Bardakos N V, Villar R N
The Richard Villar Practice, The Wellington Hospital, South Building, 8a Wellington Place, St John's Wood, London NW8, 9LE, UK.
J Bone Joint Surg Br. 2009 Feb;91(2):162-9. doi: 10.1302/0301-620X.91B2.21137.
Although the association between femoroacetabular impingement and osteoarthritis is established, it is not yet clear which hips have the greatest likelihood to progress rapidly to end-stage disease. We investigated the effect of several radiological parameters, each indicative of a structural aspect of the hip joint, on the progression of osteoarthritis. Pairs of plain anteroposterior pelvic radiographs, taken at least ten years apart, of 43 patients (43 hips) with a pistol-grip deformity of the femur and mild (Tönnis grade 1) or moderate (Tönnis grade 2) osteoarthritis were reviewed. Of the 43 hips, 28 showed evidence of progression of osteoarthritis. There was no significant difference in the prevalence of progression between hips with initial Tönnis grade 1 or grade 2 osteoarthritis (p = 0.31). Comparison of the hips with and without progression of arthritis revealed a significant difference in the mean medial proximal femoral angle (81 degrees vs 87 degrees, p = 0.004) and the presence of the posterior wall sign (39% vs 7%, p = 0.02) only. A logistic regression model was constructed to predict the influence of these two variables in the development of osteoarthritis. Mild to moderate osteoarthritis in hips with a pistol-grip deformity will not progress rapidly in all patients. In one-third, progression will take more than ten years to manifest, if ever. The individual geometry of the proximal femur and acetabulum partly influences this phenomenon. A hip with cam impingement is not always destined for end-stage arthritic degeneration.
虽然股骨髋臼撞击症与骨关节炎之间的关联已得到证实，但尚不清楚哪些髋关节最有可能迅速发展至终末期疾病。我们研究了几个影像学参数（每个参数都指示髋关节的一个结构方面）对骨关节炎进展的影响。回顾了43例患有股骨手枪柄样畸形且伴有轻度（Tönnis 1级）或中度（Tönnis 2级）骨关节炎的患者（43个髋关节）至少间隔十年拍摄的前后位骨盆平片。在这43个髋关节中，28个显示出骨关节炎进展的迹象。初始Tönnis 1级或2级骨关节炎的髋关节之间进展的患病率无显著差异（p = 0.31）。比较有和没有关节炎进展的髋关节发现，仅在平均股骨近端内侧角（81度对87度，p = 0.004）和后壁征的存在（39%对7%，p = 0.02）方面存在显著差异。构建了一个逻辑回归模型来预测这两个变量对骨关节炎发展的影响。患有手枪柄样畸形的髋关节中的轻至中度骨关节炎并非在所有患者中都会迅速进展。在三分之一的患者中，进展可能需要十多年才会显现，甚至可能不会显现。股骨近端和髋臼的个体几何形状部分影响了这一现象。存在凸轮撞击的髋关节并不总是注定会发展为终末期关节炎退变。
