髋臼后倾和凸轮形态是导致髋关节后脱位的风险因素,与创伤机制无关。

IF 2 3区 医学 Q2 ORTHOPEDICS Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI:10.1007/s00402-024-05595-w
Vera Jaecker, Stephan Regenbogen, Sven Shafizadeh, Silvan Wittenberg, Annika Steinmeier, Sven Märdian
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引用次数: 0

摘要

简介高能量的创伤冲击通常被认为是导致髋关节脱位的关键因素。然而,股骨髋臼变异被认为是导致低能量髋关节后脱位的原因,尤其是在青少年运动员中。该研究旨在分析成人创伤性髋关节后脱位患者的股骨髋臼形态,比较高能量、运动相关和低能量创伤机制:对 141 名外伤性髋关节后脱位患者进行了分析,并与 141 名无髋关节或骨盆损伤的高能量创伤机制患者组成的对照组(年龄、性别和体重指数(BMI)匹配)进行了比对。分析了创伤机制,并使用计算机断层扫描(CT)评估了股骨髋臼形态和伴随的股骨头或髋臼后壁骨折。通过测量外侧中心边缘角、髋臼指数、髋臼深度/宽度比、髋臼头顶角和中心角以及髋臼前后扇形角(AASA、PASA),评估了髋臼形态、覆盖面和钳形形态。还测量了髋臼帽-髋臼骺(CCD)角以及冠状和轴向α角,以检测凸轮形态:结果:79.4%的患者因高能量创伤导致髋关节后脱位,7.8%的患者因运动相关机制导致髋关节后脱位,12.8%的患者因低能量撞击导致髋关节后脱位。高能量和运动相关脱位患者的髋臼后倾程度更高(p 结论:髋臼后倾是导致髋关节脱位的主要原因:在高能量和运动相关的创伤机制中,髋臼后倾会导致髋关节后脱位,并降低并发骨折的可能性。髋臼形态是导致低能量撞击后髋关节脱位的次要原因。无论创伤机制如何,α角增大都是导致髋关节后脱位的风险因素。
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Acetabular retroversion and cam morphology are contributing risk factors for posterior hip dislocation independent of the trauma mechanism.

Introduction: A high-energy trauma impact is generally considered the crucial factor causing native hip dislocation. However, femoroacetabular variations are assumed to contribute to low-energy posterior hip dislocations, especially in adolescent athletes. The study aimed to analyze the femoroacetabular morphology of adults who sustained traumatic posterior hip dislocations, comparing high-energy, sports-related, and low-energy trauma mechanisms.

Materials and methods: One hundred forty-one patients with traumatic posterior hip dislocations were analyzed and matched to a control group of 141 patients with high-energy trauma mechanisms without hip or pelvic injury, matched for age, gender, and Body Mass Index (BMI). The trauma mechanism was analyzed, and the femoroacetabular morphology and concomitant femoral head or posterior acetabular wall fractures were assessed using computed tomography (CT) scans. Acetabular version, coverage, and pincer morphology were evaluated by measuring the lateral center-edge angle, acetabular index, acetabular depth/width ratio, cranial and central acetabular version angles, and the anterior and posterior acetabular sector angles (AASA, PASA). The caput-collum-diaphyseal (CCD) angle and coronal and axial alpha angles were measured to detect cam morphology.

Results: A high-energy trauma caused posterior hip dislocations in 79.4%, sports-related mechanisms in 7.8%, and a low-energy impact in 12.8%. Patients with high-energy and sports-related dislocations exhibited a higher disposition for acetabular retroversion (p < 0.001). However, the acetabular version in low-energy mechanisms did not differ from the control group (p ≥ 0.05). Acetabular retroversion was associated with isolated dislocation, while acetabular overcoverage correlated with concomitant posterior acetabular wall fractures (p < 0.05). Alpha angles were significantly increased in patients with hip dislocations, independent of the trauma mechanism (p < 0.001).

Conclusion: Acetabular retroversion contributes to posterior hip dislocation in high-energy and sports-related trauma mechanisms and decreases the likelihood of sustaining concomitant fractures. Acetabular morphology was subordinate to causing hip dislocation following a low-energy impact. Increased alpha angles were identified as a risk factor contributing to posterior hip dislocations, regardless of the trauma mechanism.

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来源期刊
CiteScore
4.30
自引率
13.00%
发文量
424
审稿时长
2 months
期刊介绍: "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).
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