Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
Orthop Surg. 2011 Feb;3(1):28-34. doi: 10.1111/j.1757-7861.2010.00121.x.
To investigate the clinical diagnosis and arthroscopic treatment of acetabular labral tears.
Twenty-one patients with unilateral acetabular labral tears hospitalized from November 2008 to December 2009 were included in this retrospective study. A definitive diagnosis was made preoperatively on the basis of physical examination, plain radiography and magnetic resonance arthrography (MRA). All cases were treated with arthroscopic surgeries: labral debridement (14 cases), labral debridement plus femoral osteoplasty (5 cases), and labral repair plus osteoplasty (2 cases). All patients were followed-up and the results evaluated using the visual analogue scale (VAS) and Harris hip score.
A positive flexion, abduction and internal rotation (FADIR) impingement sign was found in all 21 affected hips, a positive flexion, abduction and external rotation (FABER) impingement sign in 15, and a positive McCarthy test in 9. Plain radiography showed 11 cases had cam type impingement, in 6 of whom it was combined with pincer type impingement; and 2 cases had acetabular retroversion alone. Labral tears were observed on MRA in all cases and were all confirmed by arthroscopy. All patients were followed up for an average of 11.6 months (range, 6 to 19 months). The VAS decreased from (5.3 ± 1.3) preoperatively to (1.4 ± 0.9) 6 months postoperatively. The mean Harris hip score improved from (63 ± 9) preoperatively to (84 ± 10) 6 months postoperatively. All these differences were statistically significant.
Acetabular labral injury is closely correlated with femoro-acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome.
探讨髋臼唇撕裂的临床诊断和关节镜治疗。
回顾性分析 2008 年 11 月至 2009 年 12 月收治的 21 例单侧髋臼唇撕裂患者的临床资料，术前根据体格检查、骨盆正位 X 线片和磁共振关节造影（MRA）结果进行明确诊断。所有患者均行关节镜手术治疗：行髋臼唇清创术（14 例）、髋臼唇清创加股骨成形术（5 例）和髋臼唇修补加成形术（2 例）。所有患者均获得随访，采用视觉模拟评分（VAS）和 Harris 髋关节评分评估疗效。
21 例患髋均有阳性 FADIR 撞击征，15 例有阳性 FABER 撞击征，9 例有阳性 McCarthy 试验。骨盆正位 X 线片示 11 例存在凸轮型撞击，其中 6 例合并钳夹型撞击；2 例存在髋臼后倾。MRA 显示所有患者均存在髋臼唇撕裂，均经关节镜证实。所有患者平均随访 11.6 个月（6~19 个月）。VAS 评分由术前的（5.3±1.3）分降至术后 6 个月的（1.4±0.9）分，Harris 髋关节评分由术前的（63±9）分提高至术后 6 个月的（84±10）分，差异均有统计学意义。
髋臼唇损伤与股骨髋臼撞击密切相关。撞击试验和 MRA 对髋臼唇撕裂的临床诊断具有较高的敏感性和准确性。关节镜下髋臼唇清创、修补和成形术治疗髋臼唇撕裂可获得良好的早期疗效。
