Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA.
J Bone Joint Surg Am. 2011 May;93 Suppl 2:17-21. doi: 10.2106/JBJS.J.01735.
Acetabular dysplasia is recognized as a cause of early degenerative hip osteoarthritis. The purpose of this study was to prospectively determine the early clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients.
Fifty-seven consecutive skeletally mature patients with a total of sixty-five symptomatic hips were diagnosed with symptomatic acetabular dysplasia on the basis of the history, physical examination, and radiographs. These fifty-seven patients were enrolled in this study and were followed prospectively for a minimum of twenty-four months postoperatively.
The study group included forty-one female patients (72%) and sixteen male patients (28%) with a mean age of twenty-four years. All were treated with a periacetabular osteotomy and were followed for a minimum of twenty-four months. The initial presentation was insidious in 97% of the hips, and the majority (77%) of the hips were associated with moderate-to-severe pain on a daily basis. Pain was most commonly localized to the groin (72%) and/or the lateral aspect of the hip (66%). Activity-related hip pain was common (88%), and activity restriction frequently diminished hip pain (in 75% of the cases). On examination, thirty-one hips (48%) were associated with a limp; twenty-five (38%), with a positive Trendelenburg sign; and sixty-three (97%), with a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of hip dysplasia was 61.5 months. The mean number of health-care providers seen prior to the definitive diagnosis was 3.3. The mean Harris hip score improved from 66.4 points preoperatively to 91.7 points at a mean of 29.2 months after the periacetabular osteotomy.
The diagnosis of symptomatic acetabular dysplasia is commonly delayed, and procedures other than a pelvic reconstructive osteotomy are frequently recommended. The diagnosis of developmental dysplasia of the hip should be suspected and investigated when a skeletally mature, young, active patient has a predominant complaint of insidious activity-related groin pain and/or lateral hip pain.
Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.
髋臼发育不良被认为是导致早期退行性髋骨关节炎的原因。本研究的目的是前瞻性确定在骨骼成熟患者中出现症状性髋臼发育不良的早期临床表现。
根据病史、体格检查和影像学检查，共诊断出 57 例骨骼成熟且有 65 个症状性髋关节的连续患者为症状性髋臼发育不良。这些 57 例患者入组本研究，并在术后至少 24 个月进行前瞻性随访。
研究组包括 41 名女性（72%）和 16 名男性（28%），平均年龄为 24 岁。所有患者均接受髋臼周围截骨术治疗，并随访至少 24 个月。97%的髋关节初始表现隐匿，大多数（77%）髋关节每天伴有中度至重度疼痛。疼痛最常见于腹股沟（72%）和/或髋关节外侧（66%）。与活动相关的髋关节疼痛很常见（88%），活动受限常可减轻髋关节疼痛（75%的情况下）。体格检查时，31 个髋关节（48%）存在跛行；25 个髋关节（38%）存在阳性 Trendelenburg 征；63 个髋关节（97%）存在阳性撞击征。从症状出现到髋关节发育不良诊断的平均时间为 61.5 个月。在明确诊断之前，每位患者平均看了 3.3 位医疗保健提供者。髋臼周围截骨术后平均 29.2 个月时，Harris 髋关节评分从术前的 66.4 分提高到 91.7 分。
症状性髋臼发育不良的诊断常常被延误，并且除了骨盆重建截骨术之外，还常常推荐其他手术。当骨骼成熟、年轻、活跃的患者主要抱怨隐匿性与活动相关的腹股沟疼痛和/或髋关节外侧疼痛时，应怀疑并检查是否存在发育性髋关节发育不良。
预后 IV 级。有关证据等级的完整描述，请参见作者说明。
