髋关节囊未缝合对髋臼股骨撞击症关节镜治疗中长期疗效的影响  

Influence of non-sutured hip joint capsule on medium and long-term clinical efficacy of arthroscopic treatment of patients with femoral acetabular impingement syndrome

作　　者：沈林艺 李倩茹 李宏云 陈疾忤 Shen Linyi;Li Qianru;Li Hongyun;Chen Jiwu(Department of Sports Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Sports Medicine,Shanghai General Hospital,Shanghai Jiaotong University)

机构地区：[1]复旦大学附属华山医院运动医学科,上海200040 [2]上海交通大学附属上海市第一人民医院运动医学科

出　　处：《中华骨科杂志》2023年第23期1587-1592,共6页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划"主动健康和老龄化科技应对"重点专项(2020YFC2007405)。

摘　　要：目的探讨关节囊未缝合对髋臼股骨撞击症(femoral acetabular impingement,FAI)髋关节镜治疗中长期临床疗效的影响。方法回顾性分析2015年2月至2018年6月复旦大学附属华山医院采用髋关节镜下手术治疗的62例(63髋)FAI患者,男29例(30髋)、女33例(33髋);年龄为(43.08±8.88)岁(范围19~58岁),左髋32例、右髋31例。63髋均行髋关节镜手术且未缝合关节囊。评估并比较患者术前和终末随访时髋关节日常活动结果评分(hip outcome score-activity of daily living scale,HOS-ADL)、髋关节运动特异量表结果评分(hip outcome score-sport specific subscale,HOS-SSS)、Harris髋关节评分(Harris hip score,HHS)、加州大学洛杉矶分校(University of California at Los Angeles,UCLA)评分、非关节炎髋评分(non arthritic hip score,NAHS)、视觉模拟评分(visual analogue scale,VAS),并观察并发症发生情况。结果所有患者均顺利完成手术,手术切口均愈合良好,无一例发生伤口感染、局部切口血肿、局部皮肤红肿、股外侧皮神经损伤、会阴区挤压伤等并发症。62例患者均获得随访,随访时间为71(60,100)个月。术前VAS评分为6(0,10)分,末次随访时为1(0,6)分,差异有统计学意义(Z=-6.81,P<0.001)。术前HOS-ADL、HOS-SSS、HHS、UCLA、NAHS评分分别为(78.03±5.30)分、(59.88±12.51)分(78.98±7.50)分、2.00(2.00,5.00)分、83.75(81.25,97.50)分,末次随访时分别为(94.77±4.79)分、(79.89±9.07)分、(90.75±5.59)分、4.00(3.00,6.00)分、92.50(88.75,98.75)分,差异均有统计学意义(t=19.10,P<0.001;t=12.29,P<0.001;t=11.21,P<0.001;Z=-6.92,P<0.001;Z=-6.52,P<0.001)。末次随访时,无一例患侧髋关节行翻修或置换手术。结论采用未缝合关节囊的髋关节镜下盂唇成形术或修复术治疗无髋关节发育不良及全身多韧带松弛的FAI可获得良好的中长期临床疗效。ObjectiveTo investigate the medium to long-term clinical outcomes of arthroscopic treatment for femoral acetabular impingement(FAI)without capsular closure.MethodsA retrospective analysis was performed on 62 patients(63 hips)with FAI who underwent hip arthroscopy in Huashan Hospital Affiliated to Fudan University from February 2015 to June 2018.There were 29 male patients(30 hips)and 33 female patients(33 hips)with an average age of 43.08±8.88 years.Thirty-two surgeries were performed on the left hip,thirty-one on the right,and one patient underwent bilateral surgery.All 62 patients underwent arthroscopic surgery without capsular closure.The preoperative and postoperative final follow-up assessments included the hip outcome score-activity of daily living scale(HOS-ADL),hip outcome score-sport specific subscale(HOS-SSS),Harris hip score(HHS),University of California at Los Angeles(UCLA)score,Non arthritic hip score(NAHS),visual analogue scale(VAS)for pain,and observation of complications.ResultsAll the patients completed the operation successfully,and the surgical incisions healed well.No complications such as wound infection,local incisional hematoma,local skin redness,lateral femoral cutaneous nerve injury,or perineal crush injury occurred in any one case.All 62 patients were followed up for 71(60,100)months.The VAS before surgery was 6(0,10)points and 1(0,6)point at the last follow-up,with statistical significance(Z=-6.81,P<0.001).Preoperative scores were as follows:HOS-ADL:78.03±5.30;HOS-SSS:59.88±12.51;HHS:78.98±7.50;UCLA:2.00(2.00,5.00);NAHS:83.75(81.25,97.50).Postoperative final follow-up scores were as follows:HOS-ADL:94.77±4.79;HOS-SSS:79.89±9.07;HHS:90.75±5.59;UCLA:4.00(3.00,6.00);NAHS:92.50(88.75,98.75).At the final follow-up,HOS-ADL(t=19.10,P<0.001),HOS-SSS(t=12.29,P<0.001),HHS(t=11.21,P<0.001),UCLA(Z=-6.92,P<0.001),and NAHS(Z=-6.52,P<0.001)showed significant improvement.Until the end of the follow-up period,no patients underwent revision surgery or hip arthroplasty on the treated hip.Conclusion

关 键 词：关节镜检查 股骨髋臼撞击征 关节囊 缝合技术 

分 类 号：R687.4[医药卫生—骨科学]