凸轮畸形的手术矫正与髋关节撞击症及其对髋关节退行性过程的影响。
Surgical Correction of Cam Deformity in Association with Femoroacetabular Impingement and Its Impact on the Degenerative Process within the Hip Joint.
机构信息
1Division of Orthopaedic Surgery (P.E.B. and H.A.) and Department of Medical Imaging (G.M. and K.R.), The Ottawa Hospital, Ottawa, Ontario, Canada 2Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada 3School of Human Kinetics and Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
J Bone Joint Surg Am. 2017 Aug 16;99(16):1373-1381. doi: 10.2106/JBJS.16.00415.
BACKGROUND
Cam morphology in association with femoroacetabular impingement (FAI) is a recognized cause of hip pain and cartilage damage and proposed as a leading cause of arthritis. The purpose of this study was to analyze the functional and biomechanical effects of the surgical correction of the cam deformity on the degenerative process associated with FAI.
METHODS
Ten male patients with a mean age of 34.3 years (range, 23.1 to 46.5 years) and a mean body mass index (and standard deviation) of 26.66 ± 4.79 kg/m underwent corrective surgery for cam deformity in association with FAI. Each patient underwent a computed tomography (CT) scan to assess acetabular bone mineral density (BMD), high-resolution T1ρ magnetic resonance imaging (MRI) of the hips to assess proteoglycan content, and squatting motion analysis as well as completed self-administered functional questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS]) both preoperatively and 2 years postoperatively.
RESULTS
At a mean follow-up of 24.5 months, improvements in functional scores and squat performance were seen. Regarding the zone of impingement in the anterosuperior quadrant of the acetabular rim, the mean change in BMD at the time of follow-up was -31.8 mg/cc (95% confidence interval [CI], -11 to -53 mg/cc) (p = 0.008), representing a 5% decrease in BMD. The anterosuperior quadrant also demonstrated a significant decrease in T1ρ values, reflecting a stabilization of the cartilage degeneration. Significant correlations were noted between changes in clinical functional scores and changes in T1ρ values (r = -0.86; p = 0.003) as well as between the BMD and maximum vertical force (r = 0.878; p = 0.021).
CONCLUSIONS
Surgical correction of a cam deformity in patients with symptomatic FAI not only improved clinical function but was also associated with decreases in T1ρ values and BMD. These findings are the first, to our knowledge, to show that alteration of the hip biomechanics through surgical intervention improves the overall health of the hip joint.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
与股骨髋臼撞击症（FAI）相关的凸轮畸形是髋关节疼痛和软骨损伤的公认原因，并被认为是关节炎的主要原因。本研究的目的是分析凸轮畸形的手术矫正对与 FAI 相关的退行性过程的功能和生物力学影响。
方法
10 名男性患者，平均年龄 34.3 岁（范围，23.1 至 46.5 岁），平均体重指数（和标准差）为 26.66±4.79kg/m2，因 FAI 相关凸轮畸形接受矫正手术。每位患者均接受计算机断层扫描（CT）扫描以评估髋臼骨矿物质密度（BMD），髋关节高分辨率 T1ρ磁共振成像（MRI）以评估蛋白聚糖含量，并进行深蹲运动分析以及在术前和术后 2 年完成自我管理的功能问卷（髋关节残疾和骨关节炎结果评分[HOOS]）。
结果
平均随访 24.5 个月后，功能评分和深蹲表现均得到改善。在髋臼前上象限的撞击区域方面，随访时 BMD 的平均变化为-31.8mg/cc（95%置信区间[CI]，-11 至-53mg/cc）（p=0.008），代表 BMD 下降 5%。前上象限也显示 T1ρ 值显著降低，反映了软骨退化的稳定。临床功能评分的变化与 T1ρ 值的变化之间存在显著相关性（r=-0.86；p=0.003），以及 BMD 与最大垂直力之间存在显著相关性（r=0.878；p=0.021）。
结论
在有症状的 FAI 患者中矫正凸轮畸形不仅改善了临床功能，还与 T1ρ 值和 BMD 的降低有关。这些发现是我们所知的首次表明通过手术干预改变髋关节生物力学可以改善髋关节的整体健康状况。
证据水平
治疗性 IV 级。有关证据水平的完整描述，请参阅作者说明。
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