奥托·奥夫兰克奖。凸轮畸形的病因学：一项儿科 MRI 的横断面研究。
The Otto Aufranc Award. On the etiology of the cam deformity: a cross-sectional pediatric MRI study.
机构信息
Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
Clin Orthop Relat Res. 2014 Feb;472(2):430-6. doi: 10.1007/s11999-013-2990-y.
BACKGROUND
Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain as well as a cause of hip arthritis, yet despite this, little is known about the etiology of the cam morphology or possible risk factors associated with its development.
QUESTIONS/PURPOSES: The purposes of our study were to determine when the cam morphology associated with FAI developed in a cross-sectional cohort study of pediatric patients pre- and postphyseal closure using MRI and whether increased activity level during the period of physeal closure is associated with an increased likelihood that the cam deformity will develop.
METHODS
Alpha angles were measured at the 3 o'clock (anterior head-neck junction) and 1:30 (anterosuperior head-neck junction) positions in both hips with a cam deformity defined as an alpha angle ≥ 50.5° at the 3 o'clock position. Forty-four volunteers (88 hips) were studied: 23 with open physes (12 females, mean age 9.7 years; 11 males, age 11.7 years) and 21 with closed physes (five females, age 15.2 years; 16 males, age 16.2 years). Daily activity level using the validated Habitual Activity Estimation Scale was compared for patients in whom cam morphology did and did not develop.
RESULTS
None of the 23 (0%) patients prephyseal closure had cam morphology, whereas three of 21 (14%, p = 0.02; all males) postclosure had at least one hip with cam morphology. Daily activity level was higher (p = 0.02) for patients with the cam morphology (7.1 hours versus 2.9 hours). Mean alpha angles at the 3 o'clock head-neck position were 38° (95% confidence interval [CI], 37.2°-39.1°) in the open physes group and 42° (95% CI, 40.16°-43.90°) in the closed physes group; at the 1:30 head-neck position, they were 45° (95% CI, 44.0°-46.4°) in the open physes group and 50° (47.9°-52.3°) in the closed physes group.
CONCLUSIONS
The fact that cam morphology was present exclusively in the closed physeal group strongly supports its development during the period of physeal closure with increased activity level as a possible risk factor.
背景
股骨髋臼撞击症（FAI）已被认为是髋关节疼痛以及髋关节骨关节炎的常见病因，但尽管如此，对于凸轮形态的病因或与凸轮形态发展相关的可能危险因素仍知之甚少。
问题/目的：我们的研究目的是通过 MRI 研究在骺板闭合前和闭合后的儿童患者中，确定与 FAI 相关的凸轮形态何时出现，以及骺板闭合期间活动水平增加是否与凸轮畸形发展的可能性增加相关。
方法
在双侧髋关节中，在 3 点钟（前股骨头颈交界处）和 1 点 30 分（前上股骨头颈交界处）测量 alpha 角，将凸轮畸形定义为 3 点钟位置的 alpha 角≥50.5°。研究了 44 名志愿者（88 髋）：23 名骺板未闭合（12 名女性，平均年龄 9.7 岁；11 名男性，年龄 11.7 岁），21 名骺板闭合（5 名女性，年龄 15.2 岁；16 名男性，年龄 16.2 岁）。使用经过验证的习惯性活动评估量表比较了凸轮形态出现和未出现的患者的日常活动水平。
结果
骺板未闭合的 23 名（0%）患者中无一例出现凸轮形态，而骺板闭合后的 21 名患者中有 3 名（14%，p=0.02；均为男性）至少有一侧髋关节出现凸轮形态。出现凸轮形态的患者的日常活动水平较高（p=0.02；7.1 小时对 2.9 小时）。骺板未闭合组的 3 点钟股骨头颈位平均 alpha 角为 38°（95%置信区间[CI]，37.2°-39.1°），骺板闭合组为 42°（95% CI，40.16°-43.90°）；在 1 点 30 分的股骨头颈位，骺板未闭合组为 45°（95% CI，44.0°-46.4°），骺板闭合组为 50°（47.9°-52.3°）。
结论
凸轮形态仅出现在骺板闭合组的事实强烈支持其在骺板闭合期间发育，活动水平增加可能是一个危险因素。
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