由外向内纵切与由内向外横切关节囊切开技术治疗髋臼股骨撞击症的疗效比较  

Comparative efficacy of longitudinal outside-in versus transverse inside-out capsulotomy in arthroscopic intervention for femoral acetabular impingement:a clinical outcomes study

作　　者：冯峥 王雪松 宋关阳 Feng Zheng;Wang Xuesong;Song Guanyang(Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院,国家骨科医学中心,北京100035

出　　处：《中华骨科杂志》2023年第23期1547-1554,共8页Chinese Journal of Orthopaedics

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-06-90)。

摘　　要：目的比较由外向内纵切与由内向外横切关节囊切开技术治疗髋臼股骨撞击症(femoral acetabular impingement,FAI)的短期临床疗效。方法回顾性选取2020年8月至2021年6月行髋关节镜手术治疗FAI患者30例,男15例、女15例,年龄(40.9±10.7)岁(范围15~63岁),术中均采用由外向内纵向切开关节囊技术;按1∶1匹配2018年4月至2019年4月行髋关节镜手术治疗的FAI患者30例作为对照,男10例、女20例,年龄(40.6±9.2)岁(范围25~60岁),术中均采用由内向外横向切开关节囊技术。两组患者关节囊术中均未缝合。评估两组患者术后1年随访时的主观功能评分,包括改良Harris髋关节功能评分(modified Harris hip score,mHHS)和疼痛视觉模拟评分(visual analog scale,VAS),并计算两组mHHS评分的优良率和患者可接受症状状态(patient acceptable symptomatic state,PASS)达标率。结果两组患者的基线资料、术前主观功能评分、术前影像学测量结果及术中情况的差异无统计学意义(P>0.05)。纵切组VAS评分由术前(6.3±1.4)分降低至术后1年的(1.3±1.6)分,mHHS评分由术前(63.8±15.1)分改善为术后1年的(93.5±5.1)分,差异有统计学意义(t=13.00,P<0.001;t=14.63,P<0.001)。横切组VAS评分由术前(7.0±1.6)分降低至术后1年的(1.4±1.5)分,mHHS评分由术前(64.6±7.8)分改善为术后1年的(90.4±8.4)分,差异有统计学意义(t=13.44,P<0.001;t=13.68,P<0.001)。术后1年两组患者VAS评分及mHHS评分的差异均无统计学意义(t=0.03,P=0.735;t=1.75,P=0.082)。根据mHHS评分标准,术后1年纵切组优良率为100%(30/30)、横切组优良率为83.3%(25/30),组间差异有统计学意义(χ^(2)=8.32,P<0.001);纵切组术后1年mHHS评分的PASS达标率为100%、横切组为90%,组间差异有统计学意义(χ^(2)=6.54,P<0.001)。结论关节镜手术中由外向内纵向切开关节囊治疗FAI是一项有效的技术,能达到与由内向外横向切开关节囊技术相近的临床疗效。ObjectiveTo compare the short-term clinical outcomes associated with longitudinal outside-in capsulotomy and transverse inside-out capsulotomy in arthroscopic surgery for femoral acetabular impingement(FAI).MethodsA retrospective cohort study was conducted encompassing 30 patients who underwent arthroscopic surgery to address FAI from August 2020 to June 2021.This group,comprising an equal distribution of 15 males and 15 females with a mean age of 40.9±10.7 years(range 15-63 years),was subjected to longitudinal outside-in capsulotomy without subsequent capsular closure.Patients of the longitudinal capsulotomy group(Group L)were 1∶1 matched with another 30 patients who underwentarthroscopic surgery for FAI between April 2018 and April 2019 as controls,including 10 males and 20 females,aged 40.6±9.2 years old(range,25-60 years old).The control group(Group T)underwent transverse inside-out capsulotomy without capsular closure.The subjective functional outcomes within both groups were meticulously evaluated,including the modified Harris hip score(mHHS)and the visual analog scale(VAS).Additionally,the proportions of subjects achieving Grade A or B classifications and the patient acceptable symptomatic state(PASS)based upon the mHHS were scrupulously calculated.ResultsThe foundational data,encompassing pre-operative subjective functional scores,pre-operative radiological dimensions,and intra-operative discoveries,showed no significant differences between the groups(P>0.05).At the one-year follow-up,Group L demonstrated a reduced post-operative VAS score of 1.3±1.6,a diminution from the pre-operative mean of 6.3±1.4,alongside a mHHS improvement from 63.8±15.1 pre-operatively to 93.5±5.1 post-operatively.Conversely,Group T revealed a post-operative VAS score of 1.4±1.5,ameliorated from a pre-operative mean of 7.0±1.6,and an mHHS improvement from 64.6±7.8 pre-operatively to 90.4±8.4 post-operatively.The improvements of VAS and the mHHS showed statistical significance in both groups(P<0.001),yet no significant

关 键 词：关节囊 关节镜检查 治疗结果 髋臼股骨撞击症 

分 类 号：R687.4[医药卫生—骨科学]