高水平运动员髋关节镜手术临床疗效及影响因素分析  

Study on the Clinical Efficacy and Prognostic Factors of Hip Arthroscopy for High-level Athletes

作　　者：黄洪杰[1] 贺子熠 杨帆[1] 隆卫华 张竹 鞠晓东[1] 徐雁[1] 张辛[1] 王健全[1] Huang Hongjie;He Ziyi;Yang Fan;Long Weihua;Zhang Zhu;Ju Xiaodong;Xu Yan;Zhang Xin;Wang Jianquan(Institute of Sports Medicine,Peking University Third Hospital,Beijing 100191,China;School of Basic Medical Sciences,Peking University,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学科,北京大学运动医学研究所,北京100191 [2]北京大学基础医学院,北京100191

出　　处：《中国运动医学杂志》2022年第6期417-422,共6页Chinese Journal of Sports Medicine

基　　金：国家自然科学基金青年科学基金项目(81902205)。

摘　　要：目的:探讨应用髋关节镜治疗高水平运动员髋关节损伤的手术疗效及影响预后的相关因素。方法:回顾性研究2007年5月至2020年11月因髋关节损伤在我院行髋关节镜治疗的34例(35髋)高水平运动员患者的临床资料并随访。34例患者中有8例为二级运动员,5例为一级运动员,9例为运动健将,4例为国际级运动健将,8例未参与技术等级评定。患者平均年龄24.89±11.13(13~54)岁,男性18例、女性16例;左髋13例、右髋20例、双髋1例;受伤到手术时间平均为18.67±22.08月。随访时间11~172月,平均72.68±36.76月。术前拍摄X线片及CT扫描,测量α角、外侧中心边缘角(LCEA)、T?nnis角及髋臼角(Sharp角)等。术中记录髋关节镜下处理内容,包括修复损伤的盂唇及关节软骨,磨除股骨头颈部或髋臼增生,恢复髋臼和股骨头颈正常形态。通过患者术前、术后的改良Harris评分(mHHS)、疼痛视觉模拟评分(VAS)及术后回归运动情况,评估患者疼痛缓解和关节功能恢复情况。结果:患者术前α角66.71°±8.34°、LCEA 26.32°±7.80°、T?nnis角5.55°±6.17°、Sharp角40.21°±4.03°。髋关节mHHS评分由术前的77.07±15.12分提升至末次随访时的95.9±3.30分(P<0.01),VAS评分由术前的5.32±1.95分降低至末次随访时的1.94±1.79分(P<0.01)。但在从事超活动度运动(体操、舞蹈)和不对称/过顶运动(羽毛球、乒乓球)的患者中,术后疼痛VAS评分和mHHS评分改善不明显(P>0.05)。34例患者中有3例患者因术后疼痛改善不明显、盂唇软骨再次损伤在我院进行了髋关节镜翻修手术。影像学结果显示部分从事超活动度运动的患者和翻修患者Tonnis角>10°而LCEA<20°,存在明显的髋关节发育不良。全部27例现役运动员中有25例回归正常运动,回归运动率(RTS)达到92.6%。未发现患者性别和体质指数(BMI)对患者术后疗效存在影响。结论:髋关节镜治疗高水平运动员髋关节损伤术后症状显著�Objective To explore the clinical effect of hip arthroscopy in the treatment of high-level athletes’hip joint injuries and factors affecting prognosis.Methods A retrospective study was conducted on the clinical data of 34 high-level athlete patients(35 hips)who underwent hip arthroscopy in our hospital between May 2007 and November 2020 due to hip joint injuries.With an average age of24.89±11.13(13~54)years,eight and five were national second-and first-level athletes,while another nine and four were national and international master sportsmen.Among the 18 males and 16 females,13 left hips,20 right hips and 1 double hip were injured.The average injury-operation interval was 18.67±22.08 months,and the average follow-up time was 72.68±36.76 months,ranging from 11 to 172 months.Before the operation,the X-ray and CT scan were taken,and the α angle,lateral center-edge angle(LCEA),Tonnis angle and Sharp angle were measured.The treatment under the microscope were recorded,including repairing the damaged labrum and articular cartilage,removing the femoral head and neck or acetabular hyperplasia to restore the normal shape.The modified Harris hip score(mHHS)and visual analogue scale(VAS)were used to evaluate the hip function recovery and pain relief before and after the operation.Results The average preoperative α angle,LCEA,Tonnis angle and Sharp angle were 66.71±8.34,26.32±7.80,5.55±6.17 and 40.21±4.03 degrees respectively.The mHHS score of the hip joint increased significantly from 77.07±15.12 before surgery to 95.9±3.30 at the last follow-up(P<0.01),while the average VAS score decreased significantly from 5.32±1.95 before surgery to 1.94±1.79 at the last follow-up(P<0.01).However,no significant improvement was observed in the average VAS score and mHHS scores of patients engaged in flexibility sports(gymnastics and dance)and asymmetric/overhead sports(badminton and table tennis)(P>0.05).Three patients underwent a second surgery in our hospital due to insignificant improvement in pain relief and re-injury

关 键 词：髋关节镜 高水平运动员 髋关节损伤 股骨髋臼撞击综合征 

分 类 号：R687.4[医药卫生—骨科学]