股骨髋臼撞击症的影像学评估

股骨髋臼撞击症（FAI）是引起青年人髋关节运动障碍及髋部疼痛的主要原因之一,与股骨、髋臼解剖形态学异常密切相关,髋关节运动时异常撞击进而导致软骨损伤。X线摄影、CT定量测量及MRI等观察软骨的影像方法可进一步明确FAI的分型,有助于临床诊断治疗。就FAI的影像学典型表现及其定量测量方法予以综述。     

High rate of return to tennis after hip arthroscopy for patients with femoroacetabular impingement syndrome

ObjectiveThe purpose of this study was to evaluate return to sport (RTS) outcomes in tennis athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). It was hypothesized that there would be a high rate of return to tennis after hip arthroscopy.Study designLevel IV, Retrospective Analysis.SettingOutpatient sports medicine clinic at a single institution.ParticipantsA total of 28 patients (60.8% female; mean age, 36.2 ± 9.2 years; mean BMI, 22.8 ± 2.1 kg/m²) with self reported tennis activity prior to hip arthroscopy.Main outcome measuresA postoperative return to sport and minimum two-year patient reported outcomes.ResultsThere was a high rate of return to tennis, with 78% of patients eventually returning to tennis. An additional 9% of patients had the necessary hip function to return, but did not return due to lack of interest or resources. The patients returned to tennis at an average of 8.0 ± 3.3 months after surgery. The majority of athletes (66.7%) were able to continue competing at the same or higher levels following surgery.ConclusionsPatients return to tennis 78% of the time at a mean of 8.0 ± 3.3 months following hip arthroscopy for FAIS.     

Caution Should be Taken in Performing Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Patients Over the Age of 40

Background

Open and arthroscopic procedures are treatment options for patients with femoroacetabular impingement (FAI). Age has been found to be a predictive factor in the outcome of patients undergoing periacetabular osteotomy (PAO) for hip dysplasia. It is unclear if older age contraindicates joint preservation through a surgical hip dislocation (SHD).

Questions/Purpose

The purpose of this retrospective case series was to evaluate the short-term outcomes of patients over 40 years of age without radiographic evidence of end-stage arthritis who underwent SHD for the treatment of FAI and to determine whether older age should be a contraindication for joint-preserving procedures in these patients. Our specific aims included (1) documenting the intraoperative findings and procedures, (2) assessing pain relief provided, and (3) assessing treatment failures and postoperative complications, noting the number of patients that ultimately required total hip arthroplasty (THA).

Patients and Methods

All patients at age 40 and older who had SHD for the treatment of FAI were identified from a series of patients treated with SHD. Clinical notes, radiographs, and operative reports were reviewed to determine clinical results, complications, and the need for additional procedures. The minimum follow-up was 1 year (mean 3.9 years; range 1–8 years).

Results

At final follow-up, 11/22 (50%) of hips had pain relief, while 11/22 (50%) either continued having significant symptoms or required THA. Five (23%) reported nontrochanteric pain symptoms that were the same or worse than before surgery, and six hips (27%) underwent subsequent THA). The average time between SHD and THA was 1.9 years (0.9–6.2). The average age of patients who went on to require THA was 45 (42–50) years.

Conclusions

Surgical hip dislocation can be used for the treatment of FAI in patients over age 40, but strict selection criteria should be adhered to, as only half of the patients experienced significant improvement in their hip pain. THA was required in one-third of hips for continued pain and radiographic progression of arthritis. SHD for treatment of pathology that is not amenable to hip arthroscopy should remain a surgical option in older patients with FAI only if joint degeneration is not present.     

The immediate effects of a shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture: A randomized crossover design

BackgroundRound shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.Research questionThe purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.MethodsTwenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.ResultsAll clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2–2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°–0.5°, p < 0.05, respectively).SignificanceDifferent characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.     

Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis

ObjectiveTo determine whether supervised physiotherapy is more effective for functional improvement and pain relief than a home exercise program in subjects with subacromial impingement syndrome.DesignSystematic review and meta-analysis of randomized clinical trials.MethodsAn electronic search was performed in Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised physiotherapy versus home exercise program, in the shoulder function, pain, and range of motion in subjects older than 18 years of age with a medical diagnosis of subacromial impingement syndrome treated conservatively.ResultsSeven clinical trials met the eligibility criteria, and for the quantitative synthesis, four studies were included. The standardized mean difference for shoulder function was −0.14 points (95% CI: −1.04 to 0.76; p = 0.760), mean difference 0.21 cm (95% CI: −1.36 to 1.78; p = 0.790) for pain, and mean difference 0.62° (95% CI: −7.15 to 8.38; p = 0.880) for range of motion of flexion.ConclusionSupervised physical therapy and home-based progressive shoulder strengthening and stretching exercises for the rotator cuff and scapular muscles are equally effective in patients with subacromial impingement syndrome treated conservatively.Trial registration numberCRD42018086348.     

Pericapsular hip muscle activity in people with and without femoroacetabular impingement. A comparison in dynamic tasks

ObjectivesCompare anterior pericapsular muscle activity between individuals with and without femoroacetabular impingement syndrome (FAIS) during dynamic tasks, to investigate whether muscle activity is consistent with a role in retracting the capsule to prevent impingement and active restraint of the femoral head in walking.DesignCross-sectional.SettingUniversity-laboratory.ParticipantsThirteen athletes with FAIS and 13 pain-free controls.Main outcome measuresMuscle activity was recorded using fine-wire (Iliocapsularis, iliacus and anterior gluteus minimus) and surface (rectus femoris) electromyography (EMG), during three hip flexion tasks (active and assisted hip flexion; squatting) and four walking trials.ResultsIliocapsularis EMG amplitude was no different between active and assisted hip flexion tasks around 90° of hip flexion in FAIS. There was no difference in EMG between groups in squatting. The pattern of burst activity preceding peak hip extension in iliacus, iliocapsularis, and anterior gluteus minimus was similar in both groups during walking.ConclusionIn FAIS, similar activation of iliocapsularis during active and assisted hip flexion, despite reduced flexion torque demand in the latter, suggests a role in capsular retraction or enhanced hip joint protection. Pericapsular muscle activity in advance of peak hip extension during walking is consistent with a proposed contribution to femoral head control.     

Ankle Arthroscopy in a Hanging Position Combined with Hindfoot Endoscopy for the Treatment of Concurrent Anterior and Posterior Impingement Syndrome of the Ankle

The purpose of the present study was to evaluate the results of arthroscopic and endoscopic treatment of concurrent anterior and posterior ankle impingement with the patient in a prone position. From May 2009 to September 2010, 22 patients with simultaneously combined anterior and posterior ankle impingements underwent ankle arthroscopy in a prone position. Noninvasive ankle distraction was achieved by hanging the affected ankle on a shoulder-holding traction frame, followed by hindfoot endoscopy. The mean age at surgery was 22.6 (range 20 to 46) years. The mean follow-up duration was 15.4 (range 12 to 29) months. The American Orthopaedic Foot and Ankle Society scores and Foot Function Index were checked preoperatively and at the final follow-up visit. The mean American Orthopaedic Foot and Ankle Society score increased from 62.6 preoperatively to 86.0 at the final follow-up visit (p < .05). The Foot Function Index improved from 45.8 to 17.2 (p < .05). Of the 22 patients, 18 were very satisfied or satisfied with the results, 2 rated their results as fair, and 2 were dissatisfied. No complications related to ankle distraction in a hanging position occurred. Ankle arthroscopy with the patient in a prone position with the ankle hung on a shoulder-holding traction frame combined with hindfoot endoscopy provided a useful method for treating anterior and posterior ankle impingement that does not require changing the patient's position from supine to prone.     

Posterior ankle impingement disguised as peroneal tendon subluxation in young athletes – a case report

Posterior ankle impingement is a cause of posterior ankle pain common in those who perform frequent plantarflexion activities. Three young patients presented with posterior ankle pain which was initially attributed to peroneal tendon subluxation. However, detailed physical exam and imaging confirmed the diagnosis of posterior ankle impingement as the actual cause of pain. The peroneal tendon subluxation was not causal but an unrelated co-incidental finding. After failed prolonged conservative management (rest, immobilization and physical therapy), the patients underwent posterior ankle arthroscopic debridement for the impingement resulting in return to prior sporting activity without limitation and no recurrence of pain at 19 months follow-up. Posterior ankle impingement diagnosis could be masked by co-incidental asymptomatic peroneal tendon subluxation in pediatric patients.