Philippon Marc J, Patterson Diana C, Briggs Karen K
Steadman Philippon Research Institute, Vail, CO 81657, USA.
J Pediatr Orthop. 2013 Jul-Aug;33 Suppl 1:S126-30. doi: 10.1097/BPO.0b013e318274f834.
Femoroacetabular impingement (FAI) is widely understood to be an underlying etiology of injuries to the acetabular labrum and cartilage in the adult hip, although somewhat less attention has previously been spent on its incidence in the pediatric and adolescent populations. Initially recognized as a consequence of periacetabular osteotomies performed for developmental dysplasia of the hip, it can also be because of a number of other disorders or to a developmental process causing irregular bony growth. The adolescent presenting with FAI is athletic, particularly in endeavors placing excessive stress on the hip and surrounding soft tissues. The pain is characterized as sharp, localized around the anatomic femoral head location, and may be associated with catching or popping. Complete physical examination includes full range of motion testing, as a hallmark of FAI is restriction and pain with internal rotation. Special tests include the anterior impingement test, the FABER test, and the dial test. Imaging includes anteroposterior pelvic and cross-table lateral radiographs and magnetic resonance imaging. Treatment in all patients is 6 weeks of conservative therapy. If patients see no improvement with conservative treatment, they may be candidates for hip arthroscopy. Arthroscopic treatment of FAI includes rim trimming for pincer lesions, osteoplasty for cam decompression and labral detachment, and repair or reconstruction for labral tears. Studies have shown improvements in the modified Harris Hip Score and the Hip Outcomes Score postoperatively. As FAI is diagnosed most frequently in athletes, and it is estimated that 30 to 45 million adolescents 6 and 18 years old are involved in sports, it is becoming imperative to identify factors that may predict its development, study treatments, and improve outcomes.
股骨髋臼撞击症（FAI）被广泛认为是成人髋关节髋臼盂唇和软骨损伤的潜在病因，尽管此前对其在儿童和青少年人群中的发病率关注较少。最初它被认为是因髋关节发育不良而进行髋臼周围截骨术的结果，也可能是由于许多其他病症或导致不规则骨质生长的发育过程引起的。患有FAI的青少年通常爱运动，尤其是那些给髋关节及周围软组织施加过大压力的运动。疼痛的特点是尖锐，局限于解剖学上股骨头的位置，可能伴有卡顿或弹响。完整的体格检查包括全范围的活动度测试，因为FAI的一个标志是内旋时活动受限和疼痛。特殊检查包括前撞击试验、“4”字试验和旋转试验。影像学检查包括骨盆前后位和交叉台侧位X线片以及磁共振成像。所有患者均接受为期6周的保守治疗。如果患者经保守治疗无改善，可能适合进行髋关节镜检查。FAI的关节镜治疗包括对钳夹型损伤进行盂唇修整、对凸轮型撞击进行减压截骨术和盂唇分离，以及对盂唇撕裂进行修复或重建。研究表明，术后改良Harris髋关节评分和髋关节预后评分有所改善。由于FAI在运动员中最常被诊断出来，并且据估计有3000万至4500万6至18岁的青少年参与体育运动，因此识别可能预测其发生的因素、研究治疗方法并改善治疗效果变得至关重要。
