Hip osteochondral lesions: arthroscopic evaluation
Hip osteochondral lesions: arthroscopic evaluation
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DOI：
10.5301/hipint.5000406
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发表时间：
2016-05-01
影响因子：
1.5
通讯作者：
Acerbi, Alberto
中科院分区：
文献类型：
--
作者：
Fontana, Andrea;Mancini, Donato;Acerbi, Alberto
背景：髋关节镜为软骨损伤的诊断和治疗提供了可能。方法：对2012年1月至2013年12月359例髋关节镜手术患者的术中资料进行回顾性分析。对髋臼软骨损伤的发生率、损伤部位、损伤范围及其与髋臼撞击的相关性进行了研究。结果：1级和2级髋臼软骨损伤在发生率、损伤部位和损伤范围上无统计学意义。3.9%的病例髋臼没有软骨病变，显著低于股骨头(32.0%)。101例(28.1%)受髋臼软骨病变影响。244例(68.0%)软骨病变同时位于髋臼和股骨头。在髋臼，常累及外周上、上后方。4级髋臼软骨缺损区位于上前、上、后上高部位，累及周围和中央表面。113例(31.5%)患者出现分层。81例(25%)髋臼软骨病变为2a、3、4级，无FAI征象。结论：髋臼软骨病变的部位、范围及程度均呈进行性退行性变。必须考虑到髋关节软骨剥离的高比例。在没有FAI放射学证据的病例中，出现症状性软骨损害，表明其发病机制可能与生物力学改变有关。
Background: Hip arthroscopy has allowed the diagnosis and treatment of chondral injuries.Methods: We retrospectively analysed the intraoperative data of 359 patients treated with hip arthroscopy from January 2012 to December 2013. We estimated the frequency, location and extension of acetabular cartilage (AC) injuries and their correlation to femoroacetabular impingement (FAI).Results: Grade 1 and 2 acetabular chondral lesions were not statistically significant in incidence, location and extension. Chondral lesions were absent on the acetabulum in 3.9% of cases, significantly lower compared to the femoral head (32.0%). 101 (28.1%) were affected by an acetabular chondral lesion. In 244 (68.0%) the chondral lesion was located on both acetabulum and femoral head. On the acetabulum, peripheral superior and superior-posterior area were frequently involved. Grade 4 acetabular chondral defects showed a significant high location on the superior-anterior, superior and superior-posterior area, involving both the peripheral and central surface. Delamination was present in 113 (31.5%) patients. Patients affected by acetabular delamination showed a reduced injury extension if compared to grade 3 or 4. 81 patients (25%) revealed acetabular chondral lesions grade 2a, 3 and 4 without any radiological, clinical or arthroscopic sign of FAI.Conclusions: Location, extension and degree of hip chondral lesions show a progression toward a progressive degeneration. The high percentage of chondral delamination in the hip must be taken in consideration. The presence of symptomatic chondral lesion in cases with no radiological evidence of FAI, suggests that their aetiopathogenesis could be related to biomechanical alterations.