髋臼盂唇位于髋关节内,是附着在骨性髋臼边缘的纤维软骨环,是维持髋关节功能的重要结构,盂唇损伤后将改变髋关节的生物力学机制,引起关节不稳,最终导致骨性关节炎的发生。因影像技术的发展及全民运动的普及,髋臼盂唇损伤在年轻人的发病率逐渐上升,髋臼盂唇治疗的需求得到显著的上升。随着对关节镜的运用成熟,髋关节镜技术已经成为治疗髋臼盂唇损伤的主要手术形式,包括:盂唇清理术、修复术、重建术、加强术。其主要作用都是恢复盂唇的密闭性及缓解应力分布,从而恢复髋臼功能性。因此本文主要就髋臼盂唇损伤修复进行综述。Background: The acetabular labrum is located in the hip joint and is a fibrocartilaginous ring attached to the bony acetabular rim, which is an important structure for maintaining the function of the hip joint. Damage to the labrum will change the biomechanical mechanism of the hip joint, causing joint instability and ultimately leading to the development of osteoarthritis. Due to the development of imaging technology and the popularity of sports among all people, the incidence of acetabular labral injury is gradually increasing among young people, and the demand for acetabular labral treatment has risen significantly. As the use of arthroscopy has matured, hip arthroscopy has become the main surgical form of treatment for acetabular labral injuries, including labral debridement, repair, reconstruction, and strengthening. The main purpose of these procedures is to restore labral confinement and relieve stress distribution, thus restoring acetabular function. Therefore, this article mainly reviews the repair of acetabular labral injury.
目的:探讨后外侧入路小切口髋关节置换术的手术技巧和临床效果。方法:选用2006年12月至2008年12月初次人工全髋关节置换病例共94例98髋,随机分为两组,后外侧小切口人工全髋关节置换组(A组)和常规后外侧切口人工全髋关节置换术组(B组)。A组采用后外侧小切口入路人工全髋关节置换术49例50髋,男26例,女23例,年龄37.0～95.0(平均68.9)岁;体质量指数(body mass index,BMI)20.3～29.7(平均25.4)kg/m2。B组采用常规后外侧切口入路人工全髋关节置换术45例48髋,男27例,女18例,年龄45.0～92.0(平均69.7)岁;BMI 18.7～34.1(平均26.9)kg/m2。对两组病例切口长度、术中出血量、引流量、手术时间、术后Harris评分等进行比较。结果:A组手术切口长6.0～10.5(平均7.4)cm;平均术中出血量387.6(140.0～1000.0)mL,平均术后引流量143.1(60.0～375.0)mL,平均输血量77.6(0～400.0)mL,手术平均时间84.6(63.0～130.0)min,术后影像学髋臼杯外展角平均41.6°(38.0°～57.0°)。B组手术切口长15.0～23.0(平均20.0)cm,平均术中出血513.1(210.0～1350.0)mL,平均术后引流量152.3(70.0～520.0)mL,平均输血量142.2(0～800.0)mL,手术平均时间84.0(71.0～115.0)min,术后影像学髋臼杯外展角平均42.3°(37.0°～54.0°)。术后及随访两组假体位置良好,Harris评分均显著提高,两组全髋关节置换术后均未出现并发症。结论:后外侧小切口人工全髋关节置换技术在正确选择适应证、手术技巧娴熟等情况下,具有对软组织损伤小、皮肤瘢痕小等优点,在术后影像学评价、Harris评分等方面与常规后外侧切口人工全髋关节置换术无明显差异,患者对关节功能以及术后恢复情况满意。
