X线“阴性”髋痛患者髋股撞击征的临床影像学研究

Radiologic investigation for femoroacetabular impingement in X-ray "negative" patients with hip pain

目的髋股撞击征(femoroacetabular i mpingement,FAI)作为髋关节骨性关节炎的可能病因近年愈受重视,但尚缺乏国人流行病学相关研究,本研究回顾性分析既往X线"阴性(未见异常)"髋痛患者中FAI的临床流行病学特点及其临床意义。方法整理2007年12月至2008年8月期间西南医院影像中心保存的所有患者门诊骨盆前后位X线资料1128例,按设定的纳入和排除标准筛选出研究对象。FAI诊断标准:(1)Cam型FAI:α角大于55°;(2)Pincer型FAI:"8"字征阳性。分别统计FAI患者性别、年龄段及发生部位。测量髋痛一侧的髋关节前后位X线的α角测量、半径高与半径比值(1/1Ra)和1/2半径高与半径比值(1/2Ra)并观察是否存在"8"字征,对以上统计及测量进行流行病学分析。结果1128例患者骨盆前后位X线符合纳入标准269例,均表现单髋痛,其中男121例,女148例。影像学诊断符合FAI42例(15.6%),男、女性分别为27例(22.3%)和15例(10.1%),两者差异有统计学意义(P<0.05)。Cam型与Pincer型和混合型比较差异有统计学意义(P<0.05)。α角测量:Cam型FAI组为86.3°±16.7°;非FAI组为46.3°±4.1°,两组间差异有统计学意义(P<0.05)。1/1Ra和1/2Ra:Cam型FAI组分别为1.02±0.04和0.74±0.06;非FAI组分别为0.86±0.03和0.69±0.05。1/2Ra在Cam型FAI组和非FAI组间差异有统计学意义(P<0.05),而1/1Ra在两组间差异无统计学意义(P>0.05)。结论FAI在X线"阴性"的髋痛患者的高发病率,提示其可能作为患者髋痛原因,具有不可忽略的临床意义。1/2半径高与半径比值可以作为Cam型FAI诊断的特异参数以进一步筛选出。

Objective Femoroacetabular impingement（FAD is thought to be a cause of premature osteoarthritis of the hip. But study on the epidemiology of FAI in China have not been described. This study want to retrospectively analyze clinical epidemiology and their influence of FAI in X-ray ＂negative＂patients with hip pain to evaluate the use of arthroscopy in diagnosis and treatment of acetabular labral tear. Methods The retrospectively investigation analysis about FAI in X-ray ＂ negative＂ chinese patients with hip pain was performed at the Southwest Hospital from December 2007 to August 2008. Exclusion criteria was applied. FAI diagnostic criteria ： （1） Cam impingement ： a angles〉 55° ; （2） Pincer impingement ： figure-8 configuration positive. Measure a angles （°）, ratio of perpendicular height to the cortex on the point of 1/2 r or 1/1r and the radius of the femoral head ,and observed figure-8 configuration that described acetabular retroversion. Epidemiological investigation was based on measure and observation and the relation ships between a angles and ratio of perpendicular height to the cortex on the point of 1/2 r or 1/1r and the radius of the femoral head were evaluated. Results There remained 269 radiographs of 121 men and 148 women on which further analysis could be performed Applying these criteria to the gross material. Gender related difference in distribution was found, while the prevalence of FAI was 22.3% in men and 10.1% in women, a angles：Cam impingement group was 86.3°±16.7°,and the group that did not accord with FAI diagnostic criteria was 46.3°±4.1°. There was significant difference between both group. 1/1Ra和1/2Ra：Cam impingement group respectively were 1.02±0.04和 0.74±0.06 ,and the group that did not accord with FAI diagnostic criteria were 0.86±0.03 and 0.69±0.05. There was significant difference of 1/2Ra between both group,while 1/1Ra was not. Conclusion The high prevalence of FAI in FAI FAI in X-ray ＂negative＂chinese patients with hip pain suggest FAI could be important cause of hip pain in these patients. The results also support that 1/2Ra could be thought to be a new special radiological index for FAI.