超声引导髋关节封闭实验对髋关节撞击综合征关节镜手术效果的预测价值

Predictive value of ultrasound-guided intra-articular hip joint injection on the efficacy of arthroscopic surgery for femoroacetabular impingement

目的探究超声引导髋关节封闭实验对髋关节撞击综合征(FAI)患者关节镜手术的预测价值。方法本研究为回顾性研究。搜集2019年5月—2020年5月接受髋关节镜手术的89例FAI患者的病例资料。术前2周均接受超声引导髋关节封闭实验。采用Wilcoxon符号秩检验比较封闭实验前后髋关节查体屈髋90°内旋、屈髋90°外旋、过屈位、屈曲外展外旋(FABER)的疼痛视觉模拟评分(VAS)。髋关节镜手术前后的国际髋关节功能评分量表(iHOT-12)与改良Harris髋关节评分量表(MHHS)的评分符合正态分布,采用配对t检验比较。依据髋关节镜手术前后的iHOT-12评分将所有患者分为实质性临床获益(SCB)组和非SCB组。VAS结果为非正态分布,两组比较采用非参数检验,绘制受试者ROC曲线,计算预测关节镜手术效果的截断值。结果89例患者,封闭实验后髋关节屈髋90°内旋、屈髋90°外旋、过屈位、FABER各体位的VAS评分及总评分均显著低于封闭实验前,差异均有统计学意义(P均<0.001),提示封闭实验有效;髋关节镜手术后iHOT-12评分平均(78.4±13.0)分、MHHS评分平均(85.3±10.9)分,均明显高于术前评分(47.0±17.0)分、(60.8±17.4)分,差异均有统计学意义(t值分别为-12.02、-10.15,P均<0.05)。SCB组68例、非SCB组21例。SCB组封闭实验后髋关节屈髋90°内旋、屈髋90°外旋、过屈位、FABER各体位的VAS评分及总评分均明显高于非SCB组,差异均有统计学意义(P均<0.05)。单因素分析显示,髋关节封闭实验后SCB组查体不同体位的VAS评分及总评分差值均明显高于非SCB组(P均<0.05)。超声引导髋关节封闭实验前后VAS总评分差值≥7.0分时,提示术后患者可达到SCB状态,敏感度60.3%(41/68)、特异度95.2%(20/21)、准确率68.5%(61/89)、ROC曲线下面积为0.75。结论超声引导髋关节封闭实验前后的VAS评分差值可用于预测FAI患者髋关节镜手术效果。

Objective To investigate the predictive value of ultrasound-guided intra-articular hip injection for arthroscopic surgery in patients with femoroacetabular impingement(FAI).Methods This retrospective study collected clinical data of 89 patients with FAI who underwent arthroscopic surgery from May 2019 to May 2020.Two weeks before surgery,all patients underwent ultrasound-guided intra-articular hip joint injection.The Wilcoxon signed-rank test was used to compare the visual analog scale(VAS)scores of pain during hip joint examination,including internal and external rotation at 90°of hip flexion,hyperflexion,and flexion abduction external rotation(FABER)test,before and after the intra-articular hip injection.The International Hip Outcome Tool-12(iHOT-12)and Modified Harris Hip Score(MHHS)before and after surgery were compared using a paired t-test since the scores were normally distributed.According to the iHOT-12 score before and after surgery,all patients were divided into the substantial clinical benefit(SCB)group and non-SCB group.Since the VAS results were not normally distributed,a nonparametric test was used to compare the two groups,and the receiver operating characteristic curve was drawn to calculate the cutoff value for predicting the surgical effect.Results 89 patients underwent intra-articular hip joint injections.The VAS scores and total scores for internal and external rotation at 90°of hip flexion,hyperflexion,and FABER test were significantly lower after the intra-articular hip injection than before(all P<0.001),indicating the effectiveness of the intra-articular hip injection.After hip arthroscopy,the iHOT-12 score was significantly higher in the SCB group(78.4±13.0)and the MHHS score was significantly higher in the SCB group(85.3±10.9)compared to preoperative scores(47.0±17.0)and(60.8±17.4),respectively(t=-12.02,-10.15;all P<0.05).There were 68 patients in the SCB group and 21 in the non-SCB group.The VAS scores and total scores for the VAS scores and total scores for internal and external rotation at 90°of hip flexion,hyperflexion,and FABER test were significantly higher in the SCB group than in the non-SCB group(all P<0.05).In single-factor analysis,the VAS scores and total scores in different positions after the intra-articular hip injection were significantly higher in the SCB group than in the non-SCB group(all P<0.05).When the total VAS score difference before and after the intra-articular hip joint injection was≥7.0 points under ultrasound guidance,the patient could achieve the SCB state after surgery,with a sensitivity of 60.3%(41/68),specificity of 95.2%(20/21),accuracy of 68.5%(61/89),and an ROC curve area of 0.75.Conclusions The difference in VAS score before and after ultrasound-guided intra-articular hip injection can be used to predict the effect of hip joint arthroscopy in FAI patients.