髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤

Surgical hip dislocation for femoroacetabular impingement accompanied with labrum injury

[目的]介绍髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤的手术技术与初步临床疗效。[方法]2015年8月~2018年4月,采用髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤23例(23侧),"凸轮"型6例,"钳夹"型2例,混合型15例。患者取健侧卧位,采用髋关节后外侧入路,在大转子下方1.5 cm处截骨,"Z"形切开关节囊,剪断圆韧带,脱出股骨头。去除部分骨性髋臼缘和股骨头颈部多余的骨质,修整盂唇用2.8 mm的带线锚钉缝合固定,大转子骨折块并用2枚7.3 mm的空心钉固定。[结果]23例患者均顺利完成手术并获随访,随访时间12~24个月,平均(15.92±4.63)个月。术后12个月Harris、WOMAC、SF-36和Merle D’Aubignéand Postel评分与术前比较均显著改善,差异均有统计学意义(P<0.05)。末次随访时未出现大转子截骨不愈合和股骨头缺血性坏死的现象。[结论]髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤,临床疗效满意,并发症少。

[Objective]To introduce the surgical technique and primary clinical outcomes of surgical hip dislocation for femoroacetabular impingement accompanied with labrum injury.[Methods]From August 2015 to April 2018,23 patients(23 hips)underwent debridement and repair through surgical hip dislocation for femoroacetabular impingement accompanied with labrum injury,including cam type in 6 cases,pincer type in 2 cases and mixed type in 15 cases.After the patient was placed in the lateral decubitus position,a posterior lateral incision was made,and then greater trochanter osteotomy and a Z-shaped capsulotomy was conducted to expose and dislocate the hip.As the pathology identified,partial bony rim of acetabulum and the excess bone on the femoral head and neck were removed,and the injured labrum was repaired with 2.8 mm suture anchor.Reducing the hip,the fragment of greater trochanter was fixed with two 7.3 mm cannulated screws.[Results]All the 23 patients had operation performed smoothly,and were followed up for 12~24 months with a mean of(15.92±4.63)months.The Harris,WOMAC,SF-36 and Merle D’Aubignéand Postel scores significantly improved at 12 months postoperatively compared with those before operation(P<0.05).To the latest follow up,no non-union of greater trochanter and femoral head necrosis were found in anyone of them.[Conclusion]The surgical hip dislocation technique does achieve satisfactory clinical outcomes with few complications for the treatment of femoroacetabular impingement accompanied with labrum injury.