股骨髋臼撞击征关节镜下翻修手术16例

Revision Hip Preservation Surgery With Hip Arthroscopy for Femoroacetabular Impingement: a Report of 16 Cases

目的探讨髋关节镜手术失败后进行髋关节镜翻修的原因。方法 2012年7月~2016年7月我科对16例股骨髋臼撞击征(femoroacetabular impingement,FAI)行髋关节镜翻修手术,在C形臂X线机透视和下肢牵引下,行髋关节镜探查:首先进入中央间室依次检查盂唇、髋臼关节面、股骨头软骨、髋臼顶软骨及圆韧带。对撕裂退变的髋臼盂唇根据损伤情况行盂唇缝合术或盂唇修整术。Outerbridge系统对软骨损伤进行分级清理损伤软骨组织。处理中央间室后放松双下肢牵引,关节镜进入周围间室。根据术中股骨头颈和髋臼动态撞击情况、部位行股骨头颈成形术(Cam畸形)或髋臼成形术(Pincer畸形)。如果术前检查伴有大转子压痛及MRI显示臀中肌止点炎症,术中清理大转子滑囊和损伤的臀中肌止点。利用CT三维重建检查,比较髋臼股骨头成形术前后股骨髋臼形态、骨量磨除情况和确认撞击因素去除。结果 16例随访16~60个月(中位数38个月)。16例VAS评分术前中位数4.5分(4~6分),末次随访时中位数1分(0~1分),明显降低(Z=-4.953,P=0.000);髋关节功能Harris评分由术前(69.88±9.33)分提高至末次随访时(88.69±4.33)分(t=-8.377,P=0.000)。总体患者满意度平均8.46分(4~10分)。无进行第2次翻修手术和接受全髋关节置换术者。结论髋关节镜翻修手术最主要的原因是股骨头髋臼撞击因素未彻底去除,残余的骨性撞击导致疼痛和盂唇软骨再次损伤。翻修手术去除骨性撞击因素,修复损伤盂唇软骨,明显改善患者临床症状和关节功能,短中期内提高患者生活质量,减少髋关节置换发生。

Objective To analyze the reasons of patients with femoroacetabular impingement(FAI)undergoing revision hip preservation surgery with arthroscopy. Methods The hip arthroscopic exploration was performed under the C-arm X-ray fluoroscopy and lower extremities traction.Firstly,the central compartment was entered to explore the labrum,articular surface of acetabulum and femoral head cartilage,acetabular cartilage and round ligament.Then glenoid labial suture or repair was performed according to the tear conditions.The cartilage injury was classified and debrided with the Outerbridge system.Afterwards the peripheral compartment was entered after relax of lower extremities traction.Femoral head neck plasty(Cam malformation)or acetabular plasty(Pincer malformation)was carried out according to impingement conditions and locations.In case of preoperative great trochanter tenderness and inflammation of musculi glutaeus medius stop point under MRI,the great trochanter bursa and musculi glutaeus medius stop point were cleared.Finally by using CT 3D reconstruction,acetabular morphology,bone grinding,and impingement factor removal were compared with preoperation. Results The follow-up period was 16-60 months(median,38 months)in the 16 cases.The VAS scores were 4-6 points(median,4.5 points)preoperatively and 0-1 points(median,1 points)at last follow-up,which significantly decreased(Z=-4.953,P=0.000).The Harris scores increased from preoperative(69.88±9.33)points to(88.69±4.33)points at the end of the follow-up(t=-8.377,P=0.000).The overall patient satisfaction was 4-10 points(mean,8.46 points).No patient underwent a second revision of hip arthroscopy.None of the patients underwent total hip arthroplasty during the study period. Conclusions The impingement between femoral head and acetabulum is the main cause requiring revision hip arthroscopy.The bony impingement leads to pain and re-injury of labrum cartilage.Revision hip arthroscopy surgery can remove the residual femoroacetabular impingement factors,and at the same time to repair the damaged labrum.It can improve hip joint function and relieve pain and improve hip preserving rate.