Chaharbakhshi Edwin O, Perets Itay, Ashberg Lyall, Mu Brian, Lenkeit Christopher, Domb Benjamin G
American Hip Institute, Westmont, Illinois, USA.
Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
Am J Sports Med. 2017 Sep;45(11):2507-2516. doi: 10.1177/0363546517710008. Epub 2017 Jun 21.
Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting.
Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears.
Cohort study; Level of evidence, 3.
Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA <18°). Patients with LT tears were pair-matched to patients without tears for sex, age at surgery ±10 years, body mass index (<30 kg/m vs ≥30 kg/m), labral treatment type, and microfracture.
Of 68 eligible patients, 63 (93%) had a minimum 2-year follow-up, and 30 (48%) had LT tears. Twenty patients in each group were pair-matched. The mean follow-up time was 54.3 months (range, 24.2-83.8 months) for the LT tear group and 38.6 months (range, 24.6-70.6 months) for the control group ( P = .002). Ninety percent were female. There were no significant differences regarding demographics or intra-operative procedures. The LT tear group trended toward lower postoperative mHHS ( P = .09) and NAHS ( P = .09) values. Mean satisfaction was 8.1 for the LT tear group and 7.9 for the control group. Preoperative and follow-up scores were not significantly different between the groups. The LT tear group had 5 revisions, with 1 revision in the control group. Three patients (15%) in the LT tear group underwent total hip arthroplasty (THA); no patients in the control group required THA.
In borderline dysplastic patients undergoing hip arthroscopic surgery with labral treatment and capsular plication, LT tears may indicate advanced instability and portend slightly inferior outcomes when compared with a match-controlled group. Borderline dysplastic patients with LT tears may have increased propensities toward revision arthroscopic surgery and conversion to THA. LT tears in these patients may warrant consideration for additional procedures including periacetabular osteotomy and LT reconstruction.
在边缘发育不良的髋关节中进行关节镜手术仍存在争议，但在此情况下尚未对圆韧带（LT）的作用进行研究。
伴有LT撕裂的边缘发育不良患者的短期预后比无LT撕裂的患者更差。
队列研究；证据等级，3级。
前瞻性收集2008年2月至2014年4月期间接受关节镜手术患者的数据。纳入标准为边缘发育不良（外侧中心边缘角[LCEA]，18° - 25°）和盂唇撕裂；包括盂唇保留和关节囊折叠的关节镜治疗；以及术前患者报告的结局评分，包括改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节结局评分 - 运动特定子量表和疼痛视觉模拟量表。排除标准为术前Tönnis骨关节炎分级>0、工伤赔偿申请、既往同侧髋关节手术及疾病或明显发育不良（LCEA <18°）。将伴有LT撕裂的患者与无撕裂的患者按性别、手术年龄±10岁、体重指数（<30 kg/m² 与≥30 kg/m²）、盂唇治疗类型和微骨折进行配对。
68例符合条件的患者中，63例（93%）进行了至少2年的随访，30例（48%）有LT撕裂。每组20例患者进行配对。LT撕裂组的平均随访时间为54.3个月（范围，24.2 - 83.8个月），对照组为38.6个月（范围，24.6 - 70.6个月）（P = 0.002）。90%为女性。在人口统计学或术中操作方面无显著差异。LT撕裂组术后mHHS（P = 0.09）和NAHS（P = 0.09）值有降低趋势。LT撕裂组的平均满意度为8.1，对照组为7.9。两组术前和随访评分无显著差异。LT撕裂组有5例翻修，对照组有1例翻修。LT撕裂组3例患者（15%）接受了全髋关节置换术（THA）；对照组无患者需要THA。
在接受盂唇治疗和关节囊折叠的髋关节镜手术的边缘发育不良患者中，与配对对照组相比，LT撕裂可能表明存在更严重的不稳定，并预示结局略差。伴有LT撕裂的边缘发育不良患者可能有更高的关节镜翻修手术和转换为THA的倾向。这些患者的LT撕裂可能需要考虑额外的手术，包括髋臼周围截骨术和LT重建。
