关节镜治疗髋臼盂唇损伤的疗效分析

Clinical outcome of arthroscopic acetabular labral repair

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。

Abstract:

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.