髋关节镜治疗股骨髋臼撞击合并临界髋发育不良△

Hip arthroscopy for femoroacetabular impingement accompanied with borderline developmental dysplasia of the hip

摘要:

［目的］探讨髋关节镜术治疗股骨髋臼撞击（femoroacetabular impingement, FAI）合并临界型髋发育不良（borderline de- velopmental dysplasia of the hip, bDDH）的临床疗效。［方法］回顾性分析 2017 年 9 月—2019 年 12 月在本院行髋关节镜手术治疗的 FAI 患者共 232 例，筛选出年龄 50 岁以下，髋臼外侧 CE 角在 18°~25°的临界型髋关节发育不良（bDDH）患者 22 例，占 9.48%。 22 例患者均在镜下行盂唇缝合、股骨凸轮成形联合关节囊紧缩缝合术。［结果］镜下见，22 例患者均存在不同程度的盂唇撕裂损伤和股骨头颈交界部位凸轮畸形，给予相应处理。22 例患者均顺利手术，术中无重要血管、神经损伤。随访 15~39 个月，平均 （22.29±6.78）个月。与术前相比，末次随访时 VAS 评分显著降低（P<0.05），而 mHSS 和 iHOT-12 评分显著增加（P<0.05）。末次随访时，男性（13/22）患者的 mHHS 评分显著高于女性（9/22）患者（P<0.05）。影像方面，与术前相比，末次随访时 22 例患者的髋臼外侧中心边缘角 （lateral center edge angle, LCEA）、α 角显著减少 （P<0.05），而 T?nnis 角、股骨头颈偏距 （femoral head neck offset, FHNO） 显著增加（P<0.05）。至末次随访时，所有患者的 T?nnis 骨性关节炎分级无变化，无髋关节不稳或脱位征象。 ［结论］FAI 合并 bDDH 的比例为 9.48%，采用盂唇修复、股骨颈凸轮成形联合关节囊紧缩缝合可获得良好的短期临床疗效。

Abstract:

[Objective] To investigate the clinical outcomes of hip arthroscopy for femoroacetabular impingement (FAI) accompanied borderline developmental dysplasia of the hip (bDDH) . [Methods] A retrospective study was conducted on 232 patients who underwent hip arthroscopy for FAI in our hospital from September 2017 to December 2019. Of them, a total of 22 patients who were under 50 years old, and met the criteria for diagnosis of bDDH, with lateral center edge angle (LCEA) between 18° and 25° were enrolled into this study. All the 22 patients underwent arthroscopic labrum repair, femoroplasty and capsule tightened suture. [Results] As arthroscopic findings, all the 22 patients had labral tear in different extents and cam-like malformations at the femoral head and neck junction, which were treated accordingly. All the 22 patients were successfully operated on without any important vascular or nerve injury. The follow-up period lasted for 15-39 months, with a mean of (22.29±6.78) months. The VAS scores significantly decreased (P＜0.05) , while the mHSS and iHOT-12 scores significantly increased at the latest follow up compared with those preoperatively (P＜0.05) . At the latest follow-up, the mHHS score in the male (13/22) were significantly higher than that in the female (9/22) (P＜0.05) . Radiographically, the LCEA and α angle decreased significantly (P＜0.05) , while T?nnis angle and FHNO significantly increased compared with those preoperatively (P＜0.05) . The T?nnis os- teoarthritis classification remained unchanged in all patients at the last follow-up. [Conclusion] The proportion of FAI accompanied with bDDH is 9.48% in all FAI patients. Arthroscopic labrum repair, femoroplasty combined with capsular tightened suture does achieve satis- factory short-term outcomes for this condition.