Inside-out和Outside-in髋关节镜技术治疗股骨髋臼撞击征的疗效对比研究

目的：对比分析两种髋关节镜技术治疗股骨髋臼撞击征（femoroacetabular impingement，FAI）的临床疗效和并发症。方法：回顾性分析2016年6月至2019年6月采用髋关节镜手术治疗并获得随访的48例FAI患者。根据手术方式的不同分为两组，Inside-out组，由中央到外周；Outside-in组，由外周到中央。Inside-out组24例，男14例，女10例，年龄（39.8±7.6）岁；Outside-in组24例，男13例，女11例，年龄（39.5±9.1）岁。两组患者年龄、性别、体质量指数、侧别、撞击类型、病程、随访时间比较差异无统计学意义。对两组术后髋关节改良Harris （modified Harris hip score，mHHS），非骨关节炎髋关节（nonarthritic hip score，NAHS）评分和术后并发症发生率进行比较。结果：两组患者术后髋关节功能评分mHHS和NAHS评分均较术前提高，但组间比较差异无统计学意义（P>0.05）。Inside-out组术后4例出现神经牵拉伤，3例医源性损伤；而Outside-in组仅1例神经牵拉伤。Inside-out组并发症发生率高于Outside-in组（16.7% vs 4.2%，χ²=5.400，P=0.020）。结论：Inside-out和Outside-in两种髋关节镜技术治疗FAI均可取得良好的临床效果，但相对于Inside-out技术，Outside-in技术术后并发症发生率低，针对符合适应证的患者可以优先选择。

Clinical outcomes of hip arthroscopic treatment for femoroacetabular impingement: a comparative study between Inside-out and Outside-in approach

Objective: To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach.Methods: The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods,the patients were divided into two groups. Inside-out group,from central compartment to peripheral compartment;Outside-in group,from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an average age of (39.8±7.6)years old,13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age,gender,body mass index,side,impingement type,medical history and follow-up time between the two groups. The complication occurrence rate,modified Harris hip score(mHHS)and nonarthritic hip score(NAHS) were compared between these two groups.Results: The mHHs and NAHS scores of the two groups were significantly higher than those before operation,but there was no significant difference between the two groups(P>0.05). In the Inside-out group,there were 4 cases of nerve traction injury and 3 cases of iatrogenic injury,while only 1 case of nerve traction injury occurred in the Outside-in group. The incidence of complications in the inside out group was higher than that in the outside in group(16.7% vs 4.2%, χ²=5.400,P=0.020).Conclusion: Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI,but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.