Department of Orthopaedic Surgery, Inselspital, University of Berne, Switzerland.
Arthroscopy. 2011 Apr;27(4):486-92. doi: 10.1016/j.arthro.2010.11.005.
Our purpose was to study the sensitivity, specificity, and predictive values for hip adhesions, labral tears, and articular cartilage lesions in patients who had open treatment for femoroacetabular impingement, had persistent symptoms, and had both magnetic resonance arthrography (MRA) with radial slices and hip arthroscopy.
Of 750 patients, 21 patients (6 male and 15 female patients; mean age, 28 years [range, 16 to 41 years]) with persistent groin pain after open osteochondroplasty and femoroacetabular impingement were included. The mean time between open osteochondroplasty and hip arthroscopy was 19 months (range, 4 to 79 months). At index surgery, patients had open osteochondroplasty of the femoral head-neck junction, as well as resection of the acetabular rim with reattachment of the labrum. All patients had preoperative MRA.
At hip arthroscopy, 1 tear of the labrum was verified on MRA. MRA showed in all patients adhesions between the neck of the femur and joint capsule, which were confirmed at arthroscopy and removed. Sensitivity of MRA for tears and adhesions was 100%; specificity, 100% and positive predictive value (PPV), 100%. For acetabular cartilage damage, sensitivity was 66.7%; specificity, 77.8%; and PPV, 63.6%. For femoral cartilage damage, sensitivity was 80%; specificity, 100%; and PPV, 20%. Postoperative alpha angles were significantly decreased. Of 21 patients, 3 had persisting groin pain.
Persistent groin pain after open osteochondroplasty of the hip could result from pathologic changes such as intra-articular adhesions with concomitant soft-tissue impingement. This pathology, as well as cartilage damage and labral tears, can be shown on MRA with radial slices.
Twenty-one patients with persistent groin pain after open osteochondroplasty of the hip had adhesions identified by MRA with radial slices. At hip arthroscopy, these adhesions were removed and 18 of 21 patients had relief of their symptoms.
Level IV, therapeutic case series.
我们的目的是研究髋关节粘连、盂唇撕裂和关节软骨病变在接受股骨髋臼撞击症开放式治疗后持续存在症状且同时接受磁共振关节造影术（MRA）加放射状切片和髋关节镜检查的患者中的敏感性、特异性和预测值。
在 750 名患者中，有 21 名（6 名男性和 15 名女性患者；平均年龄 28 岁[范围，16 至 41 岁]）在接受开放式骨软骨成形术和股骨髋臼撞击症后持续出现腹股沟疼痛。开放式骨软骨成形术和髋关节镜检查之间的平均时间为 19 个月（范围，4 至 79 个月）。在指数手术中，患者接受了股骨头颈交界处的开放式骨软骨成形术以及髋臼缘的切除术和盂唇的再附着术。所有患者均行术前 MRA。
在髋关节镜检查中，MRA 证实了 1 例盂唇撕裂。MRA 显示所有患者的股骨颈和关节囊之间存在粘连，这些粘连在关节镜下得到证实并被切除。MRA 对撕裂和粘连的敏感性为 100%；特异性，100%和阳性预测值（PPV），100%。对于髋臼软骨损伤，敏感性为 66.7%；特异性，77.8%；和 PPV，63.6%。对于股骨软骨损伤，敏感性为 80%；特异性，100%；和 PPV，20%。术后 alpha 角明显减小。21 名患者中有 3 名持续出现腹股沟疼痛。
髋关节开放式骨软骨成形术后持续出现腹股沟疼痛可能是由于关节内粘连伴软组织撞击等病理变化引起的。这种病理学以及软骨损伤和盂唇撕裂可以通过 MRA 加放射状切片显示出来。
21 名髋关节开放式骨软骨成形术后持续出现腹股沟疼痛的患者通过 MRA 加放射状切片发现存在粘连。在髋关节镜检查中，这些粘连被切除，21 名患者中有 18 名症状得到缓解。
IV 级，治疗性病例系列研究。
