髋关节镜手术治疗髂前下棘棘下撞击失败的原因分析

Cause analysis of hip arthoscopy surgery for subspine impingement failure

目的探讨髋关节镜手术治疗髂前下棘棘下撞击(SSI)失败的原因。方法回顾性描述性研究。纳入2017年1月—2018年5月上海交通大学医学院附属新华医院骨科治疗的症状性SSI髋关节术后翻修病例42例,其中男13例、女29例,年龄22~35(28.1±3.9)岁,左髋19例、右髋23例。所有患者接受进一步手术治疗并随访至少12个月。采用国际髋关节评分33(iHOT-33)评估患者术后患者髋关节功能的变化。通过分析其影像学资料和临床资料分析其治疗失败原因。结果通过翻修手术后,末次随访的iHOT-33评分由术前的(48.7±8.7)分增至术后的(78.4±6.0)分,差异具有统计学意义(t=22.12,P<0.001);患者术后疗效不佳的主要因素为漏诊或误诊(64.29%,27/42)、股骨侧骨软骨成形术程度不足(21.43%,9/42)、股骨前倾角异常(9.52%,4/42)以及过度切除髂前下棘(4.76%,2/42)。结论漏诊或误诊、股骨侧骨软骨成形术程度不足以及过度切除髂前下棘是SSI髋关节镜手术治疗失败的主要因素。

Objective To investigate the factors associated with the failed hip arthroscopic treatment of subspine impingement(SSI).Methods Forty-two symptomatic patients(29 females and 13 males)who suffered from SSI and experienced prior arthroscopic treatment failure were subjected to revision surgeries in our department from January 2017 to May 2018.Their average age was 28.1 years(range of 22-35 years).Of the 42 patients,19 and 23 cases involved the left and right hips,respectively.All the patients were further treated and followed up for at least 12 months.The International Hip Score 33(iHOT-33)was used to assess the changes in postoperative hip joint function.Previous radiological evidence and medical records were reviewed,and the causes of failure were discussed.Results After revision surgeries,the mean iHOT-33 score improved from 48.7±8.7 pre-operatively to 78.4±6.0 in the final follow-up(t=22.12,P<0.001).The four major reasons for failed SSI treatment were misdiagnosis(64.29%,27/42),residual femoral deformity(21.43%,9/42),abnormal femoral torsion(9.52%,4/42),and over-resection of the anterior inferior iliac spine(4.76%,2/42).Conclusion Misdiagnosis,residual femoral deformity,abnormal femoral torsion,and over-resection of the anterior inferior iliac spine are poor predictive factors of SSI treatment.