The role of the labrum in early treatment of unstable developmental dysplasia of the hip

[摘要] The acetabular labrum or ‘labrum’ is a fibrocartilaginous structure which surrounds the acetabulum and contributes to the stability of the femoral head in the acetabular socket by deepening the latter and increasing the articular congruity.1 The labrum has been considered as an obstacle to reduction in unstable and dysplastic hips. Severin in 1950, reported that it was unnecessary to excise the limbus if the arthrographic follow-up demonstrated a remodelling of the inverted limbus and a favourable maturation of the acetabulum.2 Staheli in 1978 reported that the number of surgical procedures on a dysplastic hip was greater if an inverted limbus was present.3 In another study, Ponseti in 1978 described the limbus as an expression of a hypertrophic labrum;4 he reported that it was visible especially in the superior-lateral margin of the acetabulum and that it represented an important obstacle to reduction in many cases of developmental dysplasia of the hip (DDH). Fleissner in 1994, in an article regarding closed reduction of the hip, proposed an arthrographic classification in order to give an assessment of success (or lack of it) of the reduction.5 Carlioz and Felipe, in an article in 1982, used as synonyms ‘limbus’ and ‘labrum’ and referred rather vaguely to ‘limbus interposition’ and ‘inverted fibrocartilaginous labrum’.6 Previously, the term ‘labrum’ has often been, inappropriately, confused with or substituted by ‘limbus’ and ‘neolimbus’. In fact, the neolimbus is a ‘new’ fibrocartilaginous structure that forms because of the forces applied by the dislocated femoral head. This was well described by Ortolani and was demonstrated in his anatomical preparations. The limbus has also been confused with the labrum or with the acetabular cartilaginous rim or both. According to some authors, the limbus is a hypertrophic labrum, which has developed because of abnormal forces applied to it by the femoral head.

[学科分类] 神经科学

[关键词] acetabular labrum;early diagnosis;unstable dysplastic hip