Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
Clin Orthop Relat Res. 2012 Dec;470(12):3332-41. doi: 10.1007/s11999-012-2519-9.
Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs).
QUESTIONS/PURPOSES: We asked, given regional variations in biochemical composition in dysplastic hips, whether the dGEMRIC index of the anterior joint would better predict premature joint failure after PAOs than the coronal dGEMRIC index as previously reported.
We retrospectively reviewed 43 hips in 41 patients who underwent Bernese PAO for hip dysplasia. Thirty-seven hips had preserved joints after PAOs and six were deemed premature failures based on pain, joint space narrowing, or subsequent THA. We used dGEMRIC to determine regional variations in biochemical composition. Preoperative demographic and clinical outcome score, radiographic measures of osteoarthritis and severity of dysplasia, and dGEMRIC indexes from different hip regions were analyzed in a multivariable regression analysis to determine the best predictor of premature joint failure. Minimum followup was 24 months (mean, 32 months; range, 24-46 months).
The two cohorts were similar in age and sex distribution. Severity of dysplasia was similar as measured by lateral center-edge, anterior center-edge, and Tönnis angles. Preoperative pain, joint space width, Tönnis grade, and coronal and sagittal dGEMRIC indexes differed between groups. The dGEMRIC index in the anterior weightbearing region of the hip was lower in the prematurely failed group and was the best predictor.
Success of PAO depends on the amount of preoperative osteoarthritis. These degenerative changes are seen most commonly in the anterior joint. The dGEMRIC index of the anterior joint may better predict premature joint failure than radiographic measures of hip osteoarthritis and coronal dGEMRIC index.
Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
几种现有的成分 MRI 似乎可以在放射照相表现之前检测到早期骨关节炎。软骨延迟钆增强 MRI（dGEMRIC）在临床研究中被最频繁地使用，据报道，它可以预测接受伯尔尼髋臼周围截骨术（PAO）的患者的关节过早失效。
问题/目的：鉴于发育不良髋关节的生化成分存在区域性差异，我们询问 dGEMRIC 指数是否会比之前报道的冠状 dGEMRIC 指数更好地预测 PAO 后关节的过早失效。
我们回顾性分析了 41 名患者的 43 髋，这些患者因髋关节发育不良接受了伯尔尼 PAO。37 髋在 PAO 后保持关节完整，6 髋因疼痛、关节间隙变窄或随后进行 THA 而被认为是早期失败。我们使用 dGEMRIC 来确定生化成分的区域变化。在多变量回归分析中分析了术前人口统计学和临床结果评分、放射照相骨关节炎和发育不良严重程度的测量值以及不同髋关节区域的 dGEMRIC 指数，以确定早期关节失败的最佳预测因素。最小随访时间为 24 个月（平均 32 个月；范围 24-46 个月）。
两组在年龄和性别分布上相似。侧位中心边缘、前位中心边缘和 Tönnis 角测量的发育不良严重程度相似。术前疼痛、关节间隙宽度、Tönnis 分级以及冠状位和矢状位 dGEMRIC 指数在两组之间存在差异。在过早失败组中，髋关节负重前区的 dGEMRIC 指数较低，是最佳预测因素。
PAO 的成功取决于术前骨关节炎的程度。这些退行性变化最常见于前关节。与髋关节骨关节炎的放射照相测量值和冠状 dGEMRIC 指数相比，前关节的 dGEMRIC 指数可能更好地预测关节的过早失效。
II 级，预后研究。有关证据水平的完整描述，请参见作者说明。
