青少年股骨髋臼撞击征的关节镜治疗△

Hip arthroscopy for femoroacetabular impingement in adolescents

摘要:

[目的]探讨关节镜治疗青少年股骨髋臼撞击症(femoroacetabular impingement, FAI)的临床疗效。[方法]2016 年 1 月—2018 年 9 月，对 21 例青少年 FAI 患者行髋关节镜手术治疗，评估其临床与影像结果。[结果]术中见 21 例患者中，凸轮撞击 7 例，钳夹撞击 2 例，混合撞击 12 例；其中 19 例合并存在髂前下棘撞击。术中可见 21 例均存在盂唇损伤。给予相应手术处理。术后均未见重要神经损伤、关节内感染或症状性血栓等并发症。与术前相比，术后 12 个月和 24 个月 VAS 评分显著下降(P＜0.05)，而 mHHS 和 iHOT-12 评分均显著增加(P＜0.05)。影像方面，与术前相比，术后 α 角显著减少(P＜0.05)，而 FHNO 显著增加(P＜0.05)，LCEA 无显著变化(P＞0.05)。至末次随访时，21 例患者影像检查均未见髋关节无明显退变。按牛津法评估，术后骨骼生长发育正常。[结论]髋关节镜手术是治疗青少年 FAI 的有效手段，不影响骨骼生长发育。

Abstract:

[Objective] To investigate the clinical outcomes of hip arthroscopy for femoroacetabular impingement (FAI) in adolescents. [Methods] From January 2016 to September 2018, 21 adolescent patients underwent hip arthroscopic surgery for FAI. The clinical and im- aging data were evaluated. [Results] As findings of arthroscopic examination, 7 case were of cam-type impingement, 2 were of pincer-type and 12 were mixed-type, and 19 cases were accompanied with impingement of the anteroinferior iliac spine among the 21 patients, whereas all 21 cases were accompanied with labrum injury. Corresponding arthroscopic treatment was performed to the lesions with no complica- tions, such as nerve injury, intraarticular infection or symptomatic thrombosis. The VAS scores significantly decreased (P＜0.05) , while the mHHS and iHOT-12 scores significantly increased at 12 and 24 months postoperatively compared with those before surgery (P＜0.05) . Ra- diographically, the α angle and lateral center edge angle (LCEA) significantly reduced (P＜0.05) , while the femoral head neck offset (FH- NO) significantly increased (P＜0.05) , and there was no significant change in LCEA (P＞0.05) postoperatively compared with those before operation. Up to the latest follow-up, all the 21 patients had no obvious hip degeneration. According to Oxford method, bone growth and de- velopment remained normal after surgery in all the adolescents. [Conclusion] Hip arthroscopy is an effective treatment for FAI in adoles- cents without affecting bone growth and development.