髋关节镜手术治疗合并髂前下棘棘下撞击的髋臼股骨撞击症

The efficacy of hip arthroscopy for concurrent femoroacetabular and subspine impingement

目的探讨髋关节镜手术治疗合并髂前下棘棘下撞击的髋臼股骨撞击症(femoroacetabular impingement,FAI)的临床疗效。方法回顾性分析2021年8月至2022年5月收治的随访1年以上的合并髂前下棘棘下撞击的FAI患者23例(23髋),男10例、女13例,年龄(31.3±4.6)岁(范围25~45岁),左侧9例、右侧14例,合并2型髂前下棘20例、3型髂前下棘3例。在常规髋臼缘成形、股骨头颈成形、盂唇缝合的基础上,同时进行髂前下棘(anterior inferior iliac spine)成形棘下减压术。比较术前和术后1年随访时骨盆正位X线片LCE角、屈髋45°Dunn位X线片α角、髋关节最大屈曲角度、屈髋和伸膝肌力、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Harris评分(modified Harris hip scores,mHHS)、国际髋关节评分(international hip outcome tool-12,iHOT-12)。结果术后1年随访时无一例行髋关节镜或开放的翻修手术。LCE角由术前33.3°±6.1°减小到31.7°±4.1°(t=1.076,P=0.288),α角由术前63.7°±8.5°减小到50.0°±6.6°(t=6.116,P<0.001),髋关节屈曲角度由术前107.4°±6.0°增加到120.2°±4.4°(t=8.269,P<0.001),VAS评分由术前(4.0±1.1)分下降到(1.0±1.1)分(t=9.591,P<0.001),mHHS评分由术前(62.6±4.9)分增加到(87.5±8.1)分(t=12.700,P<0.001),iHOT-12评分由术前(51.4±4.9)分增加到(75.7±7.7)分(t=12.593,P<0.001)。患者术前和术后1年随访时屈髋肌力和伸膝肌力的差异无统计学意义(t=0.930,P=0.357;t=0.050,P=0.960)。所有患者均未发生与牵引相关的皮肤坏死、神经麻痹等并发症,以及股骨颈骨折、下肢深静脉血栓形成、关节内感染、髋关节周围异位骨化、髋关节不稳等严重不良事件。结论髋关节镜手术中行髂前下棘成形棘下减压术治疗合并棘下撞击的FAI安全有效,术后1年屈髋角度、髋关节功能和疼痛程度均明显改善。

Objective To assess the clinical outcomes of hip arthroscopy in patients with concurrent femoroacetabular impingement(FAI)and subspine impingement(SSI).Methods Data were retrospectively reviewed for patients with both FAI and SSI who underwent hip arthroscopy surgery from August 2021 to May 2022.A total of 23 patients(23 hips)followed up for more than 1 year,including 10 males and 13 females,9 left hips and 14 right hips,with an average age of 31.3±4.6 years(range,25-45 years).Subspine decompression by anterior inferior spine(AIIS)shaping for SSI was performed during hip arthroscopy in addition to labral repair and bony correction for FAI in the patients with concurrent FAI and SSI.Clinical outcomes were evaluated using preoperative and 1-year postoperative measures:lateral center-edge(LCE)angle,αangle on 45°Dunn view X-rays,maximum hip flexion angle,hip flexion and knee extension strength,visual analogue scale(VAS)for pain,modified Harris Hip Scores(mHHS),and International Hip Outcome Tool-12(iHOT-12).Results Of the 23 patients,20 had type 2 AIIS and 3 had type 3 AIIS.At 1-year follow-up after surgery,there were significant improvements:LCE angle decreased(33.3°±6.1°to 31.7°±4.1°,t=1.076,P=0.288),α angle reduced(63.7°±8.5°to 50.0°±6.6°,t=6.116,P<0.001),hip flexion angle increased(107.4°±6.0°to 120.2°±4.4°,t=8.269,P<0.001),VAS scores decreased(4.0±1.1 to 1.0±1.1,t=9.591,P<0.001),mHHS improved(62.6±4.9 to 87.5±8.1,t=12.700,P<0.001),and iHOT-12 scores rose(51.4±4.9 to 75.7±7.7,t=12.593,P<0.001).There was no significant difference in the strength of hip flexion and knee extension between preoperative and follow-up(t=0.930,P=0.357 and t=0.050,P=0.960,respectively).There were no reports of traction-related complications(such as skin necrosis and nerve paralysis),severe adverse events(such as femoral neck fractures,deep vein thrombosis in the lower limbs,intra-articular infections,ectopic ossification and hip instability),or the need for revision surgery.Conclusion Subspine decompression by anterior inferior spine(AIIS)shaping for SSI during conventional hip arthroscopy is safe and effective,enhancing hip function and alleviating pain at 1-year follow-up without significant complications.