Jayakar Rohit, Merz Alexa, Plotkin Benjamin, Wang Dean, Seeger Leanne, Hame Sharon L
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Skeletal Radiol. 2016 Aug;45(8):1061-7. doi: 10.1007/s00256-016-2392-9. Epub 2016 Apr 20.
Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph.
From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs.
On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.
关节镜检查对于老年患者髋臼盂唇撕裂的疼痛和功能影响极小，尤其是在合并骨关节炎的情况下。然而，许多医生仍通过磁共振关节造影来寻求这一诊断。我们的目的是评估老年髋部疼痛患者髋臼盂唇撕裂的发生率，并将盂唇病变的可能性与传统X线片上显示的骨关节炎严重程度相关联。
2004年至2013年期间，确定了208例年龄在50岁及以上患者的髋关节磁共振关节造影图像及相应的X线片。记录患者的年龄、性别、盂唇撕裂的分级和位置、α角、Tönnis分级以及关节间隙宽度。在磁共振关节造影图像上识别并测量盂唇撕裂和α角。在X线片上测量Tönnis分级和关节间隙宽度。
在磁共振关节造影中，73%的患者被发现存在真正的盂唇撕裂。93.3%的患者存在一定程度的盂唇病变，在Tönnis分级为2 - 3级或关节间隙宽度≤2mm定义的中重度骨关节炎患者中，这一比例增至100%。盂唇撕裂分级与Tönnis分级或关节间隙宽度之间无统计学显著相关性。鉴于盂唇病变的高发生率以及关节镜手术干预在老年患者中疗效存疑，磁共振关节造影应主要用于X线片显示关节炎程度较轻且可能从手术中获益的患者。如果这些患者需要进行X线片以外的进一步成像检查，标准MRI可能是更合适的成像工具。
