Clinical presentation of patients with tears of the acetabular labrum
Clinical presentation of patients with tears of the acetabular labrum
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DOI：
10.2106/jbjs.d.02806
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发表时间：
2006-07-01
影响因子：
5.3
通讯作者：
Clohisy, John C.
中科院分区：
文献类型：
--
作者：
Burnett, R. Stephen J.;Della Rocca, Gregory J.;Clohisy, John C.
背景：髋臼唇撕裂的临床表现可能是多变的，诊断往往被延误。我们试图通过回顾一组关节镜下确诊的患者来定义与有症状的髋臼唇撕裂相关的临床特征。方法：我们回顾性分析了66例连续患者（66髋）的记录，这些患者有记录的髋臼唇撕裂已被髋关节镜证实。我们前瞻性记录了人口统计学因素、症状、体格检查结果、既往治疗、功能限制、发病方式、症状持续时间直至诊断为盂唇撕裂、卫生保健提供者提供的其他诊断以及这些患者接受的其他外科手术。影像学异常和磁共振关节造影结果也recorded.Results：研究组包括47名女性患者（71%）和19名男性患者（29%），平均年龄为38岁。40例患者的初始表现为隐匿性，20例患者与低能量急性损伤相关，6例患者与严重创伤相关。57例患者（86%）报告中度至重度疼痛，腹股沟疼痛占主导地位（61例患者; 92%）。60名患者（91%）有活动相关疼痛（p < 0.0001），47名患者（71%）有夜间疼痛（p = 0.0006）。在检查中，26名患者（39%）有跛行，25名（38%）有阳性特伦德伦伯格征，63名（95%）有阳性撞击征。从出现症状到诊断为盂唇撕裂的平均时间为21个月。在确诊之前，患者平均看过3.3名医疗保健提供者。11名患者（17%）建议在另一个解剖部位进行手术，4名患者在诊断出盂唇撕裂之前接受了不成功的手术。在平均16.4个月后髋关节镜检查，59例（89%）报告的临床改善与术前status.Conclusions相比：临床表现的患者有唇撕裂可能会有所不同，并正确的诊断可能不会被认为是最初的。在以腹股沟疼痛为主要主诉的年轻活跃患者中，无论是否有外伤史，应怀疑盂唇撕裂的诊断，并通过X线片进行调查，病史可能对该诊断无特异性。
Background: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.Methods: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy. We had prospectively recorded demographic factors, symptoms, physical examination findings, previous treatments, functional limitations, the manner of onset, the duration of symptoms until the diagnosis of the labral tear, other diagnoses offered by health-care providers, and other surgical procedures that these patients had undergone. Radiographic abnormalities and magnetic resonance arthrography findings were also recorded.Results: The study group included forty-seven female patients (71%) and nineteen male patients (29%) with a mean age of thirty-eight years. The initial presentation was insidious in forty patients, was associated with a low-energy acute injury in twenty, and was associated with major trauma in six. Moderate to severe pain was reported by fifty-seven patients (86%), with groin pain predominating (sixty-one patients; 92%). Sixty patients (91%) had activity-related pain (p < 0.0001), and forty-seven patients (71%) had night pain (p = 0.0006). On examination, twenty-six patients (39%) had a limp, twenty-five (38%) had a positive Trendelenburg sign, and sixty-three (95%) had a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care providers had been seen by the patients prior to the definitive diagnosis. Surgery on another anatomic site had been recommended for eleven patients (17%), and four had undergone an unsuccessful operative procedure prior to the diagnosis of the labral tear. At an average of 16.4 months after hip arthroscopy, fifty-nine patients (89%) reported clinical improvement in comparison with the preoperative status.Conclusions: The clinical presentation of a patient who has a labral tear may vary, and the correct diagnosis may not be considered initially. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected and investigated as radiographs and the history may be nonspecific for this diagnosis.