Can the Alpha Angle Assessment of Cam Impingement Predict Acetabular Cartilage Delamination?
Can the Alpha Angle Assessment of Cam Impingement Predict Acetabular Cartilage Delamination?
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DOI：
10.1007/s11999-012-2601-3
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发表时间：
2012-12-01
影响因子：
4.2
通讯作者：
Kemp, Kyle A.
中科院分区：
文献类型：
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作者：
Beaule, Paul E.;Hynes, Kelly;Kemp, Kyle A.
背景 患有股骨髋臼撞击症（FAI）的患者通常会出现严重的髋臼软骨损伤。更好地了解哪些患者面临严重软骨损伤的风险对于制定适当的治疗指南至关重要。问题/目的我们询问：(1) 通过 α 角评估的 FAI 中的凸轮畸形严重程度是否可以预测髋臼软骨分层？ (2)髋臼软骨脱层患者的临床和影像学表现如何？方法对167例髋臼软骨脱层患者(男129例，女38例)，平均年龄38岁(范围17～59岁)，接受凸轮型FAI保留关节手术。所有数据都是前瞻性收集的。我们评估了 AP 射线照片上的中心边缘角和 Tonnis 等级以及专门的侧位射线照片上的 α 角。术中使用 Beck 等人的分类对髋臼软骨损伤进行评估，其中 3 型及以上属于分层。 结果 对于所有髋关节，平均 α 角为 65.5 度（范围，41 度 - 90 度），平均中心边缘角为 33.3 度（范围，21 度 - 52.5 度）。 α 角为 65 度或更大的患者患有 3 型或更大损伤的比值比 (OR) 为 4.00 (95% CI, 1.26-12.71)。年龄增加（OR，1.04；95% CI，1.01-1.07）和男性（OR，2.24；95% CI，1.09-4.62）与 3 型或以上损伤相关，而通过中心边缘角评估的髋臼覆盖范围则相反（OR，0.94；95% CI，0.89-0.99）。 结论凸轮型 FAI 和 65 度或更大的 α 角会增加严重软骨损伤的风险，而增加髋臼覆盖范围似乎具有保护作用。
Background Substantial acetabular cartilage damage is commonly present in patients suffering from femoral acetabular impingement (FAI). A better understanding of which patient is at risk of developing substantial cartilage damage is critical for establishing appropriate treatment guidelines.Questions/Purposes We asked: (1) Does the cam deformity severity in FAI as assessed by alpha angle predict acetabular cartilage delamination? And (2) what are the clinical and radiographic findings in patients with acetabular cartilage delamination?Methods One hundred sixty-seven patients (129 males, 38 females) with a mean age of 38 years (range, 17-59 years) underwent joint preservation surgery for cam-type FAI. All data were collected prospectively. We assessed center-edge angle and Tonnis grade on AP radiographs and alpha angle on specialized lateral radiographs. Acetabular cartilage damage was assessed intraoperatively using the classification of Beck et al., with Type 3 and greater qualifying as delamination.Results For all hips, mean alpha angle was 65.5 degrees (range, 41 degrees-90 degrees), and mean center-edge angle was 33.3 degrees (range, 21 degrees-52.5 degrees). Patients with an alpha angle of 65 degrees or greater had an odds ratio (OR) of 4.00 (95% CI, 1.26-12.71) of having Type 3 or greater damage. Increased age (OR, 1.04; 95% CI, 1.01-1.07) and male sex (OR, 2.24; 95% CI, 1.09-4.62) were associated with Type 3 or greater damage, while this was the opposite for acetabular coverage as assessed by center-edge angle (OR, 0.94; 95% CI, 0.89-0.99).Conclusions Patients with cam-type FAI and an alpha angle of 65 degrees or more are at increased risk of substantial cartilage damage while increasing acetabular coverage appears to have a protective effect.