α角与青少年股骨髋臼撞击症疾病严重程度的相关性
The Association of α Angle on Disease Severity in Adolescent Femoroacetabular Impingement.
作者信息
Youngman Tyler R, Wagner K John, Montanez Benjamin, Johnson Benjamin L, Wilson Phillip L, Morris William Z, Sucato Daniel J, Podeszwa David A, Ellis Henry B
机构信息
University of Texas Southwestern Medical Center.
Texas Scottish Rite Hospital for Children, Dallas, TX.
出版信息
J Pediatr Orthop. 2021 Feb 1;41(2):88-92. doi: 10.1097/BPO.0000000000001703.
BACKGROUND
Femoroacetabular Impingement (FAI) is a common cause of hip pain in adolescent patients. Clinical exam and radiographic markers, such as α angle and lateral center edge angle (LCEA), are commonly used to aid in the diagnosis of this condition. The purpose of this study was to correlate preoperative α angle and LCEA with preoperative symptoms, intraoperative findings, and preoperative and postoperative patient reported outcomes (PROs) in the adolescent patient.
METHODS
A retrospective analysis of prospectively collected data was conducted for all patients who underwent operative intervention for FAI at an academic institution over an 11-year period. Preoperative imaging was obtained and measured for LCEA and α angle. PROs (modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA score) were collected preoperatively, as well as 1, 2, and 5 years postoperatively. Operative intervention was either open surgical hip dislocation or arthroscopic, and intraoperative disease was graded using the Beck Classification system. Patients with minimum 1-year follow-up were included in statistical analysis.
RESULTS
There were 86 hips (64 female hips) included with an average age of 16.3 years (range, 10.4 to 20.5 y), with an average of 37 months of follow-up. There was no correlation between severity of preoperative symptoms or difference between pre and postoperative PROs for both α angle and LCEA. Overall, significant improvement was noted in modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA Score (P<0.001 for each). Independent of preoperative symptoms, increased α angle correlated with more severe intraoperative labral disease (P<0.001), and longer length of labral tear (Corr 0.295, P<0.01). Femoral head and acetabular articular cartilage damage did not correlate with α angle or LCEA, nor did overall severity of disease.
CONCLUSIONS
In adolescent patients with FAI, increased α angle was found to significantly correlate with labral pathology, including increased length of tear and severity of disease, irrespective of preoperative symptoms or postoperative patient reported outcomes.
LEVEL OF EVIDENCE
Level III-retrospective.
背景
股骨髋臼撞击症（FAI）是青少年患者髋关节疼痛的常见原因。临床检查和影像学指标，如α角和外侧中心边缘角（LCEA），常用于辅助诊断该病症。本研究的目的是探讨青少年患者术前α角和LCEA与术前症状、术中发现以及术前和术后患者报告结局（PROs）之间的相关性。
方法
对一家学术机构11年间因FAI接受手术干预的所有患者进行前瞻性收集数据的回顾性分析。获取术前影像学资料并测量LCEA和α角。术前、术后1年、2年和5年收集PROs（改良Harris髋关节评分、髋关节功能障碍和骨关节炎结局评分以及UCLA评分）。手术干预方式为开放性髋关节脱位或关节镜手术，术中疾病采用Beck分类系统分级。纳入至少随访1年的患者进行统计分析。
结果
共纳入86例髋关节（64例女性），平均年龄16.3岁（范围10.4至20.5岁），平均随访37个月。α角和LCEA的术前症状严重程度或术前与术后PROs差异之间均无相关性。总体而言，改良Harris髋关节评分、髋关节功能障碍和骨关节炎结局评分以及UCLA评分均有显著改善（每项P<0.001）。与术前症状无关，α角增大与术中更严重的盂唇疾病相关（P<0.001），且盂唇撕裂长度更长（相关系数0.295，P<0.01）。股骨头和髋臼关节软骨损伤与α角或LCEA无关，疾病总体严重程度也与之无关。
结论
在患有FAI的青少年患者中，发现α角增大与盂唇病变显著相关，包括撕裂长度增加和疾病严重程度增加，与术前症状或术后患者报告结局无关。
证据水平
III级——回顾性研究。
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