CAJ | 학술논문

目的探讨凸轮型(Cam型)股骨髋臼撞击症(femoroacetabular impingement,FAI)患者股骨头颈比例与正常人是否存在差异,并对测量方法及此结论的临床应用价值进行评估.同时探讨FAI的手术方法.方法选择468名无髋部症状成年国人:男313名,女155名;年龄17～82岁,平均42.4岁;分别测量其左右侧股骨头最大直径、股骨颈最小纵径长度,并计算其比值.Cam型FAI病例17例(24侧),年龄30～68岁,均有典型的FAI 临床症状及体征.测量方法:采用Digimizer软件对两组使用Doherty描述的方法进行测量,即划出股骨头中心与股骨颈中心连线后经中心点测量垂直线的头、颈长度并计算头颈比例.共7例(8侧)患者接受手术治疗,根据髋关节头颈撞击情况决定股骨颈成形范围.同时评估手术前后Harris评分和测量屈髋90°位的内旋角度.结果正常组股骨头颈比例1.48±0.09(1.33～1.69),FAI组为1.30±0.13(1.0l～1.46),两组间差异有统计学意义(P＜0.01).手术病例术中行头颈成形,根据术中股骨颈成形骨量进行验证显示,术前测量头颈比例较小者需要切除更多的头颈部骨赘.术后平均随访6.5个月,手术前后Harris评分分别为(63.4±8.2)分(52～76分)和(89.2±3.5)分(84～95分),差异有统计学意义(P＜0.01).屈髋90°位内旋角度从术前2.5°±2.7°(0°～5°)改善为12.5°±3.8°(5°～15°),差异有统计学意义(P＜0.01).结论对于Cam型FAI,头颈比例的测量具有一定的参考价值,有助于FAI的诊断及成形术范围的预估.
목적 탐토철륜형(Cam형)고골관구당격증(femoroacetabular impingement,FAI)환자고골두경비례여정상인시부존재차이,병대측량방법급차결론적림상응용개치진행평고.동시탐토FAI적수술방법.방법 선택468명무관부증상성년국인:남313명,녀155명;년령17～82세,평균42.4세;분별측량기좌우측고골두최대직경、고골경최소종경장도,병계산기비치.Cam형FAI병례17례(24측),년령30～68세,균유전형적FAI 림상증상급체정.측량방법:채용Digimizer연건대량조사용Doherty묘술적방법진행측량,즉화출고골두중심여고골경중심련선후경중심점측량수직선적두、경장도병계산두경비례.공7례(8측)환자접수수술치료,근거관관절두경당격정황결정고골경성형범위.동시평고수술전후Harris평분화측량굴관90°위적내선각도.결과 정상조고골두경비례1.48±0.09(1.33～1.69),FAI조위1.30±0.13(1.0l～1.46),량조간차이유통계학의의(P＜0.01).수술병례술중행두경성형,근거술중고골경성형골량진행험증현시,술전측량두경비례교소자수요절제경다적두경부골췌.술후평균수방6.5개월,수술전후Harris평분분별위(63.4±8.2)분(52～76분)화(89.2±3.5)분(84～95분),차이유통계학의의(P＜0.01).굴관90°위내선각도종술전2.5°±2.7°(0°～5°)개선위12.5°±3.8°(5°～15°),차이유통계학의의(P＜0.01).결론 대우Cam형FAI,두경비례적측량구유일정적삼고개치,유조우FAI적진단급성형술범위적예고.
Objective To explore the difference of the femoral head-neck ratio (FHNR) in patients with Cam-type femoroacetabular impingement (FAI) and healthy adults and its impact on surgical strategy.Methods We measured the FHNR using method described by Doherty.468 healthy adults without hip symptoms acted as controls in the study,including 313 males and 155 females,with the mean age of 42.4years (range,17-82 years).There were 17 patients (24 hips) in the Cam-type FAI group.The maximum diameter of the femoral head and the minimum vertical diameter of femoral neck on both sides were measured by Digimizer software on the standard anteroposterior pelvis film.The ratio of femoral head to femoral neck was calculated and was compared.The surgery was performed in 7 cases (8 hips) with FAI.The Harris score and internal rotation angle was also compared.Results The FHNR of control group and Cam-type FAI group was 1.48±0.09(1.33-1.69) and 1.30±0.13 (1.01-1.46) separately (P＜0.01).The volume of osteophyte removed during operation was related with the FHNR.The average Harris score had improved from 63.4±8.2(52-76) preoperatively to 89.2±3.5(84-95) postoperatively.The average internal rotation angle had improved from 2.5°±2.7°(0°-5°) preoperatively to 12.5±3.8°(5°-15°) postoperatively.Conclusion FHNR measurement is useful for the diagnosis and surgical treatment of Cam-type FAI.