关节囊修补对股骨髋臼撞击综合征关节镜手术疗效的影响

摘要

目的 探讨关节囊修补对股骨髋臼撞击综合征关节镜手术疗效的影响.方法 2014年7月至2017年8月接受髋关节镜手术治疗的股骨髋臼撞击综合征患者102例.术中行髋臼和股骨头颈交界区畸形打磨处理及盂唇修补,根据是否缝合关节囊分为非缝合组(64例)和缝合组(38例).比较两组患者改良Harris髋关节功能评分(modified Harris hip score,mHHS)、非骨关节炎髋关节评分(nonarthritic hip score,NAHS)、髋关节结果评分日常生活能力量表(hip outcome score activity of daily living scale,HOS-ADL)评价髋关节功能.结果 非缝合组男28例、女36例,缝合组男17例、女21例;两组患者年龄分别为(38.59±11.27)岁和(37.64±11.10)岁;非缝合组pincer畸形18例、cam畸形12例、混合型34例,缝合组pincer畸形7例、cam畸形7例、混合型24例;两组患者性别构成比、年龄及撞击类型构成的差异无统计学意义(P＞0.05).非缝合组患者术前mHHS评分、NAHS评分、HOS-ADL评分分别为(59.56±12.44)分、(58.79±12.90)分和(64.11±14.43)分,术后1年分别提高至(85.52±4.69)分、(80.76±5.27)分和(86.08±5.85)分,差异均有统计学意义(P＜0.05);缝合组患者术前评分分别为(61.68±12.41)分、(60.62±10.48)分和(65.27±17.47)分,术后1年分别提高至(88.84±3.46)分、(89.24±3.94)分和(91.03±3.97)分,差异均有统计学意义(P＜0.05).缝合组术后1年髋关节mHHS评分、NAHS评分、HOS-ADL评分明显高于非缝合组,差异均有统计学意义(P＜0.05).非缝合组的手术时间为(137.62±31.21)min,低于缝合组的(151.35±31.55) min(t=2.116,P=0.037).非缝合组并发症发生率为31％(20/64),缝合组24％(9/38),差异无统计学意义(X2=0.671,P=0.499).结论 股骨髋臼撞击综合征关节镜术中常规行关节囊修补有利于获得更好的近期临床疗效,且不增加并发症的风险.%Objective To investigate the effects of capsular repair versus that of unrepaired capsulotomy during hip arthroscopy in treating femoracetabular impingement (FAI).Methods A total of 102 cases with FAI who underwent hip arthroscopy from July 2014 to August 2017 were collected retrospectively.Patients were divided into unrepaired group (64 cases) and repair group (38 cases) according to capsular management strategies.In the repair group,in addition to the management of osteochondroplasty of pincer and cam deformity and labral repair,the capsulotomies were routinely repaired.Modified Harris hip score (mHHS),nonarthritic hip score (NAHS),and hip outcome score activity of daily living scale (HOS-ADL) were used to evaluate the clinical outcomes.The preoperative hip scores and those at 1 year postoperative follow up were collected.Operation duration and occurrence of complication were also collected.Results There were 28 males and 36 females in the unrepaired group,while 17 males and 21 females were in the repair group.The average age were 38.59±11.27 years and 37.64±11.10 years respectively.There were 18 pincer deformities,12 cam deformities and 34 mixed deformities in the unrepaired group,while 7 pincer deformities,7 cam deformities and 24 mixed deformities in the repair group.There was no difference in gender,average age and impingement type between two groups (P＞0.05).The preoperative mHHS score,NAHS score and HOS-ADL score were 59.56±12.44,58.79±12.90 and 64.11±14.43 in the unrepaired group.These scores elevated to 85.52±4.69,80.76±5.27 and 86.08±5.85 at 1 year follow up.The preoperative mHHS score,NAHS score and HOS-ADL score were 61.68± 12.41,60.62± 10.48 and 65.27± 17.47 in the repair group.These scores elevated to 88.84±3.46,89.24±3.94 and 91.03±3.97 at 1 year follow up.The scores in the repair group were higher than those in unrepaired group at 1 year follow up (P＜0.05).The average operation duration was 137.62±31.21 minutes and 151.35±31.55 minutes (P＜0.05),respectively.The complication occurrence rate in unrepaired group was 31％ (20/64) and 24％ (9/38) in repaired group with no statistical difference between two groups (P＞0.05).Conclusion During hip arthroscopy in treating FAI,short-term clinical results could be achieved after routine repair of capsulotomy without increased risk of complication.