术后发生后柱骨折及下耻骨支骨折的机制。基于1例RAO术后发生后柱骨折的26岁女性患者CT构建三种模型：术前、术后即刻及术后1年（上部耻骨支骨不连）。在坐位500 N载荷下分析von Mises应力。结果：不连模型中术后即刻下耻骨支von Mises应力约为术前的3.6倍（43.0 MPa），较骨连模型高约2.6倍；后柱应力增加约5.1倍至53.9 MPa，为骨连模型（34.2 MPa）的3.2倍。结论：RAO后骨折风险与上部耻骨支连续性密切相关，术中应确保截骨端接触以降低应力。临床意义：旋转式髋臼周围截骨术中应确保截骨端紧密贴合并获得可靠固定，以降低术后骨盆骨折与应力集中风险。
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.
该研究明确股骨髋臼撞击相关畸形在无症状老年人群中的患病率及其与骨关节炎的关系。研究采用CT横断面设计，纳入60岁以上、无髋痛及髋部疾病史的非骨科患者195例（男130例，女65例）共290个髋，按Kellgren-Lawrence（KL）分级评估骨关节炎，测量髋臼前倾角、髋臼扇形角（ASA）与α角，并用随机效应中位数回归按KL分级、性别、年龄、肥胖建模。结果：严重骨关节炎（KL 3/4级）占19.2%；80岁以上者9～11点位α角、9～12点位ASA及髋臼顶部前倾角均显著增大；进展期骨关节炎者α角与ASA更高、前倾角更低。结论：上述畸形在老年无症状人群中分布明确，其患病率与进展期骨关节炎相关。临床意义：老年髋部影像中的撞击形态参数可作为退变风险标志。
BACKGROUND: Developmental dysplasia of the hip (DDH) remains a therapeutic challenge and treatment strategies remain controversial in children diagnosed after the age of one year.
AIM: The study aim was to evaluate various treatment methods for DDH in children aged 1-4 years and to determine whether open reduction improved outcomes.
METHODS: 41 children (48 affected hips) aged ≥ 1 year with DDH were included in the study. They were treated surgically between 2012 and 2021 at a tertiary university hospital and had a documented follow up of ≥ 18 months. Patients were divided into two groups: those who underwent closed reduction (CR) and those who underwent open reduction (OR). Femoral shortening, varisation and pelvic extracapsular osteotomies (PO) were performed depending on case and surgeon preference. Outcomes were evaluated radiographically using the Severin classification, functionally using the Children's Hospital of Oakland Hip Evaluation Score (CHOHES). Avascular necrosis (AVN) if present was documented using the Kalamchi-MacEwen (K&M) classification. Optimal outcomes were defined when: quality of reduction is Severin ≤ 2, CHOHES ≥ 85 and absence of AVN. Statistical analyses were performed using R version 4.3.1, with categorical data compared using the chi-square test.
RESULTS: Optimal outcomes were observed in 19 of 21 hips treated with OR (90.5%) and 19 of 27 hips treated with CR 70.4% (p = 0.089). AVN occurred infrequently, and in several cases, resolved during follow-up.
CONCLUSIONS: OR with Femoral shortening and PO provided the most favorable outcomes. This approach may minimize AVN, and potentially delay degenerative changes.
该研究旨在评估1至4岁髋关节发育不良（DDH）患儿的治疗方式，并判断切开复位能否改善结局。回顾性纳入2012至2021年在三级大学医院接受手术的41例（48个髋）DDH患儿，随访≥18个月，按闭合复位（CR）与切开复位（OR）分组，股骨短缩、截骨及骨盆外关节囊外截骨依病例与术者选择实施，以Severin分级评价影像复位、CHOHES评分评价功能、股骨头缺血坏死（AVN）按Kalamchi-MacEwen分型记录，界定最佳结局为Severin≤2级、CHOHES≥85分且无AVN。结果：OR组21个髋中19个（90.5%）达最佳结局，CR组27个髋中19个（70.4%）达最佳结局（p=0.089），AVN 发生率低且数例随访中自行消退。结论：联合股骨短缩与骨盆截骨的切开复位可获得最满意结局，有望减少AVN并延缓退变。临床意义：对1岁以后诊断的DDH，切开复位配合股骨短缩与骨盆截骨是获得稳定同心复位、降低缺血坏死风险的重要选择，术中股骨短缩可显著降低复位所需暴力。
BACKGROUND: Axial imaging is typically obtained following operative reduction of developmental dysplasia of the hip (DDH) to confirm a concentric reduction. Although the utility of axial imaging has been studied following the index reduction, its value following spica cast exchange remains unclear.
METHODS: This single-center study included all children 2 years or younger with idiopathic DDH who underwent closed or open reduction between 2012 and 2023. Patients with concurrent osteotomies or dysplasia secondary to syndromic/neuromuscular causes were excluded. Institutional protocol during this period consisted of 3 months of immobilization with a spica cast exchange at 6 weeks for all closed or medial open reductions. Axial imaging (CT or MRI) was typically obtained after both the index procedure and cast exchange to confirm reduction. A retrospective review was conducted to assess how often axial imaging directly altered clinical management, defined as an unplanned return to the operating room or a documented change in management based on imaging findings per the treating surgeon's notes. Minimum follow-up was 1 year. Descriptive statistics were used to summarize patient characteristics and arthrogram findings.
RESULTS: The cohort included 91 patients (124 hips): 92 (74%) hips underwent closed reduction, and 32 (26%) underwent open reduction. The median age at index reduction was 7.7 months, with 52% (n=47/91) above 6 months old. Of those with preoperative radiographs (n=98), most hips were IHDI grade 3 (29%, n=27) or 4 (39%, n=38). Axial imaging changed management in 3% of hips after the index reduction (4/92 closed reductions, 0/32 open reductions). Among 124 hips receiving axial imaging at cast exchange (92=MRI, 32=CT), only 1 hip was dislocated (<1%). Analysis of a separate cohort of 12 hips that did not receive axial imaging at cast exchange suggests that an adequate arthrogram (no medial dye pool and deep concentric reduction) is sufficient to confirm reduction.
CONCLUSIONS: Axial imaging at the time of spica cast exchange rarely alters clinical management and should not be routinely obtained unless otherwise indicated by a concerning intraoperative arthrogram.
LEVEL OF EVIDENCE: Level IV-retrospective case series.
该研究评估发育性髋关节发育不良（DDH）患儿石膏换模时轴位影像（CT或MRI）的价值。研究为单中心回顾性病例系列，纳入2012—2023年2岁及以下行闭合或切开复位的91例患儿共124个髋，排除合并截骨及继发性发育不良；按院内方案复位后石膏固定3个月、6周换模，以是否再次手术或据影像调整处理衡量其对决策的影响。结果：92个髋（74%）闭合复位、32个髋（26%）切开复位，中位年龄7.7个月，52%（47/91）超6个月；术前IHDI 3级29%、4级39%；轴位影像仅在3%（4/92闭合、0/32切开）的髋改变处理；换模时92个髋用MRI、32个用CT，仅1个髋脱位（<1%）；未做轴位影像的12个髋提示关节造影满意即可确认复位。结论：换模轴位影像极少改变处理，无指征不应常规进行。临床意义：可减少不必要的麻醉与辐射暴露，术中关节造影异常时仍应作为指征。
BACKGROUND: In situ pinning is the mainstay treatment method in mild and moderate slipped capital femoral epiphysis (SCFE). Despite successful outcomes, some technical difficulties may be encountered during surgery, typically in overweight SCFE patients. The aim of the study is to compare the use of a bone marrow biopsy needle system to navigate the cannulated screw guidewire with the traditional in situ pinning technique.
METHODS: We retrospectively reviewed patients undergoing in situ pinning for stable mild-moderate SCFE at 2 different institutions between 2022 and 2024. Included patients were divided into 2 groups according to whether the cannulated screw guidewire was navigated by a bone marrow biopsy needle system (group 1) or inserted with traditional technique (group 2). Clinical, surgery-related, and radiographic data were then reviewed to compare groups.
RESULTS: Thirty-four hips of 28 patients were included (18 hips of 14 patients in group 1, 16 hips of 14 patients in group 2) with a mean age of 12±1.6 (9 to 15) years. There was no significant difference between groups in age, sex, side, body mass index, Southwick angle, acute/chronic ratio, and follow-up duration. Group 1 had significantly shorter operative time ( P =0.003) as well as total fluoroscopy images taken ( P =0.001) as compared with group 2. There was no difference between groups for screw accuracy in both anteroposterior ( P =0.163) and lateral planes ( P =0.887). No complication was reported in either group.
CONCLUSION: Using a bone marrow aspirate needle to serve as a cannula for cannulated screw guidewire in order to determine a proper femoral entry point as well as to avoid its bending and breakage throughout the procedure is a cheap and effective modification for in situ pinning of SCFE. It significantly reduced the operative time and radiation exposure as compared with the traditional method.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.
该研究比较骨骨髓活检针辅助导丝与传统原位螺钉固定治疗股骨上端骨骺滑脱（SCFE）。研究为两家医院2022—2024年回顾性对照研究，纳入稳定型轻中度SCFE行原位固定的28例患儿共34个髋（活检针组18个髋，传统组16个髋），平均年龄12±1.6岁，比较临床、手术与影像学指标。结果：两组年龄、性别、侧别、体质指数、Southwick角、急慢性比例及随访时间无显著差异；活检针组手术时间显著缩短（P=0.003），透视图像总数显著减少（P=0.001）；正位（P=0.163）与侧位（P=0.887）螺钉置入准确率无差异，两组均无并发症。结论：以骨骨髓穿刺针作套管定位股骨进针点并防导丝弯折断裂，是廉价有效的改良，可缩短手术时间、减少辐射。临床意义：适用于体重较大、定位困难患儿且不增加置钉风险。
BACKGROUND: Operative hip reductions for infantile DDH are traditionally performed under general anesthesia (GA). This introduces potential safety concerns, as risks related to GA are highest in children below 1 year. While surgery can be temporarily delayed to reduce these risks, this decreases the chances of a successful reduction via closed methods alone and also compromises valuable remodeling potential. This pilot study sought to evaluate the safety and efficacy of spinal anesthesia (SA) in infants undergoing operative hip reduction.
METHODS: This is a multicenter, retrospective cohort study of all infants 18 months or younger undergoing closed or open reductions for infantile DDH. SA was performed according to the institutional protocol previously developed for infants undergoing urologic procedures (>1200 procedures performed safely to date). A retrospective chart review was completed for demographic characteristics, treatment history, clinical exam, anesthetic course, and operative details.
RESULTS: A total of 16 index reductions were performed under SA, including 9 closed reductions and 7 open reductions (including 1 staged anterior open reduction). The mean age at first procedure was 6.4 months. Seven patients underwent a planned spica cast exchange under SA as well. In total, 23 procedures were performed under SA. The mean number of attempts at spinal was 1.4, and the mean SA setup time was 17 minutes. Following SA, most babies slept through the procedure without issue (including open reduction). Most babies (17/23, 74%) required additional IV sedation [13/17 (76% dexmedetomidine only)]. None required endotracheal intubation. There were no surgical or anesthetic complications. All treated hips remained concentrically reduced at the time of spica cast removal.
CONCLUSIONS: SA is a safe and effective anesthetic for infant hip reductions. This proof-of-concept pilot study highlights a technical advance with the potential to change how (and when) pediatric orthopaedists treat infantile DDH. In addition to eliminating the risks of GA, SA may allow earlier surgery, which could improve acetabular remodeling and decrease the need for subsequent pelvic osteotomy.
LEVEL OF EVIDENCE: Level IV-case series.
该研究评估椎管内麻醉（SA）用于婴幼儿髋关节发育不良手术的安全性与有效性。研究为多中心回顾性队列，纳入所有18个月及以下行闭合或切开复位的患儿，按院内方案实施SA并回顾麻醉与手术细节。结果：16例（9例闭合、7例切开，含1例分期前路切开复位）在SA下完成首次手术，平均年龄6.4个月；7例换模亦在SA下进行，SA下共23台手术，腰椎穿刺平均尝试1.4次，准备时间平均17分钟；多数患儿术中安静入睡；17/23（74%）需追加静脉镇静，其中13/17（76%）单用右美托咪定；无一例需气管插管，无手术或麻醉并发症，拆石膏时所有患髋保持同心复位。结论：SA安全有效。临床意义：可避免全身麻醉风险、允许更早手术，改善髋臼塑形并减少后续骨盆截骨需求。
BACKGROUND: Identifying patients at the highest risk of developmental dysplasia of the hip (DDH) is critical to the success of an efficient selective screening program. Defining and evaluating risk factors is, therefore, vital. This study was designed to analyze the relationship between classic risk factors and rates of DDH in a contemporary United States-based population.
METHODS: All patients presenting before 12 months of age to a single tertiary care pediatric hospital's orthopaedic department for DDH screening, with explicit medical record documentation of DDH risk factors from 2018 to 2022 were included. Classic risk factors were defined as breech presentation, female sex, firstborn status, and family history of hip dysplasia. Ultrasounds and radiographs obtained at initial presentation were reviewed to determine Graf and IHDI classifications. Reasons for referral for DDH screening were obtained from the chart review.
RESULTS: One thousand two hundred twenty-six patients were eligible for the study. The probability of having DDH increased as the number of risk factors present for DDH increased ( P <0.001). Female sex and firstborn status were found to be independent risk factors for DDH. Females were 2.5 times more likely to have DDH than males ( P <0.001). Firstborn children were 1.3 times more likely to have DDH than subsequent birth-order children ( P =0.048). There was no difference in the proportion of DDH in breech presenting patients compared with non-breech ( P =0.511) or in subjects with a family history of DDH ( P =0.16).
CONCLUSIONS: The primary risk factor for DDH in this contemporary cohort was female sex. Female patients without any other risk factors for DDH had a 25.2% rate of DDH, significantly higher than the estimated population incidence. Fifteen percent of these patients had no notable physical exam findings consistent with DDH. Given the high rate of DDH in female patients in the absence of notable physical exam findings, universal ultrasound screening for females at the age of 6 weeks should be considered.
LEVEL OF EVIDENCE: Level IV.
该研究重新评估髋关节发育不良（DDH）经典危险因素在当代美国人群中的风险分层作用。研究为单中心回顾性研究，纳入2018—2022年12月龄前来院筛查、病历明确记录危险因素的1226例患儿，危险因素定义为臀位产、女性、头产及髋发育不良家族史，依初诊超声与X线确定Graf和IHDI分型。结果：DDH概率随危险因素数目增加而升高（P<0.001）；女性与头产为独立危险因素，女性风险为男性2.5倍（P<0.001），头产儿为后续出生顺序儿童的1.3倍（P=0.048）；臀位产与否（P=0.511）及有无家族史（P=0.16）差异无统计学意义。结论：主要危险因素是女性性别，无其他危险因素的女性DDH率达25.2%，且15%查体无异常体征。临床意义：可考虑对6周龄女性婴儿行普遍超声筛查。
BACKGROUND: Displaced femoral neck fractures in children are rare but carry significant risk for complications such as avascular necrosis (AVN), nonunion, and malunion. Although adult literature increasingly supports closed reduction when adequate alignment is achieved, the pediatric literature lacks consensus on optimal management. This study evaluates whether the quality of reduction, regardless of open or closed technique, predicts adverse outcomes in pediatric displaced femoral neck fractures.
METHODS: We retrospectively reviewed 56 patients (ages 2 to 18) with displaced Delbet type II or III femoral neck fractures treated surgically at a single pediatric trauma center from 2000 to 2022. Fractures were classified radiographically, and the quality of postoperative reduction was assessed independently by 2 fellowship-trained orthopaedic surgeons. The primary outcome was a composite of adverse events including AVN, nonunion, malunion, fixation failure, SCFE, and infection. Survival analyses and Cox proportional hazard models were used to evaluate associations between reduction quality and outcomes.
RESULTS: Anatomic reduction was achieved in 55% of patients and was more common after open reduction than closed reduction (71% vs. 29%, P =0.001). Patients with anatomic reductions had a significantly lower hazard of adverse events (HR: 0.21; 95% CI: 0.06-0.72; P =0.013) and longer event-free survival (RMST: 6.1 vs. 3.0 y, P =0.001). Type of reduction (open vs. closed) and preoperative radiographic parameters did not independently predict adverse outcomes. Early surgery (<12 h) did not show benefit and was associated with lower odds of achieving anatomic reduction.
CONCLUSIONS: Anatomic reduction, regardless of technique, is the strongest predictor of favorable outcomes after pediatric displaced femoral neck fracture. Open reduction should be pursued when closed methods fail to achieve anatomic alignment. Radiographic injury patterns and time to surgery were not independently predictive of adverse outcomes. These findings underscore the importance of prioritizing reduction quality to optimize long-term hip preservation in children.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.
该研究评估儿童移位型股骨颈骨折中复位质量与不良结局的关系。研究为单中心回顾性对照研究，纳入2000—2022年手术治疗的56例（2～18岁）Delbet II型或III型移位型股骨颈骨折患儿，由两名专训骨科医师独立评估复位质量，主要终点为含股骨头缺血性坏死（AVN）、骨不连、畸形愈合、内固定失败、股骨上端骨骺滑脱（SCFE）及感染的复合不良事件，采用生存分析与Cox比例风险模型。结果：55%达解剖复位，开放复位高于闭合复位（71%对29%，P=0.001）；解剖复位者不良事件风险显著降低（HR 0.21，95%CI 0.06～0.72，P=0.013），无事件生存时间延长（6.1年对3.0年，P=0.001）；复位方式与术前影像参数不能独立预测不良结局；早期手术（<12小时）未见获益，解剖复位率更低。结论：解剖复位是最强预测因素。临床意义：闭合复位未达解剖对位时应行切开复位。
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.
该研究比较Pavlik吊带治疗发育性髋关节发育不良（DDH）成功后逐步卸载与直接结束治疗的影像学效果。研究为单中心随机对照试验，纳入3月龄前开始Pavlik吊带、超声指标正常化的稳定性髋发育不良患儿，随机分为卸载组（W）与不卸载组（NW），W组继续佩戴4～6周并逐步减少每日使用；主要终点为6月龄骨盆正位片髋臼指数（AI），次要终点为6月龄AI≥30°需部分时间外展支具的髋数及1岁AI。结果：72例纳入（W组36例，NW组36例），两组基线年龄、α角、股骨头覆盖率无差异；超声正常化时平均佩戴时间无差异（35.0比34.9天，P=0.84）；6月龄W组AI显著低于NW组（24.8±3.9°比26.9±3.4°，P=0.02）；6月龄需支具比例W组低于NW组（17%比22%，P=0.56）；1岁AI两组无显著差异（24.6±3.4°比25.3±2.3°，P=0.84），可能与追加支具有关。结论：卸载方案改善6月龄AI。临床意义：提示规范卸载有价值，但长期获益有限。
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.
该研究探讨软骨增生在Legg-Calvé-Perthes病（LCPD）股骨头形态演变中的作用及预后价值。研究为55例单侧LCPD行保守包容治疗的MRI分析，在疾病早期冠状位、矢状位MRI的10个区域测量软骨厚度，评估股骨头增大的骨性与软骨性成分，并分析发病年龄、软骨厚度比与骨骼成熟时Stulberg分级的相关性。结果：患侧股骨头较健侧增大，主要由软骨增生所致，骨骺增大呈年龄依赖性模式；软骨增生呈多方向分布，以外侧最显著；发病年龄与水平向软骨增生是Stulberg分级的独立预后指标；软骨厚度比≤3.7的7岁及以下患儿仅6%出现严重畸形（Stulberg III级及以上），比值>3.7者达83%。结论：早期软骨增生与股骨头增大相关，水平向增生程度和发病年龄可预测畸形进展。临床意义：可将MRI软骨厚度比纳入包容治疗的预后判断与随访决策。
BACKGROUND: In older children with Perthes disease, where containment surgery is often indicated, the comparative effectiveness of the 2 principal shelf acetabuloplasty techniques, Staheli and Tectoplasty, remains unclear.
METHODS: A total of 26 children (23 males and 3 females; mean age at surgery, 8.55±0.95 y) underwent the Staheli technique, and 20 children (18 males and 2 females; mean age at surgery, 8.65±0.89 y) were treated with the Tectoplasty technique. Clinical data and radiographs were retrospectively reviewed. Radiographic parameters, including the center-edge angle, Sharp angle, femoral head subluxation ratio, femoral head size ratio, and final Stulberg classification, were assessed.
RESULTS: Femoral head containment improved significantly in both groups. The postoperative-to-preoperative CE angle ratio was greater in the Staheli group than in the Tectoplasty group (213.14±38.66% vs. 189.33±39.08%, P =0.04). The postoperative-to-preoperative Sharp angle ratio was comparable between groups (75.09±6.60% vs. 75.31±5.41%, P =0.90). The postoperative-to-preoperative subluxation ratio was lower in the Tectoplasty group than in the Staheli group (67.66±6.64% vs. 74.90±10.05%, P =0.008). The postoperative-to-preoperative femoral head size ratio was modestly greater in the Tectoplasty group than in the Staheli group (113.66±7.81% vs. 109.18±6.77%, P =0.04). No significant difference in the final Stulberg classification was found between groups ( P =0.96).
CONCLUSIONS: Both the Staheli and Tectoplasty techniques were associated with improved acetabular coverage and femoral head remodeling in older children with Legg-Calvé-Perthes disease. The Staheli technique showed a greater postoperative-to-preoperative CE angle ratio, whereas the Tectoplasty technique showed a lower postoperative-to-preoperative subluxation ratio. Sharp angle correction and final Stulberg classification were comparable between groups. These findings should be interpreted cautiously, given the retrospective Level III design and limited sample size. Further prospective studies are needed to confirm the comparative effectiveness and long-term outcomes of these 2 techniques.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.
该研究比较大龄儿童Legg-Calvé-Perthes病（LCPD）shelf髋臼成形术Staheli与Tectoplasty两种技术的疗效。研究为回顾性比较研究，Staheli组26例（男23例，女3例），手术时平均8.55±0.95岁；Tectoplasty组20例（男18例，女2例），平均8.65±0.89岁；评估中心边缘角（CE角）、Sharp角、股骨头半脱位比率、股骨头大小比率及最终Stulberg分级。结果：两组股骨头包容均明显改善；术后/术前CE角比率Staheli组更高（213.14±38.66%比189.33±39.08%，P=0.04）；Sharp角比率相当（75.09±6.60%比75.31±5.41%，P=0.90）；半脱位比率Tectoplasty组更低（67.66±6.64%比74.90±10.05%，P=0.008）；股骨头大小比率Tectoplasty组略高（113.66±7.81%比109.18±6.77%，P=0.04）；最终Stulberg分级无显著差异（P=0.96）。结论：两种技术均能改善髋臼覆盖与股骨头重塑。临床意义：Staheli提升覆盖更多，Tectoplasty减少残余半脱位更优，但受回顾性小样本限制，需前瞻性验证。
BACKGROUND: Adolescent patients with hip dysfunction due to residual deformity in the healed stage of Legg-Calvé-Perthes disease (LCPD) remain a treatment decision-making challenge. Some advocate hip preservation via the surgical hip dislocation (SHD) approach, with concomitant procedures to address various hip pathologies. Currently, hip movement and gait analysis data before and after the SHD approach are lacking. This study aimed to determine the gait parameters, patient-reported outcomes, and radiographic outcomes of adolescent patients with LCPD who had hip preservation procedures via SHD.
METHODS: A retrospective review of a prospectively collected database at a single tertiary referral center was conducted for patients in the healed stage who had hip preservation procedures via SHD. We included patients who had preoperative and a minimum of 1-year postoperative gait analysis. Patient-reported outcomes included the UCLA Activity Score and modified Harris Hip Score (mHHS). Radiographic assessment included Stulberg classification and Sphericity Deviation Score (SDS). Similarly aged healthy controls were used for comparison of gait parameters.
RESULTS: Thirty-nine patients met the inclusion criteria, with a mean age at surgery of 16.55±2.56 years and a mean time point for post-SHD gait analysis of 2.02±0.64 years. There was improvement in the mHHS (preop: 58.59±12.98, postop: 72.12±11.36, P =0.0001) and UCLA Activity Score (preop: 6.41±2.55, postop: 8.28±2.11, P <0.001). Gait analysis revealed improved walking speed ( P =0.02), stride length ( P <0.001), Gait Deviation Index ( P =0.03), maximum degree of hip extension ( P <0.01), and power generated during hip flexion ( P =0.01). Hip abduction function showed no change ( P =0.15). Five hips improved from Stulberg IV to III ( P =0.10). There was no difference in SDS ( P =0.95).
CONCLUSION: Hip-preservation procedures via SHD produced significant improvements in gait parameters and patient-reported outcomes without loss of hip abduction function, but no improvement in SDS. This study provides new insights into how hip-preservation procedures via SHD improve gait and function in adolescent patients with LCPD and residual hip deformity.
LEVEL OF EVIDENCE: Level III retrospective cohort study.
该研究评价青少年残余Legg-Calvé-Perthes病（LCPD）经手术髋关节脱位（SHD）入路保髋手术后的步态与患者报告结局。研究回顾单中心三级转诊中心前瞻收集数据库，纳入处于愈合期、接受SHD保髋手术并有术前及术后至少1年步态分析的患儿，与同龄健康对照比较；结局包括UCLA活动评分、改良Harris髋关节评分（mHHS）、Stulberg分级和球形度偏差评分（SDS）。结果：39例纳入，手术时平均16.55±2.56岁，术后步态分析平均2.02±0.64年；mHHS由58.59±12.98升至72.12±11.36（P=0.0001），UCLA评分由6.41±2.55升至8.28±2.11（P<0.001）；步速（P=0.02）、步长（P<0.001）、步态偏差指数（P=0.03）、最大髋伸展角度（P<0.01）及屈髋功率（P=0.01）均改善，髋外展功能无变化（P=0.15）；5个髋由Stulberg IV级改善至III级（P=0.10），SDS无差异（P=0.95）。结论：SHD可显著改善步态与功能而不损害外展。临床意义：支持大龄残余畸形患儿选择保髋手术。
BACKGROUND: Petrie casting (6 wk) followed by wide-abduction bracing and weight-bearing restrictions is an established nonoperative containment treatment for Legg-Calve-Perthes disease (LCPD). Little is known about the quality-of-life impacts of this treatment. Our aim was to determine longitudinal changes to PROMIS Physical, Mental, and Social health measures during Petrie cast, abduction bracing, and weight-bearing restriction treatment.
METHODS: This is a retrospective study of prospectively collected PROMIS data from 23 LCPD patients treated with Petrie casting and subsequent abduction bracing and weight-bearing restrictions. Seven PROMIS measures (mobility, pain interference, anxiety, depressive symptoms, fatigue, anger, peer relationships) were collected at pretreatment, cast removal, and subsequent clinic visits. Mean PROMIS scores across different time points were compared using repeated measures ANOVA and multiple pairwise comparisons.
RESULTS: Mean age at Petrie casting was 7.3±1.7 years. Mean follow-up duration was 23.5±1.9 months. Mean mobility scores decreased significantly after Petrie casting (P=0.0003) but gradually improved during subsequent visits and reached mildly abnormal levels at 24 months. Mean pain interference scores improved significantly from pretreatment (P=0.018) and reached the normal range by 6 months. Mean scores for anxiety, depressive symptoms, fatigue, anger, and peer relationships measures remained within the normal range throughout the follow-up period. Three out of the 23 patients (13%) had severely abnormal mental or social health scores at multiple follow-up visits. Moderate to strong correlations were observed between pretreatment and follow-up Mental and Social health scores.
CONCLUSIONS: Mean mobility score was significantly decreased by Petrie casting, bracing , and weight-bearing restriction treatment. Mean scores for Mental and Social health measures remained within the normal range at every visit during Petrie cast and subsequent abduction bracing and weight-bearing restrictions. Three out of the 23 patients (13%), however, had severely abnormal Mental or Social health scores at multiple follow-up visits. Importantly, moderate to strong correlations between the pretreatment and follow-up visit scores were found, suggesting that the pretreatment PROMIS survey can help identify at-risk patients for severely abnormal Mental and Social health scores during treatment.
LEVEL OF EVIDENCE: Level IV-therapeutic study.
该研究描述Petrie石膏联合外展支具与限制负重治疗Legg-Calvé-Perthes病（LCPD）期间儿童生活质量的纵向变化。研究为回顾性研究，纳入23例患儿前瞻收集的PROMIS数据7个子域（活动能力、疼痛干扰、焦虑、抑郁症状、疲劳、易怒、同伴关系），于治疗前、拆石膏后及后续门诊测量，用重复测量方差分析与多重两两比较分析。结果：石膏时平均年龄7.3±1.7岁，平均随访23.5±1.9个月；石膏后活动能力评分显著下降（P=0.0003），之后逐步改善，至24个月达轻度异常水平；疼痛干扰评分较治疗前显著改善（P=0.018），6个月回到正常范围；焦虑、抑郁症状、疲劳、易怒及同伴关系全程保持正常范围；23例中3例（13%）在多个随访时点有严重异常的心理或社会健康评分；治疗前与随访的心理和社会健康评分呈中度至强相关。结论：包容治疗明显影响活动能力，心理与社会健康总体正常。临床意义：治疗前PROMIS评估可识别高危患儿。
BACKGROUND: Children with Legg-Calvé-Perthes disease (LCPD) have lower health-related quality of life compared with their age-matched peers; however, there is a paucity of literature that follows children's outcomes during different stages of the disease. This study analyzed Patient-Reported Outcomes Measurement Information System (PROMIS) t-scores for physical, mental, and social health in children diagnosed with unilateral early-stage LCPD between the ages of 6 and 11 years.
METHODS: All PROMIS t-scores of patients who had completed a minimum of 2 PROMIS surveys over their duration of care were extracted from a multicenter database. PROMIS subdomain t-scores (Mobility, Pain Interference, Fatigue, Depressive Symptoms, Anxiety, Anger, and Peer Relationships) were analyzed using linear mixed-effects regression models. A total of 629 surveys from 145 children (median age 7.4 y, 83% male) were included in analyses.
RESULTS: On average, surveys were completed 5.4 times/patient, corresponding to a median follow-up duration of 28.1 months. All physical and mental health domain scores improved over time. Patient-related pain scores were associated with Mobility, Pain Interference, Fatigue, Anxiety, and Depressive Symptoms. Mobility, Pain Interference, and Fatigue scores were better when self-reported and worse when proxy-reported. Peer Relationships t-scores were not associated with any of the factors.
CONCLUSIONS: The current study provides normative disease-specific data that enables orthopaedic surgeons to track patient wellbeing in LCPD patients, and to counsel families on realistic timelines for recovery in physical and mental health. This study also highlights that the self-reported pain intensity score is a strong predictor of overall physical and mental health.
LEVEL OF EVIDENCE: Level II-prognostic.
该研究提供6～11岁确诊单侧早期Legg-Calvé-Perthes病（LCPD）儿童身体、心理与社会健康PROMIS评分的疾病特异性数据。研究为多中心数据库回顾性分析，纳入至少完成2次PROMIS评估的145例患儿（中位年龄7.4岁，男性83%）共629份问卷，采用线性混合效应回归分析活动能力、疼痛干扰、疲劳、抑郁症状、焦虑、易怒及同伴关系t评分。结果：平均每例完成5.4次评估，中位随访28.1个月；所有身体与心理健康领域评分随时间改善；自报疼痛评分与活动能力、疼痛干扰、疲劳、焦虑及抑郁症状相关；活动能力、疼痛干扰和疲劳评分自报时更好、家长代报时更差；同伴关系t评分与各因素均无关联。结论：自报疼痛强度是整体身体与心理健康的强预测因子。临床意义：可据此向家庭说明康复的合理时间进程并追踪患儿状态。
BACKGROUND: Late-onset Legg-Calvé-Perthes disease (LCPD), defined as onset after the age of 8 years or younger, is associated with a poor prognosis and limited remodeling potential. The role of hip arthrodiastasis in this age group remains controversial.
METHODS: This prospective case series enrolled patients consecutively and collected data at predefined follow-up intervals. It included 24 patients with late-onset LCPD treated with articulated hip arthrodiastasis using a hinged Ilizarov external fixator combined with percutaneous adductor tenotomy. This reflects a deliberate institutional shift in treatment strategy rather than selective case allocation, which may reduce selection bias but limits the availability of a contemporary control group. All patients were older than 8 years at disease onset and classified as Herring lateral pillar B or C. Clinical outcomes were assessed using the Harris Hip Score (HHS) and range of motion (ROM). Radiographic evaluation included the Sharp acetabular angle, Reimer uncoverage index, epiphyseal index, and modified Stulberg classification at final follow-up.
RESULTS: The mean follow-up was 24 months (range: 18 to 30). The mean HHS improved significantly from 47.2 preoperatively to 86.7 at final follow-up (P<0.001). Significant improvements were observed in hip flexion, abduction, and internal rotation (all P<0.001). Radiographically, mean femoral head uncoverage improved from 33.3% to 25.0% (P<0.001), and the Sharp acetabular angle decreased from 42.3 to 37.6 degrees (P<0.001). According to the modified Stulberg classification, 19 hips (79%) had good outcomes (Stulberg II to III), while 5 hips (21%) had poor outcomes (Stulberg IV to V). Complications included pin-tract infections managed with local care and oral antibiotics, as well as a small number of patients requiring additional secondary procedures.
CONCLUSION: Articulated hip arthrodiastasis with adductor tenotomy resulted in favorable short-term clinical and radiographic outcomes in most patients with late-onset LCPD. This technique improved hip motion and radiographic parameters suggestive of improved femoral head containment, without the need for femoral or pelvic osteotomy, and may represent a useful treatment option in this challenging patient population.
LEVEL OF EVIDENCE: Level IV-therapeutic case series.
该研究探讨了髋关节牵引松解术（hip arthrodiastasis）对晚发型Legg-Calvé-Perthes病（LCPD）的治疗价值。研究设计为前瞻性病例系列，纳入24例发病年龄大于8岁、Herring lateral pillar B或C型的晚发型LCPD患者，采用铰链式Ilizarov外固定架进行关节内牵引并联合经皮内收肌切断术，平均随访24个月。主要结果显示：Harris髋关节评分从术前47.2分显著提高至86.7分（P<0.001），髋关节屈曲、外展及内旋活动度均显著改善（P<0.001）；影像学上，股骨头覆盖率从33.3%降至25.0%（P<0.001），Sharp髋臼角从42.3°降至37.6°（P<0.001）；按改良Stulberg分类，79%（19髋）疗效良好（Ⅱ-Ⅲ型），21%（5髋）疗效欠佳（Ⅳ-Ⅴ型）。结论认为该技术可有效改善晚发型LCPD的临床及影像学结果，且无需行股骨或骨盆截骨，为这一高难度人群提供了可行的保髋选择。适用于合并股骨头包含不良但尚存塑形潜力的晚发型LCPD患者，临床医生应关注术后针道感染及外固定护理。临床意义：髋关节牵引松解为晚发型Perthes病提供了一条无需股骨或骨盆截骨的保髋路径，适用于尚存塑形潜力的患者。
Hip instability after arthroscopy is a rare but challenging complication which can result from iatrogenic capsular deficiency and labral insufficiency. When accompanied by acetabular undercoverage, this combination compromises both the static and dynamic stabilizers of the hip joint, predisposing patients to pain, dysfunction, and progressive joint degeneration. Open reconstruction of these structures can be morbid, particularly in cases requiring a staged periacetabular osteotomy. This report describes an all-arthroscopic technique for simultaneous acetabular labral and hip capsular reconstruction in a patient with recurrent instability after prior arthroscopy. The labrum is reconstructed with a posterior tibialis tendon allograft, whereas a dermal allograft is used to restore the deficient anterior capsule using knotless suture anchor fixation. The technique restores both the suction seal and capsular integrity before a subsequent staged retroverting periacetabular osteotomy, allowing sequential management of soft-tissue and osseous pathology while minimizing morbidity. This combined arthroscopic approach provides a reproducible, minimally invasive method to address soft-tissue instability in patients with labral and capsular insufficiency, optimizing conditions for a later corrective periacetabular osteotomy and potentially delaying or preventing degenerative progression in young, active patients.
该技术报告介绍了一种全关节镜下同期行髋臼盂唇重建和髋关节囊重建的全微创术式，用于治疗复发性髋关节不稳伴髋臼覆盖不足的患者。盂唇采用后胫骨肌腱同种异体移植物重建，关节囊采用脱细胞真皮异体移植物结合无结缝合锚钉固定，以恢复关节的密封负压机制及静态稳定性。该技术为后续分期进行后倾髋臼周围截骨术（PAO）创造条件，实现软组织与骨性结构的序贯治疗。结论认为该方法为盂唇-关节囊联合缺损的复发性髋关节不稳提供了一种可重复、低侵袭的解决方案，有望推迟或阻止年轻活跃患者的退行性进展。适用于盂唇修复失败后复发性不稳或需要同期处理软组织缺损与髋臼覆盖不足的病例，术前应充分评估骨性畸形以规划分期手术方案。临床意义：盂唇-关节囊联合重建为盂唇修复失败的复发性髋不稳提供了分期治疗思路，可为后续PAO创造条件。
BACKGROUND: In cases of large, irreparable gluteus medius (GM) tears, gluteus maximus tendon transfer has emerged as a viable treatment option. The purpose of this study is to evaluate the short- to mid-term outcomes of gluteus maximus transfer as a treatment for irreparable GM tears in the native hip.
METHODS: Data was reviewed for all patients with native hips who underwent gluteus maximus transfer between 2011 and 2021. Patient were eligible for inclusion in the study if they presented with a full thickness irreparable GM tear treated with a gluteus maximus transfer and had completed preoperative and minimum 2-year postoperative questionnaires; or had a documented endpoint (revision surgery) within the study's timeframe. The minimal clinically important difference (MCID) for the mentioned PROs was calculated and included in the analysis.
RESULTS: A total of 15 native hips were included in the study, with all having a minimum 2-year follow-up and 8 reaching a minimum 5-year follow-up. The study group was predominantly female (93.3%), with a mean age of 66.7 ± 3.1 years, 3 (20%) patients underwent the gluteus maximus transfer as a primary surgery while 12 (80%) underwent a revision surgery from a prior failed GM repair. Significant improvements were observed across all evaluated patient reported outcome measures with high patient satisfaction. Additionally, only 3 patients (20%) showed a residual Trendelenburg gait, with 80% of patients regaining a normal gait. These improvements were sustained from the 2-year to the 5-year timepoint. A high percentage of patients reached the calculated MCID.
CONCLUSIONS: Gluteus maximus transfer remains a salvage procedure for irreparable GM tears. This procedure demonstrated favourable short- to mid-term outcomes, high patient satisfaction rates, high rate of restoration of normal gait, and a substantial percentage of patients achieving clinically meaningful improvements in functional scores.
评估臀大肌转位治疗不可修复臀中肌撕裂的短中期疗效。回顾性研究，2011—2021年15例原生髋患者，均为全层不可修复臀中肌撕裂并完成术前及至少2年问卷（8例满5年），计算各患者报告结局指标的最小临床重要差异（MCID）。女性占93.3%，平均66.7岁；3例（20%）为初次手术，12例（80%）为臀中肌修复失败的翻修。结果：各患者报告结局指标显著改善且满意度高；仅3例（20%）残留Trendelenburg步态，80%恢复正常步态；改善自2年维持至5年；较高比例患者达到MCID。结论：臀大肌转位仍是不可修复臀中肌撕裂的挽救手术。临床意义：提供手术参考。
BACKGROUND: Periacetabular osteotomy (PAO) is a well-established surgical treatment of symptomatic developmental dysplasia of the hip in young patients by improving the lateral centre-edge angle (LCEA) and the acetabular index (AI). Hence, the correction of the acetabular fragment is a hallmark of the PAO procedure.
PURPOSE: To evaluate the efficacy of fluoroscopy-guided visual estimation of the correction of the fragment during PAO.
METHODS: 49 patients undergoing PAO were enrolled. The surgeons (3) were asked to visual assess the perioperative LCEA and AI. Perioperative assessments were compared with perioperative and postoperative measurements. Interobserver variation was assessed by regression analysis. Bland-Altman analysis was used to determine correlation between visual assessment and measurements.
RESULTS: Mean correction of the LCEA was 11.1° (-4-23.5°) and the average AI correction was -10.7° (-20- 4°). The interobserver agreement was high for LCEA (R2 = 0.83) and acceptable for AI (R2 = 0.60). Visual estimation significantly overestimated the correction of the LCEA angle by 1.5° (95% CI, 1.0-1.9) and significantly overestimated AI by 0.31° (95% CI, 0.22-0.39) compared with the postoperative result. Retrospective measurements on the perioperative x-rays showed that this would have led to a significant underestimation of the correction of LCEA of 1.4° (95% CI 1.0-1.9) and overestimation of AI by 2.7° (95% CI, 1.9-3.5).
CONCLUSIONS: Perioperative visual estimation is on average sufficient for assessing the postoperative correction of LCEA and AI in PAO. Outliers are however observed.
评估髋臼周围截骨术（PAO）中透视引导下目测判断髋臼骨块矫正量的可靠性。前瞻性纳入49例PAO患者，3名术者围手术期目测外侧中心边缘角（LCEA）与髋臼指数（AI），与术后测量比较，回归分析观察者间变异，Bland-Altman分析一致性。结果：LCEA平均矫正11.1°，AI平均矫正−10.7°；观察者间一致性LCEA高（R2=0.83）、AI可接受（R2=0.60）；目测显著高估LCEA矫正1.5°、高估AI矫正0.31°。结论：目测总体足以判断术后矫正效果，但存在离群。临床意义：为术中判断提供依据。
PURPOSE: Understanding the trajectory of recovery after hip arthroscopy is valuable to help manage expectations and recognise patients at risk for delayed recovery. The purpose of this study was to determine the recovery profile of function, pain, and activity level up to 2 years after hip arthroscopy.
METHODS: Patients from a single centre's orthopaedic registry who underwent hip arthroscopy were identified. Function, pain, and activity level were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), a numeric pain scale (NPS), and Tegner Activity Scale (TAS) up to 2 years postoperatively. Nonlinear growth models were used to estimate the effect of recovery time on each outcome.
RESULTS: Of 92 patients identified, 64 (70%) were followed up to 2 years. There was significant improvement in all outcome measures at 2 years. The time to 50% recovery for PROMIS PF, PROMIS PI, and TAS was 11.0, 6.7, and 18.5 weeks, respectively. The time, in weeks, to full recovery of PROMIS PF, PROMIS PI, and TAS was estimated at 17.0, 37.4, and 28.8 respectively. NPS declined at a rate of -0.22 points per week, plateauing by 12 weeks.
CONCLUSIONS: Physical function and activity levels plateau at 4 and 7 months respectively, while pain recovery is more variable. These results can help guide discussions with patients regarding recovery after hip arthroscopy and provide benchmarks for identifying patients who could benefit from changes in postoperative protocol.
描述髋关节镜术后功能、疼痛与活动水平的恢复轨迹与速度，用于设定恢复预期并识别恢复延迟者。单中心数据库回顾性研究，92例患者中64例（70%）随访满2年，采用PROMIS躯体功能、疼痛干扰、数字疼痛评分与Tegner活动量表评估，非线性生长模型估计恢复时间。结果：各指标2年均显著改善；达50%恢复分别需11.0周（躯体功能）、6.7周（疼痛干扰）、18.5周（活动量表），达完全恢复估计需17.0、37.4、28.8周；数字疼痛评分12周后平台。结论：功能与活动分别在4个月和7个月达到平台，疼痛恢复个体差异更大。临床意义：为康复提供量化基准。
PURPOSE: To develop and compare machine learning-based risk prediction models to identify patients at risk for short-term adverse outcomes (overnight admission, early complication, or readmission) after hip arthroscopy and to determine key predictive demographic and clinical factors.
METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were used to develop and compare risk prediction models aiming to: (1) identify patients likely to experience short-term adverse outcomes including overnight admission, early complication, or readmission; and (2) determine the most predictive demographic and clinical factors contributing to adverse outcomes following hip arthroscopy. Predictive models were developed using support vector machine, random forest, logistic regression, gradient boosting, and extreme gradient boosting methods.
RESULTS: A total of 1478 eligible patients were included (56.4% female, mean age 40.0 ± 14.9 years), of whom 214 (14.5%) experienced a short-term adverse event. Compared to patients with an uncomplicated outpatient surgical course, those experiencing a short-term adverse event exhibited higher rates of diabetes mellitus, hypertension requiring medication, COPD, bleeding disorder, wound class ⩾2, ASA class ⩾3, lower preoperative haematocrit, and longer operative times. Logistic regression produced the optimal model for predicting short-term adverse events (AUC = 0.763), with operative time, preoperative haematocrit, ASA class, surgical procedure (CPT code), and age identified as the strongest predictive features.
CONCUSIONS: These findings demonstrate the value of ML and may assist in predicting surgical outcomes, guiding clinical decision-making, and managing patient expectations regarding their postoperative course.
开发并比较机器学习模型，识别髋关节镜术后短期不良事件（过夜住院、早期并发症或再入院）的高危患者并确定关键预测因素。基于ACS-NSQIP数据库，比较支持向量机、随机森林、logistic回归、梯度提升与极端梯度提升。纳入1478例（女性56.4%，平均40.0岁），214例（14.5%）发生不良事件；不良事件组糖尿病、高血压需服药、COPD、出血性疾病、ASA≥3比例更高，术前血细胞比容更低、手术时间更长；logistic回归模型最优（AUC=0.763），手术时间、术前血细胞比容、ASA分级与年龄为最强特征。结论：机器学习有助识别高危人群。临床意义：风险分层。
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. Normally distributed continuous variables between cohorts were compared using the independent samples t-test.
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/m2. The mean time between surgery and postoperative MRI was 14.8 ± 8.3 months. There was a significant difference between preoperative and postoperative hip muscle CSA for gluteus maximus (4298.6 ± 883.6 mm2 vs. 4384.6 ± 967.6 mm2, p < 0.01) and gluteus minimus (1037.0 ± 199.2 mm2 vs. 1074.9 ± 202.3 mm2, p < 0.001). A linear regression found that an increase in the change in CSA of the gluteus maximus (β = 3.237, p = 0.037) significantly predicted an increase in mHHS at 1 year when controlling for time between surgery and post-op MRI.
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.
分析股骨髋臼撞击患者髋关节镜前后髋周肌肉横截面积（CSA）变化及其与患者报告结局的相关性。单中心回顾性分析，纳入术前1年内有MRI、术后2个月以上至少1次MRI的89髋，平均35.8岁，女性66.3%，术后MRI距手术平均14.8个月；盲法测量8块肌肉CSA。结果：臀大肌CSA由4298.6mm²增至4384.6mm²（P<0.01），臀小肌由1037.0mm²增至1074.9mm²（P<0.001）；控制术后MRI时间后，臀大肌CSA变化显著预测1年mHHS增加（β=3.237）。结论：两大臀肌CSA显著增大且与结局正相关。临床意义：肌肉适应与功能恢复相关。
INTRODUCTION: Acetabular sourcil morphology has been linked to hip instability and pain. We investigated whether MRI findings at age 5 years predict sourcil morphology at skeletal maturity in developmental dysplasia of the hip (DDH).
METHODS: We retrospectively reviewed 71 surgically treated hips that were followed to skeletal maturity. On final anteroposterior radiographs, the sourcil was classified as type A (downsloping), type B (horizontal), or type C (upsloping). Coronal MRI at 5 years was used to measure bony, cartilaginous, and labral acetabular indices and centre-edge angles, and the labral junction obliquity angle (LJOA). Predictors of type C morphology were assessed using multivariable logistic regression and ROC analyses.
RESULTS: At 5 years, radiographic acetabular index and centre-edge angle did not differ among sourcil types. In contrast, hips that developed type C morphology showed smaller cartilaginous and labral centre-edge angles and a smaller LJOA on MRI. In multivariable analysis, a smaller cartilaginous centre-edge angle and a smaller LJOA independently predicted type C morphology. Optimal cutoff values were 23° for the cartilaginous centre-edge angle (AUC 0.902) and 89° for the labral junction obliquity angle (AUC 0.964).
CONCLUSION: MRI at age 5 years may help identify DDH hips at risk of developing an upsloping sourcil at skeletal maturity.
该研究探讨5岁时MRI能否预测DDH患儿骨骼成熟时的Sourcil形态。回顾性纳入71例手术DDH髋，成熟时X线将Sourcil分为A型（下斜）、B型（水平）及C型（上斜）。5岁时MRI测量骨性、软骨性中心边缘角及盂唇结合面倾斜角（LJOA）。多因素分析显示，较小软骨性中心边缘角（cutoff 23°，AUC 0.902）和较小LJOA（cutoff 89°，AUC 0.964）是C型上斜Sourcil的独立预测因素。结论：5岁MRI有助于识别骨骼成熟后出现上斜Sourcil风险的DDH髋，可据此制定个体化随访策略。临床意义：5岁MRI可作为DDH患儿远期髋臼形态的预测工具，为确定复查节点与是否需延长随访提供依据。
Floating hip injuries represent high-energy trauma with significant biomechanical instability. When associated with hip dislocation, unrecognized femoral shaft malrotation may alter femoral version and compromise the maintenance of a stable reduction. We present a case of postoperative recurrent hip dislocation following fixation of a floating hip injury, in which femoral shaft malrotation was identified as a key contributing factor. In the initial procedure, the femoral head was reduced prior to femoral shaft fixation and posterior acetabular wall reconstruction. However, due to persistent subluxation at the time of fixation, accurate assessment of femoral rotational alignment was limited, likely resulting in residual malrotation and subsequent instability. We describe a stepwise intraoperative protocol in which femoral head reduction is first achieved and used as the reference for rotational alignment. After removal of distal locking screws, the distal femoral segment is adjusted under fluoroscopic guidance until neutral alignment is restored, followed by definitive fixation. This approach provides a reproducible method for identifying and correcting femoral malrotation in complex floating hip injuries. This case highlights that femoral shaft malrotation is a potential, yet underrecognized, cause of postoperative hip instability. Prioritizing concentric hip reduction before definitive femoral fixation is critical to ensure accurate rotational alignment and prevent recurrent dislocation.
该病例报告旨在探讨浮髋损伤术后股骨干旋转畸形导致复发性髋脱位这一易被忽视的原因，并提出可重复的术中矫正流程。患者为浮髋损伤初次手术中先行股骨头复位、后行股骨干固定并重建后方髋臼壁，固定时仍存在持续半脱位致股骨旋转对线无法准确评估，残留旋转畸形；作者描述的步骤化术中方案为先获得股骨头同心复位并以此作为旋转对线参考，拆除远端锁钉后于透视引导下调整远端股骨段直至恢复中立对线，再行最终固定。结果：识别出股骨干旋转畸形是复发性脱位的关键促成因素，该流程提供了在复杂浮髋损伤中识别并纠正股骨旋转畸形的方法。结论：股骨干旋转畸形是术后髋关节不稳的潜在但认识不足的原因，优先保证股骨头同心复位再行确定性股骨固定对获得准确旋转对线、预防复发性脱位至关重要。临床意义：浮髋损伤手术顺序应先复位髋关节再固定股骨，勿以股骨固定顺序倒置。
BACKGROUND: Age and disease stage are critical factors in guiding management in Legg-Calvé-Perthes disease (LCPD). The modified Waldenström system is the most common staging system for LCPD but has only moderate inter-rater reliability. Deep learning (DL) has gained popularity in orthopaedics due to its potential to improve consistency/efficiency in determination of image-based classifications. The current study aimed to develop a DL model for determination of modified Waldenström staging from standard hip radiographs.
METHODS: Paired anteroposterior (AP) and frog-lateral hip radiographs from patients with confirmed LCPD treated at 2 tertiary care children's hospitals were included for model training/validation, hold-out testing, and external validation. Images of patients with skeletal dysplasias or other conditions were excluded. A modified Waldenström stage was assigned by the senior authors for each radiograph. A machine learning classification pipeline leveraging DL-automated extraction of clinically relevant and quantifiable parameters on AP/lateral radiographs was developed. Model performance was assessed on 2 separate LCPD classification schemes: early (Ia-IIa) vs late (IIb-IV) and the full classification.
RESULTS: A total of 2,164 images were included from institution 1. The DL pipeline had excellent segmentation metrics (dice coefficient = 0.93) and was able to extract and calculate epiphyseal parameters on AP/lateral radiographs within 12 s. On the hold-out testing set (n = 229 radiograph pairs), the model had an area under the receiver operating characteristic curve (AUROC) of 0.82 in classifying LCPD as either early or late stage. The most predictive parameters driving model decision-making were AP epiphyseal sclerosis and epiphyseal area. On external validation at institution 2 (n = 533 radiograph pairs), the AUROC was 0.75 when categorizing early vs late stages.
CONCLUSIONS: The DL pipeline provided high accuracy in discerning early vs late stages of LCPD based on imaging parameters and moderate accuracy on the full classification, performing better at more advanced stages. Training the model on larger samples with more representation at earlier stages may improve accuracy. This has the potential to expedite and standardize staging for both clinical encounters and research.
KEY CONCEPTS: (1)Deep learning can accurately classify early vs late-stage LCPD from standard hip radiographs.(2)Automated segmentation provides objective and quantifiable assessment of femoral morphology parameters pertinent to LCPD.(3)Artificial intelligence models could be applied to both clinical practice and research methodology as an automated tool for Waldenström staging.(4)Larger, multicenter datasets with greater representation of early stage LCPD imaging are needed to improve model performance and generalizability.
LEVEL OF EVIDENCE: III.
该研究旨在开发基于深度学习（DL）的改良Waldenström分期判定模型，以辅助Legg-Calvé-Perthes病（LCPD）的影像学评估。研究利用两家儿童医院共2164张影像（机构1）进行模型训练与内部验证，并在机构2（533张影像对）进行外部验证，采用AP位及蛙式侧位X线片建立机器学习分类流水线。结果显示：模型分割Dice系数达0.93，可在12秒内自动提取并计算骺部参数；二分类（早期Ia-Ⅱa vs 晚期Ⅱb-Ⅳ）任务中，测试集AUROC为0.82，外部验证AUROC为0.75；AP位骺部硬化及骺部面积是驱动模型判断的最重要参数。结论认为该深度学习流水线能够准确区分LCPD早晚期分期，在更晚期分期中表现更优，有潜力标准化Waldenström分期流程并提高临床及研究效率。适用于LCPD影像学评估场景，深度学习可作为人工分期的补充工具，但早期病例的识别准确性仍需提升。临床意义：深度学习辅助Waldenström分期可提升Perthes病影像评估的标准化程度，尤其适用于晚分期病例的判读。
BACKGROUND: While obesity is a well-established risk factor for slipped capital femoral epiphysis (SCFE), limited data exist regarding its impact on postoperative complication rates. This study aimed to evaluate the association between obesity and complications following SCFE treatment.
METHODS: We queried a large national database for pediatric patients who underwent treatment for SCFE between June 2005 and June 2025. We divided this cohort into patients with obesity and patients without obesity. We matched the cohorts with a propensity scoring algorithm on a one-to-one basis, resulting in 1,175 patients in each group. We tracked outcomes including infection, pulmonary embolism (PE), chondrolysis, avascular necrosis (AVN), leg length discrepancy (LLD), and hardware complications. We used the relative risk ratio (RR) and 95% confidence intervals (CIs). P values less than 0.05 were considered significant.
RESULTS: ≤10 (0.85%) patients developed an infection, and none developed a PE; ≤10 (0.85%) patients in each group developed chondrolysis. Thirty-eight (3.23%) patients in the obese group developed AVN after SCFE treatment, and 34 (2.89%) patients in the nonobese group developed AVN (RR = 1.12, CI: 0.71-1.76, P = .632). Seventy-seven (6.55%) patients in the obese group developed LLD compared to 50 (4.26%) patients in the nonobese group (RR = 1.54, CI: 1.09-2.18, P = .014). Sixty-one (5.19%) patients in the obese group had hardware complications, whereas 35 (2.98%) patients in the nonobese group had hardware complications (RR = 1.74, CI: 1.16-2.62, P = .007).
CONCLUSIONS: Patients with obesity had increased rates of LLD and hardware complications after treatment for SCFE compared to nonobese patients. Our findings highlight the importance of ongoing follow-up and monitoring of SCFE patients to detect the development of any of these outcomes.
KEY CONCEPTS: (1)Rates of infection, pulmonary embolism, and chondrolysis were low (<1%) and did not differ between obese and nonobese cohorts.(2)The rate of avascular necrosis was similar between groups.(3)In contrast, obese patients had significantly higher rates of leg length discrepancy and hardware complications.
LEVEL OF EVIDENCE: III: Retrospective cohort study.
该研究回顾性分析了肥胖对股骨上端骨骺滑脱（SCFE）治疗后并发症的影响。研究纳入了2005年6月至2025年6月期间美国国家数据库中接受SCFE治疗的儿科患者，通过倾向评分匹配生成肥胖与非肥胖组各1175例，追踪感染、肺栓塞、软骨溶解、股骨头坏死（AVN）、下肢不等长（LLD）及内固定相关并发症。结果显示：感染发生率两组均≤0.85%，肺栓塞未发生，软骨溶解两组均≤0.85%，组间无显著差异；AVN发生率肥胖组3.23%对比非肥胖组2.89%（RR=1.12，CI: 0.71-1.76，P=0.632）；LLD发生率肥胖组6.55%对比非肥胖组4.26%（RR=1.54，CI: 1.09-2.18，P=0.014）；内固定并发症肥胖组5.19%对比非肥胖组2.98%（RR=1.74，CI: 1.16-2.62，P=0.007）。结论认为肥胖SCFE患者术后LLD及内固定并发症风险显著增高，提示该人群需长期随访监测。适用于SCFE患者术前评估与术后管理，肥胖应被视为需要加强随访的危险因素。临床意义：肥胖是股骨上端骨骺滑脱治疗后并发症的独立风险因素，术前应充分评估并纳入围手术期管理。
BACKGROUND: Early-onset Legg-Calvé-Perthes disease (LCPD) carries a favorable prognosis in the majority of cases; key determinants of outcome are adequate containment (acetabular coverage) of the femoral head and preservation of range of motion during the initial Waldenström stages.
DECISION-MAKING: We present practical classifications and a treatment strategy that prioritizes conservative management and focuses operative interventions on "hips at risk." In children younger than approximately 6 years of age, treatment includes activity modification and dedicated ROM therapy. "Hip-at-risk" signs-particularly progressive decentering of the femoral head-identify the subgroup that benefits from early containment surgery.
THERAPY: Proximal femoral varus osteotomy is technically straightforward and widely established; its limitations include limb-length discrepancy and potential worsening of an existing abductor weakness; in childhood, pelvic Tönnis triple osteotomy addresses containment most comprehensively in LCPD and, in experienced hands, can be performed with low morbidity and early mobilization. As a general principle, the procedure should be selected that most reliably restores containment for the individual hip and with which the treating center has the greatest expertise.
CONCLUSION: Centralization of care would be desirable to generate robust long-term data and guidelines for this-perhaps surprisingly-insufficiently standardized condition.
该综述系统介绍了早发型Legg-Calvé-Perthes病（LCPD）的风险分层管理策略，以文献综述方式梳理了风险分层管理策略，强调保守治疗优先、仅对"高危髋"实施手术干预的原则。对于约6岁以下患儿，治疗以活动限制和专项关节活动度训练为主；股骨头进行性偏心（decentering）等"高危髋"征象是早期包容手术的指征。股骨近端内翻截骨术操作成熟、效果确切，但存在下肢不等短缩及外展肌力下降的风险；儿童期Tönnis三联骨盆截骨术在经验丰富的团队中并发症低、恢复快，是目前最全面的包容重建手段。结论指出应选择最能可靠恢复髋关节包容且团队最擅长的术式，并倡导集中化诊疗以产生高质量长期数据。适用于早发型LCPD的治疗决策，临床医生应根据患儿年龄、骺板状态及影像学"高危"征象个体化制定方案。临床意义：幼儿期Perthes病以保守治疗为主，早期识别低危亚组可避免不必要的手术干预。
Complex hip deformities after Legg-Calvé-Perthes disease are characterized by an enlarged, asymmetrically deformed femoral head, a short femoral neck, a high-riding greater trochanter, and secondary acetabular dysplasia. These features lead to intra- and extra-articular impingement, instability, abductor weakness, and early osteoarthritis. Conventional osteotomies or isolated acetabular reorientations do not directly address the femoral head deformity and, therefore, show limited results. Detailed analysis of the vascular anatomy enabled the development of intracapital osteotomy with central segment resection, without significantly compromising femoral head perfusion. Since 2001, this procedure, often combined with periacetabular osteotomy (PAO), has been used to restore sphericity and joint stability. Early data demonstrate significant radiological and functional improvements. Despite its technical complexity, the procedure is considered a promising option; long-term and multicenter studies are warranted.
该文报道了针对Legg-Calvé-Perthes病（LCPD）复杂残余畸形的股骨头截骨术（intracapital osteotomy with central segment resection）。复杂畸形特征包括股骨头增大不对称、股骨颈短缩、大转子高位骑跨及继发性髋臼发育不良，可导致关节内外撞击、不稳、外展肌无力及早期骨关节炎。传统截骨或单独髋臼改向难以直接矫正股骨头变形；该术式在详细血管解剖分析基础上进行头内截骨并切除中心骨块，2001年起常联合PAO（髋臼周围截骨术）实施，早期数据显示影像学及功能改善显著。结论认为该术式在技术要求高的前提下为LCPD复杂畸形提供了有前景的挽救选择，长期多中心数据有待积累。适用于LCPD遗留严重股骨头畸形的保髋手术规划，需在具备丰富髋关节外科经验的中心开展。临床意义：Perthes病后遗留的复杂股骨头畸形，股骨头成形截骨是保留关节功能的可行选择之一。
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.
该综述系统阐述了股骨上端骨骺滑脱（SCFE）的发病机制、临床表现、诊断、自然史及治疗策略。SCFE好发于青春期前及青春期儿童，确切发病机制不明，内分泌失调是其重要危险因素；稳定性及严重度分级是临床最实用的分类系统。轻度滑脱的治疗方案业界共识度高，中重度滑脱的处理及对侧预防性固定仍存争议；各国术者对固定螺钉数量的选择不一。股骨髋臼撞击（FAI）作为骨关节炎病因的证据日益增多，或将改变中重度SCFE的治疗格局；改良Dunn手术有潜力成为中重度SCFE的标准术式，但要求术者对局部解剖有深入认识。结论：稳定性分级仍是最实用的临床分类，中重度滑脱及对侧预防性固定的策略尚无定论，FAI相关证据的积累可能改变现有治疗格局。适用于SCFE的整体认知与临床决策，骨科医生应关注FAI相关研究进展及改良Dunn手术的技术规范。临床意义：稳定性与严重度分级是SCFE临床决策的核心工具，中重度滑脱的处理策略仍依赖术者经验与解剖熟悉度。
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.
该文综述了儿童髋关节骨盆及股骨截骨术的适应证与选择原则，旨在恢复髋关节生理几何与生物力学。主要适应证包括发育性髋关节发育不良（DDH）、神经性髋关节发育不良（NDH）、Perthes病（LCP）及股骨上端骨骺滑脱（SCFE/ECF）。儿童期首选髋臼加盖术（PDP）及Salter髋骨截骨术（SIO）；骨骼发育成熟后可采用三联骨盆截骨术（TPO）及髋臼周围截骨术（PAO），TPO甚至可在生长板未闭前完成；存在关节不匹配时，shelf截骨及Chiari截骨作为补救性手术可供选择。预后取决于适应证准确、术式合理、软组织平衡及系统化随访。结论：儿童髋关节截骨应按年龄与骨成熟度分层选择，生长板未闭时以加盖与Salter截骨为主，成熟后以三联骨盆截骨与PAO为主。适用于儿童髋关节外科的术式决策，临床医生应根据患儿年龄、骨成熟度及关节匹配状态选择截骨策略。临床意义：儿童髋关节截骨的术式选择应与年龄和骨成熟度匹配，生长板未闭时不宜采用成人PAO。