CAJ | 학술논문

目的探讨髋臼盂唇损伤的诊断方法和关节镜治疗结果.方法 2008年11月至2009年12月收治单侧髋臼盂唇损伤行关节镜手术且随访时间超过半年的患者21例,男9例,女12例;年龄17～65岁,平均37.1岁.术前行体格检查、X线和MR关节造影明确诊断.于髋关节镜下行盂唇清理术14例、盂唇清理及股骨头颈区成形术5例、盂唇修复及股骨头颈区成形术2例.结果 Fadir试验阳性21例(100%,21/21),Fabir试验阳性15例(71%,15/21),McCarthy试验阳性9例(43%,9/21).X线片显示11例存在凸轮型撞击(其中6例合并钳夹型撞击),2例为单纯钳夹型撞击.MR关节造影均显示前上象限不同程度的盂唇损伤信号,阳性率100%;所有盂唇损伤均经关节镜证实,准确率100%.全部病例随访6～19个月,平均11.6个月.术后症状明显缓解,疼痛视觉模拟评分由术前(5.3±1.3)分降至术后6个月(1.4±0.9)分,Harris髋关节评分由术前(63±9)分提高至术后6个月(84±10)分,差异均有统计学意义.结论髋臼盂唇损伤与股骨髋臼撞击有关.撞击试验和MR关节造影具有较高的诊断阳性率和准确率.关节镜下髋臼盂唇损伤的清理、修复与骨成形术可获得满意的早期临床效果.
목적 탐토관구우진손상적진단방법화관절경치료결과.방법 2008년11월지2009년12월수치단측관구우진손상행관절경수술차수방시간초과반년적환자21례,남9례,녀12례;년령17～65세,평균37.1세.술전행체격검사、X선화MR관절조영명학진단.우관관절경하행우진청리술14례、우진청리급고골두경구성형술5례、우진수복급고골두경구성형술2례.결과 Fadir시험양성21례(100%,21/21),Fabir시험양성15례(71%,15/21),McCarthy시험양성9례(43%,9/21).X선편현시11례존재철륜형당격(기중6례합병겸협형당격),2례위단순겸협형당격.MR관절조영균현시전상상한불동정도적우진손상신호,양성솔100%;소유우진손상균경관절경증실,준학솔100%.전부병례수방6～19개월,평균11.6개월.술후증상명현완해,동통시각모의평분유술전(5.3±1.3)분강지술후6개월(1.4±0.9)분,Harris관관절평분유술전(63±9)분제고지술후6개월(84±10)분,차이균유통계학의의.결론 관구우진손상여고골관구당격유관.당격시험화MR관절조영구유교고적진단양성솔화준학솔.관절경하관구우진손상적청리、수복여골성형술가획득만의적조기림상효과.
Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteoplasty for labrale tears give a good early outcomes.