摘要
临界型发育性髋关节发育不良(borderline developmental dysplasia of the hip, BDDH或borderline hip dysplasia, BHD)是一个从定义、诊断到治疗都颇具争议的疾病。国外文献报道无症状人群中符合BDDH影像学诊断标准的比例约为发育性髋关节发育不良(developmental dysplasia of the hip, DDH)的3.5倍, 在特定人群如女性大学生运动员中患病率更高, 可超过40%。BDDH的诊断依赖病史、体格检查与影像学检查的综合评估。治疗方式包括非手术治疗、髋关节镜手术及髋臼周围截骨等。选择不恰当的治疗方式可导致症状加重并加速髋关节退变。通过文献综述从定义、诊断及治疗等方面回顾国内外BDDH的研究进展。骨盆正位X线片上外侧中心边缘角(lateral centre-edge angle, LCEA)是定义BDDH的必要非充分指标, 仅反映髋臼外侧覆盖, 而BDDH患髋前方及后方的覆盖状况存在很大变异。既往研究发现LCEA<20°的髋关节将最终发展为髋关节骨关节炎, 因此建议使用LCEA 20°~25°作为BDDH初步诊断的影像学标准, 再结合症状与体征进一步评估髋关节是否存在不稳定和(或)撞击。对以髋关节不稳症状为主的患者应考虑采用髋臼周围截骨, 或联合髋关节镜处理盂唇损伤及股骨侧凸轮畸形;对以撞击症状为主的患者可考虑采用髋关节镜手术。两类手术的适应证选择至关重要, 其远期疗效尚不明确。
BDDH(borderline developmental dysplasia of the hip)or BHD(borderline hip dysplasia)is a disease with more controversies in the following aspects,including definition,diagnosis and interventions.The proportion of radiographic BDDH is 3.5 times that of developmental dysplasia of the hip(DDH)in the asymptomatic general population,and can exceed 40%in specific cohorts including female collegiate athletes.Up till now,researchers have not reached a consensus on its definition.The diagnosis depends largely on personal history,physical examinations and radiographic examination.The interventions,including non-operative approaches,hip arthroscopy and periacetabular osteotomy,are used.Inappropriate treatment may exacerbate symptoms and accelerate hip joint degeneration.Recent studies on BDDH with regard to its definition,diagnosis and interventions were reviewed.Lateral centre-edge angle(LCEA)measured on AP pelvis was crucial but not enough in defining BDDH,for it only reflects lateral coverage of the hip while anterior and posterior coverage may vary dramatically.Given that hips with an LCEA less than 20 degrees associated with developing osteoarthritis,we recommended that LCEA between 20 to 25 degrees be used as the radiographic criterion in the primary screening.Further evaluation of symptoms and physical examinations should be follow to identify hip instability and/or impingement.Periacetabular osteotomy must be indicated for hips with predominant instability and it can be performed with or without hip arthroscopy which is aimed to address labral lesion or cam deformity on the femoral side.Hip arthroscopy is indicated for hip with predominant impingement symptoms.However,there is no consensus on the outcomes of the two procedures currently.Further studies are still required to confirm long-term results.Thus,it is imperative to choose the right indications for each procedure.
作者
陈康明
夏军
Chen Kangming;Xia Jun(Department of Orthopaedics,Huashan Hopsital,Fudan University,Shanghai 200040,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第13期864-872,共9页
Chinese Journal of Orthopaedics
