Larson Christopher M, Giveans M Russell
Minnesota Sports Medicine, Eden Prairie, Minnesota 55344, USA.
Arthroscopy. 2008 May;24(5):540-6. doi: 10.1016/j.arthro.2007.11.007. Epub 2008 Jan 7.
The purpose of this study was to evaluate the early outcomes of arthroscopic management of femoroacetabular impingement (FAI).
Ninety-six consecutive patients (100 hips) with radiographically documented FAI were treated with hip arthroscopy, labral debridement or repair/refixation, proximal femoral osteoplasty, or acetabular rim trimming (or some combination thereof). Outcomes were measured with the impingement test, modified Harris Hip Score, Short Form 12, and pain score on a visual analog scale preoperatively and postoperatively at 6 weeks, 3 months, and 6 months, as well as yearly thereafter. Preoperative and postoperative radiographic alpha angles were measured to evaluate the adequacy of proximal femoral osteoplasty.
There were 54 male and 42 female patients with up to 3 years' follow-up (mean, 9.9 months). The mean age was 34.7 years. Isolated cam impingement was identified in 17 hips, pincer impingement was found in 28, and both types were noted in 55. Thirty hips underwent labral repair/refixation. A comparison of preoperative scores with those obtained at most recent follow-up revealed a significant improvement (P < .001) for all outcomes measured: Harris Hip Score (60.8 v 82.7), Short Form 12 (60.2 v 77.7), visual analog score for pain (6.74 v 1.88 cm), and positive impingement test (100% v 14%). The alpha angle was also significantly improved after resection osteoplasty. Complications included heterotopic bone formation (6 hips) and a 24-hour partial sciatic nerve neurapraxia (1 hip). No hip went on to undergo repeat arthroscopy, and three hips have subsequently undergone total hip arthroplasty.
Arthroscopic management of patients with FAI results in significant improvement in outcomes measures, with good to excellent results being observed in 75% of hips at a minimum 1-year follow-up. Alteration in the natural progression to osteoarthritis and sustained pain relief as a result of arthroscopic management of FAI remain to be seen.
Level IV, therapeutic case series.
本研究旨在评估关节镜治疗股骨髋臼撞击症（FAI）的早期疗效。
对96例（100髋）经影像学证实的FAI患者连续进行髋关节镜检查，同时进行盂唇清创或修复/固定、股骨近端截骨成形术或髋臼缘修整术（或上述方法的联合应用）。在术前以及术后6周、3个月、6个月和此后每年，通过撞击试验、改良Harris髋关节评分、简明健康状况调查量表12项（Short Form 12）以及视觉模拟疼痛评分来评估疗效。测量术前和术后的影像学α角，以评估股骨近端截骨成形术的效果。
共有54例男性和42例女性患者，随访时间最长达3年（平均9.9个月）。平均年龄为34.7岁。17髋为单纯凸轮撞击，28髋为钳夹撞击，55髋两者均有。30髋进行了盂唇修复/固定。将术前评分与最近一次随访时的评分进行比较，结果显示所有测量指标均有显著改善（P <.001）：Harris髋关节评分（60.8对82.7）、简明健康状况调查量表12项（60.2对77.7）、视觉模拟疼痛评分（6.74对1.88 cm）以及阳性撞击试验（100%对14%）。截骨成形术后α角也有显著改善。并发症包括异位骨化（6髋）和1例坐骨神经24小时的部分神经失用。无髋关节需要再次进行关节镜检查，3髋随后接受了全髋关节置换术。
关节镜治疗FAI患者可使疗效显著改善，在至少1年的随访中，75%的髋关节疗效为良好至优秀。关节镜治疗FAI能否改变骨关节炎的自然病程以及持续缓解疼痛仍有待观察。
IV级，治疗性病例系列研究。
