Serong Sebastian, Haubold Johannes, Theysohn Jens, Landgraeber Stefan
Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, Homburg 66421, Germany.
Sportklinik Duisburg, Dr. Alfred-Herrhausen-Allee 21, Duisburg 47228, Germany.
J Hip Preserv Surg. 2020 Dec 23;7(3):458-465. doi: 10.1093/jhps/hnaa059. eCollection 2020 Aug.
This study's purpose is to arthroscopically assess the occurrence of intraarticular pathologies in patients with osteonecrosis of the femoral head (OFNH) and to compare arthroscopic with radiologic findings. In a retrospective cohort analysis of ONFH patients undergoing combined core decompression (CD) and hip arthroscopy, concomitant intraarticular pathologies were qualitatively and quantitatively assessed by means of arthroscopy. Intraoperative findings were compared with preoperative radiodiagnostics. Descriptive statistics were performed with results displaying type, degree and prevalence of co-pathologies. Based on a cohort of 27 hips with ONFH at ARCO stages II and III, 26 (96.3%) presented with concomitant intraarticular findings. Cam-deformity ( = 22; 81.5%), labral defects ( = 23; 85.2%) and chondral defects ( = 20; 74.1%) were the most frequent. Four hips (14.8%) had foveal ligament anomalies. Intraoperative detection of cam-deformity positively correlated with radiologically assessed pathologic angles (=0.09). Radiologic evaluation of the acetabular labrum distinctly differed from arthroscopic findings. Reliable statements concerning the cartilage status were not possible due to the great difference in quality of the magnetic resonance imaging (MRIs). The results of this study revealed an arthroscopically proven prevalence of co-pathologies in >95% of patients with ONFH. Cam-type deformity, labral anomalies and chondral defects were the most frequent. Comparison of arthroscopic and radiologic findings showed coherent results regarding cam-deformity but revealed distinct difficulties in the assessment of the labral and chondral status emphasizing the need for standardization of preoperative radiodiagnostics. Moreover, it still has to be evaluated whether combined CD and arthroscopy can improve on the overall outcomes achieved by performance of CD only.
本研究的目的是通过关节镜评估股骨头坏死（OFNH）患者关节内病变的发生情况，并将关节镜检查结果与放射学检查结果进行比较。在一项对接受联合髓芯减压（CD）和髋关节镜检查的ONFH患者的回顾性队列分析中，通过关节镜对伴随的关节内病变进行定性和定量评估。将术中发现与术前放射诊断结果进行比较。进行描述性统计，结果显示合并病变的类型、程度和患病率。基于一组27例处于ARCO II期和III期的ONFH髋关节，26例（96.3%）出现了伴随的关节内发现。凸轮畸形（=22例；81.5%）、盂唇缺损（=23例；85.2%）和软骨缺损（=20例；74.1%）最为常见。4例髋关节（14.8%）存在髋臼凹韧带异常。术中检测到的凸轮畸形与放射学评估的病理角度呈正相关（=0.09）。髋臼盂唇的放射学评估与关节镜检查结果明显不同。由于磁共振成像（MRI）质量差异很大，无法对软骨状态做出可靠的判断。本研究结果显示，经关节镜证实，超过95%的ONFH患者存在合并病变。凸轮型畸形、盂唇异常和软骨缺损最为常见。关节镜检查结果与放射学检查结果在凸轮畸形方面显示出一致的结果，但在盂唇和软骨状态评估方面存在明显困难，强调术前放射诊断标准化的必要性。此外，联合CD和关节镜检查是否能改善仅进行CD所取得的总体结果仍有待评估。
