股骨髓臼撞击综合征

近年来学者们注意到一些中年人及喜爱运动的年轻人表现出来的髋关节疼痛无法用传统的发病机制解释.直到2003年Ganz等[1]首先提出了由于存在髋臼以及股骨近端的形态结构异常,在髋关节运动终末期发生股骨头颈和髋臼的异常碰撞,导致髋臼、盂唇及软骨损伤,从而引发髋关节疼痛症状,且持续发展并导致髋关节的退变,即股骨髋臼撞击综合征(femoroacetabular impinge-ment,FAI).     

Femoroacetabular impingement

Evidence is emerging that subtle morphologic abnormalities around the hip, resulting in femoroacetabular impingement, may be a contributing factor in some instances to osteoarthritis in the young patient. The morphologic abnormalities result in abnormal contact between the femoral neck/head and the acetabular margin, causing tearing of the labrum and avulsion of the underlying cartilage region, continued deterioration, and eventual onset of arthritis. Nonsurgical treatment typically fails to control symptoms. Surgical management involves dislocation of the hip (while preserving the blood supply to the femoral head) and femoroacetabular osteoplasty. Encouraging results have been reported following femoroacetabular osteoplasty and arthroscopic treatment of femoroacetabular impingement.     

股骨髋臼撞击综合征

骨关节炎是一个多病因引起的疾病,常累及髋关节。老年性髋关节骨关节炎患者的发病机制是在长期轴向负荷作用下关节软骨发生退行性的改变。临床上也可见到部分成年人及经常运动的年轻人表现出髋关节炎症状,用传统的发病机制不能得到满意的解释。Ganzetal提出股骨髋臼撞击综合征（femoro—acetabularimpingement,FAI）可能是导致原发性髋关节炎的重要原因。     

Femoroacetabular impingement: Avoiding arthroplasty

Femoroacetabular impingement (FAI) is caused by structural alterations of the hip joint and can lead to abnormal stresses to the cartilage and labrum. FAI can cause pain and early osteoarthritis. Diagnosis of FAI is based on specific clinical and radiographic features. While the efficacy of nonoperative treatment of FAI is unknown, various operative treatments, including surgical hip dislocation, anteversion periacetabular osteotomy, and hip arthroscopy, have shown successful outcomes.     

髋关节撞击综合征的诊断和治疗

目的 探讨髋关节撞击综合征(FAI)的临床诊断和治疗的体会.方法 通过总结2002年以来29例门诊患者和5例手术患者的临床资料,分析该综合征的临床表现,骨科检查的特点以及放射学检查的特征性改变.结果 29例门诊患者中大部分患者起病隐袭,发展缓慢,髋关节的骨科检查可见特征性撞击试验阳性.X线片发现11例股骨头有"枪柄样畸形",20例CE角大于40°,4例髋臼后倾.核磁共振造影检查能够提供准确的盂唇损伤的诊断依据.其中5例患者接受了手术治疗.结论 FAI能够引起髋关节疼痛并导致髋骨关节炎,早期发现是治疗的关键.     

Femoroacetabular impingement: minimally invasive hip surgery

Minimally invasive hip surgery is an innovative surgical technique mainly used in femoroacetabular impingement (FAI). The purpose of the surgical correction in FAI deformity is to eliminate the etiologic factor in the development of the so-called idiopathic hip osteoarthritis. Decisive for the success of joint preservation is the preoperative assessment of the deformity and the possible damage to the cartilage. The optimal intervention in the presence of substantial cartilage damage is joint replacement. The patient's history and the findings of physical examination with detailed radiographs and magnetic resonance imaging based on a sagittal oblique localizer optionally using intra-articular contrast prevent underestimation of the stage of the disease. Knowledge about the options and techniques of minimally invasive hip surgery helps to identify patients appropriate for other interventions like surgical dislocation of the hip and the periacetabular osteotomy.     

Femoroacetabular impingement syndrome--pre-arthritis of the hip

The diagnosis of femoroacetabular impingement (FAI) syndrome is relatively recent. Therefore, the concept of early hip arthritis development is an interesting issue. The assumed prevalence of this disease is rather high and any postponement of necessity to perform total hip arthroplasty (THA) for hip arthritis, as a FAI sequela, should bring benefits to medical care as well as economy. To make an exact diagnosis it is necessary, in addition to essential clinical examination and standard conventional radiography, to carry out MRI that, in indicated cases, is combined with arthrography. Surgical treatment includes extensive procedures, such as controlled surgical dislocation of the hip with modeling of the femoral head and periacetabular osteotomy. In the case of primary surgery for FAI, short- and middleterm results so far obtained are promising, but only long-term results will show whether, and for how many years, this therapy is able to postpone the necessity of THA. For the future, biological therapy using autologous hyaline cartilage transfer will remain a challenge also for this indication.     

特发性髋关节炎诱因——股骨髋臼撞击

临床上可见部分成年人及年轻人表现出髋关节炎症状,近期研究发现股骨髋臼撞击可能是其产生的重要原因.股骨髋臼撞击是由于股骨和髋臼解剖学异常造成两者不相匹配,运动终末期产生异常碰撞所致,患者常诉腹股沟处疼痛,同时伴有髋关节活动范围减小,特异性体检及良好的影像学资料均可呈阳性.引起碰撞原因众多,其机制可分为凸轮碰撞和钳夹碰撞两种.非手术治疗只能暂时缓解症状,不能阻止关节进一步退变;手术治疗可解除碰撞因素,缓解症状,并阻止病变继续发展,早期手术对患者更有利;近期随访表明,术后患者关节功能较术前明显改善,且股骨头缺血坏死等手术并发症发生率极低.     

股骨颈骨折内固定术后的股骨髋臼撞击综合征

目的初步探讨在股骨颈骨折行内固定术后的患者中出现股骨髋臼撞击综合征（femoroacetabular impingement，FAI）的发生率及可能引起这一综合征的相关因素。方法随访了2009年1～6月门诊复查的股骨颈骨折术后患者48例，手术时间为2002～2008年，男28例，女20例，年龄22～72岁，平均年龄56．3岁，左侧27例，右侧21例。采集与诊断FAI有密切关联的随访信息，对符合诊断标准的患者做出诊断。结果48例患者均获随访，发生FAI的患者3例，发生率为6．25％。其中头下型3例：Garden III型1例，GardenIV型2例。结论在股骨颈骨折行内固定术后的患者中确实存在有FAI的可能，并且有一定的发生率，其原因可能和骨折的类型及术中复位的质量有关，需引起大家的足够重视。     

Femoroacetabular impingement: a cause for osteoarthritis of the hip

A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.     

Femoroacetabular impingement syndrome: a narrative review for the chiropractor

Objective:

To familiarize the chiropractic clinician with the clinical presentation, radiographic features, and conservative versus surgical treatment options for managing femoroacetabular impingement (FAI) syndrome.

Background:

FAI syndrome is a relatively new clinical entity to be described in orthopedics, and has been strongly linked with pain and early osteoarthritis of the hip in young adults. Hip joint radiographs in these patients often appear normal at first—particularly if the clinician is unfamiliar with FAI. The role of conservative therapy in managing this disorder is questionable. Surgical treatment ultimately addresses any acetabular labral or articular cartilage damage, as well as the underlying osseous abnormalities associated with FAI. The most commonly used approach is open surgical hip dislocation; however, more recent surgical procedures also involve arthroscopy.

Conclusion:

In FAI syndrome—a condition unknown to many clinicians (including medical)—chiropractors can play an important role in its diagnosis and referral for appropriate management.     

Femoroacetabular impingement in a high school female athlete

The patient was a 17-year-old female who was referred to a physical therapist by her primary-care physician with a chief complaint of bilateral hip and groin pain. The patient was treated by the physical therapist for 8 weeks, but she was unable to successfully return to playing soccer. The patient was subsequently referred to an orthopaedic surgeon, who ordered a magnetic resonance arthrogram that did not reveal intra-articular pathology. To further evaluate bony morphology, computed tomography with 3-dimensional reconstructions was ordered, which demonstrated findings consistent with cam-type femoroacetabular impingement.     

Femoroacetabular impingement and risk factors: a study of 50 cases

Objective: To study the asphericity of the femoral head in femoroacetabular impingement using the radiological indices alpha angle and triangular index, and correlation with risk factors. Methods: The study was conducted retrospectively from January 2008 to June 2010 on 50 consecutive patients with suspected cam type femoroacetabular impingement of the hip who reported to the orthopaedics outpatients department of the Postgraduate Institute of Medical Education and Research. Ten controls were also used in the study. Radiographs of the affected hip were taken and then the alpha angle and triangular index were measured and correlated with various risk factors. Results: In the anteroposterior view the alpha angle range was from 55° to 106° for the cases and from 54° to 70° for the controls. In the lateral view the range was from 62° to 104° for the cases and from 54° to 62° for the controls. The mean alpha angle in the anteroposterior view was measured as 75°± 10° in the cases and 61°± 6° in the controls, and the mean in the lateral view was 74°± 8° in the cases and 58°± 6° for the controls. The triangular index range in the radiographs was from 1 to 7 in the cases and from 0 to 1 for the controls. The mean triangular index in the radiographs was 2.9 ± 1.2 for the cases and 0.2 ± 0.4 for the controls. Conclusion: There was no significant correlation between the age and gender of the patient and the femoroacetabular impingement. However, there was significant correlation between the body mass index of the patient and the femoroacetabular impingement.     

Femoroacetabular cup impingement after resurfacing arthroplasty of the hip

Femoroacetabular cup impingement (FACI), defined as the presence of a bony spur or indentation at the femoral neck corresponding to the abutment site of metallic cup, was observed in 9 (11%) of the 84 hips with contemporary resurfacing arthroplasty of the hip. All FACIs occurred in men after a mean of 14 months (range, 8-24 months) postoperatively. Five patients had persistent groin pain if the hip was moved into flexion, abduction, and external rotation. One patient sustained a late-onset fracture through the femoral neck already weakened by postoperative change of osteonecrosis. Mean postoperative Harris hip score in the FACI group was poorer than that in the non-FACI group (P = .003). Multiple logistic regression analysis showed a significant association of FACI with a low acetabular cup inclination (odds ratio, 1.42; 95% confidence interval, 1.01-1.99; P = .046) and a high cup uncoverage ratio (odds ratio, 1.36; 95% confidence interval, 1.01-1.84; P = .045).     

Osteopathic treatment for cam-type Femoroacetabular impingement syndrome: A case report

BackgroundFemoroacetabular impingement (FAI) syndrome treatment is initially conservative, but the number of studies is limited.ObjectivesTo examine the results of an osteopathic treatment approach in a patient with FAI.Clinical featuresThe evaluation and osteopathic treatment of an 18-year-old male athlete diagnosis of left hip cam-type FAI are presented.Intervention and outcomesExercises and protective measures were applied together with osteopathic techniques. Treatments were applied for 6 weeks, two days a week for a total of 12 sessions. The Numerical Evaluation Scale was used for pain evaluation. Functional scores were obtained by the Harris Hip Score, and deep squat test. Muscle strength was measured using the Handheld Dynamometer. Short Form-36 was used for the assessment of the quality of life. The final evaluations showed improvement in pain, function, muscle strength, and symptom-specific test results. Three weeks after the treatment, the patient made a complete return to sports, and there was no recurrence in the first year after treatment.ConclusionOsteopathic therapy may be effective in the conservative treatment of FAI. Well-designed clinical trials are needed to further evaluate this conclusion.     

Femoroacetabular impingement and comparison of radiological indexes: a study on 50 cases

To study the asphericity of femoral head in femoroacetabular impingement using radiological indices such as alpha angle and triangular index, and to compare the alpha angle and triangular index measured in the radiograph and MRI. The study was conducted prospectively from January 2008 to June 2009 on 50 consecutive patients of suspected cam-type FAI hip, reporting to orthopedics outpatients department of Postgraduate Institute of Medical Education and Research. Radiograph of the affected hip was taken, and then alpha angle and triangular index are measured and compared. The mean alpha angle in anteroposterior view was measured as 75° ± 10°, and the mean in lateral view was 740 ± 80. In MRI the mean alpha angle was 79° ± 9°. The mean triangular index in radiograph was 2.9 ± 1.2. In MRI the mean triangular index was 2.6 ± 0.8. Frog-leg lateral view is sufficient for the diagnosis of the cam-type femoroacetabular impingement. But MRI is required in cases, where surgical intervention is planned to rule out other pathological condition and for decision making.     

Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis

The exact cause of the idiopathic osteoarthritis of the hip has not been identified, although the cause of hip degeneration in developmental dysplasia can clearly be attributed to an excessive axial loading. Based on the development of a surgical technique for the safe surgical dislocation of the hip and the associated possibility of intraoperative joint evaluation, we have found motion-induced joint damage in many of these hips. This begins peripherally at the acetabular rim, progressing centrally. This so-called "femoroacetabular impingement" (FAI), leads, by an increased acetabular coverage and/or a missing sphericity of the femoral head, to an abutment of the femoral head/neck junction against the acetabular rim, or even entering of the non-spherical femoral head into the hip. It initiates damage to the labrum and/or acetabular cartilage. Frequently, this becomes symptomatic in the second or third decade of life in patients with increased sport activity. Based on the predominance of the acetabular or femoral pathology, two different types of FAI, the pincer and the cam can be differentiated. Apart from these morphological alterations, supraphysiological mobility and overuse can contribute to FAI. The impingement concept has led to a new type of mainly intracapsular hip surgery.