关节镜下清理术在髋臼发育不良合并骨关节炎的应用

The application of debridement with arthroscopy in acetabular dysplasia with osteoarthritis

目的探讨关节镜下清理术在髋臼发育不良合并骨关节炎的应用。方法髋臼发育不良合并骨关节炎患者32例(48髋),男9例(14髋),女23例(髋);年龄28￣52岁,平均38.1岁;左髋9例,右髋7例,双髋16例。32例(48髋)患者中,X线片示髋臼倾斜度较大,但股骨头位置尚好者21例(28髋),髋臼倾斜度大,头轻度外移,不超过股骨头1/3者11例(20髋)。MRI示髋关节内积液28髋,髋臼和股骨头负重区软骨下骨信号异常10髋,髋臼盂唇信号连续性中断10髋。关节镜下清理软骨磨损创面、增生肥厚的滑膜组织和盂唇组织。结果2例患者术中因持续牵引力量较大,时间较长致会阴区皮肤压伤,皮肤感觉迟钝,术后7d恢复正常。术后28例(36髋)获随访,随访时间6个月～3.5年,平均23个月。根据VAS评分标准对疼痛进行评分,术前5～9分,平均6.8分;术后4～6分,平均2分。按照Harris评分标准,术前(58.8±6.15)分,末次随访时(89.6±11.3)分,优20例,良4例,可3例,差1例,优良率为85.7%。无一例发生血管、神经损伤等并发症。结论髋关节镜清理术可延缓髋臼发育不良伴骨关节炎患者的病情,改善临床症状,提高生活质量。

Objective To study the application of debridement with arthroscopy in acetabular dysplasia with osteoarthritis. Methods Thirty-two cases in 48 hips acetabular dysplasia with osteoarthritis debrided under the arthroscopy. In this group, male 9 and female 23, the mean age was 38.1 years old (range, 28-52 years old), the left side for 9, right side for 7 and bilateralis for 16. In the 48 hips, X-ray showed that comparatively large acetabular draw with normal position of femoral head in 21 cases (28 hips), large acetabular draw with femoral head lateral shift slightly but did not exceed 1/3 of femoral head in 11 cases (20 hips).MRI demonstrated that intraarticular fluid in 28 hips, subcartilage anormal signal of acetabular and femoral head at weight loading region in 10 hips, signal interruption of glenoid lip of hip in 10 hips. The procdure which included to remove of osteophyma, loose body and hyperplasia synovial membrane, degenerated cartilage on the stress areas of the hip joint, wear and tear of glenoid lip. Results The perianal skin in 2 patients suffered dysesthesia because of the over traction during operation. They recovered 7 days postoperation. Dysesthesias twenty-eight patients (36 hips) were follow-up with an average of 23 months (range, 6 months-3.5 years). After debridement and lavage, the patients released from pain, restored function and the range of the motion. According to VAS evaluation system for pain, the preoperative score was 5-9, with an average of 6.8; the postoperative score was 4-6, with an average of 2. According to Harris hip joint score evaluation system, preoperative score was 58.8±6.15, postoperative score was 89.6±11.3. The excellent in 20, good in 4, fair in 3 and poor in 1. The excellent and good result was up to 85.7%. Conclusion Selectivity debridement and lavage were effective methods for osteoarthritis hip joint acetabular dysplasia. It can delay the developing of course of disease; improve clinical symptom and elevate quality of life.