髋关节镜下可吸收螺钉修复髋臼软骨分层损伤的早期疗效

The early effect of absorbable anchor repairing acetabular cartilage delamination under hip arthroscopy

目的探讨髋关节镜下可吸收螺钉治疗髋臼软骨分层损伤的早期疗效。方法回顾性收集2021年5月至2021年8月北京大学第三医院收治的股骨髋臼撞击症合并髋臼软骨分层损伤的患者24例,男14例、女10例,年龄(36.3±7.2)岁(范围23~53岁)。可吸收螺钉组12例,采用可吸收螺钉修复髋臼软骨分层损伤;旷置组12例,采用传统旷置方法。比较两组手术前后X线片测量的α角、外侧中心边缘角(lateral center edge angle,LCEA)以及MRI测量的髋臼软骨间隙。术前及末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)、改良Harris髋关节评分(modified Harris hip score,mHHS)、国际髋关节结果工具(12-item international hip outcome tool,iHOT12)评分、髋关节日常活动评分(hip outcome score-activities of daily living subscale,HOS-ADL)、髋关节运动评分(hip outcome score-sports subscale,HOS-SS)评估髋关节功能。随访期内观察并发症(感染、下肢静脉血栓形成)及接受髋关节镜翻修术或全髋关节置换术的比例。结果24例均获得随访,随访时间(12.0±1.2)个月(范围10~14个月)。可吸收螺钉组与旷置组的年龄、体质指数、病程的差异均无统计学意义(P>0.05)。两组术前α角、LCEA、髋臼软骨间隙、mHHS、iHOT12评分、HOS-ADL、HOS-SS及VAS的差异均无统计学意义(P>0.05)。末次随访时两组α角、LCEA、髋臼软骨间隙、mHHS、iHOT12评分、HOS-ADL、HOS-SS、VAS及患者满意度的差异均无统计学意义(P>0.05)。可吸收螺钉组术后α角为47.2°±2.6°、髋臼软骨间隙为(3.0±0.7)mm、mHHS为(73.6±16.0)分、iHOT12为(67.6±22.5)分,与术前[63.4°±3.3°、(3.3±0.6)mm、(57.7±15.4)分、(50.6±15.0)分]的差异均有统计学意义(P<0.05);旷置组术后α角为47.4°±2.6°,较术前的58.4°±8.1°降低,差异有统计学意义(t=5.081,P=0.000),而LCEA、髋臼软骨间隙、mHHS、iHOT12评分、HOS-ADL、HOS-SS、VAS与术前的差异均无统计学意义(P>0.05)。至末次随访两组均未发生并发症,无一例需行髋关节镜翻修术或全髋关节置换术。结论髋关节镜下可吸收螺钉修复髋臼软骨分层损伤早期疗效良好,不提高术后并发症或再手术的风险。

Objective To investigate the early effect of repairing acetabular cartilage delamination with absorbable anchor under hip arthroscopy compared with conventional non-intervention.Methods Retrospective cohort study was adopted.There were 24 Femoroacetabular Impingment(FAI)patients with acetabular cartilage delamination(ACD)receiving hip arthroscopy surgery in Peking University Third Hospital from May 2021 to August 2021.There were 14 males and 10 females with an average age of 36.3±7.2 years(range 23-53 years).There were 12 patients receiving acetabular cartilage repair with absorbable anchor(absorbable anchor group),and 12 patients in non-intervention group.The X-ray film indicators,αangle,lateral center edge angle(LCEA)and MRI measurement(acetabular cartilage gap,CG)were compared between the two groups.The pre-and post-operative hip functions were assessed by modified Harris Hip Score(mHHS),12-item international hip outcome tool(iHOT12),hip outcome score-activities of daily living subscale(HOS-ADL),and hip outcome score-sports subscale(HOS-SS),along with visual analogue scale(VAS).The complications(infection,lower extremity deep venous thrombosis)were followed up,as well as the revisional hip arthroscopy surgery and total hip replacement surgery.Results A total of 24 patients were followed up for 12.0±1.2 months(range 10-14 months).There was no significant difference between the two groups for age,BMI,and symptom onset time(P>0.05).There was no significant difference between the two groups for the pre-operativeαangle,LCEA,CG,mHHS,iHOT12,HOS-ADL,HOS-SS,and VAS scores(P>0.05).At the last follow-up,there was no significant difference between the two groups for theαangle,LCEA,CG,mHHS,iHOT12,HOS-ADL,HOS-SS,VAS and satisfaction(P>0.05).In the absorbable anchor group,theαangle was 47.2°±2.6°vs.63.4°±3.3°,CG was 3.0±0.7 mm vs.3.3±0.6 mm;mHHS was 73.6±16.0 vs.57.7±15.4;iHOT12 was 67.6±22.5 vs.50.6±15.0 after and before the surgery,with significant improvement(P<0.05).As for the non-intervention group,there was significant decrease of post-operativeαangle of 47.4°±2.6°compared to the pre-operative angle of 58.4°±8.1°(P<0.05).There was no significant difference in LCEA,CG,mHHS,iHOT12,HOS-ADL,HOS-SS,and VAS scores before and after the surgery in non-intervention group comparison(P>0.05).No complications,revision hip arthroscopy surgery or total hip replacement surgery occurred during the follow up.Conclusion Good effect was yielded for absorbable anchor repairing acetabular cartilage delamination under hip arthroscopy,without additional risk of complications or revision surgery.