Neumann G, Mendicuti A D, Zou K H, Minas T, Coblyn J, Winalski C S, Lang P
Musculoskeletal Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Osteoarthritis Cartilage. 2007 Aug;15(8):909-17. doi: 10.1016/j.joca.2007.02.002. Epub 2007 Mar 26.
To determine the prevalence of labral tears and cartilage lesions in patients with mechanical symptoms of the hip using magnetic resonance (MR) arthrography.
A total of 100 patients with mechanical symptoms of the hip such as pain, clicking, locking and giving way underwent MR arthrography of the hip to rule out a labral tear. Hip joints were evaluated for labral alterations, bone marrow edema (BME), and other pathology using a novel semi-quantitative scoring system. Cartilage changes were graded separately for the acetabulum and femoral head in the anterior, posterior, central, medial, and lateral hip joint regions (10 locations) on a 6-point scale: 0=normal; 1=signal heterogeneity; 2=fissuring, 3=thinning <50% of the normal thickness; 4=thinning >50% of the normal thickness; 5=full thickness cartilage loss. Labral tears were categorized into normal, intrasubstance degeneration, simple tear or complex tear with two or more tear regions. Statistical methods were contingency tables, Fisher's exact test for discrete outcomes (based on grade scores), Spearman's rank correlation (r) and t tests for continuous outcomes, using pooled and stratified analyses.
On MR arthrography, labral tears were found in 66 patients (66% prevalence) with 13 having more than one location involved. Locations were 19 lateral (13 simple, six complex), 54 anterior (39 simple, 15 complex), eight posterior (six simple, two complex). Cartilage lesions were found in 76 patients (76% prevalence) with 53 demonstrating involvement of more than one compartment. The most common finding was cartilage thinning <50% in 99 regions in 44 patients. Cartilage thinning >50% was shown in 34 patients in 67 areas. When we correlated the grade of cartilage abnormality with the grade of labral tear, we found a statistically significant correlation (r=0.29; P< or =0.01). The size of cartilage abnormality was correlated with the grade of labral tear in the lateral acetabulum (r=0.38; P<0.001), anterior acetabulum (r=0.22; P< or =0.002), and lateral femoral head (r=0.29; P< or =0.004). The grade of cartilage loss was correlated with the grade of BME (r=0.44; P< or =0.001).
Labral tears and cartilage loss are common in patients with mechanical symptoms in the hip. Cartilage loss, labral tears and BME appear interrelated and may represent important risk factors that may affect the development and progression of osteoarthritis in the hip joint.
使用磁共振（MR）关节造影术确定髋关节机械性症状患者中盂唇撕裂和软骨损伤的患病率。
共有100例有髋关节机械性症状（如疼痛、弹响、交锁和打软腿）的患者接受了髋关节MR关节造影术以排除盂唇撕裂。使用一种新型半定量评分系统对髋关节进行盂唇改变、骨髓水肿（BME）和其他病变的评估。在髋关节前、后、中、内、外侧关节区域（共10个部位）分别对髋臼和股骨头的软骨变化进行6级评分：0级=正常；1级=信号不均匀；2级=裂隙；3级=变薄<正常厚度的50%；4级=变薄>正常厚度的50%；5级=软骨全层缺失。盂唇撕裂分为正常、实质内退变、单纯撕裂或有两个或更多撕裂区域的复杂撕裂。统计方法包括列联表、针对离散结果的Fisher精确检验（基于分级评分）、Spearman秩相关（r）以及针对连续结果的t检验，采用合并分析和分层分析。
在MR关节造影中，66例患者（患病率66%）发现有盂唇撕裂，其中13例有一个以上部位受累。受累部位为19个外侧（13例单纯撕裂，6例复杂撕裂）、54个前部（39例单纯撕裂，15例复杂撕裂）、8个后部（6例单纯撕裂，2例复杂撕裂）。76例患者（患病率76%）发现有软骨损伤，其中53例显示有一个以上关节腔受累。最常见的发现是44例患者99个区域的软骨变薄<50%。34例患者67个区域显示软骨变薄>50%。当我们将软骨异常分级与盂唇撕裂分级进行关联时，发现有统计学显著相关性（r=0.29；P≤0.01）。软骨异常大小与髋臼外侧（r=0.38；P<0.001）、髋臼前部（r=0.22；P≤0.002）和股骨头外侧（r=0.29；P≤0.004）的盂唇撕裂分级相关。软骨缺失分级与BME分级相关（r=0.44；P≤0.001）。
盂唇撕裂和软骨缺失在髋关节机械性症状患者中很常见。软骨缺失、盂唇撕裂和BME似乎相互关联，可能是影响髋关节骨关节炎发生和发展的重要危险因素。
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