Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, USA.
Clin Orthop Relat Res. 2012 Nov;470(11):2968-77. doi: 10.1007/s11999-012-2375-7.
Residual Perthes and Perthes-like hip deformities are complex and may encompass proximal femoral deformity, secondary acetabular dysplasia, and associated intraarticular abnormalities. These intraarticular abnormalities have not been well characterized but may influence surgical technique and treatment outcomes.
QUESTIONS/PURPOSES: We (1) determined the characteristics of intraarticular disease associated with residual Perthes-like hip deformities; and (2) correlated these intraarticular abnormalities with clinical characteristics and radiographic parameters of hip morphology.
We retrospectively reviewed 35 patients (36 hips) with residual Perthes or Perthes-like deformities and hip symptoms treated using a surgical dislocation. There were 24 males and 11 females; mean age was 18.5 years (range, 10-36 years). We prospectively documented all intraoperative findings and comprehensively reviewed all radiographs.
Labral abnormalities and acetabular and femoral head cartilage abnormalities were present in 76%, 59%, and 81% of hips, respectively. Male sex was associated with severe chondromalacia (64% versus 27%), femoral head chondromalacia (92% versus 55%), and advanced radiographic osteoarthritis (44% versus 9%). Stulberg classification of 3 or greater was associated with moderate to severe acetabular chondromalacia (71% versus 30%). Lateral center-edge angle > 20° and acetabular inclination < 15° correlated with severe chondromalacia (73% versus 38%; 23% versus 70%). Center-trochanteric distance < -1.7 was associated with labral tears (90% versus 57%).
Chondral lesions and labral tears are common in symptomatic patients with residual Perthes or Perthes-like deformities. Male sex, a high trochanter, and joint incongruity are associated with more advanced intraarticular disease. Secondary acetabular dysplasia seems to protect the articular cartilage in that hips with acetabular dysplasia had less chondromalacia.
残余性髋臼发育不良和类似 Perthes 髋部畸形较为复杂，可能包括股骨近端畸形、继发髋臼发育不良和关节内的相关异常。这些关节内异常尚未得到很好的描述，但可能影响手术技术和治疗效果。
问题/目的：我们（1）确定与残余性类似 Perthes 髋部畸形相关的关节内疾病的特征；（2）将这些关节内异常与髋关节形态的临床特征和影像学参数相关联。
我们回顾性分析了 35 例（36 髋）接受手术脱位治疗的残余性 Perthes 或类似 Perthes 畸形伴髋部症状的患者。其中男 24 例，女 11 例；平均年龄 18.5 岁（范围，10-36 岁）。我们前瞻性记录所有术中所见，并全面回顾所有影像学资料。
髋臼唇异常、髋臼和股骨头软骨异常分别见于 76%、59%和 81%的髋关节。男性与严重的软骨软化（64%比 27%）、股骨头软骨软化（92%比 55%）和晚期影像学骨关节炎（44%比 9%）相关。Stulberg 分类为 3 级或更高级别与中重度髋臼软骨软化（71%比 30%）相关。外侧中心边缘角>20°和髋臼倾斜度<15°与严重软骨软化相关（73%比 38%；23%比 70%）。中心-转子距离<-1.7 与髋臼唇撕裂相关（90%比 57%）。
在有残余性 Perthes 或类似 Perthes 畸形和症状的患者中，软骨病变和髋臼唇撕裂很常见。男性、高位转子和关节不匹配与更严重的关节内疾病相关。继发髋臼发育不良似乎能保护关节软骨，因为髋臼发育不良的髋关节软骨软化程度较轻。
