Bedi Asheesh, Chen Neal, Robertson William, Kelly Bryan T
Sports Medicine & Shoulder Surgery Service, Hospital for Special Surgery, New York, New York 10021, USA.
Arthroscopy. 2008 Oct;24(10):1135-45. doi: 10.1016/j.arthro.2008.06.001.
The purpose of this systematic review was to determine (1) the quality of the literature assessing outcomes after surgical treatment of labral tears and femoroacetabular impingement (FAI), (2) patient satisfaction after open or arthroscopic intervention, and (3) differences in outcome with open or arthroscopic approaches.
Computerized literature databases were searched to identify relevant articles from January 1980 to May 2008. Studies were eligible for inclusion if they had a level I, II, III, or IV study design and if the patient population had a labral tear and/or FAI as the major diagnosis. Patients with severe pre-existing osteoarthritis or acetabular dysplasia were excluded.
Of the 19 articles with reported outcomes after surgery, none used a prospective study design and only 1 met the criteria for level III basis of evidence. Open surgical dislocation with labral debridement and osteoplasty is successful, with a good correlation between patient satisfaction and favorable outcome scores. The studies reviewed support that 65% to 85% of patients will be satisfied with their outcome at a mean of 40 months after surgery. A common finding in all series, however, was an increased incidence of failure among patients with substantial pre-existing osteoarthritis. Arthroscopic treatment of labral tears is also effective, with 67% to 100% of patients being satisfied with their outcomes.
The quality of literature reporting outcomes of surgical intervention for labral tears and FAI is limited. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that open techniques have outcomes superior to arthroscopic techniques.
Level IV, systematic review.
本系统评价的目的是确定：（1）评估髋臼唇盂撕裂和股骨髋臼撞击症（FAI）手术治疗后结果的文献质量；（2）开放手术或关节镜干预后的患者满意度；（3）开放手术与关节镜手术方法在结果上的差异。
检索计算机文献数据库，以识别1980年1月至2008年5月期间的相关文章。纳入标准为研究设计为I、II、III或IV级，且患者群体以髋臼唇盂撕裂和/或FAI为主要诊断。排除已有严重骨关节炎或髋臼发育不良的患者。
在19篇报告手术后结果的文章中，没有一篇采用前瞻性研究设计，只有1篇符合III级证据标准。开放手术脱位联合髋臼唇盂清创术和骨成形术是成功的，患者满意度与良好的结果评分之间具有良好的相关性。综述的研究表明，65%至85%的患者在术后平均40个月时对其结果满意。然而，所有系列研究的一个共同发现是，已有大量骨关节炎的患者失败率增加。关节镜治疗髋臼唇盂撕裂也有效，67%至100%的患者对其结果满意。
报告髋臼唇盂撕裂和FAI手术干预结果的文献质量有限。尽管开放手术脱位联合骨成形术是历史上的金标准，但科学数据并未表明开放技术的结果优于关节镜技术。
IV级，系统评价。
