髋关节外科脱位术治疗股骨髋臼撞击征的中期疗效

Mid-term effectiveness of surgical hip dislocation for femoroacetabular impingement

目的探讨髋关节外科脱位术治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的中期疗效。方法 2014年4月—2015年8月,采用髋关节外科脱位术治疗15例(16髋)FAI。男12例,女3例;年龄22～59岁,平均36.6岁。单髋14例,双髋1例。病程4～120个月,平均28个月。术前疼痛视觉模拟评分(VAS)为(7.9±1.0)分,髋关节Harris评分为(44.1±9.3)分。结果术后切口均Ⅰ期愈合,无血管神经损伤、感染等早期并发症发生。患者均获随访,随访时间30～46个月,平均39.5个月。术后3个月及末次随访时,VAS评分分别为(2.5±1.6)、(0.5±0.7)分,髋关节Harris评分分别为(85.5±4.4)、(95.6±3.9)分,均显著优于术前(P<0.05);术后两时间点间比较差异亦有统计学意义(P<0.05)。末次随访时,髋关节功能满意(Harris评分≥90分)率达93.8%(15/16)。X线片复查示,患侧髋关节股骨头颈及髋臼成形部位无撞击征象出现。随访期间无内固定物松动、截骨处不连、股骨头缺血性坏死、异位骨化等并发症发生。结论髋关节外科脱位术在行髋臼和/或股骨头颈成形同时修补撕裂的盂唇,治疗FAI中期疗效满意。

Objective To assess the mid-term effecitveness of femoroacetabular impingement (FAI) treated by surgical hip dislocation.Methods Between April 2014 and August 2015,15 patients (16 hips) with FAI were enrolled in the study and treated with surgical hip dislocation.There were 12 males and 3 females with an average age of 36.6 years (range,22-59 years).Among them,14 cases involved in unilateral hip and 1 in bilateral hips.The mean disease duration was 28 months (range,4-120 months).Preoperative visual analogue scale (VAS) score and Harris hip score were 7.9±1.0 and 44.1±9.3,respectively.Results All incisions healed by first intention.There was no main complication,such as vessel and nerve injuries and infection.All 15 patients were followed up 30-46 months (mean,39.5 months).The VAS score was 2.5±1.6 at 3 months and 0.5±0.7 at last follow-up.The Harris score was 85.5±4.4 at 3 months and 95.6±3.9 at last followup.There were significant differences in two scores between pre- and post-operation and between 3 months and last follow-up (P<0.05).The satisfaction rate of hip function was 93.8%(15/16) at last follow-up.X-ray examination showed that there was no sign of impingment at the femoral head and neck and acetabulum forming site of the affected hip joint,and no complication such as loosening of internal fixator,nonunion of osteotomy,avascular necrosis of femoral head,and heterotopic ossification occurred during follow-up.Conclusion The surgical hip dislocation is a safe and effective way to treat FAI in the mid-term follow?up,which can repair torn labrum and trim acetabulum and femoral neck.