本期目录：
1、全膝关节置换术：安全吗？韩国4124名患者的单中心研究
2、胫骨内侧髁间脊线预测单间室膝关节置换术后的骨折危险性
3、低手术量术者应用新技术与膝翻修率下降的相关性---一项包含53264例初次全膝置换病例的研究
4、髌骨去神经化对单间室膝关节置换术后预后和膝关节能力的影响
5、内侧膝关节单髁置换术的翻修指征
6、2024年骨关节炎回顾：流行病学和治疗
7、全膝关节置换术后力线中立或残留轻度内翻对预后的影响
8、COMP病及其进展
9、儿童时期因髋关节发育不良接受过治疗的患者成年后的生活质量
10、髋臼周围截骨术（PAO）患者在婴儿时期接受髋关节发育不良（DDH）治疗和未治疗的髋关节形态学比较
11、在髋臼周围截骨术中使用斜位透视和术后延迟负重可减少坐骨1年后延迟愈合
12、与CT相比，X线低估了外侧中心边缘角和Tönnis角在临界和真正髋臼发育不良中的测量值
13、髋关节发育不良患者的髌骨力线异常
14、髋臼周围截骨术后髋关节镜检查治疗髋关节发育不良
第一部分：
关节置换及保膝相关文献
文献1
全膝关节置换术：安全吗？韩国4124名患者的单中心研究
译者 张轶超
背景：虽然全膝关节置换术（TKA）被认为是治疗膝关节骨关节炎的有效方法，但它存在并发症的风险。随着越来越多的老年患者进行TKA，了解死亡原因对于提高TKA的安全性至关重要。本研究旨在确定TKA术后短期和长期死亡的主要原因，并报告主要死亡原因的死亡率趋势。
方法：对4124例TKA的患者进行了分析。手术的平均年龄为70.7岁。平均随访时间为73.5个月。通过韩国统计信息院回顾性收集死亡原因，并根据国际疾病分类-10代码将其分为13个亚组。在30、60、90、180、180天和> 180天的死亡时间间隔内确定短期和长期死亡原因。计算标准死亡率（SMRs）和累积死亡发生率，来研究TKA后的死亡率趋势。
结果：短期死亡率中30 d为0.07%，60 d为0.1%，90 d为0.2%，180 d为0.2%。恶性肿瘤和心血管疾病是短期死亡的主要原因。长期（> 180 d）死亡率为6.2%。恶性肿瘤（35%）、其他（11.7%）和呼吸系统疾病（10.1%）是主要的长期死亡原因。男性死于呼吸、代谢和心血管疾病的累积风险更高。70岁(SMR, 4.3；95%可信区间[CI]， 3.3-5.4)和70 - 79岁之间(SMR为2.9；95% CI, 2.5-3.5)TKA患者的年龄矫正死亡率明显更高，高于一般人群。
结论：TKA术后短期死亡率较低，大部分原因与TKA无关。长期死亡的主要原因与以前的发现一致。我们的研究结果可以作为了解TKA患者生存和死亡率的咨询数据。
Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea
Background: Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report
mortality trends for major causes of death.
Methods: A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA.
Results: The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death. Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3–5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5–3.5) than that in the general population.
Conclusions: The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.
文献出处：Ko K, Kim KH, Ko S, Jo C, Han HS, Lee MC, Ro DH. Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea. Clin Orthop Surg. 2023 Dec;15(6):935-941. doi: 10.4055/cios22088. Epub 2022 Dec 29. PMID: 38045584; PMCID: PMC10689220.
文献2
胫骨内侧髁间脊线预测单间室膝关节置换术后的骨折危险性
译者 马云青
背景: 非骨水泥牛津单间室膝关节置换术(OUKA)后胫骨骨折是一种罕见但严重的并发症。在亚洲国家，这种情况的报道更为频繁。这项回顾性研究的目的是使用一种简单新颖的测量方法来评估患者OUKA后胫骨骨折的形态学特征。
方法: 骨折组为采用非骨水泥型单髁治疗后胫骨骨折6例（全部为女性），回顾性分析2016年1月至2017年4月在同一家医院行的非骨水泥 OUKA 术后无明显骨折病例150例(对照组)。作者画了一条起自内侧髁间脊的直线线(ME线) ，定义为一条从内侧髁间脊的尖端延伸到与胫骨轴平行的线。ME线将胫骨分为髓内型(I型)和髓外型(E型)，并比较骨折患者和对照组之间每种类型的比例。
结果: 骨折组 E型4例(66.7%) ，I型2例(33.3%) ;对照组E型18例(12%) ，I型132例(88%)。Fisher 精确检验显示骨折组 E型的比例高于对照组(p < 0.01)。
结论: ME线的测量对于术后胫骨骨折的预测值得推荐
下图为ME线示意图和髓内（I型）髓外（E型）示意图
文献出处：Yoshikawa R, Hiranaka T, Okamoto K, Fujishiro T, Hida Y, Kamenaga T, Sakai Y. The Medial Eminence Line for Predicting Tibial Fracture Risk after Unicompartmental Knee Arthroplasty. Clin Orthop Surg. 2020 Jun;12(2):166-170. doi: 10.4055/cios19011. Epub 2020 Apr 27. PMID: 32489537; PMCID: PMC7237250.
文献3
低手术量术者应用新技术与膝翻修率下降的相关性---一项包含53264例初次全膝置换病例的研究
译者 张蔷
背景：全膝关节置换（TKA）术中应用新技术（导航与机器人）通常受到高手术量的医院和术者的追捧，但其对低手术量术者的价值并不明确。本研究的目的是确定在使用最佳假体组合（OPC）时术者手术量、新技术应用情况和翻修率的相关性。
方法：研究选择澳洲骨科协会国家关节置换登记库（AOANJRR）自2008年1月1日至2022年12月31日的所有初次TKA病例，入组标准为因骨关节炎而施行OPC置换术且距离施行初次有记录的置换手术5年以上的术者。首先比较的指标为传统器械（CV）TKA VS. 新技术辅助（TA）TKA的术者手术量。接着我们通过Kaplan-Meier值推算累计翻修百分比（CPR）。然后我们通过Cox比例风险模型的方法比较不同手术量术者的翻修率和不同手术量及新技术应用情况术者的翻修率。最后，我们将翻修依照轻/重进行了亚组分析，并评估每年100例TKA手术的术者新技术应用情况对翻修率的影响。
结果：在所有入选的53264例TKA病例中，31536例为TA-TKA、21728例为CV-TKA。应用新技术可以降低年手术量不足50例TKA术者的全因翻修率以及年手术量不足40例TKA术者的轻症翻修率。我们并未发现年手术量与重症翻修率的相关性。如果以应用传统器械且年手术量100例TKA的术者作为对照，年手术量不足50例TKA术者的全因翻修率和年手术量不足100例TKA术者的重症翻修率均显著升高。而作为对比的TA-TKA术者，年手术量不足100例和100例相比，全因或重症翻修率均无显著性差异。
结论：低手术量术者应用TKA新辅助技术与翻修率下降相关，但高手术量术者的翻修率却没有显著性变化。因此，我们推荐低手术量术者应用TA-TKA。
注：最佳假体组合（OPC）的定义是最低限度稳定或内轴设计、固定平台、交联聚乙烯（XLPE）垫片、骨水泥固定的胫骨假体和置换髌骨。
Association of Technology Usage and Decreased Revision TKA Rates for Low-Volume Surgeons Using an Optimal Prosthesis Combination
An Analysis of 53,264 Primary TKAs
Background: Technology (navigation and robotics) usage during total knee arthroplasty (TKA) is often supported by literature involving high-volume surgeons and hospitals, but the value of technology for lower-volume surgeons is uncertain. This study aimed to determine if there was a relationship among surgeon volume, technology usage, and revision rate when using an optimal prosthesis combination (OPC).
Methods: Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data were obtained from January 1, 2008, to December 31, 2022, for all primary TKA procedures performed for osteoarthritis using an OPC by a known surgeon ≥5 years after their first recorded procedure. The interaction between surgeon volume and conventional instrumentation (CV) versus technology-assisted (TA) TKA was assessed. The cumulative percent revision (CPR) was determined by Kaplan-Meier estimates. Cox proportional-hazards methods were used to compare rates of revision by surgeon volume and by the interaction of volume and technology. Sub analyses were undertaken to examine major and minor revisions separately, and to assess the influence of technology on revision rates relative to those of a surgeon undertaking 100 TKA/year.
Results: Of the 53,264 procedures that met the inclusion criteria, 31,536 were TA-TKA and 21,728 were CV-TKA. Use of technology reduced the all-cause revision rate for surgeons with a volume of <50 TKA/year and the rate of minor revisions for surgeons with a volume of <40 TKA/year. No interaction between surgeon volume and the rate of major revision surgery was found. With CV-TKA by a surgeon with a 100-TKA/year volume as the comparator, all-cause and major revision rates were significantly elevated for surgeons undertaking <50 and <100 TKA/year, respectively. In contrast, analysis of TA-TKA showed no difference in rates of all-cause or major revisions for surgeons undertaking <100 TKA/year compared with 100 TKA/year.
Conclusions: TA-TKA was associated with a decrease in the revision rate for lower-volume surgeons but no significant alterations in revision rate for higher-volume surgeons. Preferential use of TA-TKA by lower-volume surgeons should be considered.
文献4
髌骨去神经化对单间室膝关节置换术后预后和膝关节能力的影响：一项随机临床试验
译者 丁云鹏
目的：探讨单室膝关节置换术（UKA）后髌骨去神经化（PD）对疼痛、功能和下跪能力的影响。
方法：前瞻性选择行UKA的膝关节内侧骨关节炎患者。根据是否进行髌骨去神经化，将患者随机分为PD组和非PD组。采用特殊外科医院（HSS）膝关节评分、Kujiala评分、视觉模拟评分（VAS）和遗忘关节评分（FJS-12）进行临床评价，并记录术后并发症。评估两组患者术后的自我知觉和实际执行不同跪姿的能力。
结果：经PD治疗的UKA患者获得更好的Kujiala评分和FJS-12评分，术后膝关节前侧疼痛减轻，下跪能力改善，验证了PD治疗UKA的有效性。PD患者对跪的感知和实际表现仍然不匹配，但在不同的下跪活动中的表现普遍优于非PD患者。
结论：髌骨去神经化能安全有效地改善UKA术后早期髌股关节功能、疼痛和跪行能力。
The efficacy of patellar denervation on prognosis and kneeling capacity after unicompartmental knee arthroplasty: a randomized clinical trial
Objective: The aim of this study was to investigate the effect of patellar denervation (PD) on pain, function and ability to kneel after unicompartmental knee arthroplasty (UKA).
Methods: Patients with medial knee osteoarthritis who underwent UKA were prospectively selected. Patients were randomly divided into PD and non-PD groups based on whether patellar denervation was performed. Clinical assessment was performed using the Hospital for Special Surgery (HSS) knee score, Kujiala score, visual analogue scale (VAS) and forgotten joint score (FJS-12), as well as postoperative complications were recorded. The patients' postoperative self-perception and actual ability to perform different kneeling positions were assessed in the two groups.
Results: UKA patients treated with PD achieved better Kujiala scores and FJS-12 scores, reduced anterior knee pain and improved kneeling ability postoperatively, validating the effectiveness of PD in UKA. Perception and actual performance of kneeling remained mismatched in PD patients, but performance during different kneeling activities was generally better than in non-PD patients.
Trial registration: Clinical Trial Registration: ChiCTR1900025669.
Conclusion: Patellar denervation can safely and effectively improve patellofemoral joint function, pain and kneeling ability in the early postoperative period after UKA.
文献出处Ying-Jin Sun , Ning Liu ,Long Huang The efficacy of patellar denervation on prognosis and kneeling capacity after unicompartmental knee arthroplasty: a randomized clinical trial.J Orthop Surg Res. 2024 Oct 5;19(1):626.
文献5
内侧膝关节单髁置换术的翻修指征：系统回顾
译者 沈松坡
介绍：相比于全膝关节置换术，单髁膝关节置换术（UKA）具有并发症少、恢复快等优点；然而，uka也有更高的翻修率。因此，了解UKA失败的原因可以优化临床结果。我们的目的是确定内侧UKA的失效模式，并检查假体承载方式、骨水泥使用与否和时间的差异。
材料和方法：检索MedLine、EMBASE、CINAHL和Cochrane数据库，从2000年到2020年进行系统回顾。如果研究包括≥250名参与者，≥10例失败，并且报告了骨关节炎（OA）的内侧UKA的所有失败模式，则纳入研究。
结果：共选择了24项队列研究和2项注册研究（II级和III级）。最常见的失效模式是无菌性松动（24%）和OA进展（30%）。早期失效（短于6个月）是由于感染（40%）、垫片脱位（20%）和骨折（20%）；中期失败(2年至5年间)是由于OA进展（33%），无菌性松动（17%）和疼痛（21%）；和晚期(大于10年)失败主要是由于OA进展（56%）。固定平台假体的磨损失败率更高（5% cf. 0.3%），而活动平台假体的垫片脱位率更高（14% cf. 0%）。使用骨水泥假体时，由于无菌松动导致的失败率很高（27%），而使用非骨水泥假体则降低了这一失败率（4%）。
结论：UKA失效模式因假体设计、骨水泥使用和手术后时间而异。对于UKA，应该仔细考虑假体的选择和患者的选择。
关键词:内侧;骨关节炎;翻修;系统评价;单髁膝关节置换术。
Revision indications for medial unicompartmental knee arthroplasty: a systematic review
Introduction: Unicompartmental knee arthroplasty (UKA) has advantages over total knee arthroplasty including fewer complications and faster recovery; however, UKAs also have higher revision rates. Understanding reasons for UKA failure may, therefore, allow for optimized clinical outcomes. We aimed to identify failure modes for medial UKAs, and to examine differences by implant bearing, cement use and time.
Materials and methods: A systematic review was conducted by searching MedLine, EMBASE, CINAHL and Cochrane databases from 2000 to 2020. Studies were selected if they included ≥ 250 participants, ≥ 10 failures and reported all failure modes of medial UKA performed for osteoarthritis (OA).
Results: A total of 24 cohort and 2 registry-based studies (levels II and III) were selected. The most common failure modes were aseptic loosening (24%) and OA progression (30%). Earliest failures (< 6 months) were due to infection (40%), bearing dislocation (20%), and fracture (20%); mid-term failures (> 2 years to 5 years) were due to OA progression (33%), aseptic loosening (17%) and pain (21%); and late-term (> 10 years) failures were mostly due to OA progression (56%). Rates of failure from wear were higher with fixed-bearing prostheses (5% cf. 0.3%), whereas rates of bearing dislocations were higher with mobile-bearing prostheses (14% cf. 0%). With cemented components, there was a high rate of failure due to aseptic loosening (27%), which was reduced with uncemented components (4%).
Conclusions: UKA failure modes differ depending on implant design, cement use and time from surgery. There should be careful consideration of implant options and patient selection for UKA.
Keywords: Medial; Osteoarthritis; Revision; Systematic review; Unicompartmental knee arthroplasty; Unicompartmental knee replacement.
文献6
2024年骨关节炎回顾：流行病学和治疗
译者 张峻
本“年度回顾”呈现了临床骨关节炎（OA）领域精心挑选的研究主题和个人研究，重点关注流行病学和治疗。从2023年3月4日至2024年3月31日在电子数据库MEDLINE中进行搜索，专门针对涉及人参与的英语文章。纳入基于对识别风险因素或优化OA治疗的重要性和相关性的理解。5位作者共筛选了6539项研究，其中157项研究可能纳入。最终，选择了44项研究，揭示了六个与OA相关的关键主题：i）OA导致的负担（主要来自全球疾病负担研究），ii）疼痛驱动因素和轨迹，iii）生理性别/社会性别的影响，iv）OA风险因素，以及v）手和vi）膝OA的治疗。骨性关节炎的患病率继续上升，特别是对女性的影响，性别之间的风险因素和治疗反应差异不明显。在两个重要的数据库中证明了与特应性的关联。值得注意的是，作者对最近针对手部（甲氨蝶呤、地诺单抗、秋水仙碱、局部倍他米松）和膝OA的高质量随机对照试验特别感兴趣，这些试验在干细胞注射方面的结果相互矛盾。总之，这些发现有助于显示OA的负担日益加重，也有助于理解OA的病理生理学，并为加强OA患者管理的持续努力提供信息。
Osteoarthritis year in review 2024: Epidemiology and therapy
This "Year in Review" presents a curated selection of research themes and individual studies within the clinical osteoarthritis (OA) field, focusing on epidemiology and therapy. The search was conducted in electronic database MEDLINE from March 4, 2023, to March 31, 2024, specifically targeting English-language articles involving human participants. Inclusions were based on perceived importance and relevance to identifying risk factors or advancing OA treatments. A total of 6539 studies were screened by the 5 authors, resulting in 157 studies considered for potential inclusion. Ultimately, 44 studies were selected, uncovering six key OA-related themes: i) the burden of OA (mostly from Global Burden of Disease studies), ii) pain drivers and trajectories, iii) impacts of sex/gender, iv) OA risk factors, and treatments for v) hand and vi) knee OA. The prevalence of OA continues to rise, particularly affecting women, with unclear distinctions in risk factors and treatment responses between sexes. Associations with atopy were demonstrated in two significant databases. Notably, the authors were particularly interested in recent high-quality methodology randomized controlled trials focusing on hand (methotrexate, denosumab, colchicine, topical betamethasone) and knee OA with conflicting results about stem cell injection. These findings collectively contribute to show the growing burden of OA, but also to help the understanding of OA pathophysiology and inform ongoing efforts to enhance management for people with OA.
文献出处：Courties A, Kouki I, Soliman N, Mathieu S, Sellam J. Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthritis Cartilage. 2024 Nov;32(11):1397-1404. doi: 10.1016/j.joca.2024.07.014. Epub 2024 Aug 3. PMID: 39103081.
文献7
全膝关节置换术后力线中立或残留轻度内翻对预后的影响：系统综述与荟萃分析
译者 肖凯
本研究主要比较了全膝关节置换术（TKA）后力线中立和残留轻度内翻的临床和功能预后以及假体生存率。我们在PubMed、Embase、Cochrane Library和Web of Science数据库对1974年1月1日到2020年12月18日间的研究进行检索，筛选出比较不同力线TKA预后的研究。这些研究由两位研究者根据Newcastle-Ottawa Scale (NOS)进行评估。将手术后力线分为中立（0°±3°）、残留轻度内翻（3°-6°）和残留严重内翻（>6°），并进行组间比较，使用Review Manager 5.3进行荟萃分析。使用比值比（OR）和均值差（MD）来比较二分类变量和连续变量，采用固定效应模型和随机效应模型来进行数据的荟萃分析。
纳入荟萃分析的有9项研究，共包含中立力线患者1410例、残留轻度内翻564例、残留严重内翻175例，所有研究均发表于2013年之后。三项研究NOS评估7分，剩余研究得分8分，纳入文章质量较高。WOMAC评分的汇总均值差（MDs）为1.07 [95%置信区间（CI）-1.06至3.20；P=0.32；I2=79%]。荟萃分析显示，中立力线和轻度内翻具有相似的Oxford Knee Score (OKS)、Knee Society Knee Score (KS-KS)和Knee Society Function Score (KS-FS)，但力线中立的Forgotten Joint Score (FJS)较低[均值差-6.0, 95%置信区间（CI）-9.37至-2.64, P=0.0005]。力线中立比严重内翻的KS-KS得分更高（M 2.98, 95% CI 1.42至4.55, P=0.0002；I2=0%），KS-FS得分更高（M 8.20, 95% CI 4.58至11.82, P<0.00001；I2=0%）。力线中立与轻度内翻（95% CI 0.36至9.10；P=0.48；I2=65%）或严重内翻（95% CI 0.94至37.90；P=0.06；I2=61%）的假体生存率相似。其他结果无统计学差异。在术前存在膝内翻的患者中，TKA术后残留轻度内翻较力线中立可以获得类似甚至更优的结果，但现有证据似乎不足以替代当前的TKA术后中立力线的金标准。应避免TKA术后严重的内翻。
Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis
Comparing mainly clinical and functional outcomes as well as prosthesis survival with neutral and residual mild varus alignment, we searched PubMed, Embase, Cochrane Library and Web of Science databases from 1 January 1974 to 18 December 2020 to identify studies comparing clinical and functional outcomes as well as prosthesis survival in the presence of different alignments after total knee arthroplasty (TKA) for varus knees. The included studies were assessed by two researchers according to the Newcastle-Ottawa Scale (NOS). Postoperative neutral alignment (0° ± 3°) was compared to residual mild varus (3°-6°) and residual severe varus (>6°). Meta-analysis was performed using Review Manager 5.3. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. The fixed-effect model and random-effect model were used to meta-analyze the data. Nine studies were included in the meta-analysis with 1410 cases of postoperative neutral alignment, 564 of residual mild varus alignment and 175 of residual severe varus alignment following TKA, all of which were published after 2013. Three studies scored 7 points on the NOS, while the remaining studies scored 8 points, suggesting high quality. The pooled mean differences (MDs) of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were 1.07 [95% confidence interval (CI) -1.06 to 3.20; P = 0.32; I2 = 79%]. The meta-analysis showed that neutral alignment and mild varus alignment were associated with similar the Oxford Knee Score (OKS), Knee Society Knee Score (KS-KS), and Knee Society Function Score (KS-FS), while neutral alignment was associated with lower Forgotten Joint Score (FJS) [mean difference -6.0, 95% confidence interval (CI) -9.37 to -2.64, P = 0.0005]. Neutral alignment was associated with higher KS-KS than severe alignment (M 2.98, 95% CI 1.42 to 4.55, P = 0.0002; I2 = 0%) as well as higher KS-FS (M 8.20, 95% CI 4.58 to 11.82, P < 0.00001; I2 = 0%). Neutral alignment was associated with similar rate of survival as mild varus alignment (95% CI 0.36 to 9.10; P = 0.48; I2 = 65%) or severe varus alignment (95% CI 0.94 to 37.90; P = 0.06; I2 = 61%). There was no statistical difference in others. Residual mild varus alignment after TKA may lead to similar or superior outcomes than neutral alignment in patients with preoperative varus knees, yet the available evidence appears to be insufficient to replace the current gold standard of neutral alignment. Severe varus alignment should be avoided.
第二部分：保髋相关文献
文献1
COMP病及其进展
译者 罗殿中
软骨寡聚物基质蛋白（Cartilage oligomeric matrix protein，COMP）是一大类糖蛋白五聚体、在软骨及其它组织中与多种细胞外基质蛋白相互作用。已知COMP在胶原分泌、纤维生成、软骨细胞分化、增强肌腱强度等方面有重要作用，COMP全部功能范畴仍有待明确。COMP病变包括两种疾患，假性软骨发育不良（PSACH）和多发骨骺发育不良（MED），这两种骨骼发育不良均为常染色体显性COMP突变所致。主要突变位于钙结合点（结构域）、蛋白折叠受损；COMP病变主要引起内质网（ER）贮存功能紊乱，软骨细胞内质网（ER）中COMP蓄积，刺激细胞过渡应激；COMP的蓄积引起氧化和炎症反应，导致软骨细胞死亡、骨骼生长停滞。
相比之下，在很多其它疾病中发现野生型COMP不规律表达，包括纤维化、心肌病、乳腺癌和前列腺癌。
尤其令人鼓舞的是，COMP可作为特发性肺纤维化、骨关节炎和类风湿相关的关节退变诊断相关生物标志物，及关节损伤预后的标志物。
COMP在单基因疾病和多因素疾病中的广泛效应，使我们对其在细胞外基质（ECM）中的功能、及组织稳态有更清楚的理解，进而引领发展出新的治疗途径。
图1. 示意图显示COMP表达域。多数COMP突变位于T3重复区域，少数突变位于CTD区域；未见突变位于T2重复区域、和NTD区域。NTD=N末端；T2=2型重复；T3=3型重复；CTD=C末端。
图2. COMP突变导致PSACH软骨细胞内质网（ER）特殊基质诱导。荧光反卷积显微镜通过图像重建用于细胞内可视化，在人类和突变小鼠生长板软骨细胞内，内质网（ER）中II型胶原（黄色）、IX型胶原（红色）、COMP（绿色）、MATN3基质（蓝色）排列整齐。基质组装状况反映了内质网（ER）突变的COMP组装功能停止。
图3. COMP突变相关的病理变化。如图所示，软骨细胞代谢机制变化导致生长板、骨骼、软骨和关节的改变。
文献出处：Posey KL, Coustry F, Hecht JT. Cartilage oligomeric matrix protein: COMPopathies and beyond. Matrix Biol. 2018 Oct;71-72:161-173. doi: 10.1016/j.matbio.2018.02.023. Epub 2018 Mar 9. PMID: 29530484; PMCID: PMC6129439.
文献2
儿童时期因髋关节发育不良接受过治疗的患者成年后的生活质量
译者 张振东
如果治疗不当，髋关节发育不良（DDH）可导致髋关节功能过早丧失；然而，很少有研究关注DDH儿童时期治疗后的长期后果。本研究对儿童时期接受过髋关节脱位治疗的DDH 患者进行了一项健康相关生活质量调查。研究者向在其机构接受过儿童期髋关节脱位治疗的 287 名DDH 患者发放了调查问卷。使用短表-36调查了患者的人口统计学特征、特定疾病病史以及与健康相关的生活质量。将患者的身体功能评分（PCS）、心理功能评分（MCS）和社会认知评分（RCS）与日本标准值进行了比较。经排除后，对 68 名患者进行了评估。患者的 PCS、MCS 和 RCS 总平均值与标准值相当。PCS 一直保持到 50 岁，但有 10 名 50 岁以上的患者 PCS 显著下降。此外，接受切开复位术的患者的 PCS 明显低于接受保守复位术的患者。在各年龄组和治疗组中，患者的 MCS 和 RCS 与标准值无差异。此外，PCS、MCS 和 RCS 在双侧、诊断年龄或是否需要额外手术方面也没有差异。DDH患者的身体生活质量在50岁之前一直保持不变，但之后迅速下降，尤其是那些在童年时期就需要进行切开复位的患者。
Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood
Developmental dysplasia of the hip (DDH) can lead to premature loss of hip function if not properly treated; however, few studies have focused on the long-term outcomes of DDH. We conducted a survey of health-related quality of life in adult patients with DDH who were treated for hip dislocation during childhood. We sent a questionnaire to 287 adult patients with DDH who were treated for hip dislocation during childhood in our institutions. We examined patient demographics, disease-specific medical history, and health-related quality of life using the short form-36. Physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) were compared between the patients and Japanese standard values. Sixty-eight patients were evaluated after exclusion. The overall mean PCS, MCS and RCS scores of the patients were comparable to the standard values. The PCS was maintained until the age of 50, but it was significantly decreased in 10 patients over 50 years old. In addition, PCS was significantly lower in patients who underwent open reduction than in those who were conservatively reduced. The MCS and RCS of the patients did not differ from the standard values in each age and treatment group. Additionally, the PCS, MCS and RCS did not differ according to bilaterality, age at diagnosis, or requirement for additional surgeries. Physical quality of life was maintained until the age of 50 but rapidly declined thereafter in patients with DDH, especially in those who required open reduction during childhood.
文献出处：Sawamura K, Kitoh H, Matsushita M, Mishima K, Kamiya Y, Imagama S. Quality of life in adult patients with developmental dysplasia of the hip who were treated for hip dislocation during childhood. J Pediatr Orthop B. 2025 Jan 1;34(1):38-43. doi: 10.1097/BPB.0000000000001173. Epub 2024 Feb 26. PMID: 38451811.
文献3
髋臼周围截骨术（PAO）患者在婴儿时期接受髋关节发育不良（DDH）治疗和未治疗的髋关节形态学比较
译者 任宁涛
背景：婴儿时期成功治疗的发育性髋关节发育不良（DDH）患者在骨骼成熟时出现症状性髋臼发育不良，行髋臼周围截骨（PAO）治疗。本研究的目的是比较既往DDH治疗后伴有晚期髋臼发育不良的PAO患者与无DDH治疗史的PAO患者的股骨和髋臼形态变化。
方法：回顾性分析2011年至2021年期间接受PAO手术的患者。纳入既往使用Pavlik挽具、外展支具、闭合复位加spica石膏固定或切开复位加spica石膏固定治疗的婴儿DDH患者。既往做过髋骨手术的患者被排除在外。记录每个髋关节的术前X线测量，包括外侧CE角、前CE角和股骨-骨骺髋臼顶指数。计算机断层扫描测量包括冠状CE角、矢状CE角、Tönnis角、髋臼1、2、3点钟前倾、股骨颈干角、股骨扭转角和α角。无DDH诊断或治疗史的PAO为对照组，与婴幼儿DDH治疗组根据冠状CE角、年龄、性别按2:1比例匹配。
结果：18例患者21髋既往接受婴儿DDH治疗（13例为Pavlik挽具，3例外展支具，1例闭合复位，1例切开复位）。对照组为42例患者42髋既往未接受DDH治疗的患者。有过DDH治疗的患者与未有过DDH治疗的患者在记录的各项指标中，包括股骨扭转角（P=0.494）、髋臼1点钟前倾（P=0.820）、2点钟前倾（P=0.584）、3点钟前倾（P=0.137）、颈干角（P=0.612）、外侧CE角（P=0.433）、股骨-髋臼顶指数（P=0.144）、α角（P=0.156），差异均无统计学意义。
结论：经过DDH治疗后持续存在症状性髋臼发育不良的PAO患者，与骨骼成熟后出现髋臼发育不良且没有DDH治疗史的患者，其股骨和髋臼形态相似。
Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment
Background: A subset of patients successfully treated for developmental dysplasia of the hip (DDH) as infants have symptomatic acetabular dysplasia at skeletal maturity leading to periacetabular osteotomy (PAO). The purpose of this study was to compare femoral and acetabular morphology in PAO patients with late acetabular dysplasia after previous treatment for DDH with PAO patients who do not have a history of DDH treatment.
Methods: A single surgeon's patients who underwent PAO between 2011 and 2021 were retrospectively reviewed. Patients previously treated for infantile DDH with a Pavlik harness, abduction brace, closed reduction and spica casting, or open reduction and spica casting were included. Patients with previous bony hip surgery were excluded. Preoperative radiographic measurements of each hip were recorded including lateral center edge angle, anterior center edge angle, and Femoro-Epiphyseal Acetabular Roof index. Computed tomography measurements included the coronal center edge angle, sagittal center edge angle, Tönnis angle, acetabular anteversion at 1, 2, and 3 o'clock, femoral neck-shaft angle, femoral version, and alpha angle. Control PAO cases without a history of DDH diagnosis or treatment were matched with the infantile DDH treatment group in a 2:1 ratio based on coronal center edge angle, age, and sex.
Results: There were 21 hips in 18 patients previously treated for infantile DDH (13 patients Pavlik harness, 3 abduction brace, 1 closed reduction, and 1 open reduction). The control PAO cohort was 42 hips in 42 patients who did not have previous DDH treatment. There was no statistically significant difference in any of the recorded measurements between patients previously treated for DDH and those without previous treatment including femoral version (P=0.494), anteversion at 1 o'clock (P=0.820), anteversion at 2 o'clock (P=0.584), anteversion at 3 o'clock (P=0.137), neck-shaft angle (P=0.612), lateral center edge angle (P=0.433), Femoro-Epiphyseal Acetabular Roof index (P=0.144), and alpha angle (P=0.156).
Conclusions: Femoral and acetabular morphology is similar between PAO patients with persistent symptomatic acetabular dysplasia following DDH treatment and patients presenting after skeletal maturity with acetabular dysplasia and no previous history of DDH treatment.
文献出处：Ellsworth BK, Bram JT, Sink EL. Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment. J Pediatr Orthop. 2022 Jul 1;42(6):e565-e569. doi: 10.1097/BPO.0000000000002137. Epub 2022 Mar 10. PMID: 35667051.
文献4
在髋臼周围截骨术中使用斜位透视和术后延迟负重可减少坐骨1年后延迟愈合
译者 李勇
本研究旨在确定术中使用后前位和斜位图像增强器和术后开始较晚的部分负荷（PWB）在减少髋臼周围弯曲截骨术后一年内坐骨延迟愈合发生率方面的疗效。我们评估了104例患者117髋术后1年截骨部位延迟愈合的计算机断层图像。54例同时使用后前位和斜位图像增强器的患者中58髋被分配到斜位和后期PWB组（OL组），50例仅使用后前位图像增强器的患者中59髋被分配到对照组（C组）。在单因素分析中，OL组术后1年坐骨延迟愈合的发生率（3.5%）明显低于C组（22%）。在髋臼周围弯曲截骨术中使用后前位和斜位图像增强器和较晚开始的PWB对减少术后一年坐骨延迟愈合有效。
图 所示。斜位增强成像防止髋臼周围截骨术中后柱夹层和关节内截骨。(a)用弯骨刀从无名沟处行后柱坐骨截骨。(b)用弯骨刀从弓形线截骨后柱髂骨。白色实线表示髋臼关节线，白色虚线表示后柱后缘。
图 所示。43岁女性右髋发育不良行髋臼周围弧形截骨术。（a-d）术后一年，CT图像显示坐骨和耻骨截骨部位愈合延迟。在(a)矢状面和(b)冠状面（白色圆圈）上评估坐骨骨愈合或延迟愈合。在(c)冠状和(d)轴向切片（白色圆圈）上评估耻骨骨愈合或延迟愈合。
Use of oblique view in periacetabular osteotomy and delayed postoperative weight bearing reduce delayed union in the ischium after one year
This study aimed to determine the efficacy of using both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative partial weight-bearing (PWB) in reducing the incidence of delayed union in the ischium at one year after curved periacetabular osteotomy. We evaluated computed tomography images to clarify the incidence of delayed union at the osteotomy sites at one year post-operatively for 117 hips in 104 patients. Fifty-eight hips in 54 patients with use of both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative PWB were assigned to the oblique view and late PWB group (OL group) and 59 hips in 50 patients with use of only the postero-anterior image intensifier view intra-operatively and early start of post-operative PWB were assigned to the control group (C group). In univariate analyses, the incidence of delayed union in the ischium at one year post-operatively was significantly lower in the OL group (3.5%) than in the C group (22%). Use of both the postero-anterior and oblique image intensifier views during curved periacetabular osteotomy and late start of PWB were effective for reducing delayed union of the ischium at one year post-operatively.
文献出处：Kinoshita K, Fujita J, Matsunaga T, Seo H, Hideshima Y, Yoshimura F, Yamamoto T. Use of oblique view in periacetabular osteotomy and delayed postoperative weight bearing reduce delayed union in the ischium after one year. Sci Rep. 2024 Oct 10;14(1):23720. doi: 10.1038/s41598-024-75593-w. PMID: 39390253; PMCID: PMC11467257.
文献5
与CT相比，X线低估了外侧中心边缘角和Tönnis角在临界和真正髋臼发育不良中的测量值
译者 张利强
目的：比较使用市售软件在X线和CT中测量的外侧中心边缘角（lateral center-edge angle，LCEA）和Tönnis角（Tönnis angle，TA）值，并确定X线与CT在描述髋臼发育不良分类时的一致程度。
方法：回顾性收集2019年6月至2021年12月接受髋关节镜治疗患者的术前CT和X线检查数据。利用术前骨盆前后仰卧位片测量LCEA和TA，并通过商用软件将测量结果与CT进行比较
结果：共纳入323名患者（371髋），其中216名女性（67%），患者平均年龄为35.3±14.5岁。X线和CT的LCEA和TA测量值存在显著统计学差异（P<0.001），CT的平均值±SD值（LCEA: 32.9±7.3，TA: 8.2±5.9）大于X线（LCEA: 30.3±6.3，TA: 4.8±4.6）。LCEA的CT和X线绝对平均差为4.1，TA为4.4。当将发育不良定义为LCEA<25°时，X线检查发现77（21.8%）个髋关节为发育不良（比值比2.0），CT检查发现43（11.6%）个为发育不良（P<0.001）。利用TA>10°阈值时，X线检查显示71例（19.1%）为髋关节发育不良（比值比为0.5），CT检查显示118例（32%）为髋关节不良（P<0.001）。X线片和CT在测量LCEA（r=0.78）和TA（r=0.67）上具有很强的相关性。
结论：与CT相比，X线测量低估了LCEA和TA值。使用X线测量时，LCEA诊断髋关节发育不良的可能性是CT的两倍，TA的可能性是前者的一半。使用市售软件测量CT为评估髋臼发育不良提供了另一种视角。当与X射线测量一起使用时，可以作为有价值的补充。
证据级别：回顾性病例系列研究，IV级
关键词：髋、CT扫描、影像学、髋臼发育不良、外侧中心边缘角、臼顶倾斜角
LCEA测量方法。使用股骨头（FH）作为水平轴测量LCEA。第二条线穿过股骨头的中心，垂直于水平线。从股骨头中心到股骨头最外侧绘制第三条线。LCEA为第二条线和第三条线之间的角度
基于CT测量LCEA。在冠状（前-后）面中垂直轴（矢状平面）与股骨头中心和髋臼边缘上的12点钟之间的线之间的角度。将CT与X线配对
TA的测量方法。首先使用双侧眉弓下缘设置水平线。第二条线是连接内下缘与最外侧缘的连线。这两条线之间的角度为TA
基于CT测量TA。冠状面上的水平线与12点钟的髋臼外侧缘与月状面內缘连线的夹角。将CT与X线配对
Radiographs Underestimate Lateral Center Edge Angle and Tönnis Angle Measurements Compared to CT Scan in Assessment of Borderline and Frank Acetabular Dysplasia
Purpose: To compare lateral center-edge angle (LCEA) and Tönnis angle (TA) values measured in radiographs and CT scans with commercially available software and to determine the degree of concurrence in the classification of acetabular dysplasia as depicted in radiographs and CT scans.
Methods: Retrospectively collected data from patients undergoing preoperative CT protocol and X-rays for hip arthroscopy from June 2019 to December 2021. The preoperative anteroposterior supine view of the pelvis was utilized to measure LCEA and TA, and measurements were compared to CT scan views through commercially available software
Results: In total, 323 patients (371 hips) were included, with 216 females (67%) and a mean patient age of 35.3±14.5. There was a statistically significant difference (P<0.001) in LCEA and TA measurements between X-ray and CT scan, with CT yielding higher mean ± SD values (LCEA: 32.9 ± 7.3, TA: 8.2 ± 5.9) compared to X-ray (LCEA: 30.3 ± 6.3, TA: 4.8 ± 4.6). The absolute mean difference between CT and X-ray was 4.1 for LCEA and 4.4 for TA. When defining dysplasia as LCEA<25°, 77 (21.8%) hips were dysplastic by X-rays (odds ratio, 2.0), and 43 (11.6%) by CT (P<0.001). Using a threshold of >10° for TA, 71 (19.1%) hips were dysplastic by X-rays (odds ratio, 0.5) and 118 (32%) by CT (P<0.001). A strong correlation was obtained between radiographs and CT on measured LCEA (r=0.78) and TA (r=0.67).
Conclusion: Measuring with X-ray underestimates both LCEA and TA values compared to CT. Hip dysplasia diagnosis was twice as likely with LCEA, and half as likely with TA when measured through X-rays. CT scans with commercially available software offer an alternative viewpoint for assessing acetabular dysplasia and can serve as a valuable complement when used in addition to X-ray measurements.
Level of Evidence: Level IV, Retrospective Case Series
Keywords: hip; CT Scan; Radiographs; Acetabular Dysplasia; LCEA; Tönnis Angle
文献出处：Nerys-Figueroa J, Kahana-Rojkind AH, Parsa A, Walsh EG, Lambers F, Domb BG, Radiographs Underestimate Lateral Center Edge Angle and Tonnis Angle Measurements Compared to CT Scan in Assessment of Borderline and Frank Acetabular Dysplasia, Arthroscopy: The Journal of Arthroscopic and Related Surgery (2024), doi: https://doi.org/10.1016/j.arthro.2024.10.038.
文献6
髋关节发育不良患者的髌骨力线异常
译者 贾海港
背景：本研究旨在评估髋关节发育不良（DDH）对髌骨力线的影响。
研究方法：回顾性分析2015年1月至2017年7月符合纳入标准的所有患者的影像学数据，包括股四头肌角（QA）、髌骨外倾角（PTA）、沟角（SA）、髌骨外侧移位（LSP）和下肢力线。根据外侧CE角（LCE）和股骨扭转角（FNTA）将患者分为三组：A组（LCE > 25和FNTA < 40）、B组（LCE < 20和FNTA < 40）和C组（LCE < 20和FNTA > 40）。
结果：138名患者共230个髋关节（115名女性，23名男性），平均年龄22岁。A组和C组以及B组和C组在QA、SA、PTA、LSP和下肢力线方面存在显着差异（p < 0.01）。B组与C组SA、PTA、LSP、下肢力线无差异（p>0.05），而在QA方面存在显著差异（p<0.01）。对 B 组和 C 组的全部数据进行的 "皮尔逊 "相关分析表明，FNTA与LCE以及QA与LCE呈负相关，而FNTA与QA、PTA、SA和下肢力线正相关， SA与PTA和下肢力线呈正相关。
结论：DDH患者不仅存在髋关节病变，还存在髌骨力线异常，可能导致髌骨不稳。在临床上，我们应注意髌骨不稳患者的髋关节发育情况，以排除DDH。
图 1. 骨盆正位X线片， (a) 髋臼外侧缘(b) 位于股骨头上叠加的圆中心点和 (c) 垂直参考点之间测量LCE的情况。LCE：外侧中心边缘角
图2.基于 CT 扫描的 FNTA 是（d）额平面与股骨颈轴线之间的角度，以及（e）和（f）投影到股骨内侧和外侧髁中点之间连线的横向平面上的角度。FNTA：股骨颈扭转角；CT：计算机断层扫描。
图 3.在负重全长片的冠状面上测量 QA，即(a) 从髂前上棘到髌骨中心的连线与(b) 从髌骨中心到胫骨结节中心的连线之间的夹角。下肢力线是在负重全长片的冠状面上计算的，即(c)股骨头中点与股骨髁顶之间的股骨机械轴与(d)胫骨髁间棘中点与踝关节中心之间的胫骨机械轴之间的夹角。
图 4. (e) PTA 是在髌骨冠状轴与内外侧滑车脊切线之间的轴向平面（右）测量的。(f) 在轴向平面（左侧）使用内侧和外侧面的最前点以及滑车沟的最深点计算SA。
图 5. LSP 在轴面上测量为距离(I)，LSP 超过 5 毫米被定义为髌骨外移。
Patella alignment abnormality in patients with developmental dysplasia of the hip
Background: The purpose of this study was to assess the influence of developmental dysplasia of the hip (DDH) on patella alignment.
Methods: The radiographic data of all the patients who met the inclusion criteria from January 2015 to July 2017 were reviewed, including the quadriceps angle (QA), patellar lateral tilt (PTA), sulcus angle (SA), lateral shift of patella (LSP), and lower limbs alignment. The patients were divided into three groups in accordance with lateral center-edge angle (LCE) and femoral neck torsion angle (FNTA): group A (LCE > 25° and FNTA < 40°), group B (LCE < 20° and FNTA < 40°), and group C (LCE < 20° and FNTA > 40°).
Results: One hundred thirty-eight patients with 230 hips (115 females and 23 males) were recruited with an average age of 22 years. There were significant differences between group A and group C as well as group B and group C in QA, SA, PTA, LSP, and lower limbs alignment (p < 0.01). There were no differences in SA, PTA, LSP, and lower limbs alignment (p >0.05) and significant differences in QA (p < 0.01) between group B and group C. The "Pearson's" correlation analysis of the data in total of group B and group C showed that FNTA and LCE and QA and LCE were negatively correlated, whereas FNTA and QA, PTA, SA, and lower limbs alignment as well as SA, PTA, and lower limbs alignment were positively correlated.
Conclusion: Patients with DDH not only have hip joint change, but also have the patella alignment abnormality, which may lead to patella instability. In the clinic, we should pay attention to the hip development of the patella instability patients for excluding DDH. Level of Evidence: Prognostic level III.
文献出处：Hu B, Sang L, Gao D, Wu Y, Zhang H, Luo D. Patella alignment abnormality in patients with developmental dysplasia of the hip. J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019854039. doi: 10.1177/2309499019854039. PMID: 31204578.
文献7
髋臼周围截骨术后髋关节镜检查治疗髋关节发育不良——发生率和临床结果
译者 陶可
背景：髋臼周围截骨术(PAO)是治疗髋关节发育不良的首选方法，并且已证明患者报告结果指标(PROM)有所改善，并且长期生存率也可接受。然而，髋关节发育不良也与关节内病变有关，这可能会对临床结果产生负面影响。本研究旨在分析PAO后髋关节镜检查的发生率、手术结果和结果。
方法：这是一项单中心回顾性研究，通过查询我们2006年至2020年前瞻性收集的保髋数据库。确定了所有在PAO后接受髋关节镜检查且随访时间最短为1年的患者。共进行了202例PAO，平均年龄为28.3岁（12.7 - 53.6岁），其中包括39名男性和167名女性。失败定义为转换为髋关节置换术。人口统计学、手术发现、再次手术和PROM（仅针对未转换为髋关节置换术的髋关节，在最后一次随访时进行术前和术后检查）。
结果：202例PAO中有15名患者（7.4%）的15个髋关节在PAO后平均3.9年（0.3-10.3年）接受了髋关节镜检查。其中男性2例，女性13例，平均年龄29.8岁（18.5-45岁）。12髋无放射学骨关节炎（Tönnis 0），3髋有早期骨关节炎（Tönnis 1）。关节镜检查时，所有髋关节均有盂唇撕裂，9髋软骨损伤≥ Beck 4。8髋接受了盂唇清理术，7髋接受了盂唇修复术，2髋切除了粘连，4髋接受了股骨骨软骨成形术。4髋（27%）在髋关节镜检查后平均1.8年（0.5-3.2）转换为髋关节置换术。转换为髋关节置换术的患者年龄明显较大（p = 0.01），PAO后LCEA较小（p = 0.01），PAO后Tönnis角较大（p = 0.02）。PROM没有显著改善。
结论：本研究报告PAO后髋关节镜再手术率为7.4%。这组患者存在所有三种类型的发育不良（前部、后部或整体未覆盖）。27%的患者转为髋关节置换术，髋关节镜检查未显著改善PROM。因此，应谨慎对待此手术。
Hip arthroscopy after periacetabular osteotomy for acetabular dysplasia - incidence and clinical outcome
Background: The periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia and has demonstrated improvement in patient reported outcomes measures (PROMs) as well as acceptable long-term survival. However, acetabular dysplasia is also associated with intra-articular lesions that can negatively impact clinical outcome. This study aimed to analyse the incidence, operative findings, and outcomes of hip arthroscopy after PAO.
Methods: This is a single center retrospective study by querying our hip preservation prospectively collected database from 2006 to 2020. All patients having undergone hip arthroscopy after a PAO, with a minimal follow-up of one year, were identified. 202 PAOs were done with a mean age of 28.3 years (12.7 - 53.6) including 39 males and 167 females. Failure was defined as conversion to hip replacement. Demographics, surgical findings, reoperations, and PROMs (pre and post operatively at the last follow-up point only for hips not converted to hip replacement).
Results: Fifteen hips in 15 patients (7.4%) out of 202 PAOs underwent a hip arthroscopy at a mean time of 3.9 years (0.3-10.3) after PAO. There were 2 males, 13 females and the mean age was 29.8 years (18.5-45). 12 hips had no radiological osteoarthritis (Tönnis 0) and 3 hips had early osteoarthritis (Tönnis 1). At time of arthroscopy, all hips had a labral tear, 9 had a chondral damage ≥ Beck 4. Eight hips had labral debridement, 7 had labral repair, 2 had resection of adhesions and 4 underwent a femoral osteochondroplasty. Four hips (27%) were converted to a hip replacement at a mean time of 1.8 years(0.5-3.2) after hip arthroscopy. Patients converted to hip replacement were significantly older (p = 0.01), had a lower post-PAO LCEA (p = 0.01) and a higher post-PAO Tönnis angle (p = 0.02). There were no significant improvements in PROMs.
Conclusion: This study reports a hip arthroscopy reoperation rate after PAO of 7.4%. All three types of dysplasia (uncovered anteriorly, posteriorly, or globally) were present in this cohort. Twenty seven percent of patients were converted to hip replacement and PROMs were not significantly improved by hip arthroscopy. Therefore, this procedure should be approached with some caution.
文献出处：Pierre Laboudie, Thomas Dymond, Cheryl Kreviazuk, George Grammatopoulos, Paul E Beaulé. Hip arthroscopy after periacetabular osteotomy for acetabular dysplasia - incidence and clinical outcome. BMC Musculoskelet Disord. 2022 Jul 12;23(1):659. doi: 10.1186/s12891-022-05625-x.
来源：304关节学术
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