关节镜手术治疗整体和局部钳夹型股骨髋臼撞击综合征的疗效比较

Comparison of the treating effects of arthroscopic surgery in global and Focal pincer femoroacetabular impingement

摘要:

探讨关节镜手术治疗整体钳夹型股骨髋臼撞击综合征（FAI）的临床结局。方法 根据术前X线检查，将患者分为整体钳夹型FAI（中心边缘角度≥40°）和局部钳夹型FAI（中心边缘角度25°～39°）两组。比较两组患者术前和术中结果、手术操作流程、术后非关节炎髋关节评分（NAHS）和满意度（李克特LIKERT五分量表法）、并发症和接受关节置换术情况。结果 整体钳夹型FAI包括15例患者，平均年龄（37.2±11.3）岁。术前和术后第24个月NAHS分别为（51.5±22.7）和（74.1±16.6）分，两组差异具有统计学意义（P =0.001）。患者平均满意度为（4.2±1.2）分，1例患者（6.7%）接受全髋关节置换术（THA），无翻修手术或并发症发生。局部钳夹型FAI包括125例患者，平均年龄（39.8±13.5）岁。术前和术后第24个月NAHS分别（55.5±17.1）和（77.3±18.5）分，两组差异具有统计学意义（P =0.015）。平均满意度为（4.2±1.3）分。8例（6.4%）患者接受THA，3例患者发生并发症（2.4%）和2例患者接受翻修手术（1.6%）。两组患者术后第24个月NAHS（P =0.301）、满意度（P =0.926）和THA置换率（P =0.912）差异均无统计学意义。整体组和局部组患者术后24个月后的NAHS变化平均数分别为（22.2±6.9）和（21.5±8.8）分，两组NAHS变化差异无统计学意义（P =0.955）。结论 整体钳夹型FAI采用关节镜手术安全有效，并且与关节镜治疗局部钳夹型FAI疗效相当。

Abstract:

Abstract: Objective To investigate the effect of arthroscopic surgery treating global pincer femoroacetabular impingement. Methods Global (center-edge angle ≥ 40°) and Focal (center-edge angle 25° ~ 39°) cohorts were based on pre-operative radiographs. Pre-operative and intra-operative findings, surgical procedures, postoperative nonarthritic hip score (NAHS) and satisfaction (5-point Likert scale), complications and conversion arthroplasties were compared. A nested case-control study was also performed. Results The Global cohort consisted of 15 patients of mean age (37.2 ± 11.3) years. Pre-operative NAHS was (51.5 ± 22.7) and (74.1 ± 16.6) at 24 months after operation. The change in NAHS was significant (P = 0.001). Mean satisfaction was (4.2 ± 1.2). There was one total hip arthroplasty (THA) conversion (6.7%), no revision surgeries or complications. The Focal cohort consisted of 125 patients of mean age (39.8 ± 13.5) years. Pre-operative NAHS was (55.5 ± 17.1) and (77.3 ± 18.5) at 24 months after operation. The change in NAHS was significant (P = 0.015). Mean satisfaction was (4.2 ± 1.3). There were eight THA conversions (6.4%), three complications (2.4%) and two revision surgeries (1.6%). Cohort comparisons revealed no statistically significant difference in NAHS (P = 0.301), satisfaction (P = 0.926) and THA conversion rate (P = 0.912). The nested case-control study found mean post-operative change in NAHS was (22.2 ± 6.9) and (21.5 ± 8.8), respectively, at 24 months (P = 0.955). Conclusion The global pincer FAI was safe and effective with arthroscopic surgery, and the effect was similar to that of the local pincer FAI .