Department of Radiology, The Second Hospital of Shandong University, Jinan, China.
Department of Orthopaedics, The Fourth medical center, Chinese PLA General Hospital, Beijing, China.
Orthop Surg. 2021 Dec;13(8):2216-2226. doi: 10.1111/os.13128. Epub 2021 Oct 13.
To compare the difference of anterior inferior iliac spine (AIIS) and subspine hypertrophic deformity between symptomatic and asymptomatic hips in patients traditionally diagnosed with femoroacetabular impingement (FAI), and investigate the correlation of subspine decompression with AIIS variation and subspine hypertrophic deformity.
We retrospectively reviewed 70 patients with unilateral symptomatic FAI who underwent hip arthroscopy. The operative hips and contralateral hips naturally formed the symptomatic groups and asymptomatic control groups, respectively. The morphometric comparison of the hip joint was performed between the operative and contralateral sides of each patient. Radiological assessment was performed by two observers (an experienced musculoskeletal radiologist and an experienced surgeon). Three-dimensional (3D)-CT images of each patient were blindly reviewed to determine the AIIS variation and subspine hypertrophic deformity. Reformatted two-dimensional (2D)-CT images and anterior-posterior (AP) pelvic plain radiographs were blindly reviewed to determine FAI-related morphological measurements. Moreover, the surgical assessment was reviewed by one experienced surgeon to interpret whether subspine decompression was performed. The correlation of subspine decompression with AIIS variation and subspine hypertrophy was analyzed.
Out of 70 patients with unilateral symptomatic FAI, 37 were males (52.9%) and 23 (32.9%) had symptoms involving the left hip. The mean age was 39.3 ± 10.4 years and the mean BMI was 24.3 ± 3.6. The distribution of AIIS variants in symptomatic hips did not differ significantly from that in asymptomatic hips (χ = 3.092, P = 0.213). Twenty-nine hips in the symptomatic group (41.4%) and 12 hips in the asymptomatic group (17.1%) were identified as positive for subspine hypertrophy. The incidence of positive subspine hypertrophy was significantly higher in the symptomatic hips compared to the asymptomatic hips (χ = 9.968, P = 0.002). FAI-related morphological parameters including α angle, lateral center-edge angle, acetabular anteversion, crossover sign, and Tonnis grade were highly symmetrical and did not show significant differences between symptomatic and asymptomatic hips. Fifty-four of 70 hips (77.1%) had labral tears extended to the acetabular rim corresponding to the AIIS. Forty-seven hips of 70 hips (67.1%) underwent subspine decompression, which was significantly correlated with AIIS variation and subspine hypertrophic deformity (P = 0.019 and 0.001, respectively).
Subspine hypertrophic deformity was found to be more common in symptomatic side vs asymptomatic side in patients with unilateral symptomatic femoroacetabular impingement. Subspine hypertrophy may be considered as an underlying indication for subspine decompression besides low-lying AIIS.
比较传统诊断为股骨髋臼撞击症（FAI）患者中症状性和无症状性髋关节前下髂嵴（AIIS）和下脊柱增生性畸形的差异，并探讨下脊柱减压与 AIIS 变化和下脊柱增生性畸形的相关性。
我们回顾性分析了 70 例单侧症状性 FAI 患者行髋关节镜检查的病例。手术髋关节和对侧髋关节自然形成症状组和无症状对照组。对每位患者的髋关节进行形态计量比较。由两位观察者（一位有经验的肌肉骨骼放射科医生和一位有经验的外科医生）进行放射学评估。对每位患者的三维（3D）CT 图像进行盲法复查，以确定 AIIS 变化和下脊柱增生性畸形。对二维（2D）CT 图像和前后（AP）骨盆平片进行盲法复查，以确定与 FAI 相关的形态学测量值。此外，由一位有经验的外科医生对手术评估进行复查，以解释是否进行了下脊柱减压。分析了下脊柱减压与 AIIS 变化和下脊柱肥大的相关性。
70 例单侧症状性 FAI 患者中，男性 37 例（52.9%），左侧症状性 23 例（32.9%）。平均年龄 39.3±10.4 岁，平均 BMI 为 24.3±3.6。症状性髋关节的 AIIS 变异分布与无症状髋关节无显著差异（χ=3.092，P=0.213）。症状组 29 髋（41.4%）和无症状组 12 髋（17.1%）被确定为下脊柱肥大阳性。症状性髋关节的下脊柱肥大阳性率明显高于无症状髋关节（χ=9.968，P=0.002）。与症状性髋关节和无症状髋关节相比，与 FAI 相关的形态学参数，包括 α 角、外侧中心边缘角、髋臼前倾角、交叉征和 Tonnis 分级均高度对称，无显著差异。70 髋中有 54 髋（77.1%）的髋臼唇撕裂延伸至对应 AIIS 的髋臼缘。70 髋中有 47 髋（67.1%）行下脊柱减压，与 AIIS 变化和下脊柱增生性畸形有显著相关性（P=0.019 和 0.001）。
单侧症状性股骨髋臼撞击症患者中，症状侧较无症状侧更常见下脊柱增生性畸形。下脊柱肥大除了 AIIS 低置外，还可能被视为下脊柱减压的潜在指征。
