髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤的临床疗效
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1.东南大学附属中大医院;2.连云港圣安医院

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国家自然科学基金


Surgical hip dislocation for the treatment of femoroacetabular impingement with labrum injury
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1.Zhongda Hospital Southeast University;2.Lianyungang Shengan Hospital

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    摘要:

    [目的] 探讨髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤的临床疗效。[方法] 回顾性分析2015年8月至2018年4月东南大学附属中大医院骨科通过髋关节外科脱位治疗的23例(23侧)股骨髋臼撞击综合征合并盂唇损伤患者的临床资料,左侧9例,右侧14例;男性12例,女性11例;年龄18~65岁,平均44.3岁。“凸轮”型6例;“钳夹”型2例;混合型15例。患者取健侧卧位,采用髋关节后外侧入路,在大转子下方1.5cm处截骨,“Z”形切开关节囊,剪断圆韧带,脱出股骨头。去除部分骨性髋臼缘和股骨头颈部多余的骨质,修整盂唇用2.8mm的带线锚钉缝合固定,大转子骨折块并用两枚7.3mm的空心钉固定。术后4、8、12周复查X线观察大转子截骨愈合情况,术前和术后12个月根据Harris、WOMAC、SF-36和Merle D’Aubigné and Postel等四种评分标准评价临床疗效。[结果] 23例患者均获随访,随访时间12~24个月,平均15.9个月。术后12个月四种评分与术前比较,差异均有统计学意义(p<0.001)。末次随访时未出现大转子截骨不愈合和股骨头缺血性坏死的病例。[结论] 髋关节外科脱位治疗股骨髋臼撞击综合征合并盂唇损伤,临床疗效满意,并发症少,值得推广应用。

    Abstract:

    [Objective] To investigate the clinical outcomes of surgical hip dislocation for the treatment of femoroacetabular impingement with labrum injury. [Methods] From August 2015 to April 2018, 23 patients (23 sides) who suffered from femoroacetabular impingement with labrum injury were performed with surgical hip dislocation in Department of Orthopedics, Zhongda Hospital Southeast University. There were 12 males and 13 females including 9 cases at left side and 14 cases at right side, aged 44.3 years (rage: 18-65 years). The series included 6 cases of cam type, 2 cases of pincer type and 15 cases of mixed type. Patients were placed in the lateral decubitus position and a posterior lateral incision was adopted. A greater trochanter osteotomy and a Z-shaped capsulotomy was performed then. The hip would be exposed after the femoral head was dislocated. The partial bony rim of acetabulum and the excess bone from the femoral head and neck were removed. The labrum was sutured and fixed with 2.8mm suture anchor. The fracture fragment of greater trochanter was fixed with two 7.3mm cannulated screws. The healing status of greater trochanter was observed at 4, 8 and 12 weeks, and the clinical outcomes was investigated by Harris, WOMAC, SF-36, Merle D’Aubigné and Postel scoring standards before and 12 months after operation. [Results] 23 patients had been followed-up for 15.9 months (range: 12-24 months). There were significant differences between the four scoring standards at 12 months after operation and those before operation. At the last follow-up, there were no cases of nonunion of greater trochanter and osteonecrosis of the femoral head. [Conclusions] Surgical hip dislocation for the treatment of femoroacetabular impingement with labrum injury has satisfactory clinical outcomes and few complications, which is worthy of application and promotion.

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  • 收稿日期:2019-08-06
  • 最后修改日期:2019-09-23
  • 录用日期:2019-10-08
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