Western Orthopaedics, Denver, Colorado, U.S.A..
Centura Health Research Center, Denver, Colorado, U.S.A.
Arthroscopy. 2018 Feb;34(2):433-440. doi: 10.1016/j.arthro.2017.08.240.
Directly compare primary acetabular labral repair versus primary acetabular labral reconstruction using a self-controlled cohort study design.
Patients who underwent primary labral repair in one hip and primary labral reconstruction using iliotibial band allograft in the other hip by a single surgeon between August 2009 and November 2014 were identified. One patient with inflammatory arthritis was excluded. Patient-reported outcome data included change in Modified Harris Hip Score (MHHS), Lower Extremity Functional Scale (LEFS), average pain using a 10-point visual analog scale (VAS), and patient satisfaction (1: very dissatisfied, 10: very satisfied). Failure was defined as subsequent intra-articular hip surgery. Data were analyzed using McNemar's and Wilcoxon Signed Rank tests.
Overall, 29 patients (58 hips) were included in the analysis. There were 23 females and 6 males. The average age at time of surgery was 32.6 years (range: 14.9-51.6 years). Follow-up was obtained from all 29 patients (100%) at a mean of 56 months (range = 27-85 months) postoperative for repaired hips and 40 months (range = 22-61 months) postoperative for reconstructed hips. No labral reconstruction hips failed, and 9 (31%) labral repair hips failed (P < .01). Among those that did not fail treatment, there was no difference in MHHS change (32.2 ± 15.4 vs 29.6 ± 15.4; P = .63), LEFS change (26.6 ± 16.5 vs 23.9 ± 17.8; P = .61), VAS pain change (-3.2 ± 2.4 vs -3.6 ± 2.1; P = .47), or satisfaction (8.6 ± 2.0 vs 8.7 ± 2.4; P = .59) between the repair and reconstruction groups, respectively.
In this cohort of patients, hips that underwent primary labral repair were more likely to fail treatment than hips that underwent labral reconstruction (31% vs 0%, respectively). Among hips that did not fail treatment, patient-reported outcome scores were similar between groups. Excellent clinical results can be obtained with both forms of labral-preserving treatment but were more predictably observed with primary labral reconstruction in this cohort. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
采用自身对照队列研究设计，直接比较原发性髋臼盂唇修复与原发性髋臼盂唇重建。
本研究纳入了 2009 年 8 月至 2014 年 11 月间，由同一位外科医生在一侧髋关节行盂唇修复术，在另一侧髋关节行髂胫束同种异体移植重建术的患者。排除了 1 例患有炎症性关节炎的患者。患者报告的结果数据包括改良 Harris 髋关节评分（MHHS）、下肢功能评分（LEFS）、10 分视觉模拟评分（VAS）平均疼痛和患者满意度（1：非常不满意，10：非常满意）的变化。失败定义为后续的髋关节内手术。采用 McNemar 和 Wilcoxon 符号秩检验对数据进行分析。
总体而言，共纳入了 29 名患者（58 髋）进行分析。其中 23 名为女性，6 名为男性。手术时的平均年龄为 32.6 岁（范围：14.9-51.6 岁）。29 名患者（100%）均获得了随访，修复组的平均随访时间为 56 个月（范围=27-85 个月），重建组的平均随访时间为 40 个月（范围=22-61 个月）。没有盂唇重建组的髋关节失败，而 9 髋（31%）盂唇修复组的髋关节失败（P<.01）。在未失败治疗的患者中，MHHS 变化（32.2 ± 15.4 比 29.6 ± 15.4；P=.63）、LEFS 变化（26.6 ± 16.5 比 23.9 ± 17.8；P=.61）、VAS 疼痛变化（-3.2 ± 2.4 比-3.6 ± 2.1；P=.47）或满意度（8.6 ± 2.0 比 8.7 ± 2.4；P=.59）在修复组和重建组之间均无差异。
在本队列研究中，行原发性髋臼盂唇修复的髋关节比行盂唇重建的髋关节更易出现治疗失败（31%比 0%）。在未失败治疗的髋关节中，两组患者的报告的结果评分相似。在本队列中，两种保留盂唇的治疗方法均能获得良好的临床效果，但原发性髋臼盂唇重建的效果更可预测。
三级，回顾性比较研究。
