Femoroacetabular impingement(FAI)is an increasingly recognized condition,which is believed to contribute to degenerative changes of the hip.This correlation has led to a great deal of interested in diagnosis and treat...Femoroacetabular impingement(FAI)is an increasingly recognized condition,which is believed to contribute to degenerative changes of the hip.This correlation has led to a great deal of interested in diagnosis and treatment of FAI.FAI can be divided into two groups:cam and pincer type impingement.FAI can lead to chondral and labral pathologies,that if left untreated,can progress rapidly to osteoarthritis.The diagnosis of FAI involves a detailed history,physical exam,and radiographs of the pelvis.Surgical treatment is indicated in anatomic variants known to cause FAI.The primary goal of surgical treatment is to increase joint clearance and decrease destructive forces being transmitted through the joint.Treatment has been evolving rapidly over the past decade and includes three primary techniques:open surgical dislocation,mini-open,and arthroscopic surgery.Open surgical dislocation is a technique for dislocating the femoral head from the acetabulum with a low risk of avascular necrosis in orderto reshape the neck or acetabular rim to improve joint clearance.Mini-open treatment is performed using the distal portion of an anterior approach to the hip to visualize and to correct acetabular and femoral head and neck junction deformities.This does not involve frank dislocation.Recently,arthroscopic treatment has gained popularity.This however does have a steep learning curve and is best done by an experienced surgeon.Short-to mid-term results have shown relatively equal success with all techniques in patients with no or only mild evidence of degenerative changes.Additionally,all techniques have demonstrated low rates of complications.展开更多
AIM: To investigate the association between sports hernias and femoroacetabular impingement(FAI) in athletes.METHODS: Pub Med, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases...AIM: To investigate the association between sports hernias and femoroacetabular impingement(FAI) in athletes.METHODS: Pub Med, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone(89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.展开更多
Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement(FAI) with chronic acetabular rim fr...Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement(FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI.展开更多
Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: ...Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: Patients who underwent a primary total hip arthroplasty(THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle(LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam(alpha angle ≥60°), pincer(LCEA ≥40°), or mixed-type pathologies.Results: Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups(P=0.33) nor did the prevalence of cam deformities(P=0.79). The LCEAs were significantly greater in veterans than in civilians(P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians(P=0.025 and P=0.004, respectively).Conclusions: These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.展开更多
Here we describe a 28-year-old man with a history of right hip pain for the past 11 years and ankylosing spondylitis for the past 6 months. Imaging studies showed an exostosis in the femoral neck causing femoroacetabu...Here we describe a 28-year-old man with a history of right hip pain for the past 11 years and ankylosing spondylitis for the past 6 months. Imaging studies showed an exostosis in the femoral neck causing femoroacetabular imping- ement. The patient was diagnosed with coxar- throsis. This case report suggests that femoro- acetabular impingement may accelerate the degenerative process in the hip joint.展开更多
目的:探讨网格定位器在髋关节镜治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的应用效果。方法:2020年1月至2021年1月接受髋关节镜下手术治疗FAI患者50例,根据术中定位方式将患者分为两组。其中定位器组27例,男10例,女17例,年...目的:探讨网格定位器在髋关节镜治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的应用效果。方法:2020年1月至2021年1月接受髋关节镜下手术治疗FAI患者50例,根据术中定位方式将患者分为两组。其中定位器组27例,男10例,女17例,年龄(35.91±9.92)岁,采用网格定位器辅助定位穿刺下行髋关节镜手术治疗;非定位器组23例,男12例,女11例,年龄(36.01±11.03)岁,依据术者经验定位穿刺下行髋关节镜手术治疗。比较两组术中透视次数、穿刺时间、调整穿刺次数、手术时间;比较两组手术前后髋关节α角和外侧中心边缘(laterla central edge,LCE)角;比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、髋关节Harris评分、非关节炎髋评分(non arthritic hip score,NAHS)、髋关节日常活动结果评分(hip outcome score-activities of daily living,HOS-ADL)。结果:50例患者获得随访,时间6~12(18.69±3.72)个月。两组术后1个月髋关节α角和LCE角较术前均有减少(P<0.05),组间比较差异有统计学意义(P>0.05);术后VAS、Harris评分、NAHS评分和HOS-ADL评分均较术前提高(P<0.05),组间比较差异无统计学意义(P>0.05)。定位器组术中透视次数(6.04±1.13)次、穿刺时间(13.19±3.52)min、穿刺调整次数(4.59±1.55)次、手术时间(48.28±3.38)min,均少(短)于非定位器组(13.43±2.56)次、(22.39±2.93)min、(10.43±3.33)次、(62.25±5.73)min,差异有统计学意义(P<0.05)。两组术后均未发生并发症,疼痛均明显缓解。结论:应用髋关节镜治疗股骨髋臼撞击征可以获得良好的术后效果。对比传统定位方法,在应用网格定位器后可以提高皮肤定位点的定位准确率,缩短穿刺时间、减少透视次数,提高了手术穿刺效率。展开更多
目的:探讨一种改良“由外向内”技术在髋关节镜手术中的临床应用效果。方法:回顾性研究2021年6月~2023年7月在我院进行髋关节镜手术治疗的136例患者的临床资料,根据不同手术入路建立方法分为改良入路组(75例,其中男30例,女45例,年龄36&#...目的:探讨一种改良“由外向内”技术在髋关节镜手术中的临床应用效果。方法:回顾性研究2021年6月~2023年7月在我院进行髋关节镜手术治疗的136例患者的临床资料,根据不同手术入路建立方法分为改良入路组(75例,其中男30例,女45例,年龄36±14岁)和经典入路组(61例,其中男33例,女28例,年龄31±11岁)。比较两组手术情况、手术入路建立时间以及术前、术后4周、术后3月和术后6月的疼痛视觉模拟评分(visual analog scale,VAS)、Harris髋关节功能评分(Harris hip score,HHS)和手术并发症。结果:两组患者的一般资料及术前VAS评分、Harris评分无统计学差异。两组术后Harris评分无统计学差异。对比两组总手术时间,改良入路组明显少于经典入路组(49.0±16.9 min vs.66.0±13.3 min,P<0.05),且改良入路组术中未使用C形臂透视,辅助中前(mid-anterior,MA)入路建立时间明显缩短(10.4±5.9 min vs.25.9±15.1 min,P<0.05),术中牵引时间更少(66.0±13.3 min vs.49.0±16.9 min,P<0.05)。结论:改良“由外向内”髋关节镜技术是一种安全手术方法,患者手术时间更短,操作更加简便。展开更多
目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关...目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关节镜手术的患者共32例,其中男8例、女24例,年龄39.41±16.27岁(18~59岁),平均髋臼外侧中心边缘角(lateral centre-edge angle,LCEA):21.25°±2.96°(18°~25°)。匹配同期的行髋关节镜手术治疗的髋臼股骨撞击症(femoral acetabular impingement,FAI)患者32例作为对照组,男15例、女17例,年龄42.78±12.18岁(24~70岁),平均LCEA:32.97°±4.96°(26°~42°)。所有患者均采用髋关节镜下盂唇修复、头颈区成形、关节囊缝合术治疗。采用改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)、视觉模拟评分(VAS),对患者术前、术后3月、术后12月、术后24月进行功能评分测量。结果:BDDH组和FAI组所有病例均获得随访,随访时间分别为27.6±5.4月、28.3±6.5月。FAI组和BDDH组术前m HHS、HOS-SSS、HOS-ADL和VAS评分的差异无统计学意义(P>0.05)。两组术后3月、12月、24月时mHHS、HOS-SSS、HOS-ADL评分均较术前明显提高,术后VAS评分均较术前明显降低,差异有统计学意义(P<0.001)。在术后3月、12月、24月时BDDH组的m HHS评分均较FAI组低,差异有统计学意义(P<0.05)。在术后3月时BDDH组的HOS-SSS、HOS-ADL分均较FAI组低,差异有统计学意义(P<0.05)。其他随访时间点,两组的各项评分指标无统计学差异(P>0.05)。所有患者在随访期间,均未因症状复发而行再次手术治疗。结论:髋关节镜技术治疗临界发育性髋关节发育不良可获得良好的短期疗效。展开更多
基金Supported by Orthopaedic Research and Education FoundationZachary B Friedenberg,MD,Clinician Scientist Award to Dr.CuiQ
文摘Femoroacetabular impingement(FAI)is an increasingly recognized condition,which is believed to contribute to degenerative changes of the hip.This correlation has led to a great deal of interested in diagnosis and treatment of FAI.FAI can be divided into two groups:cam and pincer type impingement.FAI can lead to chondral and labral pathologies,that if left untreated,can progress rapidly to osteoarthritis.The diagnosis of FAI involves a detailed history,physical exam,and radiographs of the pelvis.Surgical treatment is indicated in anatomic variants known to cause FAI.The primary goal of surgical treatment is to increase joint clearance and decrease destructive forces being transmitted through the joint.Treatment has been evolving rapidly over the past decade and includes three primary techniques:open surgical dislocation,mini-open,and arthroscopic surgery.Open surgical dislocation is a technique for dislocating the femoral head from the acetabulum with a low risk of avascular necrosis in orderto reshape the neck or acetabular rim to improve joint clearance.Mini-open treatment is performed using the distal portion of an anterior approach to the hip to visualize and to correct acetabular and femoral head and neck junction deformities.This does not involve frank dislocation.Recently,arthroscopic treatment has gained popularity.This however does have a steep learning curve and is best done by an experienced surgeon.Short-to mid-term results have shown relatively equal success with all techniques in patients with no or only mild evidence of degenerative changes.Additionally,all techniques have demonstrated low rates of complications.
文摘AIM: To investigate the association between sports hernias and femoroacetabular impingement(FAI) in athletes.METHODS: Pub Med, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone(89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.
文摘Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement(FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI.
文摘Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: Patients who underwent a primary total hip arthroplasty(THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle(LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam(alpha angle ≥60°), pincer(LCEA ≥40°), or mixed-type pathologies.Results: Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups(P=0.33) nor did the prevalence of cam deformities(P=0.79). The LCEAs were significantly greater in veterans than in civilians(P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians(P=0.025 and P=0.004, respectively).Conclusions: These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.
文摘Here we describe a 28-year-old man with a history of right hip pain for the past 11 years and ankylosing spondylitis for the past 6 months. Imaging studies showed an exostosis in the femoral neck causing femoroacetabular imping- ement. The patient was diagnosed with coxar- throsis. This case report suggests that femoro- acetabular impingement may accelerate the degenerative process in the hip joint.
文摘目的:探讨网格定位器在髋关节镜治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的应用效果。方法:2020年1月至2021年1月接受髋关节镜下手术治疗FAI患者50例,根据术中定位方式将患者分为两组。其中定位器组27例,男10例,女17例,年龄(35.91±9.92)岁,采用网格定位器辅助定位穿刺下行髋关节镜手术治疗;非定位器组23例,男12例,女11例,年龄(36.01±11.03)岁,依据术者经验定位穿刺下行髋关节镜手术治疗。比较两组术中透视次数、穿刺时间、调整穿刺次数、手术时间;比较两组手术前后髋关节α角和外侧中心边缘(laterla central edge,LCE)角;比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、髋关节Harris评分、非关节炎髋评分(non arthritic hip score,NAHS)、髋关节日常活动结果评分(hip outcome score-activities of daily living,HOS-ADL)。结果:50例患者获得随访,时间6~12(18.69±3.72)个月。两组术后1个月髋关节α角和LCE角较术前均有减少(P<0.05),组间比较差异有统计学意义(P>0.05);术后VAS、Harris评分、NAHS评分和HOS-ADL评分均较术前提高(P<0.05),组间比较差异无统计学意义(P>0.05)。定位器组术中透视次数(6.04±1.13)次、穿刺时间(13.19±3.52)min、穿刺调整次数(4.59±1.55)次、手术时间(48.28±3.38)min,均少(短)于非定位器组(13.43±2.56)次、(22.39±2.93)min、(10.43±3.33)次、(62.25±5.73)min,差异有统计学意义(P<0.05)。两组术后均未发生并发症,疼痛均明显缓解。结论:应用髋关节镜治疗股骨髋臼撞击征可以获得良好的术后效果。对比传统定位方法,在应用网格定位器后可以提高皮肤定位点的定位准确率,缩短穿刺时间、减少透视次数,提高了手术穿刺效率。
文摘目的:探讨一种改良“由外向内”技术在髋关节镜手术中的临床应用效果。方法:回顾性研究2021年6月~2023年7月在我院进行髋关节镜手术治疗的136例患者的临床资料,根据不同手术入路建立方法分为改良入路组(75例,其中男30例,女45例,年龄36±14岁)和经典入路组(61例,其中男33例,女28例,年龄31±11岁)。比较两组手术情况、手术入路建立时间以及术前、术后4周、术后3月和术后6月的疼痛视觉模拟评分(visual analog scale,VAS)、Harris髋关节功能评分(Harris hip score,HHS)和手术并发症。结果:两组患者的一般资料及术前VAS评分、Harris评分无统计学差异。两组术后Harris评分无统计学差异。对比两组总手术时间,改良入路组明显少于经典入路组(49.0±16.9 min vs.66.0±13.3 min,P<0.05),且改良入路组术中未使用C形臂透视,辅助中前(mid-anterior,MA)入路建立时间明显缩短(10.4±5.9 min vs.25.9±15.1 min,P<0.05),术中牵引时间更少(66.0±13.3 min vs.49.0±16.9 min,P<0.05)。结论:改良“由外向内”髋关节镜技术是一种安全手术方法,患者手术时间更短,操作更加简便。
