Horner Nolan S, Vikas Khanduja, MacDonald Austin E, Naendrup Jan-Hendrik, Simunovic Nicole, Ayeni Olufemi R
Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 4E15, Hamilton, ON L8S 4K1, Canada.
Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
J Hip Preserv Surg. 2017 Jan 9;4(1):9-17. doi: 10.1093/jhps/hnw048. eCollection 2017 Jan.
The purpose of this study was to identify the causes and risk factors for hip fractures, a rare but devastating complication, following hip arthroscopy. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant clinical and basic sciences studies and pertinent data was abstracted and analysed in Microsoft Excel. Nineteen studies (12 clinical studies and seven biomechanical studies) with a total of 31 392 patients experiencing 43 hip fractures (0.1% of patients) met the inclusion criteria for this systematic review. Femoral osteochondroplasty was performed in 100% of patients who sustained a hip fracture. Six of the 12 (50%) studies identified early weight bearing (prior to 6 weeks post-operatively) as the cause for the hip fracture. Other causes of this complication included over resection during femoral osteochondroplasty, minor trauma and intensive exercise. The results suggest that early weight bearing is the largest modifiable risk factor for hip fracture after femoral osteochondroplasty. For this reason, an extended period of non-weight bearing or restricted weight bearing should be considered in select patients. Studies report a correlation between risk for post-operative hip fracture and increased age. Increased resection during osteochondroplasty has been correlated with increased risk of fracture in various basic science studies. Resection depth has significantly higher impact on risk of fracture than resection length or width. The reported amounts of resection that depth that can be performed before there is a significantly increased risk of fracture of the femoral neck varies from 10 to 30%.
本研究的目的是确定髋关节镜检查后髋部骨折（一种罕见但具有毁灭性的并发症）的原因和危险因素。对电子数据库MEDLINE、EMBASE和PubMed进行了检索，并由两人重复筛选相关的临床和基础科学研究，相关数据在Microsoft Excel中进行提取和分析。19项研究（12项临床研究和7项生物力学研究），共31392例患者发生43例髋部骨折（占患者的0.1%），符合本系统评价的纳入标准。所有发生髋部骨折的患者均接受了股骨骨软骨成形术。12项研究中有6项（50%）确定早期负重（术后6周之前）是髋部骨折的原因。该并发症的其他原因包括股骨骨软骨成形术中过度切除、轻微创伤和剧烈运动。结果表明，早期负重是股骨骨软骨成形术后髋部骨折最大的可改变危险因素。因此，对于特定患者应考虑延长非负重或限制负重的时间。研究报告了术后髋部骨折风险与年龄增加之间的相关性。在各种基础科学研究中，骨软骨成形术中切除量增加与骨折风险增加相关。切除深度对骨折风险的影响明显高于切除长度或宽度。在股骨颈骨折风险显著增加之前可进行的切除深度报告量在10%至30%之间。
