Duncan Stephen T, Bogunovic Ljiljana, Baca Geneva, Schoenecker Perry L, Clohisy John C
University of Kentucky, Lexington, KY, USA.
Clin Orthop Relat Res. 2015 Apr;473(4):1432-9. doi: 10.1007/s11999-015-4155-7. Epub 2015 Jan 31.
Many patients who undergo periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia experience decreased pain and improved function, yet some experience inadequate clinical improvement. The etiologies of treatment failure have not been completely defined, and sex-dependent disease characteristics that may be associated with less pain relief are not understood.
QUESTION/PURPOSES: We sought to determine whether there were clinically important sex-specific differences between male and female patients undergoing PAO for acetabular dysplasia in terms of (1) clinical parameters (anthropomorphic traits and hip scores), (2) radiographic findings, and (3) intraoperative findings at the time of PAO, in particular findings potentially associated with femoroacetabular impingement (FAI) such as chondromalacia at the head-neck junction, impingement trough, or reduced head-neck offset.
Between 2007 and 2012 we treated 245 patients (270 hips) with a PAO for symptomatic acetabular dysplasia. Of those, 16 patients (16 hips; 6%) had insufficient documentation for review in the medical record and another 49 patients (51 hips; 19%) met prespecified exclusion criteria, leaving 180 patients (203 hips; 75%) for analysis in this retrospective study. One hundred thirty-nine patients were females and 41 were males. Clinical data including patient demographics, physical examination, patient self-reported outcome scores, radiographic morphologic features, and intraoperative findings were collected prospectively as part of an institutional registry. Statistical analysis was performed with univariate and multivariate analyses.
Mean age was similar among sexes; however, BMI was greater in males compared with females (26 versus 24 kg/m(2); p = 0.002). Males had less hip ROM including internal rotation at 90° flexion (14° ± 13.8° versus 25° ± 16.2°; p = 0.001). Males had higher preoperative UCLA (7 ± 2, versus 6 ± 2; p = 0.02) and Harris hip scores (63 ± 15 versus 58 ± 16; p = 0.04). Radiographically, a crossover sign (88% versus 39%; p < 0.001) and posterior wall sign (92% versus 63%; p < 0.001) were more common in males. Males had greater alpha angles on the frog lateral (63° ± 15.3° versus 58° ± 16°; p = 0.04) and Dunn radiograph views (64° ± 15.5° versus 56° ± 14.8°; p = 0.02). The incidence of femoral head-neck chondromalacia (62% versus 82%; p = 0.03) and an impingement trough observed at surgery was greater in males (35% versus 17%; p = 0.01). Multivariate analysis showed differences between the sexes for reduced internal rotation in flexion, a higher Dunn alpha angle, increased incidence of a crossover sign, and a lower anterior center-edge angle.
There are sex-dependent, disease characteristic differences in patients with symptomatic acetabular dysplasia. Most notably, male patients have a greater prevalence of clinical, radiographic, and intraarticular findings consistent with concurrent FAI and instability and potentially a heightened risk of secondary FAI after PAO, however postoperative and long-term followup are needed to confirm these findings and it remains unclear which patients need surgical correction of the impingement and instability. Preoperative evaluation of acetabular dysplasia in males should at least include careful attention to factors associated with symptomatic FAI; however, further studies are needed to determine when surgical correction is needed.
许多因症状性髋臼发育不良接受髋臼周围截骨术（PAO）的患者疼痛减轻且功能改善，但仍有一些患者临床改善不充分。治疗失败的病因尚未完全明确，与疼痛缓解较少相关的性别依赖性疾病特征也尚不明确。
问题/目的：我们试图确定，在接受PAO治疗髋臼发育不良的男性和女性患者之间，在以下方面是否存在具有临床意义的性别差异：（1）临床参数（人体测量特征和髋关节评分）；（2）影像学表现；（3）PAO时的术中发现，特别是与股骨髋臼撞击（FAI）潜在相关的发现，如头颈交界处软骨软化、撞击沟或头颈偏移减小。
2007年至2012年期间，我们对245例（270髋）有症状性髋臼发育不良的患者进行了PAO治疗。其中，16例患者（16髋；6%）病历记录不充分无法进行回顾，另有49例患者（51髋；19%）符合预先设定排除标准，本回顾性研究中剩余180例患者（203髋；75%）用于分析。139例患者为女性，41例为男性。临床数据包括患者人口统计学资料、体格检查、患者自我报告的结果评分、影像学形态特征和术中发现，这些作为机构登记的一部分进行前瞻性收集。采用单因素和多因素分析进行统计分析。
两性平均年龄相似；然而，男性的体重指数高于女性（26 vs 24 kg/m²；p = 0.002）。男性髋关节活动度较小，包括90°屈曲时的内旋（14°±13.8° vs 25°±16.2°；p = 0.001）。男性术前UCLA评分（7±2 vs 6±2；p = 0.02）和Harris髋关节评分更高（63±15 vs 58±16；p = 0.04）。影像学上，交叉征（88% vs 39%；p < 0.001）和后壁征（92% vs 63%；p < 0.001）在男性中更常见。男性蛙式侧位（63°±15.3° vs 58°±16°；p = 0.04）和邓氏位X线片上的α角更大（64°±15.5° vs 56°±14.8°；p = 0.02）。男性股骨头颈软骨软化的发生率（62% vs 82%；p = 0.03）和手术中观察到的撞击沟发生率更高（35% vs 17%；p = 0.01）。多因素分析显示，两性在屈曲时内旋减小、邓氏α角增大、交叉征发生率增加和前中心边缘角降低方面存在差异。
有症状性髋臼发育不良患者存在性别依赖性疾病特征差异。最显著的是，男性患者与并发FAI和不稳定相关临床、影像学及关节内表现的发生率更高，PAO术后继发FAI的风险可能更高，然而需要术后及长期随访来证实这些发现，且尚不清楚哪些患者需要手术矫正撞击和不稳定。男性髋臼发育不良的术前评估至少应仔细关注与症状性FAI相关的因素；然而，需要进一步研究以确定何时需要手术矫正。
