Nwachukwu Benedict U, Chang Brenda, Fields Kara, Rinzler Jeremy, Nawabi Danyal H, Ranawat Anil S, Kelly Bryan T
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2017 Aug 10;5(8):2325967117723109. doi: 10.1177/2325967117723109. eCollection 2017 Aug.
Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation.
To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery.
Case series; Level of evidence, 4.
A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool-33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive.
Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o'clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools.
There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression.
股骨髋臼撞击症（FAI）现已得到广泛认可；然而，髂前下棘（AIIS；或棘下）撞击是一种未被充分认识的髋关节撞击形式，可能是导致髋关节功能障碍和功能受限的重要原因。
探讨在未进行FAI手术的情况下，关节镜治疗与AIIS/棘下相关的髋关节撞击症后的疗效。
病例系列；证据等级，4级。
回顾一项前瞻性机构髋关节保留登记研究，以确定接受关节镜下AIIS减压且未同时治疗FAI的患者。登记研究中记录的主要结局指标包括改良Harris髋关节评分（mHHS）、髋关节结局评分（HOS）和国际髋关节结局工具-33（iHOT-33）。纳入随访至少1年的患者。根据最小临床重要差异（MCID）确定有意义的结局改善情况。统计分析主要为描述性分析。
共确定33例患者，平均随访19.1个月（范围12 - 44个月）。所有患者均为女性，平均年龄±标准差为26.1±10.3岁。所有患者均伴有盂唇撕裂，髋臼在2点和3点处的平均前倾角增加（分别为14.5°和19.8°）。mHHS、HOS日常生活活动（ADL）、HOS运动和iHOT-33的术前平均结局评分分别为57.2±15.3、66.9±18.8、43.9±23.6和33.5±18.3。在最后一次可获得的随访时，这些结局指标的平均评分分别为79.5±19.0、86.8±15.8、70.4±32.8和65.0±31.0。到1年随访时，所有4种工具的大多数患者均达到MCID。
关于与AIIS/棘下相关的髋关节撞击症的结局证据较少。本研究表明，即使没有FAI，孤立的棘下撞击也可能是髋关节功能障碍的原因。孤立的棘下撞击患者更可能为女性，且患者报告的结局评分较低。然而，关节镜下AIIS减压可实现有意义的结局改善。
