Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan.
J Orthop Sci. 2024 May;29(3):835-840. doi: 10.1016/j.jos.2023.03.001. Epub 2023 Mar 15.
To evaluate the relationships among hip instability, pain, and morphology of the iliofemoral ligament (ILFL) in patients with developmental dysplasia of the hip (DDH) using ultrasonography (US).
We reviewed 86 patients (109 hips) with DDH (Group D), 40 patients (46 hips) with borderline hip dysplasia (BDDH) (Group B) and 20 patients (23 hips) without hip pain and bony abnormality (control group). Group D was classified into three subgroups-the severe (group SP), moderate (group MP), and none/mild (group NMP) hip pain groups-using the visual analogue scale (VAS). For evaluating hip instability and ILFL morphology, the distance between the anterior edge of the anterior inferior iliac spine (AIIS) and the horizontal line to the femoral head, and ILFL thickness were measured using US. The difference between the distance in the neutral position and Patrick position was calculated and defined as the femoral head translation distance (FTD).
FTD and ILFL thickness in group D were significantly larger than those in the control group and group B (P < 0.05). There was a significant positive correlation between FTD and ILFL thickness in three groups (r = 0.57, P < 0.05; r = 0.55, P < 0.05; r = 0.62, P < 0.05, respectively). FTD and ILFL thickness in group SP were significantly larger than those in group NMP (P < 0.05). FTD and ILFL thickness in group D had significantly negative correlations with the lateral center edge (r = -0.54, P < 0.05; r = -0.40, P < 0.05, respectively) and vertical-center-anterior angle (r = -0.51, P < 0.05; r = -0.43, P < 0.05, respectively).
Acetabular bony deficiency, especially in the anterior and lateral region can result in antero-posterior hip instability, leading to thickened ILFL and hip pain, even in patients with BDDH. These findings may facilitate our understanding and treatment of patients with DDH. When hip instability is suspected, hip US examination may help confirm the diagnosis and assist in providing objective clinical diagnostic evidence.
使用超声评估发育性髋关节发育不良（DDH）患者髋关节不稳定、疼痛与髂股韧带（ILFL）形态之间的关系。
我们回顾了 86 例（109 髋）DDH 患者（DDH 组）、40 例（46 髋）髋关节发育不良边缘患者（BDDH 组）和 20 例（23 髋）无髋痛和骨畸形患者（对照组）。DDH 组根据视觉模拟评分（VAS）分为三组：严重疼痛组（SP 组）、中度疼痛组（MP 组）和无/轻度疼痛组（NMP 组）。使用超声测量髂前下棘（AIIS）前缘与股骨头水平线之间的距离以及 ILFL 厚度，以评估髋关节不稳定和 ILFL 形态。计算中立位与 Patrick 位之间的差值，并定义为股骨头平移距离（FTD）。
DDH 组 FTD 和 ILFL 厚度明显大于对照组和 BDDH 组（P<0.05）。三组中 FTD 与 ILFL 厚度均呈显著正相关（r=0.57，P<0.05；r=0.55，P<0.05；r=0.62，P<0.05）。SP 组 FTD 和 ILFL 厚度明显大于 NMP 组（P<0.05）。DDH 组 FTD 和 ILFL 厚度与外侧中心边缘（r=-0.54，P<0.05；r=-0.40，P<0.05）和垂直-前中心角（r=-0.51，P<0.05；r=-0.43，P<0.05）呈显著负相关。
髋臼骨缺损，特别是前侧和外侧区域，可导致髋关节前后不稳定，导致 ILFL 增厚和髋痛，即使在 BDDH 患者中也是如此。这些发现可能有助于我们理解和治疗 DDH 患者。当怀疑髋关节不稳定时，髋关节超声检查有助于明确诊断，并提供客观的临床诊断证据。
