关节镜治疗髋臼盂唇损伤的疗效分析
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摘要
目的评估关节镜下髋关节盂唇修复的临床疗效。方法选取63例关节镜下行髋关节盂唇撕裂修复患者,手术适应证为不同原因的腹股沟区疼痛伴或不伴机械症状,非手术治疗≥6个月无效;术前影像学检查及术中关节镜探查证实存在髋关节盂唇撕裂,且无关节炎病变(T?nnis≤1级)。发病时间0.5～11.0年,平均3.1年;随访时间12～36个月,平均26个月。采用改良Harris髋关节评分(MHHS)和髋关节功能评分(HOS)、日常生活髋关节功能评分(HOS-ADL)对疗效进行评估。结果 Cam撞击伴盂唇撕裂14例,Pincer撞击伴盂唇撕裂11例,混合型撞击伴盂唇撕裂27例,单纯盂唇撕裂11例,11例患者伴有髋臼软骨损伤。手术前后MHHS、HOS、HOS-ADL评分比较,差异有统计学意义(P<0.05)。结论对于无关节炎病变的髋撞击盂唇损伤患者,关节镜下治疗髋撞击、修复盂唇撕裂,有良好的效果;由于盂唇对于髋关节长期功能完整具有重要作用,建议尽可能进行盂唇缝合修复。
Objective To assess the clinical and functional outcome of labral repair in patients undergoing arthroscopic surgery. Methods We performed a prospective analysis of 63 patients who had undergone hip arthroscopic repair of a torn acetabular labrum(24 men and 39 women; mean age, 36.7 years). The indication for surgery was groin pain due to various causes with or without associated mechanical symptoms that did not respond to operative treatment for more than 6 months and preoperative imaging examination and intraoperative arthroscopic examination confirmed the existence of hip labrum tear and no significant arthritis lesion(T?nnis level 1 or below).The mean duration of symptoms was 3.1 years(range, 0.5 to 11 years). The mean follow-up period was 26 months(range, 12 to 36 months). The outcome was prospectively measured with the modified Harris hip score(MHHS), hip outcome score(HOS) and hip outcome score-activities of daily living(HOS-ADL). Results Intraoperatively, all patients were diagnosed with labral pathology. The indication for surgery was femoroacetabular impingement(FAI)with cam deformity and a labral tear in 14 patients, FAI with pincer deformity and labral tear in 11 patients, FAI with both deformities in 27 patients, and isolated labral tear in 11 patients. Acetabular chondral lesions were present in 11 patients(17.46%). The mean preoperative and postoperative MHHS were 61.2 and 86.8, respectively(P < 0.05); the mean preoperative and postoperative HOS were 51.7 and 87.9, respectively(P < 0.05); and the mean preoperative and postoperative HOS-ADL were 45.8% and 74.6%, respectively(P < 0.05). These differences were statistically significant(P < 0.05). Conclusions Arthroscopic management of FAI and labral repair in patients without significant arthritis(T?nnis level 1 or below) are associated with significant improvement in outcome. Because of the importance of the labrum for long-term hip joint integrity, we advocate to repair the labrum as far as possible.
Objective To assess the clinical and functional outcome of labral repair in patients undergoing arthroscopic surgery. Methods We performed a prospective analysis of 63 patients who had undergone hip arthroscopic repair of a torn acetabular labrum(24 men and 39 women; mean age, 36.7 years). The indication for surgery was groin pain due to various causes with or without associated mechanical symptoms that did not respond to operative treatment for more than 6 months and preoperative imaging examination and intraoperative arthroscopic examination confirmed the existence of hip labrum tear and no significant arthritis lesion(T?nnis level 1 or below).The mean duration of symptoms was 3.1 years(range, 0.5 to 11 years). The mean follow-up period was 26 months(range, 12 to 36 months). The outcome was prospectively measured with the modified Harris hip score(MHHS), hip outcome score(HOS) and hip outcome score-activities of daily living(HOS-ADL). Results Intraoperatively, all patients were diagnosed with labral pathology. The indication for surgery was femoroacetabular impingement(FAI)with cam deformity and a labral tear in 14 patients, FAI with pincer deformity and labral tear in 11 patients, FAI with both deformities in 27 patients, and isolated labral tear in 11 patients. Acetabular chondral lesions were present in 11 patients(17.46%). The mean preoperative and postoperative MHHS were 61.2 and 86.8, respectively(P < 0.05); the mean preoperative and postoperative HOS were 51.7 and 87.9, respectively(P < 0.05); and the mean preoperative and postoperative HOS-ADL were 45.8% and 74.6%, respectively(P < 0.05). These differences were statistically significant(P < 0.05). Conclusions Arthroscopic management of FAI and labral repair in patients without significant arthritis(T?nnis level 1 or below) are associated with significant improvement in outcome. Because of the importance of the labrum for long-term hip joint integrity, we advocate to repair the labrum as far as possible.
引文
[1]MCCARTHY J C,NOBLE P C,SCHUCK M R,et al.The role of labral lesions todevelopment of early degenerative hip disease[J].Clin Orthop Relat Res,2001,393(393):25-37.
[2]NARVANI A A,TSIRIDIS E,KENDALL S,et al.A preliminary report on prevalence ofacetabular labrum tears in sports patients with groin pain[J].Knee Surg Sports TraumatolArthrosc,2003,11(6):403-408.
[3]SELDES R M,TAN V,HUNT J,et al.Anatomy,histologic features,andvascularity of the adult acetabular labrum[J].Clin Orthop Relat Res,2001,382(382):232-240.
[4]KELLY B T,WEILAND D E,SCHENKER M L,et al.Arthroscopic labral repair in the hip:Surgical techniqueand review of the literature[J].Arthroscopy,2005,21(12):1496-1504.
[5]DY C J,THOMPSON M T,CRAWFORD M J,et al.Tensile strain in the anterior partof the acetabular labrum during provocative maneuveringof the normal hip[J].J Bone Joint Surg Am,2008,90(7):1464-1472.
[6]SAFRAN M R.The acetabular labrum:anatomic and functional characteristics and rationale for surgical intervention[J].J Am Acad Orthop Surg,2010,18(16):338-345.
[7]KALBERER F,SIERRA R J,MADAN S S,et al.Ischial spine projection into the pelvis:a new sign foracetabular retroversion[J].ClinOrthopRelat Res,2008,466(3):677-683.
[8]WIBERG G.Studies on dysplastic acetabula and congenitalsubluxation of the hip joint:with special reference tothe complications of osteoarthritis[J].Journal of the American Medical Association,1939,115(1):81.
[9]BYRD J W T.Modified anterior portal for hip arthroscopy[J].Arthroscopy Techniques,2013,2(4):e337-e339.
[10]OUTERBRIDGE R E.The etiology of chondromalaciapatellae[J].Clin Orthop Relat Res,2001,43(389):5-8.
[11]HARRIS W H,BOURNE R B,OH I.Intra-articular acetabular labrum:a possible etiological factor in certain cases of osteoarthritis of the hip[J].Journal of Bone Joint Surgeryamerican Volume,1979,61(4):510-514.
[12]LIANG M H,KATZ J N,PHILLIPS C,et al.The total hip arthroplasty outcome evaluation form of the American academy of orthopaedic surgeons.results of a nominal group process.the American academy of orthopaedic surgeons task force on outcome studies[J].Journal of Bone Joint Surgery American Volume,1991,73(5):639-646.
[13]KAMATH A F,COMPONOVO R,BALDWIN K,et al.Hip arthroscopy for labral tears:Review of clinical outcomes with4.8-year mean follow-up[J].Am J Sports Med,2009,37:1721-1727.
[14]PHILIPPON M J,BRIGGS K K,YEN Y M,et al.Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up[J].Journal of Bone Joint Surgery British Volume,2009,91(1):16-23.
[15]THOMAS B J W,JONES K S.Arthroscopic management of femoroacetabular impingement(FAI)in adolescents[J].Operative Techniques in Sports Medicine,2011,27(10):1379.
[16]LARSON C M,GIVEANS M R,STONE R M.Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement:mean 3.5-year follow-up[J].Am J Sports Med,2012,25(4):1015-1021.
[17]ESPINOSA N,BECK M,ROTHENFLUH D A,et al.Treatment of femoro-acetabular impingement:preliminary results of labralrefixation.Surgical technique[J].Journal of Bone Joint Surgery-american Volume,2007,88(11):36-53.
[18]HAVIV B,O'DONNELL J.Arthroscopic treatment for acetabularlabral tears of the hip without bony dysmorphism[J].American Journal of Sports Medicine,2011,39(l):79S.
[19]PHILIPPON M J,PEIXOTO L P,GOLJAN P.Acetabular labral tears:debridement,repair,reconstruction[J].Operative Techniques in Sports Medicine,2012,20(4):281-286.
[2]NARVANI A A,TSIRIDIS E,KENDALL S,et al.A preliminary report on prevalence ofacetabular labrum tears in sports patients with groin pain[J].Knee Surg Sports TraumatolArthrosc,2003,11(6):403-408.
[3]SELDES R M,TAN V,HUNT J,et al.Anatomy,histologic features,andvascularity of the adult acetabular labrum[J].Clin Orthop Relat Res,2001,382(382):232-240.
[4]KELLY B T,WEILAND D E,SCHENKER M L,et al.Arthroscopic labral repair in the hip:Surgical techniqueand review of the literature[J].Arthroscopy,2005,21(12):1496-1504.
[5]DY C J,THOMPSON M T,CRAWFORD M J,et al.Tensile strain in the anterior partof the acetabular labrum during provocative maneuveringof the normal hip[J].J Bone Joint Surg Am,2008,90(7):1464-1472.
[6]SAFRAN M R.The acetabular labrum:anatomic and functional characteristics and rationale for surgical intervention[J].J Am Acad Orthop Surg,2010,18(16):338-345.
[7]KALBERER F,SIERRA R J,MADAN S S,et al.Ischial spine projection into the pelvis:a new sign foracetabular retroversion[J].ClinOrthopRelat Res,2008,466(3):677-683.
[8]WIBERG G.Studies on dysplastic acetabula and congenitalsubluxation of the hip joint:with special reference tothe complications of osteoarthritis[J].Journal of the American Medical Association,1939,115(1):81.
[9]BYRD J W T.Modified anterior portal for hip arthroscopy[J].Arthroscopy Techniques,2013,2(4):e337-e339.
[10]OUTERBRIDGE R E.The etiology of chondromalaciapatellae[J].Clin Orthop Relat Res,2001,43(389):5-8.
[11]HARRIS W H,BOURNE R B,OH I.Intra-articular acetabular labrum:a possible etiological factor in certain cases of osteoarthritis of the hip[J].Journal of Bone Joint Surgeryamerican Volume,1979,61(4):510-514.
[12]LIANG M H,KATZ J N,PHILLIPS C,et al.The total hip arthroplasty outcome evaluation form of the American academy of orthopaedic surgeons.results of a nominal group process.the American academy of orthopaedic surgeons task force on outcome studies[J].Journal of Bone Joint Surgery American Volume,1991,73(5):639-646.
[13]KAMATH A F,COMPONOVO R,BALDWIN K,et al.Hip arthroscopy for labral tears:Review of clinical outcomes with4.8-year mean follow-up[J].Am J Sports Med,2009,37:1721-1727.
[14]PHILIPPON M J,BRIGGS K K,YEN Y M,et al.Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up[J].Journal of Bone Joint Surgery British Volume,2009,91(1):16-23.
[15]THOMAS B J W,JONES K S.Arthroscopic management of femoroacetabular impingement(FAI)in adolescents[J].Operative Techniques in Sports Medicine,2011,27(10):1379.
[16]LARSON C M,GIVEANS M R,STONE R M.Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement:mean 3.5-year follow-up[J].Am J Sports Med,2012,25(4):1015-1021.
[17]ESPINOSA N,BECK M,ROTHENFLUH D A,et al.Treatment of femoro-acetabular impingement:preliminary results of labralrefixation.Surgical technique[J].Journal of Bone Joint Surgery-american Volume,2007,88(11):36-53.
[18]HAVIV B,O'DONNELL J.Arthroscopic treatment for acetabularlabral tears of the hip without bony dysmorphism[J].American Journal of Sports Medicine,2011,39(l):79S.
[19]PHILIPPON M J,PEIXOTO L P,GOLJAN P.Acetabular labral tears:debridement,repair,reconstruction[J].Operative Techniques in Sports Medicine,2012,20(4):281-286.