Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A..
Arthroscopy. 2019 Apr;35(4):1120-1127. doi: 10.1016/j.arthro.2018.10.142. Epub 2019 Mar 11.
To present the technique and outcomes of a limited periportal capsulotomy without capsular closure for arthroscopic treatment of femoroacetabular impingement (FAI).
Retrospective review of a prospectively collected database of patients undergoing primary hip arthroscopy for symptomatic FAI was performed to analyze patients who underwent periportal capsulotomy. Periportal capsulotomy was performed through dilation of the midanterior and anterolateral portals without completion of a full interportal capsulotomy, preserving the iliofemoral ligament. Arthroscopic labral treatment and osteochondroplasty were completed as indicated without necessitating capsular closure. Patient demographics, surgical details, and complications were recorded. Pre- and postoperatively, patients completed the modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey, and visual analog scale. Postoperative outcome data was analyzed at 1- and 2-year follow-up.
One hundred and forty-two patients treated with the periportal capsulotomy technique were included (mean age, 35.5 ± 11.7; body mass index, 25.4 ± 4.1; 50.7% men). There were no major postoperative complications including hip instability or reoperation. Significant improvements in mean patient-reported outcomes from preoperative scores were seen at the 1- and 2-year follow-ups (modified Harris Hip Score, 18.4 ± 19.1, 21.1 ±17.7, HOOS symptoms, 20.1 ± 21.2, 22.8 ± 23.5, HOOS pain, 23.4 ± 21.2, 27.6 ± 19.3, HOOS activities of daily life, 21.2 ± 20.8, 24.3 ± 21.6, HOOS sport, 32.5 ± 27.0, 36.5 ± 26.9, HOOS quality of life, 37.9 ± 26.7, 46.0 ± 22.8, and 12-item Short-Form survey physical component score, 16.4 ± 15.3, 20.8 ±13.2, respectively). Only the HOOS quality of life demonstrated further improvement from 1- to 2 years postoperatively (P = .043).
Periportal capsulotomy provides safe and sufficient access to the hip joint for arthroscopic treatment of FAI without necessitating capsular closure. Using this technique, patients showed significant clinical improvement and no postoperative instability at 1 and 2 years after surgery.
Level IV, therapeutic case series.
介绍一种不闭合关节囊的有限经门周囊切开术治疗髋关节撞击综合征（FAI）的技术和结果。
对接受初次髋关节镜治疗有症状 FAI 的患者前瞻性收集数据库进行回顾性分析，以分析接受经门周囊切开术的患者。经门周囊切开术通过扩张中前和前外侧入路完成，而不完成完整的经门周囊切开术，保留髂股韧带。根据需要完成关节镜下盂唇处理和骨软骨成形术，无需闭合关节囊。记录患者的人口统计学、手术细节和并发症。术前和术后，患者完成改良 Harris 髋关节评分、髋关节残疾和骨关节炎结果评分（HOOS）、12 项短表调查和视觉模拟评分。术后 1 年和 2 年随访时分析术后结果数据。
共纳入 142 例采用经门周囊切开术治疗的患者（平均年龄 35.5 ± 11.7 岁；体重指数 25.4 ± 4.1；50.7%为男性）。无主要术后并发症，包括髋关节不稳定或再次手术。术后 1 年和 2 年随访时，患者报告的结局均显著改善（改良 Harris 髋关节评分分别为 18.4 ± 19.1、21.1 ± 17.7，HOOS 症状分别为 20.1 ± 21.2、22.8 ± 23.5，HOOS 疼痛分别为 23.4 ± 21.2、27.6 ± 19.3，HOOS 日常生活活动分别为 21.2 ± 20.8、24.3 ± 21.6，HOOS 运动分别为 32.5 ± 27.0、36.5 ± 26.9，HOOS 生活质量分别为 37.9 ± 26.7、46.0 ± 22.8，12 项短表调查的生理成分评分分别为 16.4 ± 15.3、20.8 ± 13.2）。仅 HOOS 生活质量在术后 1 年至 2 年时进一步改善（P =.043）。
经门周囊切开术为髋关节镜治疗 FAI 提供了安全且充分的髋关节入路，无需闭合关节囊。使用该技术，患者在术后 1 年和 2 年时显示出显著的临床改善，且无术后不稳定。
IV 级，治疗性病例系列。
