Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.
Hospital CUF Descobertas, Rua Mário Botas, 1998-018, Lisboa, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1453-1460. doi: 10.1007/s00167-020-06380-z. Epub 2021 Jan 2.
This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow-up.
Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16-59).
The median alpha angle correction was 22.6º (range 5.9-46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range - 1.4-20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16-96) and improved to 83.2 at the last follow up (range 44-100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range - 16-73). No iatrogenic labral perforation and no full-thickness chondral damage were recorded during the arthroscopic procedures.
Favourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach.
Level IV.
本研究旨在评估关节镜下治疗股骨髋臼撞击综合征（FAI）的临床和影像学结果，采用的技术是初始进入外周间隙。这是一项基于单一外科医生的大型病例系列研究，随访时间至少为 2 年。
前瞻性纵向研究，连续患者。纳入标准为：非手术治疗失败的 FAI 综合征患者，且髋关节镜检查采用初始进入外周间隙的方法。排除标准为：既往髋关节手术、年龄小于 16 岁或大于 60 岁、Tönnis 分级≥2 级骨关节炎、基于 LCEA 小于 25°的放射学证据的髋关节发育不良以及工人补偿病例。符合纳入标准的 160 髋，84 例为女性，70 例为男性患者（6 例双侧），中位年龄 36 岁（范围 16-59 岁）。
中位阿尔法角校正为 22.6°（范围 5.9-46.7）（p<0.01），行髋臼成形术时平均 LCEA 校正为 6.5°（范围-1.4-20.8）（p<0.01）。基线时平均 NAHS 为 56.1（范围 16-96），无其他手术的患者末次随访时提高至 83.2（范围 44-100）（p<0.01）。平均平均改善为 27.7°点（范围-16-73）。关节镜手术过程中未记录到医源性关节唇穿孔和全层软骨损伤。
关节镜下治疗 FAI 采用初始进入外周间隙的方法可获得良好的结果。该技术对医源性软骨和关节唇损伤具有保护作用，对关节囊更为保守，但当使用缝线锚钉时，平均牵引时间相对较长。结果与经典的初始中央间隙入路相当。
IV 级。
