中国修复重建外科杂志

中国修复重建外科杂志

髋关节外科脱位术治疗股骨髋臼撞击征的中期疗效

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目的探讨髋关节外科脱位术治疗股骨髋臼撞击征(femoroacetabular impingement,FAI)的中期疗效。方法2014 年 4 月—2015 年 8 月,采用髋关节外科脱位术治疗 15 例(16 髋)FAI。男 12 例,女 3 例;年龄 22~59 岁,平均 36.6 岁。单髋 14 例,双髋 1 例。病程 4~120 个月,平均 28 个月。术前疼痛视觉模拟评分(VAS)为(7.9±1.0)分,髋关节 Harris 评分为(44.1±9.3)分。结果术后切口均Ⅰ期愈合,无血管神经损伤、感染等早期并发症发生。患者均获随访,随访时间 30~46 个月,平均 39.5 个月。术后 3 个月及末次随访时,VAS 评分分别为(2.5±1.6)、(0.5±0.7)分,髋关节 Harris 评分分别为(85.5±4.4)、(95.6±3.9)分,均显著优于术前(P<0.05);术后两时间点间比较差异亦有统计学意义(P<0.05)。末次随访时,髋关节功能满意率达 93.8%(15/16)。X 线片复查示,患侧髋关节股骨头颈及髋臼成形部位无撞击征象出现。随访期间无内固定物松动、截骨处不连、股骨头缺血性坏死、异位骨化等并发症发生。结论髋关节外科脱位术在行髋臼和/或股骨头颈成形同时修补撕裂的盂唇,治疗 FAI 中期疗效满意。

ObjectiveTo assess the mid-term effecitveness of femoroacetabular impingement (FAI) treated by surgical hip dislocation.MethodsBetween April 2014 and August 2015, 15 patients (16 hips) with FAI were enrolled in the study and treated with surgical hip dislocation. There were 12 males and 3 females with an average age of 36.6 years (range, 22-59 years). Among them, 14 cases involved in unilateral hip and 1 in bilateral hips. The mean disease duration was 28 months (range, 4-120 months). Preoperative visual analogue scale (VAS) score and Harris hip score were 7.9±1.0 and 44.1±9.3, respectively.ResultsAll incisions healed normally. There was no main complications occurred, such as vessel and nerve injuries and infection. All 15 patients were followed up 30-46 months (mean, 39.5 months). The VAS score was 2.5±1.6 at 3 months and 0.5±0.7 at last follow-up. The Harris score was 85.5±4.4 at 3 months and 95.6±3.9 at last follow-up. There were significant differences in two scores between pre- and post-operation and between 3 months and last follow-up (P<0.05). The satisfaction rate of hip function was 93.8% (15/16) at last follow-up. X-ray examination showed that there was no sign of impingment at the femoral head and neck and acetabulum forming site of the affected hip joint, and no complication such as loosening of internal fixator, nonunion of osteotomy, avascular necrosis of femoral head, and heterotopic ossification occurred during follow-up.ConclusionThe surgical hip dislocation is a safe and effective way to treat FAI in the mid-term follow-up, which can repair torn labrum while trimming acetabulum and femoral neck.

关键词: 髋关节外科脱位术; 股骨髋臼撞击征; 盂唇修补; 中期疗效

Key words: Surgical hip dislocation; femoroacetabular impingement; labral refixation; mid-term effectiveness

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1. Smith-Petersen MN. The classic: Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. 1936. Clin Orthop Relat Res, 2009, 467(3): 608-615.
2. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8): 1119-1124.
3. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res, 2003, (417): 112-120.
4. Nepple JJ, Clohisy JC, ANCHOR Study Group Members. Evolution of femoroacetabular impingement treatment: the ANCHOR experience. Am J Orthop (Belle Mead NJ), 2017, 46(1): 28-34.
5. Nwachukwu BU, Rebolledo BJ, McCormick F, et al. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med, 2016, 44(4): 1062-1068.
6. Oduwole KO, de SA D, Kay J, et al. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res, 2017, 6(8): 472-480.
7. de SA D, Lian J, Sheean AJ, et al. A systematic summary of systematic reviews on the topic of hip arthroscopic surgery. Orthop J Sports Med, 2018, 6(9): 2325967118796222.
8. Botser IB, Jackson TJ, Smith TW, et al. Open surgical dislocation versus arthroscopic treatment of femoroacetabular impingement. Am J Orthop (Belle Mead NJ), 2014, 43(5): 209-214.
9. Nwachukwu BU, Rebolledo BJ, McCormick F, et al. Arthroscopic versus open treatment of femoroacetabular impingement: A systematic review of medium- to long-term outcomes. Am J Sports Med, 2016, 44(4): 1062-1068.
10. Botser IB, Smith TW Jr, Nasser R, et al. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy, 2011, 27(2): 270-278.
11. 谢宗平, 金东旭, 盛加根, 等. 关节镜下手术治疗股骨髋臼撞击征的中期疗效. 中国修复重建外科杂志, 2018, 32(2): 129-133.
12. Çetinkaya E, Özcan Ç, Gursu SS. Current Concepts in Management of Femoroacetabuler Impingement. Ann Sports Med Res, 2017, 4(1): 1100.