关节镜下治疗髋关节盂唇炎性钙化的临床研究

Clinical Outcomes of Arthroscopic Treatment of Inflammatory Calcification of Hip Labrums

目的:探讨关节镜下治疗髋关节盂唇炎性钙化的手术方法和临床效果。方法:回顾性研究了自2015年4月至2017年8月期间采用髋关节镜进行治疗的5例髋关节盂唇炎性钙化患者。术前常规髋关节X线、CT及MRI检查,行髋关节镜下钙化灶清理、盂唇缝合或部分切除术。术前及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)、改良髋关节Harris评分(modified Harris hip score,mHHS)及髋关节非骨关节炎评分(nonarthritic hip score,NAHS)评估症状和功能情况,同时对患者进行了满意度的评估。结果:5例患者中,男性1例、女性4例,左髋3例,右髋2例,年龄37.8±6.5岁(29~47岁),病程7.8±3.5个月(3~12月)。术后随访时间34.4±9.9个月(24~51个月)。5例患者的外侧中心边缘角(lateral centraledge angle,LCE角)31.9±3.6度(28.8~36.4度),α角40.2±5.3度(33.6~48.2度),均无Cam和Pincer畸形。关节镜下清理髋臼盂唇内钙化灶后,3例行盂唇缝合,2例行盂唇部分切除术。末次随访时所有患者症状均得到明显改善,VAS评分由术前的5.8±1.7分降至1.1±0.3(P<0.01),mHHS评分由术前的57.2±10.3分提高至90.3±8.7分(P<0.01),NAHS评分由术前的60.2±11.5分提高至84.0±8.5分(P<0.01)。患者满意度评估,5例(100%)非常满意。结论:髋关节盂唇炎性钙化作为一种少见的引起髋关节疼痛的疾病,应与股骨髋臼撞击综合征(femoroacetabular impingement,FAI)伴随的髋臼小骨或盂唇钙化灶相鉴别;经髋关节镜清理盂唇钙化病灶,缝合或部分切除盂唇能显著改善患者的髋关节症状和功能,获得满意的疗效。

Objective To explore the surgical technique and clinical outcomes of the arthroscopic treatment of the inflammatory calcification of the hip labrum.Methods Five patients with inflammatory calcification of the hip labrum and receiving treatment between April 2015 and August 2017 were included in this study.X-ray,CT and MRI tests were performed before the operation.The patients underwent arthroscopic excision of calcified lesions and suture or partial resection of the labrum in the supine position with the general anesthesia.All patient were assessed using the visual analogue scale(VAS),modified Harris hip score(mHHS),nonarthritic hip score(NAHS).Their satisfaction was also evaluated.Results The five patients,1 male and 4 females,aged29~47 years with 3 of inflammatory calcification on the left side and 2 on the right.All patients had hip pain and limited range of motion symptoms for a mean of 7.8±3.5 months ranging from 3 to 12 months.The average follow-up period was 34.4±9.9 months,ranging from 24 to 51 months.The average lateral central-edge angle(LCEA)was 31.9±3.6 degrees(range,28.8~36.4 degrees)andαangle was 40.2±5.3 degrees(range,33.6~48.2 degrees).None of them had Cam and Pincer lesions.After complete removal of calcified lesions,3 cases received repair of the labrum with suture anchor,and 2 underwent the partial resection of the labrum.At the last follow-up,the average scores of VAS,mHHS and NAHS improved significantly from 5.8±1.7 to 1.1±0.3,from 57.2±10.3 to 90.3±8.7 and from 60.2±11.5 to 84.0±8.5 respectively.The satisfaction rate was100%.Conclusion The inflammatory calcification of the hip labrum is a kind of rare disease causing hip pain,and the arthroscopic treatment of labrum calcification with suture or partial resection of the labrum is an effective,safe and minimally invasive method,significantly relieving pain and improving the function of the hip joint.