CORR Insights®: A Possible New Radiographic Predictor of Progression of Osteoarthritis in Developmental Dysplasia of the Hip The Center Gap
CORR Insights®: A Possible New Radiographic Predictor of Progression of Osteoarthritis in Developmental Dysplasia of the Hip The Center Gap
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DOI：
10.1097/corr.0000000000000501
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发表时间：
2018-09
影响因子：
4.2
通讯作者：
B. Ricciardi
中科院分区：
文献类型：
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作者：
B. Ricciardi
发育性髋关节发育不良（DDH）是髋关节骨关节炎（OA）的已知危险因素，但个体DDH患者是否会进展为终末期髋关节OA很难预测。在目前的研究中，Morita及其同事[5]提供了一个回顾性系列，这些患者患有双侧放射学DDH，接受单侧偏心旋转髋臼截骨术。作者发现，在平均20年的随访中，称为中心间隙的影像学指标是对侧无症状髋关节影像学OA进展的独立风险因素。当结合股骨头挤压指数时，这两种影像学指标对OA进展的敏感性、特异性和阳性预测值分别为77%（95%置信区间[CI]，46-95）、76%（95% CI，65-85）和36%（95% CI，19-56）。在这项研究中，没有放射学参数与症状发展独立相关。研究人员之前测量了髋臼发育不良和髋臼内股骨头不协调，发现外侧中心边缘角度小于25°、髋臼深宽指数较小、股骨头挤出指数增加和股骨头偏侧增加与既往无症状髋关节的影像学OA发展相关[1，6-10，12]。此外，早期退行性变化（Tönnis 1级）的发展也预测了随着时间的推移进一步进展为髋关节OA [12]。然而，这些个体测量值均不能强烈预测个体患者进展为髋关节OA，因此手术治疗髋臼成熟患者的DDH仍然是由症状性髋关节疼痛的发展驱动的，而不是髋臼发育不良的放射学标记。新的放射学指标，如中心间隙，可能会提高X线片在识别早期OA进展或症状发展风险患者方面的总体预测价值。有趣的是，没有影像学指标可以预测症状的发展，识别症状进展的影像学标志物与影像学OA进展同样重要。
Developmental dysplasia of the hip (DDH) is a known risk factor for hip osteoarthritis (OA), but whether an individual patient with DDHwill progress to end-stage hip OA is difficult to predict. In the current study, Morita and colleagues [5] offer a retrospective series of skeletally mature patients with bilateral radiographic DDH undergoing unilateral eccentric rotational acetabular osteotomy. The authors found that a radiographic measure called the center gap was an independent risk factor for radiographic OA progression in the contralateral asymptomatic hip at a mean 20 years of follow up. When combined with the femoral head extrusion index, these two radiographic measures had a sensitivity, specificity, and positive predictive value of 77% (95% confidence interval [CI], 46-95), 76% (95% CI, 65-85), and 36% (95% CI, 19-56), respectively for OA progression. In this study, no radiographic parameters were independently associated with symptom development. Researchers previously measured acetabular dysplasia and femoral head incongruity within the acetabulum and found that lateral center edge angles less than 25°, smaller acetabular depth-towidth index, increased femoral head extrusion index, and increased femoral head lateralization were associated with the development of radiographic OA in previously asymptomatic hips [1, 6-10, 12]. Additionally, the development of early degenerative changes (Tönnis Grade 1) also predicted further progression to hip OA over time [12]. None of these individual measurements, however, strongly predicted progression to hip OA in an individual patient and thus surgically managing DDH in skeletally mature patients remains driven by the development of symptomatic hip pain, not radiographic markers of acetabular dysplasia. New radiological measures such as the center gap may improve overall predictive value of radiographs in identifying patients at risk for early OA progression or symptom development. Interestingly, no radiographic measures were predictive of symptom development, and identifying radiographic markers of symptomatic progression will be just as important as radiographic OA progression.