钳夹型髋撞击症无透视与透视下髋臼成形术比较（开放获取）

(Open Access) Comparison of nonfluoroscopy and fluoroscopy acetabuloplasty for pincer femoroacetabular impingement

摘要:

[目的] 比较无透视髋臼“一字成形”与目前常规术中透视髋臼成形术治疗钳夹型髋关节撞击综合征的临床效果。[方法] 回顾性分析2021 年10 月—2023 年2 月在解放军总医院骨科采用髋关节镜术治疗的70 例钳夹型髋撞击综合征患者的临床资料。根据医患沟通结果，35 例在无透视下行髋臼一字成形术（无透视组）；另外35 例常规在透视下行髋臼成形术。比较两组围手术期、随访和影像资料。[结果] 两组患者均顺利手术，术中无重要血管、神经损伤等严重并发症。无透视组在手术时间[(110.1±14.8) min vs (128.5±22.5) min, P＜0.001] 和术中透视次数[(0.9±0.9) 次vs (2.9±1.4) 次, P＜0.001] 均显著优于透视组。两组术中失血量、切口愈合和住院时间的差异均无统计学意义（P＞0.05）。两组患者均获随访12 个月以上，平均（26.4±5.5） 个月。与术前相比，末次随访时两组的VAS 评分均显著减少（P＜0.05），而mHHS 和iHOT 评分均显著增加（P＜0.05）。术前两组间VAS、mHHS 和iHOT 评分的差异均无统计学意义（P＞0.05）；末次随访时，透视组的VAS 评分、mHHS 评分小于无透视组，iHOT -12 评分高于无透视组，但两组间差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时，两组患者的外侧中心-边缘角（lateral center-edge angle, LCEA) 和髋臼指数（acetabular index, AI） 均较术前显著改善（P＜0.05)，相应时间点，两组间LCEA 和AI 的差异均无统计学意义（P＞0.05）。[结论] 关节镜下无透视与常规透视髋臼成形术均能获得良好的临床效果，两种方法的临床效果无明显差异，但前者能节省手术时间并减少辐射对健康的影响。

Abstract:

[Objective] To compare the clinical effect of non-fluoroscopy (NFS) arthroscopic acetabuloplasty versus conventional fluoroscopy (FS) counterpart for treatment of pincer femoroacetabular impingement (P-FAI). [Methods] A retrospective analysis was performedon 70 patients who were underwent hip arthroscopy for P-FAI in Department of Orthopedics, PLA General Hospital from October 2021 toFebruary 2023. According to the preoperative doctorpatient communication, 35 patients underwent a line-like acetabuloplasty under NFSarthroscopy, while other 35 patients underwent conventional FS arthroscopic acetabuloplasty. The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had the arthroscopic procedure performed successfully without serious complications, such as injury of important blood vessels and nerves. The NFS group proved significantlysuperior to the FS group in terms of operative time [(110.1±14.8) min vs (128.5±22.5) min, P＜0.001] and intraoperative fluoroscopy times[(0.9±0.9) times vs (2.9±1.4) times, P＜0.001], although there were no significant differences in intraoperative blood loss, incision healing andhospital stay between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, with an average of(26.4±5.5) months. At the last follow-up, VAS scores significantly decreased (P＜0.05), while mHHS and iHOT scores significantly increasedin both groups (P＜0.05). There were no statistically significant differences in VAS, mHHS and iHOT scores between the two groups beforesurgery (P＞0.05). At the last followup, the NFS group was greater than the FS group in terms of VAS and mHHS scores, and the former wasless than the latter in IHOT-12 scores, whereas all of the differences in abovementioned parameters proved not statistically significant between the two groups (P＞0.05). In terms of imaging, the lateral center-edge angle (LCEA) and acetabular index (AI) in both groups significantly improved at the last follow-up compared with those before surgery (P＜0.05), whereas which were not significantly different betweenthe two groups at any time points accordingly (P＞0.05). [Conclusion] Both non-fluoroscopy and conventional fluoroscopy arthroscopic acetabuloplasty do achieve good clinical results, with no significant differences between the two methods, but the former does save operationtime and reduce the impact of radiation on health.