髋臼横韧带是否肥厚并阻碍髋关节发育不良的复位？
Is the Transverse Acetabular Ligament Hypertrophied and Hindering Reduction in Developmental Dysplasia of Hip?
机构信息
Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
出版信息
Arthroscopy. 2018 Apr;34(4):1219-1226. doi: 10.1016/j.arthro.2017.10.024. Epub 2017 Dec 26.
PURPOSE
To investigate the arthroscopic pathoanatomy of the transverse acetabular ligament (TAL) and determine whether a TAL incision is necessary for the concentric reduction of developmental dysplasia of the hip (DDH) in infants and young children.
METHODS
We retrospectively reviewed patients who underwent arthroscopic-assisted reduction for DDH between July 2008 and April 2016. The indications for this intervention included patients in whom closed reduction failed and those who did not require bone operations. The arthroscopic findings and the effect of the TAL incision on DDH reduction were evaluated. TAL pathology was apparent when it was pulled superiorly or hypertrophied.
RESULTS
We identified a consecutive series of 13 patients (13 hips). Two patients with teratologic dislocation were excluded. There were 9 girls, 8 first-born infants, and 3 breech-position infants. Six patients showed positive Ortolani test findings. In all cases the TAL was considered not hypertrophied when it appeared as a narrow, cord-like structure that was continuous and in smooth transition with the TAL-labral ring, without prominence or elongation. All postreduction magnetic resonance imaging scans showed reduced femoral heads; however, residual subluxation was observed in 8 of 11 hips owing to the interposed anteroinferior labrum. On arthrography at 6 weeks after reduction, the femoral head was located deeper in the acetabulum and the medial dye pool width was within 2 mm in all patients.
CONCLUSIONS
The TAL was not observed to be hypertrophied or stretched in any of the DDH patients, and it did not act as an obstacle to reduction. After the TAL incision, the gap of the cut margin was not remarkably widened, although there were varying degrees of release. The incision of the TAL does not appear to result in the immediate alteration of the TAL-labral ring in favor of deeper acetabular seating or to enhance reduction.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
研究横髋臼韧带（TAL）的关节镜解剖结构，并确定对于婴幼儿发育性髋关节发育不良（DDH），TAL 切开是否有必要进行同心圆复位。
方法
我们回顾性分析了 2008 年 7 月至 2016 年 4 月期间接受关节镜辅助复位的 DDH 患者。该干预的适应证包括闭合复位失败的患者和无需行骨手术的患者。评估了关节镜检查结果和 TAL 切开对 DDH 复位的影响。当 TAL 被向上牵拉或肥大时，TAL 病理学表现明显。
结果
我们确定了连续的 13 例患者（13 髋）。排除了 2 例畸形性脱位患者。9 例为女性，8 例为第一胎，3 例为臀位。6 例患者的 Ortolani 试验阳性。所有病例的 TAL 均表现为狭窄、索状结构，连续且与 TAL-盂唇环平滑过渡，无突出或延长，被认为无肥大。所有复位后的磁共振成像扫描均显示股骨头减小；然而，由于髋臼前下盂唇的介入，11 髋中有 8 髋仍存在残余半脱位。在复位后 6 周的关节造影检查中，所有患者的股骨头均位于髋臼较深部位，内侧染料池宽度均在 2mm 以内。
结论
在任何 DDH 患者中，均未观察到 TAL 肥大或拉伸，且其未成为复位的障碍。TAL 切开后，虽然有不同程度的松解，但切开缘的间隙并没有明显增宽。TAL 的切开似乎不会立即改变 TAL-盂唇环，有利于髋臼更深的覆盖，也不会增强复位效果。
证据等级
IV 级，治疗性病例系列。
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