Heyworth Benton E, Shindle Michael K, Voos James E, Rudzki Jonas R, Kelly Bryan T
Hospital for Special Surgery, New York, New York 10021, USA.
Arthroscopy. 2007 Dec;23(12):1295-302. doi: 10.1016/j.arthro.2007.09.015.
The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy.
We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction "cam" lesions or anterosuperior acetabular "pincer" lesions).
The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery.
Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery.
Level IV, prognostic case series.
本研究的目的是通过回顾一系列需要翻修髋关节镜检查患者的术中及影像学检查结果，确定髋关节镜检查失败的可能原因。
我们回顾性分析了23例患者（14例女性，9例男性；平均年龄33.6岁；1例双侧）接受的24例髋关节镜翻修手术病例。回顾内容包括手术指征、术中发现以及初次手术和翻修手术的关节镜干预措施。对包括X线摄影、磁共振成像和三维重建计算机断层扫描在内的影像学研究进行分析，以确定术前是否存在骨撞击病变（如股骨头-颈交界处“凸轮”病变或髋臼前上缘“钳夹”病变）。
上一次髋关节镜检查与症状复发之间的平均间隔时间为6.1个月。在24例病例中的13例（54%）中，患者在初次髋关节镜检查后的任何时间点均未取得显著改善。上一次髋关节镜检查与翻修手术之间的平均间隔时间为25.6个月。在24例病例中的19例（79%）中发现了未处理或处理不充分的骨撞击病变，并且在髋关节镜翻修术前的影像学研究中得以识别。通过关节镜观察在24例病例中的7例中发现了紧张的腰大肌腱及相应的盂唇撞击病变，并对其进行了部分腰大肌腱松解。8例盂唇修复失败的病例通过盂唇清创和缝线材料取出进行处理。在这8例病例中，6例同时存在骨撞击，在翻修手术时也对其进行了处理。
未能处理髋关节的骨撞击病变以及腰大肌腱紧张是髋关节镜检查失败的关键因素，可能需要进行翻修手术。此外，盂唇修复失败可能是初次手术时未识别出骨撞击的结果。
IV级，预后病例系列。
