目的:确定髋关节镜联合内镜髂胫带(ITB)松解术治疗股骨髋臼撞击(FAI)综合征和髋关节外扣(ESH)患者的疗效。
方法:回顾性回顾2014年1月至2018年12月在髋关节镜检查期间接受内窥镜ITB松解术的FAI综合征和ESH患者(FAI+ESH组)的术前和至少2年的随访数据。对照组(FAI组)纳入相同数量的年龄和性别匹配的未接受髋关节镜检查的ESHFAI综合征患者。患者报告结果(PRO),包括国际髋关节结果工具(iHOT-33),改良哈里斯髋关节评分(mHHS),疼痛视觉模拟量表(VAS-疼痛),比较分析术后3个月和2年受累髋关节的外展力。分析两组患者术后2年的VAS满意度评分。
结果:在我们机构接受髋关节镜检查的FAI综合征患者中,ESH的患病率为5.5%(715髋中的39例),包括9名男性(10髋)和29名女性(29髋)。手术时的平均年龄为32.1±6.9岁(范围,22-48岁)。根据纳入和排除标准,FAI+ITB组23例。23例年龄和性别匹配的FAI综合征患者纳入FAI组。术后24个月,FAI+ITB组无患者仍出现ESH症状和侧区触诊疼痛。iHOT-33,mHHS,术前FAI+ESH组患者的VAS疼痛评分明显高于FAI组患者(41.6±7.5vs48.8±7.2,54.8±7.2vs59.2±6.9,5.5±0.9vs4.7±1.0;P<0.05),而FAI+ESH组和FAI组患者在3个月和24个月随访时,这些评分没有显着差异(73.6±8.5vs76.1±6.9,85.3±7.8vs84.2±6.6,0.8±0.9vs0.6±0.9;P>0.05)。手术后3个月,手术后髋关节的外展力明显小于FAI组(82.4±12.4Nvs91.9±16.1N,P<0.05),而术后24个月无显著差异(101.6±14.9Nvs106.5±13.7N,P>0.05)。两组患者的VAS满意度评分均处于相似的较高水平(90.5±6.8vs88.8±7.3,P>0.05)。两组均无并发症,无关节镜翻修,随访2年。
结论:虽然髋关节外展力恢复延迟,髋关节镜联合内镜下ITB松解术治疗FAI综合征和ESH患者的髋关节咬合,可以得到类似的功能改进,疼痛缓解,恢复速度,以及与无ESH的FAI综合征患者的纯髋关节镜检查相比的患者满意度。
OBJECTIVE: To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH).
METHODS: Retrospectively review the preoperative and minimum of 2-year follow-up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age- and gender-matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient-reported outcomes (PROs) including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS-satisfaction score of two groups at 2 years postoperatively were also analyzed.
RESULTS: The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22-48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty-three age- and sex-matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT-33, mHHS, and VAS-pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3-month and 24-month follow-up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS-satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2-year follow-up.
CONCLUSIONS: Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.