髋臼缘综合征再探。
Acetabular rim syndrome revisited.
机构信息
Scottish Rite for Children, Dallas, Texas, USA.
Orthopedic Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA.
出版信息
Bone Joint J. 2024 Dec 1;106-B(12):1393-1398. doi: 10.1302/0301-620X.106B12.BJJ-2024-0164.R1.
AIMS
There has been limited literature regarding outcomes of acetabular rim syndrome (ARS) with persistent acetabular os in the setting of acetabular dysplasia. The purpose of this study was to characterize a cohort of adolescent and young adult patients with ARS with persistent os and compare their radiological and clinical outcomes to patients with acetabular dysplasia without an os.
METHODS
We reviewed a prospective database of patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia between January 1999 and December 2021 to identify hips with preoperative os acetabuli, defined as a closed triradiate cartilage but persistence of a superolateral os acetabulum. A total of 14 hips in 12 patients with persistent os acetabuli (ARS cohort) were compared to 50 randomly selected 'control' hips without persistent os acetabuli. Preoperative and postoperative radiographs were measured for markers of dysplasia: lateral centre-edge angle, anterior centre-edge angle, acetabular inclination, and migration index. Union of the os was determined in patients with ≥ six months' follow-up. Patient-reported outcome measures (PROMs) included the University of California, Los Angeles (UCLA) activity score and modified Harris Hip Score (mHHS, maximum score 80) completed at one year postoperatively.
RESULTS
There was no significant difference between the ARS and control cohorts with regard to sex distribution (p = 0.270), age at surgery (p = 0.186), or BMI (p = 0.442). Preoperatively, the ARS cohort had more severe dysplasia, including lower lateral centre-edge angle (-9.3° (SD 12.5°) vs 7.6° (SD 10.7°); p < 0.001) and greater acetabular inclination (33.9° (SD 8.2°) vs 21.8° (SD 8.7°); p < 0.001). Postoperatively, 6/13 (46%) hips with ≥ six months of radiological follow up demonstrated union of the os. There was no difference between the ARS and control cohorts at one year in UCLA score (9.1 (SD 1.5) vs 8.2 (SD 1.9); p = 0.167) or mHHS (73.4 (SD 9.5) vs 69.9 (SD 8.8); p = 0.312).
CONCLUSION
ARS with persistent acetabular os may occur in more severe dysplasia. Union occurs in 50% cases following corrective PAO.
目的
髋臼发育不良患者中存在髋臼缘综合征（ARS）伴持续髋臼顶，关于这种情况的研究结果有限。本研究的目的是描述一组伴有持续髋臼顶的青少年和年轻成人 ARS 患者，并将其影像学和临床结果与无髋臼顶的髋臼发育不良患者进行比较。
方法
我们回顾了 1999 年 1 月至 2021 年 12 月期间因髋臼发育不良行髋臼周围截骨术（PAO）的患者的前瞻性数据库，以确定术前存在髋臼顶（定义为闭合的三辐射软骨，但存在髋臼顶的超外侧部分）的髋关节。共有 12 名患者的 14 髋存在持续髋臼顶（ARS 组），与 50 名随机选择的无持续髋臼顶的“对照”髋进行比较。测量术前和术后 X 线片以评估发育不良标志物：外侧中心边缘角、前中心边缘角、髋臼倾斜度和迁徙指数。对随访时间≥6 个月的患者进行髋臼顶融合的评估。患者报告的结果测量（PROMs）包括术后 1 年的加利福尼亚大学洛杉矶分校（UCLA）活动评分和改良 Harris 髋关节评分（mHHS，最高 80 分）。
结果
ARS 组和对照组在性别分布（p = 0.270）、手术年龄（p = 0.186）或 BMI（p = 0.442）方面无显著差异。术前，ARS 组存在更严重的发育不良，包括更低的外侧中心边缘角（-9.3°（SD 12.5°）与 7.6°（SD 10.7°）；p < 0.001）和更大的髋臼倾斜度（33.9°（SD 8.2°）与 21.8°（SD 8.7°）；p < 0.001）。术后，13 髋中有 6 髋（46%）至少随访 6 个月，髋臼顶融合。在 1 年时，UCLA 评分在 ARS 组和对照组之间没有差异（9.1（SD 1.5）与 8.2（SD 1.9）；p = 0.167）或 mHHS（73.4（SD 9.5）与 69.9（SD 8.8）；p = 0.312）。
结论
伴有持续髋臼顶的 ARS 可能发生在更严重的发育不良中。经矫正性 PAO 治疗后，50%的病例可发生髋臼顶融合。
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