Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
Orthopedics Research Institute of Zhejiang University, Hangzhou, PR China.
Orthop Surg. 2024 Nov;16(11):2862-2867. doi: 10.1111/os.14258. Epub 2024 Oct 1.
Arthroscopic treatments of hip synovial osteochondromatosis are mostly performed under traction, resulting in neurovascular injury or iatrogenic damage to the labrum or cartilage. This study aimed to assess the effectiveness of outside-in hip arthroscopy without traction in treating hip synovial osteochondromatosis. This retrospective study was conducted on a series of patients with hip synovial osteochondromatosis treated using outside-in hip arthroscopy without traction in our hospital between 2018 and 2020. Plain radiography and magnetic resonance imaging (MRI) scans were obtained. The Harris hip score (HHS), hip range of motion (ROM), and visual analog scale (VAS) scores were analyzed. The preoperative scores and last follow-up scores were compared with a paired-sample t test. The complications and recurrence postsurgery were recorded. This study included five patients (three male and two female) with an average age of 41 years (range 28-54 years). The mean follow-up time was 25.2 months (range 18-36 months). All patients experienced groin pain relief and improved ROM. The mean VAS score was significantly lower postoperatively (0.4 ± 0.5) than preoperatively (3.2 ± 0.8) (p < 0.001). The mean HHS improved from 58.6 ± 12.7 (range 43-73) to 89.8 ± 5.26 (range 81-95) (p < 0.001). No major complications, including infection, perineal numbness and swelling, neurotrosis, thromboembolism, or severe persistent pain, were reported. Synovial osteochondromatosis recurred in one patient after 2 years of follow-up without any obvious symptoms such as hip pain or joint locking. Therefore, no further treatment was necessary. This study showed that outside-in hip arthroscopy without traction might be a viable option for treating hip synovial osteochondromatosis, effectively and safely relieving symptoms with minimal complications, especially in patients without lesions in the central compartment.
关节镜下治疗髋关节滑膜软骨瘤病多在牵引下进行，可导致神经血管损伤或医源性损伤关节盂唇或软骨。本研究旨在评估非牵引式关节镜下髋关节外侧入路治疗髋关节滑膜软骨瘤病的疗效。本回顾性研究纳入 2018 年至 2020 年期间在我院接受非牵引式关节镜下髋关节外侧入路治疗的髋关节滑膜软骨瘤病患者。对所有患者进行了 X 线平片和磁共振成像（MRI）检查。分析了 Harris 髋关节评分（HHS）、髋关节活动范围（ROM）和视觉模拟评分（VAS）。采用配对样本 t 检验比较术前评分与末次随访评分。记录了术后并发症和复发情况。本研究共纳入 5 例患者（3 例男性，2 例女性），平均年龄 41 岁（28-54 岁）。平均随访时间为 25.2 个月（18-36 个月）。所有患者均有腹股沟疼痛缓解和 ROM 改善。术后 VAS 评分（0.4±0.5）明显低于术前（3.2±0.8）（p<0.001）。HHS 从 58.6±12.7（43-73）提高至 89.8±5.26（81-95）（p<0.001）。无感染、会阴麻木肿胀、神经损伤、血栓栓塞或严重持续性疼痛等严重并发症。1 例患者在随访 2 年后出现滑膜软骨瘤病复发，但无明显髋痛或关节交锁等症状，因此无需进一步治疗。本研究表明，非牵引式关节镜下髋关节外侧入路可能是治疗髋关节滑膜软骨瘤病的一种可行方法，可有效、安全地缓解症状，且并发症少，尤其适用于中央隔无病变的患者。
