关节镜手术治疗运动员髋臼股骨撞击症的临床疗效

Clinical outcomes of hip arthroscopic surgery in treating femoral acetabular impingement for athletes

目的探讨关节镜手术治疗运动员髋臼股骨撞击症(femoral acetabular impingement,FAI)的临床疗效。方法回顾性分析2014年4月至2021年6月就诊于北京大学第三医院运动医学科接受髋关节镜手术治疗的FAI运动员患者18例(运动员组),男12例、女6例,年龄(20.44±3.45)岁(范围15~27岁)。根据性别、年龄、体质指数及随访时间通过倾向性评分匹配方法以1∶2的比例与非运动员FAI患者(非运动员组)进行匹配,纳入36例非运动员患者,男18例、女18例,年龄(20.81±4.68)岁(范围14~31岁)。比较两组患者手术前后的髋关节疼痛视觉模拟评分(visual analogue scale,VAS)、改良Harris髋关节评分(modified Harris hip score,mHHS)、髋关节结局评分日常生活能力量表(hip outcome score-activity of daily living scale,HOS-ADL)评分和髋关节结局评分运动量表(hip outcome score-sports scale,HOS-SS)评分;同时比较术后两组达到最小临床重要差异(minimal clinically important difference,MCID)和患者可接受的症状状态(patient acceptable symptomatic state,PASS)的比例。结果所有患者均顺利完成手术并获得随访,随访时间为(33.56±19.20)个月(范围24~77个月)。末次随访运动员组的VAS评分由术前的(6.22±1.52)分降低至(1.28±1.67)分,非运动员组由(6.28±1.37)分降低至(1.67±1.69)分,组间比较差异无统计学意义(P>0.05)。末次随访运动员组的mHHS评分由术前的(65.53±12.90)分升高至(92.28±13.59)分,非运动员组由(61.01±11.96)分升高至(86.82±11.98)分,组间比较差异无统计学意义(P>0.05)。末次随访运动员组的HOS-ADL评分由术前的(72.77±18.86)分升高至(94.00±11.36)分,非运动员组由(70.35±13.12)分升高至(90.78±9.36)分,组间比较差异无统计学意义(P>0.05)。末次随访运动员组的HOS-SS评分由术前的(49.77±22.93)分升高至(87.28±17.62)分,非运动员组由(44.08±19.66)分升高至(72.57±20.16)分,运动员组末次随访的HOS-SS评分大于非运动员组(P<0.05)。运动员组61%(11/18)的患者术后HOS-ADL评分达到MCID,小于非运动员组的81%(31/36),差异有统计学意义(χ^(2)=4.339,P=0.037)。结论髋关节镜手术治疗运动员FAI可获得满意的疼痛缓解和运动功能。

Objective To investigate the clinical efficacy of arthroscopic surgery for the treatment of femoral acetabular impingement(FAI)in athletes.Methods A total of 18 FAI athletes(athlete group)who underwent hip arthroscopy in the Department of Sports Medicine,Peking University Third Hospital from April 2014 to June 2021 were retrospectively analyzed,including 12 males and 6 females,aged 20.44±3.45 years(range,15-27 years).According to gender,age,body mass index and follow-up time,36 non-athlete FAI patients(non-athlete group)were matched at a ratio of 1∶2 by propensity score matching method.There were 18 males and 18 females,aged 20.81±4.68 years(range 14-31 years).The hip pain visual analogue scale(VAS),modified Harris hip score(mHHS),hip outcome score-activity of daily living scale(HOS-ADL)and hip outcome score-sports scale(HOS-SS)scores were compared between the two groups before and after surgery.The minimal clinically important difference(MCID)and patient acceptable symptomatic state(PASS)were also compared between the two groups.Results All patients successfully completed the surgery and were followed up for 33.56±19.20 months(range,24-77 months).The VAS score at the last follow-up decreased from 6.22±1.52 points before surgery to 1.28±1.67 points in the athletes group,and decreased from 6.28±1.37 points before surgery to 1.67±1.69 points in the non-athletes group.There was no significant difference between the two groups(P>0.05).The mHHS score at the last follow-up increased from 65.53±12.90 points before surgery to 92.28±13.59 points in the athletes group,and increased from 61.01±11.96 points before surgery to 86.82±11.98 points in the non-athletes group.There was no significant difference between the two groups(P>0.05).The HOS-ADL score at the last follow-up increased from 72.77±18.86 points before surgery to 94.00±11.36 points in the athletes group,and increased from 70.35±13.12 points before surgery to 90.78±9.36 points in non-athletes group.There was no significant difference between the two groups(P>0.05).The HOS-SS score at the last follow-up increased from 49.77±22.93 points before surgery to 87.28±17.62 points in the athletes group,and increased from 44.08±19.66 before surgery to 72.57±20.16 in the non-athletes group.The HOS-SS scores in the athletes group at the last follow-up were higher than those in the non-athletes group(P<0.05).Furthermore,61%(11/18)in the athletes group achieved MCID in HOS-ADL after surgery,which was lower than the non-athletes group's 81%(31/36),with a statistically significant difference(χ^(2)=4.339,P=0.037).Conclusion Hip arthroscopy in the treatment of FAI in athletes can achieve satisfactory pain relief and motor function.