髋关节镜手术治疗临界型髋关节发育不良的临床疗效  

Clinical study of arthroscopic treatment for patients with borderline developmental dysplasia of the hip

作　　者：杨伟铭 吕阳 杨鹏 李聪 郭达 林定坤 Yang Weiming;Lw Yang;Yang Peng;Li Cong;Guo Da;Lin Dingkun(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广东省中医院骨关节科,广州510120

出　　处：《中国运动医学杂志》2024年第8期605-612,共8页Chinese Journal of Sports Medicine

基　　金：2023年广州市科技局基础与应用基础研究项目(2023A03J0749)。

摘　　要：目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关节镜手术的患者共32例,其中男8例、女24例,年龄39.41±16.27岁(18~59岁),平均髋臼外侧中心边缘角(lateral centre-edge angle,LCEA):21.25°±2.96°(18°~25°)。匹配同期的行髋关节镜手术治疗的髋臼股骨撞击症(femoral acetabular impingement,FAI)患者32例作为对照组,男15例、女17例,年龄42.78±12.18岁(24~70岁),平均LCEA:32.97°±4.96°(26°~42°)。所有患者均采用髋关节镜下盂唇修复、头颈区成形、关节囊缝合术治疗。采用改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)、视觉模拟评分(VAS),对患者术前、术后3月、术后12月、术后24月进行功能评分测量。结果:BDDH组和FAI组所有病例均获得随访,随访时间分别为27.6±5.4月、28.3±6.5月。FAI组和BDDH组术前m HHS、HOS-SSS、HOS-ADL和VAS评分的差异无统计学意义(P>0.05)。两组术后3月、12月、24月时mHHS、HOS-SSS、HOS-ADL评分均较术前明显提高,术后VAS评分均较术前明显降低,差异有统计学意义(P<0.001)。在术后3月、12月、24月时BDDH组的m HHS评分均较FAI组低,差异有统计学意义(P<0.05)。在术后3月时BDDH组的HOS-SSS、HOS-ADL分均较FAI组低,差异有统计学意义(P<0.05)。其他随访时间点,两组的各项评分指标无统计学差异(P>0.05)。所有患者在随访期间,均未因症状复发而行再次手术治疗。结论:髋关节镜技术治疗临界发育性髋关节发育不良可获得良好的短期疗效。Objective To explore the clinical effect of hip arthroscopy in the treatment of borderline developmental dysplasia of the hip(BDDH)with acetabular labrum injury.Methods A total of 32BDDH patients with acetabular labrum injury and undergoing hip arthroscopy between December 2019and December 2021 were analyzed retrospectively.There were 8 males and 24 females,aged 39.41±16.27 years(18~59 years)and their mean lateral acetabular central-edge angle(LCEA)was 21.25±2.96°(18°~25°).Another 32 patients with acetabular femur impingement(FAI)matching in age and undergoing hip arthroscopy during the same period were selected into the control group,which included 15 males and 17 females,aged 42.78±12.18 years(24~70 years),with their average LCEA of32.97°±4.96°(26°~42°).Both groups received the arthroscopic glenolabial repair,head and neck area plasty and joint capsule suture.Three,six and twenty-four hours after the surgery,both groups were evaluated the clinical effect using the modified Harris hip score(m HHS),hip outcome score sports specific subscale(HOS-SSS),hip outcome score-activities of daily living(HOS-ADL)and visual analogue scale(VAS).Results The BDDH and FAI groups were followed up for(27.6±5.4)and(28.3±6.5)months,respectively.There was no significant difference in all measurements between the two groups before the operation(P>0.05).However,3,12 and 24 months after surgery,the average mHHS,HOS-SSS and HOS-ADL scores of both groups increased significantly,while the average VAS scores decreased significantly(P<0.001).Moreover,the average mHHS scores of BDDH group were significantly lower than FAI group 3,12 and 24 months after surgery(P<0.05).However,3months after surgery,the average HOS-SSS and HOS-ADL scores in BDDH group were significantly lower than FAI group(P<0.05).None of the patients underwent re-surgery due to recurrence of symptoms during the follow-up period.Conclusion Hip arthroscopy can achieve satisfying short-term outcomes in treating BDDH.

关 键 词：髋关节 关节镜 发育性髋关节发育不良 股骨髋臼撞击 关节囊 

分 类 号：R687.4[医药卫生—骨科学]