髋关节镜手术治疗钳夹型股骨髋臼撞击征△

Clinical outcomes of hip arthroscopy for treatment of pincer- type femoroacetabular impingement

摘要:

［目的］探讨髋关节镜下髋臼成形术治疗钳夹型股骨髋臼撞击征的疗效。［方法］回顾性分析 2017 年 6 月—2019 年 7 月本科收治的钳夹型股骨髋臼撞击征患者 24 例。其中，男 10 例，女 14 例，平均年龄 （33.52±11.42） 岁，手术方式均为髋关节镜下髋臼成形术。［结果］所有患者均顺利手术，镜下证实 24 例患者均为单纯钳夹型撞击，无股骨头颈交界凸轮骨赘。切口均一期愈合，无关节内感染、股骨头坏死、深静脉栓塞、下肢神经损伤等并发症。24 例患者随访 12 个月以上。与术前相比，术后 6 个月和末次随访时 24 例患者 FADIR 和 FABER 试验均显著改善 （P<0.05），VAS 评分均显著减少 （P<0.05），而 mHHS 和 iHOT-12 评分均显著增加 （P<0.05）。影像方面，与术前相比，术后 6 个月和末次随访时 24 例患者 LCEA 显著减少 （P<0.05），而 AI 显著增加 （P<0.05），交叉征、后壁征阳性比率显著下降 （P<0.05）。与术前相比，术后 6 个月、末次随访时 T?nnis 骨性关节炎分期和髋臼过深征阳性比率均无显著改变（P>0.05）。［结论］髋关节镜下髋臼成形术治疗钳夹型股骨髋臼撞击征可以明显缓解患者的疼痛症状，改善髋关节功能，短期临床效果满意。

Abstract:

[Objective] To explore the clinical outcomes of hip arthroscopy for mere pincer- type femoroacetabular impingement. [Methods] A retrospective study was conducted on a total of 24 patients who underwent hip arthroscopy for mere pincer-type femoroacetab- ular impingement in our department from June 2017 to July 2019. The patients included 14 females and 10 males, aged (33.52±11.42) years on average, and received arthroscopic acetabuloplasty for the pincer-type femoroacetabular impingement. [Results] All the patients were successfully operated on under arthroscope, and were confirmed to have pincer-type impingement only without femoral head- neck junction cam-like osteophytes. All patients got incisions healing primarily without complications such as intraarticular infection, necrosis of femoral head, deep vein embolism and nerve injury of lower limb. All the 24 patients were followed up for more than 12 months. The flex- ion, adduction and internal rotation (FADIR) test, as well as the flexion, abduction and external rotation (FABER) tests significantly im- proved in the 24 patients at 6 months postoperatively and at the last follow-up compared with those preoperatively (P＜0.05) . In addition, the VAS scores significantly decreased (P＜0.05) , while the mHHS and iHOT-12 scores significantly increased postoperatively compared with those before operation (P＜0.05) . Radiographically, the lateral center edge angle (LCEA) significantly reduced (P＜0.05) , the acetabu- lar index (AI) increased significantly (P＜0.05) , whereas the positive rates of cross sign and posterior wall sign significantly decreased at 6 months postoperatively and at the latest follow-up compared with those preoperatively (P＜0.05) . However, there were no significant chang- es in terms of T?nnis osteoarthritis grades and the positive rate of deep acetabular sign at 6 months postoperatively, or at the last follow-up compared with that preoperatively (P＞0.05) . [Conclusion] Acetabuloplasty under hip arthroscopy does significantly relieve the pain, im- prove function and achieve sound short-term clinical outcomes for mere pincer-type femoroacetabular impingement.