髋关节镜术后 12 个月的术中软骨退变预测结果。
Intraoperative cartilage degeneration predicts outcome 12 months after hip arthroscopy.
机构信息
Centre for Health Exercise & Sports Medicine, The University of Melbourne, Carlton, VIC, Australia.
出版信息
Clin Orthop Relat Res. 2013 Feb;471(2):593-9. doi: 10.1007/s11999-012-2594-y. Epub 2012 Sep 20.
BACKGROUND
When considering arthroscopic surgery for treatment of hip pain, it is important to understand the influence of joint degeneration on the likelihood of success. Previous research has shown poorer outcomes among patients with osteoarthritis but new arthroscopic techniques including femoroacetabular impingement correction and microfracture may lead to better arthroscopic outcomes.
QUESTIONS/PURPOSES: We investigated the effect of intraarthroscopic articular and rim cartilage degeneration on the outcome after hip arthroscopy using contemporary techniques.
METHODS
The modified Harris hip score (MHHS) and nonarthritic hip score (NAHS) were completed preoperatively and 12 months postoperatively by 560 patients undergoing hip arthroscopy after March 2007. Change in these scores was compared between patients with and without acetabular or femoral articular cartilage degeneration and between patients with and without rim cartilage degeneration. Correlation and regression analyses were used to predict the change in outcome scores based on the severity of cartilage degeneration.
RESULTS
Hips without degeneration had greater improvement in the outcome scores. The presence of cartilage degeneration showed negative correlations with change in outcomes. The best model to explain change in MHHS included preoperative score, articular cartilage degeneration grade, and rim lesion grade (adjusted R(2) = 0.24).
CONCLUSIONS
Our data support previous findings regarding the negative influence of cartilage degeneration on improvement after hip arthroscopy. Nevertheless, many patients with cartilage degeneration still improved and the severity of degeneration accounts for little of the resulting variance in change. Future studies must determine the clinical importance of the improvements gained by patients with cartilage degeneration and identify other predictors of outcome.
LEVEL OF EVIDENCE
Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
背景
在考虑关节镜手术治疗髋关节疼痛时，了解关节退变对手术成功率的影响非常重要。先前的研究表明，骨关节炎患者的预后较差，但新的关节镜技术，包括股骨髋臼撞击症矫正和微骨折术，可能会带来更好的关节镜治疗效果。
问题/目的：我们研究了关节内关节和边缘软骨退变对采用现代技术进行髋关节镜检查后的结果的影响。
方法
2007 年 3 月后接受髋关节镜检查的 560 例患者，术前和术后 12 个月完成改良 Harris 髋关节评分（MHHS）和非关节炎髋关节评分（NAHS）。比较有髋臼或股骨关节软骨退变和无髋臼或股骨关节软骨退变患者以及有和无边缘软骨退变患者的评分变化。采用相关和回归分析，根据软骨退变的严重程度预测结果评分的变化。
结果
无退变的髋关节术后评分改善更大。软骨退变与结果变化呈负相关。解释 MHHS 变化的最佳模型包括术前评分、关节软骨退变分级和边缘病变分级（调整 R²=0.24）。
结论
我们的数据支持先前关于软骨退变对髋关节镜术后改善的负面影响的发现。尽管如此，许多有软骨退变的患者仍有改善，且退变的严重程度对变化的结果差异影响较小。未来的研究必须确定有软骨退变患者所获得的改善的临床重要性，并确定其他结果预测因素。
证据等级
III 级，预后研究。请参阅作者指南，以获取证据等级的完整描述。
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