Siebenrock K A, Schoeniger R, Ganz R
Department of Orthopaedic Surgery, University of Berne, Inselspital, Switzerland.
J Bone Joint Surg Am. 2003 Feb;85(2):278-86. doi: 10.2106/00004623-200302000-00015.
This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy.
The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigné and Postel, and the anterior center-edge angle of Lequesne and de Sèze was measured on radiographs preoperatively and at the time of the latest follow-up.
The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Sèze decreased significantly from a preoperative average of 36 degrees (range, 26 degrees to 52 degrees ) to a postoperative average of 28 degrees (range, 16 degrees to 46 degrees ) (p = 0.002). There was a significant increase in the average range of internal rotation (10 degrees, p = 0.006), flexion (7 degrees, p = 0.014), and adduction (8 degrees, p = 0.017). The average Merle d'Aubigné score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement.
Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion
本研究旨在评估髋臼后倾导致的有症状的前股骨髋臼撞击症能否通过髋臼周围截骨术得到有效治疗。
股骨髋臼撞击症的诊断基于临床症状、前撞击试验阳性以及磁共振成像上髋臼边缘病变的表现。髋臼后倾的影像学诊断基于交叉征和后壁征。22例患者（平均年龄23岁）的29个髋关节接受了髋臼周围截骨术。26个髋关节进行了关节切开术，以观察关节内病变，并在特定病例中改善股骨头颈偏心距过小的情况。测量髋关节的活动范围，采用Merle d'Aubigné和Postel描述的评分系统进行临床评估，并在术前和最近一次随访时在X线片上测量Lequesne和de Sèze的前中心边缘角。
随访时间平均为30个月（范围为24至49个月）。Lequesne和de Sèze的前中心边缘角从术前平均36°（范围为26°至52°）显著降至术后平均28°（范围为16°至46°）（p = 0.002）。内旋平均活动范围（增加10°，p = 0.006）、屈曲（增加7°，p = 0.014）和内收（增加8°，p = 0.017）均有显著增加。Merle d'Aubigné平均评分从术前的14.0分（范围为12至16分）提高到术后的16.9分（范围为15至18分）（p < 0.001），26个髋关节的结果为良好或优秀。3个髋关节接受了后续手术：1个是因为术后早期复位丢失；1个是为了纠正后下撞击；1个是因为前撞击症状复发。
髋臼周围截骨术是一种有效方法，可使因髋臼后倾导致有症状的前股骨髋臼撞击症的年轻患者的髋臼重新定位。
