股骨头“Divot”征与髋关节微不稳  

The Femoral Head“Divot”Sign and Hip Microinstability

作　　者：张晋[1] 李梦茹 王雪松[1] Zhang Jin;Li Mengru;Wang Xuesong(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院,北京100035

出　　处：《中国运动医学杂志》2021年第10期772-776,共5页Chinese Journal of Sports Medicine

摘　　要：目的:本研究旨在通过回顾性研究既往病例,描述一种新的关节镜征象股骨头"Divot"征,并探讨其与髋关节微不稳之间的联系。方法:本研究回顾性分析了2016年1月至2019年12月期间在北京积水潭医院运动损伤科全部接受初次髋关节镜手术的患者的术中影像学资料。对于术中影像证实存在有股骨头"Divot"征且随访时间不短于12月的患者入组本研究。分析存在股骨头"Divot"征患者的一般临床情况、影像学检查及手术临床效果的特点。结果:在全部589名患者中共18名患者符合入组标准(3.1%)。平均年龄24.8±9.6岁,平均随访时间22.8±0.8月。13名患者Beighton评分≥4分(72.2%)。全部18名患者前方撞击试验阳性(100%),13名患者前方恐惧试验阳性(72.2%),7名患者存在痛性弹响(38.9%)。影像学评估方面髋臼3点钟方向关节间隙4.7±0.6 mm。前方中心-边缘角21.2°±4.0°,外侧中心-边缘角23.9°±4.2°。髋臼指数12.9°±2.8°。HOS-ADL评分由术前的59.3±10.0分改善为术后的84.1±6.6分(t=8.86,P=0.000<0.05),改良Harris髋关节评分由术前的57.2±8.3分改善为术后的81.9±6.7分(t=8.70,P=0.000<0.05),均存在统计学意义。术后患者满意率83.3%。结论:股骨头"Divot"征有希望作为髋关节微不稳诊断的特异性指标,但敏感性较低,人群中较为罕见。Objective To describe a new arthroscopic “divot”sign of the femoral head and to explore its relationship with the microinstability of the hip joint.Methods The intraoperative imaging data of all patients who underwent primary hip arthroscopic surgery in Beijing Jishuitan Hospital between January 2016 and December 2019 were retrospectively analyzed.Patients with femoral head“divot”according to the intraoperative imaging and followed up for no less than 12 months were enrolled in this study.Their general clinical situation,imaging examination and clinical outcomes were analyzed.Results Among 589 patients,18 patients met the inclusion criteria(3.1%),with the mean age of 24.8 ±9.6 and the average follow-up of 22.8 ± 0.8 months.Thirteen patients(72.2%) scored no less than 4 on the Beighton score.All 18 patients(100%) were of positive results in the anterior impingment test,while 13 ones(72.2%) were positive in the anterior apprehension test,and 7 suffered from painful snapping hip(38.9%).In terms of imaging evaluation,the joint space at the 3 o’clock direction of the acetabular sourcil was 4.7 ± 0.6 mm.The anterior and lateral center-edge angle was 21.2° ±4.0° and 23.9° ± 4.2° respectively.The acetabular index was 12.9° ± 2.8°.The average Hip Outcome Score-Activity of Daily Living score increased significantly from 59.3 ± 10.0 preoperatively to 84.1 ±6.6 postoperatively(t=8.86,P=0.000<0.05),while the average modified Harris hip score improved significantly from 57.2 ± 8.3 preoperatively to 81.9 ± 6.7 postoperatively(t=8.70,P=0.000<0.05).The satisfaction rate was 83.3%.Conclusion The“divot”sign of the femoral head may be used as a specific index for the diagnosis of hip joint instability but with low sensitivity,as it is rare in the population.

关 键 词：髋关节微不稳 髋关节镜 股骨头软骨凹痕 

分 类 号：R684[医药卫生—骨科学] R681.8[医药卫生—外科学]