Forster-Horvath Csaba, von Rotz Noah, Giordano Brian D, Domb Benjamin G
Hip Unit, Orthopaedic Department, University Hospital Basel, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Arthroscopy. 2016 Nov;32(11):2401-2415. doi: 10.1016/j.arthro.2016.04.035. Epub 2016 Jul 27.
To perform a systematic review comparing outcomes of labral debridement/segmental resection with labral reconstruction as part of a comprehensive treatment strategy for femoroacetabular impingement.
A systematic review was conducted according to established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using defined inclusion and exclusion criteria. The study groups were divided into labral debridement/segmental resection (group 1) and labral reconstruction (group 2). Multiple search engines were queried (PubMed, Medline) for this analysis.
After an exhaustive search of the available literature, 20 publications were included. Twelve studies explored outcomes after labral debridement/resection in a total of 400 hips, whereas 7 studies reported on outcomes after labral reconstruction in a total of 275 hips. One additional matched-pair control study compared labral resection (22 hips) with reconstruction (11 hips). The surgical intervention was a revision in 0% to 100% for group 1 versus 5% to 55% for group 2. A direct anterior approach was not performed in group 2, and cam-type impingement appeared to make up a larger percentage of group 1. The Tönnis grade ranged from 0 to 1 for group 1 versus 0.3 to 1.1 for group 2. Joint replacements were performed in 0% to 30% and 0% to 25%, respectively. The modified Harris Hip Score was the most widely used patient-reported outcome measure and suggested that labral reconstruction was not inferior to labral debridement/segmental resection.
Clinical outcomes after labral debridement/segmental resection versus labral reconstruction were found to be comparable. In the setting of unsalvageable labral pathology, labral reconstruction was used more frequently as a revision option whereas debridement may be more commonly used in the index setting.
Level IV, systematic review of Level I, III, and IV studies.
进行一项系统评价，比较盂唇清创术/节段性切除术与盂唇重建术的疗效，作为股骨髋臼撞击症综合治疗策略的一部分。
根据既定的PRISMA（系统评价和Meta分析的首选报告项目）指南，使用明确的纳入和排除标准进行系统评价。研究组分为盂唇清创术/节段性切除术组（第1组）和盂唇重建术组（第2组）。为此分析查询了多个搜索引擎（PubMed、Medline）。
在对现有文献进行详尽检索后，纳入了20篇出版物。12项研究探讨了400例髋关节盂唇清创术/切除术后的疗效，而7项研究报告了275例髋关节盂唇重建术后的疗效。另外一项配对对照研究比较了盂唇切除术（22例髋关节）与重建术（11例髋关节）。第1组手术干预的翻修率为0%至100%，而第2组为5%至55%。第2组未采用直接前路入路，凸轮型撞击症在第1组中所占比例似乎更大。第1组的Tönnis分级为0至1，而第2组为0.3至1.1。分别有0%至30%和0%至25%的患者接受了关节置换术。改良Harris髋关节评分是最广泛使用的患者报告结局指标，提示盂唇重建术并不逊色于盂唇清创术/节段性切除术。
发现盂唇清创术/节段性切除术与盂唇重建术的临床疗效相当。在盂唇病变无法挽救的情况下，盂唇重建术作为翻修选择更常被使用，而清创术可能在初次手术时更常用。
IV级，对I级、III级和IV级研究的系统评价。
