髋臼盂唇损伤的关节镜手术  

Early outcome of hip arthroscopy for acetabular labrale tears

作　　者：王卫国[1] 李子荣[1] 岳德波[1] 张念非[1] 洪闻[2] 

机构地区：[1]中日友好医院骨科、骨坏死与关节保留重建中心,北京100029 [2]中日友好医院诊断科,北京100029

出　　处：《中华骨科杂志》2010年第10期924-930,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目（30672117）;卫生部属（管）医疗单位临床重点学科项目（2007-2010）

摘　　要：目的探讨髋臼盂唇损伤的诊断方法和关节镜治疗结果。方法2008年11月至2009年12月收治单侧髋臼盂唇损伤行关节镜手术且随访时间超过半年的患者21例，男9例，女12例；年龄17-65岁，平均37．1岁。术前行体格检查、X线和MR关节造影明确诊断。于髋关节镜下行盂唇清理术14例、盂唇清理及股骨头颈区成形术5例、盂唇修复及股骨头颈区成形术2例。结果Fadir试验阳性21例（100％，21／21），Fabir试验阳性15例（71％，15／21），McCaahy试验阳性9例（43％，9／21）。X线片显示11例存在凸轮型撞击（其中6例合并钳夹型撞击），2例为单纯钳夹型撞击。MR关节造影均显示前上象限不同程度的盂唇损伤信号，阳性率100％；所有盂唇损伤均经关节镜证实，准确率100％。全部病例随访6-19个月，平均11．6个月。术后症状明显缓解，疼痛视觉模拟评分由术前（5．3±1．3）分降至术后6个月（1．4±0．9）分，Ha而s髋关节评分由术前（63±9）分提高至术后6个月（84±10）分，差异均有统计学意义。结论髋臼盂唇损伤与股骨髋臼撞击有关。撞击试验和MR关节造影具有较高的诊断阳性率和准确率。关节镜下髋臼盂唇损伤的清理、修复与骨成形术可获得满意的早期临床效果。Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography （MRA） were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridemeut in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview. The visual analogue scale （VAS） and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips, meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9 cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months （range, 6-19）. The symptoms were obviously released after operation. The VAS decreased from （5.3±1.3） preoperatively to （1.4±0.9） 6 months postoperatively. The mean Harris hip score improved from （63＋-9） preoperatively to （84± 10） 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteo- plasty for

关 键 词：髋臼 创伤和损伤 关节造影术 关节镜检查 

分 类 号：R686[医药卫生—骨科学]