股関節唇損傷に対する股関節鏡視下手術の適応

抄録

Objective: There have been many reports about arthroscopic treatment for labrum injury accompanied by acetabular dysplasia or femoroacetabular impingement. Meanwhile, poor results including catastrophic failure in arthroscopic surgery for hip disorders have been reported. The purpose of this study was to investigate the results of arthroscopic surgery for labrum injury in order to determine the better application of arthroscopic surgery for its treatment.
Methods: There were 143 hip joints from patients with labrum injuries that underwent arthroscopic surgery. The cohort were divided into three groups; 28 joints without acetabular dysplasia (non-D group: CE angle < 25°), 30 joints with mild acetabular dysplasia (mild-D group: CE angle 20°-25°), and 85 joints with acetabular dysplasia (D group: CE angle > 20°). The morphology of each labral tear was arthroscopically evaluated and categorized into partial or complete peripheral longitudinal tear, radial flap tear, degenerative tear and inverted limbus. Clinical scores by the Japanese Orthopaedic Association (JOA) were evaluated both in the preoperative and postoperative phase. Osteoarthritic changes on the plain radiographs of the hip joint were also evaluated.
Results: There were more cases with partial peripheral longitudinal tears in non-D and mild D groups, while there were more cases with degenerative tears in D group. In D group, there were three joints with 80 points or more of the JOA score, six joints with less than 80 points of the JOA score, 15 joints which finally resulted in total hip arthroplasty (THA), and 61 joints combined with rotational acetabular osteotomy. Arthroscopic findings in 15 joints finally resulted in THA and were characterized by inverted limbs in eight joints and degenerative tears with instability in all joints. On the other hand, arthroscopic findings in three joints with JOA scores of 80 points or more were characterized by partial peripheral longitudinal tears without instability and minor degrees of chondral injury in all cases.
Conclusion: Our results suggest that arthroscopic surgery for labral tears with mild dysplastic hip joints should be avoided in cases with inverted limbs, labrum injuries with instability, or major degrees of chondral injury.