North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
Hip Int. 2024 Sep;34(5):652-659. doi: 10.1177/11207000241267709. Epub 2024 Sep 2.
Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD.
A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes.
13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries ( = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence ( = 0) compared to controls ( = 18, = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males.
Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.
髋关节后脱位（NHD）是高能损伤。Thompson-Epstein Ⅰ型脱位是指无明显股骨或髋臼骨折的髋关节后脱位。本研究旨在比较Ⅰ型 NHD 患者的临床和影像学结果。我们还评估了髋关节撞击症（FAI）的影像学指标与 NHD 的关系。
2012 年 1 月至 2021 年 5 月的一项回顾性研究比较了Ⅰ型后 NHD 的骨骼成熟患者（≥16 岁）与年龄和性别匹配的Ⅱ-Ⅴ型后 NHD 对照组。介绍了患者的人口统计学资料、损伤机制、并发症和患者报告的结果测量（PROM）。使用复位后 X 线片和 CT 评估 FAI。进行单变量分析以评估影像学结果。
13 例（77%为男性）Ⅰ型后 NHD 患者与 40 例（80%为男性）Ⅱ-Ⅴ型后 NHD 对照组进行比较。研究组中有 11 例，对照组中有 14 例为单纯损伤（ = 0.01）。复位后并发症相似。研究组的术后创伤性骨关节炎发生率（ = 0）明显低于对照组（ = 18， = 0.0083）。患者报告的牛津髋关节评分平均为 43.5 ± 2.2，EQ-5D-VAS 评分为 87.1 ± 7.4，6 例患者在所有 EQ-5D-5L 领域的症状均为轻度。两组均存在髋关节撞击症（FAI），尤其是男性。
接受Ⅰ型 NHD 急诊闭合复位的患者表现出良好的短期至中期结果。我们的影像学发现表明 FAI 发生率较高。未来的工作应旨在量化这种损伤后的长期结果。我们呼吁进一步比较无骨折和有骨折的 NHD 患者的研究，以帮助我们了解危险因素。鉴于这种损伤的罕见性，需要多中心努力才能捕获大量患者。
