摘要
目的:观察髋关节镜手术治疗50岁及以上中老年髋臼股骨撞击综合征(femoroacetabular impingement,FAI)患者的临床疗效。方法:对2015年1月至2018年6月本院骨科收治的符合排纳标准的37例50岁及以上中老年患者行髋关节镜手术治疗的临床效果进行分析。采用疼痛视觉模拟评分(visual analog scale,VAS)、改良Harris髋关节评分(modified Harris hip score,mHHS)和国际髋关节评分(international hip outcome tool,iHOT-12)评估临床疗效,并对手术前后X线片上的α角和外侧中心边缘角(central-edge angle,CE角)的变化进行对比。平均随访32.43±10.91月,最短随访时间2年。分别于术前、术后1年、2年对患者进行评分。结果:术前、术后1年、术后2年m HHS评分分别为62.27±11.07分、86.20±5.78分、87.75±5.28分;VAS评分分别为5.27±1.15分、1.72±0.79分、1.55±0.62分;iHOT-12评分分别为:31.52±7.72分、73.50±4.09分、73.72±3.92分。与术前相比,术后1年和术后2年mHHS评分、VAS评分和i HOT-12评分均有显著改善(P<0.01)。术后2年随访时患者mHHS评分较术后1年有进一步的提高,且具有统计学差异(P<0.05)。术后CE角、α角和偏心距(off-set)较术前显著减小(P<0.01)。2例髋臼和股骨双侧均有严重软骨损伤患者,分别于术后11个月和15个月行全髋关节置换。结论:50岁及以上未伴放射学征象上严重骨性关节炎的FAI患者行关节镜手术可以显著改善髋关节症状与功能。全髋关节置换转化率低,并发症少。严格的手术指征和合适的手术策略是中老年FAI患者术后取得满意疗效的基础。存在髋臼和股骨双侧严重软骨损伤可能是关节镜术后转化为全髋关节置换的前兆。
Objective To explore the outcome of hip arthroscopy for femoroacetabular impingement(FAI) of patients over 50 years old.Methods Totally 37 FAI patients over 50 and treated in the orthopedics department of our hospital between January 2015 and June 2018 were recruited and analyzed their outcomes.All patients were assessed using the Visual Analog Scale(VAS),the modified Harris Hip Score(mHHS) and the International Hip Outcome Tool(iHOT-12) before,as well as one and two years after the operation.The alpha angle and the lateral center-edge(CE) angle on the X-ray photos were also compared before and after the operation.Results All patients were followed up for at least 2 years,with an average of 32.43 ± 10.91.One and two years after the operation,the average m HHS(86.20 ± 5.78 and 87.75 ± 5.28),VAS(1.72 ± 0.79 and 1.55 ± 0.62) and iHOT-12(73.50 ± 4.09 and 73.72 ± 3.92) were significantly better than before the operation(62.27 ± 11.07,5.27 ± 1.15 and5.27 ± 1.15)(P<0.01).Moreover,the average mHHS 2 years after the operation was significantly better than one year before(P<0.05).Meanwhile,a significant decrease was observed in the postoperative CE angle,α angle and off-set(P<0.01).Two patients with severe acetabular and femoral cartilage damage underwent total hip arthroplasty(THA) 11 and 15 months after the hip arthroscopic treatment.Conclusion Hip arthroscopy can significantly relieve hip symptoms and improve the hip function among Chinese FAI patients without severe osteoarthritis radiographically and aged 50 years or older.Their conversion to THA is low and complications are rare.Strict surgical indications and appropriate surgical strategies lay the foundation for satisfactory postoperative results.Combined bipolar grade IV and grade III articular damage may be predictors for conversion to THA.
作者
高奉
胡波
张柏青
刘雨丰
鹿鸣
安明扬
齐玮
刘玉杰
李春宝
周敬滨
Gao Feng;Hu Bo;Zhang Baiqing;Liu Yufeng;Lu Ming;An Mingyang;Qi Wei;Liu Yujie;Li Chunbao;Zhou Jingbin(National Institute of Sports Medicine,Beijing 100061,China;The Fourth Medical Center,General Hospital of CPLA,Beijing 100048,China;Beijing Chaoyang Integrative Medicine Emergency Medical Center,Beijing 100022,China)
出处
《中国运动医学杂志》
CAS
CSCD
北大核心
2021年第10期761-766,共6页
Chinese Journal of Sports Medicine
基金
北京市自然科学基金(7192195)
全军医学科技青年拔尖项目(19QNP070)
国家重点研发计划课题(2018YFF0300604)。
关键词
髋关节
髋臼股骨撞击综合征
关节镜
中老年
疗效
hip
femoroacetabular impingement
arthroscopy
the middle-aged and elderly
outcome
