髋关节镜手术对髋臼股骨撞击症足轴角影响的运动学分析

A kinematic analysis of the effect of hip arthroscopy on the foot progression angle in femoral acetabular impingement

目的探讨髋关节镜手术治疗对髋臼股骨撞击症(femoral acetabular impingement,FAI)患者下肢横断面运动学的改善效果。方法前瞻性纳入2021年10月至2022年2月于北京大学第三医院运动医学科接受髋关节镜手术的FAI患者8例,男3例、女5例,年龄(35.3±13.0)岁(范围17~53岁),身高(168.0±12.8)cm(范围154~192 cm),体重(61.1±8.5)kg(范围52~74 kg),体质指数为(21.7±2.6)kg/m^(2)(范围17.6~24.5 kg/m^(2));左侧3例、右侧5例。所有患髋髋关节撞击(flexion,abduction,internal rotation,FADIR)试验均为阳性,flexion、abduction、external rotation(FABER)试验阳性4例。比较术前和术后10个月患髋的改良Harris评分(modified Harris hip joint function scale,mHHS)、疼痛视觉模拟评分(visual analogue scale,VAS)及年轻髋关节(胯)患者生活质量评分问卷12(international hip outcome tool-12,iHOT-12)评分。应用无反光点动作捕捉系统采集并测量患者步态、双腿下蹲、前向弓箭步蹲、单腿站立和原地踏步动作下的足轴角,比较术前和术后10个月足轴角的变化特点。结果8例均顺利完成手术,随访时间为(11.0±1.2)个月(范围10~13个月)。术前、术后10个月mHHS分别为(60.9±20.5)、(82.9±7.3)分,差异有统计学意义(t=-3.07,P=0.018);术前、术后10个月患侧iHOT-12评分分别为(51.4±23.7)、(79.2±14.6)分,差异有统计学意义(t=-3.76,P=0.007);术前、术后10个月VAS分别为(4.6±2.3)、(1.5±0.9)分,差异有统计学意义(t=3.16,P=0.016)。术前和术后10个月各动作下健侧与患侧足轴角的差异均无统计学意义(P>0.05);正常步态下术后健侧与患侧足轴角为26.52°±5.97°和24.41°±3.70°,较术前的34.4°±7.20°和30.80°±6.43°均减小,差异有统计学意义(t=2.83,P=0.013;t=3.05,P=0.041),手术前后双腿下蹲、前向弓箭步蹲、单腿站立及原地踏步动作的足轴角的差异均统计学意义(P>0.05)。结论髋关节镜手术可改变FAI患者下肢横断面运动学特征,对FAI患者术前足轴角异常具有潜在纠正作用。

ObjectiveTo explore the effect of hip arthroscopy on improving the cross-sectional kinematics of the lower limbs in patients with femoral acetabular impingement(FAI).MethodsEight FAI patients who underwent hip arthroscopy in the Department of Sports Medicine of Peking University Third Hospital from October 2021 to February 2022 were prospectively included,including 3 males and 5 females,with an age of 35.3±13.0 years(range 17-53 years),height of 168.0±12.8 cm(range 154-192 cm),weight of 61.1±8.5 kg(range 52-74 kg)and body mass index of 21.7±2.6 kg/m^(2)(range 17.6-24.5 kg/m^(2)).There were 3 left hips and 5 right hips.FADIR(flexion,adduction and internal rotation test)was positive in all patients and FABER(flexion,abduction and external rotation test)was positive in 4 patients.Modified Harris hip score(mHHS)and visual analogue scale(VAS)of the affected hip joint were compared before the surgery and at the follow-up of 10 months.By using a markerless motion capture system,foot progression angles during normal gait,double-leg squat,forward lunge,single-leg standing and stepping in place were measured and compared before the surgery and at the follow-up of 10 months postoperative results.ResultsAll the 8 patients underwent the surgery successfully and were followed up for 11.0±1.2 months.The mHHS scores before the surgery and at the follow-up of 10 months were 60.9±20.5 vs.82.9±7.3 with significant difference(t=-3.07,P=0.018).The iHOT-12 scores before the surgery and at the follow-up of 10 months for the affected hips were 51.4±23.7 vs.79.2±14.6 with significant difference(t=-3.76,P=0.007).The VAS scores before the surgery and at the follow-up of 10 months were 4.6±2.3 vs.1.5±0.9 with significant difference(t=3.16,P=0.016).There was no significant difference in foot progression angle between the healthy side and the affected side for all movement trials before the surgery and at the follow-up of 10 months(P>0.05).During normal gait,the postoperative and preoperative foot progression angles for the healthy side and the affected side were 26.52°±5.97 vs.34.4°±7.20°and 24.41°±3.70°vs.30.80°±6.43°with significant reduction(t=2.83,P=0.013;t=3.05,P=0.041).While there was no significant difference in foot progression angles for double-leg squat,forward lunge,single-leg standing and stepping in place before the surgery and at the follow-up of 10 months(P>0.05).ConclusionHip arthroscopy can change the cross-sectional kinematic characteristics of the lower limbs,potentially improving the progression angle in FAI patients.