髋关节镜技术治疗不同分型髋关节撞击综合征的近期疗效分析

Hip arthroscopy for different types of femoroacetabular impingement syndrome

目的探讨髋关节镜技术治疗不同分型髋关节撞击综合征(FAI)的近期疗效。方法回顾性分析2016年1月至2018年12月期间南部战区总医院骨科医院收治的85例FAI患者资料。男52例,女33例;年龄为19~59岁,平均36.9岁。根据髋臼和股骨近端解剖形态分型:凸轮型26例,钳夹型16例,混合型43例。常规行髋关节镜手术,切除增生滑膜,凸轮型患者均行股骨头颈成形术,钳夹型患者切除过度覆盖的髋臼、行盂唇缝合术,混合型患者切除过度覆盖的髋臼、盂唇缝合后行股骨头颈成形术。术后1年使用改良Harris髋关节评分(mHHS)、非骨关节炎髋关节评分(NAHS)和髋关节结果评分日常生活能力量表(HOS-ADL)对患髋功能进行评定,并应用CT测量α角和中心边缘角。结果85例患者术后获12~48个月(平均21个月)随访。术后1年所有患者的mHHS评分、NAHS评分、HOS-ADL评分分别由术前的(63.1±7.9)、(62.5±7.5)、(62.3±7.9)分提高至(83.4±8.7)、(82.9±8.2)、(83.6±8.8)分,差异均有统计学意义(P<0.05)。凸轮型、钳夹型和混合型患者术后1年mHHS评分、NAHS评分、HOS-ADL评分较术前显著提高,差异均有统计学意义(P<0.05)。术后1年凸轮型、混合型患者的α角分别由术前67.3°±5.2°、64.2°±5.2°减少至50.3°±2.9°、49.6°±2.8°,钳夹型、混合型患者的中心边缘角分别由术前52.9°±4.6°、50.9°±3.6°减少至33.1°±4.5°、31.3°±4.3°,差异均有统计学意义(P<0.05)。结论髋关节镜技术能够有效治疗凸轮型、钳夹型和混合型FAI,近期疗效良好。

Objective To investigate the short-term efficacy of hip arthroscopy for different types of femoroacetabular impingement syndrome(FAI).Methods A retrospective analysis was conducted of the 85 FAI patients who had been treated by hip arthroscopy at Department of Orthopaedic Surgery,General Hospital of Southern Theater Command of PLA from January 2016 to December 2018.They were 52 males and 33 females,aged from 19 to 59 years(average,36.9 years).According to the anatomical morphology of the acetabulum and proximal femur,there were 26 cases of cam type,16 cases of pincer type and 43 cases of mixed type.Routine hip arthroscopy was performed to remove the proliferative synovium.Femoral head and neck plasty was conducted for the cases of cam type,resection of the overly covered acetabulum followed by labral suture for those of pincer type,and resection of overly covered acetabulum and labral suture followed by femoral head and neck plasty for those of mixed type.Hip function was assessed one year after surgery using the modified Harris hip score(mHHS),nonarthritic hip score(NAHS),and hip outcome score activity of daily living scale(HOS-ADL);the alpha angle and central edge(CE)angle were measured after CT reconstruction.Results The 85 patients were successfully followed up for an average of 21 months(range,from 12 to 48 months).The mHHS,NAHS and HOS-ADL for all the patients were improved significantly from preoperative 63.1±7.9,62.5±7.5 and 62.3±7.9 to 83.4±8.7,82.9±8.2 and 83.6±8.8 one year after surgery,respectively(all P<0.05)while the mHHS,NAHS and HOS-ADL for the patients of cam,pincer and mixed types were all significantly improved compared to their preoperative values(all P<0.05).The preoperative alpha angles for the cam and mixed types(67.3°±5.2°and 64.2°±5.2°)were significantly reduced to 50.3°±2.9°and 49.6°±2.8°one year postoperatively(P<0.05);the preoperative CE angles for the pincer and mixed types(52.9°±4.6°and 50.9°±3.6°)were significantly reduced to 33.1°±4.5°and 31.3°±4.3°one year postoperatively(P<0.05).Conclusion Hip arthroscopy can effectively treat FAI of cam,pincer and mixed types,leading to good short-term efficacy.