镜下治疗股骨髋臼撞击综合征是否缝合关节囊

Arthroscopic treatments for femoroacetabular impingement syndrome with or without capsule suture

[目的]比较髋关节镜术治疗股骨髋臼撞击综合征合并盂唇损伤是否缝合关节囊的临床结果。[方法]回顾性分析2016年1月—2019年12月本院骨科采用关节镜下磨削股骨头颈凸轮骨赘或髋臼骨赘,并修复盂唇治疗股骨髋臼撞击综合征合并盂唇损伤52例患者,其中,28例术中修复关节囊,24例末修复关节囊。比较两组围手术期、随访和影像资料。[结果]两组手术均顺利完成。缝合组手术时间显著长于非缝合组(P<0.05),两组在术中失血量、术中透视次数和住院时间的差异无统计学意义(P>0.05)。但是,缝合组术后下地行走时间和完全负重活动时间均显著早于未缝合组(P<0.05)。随时间推移,两组髋内旋-外旋ROM,HHS、NAHS和HOS-ADL评分均显著增加(P<0.05)。术后1个月和末次随访时,缝合组髋内旋-外旋ROM显著小于未缝合组(P<0.05),但是缝合组的HHS、NAHS和HOS-ADL评分均显著高于未缝合组(P<0.05)。影像方面,末次随访时,两组患者的α角和CE角均较术前显著减少(P<0.05);相应时间点,两组间α角和CE角的差异均无统计学意义(P<0.05)。末次随访时缝合组髋关节退变征像显著轻于未缝合组(P<0.05)。[结论]关节下磨削股骨头颈凸轮骨赘或髋臼骨赘,并修复盂唇可有效治疗股骨髋臼撞击综合征,术中缝合关节囊可改善手术效果。

[Objective] To compare the clinical outcomes of hip arthroscopy for treatment of femoroacetabular impingement syndrome and labrum injury with or without capsule suture. [Methods] A retrospective study was done on 52 patients who had cam osteophytes on femoral head and neck, or acetabular osteophytes removed and the affected labrum repaired under hip arthroscope for femoroacetabular impingement syndrome in our hospital from January 2016 to December 2019. Among them, 28 patients had the joint capsule sutured during operation, while the remaining 24 patients had joint capsule unsutured. The patients in the two groups were compared regarding to the perioperative, follow-up and imaging documents. [Results] The patients in both groups had operations completed successfully. The sutured group consumed significantly longer operation time than the unsutured group(P<0.05), nevertheless there were no significant differences in blood loss, intraoperative fluoroscopy and hospital stay between the two groups(P>0.05). However, the sutured group resumed walking and full weight-bearing activity significantly earlier than the unsutured group(P<0.05). The hip internal rotation-external rotation ROM,as well as HHS, NAHS and HOS-ADL scores increased significantly in both groups over time(P<0.05). At 1 month postoperatively and the latest follow-up, the sutured group got significantly less hip internal rotation-external rotation ROM(P<0.05), whereas significantly greater HHS, NAHS and HOS-ADL scores than the unsutured group(P<0.05). In terms of imaging assessment, the α and CE angles in both groups significantly reduced at the last follow-up compared with those preoperatively(P<0.05), but there were no statistically significant differences in α and CE angles between the two groups at any corresponding time point(P>0.05). At the last follow-up, the sutured group had significantly less hip degeneration signs than the unsutured group(P<0.05). [Conclusion] Arthroscopic debridement of cam osteophytes on femoral head and neck, or acetabular osteophytes, combined with repair of the labrum does treat femoral-acetabular impingement syndrome effectively. By contrast, the joint capsule sutured during the operation can improve the clinical outcomes.