Incidence of Hip Pain in a Prospective Cohort of Asymptomatic Volunteers Is the Cam Deformity a Risk Factor for Hip Pain?
Incidence of Hip Pain in a Prospective Cohort of Asymptomatic Volunteers Is the Cam Deformity a Risk Factor for Hip Pain?
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DOI：
10.1177/0363546513518417
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发表时间：
2014-04-01
影响因子：
4.8
通讯作者：
Beaule, Paul E.
中科院分区：
文献类型：
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作者：
Khanna, Vickas;Caragianis, Anthony;Beaule, Paul E.
背景：尽管凸轮型股骨髋臼撞击通常与盂唇软骨损伤和髋关节疼痛有关，但大部分无症状个体会出现这种畸形。目的：确定一组前瞻性志愿者髋关节疼痛的发病率，这些志愿者接受了髋关节的磁共振成像（MRI）。研究设计：病例对照研究;证据等级，3.方法：共有200名无症状志愿者接受了双侧髋关节MRI检查，平均随访时间为4. 4年（范围，4. 01 - 4. 95年）。30人失访，剩下170人（77名男性，93名女性），平均年龄为29.5岁（范围，25.7-54.5岁）。所有患者对MRI结果均不知情。所有人都完成了一份随访问卷，询问自最初的MRI以来髋关节疼痛或髋关节疼痛持续时间超过6周的病史。每个病人被要求画出的疼痛是在身体diagram.Results：11例（5男，6女，6.5%的样本，平均年龄，29.9岁，范围，25.7-45.6岁）报告髋关节疼痛，其中3（1男，2女）有双边疼痛，共14髋关节。在初次MRI检查时，14个疼痛髋关节中有7个存在凸轮型畸形，而318个非疼痛髋关节中有37个存在凸轮型畸形（P = 0.0002）。如果存在凸轮畸形，则发生髋关节疼痛的相对风险为4.3（95%置信区间[CI]，2.3-7.8）。这14个疼痛髋关节在桡骨1：30时钟位置的α角显著大于那些没有出现疼痛伴凸轮畸形的髋关节：分别为61.5度（范围，57.3度-65.7度）和57.9度（范围，56.9度-59.1度）（P = 0.05）。明显更大比例的患者（12%）有限的内旋20度）继续发展髋关节疼痛（P = 0.009;相对风险= 3.1 [95%CI，1.6-6.0]）。结论：凸轮畸形的存在代表了髋关节疼痛发展的一个重要风险因素。1：30时钟位置的α角升高和内旋减少与髋关节疼痛风险增加相关。然而，并不是所有凸轮畸形的患者都会出现髋关节疼痛，需要进一步的研究来更好地定义那些有更大风险出现退行性症状的患者。
Background:Although cam-type femoroacetabular impingement is commonly associated with labral chondral damage and hip pain, a large proportion of asymptomatic individuals will have this deformity.Purpose:To determine the incidence of hip pain in a prospective cohort of volunteers who had undergone magnetic resonance imaging (MRI) of their hips.Study Design:Case control study; Level of evidence, 3.Methods:A total of 200 asymptomatic volunteers who underwent an MRI of both hips were followed for a mean time of 4.4 years (range, 4.01-4.95 years). Thirty were lost to follow-up, leaving 170 individuals (77 males, 93 females) with a mean age of 29.5 years (range, 25.7-54.5 years). All patients were blinded to the results of their MRI. All completed a follow-up questionnaire inquiring about the presence of hip pain or a history of hip pain lasting longer than 6 weeks since the original MRI. Each patient was asked to draw where the pain was on a body diagram.Results:Eleven patients (5 males, 6 females; 6.5% of sample; mean age, 29.9 years; range, 25.7-45.6 years) reported hip pain, of which 3 (1 male, 2 females) had bilateral pain for a total of 14 hips. Seven of the 14 painful hips had a cam-type deformity at the time of the initial MRI versus 37 of the 318 nonpainful hips (P = .0002). This gave a relative risk of 4.3 (95% confidence interval [CI], 2.3-7.8) of developing hip pain if cam deformity was present. Those 14 painful hips had a significantly greater alpha angle at the radial 1:30 clock position than did those who did not develop pain with a cam deformity: 61.5 degrees (range, 57.3 degrees-65.7 degrees) versus 57.9 degrees (range, 56.9 degrees-59.1 degrees), respectively (P = .05). A significantly greater proportion of patients (12%) with limited internal rotation 20 degrees) went on to develop hip pain (P = .009; relative risk = 3.1 [95% CI, 1.6-6.0]).Conclusion:The presence of a cam deformity represents a significant risk factor for the development of hip pain. An elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.