Shibata Kotaro R, Matsuda Shuichi, Safran Marc R
Department of Orthopaedic Surgery, Nishi-Kobe Medical Center, 5-3-7 Kojidai Nishiku, Kobe, 651-2273, Japan.
Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94063, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):84-93. doi: 10.1007/s00167-016-4342-4. Epub 2016 Oct 1.
The purpose of this study was to determine whether or not there is a distinct pattern of injury to the acetabular labrum and/or cartilage in the hip with instability without bony dysplasia.
Surgical records and intra-operative images of consecutive patients who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) and/or hip instability by the senior author from April 2007 to December 2014 were retrospectively reviewed. Pathological changes were documented and charted on a novel diagram of the acetabulum, and classified into eight patterns corresponding to the lesion's location and size. In patients who had acetabular chondroplasty treatment, the width of the cartilage lesion was recorded.
A total of 953 hips in 886 patients were included, and patients who met our inclusion/exclusion criterion were grouped into an Instability-Only group (45 hips), an Instability-Dysplasia group (12 hips), as well as Pincer-FAI, Cam-FAI, and Combined-FAI groups consisting of 100, 54, and 269 hips, respectively. In the Instability-Only group, 42.2 % of the chondral and labral lesions demonstrated a "Straight-Anterior" pattern, which proportion was statistically significantly different compared with Pincer-FAI (p < 0.000), Cam-FAI (p = 0.0002), and Combined-FAI (p < 0.000) groups. In Instability-Only patients, only 15.6 % of the lesions had an "Anterior to Lateral" pattern, a significantly lower proportion (p < 0.000) compared with the FAI groups. Also 11.1 % of the lesions demonstrated a "Lateral" pattern, which is a significantly greater proportion compared with Pincer-FAI (p < 0.000) and Combined-FAI (p < 0.000) groups. The mean width of the cartilage lesions for the Instability-Only group was 2.9 mm, which was significantly shallower than for the other FAI groups (p < 0.000).
A significant predilection of "Straight-Anterior" or "Lateral" location of labral and/or cartilage damage was observed in the hip with instability, while there was shallow width of articular cartilage damage in these patients. These results suggest that there is a distinctive labral and cartilage damage pattern for hips with instability without inherent bony dysplasia.
Diagnostic study, Level IV.
本研究旨在确定在无骨性发育异常的髋关节不稳定患者中，髋臼盂唇和/或软骨是否存在独特的损伤模式。
回顾性分析2007年4月至2014年12月期间由资深作者主刀的因股骨髋臼撞击症（FAI）和/或髋关节不稳定而接受初次髋关节镜检查的连续患者的手术记录和术中图像。记录病理变化并绘制在一张新的髋臼示意图上，并根据病变的位置和大小分为八种模式。对于接受髋臼软骨成形术治疗的患者，记录软骨损伤的宽度。
共纳入886例患者的953个髋关节，符合纳入/排除标准的患者被分为单纯不稳定组（45个髋关节）、不稳定-发育异常组（12个髋关节），以及分别由100个、54个和269个髋关节组成的钳夹型FAI组、凸轮型FAI组和复合型FAI组。在单纯不稳定组中，42.2%的软骨和盂唇损伤表现为“直线-前方”模式，与钳夹型FAI组（p < 0.000）、凸轮型FAI组（p = 0.0002）和复合型FAI组（p < 0.000）相比，该比例在统计学上有显著差异。在单纯不稳定患者中，只有15.6%的损伤呈“前至外侧”模式，与FAI组相比比例显著更低（p < 0.000）。此外，11.1%的损伤表现为“外侧”模式，与钳夹型FAI组（p < 0.000）和复合型FAI组（p < 0.000）相比比例显著更高。单纯不稳定组软骨损伤的平均宽度为2.9毫米，明显比其他FAI组浅（p < 0.000）。
在不稳定的髋关节中观察到盂唇和/或软骨损伤在“直线-前方”或“外侧”位置有明显的偏好，而这些患者的关节软骨损伤宽度较浅。这些结果表明，对于无内在骨性发育异常的不稳定髋关节，存在独特的盂唇和软骨损伤模式。
诊断性研究，IV级。
