CNRS, ISM, Department of orthopaedics and Traumatology, Aix-Marseille université, Sainte-Marguerite hospital, Institute for Locomotion, AP-HM, 13009 Marseille, France.
Institut de traumatologie et d'orthopédie du Léman-Suisse, clinique de Genolier, 1272 Genolier, Switzerland.
Orthop Traumatol Surg Res. 2019 Dec;105(8S):S267-S274. doi: 10.1016/j.otsr.2019.09.016. Epub 2019 Oct 28.
Coxa profunda is a complex entity that can result in femoro-acetabular impingement (FAI). A meticulous evaluation of the type of acetabular overcoverage is essential to determine which treatment is best suited to each individual patient. Focal overcoverage with no posterior impingement can be treated by arthroscopic recontouring of the disproportionate acetabular wall. Any femoral deformities should be managed during the same procedure. General overcoverage, with predominant postero-inferior impingement, requires open surgery to obtain access to the entire acetabular rim. Rim resection should be sparing, to avoid removing an excessive proportion of the joint surface, yet sufficient to eliminate the impingement. In the event of protrusio acetabuli, which is the extreme form of coxa profunda, reverse peri-acetabular osteotomy should be considered, particularly if the acetabular roof angle is reversed. In some patients, chiefly those with coxa vara, valgus femoral osteotomy should be considered as a means of redirecting the loads towards the acetabular roof, thereby diminishing the forces that tend to drive the femoral head deeper into the socket.
深部髋臼是一个复杂的实体，可导致股骨髋臼撞击（FAI）。仔细评估髋臼覆盖的类型对于确定哪种治疗方法最适合每个患者至关重要。无后撞击的局灶性髋臼覆盖过度可以通过关节镜下髋臼壁不成比例的重塑来治疗。任何股骨畸形都应在同一手术中处理。广泛覆盖，主要是后下撞击，需要开放手术才能到达整个髋臼边缘。边缘切除应尽量保留，以避免切除过多的关节面，但足以消除撞击。在髋臼前突（即深部髋臼的极端形式）的情况下，应考虑反向髋臼周围截骨术，特别是如果髋臼顶角度反转。在某些患者中，主要是那些有髋内翻的患者，应考虑股骨内翻截骨术作为将负荷重新导向髋臼顶的一种手段，从而减少将股骨头进一步推向髋臼的力。
