关节镜下手术治疗股骨髋臼撞击征的中期疗效

Mid-term effectiveness of arthroscopic surgery for femoroacetabular impingement

目的总结关节镜下手术治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的中期疗效。方法回顾分析2014年7月—2015年12月收治并符合选择标准的131例(132髋)FAI患者临床资料。男68例,女63例;年龄17~68岁,平均42.5岁。左髋72例,右髋58例;双髋1例。病程3~120个月,平均35个月。关节镜下行髋臼和/或股骨头颈成形、盂唇修补,同时松解粘连的髂腰肌腱、清理撕裂的圆韧带。采用疼痛视觉模拟评分(VAS)及髋关节Harris评分(HHS)评价疗效。结果术后除2例出现阴部神经麻痹、3例足背麻木外,无其他相关并发症发生。患者均获随访,随访时间20~36个月,平均27.7个月。术后3个月及末次随访时VAS评分及HHS评分与术前比较,差异均有统计学意义(P<0.05);术后3个月与末次随访时比较,差异亦有统计学意义(P<0.05)。影像学复查显示患侧髋关节间隙完全正常,股骨头颈及髋臼成形部位无撞击征象出现。结论关节镜下手术治疗FAI,在行髋臼和/或股骨头颈成形的同时修补撕裂盂唇,中期疗效满意,是一种安全、有效、微创的治疗方法。

Objective To assess the mid-term effectiveness of arthroscopic surgery in treatment of femo- roacetabular impingement （FAI）. Methods Between July 2014 and December 2015, 131 patients （132 hips） with FAI were enrolled in this study. There were 68 males and 63 females with an average age of 42.5 years （range, 17-68 years）. The FAI was located at left hip in 72 cases, right hip in 58 cases, and bilateral hips in 1 case. The mean disease duration was 35 months （range, 3-120 months）. Under arthroscopy, the femoral neck osteoplasty and/or acetabular rim trimming were performed, then the torn labrum was repaired. At the same time, the iliopsoas tendon was divided and the torn round ligament was debrided. The effectiveness was assessed by the visual analogue scale （VAS） and the Harris hip score （HHS）. Results After operation, the perineum nerve palsy and numbness of dorsal feet occurred in 2 cases and 3 cases, respectively. There was no other complication. All patients were followed up 20-36 months （mean, 27.7 months）. There were significant differences in the VAS scores and HHS scores between pre-operation, post-operative 3 months, and the last follow-up （P〈0.05）. Imaging examination showed that joint interspace of the involved hip was normal, and there was no sign of impingement and osteoarthritis in the femoral neck or acetabulum. Conclusion Arthroscopic labral repair and osteoplasty is an effective and safe management for FAI in the mid-term follow-up.