Møse Frederik B, Mechlenburg Inger, Hartig-Andreasen Charlotte, Gelineck John, Søballe Kjeld, Jakobsen Stig S
Department of Medical Sciences, Section of Orthopedics, Örebro University, 701 85 Örebro, Sweden.
Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus, Denmark.
J Hip Preserv Surg. 2019 Mar 11;6(1):60-68. doi: 10.1093/jhps/hnz003. eCollection 2019 Jan.
Labral pathology is seen in both dysplastic and borderline dysplastic hips. Periacetabular osteotomy (PAO) is the treatment of choice for dysplasia. However, some authors have suggested that borderline dysplastic hips with concurrent labral pathology should be treated arthroscopically. The purpose of this study was to investigate the frequency of labral pathology between dysplastic and borderline dysplastic hips, whether centre-edge (CE) angle is associated with labral pathology, and finally if pain and labral pathology are associated. Ninety-nine symptomatic patients (104 hips) scheduled for PAO were examined. Five patients were excluded due to complaints from multiple joints and four failed to show at 2-year follow-up. Five patients did not fill out questionnaires preoperatively. Hips were characterized as dysplastic (CE angle <20°) and borderline dysplastic (CE angle 20° ≤ 25°). A magnetic resonance arthrography was performed, and labral pathology was classified according to the Czerny classification. Association with the CE angle, the acetabular index (AI) and preoperative WOMAC pain score was tested by multiple linear regression. There was no significant difference in frequency of labral pathology when comparing the two groups. Across the cohort, 86 of 99 patients had labral pathology. The CE angle was associated with increasing severity of labral pathology, whereas the AI angle and preoperative pain were not associated with labral pathology. Decreased lateral coverage adversely loads the labrum, predisposing it to tears. We advocate reorienting the biomechanical forces through PAO, not arthroscopic treatment. Level of pain was not associated with labral pathology, suggesting that labral pathology may not alone explain the dysplastic pain complex.
髋臼盂唇病变在发育不良和临界发育不良的髋关节中均可见。髋臼周围截骨术（PAO）是治疗发育不良的首选方法。然而，一些作者认为，伴有髋臼盂唇病变的临界发育不良髋关节应采用关节镜治疗。本研究的目的是调查发育不良和临界发育不良髋关节中髋臼盂唇病变的发生率，中心边缘（CE）角是否与髋臼盂唇病变相关，以及疼痛与髋臼盂唇病变是否相关。对99例计划行PAO的有症状患者（104髋）进行了检查。5例因多关节疼痛被排除，4例在2年随访时未出现。5例患者术前未填写问卷。髋关节被分为发育不良（CE角<20°）和临界发育不良（CE角20°≤25°）。进行了磁共振关节造影，并根据Czerny分类对髋臼盂唇病变进行分类。通过多元线性回归测试与CE角、髋臼指数（AI）和术前WOMAC疼痛评分的相关性。两组之间髋臼盂唇病变的发生率无显著差异。在整个队列中，99例患者中有86例存在髋臼盂唇病变。CE角与髋臼盂唇病变严重程度增加相关，而AI角和术前疼痛与髋臼盂唇病变无关。外侧覆盖减少会对髋臼盂唇产生不利负荷，使其易于撕裂。我们主张通过PAO重新调整生物力学力量，而不是采用关节镜治疗。疼痛程度与髋臼盂唇病变无关，这表明髋臼盂唇病变可能无法单独解释发育不良性疼痛综合征。
