X线诊断髋关节撞击综合征的应用价值

目的:探讨髋关节撞击综合征(femoroacetabular impingement,FAI)的X线表现,提高其影像诊断水平。方法:分析16例具有典型影像学征象的FAI的X线表现,总结其影像学特征。结果:X线显示头颈交界处骨性突起呈"手枪柄样"畸形9例,股骨颈α角显示异常13例,股骨头颈偏距减小12例,7例中心边缘角(LCE角)大于40°,"8"字征2例,髋臼指数为0或负值6例,股骨颈疝窝5例,髋臼缘增生硬化14例,髋臼缘游离骨赘5例。结论:FAI在X线片上具有特征性表现。X线检查简单易行,可作为FAI的首选影像学检查方法。     

髋关节撞击综合征的影像学表现

目的:探讨髋关节撞击综合征(femoroacetabular impingement,FAI)的影像特征。方法:对24例FAI的影像学资料进行回顾性分析,患者均行髋关节X线、CT及MRI检查。结果:FAI表现为股骨头颈解剖学异常,其中24例X线片示股骨头颈交界处骨性突起,呈"枪柄样"改变;5例有非圆形股骨头;3例髋臼后倾、髋臼过深,呈"8字征"改变;15例髋臼边缘软骨下囊性变;5例股骨头颈交界处皮质下囊性变。MRI显示24例髋臼盂唇、软骨损伤及关节骨质改变。CT示α角增大。结论:股骨头颈解剖学异常及髋臼形态异常是诊断FAI的主要征象,结合MRI显示髋臼盂唇及关节软骨损伤,综合评价可明确诊断FAI。     

髋关节撞击综合征16例X线表现

目的探讨髋关节撞击综合征（FAI）的X线表现。方法回顾性分析16例FAl患者的影像资料,16例患者均行髋关节正侧位X线检查,其中1例进行了髋关节CT检查。结果16例患者X线表现均出现股骨头颈交界处骨性突起,非圆形股骨头4例,股骨头颈交界处皮质下囊性变4例,髋臼边缘骨赘13例,髋臼边缘软骨下囊性变6例,髋臼后倾5例,髋臼过深2例。结论X线可以显示FAI患者股骨头颈交界处及髋臼解剖异常,有助于提高FAI的诊断准确性。     

髋关节撞击综合征的MSCT测量与分析

目的:探讨髋关节撞击综合征(FAI)患者髋关节的MSCT表现及MSCT在FAI诊断中的价值。方法:30例临床确诊为FAI的患者作为病例组,另90例无临床症状的患者作为对照组(分为<30岁、30~60岁、>60岁组,每组各30例)。采用MSCT对120例患者的髋关节进行扫描,测量并记录每一位患者的四个特征值:α角、股骨颈干角(CCD角)、股骨头赤道边缘角(Equatorial-edge angle,EE角)及髋臼深度大小。分别用t检验和卡方检验/Fisher确切概率法对所得数据进行分析比较,研究组间、组内特征值差异及特征值与FAI的相关性。结果:病例组与对照组中双髋α角值、双髋EE角值及深髋臼差异均有统计学意义(P<0.05);而双髋CCD角值差异无统计学意义(P>0.05)。病例组组内,Cam型FAI、Mixed型FAI的α角值分别为64.0°±5.3°、61.0°±3.8°,Pincer型FAI的α角值为45.9°±3.7°,Cam型、Mixed型FAI的α角值与Pincer型FAI的α角值差异具有统计学意义(P<0.05)。Cam型FAI的EE角值为13.5°±3.3°,与Mixed型FAI的EE角值(10.8°±4.2°)、Pincer型FAI的EE角值(10.4°±3.8°)差异存在统计学意义(P<0.05)。同样,Cam型FAI深髋臼改变与Mixed型FAI、Pincer型FAI的深髋臼改变差异存在统计学意义(P<0.05)。而三型FAI的CCD角值差异无统计学意义(P>0.05)。结论:股骨头颈交界处畸形和髋臼异常形态是FAI的主要影像学征象,α角、EE角及深髋臼对FAI诊断有重要价值;MSCT是诊断FAI的重要方法。     

凸轮型髋臼撞击综合征影像学表现

目的 探讨凸轮型髋臼撞击综合征(FAI)影像学表现,为早期诊断FAI提供诊断依据.方法 前瞻性研究凸轮型FAI 11例,均行CT、MR检查,以平行于股骨颈轴线的平面为测量平面,测量α角,及通过距离股骨头中点r, r/2点至股骨边缘的长度d1、d2,分析其与髋关节内旋角的关系.结果 11例患者,股骨头颈联合处均可见骨性突起, 7例髋臼前缘可见骨质硬化,3例股骨头颈联合处可见囊变,3例MRI显示有软骨损伤.FAI组利用CT、MR测量α角一致性好(P=0.92),且FAI组与对照组α角度均有统计学差异(P<0.001,P<0.001),α角与d1、d2相关性强,CT(r=0.74,P=0.009;r=0.73,P=0.01),MR(r=0.94,P<0.001;r=0.93,P=0.01).FAI组随着CT、MR测量平均α角的增大,内旋角呈直线下降(y=34.3-0.41x,t=-4.7,P=0.001).结论 α角及d1、d2增大是凸轮型FAI的特征性表现.     

髋关节撞击综合征影像表现的初步探讨

目的 探讨髋关节撞击综合征(FAI)的影像表现.方法 回顾性分析经手术证实的9例FAI患者的影像资料,9例患者均行髋关节正侧位X线检查及患髋MR检查,其中1例还接受了患髋关节MR关节造影检查,探讨其影像特征性改变.结果 9例患者X线表现均出现股骨头颈交界处骨性突起或髋臼过度覆盖.MR检查显示9例患者均出现不同程度的髋臼盂唇损伤,均出现在前上盂唇,ⅠA期损伤2例,ⅠB期损伤3例,ⅡA期损伤2例,ⅡB期损伤2例;1例患髋关节MR造影检查显示髋臼前上盂唇内线样裂隙,可见对比剂进入裂隙.2例的股骨头负重区软骨下骨内出现硬化囊变区,手术证实相应部位出现直径2 cm大小的软骨剥脱.结论 MRI可以显示FAI患者髋臼盂唇及关节软骨损伤,有助于早期诊断FAI.     

正常中国成人股骨颈α角的CT测量及股骨头颈交界处形态分型

目的 应用CT图像,测量中国成人股骨颈α角的正常值范围,并对股骨头颈交界处形态的分型进行初步探讨.方法 对652例因非股骨近端病变、无髋关节撞击综合征症状而接受下腹或双髋CT扫描的成年患者的CT体积数据进行后处理.双侧股骨近端均进行股骨颈α角的被测量者459例;因为一侧股骨近端病变而仅测量健侧股骨颈α角者193例,其中仅进行左侧股骨颈α角的被测量者93例,仅进行右侧股骨颈α角的被测量者100例.共重组出1111组沿股骨颈长轴的股骨近端斜矢状图像,选取经过股骨颈中间层面的图像,利用AutoCAD2006软件测量股骨颈α角,同时对股骨头颈交界处形态进行分型,并对测量的结果数据进行t检验或方差分析.结果 1111个股骨颈α角的平均值为38.2°±5.3°,正常值范围为28°～49°;其中左侧股骨近端552个,股骨颈α角为38.0°±5.3°;右侧股骨近端559个,股骨颈α角为38.4°±5.3°;双侧股骨颈α角的差异无统计学意义(t=-1.231,P＞0.05).男性股骨近端654个,股骨颈α角为39.2°±5.8°,女性股骨近端457个,股骨颈α角为36.8°±4.1°,股骨颈α角的性别差异有统计学意义(t=-8.180,P＜0.01).各年龄段之间股骨颈α角的差异无统计学意义(F=1.765,P＞0.05).根据股骨头颈交界处前方形态将正常股骨头颈交界处分为3种类型,凹陷型(Ⅰ型)股骨头颈交界处明显凹陷,有168个,占15.1%,平均α角为31.2°±2.0°;光滑型(Ⅱ型)股骨头颈交界处皮质呈光滑的弧线与股骨头皮质相延续,有726个,占65.4%,平均α角为37.4°±2.4°;平坦型(Ⅲ型)股骨头颈交界处皮质平坦呈直线状,有217个,占19.5%,平均α角为46.4°±3.8°;3组股骨颈α角之间的差异有统计学意义(F=1636.107,P＜0.01),3组股骨颈α角两两比较组间差异均有统计学意义(P＜0.01).结论 根据股骨头颈交界处形态将正常股骨头颈交界处分为凹陷型、光滑型及平坦型可以直观反映股骨颈α角的大小,有助于全面认识股骨头颈交界处凹陷程度的变化,为诊断髋关节撞击综合征提供了必要的基础数据.     

钳夹型髋关节撞击综合征的SPECT/CT评价

目的分析钳夹型髋关节撞击综合征(FAI)的SPECT/CT特征,探讨SPECT/CT的应用价值。方法回顾性分析45例钳夹型FAI患者(56个髋)的SPECT/CT影像学资料,观察分析其图像特征。结果 CT显示髋臼前缘过度覆盖31髋,髋臼后缘过度覆盖21髋,髋臼缘硬化增生29髋,髋臼盂唇游离钙化17髋,髋臼缘骨折6髋,髋关节面下骨质囊变16髋,股骨颈滑囊疝窝23髋。SPECT显示54髋出现不同程度的团状或斑片状放射性核素异常浓聚。SPECT/CT显示除CT所见征象外,54髋出现不同程度的团状或斑片状放射性核素异常浓聚,其中髋臼前缘浓聚31髋,髋臼后缘浓聚23髋。结论 SPECT/CT既能反映钳夹型FAI的解剖学异常,又具有一定的功能学影像特征,能为其诊断及治疗提供有价值的参考信息,值得临床推广应用。     

成人髋臼发育不良并发骨囊变的影像学研讨

目的探讨成人髋臼发育不良（acetabulardysplasia,AD）并发骨囊变的临床及影像学表现特点,提高其影像诊断能力。方法回顾性分析66例成人AD的标准双髋关节前后位X线片、28例CT片、10例MRI片的影像学资料,并按有无髋周骨囊变进行分组：囊变组、无囊变组。测量方法有：髋臼指数、Sharp角、CE角、髋臼顶切线角、AHI（股骨头覆盖率）、髋关节内间隙、髋关节上间隙。数据均以平均值±标准差（x±s）方式表示,通过了检验进行统计学处理,以P〈O．05为具有显著性检验。结果66例成人AD中出现并发症的61例,占92．4％,其中髋关节脱位（含半脱位和脱位）49例,占74．2％,继发骨性关节炎18例,占27．3％。髋臼及股骨头囊状改变24例,占36．4％,其中单纯髋臼囊变14例,占21．2％,股骨头和髋臼同时囊变5例,占7．5％,单纯股骨头囊变5例,占7．5％．襞变组和无囊变组对照测量结果显示两组数据除髋臼指数和髋关节内间隙无差异外（P〉O．05）,其余均有显著性差异（P〈O．05）。结论成人髋臼发育不良易并发髋周骨囊变（软骨下假囊肿）,其发病率与年龄呈正相关,X线、CT、MRI检查是诊断成人AD并发髋周骨囊变（软骨下假囊肿）的有效检查手段,MRI在显示成人AD并发髋关节周围骨囊变方面优于x线平片和CT,尤其是早期显示软骨下小囊变。     

髋关节撞击综合征的X线诊断

髋关节撞击综合征(femoroacetabular impingement,FAI)是指由于股骨近端和髋臼盂缘间解剖形态异常,在髋关节运动时股骨近端和髋臼盂缘之间发生异常接触或碰撞,引起髋臼盂唇和关节的软骨、骨的损伤和异常,如果不早期干预处理,最终会导致髋关节骨性关节炎[1,2].X线检查是确诊其解剖形态异常的重要而简易的手段.由于FAI是近些年才被认识的病变,骨科和影像医师对其认识不足,本文通过收集FAI患者的髋关节X线片进行分析和探讨,旨在加深对该病X线表现的认识,提高其影像诊断水平.     

Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients

PURPOSE: To retrospectively characterize magnetic resonance (MR) arthrographic findings in patients with cam femoroacetabular impingement (FAI) and in those with pincer FAI. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. MR arthrographic studies obtained in 50 consecutive patients (30 men, 20 women; mean age, 28.8 years) with FAI were analyzed for labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim. The nonspherical shape of the femoral head at the head-neck junction was measured in eight positions around the femoral head and neck and used to calculate the alpha angle. Acetabular depth was measured. Surgical diagnosis served as the reference standard. The Wilcoxon rank sum test was used for statistical analysis. RESULTS: At surgery, hips in 33 patients were classified as having cam FAI and hips in 17 patients were classified as having pincer FAI. In both groups, the mean age of patients was 28.8 years. There were significantly more men (n = 27) with cam FAI and more women (n = 14) with pincer FAI. The alpha angle was significantly larger in patients with cam FAI at the anterior and anterosuperior positions. The acetabulum was significantly deeper in patients with pincer FAI than in patients with cam FAI. Cartilage lesions at the anterosuperior and superior positions were significantly larger in patients with cam FAI than in patients with pincer FAI. Cartilage lesions at the posteroinferior position were significantly larger and labral lesions at the posterior and posteroinferior positions were more pronounced in patients with pincer FAI than in patients with cam FAI. Osseous abnormalities were not significantly different between the groups. Osseous bump formation at the femoral neck was significantly more common in patients with cam FAI than in patients with pincer FAI. CONCLUSION: Characteristic MR arthrographic findings of cam FAI include large alpha angles and cartilage lesions at the anterosuperior position and osseous bump formation at the femoral neck; characteristic findings of pincer FAI include a deep acetabulum and posteroinferior cartilage lesions.     

成人髋臼发育不良并骨性关节病的X线诊断

目的:通过对髋关节正位平片的检查和测量,探讨成人髋臼发育不良并骨性关节病的X线诊断。方法:回顾性分析我院40例,共69个髋关节成人髋臼发育不良继发退行性骨关节病的X线表现,测量其CE角(中心边缘角)、sharp角(髋臼角)和髋顶切线角。结果:CE角最大27°,最小-25°,平均11.2°。sharp角最大59°,最小49°,平均55.6°。髋顶切线角全部为零度和负角,零度28髋,负角41髋。继发退行性骨关节病,表现为髋臼顶及边缘骨质增生硬化,髋臼和/(或)股骨头囊变,以髋臼更为明显。结论:X线正位平片可良好地显示髋关节骨结构,结合CE角、sharp角、髋顶切线角等相关测量,骨盆正位片目前仍是放射科诊断髋臼发育不良并骨性关节病最简单实用的方法。     

A review of femoroacetabular impingement in athletes

There are a multitude of well recognized hip and groin injuries that commonly affect athletes; however, a more recently recognized and possibly often overlooked cause of hip pain is that of femoroacetabular impingement (FAI). FAI is characterized by abutment of the femoral neck against the acetabular rim, which may occur by two mechanisms known as 'CAM' or 'pincer' impingement, although most commonly by a mixture of both. CAM impingement is characterized by abutment of the femoral neck against the acetabulum due to a morphological abnormality of the femoral head-neck junction. Pincer impingement occurs where an abnormality of the acetabulum results in impingement against an often normal femoral neck. Both CAM and pincer impingement are known to result in pathological consequences of cartilage delamination and labral lesions, leading to significant pain and disruption to athletic performance and activities of daily living in athletes. There are currently several methods of assessing the degree of impingement by use of CT and magnetic resonance imaging scans, which can be used in conjunction with magnetic resonance arthrography and arthroscopy to assess the damage caused to the underlying structures of the hip. Both open and arthroscopic surgical methods are used, with recent reports in athletes showing excellent results for lifestyle improvement and frequency of returning to sport. In cases of hip and groin pain in athletes, it is important to remember to look for typical history, and examination and imaging findings that may suggest a diagnosis of hip impingement. This article goes some way to explaining the principles, consequences and management of FAI.     

CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement

The purpose of this study was to evaluate whether there is a correlation between the presence of herniation pits (HPs) and morphological indicators of cam and pincer femoroacetabular impingement (FAI) based on computed tomography (CT) examinations. CT studies of the pelvis obtained from 200 patients were retrospectively analysed for the presence of HPs and morphological abnormalities of the femoral head and acetabulum. As an indicator for cam FAI, we used the angle alpha, describing the anterior femoral head-neck junction. As an indicator for pincer FAI, we measured the acetabular coverage and the acetabular orientation. Student's t-test was used for statistical analysis. HPs were identified in 85 of the 200 patients. HPs were predominantly found in the superior portion of the proximal anterior femoral neck; some were located in the inferior portion. The angle alpha was significantly larger by 10% in the group with HPs. A correlation between the presence of HPs and morphological indicators of pincer FAI was not found. In conclusion HPs are not only located in the superior portion of the proximal anterior femoral neck, but also in the inferior portion. There is an association between the presence of HPs and a high value of angle alpha.     

The arthroscopic management of femoroacetabular impingement

Femoroacetabular impingement (FAI) has recently been implicated in causing a spectrum of injury ranging from anterior hip pain, labral tears, chondral damage, and eventually perhaps to idiopathic arthritis of the hip. Three distinct types have been described: cam, pincer and mixed, with the mixed one being the commonest. Surgical treatment of femoroacetabular impingement is focused towards providing an adequate clearance to alleviate femoral abutment against the acetabular rim. This is achieved by restoring a normal femoral head–neck offset and recessing the acetabular rim if necessary. The treatment of FAI has been achieved with reasonable success by open surgical dislocation as described by the Swiss group. However, the protracted post-operative recovery coupled with the trauma sustained during the open procedure, have led to the development of an arthroscopic approach to manage this problem. The purpose of this article is to provide the reader with an up-to-date knowledge of the clinical and diagnostic aspects of FAI, to describe our arthroscopic technique in detail with its pitfalls and possible complications and to discuss the results and future of FAI.     

Femoroacetabular impingement: the femoral side

Femoroacetabular impingement is an abnormal conflict of the acetabular rim and the femoral head-neck junction. This condition causes labral and cartilage damage and leads to early osteoarthritis of the hip. Femoral osteoplasty is performed to restore normal femoral head-neck offset while the amount of bony resection is monitored by periodic examination. Dynamic examination of the area of impingement, which cannot be performed in open treatment of cam impingement, confirms adequate resection and labral seal through hip range of motion.     

Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement

PURPOSE: To retrospectively evaluate if there is an association between juxta-articular fibrocystic changes at the anterosuperior femoral neck and femoroacetabular impingement (FAI). MATERIALS AND METHODS: The institutional review board approved this study and did not require informed patient consent. An orthopedic surgeon and a radiologist in consensus retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 117 hips with FAI and compared these images with the AP radiographs of a control group of 132 hips with developmental dysplasia (DD) to determine the prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck. Criteria for juxta-articular fibrocystic changes at the anterosuperior femoral neck were location close to the physis and a diameter (of the fibrocystic change) of greater than 3 mm. The sensitivity and specificity of AP pelvic radiography in the detection of these fibrocystic changes were calculated by using an additional 61 hips with FAI and on the basis of findings at magnetic resonance (MR) arthrography, which was routinely performed for assessment of FAI. In 24 patients who underwent joint-preserving surgery for FAI, the fibrocystic changes were localized intraoperatively and the spatial relation of the region of these changes to the area of FAI was identified. Joint-preserving surgery consisted of anterior surgical dislocation of the hip with osteochondroplasty of the proximal femur and/or the acetabular rim to improve the impingement-free range of hip motion. For statistical comparisons, nonparametric tests were performed. RESULTS: Fibrocystic changes were identified on the AP radiographs of 39 (33%) of the 117 FAI-affected hips and on none of the radiographs of the 132 DD-affected hips. According to MR arthrogram findings, the sensitivity, specificity, and positive and negative predictive values of AP pelvic radiography were 64%, 93%, 91%, and 71%, respectively. The mean diameter of the juxta-articular fibrocystic changes was 5 mm (range, 3-15 mm); smaller lesions were more prevalent. Dynamic MR imaging with the hip flexed and intraoperative observations revealed a close spatial relationship between the region of the fibrocystic changes at the anterosuperior femoral neck and the acetabular rim. CONCLUSION: The high prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck and their spatial relation to the impingement site suggest an association and possible causal relationship between these alterations and FAI.     

髋臼股骨撞击综合征的MSCT表现及相关测量值分析

目的：探讨髋臼股骨撞击综合征(FAI)在 MSCT上的表现及相关特征值分析。方法回顾性分析病例组109侧,对照组120侧髋关节,各行 MSCT扫描。分析各髋关节解剖异常及骨质改变情况,测量相关指标：α角、偏心距及中心边缘角(CE 角)。所得数据分别采用t检验及单因素方差分析进行比较分析。结果股骨头颈区骨赘或骨性突起57侧,头颈凹陷不足26侧,髋臼过度覆盖17侧,深髋臼41侧,髋臼后倾20侧,股骨颈疝窝57侧,髋臼下囊变22侧。病例组与对照组α角,偏心距及中心边缘角差异均有统计学意义(P<0.05)。α角2组间比较,除凸轮型与混合型(P=0.071),钳夹型与对照组(P=0.083)差异无统计学意义外,其他各2组间均有统计学差异(P<0.05);偏心距2组间比较,除凸轮型与混合型(P=0.561)差异无统计学意义外,其余各2组间均有统计学差异(P<0.05);CE角2组间比较,除钳夹型与混合型(P=0.444),凸轮型与对照组(P=0.236)差异无统计学意义外,其他各2组间均有统计学差异(P<0.05)。结论不同类型髋撞击有其特有解剖学征象,α角、偏心距及中心边缘角对诊断 FAI具有重要参考价值。