Beck Martin
Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern, Switzerland.
Clin Orthop Relat Res. 2009 Mar;467(3):769-74. doi: 10.1007/s11999-008-0653-1. Epub 2008 Dec 10.
Femoroacetabular impingement (FAI) is an established cause of osteoarthrosis of the hip. Surgery is intended to remove the cause of impingement with hip dislocation and resection of osseous prominences of the acetabular rim and of the femoral head-neck junction. Using the Merle d'Aubigné score and qualitative categories, recent studies suggest good to excellent outcomes in 75% to 80% of patients after open surgery with dislocation of the femoral head. Unsatisfactory outcome is mainly related to pain, located either in the area of the greater trochanter or in the groin. There are several reasons for persisting groin pain. Joint degeneration with joint space narrowing and/or osteophyte formation, insufficient correction of the acetabula, and femoral pathology are known factors for unsatisfactory outcome. Recently, intraarticular adhesions between the femoral neck and joint capsule have been identified as an additional cause of postoperative groin pain. The adhesions form between the joint capsule and the resected area on the femoral neck and may lead to soft tissue impingement. MR-arthrography is used for diagnosis and the adhesions can be treated successfully by arthroscopy. While arthroscopic resection improves outcome it is technically demanding. Avoiding the formation of adhesions is important and is perhaps best accomplished by passive motion exercises after the initial surgery.
股骨髋臼撞击症（FAI）是髋关节骨关节炎的一个既定病因。手术旨在通过髋关节脱位以及切除髋臼边缘和股骨头 - 颈交界处的骨性隆起物来消除撞击原因。近期研究使用Merle d'Aubigné评分和定性分类表明，股骨头脱位的开放手术后，75%至80%的患者预后良好至极佳。不满意的结果主要与疼痛有关，疼痛部位要么在大转子区域，要么在腹股沟。腹股沟持续疼痛有多种原因。关节间隙变窄和/或骨赘形成导致的关节退变、髋臼矫正不足以及股骨病变是预后不满意的已知因素。最近，股骨颈与关节囊之间的关节内粘连已被确定为术后腹股沟疼痛的另一个原因。粘连在关节囊与股骨颈的切除区域之间形成，可能导致软组织撞击。磁共振关节造影用于诊断，粘连可通过关节镜成功治疗。虽然关节镜下切除可改善预后，但技术要求较高。避免粘连形成很重要，或许在初次手术后通过被动运动锻炼能最好地实现这一点。
