Abstract：Objective To investigate the factors associated with the failed hip arthroscopic treatment of subspine impingement (SSI). Methods Forty-two symptomatic patients (29 females and 13 males) who suffered from SSI and experienced prior arthroscopic treatment failure were subjected to revision surgeries in our department from January 2017 to May 2018. Their average age was 28.1 years (range of 22–35 years). Of the 42 patients, 19 and 23 cases involved the left and right hips, respectively. All the patients were further treated and followed up for at least 12 months. The International Hip Score 33 (iHOT-33) was used to assess the changes in postoperative hip joint function. Previous radiological evidence and medical records were reviewed, and the causes of failure were discussed. Results After revision surgeries, the mean iHOT-33 score improved from 48.7±8.7 pre-operatively to 78.4±6.0 in the final follow-up (t =22.12, P < 0.001). The four major reasons for failed SSI treatment were misdiagnosis (64.29%, 27/42), residual femoral deformity (21.43%, 9/42), abnormal femoral torsion (9.52%, 4/42), and over-resection of the anterior inferior iliac spine (4.76%, 2/42). Conclusion Misdiagnosis, residual femoral deformity, abnormal femoral torsion, and over-resection of the anterior inferior iliac spine are poor predictive factors of SSI treatment.
徐留洋, 彭建平, 李扬, 肖飞, 朱俊峰, 沈超, 陈晓东. 髋关节镜手术治疗髂前下棘棘下撞击失败的原因分析[J]. 中华解剖与临床杂志, 2022, 27(3): 150-155.
Xu Liuyang, Peng Jianping, Li Yang, Xiao Fei, Zhu Junfeng, Shen Chao, Chen Xiaodong. Cause analysis of hip arthoscopy surgery for subspine impingement failure. Chinese Journal of Anatomy and Clinics, 2022, 27(3): 150-155.
Carton P, Filan D.Anterior inferior iliac spine (AIIS) and subspine hip impingement[J]. Muscles Ligaments Tendons J, 2016,6(3):324-336. DOI: 10.11138/mltj/2016.6.3.324.
[2]
Amar E, Warschawski Y, Sharfman ZT, et al.Pathological findings in patients with low anterior inferior iliac spine impingement[J]. Surg Radiol Anat, 2016,38(5):569-575. DOI: 10.1007/s00276-015-1591-8.
[3]
Larson CM, Giveans MR, Samuelson KM, et al.Arthroscopic hip revision surgery for residual femoroacetabular impingement (FAI): surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction[J]. Am J Sports Med, 2014,42(8):1785-1790. DOI: 10.1177/0363546514534181.
[4]
Balazs GC, Williams BC, Knaus CM, et al.Morphological distribution of the anterior inferior iliac spine in patients with and without hip impingement: reliability, validity, and relationship to the intraoperative assessment[J]. Am J Sports Med, 2017,45(5):1117-1123. DOI: 10.1177/0363546516682230.
[5]
Wong TT, Igbinoba Z, Bloom MC, et al.Anterior inferior iliac spine morphology: comparison of symptomatic hips with femoroacetabular impingement and asymptomatic hips[J]. AJR Am J Roentgenol, 2019,212(1):166-172. DOI: 10.2214/AJR.18.19655.
[6]
Yoo JI, Ha YC, Lee HJ, et al.No difference in prevalence of radiographic subspinal impingement of the hip between symptomatic and asymptomatic subjects[J]. Knee Surg Sports Traumatol Arthrosc, 2017,25(6):1951-1957. DOI: 10.1007/s00167-016-4402-9.
[7]
Nawabi DH, Degen RM, Fields KG, et al.Anterior inferior iliac spine morphology and outcomes of hip arthroscopy in soccer athletes: a comparison to nonkicking athletes[J]. Arthroscopy, 2017,33(4):758-765. DOI: 10.1016/j.arthro.2016.10.019.
[8]
Hetsroni I, Poultsides L, Bedi A, et al.Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model[J]. Clin Orthop Relat Res, 2013,471(8):2497-2503. DOI: 10.1007/s11999-013-2847-4.
[9]
Nwachukwu BU, Chang B, Fields K, et al.Outcomes for arthroscopic treatment of anterior inferior iliac spine (subspine) hip impingement[J]. Orthop J Sports Med, 2017,5(8):2325967117723109. DOI: 10.1177/2325967117723109.
[10]
Hetsroni I, Larson CM, Dela Torre K, et al.Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression[J]. Arthroscopy, 2012,28(11):1644-1653. DOI: 10.1016/j.arthro.2012.05.882.
[11]
Larson CM, Kelly BT, Stone RM.Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept[J]. Arthroscopy, 2011,27(12):1732-1737. DOI: 10.1016/j.arthro.2011.10.004.
[12]
Ryan JM, Harris JD, Graham WC, et al.Origin of the direct and reflected head of the rectus femoris: an anatomic study[J]. Arthroscopy, 2014,30(7):796-802. DOI: 10.1016/j.arthro.2014.03.003.
[13]
Krueger DR, Windler M, Geßlein M, et al.Is the evaluation of the anterior inferior iliac spine (AIIS) in the AP pelvis possible? Analysis of conventional X-rays and 3D-CT reconstructions[J]. Arch Orthop Trauma Surg, 2017,137(7):975-980. DOI: 10.1007/s00402-017-2694-y.
[14]
Zaltz I, Kelly BT, Hetsroni I, et al.The crossover sign overestimates acetabular retroversion[J]. Clin Orthop Relat Res, 2013, 471(8):2463-2470. DOI: 10.1007/s11999-012-2689-5.
[15]
Siebenrock KA, Kalbermatten DF, Ganz R.Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers[J]. Clin Orthop Relat Res, 2003,(407):241-248. DOI: 10.1097/00003086-200302000-00033.
[16]
Karns MR, Adeyemi TF, Stephens AR, et al.Revisiting the anteroinferior iliac spine: is the subspine pathologic? A clinical and radiographic evaluation[J]. Clin Orthop Relat Res, 2018, 476(7):1494-1502. DOI: 10.1097/01.blo.0000533626.25502.e1.
[17]
Gao G, Fu Q, Wu R, et al.Ultrasound and ultrasound-guided hip injection have high accuracy in the diagnosis of femoroacetabular impingement with atypical symptoms[J]. Arthroscopy, 2021, 37(1):128-135. DOI: 10.1016/j.arthro.2020.08.013.
[18]
Aguilera-Bohorquez B, Brugiatti M, Coaquira R, et al.Frequency of subspine impingement in patients with femoroacetabular impingement evaluated with a 3-dimensional dynamic study[J]. Arthroscopy, 2019,35(1):91-96. DOI: 10.1016/j.arthro.2018.08.035.
[19]
Larson CM.Editorial commentary: subspine hip abnormalities: exploring the difference between "morphology" and "impingement"[J]. Arthroscopy, 2019,35(1):97-98. DOI: 10.1016/j.arthro.2018.10.008.
[20]
Ortiz-Declet V, Mu B, Chen AW, et al.Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review[J]. Arthroscopy, 2018,34(1):303-318. DOI: 10.1016/j.arthro.2017.06.030.
[21]
El-Shaar R, Stanton M, Biehl S, et al.Effect of subspine decompression on rectus femoris integrity and iliopsoas excursion: a cadaveric study[J]. Arthroscopy, 2015, 31(10):1903-1908. DOI: 10.1016/j.arthro.2015.03.031.
[22]
Hapa O, Bedi A, Gursan O, et al.Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression[J]. Arthroscopy, 2013, 29(12):1932-1940. DOI: 10.1016/j.arthro.2013.08.023.
2022, Vol. 27 
