髋关节镜手术在患者可接受症状状态和最小临床重要差异方面的结果
Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference.
作者信息
Levy David M, Kuhns Benjamin D, Chahal Jaskarndip, Philippon Marc J, Kelly Bryan T, Nho Shane J
机构信息
Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
Hip Preservation Center, Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
出版信息
Arthroscopy. 2016 Sep;32(9):1877-86. doi: 10.1016/j.arthro.2016.05.014. Epub 2016 Jun 18.
PURPOSE
To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates.
METHODS
All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values.
RESULTS
After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P < .01, R(2) = 0.14), HOS-SS (P = .05, R(2) = 0.12), and rates of reoperation (P = .02, R(2) = 0.08). Increasing body mass index was associated with significantly worse HOS-ADL (P = .02, R(2) = 0.35) and HOS-SS (P = .03, R(2) = 0.30).
CONCLUSIONS
In this meta-analysis of 81 studies of primary hip arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
目的
确定迄今为止髋关节镜检查的文献所显示的结果是否与已发表的患者可接受症状状态（PASS）和最小临床重要差异（MCID）估计值一致。
方法
回顾了所有使用改良Harris髋关节评分（mHHS）和/或髋关节结局评分（HOS）且随访至少1年的髋关节镜临床研究。纳入91项研究（9746例髋关节）进行综述。81项研究（9317例髋关节）仅包含初次髋关节镜检查，是本综述的主要关注点。其余研究（429例髋关节）未排除有既往手术史的患者，因此单独考虑。将平均mHHS、HOS-ADL（日常生活活动）和HOS-SS（特定运动）评分与先前发表的PASS和MCID值进行比较。
结果
在31±20个月后，5.8%的研究人群需要进行翻修关节镜检查，5.5%需要进行全髋关节置换术。分别有88%、25%和30%的研究人群达到了mHHS、HOS-ADL和HOS-SS的PASS标准，97%、90%和93%达到了MCID标准。在双变量分析中，年龄增加与术后mHHS显著变差相关（P<.01，R(2)=0.14）、HOS-SS（P=.05，R(2)=0.12）以及再次手术率（P=.02，R(2)=0.08）。体重指数增加与HOS-ADL显著变差相关（P=.02，R(2)=0.35）和HOS-SS（P=.03，R(2)=0.30）。
结论
在这项对81项初次髋关节镜检查研究的荟萃分析中，我们发现超过90%的研究人群在髋关节镜检查文献中最常用的患者报告结局测量指标mHHS和HOS方面达到了MCID标准。88%的人群达到了mHHS的PASS标准，但对于HOS-ADL（25%）和HOS-SS（30%）子量表，PASS标准要难得多。mHHS和HOS心理测量特性的差异可能是导致PASS差异的原因。
证据水平
IV级，对I至IV级研究的系统评价。
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