Hauts de France, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
Hauts de France, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
Orthop Traumatol Surg Res. 2020 Dec;106(8):1575-1580. doi: 10.1016/j.otsr.2020.07.006. Epub 2020 Nov 11.
Femoroacetabular impingement is a frequent cause of hip pain, and can be managed by conservative surgery. Many studies assessed postoperative course, but none compared operative techniques within a given population. We therefore conducted a retrospective case-control study comparing the minimally invasive anterior Hueter approach versus arthroscopy, assessing difference in 1) functional gain and 2) complications and 3) analyzing the impact of labral or cartilage lesions on functional scores.
Clinical results do not differ between the mini-open and arthroscopic approach.
Between 2007 and 2018, 91 hips in 84 patients were treated for femoroacetabular impingement: 69/91 (75.8%) cam effect, 6/91 pincer effect (6.6%) and 16/91 mixed (17.6%). Fifty-five were treated by arthroscopy and 36 by the Hueter mini-open approach. There were 20 female and 71 male hips. Mean age at surgery was 32 years (range, 17-55 years). Potential predictive factors comprised Nötzli alpha angle, labral/cartilage lesion and type of surgery.
Mean follow-up was 4.6 years (range, 1-16 years), with no loss to follow-up. The arthroscopy and Hueter groups showed no differences in functional improvement on Oxford-12 score (gain, -6.7±5.9 versus -6.2±8.1 (p=0.73), Postel Merle d'Aubigné (PMA) score (gain, 1.3±1 versus 1.1±0.9; p=0.41), operative time (75 versus 67min; p=0.16), or alpha angle correction (-10.9±12.9 versus -9.8±7.1; p=0.22). Complications did not differ: 1/55 severe complications after arthroscopy (1 definitive femoral nerve palsy) versus 4/36 non-severe complications after Hueter (3 cases of dysesthesia in the lateral cutaneous nerve of the thigh, 1 rectus femoris enthesopathy) (p=0.15). Labral lesions (37/91) did not affect clinical outcome: gain, 1.2±1 versus 1.3±0.9 on PMA (p=0.514) and -7.3±6 versus -6±7.3 on Oxford-12 (p=0.366). Cartilage lesions (27/91) were associated with poorer outcome on PMA (gain, 1±1.1 versus 1.3±0.9; p=002) but not on Oxford-12 (gain, -6.1±7.3 versus -6.7±6.6; p=0.288).
Impingement correction by the minimally invasive anterior Hueter approach gave clinical results comparable to those of hip arthroscopy in terms of Oxford and PMA scores, alpha angle correction, operative time and complications. Cartilage lesions were associated with poorer clinical results.
III; retrospective case-control study.
股骨髋臼撞击症是髋关节疼痛的常见原因，可以通过保守手术治疗。许多研究评估了术后过程，但没有一项研究在特定人群中比较手术技术。因此，我们进行了一项回顾性病例对照研究，比较了微创前 Hueter 入路与关节镜检查，评估了 1）功能增益和 2）并发症，以及 3）分析了 3）分析 labral 或软骨损伤对功能评分的影响。
微创与关节镜入路的临床结果无差异。
2007 年至 2018 年，84 例患者的 91 髋因股骨髋臼撞击症接受治疗：69/91（75.8%）凸轮效应，6/91 钳夹效应（6.6%）和 16/91 混合（17.6%）。55 髋行关节镜检查，36 髋行 Hueter 微创入路。有 20 例女性和 71 例男性髋关节。手术时的平均年龄为 32 岁（范围，17-55 岁）。潜在的预测因素包括 Nötzli alpha 角、labral/cartilage 病变和手术类型。
平均随访 4.6 年（范围，1-16 年），无失访。关节镜组和 Hueter 组在 Oxford-12 评分的功能改善（增益，-6.7±5.9 与-6.2±8.1（p=0.73），Postel Merle d'Aubigné（PMA）评分（增益，1.3±1 与 1.1±0.9（p=0.41），手术时间（75 与 67min（p=0.16）或 alpha 角校正（-10.9±12.9 与-9.8±7.1（p=0.22）方面无差异。并发症无差异：关节镜检查后 1/55 例严重并发症（1 例明确股神经麻痹）与 Hueter 后 4/36 例非严重并发症（3 例大腿外侧皮神经感觉异常，1 例股直肌附着病）（p=0.15）。labral 病变（37/91）并不影响临床结果：PMA 的增益为 1.2±1 与 1.3±0.9（p=0.514）和-7.3±6 与-6±7.3（p=0.366）在 Oxford-12 上。软骨病变（27/91）与 PMA 的预后较差相关（增益，1±1.1 与 1.3±0.9；p=0.002），但在 Oxford-12 上无相关性（增益，-6.1±7.3 与-6.7±6.6；p=0.288）。
微创前 Hueter 入路矫正撞击症在 Oxford 和 PMA 评分、alpha 角矫正、手术时间和并发症方面的临床结果与髋关节镜检查相当。软骨病变与较差的临床结果相关。
III；回顾性病例对照研究。
