Ganz Reinhold, Leunig Michael, Leunig-Ganz Katharina, Harris William H
University of Berne, Berne, Switzerland.
Clin Orthop Relat Res. 2008 Feb;466(2):264-72. doi: 10.1007/s11999-007-0060-z. Epub 2008 Jan 10.
The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present.
Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
长期以来，髋关节骨关节炎的病因一直被认为是继发性的（如继发于先天性或发育性畸形）或原发性的（假定关节软骨存在某些潜在异常）。最近的信息支持一种假说，即所谓的原发性骨关节炎也是继发于细微的发育异常，且这些病例中的机制是股骨髋臼撞击，而非过度的接触应力。股骨髋臼撞击最常见的部位是前上缘区域，最关键的动作是髋关节在90度屈曲时的内旋。已确定两种类型的股骨髋臼撞击。凸轮型股骨髋臼撞击在年轻男性患者中更为常见，是由股骨头与颈之间的偏移病理形态引起的，并导致髋臼由外向内分层。钳夹型股骨髋臼撞击在中年女性中更为常见，是由髋臼局部（髋臼后倾）或整体过度覆盖（髋臼过深/髋臼前突）之间更线性的撞击产生的。损伤模式更多局限于边缘，关节退变过程较慢。然而，大多数髋关节表现为以凸轮为主的混合性股骨髋臼撞击模式。在出现严重软骨损伤之前的早期阶段，应进行手术以恢复正常解剖结构，避免股骨髋臼撞击。
V级，治疗性研究。有关证据级别的完整描述，请参阅《作者指南》。
