髋关节镜治疗运动员髋关节损伤的疗效分析
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摘要
目的评估髋关节镜治疗运动员髋关节损伤的临床疗效与运动恢复情况。方法自2009-02—2015-05为43例运动员患者(57髋)实施了髋关节镜手术,应用哈里斯髋关节评分系统(HHS)和非关节炎髋关节评分系统(NAHS)评估髋关节功能,并随访运动恢复情况。结果 35例(46髋)获得随访,随访时间为24～95(53.5±18.5)个月。术中发现30髋存在髋臼盂唇损伤,29髋存在髋关节软骨Outerbridge 4级损伤。46髋均实施了髋关节骨切除术,其中37髋仅实施了股骨头颈连接部成形术,2髋仅实施了髋臼成形术,7髋同时实施了髋臼成形术与股骨头颈连接部成形术。术后出现2例血肿、2例神经损伤,均在10周内恢复。HHS评分由术前(81.6±6.2)分提高到末次随访时的(95.9±3.3)分,NAHS评分由术前(83.0±5.2)分改善为(96.4±2.8)分,差异有统计学意义(P <0.05)。髋关节镜术后,34例恢复参加专业体育运动项目。至末次随访时22例仍在从事专业体育运动,术后平均从事专业体育运动24～95(56.1±21.2)个月;12例退役者术后至退役从事专业运动14～59(42.5±12.6)个月。结论采用髋关节镜手术治疗运动员髋关节损伤,髋关节功能显著改善,能恢复正常参加专业体育运动,属于一种安全、有效的术式。
Objective To investigate the clinical outcomes of hip arthroscopic treatment for hip injuries in athletes.Methods From Feb 2009 to May 2015, 43 athletes(57 hips) with hip injuries underwent hip arthroscopic treatment. Harris Hip Score(HHS) and Non-Arthritic Hip Score(NAHS) were recorded to evaluate the hip function. Recovery to professional sport was also recorded. Results Thirty-five patients(46 hips) were followed up for more than 2 years for an average of(53.5±18.5) months(range, 24 to 95 months). During surgery, labral tears were found in 30 hips(65.2%), and Outerbridge type grade IV chondral defects were found in 29 hips(63.0%). Bone resection was performed in all 46 hips. Femoral osteochondroplasty was performed alone in 37 hips(80.4%), acetabuloplasty was performed alone in 2 hips(4.3%). Both femoral osteochondroplasty and acetabuloplasty were performed in 7 hips(15.2%). Two patients had hematoma, and other 2 patients had nerve complications after hip arthroscopy. All of them recovered within 10 weeks. The mean HHS score improved from(81.6±6.2) points preoperatively to(95.9±3.3) points post-operatively(P <0.05). Mean NAHS score improved from(83.0±5.2) points preoperatively to(96.4 ±2.8) points post-operatively(P <0.05). After the surgery, 34 patients returned to play professionally. At the latest follow-up, 22 patients were still playing professionally, and they had played for a mean of(56.1 ±21.2) months(range, 24 to 95 months) after surgery. Twelve patients had retired, and after surgery they had played for a mean of 42.5 ±12.6 months(range, from 14 to 59 months) before retiring. Conclusion After hip arthroscopic treatment for hip injuries in athletes, the hip function has improved significantly, and the athletes can still return to play professionally. Hip arthroscopy is proved to be a safe and effective procedure for hip injuries in athletes.
Objective To investigate the clinical outcomes of hip arthroscopic treatment for hip injuries in athletes.Methods From Feb 2009 to May 2015, 43 athletes(57 hips) with hip injuries underwent hip arthroscopic treatment. Harris Hip Score(HHS) and Non-Arthritic Hip Score(NAHS) were recorded to evaluate the hip function. Recovery to professional sport was also recorded. Results Thirty-five patients(46 hips) were followed up for more than 2 years for an average of(53.5±18.5) months(range, 24 to 95 months). During surgery, labral tears were found in 30 hips(65.2%), and Outerbridge type grade IV chondral defects were found in 29 hips(63.0%). Bone resection was performed in all 46 hips. Femoral osteochondroplasty was performed alone in 37 hips(80.4%), acetabuloplasty was performed alone in 2 hips(4.3%). Both femoral osteochondroplasty and acetabuloplasty were performed in 7 hips(15.2%). Two patients had hematoma, and other 2 patients had nerve complications after hip arthroscopy. All of them recovered within 10 weeks. The mean HHS score improved from(81.6±6.2) points preoperatively to(95.9±3.3) points post-operatively(P <0.05). Mean NAHS score improved from(83.0±5.2) points preoperatively to(96.4 ±2.8) points post-operatively(P <0.05). After the surgery, 34 patients returned to play professionally. At the latest follow-up, 22 patients were still playing professionally, and they had played for a mean of(56.1 ±21.2) months(range, 24 to 95 months) after surgery. Twelve patients had retired, and after surgery they had played for a mean of 42.5 ±12.6 months(range, from 14 to 59 months) before retiring. Conclusion After hip arthroscopic treatment for hip injuries in athletes, the hip function has improved significantly, and the athletes can still return to play professionally. Hip arthroscopy is proved to be a safe and effective procedure for hip injuries in athletes.
引文
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[7]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8]Christensen CP,Althausen PL,Mittleman MA,et al.The nonarthritic hip score:reliable and validated[J].Clin Orthop Relat Res,2003,406:75-83.
[9]McCarthy J,Barsoum W,Puri L,et al.The role of hip arthroscopy in the elite athlete[J].Clin Orthop Relat Res,2003,406:71-74.
[10]Menge TJ,Bhatia S,McNamara SC,et al.Femoroacetabular impingement in professional pootball players:return to play and predictors of career length after hip arthroscopy[J].Am J Sports Med,2017,45(8):1740-1744.
[11]Degen RM,Fields KG,Wentzel CS,et al.Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players[J].Phys Sports Med,2016,44(4):385-390.
[12]Nwachukwu BU,Bedi A,Premkumar A,et al.Characteristics and outcomes of arthroscopic femoroacetabular impingement surgery in the national football league[J].Am J Sports Med,2018,46(1):144-148.
[13]Crawford K,Philippon MJ,Sekiya JK,et al.Microfracture of the hip in athletes[J].Clin Sports Med,2006,25(2):327-335.
[14]Perets I,Hartigan DE,Chaharbakhshi EO,et al.Outcomes of hip arthroscopy in competitive athletes[J].Arthroscopy,2017,33(8):1521-1529.
[15]Mohan R,Johnson NR,Hevesi M,et al.Return to sport and clinical outcomes after hip arthroscopic labral repair in young amateur athletes:minimum 2-year follow-up[J].Arthroscopy,2017,33(9):1679-1684.
[16]Viswanath A,Khanduja V.Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?[J].J Hip Preserv Surg,2017,4(1):3-8.
[17]陈石玉,罗建光,智云龙,等.髋关节镜辅助下空心钉内固定治疗股骨颈骨折[J].中国骨与关节损伤杂志,2015,30(6):626-627.
[18]李浩,阮狄克,贾治伟,等.髋关节镜的治疗进展[J].中国矫形外科杂志,2015,23(11):1011-1014.
[19]Kraeutler MJ,Anderson J,Chahla J,et al.Return to running after arthroscopic hip surgery:literature review and proposal of a physical therapy protocol[J].J Hip Preserv Surg,2017,4(2):121-130.
[20]岳元辉,龚庆国,周刚,等.关节镜治疗髋关节疾病的临床研究[J].现代生物医学进展,2016,16(18):3540-3543.
[2]Griffin DW,Kinnard MJ,Formby PM,et al.Outcomes of hip arthroscopy in the older adult:a systematic review of the literature[J].Am J Sports Med,2017,45(8):1928-1936.
[3]Schache AG,Woodley SJ,Schilders E,et al.Anatomical and morphological characteristics may explain why groin pain is more common in male than female athletes[J].Br J Sports Med,2017,51(7):554-555.
[4]Lee WY,Kang C,Hwang DS,et al.Descriptive epidemiology of symptomatic femoroacetabular impingement in young athlete:Single center study[J].Hip Pelvis,2016,28(1):29-34.
[5]姜亚飞,孙程,桑伟林,等.股骨髋臼撞击综合征的髋关节镜治疗[J].中国矫形外科杂志,2016,24(18):1679-1682.
[6]McCarthy JC,Lee JA.Hip arthroscopy:indications,outcomes,and complications[J].J Bone Joint Surg Am,2005,87(5):1138-1145.
[7]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8]Christensen CP,Althausen PL,Mittleman MA,et al.The nonarthritic hip score:reliable and validated[J].Clin Orthop Relat Res,2003,406:75-83.
[9]McCarthy J,Barsoum W,Puri L,et al.The role of hip arthroscopy in the elite athlete[J].Clin Orthop Relat Res,2003,406:71-74.
[10]Menge TJ,Bhatia S,McNamara SC,et al.Femoroacetabular impingement in professional pootball players:return to play and predictors of career length after hip arthroscopy[J].Am J Sports Med,2017,45(8):1740-1744.
[11]Degen RM,Fields KG,Wentzel CS,et al.Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players[J].Phys Sports Med,2016,44(4):385-390.
[12]Nwachukwu BU,Bedi A,Premkumar A,et al.Characteristics and outcomes of arthroscopic femoroacetabular impingement surgery in the national football league[J].Am J Sports Med,2018,46(1):144-148.
[13]Crawford K,Philippon MJ,Sekiya JK,et al.Microfracture of the hip in athletes[J].Clin Sports Med,2006,25(2):327-335.
[14]Perets I,Hartigan DE,Chaharbakhshi EO,et al.Outcomes of hip arthroscopy in competitive athletes[J].Arthroscopy,2017,33(8):1521-1529.
[15]Mohan R,Johnson NR,Hevesi M,et al.Return to sport and clinical outcomes after hip arthroscopic labral repair in young amateur athletes:minimum 2-year follow-up[J].Arthroscopy,2017,33(9):1679-1684.
[16]Viswanath A,Khanduja V.Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?[J].J Hip Preserv Surg,2017,4(1):3-8.
[17]陈石玉,罗建光,智云龙,等.髋关节镜辅助下空心钉内固定治疗股骨颈骨折[J].中国骨与关节损伤杂志,2015,30(6):626-627.
[18]李浩,阮狄克,贾治伟,等.髋关节镜的治疗进展[J].中国矫形外科杂志,2015,23(11):1011-1014.
[19]Kraeutler MJ,Anderson J,Chahla J,et al.Return to running after arthroscopic hip surgery:literature review and proposal of a physical therapy protocol[J].J Hip Preserv Surg,2017,4(2):121-130.
[20]岳元辉,龚庆国,周刚,等.关节镜治疗髋关节疾病的临床研究[J].现代生物医学进展,2016,16(18):3540-3543.