关节镜治疗成人临界型髋关节发育不良2年以上疗效观察

张佳; 李春宝; 张建平; 肇刚; 王江涛; 刘玉杰

doi:10.12435/j.issn.2095-5227.2023.111

关节镜治疗成人临界型髋关节发育不良2年以上疗效观察

Clinical outcomes of arthroscopic treatment of adult borderline dysplasia of hip for more than 2 years

摘要

摘要:
背景髋关节镜手术治疗临界型髋关节发育不良(borderline developmental dysplasia of the hip，BDDH)一直存在争议。
目的观察髋关节镜手术治疗BDDH术后2年以上疗效，探讨关节镜手术治疗BDDH的效果。
方法回顾性分析解放军总医院第一医学中心运动医学科2016年9月 - 2020年6月收治的BDDH患者。依据术前影像学资料和术中镜下病理，给予相应手术处理。截至2023年4月，借助问卷星电话通话调查患者术前和术后2年关节功能评价改良Harris髋关节评分(modified Harris hip score，mHHS)、国际髋关节结果评分(international hip outcome tool，IHOT-12)、疼痛视觉模拟评分(visual analog scale，VAS)和术后患者满意度评分。
结果 52例患者纳入研究，男15例，女37例，平均年龄(30.75 ± 8.39)岁，平均髋臼外侧中心边缘角(lateral center-edge angle，LCEA)为21.97° ± 2.14°。术中镜下盂唇撕裂、髋臼和股骨头软骨损伤发生率分别为100%、44.23%和32.69%。所有患者在髋臼边缘骨质最小磨除基础上行损伤盂唇的修整固定和关节囊切开后的缝合术，Cam畸形磨除和异常髂前下棘(anterior inferior iliac spine，AIIS)减压成形术分别占88.46%和57.69%。术后平均随访(44.35 ± 10.96)个月，术后mHHS评分(82.88 ± 9.15 vs 44.38 ± 15.05)、iHOT-12评分(83.62 ± 9.59 vs 41.18 ± 13.20)、VAS评分(1.83 ± 1.02 vs 6.42 ± 1.29)较术前均有显著改善 (P均＜0.01)，差异有统计学意义。
结论 BDDH多由机械性因素导致盂唇和软骨损伤，髋臼边缘最小磨除基础上的盂唇修整固定、Cam畸形和2 ~ 3型AIIS的充分磨除减压以及关节囊的缝合，可获得满意的临床疗效。

Abstract:
Background Arthroscopic surgery for borderline developmental dysplasia of the hip (BDDH) remains controversial.
Objective To observe the effect of hip arthroscopy surgery for BDDH after more than 2 years of operation, and explore the effect of arthroscopic surgery for BDDH.
Methods A retrospective analysis was performed in BDDH patients who underwent arthroscopic surgery in the First Medical Center of Chinese PLA General Hospital from September 2016 to June 2020. Based on the preoperative imaging and intraoperative pathological findings, corresponding managements were conducted. By April 2023, the modified Harris hip score (mHHS), international hip outcome score -12 (IHOT-12), visual analog scale (VAS), and patient's satisfaction score were assessed via questionnaire star with telephone before operation and at two years after operation.
Results Totally 52 patients were included in the study, including 15 males and 37 females. The mean age was 30.75 ± 8.39 years, and the mean LCEA was 21.97° ± 2.14°. The incidence of intraoperative labral tear, acetabular and femoral head cartilage injury was 100%, 44.23% and 32.69%, respectively. All patients underwent acetabular minimal rim trimming with labral repair and fixation, and capsular closure after capsulotomy. The incidence of Cam deformity removal and abnormal anterior inferior iliac spine (AIIS) decompression was 88.46% and 57.69%, respectively. The mean postoperative follow-up was 44.35 ± 10.96 months, and the mHHS score (82.88 ± 9.15 vs 44.38 ± 15.05), iHOT-12 score (83.62 ± 9.59 vs 41.18 ± 13.20) and VAS score (1.83 ± 1.02 vs 6.42 ± 1.29) were all significantly improved compared with those before operation (P<0.01).
Conclusion BDDH is mainly caused by mechanical factors of labrum and cartilage injury. The labrum repair and fixation based on the acetabular minimal rim trimming, Cam deformity sufficient removal, type 2-3 AIIS decompression and capsular closure are performed to obtain satisfactory clinical results.

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