Ganz Reinhold, Parvizi Javad, Beck Martin, Leunig Michael, Nötzli Hubert, Siebenrock Klaus A
Department of Orthopedic Surgery, University of Berne, Inselspital, CH-3010 Berne, Switzerland.
Clin Orthop Relat Res. 2003 Dec(417):112-20. doi: 10.1097/01.blo.0000096804.78689.c2.
A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.
包括生化、遗传和后天异常在内的多种因素可能导致髋关节骨关节炎。尽管影响发育不良髋关节的退行性变过程的病理机制已为人熟知，但特发性骨关节炎的确切发病机制尚未明确。基于超过600例髋关节手术脱位的临床经验，这些手术允许对损伤模式进行原位检查并动态证明其起源，我们提出股骨髋臼撞击是大多数非发育不良髋关节早期骨关节炎发展的一种机制。该概念更侧重于髋关节的运动而非轴向负荷。不同的临床、影像学和术中参数可用于确诊该疾病并及时进行治疗。股骨髋臼撞击的手术治疗重点在于改善髋关节运动间隙并减轻股骨与髋臼边缘的碰撞。有人提出，对股骨髋臼撞击进行早期手术干预，除了能缓解症状外，还可能减缓这组年轻患者退行性变过程的进展。
