关节镜下股骨头颈成形术治疗凸轮型股骨髋臼撞击症

Arthroscopic femoral osteoplasty for cam-type femoroacetabular impingement

目的 探讨髋关节镜下股骨头颈成形术治疗凸轮（Cam）型股骨髋臼撞击症的可行性及临床疗效.方法 2007年10月至2009年4月收治Cam型股骨髋臼撞击症患者31例,男12例,女19例；年龄18～45岁,平均34.1岁.术前行体格检查、X线摄片和三维CT明确诊断.所有病例均行髋关节镜下关节清理术和股骨头颈成形术.术后1个月、3个月、6个月、1年及以后每年1次随访.比较术前和末次随访时的撞击试验结果、髋关节活动度、α角、疼痛视觉模拟评分（visual analogue scale,VAS）和改良Harris髋关节评分.结果 所有患者均得到随访,随访时间18～36个月,平均22.7个月.末次随访时撞击试验均为阴性,髋关节屈曲活动度和屈曲90°位内旋活动度分别达到121.0°±11.7°和30.1°±12.7°,α角由术前74.2°±10.7°降至44.7°±8.3°,疼痛VAS由术前（6.1±1.1）分降至（0.9±0.7）分,改良Harris髋关节评分由术前（41.2±5.7）分提高至（73.6±4.1）分,差异均有统计学意义（P＜0.05）.结论 髋关节镜下股骨头颈成形术能够切除股骨头颈结合部骨性隆起,恢复股骨头颈结合部的自然弧度,有效缓解Cam型股骨髋臼撞击症的症状和改善髋关节活动度.

Objective To evaluate the feasibility and clinical effectiveness of arthroscopic femoral osteoplasty for cam-type femoroacetabular impingenent（FAI）.Methods From October 2007 to April 2009,31 patients with cam-type FAI underwent hip arthroscopy,including 12 males and 19 females with an average age of 34.1 years（range,18-45）.Physical examination,X-ray,3D-CT scans were carried out preoperatively to make the definite diagnosis.All patients were treated with hip arthroscopic debridement and femoral osteoplasty.The patients were followed-up at 1 month,3 months,6 months,1 year,and every year post operation.Outcomes were measured with pain visual analogue scale（VAS）,ROM of hip,impingement tests,α angle and modified Harris hip score at final follow-up.Results All patients were followed up for average 22.7 months（range,18-36）.At final follow-up,impingement tests among all patients were negative,the range of flexion increased from 101.0°±14.2° to 121.0°±11.7°,the range of internal rotation in a position of 90° flexion increased from 5.0°±9.8° to 30.1°±12.7°,α angle decreased from 74.2°±10.7° preoperatively to 44.7°±8.3°,VAS pain score decreased from 6.1±1.1 preoperatively to 0.9±0.7,modified Harris hip score improved from 41.2±5.7 preoperatively to 73.6±4.1,all differences were statistically significant.Conclusion Arthroscopic femoral osteoplasty for cam-type FAI can win the satisfactory achievements for complete excision of bony prominence at anterior-lateral femoral head-neck junction,restoration of the femoral offset,significant relief of clinical symptoms and improvement of hip range of motion.