髋臼股骨撞击症的影像学评估  

Radiographic evaluation of femoral acetabular impingement

作　　者：张辛[1] 杨刚 徐雁[1] 黄洪杰[1] 邵嘉艺 王健全[1] 刘丁阁 刘凯平 Zhang Xin;Yang Gang;Xu Yan;Huang Hongjie;Shao Jiayi;Wang Jianquan;Liu Dingge;Liu Kaiping(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University Beijing Key Laboratory of Sports Injuries,Engineering Research Center of Sports Trauma Treatment Technology and Devices,Ministry of Education,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学科(北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,运动创伤治疗技术与器械教育部工程研究中心),北京100191

出　　处：《中华骨科杂志》2023年第23期1621-1630,共10页Chinese Journal of Orthopaedics

摘　　要：髋臼股骨撞击症(femoral acetabular impingement,FAI)是一种由于股骨头和(或)髋臼的解剖结构异常,髋关节在活动时股骨近端和髋臼边缘之间形成撞击,造成髋臼软骨和髋臼盂唇损伤、髋关节慢性疼痛和髋关节活动范围受限的一种疾病。FAI的诊断需要综合症状、体征和影像学检查评估,其中影像学检查起着至关重要的作用,影像学检查可以加深医生对FAI病理机制的理解,从而加速保髋手术的进展。X线片包括骨盆正位、假斜位和45°Dunn位等拍摄体位,医生可通过在X线片中测量相关的指标了解股骨和髋臼的解剖形态。骨盆正位X线片中股骨α角>50°~60°可提示Cam型FAI,而交叉征、后壁征、外侧中心边缘角(lateral center-edge angle,LCEA)>40°等提示Pincer型FAI;假斜位X线片主要测量反映髋臼前覆盖程度的前中心边缘角(anterior center-edge angle,ACEA),ACEA<20°被视为髋臼前方覆盖不足,可能存在髋臼发育不良,若>40°为髋臼前方过度覆盖提示Pincer型FAI;45°Dunn位X线片侧重于显示3点钟部位的股骨头颈畸形,此处是股骨髋臼撞击较明显的位置,该拍摄体位对于Cam型FAI具有较好的提示作用。CT扫描可通过对患者髋关节进行三维重建来更直观地展示髋关节形态,便于手术规划和术后评估;此外CT还可对髋关节外撞击如坐骨股骨撞击、髂前下棘撞击和大转子骨盆撞击进行鉴别诊断。MR具有优异的软组织显像能力,可显示髋臼盂唇和软骨损伤等X线片和CT难以发现的其他病变,对术前评估至关重要。合适的影像学检查对FAI的诊疗具有关键作用。Femoral acetabular impingement(FAI)is a condition characterized by abnormal anatomical structures of the femoral head and/or acetabulum,leading to impingement between the proximal femur and the rim of the acetabulum during hip movement.This impingement causes damage to the acetabular cartilage,labrum,chronic hip pain,and limited range of motion.The diagnosis of this condition requires evaluation based on symptoms,physical signs,and imaging examinations.Among these,imaging plays a crucial role in assessing the pathology of FAI.In recent years,imaging techniques have contributed to a deeper understanding of the mechanisms underlying FAI and the development of hip-preserving surgeries.The purpose of this paper is to provide a reference for the imaging-related diagnosis and measurement of FAI.X-ray films include pelvic anteroposterior view,false-profile view and 45°Dunn view.Doctors can understand the anatomical morphology of the femur and acetabulum by measuring relevant indicators in the X-ray films.For example,theαAngle of the femur>50°-60°in the pelvic anteroposterior view can indicate CAM-type FAI.However,the crisscross sign,posterior wall sign and LCE Angle>40°suggest Pincer type FAI.The ACE Angle,which reflects the anterior coverage of the acetabulum,was mainly measured on the false-profile view.The ACE Angle<20°is considered as insufficient anterior acetabular coverage,and acetabular dysplasia may be present.If it>40°is the anterior acetabular overcoverage,suggesting pincer-type FAI.The 45°Dunn view is mainly used to show the femoral head and neck deformity at 3 o'clock,where the femoroacetabular impingement is obvious.This position has a good indication effect for CAM-type FAI.CT can show the shape of the hip joint more intuitively by three-dimensional reconstruction of the patient's hip joint,which is convenient for surgical planning and postoperative evaluation.In addition,CT can also be used for the differential diagnosis of external hip impingement,such as ischiofemoral impingement,anterior infer

关 键 词：髋关节 诊断显像 运动医学 髋臼股骨撞击症 

分 类 号：R684[医药卫生—骨科学]