盂唇重建与盂唇部分切除治疗股骨髋臼撞击症合并无法修复盂唇损伤的临床对比研究

The Clinical Study of Femoroacetabular Impingement with Irreparable Labral Tear Treated with Labral Resection Compared with Labral Reconstruction

目的:通过对比分析盂唇重建和盂唇部分切除治疗股骨髋臼撞击症的临床疗效,探索无法修复的盂唇损伤的最佳治疗方法。方法:以在我科手术治疗的股骨髋臼撞击症造成盂唇损伤患者中盂唇损伤严重、无法修复的患者作为研究对象,2013年7月到2014年12月行盂唇部分切除24例(盂唇部分切除组),2015年1月到2016年8月行盂唇重建27例(盂唇重建组)。术前对患者髋关节功能进行评估,术后随访至少2年以上,对比分析两种术式的VAS疼痛程度以及日常活动的髋关节功能评分(HOS-ADL)、体育运动专用髋关节评分(HOS-SSS)、改良Harris髋关节评分(m HHS)功能评分。结果:盂唇部分切除组失随访2例,盂唇重建组失随访3例。两组患者的平均年龄、性别构成、术前HOS-ADL、HOS-SSS、mHHS和VAS评分无显著性差异。术后末次随访时,盂唇部分切除组患者的HOS-ADL评分为78.0±10.5,HOS-SSS评分为64.3±15.2,mHHS评分为73.7±12.3,VAS评分为3.9±2.0,盂唇重建组患者的HOS-ADL评分为79.7±8.8,HOS-SSS评分为72.8±14.3,mHHS评分为79.8±12.4,VAS评分为3.0±1.6,两组较术前均有显著改善,但两组之间并无显著性差异。结论:盂唇重建和盂唇部分切除均可在中短期明显改善临床症状,具有相似的临床效果,可作为盂唇损伤严重、无法修复患者的治疗方法。

Objective To evaluate the clinicaloutcomes of the acetabular labrum resection and labrum recon-struction in treating the femoroacetabular impingement(FAI). Methods Between July 2013 and December 2014,24 femoroacetabular impingement patients underwent removal of osteophyte andlabral resection in our depart-ment,while between January 2015 and August 2016,another 27 patients underwent removal of osteophyte andlabral reconstruction. We evaluated the hip functionsof all patients before the surgery and compared them withthe hip functions at least 2 years after the surgery. Results Two of the labral resection group and 3 of thelabral reconstruction group were lost during the follow-up. There were no significant differences between the twogroups in the mean age,the ratio of gender,as well as the preoperativehip outcome score-activities of daily liv-ing(HOS-ADL),hip outcome score-sports-specific subscale(HOS-SSS),modified Harris hip score(mHHS) andvisual analogue scale(VAS) scores. At the final follow-up the mean HOS-ADL,HOS-SSS,mHHS and VASscores were 78.0 ± 10.5,64.3 ± 15.2,73.7 ± 12.3 and 3.9 ± 2.0 in the labral resection group and 79.7 ±8.8,72.8 ± 14.3,79.8 ± 12.4 and 3.0 ± 1.6 in the labral reconstruction group. Significant functional improve-ments were found in both groups compared with those before the operation. However,there was no significantdifference in the mean final functional scores between the two groups. Conclusion Both labral resection and reconstruction cansignificantly alleviate clinical symptoms with similar effects,which can be used as the treatingor revision surgery for patients with irreparable labral lesion.