School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Am J Sports Med. 2018 Jul;46(9):2079-2088. doi: 10.1177/0363546518775425. Epub 2018 May 30.
Treatment of acetabular labral tears with moderate or severe intrasubstance damage or segmental defects remains a substantial challenge. Circumferential labral reconstruction with iliotibial band allograft is a relatively new technique that has been proposed to restore stability and eliminate high-stress junction points.
To compare outcomes between hips treated with primary allograft circumferential labral reconstruction and primary labral repair.
Cohort study; Level of evidence, 3.
All consecutive hips between 2014 and 2015 that underwent primary reconstruction or primary repair by the senior surgeon were included and compared. Hips that had a prior intra-articular procedure were excluded. Patient-reported outcome (PRO) scores and visual analog scales were completed by patients within 1 week before surgery and between 22 and 26 months postoperatively. PROs included the modified Harris Hip Score, the International Hip Outcome Tool, and the 12-Item Short Form Health Survey for physical health. Pain and satisfaction were assessed with visual analog scales. Crude and inverse probability of treatment weighting comparisons of PROs between groups were performed.
A total of 162 hips met the inclusion criteria for this study, including 99 labral repairs and 63 complete labral reconstructions. Patients who underwent labral reconstruction were, on average, older (43.4 vs 29.5 years; P < .01), had a slightly higher body mass index (24.6 vs 23.0; P < .01), had hips with a higher Tönnis grade (grade 1 or 2: 25% vs 9%; P < .01), had higher preoperative pain scores (49.9 vs 41.5; P = .01), and had hips with more severe pathology (68% vs 5%; P < .01) as compared with patients with labral repair hips. Five (5%) labral repair hips and 5 (8%) labral reconstruction hips failed treatment ( P = .48). Among hips that did not fail (n = 94 repairs, n = 58 reconstructions), all demonstrated statistically significant improvements in PROs, and there was no statistical difference in PROs between groups after weighting ( P > .05).
Primary circumferential labral reconstruction is a viable treatment option with promising short-term outcomes for hips that demonstrate moderate or severe labral damage. Despite less favorable preoperative characteristics, labral reconstruction offers similar outcomes when compared with labral repair in hips with less severe pathology.
对于伴有中等或重度实质内损伤或节段性缺损的髋臼唇撕裂，治疗仍然是一个重大挑战。用阔筋膜张肌髂胫束同种异体移植物进行环形盂唇重建是一种相对较新的技术，它被提议用于恢复稳定性并消除高应力结合点。
比较初次同种异体环形盂唇重建与初次盂唇修复治疗髋关节的结果。
队列研究；证据水平，3 级。
纳入 2014 年至 2015 年间由资深外科医生进行初次重建或初次修复的所有连续髋关节，并进行比较。排除有先前关节内手术的髋关节。患者在术前 1 周内和术后 22-26 个月内完成患者报告的结局（PRO）评分和视觉模拟评分。PRO 包括改良 Harris 髋关节评分、国际髋关节结局工具和 12 项简明健康调查简表的身体健康部分。疼痛和满意度通过视觉模拟评分进行评估。对两组之间的 PRO 进行原始和逆概率治疗加权比较。
本研究共纳入 162 髋，其中 99 髋行盂唇修复，63 髋行完整盂唇重建。盂唇重建组患者的平均年龄较大（43.4 岁比 29.5 岁；P <.01），体质量指数略高（24.6 比 23.0；P <.01），髋关节 Tönnis 分级较高（1 或 2 级：25%比 9%；P <.01），术前疼痛评分较高（49.9 比 41.5；P =.01），髋关节病变较重（68%比 5%；P <.01）。与盂唇修复髋关节相比，5 髋（5%）盂唇修复失败，5 髋（8%）盂唇重建失败（P =.48）。在未失败的髋关节中（94 髋修复，58 髋重建），所有髋关节的 PRO 均有统计学显著改善，加权后两组之间的 PRO 无统计学差异（P >.05）。
对于伴有中度或重度盂唇损伤的髋关节，初次环形盂唇重建是一种可行的治疗选择，具有良好的短期效果。尽管术前特征较差，但对于病变程度较轻的髋关节，盂唇重建与盂唇修复相比，提供了相似的结果。
