Arthroscopic Versus Open Cam Resection in the Treatment of Femoroacetabular Impingement
Arthroscopic Versus Open Cam Resection in the Treatment of Femoroacetabular Impingement
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DOI：
10.1016/j.arthro.2012.12.009
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发表时间：
2013-04-01
影响因子：
4.7
通讯作者：
Beck, Martin
中科院分区：
文献类型：
--
作者：
Buechler, Lorenz;Neumann, Mirjam;Beck, Martin
目的：本研究的目的是评价关节镜下实现的股骨颈骨矫正是否与手术脱位实现的骨矫正相当。研究方法：我们回顾性分析了2006年至2009年在我们机构接受髋关节镜或手术脱位治疗凸轮或混合型股骨髋臼撞击（FAI）的所有患者。入选标准是完整的临床和放射学文件与标准化的X线片。第1组包括66例接受髋关节镜治疗的患者（49例女性患者，平均年龄33.8岁）。第2组包括135例接受手术髋关节脱位治疗的患者（91例男性患者，平均年龄31.2岁）。我们比较了术前和术后的α和γ角，以及三角指数。平均随访16.7个月（范围：2 - 79个月）。结果如下：在第1组中，平均α角从术前的60.7度改善至术后的47.8度（P < .001），平均γ角从47.3度改善至44.5度（P < .001）。随着时间的推移，术前平均α角从2006年的56.3度增加到2009年的67.5度，而术后平均α角从2006年的51.2度下降到2009年的47.5度。在第2组中，平均α角从术前75.3度改善至术后44.8度（P < .001），平均γ角从65.1度改善至52.2度（P < .001）。第1组4例患者（6.1%）和第2组16例患者（12%）进行了关节镜下关节内粘连翻修。第2组中3例患者（2.2%）因大转子骨不连接受翻修。结论：髋关节镜下凸轮型FAI的骨性矫正与髋关节脱位手术获得的矫正相当。髋关节镜手术有一个显著的学习曲线，随着手术经验的增加，术后骨矫正的结果也会改善。证据等级：III级，回顾性比较研究。
Purpose: The purpose of this study was to evaluate if osseous correction of the femoral neck achieved arthroscopically is comparable to that achieved by surgical dislocation. Methods: We retrospectively analyzed all patients who were treated with hip arthroscopy or surgical dislocation for cam or mixed type femoroacetabular impingement (FAI) in our institution between 2006 and 2009. Inclusion criteria were complete clinical and radiologic documentation with standardized radiographs. Group 1 consisted of 66 patients (49 female patients, mean age 33.8 years) treated with hip arthroscopy. Group 2 consisted of 135 patients (91 male patients, mean age 31.2 years) treated with surgical hip dislocation. We compared the preoperative and postoperative alpha and gamma angles, as well as the triangular index. Mean follow-up was 16.7 months (range, 2 to 79 months). Results: In group 1, the mean alpha angle improved from 60.7 degrees preoperatively to 47.8 degrees postoperatively (P < .001) and the mean gamma angle improved from 47.3 degrees to 44.5 degrees (P < .001). Over time, the preoperative mean alpha angle increased from 56.3 degrees in 2006 to 67.5 degrees in 2009, whereas the postoperative mean alpha angle decreased from 51.2 degrees in 2006 to 47.5 degrees in 2009. In group 2, the mean alpha angle improved from 75.3 degrees preoperatively to 44.8 degrees postoperatively (P < .001), and the mean gamma angle improved from 65.1 degrees to 52.2 degrees (P < .001). Arthroscopic revision of intra-articular adhesions was performed in 4 patients (6.1%) in group 1 and 16 patients (12%) in group 2. Three patients (2.2%) in group 2 underwent revision for nonunion of the greater trochanter. Conclusions: Osseous correction of cam-type FAI with hip arthroscopy is comparable to the correction achieved by surgical hip dislocation. There is a significant learning curve for hip arthroscopy, with postoperative osseous correction showing improved results with increasing surgical experience. Level of Evidence: Level III, retrospective comparative study.