Anterior femoro-acetabular impingement due to acetabular retroversion - Treatment with periacetabular osteotomy
Anterior femoro-acetabular impingement due to acetabular retroversion - Treatment with periacetabular osteotomy
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DOI：
10.2106/00004623-200302000-00015
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发表时间：
2003-02-01
影响因子：
5.3
通讯作者：
Ganz, R
中科院分区：
文献类型：
--
作者：
Siebenrock, KA;Schoeniger, R;Ganz, R
背景资料：本研究是为了评估是否有症状的前股骨髋臼撞击由于髋臼后倾可以有效地治疗与pericabulary osteotomy.Methods：诊断股骨髋臼撞击的基础上的临床症状，积极的前撞击试验，并发现髋臼缘病变的磁共振成像。髋臼后倾的X线诊断主要依据交叉征和后壁征。22例患者（平均年龄23岁）的29个髋关节接受了髋臼周围截骨术。在26个髋关节中进行了关节切开术，以观察关节内病变，并在选定的病例中改善低股骨头-颈偏心距。髋关节的活动范围进行了测量，临床评价与使用的评分所描述的Merle d 'Aubigne和Postel，和前中心边缘角的Lequesne和de Seze的X线片术前和最后一次follow.Results：随访时间平均为30个月（范围，24至49个月）。Lequesne和de Seze的前部中心边缘角从术前平均36度（范围，26度至52度）显著降低至术后平均28度（范围，16度至46度）（p = 0.002）。内旋（10 °，p = 0.006）、屈曲（7 °，p = 0.014）和内收（8 °，p = 0.017）的平均范围显著增加。Merle d 'Aubigne评分从术前的14.0分（12 ~ 16分）提高到术后的16.9分（15 ~ 18分）（p < 0.001），26个髋关节的结果为良或优。三个髋关节接受了后续手术：一个是因为术后早期复位丢失;一个是为了矫正后下撞击;一个是因为前撞击的复发迹象。结论：髋臼周围截骨术是一种有效的方法，可以重新定位因髋臼后倾引起的有症状的年轻成人前股-髋臼撞击的髋臼。证据等级：治疗性研究，IV级（病例系列[无，或历史对照组]）。证据等级的完整描述见作者说明。
Background: This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy.Methods: The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigne and Postel, and the anterior center-edge angle of Lequesne and de Seze was measured on radiographs preoperatively and at the time of the latest follow-up.Results: The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Seze decreased significantly from a preoperative average of 36degrees (range, 26degrees to 52degrees) to a postoperative average of 28degrees (range, 16degrees to 46degrees) (p = 0.002). There was a significant increase in the average range of internal rotation (10degrees, p = 0.006), flexion (7degrees, p = 0.014), and adduction (8degrees, p = 0.017). The average Merle d'Aubigne score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement.Conclusion: Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.