Skowronek Paweł, Synder Marek, Polguj Michał, Marczak Dariusz, Sibiński Marcin
Department of Orthopaedics and Traumatology, The Jan Kochanowski University, Grunwaldzka, Kielce, Poland.
Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Łódź, Łódź, Poland.
Indian J Orthop. 2017 Nov-Dec;51(6):677-680. doi: 10.4103/ortho.IJOrtho_248_16.
The opinion about best methods of femoroacetabular impingement (FAI) treatment are not consistent. Operative treatment of this condition may be arthroscopic, but open procedures with osteotomy of the greater trochanter and hip dislocation has been used. The present study evaluates the benefits of the mini-open direct anterior approach (DAA) in treating patients with FAI, with is a procedure available for most orthopedic surgeons.
39 patients treated for FAI (25 men and 14 women) at an average age of 29.3 years (range 18-46 years) were reviewed in this retrospective study. The mean followup was 45 months, (range 24-55 months). The hip impingement test was positive in all patients. The diagnosis of FAI was confirmed on anteroposterior and lateral hip view radiographs. All patients were operated with mini-open DAA. The outcomes were assessed with the Harris Hip Score, Short-Form 36 Health Survey and VAS score. Preoperative osteoarthritis was assessed according to Tönnis score.
At the final followup, improvement was noted compared to preoperative status in Harris Hip Score ( < 0.00001), visual analog scale score ( < 0.001), and Short-Form-36 score ( < 0.001). Nineteen patients returned to their previous sports activities. No major complications occurred. One patient developed heterotopic ossification and three patients developed temporary postoperative meralgia paresthetica. Five patients from the treatment group required total hip arthroplasty for severe osteoarthritis.
Mini-open DAA is a safe and effective procedure for the treatment of FAI that gives good relief of symptoms and allows a successful return to preoperative activity levels. Further research with a longer followup period is needed to evaluate the influence of surgery on natural history of FAI.
关于股骨髋臼撞击症（FAI）最佳治疗方法的观点并不一致。这种病症的手术治疗可以是关节镜手术，但也有人采用大转子截骨和髋关节脱位的开放手术。本研究评估了微创直接前路入路（DAA）治疗FAI患者的益处，这是一种大多数骨科医生都可采用的手术方法。
本回顾性研究纳入了39例接受FAI治疗的患者（25例男性和14例女性），平均年龄29.3岁（范围18 - 46岁）。平均随访时间为45个月（范围24 - 55个月）。所有患者的髋关节撞击试验均为阳性。通过髋关节前后位和侧位X线片确诊为FAI。所有患者均采用微创DAA进行手术。采用Harris髋关节评分、简短健康调查问卷36项（Short-Form 36 Health Survey）和视觉模拟评分（VAS）对结果进行评估。根据Tönnis评分评估术前骨关节炎情况。
在末次随访时，与术前状态相比，Harris髋关节评分（< 0.00001）、视觉模拟量表评分（< 0.001）和简短健康调查问卷36项评分（< 0.001）均有改善。19例患者恢复了之前的体育活动。未发生重大并发症。1例患者出现异位骨化，3例患者出现术后暂时性股外侧皮神经感觉异常。治疗组中有5例患者因严重骨关节炎需要进行全髋关节置换术。
微创DAA是治疗FAI的一种安全有效的手术方法，能有效缓解症状，并使患者成功恢复到术前的活动水平。需要进行更长随访期的进一步研究，以评估手术对FAI自然病程的影响。
