Jacobsen Steffen, Rømer Lone, Søballe Kjeld
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
Skeletal Radiol. 2005 Dec;34(12):778-84. doi: 10.1007/s00256-005-0019-7. Epub 2005 Oct 7.
Hip dysplasia is considered pre-osteoarthritic, causing degeneration in young individuals.
To determine the pattern of degenerative change in moderate to severely dysplastic hips in young patients.
One hundred and ninety-three consecutively-referred younger patients with hip pain believed to be caused by hip dysplasia constituted the study cohort. The average age was 35.5 years (range, 15-61 years). They were examined by close-cut transverse pelvic and knee computed tomography and antero-posterior radiographs (CT). We identified 197 hips with moderate to severe dysplasia, and 78 hips with normal morphology in the study cohort, whilst 111 hip joints were borderline dysplastic according to preset definitions. Comparative analyses of anatomy and distribution of degeneration between dysplastic and normal hips in the study cohort were performed.
In dysplastic hips the anterior acetabular sector angle was significantly and inversely associated to femoral anteversion (p < 0.001). The center-edge (CE) angle, the acetabular angle (AA), and the acetabular depth ratio (ADR) were significantly interrelated (p < 0.001; correlation coefficients ranging from -0.8 to 0.7). Fifty-one hips were subluxated (24R/27L). There were no cases of complete dislocation. The formation of subchondral cysts or osteophytes in dysplastic hips was significantly associated with reduced minimum joint space width (p ranging from 0.005 to 0.02). However, in 67 hips with acetabular cysts, only 6 hips had minimum joint space widths = 2.0 mm (8.9%) in the coronal plane. In 96 cases with acetabular cysts found in the sagittal plane, 43 cases had minimum joint space widths = 2.0 mm (44.7%). Bony rim detachment at the site of labral insertion was recorded in 30 hips. Twenty-three of these were dysplastic (p = 0.01).
Degeneration was most often found in the anterolateral part of the dysplastic hip joints. Most cysts were located above the transition zone between the bony and the fibrocartilaginous acetabulum, and we found a significantly- increased number of cases with avulsed bony fragments at the antero-lateral labral insertion in dysplastic hips compared to normal hips. It seems likely that the early degenerative process in dysplastic hips originates at the watershed zone between the acetabular labrum and the acetabular cartilage in response to subluxation and femoroacetabular impingement.
髋关节发育不良被认为是骨关节炎前期病变，可导致年轻人出现关节退变。
确定年轻患者中、重度发育不良髋关节的退变模式。
193例因髋关节发育不良导致髋部疼痛而连续转诊的年轻患者组成了研究队列。平均年龄为35.5岁（范围15 - 61岁）。对他们进行了骨盆和膝关节的薄层横断计算机断层扫描（CT）及前后位X线片检查。在研究队列中，我们确定了197例中重度发育不良的髋关节，78例形态正常的髋关节，同时根据预设定义有111个髋关节为临界发育不良。对研究队列中发育不良髋关节与正常髋关节的解剖结构及退变分布进行了对比分析。
在发育不良的髋关节中，髋臼前扇区角与股骨前倾角呈显著负相关（p < 0.001）。中心边缘（CE）角、髋臼角（AA）和髋臼深度比（ADR）显著相关（p < 0.001；相关系数范围为 - 0.8至0.7）。51例髋关节半脱位（右侧24例/左侧27例）。无完全脱位病例。发育不良髋关节中软骨下囊肿或骨赘的形成与最小关节间隙宽度减小显著相关（p值范围为0.005至0.02）。然而，在67例有髋臼囊肿的髋关节中，仅6例在冠状面的最小关节间隙宽度≤2.0 mm（8.9%）。在矢状面发现96例髋臼囊肿病例中，43例最小关节间隙宽度≤2.0 mm（44.7%）。在30例髋关节中记录到髋臼盂唇附着部位的骨缘分离。其中23例为发育不良（p = 0.01）。
退变最常发生在发育不良髋关节的前外侧部分。大多数囊肿位于骨性髋臼和纤维软骨性髋臼之间的过渡区上方，并且我们发现与正常髋关节相比，发育不良髋关节在前外侧盂唇附着处撕脱性骨碎片的病例数显著增加。发育不良髋关节的早期退变过程似乎起源于髋臼盂唇和髋臼软骨之间的分水岭区，这是对半脱位和股骨髋臼撞击的反应。
