髋关节镜翻修术的原因与临床效果  

Reasons and clinical outcomes of revision hip arthroscopy

作　　者：肇刚 安明扬 王江涛 张佳 张柏青 张加廷 齐玮 李春宝 刘玉杰 ZHAO Gang;AN Ming-yang;WANG Jiang-tao;ZHANG Jia;ZHANG Bai-qing;ZHANG Jia-ting;QI Wei;LI Chun-bao;LIU Yu-jie(Department of Orthopedics,The First Medical Centre,General Hospital of CPLA,Beijing 100853t China;Z Department of Orthopaedics,The 984h Hospital,Joint Logistic Support Force of CPLA,Beijing 100029,China)

机构地区：[1]中国人民解放军总医院第一医学中心骨科,北京100853 [2]中国人民解放军联勤保障部队第九八四医院骨科,北京100094

出　　处：《中国矫形外科杂志》2022年第5期399-404,共6页Orthopedic Journal of China

基　　金：2019年度国家重点研发计划“政府间国际科技创新合作/港澳台科技创新合作”重点专项-中国和芬兰政府间科技合作项目;2019年度北京市自然科学基金面上项目(编号:7192195);全军医学科技青年拔尖项目(编号:19QNP070)。

摘　　要：[目的]探讨翻修髋关节镜术的原因及疗效.[方法]2015年6月—2019年12月,本院共行髋关节镜手术359例,其中26例再次手术翻修,占7.24%.26例患者本次翻修术前均有不同程度的疼痛和活动受限.初次手术后症状的持续时间为3~36个月,平均(15.88±8.04)个月.翻修术探明病因,并给予相应手术处理.[结果]翻修术中证实,26患者中,FAI残余畸形者21例,占80.77%;骨样骨瘤误诊为FAI 2例,占7.69%;滑膜软骨瘤复发1例,占3.85%;异位骨化1例,占3.85%;色素沉着绒毛结节性滑膜炎复发1例,占3.85%.全部26患者均成功接受翻修手术,无髋关节脱位、骨折、感染以及其他并发症发生.翻修术后随访12~26个月,平均(17.54±4.24)个月.与翻修术前相比,末次随访时26例患者的FADIR试验、FABER试验和滚动试验均显著改善(P<0.05).与翻修术前相比,末次随访时26例患者的0°位内旋ROM、0°位外旋ROM、90.位内旋ROM、90.位外旋ROM、屈髋ROM、mHHS和iHOT12评分均显著增加(P<0.05).而VAS评分显著下降(P<0.05).影像方面,与翻修术前相比,末次随访时26例患者的α角显著减小(P<0.05),而偏心距显著增加(P<0.05),但是LCEA角无显著变化(P>0.05).[结论]髋关节镜翻修手术的原因主要包括FAI成型不全、误诊、漏诊、骨病复发等.在正确的术前诊断和成熟的手术操作技术的前提下,翻修髋关节镜术仍可获得良好的临床效果.[Objective]To explore the reasons and clinical outcomes of revision hip arthroscopy.[Methods]From June 2015 to December 2019,a total of 359 patients underwent hip arthroscopy in our hospital.Of them,26 patients received revision hip arthroscopy,account-ed for 7.24%,for varying extent of pain and activity limitation before the revision surgery,which lasted for 3〜36 months,(15.88±8.04)months on an average,after initial surgery.The revision hip arthroscopy was conducted to identify the cause of the symptoms and give appropriate treatment.[Results]As findings of revision hip arthroscopy among the 26 patients,residual deformities of femoroacetabular impingement(FAI)were seen in 21 patients,accounted for 80.77%;osteoid osteoma misdiagnosed as FAI in the primary operation in the other hospital was noted in 2 patients,accounted for 7.69%;recurrent synovial chondroma was found in 1 patient,accounted for 3.85%;heterotopic ossification was in 1 case,accounted for 3.85%;and recurrent pigmented villonodular synovitis was in 1 case,accounted for 3.85%.All the 26 patients had revision hip arthroscopy performed successfully without serious complications,such as hip dislocation,fracture,infec-tion and others.The follow-up period lasted for 12~26 months,with a mean of(17.54±4.24)months after the revision.The FADIR test,FABER test,and rolling test significantly improved in all the 26 patients at the latest follow-up compared with those before revision(P<0.05).In addition,the ROMs,including internal rotation at 0°of flexion,the external rotation at 0°of flexion,internal rotation at 90°of flex-ion,the external rotation at 90°and hip flexion,as well as the mHHS and the IHOT12 scores significantly increased(P<0.05),whereas the VAS score for pain significantly decreased at the latest follow-up compared with those before revision surgery(P<0.05).In term of radiographic evaluation,the a angle decreased and the femoral head-neck offset increased significantly at the latest follow-up compared with those before revision(P<0.05),where

关 键 词：髋关节镜术 翻修 股骨髋臼撞击症 残留畸形 

分 类 号：R687.4[医药卫生—骨科学]