전방 대퇴비구 충돌과 관련된 고관절 방사선학적 이상의 관절경적 분석
Arthroscopic Analysis of the Radiologic Abnormalities of the Hip Associated with Anterior Femoroacetabular Impingement
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목적: 전방 대퇴비구 충돌에서 나타나는 대퇴골의 골성 융기와 이와 연관된 고관절의 방사선학적이상을 관절경적으로 분석하였다. 대상 및 방법: 2008년 1월부터 8월까지 대퇴비구 충돌로 관절경 시술을 받은 환자 중 비구순 파열을 보인 45명(51예)을 후향적 검토하였다. 술 전후에 단순 방사선적 검사를 시행하고, 때때로3D CT와 MRA를 시행하였다. 결과: 방사선 소견에서 15예가 두-경부 offset이 감소되었다. 대퇴골 융기가 관찰된 26예 중 11예는 비구 후경, 5예는 돌출된 비구와 연관되었고 13예는 편평해진 경부에 발생하였다. 21예의권총 손잡이 변형이 관찰되었고 비구의 후경은 32예에서 관찰되었다. 충돌의 이차적 소견으로 추정되는 비구 또는 대퇴골의 골극이 14예, 대퇴골의 낭성 병변이 23예가 관찰되었다. 관절경 상전례가 퇴행성 비구순 파열을, 32예(62.7%)에서 비구 연골 손상이 관찰되었고 이중 25예는 비구의 후경과 연관되어 있었다. 결론: 대퇴비구 충돌 환자에서 대퇴골의 골성 융기는 다양한 위치와 형태를 보이며 상당수가pincer 형과 연관되어 대퇴와 비구의 kissing 병변을 유발할 수 있다. 대퇴골의 비정상적 소견의방사선적 확인은 증상이 있는 대퇴비구 충돌을 확진하는데 도움을 줄 수 있다
Abstract
Purpose: We wanted to arthroscopically analyze the femoral osseous abnormalities (bumps) in hips with anterior femoroacetabular impingement (FAI) and the other radiologic abnormalities of the hip joint associated with this. Materials and Methods: We retrospectively reviewed the radiographs of 45 patients (51 hips) who underwent arthroscopic treatment under the impression of FAI from January to August, 2008. The indications for surgery included persistent hip pain, the absence of advanced osteoarthritis, physical examination or MRA findings consistent with an acetabualr labral tear. Preoperative and postoperative plain radiographs (pelvis AP, frog-leg lateral, cross table lateral and the false profile view) were taken. As the occasion demanded, 3D-CT or MRA were performed. Results: For the radiologic findings, a decreased head-neck offset (<8 mm) was seen in 15 hips. Femoral bumps were seen in 26 hips and among them, 11 hips were associated with acetabular retroversion, 5 hips were associated with a prominent acetabular rim and 13 hips were located on the flattening of the neck due to a decreased offset. Pistol grip deformity was found in 21 hips and acetabular retroversion was done in 32 hips. Regarding the secondary changes,spurs on the acetabulum of the femur were found in 14 hips and femoral bony cysts were found in 23 hips. Arthroscopically, all the hips had acetabular degenerative labral tear and the acetabular cartilage was injured in 32hips (62.7%). Among them, 25 hips underwent acetabular retroversion. Conclusion: Femoral osseous abnormalities are seen in various locations and these abnormalities have various shapes. A considerable number were associated with pincer impingement and they could produce a ‘kissing lesion’between the acetabulum and femur. Identification of these abnormalities on radiographs aids confirming FAI in hips with symptomatic early osteoarthritis. Key Words: Femoroacetabular impingement, Femor
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