Ribas M, Marín-Peña O R, Regenbrecht B, De La Torre B, Vilarrubias J M
Department of Orthopaedic Surgery and Traumatology, International University of Catalonia, USP-Instituto Universitario Dexeus, Barcelona, Spain.
Hip Int. 2007 Apr-Jun;17(2):91-8. doi: 10.1177/112070000701700207.
Femoroacetabular regularization in hip impingement is currently performed by means of trochanter osteotomy and hip dislocation or more recently by means of hip arthroscopy. We present a novel alternative through a unique mini-invasive anterior approach. Our first series consisted of 35 hips (32 patients) with a mean follow-up of 29.2 months. Range of motion (ROM) and clinical scores were evaluated preoperatively at six weeks, three months, six months and one-year follow-up (FU). Impingement test was negative in 33 out of 35 cases six weeks after surgery. Mean hospitalisation time was 2.6 days (2-5 days). Mean improvement in internal rotation was 23 degrees (p=0.006) and 21 degrees in flexion (p=0.011). There was a significant improvement in hip score according to the Merle d'Aubign evaluation (13.8 points preoperative vs. 16.9 at one-year visit) (p=0.017). No Trendelenburg, heterotopic calcifications or osteonecrosis were observed. Complications related to the femorocutaneous nerve appeared in six cases (17.1%) although all but one were neuroapraxia and disappeared before one year. Mean rehabilitation time was 4.4 weeks. We conclude that the anterior surgical approach for the treatment of femoroacetabular impingement enables early resumption of sport while accuracy in bone resection is maintained.
目前，髋关节撞击综合征中的股骨髋臼成形术是通过转子截骨术和髋关节脱位来进行的，或者最近采用髋关节镜检查的方式。我们通过一种独特的微创前路手术提出了一种新的替代方法。我们的首个系列包括35例髋关节（32例患者），平均随访29.2个月。在术前、术后六周、三个月、六个月和一年随访时评估活动范围（ROM）和临床评分。术后六周时，35例中有33例撞击试验为阴性。平均住院时间为2.6天（2 - 5天）。内旋平均改善23度（p = 0.006），屈曲平均改善21度（p = 0.011）。根据Merle d'Aubign评估，髋关节评分有显著改善（术前13.8分，一年随访时为16.9分）（p = 0.017）。未观察到臀中肌步态、异位钙化或骨坏死。六例（17.1%）出现与股外侧皮神经相关的并发症，不过除一例之外均为神经失用症，且在一年内消失。平均康复时间为4.4周。我们得出结论，治疗股骨髋臼撞击综合征的前路手术方法能够在保持骨切除准确性的同时使患者早期恢复运动。
