Risk Factors for Ligamentum Teres Tears
Risk Factors for Ligamentum Teres Tears
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DOI：
10.1016/j.arthro.2012.07.009
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发表时间：
2013-01-01
影响因子：
4.7
通讯作者：
Botser, Itamar B.
中科院分区：
文献类型：
--
作者：
Domb, Benjamin G.;Martin, Dorea E.;Botser, Itamar B.
目的：本研究的目的是探讨非创伤性圆韧带（LT）撕裂与髋臼影像学结构之间的关系。研究方法：本研究的入选标准是所有有骨盆前后位影像学检查并接受LT关节镜检查的患者。排除标准是Tonnis关节炎3级和创伤性高能量损伤机制。术前测量骨盆前后位影像学数据，包括髋臼倾斜度（AI）、外侧中心边缘（CE）角、交叉征的大小和坐骨棘突出度。外侧覆盖指数（LCI）定义为中心边缘角减去髋臼倾斜度。根据LCI将髋关节分为3组：（1）高：34度及以上;（2）中：19度至33度;（3）低：低于19度。结果：在纳入研究的463例髋关节（430例患者）中，226例（49%）发生部分或全层LT撕裂。有眼泪的患者明显比没有眼泪的患者年龄大（P <0.0001），平均年龄分别为38岁和33岁。影像学上，撕裂患者髋臼后倾较少，反映在坐骨棘突出值较低和交叉征象较少（分别为P = 0.01和0.0005）。使用LCI，115个髋关节（25%）被归类为高，236个（50%）被归类为中等，114个（25%）被归类为低。LCI低的髋关节发生LT撕裂的可能性是LCI高的髋关节的1.74倍。结论：本研究发现LT撕裂的存在与髋臼骨形态和年龄有关。LT撕裂在高LCI和髋臼后倾患者中不太常见，在30岁以下患者中不太常见。需要进一步的研究来确定髋臼覆盖不足和LT撕裂之间是否存在因果关系，以及LT撕裂是否可能是髋关节微不稳定的迹象。证据等级：IV级，治疗病例系列。
Purpose: The purpose of this study was to examine the relationship between nontraumatic ligamentum teres (LT) tears and acetabular radiographic architecture. Methods: The inclusion criteria for this study were all patients who had anteroposterior pelvis radiographic views and had undergone arthroscopic examination of the LT. The exclusion criteria were Tonnis arthritic grade 3 and traumatic high-energy mechanisms of injury. Radiographic data were measured preoperatively on an anteroposterior pelvis view, including acetabular inclination (AI), lateral center edge (CE) angle, magnitude of cross-over sign, and ischial spine prominence. A Lateral Coverage Index (LCI) was defined as the center edge angle minus acetabular inclination. Hips were divided into 3 groups according to the LCI: (1) high: 34 degrees and above; (2) medium: 19 degrees to 33 degrees; and (3) low: below 19 degrees. Results: Of the 463 hips (430 patients) included in the study, 226 (49%) had a partial-or full-thickness LT tear. Patients with tears were significantly older than patients without tears (P < .0001), with average ages of 38 and 33 years, respectively. Radiographically, patients with tears had less acetabular retroversion, as reflected by lower ischial spine prominence values and lesser cross-over signs (P = .01 and .0005, respectively). Using the LCI, 115 hips (25%) were classified as high, 236 (50%) as medium, and 114 (25%) as low. Hips with low LCI were 1.74 times more likely to have LT tears than high LCI hips. Conclusions: This study found that the presence of LT tears was associated with acetabular bony morphology and age. LT tears were less frequent with high LCI and acetabular retroversion and less frequent in patients younger than 30 years. Further study is needed to establish whether there is a causal relationship between acetabular undercoverage and LT tears and whether LT tears may be a sign of microinstability of the hip. Level of Evidence: Level IV, therapeutic case series.