Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique.
Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique.
复制标题
DOI：
10.2106/jbjs.f.01123
复制
发表时间：
2007-03-01
期刊：
影响因子：
--
通讯作者：
Leunig, Michael
中科院分区：
文献类型：
--
作者：
Espinosa, Norman;Beck, Martin;Leunig, Michael
背景技术背景：最近的进展，在了解髋臼唇的解剖和功能表明，它是重要的正常关节功能。我们发现没有可用的数据，是否盂唇再固定治疗后的股骨-髋臼撞击影响的临床和影像学results.METHODS：我们回顾性分析了52例（60髋）的临床和影像学结果与股骨-髋臼撞击谁接受了关节切开术和髋关节手术脱位，让修剪的髋臼缘和股骨骨软骨成形术。在前25个髋关节中，切除撕裂的盂唇（第1组）;在接下来的35个髋关节中，将盂唇的完整部分重新连接到髋臼边缘（第2组）。在术后1年和2年，Merle d 'Aubigne临床评分和Tonnis关节病分类系统用于比较两组。结果：在术后1年，两组的临床评分（主要是疼痛减轻）与术前值相比均有显著改善（第1组p = 0.0003，第2组p < 0.0001）。术后2年，第1组（盂唇切除术）中28%的髋关节的结果为极佳，48%的结果为良好，20%的结果为中度，4%的结果为较差。相比之下，在第2组（盂唇复位）中，80%的髋关节获得了极好的结果，14%的髋关节获得了良好的结果，6%的髋关节获得了中等的结果。两组之间的临床评分比较显示，第2组在1年（p = 0.0001）和2年（p = 0.01）时的结局显著更好。骨关节炎的影像学体征在1年（p = 0.02）和2年（p = 0.009）时，第1组比第2组明显更普遍。结论：与接受撕裂盂唇切除术的患者相比，接受盂唇再固定治疗的患者恢复更早，临床和影像学结果上级。虽然结果必须被认为是初步的，我们现在建议在手术治疗股骨-髋臼撞击时，在修剪髋臼缘后重新固定完整的盂唇部分。
BACKGROUND: Recent advances in the understanding of the anatomy and function of the acetabular labrum suggest that it is important for normal joint function. We found no available data regarding whether labral refixation after treatment of femoro-acetabular impingement affects the clinical and radiographic results.METHODS: We retrospectively reviewed the clinical and radiographic results of fifty-two patients (sixty hips) with femoro-acetabular impingement who underwent arthrotomy and surgical dislocation of the hip to allow trimming of the acetabular rim and femoral osteochondroplasty. In the first twenty-five hips, the torn labrum was resected (Group 1); in the next thirty-five hips, the intact portion of the labrum was reattached to the acetabular rim (Group 2). At one and two years postoperatively, the Merle d'Aubigne clinical score and the Tonnis arthrosis classification system were used to compare the two groups.RESULTS: At one year postoperatively, both groups showed a significant improvement in their clinical scores (mainly pain reduction) compared with their preoperative values (p = 0.0003 for Group 1 and p < 0.0001 for Group 2). At two years postoperatively, 28% of the hips in Group 1 (labral resection) had an excellent result, 48% had a good result, 20% had a moderate result, and 4% had a poor result. In contrast, in Group 2 (labral reattachment), 80% of the hips had an excellent result, 14% had a good result, and 6% had a moderate result. Comparison of the clinical scores between the two groups revealed significantly better outcomes for Group 2 at one year (p = 0.0001) and at two years (p = 0.01). Radiographic signs of osteoarthritis were significantly more prevalent in Group 1 than in Group 2 at one year (p = 0.02) and at two years (p = 0.009).CONCLUSIONS: Patients treated with labral refixation recovered earlier and had superior clinical and radiographic results when compared with patients who had undergone resection of a torn labrum. Although the results must be considered preliminary, we now recommend refixation of the intact portion of the labrum after trimming of the acetabular rim during surgical treatment of femoro-acetabular impingement.