“股骨髋臼撞击症”。Legg-Calve-Perthes病：从儿童期到成年期

"Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood.

作者信息

Accadbled F, Pailhé R, Launay F, Nectoux E, Bonin N, Gicquel P

机构信息

Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.

出版信息

Orthop Traumatol Surg Res. 2014 Oct;100(6):647-9. doi: 10.1016/j.otsr.2014.03.029. Epub 2014 Sep 10.

DOI:10.1016/j.otsr.2014.03.029

PMID:25217031

Abstract

OBJECTIVES

The objective of this study was to investigate cases of femoroacetabular impingement (FAI) and analyze the risk factors for a painful hip at skeletal maturity after Perthes disease. We hypothesized that FAI occurs as a sequela of Perthes disease and that coxa plana and triple osteotomy of the pelvis (TOP) may be risk factors.

METHODS

Ninety-five hips were included from 1981 to 2011, 56 of which were operated on with TOP (53) or shelf acetabuloplasty (3). The results were evaluated at a mean 13years of follow-up (range, 2-23years) with Oxford score and hip radiograph analysis including the Stulberg grade, coxometry, and presence of a femoral bump. FAI was characterized by positional hip pain with preserved joint space and aspherical/nonspherical femoral head.

RESULTS

The Oxford score was optimal (12) in 79 hips (75%) and 20 or above in nine hips (9.5%). Seventeen hips were rated Stulberg I (18%), 36 Stulberg II (38%), 27 Stulberg III (28%), and 15 Stulberg IV or V (16%). The average acetabular angle was 10° (range, -4 to 25), VCE 41.5° (range, 18-80), and VCA 38.5° (range, 13-70). A femoral bump was noted in 31 hips (33%). Five cases of FAI were managed operatively with at least pain relief. Hip pain at the latest follow-up correlated with coxa plana (P=0.0003) and femoral bump (P=0.007). No significant correlation was found with a history of hip surgery or coxometry parameters.

CONCLUSION

Perthes hips bear risk for later FAI. Risk factors include coxa plana and femoral bump. In case of TOP, it is advocated to avoid excessive tilt, which may cause FAI.

LEVEL OF EVIDENCE

IV.

摘要

目的

本研究的目的是调查股骨髋臼撞击症（FAI）病例，并分析佩特兹病（Perthes病）后骨骼成熟时髋关节疼痛的危险因素。我们假设FAI是佩特兹病的后遗症，扁平髋和骨盆三联截骨术（TOP）可能是危险因素。

方法

纳入1981年至2011年的95例髋关节病例，其中56例行TOP手术（53例）或髋臼造盖术（3例）。平均随访13年（范围2至23年）时，采用牛津评分和髋关节X线片分析评估结果，包括Stulberg分级、髋臼测量和股骨隆起的存在情况。FAI的特征为髋关节位置性疼痛，关节间隙保留，股骨头呈非球形/非球面形。

结果

79例髋关节（75%）的牛津评分为最佳（12分），9例髋关节（9.5%）评分为20分或更高。17例髋关节评分为Stulberg I级（18%），36例为Stulberg II级（38%），27例为Stulberg III级（28%），15例为Stulberg IV级或V级（16%）。平均髋臼角为10°（范围-4至25°），中心边缘角（VCE）为41.5°（范围18至80°），中心髋臼角（VCA）为38.5°（范围13至70°）。31例髋关节（33%）发现有股骨隆起。5例FAI病例接受了手术治疗，至少疼痛得到缓解。末次随访时的髋关节疼痛与扁平髋（P=0.0003）和股骨隆起（P=0.007）相关。未发现与髋关节手术史或髋臼测量参数有显著相关性。