关节镜手术治疗整体和局部钳夹型股骨髋臼撞击综合征的疗效比较

Comparison of the treating effects of arthroscopic surgery in global and Focal pincer femoroacetabular impingement

目的探讨关节镜手术治疗整体钳夹型股骨髋臼撞击综合征(FAI)的临床结局。方法根据术前X线检查,将患者分为整体钳夹型FAI(中心边缘角度≥40°)和局部钳夹型FAI(中心边缘角度25°~39°)两组。比较两组患者术前和术中结果、手术操作流程、术后非关节炎髋关节评分(NAHS)和满意度(李克特LIKERT五分量表法)、并发症和接受关节置换术情况。结果整体钳夹型FAI包括15例患者,平均年龄(37.2±11.3)岁。术前和术后第24个月NAHS分别为(51.5±22.7)和(74.1±16.6)分,两组差异具有统计学意义(P=0.001)。患者平均满意度为(4.2±1.2)分,1例患者(6.7%)接受全髋关节置换术(THA),无翻修手术或并发症发生。局部钳夹型FAI包括125例患者,平均年龄(39.8±13.5)岁。术前和术后第24个月NAHS分别(55.5±17.1)和(77.3±18.5)分,两组差异具有统计学意义(P=0.015)。平均满意度为(4.2±1.3)分。8例(6.4%)患者接受THA,3例患者发生并发症(2.4%)和2例患者接受翻修手术(1.6%)。两组患者术后第24个月NAHS(P=0.301)、满意度(P=0.926)和THA置换率(P=0.912)差异均无统计学意义。整体组和局部组患者术后24个月后的NAHS变化平均数分别为(22.2±6.9)和(21.5±8.8)分,两组NAHS变化差异无统计学意义(P=0.955)。结论整体钳夹型FAI采用关节镜手术安全有效,并且与关节镜治疗局部钳夹型FAI疗效相当。

Objective To investigate the effect of arthroscopic surgery treating global pincer femoroacetabular impingement.Methods Global(center-edge angle≥40°)and Focal(center-edge angle 25°~39°)cohorts were based on pre-operative radiographs.Pre-operative and intra-operative findings,surgical procedures,postoperative nonarthritic hip score(NAHS)and satisfaction(5-point Likert scale),complications and conversion arthroplasties were compared.A nested case-control study was also performed.Results The Global cohort consisted of 15 patients of mean age(37.2±11.3)years.Pre-operative NAHS was(51.5±22.7)and(74.1±16.6)at 24 months after operation.The change in NAHS was significant(P=0.001).Mean satisfaction was(4.2±1.2).There was one total hip arthroplasty(THA)conversion(6.7%),no revision surgeries or complications.The Focal cohort consisted of 125 patients of mean age(39.8±13.5)years.Pre-operative NAHS was(55.5±17.1)and(77.3±18.5)at 24 months after operation.The change in NAHS was significant(P=0.015).Mean satisfaction was(4.2±1.3).There were eight THA conversions(6.4%),three complications(2.4%)and two revision surgeries(1.6%).Cohort comparisons revealed no statistically significant difference in NAHS(P=0.301),satisfaction(P=0.926)and THA conversion rate(P=0.912).The nested case-control study found mean post-operative change in NAHS was(22.2±6.9)and(21.5±8.8),respectively,at 24 months(P=0.955).Conclusion The global pincer FAI was safe and effective with arthroscopic surgery,and the effect was similar to that of the local pincer FAI.