Yoo Jun-Il, Ha Yong-Chan, Lee Young-Kyun, Lee Guen-Young, Yoo Moon-Jib, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Arthroscopy. 2017 Feb;33(2):337-345. doi: 10.1016/j.arthro.2016.08.022. Epub 2016 Nov 19.
To investigate smaller sized labra after acetabular labral repair comparing preoperative and postoperative computed tomography arthrography (CTA) and to assess the correlation between the anatomic changes and clinical outcomes.
The design and protocol of this retrospective study were approved by the institutional review board of our hospital. The inclusion criteria included age older than 18 years and hip pain associated with mechanical symptoms. Patients with previous hip surgery, avascular necrosis, rheumatologic disorders, or advanced arthritis were excluded. All tears with femoroacetabular impingement were treated with bumpectomy or acetabuloplasty and repaired using arthroscopic suture anchors. We evaluated clinical outcomes using the modified Harris Hip Score (mHHS) and the morphologic changes and radiologic outcomes (labral retear and leakage of dye) using CTA at a minimum 2-year follow-up. The paired t test was performed to detect changes in labral height, labral width, and mHHS.
Forty labral tears in 40 patients (mean age, 32.1 ± 9.2 years) underwent labral repair, with femoroplasty in 20 hips and acetabuloplasty in 17 hips, and no patients required capsular repair after capsulotomy. No leakage of contrast dye was detected during the follow-up CTA procedure. No labral retears were observed after labral refixation at the postoperative CTA evaluation. However, the mean width and height of the labrum changed from 8.1 mm and 4.9 mm, respectively, preoperatively to 6.7 mm and 4.4 mm, respectively, at the postoperative follow-up (decreasing by 19% and 11%, respectively; both P < .001). In addition, the mean mHHS for the 36 patients in the complete repair group improved from 61 ± 16.0 to 90 ± 9.6 (P = .01). Four hips showed incomplete repairs.
Repaired labra are well maintained after capsulotomy based on follow-up CTA after arthroscopic labral repair. In addition, decreased height and width of the labra do not affect the clinical outcomes.
Level IV, therapeutic study (case series [no, or historical, control group]).
通过比较髋臼盂唇修复术前和术后的计算机断层扫描关节造影（CTA），研究较小尺寸的盂唇，并评估解剖学变化与临床结果之间的相关性。
本回顾性研究的设计和方案已获我院机构审查委员会批准。纳入标准包括年龄大于18岁以及与机械性症状相关的髋关节疼痛。排除既往有髋关节手术史、缺血性坏死、风湿性疾病或晚期关节炎的患者。所有合并股骨髋臼撞击症的盂唇撕裂均采用股骨成形术或髋臼成形术治疗，并使用关节镜缝合锚钉进行修复。我们在至少2年的随访中，使用改良Harris髋关节评分（mHHS）评估临床结果，使用CTA评估形态学变化和影像学结果（盂唇再撕裂和染料渗漏）。采用配对t检验来检测盂唇高度、盂唇宽度和mHHS的变化。
40例患者（平均年龄32.1±9.2岁）的40处盂唇撕裂接受了盂唇修复，其中20髋进行了股骨成形术，17髋进行了髋臼成形术，切开关节囊后无患者需要进行关节囊修复。在随访CTA检查过程中未检测到造影剂渗漏。在术后CTA评估中，盂唇重新固定后未观察到盂唇再撕裂。然而，盂唇的平均宽度和高度分别从术前的8.1mm和4.9mm，下降到术后随访时的6.7mm和4.4mm（分别下降了19%和11%；P均<.001）。此外，完全修复组的36例患者的平均mHHS从61±16.0提高到90±9.6（P =.01）。4髋显示修复不完全。
基于关节镜下盂唇修复术后的随访CTA，切开关节囊后修复的盂唇维持良好。此外，盂唇高度和宽度的减小并不影响临床结果。
IV级，治疗性研究（病例系列[无或历史对照组]）。
