盂唇撕裂患者指南

09-21

盂唇撕裂患者指南

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A PATIENTS GUIDE TO LABRAL TEARS OF THE HIP

Acetabular labrum tears (labral tears) can cause pain, stiffness, and other disabling

symptoms of the hip joint. The pain can occur if the labrum is torn, frayed, or

damaged. Active adults between the ages of 20 and 40 are affected most often,

requiring some type of treatment in order to stay active and functional. New

information from ongoing studies is changing the way this condition is treated

from a surgical approach to a more conservative (nonoperative) path.

髖臼盂唇撕裂可導致髖關節疼痛，僵硬和其他致殘癥狀。 如果盂唇撕裂，磨損或損壞，可能會發生疼痛。 20至40歲之間的活躍成年人最常受到影響，需要某種治療才能保持活躍和功能。 來自正在進行的研究的新信息正在改變這種情況從手術方式治療到更保守（非手術）方式的方式。

This guide will help you understand

what parts of the hip are involved？

how the condition develops？

how doctors diagnose the condition？

what treatment options are available？

本指南將幫助您理解

涉及臀部的什麼部位

病情如何發展

醫生如何診斷病情

有什麼治療方案可供選擇

ANATOMY

What parts of the hip are involved?

The acetabular labrum is a fibrous rim of cartilage around the hip socket that is

important in normal function of the hip. It helps keep the head of the femur

(thigh bone) inside the acetabulum (hip socket). It provides stability to the

joint.

Our understanding of the acetabular labrum has expanded just in the last 10 years.

The availability of high-power photography and improved lab techniques have

made it possible to take a closer look at the structure of this area of the

hip.

解剖

涉及髖關節的什麼部位？

髖臼盂唇是髖關節周圍軟骨的纖維狀邊緣，對髖關節的正常功能很重要。 它有助於將股骨頭 （大腿骨）保持在髖臼 （髖關節窩）內。 它為關節提供了穩定性。

我們對髖臼唇的理解在過去的10年中有所擴展。 高功率攝影和改進的實驗室技術的可用性使得人們有可能仔細觀察髖關節區域的結構。

The labrum is a piece of connective tissue around the rim of the hip socket

(acetabulum). It has two sides: one side is in contact with the head of the

femur, the other side touches and interconnects with the joint capsule. The

capsule is made up of strong ligaments that surround the hip and help hold it

in place while still allowing it to move in many directions,

盂唇是髖臼周緣（髖臼）周圍的一塊結締組織。 它有兩面：一面與股骨頭接觸，另一面與關節囊接觸並互相連接。 該關節囊由強勁的韌帶組成，圍繞髖關節並幫助將其固定在位，同時仍允許它在多個方向移動，

Finding out that there are two separate zones of the labrum was an important discovery.

The extra-articular side (next to the joint capsule) has a good blood supply

but the intra-articular zone (next to the joint) is mostlyavascular (without

blood). That means any damage to the extra-articular side is more likely to

heal while the intra-articular side (with a very poor blood supply) does not

heal well after injury or surgical repair.

The labrum helps seal the hip joint, thus maintaining fluid pressure inside the

joint and providing the overall joint cartilage with nutrition. Without an

intact seal, the risk of early degenerative arthritis increases. A damaged

labrum can also result in a shift of the hip center of rotation. A change of

this type increases the impact and load on the joint. Without the protection of

the seal or with a hip thata??s off-center, repetitive motion can create

multiple small injuries to the labrum and to the hip joint. Over time, these

small injuries can add to wear and tear in the hip joint.

發現有兩個獨立的盂唇區是一個重要的發現。 關節外側（關節囊旁）有良好的血液供應，但關節內關節區（ 關節旁）多為無血管 （無血）。 這意味著任何對關節外側的損傷更可能癒合，而關節內側（血供極差）在損傷或手術修復後不能很好地癒合。

盂唇有助於密封髖關節，從而保持關節內的液體壓力，並為整個關節軟骨提供營養 。 如果沒有完整的密封，早期退行性關節炎的風險會增加。 損傷的盂唇也會導致髖關節旋轉中心的移位。 這種類型的改變會增加關節的衝擊和負荷。 如果沒有密封保護或偏離中心的髖關節，重複性運動會對盂唇和髖關節造成多處小傷。 隨著時間的推移，這些小傷可能會增加髖關節的磨損。

CAUSES

How does this condition develop?

It was once believed that a single injury was the main reason labral tears

occurred (running, twisting, slipping). But with improved radiographic imaging

and anatomy studies, its clear now that abnormal shape and structure of the

acetabulum, labrum, and/or femoral head can also lead to the problem.

Injury is still a major cause for labral tears. Anatomical changes that contribute to

labral tears combined with repetitive small injuries lead to a gradual onset of

the problem. Athletic activities that require repetitive pivoting motions or

repeated hip flexion cause these type of small injuries.

What are these anatomical changes? The most common one called femoral acetabular

impingement (FAI) is a major cause of hip labral tears. With FAI, there is

decreased joint clearance between the junction of the femoral head and neck

with the acetabular rim.

原因

這種狀況如何發展？

曾經有人認為，單一的傷害是發生盂唇撕裂的主要原因（跑步，扭曲，滑倒）。 但隨著放射照相成像和解剖學研究的改進，現在很清楚，髖臼，盂唇和/或股骨頭的異常形狀和結構也會導致問題。

傷害仍然是導致盂唇撕裂的主要原因。 造成唇裂的解剖變化加上重複的小傷，導致問題逐漸出現。 需要反覆旋轉運動或反覆髖關節屈曲的運動會導致這類小傷。

這些「解剖變化」是什麼？ 最常見的一種稱為股骨髖臼撞擊（FAI）是髖關節盂唇撕裂的主要原因。 對於FAI，股骨頭與頸部的交界處與髖臼邊緣之間的關節間隙減小。

When the leg bends, internally rotates, and moves toward the body, the bone of the

femoral neck butts up against the acetabular rim pinching the labrum between

the femoral neck and the acetabular rim. Over time, this pinching, or

impingement, of the labrum causes fraying and tearing of the edges. A complete

rupture is referred to as an avulsion where the labrum is separated from the

edge of the acetabulum where it normally attaches.

當腿部彎曲，內旋並向身體移動時，股骨頸的骨頭靠在髖臼邊緣上，將盂唇夾在股骨頸和髖臼邊緣之間。 隨著時間的推移，盂唇的擠壓或撞擊會導致邊緣磨損和撕裂。 完全斷裂稱為撕脫 ，其中盂唇從其通常附著的髖臼邊緣分離。

Changes in normal hip movement combined with muscle weakness around the hip can lead to

acetabular labrum tears. Other causes include capsular laxity (loose

ligaments), hip dysplasia (shallow hip socket), traction injuries, and

degenerative (arthritic) changes associated with aging. Anyone who has had a

childhood hip disease (such as Legg-Calv??-Perthes disease, hip dysplasia,

slipped capital femoral epiphysis) is also at increased risk for labral tears.

正常髖關節活動的變化與髖關節周圍的肌肉無力相伴導致髖臼盂唇撕裂。 其他原因包括與老化有關的囊性鬆弛 （鬆弛韌帶），髖關節發育不良 （淺髖關節窩），牽引損傷和退行性（關節炎）改變。 任何患有兒童髖關節疾病的人（例如Legg-Calvé-

Perthes病 ，髖關節發育不良， 股骨頭骨骺滑脫 ）也會增加盂唇撕裂的風險。

SYMPTOMS

What does this condition feel like?

Pain in the front of the hip (most often in the groin area) accompanied by clicking,

locking, or catching of the hip are the main symptoms reported with hip

acetabular labral tears. Joint stiffness and a feeling of instability where the

hip and leg seem to give away are also common. The pain may radiate (travel) to

the buttocks, along

the side of the hip, or even down to the knee.

癥狀

這種情況是什麼感覺？

髖關節前部疼痛（最常見於腹股溝部位）伴有髖關節咔嗒，鎖定或髖關節攣縮是髖臼盂唇撕裂的主要癥狀。 臀部和腿部似乎放棄的關節僵硬和不穩定感也很常見。 疼痛可能會散發（旅行）到臀部，沿著髖關節的一側，甚至到膝蓋 。

Symptoms

get worse with long periods of standing, sitting, or walking. Pivoting on the

involved leg is avoided for the same reason (causes pain). Some patients walk

with a limp or have a positive Trendelenburg sign (hip drops down on the right

side when standing on the left leg and vice versa).

The pain can be constant and severe enough to limit all recreational activities and

sports participation.

長時間站立，坐著或行走會導致癥狀加重。 由於相同的原因避免在相關腿上轉動（導致疼痛）。 一些患者走路時跛行或者具有積極的特倫德倫伯符號 （當站立在左腿時臀部向右下降，反之亦然）。

疼痛可以持續並嚴重到足以限制所有娛樂活動和運動參與。

DIAGNOSIS

How will my doctor diagnose this condition?

The history and physical examination are the first tools the physician uses to

diagnose hip labral tears. There may or may not be a history of known trauma

linked with the hip pain. When there are anatomic and structural causes or

muscle imbalances contributing to the development of labral tears, symptoms may

develop gradually over time.

Your doctor will perform several tests. One common test is the impingement sign.

This test is done by bending the hip to 90 degrees (flexion), turning the hip

inward internal rotation) and bringing the thigh towards the other hip

(adduction).

Making the diagnosis isna??t always easy. In fact, this problem is frequently

misdiagnosed at first. Thata??s because there are many possible causes of hip

pain. The pain associated with labral tears can be hard to pinpoint. Your

doctor must rely on additional tests to locate the exact cause of the pain. For

example, injecting a local anesthetic agent (lidocaine) into the joint itself

can help determine if the pain is coming from inside (versus outside) the

joint.

診斷

我的醫生將如何診斷這種情況？

歷史和體格檢查是醫生診斷髖部盂唇撕裂的第一個工具。 可能有也可能沒有與髖關節疼痛有關的已知創傷史。 當存在解剖和結構性原因或肌肉失衡導致唇裂發展時，隨著時間的推移，癥狀可能逐漸發展。

你的醫生會進行幾項測試。 一個常見的測試是撞擊標誌 。 該測試通過將髖部彎曲至90度（彎曲），將髖部向內旋轉）並使大腿靠近另一髖部（內收）來完成。

做出診斷並不容易。 事實上，這個問題起初經常被誤診。 這是因為髖關節疼痛有很多可能的原因。 與唇盂撕裂相關的疼痛很難查明。 您的醫生必須依靠額外的測試來確定疼痛的確切原因。 例如，將局部麻醉劑（利多卡因）注入關節本身可以幫助確定疼痛是否從關節內部（相對於外部）進入。

X-rays provide a visual picture of any changes out of the ordinary of the entire

structure and location of the hip position. Magnetic resonance imaging (MRI)

gives a clearer picture of the soft tissues (e.g., labrum, cartilage, tendons,

muscles).

One other test called a magnetic resonance arthrography (MRA) is now considered the gold standard for diagnosis. Studies show that MRA is highly sensitive and

specific for labral tears. This test may replace arthroscopic examination as

the main diagnostic tool. Arthroscopic examination is still 100 per cent

accurate but requires a surgical procedure.

With MRAs, contrast dye (gadolinium) is injected into the hip joint. Any

irregularity in the joint surface will show up when the dye seeps into areas

where damage has occurred. MRAs give the surgeon an excellent view of the

location and extent of the tear as well as any bony abnormalities that will

have to be addressed during surgery.

X射線提供了一個與整個結構和臀部位置不同尋常的變化的視覺圖像。 磁共振成像（MRI）為軟組織（例如，盂唇，軟骨，肌腱，肌肉）提供更清晰的圖像。

另一項稱為磁共振關節造影術 （MRA）的檢查現在被認為是診斷的金標準。 研究表明，MRA對高度敏感並且特異於盂唇撕裂。 該測試可以取代關節鏡檢查作為主要診斷工具。 關節鏡檢查仍然百分之百準確，但需要手術。

MRA將對比染料（釓）注入髖關節。 當染料滲入發生損害的區域時，接縫表面的任何不規則都會顯現出來。 MRA為外科醫生提供了一個很好的觀察手術過程中撕裂的位置和範圍以及必須解決的任何骨性異常。

TREATMENT

What treatment options are available?

In the past, when arthroscopic surgery was the only way to confirm the presence of

a labral tear, the surgeon would just go ahead and remove the torn edges or

pieces during the arthroscopic examination procedure. However, studies over the

years have called this approach into question. With removal of the labrum,

changes in the way the hip functioned, increased friction of the joint, and

increased load on the joint led to degenerative changes and osteoarthritis.

Surgeons stopped cutting out the torn labrum and started repairing it instead. Physical therapists started doing studies that showed strengthening muscles and

resolving issues of muscle imbalances could reduce the need for surgery with

the traditional risks (e.g., bleeding, infection, poor wound healing, negative

reactions to anesthesia).

治療

有什麼治療方案可供選擇？

過去，當關節鏡手術是確認是否存在唇部撕裂的唯一方法時，外科醫生會在關節鏡檢查過程中繼續去除撕裂的邊緣或碎片。 然而，多年來的研究將這種方法稱為問題。 隨著盂唇的移除，髖關節功能改變，關節摩擦增加，關節負荷增加導致退行性改變和骨關節炎 。

外科醫生停止切除撕裂的唇，並開始修復它。 物理治療師開始進行研究，顯示肌肉增強，解決肌肉失衡問題可以減少傳統風險（如出血，感染，傷口癒合不良，對麻醉的負面反應）的手術需求。

More efforts are being made now to manage labral tears with conservative

(nonoperative) care. This is a possibility most often when there are no

symptoms of labral pathology. Patients with confirmed labral tears but who have

normal hip anatomy or only mild changes in the shape and structure of the hip

may also benefit from conservative care.

現在正在努力通過保守（非手術）護理來管理盂唇撕裂。 當沒有唇部病理癥狀時，這是最常見的可能性。 具有確認的唇裂眼但具有正常髖關節解剖結構或只有髖關節形狀和結構輕微改變的患者也可受益於保守治療。

NONSURGICAL TREATMENT

Physical

therapy will probably be suggested. Your physical therapist will carry out an

examination of joint motion; hip, trunk, and knee muscle strength; posture;

alignment; and gait/movement analysis (looking at walking/movement patterns). A

plan of care is designed for each patient based on his or her individual

factors and characteristics.

Nonoperative

care starts with activity modification. You should avoid pivoting on the

involved leg and avoid prolonged periods of weight-bearing activities. You

physical therapist will work with you to on strengthen your hip muscles,

restore normal neuromuscular control, and improve your posture. All of these

things can improve your hip function and reduce your pain.

Tight

muscles around the hip can contribute to pinching between the femoral head and

acetabulum in certain positions. A program of flexibility and stretching

exercises wona??t change the bony abnormalities present but can help lengthen

the muscles and reduce contact and subsequent impingement.

非手術治療

可能會建議物理治療。 你的物理治療師將對關節運動進行檢查; 臀部，軀幹和膝蓋肌肉力量; 姿勢; 對準; 和步態/運動分析（看步行/運動模式）。 根據他或她的個人因素和特徵為每位患者設計護理計劃。

非手術護理始於活動修改。 你應該避免在涉及的腿上擺動，並避免長時間的負重活動。 你的理療師將與你一起強化你的臀部肌肉，恢復正常的神經肌肉控制，並改善你的姿勢。 所有這些東西都可以改善你的臀部功能並減少你的疼痛。

髖關節周圍肌肉緊張可導致股骨頭與髖臼在某些位置之間發生夾傷。 靈活性和伸展運動的程序不會改變存在的骨骼異常，但可以幫助延長肌肉並減少接觸和隨後的撞擊。

A special strap called the SERF strap (SERF means Stability through External

Rotation of the Femur) made of thin elastic may be applied around the thigh,

knee, and lower leg to pull the hip into external rotation. The idea is to use

the strap to improve hip control and leg movement during dynamic activities. It

is important to strengthen the muscles at the same time to perform the same

task and avoid depending on external support on a long-term basis.

Some patients may also benefit from intra-articular injection with cortisone.

Cortisone is a very potent antiinflammatory medication. Injection into the hip

joint may reduce the symptoms of pain for several weeks to months.

一種稱為SERF錶帶的穩定帶（SERF表示通過股骨外旋轉的穩定性）由薄的彈性材料製成，可用於大腿，膝蓋和小腿周圍，以將髖部拉到外部旋轉。 這個想法是在動態活動中使用肩帶來改善髖關節控制和腿部運動。 在同一時間增強肌肉力量以執行相同的任務並避免長期依賴外部支持非常重要。

一些患者也可能受益於關節內注射可的松。 可的松是一種非常有效的抗炎藥物。 注入髖關節可能會將疼痛癥狀減輕數周至數月

SURGERY

Arthroscopy is commonly used to repair the torn labrum. The arthroscope is a small

fiber-optic tube that is used to see and operate inside the joint. A TV camera

is attached to the lens on the outer end of the arthroscope. The TV camera

projects the image from inside the hip joint on a TV screen next to the

surgeon. The surgeon actually watches the TV screen (not the hip) while moving

the arthroscope to different places inside the hip joint and bursa.

手術

關節鏡常用於修復撕裂的唇。 關節鏡是一種小型纖維管，用於在關節內部進行觀察和操作。 電視攝像機連接到關節鏡外端的鏡頭上。 電視攝像機在外科醫生旁邊的電視屏幕上投射來自髖關節內部的圖像。 外科醫生實際上觀看電視屏幕（而不是臀部），同時將關節鏡移動到髖關節和囊中的不同位置。

During this procedure, your surgeon will trim the torn and frayed tissue around the

acetabular rim and reattach the torn labrum to the bone of the acetabular rim.

This procedure is called labral refixation. Each layer of tissue is sewn back

together and reattached as closely as possible to its original position along

the acetabular rim.

在此過程中，外科醫生將修剪髖臼緣周圍的撕裂和磨損組織，並將撕裂的盂唇重新連接到髖臼緣的骨骼上。 這個過程被稱為盂唇重新固定 。 將每一層組織縫合在一起，並儘可能接近其沿著髖臼邊緣的原始位置。

When repair is not possible, then debridement of the torn labral tissue may be

necessary. Debridement simply means that the torn or weakened portions of the

labrum are simply removed. This prevents the torn fragments from getting caught

in the hip joint and causing pain and further damage to the hip joint.

In some cases, open treatment of femoroacetabular impingement and/or correction of bone abnormalities are required. These procedures are much more involved and

usually will require a stay of several days in the hospital.

當不能修復時，可能需要對撕裂的唇組織進行清創 。 清創術僅僅意味著盂唇撕裂或薄弱的部分被簡單地去除。 這可以防止撕裂的碎片進入髖關節並引起疼痛並進一步損傷髖關節。

在某些情況下，需要開放治療股骨髖臼撞擊和/或矯正骨異常。 這些程序涉及更多，通常需要在醫院停留數天。

REHABILITATION

What should I expect after treatment?

NONSURGICAL REHABILITATION

The goal of conservative management is to relieve pain and improve function by

correcting muscle strength imbalances. When both legs have nearly equal

strength, it is possible to resume a full and normal level of all activities as

long as there is no pain during any of those movements or activities./

For the young or active adult, this includes activities of daily living as well as

recreational and sports participation. Older adults experiencing labral tears

from degenerative arthritis may expect to be able to resume normal daily

functions, but may still find it necessary to limit prolonged sitting or

standing positions.

復原

治療後我應該期待什麼？

非手術康復

保守治療的目標是通過糾正肌肉力量不平衡來緩解疼痛和改善功能。 當兩條腿的力量幾乎相等時，只要在這些動作或活動中沒有任何疼痛，就可以恢復所有活動的完整和正常水平。

對於年輕或活躍的成年人，這包括日常生活以及娛樂和運動參與的活動。 老年人患有退行性關節炎的盂唇撕裂可能會恢復正常的日常功能，但仍可能會發現有必要限制長時間的坐姿或站立姿勢。

AFTER SURGERY

Correction of the problem causing labral tears can result in improved function and pain relief. The hope is that early treatment can prevent arthritic changes but

long-term studies have not been done to proven this idea.

Recovery after surgery needed to address hip labral tears usually takes four to six

months. In other words, patients can expect to resume normal activities six

months after surgery. Many athletes or highly active adults find this time

frame much too long for their goals and preferences.

Patients who follow the recommended rehab plan of care respond well to progression of the exercises and seem to recover faster. Discharge from rehab takes place when

the patient can perform all exercises with good form and without pain or other

symptoms. Any repeat episodes of groin and/or hip pain must be reported to the

orthopedic surgeon for evaluation right away.

手術後

糾正導致唇部撕裂的問題可以改善功能和緩解疼痛。 希望早期治療可以預防關節炎改變，但長期研究尚未證實這一想法。

解決髖關節盂唇撕裂所需的手術後恢復通常需要四到六個月的時間。 換句話說，患者可以期望術後6個月恢復正常活動。 許多運動員或高度活躍的成年人發現這個時間框架對於他們的目標和偏好太長。

遵循推薦的康復護理計劃的患者對鍛煉的進展反應良好，似乎恢復得更快。 當患者能夠以良好的形式進行所有運動並且沒有疼痛或其他癥狀時，從康復中排出。 腹股溝和/或髖部疼痛的任何重複發作必須立即報告整形外科醫生進行評估。