关节镜治疗临界发育性髋关节发育不良合并凸轮型股骨髋臼撞击综合征  

Arthroscopic treatment for patients with borderline developmental dysplasia of the hip and cam-type femoroacetabular impingement syndrome

作　　者：罗杨[1] 张佳[2] 张建平[2] 吴毅东 于康康 李海鹏[2] 肇刚[2] 李众利[2] 刘玉杰[2] 李春宝[2] Luo Yang;Zhang Jia;Zhang Jianping;Wu Yidong;Yu Kangkang;Li Haipeng;Zhao Gang;Li Zhongli;Liu Yujie;Li Chunbao(Department of Orthopaedics,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Orthopaedics,the Fourth Medical Center of PLA General Hospital,Beijing 100037,China)

机构地区：[1]解放军总医院第一医学中心骨科,北京100853 [2]解放军总医院第四医学中心骨科,北京100037

出　　处：《中华骨科杂志》2022年第21期1416-1422,共7页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划项目(2018YFF0301100、2019YFE0126300);解放军总医院临床科研扶持基金(2018FC-WJFWZX-1-06);解放军总医院军事医学创新研究项目(CX19004)。

摘　　要：目的探讨应用关节镜技术治疗临界发育性髋关节发育不良合并凸轮型股骨髋臼撞击综合征的临床疗效。方法回顾性分析2017年7月至2019年12月收治的临界性髋关节发育不良合并凸轮型股骨髋臼撞击综合征并随访2年以上的患者32例, 男15例、女17例, 年龄(36.13±8.67)岁(范围20~50岁)。术前外侧中心边缘角(lateral center-edge angle, LCEA)为22.3°±1.6°(范围20.1°~24.7°)、α角为64.1°±4.6°(范围56.0°~69.8°)。术前通过超声引导下髋关节封闭试验排除髋关节外疾病, 采用髋关节镜下髋臼有限成形、盂唇缝合、头颈区充分成形、关节囊紧缩缝合术治疗。术前、术后1年、术后2年随访时应用视觉模拟评分(visual analogue scale, VAS)、改良Harris评分(modified Harris Hip Scores, mHHS)和国际髋关节评分(International Hip Outcome Tool-12, iHOT-12)评价疗效。结果 32例患者均获得随访, 平均随访时间(2.5 ±0.8)年(范围2.0~4.7年)。VAS评分由术前(6.07±1.56)分降低至术后1年(1.96±0.92)分、术后2年(1.86±1.01)分, 手术前后的差异有统计学意义(F=112.64, P<0.001);mHHS评分由术前(53.87±13.04)分提高至术后1年(86.12±8.64)分、术后2年(88.71±8.15)分, 手术前后的差异有统计学意义(F=101.70, P<0.001);iHOT-12评分由术前(40.00±7.33)分提高至术后1年(76.27±9.50)分、术后2年(78.67±10.31)分, 差异有统计学意义(F=134.91, P<0.001)。术后α角降低至40.27°±4.52°(范围34.8°~49.7°), 与术前比较差异有统计学意义(t=9.24, P<0.001)。随访期间无一例需行翻修手术。结论关节镜技术治疗临界发育性髋关节发育不良合并凸轮型股骨髋臼撞击综合征可获得良好的短期疗效, 术后2年随访期间翻修率低。Objective To evaluate the clinical outcomes of patients with borderline developmental dysplasia of the hip(BDDH)and cam-type femoroacetabular impingement syndrome(FAIS)after hip arthroscopy.Methods Data were retrospectively reviewed for patients with BDDH and cam-type FAIS who underwent hip arthroscopy surgery from June 2017 to December 2019.A total of 32 patients were enrolled,with a mean age of 36.13±8.67 years(range,20-50 years),including 15 males and 17 females.The preoperative lateral center-edge angle was 22.3°±1.6°(range 20.1°-24.7°),while the preoperativeαangle was 64.1°±4.6°(range,56.0°-69.8°).All patients were treated with arthroscopic limited acetabular plasty,labral repair,femoral osteoplasty,and capsular plication after excluding from external hip diseases by ultrasound-guided hip blocking test.The visual analogue scale(VAS),modified Harris Hip Scores(mHHS)and International Hip Outcome Tool-12(iHOT-12)scores were used to evaluate the clinical effects.Results All patients were followed up,and the mean follow-up time was 2.5±0.8 years(range,2.0-4.7 years).The VAS score decreased from 6.07±1.56 to 1.96±0.92 at 1 year and to 1.86±1.01 at 2 years after operation(F=112.64,P<0.001);the mHHS score increased from 53.87±13.04 to 86.12±8.64 at 1 year and to 88.71±8.15 at 2 years after operation(F=101.70,P<0.001);the iHOT-12 score was improved from 40.00±7.33 to 76.27±9.50 at 1 year and to 78.67±10.31 at 2 years after operation(F=134.91,P<0.001).Theαangle improved to 40.27°±4.52°(range,34.8°-49.7°)with significant difference(t=9.24,P<0.001).Conclusion Hip arthroscopy can achieve satisfied short-term outcomes in treating BDDH and cam-type FAIS with few complications and less trauma.

关 键 词：关节镜检查 发育性髋关节发育不良 股骨髋臼撞击征 

分 类 号：R687.4[医药卫生—骨科学]