Department of Orthopaedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Tochigi Prefecture, Shimotsuke, Japan.
Department of Paediatric Orthopaedics and Orthopaedic Surgery, Jichi Children's Medical Center Tochigi, Tochigi Prefecture, Shimotsuke, Japan.
BMC Musculoskelet Disord. 2021 Jun 5;22(1):517. doi: 10.1186/s12891-021-04386-3.
Osteoarthritis (OA) of the hip rarely develops in the early second decade. As the incidence of this disease is low, no treatment method has been established. We report two patients with unilateral OA in their early teens in whom the anteversion angle of the femoral neck on the affected side was greater than that on the unaffected side.
Case 1 was an 11-year-old girl with left coxalgia and limited range of motion. There was no history of femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH). Plain X-rays revealed the disappearance of the Y cartilage, joint space narrowing of the left hip, and acetabular/femoral head osteosclerosis. In CT images, the anteversion angle of the femoral neck (lt/rt) was 45/35 degrees. As osteoarthritis was severe, proximal femoral flexional derotational varus osteotomy (PFFDVO) and triple pelvic osteotomy (TPO) were performed. Case 2 was a 13-year-old girl with left coxalgia and limited range of motion. There was no history of FAI or DDH. Plain X-ray revealed irregularity of the left anterolateral femoral head, and a subcartilaginous cyst. In CT images, the anteversion angle of the femoral neck (lt/rt) was 30/20 degrees. As osteoarthritis was severe, PFFDVO was performed. In addition, we resected bone spurs on the femoral head because flexion was limited owing to the presence of osteophytes. In both patients, coxalgia and claudication/gait disorder resolved postoperatively, and joint space narrowing and osteosclerosis improved. However, in Case 1, there was a 3-cm difference in the leg length, and in Case 2, range-of-motion limits remained.
We present the findings in two patients with unilateral OA in their early second decade in whom the femoral anteversion angle on the affected side was greater than that on the unaffected side. PFFDVO + TPO was performed in Case 1, and PFFDVO + bone spur resection on the femoral head was performed in Case 2. Coxalgia resolved, and plain X-ray demonstrated improvements in OA; however, a difference in the leg length and range-of-motion limits remained.
髋关节骨关节炎（OA）很少在 20 岁出头的早期发生。由于这种疾病的发病率较低，因此尚未建立任何治疗方法。我们报告了两名青少年单侧髋关节 OA 患者，他们受影响侧的股骨颈前倾角大于未受影响侧。
病例 1 为 11 岁女孩，左侧髋部疼痛，活动范围受限。无股骨髋臼撞击症（FAI）或发育性髋关节发育不良（DDH）病史。X 线平片显示左侧 Y 软骨消失，髋关节间隙变窄，髋臼/股骨头骨质硬化。CT 图像显示股骨颈前倾角（lt/rt）为 45/35 度。由于骨关节炎严重，行股骨近端屈曲旋转内翻截骨术（PFFDVO）和三骨盆截骨术（TPO）。病例 2 为 13 岁女孩，左侧髋部疼痛，活动范围受限。无 FAI 或 DDH 病史。X 线平片显示左侧前外侧股骨头不规则，存在软骨下囊肿。CT 图像显示股骨颈前倾角（lt/rt）为 30/20 度。由于骨关节炎严重，行 PFFDVO。此外，由于存在骨赘，我们切除了股骨头的骨刺，以改善活动受限。在这两名患者中，髋关节疼痛和跛行/步态障碍术后得到缓解，关节间隙变窄和骨质硬化得到改善。然而，在病例 1 中，存在 3 厘米的腿长差异，而在病例 2 中，活动范围仍然存在限制。
我们报告了两名青少年单侧髋关节 OA 患者的发现，他们受影响侧的股骨颈前倾角大于未受影响侧。病例 1 行 PFFDVO+TPO，病例 2 行 PFFDVO+股骨头骨刺切除术。髋关节疼痛缓解，X 线平片显示 OA 改善，但腿长差异和活动范围限制仍然存在。
