关节镜下盂唇重建治疗髋关节撞击综合征12例

doi:10.19723/j.issn.1671-167X.2021.05.033

摘要/Abstract

Abstract:

To investigate the surgical effect of hip arthroscopic labrum reconstruction. A retrospective study was performed on the clinical data of 12 patients who underwent hip arthroscopic labrum reconstruction in our department from September 2017 to February 2021 and were followed up for 5-46 months, with an average of 21.5 months. All the patients had a hip joint space of more than 2 mm, and Tonnis grade less than level Ⅱ. These 12 patients underwent arthroscopic debridement of hyperplastic synovium, femoral head and neck and/or acetabular osteoplasty, and labrum reconstruction using autograft iliotibial band or gracilis tendon. After the surgery, we conducted follow-up and data collection, recorded the satisfaction of the patients and occurrence of complications, as well as the cartilage lesion of hip joint observed under the arthroscopy. We compared the alpha angle of Dunn X-ray film, center-edge angle (CE angle) of AP X-ray film, modified Harris hip score (mHHS score), hip outcome score (HOS), international hip outcome tool 12 score (iHOT12 Score), and visual analogue scale (VAS scale) before and after the arthroscopic operation, to assess clinical symptom relief and joint function recovery. The 12 patients were followed up for 5-46 (21.5±12.8) months. The VAS scale were (5.3±2.5) and (2.5±1.4) before and after the surgery, showing significant decrease (P=0.018). The mHHS score were (60.6±22.2) and (83.1±5.8) before and after the surgery, showing significant increase (P=0.003). The patient satisfaction was high (7.8±2.0) (range: 0-10). None of the 12 patients had serious complications, revision surgery, or total hip replacement at the end of the last follow-up. Autologous tendon transplantation for reconstruction of acetabular labrum under arthroscopy can improve the clinical symptoms and joint function of patients with femoroacetabular impingement (FAI), which is a safe and effective treatment.

Key words: Femoroacetabular impingment, Hip injuries, Arthroscopes, Transplantation, autologous

中图分类号:

R687.4

董寒梅,吴睿麒,高冠英,刘镕阁,徐雁. 关节镜下盂唇重建治疗髋关节撞击综合征12例[J]. 北京大学学报（医学版）, 2021, 53(5): 1007-1011.

Han-mei DONG,Rui-qi WU,Guan-ying GAO,Rong-ge LIU,Yan XU. Arthroscopic labrum reconstruction for femoroacetabular impingement syndrome: 12 cases report[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 1007-1011.

图/表 6

表1

图1

图2

表2

患者术前、术后髋关节功能和症状改善情况"

Items	Preoperative, $x ?$ ±s	Postoperative, $x ?$ ±s	P value
α angle/(°)	71.7±9.8	50.2±6.1	0.002
CE angle/(°)	37.5±5.2	35.9±3.6	0.099
mHHS	60.6±22.2	83.1±5.8	0.003
HOS-ADL	87.0±6.6	91.8±4.6	0.018
HOS-SS	80.1±14.0	88.7±4.0	0.009
iHOT-12	77.2±11.3	88.8±6.1	0.012
VAS	5.3±2.5	2.5±1.4	0.018

表2

表3

图8

参考文献 25

[1]	Suppauksorn S, Parvaresh KC, Rasio J, et al. The effect of rim preparation, labral augmentation, and labral reconstruction on the suction seal of the hip [J]. Arthroscopy, 2021, 5:S0749-8063(21)00442-4.
[2]	Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal: Part I: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization [J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(4):722-729. doi: 10.1007/s00167-014-2874-z
[3]	Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: Technique and early outcomes [J]. Arthroscopy, 2010, 26(6):750-756. doi: 10.1016/j.arthro.2009.10.016 pmid: 20511032
[4]	Bessa FS, Williams BT, Polce EM, et al. Indications and outcomes for arthroscopic hip labral reconstruction with autografts: A systematic review [J]. Front Surg, 2020, 7:61. doi: 10.3389/fsurg.2020.00061
[5]	Cetinkaya S, Toker B, Ozden VE, et al. Arthroscopic labral repair versus labral debridement in patients with femoroacetabular impingement: A minimum 2.5 year follow-up study [J]. Hip Int, 2016, 26(1):20-24. doi: 10.5301/hipint.5000290 pmid: 26449334
[6]	Chen AW, Yuen LC, Ortiz-Declet V, et al. Selective debridement with labral preservation using narrow indications in the hip: Minimum 5-year outcomes with a matched-pair labral repair control group [J]. Am J Sports Med, 2018, 46(2):297-304. doi: 10.1177/0363546517739566
[7]	Domb BG, Hartigan DE, Perets I. Decision making for labral treatment in the hip: Repair versus debridement versus reconstruction [J]. J Am Acad Orthop Surg, 2017, 25(3):e53-e62. doi: 10.5435/JAAOS-D-16-00144
[8]	Domb BG, Yuen LC, Ortiz-Declet V, et al. Arthroscopic labral base repair in the hip: 5-year minimum clinical outcomes [J]. Am J Sports Med, 2017, 45(12):2882-2890. doi: 10.1177/0363546517713731
[9]	Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoro-acetabular impingement: Mean 3.5-year follow-up [J]. Am J Sports Med, 2012, 40(5):1015-1021. doi: 10.1177/0363546511434578
[10]	Larson CM, Ross JR, Stone RM, et al. Arthroscopic management of dysplastic hip deformities: Predictors of success and failures with comparison to an arthroscopic FAI cohort [J]. Am J Sports Med, 2016, 44(2):447-453. doi: 10.1177/0363546515613068
[11]	Maldonado DR, Perets I, Mu BH, et al. Arthroscopic capsular plication in patients with labral tears and borderline dysplasia of the hip: Analysis of risk factors for failure [J]. Am J Sports Med, 2018, 46(14):3446-3453. doi: 10.1177/0363546518808033 pmid: 30419179
[12]	Perets I, Rybalko D, Mu BH, et al. In revision hip arthroscopy, labral reconstruction can address a deficient labrum, but labral repair retains its role for the reparable labrum: A matched control study [J]. Am J Sports Med, 2018, 46(14):3437-3445. doi: 10.1177/0363546518809063 pmid: 30419171
[13]	White BJ, Patterson J, Herzog MM. Revision arthroscopic acetabular labral treatment: Repair or reconstruct? [J]. Arthroscopy, 2016, 32(12):2513-2520. doi: 10.1016/j.arthro.2016.07.024
[14]	Domb BG, Stake CE, Lindner D, et al. Revision hip preservation surgery with hip arthroscopy: Clinical outcomes [J]. Arthroscopy, 2014, 30(5):581-587. doi: 10.1016/j.arthro.2014.02.005
[15]	Youm T. Editorial commentary: Wanted dead or alive: Primary allograft labral reconstruction of the hip is as successful, if not more successful, than primary labral repair [J]. Arthroscopy, 2018, 34(2):441-443. doi: 10.1016/j.arthro.2017.09.011
[16]	Suppauksorn S, Beck EC, Chahla J, et al. Comparison of suction seal and contact pressures between 270 degrees labral reconstruction, labral repair, and the intact labrum [J]. Arthroscopy, 2020, 36(9):2433-2442. doi: S0749-8063(20)30438-2 pmid: 32504714
[17]	张晋, 武永刚, 李旭, 等. 盂唇重建与盂唇部分切除治疗股骨髋臼撞击症合并无法修复盂唇损伤的临床对比研究 [J]. 中国运动医学杂志, 2018, 37(11):916-920.
[18]	欧阳侃, 王大平, 熊建义, 等. 关节镜下带血供关节囊移植重建髋臼盂唇疗效的初步研究 [J]. 中华骨与关节外科杂志, 2019, 12(4):277-280, 315.
[19]	Philippon MJ, Briggs KK, Boykin RE. Results of arthroscopic labral reconstruction of the hip in elite athletes: response [J]. Am J Sports Med, 2014, 42(10):NP48. doi: 10.1177/0363546514550156
[20]	Maldonado DR, Kyin C, Chen SL, et al. In search of labral restoration function with hip arthroscopy: Outcomes of hip labral reconstruction versus labral repair: A systematic review [J]. Hip Int, 2020, 22:1120700020965162.
[21]	Geyer MR, Philippon MJ, Fagrelius TS, et al. Acetabular labral reconstruction with an iliotibial band autograft: Outcome and survivorship analysis at minimum 3-year follow-up [J]. Am J Sports Med, 2013, 41(8):1750-1756. doi: 10.1177/0363546513487311 pmid: 23644149
[22]	Philippon MJ, Arner JW, Crawford MD, et al. Acetabular labral reconstruction with iliotibial band autograft: Outcome and survivorship at a minimum 10-year follow-up [J]. J Bone Joint Surg Am, 2020, 102(18):1581-1587. doi: 10.2106/JBJS.19.01499 pmid: 32675477
[23]	Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: Report of a new technique [J]. Clin Orthop Relat Res, 2009, 467(3):753-759. doi: 10.1007/s11999-008-0633-5
[24]	Walker JA, Pagnotto M, Trousdale RT, et al. Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery [J]. Clin Orthop Relat Res, 2012, 470(12):3414-3420. doi: 10.1007/s11999-012-2506-1
[25]	Park SE, Ko Y. Use of the quadriceps tendon in arthroscopic acetabular labral reconstruction: Potential and benefits as an autograft option [J]. Arthrosc Tech, 2013, 2(3):e217-e219. doi: 10.1016/j.eats.2013.02.003

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Items	Data
Number of patients, n	12
Mean age at surgery/years	35.7 (22-49)^a
Female ∶Male, n	3 ∶9
Mean body mass index	21.8 (16.5-27.5)^a
Side affected (left ∶right), n	5 ∶7
Symptom onset/months	44.2 (8-100)^a
Follow-up/months	21.5 (5-46)^a
Follow-up/%	100

Items	n (%)
Labral lesions	12 (100.0)
Cam-type impingement	3 (25.0)
Pincer-type impingement	0
Mixed-type impingement	9 (75.0)
Acetabular cartilage damage (Outerbridge classification)
0	4 (33.3)
1	0
2	1 (8.3)
3	1 (8.3)
4	6 (50.0)
Femoral cartilage damage (Outerbridge classification)
0	12 (100.0)
1-4	0