骨科医生对中青年髋痛的临床认知与诊疗现状的调查研究
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摘要
目的调查分析骨科医生对中青年髋痛的临床认知与诊疗现状。方法自行设计中青年髋痛诊疗问卷,对参加2017年髋关节运动医学学术沙龙的133名骨科医生进行问卷调查。调查内容包括医生的一般情况、髋痛的临床认知、髋痛的辅助检查以及髋关节镜相关情况。回收问卷并进行统计学分析。结果从年龄分布、学历水平以及临床工作时间等数据可以发现,参与此次调查的对象代表了具有较高学历、经验丰富、学术活跃的中年骨干医生群体。55.6%的医生认为临床工作中中青年髋痛较常见,75.9%的医生在临床工作中曾诊断过髋关节撞击综合征或盂唇损伤。在影像学检查方面,骨盆X线和单髋MRI的拍摄和阅片均存在不足,76.7%的医生认为骨盆X线的拍摄不够标准,56.4%的医生所在医院不能完成单髋MRI扫描。与其他关节相比,髋关节镜手术普及相对滞后,仅39.1%的医生所在医院能够开展髋关节镜手术,具备10例以上髋关节镜手术经验的医生仅有9名(6.8%)。结论多数骨科医生认为中青年髋痛是常见的临床问题,对股骨髋臼撞击综合征普遍知晓,但认识深度还不够。髋痛诊断的影像学检查是薄弱环节,髋关节镜手术普及率不高,髋痛的诊疗是未来骨科和运动医学研究的热点。
Objective To investigate and analyze the orthopedic surgeon's clinical cognition and diagnosis and treatment of young and middle-aged hip pain. Methods A KAP questionnaire on young and middle-aged hip pain was designed, and a questionnaire survey was conducted on 133 orthopedic surgeons participating in the hip joint medical conference. The content of questionnaire included the general condition of the surgeon, clinical knowledge of hip pain, radiology of hip pain, and hip arthroscopy. All questionnaires were collected and analyzed statistically. Results The orthopedic surgeons who participated in the survey came from the middle-aged and experienced physicians group with high education. Among of them, 55.6% agreed that young and middle-aged hip pain was common, and 75.9% have encountered the patients with hip impingement or labrum tear. Pelvic radiology and hip MRI were not well conducted, 76.7% surgeons considered that the quality of pelvis radiology was not well enough, 56.4% hospitals could not complete the unilateral MRI scanning. Hip arthroscopy was more undeveloped compare to that of other joint, with only 39.1% hospitals being able to conduct hip arthroscopy. Only 9 surgeons(6.8%) finished more than 10 hip arthroscopy procedures. Conclusion Most orthopedic surgeons agreed that young and middle-aged hip pain is a common condition. Hip impingement is generally known by surgeon, but the knowledge is not enough yet. Radiologic evaluation is the weak point in the diagnostic procedure of hip pain. Hip arthroscopy has not been popular used now, but the diagnosis and treatment of hip pain will develop rapidly in future.
Objective To investigate and analyze the orthopedic surgeon's clinical cognition and diagnosis and treatment of young and middle-aged hip pain. Methods A KAP questionnaire on young and middle-aged hip pain was designed, and a questionnaire survey was conducted on 133 orthopedic surgeons participating in the hip joint medical conference. The content of questionnaire included the general condition of the surgeon, clinical knowledge of hip pain, radiology of hip pain, and hip arthroscopy. All questionnaires were collected and analyzed statistically. Results The orthopedic surgeons who participated in the survey came from the middle-aged and experienced physicians group with high education. Among of them, 55.6% agreed that young and middle-aged hip pain was common, and 75.9% have encountered the patients with hip impingement or labrum tear. Pelvic radiology and hip MRI were not well conducted, 76.7% surgeons considered that the quality of pelvis radiology was not well enough, 56.4% hospitals could not complete the unilateral MRI scanning. Hip arthroscopy was more undeveloped compare to that of other joint, with only 39.1% hospitals being able to conduct hip arthroscopy. Only 9 surgeons(6.8%) finished more than 10 hip arthroscopy procedures. Conclusion Most orthopedic surgeons agreed that young and middle-aged hip pain is a common condition. Hip impingement is generally known by surgeon, but the knowledge is not enough yet. Radiologic evaluation is the weak point in the diagnostic procedure of hip pain. Hip arthroscopy has not been popular used now, but the diagnosis and treatment of hip pain will develop rapidly in future.
引文
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[12] Maradit Kremers H,Schilz SR,Van Houten HK,et al.Trends in utilization and outcomes of hip arthroscopy in the united states between 2005 and 2013[J].J Arthroplasty,2017,32(3):750-755.DOI:10.1016/j.arth.2016.09.004.
[13] Lee YK,Ha YC,Yoon BH,et al.National trends of hip arthroscopy in Korea[J].J Korean Med Sci,2014,29(2):277-280.DOI:10.3346/jkms.2014.29.2.277.
[14] Colvin AC,Harrast J,Harner C.Trends in hip arthroscopy[J].J Bone Joint Surg Am,2012,94(4):e23.DOI:10.2106/JBJS.J.01886.
[2] Kowalczuk M,Yeung M,Simunovic N,et al.Does femoroacetabular impingement contribute to the development of hip osteoarthritis?A systematic review[J].Sports Med Arthrosc Rev,2015,23(4):174-179.DOI:10.1097/JSA.0000000000000091.
[3] Clohisy JC,Knaus ER,Hunt DM,et al.Clinical presentation of patients with symptomatic anterior hip impingement[J].Clin Orthop Relat Res,2009,467(3):638- 644.DOI:10.1007/s11999- 008- 0680-y.
[4]Smith KM,Gerrie BJ,McCulloch PC,et al.Arthroscopic hip preservation surgery practice patterns:an international survey[J].J Hip Preserv Surg,2016,4(1):18-29.DOI:10.1093/jhps/hnw036.
[5] Byrd JW.Femoroacetabular impingement in athletes:current concepts[J].Am J Sports Med,2014,42(3):737-751.DOI:10.1177/0363546513499136.
[6] Zadpoor AA.Etiology of femoroacetabular impingement in athletes:a review of recent findings[J].Sports Med,2015,45(8):1097-1106.DOI:10.1007/s40279- 015- 0339-2.
[7] Rankin AT,Bleakley CM,Cullen M.Hip joint pathology as a leading cause of groin pain in the sporting population:a 6-year review of 894 cases[J].Am J Sports Med,2015,43(7):1698-1703.DOI:10.1177/0363546515582031.
[8] Frank JM,Harris JD,Erickson BJ,et al.Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers:a systematic review[J].Arthroscopy,2015,31(6):1199-1204.DOI:10.1016/j.arthro.2014.11.042.
[9]Fukushima K,Uchiyama K,Takahira N,et al.Prevalence of radiographic findings of femoroacetabular impingement in the Japanese population[J].J Orthop Surg Res,2014,9:25.DOI:10.1186/1749-799X-9-25.
[10] Meyer DC,Beck M,Ellis T,et al.Comparison of six radiographic projections to assess femoral head/neck asphericity[J].Clin Orthop Relat Res,2006,445:181-185.DOI:10.1097/01.blo.0000201168.72388.24.
[11] Anderson CN,Riley GM,Gold GE,et al.Hip-femoral acetabular impingement[J].Clin Sports Med,2013,32(3):409- 425.DOI:10.1016/j.csm.2013.03.010.
[12] Maradit Kremers H,Schilz SR,Van Houten HK,et al.Trends in utilization and outcomes of hip arthroscopy in the united states between 2005 and 2013[J].J Arthroplasty,2017,32(3):750-755.DOI:10.1016/j.arth.2016.09.004.
[13] Lee YK,Ha YC,Yoon BH,et al.National trends of hip arthroscopy in Korea[J].J Korean Med Sci,2014,29(2):277-280.DOI:10.3346/jkms.2014.29.2.277.
[14] Colvin AC,Harrast J,Harner C.Trends in hip arthroscopy[J].J Bone Joint Surg Am,2012,94(4):e23.DOI:10.2106/JBJS.J.01886.