关节镜手术治疗髋关节疾病的临床研究  

Clinical research on treating hip diseases with arthroscopy

作　　者：陈卫衡[1] 徐祖健[2] 张淳[1] 刘道兵[1] 尹天[1] 谢斌[1] 

机构地区：[1]中国中医科学院望京医院,北京100102 [2]泸州医学院附属二院,四川640000

出　　处：《中国矫形外科杂志》2008年第17期1292-1294,共3页Orthopedic Journal of China

基　　金：首都医学发展科研基金(NO:03-Ⅲ-04)

摘　　要：[目的]研究髋关节镜治疗髋关节疾病的方法、疗效及适应证，探讨关节镜在髋关节疾病中的临床价值。[方法]2001年10月～2007年1月，采用髋关节镜手术治疗103例（129髋）髋关节疾病，其中股骨头坏死50髋；创伤性髋关节炎8髋；髋关节骨性关节炎34髋；色素沉着绒毛结节性滑膜炎9髋；强脊性髋关节炎12髋；慢性滑膜炎6髋；髋关节盂唇损伤6髋；髋关节游离体2髋；不明原因髋痛2髋。根据不同病变情况，镜下采取清理滑膜、咬除或刨削退变的软骨、修整不平的关节面和骨质面、磨除增生的骨赘、软骨下微钻孔减压、咬除并修整损伤盂唇、取出游离体、生理盐水灌洗关节腔等治疗手段。[结果]随访6个月～5年，平均1年10个月，术后Harris评分（85±3．4）分，与术前（49±4．3）分相比显著提高（t=4．18，P〈0．001）。其中，疼痛缓解程度：股骨头坏死为26髋（52．0％），骨性关节炎（包括创伤性髋关节炎）为28髋（66．7％），滑膜炎类病变（包括强直性髋关节炎、色素沉着绒毛结节性滑膜炎和慢性滑膜炎）为20髋（74．0％），髋关节游离体为2髋（100％），盂唇损伤为5髋（83．3％）；关节活动改善程度：股骨头坏死为39髋（78．0％），骨性关节炎为29髋（69．0％），滑膜炎类病变为23髋（85．1％），髋关节游离体和盂唇损伤的功能均达到正常。[结论]髋关节镜对于髋关节滑膜类病变、关节软骨类病变，可达到良好的治疗效果；对于股骨头坏死的治疗必需与其他方法配合使用。髋关节镜作为一种微创手术，具有对关节血运和稳定性破坏小的优势，对于减轻疼痛、改善关节活动功能、延缓关节置换的时间起到了积极的作用。[Objective] To research the method, curative effect and indications of applying arthroscopy to treat hip disease, and investigate the valuation of arthroscopy on hip disease. [ Method] Totally 103 patients （129 hips） were treated with arthroscopy by corresponsive modus operandi according to different pathogenetic conditions from Oct. 2001 to Jan. 2007. Among the total cases, 50 hips were osteonecrosis of the femoral head ; 8 hips were traumatic hip arthritis ; 34 hips were hip osteoarthritis ; 9 hips were pigmented villonodular synovitis ; 12 hips were hip arthritis of ankylosing spondylitis ; 6 hips were chronic synovitis; 6 hips were acetabular labrum injury; 2 hips were hip joint corpus liberum; 2 hips were coxarthropathy with indefinite reasons. According to the different pathological changes, clearing synovium, biting off or gouging cataplasis cartilage, trimming asperous articular surface and sclerotin surface, stripping hyperplastic osteophyma, drilling under the cartilage to decompress, biting off and gouging injury glenoid labrum, dislodging corpus liberum, lavaging articular cavity with physiological saline and other therapeutic tools were applied. [ Result] An average follow - up of 22 months （6 months to 5 years） showed improvements on pain and function. According to Harris Hip Score evaluation system, the postoperative score was 85 ± 3. 4 compared to the preoperative score 49 ±4. 3 （ t = 4. 18, P 〈 0. 001 ） . The extent of relieving pain： osteonecrosis of the femoral head in 26 hips （52.0%）, hip osteoarthritis （ including traumatic hip arthritis） in 28 hips （66. 7% ）, synovitis affections （ including pigmented villonodular synovitis, hip arthritis of ankylosing spondylitis and chronic synovitis） in 20 hips （74.0%）, hip joint corpus liberum in 2 hips （ 100% ）, acetabular labrum injury in 5 hips （83.3%） . The extent of improving joint motion： osteonecrosis of the femoral head in 39 hips （78.0%）, hip osteoarthritis in 29 hips （69. 0% ）, synovitis a

关 键 词：髋关节镜 髋关节疾病 临床研究 

分 类 号：R687.4[医药卫生—骨科学]