The etiology of osteoarthritis of the hip - An integrated mechanical concept
The etiology of osteoarthritis of the hip - An integrated mechanical concept
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DOI：
10.1007/s11999-007-0060-z
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发表时间：
2008-02-01
影响因子：
4.2
通讯作者：
Harris, William H.
中科院分区：
文献类型：
--
作者：
Ganz, Reinhold;Leunig, Michael;Harris, William H.
髋关节骨关节炎的病因一直被认为是继发性的（如先天性或发育性畸形）或原发性的（假设关节软骨的一些潜在异常）。最近的信息支持一种假设，即所谓的原发性骨关节炎也继发于细微的发育异常，这些病例的机制是股骨髋臼撞击，而不是过度的接触应力。股骨髋臼撞击最常见的位置是前上缘区域，最关键的运动是屈曲90度时髋关节的内旋。两种类型的股骨髋臼撞击已被确定。凸轮型股骨髋臼撞击，多见于年轻男性患者，是由头部和颈部之间的偏移病理形态学引起的，并产生髋臼由外向内的分层。钳型股骨髋臼撞击，在中年女性中更常见，是由髋臼的局部（髋臼后倾）或整体过度覆盖（髋深/髋关节）之间的线性撞击产生的。损伤模式更局限于边缘，关节退变过程较慢。然而，大多数髋关节表现为混合型股骨髋臼撞击模式，凸轮占优势。应在出现严重软骨损伤之前的早期进行手术，以恢复正常解剖结构，避免股骨髋臼撞击。
The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and Produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present.