关节镜下髋臼盂唇清理及髋臼缘微骨折治疗不可修复性盂唇损伤的临床疗效观察

Therapeutic effect of arthroscopic segmental labral resection combined with microfracture at the rim of the acetabulum for irreparable labral lesions

目的探讨盂唇清理及髋臼缘微骨折治疗不可修复盂唇损伤的盂唇再生可能性及临床疗效。方法回顾性分析2014年2月至2016年8月,因不可修复性盂唇损伤于本院关节外科中心行关节镜下盂唇清理伴或不伴髋臼缘微骨折的17例(22髋)患者。男性9例(14髋),女性8例(8髋);年龄23～61(45.6±10.6)岁。术中不可修复盂唇撕裂部分仅行盂唇清理者,为单纯盂唇清理组;除盂唇清理外,在清理后盂唇缺损区域行髋臼缘微骨折者为微骨折组。术后半年以上进行单髋髋臼盂唇放射状MRI检查及仰卧位牵引单髋X线透视检查,判断盂唇缺损区域形态及生理功能的恢复,同时对比术前及术后的疼痛视觉模拟评分(VAS)、Harris髋关节评分(HHS评分)及HOS-ADL评分评估患者术后的疼痛缓解及髋关节功能恢复情况。结果 17例患者随访时间26～56(35.5±10.6)个月。末次随访,盂唇清理及髋臼缘微骨折患者微骨折区域在术后MRI上均可见低信号组织充填覆盖,牵引透视下患髋可观察到关节负压透亮带的形成;行单纯盂唇清理(节段性切除)的患者术后MRI在相应盂唇缺损区域未观察到低信号组织覆盖,同时牵引透视未观察到患髋中央间室负压透亮带形成。两组术后VAS评分、HHS评分及HOS-ADL评分与术前比较,均有统计学差异(P<0.05),而两组间术前及末次随访的VAS评分、HHS评分及HOS-ADL评分比较,均没有统计学差异。结论单纯盂唇清理或合并微骨折均可获得盂唇撕裂良好的近中期疗效,但微骨折可恢复盂唇清理后缺损区域的形态及维持负压的生理功能,有利于髋关节远期良好功能的维持,为不可修复性盂唇损伤治疗提供了新的方式。

Objective To explore the clinical outcomes and the possibility of labrum regrowth in patients undergoing arthroscopic segmental labral resection combined with microfracture at the rim of the acetabulum for irreparable labral lesions.Methods From February,2014 to August,2016,17 patients(including 9 male and 8 female patients with a mean age of 45.6 years,range 23-61 years)with irreparable labral injury involving 22 hips underwent arthroscopic labral resection with or without microfracture at the rim of the acetabulum at our center(microfracture group and resection group,respectively).Single radial hip magnetic resonance imaging(MRI)at least 6 months postoperatively was performed to observe the homogeneous low signal in the involved area,and fluoroscopic image of the involved hip under distraction were obtained to evaluate the recovery.Harris Hip Score(HHS),Hip Outcome Score-Activity of Daily Life(HOS-ADL)and Visual Analogue Scale(VAS)score were assessed both preoperatively and postoperatively to evaluate the functional outcome of the patients.Results The patients were followed up for 35.5±10.6 months(range,26-56 months)after the surgeries.At the last follow up,single radial hip MRI revealed homogeneous low signal intensity in the area where the labrum was deemed irreparable and resected followed by microfracture of the remaining acetabular rim in all the patients in the microfracture group;in the resection group,no homogeneous low signal intensity were detected in the defects of the acetabular rim.Obvious vacuum effect was observed in all the fluoroscopic views in patients in the microfracture group,but not in the resection group.Functional assessment of the hip joint showed significant improvement of postoperative HHS,HOS-ADL and VAS scored in both groups(P<0.05)without significant differences between the 2 group.Conclusion Arthroscopic segmental labral resection with or without microfracture at the rim of acetabulum achieves similar short-term functional outcomes.Marrow stimulation by microfracture recreates a fibrocartilage-like tissue at the labrum defects of the acetabular rim and restores the hydraulic seal effect of the labrum,which helps to preserve the long-term hip function.This surgical approach provides a new treatment option for irreparable labral lesions.