髋关节镜下盂唇修补与盂唇切除治疗髋关节退变性盂唇损伤的近期疗效比较  

Early Comparative Study of Hip Arthroscopic Labrum Repair and Labrum Resection in the Treatment of Hip Labrum Tear

作　　者：刘亮[1] 桂琦[1] 赵峰[1] 申学振 丛晓鹏 张星火[1] LIU Liang;GUI Qi;ZHAO Feng;SHEN Xue-zhen;CONG Xiao-peng;ZHANG Xing-huo(Orthopaedic Center, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京潞河医院骨中心,北京101149

出　　处：《中国现代手术学杂志》2021年第2期110-116,共7页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较关节镜下盂唇修补术与盂唇切除术治疗髋关节盂唇损伤的近期临床疗效。方法回顾性分析2019年1月至2020年1月首都医科大学附属北京潞河医院骨中心治疗的55例患者的临床资料,均因股骨髋臼撞击症造成髋关节严重退变性盂唇损伤行髋关节镜手术。其中32例采用关节镜下盂唇切除治疗(切除组),23例采用盂唇修补治疗(修补组)。术后对患者进行随访,并行髋关节MRI检查,收集患者的手术时间、术前及末次随访时的改良Harris评分、非关节炎髋关节评分(non arthritis hip score,NAHS)、髋关节结局评分(hip outcome score,HOS)及疼痛视觉模拟评分(visual analogue scale,VAS)。结果切除组手术时间[M(P25,P75)]为109.5(85.8,130.0)min,短于修补组的130.7(115.0,145.0)min,差异有统计学意义(P<0.05)。55例患者术后平均随访时间为15.5(9~24)个月。末次随访时切除组患者的mHHS、NAHS、HOS-ADL及HOS-SSS评分分别为86.1(84.0,90.0)分,83.0(71.9,91.9)分,89.2(87.1,91.2)分和(79.7±7.2)分,相较于修补组的86.4(82.0,91.0)分,85.6(81.3,91.3)分,88.6(88.3,92.7)分和(79.1±5.7)分,无统计学差异(P>0.05);VAS评分切除组为2.3(1.3,3.0)分,修补组为3.3(3.0,4.0)分,差异有统计学意义(P<0.05);5例修补组患者在术后1年随访时主诉有负重后疼痛,查MRI示部分盂唇修补后愈合不良。结论关节镜下盂唇修补及切除手术对于治疗ALADⅢ、Ⅳ型退变的盂唇损伤均能获得良好的临床近期效果,两者在临床评分方面无明显差异。但盂唇修补组手术时间偏长,部分患者存在局部疼痛,需进一步长期随访观察。Objective To compare the early clinical efficacy of arthroscopic labrum repair and labrum resection in the treatment of hip labrum injury.Methods From January 2019 to January 2020,55 patients with severe degenerative labrum injury due to hip impingement who underwent hip arthroscopic surgery were retrospectively analyzed.32 cases were treated with arthroscopic labrum resection(group A),and 23 cases were treated with labrum repair(group B).The patients were followed up for 1 year after operation and MRI examination of hip joint was performed.Operation time,modified Harris score,non arthritis hip score(NaHS),hip outcome score(HOS)and visual analogue scale(VAS)were collected.Results Operation time of group A[M(P25,P75)]was 109.5(85.8,130.0)min,which was shorter than that of group B,130.7(115.0,145.0)min.And the difference was statistically significant(P<0.05).The mean follow-up period was 15.5(9~24)months.At the end of follow-up,mHHS,NAHS,HOS-ADL and HOS-SSS of group A was 86.1(84.0,90.0),83.0(71.9,91.9),89.2(87.1,91.2)and(79.7±7.2),which had no significant difference with group B,86.4(82.0,91.0),85.6(81.3,91.3),88.6(88.3,92.7)and(79.1±5.7)(P>0.05).VAS was 2.3(1.3,3.0)of group A,which was lower than 3.3(3.0,4.0)of group B(P<0.05).At the end of follow-up,5 patients of group B complained of hip pain after weight bearing,and MRI showed poor healing of labrum after partial repair.Conclusion It can obtain good early clinical results by both of arthroscopic labrum repair and resection for ALADⅢandⅣtype of degenerative labrum injury.However,in the labrum repair group,longer operation time and postoperative local pain is observed,which needs further long-term follow-up.

关 键 词：髋关节 盂唇损伤 关节镜检查 盂唇修补 盂唇切除 

分 类 号：R616.2[医药卫生—外科学]