Nepple Jeffrey J, Clohisy John C
Department of Orthopedic Surgery, School of Medicine, Washington University, St. Louis, MO.
Am J Orthop (Belle Mead NJ). 2017 Jan/Feb;46(1):28-34.
Our understanding of femoroacetabular impingement (FAI) as a cause of hip pain and secondary osteoarthritis has rapidly evolved since Ganz's description in 2003, which refined concepts described a half century earlier. The concepts of cam and pincer-type impingement continue to be better defined and have evolved from relatively simple concepts to more complex and variable disease patterns that are patient-specific. Ganz and colleagues described open treatment of FAI through the development of the surgical hip dislocation approach. Increased experience and advances in arthroscopic techniques have increasingly allowed for arthroscopic treatment of the most common FAI deformities. Yet, adequate bony correction of FAI continues to be a challenge for many surgeons and remains a common cause for revision surgery. Inferior outcomes after revision FAI surgery might indicate the importance of an accurate correction, regardless of the surgical approach, during the index surgery. Open surgical dislocation continues to play a role in the treatment of complex FAI where additional reconstruction is necessary or adequate bony correction may be inconsistently performed or inaccessible via an arthroscopic approach.
自2003年甘茨首次描述以来,我们对股骨髋臼撞击症(FAI)作为髋部疼痛和继发性骨关节炎病因的理解迅速发展,这一描述完善了半个世纪前提出的概念。凸轮型和钳夹型撞击的概念不断得到更清晰的界定,已从相对简单的概念演变为更复杂、因患者而异的疾病模式。甘茨及其同事通过开发手术性髋关节脱位入路描述了FAI的开放治疗。随着关节镜技术经验的增加和进步,越来越多最常见的FAI畸形可以通过关节镜进行治疗。然而,对许多外科医生来说,对FAI进行充分的骨质矫正仍然是一项挑战,并且仍是翻修手术的常见原因。翻修FAI手术后效果不佳可能表明,在初次手术时,无论采用何种手术入路,准确矫正都至关重要。开放性手术脱位在治疗复杂FAI中仍发挥着作用,对于复杂FAI,可能需要额外重建,或通过关节镜入路可能无法一致地进行充分的骨质矫正或无法进行矫正。