盂唇骨化及骶髂关节病：与自身免疫病因有关联吗？
Labral Ossification and Sacroiliac Joint Disease: Could There Be a Link to an Autoimmune Etiology?
机构信息
Nashville Hip Institute, Nashville, Tennessee, U.S.A.
Jacksonville Orthopaedic Institute, Jacksonville, Florida, U.S.A.
出版信息
Arthroscopy. 2019 Aug;35(8):2333-2337. doi: 10.1016/j.arthro.2019.03.049. Epub 2019 Jul 23.
PURPOSE
To determine the prevalence of ipsilateral sacroiliac (SI) joint disease among patients with symptomatic femoroacetabular impingement (FAI) associated with labral ossification (LO) who underwent hip arthroscopy compared with a matched control group of patients with symptomatic FAI and no LO.
METHODS
Computed tomography (CT) scans of all patients undergoing arthroscopic correction of FAI were obtained. The inclusion criterion for the study group was a diagnosis of FAI with a secondary diagnosis of LO made by plain radiography, CT, or magnetic resonance imaging or made intraoperatively. The exclusion criterion was the absence of evidence of LO. We reviewed 52 patients (56 hips) with LO to assess the SI joint and compared them with a control group matched by age, sex, and FAI type. The SI joints were graded according to the modified New York criteria.
RESULTS
CT scans were available for evaluation of the ipsilateral SI joint in 28 patients (29 hips) with LO: 17 women and 11 men with an average age of 44.6 years (range, 26-56 years). Of the hips, 23 had combined FAI and 6 had pincer-type FAI. The control group consisted of 29 hips, exactly matched for sex and FAI type, with an average age of 44.8 years (range, 21-58 years). Grade 3 SI joint abnormalities were significantly more prevalent in the LO group (28%) than in the control group (7%, P = .037), and grade 0 or 1 changes (relatively normal SI joints) were significantly less common in patients with LO (38%) than in controls (72%, P = .008). Subanalysis showed that 35% of the LO group aged 45 years or younger had ipsilateral grade 3 SI joint abnormalities compared with none of the control patients aged 45 years or younger (P = .041). Grade 3 changes were found in 42% of male patients with LO compared with 8% of male controls (P = .155). Grade 3 changes were noted in 18% of women in the LO group compared with 6% of female controls (P = .601).
CONCLUSIONS
Patients with symptomatic FAI and LO are more likely to show associated SI joint pathology than patients with FAI not involving LO. These differences are greatest among men and among patients aged 45 years or younger.
LEVEL OF EVIDENCE
Level III, retrospective case-control study.
目的
确定与髋臼撞击症（FAI）相关的伴有滑膜骨软骨瘤病（LO）的症状性患者在接受髋关节镜检查时，其同侧骶髂（SI）关节疾病的患病率，并与具有相同 LO 但无症状的 FAI 患者的对照组进行比较。
方法
获取所有接受关节镜 FAI 矫正术的患者的计算机断层扫描（CT）扫描。研究组的纳入标准为：通过 X 线、CT 或磁共振成像或术中诊断为 FAI 合并 LO ；排除标准为 LO 证据缺失。我们共评估了 52 例（56 髋）伴有 LO 的患者，以评估 SI 关节，并与年龄、性别和 FAI 类型相匹配的对照组进行比较。SI 关节根据改良纽约标准进行分级。
结果
共有 28 例（29 髋） LO 患者的 CT 扫描可用于评估同侧 SI 关节：17 例女性，11 例男性，平均年龄为 44.6 岁（范围，26-56 岁）。其中 23 髋为 FAI 合并型，6 髋为钳夹型 FAI。对照组由 29 髋组成，性别和 FAI 类型完全匹配，平均年龄为 44.8 岁（范围，21-58 岁）。LO 组的 SI 关节 3 级异常明显更为常见（28%），而对照组为 7%（P=0.037），LO 患者中 SI 关节 0 级或 1 级改变（相对正常的 SI 关节）明显更少（38%），而对照组为 72%（P=0.008）。亚组分析显示，45 岁或以下 LO 组的 35%患者存在同侧 SI 关节 3 级异常，而 45 岁或以下对照组患者无 1 例（P=0.041）。LO 组 42%的男性患者和对照组 8%的男性患者存在 4 级改变（P=0.155）。LO 组的 18%女性患者和对照组的 6%女性患者存在 3 级改变（P=0.601）。
结论
与不伴有 LO 的 FAI 患者相比，伴有 LO 的症状性 FAI 患者更有可能出现相关的 SI 关节病变。这些差异在男性和 45 岁或以下的患者中最大。
证据等级
III 级，回顾性病例对照研究。
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