镜下两种关节囊切开凸轮型股骨髋臼撞击治疗的比较△

Comparison of two kinds of capsulotomy in hip arthroscopy for cam-type femoroacetabular impingement

摘要:

[目的]比较镜下 T 形关节囊切开与横形切开凸轮型股骨髋臼撞击治疗的临床疗效。[方法]回顾分析 2017 年 7 月 —2018 年 6 月关节镜手术治疗凸轮型髋关节撞击征的 70 例患者。其中，35 例采用 T 形关节囊切开(T 切组)，另外 35 例采用横形关节囊切开(横切组)。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利手术，术中无重要血管、神经损伤等严重并发症。T 切组的手术时间和术中透视次数均显著少于横切组(P＜0.05)。两组术中失血量、术后下地时间和住院时间的差异均无统计学意义 (P＞0.05)。两组患者均随访 24 个月以上，平均 (26.66±2.10) 个月。与术前相比，末次随访时两组的 VAS 评分均显著下降 (P＜0.05)，而 mHHS 和 iHOT 评分均显著增加 (P＜0.05)。末次随访时，T 切组的 VAS 评分小于横切组， 但差异无统计学意义(P＞0.05)，但是，T 切组的 mHHS 评分和 iHOT-12 评分均显著高于横切组(P＜0.05)。影像方面，与术前相比，末次随访时两组患者的 α 角和 LCEA 均显著减小 (P＜0.05)，而 FO 显著增加 (P＜0.05)。末次随访时，T 切组在 α 角和 FO 显著优于横切组(P＜0.05)，但是两组间 LCEA 的差异无统计学意义(P＞0.05)。[结论]镜下 T 形关节囊切开治疗凸轮型股骨髋臼撞击综合征的临床效果明显优于关节囊横形切开。

Abstract:

[Objective] To compare the clinical efficacy of T-shaped capsulotomy versus transverse capsulotomy in hip arthroscopy for treatment of the cam-type femoroacetabular impingement syndrome (FAI) . [Methods] A retrospective study was done on 70 patients who underwent arthroscopic surgery for cam-type FAI from July 2017 to June 2018. Among them, 35 patients had the capsule opened by Tshaped incision (the T-shaped group) , while the remaining 35 patients received transverse capsulotomy (the transverse group) . The periop- erative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had operation per- formed successfully without serious complications, such as injuries to important blood vessel and nerve. The T-shaped group proved signifi- cantly superior to the transverse group in terms of operation time and intraoperative fluoroscopy frequency (P＜0.05) , although there were no significant differences in total incision length, intraoperative blood loss, time to recover ambulation and hospital stay between the two groups (P＞0.05) . All patients in both groups were followed up for more than 24 months, with an average of (26.66±2.10) months. The VAS scores significantly decreased (P＜0.05) , whereas the mHHS and iHOT scores significantly increased in both groups at the latest follow up compared with those preoperatively (P＜0.05) . The T-shaped group had lower VAS score than the transverse group at the latest follow up, but the difference was not statistically significant (P＞0.05) . However, the T-shaped group had significantly higher mHHS and iHOT-12 scores than the transverse group at the latest follow up (P＜0.05) . Radiographically, the α angle and lateral center edge angle (LCEA) signifi- cantly reduced (P＜0.05) , while the femoral head-neck offset (FHNO) significantly increased in both groups at the latest follow-up com- pared with those preoperatively (P＜0.05) . The T-shaped group proved significantly superior to the transverse group in terms of α angle and FHNO at the last follow-up (P＜0.05) , nevertheless, there was no a significant difference in LCEA between the two groups (P＞0.05) . [Conclusion] Hip arthroscopy by T-shaped capsulotomy does achieve considerably better clinical outcomes than that by transverse capsulotomy for treatment of cam-type femoroacetabular impingement.