关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。

Clinical Study on Arthroscopic Treatment of Hip Joint Disease

Objective:To study the method and curative effect of hip arthroscopy treatment on hip joint disease indications, as well as clinical value of arthroscopy in hip joint disease.Methods:The objects were 86 cases of patients who have obvious hip pain, including osteonecrosis of the femoral head (43%), labrum injury (20%), degenerative joint disease (DJD) (10%), Legg-Calve'' -Perthes (LCP) (10%), loose body (10%), Pain (100%), mechanical injury (78%), sports injury (56%). The patients were detected by hip arthroscopy in a supine position. The traction bed was applied, 300 or 700, with an anterior lateral entrance. Observe the results of different diseases after treatment.Results:All patients had no complications. The mean follow-up time was 30 months. In a total, 60%of the patients had their pain symptoms relieved. Labrum (91%, P<0.003) or LCP (89%, P<0.05) patients had better effect, while ON and DJD patients had relatively poor effect, for only 40% and 44% of them improved. As for patients with free vascularized fibular grafting (free-vascularized fibular graft FVEG), 34%of themwere improved during the follow-up period (P=0.003). 18 patients (21%) received total hip replacement.Conclusion:The hip arthroscopy operation had good therapeutic effect for patients with loose body, labrum injury, focal cartilage lesions, or late sequela of LCP, but has no effect on the femoral head necrosis.