Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
Twin City Orthopaedics, Edina, MN.
Sports Med Arthrosc Rev. 2021 Mar 1;29(1):15-21. doi: 10.1097/JSA.0000000000000298.
Borderline acetabular dysplasia represents a "transitional acetabular coverage" pattern between more classic acetabular dysplasia and normal acetabular coverage. Borderline dysplasia is typically defined as a lateral center-edge angle of 20 to 25 degrees. This definition of borderline dysplasia identifies a relatively narrow range of lateral acetabular coverage patterns, but anterior and posterior coverage patterns are highly variable and require careful assessment radiographically, in addition to other patient factors. Treatment decisions between isolated hip arthroscopy (addressing labral pathology, femoroacetabular impingement bony morphology, and capsular laxity) and periacetabular osteotomy (improving osseous joint stability; often combined with hip arthroscopy) remain challenging because the fundamental mechanical diagnosis (instability vs. femoroacetabular impingement) can be difficult to determine clinically. Treatment with either isolated hip arthroscopy or periacetabular osteotomy (with or without arthroscopy) appears to result in improvements in patient-reported outcomes in many patients, but with up to 40% with suboptimal outcomes. A patient-specific approach to decision-making that includes a comprehensive patient and imaging evaluation is likely required to achieve optimal outcomes.
边缘性髋臼发育不良代表了一种介于更经典的髋臼发育不良和正常髋臼覆盖之间的“过渡性髋臼覆盖”模式。边缘性发育不良通常被定义为外侧中心边缘角为 20 至 25 度。这种对边缘性发育不良的定义确定了相对狭窄的外侧髋臼覆盖模式范围，但前后覆盖模式高度可变，需要在影像学上进行仔细评估，此外还需要考虑其他患者因素。孤立性髋关节镜检查（处理盂唇病理、股骨髋臼撞击症骨形态和囊带松弛）和髋臼周围截骨术（改善骨关节稳定性；常与髋关节镜检查联合进行）之间的治疗决策仍然具有挑战性，因为基本的机械诊断（不稳定与股骨髋臼撞击症）在临床上很难确定。许多患者接受单纯髋关节镜检查或髋臼周围截骨术（伴或不伴关节镜检查）治疗后，患者报告的结果似乎都有所改善，但多达 40%的患者结果并不理想。需要采用一种针对特定患者的决策方法，包括全面的患者和影像学评估，以实现最佳结果。
