Objective: To investigate the effectiveness of arthroscopic treatment for irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions.
Methods: Between February 2008 and August 2016, 11 patients with irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions, were treated with arthroscopic reduction and fixation of bony Bankart lesions. There were 7 males and 4 females, with an average age of 23.7 years (mean, 15-36 years). The injury was caused by traffic accident in 8 cases and falling from height in 3 cases. The interval between hip dislocation and the first manual reduction was 2-8 hours (mean, 5.3 hours) and between the first manual reduction and arthroscopic surgery was 6-31 days (mean, 12.8 days). The preoperative visual analogue scale (VAS) was 5.2±0.9, the modified Harris score was 32±8, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was 30±5.
Results: The operative time was 90-150 minutes (mean, 120.9 minutes), with no hip arthroscopic surgery related complications. All incisions healed by first intention. All patients were followed up 26-68 months (mean, 42.7 months). Postoperative X-ray films showed that all hip joints were reduction; CT showed that the reduction of posterior acetabular wall fracture was satisfactory. And all fractures healed at last follow-up with no avascular necrosis of the femoral head or osteoarthritis. At last follow-up, the VAS score was 0.5±0.5, the modified Harris score was 94±5, and the WOMAC score was 95±4. There were significant differences in those indexes between pre- and post-operation ( P<0.05).
Conclusion: The irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions is rare. Arthroscopic therapy has the advantages of less trauma, quick recovery, and less complications.
目的: 总结关节镜下复位固定盂唇骨性 Bankart 损伤治疗难复性髋关节后脱位的疗效。.
方法: 2008 年 2 月—2016 年 8 月，收治 11 例髋关节盂唇骨性 Bankart 损伤导致的难复性髋关节后脱位患者，采用关节镜下复位固定盂唇骨性 Bankart 损伤治疗。男 7 例，女 4 例；年龄 15～36 岁，平均 23.7 岁。交通事故伤 8 例，高处坠落伤 3 例。关节脱位至手法复位时间为 2～8 h，平均 5.3 h；首次手法复位至关节镜手术时间为 6～31 d，平均 12.8 d。术前疼痛视觉模拟评分（VAS）为（5.2±0.9）分，改良 Harris 评分为（32±8）分，美国西部 Ontario 与 McMaster 大学骨关节炎指数评分（WOMAC）为（30±5）分。.
结果: 手术时间 90～150 min，平均 120.9 min；无髋关节镜手术并发症发生。术后切口均Ⅰ期愈合。患者均获随访，随访时间 26～68 个月，平均 42.7 个月。术后 X 线片复查示髋关节均完全复位，CT 提示髋臼后壁骨块复位良好；末次随访时骨块均愈合，无股骨头缺血性坏死及骨关节炎等并发症发生。末次随访时，VAS 评分为（0.5±0.5）分，改良 Harris 评分为（94±5）分，WOMAC 评分为（95±4）分，均较术前明显改善（ P<0.05）。.
结论: 关节镜下复位固定盂唇骨性 Bankart 损伤治疗难复性髋关节后脱位，具有创伤小、恢复快、并发症少等优点。.
Keywords: Arthroscopy; acetabular labrum lesion; bony Bankart lesion; hip dislocation.