Comba Fernando M, Slullitel Pablo A, Bronenberg Pedro, Zanotti Gerardo, Buttaro Martin A, Piccaluga Francisco
Hip Surgery Unit, Carlos E. Ottolenghi, Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St., Buenos Aires 1199, Argentina.
J Hip Preserv Surg. 2017 Apr 12;4(2):145-152. doi: 10.1093/jhps/hnx015. eCollection 2017 Jul.
In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. When the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. During the study period, we retrospectively analysed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average follow-up of 32 months (range: 27-38). We excluded patients with isolated CAM-type impingement and previous hip pathology. Radiographs were analysed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of pre-operative and post-operative modified Harris hip score (mHHS) and WOMAC as well as post-operative visual analogue scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Mean mHHS changed from 51.06 (SD 4.81) pre-operatively to 84.97 (SD 12.79) post-operatively. Pre-operative WOMAC was 29.18 (SD 8) and post-operative, 13.10 (SD 11). Post-operative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding post-operative mHHS (89.9 s versus 77.85, = 0.03), pain VAS (1.5 versus 6.3, = 0.03) and satisfaction VAS (8.2 versus 6.3, = 0.01). Survival was 100% at 24 months and 76% at 40 months (95% CI: 35-98%). Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes. Slight degenerative changes on radiographs correlated with poorer clinical outcomes.
为了显露和切除髋臼边缘，有人描述了采用关节镜下髋臼成形术并进行盂唇分离。当软骨盂唇交界处保持完整时，可以在不损伤盂唇的情况下进行髋臼成形术和盂唇重新固定。我们旨在评估一组接受关节镜下髋臼成形术且未进行盂唇分离的患者的治疗效果。在研究期间，我们回顾性分析了44例合并钳夹型撞击且软骨盂唇交界处完整的患者，平均随访32个月（范围：27 - 38个月）。我们排除了单纯凸轮型撞击和既往有髋关节病变的患者。分析X线片以确定撞击情况并对骨关节炎分级。临床评估包括术前和术后的改良Harris髋关节评分（mHHS）和WOMAC评分，以及术后疼痛和满意度的视觉模拟量表（VAS）。为了生存分析的目的，再次手术被视为手术失败。平均mHHS从术前的51.06（标准差4.81）提高到术后的84.97（标准差12.79）。术前WOMAC评分为29.18（标准差8），术后为13.10（标准差11）。术后满意度VAS为7.5，疼痛VAS为2.27。将Tönnis 0级患者与Tönnis 1级患者进行比较时，前者在术后mHHS（89.9对77.85，P = 0.03）、疼痛VAS（1.5对6.3，P = 0.03）和满意度VAS（8.2对6.3，P = 0.01）方面显示出更好的结果。24个月时生存率为100%，40个月时为76%（95%可信区间：35 - 98%）。未进行盂唇分离的关节镜下髋臼成形术取得了良好的临床效果。X线片上的轻微退变改变与较差的临床效果相关。
