Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China.
Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA, Beijing, China.
Orthop Surg. 2021 Aug;13(6):1810-1817. doi: 10.1111/os.13104. Epub 2021 Aug 19.
To investigate the effectiveness of ultrasound (US) guided intra-hip joint injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome.
Patients with FAI syndrome (n = 60) were prospectively enrolled in our study. Before hip arthroscopy, a mix of 4 mL 2% lidocaine and 4 mL 1% ropivacaine were injected into the hip joint under the guidance of US. The clinical efficacy of the intra-articular injection was evaluated by comparing the visual analog scale (VAS) and international hip outcome tool 12 (iHOT-12) results before and after the injection. The outcome of hip arthroscopy was evaluated by iHOT-12, the modified Harris hip score (MHHS), and the patient's satisfaction 12 months after the operation. The outcome of intra-articular injection and hip arthroscopy were compared. Factors related to the outcomes of hip arthroscopy were evaluated. The correlation between the efficacy of intra-hip joint injection and arthroscopy was evaluated.
The VAS of patients decreased from 11.3 ± 7.7 to 3.3 ± 4.5, and the iHOT-12 increased from 52.1 ± 23.2 to 84.1 ± 18.1 after intra-articular injection (all P < 0.001). The iHOT-12 score increased from 52.1 ± 23.2 to 78.9 ± 19.2, and the MHHS increased from 66.5 ± 6.8 to 81.6 ± 8.1 after hip arthroscopy (all P < 0.001). The satisfaction rate of arthroscopy, including very satisfied and effective patients, was 93.3%. Multi-variable logistic regression showed that only iHOT-12 improved value after injection was included in the regression formula of satisfaction, with the β of -0.154, standard error of 0.071, Wald value of 4.720, and OR of 0.857 (95%CI 0.746-0.985) (P = 0.03). Significant correlation was detected between iHOT-12 scores after intra-articular anesthesia and at 12 months after arthroscopy (r = 0.784, P < 0.001). So was the iHOT-12 improved value (r = 0.781, P < 0.001) and the iHOT-12 improved ratio (r = 0.848, P < 0.001). If we had performed arthroscopy only on patients with post-injection iHOT-12 score improvement ≥10, the satisfaction rate of arthroscopy would have increased to 96.6%.
US-guided intra-hip joint injection may provide a feasible way to estimate the outcome of hip arthroscopy in patients with FAI syndrome, and could be used as a method for indication selection of hip arthroscopy.
探讨超声（US）引导下髋关节内注射对股骨髋臼撞击综合征（FAI）患者髋关节镜治疗效果的评估作用。
前瞻性纳入 60 例 FAI 综合征患者，在髋关节镜术前，将 4mL 2%利多卡因和 4mL 1%罗哌卡因混合液在 US 引导下注入髋关节内。通过比较注射前后视觉模拟量表（VAS）和国际髋关节结局工具 12 （iHOT-12）评分评估关节内注射的临床疗效。髋关节镜术后通过 iHOT-12、改良 Harris 髋关节评分（MHHS）和患者术后 12 个月的满意度评估髋关节镜的治疗效果。比较关节内注射和髋关节镜的治疗效果，评估髋关节镜治疗效果的相关因素，评估髋关节内注射疗效与关节镜疗效的相关性。
患者的 VAS 评分从 11.3±7.7 降至 3.3±4.5，iHOT-12 评分从 52.1±23.2 增至 84.1±18.1（均 P<0.001）。髋关节镜术后，iHOT-12 评分从 52.1±23.2 增至 78.9±19.2，MHHS 评分从 66.5±6.8 增至 81.6±8.1（均 P<0.001）。髋关节镜的满意度（非常满意和有效）率为 93.3%。多变量逻辑回归显示，只有注射后 iHOT-12 评分改善值被纳入满意度回归公式，β=-0.154，标准误为 0.071，Wald 值为 4.720，OR 为 0.857（95%CI 0.746-0.985）（P=0.03）。关节内麻醉后 iHOT-12 评分与术后 12 个月 iHOT-12 评分呈显著正相关（r=0.784，P<0.001）。iHOT-12 评分改善值（r=0.781，P<0.001）和 iHOT-12 评分改善率（r=0.848，P<0.001）也呈显著正相关。如果我们只对注射后 iHOT-12 评分改善≥10 的患者进行髋关节镜治疗，髋关节镜的满意度将提高至 96.6%。
US 引导下髋关节内注射可能为评估 FAI 综合征患者髋关节镜治疗效果提供一种可行的方法，可作为髋关节镜治疗适应证选择的一种方法。
