关节镜下带血供关节囊移植重建髋臼盂唇疗效的初步研究  

Preliminary study of arthroscopic reconstruction of acetabular labrum by capsular autograft

作　　者：欧阳侃[1] 王大平[1] 熊建义[1] 陆伟[1] 朱伟民[1] 钟名金 许鉴 OUYANG Kan;WANG Daping;XIONG Jianyi;LU Wei;ZHU Weimin;Zhong Mingjin;XU Jian(Department of Sport Medicine,Shenzhen Second People's Hospital,Shenzhen 518035,Guangdong,China)

机构地区：[1]深圳市第二人民医院运动医学科,广东深圳518035

出　　处：《中华骨与关节外科杂志》2019年第4期277-280,315,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:髋臼盂唇在维持髋功能和减少髋退行性病变中起十分重要的作用。盂唇重建手术在全世界范围内仍是一个相对较新的领域,对于无法修复或需要在初次修复后进行翻修的髋臼盂唇损伤,采用各种组织来源的移植物重建髋臼盂唇正逐渐成为一种新的充满前景的治疗方式。目的:介绍关节镜下关节囊移植重建髋臼盂唇手术技术并评估其临床疗效。方法:2014年1月至2016年1月,对21例患者进行关节镜下关节囊移植重建髋臼盂唇,其中男9例,女12例,平均年龄(46.7±5.7)岁;患者随访6~23个月,平均随访(14.5±2.3)个月;采用改良Harris髋关节评分(mHHS)、髋关节功能评分(HOS)、日常生活髋关节功能评分(HOS-ADL)对疗效进行评估。结果:盂唇发育不良(宽度<5 mm)7例,复杂撕裂9例,明显退变5例。术后患者无严重并发症发生。手术前后mHHS比较,差异有统计学意义[(62.5±3.1)vs(87.2±3.3)分,P<0.001];手术前后HOS比较,差异有统计学意义[(42.7±5.5)vs(86.3±2.3)分,P<0.001];手术前后HOSADL评分比较,差异有统计学意义[(46.0%±3.6%)vs(73.7%±3.5%),P<0.001]。不同性别mHHS、HOS及HOS-ADL评分比较,差异无统计学意义。结论:对于盂唇发育不良、复杂撕裂、明显退变,建议行盂唇重建术,以恢复盂唇复合体的完整性;采用局部关节囊重建盂唇,在不增加手术复杂程度的同时保障了供体组织的血供,且不增加移植部位的并发症。Background: The acetabular labrum plays an important role in maintaining hip function and minimizing hip degeneration. Although as a relatively new field, labral reconstruction surgery with various autograft and allograft is becoming more and more popular in patients with acetabular labrum injury irreparable or requiring revision after primary repair. Objective: To introduce a technique for reconstruction of the acetabular labrum by capsular autograft and assess the outcome. Methods: From January 2014 to January 2016, 21 patients underwent arthroscopic reconstruction of the acetabular labrum by capsular autograft including 9 males and 12 females, with the mean age of(46.7 ±5.7) years. All patients were followed up for 6 to 23 months, with an average of(14.5±2.3) months. The outcomes were measured with the modified Harris Hip Score(mHHS), Hip Outcome Score(HOS) and Hip Outcome Score-Activities of Daily Living(HOS-ADL). Results: 7 patients were found hypoplastic acetabular labrum(width <5 mm), 9 patients were found complex tearing of acetabular labrum, and 5 patients were found degenerative acetabular labrumin. The differences in mHHS [(62.5±3.1) vs(87.2±3.3)分, P<0.001], HOS [(42.7±5.5) vs(86.3±2.3)分,P<0.001] and HOS-ADL [(46.0%±3.6%)vs(73.7%±3.5%),P<0.001] were statistically significant between preoperation and final follow up. No significant difference was identified in mHHS, HOS and HOS-ADL between gender groups.Conclusions: Reconstruction of the acetabular labrum by capsular autograft is recommended in patients with hypoplastic acetabular labrum,complex tearing of acetabular labrum and degenerative acetabular labrumin to restore functional labral anatomy, and will not increase the complications of donor-site or make the procedure more complicated for preservation of the donor-tissue blood supply when using of capsular autograft.

关 键 词：关节镜 髋关节 髋臼盂唇 盂唇重建 

分 类 号：R687.4[医药卫生—骨科学]