Der Orthopäde

, Volume 38, Issue 5, pp 419–428

Behandlung des FAI durch einen minimal-invasiven ventralen Zugang mit arthroskopischer Unterstützung

Technik und mittelfristige Ergebnisse
Leitthema

Zusammenfassung

Das femoroazetabuläre Impingement (FAI) gilt als eine Hauptursache von Hüftschmerzen bei jungen Patienten. 1999 entwickelte unsere Abteilung eine neue Operationstechnik unter Verwendung eines minimal offenen Hueter-Zugangs mit arthroskopischer Unterstützung. Der Zweck unserer Studie war die Evaluierung der mittelfristigen klinischen Ergebnisse und der Lebensqualität nach Cam-Resektion, Pfannenrandtrimmung und Labrumrefixation unter Einsatz dieser Technik.

Die ersten 100 Hüften wurden mittels des „Nonarthritic Hip Scores“ (NAHS) mit mittlerer Nachbeobachtungszeit von 54 Monaten bewertet. Das Durchschnittsalter der Patienten betrug 33,4 Jahre; es wurden 50 Männer und 47 Frauen behandelt. Bei der letzten Untersuchung hatte sich der durchschnittliche NAHS-Score signifikant von 55±12 auf 84±16 Punkte erhöht (p<0,001). Das klinische Ergebnis war in 40 Fällen sehr gut, in 38 gut, in 8 zufrieden stellend und in 14 Fällen schlecht. Bei 11 Hüften kam es zu einer Osteoarthrose und schließlich zum Gelenkersatz. Eine Patientin zog sich 3 Wochen postoperativ eine Schenkelhalsfraktur zu. Die besten Ergebnisse hatten Patienten <40 Jahre (53 Patienten) und solche mit einem Tönnis-Arthrosegrad 0, von denen 90% nach einer mittleren Nachuntersuchungszeit von 55 Monaten sehr gute oder gute Ergebnisse hatten. Die Refixation des Labrums korrelierte bei der letzten Untersuchung nicht signifikant mit einem höheren NAHS-Score.

Die Cam-Resektion am Übergang zwischen Femurkopf und Femurhals unter Verwendung eines ventralen „Mini-Hueter-Zugangs“ mit arthroskopischer Unterstützung ist eine sichere und effektive Methode zur Behandlung junger Patienten mit FAI. Die Technik bietet direkte Sicht auf den ventralen Femurkopf-Hals-Übergangsbereich und ist weniger invasiv als eine chirurgische Luxation.

Schlüsselwörter

Femoroazetabuläres Impingement Minimal-invasiver ventraler Zugang Hüftschmerzen „Nonarthritic Hip Score“ Cam-Resektion 

Treatment of FAI via a minimally invasive ventral approach with arthroscopic assistance

Technique and midterm results

Abstract

Femoroacetabular impingement (FAI) may be considered as an important cause of hip pain among young patients. A new surgical technique using a mini open anterior Hueter approach with arthroscopic assistance was developed in our department in 1999. The goal of our study was to evaluate the midterm clinical results and the quality of life after cam resection, rim trimming, and labrum refixation using this technique.

The first 100 hips operated on using this technique were evaluated with the Nonarthritic Hip Score (NAHS) at a mean follow-up of 54 months. The mean age of the patients was 33.4 years, with 50 men and 47 women. At the last follow-up, the mean NAHS score increased significantly from 54.5±12 by 29.6 points to 84.3±16 (p<0.001). The clinical result was very good in 40 cases, good in 38 cases, fair in 8 cases, and poor in 14 patients. Eleven hips developed osteoarthrosis and finally had a total hip replacement. One patient had a femoral neck fracture at 3 weeks postoperatively. The best results were obtained in patients under 40 years of age (53 patients) and with a Tönnis osteoarthrosis grade of 0, 90% of whom had a very good or good result at a mean follow-up of 55 months. Refixation of the labrum was not significantly correlated with a higher NAHS (87±11 versus 82±19, p=0.13) at the last follow-up.

Resection of cam FAI of the femoral head-neck junction using a mini anterior Hueter approach with arthroscopic assistance is a safe and effective technique in treating young adults with femoroacetabular impingement. This technique offers direct visualization of the anterior femoral head-neck junction and is less invasive than the surgical dislocation approach.

Keywords

Femoroacetabular impingement Minimally invasive ventral approach Hip pain Nonarthritic hip score Cam resection 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.CMC Paris VParisFrankreich
  2. 2.Hopital la Pitié SalpêtrièreParisFrankreich

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