关节镜下股骨头颈成形术治疗混合型股骨髋臼撞击症

doi:10.3877/cma.j.issn.1674-134X.2020.01.017

目的

评估和分析关节镜下股骨头颈成形术治疗混合型股骨髋臼撞击症(FAI)的疗效。

方法

选取2016至2018年在青岛市市立医院收治的混合型FAI患者33例，其中男12例，女21例；年龄平均(38±3)岁，均经查体和X线片、CT确诊。髋关节镜下行关节清理和Cam成形，术后1、3、6、12个月进行随访，1年后每年随访1次。利用配对样本t检验比较术前和末次随访时患者撞击实验结果、髋关节活动度、α角、疼痛视觉模拟评分VAS疼痛评分、Harris髋关节功能评分及术后并发症发生情况。

结果

术前与末次随访结果比较，撞击试验结果均为阴性，髋关节屈曲活动度(t＝－13.58，P<0.01)、屈曲90°内旋范围(t＝－13.22，P<0.01)、Harris髋关节功能评分(t＝－23.56，P<0.01)、α角(t＝15.08，P<0.01)、VAS疼痛评分(t＝17.05，P<0.01)较术前相比，差异均具有统计学意义。

结论

髋关节镜Cam成形术治疗混合型FAI近期临床效果显著，有效缓解患者疼痛，改善髋关节活动度，提高关节功能。

关键词: 关节镜检查, 股骨, 股骨髋臼撞击, 创伤和损伤

Objective

To evaluat and analysis the clinical effect of arthroscopic femoral osteoplasty for mixed-type femoroacetabular impingememt (FAI) .

Methods

Thirty-three patients suffering mixed FAI were selected from 2016 to 2018, including 12 males and 21 females. The patients age were (38±3) years, and all the patients were confirmed by physical examination, X-ray and CT. The patients were followed-up at one months, three months, six months, one year and post-operative every year. Outcomes were measured with impingement tests, range of motion (ROM)of hip, α angle, visual analogue scale (VAS) and modified Harris hip score at final follow-up by paired sample t test.

Results

At the final follow-up, impingememt tests were all negative, the range of flexion increased compared with preoperative (t=-13.58, P<0.01), the range of internal rotation in a position of 90°flexion increased (t=-13.22, P<0.01), the Harris hip score improved(t=-23.56, P<0.01), the α angle decreased(t=15.08, P<0.01), VAS score decreased (t=17.05, P<0.01), all the differences were statistically significant.

Conclusion

The clinical effect of hip arthroscopic surgery for mixed-type femoroacetabular impingememt is significant, which can effectively relieve the pain of patients, improve the range of motion of hip joint, and improve the joint function.

Key words: Arthroscopy, Femur, Femoracetabular impingememt, Wounds and injuries

表1 末次随访髋关节功能、影像学指标与术前的比较[n＝33，(±s)]

	屈曲活动度(°)	屈曲90°内旋范围(°)	α角(°)	疼痛VAS分	Harris分数
术前	94.2±6.4	7.1±4.6	71.4±8.5	4.9±1.5	47.4±7.7
末次随访	119.2±7.0	31.5±9.5	42.0±6.0	0.8± 0.6	89.1±7.0
t值	－13.6	－13.2	15.1	17.1	－23.6
P值	<0.01	<0.01	<0.01	<0.01	<0.01

表1 末次随访髋关节功能、影像学指标与术前的比较[n＝33，(±s)]

	屈曲活动度(°)	屈曲90°内旋范围(°)	α角(°)	疼痛VAS分	Harris分数
术前	94.2±6.4	7.1±4.6	71.4±8.5	4.9±1.5	47.4±7.7
末次随访	119.2±7.0	31.5±9.5	42.0±6.0	0.8± 0.6	89.1±7.0
t值	－13.6	－13.2	15.1	17.1	－23.6
P值	<0.01	<0.01	<0.01	<0.01	<0.01

图1 混合型股骨髋臼撞击综合症双髋骨盆蛙式位X线片。图A示术前α角Cam起始点与股骨头圆心的连线和股骨颈纵轴线的夹角94.86°；图B白线示髋臼交叉征

图2 关节镜下股骨头颈成形术治疗混合型股骨髋臼撞击综合征。图A为镜下见股骨头颈交界处异常骨性隆起，示Cam形成；图B为髋关节镜下Cam成形术后，示股骨头颈交界处异常隆起消失

图3 混合型股骨髋臼撞击综合症股骨头颈成形术后影像。图A为末次随访双髋Dunn位X线片Cam起始点与股骨头圆心的连线和股骨颈纵轴线的夹角44.49°；图B为末次随访三维CT重建，示Cam成形术后异常骨性隆起消失

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Arthroscopic femoral osteoplasty for mixed-type femoroacetabular impingememt

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Arthroscopic femoral osteoplasty for mixed-type femoroacetabular impingememt