Zhang Jia, Li Zhongyao, Wu Yidong, Yu Kangkang, Gan Lu, Liu Yujie, Xu Chengfeng, Li Chunbao
Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Orthop J Sports Med. 2024 Aug 28;12(8):23259671241249948. doi: 10.1177/23259671241249948. eCollection 2024 Aug.
Borderline developmental dysplasia of the hip (BDDH) accompanied by cam deformity and subspinous impingement has been found to benefit from arthroscopic surgery. However, the research comparing BDDH combined with osseous impingement to femoroacetabular impingement (FAI) without borderline dysplasia remains limited.
PURPOSE/HYPOTHESIS: To compare the clinical symptoms, intraoperative findings, and outcomes of hip arthroscopy in patients with BDDH and osseous impingement versus cam-type FAI. It was hypothesized that BDDH with osseous impingement could be classified as a distinct entity between FAI and developmental dysplasia of the hip (DDH).
Cohort study; Level of evidence, 3.
Data were collected from patients 18 to 50 years old who underwent primary hip arthroscopy between September 2016 and October 2020. Patients were divided based on preoperative lateral center-edge angle (LCEA) into 2 groups: (1) BDDH group (LCEA 18°-25°; n = 67); and (2) cam-type FAI group without BDDH (FAI group; LCEA 25°-40° and alpha angle >55°; n = 145). Disparities in symptoms, preoperative examination, intraoperative findings and procedures, and patient-reported outcome (PRO) scores were compared.
Follow-up was available for 61 (91.0%) patients in the BDDH group and 125 (86.2%) patients in the FAI group. The incidence of cam deformity in BDDH patients was 91.8%. The preoperative characteristics and intraoperative findings were similar between the groups; however, preoperative internal and external hip rotation, Tönnis angle, femoroepiphyseal acetabular roof index, labral size, capsule thickness, and percentage of ligamentum teres tear were significantly higher in the BDDH group than the FAI group, and the percentage of pain aggravating factor, cam deformity, and anterior inferior iliac spine types 2 and 3 were also significantly different between groups ( < .05 for all). The percentage of intraoperative minimal acetabuloplasty, subspinous decompression, labral repair, ligamentum teres debridement, and capsular closure was significantly higher in the BDDH group than the FAI group, while the percentage of femoroplasty was higher in the FAI group ( < .05). Pre- to postoperative improvement on PRO scores was seen in both groups.
Given the differences in etiology and surgical procedures between the 2 conditions, it is suggested that BDDH with osseous impingement be classified as an entity distinct from FAI and DDH (and separate from BDDH without impingement) while excluding joint instability.
已发现伴有凸轮畸形和棘下撞击的髋关节边缘发育不良（BDDH）可从关节镜手术中获益。然而，将BDDH合并骨撞击与无边缘发育不良的股骨髋臼撞击症（FAI）进行比较的研究仍然有限。
目的/假设：比较BDDH合并骨撞击患者与凸轮型FAI患者髋关节镜检查的临床症状、术中发现及结果。假设伴有骨撞击的BDDH可被归类为FAI和髋关节发育不良（DDH）之间的一种独特实体。
队列研究；证据等级，3级。
收集2016年9月至2020年10月期间接受初次髋关节镜检查的18至50岁患者的数据。根据术前外侧中心边缘角（LCEA）将患者分为两组：（1）BDDH组（LCEA 18°-25°；n = 67）；（2）无BDDH的凸轮型FAI组（FAI组；LCEA 25°-40°且α角>55°；n = 145）。比较两组在症状、术前检查、术中发现及操作以及患者报告结局（PRO）评分方面的差异。
BDDH组61例（91.0%）患者和FAI组125例（86.2%）患者获得随访。BDDH患者中凸轮畸形的发生率为91.8%。两组术前特征和术中发现相似；然而，BDDH组术前髋关节内旋和外旋、Tönnis角、股骨骨骺髋臼顶指数、盂唇大小、关节囊厚度以及圆韧带撕裂百分比均显著高于FAI组，且两组间疼痛加重因素百分比、凸轮畸形以及髂前下棘2型和3型也存在显著差异（均P <.05）。BDDH组术中最小髋臼成形术、棘下减压、盂唇修复、圆韧带清创和关节囊闭合的百分比显著高于FAI组，而FAI组股骨成形术的百分比更高（P <.05）。两组PRO评分均有术前至术后的改善。
鉴于这两种情况在病因和手术操作上的差异，建议将伴有骨撞击的BDDH归类为一种与FAI和DDH不同的实体（且与无撞击的BDDH分开），同时排除关节不稳定情况。
