| BACKGROUND: Femoroacetabular impingement(FAI) is a kind of disease caused by abnormity of hip arthrosis structure which brings about the unusual collision between proximal femur and acetabulum leading to the degenerative changes of the hip joint labrum and cartilage, so that the hip joint would be in discomfort or pain. The range of hip joint movement especially buckling and intemal rotation is limited which will finally develop into osteoarthritis(OA). FAI is internationally recognized as an important factor of younger and middle aged hip joint pain also with early OA. It can be correctly diagnosed through the examination of the patient and the Dunn view X ray, Cross-table lateral view X ray, CT and MRI of the special position for hip joint, especially the imaging examination of hip MR Arthography(MRA) with special multi-level small vision special sequence. And then, it can be treated by surgical dislocation of hip operation after the correct diagnosis. The surgical dislocation of hip operation can expose its inside in 360 degree and completely solve fundamental pathogeny of FAI which effectively avoid the shortcomings of hip arthroscope operation. It can also skillfully protrct the deep branch of medial femoral circumflex artery and efficiently prevent the the largest complications—avascular necrosis of the femoral head(AVN) after operation. Saving early intervention of patient￠s hip joint can be truly achieved. FAI is a new concept in our country and the number of cases being clinically diagnosed is not that much. However, the number in fact is not quite a few and among the a considerable part is caused by FAI. Usual analgesic couldn￠t rekieve the continuing impact thereby OA will eventually occur, which can be treated only by total hip arthroplasty(THA). Thus, it is of great economic and social value that early diagnosis and surgical intervention would relieve the pain and prevent OA, further delaying or eliminating the THA. We can make the distribution of Chinese peripheral vascular anatomic clear and observe the abutting relationship among running blood vessels of femoral head through autopsy. Especially the deep branch of medial femoral circumflex artery, and checking the blood supply to the femoral head from vessels around by means of injecting contrast medium for Cross-table lateral view and CT. To enable the clinician to have a good knowledge of anatomic distribution of each vessel, and then combine anatomy with theory so as to be applied in clinical practice. Treating the patients with FAI by surgical dislocation of hip joint can get people familiar with and strengthen the understanding of it so that patients can get correct diagnosis and treatmeng in an early stagr, with provides greater help for carrying out suegical dislocation of hip joint and realizing popularization and application to basic medical institution soon.Anatomical study on surgical dislocation of hip for treating thefemoroacetabular impingementObjective: To provide an anatomical evidence for preventing avascular necrosis of the femoral head after hip salvage operation through the anatomy study of the vascular tissue around femoral head. Methods: We had two adult carcass(four hips) dissected to confirm the surrouding neighbor of femoral head especially the deep branch of medial femoral circumflex artery. We also had femoral head CT and X-ray scaned after injecting contrast agent to the the deep branch of medial femoral circumflex artery to observe the blood supply of it. Results: The blood supply of femoral head depends on branches of the medial and lateral femoral circumflex artery, and mostly depends on the deep branch of medial femoral circumflex artery, and the lateral ascending cervical artery plays the main role in the the deep branch of medial femoral circumflex artery. X-ray radiography and CT scans of injecting contrast medium to the deep branch of medial femoral circumflex artery and the injured femoral head shows that the deep branch of medial femoral circumflex artery blood supply distribution. The lateral ascending cervical artery supplies about 2/3 or 3/4 blood supply of femoral head, especially on the weight-bearing area, it occupies a very important role in the blood supply of femoral head; The medial ascending cervical artery supplies 1/4 or 1/3 blood supply of femoral head, which plays a less important role in the blood supply of femoral head; The anterior ascending cervical artery and the posterior ascending cervical artery supply small proportion in the blood supply of femoral head; The femoral head ligament artery also supplies the small proportion in the blood supply of femoral head, they are not the main blood vessels. Conclusion: Through the anatomical study of the vascular tissue around femoral head, we confirm the surrouding neighbor of the femoral head main blood supply arteries. We must avoid the damage of deep branch of medial femoral circumflex artery, prevent avascular necrosis of the femoral head. It is important significance for directing the hip salvage operation.Clinical study on surgical dislocation of hip for treating thefemoroacetabular impingement Objective: To cure FAI with the surgical dislocation of the hip, applies anatomical and theory combined with pratices a clinical basis for surgical dislocation of the hip. Methods: Excluded patients with severe hip osteoarthritis, avascular necrosis of the femoral head, developmental dysplasia of hip, inflammatory joint disease and has a history of around hip surgery, 5 patients with diagnosis of FAI(5 hips) accepted surgical dislocation of the hip. Patients with preoperative Harris hip score assessment, international hip outcome tool(i HOT-12) to evaluate patients with hip function,use visual analogue scale(VAS) to evaluate patients with hip pain, evaluate the patients with hip motion, strength simultaneously. Evalute hip pain, joint function in postoperative 1 months, 3 months, 6 months and 12 months follow-up and compare. Results: The 5 patients(5 hips) in preoperative Harris scoring average of 58.2 points, i HOT-12 scoring average of 10.8 points, VAS score averages of 5.8 points, after 1 months, 3 months, 6 months and 12 months in patients with VAS scoring average of 4.4 points、3.2 points、2.2 points、1.8 points, and postoperative 3 months, 6 months and 12 months, Harris scoring average of 76.4 points、88.4 points、90.2 points, i HOT-12 scoring average of 30.4 points、60.8 points、88.4 points, compared with preoperative patients of motion, muscle power have certain improvement, no hip osteoarthritis occurs or development, ischemic necrosis of femoral head was not occurred. Conclusion: In this group of patients, surgical dislocation of the hip can significantly reduce FAI hip pain, prevent hip osteoarthritis occurs or development, avascular necrosis of the femoral head was not occurred. This application can ease the symptom of FAI patients, it has positive effect in preventing hip osteoarthritis occurs or development, thus to delay or exempt THA surgery. |
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