髋臼股骨撞击症髋臼软骨损伤的发生机制及诊疗进展  

Advances in the pathogenesis,diagnosis and treatment of femoral acetabular impingement related acetabular cartilage lesions

作　　者：栗智 安沛桐 李杰[1] 张卫国[1] 田康[1] Li Zhi;An Peitong;Li Jie;Zhang Weiguo;Tian Kang(Department of Joint and Sports Medicine,the First Affiliated Hospital of Dalian Medical University,Dalian 116021,China)

机构地区：[1]大连医科大学附属第一医院关节运动医学科,大连116021

出　　处：《中华骨科杂志》2023年第23期1610-1620,共11页Chinese Journal of Orthopaedics

摘　　要：髋臼股骨撞击症是一种与髋关节运动相关的临床疾病,撞击相关的髋臼软骨损伤十分常见。不同类型的髋臼股骨撞击症软骨损伤的模式和自然病程不同,各自具有独特的大体表现和损伤机制。本文根据现有证据综述髋臼股骨撞击症髋臼软骨损伤的发生机制及诊疗进展。凸轮型髋臼股骨撞击症常与髋臼软骨损伤和髋关节早期骨关节炎的发生密切相关。然而,目前对撞击导致髋臼软骨损伤演变至骨关节炎的途径仍知之甚少。除直接的机械撞击和软骨盂唇连接处易损伤的解剖基础外,异常运动或解剖形态造成的不良应力还可导致软骨生物力学环境改变,诱发关节内软骨慢性炎症变化。术前准确地识别髋臼软骨损伤需结合临床症状、体征和影像学检查结果进行综合判断。1.5 T磁共振造影和3.0 T磁共振成像是目前主要的客观检查方法,两者诊断能力相当。髋臼软骨损伤的诊断依赖术中探查,但如何精准地描述及评估损伤的范围、位置、形态和程度尚无共识方案,现阶段推荐使用Beck分级联合钟面法。髋臼软骨损伤的治疗方案大多从膝关节借鉴发展而来:初始的保守治疗包括休息、运动调整、服用非甾体抗炎镇痛药和物理治疗;保守治疗6个月无效应考虑进行外科干预,包括软骨成形术、微骨折及增强微骨折、自体软骨细胞移植、自体基质诱导软骨生成、骨软骨移植及软骨修复技术等。髋臼股骨撞击症髋臼软骨损伤的规范化治疗目前尚无共识,缺乏循证指导。Femoral acetabular impingement(FAI)syndrome is a motion-related clinical disorder of the hip joint,resulting in cartilage lesions frequently.The pattern and natural history of these cartilage lesions vary with types of FAI,each bearing unique gross appearance and injury mechanism.On the basis of available evidence,this paper reviews the progress of the FAI-related acetabular cartilage lesions in pathogenesis,diagnosis and treatment.Cam-type FAI is always closely associated with acetabular cartilage lesions and early-onset of hip osteoarthritis.However,the reason why acetabular cartilage developed into osteoarthritis in FAI of Cam-type is unknown.In addition to the direct mechanical impingement and the vulnerable anatomic base of chondrolabral junction,stress change from abnormal movement or anatomical morphology will lead to the change of biomechanical environment,causing a chronic-recurrent inflammation in articular cartilage.The preoperative diagnosis of acetabular cartilage lesions depends on a triad of symptoms,clinical signs and imaging findings.1.5 T magnetic resonance arthrography and 3.0 T magnetic resonance imaging are equally valued in objectively diagnosing cartilage lesions.Final diagnosis relies on surgical exploration,however,there is no consensus on how cartilage lesions should be reported,including the description of extent,location,pattern and grade.Using Beck classification of clock-face method to describe lesions observed in surgery is recommended at present.Most treatment methods of FAI-related acetabular cartilage lesions are borrowed from treating cartilage lesions in knee joints.Conservative treatment includes rest,activity modification,nonsteroidal anti-inflammatory medications and physical therapy.Surgery is an option if conservative treatment of at least 6 months fails.The surgical procedures commonly include chondroplasty,microfracture and enhanced microfracture,autologous matrix-induced chondrogenesis,autologous chondrocyte implantation,matrix-induced autologous chondrocyte implantatio

关 键 词：髋关节 髋臼 软骨 关节 髋臼股骨撞击症 

分 类 号：R684[医药卫生—骨科学]