镜下治疗不同年龄髋臼股骨撞击综合征的疗效△

Comparison of hip arthroscopy for femoral acetabular impingement syndrome in different ages

摘要:

[目的] 比较关节镜治疗不同年龄髋臼股骨撞击综合征 (femoroacetabular impingement, FAI) 患者的临床疗效。[方法]回顾性分析 2015 年 1 月—2018 年 6 月本院行髋关节镜手术治疗 FAI 且符合纳入标准的 64 例患者。依据患者年龄，32 例＞ 55 岁的患者列入中老年组，根据中老年组性别、FAI 类型、骨性关节炎分级、软骨损伤情况和病程匹配了 32 例年龄 18~40 岁患者，列入青年组。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术，术中均无严重并发症。患者均随访 24 个月以上。与术前相比较，末次随访时，两组患者 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)。随访相应时间点两组间上述评分的差异均无统计学意义(P＞0.05)。影像学方面，与术前相比，末次随访时两组患者 α 角、股骨头颈偏心距(femoral head-neck offset, offset)和中心边缘角(center edge angle, CE)均显著改善(P＜0.001)。相应时间点两组间上述影像指标的差异均无统计学意义(P＞0.05)。末次随访时两组患者 T?nnis 分级均无显著改变(P＞0.05)，两组间 T?nnis 分级差异均无统计学意义(P＞0.05)。[结论]对＞55 岁的 FAI 患者只要手术适应证选择适当，行关节镜手术治疗仍可获得与年轻患者相当的临床效果。

Abstract:

[Objective] To compare the clinical efficacy of hip arthroscopy for femoroacetabular impingement (FAI) in different ages. [Methods] A retrospective analysis was performed on 64 patients who underwent hip arthroscopy for FAI in our hospital from January 2015 to June 2018. According to the age of patients, 32 patients who aged more than 55 years were named as the mid-elderly group, while the remaining 32 patients who aged 18~40 years were termed as the young group. Perioperative, follow-up and imaging documenta- tions were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious compli- cations. There were no statistically significant differences between the two groups in term of arthroscopic findings, including the types of FAI lesions, Outerbridge grades of the acetabulum and femoral head cartilage lesions, and the rate of labrum injury between the two groups (P＞0.05) . Patients in both groups were followed up for more than 24 months. The VAS scores significantly reduced in both groups, whereas the mHHS and iHOT-12 scores significantly increased at the latest follow-up compared with those before surgery (P＜ 0.05) . However, there were no significant differences in the abovementioned scores between the two groups at any corresponding time points (P＞0.05) . Radiographically, the α angle, femoral offset (FO) , and center edge angle (CE) were significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05) , whereas no statistically significant differences were noted in the abovesaid imaging items between the two groups at any corresponding time point (P＞0.05) . Additionally, the T?nnis classification for osteoarthritis remained unchanged in both groups at the latest follow-up compared with that preoperatively (P＞0.05) , which was not sig- nificantly different between the two groups at any matching time point (P＞0.05) . [Conclusion] As long as the indications are appropri- ately selected, hip arthroscopy for FAI in the patients who are old more than 55 years still achieve sound clinical outcomes comparable to those in younger patients.