本期目录
1、类风湿关节炎和骨关节炎患者全膝关节置换术后效果的meta分析
2、术者性别对初次全髋关节置换术不良事件的影响
3、前交叉韧带缺失的膝内侧单髁置换术
4、外侧间室单髁膝关节置换术真的是一个好选择吗？
5、青少年全髋关节置换
6、患者对保髋手术期望值的调查
7、哪些因素影响股骨头坏死的保头
8、机器人辅助增强现实引导的髋臼周围截骨手术导航
9、髋臼周围截骨术中使用外固定器进行术中导航的方法
10、基于CT的北印度人群髋臼形态分析
11、髋臼周围截骨术对分娩方式有影响吗？
MULU
01
关节置换及保膝相关文献
文献1
类风湿关节炎和骨关节炎患者全膝关节置换术后效果的meta分析
译者 张轶超
本研究的目的是比较类风湿关节炎（RA）和骨关节炎（OA）患者全膝关节置换（TKA）术后的功能评分和并发症发生率的差异。检索了PubMed, MedLine, Cochrane Library, Embase和Web of Science数据库，检索截至2023年3月15日前的所有临床研究，比较RA和OA患者全膝关节置换术后的效果，由两位作者分别筛选文献。有34项研究共纳入7820115例(按膝关节计数)病例。meta分析结果显示，RA组术后膝关节评分[MD=-2.72，95%CI(-5.06，-0.38)，P=0.02]和术后膝关节功能评分[MD=-11.47，95%CI(-16.55，-6.39)，P<0.00001]均低于骨关节炎组，差异有统计学意义。RA组深静脉血栓(OR= 0.84，95%CI(0.79,0.90)，P<0.00001)和肺栓塞(OR= 0.84，95%CI(0.78,0.91)，P<0.00001)的发生率明显低于骨关节炎组(P<0.00001)。与骨关节炎患者相比，类风湿关节炎患者全膝关节置换术后膝关节协会评分和功能评分较低，假体感染、松动和翻修的风险较高，但TKA仍能有效减轻RA患者的疼痛，改善功能和生活质量，而不会增加下肢静脉血栓形成和肺栓塞的风险。因此，对于保守治疗无效的类风湿关节炎患者，全膝关节置换术可作为一种治疗选择。患者应充分了解全膝关节置换术的益处和可能的风险，并制定个性化的治疗计划。
Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis
The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD¼2.72,95%CI(-5.06,-0.38),P¼0.02] and the postoperative knee joint function score [MD¼11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR¼0.84,95% CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR¼0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.
文献出处：Zhang AR, Cheng QH, Yang YZ, Yang X, Zhang ZZ, Guo HZ. Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis. Asian J Surg. 2024 Jan;47(1):43-54. doi: 10.1016/j.asjsur.2023.09.015. Epub 2023 Sep 28. PMID: 37777403.
文献2
术者性别对初次全髋关节置换术不良事件的影响：一项包含11993例手术病例和200名术者的瑞典公立医院研究
译者 张蔷
背景：人们心中常常存在难以磨除的刻板印象，而术者性别对手术疗效的影响我们其实知之甚少。本研究的目的是探究瑞典医疗系统内术者性别对初次全髋关节置换手术（THA）后90天内不良事件发生率的影响。
方法：研究回顾性纳入了瑞典西部地区共10家医院自2008年至2016年间所有的因骨关节炎而施行的初次THA手术病例。当地医院的数据被上传至瑞典国家髋关节置换登记库（SHAR）和地区患者登记库中。我们从中提取了术者相关信息（如性别、年手术量和专业水平）和患者相关信息（如性别、年龄和Elixhauser合并症指数）。而不良事件的信息，我们从地区患者登记库中提取。对于明确何为不良事件，我们选择遵从SHAR的官方定义。最后我们应用不同的检验模型来研究术者性别对不良事件的影响。
结果：共有200位术者，其中17.5%为女性，共施行了11993例初次THA手术。术后90天内不良事件的发生率，男性（7%）和女性（6%）术者相当。即使纳入所有术者（主治医师和住院医师），我们也并未发现术者性别和不良事件之间的相关性（调整后概率，0.72；95%置信区间，0.52-1.00）。如果只纳入主治医师，我们得到的结果（调整后概率，0.88；95%置信区间，0.60-1.29）也是相似的。
结论：尽管女性术者施行初次THA术后90天内不良事件的概率略低于男性术者，我们却并未发现术者性别和THA术后不良事件之间的显著相关性。
The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty-A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals
Background: Stereotypes may prevail, but little is known about the influence that the sex of an orthopedic surgeon may have on outcomes. In a recently published study, there were no differences in the rate of adverse events following total hip arthroplasties (THAs) performed by female or male orthopedic surgeons. The objective of the present study was to investigate whether there was any difference in adverse events within 90 days following a primary THA performed by either a male or female surgeon in Sweden.
Methods: A retrospective study was performed to evaluate primary THAs performed for osteoarthritis between 2008 and 2016 at 10 hospitals in western Sweden. Local hospital data were linked with the Swedish Hip Arthroplasty Register (SHAR) and with a regional patient register. Data collected from local hospitals and the SHAR included surgeon-related information (e.g., sex, annual volume, and level of training) and patient-related information (e.g., age, sex, and Elixhauser comorbidity index). Adverse events were retrieved from the regional patient register. The definition of adverse events followed the SHAR definition of adverse events. Mixed models were used to investigate the impact of surgeon sex on adverse events.
Results: A total of 11,993 primary THAs were performed by 200 surgeons, of whom 17.5% were women. The proportions of adverse events within 90 days were similar for female (6%) and male (7%) surgeons. No association was found between surgeon sex and adverse events (adjusted odds ratio, 0.72; 95% confidence interval, 0.52 to 1.00) when all surgeons (both attendings and residents) were included in the analysis. A sensitivity analysis that included attendings only yielded similar results (adjusted odds ratio, 0.88; 95% confidence interval, 0.60 to 1.29).
Conclusions: Despite a small tendency toward lower rates of adverse events at 90 days after THAs performed by female surgeons, there was no significant association between surgeon sex and the risk of adverse events following THA.
文献出处：Jolbäck P, Rogmark C, Bedeschi Rego De Mattos C, Chen AF, Nauclér E, Tsikandylakis G. The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty: A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals. J Bone Joint Surg Am. 2022 Aug 3;104(15):1327-1333. doi: 10.2106/JBJS.21.00744. Epub 2022 May 24. PMID: 35867715.
文献3
前交叉韧带缺失的膝内侧单髁置换术
译者 丁云鹏
膝关节的症状性骨关节炎（OA）通常与前交叉韧带（ACL）损伤缺失有关。在考虑终末期内侧室骨关节炎和前交叉韧带缺失患者的治疗方案时，应认识到两种不同的病理。原发性前交叉韧带缺失（通常是外伤性前交叉韧带断裂）的患者可发展为继发性骨关节炎（通常表现为不稳定和疼痛的症状），这些患者通常是年轻和活跃的。原发性终末期内侧室骨关节炎患者可发展为继发性前交叉韧带缺失（通常是退行性前交叉韧带损伤），这些患者往往年龄较大。这两组患者的治疗选择包括关节镜清创、前交叉韧带重建、胫骨高位截骨（HTO）伴或不伴前交叉韧带重建、单室膝关节置换术（UKA）和全膝关节置换术（TKA）。一般的看法是，功能完整的ACL是选择UKA的基本先决条件。这是因为先前的报道显示前交叉韧带缺失时失败率更高，可能继发磨损和胫骨松动。然而，在一些ACL缺失合并终末期内侧室关节炎的病例中，进行了单独UKA治疗，最近的研究证实了良好的中短期结果，没有增加假体失败的风险。与TKA相比，更短的住院时间、更少的输血、更快的恢复和更低的并发症发生（如死亡、心肌梗死、中风、深静脉血栓形成）的风险使UKA成为一种有吸引力的选择，特别是对老年患者。另一方面，对功能要求较高的年轻患者，除了UKA外，还可能从同时或分期前交叉韧带重建中获益，以恢复膝关节稳定性。这些往往在技术上要求很高。
文献出处：Francesco Mancuso , Christopher A Dodd ,Medial unicompartmental knee arthroplasty in the ACL-deficient knee.J Orthop Traumatol. 2016 Sep;17(3):267-75.
文献4
外侧间室单髁膝关节置换术：真的是一个好选择吗？
译者 沈松坡
简介：外侧间室单髁膝关节置换术（LUKA）仅占所有膝关节置换术的不足1%，仅占所有单髁膝关节置换术的5-10%。这意味着关于这些手术的发表文献较少，外科医生的经验也少于内侧UKA。本研究的目的是根据所使用的承载面类型（全聚乙烯与金属背衬）来分析LUKA的生存和临床功能结果。
材料和方法：本研究是一项回顾性研究，包括2009年至2021年期间手术的42例LUKA。使用了两种固定的聚乙烯平台假体：全聚乙烯ACCURIS膝关节（38%）和金属支撑的Triathlon PKR系统（62%）。人口统计学参数、膝关节活动度（ROM）、胫股对线、假体存活（通过Kaplan-Meier曲线估计）和临床功能结果（通过膝关节社会评分测量）进行分析。
结果：患者平均年龄为65.5岁（范围36-87岁），平均随访时间为8.2年（范围2.1-12.8年）。30个（71.4%）luka手术为女性患者。行LUKA的主要原因是骨关节炎（88.1%）。无患者出现术后并发症或再次手术。1年和5年随访时的总LUKA生存率为100%。术后膝关节社会评分、膝关节活动度和胫股对线均显著改善(p <0.001)。临床膝关节学会评分由术前的46.5±14.5提高到术后的93.5±10.3，膝关节学会功能评分由术前的48.1±13.5提高到术后的94.6±9.3，最大屈曲度由术前的108.5±8.7度提高到术后的121±8.9度，胫股对线由术前的13.1±1.74度矫正到术后的5.7±0.8度。两组间临床功能改善或膝关节ROM无统计学意义差异(两者p <0.05)。
结论：LUKA是治疗胫股外侧骨关节炎的一种有效且明确的选择，其生存率5年随访为95%。无论使用何种胫骨假体，临床功能结果都是相同的。
Lateral unicompartmental knee arthroplasty: is really a good option?
Introduction: Lateral unicompartmental knee arthroplasties (LUKA) account for only < 1% of all knee arthroplasties and for only 5-10% of all unicompartmental knee replacements. This means that there is less published literature on these procedures and that the surgeon's experience with them is smaller than with medial UKA. The aim of this study was to analyze the survival and the clinical-functional outcomes of LUKA according to the type of bearing surface (all-polyethylene versus metal-backed) used.
Materials and methods: This was a retrospective study including 42 LUKAs operated between 2009 and 2021. Two fixed polyethylene-bearing models were used: the all-polyethylene ACCURIS knee (38%) and the metal-backed Triathlon PKR system (62%). Demographic parameters, knee range of motion (ROM), tibiofemoral alignment, implant survival (as estimated with the Kaplan-Meier curve), and clinical-functional outcomes (as measured with the Knee Society Score) were analyzed.
Results: Average patient age was 65.5 (range, 36-87) years and mean follow-up was 8.2 (range, 2.1-12.8) years. Thirty LUKAs (71.4%) were implanted in women. The main reason for performing a LUKA was osteoarthritis (88.1%). No patient developed post-surgical complications or had to be re-operated. Overall LUKA survival was 100% at 1-year and 5-year's follow-up. Knee Society Score, knee ROM and tibiofemoral alignment all improved significantly post-surgery (p < 0.001). The clinical Knee Society Score increased from 46.5 ± 14.5 pre-surgery to 93.5 ± 10.3 post-surgery, the functional Knee Society Score increased from 48.1 ± 13.5 pre-surgery to 94.6 ± 9.3 post-surgery, maximum flexion increased from 108.5 ± 8.7 degrees pre-surgery to 121 ± 8.9 degrees post-surgery and tibiofemoral alignment was corrected from 13.1 ± 1.74 degrees pre-surgery to 5.7 ± 0.8 degrees post-surgery. There were no statistically significant clinical-functional improvement or knee ROM differences between groups (p < 0.05, respectively).
Conclusion: LUKA is a valid and definitive option for patients with lateral tibiofemoral osteoarthritis, with a survival rate of > 95% at 5-years follow-up. Clinical-functional outcomes are the same, irrespective of the tibial component used.
02
保髋相关文献
文献1
青少年全髋关节置换：系统回顾和荟萃分析
译者 罗殿中
目的：全髋关节置换术（THA）在老年人群中取得了良好效果，但针对青少年患者，其适应证、治疗效果、及远期结果并不清楚。本研究的目的是评估21岁以下人群中THA的疗效，并对这类人群的临床决策提供参考。
方法：该系统回顾基于PubMed、Ovid MEDICINE、Embase数据库资料。我们纳入的研究包括：各种病因21岁以下THA，至少1年以上随访的临床报告、影像资料、和临床功能。采用荟萃分析的方法学，累计估计10年生存率；根据出版文献的置信区间，算出标准误，对各研究进行加权分析。
结果：共有25项1166髋纳入本研究。平均年龄17岁，60%为女性，平均随访8.1年。青少年THA的主要适应证是幼年炎性关节病。所有原因（全因）翻修率为14.4%，无菌性松动是首要翻修因素。从获取的数据中，仅有8篇研究报告了10年生存率，累计生存率为84.91%（95%的置信区间为70.56-99.27）。观察到的平均哈里斯髋关节评分（HHS）为88.08分。手术并发症为3.43%。
结论：针对青少年终末期髋骨关节炎，THA是可接受的选项。但对青少年患者提供THA之前，需要考虑到给髋部解剖带来的变化、增加的翻修率、假体长期生存状况等情况。
图1. 本研究的搜索流程图。
图2. THA的适应证。Juvenile Inflammatory Arthritis, 幼年炎性关节病；Avascular Necrosis Femoral Head, 股骨头缺血坏死；Developmental Hip Dysplasia, 髋关节发育不良；Slipped Capital Femoral Epiphysis, 股骨头骨骺滑脱；Legg-Calve-Perthes, 儿童股骨头骨骺坏死；Other, 其它。
文献出处：Huerfano E, Bautista M, Huerfano M, Nossa JM. Total hip arthroplasty in adolescents: a systematic review and meta-analysis. Int Orthop. 2024 Sep;48(9):2483-2492. doi: 10.1007/s00264-024-06175-8. Epub 2024 Apr 15. PMID: 38619564.
文献2
患者对保髋手术的期望值调查
译者 张振东
通过对保髋患者对手术期望值的调查，以确定其术前期望值的分布情况，并明确不同人口统计学或临床特征患者期望程度的差异。
纳入年龄18岁以上且母语为英语的患者，排除既往髋关节手术史或骨关节炎分级≥2的患者。患者共完成了21个项目的调查，确定了每个项目的单项期望值及总体期望值，以及iHOT评分。通过多变量回归方法进行统计学分析。分别对患者不同受教育程度、专业、从事竞技活动以及平时体育水平进行亚组分析。
结果显示，共纳入患者320例，平均年龄32岁; 髋关节撞击征270例(89%)，症状<6个月72例(24%)，平均iHOT评分41分。所有21个调查项目均完成选择的有120例患者(40%)，选择18 ~ 20个项目的有112例(37%)，选择数目≤17个的有70例(23%)。在多变量分析中，年龄年轻(比值比[OR] = 1.3; P =0 .02)、症状<6个月(OR = 1.3; P =0 .03)以及iHOT评分较差(OR = 2.5; P =0 .0001)与保髋期望值高相关。另外，平均期望值总分为80分(范围31-100分)，同样，在多变量分析中，年龄年轻(P = .05)、症状<6个月(P = 0.01)和iHOT评分低(P =0 .03)与期望值得分高相关。大学生学历或职业运动员选择所期望的调查条目更多(P =0 .01)，更期望术后有可能提高运动成绩(OR = 7.5; P =0 .001)，实现运动潜能突破(OR = 3.7; P = 0.002)，并期望未来可选择更苛刻的运动(OR = 2.7; P =0 . 01)。
患者对当前和未来身体功能和心理健康状况的改善均有较高期望，尤其是对于较年轻、症状持续时间较短或者髋关节功能状态较差的患者。了解不同患者的期望可以更好的指导术前教育，使患者对术后恢复和远期预后提供更客观的预期。
Patients' Expectations of Hip Preservation Surgery: A Survey Study
Purpose: To administer the Hip Preservation Surgery Expectations Survey to a large sample of patients to ascertain the prevalence of their preoperative expectations and to assess expectations in terms of demographic and clinical characteristics.
Methods: Consecutive patients were enrolled if they were ≥18 years old/spoke English and excluded if they had prior hip surgery/degenerative changes Tönnis ≥2. Patients completed the 21-item survey addressing the amount of improvement expected for each item (number of items and an overall score were determined) and the International Hip Outcome Tool (iHOT; hip score determined). Analyses included multivariable regression with survey score and number of expectations as dependent variables. Subanalyses considered collegiate/professional, competitive, and recreational sports level.
Results: Three hundred two patients participated, with a mean age of 32; 270 (89%) had cam impingement, 72 (24%) had symptoms <6 months, and mean iHOT score was 41. One hundred twenty patients (40%) selected all 21 survey items, 112 (37%) selected 18 to 20, and 70 (23%) selected ≤17 items. In multivariable analysis, younger age (odds ratio [OR] = 1.3; P = .02), symptoms <6 months (OR = 1.3; P = .03), and worse iHOT score (OR = 2.5; P = .0001) were associated with selecting more items. The mean survey score was 80 (range, 31-100). In multivariable analysis, younger age (P = .05), symptoms <6 months (P = .01), and worse iHOT score (P = .03) were associated with greater survey scores. Collegiate/professional athletes selected more items (P = .01) and were more likely to select improvement in sports performance (OR = 7.5; P = .001), achievement of athletic potential (OR = 3.7; P = .002), and maintaining options for more demanding future activities (OR = 2.7; P = .01).
Conclusions: Patients had multiple expectations for marked improvement in current and future physical function and psychological well-being. Younger patients, shorter symptom duration, and worse hip-specific functional status were associated with greater expectations. Understanding patients' expectations can guide preoperative education regarding realistic expectations for recovery and long-term outcome.
Clinical relevance: Patients' preoperative expectations vary according to demographic and clinical characteristics as measured in a survey study.
文献出处：Mancuso CA, Wentzel CH, Kersten SM, Kelly BT. Patients' Expectations of Hip Preservation Surgery: A Survey Study. Arthroscopy. 2019 Jun;35(6):1809-1816. doi: 10.1016/j.arthro.2019.01.028. Epub 2019 May 6. PMID: 31072723.
文献3
哪些因素影响股骨头坏死的保头
译者 任宁涛
背景：虽然外科医生使用了许多方法来治疗股骨头坏死，进行保头，但对于最佳的方法还没有共识。
问题/目的：我们提出了以下问题：(1)根据已发表的数据是否优选一种手术治疗？(2)塌陷前后髋关节治疗后影像学进展或转为THA的比率是多少？(3)股骨头病变大小是否影响疾病进展？(4)股骨头负重面受累的程度是否影响预后？
方法：在MEDLINE和Scopus中检索1998 - 2010年间发表的文章。我们只纳入了评估髋关节骨坏死手术干预的文章，并且证据等级为I到IV。我们纳入了488篇文献中的54篇。
结果：没有一种方法优于其他方法。在髋塌陷前和髋塌陷后，864髋中分别有264（31%）和850髋中分别有419（49%）表现出影像学上的疾病进展。当病变累及股骨头小于15%或坏死角度小于200°时（14%-25%），当坏死病变仅累及承重面内侧1/3时（4.6%），失败率较低。
结论：由于现有文献的局限性，很难确定塌陷前病变的最佳治疗方法。然而，数据表明，当累及的负重面有限时，手术干预可以防止股骨头局部病变的塌陷。保头后，头部塌陷的患者进展率很高。
Which factors influence preservation of the osteonecrotic femoral head
Background: Although surgeons use many procedures to preserve the femoral head in patients with hip osteonecrosis, there is no consensus regarding the best procedure.
Questions/purposes: We raised the following questions: (1) Is one surgical treatment preferred based on published data? (2) What are the rates of radiographic progression or conversion to THA after treatment of pre- and postcollapse hips? (3) Does lesion size in the femoral head influence progression? And (4) does the extent of involvement of the weightbearing surface of the femoral head influence outcome?
Methods: We searched MEDLINE and Scopus for articles published between 1998 and 2010. We included only articles assessing an operative intervention for hip osteonecrosis and having a level of evidence of I to IV. We included 54 of the 488 reviewed manuscripts.
Results: No procedure was superior to others. In pre- and postcollapse hips, 264 of 864 hips (31%) and 419 of 850 hips (49%), respectively, exhibited radiographic disease progression. There were lower failure rates when the lesion involved less than 15% of the femoral head or had a necrotic angle of less than 200° (14%-25%) and when the osteonecrotic lesion involved only the medial 1/3 of the weightbearing surface (4.6%).
Conclusions: The best treatment of precollapse lesions is difficult to determine due to the limitations of the available literature. However, the data suggest operative intervention prevents collapse of small lesions of the femoral head or when there is a limited amount of the weightbearing surface involved. Patients with head collapse have a high progression rate after a femoral head-saving procedure.
文献出处：Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res. 2012 Feb;470(2):525-34. doi: 10.1007/s11999-011-2050-4. PMID: 21879405; PMCID: PMC3254748.
文献4
机器人辅助增强现实（AR）引导的髋臼周围截骨手术导航
译者 李勇
摘要：髋关节周围截骨术（PAO）是手术治疗髋关节发育不良（DDH）的有效方法。 然而，由于髋关节周围解剖结构复杂，且手术视野（FoV）有限，外科医生进行 PAO 手术具有挑战性。为解决这一难题，我们提出了一种机器人辅助、增强现实（AR）引导的 PAO 手术导航系统。该系统主要由机械臂、光学跟踪器和微软 HoloLens 2 头显组成，后者是最先进的（SOTA）光学透视（OST）头戴式显示器（HMD）。为了进行 AR 引导，我们提出了一种基于光学标记的 AR 注册方法，用于估算从光学跟踪器坐标系（COS）到虚拟空间坐标系（COS）的变换，从而将虚拟模型叠加到相应的物理模型上。此外，为了引导截骨手术，所开发的系统会自动将骨锯与术前图像中规划的截骨平面对齐。 然后，它不仅为外科医生提供了限制骨锯移动的虚拟约束，还提供了视觉反馈的 AR 引导，不会转移视线，从而提高了手术精度和手术安全性。对所开发导航系统的 AR 注册精度和截骨精度进行了全面的实验评估。 所提出的 AR 套准方法的平均绝对距离误差（mADE）为 1.96 ± 0.43 毫米。机器人系统的平均中心平移误差为 0.96 ± 0.23 毫米，平均最大距离为 1.31 ± 0.20 毫米，平均角度偏差为 3.77 ± 0.85°。实验结果证明了所开发系统的 AR 套准精度和截骨精度。
Robot-Assisted Augmented Reality (AR)-Guided Surgical Navigation for Periacetabular Osteotomy
Abstract: Periacetabular osteotomy (PAO) is an effective approach for the surgical treatment of developmental dysplasia of the hip (DDH). However, due to the complex anatomical structure around the hip joint and the limited field of view (FoV) during the surgery, it is challenging for surgeons to perform a PAO surgery. To solve this challenge, we propose a robot-assisted, augmented reality (AR)guided surgical navigation system for PAO. The system mainly consists of a robot arm, an optical tracker, and a Microsoft HoloLens 2 headset, which is a state-of-the-art (SOTA) optical see-through (OST) head-mounted display (HMD). For AR guidance, we propose an optical marker-based AR registration method to estimate a transformation from the optical tracker coordinate system (COS) to the virtual space COS such that the virtual models can be superimposed on the corresponding physical counterparts. Furthermore, to guide the osteotomy, the developed system automatically aligns a bone saw with osteotomy planes planned in preoperative images. Then, it provides surgeons with not only virtual constraints to restrict movement of the bone saw but also AR guidance for visual feedback without sight diversion, leading to higher surgical accuracy and improved surgical safety. Comprehensive experiments were conducted to evaluate both the AR registration accuracy and osteotomy accuracy of the developed navigation system. The proposed AR registration method achieved an average mean absolute distance error (mADE) of 1.96 ± 0.43 mm. The robotic system achieved an average center translation error of 0.96 ± 0.23 mm, an average maximum distance of1.31 ± 0.20 mm, and an average angular deviation of 3.77 ± 0.85°. Experimental results demonstrated both the AR registration accuracy and the osteotomy accuracy of the developed system.
文献出处：Ding H, Sun W, Zheng G. Robot-Assisted Augmented Reality (AR)-Guided Surgical Navigation for Periacetabular Osteotomy. Sensors (Basel). 2024 Jul 22;24(14):4754. doi: 10.3390/s24144754.
文献5
髋臼周围截骨术中三维髋臼定位：一种使用外固定器进行髋臼周围截骨术的术中导航方法
译者 张利强
介绍 伯尔尼髋臼周围截骨术（PAO）是治疗髋臼发育不良的有效术式。然而，手术期间对髋臼位置的视觉控制受限可能会导致髋臼矫正不足或过度，或髋臼扭转的变化，从而导致残余发育不良或股骨髋臼撞击。因此，我们想开发一种简单直接的导航方法，在手术过程中提供所有三个平面髋臼矫正的有关信息。
方法 术中，两根垂直连接杆安装在用两个Schanz螺钉固定在活动的髋臼截骨块上的第三根连接杆上，显示冠状面、矢状面和横断面上的髋臼坐标。我们在27例PAO上使用了这种模拟导航方法，主要进行了横向旋转校正。考虑到骨盆倾斜，对这27例髋关节的术前和术后X线片进行了髋关节放射学参数分析。
结果 27例PAO的术前平均外侧中心边缘角（LCEA）从16°（+-6°）改善到平均34°（+-6°），平均髋臼指数（AI）从15°（+-4）校正到2°（+-4%）。该人群术后外侧覆盖恢复生理值。在本病例系列中，27例PAO均未测量到术后髋臼后倾。
结论 髋臼周围截骨术中髋臼方位的三维控制对于避免过度和不足矫正非常重要。使用外固定器作为模拟三维控制导航方法可以在PAO手术中实现。
在人工骨骨盆模型上通过两个Schanz螺钉将外固定架安装到活动的髋臼截骨块上。外固定架的两个垂直连接杆作为一个坐标系。红色、蓝色和黑色箭头表示髋臼在矢状面、横断面和冠状面的矫正方向
骨盆的前后位和侧位视图，外固定架通过第一个（红色箭头）和第二个（蓝色箭头）Schanz螺钉连接到髋臼截骨快上（A）。在X线透视斜位（B）下，第一个Schanz螺钉的向尾侧成角，以避免髋臼外侧边缘上的棒对棒夹的X线投影阻挡。
(A)术中测量髋臼截骨块在450 mm棒（蓝色箭头）和外固定架水平棒（黄色虚线箭头）之间向外侧旋转。在单独的向外旋转过程中，垂直杆（红色虚线箭头）必须在侧位（B）和尾侧位（C）保持垂直。这避免了髋臼扭转的任何意外变化
Three-dimensional acetabular reorientation during periacetabular osteotomy: an intraoperative navigation method using an external fixator for periacetabular osteotomy
Introduction Bernese periacetabular osteotomy (PAO) is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection or changes in acetabular version resulting in residual dysplasia or femoroacetabular impingement. Thus, we wanted to develop a simple and straightforward navigation method that provides information about acetabular correction in all three planes during surgery.
Method Intraoperatively, acetabular coordinates are shown in coronal, sagittal, and transverse plane by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the mobilized acetabular fragment with two Schanz screws. The application and fixation of the external fixator on the pelvis are demonstrated in this article. We used this analog navigation method on 27 PAOs, where we mainly performed a lateral rotational correction. The pre- and postoperative radiographs of these 27 hips were analyzed regarding the radiological hip parameters, taking into account the pelvic tilt.
Results The mean preoperative lateral center edge angle (LCEA) of the 27 PAOs improved from 16° (+-6) to a mean of 34° (+-6°) and the mean acetabular index (AI) was corrected from 15° (+-4) to 2° (+-4). This implements highly physiologic postoperative values for lateral coverage in this population. In this case series, no postoperative acetabular retroversion was measured in any of the 27 PAOs.
Conclusion Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and undercorrection. Using a fixateur externe as an analog navigation method this three-dimensional control can be implemented intraoperatively for PAOs.
文献出处：Schwarz TJ, Maderbacher G, Leiss F, Grifka J, Kappenschneider T, Knebl M. Three-dimensional acetabular reorientation during periacetabular osteotomy: an intraoperative navigation method using an external fixator for periacetabular osteotomy. Arch Orthop Trauma Surg. 2024 Sep 24. doi: 10.1007/s00402-024-05590-1. Epub ahead of print. PMID: 39313642.
文献6
基于CT的北印度人群髋臼形态分析
译者 贾海港
目的:髋臼形态在世界不同地区存在差异。通过计算机断层扫描 (CT) 进行多平面评估是同时评估髋臼深度、旋转度和倾斜度的关键，而这在印度人群中还鲜有探索。通过 CT 冠状面、矢状面和轴向参数对北印度人群的原生髋臼进行了人体测量研究。
方法：对122例（244 髋）无任何骨骼病变的患者的 CT 扫描结果进行了髋臼前倾角（AA）、sharp角（AAS）、髋臼矢状角（SAA）、外侧CE角（LCEA）、髋臼深度（AD）、髋臼水平偏移（AHO）、挤压指数（EI）和髋臼深度比（ADR）的测量。LCEA < 20°、ADR < 250、AD < 9 mm、AAS > 43°、EI ≥ 25% 是髋臼发育不良的标准。
成果：研究中，男性 62 人，女性 60 人，平均年龄为 63.8 ± 17.2 岁（21-98 岁）。在这项研究中，女性的ADR（p = 0.002）和EI（p = 0.01）明显低于男性。根据 LCEA，发育不良的患病率为 3.2%，而综合所有标准，则为 1.6%。
结论：与西方国家或亚洲其他地区的人口相比，印度人口的髋臼深度存在明显差异。女性的髋臼比男性浅。将我们的研究获得的放射学参数与不同国家的研究数据进行比较分析，有助于更好地了解印度和世界人口的髋臼形态。
图1：图示测量髋臼前倾角，a = 髋臼前倾角
图2：图示外侧CE角和sharp角的测量结果（a = 外侧CE缘角，b = sharp角）
图3：髋臼矢状角测量图（a =髋臼矢状角）
图4：图中显示了髋臼深度和髋臼深度比的测量结果（a = 髋臼深度，(a/b) × 1000 = 髋臼深度比）
图5：图示挤压指数（a/b）和髋臼水平偏移量（c）的测量结果
CT Based Analysis of Acetabular Morphology in Northern Indian Population: A Retrospective Study
Purpose
The acetabular morphology has shown to differ among different regions of the world. Multiplanar evaluation by computed tomography (CT) scan is the key to assess acetabular depth, version, and inclination at the same time which have been rarely explored before in the Indian population. We present an anthropometric study of the native acetabulum by CT based coronal, sagittal, and axial parameters in the Northern Indian population.
Methods
The acetabular anteversion (AA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), lateral center edge angle (LCEA), acetabular depth (AD), acetabular horizontal offset (AHO), extrusion index (EI) and acetabular depth ratio (ADR) was measured in CT scans of 122 patients (244 hips) without any bony pathologies. LCEA < 20°, ADR < 250, AD <9 mm, AAS > 43°, and EI ≥ 25% were taken as criteria for dysplastic acetabulum.
Results
There were 62 males and 60 females included in the study with a mean age of 63.8 ± 17.2 years (21–98 years). In this study, females were having significantly lower ADR (p = 0.002) and higher EI (p = 0.01) than males. The prevalence of dysplasia was 3.2% according to LCEA and 1.6% while combining all of the criteria.
Conclusion
There are prominent differences in acetabular depth in the Indian population compared with the population of Western countries or other parts of Asia. Females were shown to have shallower acetabulum than males. The comparative analysis of radiographic parameters obtained from our study with the data available on different country-based studies can help better understanding the acetabular morphology of Indian as well as the worldwide population.
文献出处：Paul S, Singh S, Raja BS, Mishra D, Kalia RB. CT Based Analysis of Acetabular Morphology in Northern Indian Population: A Retrospective Study. Indian J Orthop. 2020 Oct 20;55(3):606-613. doi: 10.1007/s43465-020-00267-4. PMID: 33995863; PMCID: PMC8081800.
文献7
髋臼周围截骨术对分娩方式有影响吗？
译者 陶可
作为髋关节发育不良的一种手术治疗选择，髋臼周围截骨术(PAO)通常用于育龄女性患者。然而，迄今为止，人们对该手术对术后妊娠和分娩方式的影响知之甚少。因此，研究目的是调查女性在接受PAO后患者和医生的决策。本研究邀请了2015年1月至2017年6月期间在该机构接受过PAO的所有患者参加一项纸质调查。纳入了所有女性患者，并进行了回顾性图表审查以及术前和术后放射影像分析。共纳入87名患者，其中20名在PAO后生下了26个孩子。平均总随访时间为5.3 ± 0.8年。4名(20.0%)患者报告称，产科医生因她们有PAO病史而对其表示担忧。第一个孩子出生前的平均时间为2.9 ± 1.3年。11名(55.0%)患者在PAO后首次分娩时进行了剖宫产，其中3名患者报告称她们有PAO病史，因此选择剖宫产分娩。有PAO病史的患者剖宫产分娩的风险高于一般人群，一般人群的剖宫产率为29.7%。由于与阴道分娩相比，剖宫产的发病率和死亡率更高，因此需要针对髋臼周围截骨术后妊娠提供循证建议。
图 接受PAO治疗的发育不良髋关节的放射学测量结果（a）术前和（b）术后。LCEA、TA和FHEI在术前和术后均有显著改善。
Periacetabular Osteotomy and Postoperative Pregnancy-Is There an Influence on the Mode of Birth?
As a surgical treatment option in symptomatic developmental dysplasia of the hip, periacetabular osteotomy (PAO) is often performed in female patients of childbearing age. Yet, to date, little is known about the procedure's influence on postoperative pregnancies and the mode of delivery. Our study's aim therefore was to investigate patient and physician decision making in women after PAO. We invited all patients who had undergone PAO in our institution from January 2015 to June 2017 to participate in a paper-based survey. Of these, we included all female patients and performed a retrospective chart review as well as analysis of pre- and postoperative radiological imaging. A total of 87 patients were included, 20 of whom gave birth to 26 children after PAO. The mean overall follow-up was 5.3 ± 0.8 years. Four (20.0%) patients reported that their obstetrician was concerned due to their history of PAO. The mean time before the first child's birth was 2.9 ± 1.3 years. Eleven (55.0%) patients underwent cesarean section for the first delivery after PAO, three of whom reported their history of PAO as the reason for this type of delivery. Patients with a history of PAO have a higher risk of delivering a child by cesarean section compared with the general population, in which the rate of cesarean section is reported to be 29.7%. As cesarean sections are associated with increased morbidity and mortality compared with vaginal deliveries, evidence-based recommendations for pregnancies after pelvic osteotomy are needed.
文献出处：Friederike Schömig, Christian Hipfl, Jannis Löchel, Carsten Perka, Sebastian Hardt, Vincent Justus Leopold. Periacetabular Osteotomy and Postoperative Pregnancy-Is There an Influence on the Mode of Birth? J Clin Med. 2022 Aug 18;11(16):4836. doi: 10.3390/jcm11164836.
来源：304关节学术
作者：304关节团队
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