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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 97 -101. doi: 10.3877/cma.j.issn.1674-134X.2020.01.017

所属专题: 文献

临床经验

关节镜下股骨头颈成形术治疗混合型股骨髋臼撞击症
辛运强1, 高炜2, 梁华2, 滕学仁3, 刘玉新3,()   
  1. 1. 116000 辽宁,大连医科大学
    2. 266000 青岛市肿瘤医院
    3. 266000 青岛市市立医院东院区
  • 收稿日期:2019-05-08 出版日期:2020-02-01
  • 通信作者: 刘玉新

Arthroscopic femoral osteoplasty for mixed-type femoroacetabular impingememt

Yunqiang Xin1, Wei Gao2, Hua Liang2, Xueren Teng3, Yunxin Liu3,()   

  1. 1. Dalian Medical University, Liaoning 116000, China
    2. Qingdao Cancer Hospital, Qingdao 266000, China
    3. Qingdao Municipal Hospital East Campus, Qingdao 266000, China
  • Received:2019-05-08 Published:2020-02-01
  • Corresponding author: Yunxin Liu
  • About author:
    Corresponding author: Liu Yunxin, Email:
引用本文:

辛运强, 高炜, 梁华, 滕学仁, 刘玉新. 关节镜下股骨头颈成形术治疗混合型股骨髋臼撞击症[J/OL]. 中华关节外科杂志(电子版), 2020, 14(01): 97-101.

Yunqiang Xin, Wei Gao, Hua Liang, Xueren Teng, Yunxin Liu. Arthroscopic femoral osteoplasty for mixed-type femoroacetabular impingememt[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(01): 97-101.

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。

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.

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)]
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
[1]
Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip[J]. Clin Orthop Relat Res, 2003, 417(417): 112-120.
[2]
Griffin DR, Dickenson EJ, JO’Donnell, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome):an international consensus statement[J]. Br J Sports Med, 2016, 50(19):1169-1176.
[3]
Beck M, Leunig M, Parvizi J, et al. Anterior femoroaeetabular impingement: part II, midterm results of surgical treatment[J]. Clin Orthop Relat R, 2004, 418(418):67-73.
[4]
Beck M, Kalhor M, Leunig M, et al. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip[J]. J Bone Joint Surg Br, 2005, 87(7): 1012-1018.
[5]
Amanatullah DF, Antkowiak T, Pillay KA, et al. Femoroacetabular impingement: current concepts in diagnosis and treatment[J]. Orthopedics, 2015, 38(3): 185-199.
[6]
Lavigne M, Parvizi J, Beck M, et al. Anterior femoroacetabular impingement:part I, techniques of joint preserving surgery[J]. Clin Orthop Relat R, 2004, 418(418):61-66.
[7]
Lizaliturri VJ, Orozco RL. Arthroscopic treatment of cam-type femoroacetabular impingement[J]. J Arthroplasty, 2008, 23(2): 226-234.
[8]
Larson CM, Giveans MR. Arthroscopic management offemoroacetabular impingement:early outcomes measures[J]. Arthroscopy, 2008, 24(5): 540-546.
[9]
Leunig M, Beck M, Kalhor M, et al. Fibrocystic changes at antero superior femoral neck:prevalence in hips with femoroace-tabular impingemen[J]. Radiology, 2005, 236(1): 237-246.
[10]
James SL, Ali K, Malara F, et al. MRI findings of femoroacetabular impingement[J]. Am J Roentgenol, 2006, 87(6): 1412-1419.
[11]
Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tih on acetabular retroversion:a study of pelves from cadavers[J]. Clin Orthop Relat R, 2003, 407(407):241-248.
[12]
张洪,蒋毅,吕明,等.髋关节撞击综合征的诊断和治疗[J/CD].中华关节外科杂志(电子版),2009,3(3):352-357.
[13]
Leunig M, Beaulé PE, Ganz R, et al. The concept of femoroacetabular impingement:current status and future perspectives[J]. Clin Orthop Relat Res, 2009, 467(3): 616-622.
[14]
Hart ES, Metkar US, Rebello GN, et al. Femoroacetabular impingement in adolescents and young adults[J]. Orthop Nurs, 2009, 28(3): 117-124.
[15]
Emary P. Femoroacetabular impingement syndrome:a narrative review for the chiropractor[J]. J Can Chiropr Assoc, 2010, 54(3): 164-176.
[16]
Kalberer F, Sierra RJ, Madan SS, et al. Ischial spine projection into the pelvis:a new sign for acetabular retroversion[J]. Clin Orthop Relat Res, 2008, 466(3): 677-683.
[17]
Yang-Pin L. Complications of hip arthroscopy:analysis of seventy three cases[J]. Chang Gung Med J, 2006, 29(1): 86-91.
[18]
Ilizaliturri J. Complications of arthroscopic femoroacetabular impingement treatment: a review[J]. Clin Orthop Relat Res, 2009, 467(3): 760-768.
[19]
吴子英,陈疾忤,陈世益,等.关节镜下股骨头颈成形术治疗凸轮型股骨髋臼撞击症[J].中华骨科杂志,2012,32(2):132-137.
[20]
Beck M, Kalhor M, Leunig M, et al. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip[J]. J Bone Joint Surg Br, 2005, 87(7): 1012-1018.
[21]
Hilippon MJ, Stubbs AJ, Schenker ML, et al. Arthmscopic management of femoroacetabular impingement:osteoplasty technique and literature review[J]. Am J Sports Med, 2007, 35(9): 1571-1580.
[22]
Mardones RM, Gonzalez C, Chen Q, et al. Surgical treatment of femoroacetabular impingement:evaluation of the effect of the size of the resection[J]. J Bone Joint Surg Am, 2005, 87(2): 273-279.
[23]
王卫国,李子荣,岳德波,等.髋臼盂唇损伤的关节镜手术[J].中华骨科杂志,2010,30(10):924-930.
[24]
Nötzli HP, Wyss TF, Stoecklin CH, et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement[J]. J Bone Joint Surg Br, 2002, 84(4): 556-560.
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