髋关节镜在急性髋关节后脱位检查和治疗中的应用

Arthroscopy for diagnosis and treatment of acute posterior dislocation of the hip

目的 探讨髋关节后脱位急性期行髋关节镜检查和治疗的临床疗效. 方法2005年8月-2009年4月,对32例急性髋关节后脱位患者行髋关节镜检查和治疗.其中男26例,女6例;平均年龄38.5岁（23～55岁）.全部患者均根据临床症状、体征及常规前后位骨盆摄片或CT扫描证实为髋关节后脱位.镜下观察髋关节内损伤情况,并在关节镜下行关节清理.8例患者Ⅱ期行髋臼骨折切开复位内固定术.根据Sanders评分评价术后髋关节功能. 结果术中发现29例关节腔内有大小不等游离体,3例股骨头圆韧带断裂,12例髋臼盂唇损伤,8例髋臼骨折需Ⅱ期行切开复位内固定术.术中及术后未出现血管、神经损伤.随访时间平均10个月（5～24个月）.根据Sanders评分：优23例,良5例,一般4例. 结论髋关节后脱位急性期行髋关节镜检查能够充分评估关节内的损伤情况,进而对关节内游离体、股骨头圆韧带及盂唇损伤进行有效清理.

Objective To evaluate the significance of arthroscopy in diagnosis and treatment of acute posterior dislocation of the hip. Methods From August 2005 to April 2009, 32 patients with acute posterior hip dislocation underwent hip arthroscopy in our hospital. All patients were confirmed by symptoms, signs, X-ray examination and CT scan. There were 26 males and 6 females, at mean age of 38.5 years （range 23-55 years）. An arthroscope was introduced to evaluate the intraarticular lesions routinely. Then, arthroscopic debridement was performed. Eight patients with acetabular fractures were treated by open reduction and internal fixation after arthroscopy. The Sanders scores were employed to evaluate the postoperative hip functions. Results Among 32 patients, there were 29 patients with loose bodies, three with tear of the ligamentum, 12 with labrum injuries and eight with acetabulum fractures that required a second stage open reduction and internal fixation. There were no complications of vessel or nerve injuries peri- or post-operatively. An average period of follow-up for 10 months （range, 5-24months） were available for all patients, which showed excellent results in 23 patients, good in five and fair in four according to the Sanders scores. Conclusion Hip intraarticular lesions can be evaluated and confirmed by the arthroscope, under which the loose bodies, tear of the ligamentum teres and labrum injuries can be cleared effectively.