de Sa Darren, Alradwan Hussain, Cargnelli Stephanie, Thawer Zoyah, Simunovic Nicole, Cadet Edwin, Bonin Nicolas, Larson Christopher, Ayeni Olufemi R
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada; Ministry of Higher Education, Riyadh, Saudi Arabia.
Arthroscopy. 2014 Aug;30(8):1026-41. doi: 10.1016/j.arthro.2014.02.042. Epub 2014 May 2.
Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management.
We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented.
Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score (P = .008), Hip Outcome Score-Activities of Daily Living (P = .02), and Hip Outcome Score-Sport (P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported.
This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes.
Systematic review of Level IV and V (case report) studies.
关节外髋关节撞击症可能由腰大肌撞击（PI）、棘下撞击（SSI）、坐骨股骨撞击（IFI）以及大转子/骨盆撞击（GTPI）引起。症状可能源于骨接触或软组织刺激，而且术前区分这些症状往往具有挑战性。目前，针对这些病症的临床表现和诊断标准仍在完善中。进行这项系统评价旨在研究每种病症，并阐明手术治疗的适应证、治疗选择及临床结果。
我们在在线数据库（Medline、Embase和PubMed）中检索了从数据库建立至2013年12月31日发表的关于PI、SSI、IFI和GTPI手术治疗的英文临床研究。对于每种病症，由2名独立评估者对符合条件的研究进行评审。呈现描述性统计结果。
总体而言，最初检索到9521项研究；最终纳入14项研究，共涉及333例髋关节。对于PI，关节镜手术使88%的患者取得了良好至优秀的结果，同时Harris髋关节评分（P = 0.008）、髋关节功能评分 - 日常生活活动（P = 0.02）以及髋关节功能评分 - 运动（P = 0.04）均有显著改善。对于SSI，关节镜减压术无重大并发症，使屈曲活动范围平均改善18.5°，疼痛（术前视觉模拟量表平均评分为5.9分，术后为1.2分）及改良Harris髋关节评分（术前平均为64.97分，术后为91.3分）也有所改善。对于IFI和GTPI，据传闻开放手术改善了患者症状，但未报告正式的客观结果数据。
本评价表明，有一些证据支持手术治疗，对于PI和SSI采用关节镜手术，对于IFI和GTPI采用开放手术，可改善患者预后。
对IV级和V级（病例报告）研究的系统评价。
