Assaf HaRofe Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Zriffin, Israel.
Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2756-2762. doi: 10.1007/s00167-018-4923-5. Epub 2018 Apr 2.
This study was designed to (1) evaluate the clinical outcomes after arthroscopic subspinal decompression in patients with hip impingement symptoms and low AIIS, and to (2) assess the presence of low anterior inferior iliac spine on the pre-operative radiographs of patients with established subspinal impingement diagnosed intra-operatively.
Retrospective analysis of patients who underwent arthroscopic subspinal decompression has been performed. The indications for surgery were femoroacetabular impingement (FAI), or subspinal impingement. Pre-operative radiographs were assessed for anterior inferior iliac spine type. Intra-operative diagnosis of low anterior inferior iliac spine was based on the level of anterior inferior iliac spine extension relative to the acetabulum and the presence of reciprocal labral and chondral lesions. In patients where low anterior inferior iliac spine was not diagnosed on pre-operative radiographs, the pre-operative radiographs were re-read retrospectively to assess missed signs of low anterior inferior iliac spine.
Thirty-four patients underwent arthroscopic subspinal decompression between 2012 and 2015. The patients were followed for a median of 25 months (13-37 months). Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients. MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11-90), 48 (20-91) and 20 (0-80) to 95 (27-100), 94 (30-100) and 91 (5-100), respectively (p < 0.0001, p = 0.001, p < 0.0001, respectively). Pre-operative diagnosis of low AIIS was made in 6/34 patients via AP radiographs. On retrospective analysis of pre-operative radiographs, signs of low AIIS were still not observed in 21/34 (61.8%) patients.
Arthroscopic subspinal decompression of low AIIS yielded significantly improved outcome measures and high patient satisfaction at a minimum of 13 months follow-up. Low AIIS is often under-diagnosed on AP pelvis and lateral frog radiographs and if left untreated, may result in unresolved symptoms and failed procedure.
IV.
本研究旨在：（1）评估髋关节撞击综合征合并低髋臼指数患者行关节镜下脊柱下减压术后的临床疗效；（2）评估术中诊断为脊柱下撞击征的患者术前 X 线片上是否存在低前下髂嵴。
对行关节镜下脊柱下减压术的患者进行回顾性分析。手术指征为髋关节撞击征（FAI）或脊柱下撞击征。术前 X 线片评估前下髂嵴类型。术中诊断低前下髂嵴是基于前下髂嵴相对于髋臼的延伸水平以及存在相应的盂唇和软骨损伤。对于术前 X 线片未诊断为低前下髂嵴的患者，回顾性重读术前 X 线片以评估是否遗漏了低前下髂嵴的征象。
2012 年至 2015 年期间，34 例患者行关节镜下脊柱下减压术，平均随访时间为 25 个月（13-37 个月）。术中发现 27 例患者存在 2 级前下髂嵴，7 例患者存在 3 级前下髂嵴。MHHS、HOS 和 HOSS 评分分别从术前的 55（11-90）、48（20-91）和 20（0-80）中位数提高至术后的 95（27-100）、94（30-100）和 91（5-100）（p<0.0001，p=0.001，p<0.0001）。34 例患者中，术前通过骨盆正位 X 线片诊断为低 AIIS 者 6 例。回顾性分析术前 X 线片，仍有 21/34（61.8%）例患者未观察到低 AIIS 的征象。
关节镜下治疗低 AIIS 脊柱下减压术可显著改善患者的预后，并在至少 13 个月的随访中获得较高的患者满意度。低 AIIS 在骨盆正位和侧蛙位 X 线片上常被漏诊，如果不治疗，可能导致症状未缓解和手术失败。
IV。
