50岁以上髋关节撞击综合征患者关节镜治疗效果临床研究  

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in Patients over 50 Years Old

作　　者：张辛[1] 徐雁[1] 鞠晓东[1] 梅宇[1] 牛星跃 麦合木提.麦麦提敏 孙疆 王健全[1] 

机构地区：[1]北京大学第三医院运动医学研究所,北京100191

出　　处：《中国运动医学杂志》2018年第2期97-103,共7页Chinese Journal of Sports Medicine

基　　金：北京市自然科学基金(71622201;7172229);北京市科技新星交叉合作项目(Z171100001117133)

摘　　要：目的:通过研究50岁以上髋关节撞击综合征(femoroacetabular impingement,FAI)患者关节镜治疗后的临床效果,初步探讨国人中老年髋关节撞击综合征患者的发病规律和治疗方案。方法:回顾性研究2012年5月到2017年5月71例(78例髋)因FAI在我科行关节镜治疗的50岁以上老年患者的临床资料并随访,随访时间6~66月,平均31.78±18.07月。患者关节间隙2 mm以上,髋关节骨关节病T?nnis评分Ⅰ至Ⅱ级,关节镜下进行增生滑膜清理、同时修复损伤盂唇及软骨,磨除股骨头颈部或髋臼增生,去除撞击因素,恢复髋臼和股骨头颈正常形态。术后随访,对比患者术前术后关节隙宽度、Dunn位X线片上的α角的变化和正位X线CE角变化;记录患者术中软骨和盂唇损伤、修复情况和髋关节撞击畸形纠正情况;通过患者术前术后的mHHS评分、VAS评分评估患者疼痛缓解和关节功能恢复情况;并对患者手术满意度、并发症等进行观察。结果:患者的平均年龄为55.15±5.02岁,男23例(27髋),女48例(51髋);年龄50~69岁,左髋33例,右髋45例。患者术前关节隙平均4.81±0.87 mm。术后切口均Ⅰ期愈合。患者术前α角50.11±4.75度,术后α角42.72±4.7度,7例髋8.97%的患者α角>55度,40例髋51.28%的患者α角>50度。患者术前CE角36.54±9.14度,术后CE角35.19±8.55度,27例髋34.62%的患者CE角>40度。患者主要临床表现为髋关节疼痛、肿胀,其中36例髋(36/78,46.15%)合并关节绞锁。查体70例髋(70/78,89.74%)存在腹股沟区压痛,髋内收内旋撞击试验(FADIR)阳性75髋(75/78,96.15%),髋外展外旋撞击试验阳性64髋(64/78,83.33%),均以引起髋关节疼痛或活动受限为阳性。术后患者疼痛症状均明显缓解或消失,VAS评分由术前的4.42±1.42分降至末次随访时的1.31±1.28分(P<0.01);髋关节功能恢复明显,mHHS评分由术前的52.4±19.38分提高至末次随访时的81.72±10.82分(P<0.01)。89%的患者mHHs和VAS评分有显著提高(P<0.01Objective To evaluate the clinical effect of arthroscopic treatment of femoroacetabular impingement syndrome（FAI）for patients over 50 years old,and explore the occurrence regularity and treating rules for such a disease. Methods The clinical data of 71 patients（78 hips with FAI） over 50 years old who underwent arthroscopic treatment for FAI in our department between May 2012 and May2017 were studied retrospectively. Physical examination,X-ray and CT 3D scans were made preoperatively for explicit diagnosis. The follow-up period ranged from 6 to 66 months,with an average of 31.78 ±18.07 months. Every patient had a joint space greater than 2 mm,and a grade Ⅰ or Ⅱ hip osteoarthrosis according to the T？nnis scale. Under the hip arthroscopy the synovial hyperplasia was cleaned,the damaged labrum and cartilage were repaired,and the femoroacetabular hyperplasia and the impingement factors were removed to restore the normal shape of femoroacetabular. The joint clearance,changes of the alpha angle when at Dunn position and centre edge（CE） angle at normotopia on the X-ray,the intraoperative injuries of cartilages and glenoid labrum and surgical satisfaction and complications were measured and recorded. The modified Harris hip score（mHHS） and visual analogue scale（VAS） were used to evaluate the hip function recovery and pain relief of patients. Results The average age of the patients was 55.15 ± 5.02 years old,ranging from 50 to 69. Among the 23 males and 48 females,there were 33 left hips with FAI and 45 right hips with FAI. The average preoperative joint clearance was 4.81 ± 0.87 mm,and all incisions were healed by first intention after the treatment. The average α angle of the patients decreased from 50.11 ± 4.75 to 42.72 ± 4.7 degrees after the treatment,with the α angle of 7 patients（8.97%）bigger than 55 degree,and that of 40 patients（51.28%）smaller than 50 degree. The average CE angle decreased from 36.54 ± 9.14 degrees to 35.19 ± 8.55 degrees after the treatment,with that of

关 键 词：髋关节 关节镜 股骨髋臼撞击症 老年患者 

分 类 号：R687.4[医药卫生—骨科学]