Department of Orthopaedics, Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Hip Health and Mobility, School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
J Orthop Res. 2022 Feb;40(2):370-379. doi: 10.1002/jor.25037. Epub 2021 Apr 6.
It is not clear whether femoral neck osteochondroplasty achieves its objective of increasing femoroacetabular clearance. We used an upright open magnetic resonance imaging scanner to image the hip joint in multiple postures to explore the effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. We recruited 13 consecutive patients scheduled to undergo arthroscopic femoral neck osteochondroplasty and completed assessments on 10 patients. We scanned each subject before surgery and at 6 months post-op in supine and 3 other physiological postures: supine 90° flexion with adduction and internal rotation (FADIR), sitting deep (maximal flexion with internal rotation and adduction), and sitting crossed leg (maximal adduction with flexion and internal rotation). We measured the alpha angle, which describes the severity of cam deformity, and the beta angle, which defines joint clearance. We also evaluated hip flexion, internal rotation, and adduction before and after surgery. Femoral neck osteochondroplasty significantly decreased alpha angle by 23.9° ± 4.6° (p = 0.001) and increased beta angle across all postures by 28.1° ± 6.3° (p = 0.002). An increase in beta angle represented a decreased chance of impingement. Femoral neck osteochondroplasty significantly increased flexion by an average of 8.6° in the sitting deep posture after surgery (p = 0.007) which might indicate an improvement of joint function. These findings lend support to the hypothesis that arthroscopic osteochondroplasty accomplishes its stated goals of increasing bone-bone clearance in the hip joint and improving joint mechanics for the static postures assessed.
目前尚不清楚股骨颈骨软骨成形术是否能达到增加股骨髋臼间隙的目的。我们使用直立式开放式磁共振成像扫描仪对髋关节进行多体位成像，以探讨体位和股骨颈骨软骨成形术对凸轮型股骨髋臼撞击症患者股骨髋臼间隙的影响。我们招募了 13 名连续接受关节镜下股骨颈骨软骨成形术的患者，并对 10 名患者完成了评估。我们在术前和术后 6 个月分别对每个患者进行仰卧位和另外 3 种生理体位（仰卧位内收内旋 90°（FADIR）、坐位深屈位（最大内收内旋和屈曲）和坐位交叉腿位（最大内收位、屈曲和内旋））的扫描。我们测量了描述凸轮畸形严重程度的α角和定义关节间隙的β角。我们还评估了术前和术后髋关节的屈曲、内旋和内收。股骨颈骨软骨成形术可使α角显著减小 23.9°±4.6°（p=0.001），β角在所有体位均显著增加 28.1°±6.3°（p=0.002）。β角的增加代表了撞击的可能性降低。股骨颈骨软骨成形术后，在坐位深屈位时髋关节屈曲平均增加 8.6°（p=0.007），这可能表明关节功能得到改善。这些发现支持关节镜下骨软骨成形术可达到增加髋关节骨-骨间隙和改善评估的静态体位关节力学的假说。
