Hospital for Special Surgery, 525 East 71st Street, New York, NY, 10021, USA,
Curr Rev Musculoskelet Med. 2012 Mar;5(1):1-8. doi: 10.1007/s12178-011-9105-8.
The level of understanding of pain in the non-arthritic hip has made significant strides in the last couple of decades beginning with the discoveries of Reinhold Ganz, MD. However, even with the detection of subtle bony abnormalities, including femoroacetabular impingement, a clinician's ability to differentiate pain generators in the hip has been ambiguous. Deciphering the etiology of the pathology versus the pain generator is essential in prescribing the proper treatment. The Layer Concept developed by Dr. Bryan Kelly, is a systematic means of determining which structures about the hip are the source of the pathology, which are the pain generators and how to then best implement treatment. Four layers will be discussed in this article. Layer I, the osseous layer, Layer II, the inert tissue layer, Layer III, the contractile layer and Layer IV, the neuromechanical layer.
在过去的几十年中，非关节炎性髋关节疼痛的理解水平取得了重大进展，这要归功于医学博士 Reinhold Ganz 的发现。然而，即使发现了细微的骨异常，包括股骨髋臼撞击症，临床医生区分髋关节疼痛源的能力仍然存在模糊性。解析病理学与疼痛源的病因对于制定正确的治疗方案至关重要。布赖恩·凯利（Bryan Kelly）博士提出的“层概念”是一种系统的方法，可以确定髋关节的哪些结构是病理学的来源，哪些是疼痛源，以及如何最好地实施治疗。本文将讨论四个层次。第 I 层，骨骼层；第 II 层，惰性组织层；第 III 层，收缩层；第 IV 层，神经机械层。
