Goriainov Vitali, Chapman Laura, Hindi Fadi, Langdown Andrew J
Department of Trauma and Orthopaedics, Portsmouth Hospitals University NHS Trust, Portsmouth, England.
Bone and Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, England.
Arthrosc Sports Med Rehabil. 2021 Sep 11;3(6):e1599-e1606. doi: 10.1016/j.asmr.2021.07.015. eCollection 2021 Dec.
To review the relative accuracy of preoperative magnetic resonance imaging (MRI) and fluoroscopically guided examination-under-sedation (EUS) findings and to explore the validity of the anterior acetabular sector angle (AASA) as a radiologic MRI-based marker of anterior acetabular coverage in pincer-type impingement.
A cohort of 150 consecutive patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) in 2018 to 2019 was reviewed. The inclusion criteria were pure FAI unilateral symptomatic pathology and the availability of complete data sets (MRI, EUS, and intraoperative records). Preoperative MRI and EUS findings were compared with gold-standard intraoperative arthroscopic findings, specifically evaluating the alpha angle in the presence of cam lesions, AASA in the presence of pincer lesions, as well as soft-tissue lesions. An alpha angle greater than 50° and an AASA greater than 65° were deemed pathologic.
The patient cohort included 78 women and 72 men with an average age of 38 years (range, 18-53 years). Intraoperatively, pincer lesions were present in 20% of patients; cam lesions, 26%; and mixed impingement, 54%. MRI versus EUS correctly identified pincer lesions in 36% versus 89% of cases and identified cam lesions in 44% versus 77% of cases. MRI findings characterizing labral tears and articular cartilage pathology were accurate in 80% and 10% of cases, respectively. Although there was no difference in the AASA between pure pincer- and mixed-type impingements (62° and 63°, respectively; = .62), there was a statistically significant difference in reported AASA values between pure cam-type impingement and impingement involving the presence of pincer lesions (57° and 63°, respectively; = .03). Furthermore, 31% of patients with intraoperatively identified pincer lesions had an AASA of 60° to 65°.
Fluoroscopic EUS is accurate in characterizing FAI pathology. In addition, MRI is useful to diagnose or rule out non-FAI pathology, ascertain labral pathology, and outline hip alignment. These methods of preoperative planning are complementary.
Level IV, therapeutic case series.
回顾术前磁共振成像（MRI）和荧光镜引导下镇静检查（EUS）结果的相对准确性，并探讨髋臼前扇区角（AASA）作为基于MRI的影像学标记物在钳夹型撞击中髋臼前覆盖情况的有效性。
回顾了2018年至2019年连续150例因股骨髋臼撞击症（FAI）接受初次髋关节镜检查的患者队列。纳入标准为单纯FAI单侧有症状的病变以及完整数据集（MRI、EUS和术中记录）的可用性。将术前MRI和EUS结果与金标准术中关节镜检查结果进行比较，特别评估凸轮病变存在时的α角、钳夹病变存在时的AASA以及软组织病变。α角大于50°和AASA大于65°被视为病理性的。
患者队列包括78名女性和72名男性，平均年龄38岁（范围18 - 53岁）。术中，20%的患者存在钳夹病变；26%存在凸轮病变；54%存在混合性撞击。MRI与EUS分别在36%和89%的病例中正确识别出钳夹病变，在44%和77%的病例中正确识别出凸轮病变。MRI对盂唇撕裂和关节软骨病变的特征性表现分别在80%和10%的病例中是准确的。虽然单纯钳夹型和混合型撞击之间的AASA无差异（分别为62°和63°；P = 0.62），但单纯凸轮型撞击与存在钳夹病变的撞击之间报告的AASA值存在统计学显著差异（分别为57°和63°；P = 0.03）。此外，术中确定有钳夹病变的患者中有31%的AASA为60°至65°。
荧光镜EUS在FAI病变特征性表现方面准确。此外，MRI有助于诊断或排除非FAI病变、确定盂唇病变并勾勒髋关节对线情况。这些术前规划方法具有互补性。
IV级，治疗性病例系列。
