Sawyer Gregory A, Briggs Karen K, Dornan Grant J, Ommen N Dawn, Philippon Marc J
Steadman Philippon Research Institute, Vail, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA
Am J Sports Med. 2015 Jul;43(7):1683-8. doi: 10.1177/0363546515581469. Epub 2015 May 4.
With an improved understanding of the importance of the labrum, labral repair is replacing labral debridement as a component of hip arthroscopy for femoroacetabular impingement. Labral repair can be performed by passing suture limbs either around (looped) or through (pierced) the labral tissue.
To determine whether there is any clinical difference between these different labral repair techniques.
Cohort study; Level of evidence, 3.
A prospective data registry was queried for patients who underwent primary hip arthroscopy with labral repair from 2009 to 2011. Patients older than 18 years who had undergone labral repair were included in the study. Exclusion criteria included previous hip surgery, avascular necrosis, joint space less than 2 mm, and labral reconstruction or augmentation. Patients were grouped based upon the 3 labral repair techniques: looped, pierced, or combined. Statistical equivalence testing was performed to evaluate the primary outcome measure, the Hip Outcome Score-activities of daily living subscale (HOS-ADL). Other measures included the HOS-sport subscale (HOS-Sport), modified Harris hip score (mHHS), Short Form-12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction with outcome (1-10 scale; 10 = very satisfied).
Preoperative scores improved in the looped group (HOS-ADL, from 68 to 91; mHHS, from 64 to 83; HOS-Sport, from 51 to 81; and WOMAC, from 23 to 9), the pierced group (HOS-ADL, from 64 to 89; mHHS, from 62 to 83; HOS-Sport, from 46 to 77; and WOMAC, from 34 to 12), and the combined group (HOS-ADL, from 64 to 89; mHHS, from 63 to 83; HOS-Sport, from 52 to 79; and WOMAC, from 26 to 12). Median patient satisfaction in all groups was 9.0. The 3 labral repair groups were shown to be statistically and clinically equivalent (P < .05) with respect to the validated HOS-ADL to within a clinically irrelevant threshold at mean 36-month follow-up. In addition, there were no differences in secondary outcome measures or in the revision rate (looped, 7% [14/209], pierced, 8% [5/65], and combined, 6% [5/83]).
This study showed equivalent HOS-ADL outcomes between looped, pierced, and combined labral repairs. Secondary outcome measures, including failure and revision rates, were not significantly different among the groups. Thus, suture type did not influence outcomes.
随着对髋臼唇重要性的认识不断提高，髋臼唇修复正取代髋臼唇清创术，成为股骨髋臼撞击症髋关节镜检查的一个组成部分。髋臼唇修复可通过将缝线肢环绕（环形）或穿过（穿刺）髋臼唇组织来进行。
确定这些不同的髋臼唇修复技术之间是否存在临床差异。
队列研究；证据等级，3级。
查询前瞻性数据登记库，以获取2009年至2011年接受初次髋关节镜检查并进行髋臼唇修复的患者。年龄超过18岁且接受过髋臼唇修复的患者纳入本研究。排除标准包括既往髋关节手术史、缺血性坏死、关节间隙小于2mm以及髋臼唇重建或增强术。患者根据三种髋臼唇修复技术分组：环形、穿刺或联合。进行统计等效性检验以评估主要结局指标，即髋关节结局评分-日常生活活动分量表（HOS-ADL）。其他指标包括HOS-运动分量表（HOS-Sport）、改良Harris髋关节评分（mHHS）、简短健康调查问卷12项版（SF-12）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及患者对结局的满意度（1-10分制；10分=非常满意）。
环形组术前评分有所改善（HOS-ADL，从68分提高到91分；mHHS，从64分提高到83分；HOS-Sport，从51分提高到81分；WOMAC，从23分提高到9分），穿刺组（HOS-ADL，从64分提高到89分；mHHS，从62分提高到83分；HOS-Sport，从46分提高到77分；WOMAC，从34分提高到12分），联合组（HOS-ADL，从64分提高到89分；mHHS，从63分提高到83分；HOS-Sport，从52分提高到79分；WOMAC，从26分提高到12分）。所有组患者满意度中位数为9.0。在平均36个月的随访中，就经过验证的HOS-ADL而言，三种髋臼唇修复组在统计学和临床上均等效（P <.05），且差异在临床无关阈值范围内。此外，次要结局指标或翻修率（环形组，7%[14/209]，穿刺组，8%[5/65]，联合组，6%[5/83]）均无差异。
本研究表明，环形、穿刺和联合髋臼唇修复在HOS-ADL结局方面相当。包括失败率和翻修率在内的次要结局指标在各组之间无显著差异。因此，缝线类型不影响结局。
