股骨髋臼撞击征关节镜手术后磁共振成像结果与疼痛的关系研究

Postoperative MRI findings and associated pain changes after arthroscopic surgery for femoroacetabular impingement

目的探讨股骨髋臼撞击征(FAI)关节镜手术后磁共振成像(MRI)结果与疼痛的关系。方法前瞻性地连续募集计划行关节镜手术的FAI患者42例(43个髋关节)。采用3.0T MRI获取术前和术后MRI图像。采用髋关节残疾与骨关节炎结果评分(HOOS)评估疼痛变化情况。采用术后MRI图像评估髋关节成形术、股骨成形术、软骨和盂唇修复术、骨髓水肿、软骨下囊肿、软骨缺陷、盂唇撕裂、囊部缺陷和渗出情况,并分析最佳检测方位。结果髋臼清理术长度增加与HOOS改善有关(OR:-2.07,95%CI:-3.53~-0.62,P=0.008),而其他成像结果与HOOS改善无相关性。股骨成形术和关节囊改变斜轴位检测效果最好,而髋臼成形术、软骨和盂唇修复术矢状位检测效果最好。MRI反映盂唇修复术后变化的敏感性和特异性均为100.0%,反映股骨成形术后变化的敏感性为97.7%。MRI反映髋臼成形术后变化的敏感性和特异性分别为83.3%和75.0%。MRI反映软骨修复术后变化的敏感性和特异性分别为75.0%和54.3%。结论关节镜下髋臼成形术与术后疼痛相关。

Objective To investigate postoperative MRI findings after femoroacetabular impingement(FAI)arthroscopic surgery in correlation with pain changes.Methods We prospectively enrolled 42 patients(43 hips)who were scheduled for FAI arthroscopic surgery.Pre-and postoperative MRI were obtained using a 3.0T MRI system.Changes in pain were assessed using the hip disability and osteoarthritis outcome score(HOOS).Postoperative MRI were evaluated for the presence of acetabuloplasty or femoroplasty,presence of chondral and labral repair surgery,bone marrow edema,subchondral cysts,chondral defects,labral tears,capsular defects,and effusion.Results Increased acetabular bony débridement length was associated with decreased improvement in HOOS(OR:-2.07,95%CI:-3.53~-0.62,P=0.008),whereas other imaging findings were not significantly different.Femoroplasty and capsular alterations were best detected on oblique axial sequences;acetabuloplasty and cartilage and labral repair were best seen on sagittal sequences.MRI showed excellent sensitivity(100.0%)and specificity(100.0%)for detecting labral repair and excellent sensitivity for detecting femoroplasty(97.7%).Sensitivity and specificity were lower for detecting acetabuloplasty(83.3%and 75.0%,respectively)and chondral repair(75.0%and 54.3%,respectively).Conclusion Arthroscopic acetabularplasty is associated with postoperative pain.