双侧股骨髋臼撞击综合征的临床特点与关节镜治疗  

Clinical characteristics and arthroscopic treatment of bilateral femoroacetabular impingement syndrome

作　　者：钟名金 耿红荔 丘志河 梁达强 柳海峰[1] 彭亮权[1] 欧阳侃[1] 朱伟民[1] 陆伟[1] 王大平[1] ZHONG Mingjin;GENG Hongli;QIU Zhihe;LIANG Daqiang;LIU Haifeng;PENG Liangquan;OUYAN Kan;ZHU Weimin;LU Wei;WANG Daping(Department of Sports Medicine,The Second People's Hospital of Shenzhen,Shenzhen 518025,Guangdong;Department of Rehabilitation Medicine,The First Affiliated Hospital of Shenzhen University,The Second People's Hospital of Shenzhen,Shenzhen 518025,Guangdong;Shenzhen University Health Science Center,Shenzhen 518060,Guangdong,China)

机构地区：[1]深圳大学第一附属医院深圳市第二人民医院运动医学科,广东深圳518025 [2]深圳大学第一附属医院深圳市第二人民医院康复医学科,广东深圳518025 [3]深圳大学医学部,广东深圳518060

出　　处：《中华骨与关节外科杂志》2021年第11期941-946,共6页Chinese Journal of Bone and Joint Surgery

基　　金：深圳市第二人民医院临床研究项目(20193357019)。

摘　　要：目的:探讨双侧股骨髋臼综合征(B-FAI)的临床特点和关节镜治疗效果。方法:回顾性分析2015年5月至2017年5月进行分期两次髋关节镜手术治疗的18例B-FAI患者,记录并比较手术前后双侧髋关节的影像学指标、临床症状和关节镜下病理表现,以及术前与末次随访时疼痛视觉模拟量表(VAS)评分和改良髋关节Harris评分(mHHS)。结果:本组18例患者第一次手术和第二手术时间间隔为3~14个月,平均(6.2±4.5)个月。术后随访8~24个月,平均随访时间(8.0±2.5)个月。术前两侧髋关节α角、外侧CE角(LCE)差异均无统计学意义(P均>0.05)。第一次手术侧髋关节SeldesⅠ型盂唇撕裂、Ⅱ级盂唇-软骨移行区损伤(ALAD)、OutbridgeⅡ度软骨损伤的比例要高于第二次手术侧髋关节,且差异均有统计学意义(P均<0.05);而两侧髋关节FAI类型、盂唇缝合及关节囊缝合的比例差异均无统计学意义(P均>0.05)。与术前相比,末次随访时两侧髋关节VAS评分均降低、m HHS评分均增高,且差异均有统计学意义(P均<0.01);而末次随访时两侧髋关节VAS评分、m HHS评分差异均无统计学意义(P均>0.05)。结论:FAI常常累及双侧髋关节,临床中应该常规进行双侧髋关节评估。B-FAI两侧髋关节影像学指标与髋关节的病理损伤相似。分期两次髋关节镜手术治疗B-FAI短期临床效果满意,建议两次手术的合理间隔为3~6个月。Objective:To explore the clinical characteristics of bilateral femoroacetabular impingement(B-FAI)and the arthroscopic effectiveness.Methods:Eighteen patients who underwent staged bilateral hip arthroscopy for B-FAI from May2015 to May 2017 were retrospectively analyzed.Imaging indexes,clinical presentations and symptoms,and arthroscopic pathological findings of both hips,as well as visual analog scale(VAS)score and modified Harris hip score(mHHS)were recorded.Results:The mean time interval between surgical procedures was(6.2±4.5)months(range,3-14 months).The mean duration of follow-up was(8.0±2.5)months(range,8-24 months).There was no significant difference in alpha angle or lateral center edge angle between two sides of hips(P>0.05).Patients had higher rates of SeldesⅠlabral tear,ALAD gradeⅡinjury and Outbridge gradeⅡcartilage lesion in the first surgery versus the second surgery(P<0.05).There were no statistical differences between the first and second surgical procedures in the FAI type,labral or capsule repair rate(P>0.05).Compared with preoperative ones,VAS score was significantly decreased and m HHS was increased on the both sides of hips at the final follow-up(P<0.01).But there were no statistical differences in the VAS score or mHHS between two sides(P>0.05).Conclusions:Bilateral hips are often involved in FAI and should be routinely evaluated.There are similar radiological parameters and pathological lesions on both sides of hips.Patients with bilateral FAI can benefit from staged hip arthroscopic surgery.It is recommended that the time interval between two surgical procedures should be 3 to 6 months.

关 键 词：股骨髋臼撞击综合征 双侧髋关节 病理损伤 髋关节镜 

分 类 号：R687.4[医药卫生—骨科学]