关节镜下带血供关节囊移植重建髋臼盂唇疗效的初步研究
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摘要
背景:髋臼盂唇在维持髋功能和减少髋退行性病变中起十分重要的作用。盂唇重建手术在全世界范围内仍是一个相对较新的领域,对于无法修复或需要在初次修复后进行翻修的髋臼盂唇损伤,采用各种组织来源的移植物重建髋臼盂唇正逐渐成为一种新的充满前景的治疗方式。目的:介绍关节镜下关节囊移植重建髋臼盂唇手术技术并评估其临床疗效。方法:2014年1月至2016年1月,对21例患者进行关节镜下关节囊移植重建髋臼盂唇,其中男9例,女12例,平均年龄(46.7±5.7)岁;患者随访6~23个月,平均随访(14.5±2.3)个月;采用改良Harris髋关节评分(mHHS)、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:盂唇发育不良(宽度<5 mm)7例,复杂撕裂9例,明显退变5例。术后患者无严重并发症发生。手术前后mHHS比较,差异有统计学意义[(62.5±3.1)vs(87.2±3.3)分,P<0.001];手术前后HOS比较,差异有统计学意义[(42.7±5.5)vs(86.3±2.3)分,P<0.001];手术前后HOSADL评分比较,差异有统计学意义[(46.0%±3.6%)vs(73.7%±3.5%),P<0.001]。不同性别mHHS、HOS及HOS-ADL评分比较,差异无统计学意义。结论:对于盂唇发育不良、复杂撕裂、明显退变,建议行盂唇重建术,以恢复盂唇复合体的完整性;采用局部关节囊重建盂唇,在不增加手术复杂程度的同时保障了供体组织的血供,且不增加移植部位的并发症。
Background: The acetabular labrum plays an important role in maintaining hip function and minimizing hip degeneration. Although as a relatively new field, labral reconstruction surgery with various autograft and allograft is becoming more and more popular in patients with acetabular labrum injury irreparable or requiring revision after primary repair. Objective: To introduce a technique for reconstruction of the acetabular labrum by capsular autograft and assess the outcome. Methods: From January 2014 to January 2016, 21 patients underwent arthroscopic reconstruction of the acetabular labrum by capsular autograft including 9 males and 12 females, with the mean age of(46.7 ±5.7) years. All patients were followed up for 6 to 23 months, with an average of(14.5±2.3) months. The outcomes were measured with the modified Harris Hip Score(mHHS), Hip Outcome Score(HOS) and Hip Outcome Score-Activities of Daily Living(HOS-ADL). Results: 7 patients were found hypoplastic acetabular labrum(width <5 mm), 9 patients were found complex tearing of acetabular labrum, and 5 patients were found degenerative acetabular labrumin. The differences in mHHS [(62.5±3.1) vs(87.2±3.3)分, P<0.001], HOS [(42.7±5.5) vs(86.3±2.3)分,P<0.001] and HOS-ADL [(46.0%±3.6%)vs(73.7%±3.5%),P<0.001] were statistically significant between preoperation and final follow up. No significant difference was identified in mHHS, HOS and HOS-ADL between gender groups.Conclusions: Reconstruction of the acetabular labrum by capsular autograft is recommended in patients with hypoplastic acetabular labrum,complex tearing of acetabular labrum and degenerative acetabular labrumin to restore functional labral anatomy, and will not increase the complications of donor-site or make the procedure more complicated for preservation of the donor-tissue blood supply when using of capsular autograft.
Background: The acetabular labrum plays an important role in maintaining hip function and minimizing hip degeneration. Although as a relatively new field, labral reconstruction surgery with various autograft and allograft is becoming more and more popular in patients with acetabular labrum injury irreparable or requiring revision after primary repair. Objective: To introduce a technique for reconstruction of the acetabular labrum by capsular autograft and assess the outcome. Methods: From January 2014 to January 2016, 21 patients underwent arthroscopic reconstruction of the acetabular labrum by capsular autograft including 9 males and 12 females, with the mean age of(46.7 ±5.7) years. All patients were followed up for 6 to 23 months, with an average of(14.5±2.3) months. The outcomes were measured with the modified Harris Hip Score(mHHS), Hip Outcome Score(HOS) and Hip Outcome Score-Activities of Daily Living(HOS-ADL). Results: 7 patients were found hypoplastic acetabular labrum(width <5 mm), 9 patients were found complex tearing of acetabular labrum, and 5 patients were found degenerative acetabular labrumin. The differences in mHHS [(62.5±3.1) vs(87.2±3.3)分, P<0.001], HOS [(42.7±5.5) vs(86.3±2.3)分,P<0.001] and HOS-ADL [(46.0%±3.6%)vs(73.7%±3.5%),P<0.001] were statistically significant between preoperation and final follow up. No significant difference was identified in mHHS, HOS and HOS-ADL between gender groups.Conclusions: Reconstruction of the acetabular labrum by capsular autograft is recommended in patients with hypoplastic acetabular labrum,complex tearing of acetabular labrum and degenerative acetabular labrumin to restore functional labral anatomy, and will not increase the complications of donor-site or make the procedure more complicated for preservation of the donor-tissue blood supply when using of capsular autograft.
引文
[1] Ferguson SJ, Bryant JT, Ganz R, et al. The acetabularlabrum seal:A proelastic finite element model. ClinBiomech(Bristol, Avon), 2000, 15(6):463-468.
[2] Espinosa N, Beck M, Rothenfluh DA, et al. Treatment of femoro-acetabular impingement:Preliminaryresults of labral refixation. Surgical technique. J Bone Joint Surg Am, 2007, 89(suppl 2, Pt 1):36-53.
[3] Cadet ER, Chan AK, Vorys GC, et al. Investigationof the preservation of the fluid seal effect in the repaired,partially resected, and reconstructed acetabular labrum in acadaveric hip model. Am J Sports Med, 2012,40(10):2218-2223.
[4] Deshmane PP, Kahlenberg CA, Patel RM, et al. All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique. Arthrosc Tech, 2012, 2(1):e15-e19.
[5] White BJ, Herzog MM. Arthroscopic labral reconstruction of the hip usingIliotibialband allograft and front-to-back fixation technique. Arthrosc Tech, 2016, 5(1):e89-e97.
[6] Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with fascia lata allograft:Clinical outcomes at minimum one-year follow-up. Open Orthop J, 2017, 11:554-561.
[7] Thomas Byrd JW. Modified anterior portal for hip arthroscopy. Arthrosc Tech, 2013, 2(4):e337-e339.
[8] Sharfman ZT, Amar E, Sampson T, et al. Arthroscopic labrum reconstruction in the hip using the indirect head of rectus femoris as a local graft:Surgical technique. Arthrosc Tech, 2016, 5(2):e361-e364.
[9] Mcarthy JC, Noble PC, Schuck MR, et al. The role of labrallesions to development of early degenerative hip disease.Clin Orthop Relat Res, 2001, 393(393):25-37.
[10] Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal—Part I:the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc, 2014, 22(4):722-729.
[11] Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation:2-year minimum outcomes. Am J Sports Med, 2013, 41(5):980-987.
[12] Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibialband autograft:technique and early outcomes. Arthroscopy, 2010,26(6):750-756.
[13] Moya E, Ribas M, Natera L, et al. Reconstruction of nonrepairable acetabular labral tears with allografts:Mid-term results. Hip Int, 2016, 26(Suppl. 1):43-47.
[14] Chandrasekaran S, Darwish N, Close MR, et al. Arthroscopic reconstruction of segmental defects of the hip labrum:Results in 22 patients with mean 2-year follow-up. Arthroscopy, 2017, 33(9):1685-1693.
[15] Sankar WN, Nevitt M, Parvizi J, et al. Femoroacetabular impingement:defining the condition and its role in the pathophysiology of osteoarthritis. J Am Acad Orthop Surg, 2013,21(Suppl. 1):S7-S15.
[16] Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis:report of a new technique. Clin OrthopRelat Res, 2009, 467(3):753-759.
[17] Lee S, Wuerz TH, Shewman E, et al. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure:an in vitro analysis. Am J Sports Med, 2015, 43(1):98-104.
[18] McConkey MO, Moreira B, Mei-Dan 0. Arthroscopic hip labral reconstruction and augmentation using knotless anchors. Arthrosc Tech, 2015,4(6):e701-e705.
[19] Costa Rocha P, Klingenstein G, Ganz R, et al. Circumferential reconstruction of severe acetabular labral damage usinghamstring allograft:surgical technique and case series. Hip Int, 2013, 23(Suppl. 9):S42-S53.
[20] Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med, 2007, 26(4):661-681.
[2] Espinosa N, Beck M, Rothenfluh DA, et al. Treatment of femoro-acetabular impingement:Preliminaryresults of labral refixation. Surgical technique. J Bone Joint Surg Am, 2007, 89(suppl 2, Pt 1):36-53.
[3] Cadet ER, Chan AK, Vorys GC, et al. Investigationof the preservation of the fluid seal effect in the repaired,partially resected, and reconstructed acetabular labrum in acadaveric hip model. Am J Sports Med, 2012,40(10):2218-2223.
[4] Deshmane PP, Kahlenberg CA, Patel RM, et al. All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique. Arthrosc Tech, 2012, 2(1):e15-e19.
[5] White BJ, Herzog MM. Arthroscopic labral reconstruction of the hip usingIliotibialband allograft and front-to-back fixation technique. Arthrosc Tech, 2016, 5(1):e89-e97.
[6] Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with fascia lata allograft:Clinical outcomes at minimum one-year follow-up. Open Orthop J, 2017, 11:554-561.
[7] Thomas Byrd JW. Modified anterior portal for hip arthroscopy. Arthrosc Tech, 2013, 2(4):e337-e339.
[8] Sharfman ZT, Amar E, Sampson T, et al. Arthroscopic labrum reconstruction in the hip using the indirect head of rectus femoris as a local graft:Surgical technique. Arthrosc Tech, 2016, 5(2):e361-e364.
[9] Mcarthy JC, Noble PC, Schuck MR, et al. The role of labrallesions to development of early degenerative hip disease.Clin Orthop Relat Res, 2001, 393(393):25-37.
[10] Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal—Part I:the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc, 2014, 22(4):722-729.
[11] Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation:2-year minimum outcomes. Am J Sports Med, 2013, 41(5):980-987.
[12] Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibialband autograft:technique and early outcomes. Arthroscopy, 2010,26(6):750-756.
[13] Moya E, Ribas M, Natera L, et al. Reconstruction of nonrepairable acetabular labral tears with allografts:Mid-term results. Hip Int, 2016, 26(Suppl. 1):43-47.
[14] Chandrasekaran S, Darwish N, Close MR, et al. Arthroscopic reconstruction of segmental defects of the hip labrum:Results in 22 patients with mean 2-year follow-up. Arthroscopy, 2017, 33(9):1685-1693.
[15] Sankar WN, Nevitt M, Parvizi J, et al. Femoroacetabular impingement:defining the condition and its role in the pathophysiology of osteoarthritis. J Am Acad Orthop Surg, 2013,21(Suppl. 1):S7-S15.
[16] Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis:report of a new technique. Clin OrthopRelat Res, 2009, 467(3):753-759.
[17] Lee S, Wuerz TH, Shewman E, et al. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure:an in vitro analysis. Am J Sports Med, 2015, 43(1):98-104.
[18] McConkey MO, Moreira B, Mei-Dan 0. Arthroscopic hip labral reconstruction and augmentation using knotless anchors. Arthrosc Tech, 2015,4(6):e701-e705.
[19] Costa Rocha P, Klingenstein G, Ganz R, et al. Circumferential reconstruction of severe acetabular labral damage usinghamstring allograft:surgical technique and case series. Hip Int, 2013, 23(Suppl. 9):S42-S53.
[20] Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med, 2007, 26(4):661-681.