髋关节镜翻修术的原因与临床效果△

Reasons and clinical outcomes of revision hip arthroscopy

摘要:

［目的］ 探讨翻修髋关节镜术的原因及疗效。［方法］ 2015 年 6 月—2019 年 12 月，本院共行髋关节镜手术 359 例， 其中 26 例再次手术翻修，占 7.24%。26 例患者本次翻修术前均有不同程度的疼痛和活动受限。初次手术后症状的持续时间为 3~36 个月，平均 （15.88±8.04） 个月。翻修术探明病因，并给予相应手术处理。［结果］ 翻修术中证实，26 患者中，FAI 残余畸形者 21 例，占 80.77％；骨样骨瘤误诊为 FAI 2 例，占 7.69％；滑膜软骨瘤复发 1 例，占 3.85％；异位骨化 1 例，占 3.85%；色素沉着绒毛结节性滑膜炎复发 1 例，占 3.85％。全部 26 患者均成功接受翻修手术，无髋关节脱位、骨折、感染以及其他并发症发生。翻修术后随访 12~26 个月，平均 （17.54±4.24） 个月。与翻修术前相比，末次随访时 26 例患者的 FADIR 试验、FABER 试验和滚动试验均显著改善 （P<0.05）。与翻修术前相比，末次随访时 26 例患者的 0°位内旋 ROM、0°位外旋 ROM、90°位内旋 ROM、90°位外旋 ROM、屈髋 ROM、mHHS 和 iHOT12 评分均显著增加 （P<0.05）。而 VAS 评分显著下降 （P<0.05）。影像方面，与翻修术前相比，末次随访时 26 例患者的 α 角显著减小 （P<0.05），而偏心距显著增加 （P<0.05），但是 LCEA 角无显著变化（P>0.05）。［结论］髋关节镜翻修手术的原因主要包括 FAI 成型不全、误诊、漏诊、骨病复发等。在正确的术前诊断和成熟的手术操作技术的前提下，翻修髋关节镜术仍可获得良好的临床效果。

Abstract:

[Objective] To explore the reasons and clinical outcomes of revision hip arthroscopy. [Methods] From June 2015 to Decem- ber 2019, a total of 359 patients underwent hip arthroscopy in our hospital. Of them, 26 patients received revision hip arthroscopy, account- ed for 7.24%, for varying extent of pain and activity limitation before the revision surgery, which lasted for 3~36 months, (15.88±8.04) months on an average, after initial surgery. The revision hip arthroscopy was conducted to identify the cause of the symptoms and give ap- propriate treatment. [Results] As findings of revision hip arthroscopy among the 26 patients, residual deformities of femoroacetabular im- pingement (FAI) were seen in 21 patients, accounted for 80.77%; osteoid osteoma misdiagnosed as FAI in the primary operation in the other hospital was noted in 2 patients, accounted for 7.69%; recurrent synovial chondroma was found in 1 patient, accounted for 3.85%; heterotop- ic ossification was in 1 case, accounted for 3.85%; and recurrent pigmented villonodular synovitis was in 1 case, accounted for 3.85%. All the 26 patients had revision hip arthroscopy performed successfully without serious complications, such as hip dislocation, fracture, infec- tion and others. The follow-up period lasted for 12~26 months, with a mean of (17.54±4.24) months after the revision. The FADIR test, FABER test, and rolling test significantly improved in all the 26 patients at the latest follow-up compared with those before revision (P＜ 0.05) . In addition, the ROMs, including internal rotation at 0° of flexion, the external rotation at 0° of flexion, internal rotation at 90° of flex- ion, the external rotation at 90° and hip flexion, as well as the mHHS and the IHOT12 scores significantly increased (P＜0.05) , whereas the VAS score for pain significantly decreased at the latest follow-up compared with those before revision surgery (P＜0.05) . In term of radio- graphic evaluation, the α angle decreased and the femoral head-neck offset increased significantly at the latest follow-up compared with those before revision (P＜0.05) , whereas the LCEA remained unchanged in the 26 patients (P＞0.05) . [Conclusion] The main causes of revi- sion hip arthroscopy include residual FAI, misdiagnosis and recurrence of diseases. On the premise of correct preoperative diagnosis and mature surgical techniques, revision hip arthroscopy does still achieve good clinical outcome.