髋关节微不稳的病因、诊断与治疗

Microinstability of the hip:causes,diagnosis,and treatments

髋关节微不稳是由于关节稳定因素(骨关节、韧带、肌肉)与运动幅度(反复超生理范围活动)之间失衡进而诱发疼痛的髋关节疾患。目前尚没有明确的诊断标准,需综合分析患者的症状、体征(特别是全身关节松弛度和不稳激发试验)及影像学资料,并结合术中观察加以判断。髋关节镜手术可能造成医源性破坏而导致医源性不稳,这是疗效不佳以致再次手术的重要原因之一。手术治疗的关键是对髋关节髂股韧带的修复和加强,其远期疗效尚待进一步评价。

Microinstability of the hip is a recently recognized pathology resulting from bone architecture or periarticular soft tissue abnormalities impairing joint stability with supra-physiological mobility of the hip.Diagnosis is based on a comprehensive evaluation of pain symptoms,physical examination,especially provocative tests regarding generalized ligamentous laxity,and hip imaging.Intraoperative assessment of the location and pattern of pathology and femoral head stability is also helpful in differential diagnosis with femoroacetabular impingement.Iatrogenic instability should be taken into account for the patients who underwent hip arthroscopy.If conservative treatments failed,surgical intervention should be performed,which mainly focus on strengthening the capsuloligaments,as well as the associated intraarticular lesions.