White Brian J, Patterson Julie, Herzog Mackenzie M
Western Orthopaedics, Denver, Colorado, U.S.A..
Centura Health Research Center, Denver, Colorado, U.S.A.
Arthroscopy. 2016 Dec;32(12):2513-2520. doi: 10.1016/j.arthro.2016.07.024. Epub 2016 Oct 5.
To compare the outcome of labral repair versus labral reconstruction in patients presenting to a single surgeon for revision hip arthroscopy following previous labral treatment.
Patients who underwent revision labral repair or labral reconstruction using iliotibial band allograft, after previous labral debridement or repair, between 2009 and 2013 were identified. Hips that underwent revision labral reconstruction were further stratified into 2 graft groups (freeze-dried vs frozen allograft). Exclusion criteria were age <16 years, previous open hip surgery, or previous labral reconstruction. Failure was defined by subsequent intra-articular hip surgery.
113 hips (15 repair, 98 reconstruction) met the inclusion criteria. Patients who underwent revision labral repair were younger than patients who underwent revision labral reconstruction (27.8 years vs 34.6 years; P = .02). Follow-up was obtained from 14 (93%) labral repairs at an average of 4.7 years postoperation (range: 2.0-6.0 years) and 90 (92%) labral reconstructions at an average of 2.4 years postoperation (range: 2.0-4.0 years). Seven of 14 (50%) labral repair hips failed compared with 11/90 (12%) labral reconstruction hips (P < .01). Six of 61 (10%) frozen allografts failed compared with 5/29 (17%) freeze-dried allografts (P = .32). Patients who underwent revision labral repair were 4.1 (95% confidence interval 1.9, 8.8) times more likely to fail than patients who underwent revision labral reconstruction.
Patients who underwent revision labral repair following previous repair or debridement were 2.6 times more likely to fail than patients who underwent revision labral reconstruction, controlling for calendar time. In addition, revision labral reconstruction with frozen allograft had lower propensity of failure than freeze-dried allograft. However, there was no statistically significant difference in patient-reported outcome scores between the 2 groups. Based on these results, complete labral reconstruction with longer, nonsegmental graft led to a lower failure rate in this study population and can be considered for treatment of patients presenting for revision labral treatment.
Level III, retrospective comparative study.
比较在同一位外科医生处接受过髋关节镜下盂唇翻修手术的患者中，盂唇修复与盂唇重建的疗效。
确定2009年至2013年间，曾接受过盂唇清创或修复手术，之后又接受了盂唇翻修手术，采用髂胫束同种异体移植物进行盂唇修复或盂唇重建的患者。接受盂唇翻修重建的髋关节进一步分为2个移植物组（冻干同种异体移植物与冷冻同种异体移植物）。排除标准为年龄<16岁、既往有髋关节切开手术史或既往有盂唇重建史。失败定义为随后进行的髋关节镜内手术。
113例髋关节（15例修复，98例重建）符合纳入标准。接受盂唇翻修修复的患者比接受盂唇翻修重建的患者年轻（27.8岁对34.6岁；P = 0.02）。对14例（93%）盂唇修复患者进行了随访，平均随访时间为术后4.7年（范围：2.0 - 6.0年）；对90例（92%）盂唇重建患者进行了随访，平均随访时间为术后2.4年（范围：2.0 - 4.0年）。14例盂唇修复髋关节中有7例（50%）失败，而90例盂唇重建髋关节中有11例（12%）失败（P < 0.01）。61例冷冻同种异体移植物中有6例（10%）失败，而29例冻干同种异体移植物中有5例（17%）失败（P = 0.32）。接受盂唇翻修修复的患者失败的可能性是接受盂唇翻修重建患者的4.1倍（95%置信区间1.9，8.8）。
在控制时间因素后，既往接受过修复或清创手术的患者接受盂唇翻修修复后失败的可能性是接受盂唇翻修重建患者的2.6倍。此外，冷冻同种异体移植物进行盂唇翻修重建的失败倾向低于冻干同种异体移植物。然而，两组患者报告的疗效评分在统计学上无显著差异。基于这些结果，在本研究人群中，采用更长的、非节段性移植物进行完全盂唇重建导致较低的失败率，可考虑用于盂唇翻修治疗的患者。
III级，回顾性比较研究。
