摘要
目的 探讨钳夹型髋关节撞击综合征术后残存骨性撞击的临床特点及其对疗效的影响.方法 2010年12月至2012年1月接受关节镜下手术且随访2年以上的单纯钳夹型髋关节撞击综合征患者30例,男21例,女9例;年龄28～42岁,平均34.5岁.术前骨关节炎分期为T（o）nnis 0～2期.应用三维CT重建对残存骨性撞击进行量化评估,包括发生率、骨性撞击角、残存率及好发区域.根据骨性残存程度将患者分为残存率＜10％组、残存率10％～20％组、残存率＞20％组,采用线性回归分析术后残存率与临床疗效的关系.结果 随访时间22～34个月,平均26.3个月.19例（63.3％,19/30）术后残存骨性撞击结构,其中84.2％ （16/19）位于髋臼后方.骨性撞击角术前77.47°±21.31°,术后12.94°±18.04°,残存率16.7％±8.83％.改良Harris髋关节评分由术前（55.18±7.96）分提高至术后（94.71±4.39）分,总体满意率76.7％（23/30）.不同残存程度三组患者术后改良Harris髋关节评分分别为（95.86±1.71）分、（95.23±1.99）分和（85.52±6.41）分,残存率＞20％组评分低于其他两组.满意率分别为92.9％（13/14）,80.0％（8/10）和33.3％（2/6）,残存率＞20％组患者满意率低于其他两组.术后残存率与术后功能评分存在负线性相关关系.结论 单纯钳夹型髋关节撞击综合征术后残存骨性撞击发生率为63.3％,残存率约为16.7％,残存骨性撞击主要发生于髋臼后方.残存率＞20％的患者术后功能评分及患者满意度差.
Objective To determine the clinical characteristics and its effect on the clinical efficacy of residual bony impingement lesion after hip arthroscopic osteoplasty for pincer-type femoroacetabular impingement.Methods There were 30 patients who underwent hip arthroscopic osteoplasty for isolated pincer-type femoroacetabular impingement from December 2010 to January 2012 and had a minimum follow-up period of 2 years,including 21 males and 9 females.The average age at surgery was 34.5 years （range from 28-42 years）.All of the patients had no advanced hip arthritis and the T（o）nnis grade was 0-2.Radiological evaluation was performed by 3-dimensional CT.According to residual rate,these patients were divided into 3 groups：residual rate 〈10% group,residual rate of 10%-20% groups and residual rate 〉20% group.Results The average follow-up period was 26.3 months （range,22-34 months） and nineteen cases had residual bony impingement lesion after surgery.Among them,84.2% of the residual bony impingement lesion was posterior to the acetabular actual resection zone.The preoperative and postoperative bony impingement angle were 77.47°±21.31° and 12.94°±18.04°,respectively.The residual rate was 16.7%± 8.83%.The modified Harris hip score got significantly improved from 55.18±7.96 preoperatively to 94.71±4.39 postoperatively.The overall satisfactory rate was 76.7%,and the postoperative modified Harris hip score for these three groups was 95.86±1.71,95.23±1.99 and 85.52±6.41,respectively.The postoperative modified Harris hip score in residual rate 〉20% group was significantly worse than those in other two groups.The satisfactory rate was 92.9%,80.0% and 33.3%,respectively.The satisfactory rate in residual rate 〉20% group was significantly worse than those in other two groups.There was a significant negative linear relationship between the residual rate and postoperative modified Harris hip score （R2=0.516,P=0.001）.Conclusion The incidence of residual bony impingement lesion after hip arthroscopic osteoplasty for pincer-type femoroacetabular impingement was 63.3%.The residual rate was 16.7%.The residual impingement lesion was mainly at the posterior part of the acetabulum.The patients with residual rate 〉20% got significantly worse clinical score and satisfactory rate.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2015年第3期227-233,共7页
Chinese Journal of Orthopaedics
基金
北京市科学技术委员会资助课题（Z131107002213125）
关键词
股骨髋臼撞击征
成像
三维
关节镜检查
Femoraeetabular impingement
Imaging, three-dimensional
Arthroscopy
