Center for Musculoskeletal Surgery, Charitè - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
Arch Orthop Trauma Surg. 2024 Nov;144(11):5013-5020. doi: 10.1007/s00402-024-05595-w. Epub 2024 Sep 28.
A high-energy trauma impact is generally considered the crucial factor causing native hip dislocation. However, femoroacetabular variations are assumed to contribute to low-energy posterior hip dislocations, especially in adolescent athletes. The study aimed to analyze the femoroacetabular morphology of adults who sustained traumatic posterior hip dislocations, comparing high-energy, sports-related, and low-energy trauma mechanisms.
One hundred forty-one patients with traumatic posterior hip dislocations were analyzed and matched to a control group of 141 patients with high-energy trauma mechanisms without hip or pelvic injury, matched for age, gender, and Body Mass Index (BMI). The trauma mechanism was analyzed, and the femoroacetabular morphology and concomitant femoral head or posterior acetabular wall fractures were assessed using computed tomography (CT) scans. Acetabular version, coverage, and pincer morphology were evaluated by measuring the lateral center-edge angle, acetabular index, acetabular depth/width ratio, cranial and central acetabular version angles, and the anterior and posterior acetabular sector angles (AASA, PASA). The caput-collum-diaphyseal (CCD) angle and coronal and axial alpha angles were measured to detect cam morphology.
A high-energy trauma caused posterior hip dislocations in 79.4%, sports-related mechanisms in 7.8%, and a low-energy impact in 12.8%. Patients with high-energy and sports-related dislocations exhibited a higher disposition for acetabular retroversion (p < 0.001). However, the acetabular version in low-energy mechanisms did not differ from the control group (p ≥ 0.05). Acetabular retroversion was associated with isolated dislocation, while acetabular overcoverage correlated with concomitant posterior acetabular wall fractures (p < 0.05). Alpha angles were significantly increased in patients with hip dislocations, independent of the trauma mechanism (p < 0.001).
Acetabular retroversion contributes to posterior hip dislocation in high-energy and sports-related trauma mechanisms and decreases the likelihood of sustaining concomitant fractures. Acetabular morphology was subordinate to causing hip dislocation following a low-energy impact. Increased alpha angles were identified as a risk factor contributing to posterior hip dislocations, regardless of the trauma mechanism.
高能创伤冲击通常被认为是导致原生髋关节脱位的关键因素。然而，股髋臼形态的变化被认为是导致低能量性髋关节后脱位的原因，尤其是在青少年运动员中。本研究旨在分析遭受创伤性髋关节后脱位的成年人的股髋臼形态，比较高能、与运动相关和低能创伤机制。
对 141 例创伤性髋关节后脱位患者进行分析，并与 141 例无髋关节或骨盆损伤的高能创伤机制对照组相匹配，年龄、性别和体重指数（BMI）相匹配。分析创伤机制，使用计算机断层扫描（CT）评估股髋臼形态和同时发生的股骨头或后髋臼壁骨折。通过测量外侧中心边缘角、髋臼指数、髋臼深度/宽度比、颅状和中央髋臼角以及前髋臼扇区角（AASA、PASA）评估髋臼的覆盖和前、后髋臼角。测量颈干角（CCD）和冠状面及轴面的α角，以检测凸轮形态。
高能创伤导致髋关节后脱位 79.4%，运动相关机制导致髋关节后脱位 7.8%，低能撞击导致髋关节后脱位 12.8%。高能和运动相关髋关节脱位患者髋臼后旋的发生率更高（p < 0.001）。然而，低能机制下的髋臼位置与对照组无差异（p ≥ 0.05）。髋臼后旋与单纯脱位有关，而髋臼过度覆盖与同时发生的后髋臼壁骨折相关（p < 0.05）。髋关节脱位患者的α角显著增加，与创伤机制无关（p < 0.001）。
髋臼后旋导致高能和运动相关创伤机制引起髋关节后脱位，并降低同时发生骨折的可能性。髋臼形态在低能冲击后引起髋关节脱位的可能性较小。增加的α角被认为是髋关节后脱位的危险因素，与创伤机制无关。
