Chandrasekaran Sivashankar, Darwish Nader, Martin Timothy J, Suarez-Ahedo Carlos, Lodhia Parth, Domb Benjamin G
American Hip Institute, Westmont, Illinois, U.S.A.
American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A..
Arthroscopy. 2017 Jul;33(7):1332-1340. doi: 10.1016/j.arthro.2017.01.037. Epub 2017 Apr 10.
To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication.
Patients younger than 40 years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2 mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tönnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calvé-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, and Hip Outcome Score-Activities of Daily Living. The visual analog scale score, patient satisfaction score, complications, and revision procedures were also recorded. A 2-tailed paired t test was used to analyze change in preoperative to postoperative PRO scores. Significance was defined as P < .05.
During the study period, 232 hip arthroscopies were performed in patients with a lateral center-edge angle between 18° and 25°. The inclusion criteria were met by 59 procedures. Of these procedures, 55 (93.2%) were available for follow-up. The labrum was repaired, debrided, and reconstructed in 37 procedures, 17 procedures, and 1 procedure, respectively. The iliopsoas was released in 34 procedures, the ligamentum teres was debrided in 29, and femoral osteoplasty was performed in 32. At 2-year follow-up, there was significant improvement in the mean scores of all PROs compared with baseline. Mean improvements for the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and Non-Arthritic Hip Score were 20.7, 17.5, 27.6, and 20.0, respectively. There was significant improvement in the visual analog scale score at 2 years, decreasing by 3.16 compared with baseline, and the mean patient satisfaction score was 8.09, with 83.6% of patients achieving a good to excellent result (patient satisfaction score ≥7). No complications were related to the procedure, and 6 patients (11%) required revision procedures (4 for labral retear, 1 for painful iliopsoas internal snapping, and 1 for removal of a symptomatic loose body).
Arthroscopic intervention that encompasses minimal rim resection, restoration of labral function, and capsular plication significantly improves outcomes in patients with borderline dysplasia who do not warrant a periacetabular osteotomy.
Level IV, therapeutic case series.
报告采用关节镜技术进行盂唇密封修复并进行最小限度髋臼缘切除和关节囊折叠术治疗边缘发育不良患者的临床结果。
纳入年龄小于40岁、外侧中心边缘角大于18°且小于或等于25°，并在接受关节镜盂唇密封修复技术（最小限度边缘切除≤2mm，关节囊折叠，以倾斜方向放置3-5根缝线以形成叠瓦状和向下移位）后进行2年随访的患者。患者因症状经至少6周的结构化物理治疗计划仅有轻微改善而接受关节镜检查。排除Tönnis分级为1级或更高、中心边缘角为17°或更小以及患有Legg-Calvé-Perthes病的患者。前瞻性记录但回顾性审查以下患者报告结局（PRO）：改良Harris髋关节评分、非关节炎髋关节评分、髋关节结局评分-运动特定子量表和髋关节结局评分-日常生活活动。还记录了视觉模拟量表评分、患者满意度评分、并发症和翻修手术情况。采用双尾配对t检验分析术前至术后PRO评分的变化。显著性定义为P < 0.05。
在研究期间，对232例外侧中心边缘角在18°至25°之间的患者进行了髋关节镜检查。59例手术符合纳入标准。在这些手术中，55例（93.2%）可供随访。分别有37例、17例和1例手术对盂唇进行了修复、清创和重建。34例手术中松解了髂腰肌，29例手术中清创了圆韧带，32例手术中进行了股骨截骨术。在2年随访时，与基线相比，所有PRO的平均评分均有显著改善。改良Harris髋关节评分、髋关节结局评分-日常生活活动、髋关节结局评分-运动特定子量表和非关节炎髋关节评分的平均改善分别为20.7、17.5、27.6和20.0。2年时视觉模拟量表评分有显著改善，与基线相比下降了3.16，患者平均满意度评分为8.09，83.6%的患者获得了良好至优秀的结果（患者满意度评分≥7）。没有并发症与手术相关，6例患者（11%）需要翻修手术（4例因盂唇再次撕裂，1例因疼痛性髂腰肌内弹响，1例因取出有症状的松动体）。
包括最小限度边缘切除、盂唇功能恢复和关节囊折叠的关节镜干预显著改善了不适合进行髋臼周围截骨术的边缘发育不良患者的结局。
IV级，治疗性病例系列。
