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[髋关节边缘型发育性发育不良合并凸轮型股骨髋臼撞击症的诊断与髋关节镜治疗进展]

[Progress in diagnosis and hip arthroscopic treatment of borderline developmental dysplasia of hip with Cam-type femoroacetabular impingement].

作者信息

He Yinhao, Li Xiaosheng, Chen Hongwen, Peng Qiang, Chen Tiezhu

机构信息

Department of Osteoarthritis and Sports Medicine, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital) , Changsha Hunan, 410005, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):629-634. doi: 10.7507/1002-1892.202301058.

Abstract

OBJECTIVE

To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI).

METHODS

The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed.

RESULTS

In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint.

CONCLUSION

Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.

摘要

目的

总结伴凸轮型股骨髋臼撞击症(Cam FAI)的临界发育性髋关节发育不良(BDDH)的生物力学特征、诊断及髋关节镜治疗方法。

方法

广泛回顾和分析近年来国内外关于伴Cam FAI的BDDH的文献。

结果

在伴Cam FAI的BDDH患者中,股骨颈前倾角和股骨颈干角增大,骨盆倾斜,髋臼旋转,导致髋关节不稳定。为维持髋关节稳定性,髋关节生物力学作用方向发生改变,进而影响股骨近端和髋臼形态等解剖结构。伴Cam FAI的BDDH可通过结合外侧中心边缘角、前方中心边缘角和髋臼指数进行临床诊断。伴Cam FAI的BDDH可通过关节镜下髋臼增生骨边缘打磨、Cam畸形切除以及髋关节盂唇和软骨的微创修复进行有效治疗。

结论

目前,伴Cam FAI的BDDH的诊断和治疗尚无统一标准。关节镜下髋关节微创治疗可取得较好的早中期疗效,在修复和维持盂唇完整性及缝合/压缩关节囊方面具有一定优势。然而,长期疗效有待进一步随访确定。手术时机、术中骨边缘深度打磨以及关节囊缝合/压缩技术也有待进一步探索。

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