American Hip Institute, Westmont, Illinois, U.S.A.
American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Hinsdale, Illinois, U.S.A..
Arthroscopy. 2018 Jan;34(1):303-318. doi: 10.1016/j.arthro.2017.06.030. Epub 2017 Aug 31.
To critically evaluate the existing literature on hip capsule biomechanics, clinical evidence of instability, and outcomes of capsular management to answer the following question: Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability?
We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines to find articles using PubMed and Embase. Included studies were Level I through V studies and focused on hip capsule biomechanics, postarthroscopic instability, and clinical outcomes. Articles were excluded if they discussed treatment of the hip capsule during arthroplasty, dislocations without a history of arthroscopy, and pre-existing conditions. The Methodological Index for Non-randomized Studies (MINORS) was used for quality assessment of clinical outcome studies.
A total of 34 articles were included: 15 biomechanical studies, 9 instability case reports, and 10 outcome studies. There is consensus from biomechanical studies that the capsule is an important stabilizer of the hip and repairing it provides better stability than when unrepaired. Case reports of instability have raised concerns about capsular management during the index procedure to decrease the complications associated with this problem. Furthermore, outcome studies suggest that there may be an advantage of capsular closure versus capsulotomy during hip arthroscopy for nonarthritic patients.
Short-term outcome studies suggest that capsular closure is safe and effective in nonarthritic patients undergoing hip arthroscopic procedures and may yield superior outcomes compared with unrepaired capsulotomy. Moreover, biomechanical evidence strongly supports the role of capsular repair in maintaining stability of the hip. In patients with stiffness or inflammatory hip disorders, a release may be appropriate. In patients who have signs and symptoms of instability, there is existing evidence that capsular plication may be associated with significant improvement in patient-reported outcomes. Although the multiple procedures performed in combination with capsular treatment present confounding variables, current evidence appears to support routine capsular closure in most cases and to support capsular plication in cases of instability or borderline dysplasia.
Level IV, systematic review of Level II through IV studies.
批判性地评估髋关节囊生物力学、临床不稳定证据以及囊管理结果的现有文献，以回答以下问题：对于与股骨髋臼撞击或不稳定相关的盂唇撕裂行髋关节镜检查后，是否应该修复或折叠髋关节囊？
我们使用 PRISMA（系统评价和荟萃分析的首选报告项目）指南在 PubMed 和 Embase 上查找文章。纳入的研究为 I 级至 V 级研究，重点关注髋关节囊生物力学、关节镜检查后不稳定和临床结果。如果文章讨论髋关节置换术中髋关节囊的治疗、无关节镜检查史的脱位以及先前存在的疾病，则将其排除在外。非随机研究方法学指数（MINORS）用于临床结果研究的质量评估。
共纳入 34 篇文章：15 篇生物力学研究、9 篇不稳定病例报告和 10 篇结果研究。生物力学研究一致认为，髋关节囊是髋关节的重要稳定器，修复后可提供更好的稳定性。不稳定病例报告引起了人们对索引手术过程中囊管理的关注，以减少与该问题相关的并发症。此外，结果研究表明，对于非关节炎患者，髋关节镜检查时闭合囊优于切开囊。
短期结果研究表明，对于行髋关节镜手术的非关节炎患者，闭合囊是安全有效的，与未修复的囊切开术相比，可能会产生更好的结果。此外，生物力学证据有力地支持了修复囊在维持髋关节稳定性方面的作用。在僵硬或炎症性髋关节疾病患者中，可能需要松解。对于有不稳定迹象和症状的患者，现有证据表明，囊折叠可能与患者报告的结果显著改善相关。尽管与囊处理相结合的多种手术存在混杂变量，但目前的证据似乎支持在大多数情况下常规闭合囊，并在不稳定或边缘性发育不良的情况下支持囊折叠。
IV 级，对 II 级至 IV 级研究的系统评价。
