髋关节镜术治疗股骨髋臼撞击合并外侧弹响髋△

Hip arthroscopy for femoroacetabular impingement accompanied with lateral external snapping

摘要:

［目的］ 评估髋关节镜术治疗股骨髋臼撞击综合征 （femoroacetabular impingement syndrome, FAI） 合并外侧弹响髋 （external snapping hip, ESH）的临床疗效。［方法］回顾性分析 2014 年 1 月—2019 年 6 月本院行髋关节镜术患者，25 例 FAI 合并 ESH 的患者列入观察组，行镜下关节内病变处理和镜下髂胫束松解；另外 25 例单纯 FAI 患者列为对照组，仅行镜下 FAI 病变处理。比较两组围手术期、随访与影像资料。［结果］两组患者均顺利手术，均未发生严重并发症。观察组手术时间显著长于对照组（P<0.05），但两组术后完全脱拐行走时间、切口愈合等级和住院时间的差异均无统计学意义（P>0.05）。所有患者均随访 12 个月以上，与术前相比，末次随访时，两组患者疼痛视觉模拟评分 （visual analogue scale, VAS） 显著降低 （P<0.05）， 而改良 Harris 髋关节评分 （modified Harris Hip Scores, mHHS） 和国际髋关节结果工具评分 （International Hip Outcome Tool, iHOT-33） 显著增加 （P<0.05）；观察组伸直位髋内收活动度 （range of motion, ROM） 显著增加 （P<0.05）。术前，观察组 VAS 评分显著高于对照组（P<0.05），观察组 iHOT-33 评分显著低于对照组（P<0.05），观察组下肢伸直位内收 ROM 显著小于对照组（P<0.05）；末次随访时，两组上述指标的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 α 角显著减小 （P<0.05），股骨头颈偏矩 （femoral head neck offset, FHNO） 显著增加 （P<0.05）。相应时间点，两组间 α 角、 FHON、LCE 角和 T?nnis 分级的差异均无统计学意义（P>0.05）。［结论］关节镜同时处理 FAI 和 ESH 病变具有创伤小、操作简单的优点，其临效床果与单纯 FAI 患者相近。

Abstract:

[Objective] To evaluate the clinical efficacy of hip arthroscopy for the treatment of femoroacetabular impingement (FAI) ac- companied with external snapping hip (ESH) . [Methods] A retrospective analysis was performed on the patients who received hip arthros- copy in our hospital from January 2014 to June 2019. Among them, 25 patients who suffered from FAI accompanied with ESH were termed as the trial group and underwent arthroscopic intraarticular lesion management and iliotibial band release, while the other 25 patients who had mere FAI were named as the control group and received arthroscopic treatment of FAI lesions only. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation finished successfully with no serious complications. Although the trial group consumed significantly longer operation time than the control group (P＜0.05) , there were no significant differences in total incision length, intraoperative X-ray exposure time, postoperative walking time, incision healing grade and hospital stay between the two groups (P＞0.05) . The VAS scores significantly decreased (P＜0.05) , whereas the mHHS score and iHOT-33 scores significantly increased in both groups at the latest follow-up lasted for more than 12 months compared with those preoperatively (P＜ 0.05) . In addition, the trial group got significant increase of hip adduction range of motion at straight leg, associated with that Ober signs be- came all negative at the latest interview (P＜0.05) . The trial group was significantly inferior to the control group in terms of VAS score and iHOT-33 score preoperatively (P＜0.05) , however which turned to be not statistically significant at the latest follow-up between them (P＞ 0.05) . Radiographically, the α angle and lateral center edge angle (LCEA) significantly reduced (P＜0.05) , while the femoral head neck off-set (FHNO) significantly increased in both groups at the last follow- up compared with those before surgery (P＜0.05) . At corresponding time points, there were no significant differences in aforesaid radiographic items between the two groups (P＞0.05) . [Conclusion] Hip ar- throscopy for simultaneous treatment of FAI and ESH has the advantages of less trauma and simple operation, and does achieve clinical out- comes similar to those with FAI alone.