Leunig M, Ganz R
Orthopädie, Balgrist Universitätsklinik, Zürich, Schweiz.
Unfallchirurg. 2005 Jan;108(1):9-10, 12-7. doi: 10.1007/s00113-004-0902-z.
The exact cause of the idiopathic osteoarthritis of the hip has not been identified, although the cause of hip degeneration in developmental dysplasia can clearly be attributed to an excessive axial loading. Based on the development of a surgical technique for the safe surgical dislocation of the hip and the associated possibility of intraoperative joint evaluation, we have found motion-induced joint damage in many of these hips. This begins peripherally at the acetabular rim, progressing centrally. This so-called "femoroacetabular impingement" (FAI), leads, by an increased acetabular coverage and/or a missing sphericity of the femoral head, to an abutment of the femoral head/neck junction against the acetabular rim, or even entering of the non-spherical femoral head into the hip. It initiates damage to the labrum and/or acetabular cartilage. Frequently, this becomes symptomatic in the second or third decade of life in patients with increased sport activity. Based on the predominance of the acetabular or femoral pathology, two different types of FAI, the pincer and the cam can be differentiated. Apart from these morphological alterations, supraphysiological mobility and overuse can contribute to FAI. The impingement concept has led to a new type of mainly intracapsular hip surgery.
髋关节特发性骨关节炎的确切病因尚未明确,尽管发育性髋关节发育不良中髋关节退变的病因可明确归因于过度的轴向负荷。基于一种用于髋关节安全手术脱位的外科技术的发展以及术中关节评估的相关可能性,我们在许多此类髋关节中发现了运动诱发的关节损伤。这种损伤始于髋臼边缘的外周,向中心发展。这种所谓的“股骨髋臼撞击症”(FAI),由于髋臼覆盖增加和/或股骨头球形度缺失,导致股骨头/颈交界处与髋臼边缘相抵,甚至非球形股骨头进入髋关节。它引发盂唇和/或髋臼软骨的损伤。在运动活动增加的患者中,这种情况通常在生命的第二个或第三个十年出现症状。根据髋臼或股骨病变的优势,可区分FAI的两种不同类型,即钳夹型和凸轮型。除了这些形态学改变外,超生理活动度和过度使用也可导致FAI。撞击概念引发了一种新型的主要为关节囊内的髋关节手术。