本期目录：
1、全膝关节置换术后反复神经瘤性疼痛的局部去神经化治疗
2、全髋关节置换术治疗创伤性髋部骨折的趋势：基于全国性全自费数据库的分析
3、陶对陶摩擦界面可以减少骨溶解：一项与对侧陶对聚乙烯界面比较的20年随访研究
4、髋关节发育不良患者的骨与盂唇联合外侧覆盖是正常的
5、发育不良髋关节的盂唇损伤，发病机理和生物力学考量
6、髋关节发育不良患者进行渐进性抗阻训练：可行性研究
7、下肢不等长：自然史
8、髋臼壁指数评价有症状患者股骨头前后覆盖率
第一部分：关节置换及保膝相关文献
文献1
全膝关节置换术后反复神经瘤性疼痛的
局部去神经化治疗
译者：张轶超
尽管患者对于全膝关节置换手术有很高的满意度，但有一小部分患者还会残留反复的神经瘤性疼痛。最近，对于膝关节周围皮肤和关节囊周围的神经分布和走形有了非常详细的了解，这给通过局部去神经化而缓解疼痛的治疗方法提供了很好的依据。我们选择了15名全膝置换术后残留反复或严重膝关节疼痛超过6个月的患者。每个患者都排除了假体松动、力线不良、膝关节不稳和感染所造成疼痛的可能。采用膝关节系会评分问卷及视觉模拟疼痛评分（VAS）在术前对于疼痛进行评估。如何选择手术方式呢？每个患者在做选择性神经封闭时必须有5个点的VAS评分能下降。术后由未参加手术的一组医生来评估治疗效果。详细记录膝关节去神经化手术的细节。所有15名患者都做了至少一根神经的选择性去神经化治疗（15名患者做了45根神经的去神经化治疗）。所有患者均反应术后即刻就出现疼痛缓解。这个疼痛的缓解至少保持12个月（6-16个月）。选择性膝关节周围去神经化治疗可以被应用于全膝关节置换术后难治性神经瘤来源的膝关节周围疼痛。
Partial denervation for persistent neuroma pain after total knee arthroplasty
Despite the high percentage of patients who are satisfied completely with the results of total knee arthroplasty, there is a small group who remain disabled because of persistent neuroma pain. Recently, a better understanding of the innervation of the skin and capsule around the human knee joint has provided a theoretical basis for denervation in this group of patients. Fifteen patients were identified who had persistent or worse knee pain for > 6 months after total knee arthroplasty. In each patient, component loosening, malalignment, knee instability, and infection had been excluded systematically as a source of pain. Pain was evaluated preoperatively with the Knee Society Functional Score Questionnaire and a visual analog scale. To be selected for surgery, each patient must have had a reduction by 5 points on the visual analogue scale for pain after undergoing selective nerve blocks. Postoperative assessment was done by a team that did not include the surgeon who did the denervation. The technique for selective knee denervation is described in detail. All 15 patients had at least 1 of the nerves to the knee selectively denervated (45 nerves in 15 patients). All patients reported subjective improvement in the immediate postoperative period. This improvement was maintained at a mean followup of 12 months (range, 6-16 months). Selective knee denervation is indicated in the management of intractable knee pain of neuroma origin after total knee arthroplasty.
文献出处：Dellon AL, Mont MA, Krackow KA, Hungerford DS. Partial denervation for persistent neuroma pain after total knee arthroplasty. Clin Orthop Relat Res. 1995 Jul;(316):145-50.
文献2
全髋关节置换术治疗创伤性髋部骨折的趋势：
基于全国性全自费数据库的分析
译者：马云青
背景：人工股骨头置换术（HA）是传统上治疗老年移位型股骨颈骨折的首选方法。对于年轻、不卧床的患者，理想的治疗方法并不那么明确。全髋关节置换术（THA）在这类人群中得到了越来越多的应用，但接受HA或THA手术的相关因素尚未完全明确。
目的：分析患者的哪些特征与接受THA或HA有关。以确定各治疗方法间的结果是否不同。
方法：通过查询2005年至2014年期间接受HA或THA治疗股骨颈骨折患者的全国住院样本（NIS），全国住院样本包括了美国住院患者的大量代表性样本。在我们的样本中使用了国际疾病分类，第九版（ICD-9）代码来识别患者的诊断，比较了两种手术的人口变量、医院特征、付款人状况、医疗并发症和死亡率。然后进行多元Logistic回归分析，以确定所使用的治疗方式的独立危险因素。
结果：在接受股骨颈骨折治疗的502060例患者中，51568例（10.3%）接受了THA，THA的比例率从8.3%上升到13.7%。私人保险付费的患者在THA的比例高于HA。与城市非教学医院相比，THA手术在城市教学医院中的增加。HA的平均住院时间较长。HA的平均收费较低，但两组手术的收费均稳步下降。然而，在调整年龄后，HA的死亡率较高，合并症并不是死亡的独立危险因素。有趣的是，私人保险付费是采用THA治疗的独立预测因子。
结论：在美国，使用THA治疗股骨颈骨折的情况有所增加，特别是在城市医院。HA和THA的总费用和住院时间都在减少。
National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database
BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.
AIM: To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.
METHODS: We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.
RESULTS: Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA.
CONLUSION: There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS.
文献出处：Boniello AJ, Lieber AM, Denehy K, Cavanaugh P, Kerbel YE, Star A. National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database. World J Orthop. 2020 Jan 18;11(1):18-26. doi: 10.5312/wjo.v11.i1.18. eCollection 2020 Jan 18.
文献3
陶对陶摩擦界面可以减少骨溶解：
一项与对侧陶对聚乙烯界面比较的20年随访研究
译者：张蔷
尽管陶瓷假体已被广泛应用许多年，最初的目的也是为了尽可能减少磨损碎屑，但是陶对陶或陶对聚乙烯摩擦界面产生的磨损和骨溶解是否更少仍然未知。我们研究了28例随访20年以上的双侧全髋关节置换病例（一侧陶对陶，一侧陶对聚乙烯），所有病例均未出现松动和后续的翻修。在骨盆前后位片和三维CT上我们确认了骨溶解程度。我们发现CT上发现的溶骨性病灶比平片上发现的多。而陶对聚乙烯一侧的损伤数量高过对侧。两侧随访时间近似的情况下，陶对聚乙烯一侧的骨溶解表面积和容积均高过对侧。我们发现骨溶解的容积与摩擦界面的选择相关，而与磨损的容积无关。有骨溶解的髋关节Harris评分更低。
Ceramic-Ceramic Bearing Decreases Osteolysis：A 20-year Study versus Ceramic-Polyethylene on the Contralateral Hip
Although ceramic implants have been in use for many years and they are intended to minimize wear debris it is unknown whether alumina-on-alumina or alumina-on-polyethylene produce less wear and osteolysis. We therefore investigated wear and osteolysis on 28 bilateral arthroplasties (one ceramic-ceramic and the contralateral ceramic-polyethylene) of patients who had survived 20 years without revision and without loosening of either hip. Osteolysis was identified on anteroposterior pelvic radiographs and 3-D volume from CT scans. The number of osteolytic lesions detected with CT scan was higher than with radiographs. The number of lesions was higher on the side with the alumina-PE couple. With a similar length of follow-up on each side, the surface and the volume of osteolysis were consistently higher on the side with the alumina-PE couple. We found no correlation between the volume of osteolysis and the volume of estimated wear in each couple of friction. Hips with osteolysis had a lower Harris score.
文献出处：Hernigou P, Zilber S, Filippini P, Poignard A. Ceramic-ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res. 2009 Sep;467(9):2274-80. doi: 10.1007/s11999-009-0773-2. Epub 2009 Mar 13.
第二部分：保髋相关文献
文献1
髋关节发育不良患者的骨与盂唇
联合外侧覆盖是正常的
译者：罗殿中
目的：比较不同髋臼畸形程度发育不良患者骨与盂唇覆盖情况的差异，测量方法通过在磁共振影像上测量联合外侧中心边缘角（cLCEA）。
方法：对连续就诊的准备接受保髋手术的一队患者进行研究，在磁共振影像上测量cLCEA。用于测量的磁共振序列选择T1相或质子密度相。测量方法为：选择一条过股骨头中心且与双侧泪滴连线垂直的线，另一条线选择股骨头中心与髋臼盂唇的外缘间的连线，两条线之间的夹角为cLCEA。根据髋臼骨覆盖程度将患者分为4组，分别为发育不两组（LCEA < 20°）、临界发育不良组（LCEA 20°-24.9°）、正常覆盖组（LCEA 25°-39.9°）、过度覆盖组（LCEA≥40°），统计各组间LCEA与cLCEA之间的平均差异。
结果：本研究共纳入341名患者（386髋）。正常覆盖组与发育不良组（P=0.10）及临界发育不良组间（P=0.46）的cLCEA均无明显差异。尽管LCEA在发育不良组（14.8° ± 3.9°）与过度覆盖组（43.1° ± 2.8°）之间存在巨大差异，但两组的平均cLCEA仅存在较小的差别（44.7° ± 4.9° vs 52.7° ± 4.5°）。发育不良患者的LCEA与cLCEA间差异最大（delta = 29.9° ± 4.7°），而过度覆盖组这连个指标间的差异最小（9.6° ± 5.2°）。
结论：髋关节发育不良患者骨性覆盖降低，但盂唇会相应的代偿肥大，发育不良患者于正常人群的骨与盂唇的联合LCEA并无明显差异。
A 在发育正常人的骨盆正位片上测量LCEA；B 磁共振影像上测量正常人cLCEA；C 在发育不良患者的骨盆正位片上测量LCEA；B 磁共振影像上测量发育不良患者的cLCEA
Combined Lateral Osseolabral Coverage Is Normal in Hips With Acetabular Dysplasia
PURPOSE: To compare the lateral osseolabral coverage between groups of patients with different degrees of acetabular bony coverage using a magnetic resonance imaging parameter known as the combined lateral center-edge angle (cLCEA).
METHODS: The cLCEA was measured among a consecutive series of patients presenting to a dedicated hip preservation surgeon with a magnetic resonance imaging scan. The cLCEA was measured using a coronal T1 or proton density image and was defined as the angle subtended by (1) a line through the center of the femoral head and orthogonal to the transverse line passing through the teardrops of both hips and (2) an oblique line drawn from the center of the femoral head to the free edge of the lateral acetabular labrum. The average difference between the lateral center-edge angle (LCEA) and the cLCEA was calculated and compared between groups based on acetabular bony coverage: dysplasia (LCEA <20°), borderline dysplasia (LCEA 20°-24.9°), normal coverage (LCEA 25°-39.9°), and overcoverage (LCEA ≥40°).
RESULTS: In total, 341 patients (386 hips) were included. There were no significant differences in cLCEA between hips with normal acetabular coverage and dysplasia (P = .10) or borderline dysplasia (P = .46). Despite the large difference in mean LCEA between dysplasia (14.8° ± 3.9°) and acetabular overcoverage (43.1° ± 2.8°), the mean cLCEA values exhibited only a modest difference (44.7° ± 4.9° vs 52.7° ± 4.5°, respectively). Concordantly, hips with dysplasia exhibited the largest difference between mean LCEA and cLCEA (delta = 29.9° ± 4.7°) and hips with acetabular overcoverage had the smallest difference between measures (9.6° ± 5.2°).
CONCLUSIONS: With decreasing acetabular bony coverage, there is increasing labral size such that the total osseolabral coverage, measured by the combined LCEA, remains equivalent between hips with normal acetabular coverage versus dysplasia.
文献出处：Kraeutler MJ, Goodrich JA, Ashwell ZR, Garabekyan T, Jesse MK, Mei-Dan O. Combined Lateral Osseolabral Coverage Is Normal in Hips With Acetabular Dysplasia. Arthroscopy. 2019 Mar;35(3):800-806. doi: 10.1016/j.arthro.2018.10.133. Epub 2019 Feb 4.
文献2
发育不良髋关节的盂唇损伤，
发病机理和生物力学考量
译者：程徽
关节囊-盂唇复合体由三角形的纤维软骨唇组成，固定在髋臼环上，并由下方的横韧带支撑。在发育正常的髋臼中，股骨头、月状面接触面的负重区域呈中心对称。
图1 月状面的仰视图，可见中心对称。
髋关节合力的垂直分量同心地与水平承重面平行。关节囊-盂唇复合体不必代偿过度的剪切或拉紧。而在髋臼增生异常中，股骨头被异常的月状面覆盖得很差：月状面向前外侧倾斜，导致在关节囊-盂唇复合体上外侧产生张力和剪切力。需要关节囊-盂唇复合体作为代偿稳结构定拉住非同心的股骨头，。
图2 失代偿的发育不良髋
所产生的力平行于倾斜的负重关节面，从而在唇中产生额外的应力：关节囊-盂唇复合体可以发生适应性的肥大来补偿这种生物力学应力（IB型）。随之应力增大，关节囊-盂唇复合体也可能出现渐进性机械失代偿，导致唇裂（IIB型）或完全撕脱（IIIB型）。总之，盂唇病变是由残余髋关节发育不良引起的病理生物力学所致。理论上，基本治疗原则只能是矫正截骨术。
Labrumläsion bei der Restdysplasie des Hüftgelenks Biomechanische Überlegungen zur Pathogenese und Behandlung
The capsular-labrum-complex consists of the triangular fibrocartilaginous labrum, which is fixed at the bony acetabular ring and supported by the ligamentum transversum actetabuli in the caudal part. In a normally developed and correctly orientated acetabulum, the femoral head is symmetrically covered by the contact area of the lunate surface. The vertical component of the resultant hip joint force concentrically meets the horizontal weight bearing surface: Evenly distributed compressive forces are transmitted; the capsular-labrum-complex does not have to compensate excessive shear or tension. In contrast, in a ªdysplasticº acetabulum the femoral head is poorly covered by the pathologically orientated lunate surface: The lunate surface is sloping in an anterolateral direction, leading to tension and shear on the superolateral capsular-labrum-complex, which becomes a secondary stabilizer (ªguide railº) against the decentering femoral head. The vertical component of the resultant hip force eccentrically meets the oblique weight bearing surface, causing extra stress in the labrum: The capsular-labrumcomplex is trying to compensate this biomechanical stress with hypertrophy (Type IB). Progressive mechanical decompensation of the capsular-labral-complex might lead to tears (Type IIB) or complete avulsions (Type IIIB) of the labrum. In conclusion labral lesions result from pathobiomechanics caused by residual hip dysplasia (RHD). Logically, the basic therapeutic principle can only be corrective osteotomy.
文献出处：Tschauner C, Hofmann S. [Labrum lesions in residual dysplasia of the hip joint. Biomechanical considerations on pathogenesis and treatment]. Orthopade. 1998 Nov;27(11):725-32.
文献3
髋关节发育不良患者进行渐进性抗阻训练：
可行性研究
译者：肖凯
目的：明确有症状的髋关节发育不良患者在接受髋臼周围截骨术治疗前进行渐进性抗阻训练是否可行。次要目标是调查患者自我评分结果、髋关节功能及和髋部肌肉力量改善情况。
设计：可行性研究。
患者和方法：17名患者（中位年龄28岁，范围22-40岁）在指导下进行了为期8周（20次）的渐进性抗阻训练。记录了患者训练依从性、中途退出训练情况和不良事件的发生率。记录疼痛VAS评分。患者完成髋关节和腹股沟结果评分（Hip andGroin Outcome Score），进行2次跳跃测试，并通过等速测力法评估髋部峰值扭矩。
结果：患者训练依从性为90.3±9％。不良事件发生很少且轻微，一名患者中途退出，在训练期间患者报告了可接受的疼痛水平。6个患者自我评分量表中有4个得分改善（p<0.05），站立跳跃距离提高了12.2％（95％置信区间[1.3,23.0]），反向运动跳跃提高了25.1％（95％置信区间 [1.3,48.8]）。患侧等速髋关节屈曲峰值扭矩改善16.5%（95％置信区间[4.6,28.6]），健侧等长髋关节屈曲改善10.9%（95％置信区间 [0.3,21.6]）。
结论：对于髋关节发育不良患者，在进行髋臼周围截骨术前指导进行抗阻训练是可行的。此干预可改善疼痛水平，提高患者自我评分量表结果，改善髋关节功能表现和髋关节屈曲肌肉力量。
Progressive resistance training in patients with hip dysplasia: A feasibility study
OBJECTIVES: To examine whether progressive resistance training is feasible in patients with symptomatic hip dysplasia scheduled for periacetabular osteotomy. A secondary objective was to investigate patient-reported outcomes, functional performance and hip muscle strength.
DESIGN: Feasibility study.
PATIENTS AND METHODS: Seventeen patients (median age 28 years, range 22-40 years) performed 8 weeks (20 sessions) of supervised sessions of progressive resistance training. Training-adherence, number of dropouts and adverse events, and visual analogue scale scores on pain were registered. Patients completed the Hip and Groin Outcome Score, performed 2 hop-tests, and hip peak torque was assessed by isokinetic dynamometry.
RESULTS: Training-adherence was 90.3±9%. Few and minor adverse events were observed, one patient dropped out and acceptable pain levels were reported during the intervention. Scores on 4 out of 6 subscales on patient-reported outcome improved (p <0.05), as did standing distance jump (12.2%, 95% confidence interval (CI) [1.3, 23.0]), countermovement jump (25.1%, 95% CI [1.3, 48.8]). Isokinetic concentric hipflexion peak torque showed significant improvements (16.6%, 95% CI [4.6, 28.6]) on the affected side while isometric hip flexion (10.9%, 95% CI [0.3, 21.6]) improved on the non-affected side.
CONCLUSION: Supervised progressive resistance training is feasible in patients with hip dysplasia. The intervention may improve pain levels, patient-reported outcomes, functional performance and hip flexion muscle strength.
文献出处：Mortensen L, Schultz J, Elsner A, Jakobsen SS, Søballe K, Jacobsen JS, Kierkegaard S, Dalgas U, Mechlenburg I. Progressive resistance training in patients with hip dysplasia: A feasibility study. J Rehabil Med. 2018 Aug 22;50(8):751-758. doi: 10.2340/16501977-2371.
文献4
下肢不等长：自然史
译者：任宁涛
背景：文献中很少有关于下肢不等长长期影响的报道，有关腰痛、髋关节病理学、膝关节病理学和足部问题的文献比比皆是。临床上常使用下肢垫高来处理肢体长度的结构和功能差异，然而下肢不等长的自然史以及可能建议治疗方法的有效性尚无明确。本文旨在记录和评估与下肢不等长相关的文献。
方法：使用PubMed对英文文献进行了检索，搜索关于下肢不等长影响的文献，仅报告专家意见或案例报告的文献除外。
结果：论文涉及下肢体不等长的自然史以及对下肢体不等长患者进行步态分析的研究。只有10%的人口下肢长度完全相同，95%的人口下肢长度差异在1cm以内，当下肢长度差异超过5mm时可出现髋膝的症状，长腿侧常出现髋关节症状，膝关节症状在各种研究中都有报道，在长腿或短腿中都可出现，短腿侧腰背问题似乎更为常见，在步态分析过程中发现了许多不同的下肢不等长的代偿机制。
结论：临床上常常认为下肢长度差超过2cm才会引起注意，但是有证据表明，下肢长度差只要大于5 mm就可以导致长期的病理变化。
Leg Length Discrepancy: The Natural History (And What Do We Really Know)
BACKGROUND: The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies.
METHODS: A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb lengthdiscrepancies. Papers reporting only expert opinion or case reports were excluded.
RESULTS: Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb lengthdiscrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb lengthdiscrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis.
CONCLUSIONS: There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.
文献出处：Gordon JE, Davis LE.Leg Length Discrepancy: The Natural History (And What Do We Really Know). J Pediatr Orthop. 2019 Jul;39(Issue 6, Supplement 1 Suppl 1):S10-S13. doi: 10.1097/BPO.0000000000001396.
文献5
髋臼壁指数评价有症状患者股骨头前后覆盖率
译者：张利强
背景：了解髋臼的病理形态学是正确治疗髋关节疾病的必要条件。现有的放射学参数用缺陷，正常或过度分类髋臼覆盖，但未能量化前后壁覆盖情况。一个简单、可重复、有效的测量髋部疼痛患者前后壁覆盖率的方法将是一个有用的临床工具。
问题/目的：我们（1）引入前壁指数（AWI）和后壁指数（PWI），（2）报告这些测量的观察者内部和观察者之间的可靠性，以及（3）根据已建立的计算机模型验证这些测量。
方法：回顾性分析87例（63位患者）有症状的髋关节的临床资料。用一个经过验证的计算机模型来确定骨盆正位片上髋臼前后的总覆盖率（TAC和TPC）。两个独立的观察者在每个平片上测量AWI和PWI，并计算了组内相关系数（ICC）。利用Pearson相关分析来确定我们的测量和计算机模型之间的线性依赖强度。
结果：AWI的观察者内和观察者间ICCs分别为0.94和0.99，PWI分别为0.81和0.97。对于计算机模型的验证，Pearson r值分别为0.837（AWI与TAC）和0.895（PWI与TPC）。发育不良髋组的平均AWI和PWI分别为0.28和0.81，正常髋的平均AWI和PWI分别为0.41和0.91，髋臼较深髋的平均AWI和PWI分别为0.61和1.15。
结论：我们的数据表明，这些措施将有助于评估手术前后股骨头的覆盖率，但需要对无髋关节异常的无症状个体进行评估，以确定正常范围。
圆圈代表股骨头，r为股骨头的半径，沿股骨颈轴线画一条由圆圈内侧通过前壁(a)和后壁(p)的线，AWI 和PWI 分别为a/r 和p/r
（A）正常髋关节AWI 为1.1 cm/2.7 cm = 0.41. （B）发育不良的髋关节AWI 为0.8 cm/2.4 cm = 0.33. (C)髋臼较深的髋关节AWI 为 2.7 cm/2.9 cm = 0.93.
The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients
Background Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool.
Questions/Purposes We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model.
Methods We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model.
Results Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum.
Conclusions Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges.
文献出处：Siebenrock K A , Kistler L , Schwab J M , et al. The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients[J]. Clinical Orthopaedics and Related Research®, 2012, 470(12):3355-3360.
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