髖臼股骨撞擊

1、股骨髖臼撞擊的關(guān)節(jié)鏡治療,Femoroacetabular Impingement （FAI）,髖關(guān)節(jié)慢性疼痛的原因,關(guān)節(jié)內(nèi)關(guān)節(jié)內(nèi)游離體盂唇損傷關(guān)節(jié)外肌肉肌腱損傷神經(jīng)牽拉滑囊炎髖臼股骨撞擊,常見的FAI的病因,“手槍柄形”股骨頸 髖臼后傾,a 手槍柄形股骨頸b 正常股骨頸,“8” figure,,盂唇撕裂與髖關(guān)節(jié)退化、骨性關(guān)節(jié)炎密切相關(guān)非球面股骨頭、髖臼與早期出現(xiàn)髖關(guān)節(jié)骨性關(guān)節(jié)炎相關(guān)FAI是否與退化性髖關(guān)節(jié)疾病相

2、關(guān)-目前未知,消除結(jié)構(gòu)上的異常解除疼痛延緩?fù)嘶?在極度的活動范圍下股骨頸直徑增大股骨頭、頸偏移減小均可能由于股骨頸、髖臼反復(fù)接觸，產(chǎn)生剪式應(yīng)力，造成盂唇和髖臼軟骨的損傷撞擊性的盂唇損傷，絕大多數(shù)位于髖臼前上區(qū),Murry最早將撞擊的理論用于解釋退化性髖關(guān)節(jié)疾病病因Leunig等人發(fā)現(xiàn)髖臼邊緣的退化常見于老年髖關(guān)節(jié)，并認為FAI引發(fā)了這一過程Beck等人在手術(shù)治療髖臼前上象限的盂唇損傷時發(fā)現(xiàn)損傷與股骨頭、頸前外側(cè)偏移有關(guān),

3、股骨頭、頸偏移減小病因不清“手槍柄”形股骨頸亞臨床型的股骨頭骺滑脫股骨近端生長障礙,病因,Ganz撞擊類型,凸輪（Cam）撞擊非球面股骨頭在屈髖時與髖臼接觸，產(chǎn)生剪式應(yīng)力，造成髖臼盂唇在前上象限自外向內(nèi)的磨損。盂唇損傷淺，僅局限于撞擊部位鉗形（Pincer）撞擊髖臼邊緣與股骨頭、頸結(jié)合部線狀的撞擊，撞擊的起源在髖臼，常造成髖臼前方過度覆蓋（髖臼后傾），或前方骨贅形成。盂唇磨損嚴重,患肢屈曲內(nèi)旋時產(chǎn)生撞擊,“8” figure

4、,,臨床表現(xiàn),病史,年輕病人多見中年運動員，活動時腹股溝區(qū)疼痛常發(fā)生在與屈髖有關(guān)的活動中簡單活動和運動時都可能引發(fā)疼痛癥狀間歇發(fā)生，由輕到重腹股溝疼痛可能造成活動受限，特別是運動員經(jīng)常誤診，保守治療無效或加重,體檢,屈髖狀態(tài)下，內(nèi)旋內(nèi)收受限髖關(guān)節(jié)體檢時常伴隨疼痛撞擊實驗：被動屈曲內(nèi)收髖關(guān)節(jié)，逐漸內(nèi)旋，引發(fā)腹股溝區(qū)的疼痛須鑒別排除：滑囊炎，神經(jīng)牽拉痛，腹股溝疝,影像學(xué)檢查,雙髖正位相骨盆正位相穿臺側(cè)位相（A cros

5、s-table lateral radiograph）CTMRI三維CT,X線片測量,CE角 (Wiberg) 25度: 正常 20-25度:邊緣髖臼指數(shù)>10度：髖臼發(fā)育不良4-10度：正常頸干角：>140 發(fā)育不良,>15.2%,治療,非手術(shù)治療非甾體抗炎藥限制活動-屈髖由于是機械原因，非手術(shù)治療不能解除病源切開手術(shù)治療關(guān)節(jié)鏡下清創(chuàng)并處理盂唇、軟骨損傷,軟骨損傷的處理,Acetabul

6、ar chondral injuries may be addressed by chondroplasty, drilling, or microfractureThese lesions are not uncommon and tend to extend about 5 to 7 mm in width along the length of the impingement lesionIn most cases of FA

7、I, the femoral articular surface is intact,骨量的控制,The amount of resection that predictably ended in a fracture was greater than 30% of the femoral neckNo more than approximately 20% of the width of the neck should be res

8、ectedPreoperative measurement of the overall width of the neck allows the surgeon to plan for as conservative a resection as is possible,切開手術(shù)結(jié)果,open surgical dislocation approachBeck M ,2004，The open surgical dislocat

9、ion approach， 14 / 19 patients for good resultsMurphy S,2004, 23 hips evaluation, 7 patients had been converted to total hip arthroplasty,,,關(guān)節(jié)鏡手術(shù)結(jié)果,Christensen C, 10 patients Follow-up averaged 16 months (range, 9 to 2

10、4 months). Eight patients with evidence of FAI and no intra-articular cartilage degenerative disease did substantially better than the 2 patients who had degenerative disease diagnosed at the time of arthroscopy The McCa

11、rthy scoring averaged 75 preoperatively and 95 at follow-upSampson has reported on a series of 90 patients treated arthroscopically for FAI. In his experience, nearly all patients had elimination of the impingement sign