关节镜术治疗凸轮型髋关节撞击综合征

Arthroscopic surgeries for cam-type femoroacetabular impingement

摘要:

[目的] 探讨髋关节镜手术治疗凸轮 （cam 畸形） 型髋关节撞击综合征 （femoroacetabular impingement, FAI） 的诊疗要点与临床疗效。[方法]2016 年 9 月—2020 年 10 月本科收治的经关节镜手术治疗的 102 例凸轮型 FAI 患者纳入本研究，包括男 67 例，女 35 例；年龄 18~50 岁，平均（30.9±9.6）岁。术中依据病理所见给予相应手术处理。总结术中所见和处理，以及随访和影像资料。[结果]102 例患者均顺利手术，术中无严重并发症。术中见所有患者均有股骨头-颈交界处凸轮骨赘畸形； 盂唇撕裂发生率为 100%，其中 Seldes 分级 2 级占 45.1%；髋臼软骨损伤发生率为 50.0%，其中 Outerbridge 分级 1~2 级占 47.1%，3~4 级占 2.9%；股骨头软骨损伤 Outerbridge 分级 1~2 级发生率为 27.5%；圆韧带撕裂发生率为 22.6%，且以 Domb 分级 1 级为主。所有患者均获随访 25~74 个月，平均 （44.7±10.0） 个月。与术前相比，末次随访时患者的 mHHS 评分 [(43.1±12.5), (83.8±8.0), P＜0.001]、iHOT-12 评分 [(48.7±10.9), (85.4±10.0), P＜0.001] 和 VAS 评分 [(5.8±1.8), (2.2±1.6), P＜0.001] 均显著改善。影像方面，术后影像检查显示所有患者股骨头-颈交界凸轮骨赘均有效去除。与术前相比，末次随访时患者的 LCEA [(32.3±3.1)°, (30.5±3.2)°, P＜0.001] 和 α 角显著减小 [(64.2±5.5)°, (43.2±4.6)°, P＜0.001]，关节间隙无显著变化 [(3.6±0.6) mm, (3.5±0.6) mm, P= 0.122]，髋关节 T?nnis 分级无显著变化 [0/1/2, (69/33/0), (58/42/2), P=0.135]。[结论]凸轮型 FAI 多伴有盂唇和关节软骨等其他结构损伤，应依据术中所见，在凸轮畸形充分磨除的基础上，行其他病变处理，并缝合关节囊，以获得满意的临床效果。

Abstract:

[Objective] To investigate the technique notes and clinical outcome of hip arthroscopy for cam-type femoroacetabular im- pingement (FAI). [Methods] A total of 102 patients who underwent hip arthroscopy for the cam-type FAI in our department from September 2016 to October 2020 were enrolled into this study, including 67 males and 35 females, aged from 18 to 50 years old with an average age of (30.9±9.6) years. Based on the intraoperative pathological findings, corresponding managements were conducted. The documents regarding to intraoperative findings and treatments, as well as follow-up and images were summarized in this paper. [Results] All the 102 patients had hip arthroscopic procedures performed successfully without serious complications. In terms of intraoperative pathological findings, the cam deformity presenting femoral head-neck junction osteophyte was observed in all patients. In addition, the incidence of labral tear was 100%, of which Seldes grade 2 accounted for 45.1%, and the incidence of acetabular cartilage injury was 50.0%, with Outerbridge grades 1~2 inju- ry of 47.1% and Outerbridge grades 3~4 damage of 2.9%, while the incidence of femoral head cartilage injury with Outerbridge grade 1~2 was of 27.5%, and incidence of ligamentum teres tear was 22.6%, of which the Domb grade 1 was dominant. All the patients were followed up for 25 to 74 months, with a mean of (44.7±10.0) months. Compared with those preoperatively, the HHS score [(43.1±12.5), (83.8±8.0), P＜ 0.001], iHOT-12 score [(48.7±10.9), (85.4±10.0), P＜0.001] and VAS score [(5.8±1.8), (2.2±1.6), P＜0.001] significantly improved at the lat- est follow-up. Radiographically, the postoperative images showed that the femoral head-neck junction cam-like osteophytes were effectively removed in all patients. Compared with those preoperatively the lateral center-edge angle (LCEA) [(32.3±3.1)°, (30.5±3.2)°, P＜0.001] and α angle [(64.2±5.5)°, (43.2±4.6)°, P＜0.001] significantly decreased, while the joint space [(3.6±0.6) mm, (3.5±0.6) mm, P=0.122], and T?nnis classification for hip osteoarthritis [0/1/2, (69/33/0), (58/42/2), P=0.135] remained unchanged. [Conclusion] The cam-type FAI is usually associated with other structural pathologies involving the labrum and articular cartilage. Based on the intraoperative findings, other lesions should be treated on the basis of the removal of the cam-like osteophyte, and suture of the joint capsule should be conducted, in order to ob- tain satisfactory clinical results.