MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, Michigan 48106, USA.
Am J Sports Med. 2011 Jul;39 Suppl:20S-8S. doi: 10.1177/0363546511412734.
Whether open or arthroscopic techniques are employed, the goal of femoroacetabular impingement (FAI) surgery is to achieve impingement-free range of motion. While arthroscopic approaches have improved and gained popularity, an objective evaluation of the surgical correction achieved with this approach compared with open surgery remains to be defined in the literature.
This study was undertaken to compare the efficacy of arthroscopic osteoplasty and open surgical dislocation in treating FAI dysmorphology in a consecutive series of patients.
Cohort study; Level of evidence, 3.
Surgical treatment was performed in 60 male patients under 40 years of age for symptomatic FAI refractory to nonoperative management. Patients were matched (not randomized) to treatment groups: 30 patients (15 left and 15 right hips) underwent arthroscopic cam and/or rim osteoplasty with labral debridement and/or refixation by an arthroscopic surgeon; and 30 (14 left and 16 right hips) underwent open surgical dislocation, cam and/or rim osteoplasty, and labral debridement or refixation by a hip preservation surgeon. Anteroposterior (AP) pelvis and extended-neck (Dunn) lateral radiographs were obtained and the depth of resection and arc of resection were measured by assessment of anterior femoral head-neck offset, AP and lateral α angle, and β angle on preoperative and postoperative radiographs.
In the arthroscopic group, the extended-neck lateral α angle was reduced by a mean of 17.2° (28.3%, P < .05), AP α angle was reduced by a mean of 12.6° (16.8%), anterior head-neck offset improved 5.0 mm (111%, P < .05), and β angle increased by a mean of 23.1°. In the open dislocation group, the extended-neck lateral α angle was reduced by a mean of 21.2° (30.7%, P < .05), AP α angle was reduced by a mean of 20.1° (25.7%), anterior head-neck offset improved 6.56 mm (108%, P < .05), and β angle increased by a mean of 18.35°.
Arthroscopic osteoplasty can restore head-neck offset and achieve similar depth, arc, and proximal-distal resection with comparable efficacy to open surgical dislocation for anterior and anterosuperior cam and focal rim impingement deformity. The open technique, however, may allow greater correction of posterosuperior loss of femoral offset and may be favorable for FAI patterns that demonstrate considerable proximal femoral deformity on AP radiographs.
无论是采用开放式还是关节镜技术，股骨髋臼撞击症（FAI）手术的目标都是实现无撞击的运动范围。虽然关节镜方法已经得到改进并得到普及，但与开放式手术相比，这种方法所达到的手术矫正效果在文献中仍有待确定。
本研究旨在比较关节镜骨成形术和开放式手术脱位治疗 FA 畸形的疗效，对一系列连续患者进行比较。
队列研究；证据水平，3 级。
对 60 名年龄在 40 岁以下的因 FA 症状而出现非手术治疗无效的男性患者进行手术治疗。患者按照治疗组进行匹配（非随机）：30 名患者（15 个左侧和 15 个右侧髋关节）接受关节镜下凸轮和/或边缘骨成形术，并由关节镜外科医生进行关节盂唇清创和/或修复；30 名患者（14 个左侧和 16 个右侧髋关节）接受开放式手术脱位、凸轮和/或边缘骨成形术，并由髋关节保存外科医生进行关节盂唇清创或修复。获取前后骨盆（AP）和延长颈（Dunn）侧位 X 线片，并通过评估术前和术后 X 线片上的股骨头颈前偏移、AP 和外侧α角以及β角来测量切除深度和切除弧。
在关节镜组中，延长颈侧α角平均减少 17.2°（28.3%，P<.05），AP α角平均减少 12.6°（16.8%），头颈前偏移增加 5.0mm（111%，P<.05），β角平均增加 23.1°。在开放式脱位组中，延长颈侧α角平均减少 21.2°（30.7%，P<.05），AP α角平均减少 20.1°（25.7%），头颈前偏移增加 6.56mm（108%，P<.05），β角平均增加 18.35°。
关节镜下骨成形术可恢复股骨头颈偏移，实现与开放式手术脱位相似的深度、弧和近-远侧切除，对前侧和前上侧凸轮和局灶性边缘撞击畸形具有相似的疗效。然而，开放式技术可能允许更大程度地纠正后上侧股骨偏移的丢失，并且对于在 AP 射线照片上显示出明显的股骨近端畸形的 FA 模式可能是有利的。
