Service de chirurgie orthopédique et traumatologique, CHU Lyon Sud, 165, Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
Chirurgie orthopédique et de traumatologie, CHU Nord Saint-Étienne, 42270 Saint Priest en Jarez, France.
Orthop Traumatol Surg Res. 2019 Feb;105(1):7-10. doi: 10.1016/j.otsr.2018.10.011. Epub 2019 Jan 7.
Arthroscopic management of femoroacetabular impingement (FAI) is classically contraindicated when acetabular dysplasia is associated, although this is controversial in case of moderate dysplasia or isolated cam effect. A case-control study was therefore conducted comparing borderline (center-edgeangle (CEA), 20-24°), moderate (15-19°) and severe dysplasia (<15°) (group D) versus a control group with normal acetabular cover (CEA, 25-30°). The aims were 1) to determine functional results and satisfaction, and 2) to correlate functional results with severity of dysplasia and of cam effect.
Improvement in functional scores and satisfaction is lower in group D than in controls, due to non-correction of dysplasia.
A single-center, single-surgeon retrospective comparative case-control study included all patients with isolated cam-effect FAI and dysplasia but without osteoarthritis (group D) or with isolated cam-effect FAI without dysplasia (controls) operated on during the study period. Cases of mixed impingement were excluded. Preoperative and last-follow-up functional variables included McCarthy's modified Harris Hip Score (mHHS) and Christensen's Non-Arthritic Hip Score (NAHS).
Between 2011 and 2014, details of 407 patients operated on by arthroscopy were entered in a data-base. Twenty patients (22 hips) were included in group D, with CEA<25° (mean, 19±3.1; range, 10-23°). The control group comprised 23 patients (25 hips) with CEA>25° (mean, 29±2.1°; range, 25-30°) matched for gender, age and body-mass index. Mean follow-up was 29.6±14.1 months (range, 14-58 months) in group D and 31.4±10.6 months (range, 15-57 months) in the control group (p=0.66). For functional scores, the two groups showed respectively 9.9 (-34 to +47) (p=0.038) and 10.4 (-20 to +48) (p=0.0038) gain in mHHS (non-significant: p=0.943). Mean gain in NAHS was 16.6 (-19 to +33) (p=0.0001) and 13.7 (-11 to +47) (p=0.0002), respectively (non-significant: p=0.56) CONCLUSION: Short-term functional results for cam FAI treatment were equivalent with<25° acetabular cover (mean, 19°; range, 13-24°) or normal cover. Longer-term assessment is indispensable to determine the impact of dysplasia and its severity.
III, case-control study.
当髋臼发育不良伴发时，经典的关节镜下处理股骨髋臼撞击症（FAI）是禁忌的，尽管在中度发育不良或孤立凸轮效应的情况下存在争议。因此进行了一项病例对照研究，比较了边界（中心边缘角（CEA），20-24°）、中度（15-19°）和重度发育不良（<15°）（D 组）与髋臼覆盖正常的对照组（CEA，25-30°）。目的是 1）确定功能结果和满意度，2）将功能结果与发育不良和凸轮效应的严重程度相关联。
由于发育不良未得到纠正，D 组的功能评分和满意度改善低于对照组。
单中心、单外科医生回顾性病例对照研究包括在研究期间接受手术的所有伴有孤立凸轮效应 FAI 和发育不良但无骨关节炎（D 组）或伴有孤立凸轮效应 FAI 无发育不良（对照组）的患者。排除混合撞击病例。术前和末次随访的功能变量包括麦卡锡改良 Harris 髋关节评分（mHHS）和克里斯滕森非关节炎髋关节评分（NAHS）。
2011 年至 2014 年，407 例接受关节镜手术的患者详细资料录入数据库。20 例（22 髋）患者纳入 D 组，CEA<25°（平均 19±3.1；范围 10-23°）。对照组包括 23 例（25 髋）CEA>25°（平均 29±2.1°；范围 25-30°），性别、年龄和体重指数匹配。D 组的平均随访时间为 29.6±14.1 个月（范围 14-58 个月），对照组为 31.4±10.6 个月（范围 15-57 个月）（p=0.66）。对于功能评分，两组分别显示 mHHS 增加 9.9（-34 至 +47）（p=0.038）和 10.4（-20 至 +48）（p=0.0038）（无显著性：p=0.943）。NAHS 平均增加 16.6（-19 至 +33）（p=0.0001）和 13.7（-11 至 +47）（p=0.0002）（无显著性：p=0.56）。
对于<25°髋臼覆盖（平均 19°；范围 13-24°）或正常覆盖的凸轮 FAI 治疗，短期功能结果是等效的。需要进行更长期的评估，以确定发育不良及其严重程度的影响。
III，病例对照研究。
