Cam型股骨髋臼撞击症的关节镜治疗  

Arthroscopic treatment of Cam-type femoroacetabular impingement

作　　者：从爽 刘少华 孙亚英 丁哲慈 陈疾忤 Cong Shuang;Liu Shaohua;Sun Yaying;Ding Zheci;Chen Jiwu(Department of Sports Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院运动医学科运动医学科,上海200040

出　　处：《中华骨科杂志》2019年第22期1405-1412,共8页Chinese Journal of Orthopaedics

摘　　要：股骨髋臼撞击症(femoroacetabular impingement,FAI),是在中青年活跃人群和运动员中导致髋关节疼痛和活动受限的常见原因。其继发的髋臼盂唇撕裂和软骨损伤,会增加髋关节发生骨性关节炎的风险。FAI是由股骨头颈交界处和髋臼边缘骨性结构畸形导致的病理性撞击,根据产生撞击的病理解剖,FAI可被分为股骨侧的凸轮(Cam)型,髋臼侧的钳夹(Pincer)型,和混合型。近年来,髋关节镜下股骨头颈成型术是治疗Cam型撞击的主要方法;然而,如何进行充分有效的关节镜下股骨头颈成型,仍未达成共识。基于这一问题,对于FAI中Cam畸形的术前判断、术中评估、手术技术和术后评估等相关文章进行了综述,探究如何在关节镜下充分切除Cam畸形。通过检索PubMed、Web of Science、Cochrane library、中国知网、万方全文数据库、维普科技期刊数据库,根据纳入及排除标准进行筛选,最终纳入文献43篇。经过对以上文献的总结归纳发现,通过X线、三维CT和MRI检查,可以在术前评估Cam畸形、股骨颈前倾角和髋臼覆盖等解剖结构。在股骨头颈成型术中,需要借助X线透视和关节镜动态检查来定位Cam畸形,并判断股骨颈偏心率和股骨头球形结构是否得到矫正,同时需要综合考虑髋关节整体解剖结构,以充分有效地切除Cam畸形,恢复患者髋关节的正常活动度。Femoroacetabular impingement(FAI)is a common cause of hip pain and limited range of motion among young and middle-aged active adults and athletes.The acetabular labral tear and cartilage damage secondary to FAI may increase the risk of hip osteoarthritis.FAI is characterized by pathologic impact between the femoral headneck junction and the acetabular rim secondary to bony deformity.According to the pathological anatomy leading to impingement,the FAI can be divided into the femoral cam-type deformity(Cam),the acetabular over-coverage deformity(Pincer)and a combination of both.In recent years,arthroscopic osteoplasty of the femoral head-neck junction is the main way to treat the Cam deformity;However,there still remain some controversies about how to perform an adequate and effective arthroscopic femoroplasty.Based on this problem,the present article reviewed the preoperative diagnosis,intraoperative evaluation,surgical techniques and postoperative evaluation of Cam-type FAI to explore how to adequately correct Cam deformity under arthroscopy.In the present study,a total of 1928 related articles were obtained by searching PubMed,Web of Science,Cochrane library,China Knowledge Network,Wanfang Full-text Database and Weipu Science and Technology Journal Database.According to the inclusion and exclusion criteria,43 papers were finally included.After summarizing the above literatures,it was found that anatomical structures such as Cam deformity,femoral neck anteversion,and acetabular coverage can be evaluated preoperatively by X-ray,three-dimensional CT and MRI.X-ray fluoroscopy and arthroscopic dynamic examination are performed during the femoroplasty to locate the Cam deformity and to determine whether the femoral neck offset radio and the spherical structure of femoral head are corrected,at the same time,it is necessary to consider the overall anatomy of the hip joint to achieve an adequate resection of the Cam deformity and restore the normal mobility of the hip joint.

关 键 词：股骨头颈 股骨颈前倾角 髋关节疼痛 成型术 骨性结构 软骨损伤 骨性关节炎 动态检查 

分 类 号：R68[医药卫生—骨科学]