Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Hip Int. 2021 Sep;31(5):663-668. doi: 10.1177/1120700020912169. Epub 2020 Mar 16.
Osteoarthritis in dysplastic hips should develop from the lateral side of the acetabulum and the femoral head just below. However, the existence of subchondral cysts located more on the medial side contradicts the weight-loading theory. The aim of this study was to confirm the presence of medial cysts at the femoral head and to investigate the relationship between medial cysts and injuries of the ligamentum teres in hip dysplasia.
A retrospective analysis was conducted on 257 cases of hip dysplasia. All patients had x-rays and 3-dimensional computed tomographies (3D CT) preoperatively and 123 patients had magnetic resonance arthrographies. A comparison was performed between cases with and without medial cysts according to the severity of damage to the ligamentum teres, the presence of bony spurs around the fovea capitis, and the Tönnis grade.
Medial subchondral cysts around the fovea capitis were found in 100 cases. Mild osteoarthritis (Tönnis grade 0 or 1) was present in 89% of cases in the medial cyst group. A significant difference between the groups was observed in the incidence of bony spurs around the fovea capitis ( < 0.05) and injuries of the ligamentum teres ( < 0.05).
The formation of subchondral cysts at the medial femoral head in hip dysplasia may be related to damage in the ligamentum teres. Considering that subchondral cysts develop in early osteoarthritis, the progression of arthritis in hip dysplasia appears to correlate with damage to the ligamentum teres, as well as compressive pressure on the joint.
发育性髋关节不良患者的骨关节炎应从髋臼的外侧和股骨头的下方开始发展。然而，位于内侧的软骨下囊肿的存在与负重理论相矛盾。本研究的目的是确认股骨头内侧囊肿的存在，并研究髋关节发育不良中盂唇撕裂与髋臼盂唇囊肿之间的关系。
回顾性分析了 257 例髋关节发育不良患者的病例。所有患者术前均行 X 线和三维 CT（3D CT）检查，123 例患者行磁共振关节造影检查。根据盂唇撕裂的严重程度、股骨头窝周围骨赘的存在以及 Tönnis 分级，对有和无内侧囊肿的病例进行比较。
在 100 例患者中发现了股骨头窝周围的内侧软骨下囊肿。内侧囊肿组中 89%的患者为轻度骨关节炎（Tönnis 分级 0 或 1）。在股骨头窝周围骨赘的发生率（ < 0.05）和盂唇撕裂的发生率（ < 0.05）方面，两组之间存在显著差异。
髋关节发育不良中股骨头内侧软骨下囊肿的形成可能与盂唇撕裂有关。考虑到软骨下囊肿在早期骨关节炎中形成，髋关节发育不良中关节炎的进展似乎与盂唇撕裂以及关节的压迫压力有关。
