Collins Jason Andrew, Ward James P, Youm Thomas
New York University Hospital for Joint Diseases, New York, New York
New York University Hospital for Joint Diseases, New York, New York.
Am J Sports Med. 2014 Dec;42(12):3009-15. doi: 10.1177/0363546513499227. Epub 2013 Aug 21.
This is a systematic review to determine if prophylactic surgical intervention for asymptomatic patients with radiographic evidence of femoroacetabular impingement (FAI) is warranted to prevent early degenerative joint disease of the hip.
A systematic search was performed from 1965 to 2013 in PubMed and EMBASE. Inclusion criteria were prospective or retrospective studies comparing skeletally mature asymptomatic patients with radiographic evidence of FAI treated with prophylactic hip arthroscopic surgery versus nonoperative management. A total of 840 references were identified from the searches. After detailed eligibility screening, none of the references met the eligibility criteria.
No trials were identified that met the criteria for inclusion in the review.
There is a lack of available evidence to support surgical intervention for the treatment of FAI in asymptomatic patients. This article attempts to address this dilemma by reviewing the available literature to answer several questions that would indirectly address the topic. First, what is the prevalence of FAI in the asymptomatic population? Second, what is the natural history of FAI if left untreated? Upon reviewing these issues, the authors' conclusion parallels that of the systematic review: Current evidence does not support prophylactic surgery for asymptomatic FAI in the vast majority of cases. However, limited evidence suggests that asymptomatic patients who have previously undergone total hip arthroplasty for FAI-induced osteoarthritis of the contralateral hip are at a significantly increased risk for early degenerative joint disease. Further research is needed to better clarify surgical indications.
本系统评价旨在确定对于有股骨髋臼撞击症（FAI）影像学证据的无症状患者，预防性手术干预是否有必要以预防早期髋关节退行性关节病。
于1965年至2013年在PubMed和EMBASE中进行系统检索。纳入标准为前瞻性或回顾性研究，比较骨骼成熟的有FAI影像学证据的无症状患者接受预防性髋关节镜手术与非手术治疗的情况。检索共识别出840篇参考文献。经过详细的资格筛选，没有一篇参考文献符合资格标准。
未识别出符合本综述纳入标准的试验。
缺乏支持对无症状患者的FAI进行手术干预的现有证据。本文试图通过回顾现有文献来解决这一困境，以回答几个间接涉及该主题的问题。第一，无症状人群中FAI的患病率是多少？第二，如果不治疗，FAI的自然病程是怎样的？在回顾这些问题后，作者的结论与系统评价一致：目前的证据不支持在绝大多数情况下对无症状的FAI进行预防性手术。然而，有限的证据表明，先前因对侧髋关节FAI诱导的骨关节炎而接受全髋关节置换术的无症状患者，早期退行性关节病的风险显著增加。需要进一步研究以更好地明确手术指征。
