髋关节镜治疗凸轮型股骨髋臼撞击综合征的近期疗效

Short-term efficacy of hip arthroscopy in the treatment of Cam type femoroacetabular impingement syndrome

背景:凸轮型股骨髋臼撞击综合征(FAI)临床常见,保守治疗效果不佳,髋关节镜技术是近年来治疗FAI的主流方法。目的:探讨使用髋关节镜治疗凸轮型FAI髋)凸轮型FAI患者。所有患者行髋关节镜手术,清理增生滑膜,缝合或者清理损伤盂唇,股骨头颈部"凸轮"状增生隆起磨削成形术。记录并比较术前及末次随访时患者髋关节活动度(包括屈髋活动度及屈髋90°内旋活动度)、α角、疼痛视觉模拟评分(VAS)及改良Harris评分。结果:所有患者切口均甲级愈合。术后1例患者出现会阴区麻木,1例出现大腿外侧麻木,术后给予消肿、营养神经等常规药物治疗1周后症状均消失。所有患者均获得随访,随访11～25个月,平均随访(13.6±3.4)个月。末次随访时患者髋关节活动度及改良Harris10.4)°,(29.5±12.6)°vs(7.1±4.3)°,(81.8±7.6)分vs(51.6±5.4)分],α角及疼痛VAS评分均较术前降低[(42.2±7.5)°vs(65.3±11.4)°,(1.5±0.8)分vs(6.3±1.5)分],且差异均有统计学意义(t=4.2、6.7、14.4、8.1、15.3,P均<0.05)。结论:髋关节镜治疗凸轮型FAI能明显缓解患者症状,创伤小,恢复快,近期疗效满意。

Background: Cam type femoroacetabular impingement(FAI) syndrome is common in clinic. Conservative treatmentis not an effective method, while hip arthroscopy is becoming a popular treatment for FAI in recent years. Objective: To evalu-ate short-term clinical effectiveness of hip arthroscopy in the treatment of cam type FAI syndrome. Methods: From June 2015 to May 2017, 33 patients(33 hips) with cam type FAI were enrolled in this study. Hip arthroscopic surgery was performed forall patients to clear the hyperplastic synovium and to suture or clean the injured glenoid labrum. Arthroscopic osteoplasty wasperformed of the "cam-like" hyperplasia of the femoral head and neck. The range of hip motion(including the range of motionof hip flexion and internal rotation when hip flexion was 90 degrees), α angle, visual analogue scale(VAS) and modified Harrisscore were recorded before operation and at the final follow up. Results: The incision of all patients healed well. The numbnessof perineal region and lateral thigh occurred in two patients after operation, respectively. The symptoms disappeared within oneweek after detumescence and neurotrophic drug treatment. The mean duration of follow-up was(13.6±3.4) months(range, 11-25 months) in all the patients., The range of hip flexion, range of internal rotation and modified Harris score at the final follow-up were significantly increased as compared with preoperative ones(114.2°±11.8° vs 97.5°±10.4°, 29.5°±12.6° vs 7.1°±4.3°,81.8±7.6 vs 51.6±5.4, t=4.2, 6.7, 14.4, P<0.05), while α angle and VAS score were significantly decreased(42.2°±7.5° vs65.3°±11.4°,1.5±0.8 vs 6.3±1.5, t=8.1, 15.3, P<0.05). Conclusions: The hip arthroscopy can significantly relieve symptoms,with small trauma, rapid recovery and satisfactory short-term efficacy in patients with cam type FAI.