髋关节镜下关节囊不同切开方式早期术后并发症

Incidence of early postoperative complications following different capsulotomy methods in hip arthroscopy

摘要

目的 探讨髋关节镜下关节囊不同切开方式对髋关节撞击综合征(femoroacetabular impingement, FAI)患者早期术后并发症的影响。 方法 回顾性分析2019年1月至2024年9月收治于山东第一医科大学附属省立医院运动医学科FAI患者135例,其中男65例,女70例,15~60(38.5±8.5)岁,135例患者合并凸轮与钳夹畸形,均接受髋关节镜手术治疗;手术方式采用由外向内的关节囊切开技术,其中46例为横切关节囊组,89例为纵切关节囊组,记录术中患者牵引时间,分析患者术后1年不同术式产生的术后并发症、随访时的改良髋关节功能Harris评分(modified harris hip score, mHHS)、国际髋关节结果评分(international hip outcome tool, iHOT-12)和疼痛视觉模拟评分(visual analog scale, VAS)。 结果 135例患者术后均获得随访,总并发症13例(9.6%),其中唯一1例严重并发症(液体外渗合并股神经损伤)来自横切关节囊组;12例轻微并发症(神经暂时麻痹、医源性软骨、盂唇损伤)中8例来自横切关节囊组,4例来自纵切关节囊组。横切关节囊组总体并发症发生率高于纵切关节囊组(19.6% vs. 4.5%, P=0.006)。纵切关节囊组[(35.3±8.4)min]术中牵引时间低于横切关节囊组[(58.1±18.5)min],差异有统计学意义( P<0.001)。两组患者术后mHHS、VAS和iHOT-12评分均较术前改善。 结论 纵切关节囊术式与横切关节囊术式相比,在临床应用中更具优势,能有效缩短术中牵引时间并降低术后早期并发症的发生率,是治疗 FAI 的优选术式之一。

Abstract

Objective To examine effects of different capsulotomy techniques used in hip arthroscopy on early postoperative complications in patients with femoroacetabular impingement(FAI). Methods A retrospective analysis included 135 patients with FAI treated in Department of Sports Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, between January 2019 and September 2024. Cohort comprised 65 men and 70 women aged 15-60(38.5±8.5)years. All patients presented with combined cam and pincer morphology and underwent hip arthroscopic surgery. An outside-in capsulotomy technique was performed in all cases, including 46 patients in transverse capsulotomy group and 89 in longitudinal capsulotomy group. Intraoperative traction time was recorded. Postoperative complications within 1 year were analysed, together with modified Harris Hip Score(mHHS), International Hip Outcome Tool-12(iHOT-12), and Visual Analogue Scale(VAS)pain scores assessed at follow-up. Results All 135 patients completed postoperative follow-up. Complications occurred in 13 cases overall(9.6%), including a single major complication—fluid extravasation with femoral nerve injury—which arose in transverse capsulotomy group. Of 12 minor complications, comprising transient nerve palsy and iatrogenic injury to cartilage and labrum, 8 occurred in transverse capsulotomy group and 4 in longitudinal capsulotomy group. Overall complication rate was higher in transverse capsulotomy group than in longitudinal capsulotomy group(19.6% vs. 4.5%, P=0.006). Intraoperative traction time was significantly shorter in longitudinal capsulotomy group than in transverse capsulotomy group [(35.3±8.4)min vs.(58.1±18.5)min, P<0.001]. Postoperative mHHS, VAS and iHOT-12 scores improved in both groups compared with preoperative values. Conclusion Longitudinal capsulotomy shows clearer advantages, with significantly shorter traction time and lower rate of early postoperative complications, making it preferred surgical approach for FAI.

关键词

髋关节撞击综合征 / 髋关节镜 / 髋关节囊切开方式 / 术后并发症 / 术中牵引时间

Key words

Femoroacetabular impingement / Hip arthroscopy / Hip capsulotomy technique / Postoperative complications / Intraoperative traction time

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