关节囊修补治疗伴有临界型发育性髋关节发育不良的股骨髋臼撞击综合征患者的效果

Efficacy of joint capsule repair for patients with femoroacetabular impingement syndrome accompanied by borderline developmental dysplasia of the hip

摘要

目的 探讨髋关节镜微创手术治疗伴有临界型发育性髋关节发育不良（BDDH）的股骨髋臼撞击综合征（FAI）的疗效及安全性。方法 回顾性分析2019年4月至2022年4月沧州市人民医院关节运动医学骨科83例伴有BDDH的FAI患者临床资料，均行髋关节镜微创手术，根据术中是否实施关节囊修补分为关节囊修补组（n=42）与关节囊未修补组（n=41）。比较两组手术相关指标、围术期疼痛介质[P物质（SP）、去甲肾上腺素（NE）、前列腺素E₂（PGE₂）]、影像学参数[α角、外侧中心边缘角（LCEA）]、髋关节活动度、髋关节结果评分日常生活能力量表（HOS-ADL）评分、非骨性关节炎髋关节评分（NAHS）、Harris髋关节功能评分（HHS）及术后并发症。计量资料组间比较采用独立样本t检验，多时间点资料采用重复测量方差分析；计数资料采用χ²检验。结果 与关节囊未修补组比较，关节囊修补组手术时间更长（t=2.310，P=0.023），两组术中出血量（t=0.747，P=0.457）、术后住院时间（t=0.449，P=0.654）差异均无统计学意义。两组术前及术后24、48、72 h血清SP、NE、PGE₂水平均存在时间效应，差异有统计学意义（F_SP=10.419，F_NE=17.685，F_PGE2=14.473，均P<0.001）；组别与时间交互效应差异均无统计学意义。两组术前及术后1、6、12个月α角、LCEA均存在时间效应，差异有统计学意义（F_α角=18.827，F_LCEA=17.495，P均<0.001），组间效应及组别与时间交互效应差异均无统计学意义（均P>0.05）。两组髋关节外展、内旋及屈曲活动度均存在时间效应，差异有统计学意义（F_外展=10.232，F_内旋=13.473，F_屈曲=9.802，P均<0.001），组间效应及组别与时间交互效应差异均无统计学意义（均P>0.05）。两组HHS、NAHS、HOS-ADL评分均随时间改善，且组间效应、时间效应及组别与时间交互效应差异均有统计学意义（均P<0.001），关节囊修补组评分更高，功能恢复更优。两组均无严重并发症，并发症总发生率分别为14.3%、19.5%，差异无统计学意义（χ²=0.40，P=0.527）。结论 髋关节镜微创手术治疗伴有BDDH的FAI可有效改善髋关节活动度和关节功能，且严重并发症少；联合关节囊修补虽延长手术时间，但有助于改善关节功能，且未见因关节囊修补而进一步增加疼痛介质水平。

Abstract

Objective To explore the efficacy and safety of minimally invasive hip arthroscopy for femoroacetabular impingement syndrome (FAI) accompanied by borderline developmental dysplasia of the hip (BDDH). Methods The clinical data of 83 patients with FAI accompanied by BDDH who underwent minimally invasive hip arthroscopy at the Department of Orthopedic Sports Medicine, Cangzhou People’s Hospital from April 2019 to April 2022 were retrospectively analyzed. According to whether capsular repair was performed intraoperatively, the patients were divided into a capsular repair group (n=42) and a capsular nonrepair group (n=41). Surgical indicators, perioperative pain mediators [substance P (SP), norepinephrine (NE), prostaglandin E₂ (PGE₂)], imaging parameters [α angle and lateral center-edge angle (LCEA)], hip range of motion, Hip outcome score-activities of daily living (HOS-ADL), Nonarthritic Hip Score (NAHS), Harris hip score (HHS), and postoperative complications were compared between the two groups. Independent-samplet test was used for between-group comparisons of measurement data, repeated-measures analysis of variance was used for data at multiple time points, and χ² test was used for count data. Results Compared with the capsular nonrepair group, the capsular repair group had a longer operative time (t=2.310, P=0.023), whereas intraoperative blood loss (t=0.747, P=0.457) and postoperative hospital stay (t=0.449, P=0.654) did not differ significantly between the two groups. Serum SP, NE, and PGE₂ levels before surgery and at 24, 48, and 72 h after surgery showed significant time effects in both groups (F_SP=10.419, F _NE=17.685, F_PGE2=14.473, all P<0.001), whereas the group-by-time interaction effects were not statistically significant. Theα angle and LCEA before surgery and at 1, 6, and 12 months after surgery showed significant time effects in both groups (F _{α angle}=18.827, F _LCEA=17.495, all P<0.001), with no significant group effects or group-by-time interaction effects (allP>0.05). Hip abduction, internal rotation, and flexion ranges of motion showed significant time effects in both groups (F _abduction=10.232, F _{internal rotation}=13.473, F _flexion=9.802, all P<0.001), with no significant group effects or group-by-time interaction effects (allP>0.05). HHS, NAHS, and HOS-ADL scores improved over time in both groups, and the group effects, time effects, and group-by-time interaction effects were statistically significant (allP<0.001); the capsular repair group had higher scores and better functional recovery. No severe complications occurred in either group. The overall complication rates were 14.3% and 19.5%, respectively, with no significant difference (χ²=0.40, P=0.527). Conclusions Minimally invasive hip arthroscopy for FAI accompanied by BDDH can improve hip range of motion and hip function, with few severe complications. Additional capsular repair prolongs operative time but may help improve hip function, without further increasing pain mediator levels.

关键词

股骨髋臼撞击综合征 / 髋关节 / 关节镜检查 / 手术后并发症 / 活动范围，关节

Key words

Femoroacetabular impingement / Hip joint / Arthroscopy / Postoperative complications / Range of motion, articular

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基金资助

河北省医学科学研究课题(20220320)