Chaudhary Milind M, Chaudhary Ishani M, Vikas K N, KoKo Aung, Zaw Than, Siddhartha A
Department of Orthopaedics, Centre for Ilizarov Techniques, Chaudhary Hospital, Akola, Maharashtra, India.
Indian J Orthop. 2015 Sep-Oct;49(5):496-501. doi: 10.4103/0019-5413.164040.
Cam femoroacetabular impingement is caused by a misshapen femoral head with a reduced head neck offset, commonly in the anterolateral quadrant. Friction in flexion, adduction and internal rotation causes limitation of the hip movements and pain progressively leading to labral and chondral damage and osteoarthritis. Surgical hip dislocation described by Ganz permits full exposure of the hip without damaging its blood supply. An osteochondroplasty removes the bump at the femoral head neck junction to recreate the offset for impingement free movement.
Sixteen patients underwent surgery with surgical hip dislocation for the treatment of cam femoroacetabular impingement by open osteochondroplasty over last 6 years. Eight patients suffered from sequelae of avascular necrosis (AVN). Three had a painful dysplastic hip. Two had sequelae of Perthes disease. Three had combined cam and pincer impingement caused by retroversion of acetabulum. All patients were operated by the trochanteric flip osteotomy with attachments of gluteus medius and vastus lateralis, dissection was between the piriformis and gluteus minimus preserving the external rotators. Z-shaped capsular incision and dislocation of the hip was done in external rotation. Three cases also had subtrochanteric osteotomy. Two cases of AVN also had an intraarticular femoral head reshaping osteotomy.
Goals of treatment were achieved in all patients. No AVN was detected after a 6 month followup. There were no trochanteric nonunions. Hip range of motion improved in all and Harris hip score improved significantly in 15 of 16 cases. Mean alpha angle reduced from 86.13° (range 66°-108°) to 46.35° (range 39°-58°).
Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.
凸轮型股骨髋臼撞击症是由股骨头畸形导致头颈偏心距减小引起的，常见于前外侧象限。屈曲、内收和内旋时的摩擦会导致髋关节活动受限和疼痛，进而逐渐导致盂唇和软骨损伤以及骨关节炎。甘茨描述的手术性髋关节脱位可在不破坏其血供的情况下充分暴露髋关节。骨软骨成形术可去除股骨头颈交界处的隆起，以重建偏心距，实现无撞击的活动。
在过去6年中，16例患者接受了手术性髋关节脱位手术，通过开放式骨软骨成形术治疗凸轮型股骨髋臼撞击症。8例患者患有缺血性坏死（AVN）后遗症。3例患有疼痛性髋关节发育不良。2例患有佩特兹病后遗症。3例因髋臼后倾导致凸轮型和钳夹型撞击合并存在。所有患者均采用大转子翻转截骨术，保留臀中肌和股外侧肌附着点，在梨状肌和臀小肌之间进行解剖，保留外旋肌。采用Z形关节囊切口，在髋关节外旋位进行脱位。3例患者还进行了转子下截骨术。2例AVN患者还进行了关节内股骨头重塑截骨术。
所有患者均达到治疗目标。随访6个月后未发现AVN。未发生大转子不愈合。所有患者的髋关节活动范围均有所改善，16例患者中有15例的Harris髋关节评分显著提高。平均α角从86.13°（范围66°-108°）降至46.35°（范围39°-58°）。
通过手术性髋关节脱位后的开放式骨软骨成形术治疗引起疼痛和髋关节活动受限的凸轮型股骨髋臼撞击症。这减轻了疼痛，改善了髋关节活动，短期内取得了良好至优异的效果。
