中国修复重建外科杂志

中国修复重建外科杂志

关节镜联合直接前方入路在髋关节疾病中的应用研究

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目的探讨应用关节镜联合直接前方入路治疗髋关节疾病的近期疗效。方法2015 年 1 月—2016 年 12 月,采用关节镜下清理联合直接前方入路治疗 23 例(23 髋)髋关节疾病患者。男 9 例,女 14 例;年龄 27~49 岁,平均 38.6 岁。髋关节后脱位并股骨头骨折(Pipkin Ⅰ型)11 例、股骨颈骨折(Garden Ⅳ型)7 例,受伤至手术时间 2~8 d,平均 4.3 d;塌陷前期股骨头缺血性坏死 5 例,国际骨循环协会(ARCO)分期为ⅡA 期,病程 3~8 个月,平均 5.9 个月。术前 Harris 髋关节评分为(57.3±8.2)分,牛津大学髋关节评分(OHS)为(11.2±3.6)分,Postel 系统评分为(3.2±1.5)分,疼痛视觉模拟评分(VAS)为(7.2±1.3)分。手术联合骨折内固定或清理坏死股骨头并植骨治疗。结果术后切口均Ⅰ期愈合。3 例出现股外侧皮神经损伤。患者均获随访,随访时间 8~19 个月,平均 15.6 个月。术后骨折均愈合,愈合时间为 14~19 周,平均 15.8 周;未出现继发性骨关节炎及异位骨化等。末次随访时,Harris 髋关节评分为(92.5±5.3)分,OHS 评分为(36.5±5.9)分,Postel 系统评分为(14.2±2.6)分,均较术前显著提高(t=45.274,P=0.000;t=36.586,P=0.000;t=32.486,P=0.000);VAS 评分为(1.8±0.9)分,较术前显著降低(t=21.314,P=0.000)。结论应用关节镜联合直接前方入路治疗髋关节疾病,可有效缓解关节疼痛、改善关节功能,近期疗效满意。

ObjectiveTo evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases.MethodsA retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively.ResultsAll the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores (t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score (t=21.314, P=0.000).ConclusionArthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.

关键词: 髋关节镜; 直接前方入路; 股骨头骨折; 股骨颈骨折; 股骨头缺血性坏死

Key words: Hip arthroscopy; direct anterior approach; femoral head fracture; femoral neck fracture; osteonecrosis of femoral head

引用本文: 邓翔天, 刘俊才, 杨顺成, 王新源, 李忠. 关节镜联合直接前方入路在髋关节疾病中的应用研究. 中国修复重建外科杂志, 2018, 32(9): 1167-1171. doi: 10.7507/1002-1892.201803115 复制

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